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EFFECTIVENESS OF A SOCIAL SKILLS PLAY-BASED TRAINING PROGRAM INTERVENTION FOR CHILDHOOD SOCIAL ANXIETY.

Introduction

Following Wong and Rapee (2015), social anxiety is a common experience that occurs in response to the perceived threat of being negatively evaluated by others before, during, or after involvement in social situations. For some individuals, the level of social anxiety experienced is sufficiently high to negatively impact their functioning and cause distress, in which case a diagnosis of social anxiety disorder (SAD) is warranted (Ollendick, Benoit, & Grills-Taquechel, 2014). The latest edition of the Diagnostic and statistical manual of mental disorders (DSM-5; American Psychiatric Association [APA], 2013) presents the same SAD diagnostic criteria for children and adults, although it does provide some specific qualifiers when diagnosing the disorder in children. For example, the new manual indicates that in children, "the anxiety must occur in peer settings and not just during interactions with adults" (p. 202). According to the DSM, the 12-month prevalence rates of SAD in children and adolescents are comparable to those in adults, ranging from 2.3% in Europe to 7% in the United States. However, these estimates are not very reliable since different rates have been found depending on the specific study and where it was conducted. For example, a study by Burstein et al. (2011) in the United States found a prevalence rate of social phobia in adolescents (aged 13 to 18) of 8.6 (9.2% in females and 7.9 in males), while some studies in Spain reported estimates of 1.2% to 14.2% in children and adolescents (Bragado, Bersabe, & Carrasco, 1999; Bragado, Carrasco, Sanchez, & Bersabe, 1996; Olivares, 2005; Taboada, Ezpeleta, & De la Osa, 1998).

Regarding the assessment and treatment of social anxiety in children, much remains to be accomplished. Overall, there are fewer studies supporting both the validity and reliability of the assessment tests and the effectiveness of intervention programs. In the case of self-report assessment tests of social anxiety in children, three instruments have been used primarily: the Social Anxiety Scale for Children-Revised (SASC-R; La Greca & Stone, 1993), the Social Phobia and Anxiety Inventory for Children (SPAI-C; Beidel, Turner, & Morris, 1995), and the Liebowitz Social Anxiety Scale for Children and Adolescents (LSAS-CA; Masia-Warner, Klein, & Liebowitz, 2002). Each of these measures was generated in English-speaking countries and has major limitations when applied to Spanish-speaking countries, either due to the specific content of the items or to the way the items were formulated (Caballo, Salazar, Irurtia, Arias & Nobre, 2013; Salazar, 2013). Recently, in order to address some of these problems, our team developed the "Social Anxiety Questionnaire for Children" (SAQ-C) (Caballo, Arias, Calderero, Salazar, & Irurtia, 2011; Caballo, Arlas, Salazar, Calderero, Irurtia, & Ollendick, 2012) based on samples of youth collected in Spain, Portugal, and Ibero America. This questionnaire contains six empirically derived dimensions of social anxiety in children: 1) Interactions with the opposite sex, 2) Speaking in public/Interactions with teachers, 3) Criticism and embarrassment, 4) Interactions with strangers, 5) Assertive expression of annoyance or disgust, and 6) Performing in public. Some of the situations included in the questionnaires originating in English-speaking countries do not appear to be useful in Spanish-speaking countries (e. g., "writing in public", "urinating in a public bathroom"), as has been found in the case of adults (Caballo et al., 2015; Caballo, Salazar, Irurtia, et al., 2012) Hence, the importance of empirically developing an instrument for children from Ibero American and Spanish samples is evident. A version of this SAQ-C was used in the current study.

When treating social anxiety in children and adolescents, multicomponent cognitive-behavioral programs which commonly include exposure, social skills training (SST), and cognitive techniques are frequently used. However, the utility of these cognitive techniques is less clear given the young age of the children frequently enlisted in such studies (Beidel, Turner, & Young, 2006). For this reason, Beidel Turner, and Morris (1996), in their Social Effectiveness Therapy for Children (SET-C), only include exposure and SST as intervention procedures of their evidence-based program, given that the therapy deals with children aged 8 to 12. Cognitive restructuring could be of help for older children (adolescents), but less so for younger children because they have not yet achieved a level of cognitive development that allows for the presence of "future-oriented" cognitions or they mistake the presence of negative feelings for negative thoughts (Beidel & Turner, 1998). On the other hand, social skills deficits seem to characterize many forms of child psychopathology, particularly social anxiety (Foster & Bussman, 2008; Matson & Ollendick, 1988).

It is common, particularly in the case of children, to use school-based interventions, because this setting provides an ecologically valid context in which social concerns are noted. Exposure and SST are the essential procedures of this type of school-based intervention. However, to date such interventions have focused more on adolescents than children (Masia-Warner, Colognori, Brice, & Sanchez, 2015; Mesa, Le, & Beidel, 2015), as can be seen in programs such as Therapy for Adolescents with Social Phobia ("Intervencion en adolescentes con fobia social", IAFS; Olivares 2005) and Skills for Academic and Social Success (SASS; Masia, Klein, Storch, & Corda, 2001). It is unclear whether what works for adolescents will also work with children, particularly when comparing children aged 9, 10 or 11 with adolescents aged 15, 16 or 17. It seems to be desirable for programs to be more specific at these ages, particularly with regard to certain dimensions of social anxiety, such as "Interactions with the opposite sex". SST-based intervention programs commonly include different kinds of skills, such as "Initiating conversations", "Giving and receiving compliments", and so on (Matson & Ollendick, 1988). It is not clear whether all the kinds of social skills needed are included in these programs (e.g., Caballo, Salazar, Olivares, et al., 2014), or whether those skills match the dimensions of social anxiety found in children (Caballo, Arias, et al., 2011, 2012) and adults (Caballo et al., 2010; Caballo, Salazar, Irurtia, et al., 2012). In other words, it seems clear that exposure and SST are the necessary techniques for intervention in childhood social anxiety (Beidel & Turner, 1998); what are less clear are the specific skills that need to be taught and the specific dimensions of social anxiety that need to be addressed.

