Can school counselors deliver cognitive-behavioral treatment for social anxiety effectively? A randomized controlled trial

Carrie Masia Warner, Daniela Colognori, Chad Brice, Kathleen Herzig, Laura Mufson, Chelsea Lynch, Philip T. Reiss, Eva Petkova, Jeremy Fox, Dominic C. Moceri, Julie Ryan, Rachel G. Klein

Research output: Contribution to journalArticlepeer-review


Background: Social anxiety disorder (SAD) typically onsets in adolescence and is associated with multiple impairments. Despite promising clinical interventions, most socially anxious adolescents remain untreated. To address this clinical neglect, we developed a school-based, 12-week group intervention for youth with SAD, Skills for Academic and Social Success (SASS). When implemented by psychologists, SASS has been found effective. To promote dissemination and optimize treatment access, we tested whether school counselors could be effective treatment providers. Method: We randomized 138, ninth through 11th graders with SAD to one of three conditions: (a) SASS delivered by school counselors (C-SASS), (b) SASS delivered by psychologists (P-SASS), or (c) a control condition, Skills for Life (SFL), a nonspecific counseling program. Blind, independent, evaluations were conducted with parents and adolescents at baseline, post-intervention, and 5 months beyond treatment completion. We hypothesized that C-SASS and P-SASS would be superior to the control, immediately after treatment and at follow-up. No prediction was made about the relative efficacy of C-SASS and P-SASS. Results: Compared to controls, adolescents treated with C-SASS or P-SASS experienced significantly greater improvement and reductions of anxiety at the end of treatment and follow-up. There were no significant differences between SASS delivered by school counselors and psychologists. Conclusion: With training, school counselors are effective treatment providers to adolescents with social anxiety, yielding benefits comparable to those obtained by specialized psychologists. Questions remain regarding means to maintain counselors’ practice standards without external support.

Original languageEnglish
Pages (from-to)1229-1238
Number of pages10
JournalJournal of Child Psychology and Psychiatry and Allied Disciplines
Issue number11
StatePublished - 1 Nov 2016
Externally publishedYes

Bibliographical note

Funding Information:
This study was supported by an NIMH grant (No. R01 MH081881) awarded to C.M.W., and was registered with the U.S. NIH Clinical Trials database, Identifier No. NCT01320800. The authors thank Deborah C. Beidel, Ronald Rapee, and Anne Marie Albano for assistance with the intervention. They appreciate the support of school administrators, personnel, and counselors; and acknowledge the contributions of Lan Huo, Kristy Ludwig, Rebecca Rialon, Catherine Stewart, Amanda Sanchez, Petra Esseling, Rachel Freed, and Rachel Kim. The authors have declared that they have no potential or competing conflicts of interest in relation to this work.

Publisher Copyright:
© 2016 Association for Child and Adolescent Mental Health.


  • SASS
  • Social anxiety
  • adolescents
  • school counselors

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Developmental and Educational Psychology
  • Psychiatry and Mental health


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