Internet-delivered cognitive therapy for social anxiety disorder in Hong Kong: A randomized controlled trial
Open accessAbstract
Background: Research is needed to determine the extent to which internet-delivered psychological therapies are effective when delivered in countries and cultures outside of where they were developed. Objective: This waitlist-controlled study evaluated the efficacy of a UK-developed, therapist-guided internet Cognitive Therapy programme for Social Anxiety Disorder (iCT-SAD) when delivered in Hong Kong by local therapists. Methods: Patients were randomized to iCT-SAD (n = 22) or a waitlist control group (n = 22). Assessments took place at weeks 0, 8, and 15 (posttreatment/postwait), with a further 3-month follow-up assessment for the iCT-SAD group. The primary outcome measure was the Liebowitz Social Anxiety Scale (self-report), and posttreatment/postwait diagnostic assessments were completed by independent assessors blind to condition. Trial Registration: ISRCTN11357117. Results: 2.41). The treatment was also superior to waitlist on all secondary outcome measures. 86% of the iCT-SAD group demonstrated remission from SAD based on the LSAS, compared to 5% of the waitlist group. 73% no longer met diagnostic criteria at posttreatment, compared to 9% of the waitlist group. The gains made by the iCT-SAD group were maintained at three-month follow-up. Conclusions: iCT-SAD showed strong efficacy for the treatment of SAD in Hong Kong. As the clinical outcomes were similar to UK studies, this suggests the dissemination of the treatment into a different cultural setting did not result in a substantial loss of efficacy.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Results of a pilot trial and randomised controlled trial in Hong Kong showed outcomes comparable to the UK trial, suggesting that it is possible to transport iCT-SAD between cultures without a substantial drop in efficacy.
“Results of a pilot trial and randomised controlled trial in Hong Kong showed outcomes comparable to the UK trial, which suggests that it is possible to transport iCT-SAD between cultures without a substantial drop in efficacy [11, 12].”
The Hong Kong trials used the English version of iCT-SAD and included only English-speaking participants.
“As the Hong Kong trials used the English version of iCT-SAD and included only English-speaking participants”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Baron, R. M., & Kenny, D. A. (1986) · Journal of Personality and Social Psychology · doi:10.1037//0022-3514.51.6.1173 · Cited by 91,542 · see citing works
Baron, R. M., & Kenny, D. A. (1986) · Journal of Personality and Social Psychology · doi:10.1037/0022-3514.51.6.1173 · Cited by 91,532 · see citing works
The Measurement of Observer Agreement for Categorical Data
Landis, J. R., & Koch, G. G. (1977) · Biometrics · doi:10.2307/2529310 · Cited by 81,148 · see citing works
The PHQ-9: Validity of a brief depression severity measure
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001) · Journal of General Internal Medicine · doi:10.1046/j.1525-1497.2001.016009606.x · Cited by 44,910 · see citing works
A Brief Measure for Assessing Generalized Anxiety Disorder: The GAD-7
Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006) · Archives of Internal Medicine · doi:10.1001/archinte.166.10.1092 · Cited by 31,765 · see citing works
Development and validation of the working alliance inventory
Horvath, A. O., & Greenberg, L. S. (1989) · Journal of Counseling Psychology · doi:10.1037//0022-0167.36.2.223 · Cited by 3,520 · see citing works
Measurement of social-evaluative anxiety.
