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Santoft, F., Salomonsson, S., Hesser, H., Lindsater, E., Ljotsson, B., Lekander, M., . . . Hedman-Lagerlof, E. (2019). Mediators of Change in Cognitive Behavior Therapy for Clinical Burnout. Behavior Therapy, 50(3), 475-488
Open this publication in new window or tab >>Mediators of Change in Cognitive Behavior Therapy for Clinical Burnout
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2019 (English)In: Behavior Therapy, ISSN 0005-7894, E-ISSN 1878-1888, Vol. 50, no 3, p. 475-488Article in journal (Refereed) Published
Abstract [en]

Evidence supporting the effectiveness of cognitive behavior therapy (CBT) for stress-related illness is growing, but little is known about its mechanisms of change. The aim of this study was to investigate potential mediators of CBT for severe stress in form of clinical burnout, using an active psychological treatment as comparator. We used linear mixed models to analyze data from patients (N = 82) with clinical burnout who received either CBT or another psychological treatment in a randomized controlled trial. Potential mediators (i.e., sleep quality, behavioral activation, perceived competence, and therapeutic alliance) and outcome (i.e., symptoms of burnout) were assessed weekly during treatment. The results showed that the positive treatment effects on symptoms of burnout favoring CBT (estimated between-group d = 0.93) were mediated by improvements in sleep quality, ab = -0.017,95% CIasymmetric [-0.037, -0.002], and increase in perceived competence, ab = -0.037, 95% CIasymmetric [-0.070, -0.010]. Behavioral activation, ab = -0.004 [-0.016, 0.007], and therapeutic alliance, ab = 0.002 [-0.006, 0.011], did not significantly mediate the difference in effects between the treatments. Improving sleep quality and increasing perceived competence may thus constitute important process goals in order to attain symptom reduction in CBT for clinical burnout.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
clinical burnout; cognitive behavior therapy; exhaustion disorder; mediation
National Category
Applied Psychology
Identifiers
urn:nbn:se:liu:diva-157533 (URN)10.1016/j.beth.2018.08.005 (DOI)000467663600001 ()31030867 (PubMedID)2-s2.0-85053921900 (Scopus ID)
Note

Funding Agencies|Karolinska Institutet; Stockholm County Council

Available from: 2019-06-23 Created: 2019-06-23 Last updated: 2019-06-26Bibliographically 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
Hadjistavropoulos, H. D., Pugh, N. E., Hesser, H. & Andersson, G. (2016). Predicting Response to Therapist-Assisted Internet-Delivered Cognitive Behavior Therapy for Depression or Anxiety Within an Open Dissemination Trial. Behavior Therapy, 47(2), 155-165
Open this publication in new window or tab >>Predicting Response to Therapist-Assisted Internet-Delivered Cognitive Behavior Therapy for Depression or Anxiety Within an Open Dissemination Trial
2016 (English)In: Behavior Therapy, ISSN 0005-7894, E-ISSN 1878-1888, Vol. 47, no 2, p. 155-165Article in journal (Refereed) Published
Abstract [en]

Therapist-assisted Internet-delivered cognitive behavior therapy (ICBT) is efficacious for treating anxiety and depression, but predictors of response to treatment when delivered in clinical practice are not well understood. In this study, we explored demographic, clinical, and program variables that predicted modules started and symptom improvement (i.e., Generalized Anxiety Disorder-7 or Patient Health Questionnaire-9 total scores over pre-, mid-, and posttreatment) within a previously published open dissemination trial (Hadjistavropoulos et al., 2014). The sample consisted of 195 patients offered 12 modules of therapist-assisted ICBT for depression or generalized anxiety; ICBT was delivered by therapists working in six geographically dispersed clinics. Consistent across ICBT for depression or generalized anxiety, starting fewer modules was associated with more phone calls from therapists reflecting that therapists tended to call patients who did not start modules as scheduled. Also consistent for both ICBT programs, greater pretreatment condition severity and completion of more modules was associated with superior ICBT-derived benefit. Other predictors of response to treatment varied across the two programs. Younger age, lower education, taking psychotropic medication, being in receipt of psychiatric care and lower comfort with written communication were associated with either fewer program starts or lower symptom improvement in one of the two programs. It is concluded that monitoring response to ICBT may be particularly important in patients with these characteristics. Research directions for identifying patients who are less likely to benefit from ICBT are discussed.

