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Topooco, N., Berg, M., Johansson, S., Liljethörn, L., Radvogin, E., Vlaescu, G., . . . Andersson, G. (2018). Chat- and internet-based cognitive-behavioural therapy in treatment of adolescent depression: randomised controlled trial. Bjpsych Open, 4(4), 199-207
Open this publication in new window or tab >>Chat- and internet-based cognitive-behavioural therapy in treatment of adolescent depression: randomised controlled trial
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2018 (English)In: Bjpsych Open, ISSN 2056-4724, Vol. 4, no 4, p. 199-207Article in journal (Refereed) Published
Abstract [en]

Background

Depression is a major contributor to the burden of disease in the adolescent population. Internet-based interventions can increase access to treatment.

Aims

To evaluate the efficacy of internet-based cognitive–behavioural therapy (iCBT), including therapist chat communication, in treatment of adolescent depression.

Method

Seventy adolescents, 15–19 years of age and presenting with depressive symptoms, were randomised to iCBT or attention control. The primary outcome was the Beck Depression Inventory II (BDI-II).

Results

Significant reductions in depressive symptoms were found, favouring iCBT over the control condition (F(1,67) = 6.18, P < 0.05). The between-group effect size was Cohen's d = 0.71 (95% CI 0.22–1.19). A significantly higher proportion of iCBT participants (42.4%) than controls (13.5%) showed a 50% decrease in BDI-II score post-treatment (P < 0.01). The improvement for the iCBT group was maintained at 6 months.

Conclusions

The intervention appears to effectively reduce symptoms of depression in adolescents and may be helpful in overcoming barriers to care among young people.

Declaration of interest

N.T. and G.A. designed the programme. N.T. authored the treatment material. The web platform used for treatment is owned by Linköping University and run on a non-for-profit basis. None of the authors receives any income from the programme.

Place, publisher, year, edition, pages
Cambridge University Press, 2018
Keywords
Cognitive–behavioural therapy, blended treatment, adolescent, depression, treatment gap, stigma, internet-based treatment, internet-supported, digital, iCBT
National Category
Psychiatry
Identifiers
urn:nbn:se:liu:diva-149803 (URN)10.1192/bjo.2018.18 (DOI)000436934800006 ()29988969 (PubMedID)
Available from: 2018-07-25 Created: 2018-07-25 Last updated: 2018-08-14Bibliographically approved
Carlbring, P., Andersson, G., Cuijpers, P., Riper, H. & Hedman-Lagerlöf, E. (2018). Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: an updated systematic review and meta-analysis. Cognitive Behaviour Therapy, 47(1), 1-18
Open this publication in new window or tab >>Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: an updated systematic review and meta-analysis
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2018 (English)In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 47, no 1, p. 1-18Article, review/survey (Refereed) Published
Abstract [en]

During the last two decades, Internet-delivered cognitive behavior therapy (ICBT) has been tested in hundreds of randomized controlled trials, often with promising results. However, the control groups were often waitlisted, care-as-usual or attention control. Hence, little is known about the relative efficacy of ICBT as compared to face-to-face cognitive behavior therapy (CBT). In the present systematic review and meta-analysis, which included 1418 participants, guided ICBT for psychiatric and somatic conditions were directly compared to face-to-face CBT within the same trial. Out of the 2078 articles screened, a total of 20 studies met all inclusion criteria. Results showed a pooled effect size at post-treatment of Hedges g = .05 (95% CI, -.09 to .20), indicating that ICBT and face-to-face treatment produced equivalent overall effects. Study quality did not affect outcomes. While the overall results indicate equivalence, there have been few studies of the individual psychiatric and somatic conditions so far, and for the majority, guided ICBT has not been compared against face-to-face treatment. Thus, more research, preferably with larger sample sizes, is needed to establish the general equivalence of the two treatment formats.

