Guided and unguided self-help for social anxiety disorder: randomised controlled trial

Furmark, Tomas
Carlbring, Per
Hedman, Erik
Sonnenstein, Annika
Clevberger, Peder
Bohman, Benjamin
Eriksson, Anneli
Hållén, Agneta
Frykman, Mandus
Holmström, Annelie
Sparthan, Elisabeth
Tillfors, Maria
Ihrfelt, Elisabeth Nilsson
Spak, Maria
Eriksson, Anna
Ekselius, Lisa
Andersson, Gerhard

Tomas Furmark, PhD, Department of Psychology, Uppsala University; Per Carlbring, PhD, Department of Behavioural Sciences and Learning, Linköping University; Erik Hedman, MSc, Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institute, Stockholm; Annika Sonnenstein, MSc, Peder Clevberger, MSc, Benjamin Bohman, MSc, Anneli Eriksson, MSc, Agneta Hållén, MSc, Mandus Frykman, MSc, Annelie Holmström, MSc, Elisabeth Sparthan, MSc, Department of Psychology, Uppsala University; Maria Tillfors, PhD, Department of Behavioural, Social and Legal Sciences, Örebro University; Elisabeth Nilsson Ihrfelt, MSc, Maria Spak, MSc, Anna Eriksson, MSc, Department of Psychology, Uppsala University; Lisa Ekselius, PhD, Department of Neuroscience, Psychiatry, Uppsala University; Gerhard Andersson, PhD, DMedSc, Department of Behavioural Sciences and Learning, Linköping University, Swedish Institute for Disability Research, Linköping University, and Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institute, Stockholm, Sweden

Correspondence: Dr Tomas Furmark, Department of Psychology, Uppsala University, Box 1225, SE-751 42 Uppsala, Sweden. Email: [email protected]

First received 25 Oct 2008, final revision 15 Apr 2009, accepted 6 May 2009

British Journal of Psychiatry 195(5):p 440-447, November 2009.

Background

Internet-delivered self-help programmes with added therapist guidance have shown efficacy in social anxiety disorder, but unguided self-help has been insufficiently studied.

Aims

To evaluate the efficacy of guided and unguided self-help for social anxiety disorder.

Method

Participants followed a cognitive-behavioural self-help programme in the form of either pure bibliotherapy or an internet-based treatment with therapist guidance and online group discussions. A subsequent trial was conducted to evaluate treatment specificity. Participants (n = 235) were randomised to one of three conditions in the first trial, or one of four conditions in the second.

Results

Pure bibliotherapy and the internet-based treatment were better than waiting list on measures of social anxiety, general anxiety, depression and quality of life. The internet-based therapy had the highest effect sizes, but directly comparable effects were noted for bibliotherapy augmented with online group discussions. Gains were well maintained a year later.

Conclusions

Unguided self-help through bibliotherapy can produce enduring improvement for individuals with social anxiety disorder.

Declaration of interest

T.F., A.H., E.S., P.Ca. and G.A. receive royalties for authoring the self-help book used for bibliotherapy.