Key result
Cognitive behavioral therapy did not significantly alter psychophysiological arousal, including heart rate and sympathetic activity, in response to a social stress test in children with social anxiety disorder.
Why the study?
Models of social anxiety disorder stress the relevance of physiological arousal, but limited research has been conducted in children with social anxiety disorder using experimental stress designs.
Does cognitive behavior therapy improve autonomic dysregulation during social stress in children with social anxiety disorder?
RCT (n=119)
Block randomized
Yes
Does cognitive behavior therapy improve autonomic dysregulation during social stress in children with social anxiety disorder?
p-value: p=0.162
Children with social anxiety disorder exhibit baseline autonomic dysregulation compared to healthy controls, which is not rapidly reversed by cognitive behavioral therapy.
Hypothesis-generating for CBT effects on autonomic arousal in pediatric SAD; larger trials needed before practice change.
Models of social anxiety disorder (SAD) stress the relevance of physiological arousal. So far, limited research has been conducted in children with SAD in experimental stress designs. Thus, examining autonomic arousal, children with and without SAD completed a standardized social stressor (Trier Social Stress Test for Children-C; TSST-C). Pre-existing differences to healthy controls (HC) were expected to decrease after receiving cognitive behavior therapy (CBT). Children with SAD (n = 64) and HC children (n = 55) completed a TSST-C. Children with SAD participated in a second TSST-C after either cognitive-behavioral treatment or a waitlist-control period (WLC). As expected, children with SAD showed blunted heart rate reactivity compared to HC children. Further, children with SAD had elevated levels of tonic sympathetic arousal as indexed by skin conductance level compared to HC. Children with SAD showed lower parasympathetic arousal during the baseline compared to HC. Children receiving treatment did not differ from children in the WLC condition in a repeated social stress test. Psychophysiological differences between children with SAD and HC children could be confirmed as indicated by previous research. The lack of physiological effects of the intervention as an experimental manipulation might be related to slower changes in physiology compared to e.g. cognition.
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Asbrand et al. (2022) conducted an RCT in Social anxiety disorder (n=119). Cognitive behavior therapy (CBT) vs. Waitlist control (WLC) was evaluated on Improvement of sympathetic arousal (Heart rate / Inter-beat interval) after CBT (p=0.162). Cognitive behavioral therapy did not significantly alter psychophysiological arousal, including heart rate and sympathetic activity, in response to a social stress test in children with social anxiety disorder.
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