Place, publisher, year, edition, pages
Routledge, 2018
Keywords
Guided internet-delivered cognitive behavior therapy, anxiety and mood disorders, face-to-face therapy, meta-analysis, somatic disorders
National Category
Applied Psychology
Identifiers
urn:nbn:se:liu:diva-143848 (URN)10.1080/16506073.2017.1401115 (DOI)000419952900001 ()29215315 (PubMedID)2-s2.0-85037730265 (Scopus ID)
Available from: 2017-12-21 Created: 2017-12-21 Last updated: 2018-01-29Bibliographically approved
Lundgren, O., Garvin, P., Andersson, G., Jonasson, L. & Kristenson, M. (2018). Inverted items and validity: A psychobiological evaluation of two measures of psychological resources and one depression scale. Health psychology open, 5(1), Article ID 2055102918755045.
Open this publication in new window or tab >>Inverted items and validity: A psychobiological evaluation of two measures of psychological resources and one depression scale
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2018 (English)In: Health psychology open, ISSN 2055-1029, Vol. 5, no 1, article id 2055102918755045Article in journal (Refereed) Published
Abstract [en]

Psychological resources and risk factors influence risk of coronary heart disease. We evaluated whether inverted items in the Self-esteem, Mastery, and Center for Epidemiological Studies Depression scales compromise validity in the context of coronary heart disease. In a population-based sample, validity was investigated by calculating correlations with other scales (n = 1004) and interleukin-6 (n = 374), and by analyzing the relationship with 8-year coronary heart disease risk (n = 1000). Negative items did not affect the validity of the resource scales. In contrast, positive items from Center for Epidemiological Studies Depression showed no significant relationships with biological variables. However, they had no major impact on the validity of the original scale.

Place, publisher, year, edition, pages
Sage Publications, 2018
Keywords
coronary heart disease, depressiveness, interleukin-6, mastery, self-esteem, wording effect
National Category
General Practice
Identifiers
urn:nbn:se:liu:diva-146087 (URN)10.1177/2055102918755045 (DOI)29479456 (PubMedID)
Available from: 2018-03-27 Created: 2018-03-27 Last updated: 2018-06-08Bibliographically approved
Kues, J. N., Janda, C., Krzikalla, C., Andersson, G. & Weise, C. (2018). The effect of manipulated information about premenstrual changes on the report of positive and negative premenstrual changes.. Women & health, 58(1), 16-37
Open this publication in new window or tab >>The effect of manipulated information about premenstrual changes on the report of positive and negative premenstrual changes.
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2018 (English)In: Women & health, ISSN 0363-0242, E-ISSN 1541-0331, Vol. 58, no 1, p. 16-37Article in journal (Refereed) Published
Abstract [en]

Although women predominantly report negative premenstrual changes, a substantial portion of women also reports positive changes. Little is known about factors related to report of positive and negative premenstrual changes. The aim of this experimental study at the Philipps-University of Marburg from January and February 2015 was to investigate the effect of manipulated information about premenstrual changes on the retrospective report of premenstrual changes. A total of 241 healthy women were randomly assigned either to an experimental group (EG) reading: (1) text focusing on negative and positive premenstrual changes (EG1 (+/-)); (2) text focusing on negative changes (EG2 (-)); or (3) control group (CG) text. At least one positive premenstrual change was reported by the majority of the participating women. The results of the MANOVA and discriminant analysis showed that, after having read the text, EG2 (-) reported more negative and fewer positive premenstrual changes in a retrospective screening compared to EG1 (+/-) and CG. No significant difference was observed between EG1 (+/-) and CG. The results show the negative influence of information focusing on negative premenstrual changes on the retrospective report of both negative and positive premenstrual changes.

Place, publisher, year, edition, pages
Routledge, 2018
Keywords
Expectations, information, menstruation, positive premenstrual changes, premenstrual syndrome
National Category
Applied Psychology
Identifiers
urn:nbn:se:liu:diva-143854 (URN)10.1080/03630242.2016.1263274 (DOI)000428206400002 ()27892822 (PubMedID)2-s2.0-85006930893 (Scopus ID)
Available from: 2017-12-21 Created: 2017-12-21 Last updated: 2018-05-15Bibliographically approved
Nordgreen, T., Gjestad, R., Andersson, G., Carlbring, P. & Havik, O. E. (2018). The implementation of guided Internet-based cognitive behaviour therapy for panic disorder in a routine-care setting: effectiveness and implementation efforts. Cognitive Behaviour Therapy, 47(1), 62-75
Open this publication in new window or tab >>The implementation of guided Internet-based cognitive behaviour therapy for panic disorder in a routine-care setting: effectiveness and implementation efforts
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2018 (English)In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 47, no 1, p. 62-75Article in journal (Refereed) Published
Abstract [en]

Panic disorder is a common mental disorder. Guided Internet-based cognitive behavioural therapy (Guided Internet-based cognitive behaviour therapy (ICBT)) is a promising approach to reach more people in need of help. In the present effectiveness study, we investigated the outcome of guided ICBT for panic disorder after implementation in routine care. A total of 124 patients were included in the study, of which 114 started the treatment. Large within-group effect sizes were observed on the primary panic disorder symptoms (post-treatment: d = 1.24; 6-month follow-up: d = 1.39) and moderate and large effects on secondary panic disorder symptoms and depressive symptoms at post-treatment and follow-up (d = .55-1.13). More than half (56.1%) of the patients who started treatment recovered or improved at post-treatment. Among treatment takers (completed at least five of the nine modules), 69.9% recovered or improved. The effectiveness reported in the present trial is in line with previous effectiveness and efficacy trials of guided ICBT for panic disorder. This provides additional support for guided ICBT as a treatment alternative in routine care.

