Group CBT

At a glance

Compared with waiting

Clearly better than waiting. In a combined analysis of 101 trials, the difference was large.

Compared with other treatments

Better than a pill placebo and an attention placebo in a US trial. About the same as internet CBT in a Swedish trial.

How many get better

In one US trial, about 1 in 4 people were in remission at 24 weeks after group CBT alone.

What it takes

In the main trials, weekly group sessions for about 12 weeks, led by one or two therapists.

What it is

In group CBT you meet with a small group of people who also have social anxiety. One or two therapists lead it. CBT (cognitive behavioural therapy) is talking therapy that works on how you think and what you do.

The best-known version was developed in the US by Richard Heimberg. It is called cognitive behavioural group therapy (CBGT). A typical session includes:

• Learning about the anxiety loop. Why fear grows when you avoid things.
• Spotting and testing anxious thoughts. For example, “everyone will see me blush”.
• Practising in the room. Group members act as the audience or the other person in a role-play. You might give a short talk, start a conversation, or be interviewed.
• Homework. Small real-life steps between sessions.

The group itself is a practice ground. Just being there is a form of exposure: facing a feared situation on purpose, in small steps.

Why people choose it

• You are not the only one. Many people say meeting others with the same problem was a relief.
• Real people to practise with. Role-plays with real people feel closer to life than practising alone.
• It can be cheaper or quicker to get. Some services offer groups when individual therapy has a long waiting list.

What the evidence shows

• It helps much more than waiting. A study that combined 101 trials found a large difference between group CBT and a waiting list.
• It beat placebos. In a US trial of 133 people, group CBT beat both a pill placebo and an attention placebo (meetings with no active treatment) after 12 weeks. The MAOI medicine phenelzine worked faster.
• Combining helped in one trial. In a later US trial of 128 people, 23.5% were in remission (symptoms below the level of the disorder) after group CBT alone at 24 weeks. With phenelzine alone, 25.7% were. With both together, 53.1% were. With placebo, 14.8% were.
• Online CBT matched it. In a Swedish trial, internet CBT was no worse than group CBT.
• Mindfulness and ACT came out similar. In a US trial, group CBT and a mindfulness course gave similar symptom changes, though group CBT reduced subtle avoidance more. A US trial of individual CBT and acceptance and commitment therapy also found no difference between them.
• Guided books came close. In an Australian trial of 224 people, a self-help book with five group sessions did not differ significantly from full therapist-led group therapy.

Why it is not rated higher

In the big comparison of 101 trials, individual CBT made for social anxiety did better than group CBT. The UK guideline (NICE) recommends individual CBT first and does not prefer group CBT. If you can get individual cognitive therapy for social anxiety, it is the first choice. If a group is what is available, it is a good option.

How to get it

• Ask your doctor or local mental health service whether they run a CBT group for social anxiety. Some university clinics and anxiety clinics run them too.
• Check the group is for social anxiety specifically, not general stress or anxiety.
• It is normal to dread the first session. Most groups start gently, with introductions and no one put on the spot.

What to expect in therapy describes a first session. When booking is hard helps if the first call is the hardest part.