Overall, the effect size of cognitive behavioral programs for the treatment of childhood social anxiety disorder (or social phobia) ranges from moderate to high. However, it is difficult to draw firm conclusions on the implementation of such programs for children, since the age of participants is overly broad, including, for example, children aged 7 to 17 (e.g., Alfano et al., 2009; Beidel et al., 2007), and for the most part, children and adolescents are combined together in systematic reviews. For example, in the meta-analytic review by Olivares, Caballo, Garcia-Lopez, Rosa, and Lopez-Gollonet (2003) on the effectiveness of the treatment of social phobia, the age of participants varied from 7 to 17. If we restrict this meta-analysis solely to those studies with participants under the age of 14, we find only two studies. One of them, by Beidel, Turner, and Morris (2000), applied the SET-C program to 50 children aged 8 to 12 with generalized social phobia, and the effect size (Cohen's d) pre-post-intervention was found to be 1.24 and 1.75 at 6-month follow-up (using the SPAI-C as the assessment measure). The other study, by Spence, Donovan, and Brechman-Toussaint (2000), applied a multicomponent program, with emphasis on SST, to 50 children aged 7-14 and the effect size (Cohen's d) of the pre-post-intervention improvement was 1.26 and 1.49 at 12-month follow-up. In a more recent study undertaken by Caballo, Calderero, Carrillo, Salazar, and Irurtia (2011), the program "Playing and Learning Social Skills" (JAHSO) was applied to 30 children aged 9-14 who had social anxiety (measured by the Social Interaction Questionnaire for Children [SAQ-CIII], a former version of the Social Anxiety Questionnaire for Children [SAQ-C]), and the effect size (Cohen's d) pre-post-intervention was 0.93 for the total score of the questionnaire (the specific effect size [d] for each of the six dimensions of the SAQ-CIII varied from 0.17 to 1.80). Finally, in a more recent study, Donovan, Cobham, Waters, and Occhipinti (2015) used a cognitive behavioral intervention program involving 40 children aged 7-12 with a clinical diagnosis of social phobia, and the effect size (Cohen's d) pre-post-intervention was 1.04 and 1.41 at the 6-month follow-up (using the SPAI-C as the assessment measure).

The goal in the current study was to test the effectiveness of a play-based SST school program (JAHSO) targeting disruptive children aged 9-12 and designed to reduce their social anxiety. In addition, we sought to determine whether children improved clinically, i.e., whether their social anxiety decreased to the level of non-disruptive children of the same age and environment (known as social validation; see Kazdin, 1977).

Method

Participants

The participants in this study were 112 students, 65 boys and 47 girls, from fourth, fifth and sixth levels of Primary Education, and aged between 9 and 12 years. They were drawn from six classes in a state school in the province of Granada, Spain. Initially 96 students from five disruptive classes formed the intervention group, although nine students were discarded because they missed several sessions or left many questions unanswered in their questionnaire. Of the 87 students who participated in the intervention program, 53 were boys with a mean age of 10.43 years (SD= 1.13) and 34 were girls, with a mean age of 10.59 (SD= 0.96). The reference group was composed of 25 students randomly selected from a sixth-level class without any special issues at the same school, of which 12 were boys with a mean age of 11.33 years (SD= 0.65) and 13 were girls, with a mean age of 11.08 (SD= 0.64) (Table 1).

Instruments

The assessment instrument used at pre- and post-intervention and follow-up was the "Social Interaction Questionnaire for Children" (SAQ-CIII) (Caballo, Arias, et al., 2011). This self-report measure was a preliminary version of the "Social Anxiety Questionnaire for Children" (SAQ-C) (Caballo, Arias, et al., 2012) and consists of 52 items plus two control items. Each of the items is answered on a Likert scale of 1-4 points depending on the degree of embarrassment or nervousness associated with each item (1= "None" to 4= "A lot"). Exploratory factor analysis of the SAQ-CIII, conducted with a sample of 1810 children from 18 schools, resulted in a 6-factor solution that explained 60.61% of variance (Caballo, Arias, et al., 2011). These factors or dimensions included: 1) Interactions with the opposite sex (7 items), 2) Speaking in public/Interaction with teachers (7 items), 3) Criticism and embarrassment (6 items), 4) Interactions with strangers (6 items), 5) Assertive expression of annoyance or disgust (5 items), and 6) Performing in public (4 items). Higher scores in each dimension and the total score reflect higher social anxiety. The questionnaire has good psychometric properties, with high internal consistency (Cronbach's alpha= .93; Guttman split-half reliability= .95). The selection of this questionnaire was based on its special characteristics as a multidimensional measure (including six dimensions) and its use of items specific to Spanish and Portuguese-speaking countries, something not provided by the other measures currently used internationally to assess social anxiety in children.

Procedure

The research involved six teachers-tutors (three women and three men) from six classes who volunteered to participate. All the teachers had more than six years' experience. The staff team, the counselor and the teachers-tutors all received information about the goals of the intervention plan. These teachers helped to evaluate some of the variables chosen and other aspects associated with the intervention program. However, the same psychologist applied the play-based intervention program in the five disruptive classes that constituted the experimental group over a three and a half month period. No student was excluded, and the whole class participated in the program. The sixth non-disruptive class served as a reference group, and did not receive any intervention.

The selection of the experimental groups was carried out by the staff at the school. These groups consisted of the most conflicted and troublesome students at the school, and therefore required immediate attention. The decision was made to respect the natural formation of the groups at the initial stage of the study, and implement the intervention program as a tutorial activity as naturally as possible. The main problems presented by these groups were frequent conflicts between students (threats, insults, and physical attacks). However, not only was aggressive behaviors commonplace in these classrooms, as there were also high rates of passive and withdrawn behavior in which many of the students felt helpless about dealing with the aggressive behavior of the other students. Due to the serious problems presented by the five disruptive classes and the importance of immediate action, it was not possible to use one of these classes as a control group. It was deemed unethical not to intervene in a group that required prompt action. However, we used a class without any special problems as a reference group. The idea was to see whether following the intervention the students in the disruptive classes possessed the same level of social behavior as the reference group in the variables measured. In this way, we could socially validate the intervention (Kazdin, 1977).

The research was implemented in four stages:

1) Pre-intervention assessment. In this phase, the SAQ-CIII and other questionnaires (not considered in this study) were administered to the intervention and reference groups.

2) Intervention. The "Playing and Learning Social Skills" (JAHSO) program was delivered to the intervention group for fourteen 60-minute sessions at a rate of one session per week. The reference group received no intervention.

3) Post-intervention assessment. Following the Intervention, the same assessment Instruments in phase 1 were administered again to the intervention and reference groups.

4) Follow-up assessment. Six months after the intervention, the SAQ-CIII was administered once again to the students in the intervention group who were still at school (see below). The reference group was not assessed in the follow-up.

Brief description of the intervention program

"Playing and Learning Social Skills" (JAHSO) is a school-based social skills program for children aged between 9 and 14 years. The first part (seven sessions) is devoted to providing students with a set of social skills. The dimensions of social skills include: 1) Introduction to social skills including styles of behavior, 2) Giving and receiving compliments, 3) Expressing positive and negative feelings, 4) Initiating, maintaining and ending conversations, 5) Making and rejecting requests, 6) Dealing with criticism and coping with it, and 7) Interpersonal problem-solving.

