Skills for Social and Academic Success (SASS)

Description of a School-Based Program for Social Anxiety Disorder

School can be the perfect place to work on social anxiety.
School-based programs for SAD can be helpful. Lawrence Manning / Getty Images

School can be challenging for children and adolescents dealing with social anxiety disorder (SAD). From trouble making friends to difficulty answering questions in class, life at school is one long constant social challenge.

Even kids who are socially adept sometimes struggle, but the child or teen with SAD may have such severe anxiety symptoms or avoidance that school attendance suffers or other problems develop, such as depression or substance abuse.

Most kids with SAD are not identified either by parents or teachers, because their symptoms are less obvious than those who act out in class. At the same time, what they experience is a very real problem that needs evidence-based treatment—not just hope that it will go away or is a passing phase.

School is the ideal setting to implement treatment programs because there are ample opportunities for kids to practice what they are learning—with their own peers no less! Teachers can get involved, principals can get involved, even the secretaries and cafeteria staff can help with the process. The more parents and educational staff are aware of SAD and its treatment, the better the options become for kids with SAD.

Skills for Social and Academic Success (SASS)

One such program designed to help children and teens with SAD is the Skills for Social and Academic Success (SASS) program developed by Masia Warner and colleagues.

This efficacy of this program has been shown for adolescents compared to a waitlist control group and an attention control group (a group that participated in the same data collection procedures and contacts as the treatment group, but without receiving specific information about managing their condition).

This program involves five components that follow the core concepts of cognitive-behavioral therapy (CBT). Many tips for students, teachers, and parents can also be drawn from this program, and have been noted below.

Structure of the Program

Overall, if you take part in the SASS program you can expect it to last about three months.

As a student, you will take part in the following:

  • 12 weekly group sessions in your school that will last about 40 minutes each
  • two group follow-up sessions about relapse and obstacles you may face after the SASS program
  • two short individual meetings of about 20 minutes each
  • plus, there is the fun part! You will also attend four weekend "social events" lasting 1.5 hours each

As a parent, you will take part in the following:

  • two group meetings of 45 minutes each

Content of the Program

What exactly does the SASS program involve? If you've done any reading or had any experience with CBT, most of this will sound familiar to you. If CBT doesn't appeal to you or you've already tried it without success, you might ask about alternative programs such as those based on acceptance and mindfulness-based treatments.

Stop. Wait! Before you start attending the SASS sessions is there anything you should do to prepare? Make sure you are getting enough sleep each night, eating healthy foods, getting regular exercise, drinking enough water each day, and finding ways to manage stress not related to social anxiety (such as with meditation or yoga).

If any of these areas of your life are causing you difficulty, either work on correcting them on your own, or let the program leader know that you have these extra "issues" that may be making your anxiety worse. 

In any case, here are the five topics covered by SASS:

1. Psychoeducation

2. Realistic Thinking

3. Social Skills Training

4. Exposure

5. Relapse Prevention

Sound familiar? If not, don't worry. The group leader will explain each topic as you go, and will move slowly enough that you don't become overwhelmed.

Psychoeducation

The goal of this part of the program is to help you understand what you've been feeling. What sorts of symptoms have been causing you trouble? You might think of things like:

  • worrying at night about an upcoming speech you have to give
  • your heart racing or hands shaking when you try to talk to new people

What is it that you want to change? What situations make you feel the most anxious?

Most importantly, you should come away from this part of the program feeling comfortable. The leader should not put you on the spot, or make you feel strange about having social anxiety. At the end of this section, you should be motivated and ready to start making changes!

Realistic Thinking

A large part of CBT involves understanding the relationship between your thoughts, feelings, and behaviors. 

Children and teens with SAD are more likely to expect the worst to happen—and believe that it is the end of the world if that does happen.

For example, a teenager might think that he will be turned down if he asks a friend to do something and that the rejection means there is something wrong with him.

Thought experiments are useful ways to break free from negative thinking patterns and move toward more realistic ways of viewing situations.

