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Is internet-delivered CBT effective in treating social anxiety disorder?


Cognitive behavioral therapy (CBT) is an effective way to treat social anxiety disorder, but some children and families struggle to find a local therapist that can help. A study examines whether internet delivered CBT can be effective.

Social anxiety disorder is a childhood-onset disorder often linked to high costs for care and lifelong adversity. Cognitive behavioral therapy is an effective evidence-based treatment for the condition, but caregivers of these children sometimes struggle to find a cognitive behavioral therapist in their area. A study in JAMA Psychiatry examines if internet-delivered cognitive behavioral therapy is an effective and cost-effective treatment option.1

The investigators enrolled participants from a clinical research unit in Stockholm, Sweden. Children and teenagers aged 10 to 17 years who had a principal diagnosis of social anxiety were included in the study along with their parents. The interventions were internet-delivered cognitive behavioral therapy and ISUPPORT and both included 10 online modules, 5 separate parental modules, and 3 video call sessions with a therapist. They use the Clinician Severity Rating to assess the participants 3 months after the end of treatment.

From a potential pool of 307 children and adolescents, 103 were selected and randomized to either 10 weeks of therapist-guided internet-based cognitive behavioral therapy (n = 51) or therapist-guided ISUPPORT (n = 52) for social anxiety disorder. Internet-delivered cognitive behavioral therapy was found to be significantly more effective than ISUPPORT in reducing the severity of a child’s social anxiety disorder symptoms. Average Clinician Severity Rating for the internet-delivered cognitive behavioral therapy at baseline and at the 3-month follow-up were 5.06 (0.95) and 3.96 (1.46), respectively, compared with 4.94 (0.94) and 4.48 (1.30) for ISUPPORT. A significant between-group effect size of d = 0.67 (95% CI, 0.21-1.12) was found at the 3-month follow-up. All secondary outcome measures had significant differences, except for child-rated quality of life. An examination of cost, indicated cost-savings with the internet-delivered cognitive behavioral therapy with the main causes being increased school productivity (z = 1.99, P = .047) and lower medication costs (z = 2.38, P = .02). The ISUPPORT group had 1 suicide attempt and no other serious adverse events happened in either of the groups.

The investigators concluded that internet-delivered cognitive behavioral therapy was both a successful form of treatment as well as being cost-effective. Implementing it in a clinical practice could be an important way to increase the availability of effective interventions for social anxiety disorder.


1. Nordh M, Wahlund T, Jolstedt M, et al. Therapist-guided internet-delivered cognitive behavioral therapy vs internet-delivered supportive therapy for children and adolescents with social anxiety disorder. JAMA Psychiatry. May 12, 2021. Epub ahead of print. doi:10.1001/jamapsychiatry.2021.0469

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