Watson, D., & Friend, R. (1969) · Journal of Consulting and Clinical Psychology · doi:10.1037/h0027806 · Cited by 3,467 · cited 3× · see citing works
“Social anxiety was also assessed using the Social Phobia Weekly Summary Scale (SPWSS; Clark et al., 2003; Oxford Centre for Anxiety Disorders and Trauma, 2019), Social Phobia Inventory (SPIN; Connor et al., 2000), Fear of Negative Evaluation Scale (FNE; Watson and Friend, 1969), Social Phobia Scale (SPS; Mattick and C…”
Backgroundpsych: Procedures for Personality and Psychological Research
Revelle, W. (2017) · Cited by 3,439 · see citing works
Mattick, R. P., & Clarke, J. C. (1998) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(97)10031-6 · Cited by 3,367 · see citing works
The Work and Social Adjustment Scale: a simple measure of impairment in functioning
Mundt, J. C., Marks, I. M., Shear, M. K., & Greist, J. M. (2002) · British Journal of Psychiatry · doi:10.1192/bjp.180.5.461 · Cited by 2,515 · see citing works
Psychosomatic medicine in Germany: more timely than ever
Zipfel, S., Herzog, W., Kruse, J., & Henningsen, P. (2016) · Psychotherapy and Psychosomatics · doi:10.1159/000447701 · Cited by 2,323 · see citing works
Psychometric properties of the Social Phobia Inventory (SPIN): New self-rating scale
Connor, K. M., Davidson, J. R. T., Churchill, L. E., Sherwood, A., Weisler, R. H., & Foa, E. (2000) · British Journal of Psychiatry · doi:10.1192/bjp.176.4.379 · Cited by 1,624 · see citing works
Credibility of analogue therapy rationales
Borkovec, T. D., & Nau, S. D. (1972) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/0005-7916(72)90045-6 · Cited by 1,553 · see citing works
Factor structure of the working alliance inventory
Tracey, T. J., & Kokotovic, A. M. (1989) · Psychological Assessment: A Journal of Consulting and Clinical Psychology · doi:10.1037/1040-3590.1.3.207 · Cited by 1,501 · see citing works
Social Phobia: Diagnosis, Assessment, and Treatment
Amada, G. (1996) · American Journal of Psychotherapy · doi:10.1176/appi.psychotherapy.1996.50.3.373 · Cited by 1,248 · see citing works
Cultural adaptation of treatments: A resource for considering culture in evidence-based practice
Bernal, G., Jiménez-Chafey, M. I., & Domenech Rodríguez, M. M. (2009) · Professional Psychology: Research and Practice · doi:10.1037/a0016401 · Cited by 1,186 · cited 1× · see citing works
“Frameworks for undertaking cultural adaptation have been described (Bernal et al., 2009; Hwang, 2009), but only more recently has a more empirical approach to this process been taken (Naeem et al.”
MethodFreeman, D., Sheaves, B., Goodwin, G. M., Yu, L.-M., Nickless, A., Harrison, P. J., Emsley, R., Luik, A. I., Foster, R. G., Wadekar, V., et al. (2017) · The Lancet Psychiatry · doi:10.1016/s2215-0366(17)30328-0 · Cited by 652 · see citing works
The Liebowitz social anxiety scale as a self-report instrument: a preliminary psychometric analysis
Baker, S. L., Heinrichs, N., Kim, H.-J., & Hofmann, S. G. (2002) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(01)00060-2 · Cited by 640 · see citing works
Clark, D. M., Ehlers, A., Hackmann, A., McManus, F., Fennell, M., Grey, N., Waddington, L., & Wild, J. (2006) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.74.3.568 · Cited by 603 · see citing works
Self-citationClark, D. M., Ehlers, A., McManus, F., Hackmann, A., Fennell, M., Campbell, H., Flower, T., Davenport, C., & Louis, B. (2003) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.71.6.1058 · Cited by 561 · see citing works
Self-citationZimmerman, M., & Mattia, J. I. (2001) · Archives of General Psychiatry · doi:10.1001/archpsyc.58.8.787 · Cited by 375 · see citing works
