Self-help books

At a glance

Compared with waiting

Better than waiting in trials in Sweden and Australia.

Compared with other treatments

In an Australian trial, a book plus five group sessions did about as well as full group therapy. A book alone did less well.

Does it last

Gains held for a year in a Swedish trial.

What it takes

The cost of a book and a few hours a week of reading and practice, for a few months.

What it is

A self-help book for social anxiety walks you through the same steps a therapist would use. You read a chapter, then do the exercises in your own life. This is also called bibliotherapy: using a book as treatment.

Most people with social anxiety never get treatment. In surveys across 24 countries, only about 23 in 100 ever got treatment, after an average wait of about 15 years. A book is something you can start today.

What the evidence shows

• A book alone helped in Sweden. In a Swedish trial, people with social anxiety disorder who used a CBT book on their own did better than people on a waiting list. The gains were still there a year later. Several of the researchers earned royalties from the book they tested.
• Support made a book work better. In an Australian trial of 224 people with severe social anxiety, a book alone helped more people lose the diagnosis than waiting did. But on symptoms and daily life, the book alone did not clearly beat waiting. A book plus five group sessions with a therapist beat waiting on everything, and came out about even with full group therapy.
• Good value. A UK cost study found that book-based self-help without support was among the most cost-effective options, after individual therapy and the medicine phenelzine.
• Smaller than therapy. In the study that combined 101 trials, individual CBT with a therapist had the largest effect. Self-help is a good start, not the strongest option.

The UK guideline (NICE) offers supported self-help based on CBT to adults who do not want individual CBT.

How to choose a book

Hundreds of books exist. Almost none has been tested in a trial. So instead of a list of titles, here is what to look for. A good book:

1. Is based on CBT for social anxiety. It should explain a model of what keeps social anxiety going, such as the Clark and Wells model. What keeps social anxiety going describes it.
2. Asks you to face situations, not just read. Look for exposure (facing a feared situation on purpose, in small steps) and behavioural experiments (planned tests of a fear).
3. Deals with safety behaviours. Exposure works much better when you also drop the small things you do to hide or protect yourself. In one trial, a therapy that worked on safety behaviours helped twice as many people lose the diagnosis as exposure with relaxation did.
4. Has worksheets and a plan, such as an exposure ladder and a log of what you predicted and what happened.
5. Is written by clinicians or researchers who treat social anxiety.

Be wary of books or courses that promise a quick cure, sell a “secret”, or focus only on confidence tricks or positive thinking. On Reddit, some “here’s what worked for me” posts turn out to be adverts for a course or app.

How to get the most from it

• Get support if you can. A friend, a GP, or a weekly check-in with a therapist makes it more likely you keep going. The Australian trial suggests support matters.
• Do the exercises. Reading alone changes little. The change comes from the practice.
• Go slowly. One chapter a week is fine.
• Move on if you are stuck. If after a few months you have not improved, try guided internet CBT or therapy.