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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
Keyword
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
Keyword
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: 2018-04-10Bibliographically 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
Keyword
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)27892822 (PubMedID)2-s2.0-85006930893 (Scopus ID)
Available from: 2017-12-21 Created: 2017-12-21 Last updated: 2018-04-25Bibliographically 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
Keyword
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
Keyword
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: 2018-04-25Bibliographically 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).

Keyword
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
Zwerenz, R., Becker, J., Johansson, R., Frederick, R. J., Andersson, G. & Beutel, M. E. (2017). Transdiagnostic, Psychodynamic Web-Based Self-Help Intervention Following Inpatient Psychotherapy: Results of a Feasibility Study and Randomized Controlled Trial.. JMIR mental health, 4(4), Article ID e41.
Open this publication in new window or tab >>Transdiagnostic, Psychodynamic Web-Based Self-Help Intervention Following Inpatient Psychotherapy: Results of a Feasibility Study and Randomized Controlled Trial.
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2017 (English)In: JMIR mental health, ISSN 2368-7959, Vol. 4, no 4, article id e41Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Mental disorders have become a major health issue, and a substantial number of afflicted individuals do not get appropriate treatment. Web-based interventions are promising supplementary tools for improving health care for patients with mental disorders, as they can be delivered at low costs and used independently of time and location. Although psychodynamic treatments are used frequently in the face-to-face setting, there has been a paucity of studies on psychodynamic Web-based self-help interventions.

OBJECTIVE: The objective of this study was to determine the feasibility and preliminary efficacy of a transdiagnostic affect-focused psychodynamic Web-based self-help intervention designed to increase emotional competence of patients with mental disorders.

METHODS: A total of 82 psychotherapy inpatients with mixed diagnoses were randomized into two groups. Following discharge, the intervention group (IG) got access to a guided version of the intervention for 10 weeks. After a waiting period of 10 weeks, the wait-list control group (WLCG) got access to an unguided version of the intervention. We reported the assessments at the beginning (T0) and at the end of the intervention, resp. the waiting period (T1). The primary outcome was satisfaction with the treatment at T1. Secondary outcome measures included emotional competence, depression, anxiety, and quality of life. Statistical analyses were performed with descriptive statistics (primary outcome) and analysis of covariance; a repeated measurement analysis of variance was used for the secondary outcomes. Effect sizes were calculated using Cohen d and data were analyzed as per protocol, as well as intention-to-treat (ITT).

RESULTS: Patients were chronically ill, diagnosed with multiple diagnoses, most frequently with depression (84%, 58/69), anxiety (68%, 47/69), personality disorder (38%, 26/69), and depersonalization-derealization disorder (22%, 15/69). A majority of the patients (86%, 36/42) logged into the program, of which 86% (31/36) completed the first unit. Satisfaction with the units mastered was rated as good (52%, 16/31) and very good (26%, 9/31). However, there was a steady decline of participation over the course of the program; only 36% of the participants (13/36) participated throughout the trial completing at least 50% of the sessions. According to the ITT analysis, participants improved statistically significantly and with moderate effect sizes (Cohen d) compared with the WLCG regarding depression (d=0.60), quality of life (d=0.53), and emotional competence (d=0.49). Effects were considerably stronger for the completers with respect to depression (d=1.33), quality of life (d=0.83), emotional competence (d=0.68), and general anxiety (d=0.62).

CONCLUSIONS: Although overall program satisfaction and benefit of the program were favorable with respect to the indicators of emotional disorders, the rate of completion was low. Our findings point to the need to target the intervention more specifically to the needs and capabilities of participants and to the context of the intervention.

TRIAL REGISTRATION: Clinicaltrials.gov NCT02671929; https://clinicaltrials.gov/ct2/show/NCT02671929 (Archived by WebCite at http://www.webcitation.org/6ntWg1yWb).

