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Kothari, R., Barker, C., Pistrang, N., Rozental, A., Egan, S., Wade, T., . . . Shafran, R. (2019). A randomised controlled trial of guided internet-based cognitive behavioural therapy for perfectionism: Effects on psychopathology and transdiagnostic processes. Journal of Behavior Therapy and Experimental Psychiatry, 64, 113-122
Open this publication in new window or tab >>A randomised controlled trial of guided internet-based cognitive behavioural therapy for perfectionism: Effects on psychopathology and transdiagnostic processes
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2019 (English)In: Journal of Behavior Therapy and Experimental Psychiatry, ISSN 0005-7916, E-ISSN 1873-7943, Vol. 64, p. 113-122Article in journal (Refereed) Published
Abstract [en]

Background and objectives

Perfectionism is a transdiagnostic process that has been associated with a range of psychopathology and also with other transdiagnostic processes. We have previously shown that guided internet-based cognitive behavioural therapy (ICBT) can reduce symptoms of dysfunctional perfectionism, however, no impact was observed on symptoms of depression and anxiety. Here we explore the impact of guided ICBT for perfectionism on symptoms of other associated psychopathology, specifically obsessive-compulsive disorder (OCD) and eating disorders, and also on other associated transdiagnostic processes (self-esteem, intolerance of uncertainty, and self-compassion).

Methods

Participants who presented with clinical levels of perfectionism were randomised to an experimental group that received the intervention (n = 62), or a wait list control group (n = 58). Questionnaires assessing symptoms of OCD, eating disorders, self-esteem, intolerance of uncertainty, and fear of self-compassion were completed pre-intervention, post-intervention (12 weeks), and at follow-up (24 weeks). Between group effect sizes are reported.

Results

The intervention led to significant decreases in symptoms of OCD (d = −0.9; CI: -1.4, −0.4) and eating disorders (d = −0.6; CI: -1.0, −0.1), and had an impact on other transdiagnostic processes resulting in increased self-esteem (d = 0.7; CI: 0.2, 1.2), decreases in intolerance of uncertainty (d = −0.9; CI: -1.4, −0.4), and fear of self-compassion (d = −0.8; CI: -1.3, −0.3). At follow-up changes were maintained in symptoms of OCD (d = −1.3; CI: -1.8, −0.8), disordered eating (d = −0.7; CI: -1.2, −0.2), intolerance of uncertainty (d = −0.8; CI: -1.2, −0.3), and fear of self-compassion (d = −1.0; CI: -1.5, −0.5).

Conclusions

Guided ICBT for perfectionism improves associated psychopathology and transdiagnostic processes. ClinicalTrials.gov registration no. NCT02756871.

Place, publisher, year, edition, pages
Pergamon Press, 2019
Keywords
Perfectionism; Cognitive behavioural therapy; Online intervention; Guided self-help; Transdiagnostic; Randomised controlled trial; Self-esteem; Intolerance of uncertainty; Self-compassion; Obsessive-compulsive disorder; Eating disorder
National Category
Psychiatry
Identifiers
urn:nbn:se:liu:diva-158037 (URN)10.1016/j.jbtep.2019.03.007 (DOI)000469161400016 ()30981162 (PubMedID)2-s2.0-85064075585 (Scopus ID)
Available from: 2019-06-25 Created: 2019-06-25 Last updated: 2019-08-07Bibliographically approved
Miloff, A., Lindner, P., Dafgard, P., Deak, S., Garke, M., Hamilton, W., . . . Carlbring, P. (2019). Automated virtual reality exposure therapy for spider phobia vs. in-vivo one-session treatment: A randomized non-inferiority trial. Behaviour Research and Therapy, 118, 130-140
Open this publication in new window or tab >>Automated virtual reality exposure therapy for spider phobia vs. in-vivo one-session treatment: A randomized non-inferiority trial
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2019 (English)In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 118, p. 130-140Article in journal (Refereed) Published
Abstract [en]

Objective This study compared the efficacy of a technician-assisted single-session virtual reality exposure therapy (VRET) for the treatment of spider phobia featuring low-cost consumer-available hardware and novel automated software to gold-standard in-vivo one-session treatment (OST), using a parallel group randomized non-inferiority design.

