Underlying processes in the Norwegian Universal Preventive Program for social anxiety

Objective: Social Anxiety Disorder (SAD) is among the most common, widespread, and incapacitating psychiatric disorders, also among children and adolescents. Although efficient treatments have been reported, few children and adolescents receive adequate treatment. A universal prevention program has been shown to be efficacious both among those with syndromal and subsyndromal social anxiety. However, few universal prevention investigations undergo testing of mechanistic hypotheses or how an intervention works across levels of social anxiety. This study aims to test and report the processes underlying the effectiveness of an RCT prevention program to reduce social anxiety in a population-based sample of preadolescents. Method: A parallel multiple mediator model was used to examine the mediation of outcomes from the Norwegian Universal Prevention Program for Social Anxiety (NUPP-SA) by five intermediary variables that well approximate established DSM-5 social anxiety disorder diagnostic criteria. The sample consisted of 1748 pupils between 11 years - 14 years (SD = 1.1) of age assessed twice during a one-year period. Results: The NUPP-SA works differently for the total sample compared to those with social anxiety disorder symptoms. Among the former, the NUPP-SA intervention works via public performance, avoidance, physical/cognitive, and assertiveness factors. For the latter, the NUPP-SA works via the public performance factor. The intervention did not work for either group via the social encounter factor. Conclusion: Universal prevention programs are essential for reducing the impacts of chronic disorders at the individual, institutional, and societal levels. The results from this study support the notion that many children with various levels of social anxiety can be impacted with a Universal prevention intervention program specifically aimed at reducing public performance anxiety.