Shyness 2: Treating Social Phobia Online: Replication and Extension
Abstract
Objective: In a randomized controlled trial Titov et al. (2008) demonstrated significant benefit from an Internet- and email-based treatment programme for social phobia. The present study (Shyness 2) seeks to replicate that finding and compares results with benchmark data. Method: Eighty-eight individuals with social phobia were randomly assigned to a clinician-assisted computerized cognitive behavioural treatment programme or to a waitlist control group. Participants completed the same treatment programme used in Shyness 1, consisting of six online lessons, cognitive behavioural homework assignments, email contact with a therapist, and participation in an online discussion forum. An intention-to-treat model was used for data analyses. Results: A total of 80% of treatment group participants completed all lessons, and post-treatment data were obtained from 78/81 participants. Treatment group participants each had an average of 127 min of therapist contact over the 10 week programme, including an average of 22 email contacts plus therapist responses to forum postings. Pre- to post-treatment differences were seen between treatment and waitlist participants across two measures of symptoms of social phobia, and across a measure of disability. Mean within- and between-group effect sizes (Cohen's d) across the two primary outcome measures were 1.18, and 1.20, respectively. Quantitative and qualitative data indicate that the procedure is very acceptable to participants. Conclusions: These results closely replicate those obtained in Shyness 1, indicating that the treatment procedure is reliable. These results compare favourably with outcomes reported in benchmarking studies from high-quality face-to-face treatment programmes for social phobia. These results provide further positive data about the utility of Internet-based guided self-help programmes for people with social phobia.
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Several studies categorized participants into adherent or not, or usage categories such as low, medium, and high, while others used continuous variables or a combination of these.
“Several studies categorized participants into adherent or not [49,54,57,75], or usage categories such as low, medium, and high [60], while others used continuous variables [23,24,33-36,38-41,43-45,50-52,55,56,58,59,61,76] or a combination of these [42,46,53,64-66,77].”
From A Systematic Review of the Impact of Adherence on the Effectiveness of e-Therapies (2011) · cites this paper as [54]
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“The core components of the Shyness Programme have been described in detail previously (Titov et al., 2008c) and the programme has been evaluated in a number of trials (Aydos et al., 2009; Titov et al., 2008a,b,c).”
MethodSelf-citationO'Donohue, W., & Draper, C. (2011) · Springer eBooks · doi:10.1007/978-1-4419-6510-3 · Cited by 17 · see citing works
Online CBT I: Bridging the Gap Between Eliza and Modern Online CBT Treatment Packages
Helgadóttir, F. D., Menzies, R. G., Onslow, M., Packman, A., & O’Brian, S. (2009) · Behaviour Change · doi:10.1375/bech.26.4.245 · Cited by 52 · see citing works
Acceptability of Digital Mental Health Interventions for Depression and Anxiety: Systematic Review
Lau, C. K. Y., Saad, A., Camara, B., Rahman, D., & Bolea-Alamanac, B. (2024) · Journal of Medical Internet Research · doi:10.2196/52609 · Cited by 51 · see citing works
Effectiveness of computerised cognitive behaviour therapy for anxiety disorders in secondary care
Bell, C. J., Colhoun, H. C., Carter, F. A., & Frampton, C. M. (2012) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867412437345 · Cited by 50 · see citing works
“In comparison with other studies, particularly those of self-referred participants, there were high rates of psychotropic medication use (59% in comparison with 21–34% (Titov et al., 2008b)) and previous mental health treatment (71% in comparison with 30–40% (Titov et al., 2008b)).”
BackgroundResultInfluentialAydos, L., Titov, N., & Andrews, G. (2009) · Australasian Psychiatry · doi:10.1080/10398560903284943 · Cited by 49 · see citing works
Helgadóttir, F. D., Menzies, R. G., Onslow, M., Packman, A., & O'Brian, S. (2009) · Behaviour Change · doi:10.1375/bech.26.4.254 · Cited by 48 · see citing works
Patient Expectations in Internet-Based Self-Help for Social Anxiety
Boettcher, J., Renneberg, B., & Berger, T. (2013) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2012.759615 · Cited by 47 · see citing works
Attwood, M., Meadows, S., Stallard, P. N., & Richardson, T. H. (2011) · Child and Adolescent Mental Health · doi:10.1111/j.1475-3588.2011.00627.x · Cited by 45 · see citing works
Internet-Based Course for the Management of Stress for Junior High Schools
van Vliet, H., & Andrews, G. (2009) · Australian & New Zealand Journal of Psychiatry · doi:10.1080/00048670902721145 · Cited by 40 · see citing works
Self-citationIs internet treatment for depressive and anxiety disorders ready for prime time?