Method Participants (N = 100) were randomized to VRET and OST arms. Assessors blinded to treatment allocation evaluated participants at pre- and post-treatment as well follow-up (3 and 12 months) using a behavioral approach test (BAT) and self-rated fear of spider, anxiety, depression and quality-of-life scales. A maximum post-treatment difference of 2-points on the BAT qualified as non-inferiority margin.

Results Linear mixed models noted large, significant reductions in behavioral avoidance and self-reported fear in both groups at post-treatment, with VRET approaching the strong treatment benefits of OST over time. Non-inferiority was identified at 3- and 12- months follow-up but was significantly worse until 12-months. There was no significant difference on a questionnaire measuring negative effects.

Conclusions Automated VRET efficaciously reduced spider phobia symptoms in the short-term and was non-inferior to in-vivo exposure therapy in the long-term. VRET effectiveness trials are warranted to evaluate real-world benefits and non-specific therapeutic factors accruing from the presence of a technician during treatment.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Exposure therapy; One-session treatment; Virtual reality; Spider phobia
National Category
Applied Psychology
Identifiers
urn:nbn:se:liu:diva-158843 (URN)10.1016/j.brat.2019.04.004 (DOI)000471738600014 ()31075675 (PubMedID)2-s2.0-85065126648 (Scopus ID)
Note

Funding Agencies|Swedish Government innovation agency Vinnova

Available from: 2019-07-16 Created: 2019-07-16 Last updated: 2019-08-13Bibliographically approved
Beukes, E. W., Manchaiah, V., Allen, P. M., Baguley, D. M. & Andersson, G. (2019). Internet-Based Interventions for Adults With Hearing Loss, Tinnitus, and Vestibular Disorders: A Systematic Review and Meta-Analysis. TRENDS IN HEARING, 23, Article ID 2331216519851749.
Open this publication in new window or tab >>Internet-Based Interventions for Adults With Hearing Loss, Tinnitus, and Vestibular Disorders: A Systematic Review and Meta-Analysis
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2019 (English)In: TRENDS IN HEARING, ISSN 2331-2165, Vol. 23, article id 2331216519851749Article, review/survey (Refereed) Published
Abstract [en]

Internet-based interventions have been developed to improve access to audiovestibular health care. This review aimed to identify outcomes of Internet interventions for adults with hearing loss, tinnitus, and vestibular disorders. Electronic databases and manual searches were performed to identify studies meeting eligibility for inclusion. Fifteen studies (1,811 participants) met the inclusion criteria, with nine studies targeting tinnitus distress, five considering hearing loss, and one for vestibular difficulties. Only the tinnitus and hearing loss Internet intervention studies were eligible for data synthesis. Internet-based interventions for hearing loss were diverse. Overall, they showed no significant effects, although a statistically significant moderate effect (d = 0.59) was found after removing the study with the highest risk of bias (as a result of high attrition). Most Internet-based interventions for tinnitus provided cognitive behavioural therapy. They yielded statistically significant mean effect sizes for reducing tinnitus distress compared with both inactive (d = 0.59) and active controls (d = 0.32). Significant effects were also present for the secondary outcomes of anxiety, depression, insomnia, and quality of life (combined effect d = 0.28). Only Internet-based interventions for tinnitus evaluated the 1-year postintervention effects indicated that results were maintained long term (d = 0.45). Scientific study quality was appraised using the Grading of Recommendations Assessment, Development and Evaluation approach and found to vary from very low to moderate. This review indicates the potential of Internet interventions for tinnitus to provide evidence-based accessible care. There is a need for additional high-quality evidence before conclusive results can be established regarding the effects of audiovestibular Internet interventions.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
Internet interventions; hearing loss; tinnitus; vestibular disorders; systematic review
National Category
Otorhinolaryngology
Identifiers
urn:nbn:se:liu:diva-159284 (URN)10.1177/2331216519851749 (DOI)000476759000001 ()31328660 (PubMedID)2-s2.0-85069792941 (Scopus ID)
Available from: 2019-08-07 Created: 2019-08-07 Last updated: 2019-08-16Bibliographically approved
Manchaiah, V., Abrams, H., Bailey, A. & Andersson, G. (2019). Negative Side Effects Associated with Hearing Aid Use in Adults with Hearing Loss. Journal of american academy of audiology, 30(6), 472-481
Open this publication in new window or tab >>Negative Side Effects Associated with Hearing Aid Use in Adults with Hearing Loss
2019 (English)In: Journal of american academy of audiology, ISSN 1050-0545, E-ISSN 2157-3107, Vol. 30, no 6, p. 472-481Article in journal (Refereed) Published
Abstract [en]

