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This randomised controlled trial evaluated the guided online intervention SOPHIE for adolescents (<jats:italic>N<\/jats:italic>\u2009=\u2009133; 11\u201317 years) with social anxiety disorder (SAD; treatment) or subclinical social anxiety (indicated prevention) compared to care-as-usual control condition and qualitatively explored their experiences. Outcomes were assessed at baseline, mid-intervention (4 weeks), post-intervention (8 weeks) and 5-month follow-up and analysed using linear mixed-effects models. SOPHIE did not significantly reduce social anxiety symptoms post-intervention but showed a significant between-group effect at follow-up (<jats:italic>d<\/jats:italic>\u2009=\u20090.67, 95%CI [0.32;1.02]). Subgroup analyses by diagnostic condition showed a significant between-group effect at follow-up in the subclinical social anxiety (<jats:italic>d<\/jats:italic>\u2009=\u20091.53, 95%CI [1.74;0.41]) but not in the SAD condition. Social functioning significantly improved at post-intervention and follow-up, with medium to large effects (post: <jats:italic>d<\/jats:italic>=-0.73, 95%CI [-1.08; -0.37]; follow-up: <jats:italic>d=<\/jats:italic>-0.32, 95%CI [-0.66; 0.02]). Qualitative interviews post-intervention revealed that participants found the intervention beneficial, although some found exposure exercises challenging and desired additional support. Very heterogeneous needs emerged regarding the guidance provided during the programme. Low-threshold online interventions for adolescents with social anxiety may be effective, particularly as an indicated prevention approach.<\/jats:p>","DOI":"10.1038\/s41598-025-10193-w","type":"journal-article","created":{"date-parts":[[2025,7,11]],"date-time":"2025-07-11T18:54:40Z","timestamp":1752260080000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Prevention and treatment of social anxiety disorder in adolescents: mixed method randomised controlled trial of the guided online intervention SOPHIE"],"prefix":"10.1038","volume":"15","author":[{"given":"Noemi","family":"Walder","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Berger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominique","family":"H\u00fcrzeler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"McDougal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian","family":"Edbrook-Childs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefanie J.","family":"Schmidt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,7,11]]},"reference":[{"key":"10193_CR1","doi-asserted-by":"crossref","unstructured":"Solmi, M. et al. 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