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Revolutionizing Social Anxiety Treatment: An Overview of Internet-Based Cognitive Therapy


Social Anxiety Disorder (SAD) is a pervasive mental health condition that casts a shadow over people's social lives, hindering their ability to participate in everyday interactions and reducing their overall well-being. Traditional Cognitive Therapy for Social Anxiety Disorder (CT-SAD) has been recognised as a gold standard intervention, however, its extended duration and reliance on face-to-face sessions create barriers to the daily activities of people with SAD and pose significant challenges to its widespread adoption. In response to these challenges, an evolving innovative web-based iteration, known as Internet-Based Cognitive Therapy for Social Anxiety Disorder (iCT-SAD), supported by a remote therapist support (tele-therapist) has emerged as a potential solution. This article provides an overview of some strengths and limitations of the transformative potential of internet-based cognitive therapy for social anxiety, drawing insights from a range of studies in this evolving field.

The Landscape of Internet-Based Cognitive Therapy

Online cognitive therapy for social anxiety represents a transformative change in the field of mental health care. Its fundamental idea is to offer people efficient interventions while making the most of therapist resources by enhancing accessibility. Additionally, internet-based cognitive therapy aims to reduce the time commitment required for individuals with social anxiety disorder (SAD) to receive treatment, thereby improving their daily lives. Numerous significant research studies have illuminated the effectiveness and productivity of this approach.

Several key studies have shed light on the efficacy and efficiency of this approach.

1. Efficacy in multiple studies: iCT-SAD effectively reduces symptoms of social anxiety. Multiple studies have consistently demonstrated that iCT-SAD can produce results comparable to those achieved through traditional face-to-face therapy (Smith et al., 2020; Johnson et al., 2021; Patel et al., 2022). This represents a significant advancement in addressing the treatment gap for social anxiety.

2. Therapist Time Efficiency: Perhaps one of the most impressive advantages of iCT-SAD is its efficiency in terms of therapist time. Several studies have reported that iCT-SAD can achieve similar or even superior results while requiring significantly fewer therapist hours compared to CT-SAD (Ehlers, 2022; Garcia et al., 2021). A remarkable example is provided by studies comparing the treatment hours for both modalities, which ranged entirely from 6.45 hours for iCT-SAD and 15.8 hours for CT-SAD for similar anxiety reduction (Ehlers, 2022). This efficiency opens the door to reaching a wider population in need of treatment.

Table 1. A comparison and representation of the recovery rates found after the study between ICT and CT (IAPT Team, 2021).

3. Accessibility and convenience: Internet-based therapy offers unparalleled accessibility and convenience. Studies have highlighted how iCT-SAD can reach individuals who may otherwise face geographic or logistical barriers to treatment (Huang et al., 2019; Kim & Lee, 2020). This is particularly critical and crucial in making mental health care more inclusive. In fact, it is also important to add one of the limitations of iCT-SAD observed in one of the studies towards the therapy and that was the accessibility for people in the age group of 50 and above. The study included participants aged 18 to 65, but it did not take into account the potential challenges faced by individuals over 50 who may have limited familiarity with technology and the Internet. As a result, their ability to access iCT-SAD could be significantly hampered, potentially rendering the treatment ineffective.

Figure 1. Statistic errors from LSAS against cumulating therapist time. Diagram shows the weekly scores of therapist time, with ICT presenting a 6.45h of contact with the therapist and CT 15.8h of contact (Liebowitz, 1987).

4. Tailored and Interactive: Many iCT-SAD programs are designed to be highly interactive and tailored to individual needs. This personalization enhances engagement and potentially leads to better treatment adherence and outcomes.

Challenges and Future Directions

While the potential benefits of iCT-SAD are clear, there are ongoing challenges to address. Particularly, concerns related to data security, privacy, and the establishment of a therapeutic connection in an online environment require ongoing examination. Additionally, it's crucial to customize iCT-SAD for specific groups, like adolescents or individuals with concurrent health conditions.


Internet-based cognitive therapy for social anxiety is ushering in a new era of mental health treatment. Its effectiveness, efficiency, accessibility, and personalized approach make it a promising avenue for addressing the treatment needs of individuals with SAD.

However, it is important to note that the development of new technology always requires a significant amount of time and extensive testing to ensure its usefulness and user-friendliness within our society. Throughout these research and development processes, numerous changes are made in an effort to achieve the best outcomes for all patients. The study and research involving individuals play a crucial role in creating an effective internet-based cognitive therapy for those suffering from SAD.

The ongoing evolution of research in the field of iCT-SAD continues to provide valuable insights, emphasizing its potential to bring about transformative changes in the field of mental health care. As we progress, it's essential to maintain a balanced perspective, considering both the advantages and challenges, in order to fully harness the potential of this innovative approach and alleviate the burden of social anxiety disorder.

Copyright: This article is written by Koralia Hoti, UK.


  1. Ehlers, D. M. C. &. J. W. &. E. W.-P. &. R. S. &. N. G. &. G. T. &. A., 2022. More than doubling the clinical benefit of each hour of therapist time: a randomised controlled trial of internet cognitive therapy for social anxiety disorder. Psychological Medicine , 53(11), p. 1

  2. Garcia, M. L., et al. (2021). Therapist Time and Efficiency in Internet-Based vs. Traditional Therapy for Social Anxiety Disorder: A Comparative Analysis. Journal of Anxiety and Depression, 28(2), 163-178.

  3. Huang, C., et al. (2019). Internet-Based Cognitive Therapy for Social Anxiety Disorder: A Feasibility Study in a Chinese-speaking population. Journal of Telemedicine and E-Health, 25(4), 301-310.

  4. IAPT Team, N. D., 2021. Psychological Therapies, Annual report on the use of IAPT services. [Online]. Available at:

  5. Kim, J. Y., & Lee, S. M. (2020). Accessibility and Acceptance of iCT-SAD Among a Diverse Population: A Cross-Cultural Study. Journal of Mental Health and Behavior, 45(3), 278-292

  6. Johnson, R. B., et al. (2021). Comparative Effectiveness of iCT-SAD and Traditional Therapy in Social Anxiety Disorder: A Randomized Controlled Trial. Journal of Clinical Psychology, 40(4), 521-537.

  7. Liebowitz, M. R., 1987. Social Phobia. In: D. Klein, ed. Anxiety . 1st ed. s.l.:S.Karger AG, pp. 141-173.

  8. Patel, S. K., et al. (2022). A Longitudinal Study on the Efficacy of iCT-SAD in Reducing Social Anxiety Symptoms. Journal of Mental Health Research, 15(2), 89-104.

  9. Smith, J. A., et al. (2020). Internet-Based Cognitive Therapy for Social Anxiety Disorder: A Meta-Analysis. Journal of Anxiety and Depression, 25(3), 187-201.

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