![]() A small open trial ( n = 38) that delivered PDFs with self‐help material and offered minimal contact with a psychotherapist resulted in large pre–post within‐group effects (Social Interaction Anxiety Scale : d = 0.81 Social Phobia Scale : d = 1.18) for both the iCBT group and the iCBT group with additional in vivo group exposure (Tillfors et al., 2008). We are aware of two studies that evaluated internet‐based cognitive behavioral therapy (iCBT) for SAD in university students. Therefore, additional research is needed to investigate the efficacy of unguided IMIs as treatment of SAD. However, effect sizes of unguided treatment vary widely (95% CI Berger et al., 2011 Botella et al., 2010 Furmark et al., 2009 Gallego, Emmelkamp, Maria, van der Kooij, & Mees, 2011 Lopez, Botella, Quero, Gomez, & Baños, 2014 Titov et al., 2010 Titov, Andrews, Choi, Schwencke, & Johnston, 2009 Titov, Andrews, Choi, Schwencke, & Mahoney, 2008) and high dropout >40% at posttreatment (Botella et al., 2010 Gallego et al., 2011). The most recent meta‐analysis found an average effect of g = 0.78 (95% confidence interval ) for unguided IMIs compared with passive controls ( n = 8) and of g = 0.19 (95% CI ) compared with active conditions ( n = 7 Kampmann et al., 2016). Thus, in light of technological developments that allow them to mimic some functions of human support, unguided IMIs have received more attention. However, once developed, costs of IMIs are substantially linked to professional guidance time, which clearly limits their possible reach and consequently lowers the potential to reduce the negative consequences of SAD at population level. Most studies to date that targeted SAD evaluated guided IMIs. The latest systematic review on IMIs for SAD found a mean standardized effect size of g = 0.84 (0.72–0.97) compared with untreated control groups and g = 0.38 (0.13–0.62) compared with active control conditions (Kampmann, Emmelkamp, & Morina, 2016). IMIs have been shown to be effective in the treatment of a broad range of disorders (Ebert, Van Daele, et al., 2018b). Internet‐ and mobile‐based interventions (IMIs) are a promising strategy to overcome treatment barriers by offering a low‐access threshold, anonymous, flexible, and effective treatment option (Ebert, Cuijpers, Muñoz, & Baumeister, 2017 Griffiths, Lindenmeyer, Powell, Lowe, & Thorogood, 2006). Furthermore, the fear of negative evaluation (FNE Rapee & Heimberg, 1997 Stangier, Heidenreich, & Peitz, 2009), the expectation that others might judge one's behavior as embarrassing (Kessler, 2003 King & Poulos, 1998), a key feature of SAD, prevents university students from seeking professional advice (Kessler, 2003 King & Poulos, 1998). Reasons for this unmet need include shortage in available clinicians and fear of stigmatization. However, only a fraction of those in need (Runge, Beesdo, Lieb, & Wittchen, 2008 Wang et al., 2005) receive help. Thus, treatment of SAD is of interest to the public health care system and health services in and outside of the university setting (Wittchen & Jacobi, 2005 Wittchen, Jacobi, Rehm, & Gustavsson, 2011), particularly as SAD can manifest as a chronic condition when untreated (Chartier, Hazen, & Stein, 1998). The resulting lower qualification and social impairment (Kessler, 2003 Magee, Eaton, Wittchen, McGonagle, & Kessler, 1996) may subsequently lead to a high economic burden for those affected as well as for society at large. In addition, emotional distress due to SAD triggers dysfunctional avoidance strategies (Tillfors & Furmark, 2007), which are associated with underachievement and may lead to university dropout. University students with SAD face a number of adverse effects including problems with identity formation (Gültekin & Dereboy, 2011), increased consumption of alcohol (Gilles, Turk, & Fresco, 2006), higher levels of suicidal ideation (Olfson, 2000), and lower quality of life (Mendlowicz, 2000). Prevalence estimates for SAD in university students show a wide range from 3.4% (12 months) in the United States (Blanco et al., 2008) to 16.1% (point prevalence) in Sweden (Tillfors & Furmark, 2007). Social anxiety disorder (SAD) is the most common anxiety disorder in the general population (Kessler, Chiu, Demler, & Walters, 2005). ![]()
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