Finland put 7-session internet CBT for social anxiety into routine care. Did it work?

Across 1,654 physician-referred patients nationwide, a free 7-session therapist-guided internet CBT programme produced a large improvement in social anxiety (d = 1.09), with 41.1% improving reliably and 1.7% getting reliably worse -- but there was no control group.

Internet-delivered CBT for social anxiety works in trials. Whether it works in an ordinary health service, where nobody is screened into a study and people drop out for their own reasons, is a different question. Helsinki University Hospital runs a nationwide programme, and researchers led by Anna Paula Laizane examined its register from 2019 to 2022: 1,654 adults across Finland, all referred by a physician rather than self-referred, all scoring at least 21 on the Social Phobia Inventory, treated free of charge in seven therapist-supported sessions on a flexible schedule. On the primary social anxiety measure the improvement was large, d = 1.09 overall and d = 1.15 among those who finished, with smaller gains for people who left late (d = 0.72) or early (d = 0.41). Patients improved by about 2.2 points every other session. Using a threshold of a 10-point change as reliable, 41.1% improved reliably and 1.7% got reliably worse; 19.9% ended in the subclinical range, rising to 30.2% among completers. Adherence was good for a digital programme: an average of 5.74 of 7 sessions, and 54% finished. The authors argue the short course is part of why. The honest limit is stated in the paper: there is no control group, so the specific effect of the therapy cannot be separated from the natural course of the condition or from simply being in care. Two design choices cut both ways. No diagnostic interview was done at screening, which made the programme cheaper to scale but means the diagnosis rests on the referring physician plus a questionnaire cutoff. And restricting entry to more severe cases, along with the fact that people who completed treatment started out slightly older with less depression, means the completer figures describe a self-selected group rather than everyone referred.