Consensus statement on defining and measuring negative effects of internet interventions
Rozental, A., Andersson, G., Boettcher, J., Ebert, D. D., Cuijpers, P., Knaevelsrud, C., Ljótsson, B., Kaldo, V., Titov, N., & Carlbring, P. (2014) · Internet Interventions · doi:10.1016/j.invent.2014.02.001 · Cited by 371 · see citing works
Leichsenring, F., Salzer, S., Beutel, M. E., Herpertz, S., Hiller, W., Hoyer, J., Huesing, J., Joraschky, P., Nolting, B., Poehlmann, K., et al. (2013) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2013.12081125 · Cited by 300 · see citing works
Bandelow, B., Baldwin, D. S., Dolberg, O. T., Andersen, H. F., & Stein, D. J. (2006) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v67n0914 · Cited by 203 · see citing works
Meta-analysis of technology-assisted interventions for social anxiety disorder
Kampmann, I. L., Emmelkamp, P. M. G., & Morina, N. (2016) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2016.06.007 · Cited by 180 · see citing works
Hwang, W.-C. (2009) · Professional Psychology: Research and Practice · doi:10.1037/a0016240 · Cited by 166 · see citing works
An evidence-based framework to culturally adapt cognitive behaviour therapy
Rathod, S., Phiri, P., & Naeem, F. (2019) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x18000247 · Cited by 93 · see citing works
Clark, D. M., Wild, J., Warnock-Parkes, E., Stott, R., Grey, N., Thew, G., & Ehlers, A. (2023) · Psychological Medicine · doi:10.1017/s0033291722002008 · Cited by 88 · see citing works
Self-citationTulbure, B. T., Szentagotai, A., David, O., Ștefan, S., Månsson, K. N. T., David, D., & Andersson, G. (2015) · PLOS ONE · doi:10.1371/journal.pone.0123997 · Cited by 81 · see citing works
Alden, L. E., & Taylor, C. T. (2011) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2010.10.003 · Cited by 77 · see citing works
Internet-Delivered Cognitive Therapy for Social Anxiety Disorder: A Development Pilot Series
Stott, R., Wild, J., Grey, N., Liness, S., Warnock-Parkes, E., Commins, S., Readings, J., Bremner, G., Woodward, E., Ehlers, A., et al. (2013) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465813000404 · Cited by 61 · see citing works
Self-citationJohansson, R., Hesslow, T., Ljótsson, B., Jansson, A., Jonsson, L., Färdig, S., Karlsson, J., Hesser, H., Frederick, R. J., Lilliengren, P., et al. (2017) · Psychotherapy · doi:10.1037/pst0000147 · Cited by 55 · see citing works
Treating social anxiety disorder remotely with cognitive therapy
Warnock-Parkes, E., Wild, J., Thew, G. R., Kerr, A., Grey, N., Stott, R., Ehlers, A., & Clark, D. M. (2020) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x2000032x · Cited by 45 · see citing works
Self-citationThew, G. R. (2020) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x20000033 · Cited by 36 · see citing works
Self-citationKishimoto, T., Krieger, T., Berger, T., Qian, M., Chen, H., & Yang, Y. (2016) · Psychotherapy and Psychosomatics · doi:10.1159/000446584 · Cited by 30 · see citing works
Thew, G. R., Powell, C. L., Kwok, A. P., Lissillour Chan, M. H., Wild, J., Warnock-Parkes, E., Leung, P. W., & Clark, D. M. (2019) · JMIR Formative Research · doi:10.2196/13446 · Cited by 24 · see citing works
Self-citationJakobsen, H., Andersson, G., Havik, O., & Nordgreen, T. (2016) · Internet Interventions · doi:10.1016/j.invent.2016.11.002 · Cited by 23 · see citing works
Gallego, M. J., Emmelkamp, P. M. G., van der Kooij, M., & Mees, H. (2011) · UvA-DARE (University of Amsterdam) · Cited by 22 · see citing works
