First, we used a detailed treatment manual. Second, group therapists received supervision throughout the trial by a licensed psychotherapist specialized in CBT for SAD. Third, all sessions were audio recorded and a random sample of 5 sessions was audited by a clinical psychologist with more than 10 years of experience in treating SAD with CBT. Using the Therapist Adherence Scale developed by the originators of CBGT, all reviewed sessions were judged to have been conducted in accordance with the treatment manual. The average TAS score of the reviewed session was 4.5 on a 1 to 5 scale. Due to the fixed nature of ICBT and the limited role of the therapist, no measure of treatment integrity was taken for ICBT. However, all therapists who provided the guidance of ICBT received supervision from a clinical psychologist throughout the trial and all therapists had previous experience of that treatment format. The ICBT employed in this study was based on the treatment developed by Andersson and coworkers, and has been validated by several randomized controlled trials. The treatment followed a CBT-model, developed for individual therapy, that stresses the importance of MG132 133407-82-6 avoidance and safety behaviors as well as misinterpretations of social events and internal focus as maintaining factors of SAD. A vital part of the treatment was the gradual access to internet-based self-help text comprising 15 text modules, each covering a specific theme completed with a homework component. The modules provided the participants with the same knowledge and tools as conventional individual CBT for SAD. The duration of ICBT was 15 weeks and throughout this period the patient had access to a therapist via an online secure messaging system. The role of the therapist was mainly to provide feedback regarding home work and to grant access to the treatment modules. However, the patient could contact the therapist at any time and expect a reply within 24 hours during week days. Patients and therapists had no face-to-face or telephone contact during the treatment. The general instruction to the internet therapists was to have the ambition to restrict time spent on each patient to less than 10 minutes per week. This time frame was judged possible as most messages to patients are very brief entailing the core SP600125 feed-back that the homework was successfully completed and the next treatment module is accessible. The therapists conducting ICBT were eight psychologists with one to four years of experience in delivering CBT via the internet. This treatment comprised an initial individual session followed by 14 group sessions over 15 weeks. The individual session prepared the participant to begin group treatment sessions and included a rationale for group treatment. Each group session was 2.5 hours long, including a 15 minute break. Groups were lead by two therapists and had six to seven participants.