Learning each skill involves following several steps: 1) review of the homework of the social skill taught in the previous week (except for the first skill), 2) definition of the skill, 3) importance of the skill, 4) steps to perform the skill, 5) examples to check that what has been explained in the session has been understood, 6) group activities in which the skill is taught through group exercises and behavior rehearsal, and 7) homework, so that students can practice outside the session the skills taught. The program's sessions are described in more detail in the Appendix.

The second part (seven sessions) focuses on practicing the social skills learned in the first part of intervention play activities (called "Sokill Galaxy"). The game includes the following elements: a) a large magnetic board with 72 boxes arranged in the form of two stars, a larger one outside and a smaller one inside; b) a dice; c) 500 six-color cards with tasks (e.g., role-playing) and questions and answers on social skills; d) 300 six-color stars; e) Six player tokens; f) a manual for the group conductor; g) diplomas for the winners of the game; and h) records of participation. The six-color boxes are associated to the six dimensions of social skills. The classroom is divided in groups of 4-6 students. The different groups compete doing the tasks and answering the questions included on the cards. When they do well they receive a star. The first group to reach 15 stars of each color wins the game.

The game helps strengthen the dimensions previously trained, involves more active participation by students, and makes learning of the social skills fun. Basically, this part of the intervention is similar to exposure exercises in other treatments

Statistical analysis

Nonparametric statistical tests were used due to both the small sample size of the reference group (although still a normal distribution in six of the study's seven variables [Shapiro-Wilk test]) and the scores of the experimental group formed by disruptive students, which did not follow a normal distribution in five of the seven variables used [Shapiro-Wilk test]. Specifically, the Wilcoxon test was used for related samples to compare pre-post-intervention for the two groups and follow-up scores in the experimental group, and the Mann-Whitney test was used to compare the experimental group with the reference group. To find the effect size of the intervention r was used, which was calculated by dividing the z value by the square root of N (number of cases used in the analysis). The interpretation of r values for effect size is relatively similar to Cohen's d. It was considered negligible if it was less than .10, small from .10 to .30, medium between .30 and .50, and high if it was greater than .50. Although we used nonparametric statistics for the analyses, the tables include means and standard deviations of the variables (instead of the median), because we consider them more informative when comparing this study with others in the literature. The statistical package used was Statistica v. 12 (StatSoft, 2013).

In order to obtain more accurate information regarding the results of students with high social anxiety, the experimental group was divided into two subgroups, one with high social anxiety (students who scored above the mean plus one standard deviation on the total score of the SAQ-CIII, according to data obtained in a previous study with a large sample of 1810 students of similar age with no special conflicts) [see Caballo, Calderero, et al., 2011]) and another one with normal anxiety problems (students who scored below the mean plus one standard deviation in the former SAQ-CIII).

Results

The results are presented considering the full experimental group, the high and normal social anxiety subgroups, and the reference group. There were no significant differences in any one of the variables at the pre-intervention stage or among groups of students of different ages (9-12) or among the five classrooms that constituted the experimental group (Kruskal-Wallis test). Although there was a tendency for older children to be less socially anxious, the trend was not uniform, and in no case were the differences statistically significant.

Pre-post-intervention differences regarding the full experimental group

Table 2 shows the scores in the SAQ-CIII and its dimensions regarding the full experimental group before and immediately after the intervention. As can be seen, the experimental group improved significantly (p< .001) in each of the six dimensions of the SAQ-CIII and the overall social anxiety score. The effect size of these improvements (r) was medium in the dimensions of "Interaction with the opposite sex", "Criticism and embarrassment", and "Performing in public", and large in the other three dimensions. The effect size in global social anxiety (total score in the SAQ-CIII) was high (r= .75).

Pre-post-intervention differences regarding the high social anxiety experimental group

Given that the above results included all the students in the disruptive classes, whether or not they had high social anxiety, we selected students who scored higher than M + 1SD in each of the six dimensions and global social anxiety (SAQGN). The number of students for each dimension differed given that a student could have a high score in some factor(s) but not in other(s). Table 3 shows the mean scores and standard deviations (for these seven variables) for that group of subjects before and immediately after the intervention program. Scores were compared by the Wilcoxon test. As can be seen in Table 3, the pre-post-intervention differences remain highly significant (p< .001), but now the effect sizes (r) are higher, ranging from .78 to .86 in the different dimensions of social anxiety, with a score of .87 in global social anxiety.

Pre-post-intervention differences regarding the normal social anxiety experimental group

We also wanted to find out whether the intervention program had a significant impact on the other students in the experimental group whose level of social anxiety was not problematic (a score of less than the M + 1SD in the SAQ-GN). We compared the pre-post-intervention scores of these students by means of the Wilcoxon test, and found that these differences were statistically significant in four of the six dimensions and the total score of the SAQ-CIII. The effect size was small in one of these four dimensions and medium in the other three (r). The effect size was large for the total score of the questionnaire (r= .57) (Table 4). In short, the scores of students with normal anxiety decreased in all the dimensions and in overall anxiety; nevertheless, this reduction was not statistically significant for two of the dimensions.

Pre-intervention/follow-up differences regarding the full experimental group

The participants in the full experimental group decreased to 41 students (26 boys and 15 girls) at the follow-up assessment. Table 5 shows the scores of the full experimental group in the SAQ-CIII and its dimensions at pre-intervention and at 6-month follow-up. The effect size of the improvements remained medium or large in four of the six dimensions and in the overall social anxiety score (r).

In the two dimensions of the SAQ-CIII in which the effect size was lower, p was no longer statistically significant. However, the effect size (r) of the improvement was above 0.20 in both cases. The effect size (r) decreased slightly in three dimensions ("Speaking in public/Interaction with teachers", "Interactions with strangers", and "Assertive expression of annoyance or disgust") and in the total score of the SAQ-CIII, while it increased in one dimension ("Criticism and embarrassment").

Moreover, there were no statistically significant differences (Wilcoxon test) in any one of the dimensions of the SAQ-CIII or in its global score in the experimental group when the follow-up assessment was compared with the post-intervention one. The r was also negligible in all cases (p< .10). This indicates that the changes remained stable over the six months following the intervention in the experimental group.

