Delivering cognitive therapy for adolescent social anxiety disorder in NHS CAMHS: A clinical and cost analysis

Eleanor Leigh, Cathy Creswell, Paul Stallard, Polly Waite, Mara Violato, Samantha Pearcey, Emma Brooks, Lucy Taylor, Emma Warnock-Parkes, David M. Clark

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5 Citations (SciVal)


Cognitive therapy, based on the Clark and Wells (1995) model, is a first-line treatment for adults with social anxiety disorder (SAD), and findings from research settings suggest it has promise for use with adolescents (Cognitive Therapy for Social Anxiety Disorder in Adolescents; CT-SAD-A). However, for the treatment to be suitable for delivery in routine clinical care, two questions need to be addressed. Aims: Can therapists be trained to achieve good outcomes in routine Child and Adolescent Mental Health Services (CAMHS), and what are the costs associated with training and treatment Method: CAMHS therapists working in two NHS trusts received training in CT-SAD-A. They delivered the treatment to adolescents with SAD during a period of supervised practice. We examined the clinical outcomes for the 12 patients treated during this period, and estimated costs associated with treatment and training. Results: Treatment produced significant improvements in social anxiety symptoms, general anxiety and depression symptoms, and reductions in putative process measures. Seventy-five per cent (9 out of 12) patients showed a reliable and clinically significant improvement in social anxiety symptoms, and 64% (7/11) lost their primary diagnosis of SAD. The total cost to the NHS of the CT-SAD-A treatment was £4047 (SD = £1003) per adolescent treated, of which £1861 (SD = £358) referred to the specific estimated cost of face-to-face delivery; the remaining cost was for training and supervising therapists who were not previously familiar with the treatment. Conclusions: This study provides preliminary evidence that clinicians can deliver good patient outcomes for adolescents with SAD in routine CAMHS during a period of supervised practice after receiving a 2-day training workshop. Furthermore, the cost of delivering CT-SAD-A with adolescents appeared to be no more than the cost of delivering CT-SAD with adults.

Original languageEnglish
Pages (from-to)385-397
Number of pages13
JournalBehavioural and Cognitive Psychotherapy
Issue number4
Early online date1 Mar 2021
Publication statusPublished - 31 Jul 2021


  • adolescents
  • CBT
  • psychological therapy
  • social anxiety disorder
  • young people

ASJC Scopus subject areas

  • Clinical Psychology


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