CLINICAL FEASIBILITY OF THE UNFAMILIAR PEER PARADIGM IN CLINICAL PRACTICE SETTINGS: CLINICAL INSIGHT INTO POSSIBLE IMPLEMENTATION AND EFFECTIVENESS IN CLINICAL PRACTICE

Abstract

Exposure-based treatment for social anxiety disorder (SAD) is an extensively supported evidence-based treatment. However, there are multiple barriers to implementation in routine practice. Furthermore, exposure-based treatments must accurately reflect clients’ social environments for optimal effect. Emulating an adolescent client’s social environment can be particularly challenging, as this often involves interactions with same-age, unfamiliar peers. To this end, the current study explored whether a lab-based model for eliciting social anxiety (i.e., Unfamiliar Peer Paradigm [UPP]) can be modified to leverage task-sharing principles, namely use of lay individuals, to more accurately simulate the social contexts that typify adolescent clients’ symptoms and impairments during in-session exposures. For this dissertation, I reviewed lab-based applications of the UPP and proposed ways to tailor the UPP for therapeutic exposures with adolescent clients. To further expand this proposed model, I sought clinical insight from experts in the field: practicing clinical psychologists. I surveyed clinicians on their current clinical practices of utilizing exposure-based treatment for social anxiety disorders and conducted qualitative interviews to gather feedback on their perceived feasibility and the clinical utility of implementing the UPP in therapeutic settings. Ten practicing psychologists were interviewed. Major themes identified across interviews included generally positive impressions of exposure-based treatments and multiple barriers to implementation. With regards to the UPP, major themes included discussions of feasibility and practicality of implementation, with a generally positive impression of the UPP as a clinically useful approach. With insight from clinical experts, the current study can further the work on utilizing the UPP using lay individuals through task-sharing principles to further enhance the effectiveness of in-person social anxiety-based exposures for adolescents.