Thew, G. R., Ehlers, A., Grey, N., Wild, J., Warnock-Parkes, E., Dawson, R. L., & Clark, D. (2020) · Clinical Psychology in Europe · doi:10.32872/cpe.v2i2.2947 · Cited by 21 · see citing works
Self-citation
Flagged first, then by citations
Research works printed but not linked: 2
- Brown T.A. Barlow D.H. Anxiety And Related Disorders Interview Schedule for DSM-5 (ADIS-5).: Adult Version. Client Interview Schedule 2014 Oxford University Press
- Oxford Centre for Anxiety Disorders and Trauma OXCADAT Resources: Resources for cognitive therapy for PTSD, social anxiety disorder and panic disorder https://oxcadatresources.com/ 2019
Cited by
Sorted by citations
Scholten, W., Seldenrijk, A., Hoogendoorn, A. W., Bosman, R. C., Muntingh, A., Karyotaki, E., Andersson, G., Berger, T., Carlbring, P., Furmark, T., et al. (2023) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2023.1291 · Cited by 28 · see citing works
Jackson, H. M., Calear, A. L., Batterham, P. J., Ohan, J. L., Farmer, G. M., & Farrer, L. M. (2023) · Journal of Medical Internet Research · doi:10.2196/44673 · Cited by 25 · see citing works
Wang, M., Chen, H., Yang, F., Xu, X., & Li, J. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.06.057 · Cited by 25 · see citing works
Creswell, C., Chessell, C., & Halliday, G. (2022) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465822000546 · Cited by 25 · see citing works
The efficacy of psychotherapy for social anxiety disorder, a systematic review and meta-analysis
de Ponti, N., Matbouriahi, M., Franco, P., Harrer, M., Miguel, C., Papola, D., Sicimoğlu, A., Cuijpers, P. J., & Karyotaki, E. (2024) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2024.102881 · Cited by 26 · see citing works
Sun, L., Dai, X., Zhu, S., Liu, Z., & Zhongming, Z. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.02.092 · Cited by 14 · see citing works
Rad, H. S., Goodarzi, H., Bahrami, L., & Abolghasemi, A. (2023) · The Behavior Therapist · doi:10.1016/j.beth.2023.08.005 · Cited by 15 · see citing works
Matsumoto, K., Hamatani, S., Shiga, K., Iiboshi, K., Kasai, M., Kimura, Y., Yokota, S., Watanabe, K., Kubo, Y., & Nakamura, M. (2024) · JMIR Pediatrics and Parenting · doi:10.2196/55786 · Cited by 13 · see citing works
Hall, M., Luo, A., Bhullar, N., Moses, K., & Wootton, B. M. (2024) · Australian psychologist · doi:10.1080/00050067.2024.2356804 · Cited by 11 · see citing works
Sakai, M., Yoshinaga, N., Thew, G. R., & Clark, D. M. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1368722 · Cited by 9 · see citing works
Self-citationWild, J., Warnock‐Parkes, E., Stott, R. B., Kwok, A. P., Chan, M. H. L., Powell, C. L. Y. M., Leung, P. W. L., Clark, D. M., & Thew, G. R. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.03.017 · Cited by 8 · see citing works
Self-citationŠipka, D., Lopes, R. D. C. T., Krieger, T., Klein, J. P., & Berger, T. (2025) · Psychotherapy and Psychosomatics · doi:10.1159/000542425 · Cited by 9 · see citing works
Pan, J., Thew, G. R., & Clark, D. M. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.04.100 · Cited by 8 · see citing works
Self-citationYoshinaga, N., Thew, G. R., Hayashi, Y., Matsuoka, J., Tanoue, H., Takanashi, R., Araki, M., Kanai, Y., Smith, A., Grant, S. H. L., et al. (2023) · JMIR Formative Research · doi:10.2196/45136 · Cited by 6 · see citing works
Self-citationWinter, H. R., Norton, A. R., & Wootton, B. M. (2025) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2025.2540916 · Cited by 5 · see citing works
Zhu, Y., Sun, L., Guan, S., Li, R., Yang, J., Cao, Y., Zhang, L., Li, T., Zhang, H., Bueber, M. A., et al. (2025) · The Lancet Regional Health - Western Pacific · doi:10.1016/j.lanwpc.2025.101515 · Cited by 4 · see citing works
