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      The effectiveness of guided internet-based cognitive behavioral therapy for social anxiety disorder in a routine care setting

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          Social anxiety disorder (SAD) is a common mental disorder with high persistence when untreated. As access to effective treatment is limited, guided internet-based cognitive behavioral therapy (ICBT) has been proposed as an effective alternative to face-to-face treatment. In this study, we examined the effectiveness of a 14-week therapist-guided ICBT program for patients with SAD undergoing routine care. From 2014 to 2017, 169 patients were included in the study, of which 145 started the treatment. The sample was all general practitioner-referred and had a lower educational level and higher rate of work absence compared to similar effectiveness studies. Regarding social anxiety symptoms, we identified significant within-group effect sizes (post-treatment: d = 1.00–1.10; six-month follow-up: d = 1.03–1.55). We also found significant effects on secondary depression symptoms ( d = 0.67). Clinically significant improvement was reported by 66.2% of the participants, and 16.6% had a significant deterioration. Clinical implications of the current study are that guided ICBT for SAD is an effective treatment for the majority of the patients undergoing routine care. Future studies should explore interventions targeting non-responders and deteriorated patients.


          • The effectiveness of guided ICBT for 169 patients with social anxiety disorder was studied in routine care.

          • All patients were GP- referred and had a low educational level and high rate of work absence compared to other studies.

          • Significant within-group effect sizes were identified at post treatment and follow-up for primary and secondary symptoms.

          • Clinically significant improvement (66.2%) and deterioration (16.6%) are reported.

          • Non-responding and deteriorated patients needs to be addressed in future studies.

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          Most cited references 25

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          Credibility of analogue therapy rationales

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            Internet-based self-help with therapist feedback and in vivo group exposure for social phobia: a randomized controlled trial.

            Sixty-four individuals with social phobia (social anxiety disorder) were assigned to a multimodal cognitive-behavioral treatment package or to a waiting list control group. Treatment consisted of a 9-week, Internet-delivered, self-help program that was combined with 2 group exposure sessions in real life and minimal therapist contact via e-mail. Results were analyzed on an intention-to-treat basis, including all randomized participants. From pre- to posttest, treated participants in contrast to controls showed significant improvement on most measured dimensions (social anxiety scales, general anxiety and depression levels, quality of life). The overall within- and between-groups effect sizes were Cohen's d = 0.87 and 0.70, respectively. Treatment gains were maintained at 1-year follow-up. The results from this study support the continued use and development of Internet-distributed, self-help programs for people diagnosed with social phobia.
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              Guided and unguided self-help for social anxiety disorder: randomised controlled trial.

              Internet-delivered self-help programmes with added therapist guidance have shown efficacy in social anxiety disorder, but unguided self-help has been insufficiently studied. To evaluate the efficacy of guided and unguided self-help for social anxiety disorder. Participants followed a cognitive-behavioural self-help programme in the form of either pure bibliotherapy or an internet-based treatment with therapist guidance and online group discussions. A subsequent trial was conducted to evaluate treatment specificity. Participants (n = 235) were randomised to one of three conditions in the first trial, or one of four conditions in the second. Pure bibliotherapy and the internet-based treatment were better than waiting list on measures of social anxiety, general anxiety, depression and quality of life. The internet-based therapy had the highest effect sizes, but directly comparable effects were noted for bibliotherapy augmented with online group discussions. Gains were well maintained a year later. Unguided self-help through bibliotherapy can produce enduring improvement for individuals with social anxiety disorder.

                Author and article information

                Internet Interv
                Internet Interv
                Internet Interventions
                31 May 2018
                September 2018
                31 May 2018
                : 13
                : 24-29
                [a ]eMeistring, Bjørgvin DPS, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
                [b ]Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Norway
                [c ]Research Department, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
                [d ]Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
                [e ]Department of Behavioural Sciences and Learning, Linköping University, Sweden
                [f ]Department of Clinical Neuroscience, Karolinska Institutet, Sweden
                [g ]Department of Psychology, Stockholm University, Sweden
                [h ]Department of Psychology, University of Southern Denmark, Denmark
                Author notes
                [* ]Corresponding author at: eMeistring, Bjørgvin DPS, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway. tine.nordgreen@
                © 2018 The Authors

                This is an open access article under the CC BY-NC-ND license (

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