Abstract
Social anxiety disorder (SAD) is characterized by a marked and persistent fear of being scrutinized by others in social situations. It is highly prevalent and follows a chronic course for many affected if untreated. Treatment with cognitive behavior therapy (CBT) has been shown to be highly effective for SAD with responder rates of 50–75 %. For more than a decade, Internet-based CBT (ICBT) has been researched and evidence has been provided by four independent research groups. In essence, most forms of ICBT for SAD can generally be described as therapist-guided Internet-based self-help CBT where a named therapist guides the client through the treatment. The treatments are manualized and highly structured comprising 5–15 modules or lessons, which are the equivalent of sessions in face-to-face CBT. The existing treatments for SAD all have vital features in common including that they are based in CBT, comprise the same interventions as have been shown to be effective in face-to-face CBT, have large amount of psychoeducational material, and use asynchronous text messages as the main communication between patient and therapist. ICBT for SAD has been proven to be effective in at least 16 randomized trials and found to be non-inferior to face-to-face CBT. A few studies suggest that ICBT is a cost-effective treatment. Since SAD is known to appear at an early age in most cases, one central future challenge is to increase the body of knowledge on ICBT for children and adolescents. For adults, ICBT for SAD is clearly an effective treatment and a promising option for increasing accessibility to evidence-based psychological treatment.
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References
American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders: DSM-IV, 4th edn. American Psychiatric Association, Washington
American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Publishing, Arlington
Andersson G, Carlbring P, Holmström A, Sparthan E, Furmark T, Nilsson-Ihrfelt E, Buhrman M, Ekselius L (2006) Internet-based self-help with therapist feedback and in vivo group exposure for social phobia: a randomized controlled trial. J Consult Clin Psychol 74:677–686
Andersson G, Estling F, Jakobsson E, Cuijpers P, Carlbring P (2011) Can the patient decide which modules to endorse? An open trial of tailored internet treatment of anxiety disorders. Cogn Behav Ther [Research Support, Non-U.S. Gov’t] 40:57–64
Andersson G, Carlbring P, Furmark T, Group SOFIER (2012) Therapist experience and knowledge acquisition in internet-delivered CBT for social anxiety disorder: a randomized controlled trial. PLoS One [Randomized Controlled Trial Research Support, Non-U.S. Gov’t] 7:e37411
Andrews G, Cuijpers P, Craske MG, McEvoy P, Titov N (2010) Computer therapy for the anxiety and depressive disorders is effective, acceptable and practical health care: a meta-analysis. PLoS One 5, e13196
Andrews G, Davies M, Titov N (2011b) Effectiveness randomized controlled trial of face to face versus internet cognitive behaviour therapy for social phobia. Aust N Z J Psychiatry [Randomized Controlled Trial] 45:337–340
Aydos L, Titov N, Andrews G (2009) Shyness 5: the clinical effectiveness of internet-based clinician-assisted treatment of social phobia. Australas Psychiatry 17:488–492
Beesdo K, Bittner A, Pine DS, Stein MB, Hofler M, Lieb R, Wittchen HU (2007) Incidence of social anxiety disorder and the consistent risk for secondary depression in the first three decades of life. Arch Gen Psychiatry 64:903–912
Berger T (2011) Web 2.0 – soziale netzwerke und psychotherapie. Psychother Dialog 12:118–122
Berger T, Hohl E, Caspar F (2009) Internet-based treatment for social phobia: a randomized controlled trial. J Clin Psychol 65:1021–1035
Berger T, Caspar F, Richardson R, Kneubuhler B, Sutter D, Andersson G (2011) Internet-based treatment of social phobia: a randomized controlled trial comparing unguided with two types of guided self-help. Behav Res Ther 49:158–169
