Cultural Differences in the Efficacy of Group Psychotherapy for Social Anxiety Disorder: A Meta-Analysis Comparing Asia and Western Countries
Keywords:
meta-analysis, group psychotherapy, social anxietyAbstract
This study aims to evaluate the effectiveness of group-based psychotherapy interventions in reducing social anxiety. This meta-analysis included 12 articles involving 539 participants (323 in the intervention group and 216 in the control group). This study hypothesized that group psychotherapy is effective in reducing the symptoms of social anxiety disorder. Data analyzed included sample size (N), mean (M), and standard deviation (SD) to calculate the effect size using a random-effects model. The results showed a Hedge’s g effect size of -0.809 (95% CI -1.202 to -0.416) with moderate heterogeneity (I² = 73.84%). Moderator analysis based on country of origin revealed a difference in effect size of -1.217 (95% CI -2.109 to -0.325) with lower heterogeneity (I² = 61.28%). These findings indicate that group-based psychotherapy is significantly effective in reducing social anxiety. Furthermore, Asian countries demonstrated greater effectiveness compared to Western countries in using group psychotherapy to alleviate social anxiety symptoms. This study highlights the importance of incorporating cultural contexts into the development of group psychotherapy interventions.
References
Agersnap, T. N., Hougaard, E., Jensen, M. B., & Thastum, M. (2022). Diagnosis-Specific Group CBT Treating Social Anxiety in Adolescents: A Feasibility Study. Scandinavian Journal of Child and Adolescent Psychiatry and Psychology, 10(1), 89-101.
American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). American Psychiatric Association Publishing. https://www.psychiatry.org/psychiatrists/practice/dsm
APA Dictionary of Psychology. (2023). American Psychology Association. Available at: https://dictionary.apa.org/reality-therapy
Baer, S., & Garland, E. J. (2005). Pilot study of community-based cognitive behavioral group therapy for adolescents with social phobia. Journal of the American Academy of Child & Adolescent Psychiatry, 44(3), 258-264.
Bangun, S. R. (2022). The Effectiveness of Group Psychotherapy on Reducing Anxiety and Depression Symptoms in Adolescents. Jurnal Psikiatri Surabaya, 11(2).
Barkowski, S., Schwartze, D., Strauss, B., Burlingame, G. M., & Rosendahl, J. (2020). Efficacy of group psychotherapy for anxiety disorders: a systematic review and meta-analysis. Psychotherapy Research, 30(8), 965-982.
Barkowski, S., Schwartze, D., Strauss, B., Burlingame, G. M., Barth, J., & Rosendahl, J. (2016). Efficacy of group psychotherapy for social anxiety disorder: A meta-analysis of randomized-controlled trials. Journal of anxiety disorders, 39, 44-64. http://dx.doi.org/doi:10.1016/j.janxdis.2016.02.005
Borenstein, M., Cooper, H., Hedges, L., & Valentine, J. (2009). Effect sizes for continuous data. The handbook of research synthesis and meta-analysis, 2, 221-235.
Christensen, P.N., Stein, M.B., & Christensen, A.M. (2003). Social Anxiety and Interpersonal Perception:A Social Relations Model Analysis.Behaviour Research and Therapy,41, 1355–1371. doi:10.1016/ S0005-7967(03)00064-0.
Cohen, J. (1992). Statistical power analysis. Current directions in psychological science, 1(3), 98-101.
Colhoun, H., Kannis-Dymand, L., Rudge, M., Le Compte, D., O'Flaherty, S., Gilbert, C., . . . Bell, C. (2021). Effectiveness of Group Cognitive Therapy for Social Anxiety Disorder in Routine Care. Behaviour Change, 38(2), 60-72. doi:10.1017/bec.2020.19
Erickson, D. H., Janeck, A. S., & Tallman, K. (2007). A cognitive-behavioral group for patients with various anxiety disorders. Psychiatric Services, 58(9), 1205-1211.
Goldin, P. R., Morrison, A., Jazaieri, H., Brozovich, F., Heimberg, R., & Gross, J. J. (2016). Group CBT versus MBSR for social anxiety disorder: A randomized controlled trial. Journal of consulting and clinical psychology, 84(5), 427.
Halperin, S., Nathan, P., Drummond, P., & Castle, D. (2000). A cognitive-behavioural, group-based intervention for social anxiety in schizophrenia. Australian & New Zealand Journal of Psychiatry, 34(5), 809-813.
Hedman, E., Strome, P., Stunkel A., & Mortberg, E. (2013). Shame and Guilt in Social Anxiety Disorder: Effects of Cognitive Behavior Therapy and Association with Social Anxiety and Depressive Symptoms. Plos One, Vol. 8, No. 4.
Herbert, J. D., Rheingold, A. A., & Goldstein, S. G. (2002). Brief cognitive behavioral group therapy for social anxiety disorder. Cognitive and Behavioral Practice, 9(1), 1-8.