Place, publisher, year, edition, pages
Toronto, Canada: J M I R Publications, Inc., 2017
Keyword
Internet, aftercare, clinical trial, emotion-focused therapy, inpatients, psychoanalytic psychotherapy
National Category
Applied Psychology
Identifiers
urn:nbn:se:liu:diva-143856 (URN)10.2196/mental.7889 (DOI)000414983000009 ()29038094 (PubMedID)
Available from: 2017-12-21 Created: 2017-12-21 Last updated: 2018-01-26Bibliographically approved
Andersson, G., Topooco, N., Havik, O. & Nordgreen, T. (2016). 6 Internet-supported versus face-to-face cognitive behavior therapy for depression. Expert Review of Neurotherapeutics, 16(1), 55-60
Open this publication in new window or tab >>6 Internet-supported versus face-to-face cognitive behavior therapy for depression
2016 (English)In: Expert Review of Neurotherapeutics, ISSN 1473-7175, E-ISSN 1744-8360, Vol. 16, no 1, p. 55-60Article, review/survey (Refereed) Published
Abstract [en]

Major depression and depressive symptoms are highly prevalent and there is a need for different forms of psychological treatments that can be delivered from a distance at a low cost. In the present review the authors contrast face-to-face and Internet-delivered cognitive behavior therapy (ICBT) for depression. A total of five studies are reviewed in which guided ICBT was directly compared against face-to-face CBT. Meta-analytic summary statistics were calculated for the five studies involving a total of 429 participants. The average effect size difference was Hedges g=0.12 (95% CI: -0.06-0.30) in the direction of favoring guided ICBT. The small difference in effect has no implication for clinical practice. The overall empirical status of clinician-guided ICBT for depression is commented on and future challenges are highlighted. Among these are developing treatments for patients with more severe and long-standing depression and for children, adolescents and the elderly. Also, there is a need to investigate mechanisms of change.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD, 2016
Keyword
Cognitive behavior therapy; depression; face-to-face treatment; Internet delivery; mood disorders
National Category
Basic Medicine
Identifiers
urn:nbn:se:liu:diva-125156 (URN)10.1586/14737175.2015.1125783 (DOI)000368642400001 ()26610160 (PubMedID)
Note

Funding Agencies|Swedish research council; Linkoping University; E-COMPARED project (EC)

Available from: 2016-02-15 Created: 2016-02-15 Last updated: 2018-01-10
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
Open this publication in new window or tab >>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.
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2016 (English)In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 84, p. 14-26Article in journal (Refereed) Published
Abstract [en]

A growing body of evidence suggests that internet-based cognitive behavioural treatments (ICBT) are effective to treat social anxiety disorder (SAD). Whereas the efficacy of clinician-guided ICBT has been established, ICBT in a group format has not yet been systematically investigated. This three-arm RCT compared the efficacy of clinician-guided group ICBT (GT) with clinician guided individual ICBT (IT) and a wait-list (WL). A total of 149 individuals meeting the diagnostic criteria for SAD were randomly assigned to one of three conditions. Primary endpoints were self-report measures of SAD and diagnostic status taken at baseline, after the twelve-week intervention and at six-month follow-up. Secondary endpoints were symptoms of depression, interpersonal problems and general symptomatology. At post-treatment, both active conditions showed superior outcome regarding SAD symptoms (GT vs. WL: d = 0.84-0.74; IT vs. WL: d = 0.94-1.22). The two active conditions did not differ significantly in symptom reduction (d = 0.12-0.26, all ps > 0.63), diagnostic response rate or attrition. Treatment gains were maintained at follow-up. The group format reduced weekly therapist time per participant by 71% (IT: 17 min, GT: 5 min). Findings indicate that a clinician-guided group format is a promising approach in treating SAD.

Place, publisher, year, edition, pages
Elsevier, 2016
Keyword
Internet treatment; ICBT; Social anxiety disorder; Guided self-help; Group therapy; Peer support; RCT
National Category
Psychology
Identifiers
urn:nbn:se:liu:diva-130823 (URN)10.1016/j.brat.2016.07.001 (DOI)000382411000003 ()27423374 (PubMedID)
Note

Funding agencies: Swiss National Science Foundation [PP00P1_144824/1]

Available from: 2016-08-26 Created: 2016-08-26 Last updated: 2017-11-28Bibliographically approved
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Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-4753-6745

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