Place, publisher, year, edition, pages
Routledge, 2018
Keywords
Panic disorder, cognitive behavioural therapy, effectiveness, guided Internet-based treatment, implementation
National Category
Applied Psychology
Identifiers
urn:nbn:se:liu:diva-143853 (URN)10.1080/16506073.2017.1348389 (DOI)000419952900005 ()28714775 (PubMedID)2-s2.0-85024385408 (Scopus ID)
Available from: 2017-12-21 Created: 2017-12-21 Last updated: 2018-01-29Bibliographically approved
Rozental, A., Forsström, D., Lindner, P., Nilsson, S., Mårtensson, L., Rizzo, A., . . . Carlbring, P. (2018). Treating Procrastination Using Cognitive Behavior Therapy: A Pragmatic Randomized Controlled Trial Comparing Treatment Delivered via the Internet or in Groups.. Behavior Therapy, 49(2), 180-197
Open this publication in new window or tab >>Treating Procrastination Using Cognitive Behavior Therapy: A Pragmatic Randomized Controlled Trial Comparing Treatment Delivered via the Internet or in Groups.
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2018 (English)In: Behavior Therapy, ISSN 0005-7894, E-ISSN 1878-1888, Vol. 49, no 2, p. 180-197Article in journal (Refereed) Published
Abstract [en]

Procrastination is a common problem among university students, with at least half of the population reporting great difficulties initiating or completing tasks and assignments. Procrastination can have a negative impact on course grades and the ability to achieve a university degree, but can also lead to psychological distress. Cognitive behavior therapy (CBT) is believed to reduce procrastination, but few studies have investigated its effectiveness in a regular clinical setting. The current study explored its effects using a pragmatic randomized controlled trial comparing treatment delivered during 8 weeks as self-guided CBT via the Internet (ICBT) or as group CBT. In total, 92 university students with severe procrastination were included in the study (registered as a clinical trial on Clinicaltrials.gov: NCT02112383). Outcome measures on procrastination, depression, anxiety, and well-being were distributed at pre- and posttreatment as well as 6-month follow-up. An outcome measure of procrastination was administered weekly. Linear mixed and fixed effects models were calculated, along with improvement and deterioration rates. The results showed large within-group effect sizes on procrastination, Cohen's d of 1.29 for ICBT, 95% Confidence Interval (CI) [0.81, 1.74], and d of 1.24 for group CBT, 95% CI [0.76, 1.70], and small to moderate benefits for depression, anxiety, and well-being. In total, 33.7% were regarded as improved at posttreatment and 46.7% at follow-up. No differences between conditions were observed after the treatment period, however, participants in group CBT continued or maintained their improvement at follow-up, while participants in self-guided ICBT showed some signs of deterioration. The findings from the current study suggest that CBT might be an effective treatment for those struggling with severe procrastination, but that a group format may be better for some to sustain their benefits over time and that the clinical significance of the results need to be investigated further.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
cognitive behavior therapy, group therapy, internet interventions, procrastination
National Category
Applied Psychology
Identifiers
urn:nbn:se:liu:diva-146086 (URN)10.1016/j.beth.2017.08.002 (DOI)000429632800003 ()29530258 (PubMedID)2-s2.0-85028705317 (Scopus ID)
Note

Funding agencies: Linkoping University

Available from: 2018-03-27 Created: 2018-03-27 Last updated: 2018-04-26Bibliographically approved
Ly, K. H., Ly, A.-M. & Andersson, G. (2017). A fully automated conversational agent for promoting mental well-being: A pilot RCT using mixed methods. Internet Interventions, 10, 39-46
Open this publication in new window or tab >>A fully automated conversational agent for promoting mental well-being: A pilot RCT using mixed methods
2017 (English)In: Internet Interventions, ISSN 2214-7829, Vol. 10, p. 39-46Article in journal (Refereed) Published
Abstract [en]