Andrews, G., & Titov, N. (2010) · The Medical Journal of Australia · doi:10.5694/j.1326-5377.2010.tb03693.x · Cited by 37 · see citing works
Self-citationShyness: Subtypes, Psychosocial Correlates, and Treatment Interventions
Jones, K. M., Schulkin, J. A., & Schmidt, L. A. (2014) · Psychology · doi:10.4236/psych.2014.53035 · Cited by 36 · see citing works
TRANSDIAGNOSTIC INTERNET TREATMENT FOR ANXIETY AND DEPRESSION
Titov, N., Dear, B. F., Johnston, L., & Terides, M. D. (2012) · Revista de Psicopatología y Psicología Clínica · Cited by 31 · see citing works
Self-citationThe Factor Structure of the Kessler-10 Questionnaire in a Treatment-Seeking Sample
Berle, D., Starčević, V., Milicevic, D., Moses, K., Hannan, A., Sammut, P., & Brakoulias, V. (2010) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0b013e3181ef1f16 · Cited by 31 · see citing works
El Alaoui, S., Hedman, E., Ljótsson, B., & Lindefors, N. (2015) · BMJ Open · doi:10.1136/bmjopen-2015-007902 · Cited by 30 · see citing works
Understanding adherence to web-based interventions
Kelders, S. M. (2012) · doi:10.3990/1.9789036534178 · Cited by 29 · see citing works
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
Digitally Delivered Psychological Interventions for Anxiety Disorders: a Comprehensive Review
Stefanopoulou, E., Lewis, D., Taylor, M., Broscombe, J., & Larkin, J. (2018) · Psychiatric Quarterly · doi:10.1007/s11126-018-9620-5 · Cited by 28 · see citing works
Hit and miss: Innovation and the dissemination of evidence based psychological treatments
Andrews, G., & Titov, N. (2009) · Behaviour Research and Therapy · doi:10.1016/j.brat.2009.07.007 · Cited by 26 · see citing works
Self-citationTreating people you never see: Internet-based treatment of the internalising mental disorders
Andrews, G., & Titov, N. (2010) · Australian Health Review · doi:10.1071/ah09775 · Cited by 23 · see citing works
Self-citationGallego, M. J., Emmelkamp, P. M. G., van der Kooij, M., & Mees, H. (2011) · UvA-DARE (University of Amsterdam) · Cited by 22 · see citing works
Remote cognitive behaviour therapy for social anxiety disorder: A meta-analysis
Winter, H. R., Norton, A. R., Burley, J., & Wootton, B. M. (2023) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2023.102787 · Cited by 22 · see citing works
Pihlaja, S., Lahti, J. M. T., Lipsanen, J. O., Ritola, V., Gummerus, E.-M., Stenberg, J., & Joffe, G. (2020) · Journal of Medical Internet Research · doi:10.2196/15732 · Cited by 21 · see citing works
“Neither did technician-delivered telephone support demonstrate advantages over a clinician-moderated online discussion forum in iCBT for social phobia [28], although in the same program, telephone calls facilitated symptomatic improvement and adherence versus automatic reminders only [29].”
BackgroundAre Trials of Computerized Therapy Generalizable? A Multidimensional Meta-analysis
Wilks, C. R., Zieve, G. G., & Lessing, H. K. (2016) · Telemedicine and e-Health · doi:10.1089/tmj.2015.0129 · Cited by 18 · see citing works
Tulbure, B. T. (2011) · Procedia - Social and Behavioral Sciences · doi:10.1016/j.sbspro.2011.10.108 · Cited by 20 · see citing works
“In six studies (Andersson et al., 2006; Berger et al., 2009; Botella et al., 2010; and Titov et al., 2008a, 2008b, 2008c) an intention-to-treat design was used by following all randomized patients until the end of the trial, whether or not they dropped out from the study.”
MethodInfluentialThe 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
Lampe, L. A. (2009) · Australian & New Zealand Journal of Psychiatry · doi:10.1080/00048670903179111 · Cited by 18 · see citing works
“2 on measures of social anxiety, with attrition rates of only approximately 20% [116,117].”
