Therapist-guided cognitive behavioral therapy (CBT) delivered virtually is shown to be effective in helping children and adolescents with social anxiety disorder (SAD) compared to a supportive therapy. Results of the randomized clinical trial were published in JAMA Psychiatry.

In a single-masked randomized clinical trial (RCT), the researchers compared therapist-guided internet-delivered CBT (ICBT) with therapist-guided internet-delivered supportive therapy (ISUPPORT) for children and adolescents given a principal diagnosis of SAD.

A total of 103 participants were randomized to either 10 weeks of ICBT or ISUPPORT. Follow up was set at 3 months. All participants lived in Sweden.

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Participants received three 20- to 30-minute sessions at weeks 3, 5, and 7. The parents were given 5 modules to access online.

Both groups improved as the weeks went on. The effect of treatment was large for the ICBT group and moderate for the ISUPPORT group (d = 1.24 vs. d = 0.52).

Looking at all symptoms, results favored ICBT. Most between-group effect sizes at 3-month follow-up were in the moderate range (d = 0.64; 95% CI, 0.27-1.01 for child-reported SAD symptoms; d = 0.83; 95% CI, 0.43-1.22 for parent-reported SAD symptoms; d = 0.47; 95% CI, 0.07-0.88 for child-reported depressive symptoms; d = 0.78; 95% CI, 0.38-1.17 for parent-reported anxiety and depressive symptoms; d = 0.39; 95% CI, 0.03-0.74 for masked assessor–reported global functioning; and d = 0.48; 95% CI, 0.08-0.89 for parent-reported general functioning).

Limitations were that most participants were self-referred and ISUPPORT was viewed by the participants as less credible than ICBT.

The researchers concluded, “Internet-delivered cognitive behavioral therapy has the potential to overcome common treatment barriers and increase availability of evidence-based psychological treatments for this patient group.”

Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Nordh M, Wahlund T, Jolstedt M, et al. Therapist-guided internet-delivered cognitive behavioral therapy vs internet-delivered supportive therapy for children and adolescents with social anxiety disorder: a randomized clinical trial. JAMA Psychiatry. Published online May 12, 2021. doi:10.1001/jamapsychiatry.2021.0469