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Social Effectiveness Therapy for Children (SET-C)

Scientific Rating:
3
Promising Research Evidence
See scale of 1-5
Child Welfare Relevance Level:
Medium

See descriptions of 3 levels

Brief Description

The information in this program outline is provided by the program representative and edited by the CEBC staff. The Social Effectiveness Therapy for Children (SET-C) program has been rated by the CEBC in the area of: Anxiety Treatment (Child & Adolescent).

  • Types of Maltreatment: Does not target any specific kind of maltreatment
  • Target Population: Children ages 7 through 17 with social phobia.

SET-C is a comprehensive behavioral treatment program that combines group social skills training, peer generalization sessions, and individual exposure therapy sessions for the treatment of social phobia in children and adolescents.

Essential Components

There are three main components of Social Effectiveness Therapy for Children (SET-C):

  • Group social skills training – covers basic conversational skills, getting along with peers, assertiveness, and telephone skills. Program uses basic behavioral strategies including instruction, modeling, behavior rehearsal, feedback, and positive reinforcement.
  • Peer generalization sessions – allows peers to practice social skills with typically developing peers in naturalistic settings (pizza parlors, miniature golf, etc.). Requires clinicians to arrange for typically developing children to meet the group at an activity (miniature golf course) and supervise a 90-minute activity. The activity is not structured further other than to direct typically developing peers to “buddy up” with the children in the group – talking to them and participating with them in the activity.
  • Individual exposure sessions - therapist develops a hierarchy of the child’s social fears (reading aloud, talking to a peer, asking questions of adults, etc.) and exposure is conducted on one item during the individual session. The therapist does not progress to the next item until there is habituation of the first item.

Child Component

Social Effectiveness Therapy for Children (SET-C) was designed with a child component that addresses the following presenting problems and symptoms:

  • Social Phobia

Age range: 7 – 17

Developmental Delays:

This program was not developed for children with developmental delays, and has not been tested for children with developmental delays.

Parent / Caregiver Component

Social Effectiveness Therapy for Children (SET-C) was not designed with a parent/caregiver component.

Group Format

Social Effectiveness Therapy for Children (SET-C) was designed to be conducted in a group setting, and has been tested for use in a group setting.

Recommended group size:

6 participants and 2 therapists.

Testing References:

Beidel, D. C., Turner, S. M., & Morris, T. L. (2000). Behavioral treatment of childhood social phobia. Journal of Consulting and Clinical Psychology, 68, 1072-1080.

Beidel, D. C., Turner, S. M., Sallee, F. R., Ammerman, R. T., Crosby, L. A., &, Pathak, S. (2007). SET-C vs. Fluoxetine in the treatment of childhood social phobia. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 1622-1632.

Delivery Settings

This program is typically conducted in a(n):

  • Outpatient Clinic
  • School

Homework

Social Effectiveness Therapy for Children (SET-C) includes a homework component:

Children are assigned a homework task that is identical to, or very similar to, the task that occurred in the exposure session.

Languages

Social Effectiveness Therapy for Children (SET-C) does not have materials available in a language other than English.

Resources Needed to Run Program

The typical resources for implementing the program are:

A group room large enough for 8 people, rooms for individual sessions, and a group of peers willing to participate in the peer generalization sessions. We usually recruit from the general community and the institution in which we work.

Minimum Provider Qualifications

Master's degree and thorough training in behavior therapy procedures such as social skills training and exposure therapy.

Education and Training Resources

There is a manual that describes how to implement this program, and there is training available for this program.

Training Contact:
Training is obtained:

The training program is individualized to the needs of the participants.

Number of days/hours:

This is customized to the needs of the participants.

Relevant Published, Peer-Reviewed Research

This program is rated a "3 - Promising Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The practice must have at least one study utilizing some form of control (e.g., untreated group, placebo group, matched wait list study) establishing the practice's benefit over the placebo, or found it to be comparable to or better than an appropriate comparison practice. Please see the Scientific Rating Scale for more information.

Child Welfare Outcome: Child/Family Well-Being

Show relevant research...

Beidel, D., Turner, S., & Morris, T. (2000). Behavioral treatment of childhood social phobia. Journal of Consulting & Clinical Psychology, 68(6), 1072-1080.

Type of Study: Randomized controlled trial
Number of Participants: 67

Population:

  • Age range — 8-12 years
  • Race/Ethnicity — Out of study completers: 35 (70%) White, 11 (22%) African American, 2 (4%) Hispanic, 2 (4%) Biracial
  • Gender — (Out of study completers, n = 50): 20 (40%) boys, 30 (60%) girls
  • Status — Participants were drawn from a pool of 102 children between 8 and 12 years who were screened for the study and were seeking treatment in the clinic, referred from other professionals, referred from schools, or responded to advertisements indicating the availability of a treatment program for “shy” children. The remaining 67 children all met criteria for a primary diagnosis of social phobia.

