Clinical and therapeutic context
Social anxiety can affect participation, relationships, education, and work. Its treatment target is more specific than encouraging confidence. NICE’s adult guidance recommends individual CBT designed for social anxiety, with approaches addressing self-focused attention, safety behaviours, negative predictions, and behavioural practice; supported self-help is another option in the appropriate pathway (NICE, 2013). The implication for public writing is to describe what the intervention asks a person to learn and practise, rather than suggesting that social anxiety reflects a simple lack of positive thinking.
Sources: NICE, 2013
Current synthesis and its limits
The 2024 review by de Ponti et al. included 66 randomized trials and 5,560 adults across psychotherapies, predominantly CBT. The pooled posttreatment symptom advantage over controls was g=0.88 (95% CI 0.76–1.00). However, 41 of 66 trials were high risk of bias and only 4 were low risk. Heterogeneity and broad prediction intervals make the average an uncertain forecast for a new service. Publication-bias adjustments differed considerably, which makes that sensitivity important when interpreting the estimate.
Sources: de Ponti et al., 2024
Delivery-format evidence
Hall et al. (2025; online 2024) synthesized 37 trials using waitlist controls. Individual, group, and remote CBT all showed benefits; numerical effects differed, but the between-format test did not demonstrate a significant difference. Because these are separate comparisons with waitlists, that finding is not evidence of randomized equivalence. Exploratory associations with clinician guidance are useful hypotheses, not proof that support alone causes the difference. The study’s lack of preregistration and underpowered moderators further temper interpretation.
Sources: Hall et al., 2025
A newer trial and the question it answers
Winter et al. (2026; online 2025) randomized 78 adults to videoconference CBT or waitlist. The between-group effect on the brief Social Interaction Anxiety Scale was d=0.55 (95% CI 0.09–1.00). The study also followed treated participants for three months. These findings support further evaluation of therapist-led remote treatment. Benchmarking against earlier face-to-face studies is an observational cross-study comparison; it cannot replace a direct, adequately powered noninferiority trial. Diagnostic improvement in this selected trial must not become an advertised recovery percentage for another product.
Sources: Winter et al., 2026
Functioning and future research
Symptom change, participation in everyday life, treatment support, and acceptability answer different questions. Satisfaction alone does not demonstrate effectiveness. One useful research question is whether supported practice between sessions improves completion of meaningful social activities. Answering it would require measures of avoidance and functioning, a credible comparison, a description of support, and follow-up beyond the immediate programme. The studies reviewed here predominantly concern adults; adolescent and school-based applications require their own evidence.
Sources: NICE, 2013; Hall et al., 2025; de Ponti et al., 2024; Winter et al., 2026
References
Links open the original papers or official sources. Access labels describe the material assessed for this review.
National Institute for Health and Care Excellence (2013). Social anxiety disorder: Recognition, assessment and treatment. NICE clinical guideline CG159.
Access assessed: official indexed public-information and recommendation excerpts; direct403
de Ponti, N., Matbouriahi, M., Franco, P., Harrer, M., Miguel, C., Papola, D., Sicimoğlu, A., Cuijpers, P., & Karyotaki, E. (2024). The efficacy of psychotherapy for social anxiety disorder, a systematic review and meta-analysis. Journal of Anxiety Disorders, 104, 102881. 10.1016/j.janxdis.2024.102881
Access assessed: publisher indexed abstract/results table/discussion; publisher and repository direct403
Hall, M., Luo, A., Bhullar, N., Moses, K., & Wootton, B. M. (2025). Cognitive behaviour therapy for social anxiety disorder: A systematic review and meta-analysis investigating different treatment formats. Australian Psychologist, 60(1), 1–14. 10.1080/00050067.2024.2356804
Access assessed: publisher indexed abstract/discussion excerpts; direct403; issue metadata corroborated by UTS repository
Winter, H. R., Norton, A. R., & Wootton, B. M. (2026). Videoconferencing-delivered cognitive behavioural therapy for social anxiety disorder: A randomised controlled trial. Cognitive Behaviour Therapy, 55(6), 880–896. 10.1080/16506073.2025.2540916
Access assessed: publisher indexed abstract/methods/results excerpts; full direct access not established
This evidence review is educational. It does not provide an individual diagnosis or treatment plan. Read the review methods, access limits, and clinical-review status.