Pre-intervention/follow-up differences regarding the high social anxiety experimental group

Table 6 shows the means and standard deviations of students with high social anxiety (score above the M + 1SD in the SAQ-CIII) before the intervention program and in the follow-up. Scores were compared in both stages by the Wilcoxon test. As can be seen, the differences in the follow-up remained significant (p< .01). The effect size of the changes increased, and the range of these values was .77 to .88, with a value of .88 for global social anxiety.

In addition, there were no significant differences in this group of students for any of the dimensions or in overall social anxiety when comparing post-intervention scores with those obtained at the follow-up (lower in all variables). However, the effect size (r) indicated that while it was negligible (r< .10) in two dimensions ("Criticism and embarrassment" and "Assertive expression of annoyance or disgust") and global social anxiety, in another three dimensions it was small (.10 > r < .30), and in a fourth dimension ("Performing in public") it was large (r= .59).

Pre-intervention/follow-up differences regarding the normal social anxiety experimental group

We also compared pre-intervention and follow-up scores in the subgroup of students with normal social anxiety (lower score than the M + 15D in the SAQ-CIII). Wilcoxon test was used and no significant differences were found in any one of the dimensions of social anxiety or in the overall score. These data indicate that although social anxiety decreased significantly in the post-intervention stage in this subgroup, these improvements were not maintained at follow-up, at which time the score for most of the dimensions and for overall anxiety returned to its initial pre-intervention level at the 6-month follow-up.

Moreover, there were no statistically significant differences in this subgroup in any of the social anxiety variables when comparing follow-up to post-intervention scores.

Comparison between the results for the full experimental group and the reference group

In order to determine whether the changes in the full experimental group were clinically relevant, i.e., whether they were validated socially, we included a reference group and compared it to the full experimental group at both pre-intervention and post-intervention stages.

The pre-intervention stage presented statistically significant differences (p< .05) between the two groups on two dimensions ("Criticism and embarrassment" and "Assertive expression of annoyance or disgust") and in global social anxiety (p< .01), and almost significant ones (p< .06) in two other dimensions ("Speaking in public/Interaction with teachers" and "Performing in public"). Considering the effect sizes (r) between the two groups at the pre-intervention stage, small (.10> r < .30) differences were noted in the six dimensions and medium differences (r= .30) in overall social anxiety. The experimental group scored higher than the reference group in all the variables.

In contrast, when the full experimental group and the reference group were compared at the post-intervention stage, no statistically significant differences were found on five of the six dimensions or in overall social anxiety. In the sixth dimension, "Interactions with strangers", the full experimental group achieved a significantly lower score than the reference group (p< .05). Regarding the effect size of the differences, it was small only in this last dimension (r= .20); it was negligible in the other five dimensions and in overall social anxiety.

Comparing the results of the high and normal social anxiety experimental subgroups with the reference group

When selecting the subgroup of students who scored high on social anxiety (M + 15D in the SAQ-CIII), in any of the dimensions and/or in global social anxiety, using Mann-Whitney test we found that this subgroup scored higher than the reference group (p< .001) at the pre-intervention stage in all the variables. The effect size of these differences ranged from r= .54 to r= .78 (Table 7).

When selecting the subgroup of students who did not have social anxiety problems (scoring less than M + 15D in the SAQ-CIII) in any dimension or in global social anxiety, we found that this subgroup did not differ statistically from the reference group at the pre-intervention stage.

When we focus on the post-intervention stage and select the subset of students who scored higher in social anxiety (M + 15D in the SAQ-CIII) in any one of the dimensions and in global social anxiety, we found that this subgroup did not differ significantly from the reference group on four of the six dimensions and on overall social anxiety. Only in the dimensions of "Interactions with the opposite sex" (p< .05) and "Performing in public" (p< .01) did the subgroup of high social anxiety score significantly above the reference group (Table 8). In the first of these two dimensions the effect size was small (r= .26), while in the second it was medium (r= .41). In the other dimensions as well as in global social anxiety, the effect size was small (.10> r < .30), except for the dimension "Interactions with strangers", which was negligible (r= .01).

If we focus again on the post-intervention stage and select the subgroup of students without social anxiety problems (scoring less than M + 15D in the SAQ-CIII), in any one of the dimensions and in global social anxiety, we find that this subgroup scored significantly lower than the reference group on the dimensions of "Speaking in public/Interaction with teachers" (p< .05), "Interactions with strangers" (p< .001) and "Assertive expression of annoyance or disgust" (p< .01), as well as on global social anxiety (p< .05). In the other three dimensions, the differences were not statistically significant. Regarding the effect size of these differences, only on one dimension ("Performing in public") was the effect size negligible (r= .09), while in three there were small differences (.10> r < .30), a medium difference in one ("Assertive expression of annoyance or disgust"), and for one dimension ("Interactions with strangers") the difference was large (r= .45). The effect size on global social anxiety was medium (r= .31).

Pre-post-intervention scores in the reference group

In order to test whether the reference group remained unchanged throughout the intervention period, the SAQ-CIII was administered to the reference group at the pre- and post-intervention stages. Using the nonparametric Wilcoxon test for related samples at the pre and post-intervention stages, no significant differences were found between the scores obtained in the different dimensions of the questionnaire or in its overall score. In short, the social anxiety level of the reference group remained unchanged throughout the intervention program.

Discussion

This study assessed the effectiveness of a play-based school SST program (the JAHSO program) on social anxiety in disruptive children (aged 9-12) by means of a multidimensional self-report measure of social anxiety, the SAQ-CIII. The innovative aspects of this research focused on the play-based SST intervention program and the new multidimensional self-report measure for assessing social anxiety in children (SAQ-CIII), which consists of a global score and six specific scores corresponding to the six dimensions in the questionnaire (Caballo, Arias, et al., 2012; Caballo, Calderero, et al., 2011).

The results show the effectiveness of the program in decreasing the social anxiety of children in disruptive classes. The children in the full intervention group improved significantly in terms of both global social anxiety and on each of the six social anxiety dimensions at the post-intervention stage, with an effect size (r) ranging from medium to large (depending on the specific dimension or the overall score in social anxiety). These improvements in the full group were generally maintained six months after the intervention (follow-up), albeit with a slight decline. Although the effect size also decreased across dimensions, they remained at a value of large (r> .50) for three dimensions and for global social anxiety. Although the students in the full group did not improve in a statistically significant way, from post-intervention to follow-up, they did not worsen, supporting the maintenance of changes due to the intervention program six months after its completion.

