Clinical effectiveness and cost-effectiveness of Internet- vs. group-based cognitive behavior therapy for social anxiety disorder: 4-Year follow-up of a randomized trial
Abstract
Social anxiety disorder (SAD) is common, debilitating and associated with high societal costs. The disorder can be effectively treated with Internet-based cognitive behavior therapy (ICBT), but no previous study has investigated the long-term clinical or health economic effects of ICBT for SAD in comparison to an evidence-based control treatment. The aim of the study was to investigate the clinical effectiveness and cost-effectiveness of ICBT compared to cognitive behavioral group therapy (CBGT) four years post-treatment. We conducted a 4-year follow-up study of participants who had received ICBT or CBGT for SAD within the context of a randomized controlled non-inferiority trial. The cost-effectiveness analyses were conducted taking a societal perspective. Participants in both treatment groups made large improvements from baseline to 4-year follow-up on the primary outcome measure (d = 1.34-1.48) and the 95% CI of the mean difference on the primary outcome was well within the non-inferiority margin. ICBT and CBGT were similarly cost-effective and both groups reduced their indirect costs. We conclude that ICBT for SAD yields large sustainable effects and is at least as long-term effective as CBGT. Intervention costs of both treatments are offset by net societal cost reductions in a short time.
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Within-group effect sizes for primary symptoms (Hedges g=1.38 for LSAS and 1.79 for PDSS) were as substantial as those observed in previous representative studies.
“Notably, the within-group effect sizes for the primary symptoms in this study (Hedges g=1.38 for LSAS and 1.79 for PDSS) were as substantial as those observed in previous representative studies [49-51].”
From Feasibility of Guided Internet-Based Cognitive Behavioral Therapy for Panic Disorder and Social Anxiety Disorder in Japan: Pilot Single-Arm Trial (2024) · cites this paper as [50]
iCBT designed as self-help interventions with no or only very limited therapeutic guidance can improve depressive symptoms and symptoms of various anxiety disorders in adults.
“iCBT, designed as self-help interventions with no or only very limited therapeutic guidance, can improve depressive symptoms and symptoms of various anxiety disorders in adults [26–29].”
From Effectiveness and cost-effectiveness of guided Internet- and mobile-based CBT for adolescents and young adults with chronic somatic conditions and comorbid depression and anxiety symptoms (youthCOACHCD): study protocol for a multicentre randomized controlled trial (2020) · cites this paper as [27]
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- Authors
- Hedman, E., El Alaoui, S., Lindefors, N., Andersson, E., Rück, C., Ghaderi, A., Kaldo, V., Lekander, M., Andersson, G., & Ljótsson, B.
- Affiliations
- Karolinska Institutet (SE)
- Stockholm University (SE)
- Linköping University (SE)
- ORCID
- Venue
- Behaviour Research and Therapy
- Publisher
- Elsevier BV
- Published
- 2014-08
- Volume
- 59
- Pages
- 20-29
- ISSN
- 0005-7967 (ISSN-L)
- OpenAlex
- W2088910494
- Cited by
- 79
- References
- 64
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 4 · 2023: 6 · 2022: 7 · 2021: 6 · 2020: 7 · 2019: 10 · 2018: 7 · 2017: 7 · 2016: 8 · 2015: 11 · 2014: 2
- FWCI
- 14.45
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Behaviour Research and Therapy (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Keywords
- social anxiety disorder, internet-based cognitive behavioral therapy, group cognitive behavioral therapy, cost-effectiveness, long-term treatment outcomes, non-inferiority, social costs, indirect costs
- MeSH terms
- Adult, Anxiety Disorders, Cost-Benefit Analysis, Depression, Follow-Up Studies, Humans, Patient Compliance, Psychotherapy, Group, Quality of Life, Cognitive Behavioral Therapy, Treatment Outcome, Health Care Costs, Internet, Young Adult
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