Place, publisher, year, edition, pages
Elsevier, 2016
Keywords
depression; generalized anxiety; Internet-delivered; cognitive behavior therapy
National Category
Basic Medicine
Identifiers
urn:nbn:se:liu:diva-127441 (URN)10.1016/j.beth.2015.10.006 (DOI)000372665700002 ()26956649 (PubMedID)
Note

Funding Agencies|Canadian Institutes of Health Research [101526]; Saskatchewan Health Research Foundation

Available from: 2016-05-01 Created: 2016-04-26 Last updated: 2018-12-12Bibliographically approved
Kemani, M., Hesser, H., Olsson, G., Lekander, M. & Wicksell, R. (2016). Processes of change in Acceptance and Commitment Therapy and Applied Relaxation for longstanding pain. Paper presented at the 9th Congress of the European Pain Federation, September, EFIC, Vienna, Austria. European Journal of Pain, 20(4), 521-531
Open this publication in new window or tab >>Processes of change in Acceptance and Commitment Therapy and Applied Relaxation for longstanding pain
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2016 (English)In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 20, no 4, p. 521-531Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

The utility of cognitive behavioural (CB) interventions for chronic pain has been supported in numerous studies. This includes Acceptance and Commitment Therapy (ACT), which has gained increased empirical support. Previous research suggests that improvements in pain catastrophizing and psychological inflexibility are related to improvements in treatment outcome in this type of treatment. Although a few studies have evaluated processes of change in CB-interventions, there is a particular need for mediation analyses that use multiple assessments to model change in mediators and outcome over time, and that incorporate the specified timeline between mediator and outcome in the data analytic model.

METHODS:

This study used session-to-session assessments to evaluate if psychological inflexibility, catastrophizing, and pain intensity mediated the effects of treatment on pain interference. Analyses were based on data from a previously conducted randomized controlled trial (n = 60) evaluating the efficacy of ACT and Applied Relaxation (AR). A moderated mediation model based on linear mixed models was used to analyse the data.

RESULTS:

Neither catastrophizing nor pain intensity mediated changes in pain interference for any of the treatments. In contrast, psychological inflexibility mediated effects on outcome in ACT but not in AR.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2016
National Category
Applied Psychology
Identifiers
urn:nbn:se:liu:diva-123652 (URN)10.1002/ejp.754 (DOI)000372516800004 ()26684472 (PubMedID)
Conference
the 9th Congress of the European Pain Federation, September, EFIC, Vienna, Austria
Note

Funding agencies: Department of Psychology at the Karolinska University Hospital, Stockholm; Stockholm City Council; Karolinska Institutet

Available from: 2016-01-05 Created: 2016-01-05 Last updated: 2018-12-12
Hesser, H., Bånkestad, E. & Andersson, G. (2015). Acceptance of Tinnitus As an Independent Correlate of Tinnitus Severity. Ear and Hearing, 36(4), e176-e182
Open this publication in new window or tab >>Acceptance of Tinnitus As an Independent Correlate of Tinnitus Severity
2015 (English)In: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, Vol. 36, no 4, p. e176-e182Article in journal (Refereed) Published
Abstract [en]

Objectives: Tinnitus is the experience of sounds without an identified external source, and for some the experience is associated with significant severity (i.e., perceived negative affect, activity limitation, and participation restriction due to tinnitus). Acceptance of tinnitus has recently been proposed to play an important role in explaining heterogeneity in tinnitus severity. The purpose of the present study was to extend previous investigations of acceptance in relation to tinnitus by examining the unique contribution of acceptance in accounting for tinnitus severity, beyond anxiety and depression symptoms. Design: In a cross-sectional study, 362 participants with tinnitus attending an ENT clinic in Sweden completed a standard set of psychometrically examined measures of acceptance of tinnitus, tinnitus severity, and anxiety and depression symptoms. Participants also completed a background form on which they provided information about the experience of tinnitus (loudness, localization, sound characteristics), other auditory-related problems (hearing problems and sound sensitivity), and personal characteristics. Results: Correlational analyses showed that acceptance was strongly and inversely related to tinnitus severity and anxiety and depression symptoms. Multivariate regression analysis, in which relevant patient characteristics were controlled, revealed that acceptance accounted for unique variance beyond anxiety and depression symptoms. Acceptance accounted for more of the variance than anxiety and depression symptoms combined. In addition, mediation analysis revealed that acceptance of tinnitus mediated the direct association between self-rated loudness and tinnitus severity, even after anxiety and depression symptoms were taken into account. Conclusions: Findings add to the growing body of work, supporting the unique and important role of acceptance in tinnitus severity. The utility of the concept is discussed in relation to the development of new psychological models and interventions for tinnitus severity.