Berger T, Boettcher J, Caspar F (2014) Internet-based guided self-help for several anxiety disorders: a randomized controlled trial comparing a tailored with a standardized disorder-specific approach. Psychotherapy [Research Support, Non-U.S. Gov’t] 51:207–219
Blanco C, Heimberg RG, Schneier FR, Fresco DM, Chen H, Turk CL, Vermes D, Erwin BA, Schmidt AB, Juster HR, Campeas R, Liebowitz MR (2010) A placebo-controlled trial of phenelzine, cognitive behavioral group therapy, and their combination for social anxiety disorder. Arch Gen Psychiatry 67:286–295
Boettcher J, Berger T, Renneberg B (2012a) Does a pre-treatment diagnostic interview affect the outcome of internet-based self-help for social anxiety disorder? A randomized controlled trial. Behav Cogn Psychother 40:513–528
Boettcher J, Berger T, Renneberg B (2012b) Does a pre-treatment diagnostic interview affect the outcome of internet-based self-help for social anxiety disorder? A randomized controlled trial. Behav Cogn Psychother [Randomized Controlled Trial] 40:513–528
Boettcher J, Renneberg B, Berger T (2013a) Patient expectations in internet-based self-help for social anxiety. Cogn Behav Ther 42:203–214
Boettcher J, Carlbring P, Renneberg B, Berger T (2013b) Internet-based interventions for social anxiety disorder – an overview. Verhaltenstherapie 23:160–168
Botella C, Banos RM, Guillén V, Perpina C, Alcaniz M, Pons A (2000) Telepsychology: public speaking fear treatment on the internet. Cyber Psychol Behav 3:959–968
Botella C, Hofmann S, Moscovitz D (2004) A self-applied internet-based intervention for fear of public speaking. J Clin Psychol 60:1–10
Botella C, Guillen V, Banos RM, García-Palacios A, Gallego MJ, Alcaniz M (2007) Telepsychology and self-help: the treatment of fear of public speaking. Cogn Behav Pract 14:46–57
Botella C, Gallego MJ, Garcia-Palacios A, Guillen V, Banos RM, Quero S, Alcaniz M (2010) An internet-based self-help treatment for fear of public speaking: a controlled trial. Cyberpsychol Behav Soc Netw 13:407–421
Bruch MA, Fallon M, Heimberg RG (2003) Social phobia and difficulties in occupational adjustment. J Counc Psychol 50:109–117
Carlbring P, Furmark T, Steczko J, Ekselius L, Andersson G (2006) An open study of internet-based bibliotherapy with minimal therapist contact via email for social phobia. Clin Psychol 10:30–38
Carlbring P, Gunnarsdottir M, Hedensjo L, Andersson G, Ekselius L, Furmark T (2007) Treatment of social phobia: randomised trial of internet-delivered cognitive-behavioural therapy with telephone support. Br J Psychiatry 190:123–128
Carlbring P, Bergman Nordgren L, Furmark T, Andersson G (2009) Long-term outcome of internet-delivered cognitive-behavioural therapy for social phobia: a 30-month follow-up. Behav Res Ther 47:848–850
Carlbring P, Maurin L, Torngren C, Linna E, Eriksson T, Sparthan E, Straat M, Marquez von Hage C, Bergman-Nordgren L, Andersson G (2011a) Individually-tailored, internet-based treatment for anxiety disorders: a randomized controlled trial. Behav Res Ther 49:18–24
Carlbring P, Maurin L, Torngren C, Linna E, Eriksson T, Sparthan E, Straat M, Marquez von Hage C, Bergman-Nordgren L, Andersson G (2011b) Individually-tailored, internet-based treatment for anxiety disorders: a randomized controlled trial. Behav Res Ther [Randomized Controlled Trial Research Support, Non-U.S. Gov’t] 49:18–24
Chartier MJ, Walker JR, Stein MB (2003) Considering comorbidity in social phobia. Soc Psychiatry Psychiatr Epidemiol 38:728–734
Clark DM, Wells A (1995) A cognitive model of social phobia. In: Heimberg RG, Leibowitz M, Hope DA, Schneider FR (eds) Social phobia: diagnosis, assessment and treatment. Guilford press, New York
Clark DM, Ehlers A, McManus F, Hackmann A, Fennell M, Campbell H, Flower T, Davenport C, Louis B (2003) Cognitive therapy versus fluoxetine in generalized social phobia: a randomized placebo-controlled trial. J Consult Clin Psychol 71:1058–1067
Dahl AA, Dahl CF (2010) Are there gender differences in impairment associated with high social anxiety? A community-based study. J Anxiety Disord 24:487–493
Davidson JR, Hughes DL, George LK, Blazer DG (1993) The epidemiology of social phobia: findings from the duke epidemiological catchment area study. Psychol Med 23:709–718
