Randomized controlled trial of web-based treatment of social phobia without clinician guidance

Objective: The aim of the present study was (Shyness 4) to determine which level of reminder best facilitated a clinician-free Internet treatment for social phobia. Method: A pragmatic randomized controlled trial of an enhanced Internet treatment, with and without weekly telephone reminders, was done. Participants consisted of 163 volunteers with social phobia, who completed six lessons of computerized cognitive behaviour therapy for social phobia with complex automated reminders. Main outcome measures were the Social Interaction Anxiety Scale and Social Performance Scale. Results: Social phobia improved in both groups. Adherence (68% vs 81%) and improvement in social phobia (effect size = 0.86 vs 1.15) was better in the group with the added telephone reminders. Conclusions: Enhanced Internet-based cognitive behaviour therapy without clinician guidance is a strong treatment for social phobia. Telephone reminders further improve outcome. Because both interventions are effective, it is a pragmatic decision for a practice or a service as to whether the 33% increase in efficacy justifies 1 h of practice nurse or receptionist time.