Place, publisher, year, edition, pages
Lippincott, Williams and Wilkins, 2015
Keywords
Acceptance; Anxiety; Avoidance; Depression; Tinnitus disability
National Category
Basic Medicine
Identifiers
urn:nbn:se:liu:diva-120277 (URN)10.1097/AUD.0000000000000148 (DOI)000357266500005 ()25665072 (PubMedID)
Available from: 2015-07-24 Created: 2015-07-24 Last updated: 2018-12-12
Weineland, S., Andersson, G., Lunner, T., Carlbring, P., Hesser, H., Ingo, E., . . . Laplante-Lévesque, A. (2015). Bridging the Gap Between Hearing Screening and Successful Rehabilitation: Research Protocol of a Randomized Controlled Trial of Motivational Interviewing via Internet. American Journal of Audiology, 24(3), 302-306
Open this publication in new window or tab >>Bridging the Gap Between Hearing Screening and Successful Rehabilitation: Research Protocol of a Randomized Controlled Trial of Motivational Interviewing via Internet
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2015 (English)In: American Journal of Audiology, ISSN 1059-0889, E-ISSN 1558-9137, Vol. 24, no 3, p. 302-306Article in journal (Refereed) Published
Abstract [en]

Purpose: Studies point to low help-seeking after a failed hearing screening. This research forum article presents the research protocol for a randomized controlled trial of motivational interviewing via the Internet to promote help-seeking in people who have failed an online hearing screening. Method: Adults who fail a Swedish online hearing screening, including a speech-in-noise recognition test, will be randomized to either an intervention group (participating in motivational interviewing) or an active control group (reading a book on history of hearing aids). Both of the conditions will be delivered via the Internet. The primary outcome is experience with seeking health care and using hearing aids 9 months after the intervention. Secondary outcomes are changes in before and after measures of self-reported hearing difficulties, anxiety, depression, and quality of life. Stages of change and self-efficacy in hearing help-seeking are measured immediately after intervention and at a 9-month follow-up for the purpose of mediation analysis. Results: The results of this randomized controlled trial may help bridge the gap between hearing screening and successful hearing rehabilitation. Conclusion: Although no large instantaneous benefits are expected, a slow change toward healthy behaviors-seeking health care and using hearing aids-would shed light on how to use the Internet to assist people with hearing impairment.

Place, publisher, year, edition, pages
AMER SPEECH-LANGUAGE-HEARING ASSOC, 2015
National Category
Applied Psychology Psychology (excluding Applied Psychology)
Identifiers
urn:nbn:se:liu:diva-123081 (URN)10.1044/2015_AJA-15-0012 (DOI)000364315200009 ()
Note

Funding Agencies|Swedish Council for Wealth, Working Life and Welfare (FORTE) [2009-0055]

Available from: 2015-12-03 Created: 2015-12-03 Last updated: 2019-06-28
El Alaoui, S., Hedman, E., Kaldo, V., Hesser, H., Kraepelien, M., Andersson, E., . . . Lindefors, N. (2015). Effectiveness of Internet-Based Cognitive-Behavior Therapy for Social Anxiety Disorder in Clinical Psychiatry. Journal of Consulting and Clinical Psychology, 83(5), 902-914
Open this publication in new window or tab >>Effectiveness of Internet-Based Cognitive-Behavior Therapy for Social Anxiety Disorder in Clinical Psychiatry
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2015 (English)In: Journal of Consulting and Clinical Psychology, ISSN 0022-006X, E-ISSN 1939-2117, Vol. 83, no 5, p. 902-914Article in journal (Refereed) Published
Abstract [en]

