Long-term effectiveness and outcome predictors of therapist-guided internet-based cognitive–behavioural therapy for social anxiety disorder in routine psychiatric care
Open accessAbstract
Objectives: Although the short-term outcome of therapist-guided internet-based cognitive–behavioural therapy (ICBT) for treating social anxiety disorder (SAD) has been well studied, little research has been undertaken on the sustainability of treatment gains, especially under clinically representative conditions. Further, there is some debate whether delivering psychological treatment via the internet may be suitable for more severely ill patients. Design: Longitudinal multilevel growth-modelling of long-term (1–4 years) follow-up cohort data. Setting: An outpatient psychiatric clinic specialised in internet interventions. Participants: 446 adults having been treated for SAD. Primary and secondary outcome measures: Primary outcomes were estimated improvement rate and Cohen's d effect size on the self-rated Liebowitz Social Anxiety Disorder Scale. Secondary outcome measures were change in comorbid depressive symptoms and health-related quality of life. Results: A large treatment effect was observed on the primary outcome measure after treatment (d=0.8 (95% CI 0.7 to 0.9)), with continued long-term improvements (d=1.2 (95% CI 1.0 to 1.3)). However, the rate of change varied significantly between individuals over time. A faster rate of improvement was observed among patients with higher illness severity, whereas having a family history of social anxiety was related to worse response. Long-term improvements were also observed in comorbid depressive symptoms (d=0.7 (95% CI 0.5 to 0.8)) and health-related quality of life (d=−0.3 (95% CI −0.4 to −0.1)). Conclusions: These findings provide evidence for the long-term effectiveness of ICBT for SAD in routine clinical practice, even for more severe cases.
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Treatment credibility was high and similar to credibility ratings in similar ICBT studies.
“Treatment credibility was high and similar to credibility ratings in similar ICBT studies (Carlbring et al., 2003;El Alaoui et al., 2015).”
From Internet delivered cognitive behavior therapy for antenatal depression: A randomised controlled trial (2017) · cites this paper as El Alaoui et al., 2015
The Results (Sample description, Table 1; page unavailable) report a mean treatment-credibility score of 36.24 out of 50, supporting the description of credibility as high. The paper does not compare that score with credibility ratings in similar ICBT studies, so the similarity claim is unsupported by this source. (LLM, conf=0.86)
Experimental — accuracy not yet measuredEven in settings providing ICBT in regular care, the main part of the patients can come from self-referral.
“However, even in settings providing ICBT in regular care, the main part of the patients can come from self-referral (El Alaoui et al., 2015;Hedman et al., 2014).”
From Internet delivered cognitive behavior therapy for antenatal depression: A randomised controlled trial (2017) · cites this paper as El Alaoui et al., 2015
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Credibility of analogue therapy rationales
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“DISCUSSION Previous research on the clinical effectiveness of ICBT for SAD has demonstrated large short-term effects.(12) 13 The aim of the present study was to determine the sustainability of treatment effects in a naturalistic setting (ie, routine psychiatric care) and identify factors that might explain individual…”
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- Authors
- El Alaoui, S., Hedman, E., Ljótsson, B., & Lindefors, N.
- Affiliations
- Division of Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Karolinska Institutet (SE)
- Venue
- BMJ Open
- Publisher
- BMJ
- Published
- 2015-06
- Volume
- 5
- Issue
- 6
- Pages
- e007902
- ISSN
- 2044-6055 (ISSN-L)
- PMC
- PMC4479995
- OpenAlex
- W1940766854
- Cited by
- 30
- References
- 24
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 2 · 2023: 2 · 2022: 2 · 2020: 3 · 2019: 2 · 2018: 7 · 2017: 2 · 2016: 5
- FWCI
- 7.56
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ Open (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Funders
- Stockholms Läns Landsting (ALF 20130413)
- 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, long-term treatment effectiveness, predictors of treatment response, disease severity, comorbid depression, health-related quality of life, psychiatric outpatient clinic
- MeSH terms
- Adult, Anxiety Disorders, Female, Follow-Up Studies, Humans, Longitudinal Studies, Male, Middle Aged, Phobic Disorders, Prognosis, Psychotherapy, Quality of Life, Sweden, Cognitive Behavioral Therapy, Treatment Outcome, Evidence-Based Practice
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