A one-week, clinician-supported online therapy program significantly reduced anxiety and improved daily functioning for adults with social anxiety disorder, according to a new study. It’s a promising step toward more flexible, accessible treatments.
Social anxiety disorder (SAD), formerly social phobia, causes an intense fear of being judged or embarrassed in social settings, and affects about 5% to 10% of people globally. Traditional cognitive behavior therapy (CBT) is effective, but the months-long treatment required can make it hard for people to stick with.
A new study by researchers at the University of New South Wales (UNSW) Sydney investigated the effectiveness of an intensive, seven-day internet-delivered CBT (iCBT) in treating SAD.
To the researchers’ knowledge, theirs is the first randomized controlled trial to examine the effectiveness of an intensive iCBT treatment for SAD in comparison to a control group. They enrolled 61 adults (average age of 45; 75% female) with clinically diagnosed SAD and randomly assigned them to either an iCBT group or a waitlist group. They waited six weeks before accessing the course. Both groups completed questionnaires on social anxiety, depression, and daily functioning at baseline, two weeks, and six weeks after starting.
iCBT treatment included six online lessons over seven days, with support from clinicians via phone or email. In addition to practicing breathing, relaxation and cognitive techniques daily, participants also covered the following topics:
- Understanding anxiety and the “fight-or-flight” response
- Reducing avoidance behaviors through gradual exposure
- Troubleshooting exposure challenges
- Identifying unhelpful thinking patterns
- Challenging thoughts and improving social skills
- Preventing relapse
The treatment was a condensed version of what appears on the Australian THIS WAY UP website, which provides evidence-based, on-demand iCBT programs for a range of mental health conditions.
The iCBT group showed large reductions in social anxiety compared to the control group, with effect sizes that denoted very strong effects. In statistics, an “effect size” measures the practical significance of a relationship between variables or the difference between groups, rather than just statistical significance. It quantifies how strong a real-world effect is.
After treatment, only 47.6% of the iCBT group still met the diagnostic criteria for SAD, compared to 96.4% of the waitlist group. Participants in the iCBT group reported significant improvements in work, social life, and overall functioning, with medium-to-large effects maintained at one-month follow-up. Depression scores improved slightly, but not significantly. This might be because participants’ depression levels were low to begin with.
The program was well adhered to by participants, with 84% completing all six sessions and 85% reporting they were “mostly” or “very satisfied”. Participants appreciated learning new coping skills and understanding their anxiety better. A few (about 11%) said that the one-week pace felt overwhelming or stressful.
There were some limitations with the study. It was a small, self-selected group of mostly educated Australian women. The researchers used a waitlist rather than an active control group, so results could partly reflect expectancy or placebo effects. And, there was only a short follow-up period of one month; long-term outcomes or differences in comorbid depression weren’t tested in depth.
Nonetheless, the study demonstrated that a clinician-supported seven-day online CBT program is feasible, acceptable, and effective for reducing symptoms of social anxiety. It could make treatment more accessible for people who have limited time for weekly sessions, live in remote areas, and want faster symptom relief or a lower-cost option.
However, the researchers stress that more research is needed using larger, more diverse populations, comparing this format to standard, eight-to-12-week CBT and face-to-face CBT, including an assessment of longer-term outcomes.
The study was published in the Journal of Anxiety Disorders