Sudden gains in internet cognitive therapy for social anxiety disorder in routine clinical practice
Yim, S. H., Clark, D. M., Salkovskis, P. M., & Thew, G. R. (2024) · Internet Interventions · doi:10.1016/j.invent.2024.100788 · Cited by 3 · see citing works
Self-citationCognitive‐Behavioral Therapy for Disruptive Mood Dysregulation Disorder: A Randomized Control Trial
Rad, H. S., Bahrami, L., Goodarzi, H., & Ariapooran, S. (2025) · Journal of Clinical Psychology · doi:10.1002/jclp.70015 · Cited by 2 · see citing works
Impact of the Pandemic on Therapy: Addressing Modality Change in Post-COVID Japan
Tighe, R., & McKiernan, P. (2025) · American Journal of Qualitative Research · doi:10.29333/ajqr/16817 · Cited by 1 · see citing works
Experiential therapies including Chairwork: a systematic review of randomized controlled trials
Ottingerová, L., Halamová, J., & Szitás, D. (2026) · Frontiers in Psychology · doi:10.3389/fpsyg.2025.1692630 · Cited by 1 · see citing works
Rad, H. S., Abolghasemi, A., Shakerinia, I., & Rahimi, S. (2026) · Early Intervention in Psychiatry · doi:10.1111/eip.70146 · Cited by 1 · see citing works
Yoshinaga, N., Thew, G. R., Hayashi, Y., Tanoue, H., Nakai, M., & Clark, D. M. (2024) · Trials · doi:10.1186/s13063-024-08303-6
“Results of a pilot trial and randomised controlled trial in Hong Kong showed outcomes comparable to the UK trial, which suggests that it is possible to transport iCT-SAD between cultures without a substantial drop in efficacy [11, 12].”
MethodResultSelf-citationAxelsson, E., Santoft, F., Särnholm, J., & Ljótsson, B. (2023) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465823000541
Thew, G. R., Powell, C. L. Y. M., Chan, L. S., Cheung, E. S. L., Chung, J. L. T., Li, C. L., So, M. M., Hsu, Y. K., Ng, M. Y., Siu, S. H., et al. (2025) · JMIR Formative Research · doi:10.2196/69818
Self-citationMatsumoto, K., Hamatani, S., Mizuno, Y., Maeno, A., Kasai, M., Watanabe, K., Kamashita, R., Sunami, N., Ikeda, M., Nagata, S., et al. (2025) · Psychiatry and Clinical Neurosciences Reports · doi:10.1002/pcn5.70236
Xiong, Y., Xiao, N., Ding, X., Zhang, J., & Luo, H.-S. (2026) · Frontiers in Psychology · doi:10.3389/fpsyg.2026.1787151 · Cited by 1 · see citing works
Wang, H., Song, B., Kan, C., & Zhang, Y. (2026) · Cognitive Therapy and Research · doi:10.1007/s10608-026-10770-x
Fonteles, V. S. (2026) · Saúde Coletiva (Barueri) · doi:10.36489/saudecoletiva.2026v18i111p20706-20721
- Authors
- Thew, G. R., Kwok, A. P. L., Lissillour Chan, M. H., Powell, C. L. Y. M., Wild, J., Leung, P. W. L., & Clark, D. M.
- Affiliations
- Oxford Health NHS Foundation Trust (GB)
- Hospital Authority (HK)
- University of Oxford (GB)
- Chinese University of Hong Kong (HK)
- Corresponding author
- Thew, Graham R.
- ORCID
- Venue
- Internet Interventions
- Publisher
- Elsevier BV
- Published
- 2022-04
- Volume
- 28
- Pages
- 100539
- ISSN
- 2214-7829 (ISSN-L)
- PMC
- PMC9046639
- OpenAlex
- W4224316453
- Cited by
- 28
- References
- 38
- Citations by year
- 2026: 5 · 2025: 9 · 2024: 6 · 2023: 7 · 2022: 1
- FWCI
- 5.08
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Internet Interventions (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Wellcome Trust (102176)
- National Institute for Health and Care Research
- NIHR Oxford Biomedical Research Centre (00070, 069777, 200796)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Keywords
- social anxiety disorder, cross-cultural dissemination, treatment efficacy, Hong Kong, Liebowitz Social Anxiety Scale, remission, maintenance of treatment gains
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
