App-based cognitive therapy for social anxiety disorder: A randomized-controlled comparison of guided and unguided...

Internet-based cognitive behavioral therapy has demonstrated encouraging outcomes for patients diagnosed with social anxiety disorder (SAD). However, the impact of additional therapist-guidance remains debatable. The present study evaluates the effectiveness of the cognitive therapy app "Mindable: Social Phobia" comparing a therapist-guided (vCT) and unguided self-help app (iCT) against a waitlist control group (WLC).

We assigned 164 patients diagnosed with SAD randomly to one of the three groups, treatment lasting 12 weeks with 8 manualized video-conference delivered sessions in vCT. Assessments took place pre-treatment, midtreatment, posttreatment and follow-up 6 months after treatment (follow-up). The primary outcome was clinician-rated symptom severity (Liebowitz Social Anxiety Scale; LSAS), secondary outcomes included symptoms of depression and interpersonal pleasure.

Drop-out rates were 9.3 % in WLC, 42.6 % in iCT and 15 % in vCT (χ² = 19.5, p < .01). Both treatments reached significant stronger reduction of LSAS scores compared to WLC in all analyses (d [iCT vs. WLC] = -1.01, d [vCT vs. WLC] = -1.1). Using multiple imputation analyses, no significant difference was found in the LSAS between the two treatment groups (t = -0.22, p = .830, d = 0.04). Patterns of results were similar for secondary outcomes. At follow-up, both treatment groups maintained treatment gains.

Overall, the app demonstrates promising results, with patients clearly benefiting from the intervention. The add-on effects of the therapist-guidance favor provision of blended care as it prevents drop-out.