The Covideo Study - a Randomized Controlled Trial of Cognitive Therapy for Social Anxiety Disorder in Youth, Comparing Screen to Office Delivery

Study aim The main aim of the study is to evaluate screen delivery (SD) as an alternative approach to traditional office delivery (OD) for reaching young people with cognitive therapy (CT) for Social Anxiety Disorder (SAD). In this multi-centre randomized controlled trial (RCT) includes three work packages (WPs), focusing on effectiveness (WP1), acceptability (WP2), health economy and sustainability (WP3), and predictors for outcome (WP4). We aim to show that effectiveness of CT for SD is not inferior compared to OD, that CD is well accepted by youths and therapists, that CD has economic and climate benefits over OD, and we will identify predictors for therapy outcome. SD may represent a novel way of increasing access to effective therapy for young people, leading to improved health and success in education, employment and social life.

Screen delivery (SD) The study originates from the Child and Adolescent Mental Health Services (CAMHS) department at Innlandet Hospital, Norway. Innlandet CAMHS covers a large and mainly rural area, with some clients having long travel distances, and with very limited public transportation. Video communication with patients and families has therefore been of interest to our department over the last decade.

Early into the Covid-19 pandemic, a survey among clinicians in our department found high satisfaction with consultations on screen, especially among younger clinicians (below 40 years of age), and in the treatment of anxiety disorders (after an initial office consultation). A subsequent paper confirmed and extended our findings, noting several potential advantages for SD over OD, including time and cost for travel, logistics, inclusion of "hard to reach" family members, and the possibility to observe clients in their natural setting. This inspired the present study where we examine SD for anxiety in youth.

Public demand and state of the art In 2001 the Norwegian government set a target for at least 15% virtual consultations within the specialist health service. The following year, our four regional health authorities launched a plan for 40% reduction in CO2e-emission by 2030, stating that 20% of consultations should be by screen or telephone. Being the closest analogue to OD, SD may have the potential to reach out to people with effective, acceptable and sustainable mental health interventions. Following more than three decades of research, several online therapy manuals have acquired a solid evidence base. Contrasting this, surprisingly little has been published on SD, especially in light of the surge in its use after the pandemic. Two recent reviews of SD of mental health interventions identified only a single pilot study with adolescents. A review of SD in cognitive behavior therapy (CBT) needed to exclude youth due to lack of studies, urging future original studies to include this age group.

Social Anxiety Disorder SAD is prevalent, with a life-time prevalence around 13%, and a median age of onset of 13 years. Untreated, it follows a chronic course throughout the lifespan, with adverse effects on mental health, education, employment, social life and family life. Treatment is often delayed for years or decades, until those affected develop comorbid depression or substance abuse, and/or drop out of education or work. Social isolation and unstable family life are frequent consequences. Early and easy access to effective treatment is therefore important to prevent such negative impact on mental health and development, and also to reduce school absenteeism in youth which has risen sharply after the pandemic.