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Shyness 3: Randomized Controlled Trial of Guided Versus Unguided Internet-Based CBT for Social Phobia
Abstract
Objective: In two previous randomized controlled trials Titov et al. demonstrated significant benefit from an Internet- and email-based treatment programme for social phobia. The present study (Shyness 3) explores whether participants are able to complete this programme independently. Method: A total of 98 individuals with social phobia were randomly assigned to a clinician-assisted computerized cognitive behavioural treatment (CaCCBT) group, a self-guided computerized CBT (CCBT) group, or to a waitlist control group. CaCCBT group participants completed the usual Shyness programme consisting of six online lessons, cognitive behavioural homework assignments, email contact with a therapist, and participation in an online discussion forum. CCBT group participants accessed the same resources except for therapist emails. An intention-to-treat model was used for data analyses. Results: A total of 77% of CaCCBT and 33% of CCBT group participants completed all lessons. Significant differences were found after treatment between CaCCBT and control groups (mean between-groups effect size (ES) for the social phobia measures = 1.04), and between the CaCCBT and CCBT groups (mean between-groups ES for the social phobia measures = 0.66). No significant differences were found after treatment between the CCBT and control groups (mean between-groups ES for the social phobia measures = 0.38). CCBT participants, however, who completed the six lessons made good progress (mean within-group ES for the social phobia measures = 0.62). Quantitative and qualitative data indicate that both the CaCCBT and CCBT procedures were acceptable to participants. Conclusions: The reliability of this Internet-based treatment programme for social phobia has been confirmed. The therapist-guided condition was superior to the self-guided condition, but a subgroup of participants still benefited considerably from the latter. These data confirm that self-guided education or treatment programmes for common anxiety disorders can result in significant improvements.
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“The number of modules completed was found to correlate with outcomes in interventions that targeted cigarette smoking [42,46,47], depression [45,48-51], and anxiety disorders [52-57].”
From A Systematic Review of the Impact of Adherence on the Effectiveness of e-Therapies (2011) · cites this paper as [53]
In the citing paper
“What was unclear from the study was the extent to which it was the facilitated bulletin board or the email support that successfully provided the additional therapist guidance.”
In the citing paper
“Other studies have included online discussion groups as part of an online intervention (for example: [27, 29, 30]), but failed to either report usage data, differentiate the usage of the groups across the treatment groups, or analyse the impact of the discussion groups on the study outcomes.”
In the citing paper
“it is remarkable that 18 state that encouraging adherence is a task for the counselor [45-62]”
From Persuasive System Design Does Matter: a Systematic Review of Adherence to Web-based Interventions (2012) · cites this paper as [54]
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Cited by
Sorted by citations
Persuasive System Design Does Matter: a Systematic Review of Adherence to Web-based Interventions
Kelders, S. M., Kok, R. N., Ossebaard, H. C., & Van Gemert-Pijnen, J. E. (2012) · Journal of Medical Internet Research · doi:10.2196/jmir.2104 · Cited by 1,308
“Although 33 studies that are included in this review state that they have planned for adherence, it is remarkable that 18 state that encouraging adherence is a task for the counselor [45-62] and one study included monetary incentives to promote adherence [63].”
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“Results of the meta-analysis of the 22 studies [22–43] are displayed in Table 1: grouped by diagnosis, listing author and date of publication, N randomized, effect size of intervention compared iCBT Anxiety and Depression”
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“…compared guided and unguided interventions (Berger et al., 2011a,b; Farrer et al., 2011; Lancee et al., 2013; Low et al., 2006; Mohr et al., 2013; Titov et al., 2008, 2009a), one compared the dose–response-relationship of guidance (Klein et al., 2009), four studies investigated the effects of…”
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“Most ICBT programs include minimal therapist contact via email [404-410] or telephone [405,409].”
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Self-citation
Metadata
- Authors
- Titov, N., Andrews, G., Choi, I., Schwencke, G., & Mahoney, A.
- Affiliations
- UNSW Sydney (AU)
- St Vincent's Hospital Sydney (AU)
- Corresponding author
- Titov, Nickolai
- Venue
- Australian & New Zealand Journal of Psychiatry
- Publisher
- SAGE Publications
- Published
- 2008-01-01
- Volume
- 42
- Issue
- 12
- Pages
- 1030-1040
- ISSN
- 0004-8674 (ISSN-L)
- 1440-1614
- OpenAlex
- W2003524081
- Cited by
- 221
- References
- 40
- Citations by year
- 2026: 2 · 2025: 7 · 2024: 10 · 2023: 7 · 2022: 6 · 2021: 14 · 2020: 7 · 2019: 9 · 2018: 10 · 2017: 9 · 2016: 16 · 2015: 15 · 2014: 22 · 2013: 16 · 2012: 22
- FWCI
- 21.13
- 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, internet-based cognitive behavioral therapy, self-guided treatment, online forums, treatment completion, treatment acceptability
- MeSH terms
- Adolescent, Adult, Female, Humans, Male, Middle Aged, Outcome and Process Assessment, Health Care, Phobic Disorders, Psychometrics, Self Care, Shyness, Therapy, Computer-Assisted, Cognitive Behavioral Therapy, Internet, Electronic Mail, Young Adult
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