Location / Institution: Anxiety Prevention and Treatment Center of the Medical University of South Carolina

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Participants were randomized to either a behavioral treatment program designed to enhance social skills and decrease social anxiety (Social Effectiveness Therapy for Children (SET-C)) or an active, but nonspecific intervention (Testbusters). Measures included self-report inventories such as the Children’s Depression Inventory (CDI) and State-Trait Anxiety Inventory for Children (STAI-C), parent ratings using the Child Behavior Checklist (CBCL), independent evaluator ratings from assessments such as the Children’s Global Assessment Scale (K-GAS), daily diary entries to assess the frequency of engagement in various social situations, as well as behavioral tasks such as role-play scenes and reading aloud before a group, which assessed skill and anxiety. Children treated with SET-C were significantly more improved across multiple dimensions, including enhanced social skill, reduced social fear and anxiety, decreased associated psychopathology, and increased social interaction. At post-treatment, 67% of the SET-C group participants no longer met diagnostic criteria for social phobia, compared with 5% of participants in the Testbusters group. Treatment gains were maintained at 6-month follow-up. Limitations of the study include the lack of follow-up data for the control (Testbusters) group, which do not allow the CEBC to determine whether outcomes at follow-up are solely due to the intervention.

Length of post-intervention follow-up: 6 months.

Beidel, D., Turner, S., Young, B., & Paulson, A. (2005). Social Effectiveness Therapy for Children: Three-year follow-up. Journal of Consulting & Clinical Psychology, 73(4), 721-725.

Type of Study: Within-group follow-up study
Number of Participants: 29

Population:

  • Age range — 11-18 years
  • Race/Ethnicity — 20 (69%) Caucasian, 8 (28%) African American, 1 (3%) Latin American
  • Gender — 18 girls (62%), 11 boys (38%)
  • Status — 27 of 30 children (90%) who completed Social Effectiveness Therapy for Children (SET-C) treatment in a previous study (Beidel et al., 2000) and 2 young adolescents who completed a pilot version of SET-C for adolescents participated in this follow-up study. Participants all had a primary diagnosis of social phobia, and 14 (48%) had a comorbid diagnosis at pretreatment.

Location / Institution: University of Maryland

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Participants had been randomly assigned in a previous study to a nonspecific active treatment control (Testbusters) or to SET-C (Beidel et al., 2000). SET-C consisted of 12 weekly sessions of individual graduated exposure and 12 weekly sessions of group social skills training, plus peer generalization sessions. Testbusters paralleled SET-C in number and frequency of sessions. In this follow-up study, all children received SET-C, including those originally randomized to the active, nonspecific intervention. Measures included self-report and parent inventories such as the Children’s Depression Inventory (CDI), the Social Phobia and Anxiety Inventory for Children (SPAI-C), the Loneliness Scale (LS), and the Child Behavior Checklist (CBCL). Additionally, a PhD-level psychologist administered the Anxiety Disorders Interview Schedule for Children/Parents (ADIS-C/P) and the Children’s Global Assessment Scale (K-GAS) in order to assess daily functioning and the presence of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) Axis I disorders. Social skill and anxiety were assessed using two behavioral tasks, including role-playing and reading aloud to a group. At 3-year follow-up, 21 of the 29 children (72%) no longer met criteria for social phobia, an increase from 62% at posttreatment who didn’t meet criteria. In contrast, 6 children who did meet diagnostic criteria for social phobia at posttreatment (20% of those in the follow-up sample) no longer met criteria at follow-up. Limitations of the study include the small sample size and lack of control group.

Length of post-intervention follow-up: 3 years.

Beidel, D. C., Turner, S. M., & Young, B. J. (2006). Social Effectiveness Therapy for Children: Five years later. Behavior Therapy, 37, 416-425.

Type of Study: Within-group follow-up study
Number of Participants: 31 (26 completed the entire 5-year follow-up project)

Population:

  • Age range — 13-20 years (at 5 year follow-up)
  • Race/Ethnicity — 20 Caucasian, 9 African American, 2 Latino
  • Gender — 19 girls, 12 boys
  • Status — Participants were adolescents previously treated with Social Effectiveness Therapy for Children (SET-C); 30 were those treated with SET-C in the original treatment sample (Beidel et al, 2000), and 1 adolescent (age 14) treated in a pilot study of SET-C for adolescents was available for follow-up.