Fully automated self-help interventions can serve as highly cost-effective mental health promotion tools for massive amounts of people. However, these interventions are often characterised by poor adherence. One way to address this problem is to mimic therapy support by a conversational agent. The objectives of this study were to assess the effectiveness and adherence of a smartphone app, delivering strategies used in positive psychology and CBT interventions via an automated chatbot (Shim) for a non-clinical population — as well as to explore participants views and experiences of interacting with this chatbot. A total of 28 participants were randomized to either receive the chatbot intervention (n = 14) or to a wait-list control group (n = 14). Findings revealed that participants who adhered to the intervention (n = 13) showed significant interaction effects of group and time on psychological well-being (FS) and perceived stress (PSS-10) compared to the wait-list control group, with small to large between effect sizes (Cohens d range 0.14–1.06). Also, the participants showed high engagement during the 2-week long intervention, with an average open app ratio of 17.71 times for the whole period. This is higher compared to other studies on fully automated interventions claiming to be highly engaging, such as Woebot and the Panoply app. The qualitative data revealed sub-themes which, to our knowledge, have not been found previously, such as the moderating format of the chatbot. The results of this study, in particular the good adherence rate, validated the usefulness of replicating this study in the future with a larger sample size and an active control group. This is important, as the search for fully automated, yet highly engaging and effective digital self-help interventions for promoting mental health is crucial for the public health. © 2017 The Authors

Place, publisher, year, edition, pages
Elsevier, 2017
National Category
Psychiatry
Identifiers
urn:nbn:se:liu:diva-146974 (URN)10.1016/j.invent.2017.10.002 (DOI)2-s2.0-85032031216 (Scopus ID)
Available from: 2018-04-09 Created: 2018-04-09 Last updated: 2018-04-09
Janda, C., Kues, J. N., Andersson, G., Kleinstäuber, M. & Weise, C. (2017). A symptom diary to assess severe premenstrual syndrome and premenstrual dysphoric disorder. Women & health, 57(7), 837-854
Open this publication in new window or tab >>A symptom diary to assess severe premenstrual syndrome and premenstrual dysphoric disorder
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2017 (English)In: Women & health, ISSN 0363-0242, E-ISSN 1541-0331, Vol. 57, no 7, p. 837-854Article in journal (Refereed) Published
Abstract [en]

The differentiation between premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) has been widely discussed. PMDD is listed as a mental disorder in the DSM-5, whereas PMS is not considered as a mental disorder in any diagnostic manual. Consequently, PMS is operationalized in different ways. Keeping a symptom diary is required to diagnose PMDD but is also recommended for PMS. The aim of our study was, therefore, to operationalize PMS and PMDD within a DSM-5-based symptom diary. We developed a symptom-intensity-score (SI-score) and an interference-score (INT-score) to evaluate the symptom diary. Ninety-eight women (aged 20-45 years) completed a symptom diary over two menstrual cycles, a retrospective screening for premenstrual symptoms, and answered additional impairment questionnaires from August 2013 to August 2015. The scores revealed moderate to good reliability (Cronbachs a = 0.83-0.96). Convergent validity was shown by significant correlations with a retrospective screening, the Pain Disability Index, and the German PMS-Impact Questionnaire. Discriminant validity was indicated by low correlations with the Big Five Inventory-10. These scores may facilitate the evaluation of prospective symptom ratings in research and clinical practice. Future research should focus on continuing to validate the scores (e.g., in an ambulatory setting).

Keywords
DSM-5; menstrual cycle; premenstrual dysphoric disorder (PMDD); premenstrual syndrome (PMS); psychological diagnostics; symptom diary
National Category
Psychology
Identifiers
urn:nbn:se:liu:diva-146317 (URN)10.1080/03630242.2016.1206055 (DOI)000407790600006 ()27355449 (PubMedID)
Available from: 2018-04-07 Created: 2018-04-07 Last updated: 2018-04-25
Topooco, N., Riper, H., Araya, R., Berking, M., Brunn, M., Chevreul, K., . . . Andersson, G. (2017). Attitudes towards digital treatment for depression: A European stakeholder survey. Internet Interventions, 8
Open this publication in new window or tab >>Attitudes towards digital treatment for depression: A European stakeholder survey
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2017 (English)In: Internet Interventions, ISSN 2214-7829, Vol. 8Article in journal (Refereed) Published
Abstract [en]

