The British Journal of Psychiatry (2009) 195: 440-447. doi: 10.1192/bjp.bp.108.060996
© 2009 The Royal College of Psychiatrists
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Guided and unguided self-help for social anxiety disorder: randomised controlled trial

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 and 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 and 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: tomas.furmark{at}psyk.uu.se

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.

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.