Erwin BA, Turk CL, Heimberg RG, Fresco DM, Hantula DA (2004) The internet: home to a severe population of individuals with social anxiety disorder? J Anxiety Disord 18:629–646
Eskildsen A, Hougaard E, Rosenberg NK (2010) Pre-treatment patient variables as predictors of drop-out and treatment outcome in cognitive behavioural therapy for social phobia: a systematic review. Nord J Psychiatry 64:94–105
Fehm L, Pelissolo A, Furmark T, Wittchen H-U (2005) Size and burden of social phobia in europe. Eur Neuropsychopharmacol 15:453–462
Furmark T (2002) Social phobia: overview of community surveys. Acta Psychiatr Scand 105:84–93
Furmark T, Tillfors M, Everz P, Marteinsdottir I, Gefvert O, Fredrikson M (1999) Social phobia in the general population: prevalence and sociodemographic profile. Soc Psychiatry Psychiatr Epidemiol 34:416–424
Furmark T, Carlbring P, Hedman E, Sonnenstein A, Clevberger P, Bohman B, Eriksson A, Hallen A, Frykman M, Holmstrom A, Sparthan E, Tillfors M, Ihrfelt EN, Spak M, Ekselius L, Andersson G (2009a) Guided and unguided self-help for social anxiety disorder: randomised controlled trial. Br J Psychiatry J Ment Sci [Randomized Controlled Trial Research Support, Non-US Gov’t] 195:440–447
Furmark T, Carlbring P, Hedman E, Sonnenstein A, Clevberger P, Bohman B, Eriksson A, Hallen A, Frykman M, Holmstrom A, Sparthan E, Tillfors M, Ihrfelt EN, Spak M, Eriksson A, Ekselius L, Andersson G (2009b) Guided and unguided self-help for social anxiety disorder: randomised controlled trial. Br J Psychiatry J Ment Sci [Randomized Controlled Trial Research Support, Non-U.S. Gov’t] 195:440–447
Gallego M, Emmelkamp P, van der Kooj M, Mees H (2011) The effects of a Dutch version of an internet based treatment program for fear of public speaking: a controlled study. Int J Clin Health Psychol 11:459–472
Hedman E, Furmark T, Carlbring P, Ljotsson B, Ruck C, Lindefors N, Andersson G (2011a) A 5-year follow-up of internet-based cognitive behavior therapy for social anxiety disorder. J Med Internet Res 13, e39
Hedman E, Andersson G, Ljótsson B, Andersson E, Rück C, Mörtberg E, Lindefors N (2011b) Internet-based cognitive behavior therapy vs cognitive behavioral group therapy for social anxiety disorder: a randomized controlled non-inferiority trial. PLoS ONE 6, e18001
Hedman E, Andersson E, Ljotsson B, Andersson G, Ruck C, Lindefors N (2011c) Cost-effectiveness of internet-based cognitive behavior therapy vs. cognitive behavioral group therapy for social anxiety disorder: results from a randomized controlled trial. Behav Res Ther 49:729–736
Hedman E, Andersson E, Ljótsson B, Andersson G, Andersson E, Schalling M, Lindefors N, Ruck C (2012a) Clinical and genetic outcome determinants of internet- and group-based cognitive behavior therapy for social anxiety disorder. Acta Psychiatr Scand 126:126–136
Hedman E, Ljótsson B, Lindefors N (2012b) Cognitive behavior therapy via the internet: a systematic review of applications, clinical efficacy and cost-effectiveness. Expert Rev Pharmacoecon Outcomes Res 12:745–764
Hedman E, Carlbring P, Ljótsson B, Andersson G (2014a) Internetbaserad psykologisk behandling: evidens, indikation och praktiskt genomförande. Natur & Kultur, Stockholm
Hedman E, El Alaoui S, Lindefors N, Andersson E, Ruck C, Ghaderi A, Kaldo V, Lekander M, Andersson G, Ljotsson B (2014b) Clinical effectiveness and cost-effectiveness of internet- vs. group-based cognitive behavior therapy for social anxiety disorder: 4-year follow-up of a randomized trial. Behav Res Ther 59:20–29
Heimberg RG, Becker RE (2002) Cognitive-behavioral group therapy for social phobia. Basic mechanisms and clinical strategies. Guilford Press, New York
Heimberg RG, Salzman DG, Holt CS, Blendell KA (1993) Cognitive-behavioral group treatment for social phobia: effectiveness at five-year follow up. Cogn Ther Res 17:325–339
Hofmann SG, Sawyer AT, Korte KJ, Smits JA (2009) Is it beneficial to add pharmacotherapy to cognitive-behavioral therapy when treating anxiety disorders? A meta-analytic review. Int J Cogn Ther 2:160–175