Objective: Internet-based cognitive-behavioral therapy (ICBT) has received increased attention as an innovative approach to improve access to evidence-based psychological treatments. Although the efficacy of ICBT for social anxiety disorder has been established in several studies, there is limited knowledge of its effectiveness and application in clinical psychiatric care. The purpose of this study was to evaluate the effectiveness of ICBT in the treatment of social anxiety disorder and to determine the significance of patient adherence and the clinics years of experience in delivering ICBT. Method: A longitudinal cohort study was conducted using latent growth curve modeling of patients (N = 654) treated with ICBT at an outpatient psychiatric clinic between 2009 and 2013. The primary outcome measure was the Liebowitz Social Anxiety Scale-Self-Rated. Results: Significant reductions in symptoms of social anxiety were observed after treatment (effect size d = 0.86, 99% CI [0.74, 0.98]). Improvements were sustained at 6-month follow-up (d = 1.15, 99% CI [0.99, 1.32]). Patient adherence had a positive effect on the rate of improvement. A positive association between the clinics years of experience with ICBT and treatment outcome was also observed. Conclusions: This study suggests that ICBT for social anxiety disorder is effective when delivered within the context of a unit specialized in Internet-based psychiatric care and may be considered as a treatment alternative for implementation within the mental health care system.

Place, publisher, year, edition, pages
AMER PSYCHOLOGICAL ASSOC, 2015
Keywords
Internet; CBT; social anxiety; growth curve analysis
National Category
Basic Medicine
Identifiers
urn:nbn:se:liu:diva-121736 (URN)10.1037/a0039198 (DOI)000361226400006 ()26009780 (PubMedID)
Note

Funding Agencies|Stockholm County Council [ALF 20130413]

Available from: 2015-10-07 Created: 2015-10-05 Last updated: 2018-12-12
Kemani, M. K., Olsson, G. L., Lekander, M., Hesser, H., Andersson, E. & Wicksell, R. K. (2015). Efficacy and Cost-effectiveness of Acceptance and Commitment Therapy and Applied Relaxation for Longstanding Pain A Randomized Controlled Trial. The Clinical Journal of Pain, 31(11), 1004-1016
Open this publication in new window or tab >>Efficacy and Cost-effectiveness of Acceptance and Commitment Therapy and Applied Relaxation for Longstanding Pain A Randomized Controlled Trial
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2015 (English)In: The Clinical Journal of Pain, ISSN 0749-8047, E-ISSN 1536-5409, Vol. 31, no 11, p. 1004-1016Article in journal (Refereed) Published
Abstract [en]

Background and Objectives:To date, few studies have compared Acceptance and Commitment Therapy (ACT) for longstanding pain with established treatments. Only 1 study has evaluated the cost-effectiveness of ACT. The aim of the current study was to evaluate the efficacy and cost-effectiveness of ACT and applied relaxation (AR) for adults with unspecific, longstanding pain.Materials and Methods:On the basis of the inclusion criteria 60 consecutive patients received 12 weekly group sessions of ACT or AR. Data were collected pretreatment, midtreatment, and posttreatment, as well as at 3- and 6-month follow-up. Growth curve modeling was used to analyze treatment effects on pain disability, pain intensity, health-related quality of life (physical domain), anxiety, depression, and acceptance.Results:Significant improvements were seen across conditions (pretreatment to follow-up assessment) on all outcome measures. Pain disability decreased significantly in ACT relative to AR from preassessment to postassessment. A corresponding decrease in pain disability was seen in AR between postassessment and 6-month follow-up. Pain acceptance increased only in ACT, and this effect was maintained at 6-month follow-up. Approximately 20% of the participants achieved clinically significant change after treatment. Health economic analyses showed that ACT was more cost-effective than AR at post and 3-month follow-up assessment, but not at 6-month follow-up.Discussion:More studies investigating moderators and mediators of change are needed. The present study is one of few that have evaluated the cost-effectiveness of ACT and AR and compared ACT with an established behavioral intervention, and the results provide additional support for behavioral interventions for longstanding pain.

Place, publisher, year, edition, pages
LIPPINCOTT WILLIAMS and WILKINS, 2015
Keywords
acceptance and commitment therapy (ACT); applied relaxation (AR); chronic pain; cost-effectiveness
National Category
Basic Medicine
Identifiers
urn:nbn:se:liu:diva-123065 (URN)10.1097/AJP.0000000000000203 (DOI)000364089900010 ()25585272 (PubMedID)
Note

Funding Agencies|Department of Psychology at the Karolinska University Hospital, Stockholm, Sweden

