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Internet-Based Cognitive Behavior Therapy vs. Cognitive Behavioral Group Therapy for Social Anxiety Disorder: A Randomized Controlled Non-inferiority Trial
Open accessAbstract
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 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
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“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]
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“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]).”
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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
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Self-citationKatzman, M. A., Bleau, P., Blier, P., Chokka, P., Kjernisted, K., Van Ameringen, M., & the Canadian Anxiety Guidelines Initiative Group on behalf of the Anxiety Disorders Association of Canada/Association Canadienne des troubles anxieux and McGill University (2014) · BMC Psychiatry · doi:10.1186/1471-244x-14-s1-s1 · Cited by 1,090
“CBT [414,415], while being more cost-effective [416].”
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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)
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2011-03-25
- Volume
- 6
- Issue
- 3
- Pages
- e18001
- ISSN
- 1932-6203 (ISSN-L)
- 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
- gold
- doi.org
- 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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