BackgroundInternetbasierte Therapie der sozialen Phobie: Ergebnisse einer 6-Monate-Katamnese
Berger, T., Hohl, É., & Caspar, F. (2010) · Zeitschrift für Klinische Psychologie und Psychotherapie · doi:10.1026/1616-3443/a000050 · Cited by 15 · see citing works
Talbot, F. (2012) · Behaviour Change · doi:10.1017/bec.2012.4 · Cited by 15 · see citing works
“Titov et al. (2008c) were able to completely eliminate therapist’s guidance by using automated NGCs in the form of automated emails and reminders, with no associated detrimental impact on outcomes or treatment satisfaction.”
MethodRozen, N., & Aderka, I. M. (2021) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2021.1966089 · Cited by 14 · see citing works
Titov, N., Dear, B. F., Johnston, L., & Terides, M. (2012) · Revista de Psicopatología y Psicología Clínica · doi:10.5944/rppc.vol.17.num.3.2012.11842 · Cited by 13 · see citing works
Self-citationKatzman, M. A., Bleau, P., Blier, P., Chokka, P. R., Kjernisted, K. D., & Ameringen, M. V. (2021) · doi:10.32920/14638581 · Cited by 13 · see citing works
Internet-Based Cognitive Behavior Therapy for Social Anxiety Disorder
Hedman‐Lagerlöf, E., Botella, C., & Berger, T. (2016) · Springer eBooks · doi:10.1007/978-3-319-06083-5_4 · Cited by 12 · see citing works
Finding Web-Based Anxiety Interventions on the World Wide Web: A Scoping Review
Ashford, M. T., Olander, E. K., & Ayers, S. (2016) · JMIR Mental Health · doi:10.2196/mental.5349 · Cited by 11 · see citing works
“…#28, #29, #30) This Way Up Self-help (#31, #32) Panic: - 1 RCT a [85] - Pre-post intervention trial without comparison group [86] Social phobia: - 5 RCTs a [87-91] - Implementation study [92] - Cost-effectiveness, acceptability, and follow-up analysis [93] This Way Up School (#33, #34) Anxiety”
Social Anxiety and the Internet: Positive and Negative Effects
Mazalin, D., & Klein, B. (2008) · E-Journal of Applied Psychology · doi:10.7790/ejap.v4i2.137 · Cited by 11 · 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
Development of a graphic medicine-enabled social media-based intervention for youth social anxiety
Rice, S., O’Bree, B., Wilson, M., McEnery, C., Lim, M. H., Hamilton, M. P., Gleeson, J., Bendall, S., D’Alfonso, S., Russon, P., et al. (2021) · Clinical Psychologist · doi:10.1080/13284207.2021.1923128 · Cited by 12 · see citing works
Evaluation of a DVD-based self-help program in highly socially anxious individuals--pilot study.
Mall, A., Mehl, A., Kiko, S., Kleindienst, N., Salize, H., Hermann, C., Hoffmann, T., Bohus, M., & Steil, R. (2011) · The Behavior Therapist · doi:10.1016/j.beth.2010.11.007 · Cited by 7 · see citing works
Computerised cognitive behavioural therapy: helping Ireland log on
Twomey, C., O'Reilly, G., & Byrne, M. (2013) · Irish Journal of Psychological Medicine · doi:10.1017/ipm.2012.5 · Cited by 11 · see citing works
- Authors
- Titov, N., Andrews, G., & Schwencke, G.
- Affiliations
- UNSW Sydney (AU)
- Corresponding author
- Titov, Nickolai
- Venue
- Australian & New Zealand Journal of Psychiatry
- Publisher
- SAGE Publications
- Published
- 2008-01-01
- Volume
- 42
- Issue
- 7
- Pages
- 595-605
- ISSN
- 0004-8674 (ISSN-L)
- 1440-1614
- OpenAlex
- W1995762476
- Cited by
- 133
- References
- 28
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 6 · 2023: 3 · 2022: 1 · 2021: 5 · 2020: 5 · 2019: 2 · 2018: 3 · 2017: 2 · 2016: 10 · 2015: 5 · 2014: 7 · 2013: 10 · 2012: 14
- FWCI
- 24.58
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Australian & New Zealand Journal of Psychiatry (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, online therapy, online forums, guided self-help, replication study, treatment acceptability, treatment outcome comparison
- MeSH terms
- Adult, Demography, Female, Humans, Male, Phobic Disorders, Surveys and Questionnaires, Shyness, Waiting Lists, Reproducibility of Results, Cognitive Behavioral Therapy, Internet
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