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

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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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Figure 1 Participant flow and reasons for dropping out throughout the trial. Abbreviations: ICBT, Internet-based cognitive behavior therapy; CBGT, Cognitive behavioral group therapy; SAD, Social anxiety disorder; Received, completed at least 5 modules (ICBT) or 5 sessions (CBGT).
Figure 1 Participant flow and reasons for dropping out throughout the trial. Abbreviations: ICBT, Internet-based cognitive behavior therapy; CBGT, Cognitive behavioral group therapy; SAD, Social anxiety disorder; Received, completed at least 5 modules (ICBT) or 5 sessions (CBGT).CC BY · PubMed Central
Figure 2 Weekly change on LSAS-SR during treatment and LSAS scores at each assessment point. Abbreviations: ICBT, Internet-based cognitive behavior therapy; CBGT, Cognitive behavioral group therapy; LSAS, Liebowitz Social Anxiety Scale; -SR, Self-report; CA, Clinician administered; Pre, Before treatment; Post, Post-treatment; 6MFU, Six months after treatment.
Figure 2 Weekly change on LSAS-SR during treatment and LSAS scores at each assessment point. Abbreviations: ICBT, Internet-based cognitive behavior therapy; CBGT, Cognitive behavioral group therapy; LSAS, Liebowitz Social Anxiety Scale; -SR, Self-report; CA, Clinician administered; Pre, Before treatment; Post, Post-treatment; 6MFU, Six months after treatment.CC BY · PubMed Central
Figure 3 CGI-I scores at post-treatment and six-month follow-up. Abbreviations: ICBT, Internet-based cognitive behavior therapy; CBGT, Cognitive behavioral group therapy; CGI-I, Clinical Global Impression Improvement Scale.
Figure 3 CGI-I scores at post-treatment and six-month follow-up. Abbreviations: ICBT, Internet-based cognitive behavior therapy; CBGT, Cognitive behavioral group therapy; CGI-I, Clinical Global Impression Improvement Scale.CC BY · PubMed Central

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

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Metadata

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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