However, since for practical and ethical issues the play-based intervention program was applied to entire classes (i. e., a universal intervention), not all the students in these classes had high social anxiety. In order to gauge the impact the program specifically had for students with high social anxiety, the results of this subgroup were analyzed separately. In this case, the program's impact was much greater, in terms of both statistical significance and effect size, whether at the post-intervention or follow-up stages. The r values were similar and generally higher than other cognitive behavioral intervention programs with children (aged 8 to 14), usually SST-based to reduce their social anxiety (e. g., Beidel et al., 2000; Donovan et al., 2015; Spence et al., 2000). Although our sample was not a clinical one, it was selected on the basis of scores on our questionnaire, differing from the clinical samples of those former studies that were generally selected on the basis of a semi-structured interview. Nonetheless, presence of high levels of social anxiety pose a major problem for many school-aged children and a more environmentally friendly way to address it, without individually attending a clinic (or receiving a clinical diagnosis), is the kind of assessment and intervention that we implemented in this study.

The JAHSO program reduced the social anxiety of both children with high anxiety and those with no serious problems with social anxiety (normal SA) at the post-intervention stage, and those gains were maintained, and even increased, at the six-month follow-up but only for those students who initiated the program with high social anxiety, while in the other students (with normal SA) the program's benefits were not evident six months later. One possible explanation is that students with high social anxiety feel more motivated to apply what they have learned during the program, since the application of the skill learned to everyday life is likely to have a greater impact than in the case of children who do not have significant social anxiety problems. In other words, although group intervention programs, focusing on SST, for reducing social anxiety were applied to an entire class, only students with high social anxiety would clearly benefit from this program. This is to be expected. The question to consider is the program's cost/benefit. Is it preferable to use a play-based intervention program within the ecological niche of the classrooms, continuing with their usual routine, or is it more expedient to remove students with high social anxiety from their classrooms to include them in specific clinical intervention groups? Both options have their advantages and disadvantages, and the choice will likely depend on particular conditions present at each school.

This study addressed not only the possible improvement of participating students immediately after the implementation of the program, but also six months after its completion. It also included a reference group of students from a class without special problems that was part of the same school where the play-based intervention program was conducted. The purpose of the inclusion of this group was to find out whether the program would have a clinical effect on participating students, i.e., whether these students would reach the same level of social anxiety as students in the reference group. This is what is referred to as social validation (Kazdin, 1977). The study results at the post-intervention stage showed that, when we consider the full experimental group, the mean of the different dimensions and that of the total score of this group did not differ statistically from the reference group, except in the dimension of "Interactions with strangers", where the full intervention group scored lower (p< .05) than the reference group. Yet what really interested us was whether the subgroup of students with high social anxiety decreased their anxiety to the level of the reference group. Differences in the scores of both groups at the pre-intervention stage were high (p< .0001), including the effect size (r) of these differences (from .54 to .78). After the application of the play-based intervention program, the results showed that in four dimensions and in overall social anxiety the subgroup with high social anxiety scores matched the reference group. Only in two dimensions, "Interactions with the opposite sex" and "Performing in public" did the differences remain significant (albeit much smaller), with the experimental subgroup showing greater anxiety than the reference group.

One possible explanation for these results would be that the kind of social skills dimensions that were addressed by the play-based intervention program did not coincide exactly with the dimensions of social anxiety assessed by the SAQ-CNL However, some of these social skills can be considered transdimensional, i.e., they may be useful for improving several dimensions of social anxiety. Accordingly, for example, the social skill "Initiating, maintaining and terminating conversations" may improve the dimensions of social anxiety "Interactions with the opposite sex" and "Interactions with strangers." The social skill "Making and coping with criticism" may improve the social anxiety dimensions of "Criticism and embarrassment" and "Assertive expression of annoyance or disgust," while the social skill "Making and refusing requests" may also improve this last dimension. Overall, SST-based intervention programs for social anxiety tend not to include specific modules for the dimensions composing this last construct (Caballo, Arias, et al., 2012), in children (e. g., Beidel et al., 2000), adolescents (e. g., Olivares, Olivares-Olivares, & Macia, 2014), and adults (e. g., Wagner, Pereira, & Oliveira, 2014), although they were effective in reducing social anxiety. However, given the close relationships between social skills and social anxiety (e. g., Caballo, Olivares, Lopez-Gollonet, Irurtia, & Rosa, 2003; Caballo, Salazar, Irurtia, Olivares, & Olivares, 2014), protocols in which social skills focus on specific dimensions of social anxiety should be more common when intervening in social anxiety, be it in children, adolescents or adults.

This study also has its limitations. The main limitation is the lack of a control group of students from a troublesome classroom with which to compare the experimental group. Although the research conditions did not allow us to establish a control group, it would be desirable for future studies to include such a group. Another limitation was the low number of students in the reference group for social validation purposes, something which could also be addressed in future studies. A possible improvement for future studies would be to replace the SAQ-CIII with the final version of this same questionnaire, the SAQ-C (Caballo, Arias, et al., 2012). Although both questionnaires consist of the same dimensions of social anxiety, the latest version has a more detailed test of its psychometric characteristics. Finally, we would like to note that this study did not use any semi-structured diagnostic interviews to assess the students. It is unclear whether such extensive individual assessment would be of help for this kind of school-based group intervention, where high social anxiety students are mixed with other students. Future research will clarify these matters.

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Appendix
Structure of the "Playing and Learning Social Skills" program (JAHSO)

Session                                              Description of
number         Topic               Goals                activities

1         Introduction to   * Learning to          Classrooms are
          social skills:    differentiate          divided into two or
          behavior styles   between aggressive,    three-student
                            passive and            groups, and each
                            assertive styles of    group is given a
                            behavior.              situation that they
                                                   will have to role-
                            * Understanding and    play in front of
                            practicing             their peers. Each
                            assertiveness.         student in each
                                                   group is assigned a
                            * Encouraging          role (assertive,
                            assertive behavior.    passive or
                                                   aggressive). The
                                                   rest of the group
                                                   will have to
                                                   identify each one of
                                                   the roles with a
                                                   style of behavior,
                                                   and then move to a
                                                   final reflection on
                                                   what is the most
                                                   appropriate style
                                                   for each situation
                                                   and why.

2         Giving and        * Learning and         First activity. Say
          receiving         practicing the         the name of the
          compliments       required skills to     student next to him/
                            express and receive    her and then replace
                            positive               the names with
                            reinforcement          compliments.
                            through compliments.   Example: Alice
                                                   "Funny" "Friendly".
                            * Understanding the
                            importance of          Second activity. A
                            positive language in   chair is placed in a
                            social                 visible place in
                            relationships.         front of the class;
                                                   a student sits on
                            * Learning to          the chair and the
                            positively value       rest of the group,
                            others and feel        in order,
                            valued by them.        compliments him/
                                                   her.
                            * Encouraging the
                            payment of             Third activity. Each
                            compliments to         student writes their
                            others.                name on a slip of
                                                   paper. Once all the
                            * Making               names have been
                            relationships with     written down, the
                            others more            teacher collects and
                            enjoyable.             distributes them
                                                   randomly so that
                            * Improving our        everybody receives a
                            self-esteem and that   slip with the name
                            of others.             of a classmate.
                                                   Then, one by one,
                                                   following an order,
                                                   each student will
                                                   have to go up to the
                                                   given classmate and
                                                   pay them a
                                                   compliment.