Johansson R, Sjoberg E, Sjogren M, Johnsson E, Carlbring P, Andersson T, Rousseau A, Andersson G (2012) Tailored vs. standardized internet-based cognitive behavior therapy for depression and comorbid symptoms: a randomized controlled trial. PLoS One [Clinical Trial Randomized Controlled Trial Research Support, Non-U.S. Gov’t] 7:e36905
Johnston L, Titov N, Andrews G, Spence J, Dear BF (2011) A RCT of a transdiagnostic internet-delivered treatment for three anxiety disorders: examination of support roles and disorder-specific outcomes. PLoS One 6, e28079
Kessler RC. The impairments caused by social phobia in the general population: implications for intervention. Acta Psychiatr Scand Suppl [Research Support, Non-U.S. Gov’t Review] 2003:19–27
Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, Wittchen HU, Kendler KS (1994) Lifetime and 12-month prevalence of dsm-iii-r psychiatric disorders in the United States. Results from the national comorbidity survey. Arch Gen Psychiatry 51:8–19
Kessler RC, Petukhova M, Sampson NA, Zaslavsky AM, Wittchen HU (2012) Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. Int J Methods Psychiatr Res 21:169–184
Klein B, Meyer D, Austin DW, Kyrios M (2011) Anxiety online: a virtual clinic: preliminary outcomes following completion of five fully automated treatment programs for anxiety disorders and symptoms. J Med Internet Res [Clinical Trial Research Support, Non-U.S. Gov’t]. 13:e89
Kraemer HC, Wilson GT, Fairburn CG, Agras WS (2002) Mediators and moderators of treatment effects in randomized clinical trials. Arch Gen Psychiatry 59:877–883
Lampe L, Slade T, Issakidis C, Andrews G (2003) Social phobia in the Australian national survey of mental health and well-being (NSMHWB). Psychol Med 33:637–646
Lewis C, Pearce J, Bisson JI (2012) Efficacy, cost-effectiveness and acceptability of self-help interventions for anxiety disorders: systematic review. Br J Psychiatry 200:15–21
Liebowitz MR, Heimberg RG, Fresco DM, Travers J, Stein MB (2000) Social phobia or social anxiety disorder: what’s in a name? Arch Gen Psychiatry 57:191–192
Lipsitz JD, Schneier FR (2000) Social phobia. Epidemiology and cost of illness. Pharmacoeconomics 18:23–32
Magee WJ, Eaton WW, Wittchen HU, McGonagle KA, Kessler RC (1996) Agoraphobia, simple phobia, and social phobia in the national comorbidity survey. Arch Gen Psychiatry 53:159–168
McEvoy PM (2007) Effectiveness of cognitive behavioural group therapy for social phobia in a community clinic: a benchmarking study. Behav Res Ther 45:3030–3040
Mohr DC, Siddique J, Ho J, Duffecy J, Jin L, Fokuo JK (2010) Interest in behavioral and psychological treatments delivered face-to-face, by telephone, and by internet. Ann Behav Med Publ Soc Behav Med [Comparative Study Research Support, N.I.H., Extramural] 40:89–98
Mörtberg E, Clark DM, Bejerot S (2011) Intensive group cognitive therapy and individual cognitive therapy for social phobia: sustained improvement at 5-year follow-up. J Anxiety Disord 25:994–1000
Nordgreen T, Havik OE, Ost LG, Furmark T, Carlbring P, Andersson G (2012) Outcome predictors in guided and unguided self-help for social anxiety disorder. Behav Res Ther 50:13–21
Nordgren LB, Hedman E, Etienne J, Bodin J, Kadowaki A, Eriksson S, Lindkvist E, Andersson G, Carlbring P (2014) Effectiveness and cost-effectiveness of individually tailored internet-delivered cognitive behavior therapy for anxiety disorders in a primary care population: a randomized controlled trial. Behav Res Ther 59:1–11
Olatunji BO, Cisler JM, Tolin DF (2007) Quality of life in the anxiety disorders: a meta-analytic review. Clin Psychol Rev 27:572–581
Ponniah K, Hollon SD (2008) Empirically supported psychological interventions for social phobia in adults: a qualitative review of randomized controlled trials. Psychol Med 38:3–14
Richards D, Richardson T (2012) Computer-based psychological treatments for depression: a systematic review and meta-analysis. Clin Psychol Rev [Meta-Analysis] 32:329–342
Ruscio AM, Brown TA, Chiu WT, Sareen J, Stein MB, Kessler RC (2008) Social fears and social phobia in the USA: results from the national comorbidity survey replication. Psychol Med 38:15–28