Location / Institution: Penn State College of Medicine, PA

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The purpose of this follow-up study was to determine the long-term outcome (3, 4, and 5 years later) in a sample of adolescents previously treated with SET-C (Beidel et al, 2005; see above summary). In contrast to this previous study, the current study assessed participants on other aspects of psychopathology, in addition to social phobia symptoms. Measures included self-report and parent inventories such as the Children’s Depression Inventory (CDI), the Social Phobia and Anxiety Inventory for Children (SPAI-C), the Loneliness Scale (LS), and the Child Behavior Checklist (CBCL). Additionally, a PhD-level psychologist administered the Anxiety Disorders Interview Schedule for Children/Parents (ADIS-C/P) and the Children’s Global Assessment Scale (K-GAS) in order to assess daily functioning and the presence of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) Axis I disorders. At 5-year follow-up, twenty-one of the participants (80.8%) did not meet criteria for social phobia. The results indicate that the majority of initial positive changes achieved by SET-C were maintained 5 years later. The primary limitation is the lack of a control group.

Length of post-intervention follow-up: 5 years.

Beidel, D., Turner, S., Sallee, F., Ammerman, R., Crosby, L., & Pathak S. (2007). SET-C versus fluoxetine in the treatment of childhood social phobia. Journal of the American Academy of Child & Adolescent Psychiatry, 46(12), 1622-1632.

Type of Study: Randomized controlled trial
Number of Participants: 139 (122 treatment completers)

Population:

  • Age range — 7-17 years
  • Race/Ethnicity — (Out of treatment completers) 95 (77.9%) White, 15 (12.3%) African American, 4 (3.3%) Asian, 2 (1.6% Latino), 1 (0.8%) American Indian, 4 (3.3%) Other, 1 (0.8%) No endorsement
  • Gender — (Out of treatment completers, n = 122): 65 (53.3%) Male, 57 (46.7%) Female
  • Status — Participants were recruited from the Maryland Center for Anxiety Disorders (University of Maryland, College Park) and the Department of Pediatrics (Cincinnati Children’s Hospital Medical Center) from September 2001 through September 2004, through media announcements or referrals from mental health clinicians. Participants all had a primary diagnosis of social phobia.

Location / Institution: Maryland Center for Anxiety Disorders (University of Maryland, College Park) and the Department of Pediatrics (Cincinnati Children’s Hospital Medical Center)

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Participants were randomly assigned to receive either Social Effectiveness Therapy for Children (SET-C), fluoxetine, or pill placebo. Self-report inventories such as the Social Phobia and Anxiety Inventory for Children (SPAI-C), Multimdensional Anxiety Scale for Children (MASC), and the Children’s Depression Inventory (CDI), were administered at pre- and post-treatment, and at the 3, 6, and 12-month follow-up periods. Also, at each of these assessment points, the Child Behavior Checklist (CBCL) was administered to the parent. In order to assess social competence, the participants were asked to take part in brief role-playing interactions. For the medical conditions, a psychiatrist used a weekly adverse events checklist to assess symptoms within such categories as gastrointestinal, ocular, respiratory, dermatological, musculoskeletal, etc. Both fluoxetine and SET-C were superior to pill placebo in decreasing social anxiety and behavioral avoidance, and increasing overall functioning. SET-C was superior to fluoxetine on each of these measures and was the only treatment superior to placebo in terms of improving social skills, decreasing anxiety in specific social interactions, and enhancing ratings of social competence. Whereas fluoxetine appeared to exert maximum effect by 8 weeks, SET-C provided continued improvement through week 12. At 1-year follow-up, all of the treatment gains were maintained. A notable limitation of the study is that participants and parents assigned to SET-C knew they were receiving an active intervention, whereas the pill condition was a true double blind. Other limitations of the study include the use of self-report measures and relatively high pretreatment dropout rates. In addition, follow-up assessments were only conducted with treatment responders who were matched to non-responders who chose not to get SET-C following the post-treatment assessment. Because the randomized groups were no longer intact at the follow-up time-points, the CEBC cannot determine whether outcomes at follow-up are solely due to the intervention.

Length of post-intervention follow-up: 3, 6, and 12 months.

References

Beidel, D. C., & Roberson-Nay, R. (2005). Treatment of social phobia in children: Social Effectiveness Therapy for Children. In E. D. Hibbs and P. Jensen (Eds). Psychosocial treatments for children and adolescents: Empirically validated treatments (pp.75-96). Washington, DC: American Psychological Association.

Beidel, D. C., Turner, S. M. & Morris, T. L. (2004). Social Effectiveness Therapy for Children and Adolescents (SET-C). Multi-Health Systems, Inc.: Toronto, Ontario.

Contact Information

Name: Deborah C. Beidel, PhD, ABPP
Agency/Affiliation: University of Central Florida
Website: anxietyclinic.cos.ucf.edu
Email:
Phone: (407) 823-3254
Fax: (407) 823-5862

Date Reviewed: August 2010