                                                   Fourth activity.
                                                   Students start
                                                   calling out in order
                                                   a sentence beginning
                                                   with the words "I
                                                   like ..." and /or
                                                   "I'm good at ..."
                                                   They finish it by
                                                   saying something
                                                   they like about
                                                   themselves and/or
                                                   something they are
                                                   good at and they do
                                                   well.

3         Expressing        * Learning to          First activity:
          positive          identify feelings.     Following an order,
          and negative                             all the students
          feelings          * Developing the       express how they
                            ability to generate    feel or how they
                            positive feelings      felt in a given
                            and enjoy them.        situation. They can
                                                   start by saying: "I
                            * Learning to          feel /felt ... when
                            communicate and        ... ","I feel /felt
                            control negative       ... because Second
                            feelings.              activity: Each child
                                                   is given a card with
                            * Knowing what to do   the name of a
                            when someone           feeling, then one by
                            expresses feelings.    one they have to
                                                   form a phrase with
                            * Understanding        the feeling on their
                            their own and          card and why they
                            others' feelings.      feel that way. Third
                                                   activity: Two cards,
                            * Promoting the        one with a positive
                            expression of          feeling and the
                            positive and           other with a
                            negative feelings to   negative one. These
                            others.                cards are given to
                                                   two volunteers. Then
                                                   one of them gets up
                                                   and expresses their
                                                   feeling to a
                                                   classmate. The other
                                                   volunteer does the
                                                   same.

4         Initiating,       * Acquiring the        First activity:
          maintaining and   skills to initiate,    Grouping by pairs.
          terminating       maintain and           For a few minutes
          conversations     terminate              one of the partners
                            conversation skills.   will talk about what
                                                   his-her partner
                            * Providing the        wants, and the
                            opportunity to         latter has to
                            establish social       listen. When time
                            contacts.              runs out, the
                                                   students who have
                            * Learning the         played the listener
                            importance of          role will have to
                            responding             tell the classroom
                            appropriately when     what his-her partner
                            another child wants    told him-her. The
                            to have a              roles are then
                            conversation with      swapped with the
                            him/her.               students who
                                                   listened adopting
                            * Learning to ask      the speaking role.
                            questions in order
                            to initiate and        Second activity:
                            maintain               Some volunteer
                            conversations with     students will role-
                            others.                play a range of
                                                   situations in which
                            * Encouraging and      they will have to
                            motivating students    initiate, maintain
                            to interact in and     and terminate
                            out of school.         conversations. For
                                                   instance: "A new
                                                   classmate has
                                                   arrived in your
                                                   classroom, she comes
                                                   from Colombia. You
                                                   have to initiate,
                                                   maintain and
                                                   terminate a
                                                   conversation with
                                                   her."

                                                   Third activity: Each
                                                   student writes their
                                                   name on a slip of
                                                   paper and folds it
                                                   without showing it.
                                                   The teacher collects
                                                   all the slips and
                                                   distributes them at
                                                   random, so that
                                                   everybody gets a
                                                   slip with the name
                                                   of a classmate.
                                                   Then, in turn, at
                                                   the front of the
                                                   classroom, each
                                                   child will has to
                                                   initiate, maintain
                                                   and terminate a
                                                   conversation with
                                                   the classmate whose
                                                   name is written on
                                                   their slip.

5         Making and        * Learning to          First activity:
          refusing          differentiate          Volunteer students
          requests          reasonable or honest   will make a request
                            requests from those    to their classmates
                            that are not.          or the teacher
                                                   present in the
                            * Learning to ask      classroom.
                            others for favors
                            and for help.          Second activity: A
                                                   situation of making
                            * Organizing and       a request is
                            verbalizing desires    randomly distributed
                            and needs clearly      to each student. In
                            and appropriately.     order, each student
                                                   makes their request.
                            * Encouraging them
                            to implement the       Third activity: Each
                            skill following the    student is randomly
                            recommended steps.     given one of the
                                                   situations dealing
                            * Knowing how to       with saying no.
                            refuse requests or     Students have to

                            say "no".              role-play the given
                                                   situation in which
                            * Knowing the          one makes the
                            importance of          request and the
                            refusing requests      other refuses it.
                            properly.

                            * Being able to
                            refuse requests
                            properly.

6         Making and        * Learning to          First activity: Some
          coping with       differentiate          students will try to
          criticism         between constructive   express one by one
                            or well-intentioned    in a friendly manner
                            criticism from         one or more
                            malicious or           criticisms to a
                            destructive one.       classmate following
                                                   the format already
                            * Losing the fear of   described (positive
                            expressing             message + negative
                            criticism.             feeling + change
                                                   request).
                            * Identifying
                            situations or times    Second activity
                            when there is a need   (Mail of criticism):
                            to express             The student will
                            criticism.             have to write their
                                                   criticism of a
                            * Knowing the          classmate. It is
                            importance of          explained that the
                            learning to express    criticism will be
                            criticism and cope     private and not read
                            with it properly.      aloud, only the
                                                   target of the
                            * Learning to apply    criticism will read
                            the skill both to      it.
                            express criticism      Once written down,
                            and to cope with it    the students will
                            in everyday            fold the sheet in
                            situations.            half and fold it
                                                   again so nobody can
                            * Learning to          see what has
                            respect others and     been written. It
                            be respected.          will then simulate
                                                   an envelope, with
                                                   one side bearing the
                                                   sender's name (i.e.,
                                                   the person who wrote
                                                   the criticism) and
                                                   on the other side,
                                                   the addressee (i.e.,
                                                   the person to whom
                                                   the criticism is
                                                   addressed).

                                                   Third activity: Each
                                                   student is randomly
                                                   put in a situation
                                                   of coping with
                                                   criticism. Two
                                                   students have to
                                                   role-play the given
                                                   situation in which
                                                   one makes the
                                                   criticism and the
                                                   other copes with it,
                                                   according to the
                                                   instructions given
                                                   in the modules.

