In Session With Thomas Berger, PhD

Internet-Based Therapy for Social Phobia

Department of Clinical Psychology and Psychotherapy, University of Bern, Switzerland

First published in Psychiatry Weekly, Volume 6, Issue 3, on February 7, 2011

Q: Your study found no differences between self-guided and therapist-aided Internet-based treatment for social phobia. Why might Internet-based treatment for social phobia, compared to traditional therapist visits, be effective?

A: Indeed, it is not obvious that Internet-based treatment should work for patients with social phobia. It has been found that persons with social phobia do use the Internet extensively, and it could be argued that an Internet-based treatment reinforces their avoidance of contact with people. On the other hand, our self-help program is based on cognitive-behavioral interventions that include exposure to real life situations. We do not want participants to stay at home in front of their computer. We want them to go out and to test reality. Our experience is that many people with social anxiety manage to seek outside exposure with the guidance of a self-help program. In addition, the “safe” environment in front of the computer might facilitate the necessary learning phase in cognitive-behavior therapy.

Q: What was the extent of patients’ improvement in your study?

A: We compared the efficacy of (1) a 10-week web-based unguided self-help treatment with (2) the same intervention complemented with minimal, although weekly, therapist support via e-mail. Another (3) treatment arm was also included, in which the level of support was flexibly stepped up, from no support, to e-mail or telephone contact on demand of the participants. The aim of this randomized trial was to examine the role and necessity of therapist guidance. We found significant symptom reductions in all 3 groups at posttreatment and at 6-month follow-up, with effects that are comparable to those obtained in face-to-face psychotherapy. No difference was found between the 3 conditions, suggesting that Internet-based treatment for social phobia is a promising treatment option, whether support is provided or not. However, it is important to note that our results cannot be generalized to regular psychiatric settings. Although all participants were diagnosed with a social anxiety disorder at pretreatment, they were recruited from the community by means of articles in newspapers. This self-selected group could have been especially motivated. We clearly need studies to test this treatment form’s effectiveness in regular health care settings.

Q: Do you envision Internet-based treatment expanding to other anxiety disorders?

A: In fact, Internet-based treatments have developed rapidly over the last decade. A growing body of evidence suggests that they can lead to significant and enduring improvements in a variety of mental disorders, including all anxiety disorders and depression. We have developed and evaluated Internet-based treatments for several conditions, but other groups are undertaking this research, as well.

Disclosure: Dr. Berger has received research support for this work from the Swiss National Science Foundation (PA0011-121464).

Reference:

Berger T, Caspar F, Richardson R, et al. Internet-based treatment of social phobia: A randomized controlled trial comparing unguided with two types of guided self-help. Behav Res Ther. In Press.

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