Shyness 3: randomized controlled trial of guided versus unguided Internet-based CBT for social phobia

Aust N Z J Psychiatry. 2008 Dec;42(12):1030-40. doi: 10.1080/00048670802512107.


Objective: In two previous randomized controlled trials Titov et al. demonstrated significant benefit from an Internet- and email-based treatment programme for social phobia. The present study (Shyness 3) explores whether participants are able to complete this programme independently.

Method: A total of 98 individuals with social phobia were randomly assigned to a clinician-assisted computerized cognitive behavioural treatment (CaCCBT) group, a self-guided computerized CBT (CCBT) group, or to a waitlist control group. CaCCBT group participants completed the usual Shyness programme consisting of six online lessons, cognitive behavioural homework assignments, email contact with a therapist, and participation in an online discussion forum. CCBT group participants accessed the same resources except for therapist emails. An intention-to-treat model was used for data analyses.

Results: A total of 77% of CaCCBT and 33% of CCBT group participants completed all lessons. Significant differences were found after treatment between CaCCBT and control groups (mean between-groups effect size (ES) for the social phobia measures=1.04), and between the CaCCBT and CCBT groups (mean between-groups ES for the social phobia measures=0.66). No significant differences were found after treatment between the CCBT and control groups (mean between-groups ES for the social phobia measures=0.38). CCBT participants, however, who completed the six lessons made good progress (mean within-group ES for the social phobia measures=0.62). Quantitative and qualitative data indicate that both the CaCCBT and CCBT procedures were acceptable to participants.

Conclusions: The reliability of this Internet-based treatment programme for social phobia has been confirmed. The therapist-guided condition was superior to the self-guided condition, but a subgroup of participants still benefited considerably from the latter. These data confirm that self-guided education or treatment programmes for common anxiety disorders can result in significant improvements.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Cognitive Behavioral Therapy / methods*
  • Electronic Mail
  • Female
  • Humans
  • Internet*
  • Male
  • Middle Aged
  • Outcome and Process Assessment, Health Care / statistics & numerical data
  • Phobic Disorders / diagnosis
  • Phobic Disorders / psychology
  • Phobic Disorders / therapy*
  • Psychometrics
  • Self Care / methods
  • Shyness*
  • Therapy, Computer-Assisted / methods*
  • Young Adult