7         Solving           * Acquiring the        First activity: Give
          interpersonal     necessary              every two students
          problems          problem-solving        the card dealing
                            strategies.            with problem
                                                   solving, and they
                            * Increasing the       will have to answer
                            personal               the following points
                            effectiveness of       in written: 1)
                            students in the        Identify what the
                            skill of solving       problem is.
                            problems in an
                            independent way.       2) The options the
                                                   child of the
                            * Learning to          vignette presents to
                            develop the            solve the problem.
                            necessary steps to
                            solve a problem.       3) The style of
                                                   behavior (assertive,
                            * Developing           passive or
                            creativity in          aggressive) that
                            searching for          would occur in each
                            solutions.             solution.

                            * Learning to          4) The potential
                            reflect upon the       implementing each
                            consequences of a      one of the
                            given solution.        consequences of
                                                   solutions.
                            * Promoting
                            assertive and          5) Choosing the
                            rational responses     solution that best
                            and blocking the       solves the problem.
                            immediate aggressive
                            response.              Second activity: Ask
                                                   the students about
                            * Relating better      problems they have
                            and feel more          had and have not
                            comfortable in our     been able to solve
                            relationships with     and-or known
                            others.                problems that
                                                   concern them. Groups
                            * Avoiding conflicts   of three or four
                            and arguments about    students are formed,
                            unimportant things.    and each group has
                                                   to solve the problem
                                                   using the steps in
                                                   the problem-solving
                                                   module.


RECEIVED: March 16, 2015

ACCEPTED: June 23, 2015

Vicente E. Caballo (1), Gloria B. Carrillo (2), and Thomas H. Ollendick (3)

(1) University of Granada; (2) FUNVECA Center of Clinical Psychology, Granada (Spain); (3) Virginia Polytechnic Institute and State University (USA)

This study was partially supported by the Fundacion VECA para el Avance de la Psicologia Clinica Conductual, by a grant from the European Regional Development Fund (ERDF), and by the regional government of Andalusia as part of the University of Granada's program "Fortalecimiento de la I+D+i".

Correspondence: Vicente E. Caballo, Faculty of Psychology, University of Granada, 18071 Granada (Spain). E-mail: vcaballo@ugr.es
Table 1
Distribution by age and sex of the subjects participating in the study

Group          Age (years)   Boys (n)   Girls (n)   Total (N)

Intervention   9                15          5          20
               10               12         10          22
               11               14         13          27
               12               12          6          18
               Total            53         34          87

Reference      10               1           2           3
               11               6           8          14
               12               5           3           8
               Total            12         13          25

Table 2
Means, standard deviations and results of the Wilcoxon test for the
full intervention group before and just after the application of the
intervention program on the various dimensions of the SAQ-CIII

SAQ-CIII         Pre-interv.    Post-interv.
dimensions          M (SD)         M (SD)      N *    z      p      r

F1.                 21.46          19.46       73    3.51   .000   .41
Interactions        (5.49)         (5.82)
with the
opposite sex

F2. Speaking        15.05            12        72    5.12   .000   .60
in public /         (5.34)         (4.29)
Interaction
with teachers

F3. Criticism       16.68          14.54       70    3.96   .000   .47
and                 (3.97)         (3.93)
embarrassment

F4.                 14.72           12.4       72    4.97   .000   .58
Interactions        (3.81)         (3.70)
with strangers

F5. Assertive       11.66           9.13       72    5.79   .000   .68
expression of       (3.93)         (3.23)
annoyance or
disgust

F6. Performing      11.08           9.84       73    3.97   .000   .46
in public           (2.97)         (2.92)

Total score          90.9          77.37       63    5.98   .000   .75
                   (15.35)        (13.68)

Note: SAQ-CIII= "Social Interaction Questionnaire for Children".
* Number of subjects used by the Wilcoxon matched pairs test. Effect
size (r) values following Cohen: < .10, negligible effect; .10.30,
small effect; .30-.50, medium effect; > .50, large effect.

Table 3
Means, standard deviations and results of the Wilcoxon test for the
subset of high social anxiety students before and just after the
application of the intervention program

SAQ-CIII          Pre-interv.   Post-interv.
dimensions          M (SD)         M (SD)      N *    z      p      r

F1.                  25.95         22.15       31    4.37   .000   .78
Interactions        (1.57)         (4.74)
with the
opposite sex

F2. Speaking in      20.59         14.15       32    4.89   .000   .86
public /            (2.95)         (3.86)
Interaction
with teachers

F3. Criticism        20.8          15.93       28    4.38   .000   .83
and                 (1.49)         (4.40)
embarrassment

F4.                  18.56         14.12       32    4.56   .000   .81
Interactions        (1.50)         (3.20)
with strangers

F5. Assertive        15.02         10.69       39    5.37   .000   .86
expression of       (2.31)         (2.96)
annoyance or
disgust

F6. Performing       14.71         11.92       21    3.87   .000   .84
in public           (0.69)         (2.52)

Total score         104.03         84.07       30    4.78   .000   .87
                    (9.78)        (10.51)

Note: Students with high social anxiety had a score equal to or
higher than M+1SD in the SAQ-CIII before the intervention. SAQ-CIII=
"Social Interaction Questionnaire for Children". * Number of subjects
used by the Wilcoxon matched pairs test. Effect size (r) values
following Cohen: < .10, negligible effect; .10-.30, small effect;
.30-.50, medium effect; > .50, large effect.

Table 4
Means, standard deviations and results of the Wilcoxon test for the
subset of normal social anxiety students before and just after the
application of the intervention program

SAQ-CIII         Pre-interv.    Post-interv.
dimensions          M (SD)         M (SD)       N *    z      p      r

F1.              17.39 (4.51)   17.02 (5.65)    42    0.87   .381   .13
Interactions
with the
opposite sex

F2. Speaking     11.42 (2.83)   10.51 (3.95)    40    2.05   .040   .32
in public /
Interaction
with teachers

F3. Criticism    14.39 (2.91)   13.86 (3.35)    42    1.10   .271   .17
and
embarrassment

F4.              11.82 (2.01)   10.91 (3.15)    40    2.10   .035   .33
Interactions
with strangers

F5. Assertive    8.45 (1.98)     7.73 (2.78)    33    2.11   .035   .37
expression of
annoyance or
disgust

F6. Performing   9.65 (2.20)     8.97 (2.68)    52    2.07   .039   .29
in public

Total score      78.84 (7.62)   71.88 (13.04)   33    3.29   .001   .57

Note: Students with normal social anxiety had a score lower than
M+1SD in the SAQ-CIII before the intervention. SAQ-CIII= "Social
Interaction Questionnaire for Children". * Number of subjects used by
the Wilcoxon matched pairs test. Effect size (r) values following
Cohen: < .10, negligible effect; .10-.30, small effect; .30-.50,
medium effect; > .50, large effect.