For example, a child or teen might be taught to ask a question like:

"How often has this really happened in the past?"

The most important part of this section is the doing rather than the listening. You should be actively engaged in role-playing to develop the skills to practice realistic thinking.

Plus—even if you think the program is ridiculous at first—withhold your judgment. Maybe you think the group leader just doesn't get it! Everyone hates me and nobody will ever want to be my friend.

Guess what? That's your voice, not the voice of everyone else. Give this one shot and keep an open mind. You might be surprised how you feel by the end!

Social Skills Training

Kids and teens with SAD often don't get ​a chance to practice social skills like adults with the disorder.

Some areas that you may work on in this section include conversations (starting them and maintaining them), building friendships, listening/remembering, and being assertive.

Again, you will most likely be participating in role-plays to learn about these concepts.

For example, you might practice:

  • starting a conversation (brainstorm different ways to do it rather than always commenting on the weather)
  • extending an invitation to someone
  • not changing the topic of conversation until the leader gives permission (turns out, those with SAD tend to change the topic of conversation too soon because of anxiety, which can make things a bit uncomfortable, abrupt and awkward for others)
  • staying focused and not becoming preoccupied with anxiety to the point that you can't concentrate on what the other person is saying (a memory game is one way to practice this, in which everyone shares information about themselves and the others must try to remember it)
  • Refusing requests and making "I" statements to express feelings 

During role plays, the group leader and other group members might encourage you to:

  • speak louder
  • use more eye contact
  • smile more often
  • use a relaxed body posture
  • or practice any other nonverbal behaviors that show you are approachable

Facing Fears

This part of the program involves practicing exposures to gradually face your fears. In it, students develop a hierarchy or "fear ladder" of 10 anxiety-provoking situations from least to worst. These might be situations that are feared or avoided altogether.

For example, you might choose:

  • giving a wrong answer
  • forgetting someone's name
  • tripping in the hallway
  • arriving late to class
  • giving a presentation
  • talking to someone new
  • visiting the main office
  • buying food in the cafeteria
  • asking the librarian a question
  • talking to the principal
  • delivering the morning announcements
  • joining a club
  • asking a question in class
  • asking a friend to get together
  • attending a party or dance
  • or anything else that makes you anxious

The great thing about doing this program in a school is that kids and teens can practice in real-life situations such as in the cafeteria, in class, or in the playground. Often, teachers or other professionals at the school may be enlisted to help. 

While a child or teen does the exposure, ratings of distress are recorded and monitored in the hopes that they decrease at least 50 percent by the end.

You will also probably take note of what makes these situations better or worse. Is a particular type of teacher harder for you to approach? Familiarity, age, and size of audience are factors that may play a role.

Relapse Prevention

How can a child or teen make sure that all is not forgotten once the program is over? Get to know your warning signs that symptoms are starting again and plan the strategies you will use to combat them. Also, realize that setbacks are normal and to be expected.

In addition to these core parts of the program, kids and teens also take part in: 

  • individual sessions (to address personal issues and stressors)
  • follow-up sessions (to make sure you don't slip back into old habits)
  • social events (weekend events to practice your new skills, such as miniature golf—usually start of structured and then move to less structured activities)

Parents

Parents are also involved! They get to learn more about SAD and how to support their child or teen's skill development. 

Research Evidence for the SASS

The SASS has been shown to be effective when delivered by clinical psychologists. More research is needed to make sure that school counselors can effectively administer the program.

If your child or teen is displaying signs of social anxiety at school, such as not wanting to attend or trying to avoid presentations or social aspects of daily life, it is important to consider the possibility that social anxiety is an issue.

Once identified, SAD can be treated using programs such as the SASS in schools. The advantages of using the school environment are great—but students need to be identified as needing help first.

Source:

Ryan JL, Warner CM. Treating Adolescents with Social Anxiety Disorder in Schools. Child Adolesc Psychiatr Clin N Am. 2012;21(1):105-ix. doi:10.1016/j.chc.2011.08.011.

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