Background:

The low uptake of hearing aids in the United States has been attributed to a number of reasons, including low perceived hearing disability, limited perceived benefit and cost. Another possible reason may be related to negative side effects associated with hearing aid use.

Purpose:

The present study was aimed at determining and classifying the negative side effects associated with hearing aid use in adults with hearing loss.

Research Design:

The study used a cross-sectional survey design.

Study Sample:

Five hundred and twelve participants completed an electronic survey.

Data Collection and Analysis:

The data was collected using the negative side effects of hearing aids (NSE-HAs) questionnaire. Data were analyzed using Chi square analysis, principal components analysis, and calculation of Cronbach’s alpha.

Results:

Some individuals reported negative side effects for all 32 items. However, careful examination of results suggests that, as a whole, reported negative side effects tend to be mild with mean scores falling close to the lower quartile of the total scores. Chi square test results suggest that the variables of age, gender, duration of hearing loss, self-reported hearing disability, and duration of hearing aid use seem to be significantly associated with the reported negative side effects. The NSE-HAs questionnaire was found to have a complex structure as indicated by the principal components analysis. However, good internal consistency was found in both the full scale and subscales.

Conclusions:

The present study suggests that, although a large number of adults with hearing loss who use hearing aids experience some degree of negative side effects, those effects tend to be mild.

Place, publisher, year, edition, pages
Reston, VA, United States: American Academy of Audiology, 2019
Keywords
hearing aids; hearing loss; negative effects; side effects
National Category
Other Medical Sciences not elsewhere specified
Identifiers
urn:nbn:se:liu:diva-158989 (URN)10.3766/jaaa.17118 (DOI)000472684900004 ()30461414 (PubMedID)2-s2.0-85068618074 (Scopus ID)
Available from: 2019-07-19 Created: 2019-07-19 Last updated: 2019-08-21Bibliographically approved
Manchaiah, V., Dockens, A. L., Flagge, A., Bellon-Harn, M., Azios, J. H., Kelly-Campbell, R. J. & Andersson, G. (2019). Quality and Readability of English-Language Internet Information for Tinnitus. Journal of american academy of audiology, 30(1), 31-40
Open this publication in new window or tab >>Quality and Readability of English-Language Internet Information for Tinnitus
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2019 (English)In: Journal of american academy of audiology, ISSN 1050-0545, E-ISSN 2157-3107, Vol. 30, no 1, p. 31-40Article in journal (Refereed) Published
Abstract [en]

Background:

Because of the wealth of information available on the internet and increasing numbers of individuals relying on websites as a primary source of information for health-related questions, it is important that the readability of their content is within the comprehension level of most readers.

Objective:

The study evaluated the quality and readability of English-language Internet information for tinnitus.

Research Design:

Analysis of Internet websites on tinnitus.

Study Sample:

A total of 134 websites with tinnitus information.

Data Collection and Analysis:

Three key words (i.e., tinnitus, ringing in the ear, and buzzing in the ear) were entered in five country-specific versions of the most commonly used internet search engine in August 2016. For each of the 15 searches, the first 20 relevant websites were examined. After removing duplicates, a total of 134 websites were assessed. Their origin (commercial, nonprofit organization, government, personal, or university), quality (Health On the Net [HON] certification and DISCERN scores), and readability (Flesch Reading Ease score, Flesch-Kincaid Reading Grade Level Formula, and Simple Measure of Gobbledygook) were assessed.