Background The integration of digital treatments into national mental health services is on the agenda in the European Union. The E-COMPARED consortium conducted a survey aimed at exploring stakeholders’ knowledge, acceptance and expectations of digital treatments for depression, and at identifying factors that might influence their opinions when considering the implementation of these approaches. Method An online survey was conducted in eight European countries: France, Germany, Netherlands, Poland, Spain, Sweden, Switzerland and The United Kingdom. Organisations representing government bodies, care providers, service-users, funding/insurance bodies, technical developers and researchers were invited to participate in the survey. The participating countries and organisations reflect the diversity in health care infrastructures and e-health implementation across Europe. Results A total of 764 organisations were invited to the survey during the period March–June 2014, with 175 of these organisations participating in our survey. The participating stakeholders reported moderate knowledge of digital treatments and considered cost-effectiveness to be the primary incentive for integration into care services. Low feasibility of delivery within existing care services was considered to be a primary barrier. Digital treatments were regarded more suitable for milder forms of depression. Stakeholders showed greater acceptability towards blended treatment (the integration of face-to-face and internet sessions within the same treatment protocol) compared to standalone internet treatments. Organisations in countries with developed e-health solutions reported greater knowledge and acceptability of digital treatments. Conclusion Mental health stakeholders in Europe are aware of the potential benefits of digital interventions. However, there are variations between countries and stakeholders in terms of level of knowledge about such interventions and their feasibility within routine care services. The high acceptance of blended treatments is an interesting finding that indicates a gradual integration of technology into clinical practice may fit the attitudes and needs of stakeholders. The potential of the blended treatment approach, in terms of enhancing acceptance of digital treatment while retaining the benefit of cost-effectiveness in delivery, should be further explored. Funding The E-COMPARED project has received funding from the European Union Seventh Framework Programme (FP7/2007–2013) under grant agreement no. 603098. © 2017 The Authors

Place, publisher, year, edition, pages
Elsevier, 2017
Keywords
Blended treatment; Comparative effectiveness research; Depression; Digital treatment; E-mental health; Internet-delivered
National Category
Psychiatry
Identifiers
urn:nbn:se:liu:diva-146995 (URN)10.1016/j.invent.2017.01.001 (DOI)2-s2.0-85013828524 (Scopus ID)
Note

Funding Agencies|603098, FP7, Seventh Framework Programme

Available from: 2018-05-01 Created: 2018-05-01 Last updated: 2018-05-24
Jakobsen, H., Andersson, G., Havik, O. & Nordgreen, T. (2017). Guided Internet-based cognitive behavioral therapy for mild and moderate depression: A benchmarking study. Internet Interventions, 7
Open this publication in new window or tab >>Guided Internet-based cognitive behavioral therapy for mild and moderate depression: A benchmarking study
2017 (English)In: Internet Interventions, ISSN 2214-7829, Vol. 7Article in journal (Refereed) Published
Abstract [en]

Major depression is among the most common and debilitating disorders worldwide, associated with large societal and individual costs. Effective treatments exist, but accessibility is scarce. Guided Internet-Based Cognitive Behavioral Therapy (guided iCBT) is a promising approach to reach more people in need of help. In the present pilot study, we investigated the outcome of a guided iCBT program for mild and moderate depression when disseminated from Sweden to Norway. The guided iCBT intervention was implemented within a university-based outpatient clinic by six student therapists under supervision. Twenty-two participants with mild and moderate depression were included in the study. Large treatment effects were found for depressive symptoms, whereas small to medium effects were observed for anxiety symptoms. More than half (55%) of the participants were classified as recovered at post-treatment and more than a third (41%) at follow-up. No participants had a significant deterioration from pre- to post-treatment, but two reported a significant deterioration from post-treatment to 6-month follow-up. Benchmarking the present results against those reported in the four original Swedish studies, we found that the treatment effect in the Norwegian study was slightly higher at post-treatment and slightly lower at 6-month follow-up compared to the outcome in the Swedish studies. The results should be interpreted with caution, as our sample was small and had no control group. � 2016 The Authors

Place, publisher, year, edition, pages
Elsevier B.V., 2017
Keywords
Cognitive behavioral therapy; Guided internet-based treatment; Mild and moderate depression; Self-help
National Category
Psychiatry
Identifiers
urn:nbn:se:liu:diva-147011 (URN)10.1016/j.invent.2016.11.002 (DOI)2-s2.0-84998631489 (Scopus ID)
Available from: 2018-05-01 Created: 2018-05-01 Last updated: 2018-05-01
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-4753-6745

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