Available from: 2015-12-04 Created: 2015-12-03 Last updated: 2018-12-12
Molander, P., Hesser, H., Weineland, S., Bergwall, K., Buck, S., Hansson-Malmlof, J., . . . Andersson, G. (2015). Internet-Based Acceptance and Commitment Therapy for Psychological Distress Experienced by People With Hearing Problems: Study Protocol for a Randomized Controlled Trial. American Journal of Audiology, 24(3), 307-310
Open this publication in new window or tab >>Internet-Based Acceptance and Commitment Therapy for Psychological Distress Experienced by People With Hearing Problems: Study Protocol for a Randomized Controlled Trial
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2015 (English)In: American Journal of Audiology, ISSN 1059-0889, E-ISSN 1558-9137, Vol. 24, no 3, p. 307-310Article in journal (Refereed) Published
Abstract [en]

Purpose: Psychological distress and psychiatric symptoms are prevalent among people with hearing loss or other audiological conditions, but psychological interventions for these groups are rare. This article describes the study protocol for a randomized controlled trial for evaluating the effect of a psychological treatment delivered over the Internet for individuals with hearing problems and concurrent psychological distress. Method: Participants who are significantly distressed will be randomized to either an 8-week Internet-delivered acceptance-based cognitive behavioral therapy (i.e., acceptance and commitment therapy [ACT]), or wait-list control. We aim to include measures of distress associated with hearing difficulties, anxiety, and depression. In addition, we aim to measure acceptance associated with hearing difficulties as well as quality of life. Conclusion: The results of the trial may further our understanding of how to best treat people who present problems with both psychological distress and hearing in using the Internet.

Place, publisher, year, edition, pages
AMER SPEECH-LANGUAGE-HEARING ASSOC, 2015
National Category
Basic Medicine
Identifiers
urn:nbn:se:liu:diva-123082 (URN)10.1044/2015_AJA-15-0013 (DOI)000364315200010 ()
Available from: 2015-12-03 Created: 2015-12-03 Last updated: 2018-12-12
Blom, K., Tarkian Tillgren, H., Wiklund, T., Danlycke, E., Forssen, M., Söderström, A., . . . Kaldo, V. (2015). Internet-vs. group-delivered cognitive behavior therapy for insomnia: A randomized controlled non-inferiority trial. Behaviour Research and Therapy, 70, 47-55
Open this publication in new window or tab >>Internet-vs. group-delivered cognitive behavior therapy for insomnia: A randomized controlled non-inferiority trial
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2015 (English)In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 70, p. 47-55Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to compare guided Internet-delivered to group-delivered cognitive behavioral therapy (CBT) for insomnia. We conducted an 8-week randomized controlled non-inferiority trial with 6-months follow-up. Participants were forty-eight adults with insomnia, recruited via media. Interventions were guided Internet-delivered CBT (ICBT) and group-delivered CBT (GCBT) for insomnia. Primary outcome measure was the Insomnia Severity Index (ISI), secondary outcome measures were sleep diary data, depressive symptoms, response- and remission rates. Both treatment groups showed significant improvements and large effect sizes for ISI (Within Cohens d: ICBT post = 1.8, 6-months follow-up = 2.1; GCBT post = 2.1, 6-months follow-up = 2.2). Confidence interval of the difference between groups posttreatment and at FU6 indicated non-inferiority of ICBT compared to GCBT. At post-treatment, two thirds of patients in both groups were considered responders (ISI-reduction greater than 7p). Using diagnostic criteria, 63% (ICBT) and 75% (GCBT) were in remission. Sleep diary data showed moderate to large effect sizes. We conclude that both guided Internet-CBT and group-CBT in this study were efficacious with regard to insomnia severity, sleep parameters and depressive symptoms. The results are in line with previous research, and strengthen the evidence for guided Internet-CBT for insomnia. Trial registration: The study protocol was approved by, and registered with, the regional ethics review board in Linkoping, Sweden, registration number 2010/385-31.

Place, publisher, year, edition, pages
Elsevier, 2015
Keywords
CBT; Insomnia; Internet; Non-inferiority; Group therapy; Psychotherapy
National Category
Physiotherapy
Identifiers
urn:nbn:se:liu:diva-120137 (URN)10.1016/j.brat.2015.05.002 (DOI)000356552200006 ()25981329 (PubMedID)
Note

Funding Agencies|Linkoping University; Stockholm County Council; Karolinska Institutet

Available from: 2015-07-14 Created: 2015-07-13 Last updated: 2018-12-12
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-9736-8228

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