A sorrow shared is a sorrow halved? A randomized controlled trial comparing Internet-based individually versus group-guided self-help treatment for social anxiety disorder

Social anxiety disorder (SAD) is one of the most researched conditions in the field of Internet-based self-help. Various studies have shown that cognitive-behavioral treatments can be efficacious to reduce social phobic symptoms. Most of the interventions tested include some form of support, whereas the efficacy of a web-based group format has yet to be investigated. This three-arm RCT investigated the possible added value of therapist-guided group support in an Internet-based guided self-help treatment for SAD.A total of 149 adults with a diagnosis of SAD were randomly assigned to either a wait list control group (n=29) or one of two active treatment conditions (n=60). Participants in the two active conditions used the same Internet-based self-help program, either with individual guidance by a therapist or with the support of a therapist-guided group of six individuals. In the group condition, participants communicated with each other via an integrated, protected discussion forum. The primary outcome variables were symptoms of SAD and diagnostic status immediately after the intervention (12 weeks) and at six-month follow-up. Secondary endpoints were general symptomatology, depression, quality of life and adherence to treatment. Mean between-group effect sizes were d=0.79 for the group-guided treatment versus the wait list controls and d=1.08 for the individually guided treatment versus the wait list controls. At post-treatment, 25% of the participants in each of the active treatment conditions no longer met the criteria for SAD. In both of the active conditions, treatment gains were maintained at six-month follow-up. Both active treatment conditions showed superior outcome on the primary social anxiety measures compared to the waitlist. The two active treatment conditions did not differ significantly in effectiveness, diagnostic response rate or attrition. Group guidance reduced the required therapist time by two thirds. Results indicate that a group-guided self-help treatment is a promising and cost-effective approach in the treatment of SAD. It seems recommendable for the mutual exchange to take place within small groups of patients, who start the treatment simultaneously and are guided by a psychologist