Jefferies, P., & Ungar, M. (2020). Social anxiety in young people: A prevalence study in seven countries. PloS one, 15(9), e0239133. doi: 10.1371/journal.pone.0239133
Khaleghi, N., Amiri, M., & Taheri, E. (2017). Effectiveness of group reality therapy on symptoms of social anxiety, interpretation bias and interpersonal relationships in adolescents. Journal of Fundamentals of Mental Health, 19(2).
Kocovski, N. L., Fleming, J. E., Hawley, L. L., Huta, V., & Antony, M. M. (2013). Mindfulness and acceptance-based group therapy versus traditional cognitive behavioral group therapy for social anxiety disorder: A randomized controlled trial. Behaviour research and therapy, 51(12), 889-898.
Lemon, C. A., Svob, C., Bonomo, Y., Dhungana, S., Supanya, S., Sittanomai, N., ... & Sartorius, N. (2024). Priorities for research promoting mental health in the south and east of Asia. The Lancet Regional Health-Southeast Asia, 23. DOI: 10.1016/j.lansea.2023.100287
Lepage, M., Bowie, C. R., Montreuil, T., Baer, L., du Sert, O. P., Lecomte, T., ... & Malla, A. K. (2023). Manualized group cognitive behavioral therapy for social anxiety in first-episode psychosis: a randomized controlled trial. Psychological Medicine, 53(8), 3335-3344.
Liu, X., Yi, P., Ma, L., Liu, W., Deng, W., Yang, X., ... & Li, X. (2021). Mindfulness-based interventions for social anxiety disorder: A systematic review and meta-analysis. Psychiatry research, 300, 113935. https://doi.org/10.1016/j.psychres.2021.113935
Massah, O., Farmani, F., Karimi, R., Karami, H., Hoseini, F., & Farhoudian, A. (2015). Group reality therapy in addicts rehabilitation process to reduce depression, anxiety and stress. Iranian Rehabilitation Journal, 13(1), 50-44.
Mayo-Wilson, E., Dias, S., Mavranezouli, I., Kew, K., Clark, D. M., Ades, A. E., & Pilling, S. (2014). Psychological and pharmacological interventions for social anxiety disorder in adults: a systematic review and network meta-analysis. The Lancet Psychiatry, 1(5), 368-376. DOI: 10.1016/S2215-0366(14)70329-3
McEvoy, P. M. (2007). Effectiveness of cognitive behavioural group therapy for social phobia in a community clinic: A benchmarking study. Behaviour research and therapy, 45(12), 3030-3040.
National Institute of Mental Health. (2016). Social Anxiety Disorder: More Than Just Shyness. National Institute of Health (NIH).
Neufeld, C. B., Palma, P. C., Caetano, K. A., Brust-Renck, P. G., Curtiss, J., & Hofmann, S. G. (2020). A randomized clinical trial of group and individual cognitive-behavioral therapy approaches for social anxiety disorder. International Journal of Clinical and Health Psychology, 20(1), 29-37.
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., ... & Moher, D. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. International journal of surgery, 88, 105906.
Schulz, A., Stolz, T., Vincent, A., Krieger, T., Andersson, G., & Berger, T. (2016). A sorrow shared is a sorrow halved? A three-arm randomized controlled trial comparing internet-based clinician-guided individual versus group treatment for social anxiety disorder. Behaviour Research and Therapy, 84, 14-26.
Stein, D. J., Lim, C. C., Roest, A. M., De Jonge, P., Aguilar-Gaxiola, S., Al-Hamzawi, A., ... & WHO World Mental Health Survey Collaborators. (2017). The cross-national epidemiology of social anxiety disorder: Data from the World Mental Health Survey Initiative. BMC medicine, 15, 1-21. DOI 10.1186/s12916-017-0889-2
Swasti, I. K., & Martani, W. (2013). Menurunkan kecemasan sosial melalui pemaknaan kisah hidup. Jurnal Psikologi, 40(1), 39-58.
The jamovi project (2022). jamovi. (Version 2.3) [Computer Software]. Retrieved from https://www.jamovi.org.
Toghiani, Z., Ghasemi, F., & Samouei, R. (2019). The effectiveness of acceptance and commitment group therapy on social anxiety in female dormitory residents in Isfahan university of medical sciences. Journal of education and health promotion, 8.
Wahdi, A. E., Setyawan, A., Putri, Y. A., Wilopo, S. A., Erskine, H. E., Wallis, K., ... & Blum, R. (2022). National Adolescent Mental Health Survey (I-NAMHS) Laporan Penelitian. Pusat Kesehatan Reproduksi: Jakarta, Indonesia.
Zaboski, B. A., Joyce‐Beaulieu, D., Kranzler, J. H., McNamara, J. P., Gayle, C., & MacInnes, J. (2019). Group exposure and response prevention for college students with social anxiety: A randomized clinical trial. Journal of Clinical Psychology, 75(9), 1489-1507.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Adinda Nasha Ayu Febrianthi, Ananta Yudiarso

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Authors who publish with this journal agree to the following terms:- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).