| Shrnutí: | <p><strong>Background:</strong> Cognitive therapy for social anxiety disorder (CT-SAD) is
recommended by NICE (2013) as a first line intervention. Take up in routine
services is limited by the need for up to 14 ninety-minute face-to-face sessions ,
some of which are out of the office. An internet-based version of the treatment (iCTSAD) with remote therapist support may achieve similar outcomes with less
therapist time.</p>
<p><strong>Methods:</strong> 102 patients with social anxiety disorder were randomized to
iCT-SAD, CT-SAD, or waitlist (WAIT) control, each for 14 weeks. WAIT patients
were randomized to the treatments after wait. Assessments were at pretreatment/wait, midtreatment/wait, posttreatment/wait, and follow-ups 3 & 12
months after treatment. The pre-registered (ISRCTN95458747) primary outcome
was the Social Anxiety Disorder Composite, which combines 6 independent assessor
and patient self-report scales of social anxiety. Secondary outcomes included
disability, general anxiety, depression and a behaviour test.</p>
<p><strong>Results:</strong> CT-SAD and iCT-SAD were both superior to WAIT on all measures. iCT-SAD did not differ from CT-SAD on the primary outcome at post-treatment or
follow-up. Total therapist time in iCT-SAD was 6.45 hours. CT-SAD required 15.8
hours for the same reduction in social anxiety. Mediation analysis indicated that
change in process variables specified in cognitive models accounted for 60% of the
improvements associated with either treatment. Unlike the primary outcome, there
was a significant but small difference in favour of CT-SAD on the behaviour test.</p>
<p><strong>Conclusions:</strong> When compared to conventional face-to-face therapy, iCT-SAD can more than double the amount of symptom change associated with each therapist hour.</p>
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