Results:

Most websites were of commercial (49.3%) or nonprofit organization (38.8%) origin. Their quality and readability was highly variable. Only 13.5% of websites had HON certification. χ2 analysis showed that there was significant association between website origin and HON certification [χ2(4) = 132.9, p < 0.0001]. The mean DISCERN scores were 2.39. No association between DISCERN scores and website origin was found. Readability measures showed that on average, only people with at least 10‐12 yr of education could read and understand the internet information for tinnitus in websites. Almost all the websites exceeded the most stringent reading level recommended for health information.

Conclusions:

The results highlight great variability in the quality and readability of health information, specifically for tinnitus in the internet. These findings underscores the need for stakeholders (e.g., web-developers, clinicians) to be aware of this and to develop more user-friendly health information on websites to make it more accessible for people with low literacy.

Place, publisher, year, edition, pages
Reston, VA, United States: American Academy of Audiology, 2019
Keywords
health information quality; health information readability; internet health information; tinnitus
National Category
Other Medical Sciences not elsewhere specified
Identifiers
urn:nbn:se:liu:diva-158389 (URN)10.3766/jaaa.17070 (DOI)000467875800004 ()30461391 (PubMedID)2-s2.0-85059739595 (Scopus ID)
Available from: 2019-07-01 Created: 2019-07-01 Last updated: 2019-08-09Bibliographically approved
Lindner, P., Miloff, A., Fagernas, S., Andersen, J., Sigeman, M., Andersson, G., . . . Carlbring, P. (2019). Therapist-led and self-led one-session virtual reality exposure therapy for public speaking anxiety with consumer hardware and software: A randomized controlled trial (vol 61, pg 45, 2019). Journal of Anxiety Disorders, 64, 90-90
Open this publication in new window or tab >>Therapist-led and self-led one-session virtual reality exposure therapy for public speaking anxiety with consumer hardware and software: A randomized controlled trial (vol 61, pg 45, 2019)
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2019 (English)In: Journal of Anxiety Disorders, ISSN 0887-6185, E-ISSN 1873-7897, Vol. 64, p. 90-90Article in journal (Refereed) Published
Abstract [en]

n/a

Place, publisher, year, edition, pages
PERGAMON-ELSEVIER SCIENCE LTD, 2019
National Category
Basic Medicine
Identifiers
urn:nbn:se:liu:diva-158348 (URN)10.1016/j.janxdis.2019.04.002 (DOI)000469162700011 ()31003898 (PubMedID)2-s2.0-85064206518 (Scopus ID)
Available from: 2019-07-02 Created: 2019-07-02 Last updated: 2019-08-12Bibliographically approved
Vernmark, K., Hesser, H., Topooco, N., Berger, T., Riper, H., Luuk, L., . . . Andersson, G. (2019). Working alliance as a predictor of change in depression during blended cognitive behaviour therapy. Cognitive Behaviour Therapy, 48(4), 285-299
Open this publication in new window or tab >>Working alliance as a predictor of change in depression during blended cognitive behaviour therapy
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2019 (English)In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 48, no 4, p. 285-299Article in journal (Refereed) Published
Abstract [en]

Blended Cognitive Behaviour Therapy (bCBT) is a new form of treatment, mixing internet-based modules and face-to-face therapist sessions. How participants rate the therapeutic alliance in bCBT has not yet been thoroughly explored, and neither is it clear whether therapist- and patient-rated alliances are predictors of change in depression during treatment. Depression and alliance ratings from 73 participants in a treatment study on bCBT (part of the E-COMPARED project) were analysed using growth curve models. Alliance, as rated by both patients and therapists, was high. The therapist-rated working alliance was predictive of subsequent changes in depression scores during treatment, whereas the patient-rated alliance was not. A therapeutic alliance can be established in bCBT. The role of the therapist-rated alliance seems to be of particular importance and should be carefully considered when collecting data in future studies on bCBT.

