Internet-delivered cognitive-behavioral therapy for social anxiety disorder in Romania: a randomized controlled trial

PLoS One. 2015 May 4;10(5):e0123997. doi: 10.1371/journal.pone.0123997. eCollection 2015.

Abstract

Background and aims: Internet-based cognitive-behavioral therapy (iCBT) for social anxiety disorder has been found effective, as attested by independently conducted randomized controlled trials in four languages. The study aim is to test the efficacy of an iCBT program in a culture where it was not tested before (i.e. Romania).

Methods: Participants (n = 76) were recruited, screened and randomized to either a nine-week guided iCBT or a wait-list control group in April and May 2012. Self-report measures were collected before (April 2012) and after the intervention (July 2012), as well as six months later (January 2013). Although social anxiety was assessed with multiple measures, the Liebowitz Social Anxiety Scale - Self Report version (LSAS-SR) and Social Phobia Inventory (SPIN) were used as the primary outcome measures.

Results: A significant difference with a large between-group effect size in favor of iCBT was found (Cohen's d = 1.19 for LSAS-SR and d = 1.27 for SPIN). Recovery rates show that 36.8% (n = 14) in the treatment group score below the SPIN clinical cut-off compared to only 2.6% (n = 1) in the wait-list control group. Post-intervention clinical interviews also revealed that 34.2% (n = 13) of the treatment group was completely recovered (full remission) while additionally 36.8% (n = 14) retained some social anxiety symptoms (partial remission). However, an important study limitation is that post-intervention interviewers were not blinded to the study conditions. The program also effectively reduced depression and dysfunctional thinking (between-group Cohen's d = 0.84 for depression and d = 0.63 for dysfunctional thinking). Moreover, the iCBT intervention appears to have a long-term impact for participants' functioning, as the treatment gains were maintained six months later.

Conclusions: Internet-delivered interventions display a high potential to quickly and widely disseminate effective evidence-based programs around the world. This study provides support for guided iCBT as a promising treatment approach in Romania.

Trial registration: ClinicalTrials.gov NCT01557894.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anxiety Disorders / therapy*
  • Case-Control Studies
  • Cognitive Behavioral Therapy*
  • Demography
  • Female
  • Humans
  • Internet*
  • Male
  • Patient Compliance
  • Patient Satisfaction
  • Romania
  • Treatment Outcome

Associated data

  • ClinicalTrials.gov/NCT01557894

Grants and funding

This work was possible with the financial support of the Sectoral Operational Program for Human Resources Development 2007–2013, co-financed by the European Social Fund, under the project number POSDRU 89/1.5/S/60189 with the title ”Postdoctoral Programs for Sustainable Development in a Knowledge Based Society” (Postdoctoral researcher: Dr. Bogdan Tudor Tulbure; Director of the Postdoctoral program: Dr. Daniel David), and grants awarded to the last author from Linköping University, Sweden. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.