Samoocha D, Bruinvels DJ, Elbers NA, Anema JR, van der Beek AJ (2010) Effectiveness of web-based interventions on patient empowerment: a systematic review and meta-analysis. J Med Internet Res [Meta-Analysis Review] 12:e23
Spek V, Cuijpers P, Nyklicek I, Riper H, Keyzer J, Pop V (2007) Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: a meta-analysis. Psychol Med [Comparative Study Meta-Analysis Research Support, Non-U.S. Gov’t] 37:319–328
Stein MB, Stein DJ (2008) Social anxiety disorder. Lancet 371:1115–1125
Stott R, Wild J, Grey N, Liness S, Warnock-Parkes E, Commins S, Readings J, Bremner G, Woodward E, Ehlers A, Clark DM (2013) Internet-delivered cognitive therapy for social anxiety disorder: a development pilot series. Behav Cogn Psychother 41:383–397
Stuhldreher N, Leibing E, Leichsenring F, Beutel ME, Herpertz S, Hoyer J, Konnopka A, Salzer S, Strauss B, Wiltink J, Konig HH (2014) The costs of social anxiety disorder: the role of symptom severity and comorbidities. J Affect Disord 165:87–94
Tillfors M, Carlbring P, Furmark T, Lewenhaupt S, Spak M, Eriksson A, Westling BE, Andersson G (2008) Treating university students with social phobia and public speaking fears: internet delivered self-help with or without live group exposure sessions. Depress Anxiety 25:708–717
Titov N, Andrews G, Schwencke G, Drobny J, Einstein D (2008a) Shyness 1: distance treatment of social phobia over the internet. Aust N Z J Psychiatry 42:585–594
Titov N, Andrews G, Schwencke G (2008b) Shyness 2: treating social phobia online: replication and extension. Aust N Z J Psychiatry 42:595–605
Titov N, Andrews G, Choi I, Schwencke G, Mahoney A (2008c) Shyness 3: randomized controlled trial of guided versus unguided internet-based CBT for social phobia. Aust N Z J Psychiatry 42:1030–1040
Titov N, Andrews G, Choi I, Schwencke G, Johnston L (2009a) Randomized controlled trial of web-based treatment of social phobia without clinician guidance. Aust N Z J Psychiatry 43:913–919
Titov N, Andrews G, Schwencke G, Solley K, Johnston L, Robinson E (2009b) An RCT comparing effect of two types of support on severity of symptoms for people completing internet-based cognitive behaviour therapy for social phobia. Aust N Z J Psychiatry 43:920–926
Titov N, Andrews G, Johnston L, Schwencke G, Choi I (2009c) Shyness programme: longer term benefits, cost-effectiveness, and acceptability. Aust N Z J Psychiatry 43:36–44
Titov N, Andrews G, Schwencke G, Robinson E, Peters L, Spence J (2010a) Randomized controlled trial of internet cognitive behavioural treatment for social phobia with and without motivational enhancement strategies. Aust N Z J Psychiatry 44:938–945
Titov N, Andrews G, Johnston L, Robinson E, Spence J (2010b) Transdiagnostic internet treatment for anxiety disorders: a randomized controlled trial. Behav Res Ther [Randomized Controlled Trial Research Support, Non-U.S. Gov’t] 48:890–899
Titov N, Dear BF, Schwencke G, Andrews G, Johnston L, Craske MG, McEvoy P (2011) Transdiagnostic internet treatment for anxiety and depression: a randomised controlled trial. Behav Res Ther [Randomized Controlled Trial Research Support, Non-U.S. Gov’t] 49:441–452
Wittchen HU, Fehm L (2003) Epidemiology and natural course of social fears and social phobia. Acta Psychiatr Scand Suppl 4–18
Wittchen HU, Fuetsch M, Sonntag H, Müller N, Liebowitz M (2000) Disability and quality of life in pure and comorbid social phobia. Findings from a controlled study. Eur Psychiatry 15:46–58
Yonkers KA, Dyck IR, Keller MB (2001) An eight-year longitudinal comparison of clinical course and characteristics of social phobia among men and women. Psychiatr Serv 52:637–643
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Hedman, E., Botella, C., Berger, T. (2016). Internet-Based Cognitive Behavior Therapy for Social Anxiety Disorder. In: Lindefors, N., Andersson, G. (eds) Guided Internet-Based Treatments in Psychiatry. Springer, Cham. https://doi.org/10.1007/978-3-319-06083-5_4
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