Place, publisher, year, edition, pages
Routledge, 2019
Keywords
Therapeutic alliance; depression; blended treatment; internet-based treatment; growth models
National Category
Applied Psychology
Identifiers
urn:nbn:se:liu:diva-153321 (URN)10.1080/16506073.2018.1533577 (DOI)000470850800002 ()30372653 (PubMedID)
Funder
EU, FP7, Seventh Framework Programme, 603098
Note

We thank the E-COMPARED consortium forfinancialsupport.

Available from: 2018-12-12 Created: 2018-12-12 Last updated: 2019-07-15Bibliographically approved
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: 2018-12-12Bibliographically approved
Andersson, G. (2018). Internet interventions: Past, present and future. Internet Interventions, 12, 181-188
Open this publication in new window or tab >>Internet interventions: Past, present and future
2018 (English)In: Internet Interventions, ISSN 2214-7829, Vol. 12, p. 181-188Article in journal (Refereed) Published
Abstract [en]

Internet interventions have been around now for about 20 years. While the field still suffers from a scattered terminology a large number of programs and studies exist. In the present paper I present an overview of my experiences of studying internet-supported cognitive-behaviour therapy (ICBT), but also mention other approaches including the use of smartphones. The paper covers the history of ICBT, short-term effects in controlled trials for a range of conditions, long-term effects, comparisons against face-to-face therapy, effectiveness studies, prediction studies, how the treatment is perceived, critique, and finally future directions. I conclude that we have now reached a stage in which we have numerous evidence-based treatments and procedures, and increasingly internet interventions including ICBT are disseminated.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Anxiety, Internet treatment, Mood disorders, Somatic disorders, Therapist guidance
National Category
Applied Psychology
Identifiers
urn:nbn:se:liu:diva-151838 (URN)10.1016/j.invent.2018.03.008 (DOI)000457134800021 ()30135782 (PubMedID)2-s2.0-85045213909 (Scopus ID)
Available from: 2018-10-05 Created: 2018-10-05 Last updated: 2019-02-26Bibliographically approved
Beukes, E. W., Manchaiah, V., Baguley, D. M., Allen, P. M. & Andersson, G. (2018). Internet-based interventions for adults with hearing loss, tinnitus and vestibular disorders: a protocol for a systematic review. Systematic Reviews, 7(1), Article ID 205.
Open this publication in new window or tab >>Internet-based interventions for adults with hearing loss, tinnitus and vestibular disorders: a protocol for a systematic review
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2018 (English)In: Systematic Reviews, E-ISSN 2046-4053, Vol. 7, no 1, article id 205Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Internet-based interventions are emerging as an alternative way of delivering accessible healthcare for various conditions including hearing and balance disorders. A comprehensive review regarding the evidence-base of Internet-based interventions for auditory-related conditions is required to determine the existing evidence of their efficacy and effectiveness. The objective of the current protocol is to provide the methodology for a systematic review regarding the effects of Internet-based interventions for adults with hearing loss, tinnitus and vestibular disorders.

METHOD: This protocol was developed according to the Preferred Reporting Items for Systematic reviews and Meta-analyses for Protocols (PRISMA-P) 2015 guidelines. Electronic database searches will include EBSCOhost, PubMed and Cochrane Central Register performed by two researchers. This will be complemented by searching other resources such as the reference lists for included studies to identify studies meeting the eligibility for inclusion with regard to study designs, participants, interventions, comparators and outcomes. The Cochrane risk of bias tool (RoB 2) for randomised trials will be used for the bias assessments in the included studies. Criteria for conducting meta-analyses were defined.

DISCUSSION: The result of this systematic review will be of value to establish the effects of Internet-based interventions for hearing loss, tinnitus and vestibular disorders. This will be of importance to guide future planning of auditory intervention research and clinical services by healthcare providers, researchers, consumers and stakeholders.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018094801.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
Hearing loss, Internet interventions, Protocol, Self-help, Systematic review, Tinnitus, Vestibular disorders, eHealth
National Category
Psychology
Identifiers
urn:nbn:se:liu:diva-154954 (URN)10.1186/s13643-018-0880-9 (DOI)000451064600001 ()30470247 (PubMedID)2-s2.0-85057106707 (Scopus ID)
Available from: 2019-03-07 Created: 2019-03-07 Last updated: 2019-07-04Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-4753-6745

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