Table 5
Means, standard deviations and results of the Wilcoxon test for the
full intervention group before the application of the intervention
program and at the six-month follow-up

SAQ-CIII         Pre-interv.   Follow-up
dimensions         M (SD)       M (SD)     N *    z      p      r

F1.                 21.46        20.05     37    1.95   .051   .32
Interactions       (5.49)       (5.98)
with the
opposite sex

F2. Speaking        15.05        12.02     37    2.70   .007   .44
in public /        (5.34)       (4.69)
Interaction
with teachers

F3. Criticism       16.68        15.02     32    2.93   .003   .52
and                (3.97)       (3.52)
embarrassment

F4.                 14.72        12.63     33    2.92   .003   .51
Interactions       (3.81)       (3.94)
with strangers

F5. Assertive       11.66        9.29      37    3.45   .001   .57
expression of      (3.93)       (3.72)
annoyance or
disgust

F6. Performing      11.08        10.17     38    1.82   .069   .29
in public          (2.97)       (2.75)

Total score         90.90        79.13     33    3.41   .001   .59
                   (15.35)      (13.86)
Note: SAQ-CIII= "Social Interaction Questionnaire for Children".
* Number of subjects used by the Wilcoxon matched pairs test. Effect
size (r) values following Cohen: < .10, negligible effect; .10-.30,
small effect; .30-.50, medium effect; > .50, large effect.

Table 6
Means, standard deviations and results of the Wilcoxon test for the
subset of high social anxiety students before the application of the
intervention program and at the follow-up

SAQ-CIII          Pre-interv.   Follow-up
dimensions          M (SD)       M (SD)     N *    z      p      r

F1.                  25.95        21.47     19    3.56   .000   .81
Interactions        (1.57)       (5.30)
with the
opposite sex

F2. Speaking in      20.59        12.93     14    3.29   .001   .88
public /            (2.95)       (3.65)
Interaction
with teachers

F3. Criticism        20.8         15.78     16    3.52   .000   .88
and                 (1.49)       (3.44)
embarrassment

F4.                  18.56         13       18    3.27   .001   .77
Interactions        (1.50)       (4.29)
with strangers

F5. Assertive        15.02        10.48     21    3.61   .000   .79
expression of       (2.31)       (3.68)
annoyance or
disgust

F6. Performing       14.71        10.00     11    2.93   .003   .88
in public           (0.69)       (2.41)

Total score         104.03        81.17     17    3.62   .000   .88
                    (9.78)       (12.77)

Note: Students with high social anxiety had a score equal to or
higher than M+1SD in the SAQ-CIII before the intervention. SAQ-CIII=
"Social Interaction Questionnaire for Children". * Number of subjects
used by the Wilcoxon matched pairs test. Effect size (r) values
following Cohen: < .10, negligible effect; .10-.30, small effect;
.30-.50, medium effect; > .50, large effect.

Table 7
Means, standard deviations and results of the Mann-Whitney U test for
the subset of high social anxiety students and the reference group
before the application of the intervention program

                Pre-interv.  Pre-interv.
                  SA Gr.     Refer. Gr.             z
SAQ-CIII          M (SD)       M (SD)      N *   adjusted   p     r
dimensions

F1.                25.95        19.24     40/25    4.38    .000  .54
Interactions      (1.57)       (6.18)
with the
opposite sex

F2. Speaking       20.59        12.80     34/25    5.26    .000  .68
in public /       (2.95)       (4.74)
Interaction
with teachers

F3. Criticism      20.80        14.40     30/25    5.79    .000  .78
and               (1.49)       (3.97)
embarrassment

F4.                18.56        13.48     34/25    5.05    .000  .66
Interactions      (1.50)       (3.76)
with strangers

F5. Assertive      15.02        9.72      42/25    5.84    .000  .71
expression of     (2.31)       (2.86)
annoyance or
disgust

F6. Performing     14.71        9.72      24/25    5.05    .000  .72
in public         (0.69)       (3.07)

Total score       104.03        79.36     34/25    5.80    .000  .75
                  (9.78)       (13.70)

Note: SAQ-CIII= "Social Interaction Questionnaire for Children". SA
Gr.= high social anxiety students. Students with high social anxiety
had a score equal to or higher than M+1SD in the SAQ-CIII before the
intervention. Refer Gr.= reference group. N * = Number of subjects of
the experimental subgroup-Number of subjects of the reference group.
Effect size (r) values following Cohen: < .10, negligible effect;
.10-.30, small effect; .30-.50, medium effect; > .50, large effect.

Table 8
Means, standard deviations and results of the Mann-Whitney U test for
the subset of high social anxiety students and the reference group
just after the application of the intervention program

                Post-interv.  Post-interv.
SAQ-CIII           SA Gr.      Refer Gr.              z
dimensions         M (SD)        M (SD)      N *   adjusted   p     r

F1.                22.15         19.68      38/25    2.09    .036  .26
Interactions       (4.74)        (5.09)
with the
opposite sex

F2. Speaking       14.15         12.92      34/25    1.11    .265  .14
in public /        (3.86)        (4.40)
Interaction
with teachers

F3. Criticism      15.93         14.92      28/25    1.32    .185  .18
and                (4.40)        (3.73)
embarrassment

F4.                14.12         14.04      34/25    0.08    .932  .01
Interactions       (3.20)        (3.22)
with strangers

F5. Assertive      10.69          9.44      42/25    1.60    .108  .19
expression of      (2.96)        (2.72)
annoyance or
disgust

F6. Performing     11.92          9.56      24/25    2.88    .004  .41
in public          (2.52)        (3.04)

Total score        84.07         80.56      30/25    1.18    .239  .16
                  (10.51)       (14.36)
Note: SAQ-CIII= "Social Interaction Questionnaire for Children". SA
Gr.= high social anxiety students. Students with high social anxiety
had a score equal to or higher than M+1SD in the SAQ-CIII before the
intervention. Refer Gr.= reference group. N * = Number of subjects of
the experimental subgroup-Number of subjects of the reference group.
Effect size (r) values following Cohen: < .10, negligible effect;
.10-.30, small effect; .30-.50, medium effect; > .50, large effect.
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Author:Caballo, Vicente E.; Carrillo, Gloria B.; Ollendick, Thomas H.
Publication:Behavioral Psychology/Psicologia Conductual
Article Type:Ensayo
Date:Sep 1, 2015
Words:10695
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