What Works in Preventing Emerging Social Anxiety: Exposure, Cognitive Restructuring, or a Combination?

Programs that aim to reduce symptoms of social anxiety in children generally include multiple components, such as exposure and cognitive restructuring. It is unknown if separate components yield positive intervention effects in children or whether a combination of components is required. We investigated the effectiveness of exposure, cognitive restructuring, and a combination of both components in reducing social anxiety symptoms and anxiety-related social-emotional outcomes in an indicated-prevention setting. To this end, we conducted a cluster-randomized microtrial using a sample of 191 children aged 8 to 13 years ( M = 10.48, SD = 1.10). Children with elevated social anxiety symptoms participated in one of three group interventions, each lasting four weeks, and completed a questionnaire on four measurement occasions. Latent change models demonstrated that the intervention with either exposure or cognitive restructuring reduced social anxiety symptoms and anxiety-related outcomes. The analyses showed that both of these intervention components were effective, with more favorable effects for exposure. Combining exposure and cognitive restructuring techniques did not yield greater benefit than either component alone. Future research should investigate whether specific components may be more effective for particular subgroups (e.g., based on sex or level of behavioral inhibition) in more detail. Highlights Exposure had a positive effect on social anxiety, distress, avoidant behavior, positive thoughts, perceived social threat, internalizing behavior, social skills, and self-perceived competence in children with emerging social anxiety. Cognitive restructuring had a positive effect on social anxiety, distress, avoidant behavior, positive thoughts, perceived social threat, internalizing behavior, self-efficacy, and self-perceived competence in children with emerging social anxiety. An intervention combining exposure and cognitive restructuring was less effective in preventing social anxiety and related outcomes than either component alone. Stacking multiple intervention components may not necessarily yield greater prevention benefits. Findings reveal the possible benefits of short-term intervention modules.