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Cited by 285Digital Mental Health InterventionsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychological Treatments and Assessments

Internet-Based Cognitive Behavior Therapy vs. Cognitive Behavioral Group Therapy for Social Anxiety Disorder: A Randomized Controlled Non-inferiority Trial

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Hedman, Erik, Andersson, Gerhard, Ljótsson, Brjánn, Andersson, Erik, Rück, Christian, Mörtberg, Ewa, Lindefors, Nils·2011·PLoS ONE
DOI 10.1371/journal.pone.0018001PMC PMC3070741
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Abstract

BACKGROUND AND AIMS: Cognitive behavioral group therapy (CBGT) is an effective, well-established, but not widely available treatment for social anxiety disorder (SAD). Internet-based cognitive behavior therapy (ICBT) has the potential to increase availability and facilitate dissemination of therapeutic services for SAD. However, ICBT for SAD has not been directly compared with in-person treatments such as CBGT and few studies investigating ICBT have been conducted in clinical settings. Our aim was to investigate if ICBT is at least as effective as CBGT for SAD when treatments are delivered in a psychiatric setting. METHODS: We conducted a randomized controlled non-inferiority trial with allocation to ICBT (n=64) or CBGT (n=62) with blinded assessment immediately following treatment and six months post-treatment. Participants were 126 individuals with SAD who received CBGT or ICBT for a duration of 15 weeks. The Liebowitz Social Anxiety Scale (LSAS) was the main outcome measure. The following non-inferiority margin was set: following treatment, the lower bound of the 95 % confidence interval (CI) of the mean difference between groups should be less than 10 LSAS-points. RESULTS: Both groups made large improvements. At follow-up, 41 (64%) participants in the ICBT group were classified as responders (95% CI, 52%-76%). In the CBGT group, 28 participants (45%) responded to the treatment (95% CI, 33%-58%). At post-treatment and follow-up respectively, the 95 % CI of the LSAS mean difference was 0.68-17.66 (Cohen's d between group=0.41) and -2.51-15.69 (Cohen's d between group=0.36) favoring ICBT, which was well within the non-inferiority margin. Mixed effects models analyses showed no significant interaction effect for LSAS, indicating similar improvement across treatments (F=1.58; df=2, 219; p=.21). CONCLUSIONS: ICBT delivered in a psychiatric setting can be as effective as CBGT in the treatment of SAD and could be used to increase availability to CBT. TRIAL REGISTRATION: ClinicalTrials.gov NCT00564967.

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  • In a recent comparative trial on social anxiety disorder, patients preferred internet treatment over group treatment.

    “In one of our more recent comparative trials on social anxiety disorder, we found that patients preferred internet treatment over group treatment [Hedman et al., 2011]”

    From Internet-based treatments - Experiences from Sweden (2013) · cites this paper as Hedman et al., 2011

    The Discussion says internet treatment may be preferred over group treatment, but explicitly states that this had not yet been studied. The trial therefore did not find that patients preferred internet treatment. (LLM, conf=0.90)

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  • For common psychiatric disorders, ICBT is as effective as face-to-face delivered treatment.

    “an increasing number of controlled studies indicate that for common psychiatric disorders ICBT is as effective as face-to-face delivered treatment [11-13]”

    From Acceptability, effectiveness, and cost-effectiveness of internet-based exposure treatment for irritable bowel syndrome in a clinical sample: A randomized controlled trial (2011) · cites this paper as [13]

    The Discussion concludes that ICBT may be at least as effective as face-to-face cognitive behavioral group therapy for social anxiety disorder in a psychiatric setting. This supports the comparison for that disorder, but this trial does not establish equivalence across common psychiatric disorders generally. The supplied passages do not give page numbers. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Both treatments are well documented and have been implemented in scientific research before in treatment studies for GCBT and individual and group ST.

    “Both treatments are well documented [17, 24, 75] and have been implemented in scientific research before in treatment studies for GCBT (e.g. [76–79]) and individual and group ST (e.g. [19, 43, 80, 81]).”

    From Group schema therapy versus group cognitive behavioral therapy for social anxiety disorder with comorbid avoidant personality disorder: study protocol for a randomized controlled trial. (2016) · cites this paper as [79]

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Research works printed but not linked: 1

  1. 2002, Structured clinical interview for DSM-IV-TR axis I Disorders, research version, patient edition.

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Authors
Hedman, E., Andersson, G., Ljótsson, B., Andersson, E., Rück, C., Mörtberg, E., & Lindefors, N.
Affiliations
  • Linköping University (SE)
  • Karolinska Institutet (SE)
  • Stockholm University (SE)
ORCID
Venue
PLoS ONE
Publisher
Public Library of Science (PLoS)
Published
2011-03-25
Volume
6
Issue
3
Pages
e18001
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0018001
PMC
PMC3070741
OpenAlex
W1979037945
Cited by
285
References
66
Citations by year
2026: 7 · 2025: 12 · 2024: 9 · 2023: 18 · 2022: 10 · 2021: 50 · 2020: 10 · 2019: 11 · 2018: 11 · 2017: 19 · 2016: 19 · 2015: 16 · 2014: 28 · 2013: 34 · 2012: 26
FWCI
37.80
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • KTH Publication Database DiVA (KTH Royal Institute of Technology) (submittedVersion, other-oa)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Figshare (submittedVersion, cc-by)
Funders
Stockholms Läns Landsting
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
internet-based cognitive behavioral therapy, group cognitive behavioral therapy, social anxiety disorder, non-inferiority, psychiatric treatment, treatment availability, dissemination of psychotherapy, Liebowitz Social Anxiety Scale
MeSH terms
Adolescent, Adult, Female, Humans, Male, Middle Aged, Phobic Disorders, Psychotherapy, Group, Cognitive Behavioral Therapy, Treatment Outcome, Internet, Young Adult

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