liu.seSearch for publications in DiVA
Change search
Link to record
Permanent link

Direct link
BETA
Publications (6 of 6) Show all publications
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
Show others...
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. (2018). Blended cognitive behavior therapy: efficacy and acceptability for treating depression in the adult and adolescent population. (Doctoral dissertation). Linköping: Linköping University Electronic Press
Open this publication in new window or tab >>Blended cognitive behavior therapy: efficacy and acceptability for treating depression in the adult and adolescent population
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Blended kognitiv beteendeterapi : acceptans och klinisk effekt för depression hos vuxna och unga
Abstract [en]

Depression is the most burdensome disorder worldwide in terms of health loss. The potential of internet and technologies to scale up psychological treatment resources is substantial. A blended treatment approach, reducing therapist time and combining sessions with online self-help components, could enhance availability of psychological treatment, while maintaining and possibly enhancing effect of treatment. The aim of this thesis was to develop and investigate the blended treatment approach, in terms of acceptance among key stakeholders, and clinical effect in treatment of depression in the adult and adolescent population.

Study I investigated acceptance of the blended treatment approach among mental health care stakeholders by means of a European survey. The results demonstrated that the majority readily accepted blended treatment for management of mild and moderate depression.

Study II evaluated blended treatment compared to standard face-toface psychotherapy in treatment of adult depression in a controlled non-inferiority trial. The results showed a similar decrease in depression from both interventions at post-treatment, with decreased levels maintained over six months. Non-inferiority for the blended treatment could not be statistically established.

Study III was a controlled non-inferiority trial evaluating blended treatment compared to treatment as usual. The results indicated superiority for the blended treatment at post-treatment and partly at six months. After twelve months the outcomes in the two conditions were similar.

Study IV evaluated blended treatment for adolescent depression in a controlled superiority trial, where the therapist time was not reduced, but sessions delivered via chat for improved reach and efficiency. Compared to attention control, the blended treatment significantly reduced depression symptoms, with effects indicated to be maintained over six months.

Study V was a controlled superiority trial, evaluating an improved version of the blended treatment used in Study IV to similar methods and in a similar population. In comparison to minimal attention control, the blended treatment significantly reduced depression symptoms at post-treatment, corresponding to a large treatment effect.

Across Study II to V, estimates indicated that the amount of therapist time that could be saved in blended treatment, compared to standard psychological treatment, was around 40%.

In conclusion, a gradual, blended integration of technology into psychological treatment i) performed well in treatment of adult and adolescent populations, ii) could substantially reduce therapist time in comparison to standard face-to-face psychological treatment, and iii) was accepted by patients as well as other mental health care stakeholders.

The thesis demonstrates the potentials of technology-assisted blended treatment models to deliver treatment of depression in the young and adult population in accordance with the current, urgent need to increase availability of psychological treatment as well as increase acceptance of technology-assisted mental health interventions.  

Abstract [sv]

Depression är en av vår tids största folksjukdomar. I Sverige och internationellt är behandlingsresurserna otillräckliga. Psykologisk behandling där terapisessioner kombineras med, och delvis ersätts av digitala självhjälpskomponenter – så kallad blended-terapi – kan vara ett sätt att öka tillgängligheten av behandling, samtidigt som individuella behandlarträffar fortfarande ingår. Denna avhandling syftar till att utvärdera acceptansen för, och effekten av, blended-terapi för depression.

Studie I var en europeisk enkätstudie som undersökte acceptansen för blended-terapi bland organisationer inom hälso- och sjukvård. Majoriteten av de medverkande organisationerna visade sig positivt inställda till behandlingsformen och föredrog den framför ren internetterapi. Studie II, III, IV och V var randomiserade kontrollerade studier som undersökte effekten av blended-terapi baserad på kognitiv beteendeterapi (KBT) för depression hos vuxna och hos tonåringar. Blended KBT utvärderades gentemot sedvanlig psykologisk behandling, uppmärksamhets- kontroll, samt interventioner representativa för primärvården. Resultaten i studierna visade genomgående stöd för att blended KBT som behandlingsmetod kan minska depression hos vuxna och tonåringar. Därutöver så indikerade resultaten att den totala tiden för behandlaren skulle kunna minskas betydligt i blended KBT, jämfört med sedvanlig psykologisk behandling.

Utifrån resultaten i Studie I-V så kan det konkluderas att blended-terapi baserad på KBT i) kan vara effektiv för att minska depression hos vuxna och unga individer, ii) har potential att minska behandlartid jämfört med traditionell behandling, iii) är en behandlingsform som ser ut att kunna uppnå acceptans hos såväl patienter som hos organisationer inom hälso- och sjukvård. Sammanfattningsvis visar resultaten på potentialen i blended-terapi vad gäller möjligheten att öka tillgängligheten av psykologisk behandling, på ett sätt som är kliniskt relevant och som kan främja acceptansen för digitala behandlingsformat.  

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2018. p. 107
Series
Linköping Studies in Arts and Sciences, ISSN 0282-9800 ; 740Linköping Studies in Behavioural Science, ISSN 1654-2029 ; 206
Keywords
acceptance, adolescents, adults, blended treatment, cognitive behavioral therapy, depression, digital, internet-delivered, e-mental health, stakeholders, technology-assisted, acceptans, blended, kognitiv beteendeterapi, KBT, depression digital, internetbehandling
National Category
Applied Psychology
Identifiers
urn:nbn:se:liu:diva-148016 (URN)10.3384/diss.diva-148016 (DOI)9789176852972 (ISBN)
Public defence
2018-05-31, I:101, Hus I, Campus Valla, Linköping, 13:00 (English)
Opponent
Supervisors
Available from: 2018-05-24 Created: 2018-05-24 Last updated: 2019-09-26Bibliographically 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
Show others...
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., 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
Keywords
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: 2018-12-12
Kleiboer, A., Smit, J., Bosmans, J., Ruwaard, J., Andersson, G., Topooco, N., . . . Riper, H. (2016). European COMPARative Effectiveness research on blended Depression treatment versus treatment-as-usual (E-COMPARED): study protocol for a randomized controlled, non-inferiority trial in eight European countries. Trials, 17(1)
Open this publication in new window or tab >>European COMPARative Effectiveness research on blended Depression treatment versus treatment-as-usual (E-COMPARED): study protocol for a randomized controlled, non-inferiority trial in eight European countries
Show others...
2016 (English)In: Trials, ISSN 1745-6215, E-ISSN 1745-6215, Vol. 17, no 1Article in journal (Refereed) Published
Abstract [en]

Background: Effective, accessible, and affordable depression treatment is of high importance considering the large personal and economic burden of depression. Internet-based treatment is considered a promising clinical and cost-effective alternative to current routine depression treatment strategies such as face-to-face psychotherapy. However, it is not clear whether research findings translate to routine clinical practice such as primary or specialized mental health care. The E-COMPARED project aims to gain knowledge on the clinical and cost-effectiveness of blended depression treatment compared to treatment-as-usual in routine care.

Methods/design: E-COMPARED will employ a pragmatic, multinational, randomized controlled, non-inferiority trial in eight European countries. Adults diagnosed with major depressive disorder (MDD) will be recruited in primary care (Germany, Poland, Spain, Sweden, and the United Kingdom) or specialized mental health care (France, The Netherlands, and Switzerland). Regular care for depression is compared to "blended" service delivery combining mobile and Internet technologies with face-to-face treatment in one treatment protocol. Participants will be followed up at 3, 6, and 12 months after baseline to determine clinical improvements in symptoms of depression (primary outcome: Patient Health Questionnaire-9), remission of depression, and cost-effectiveness. Main analyses will be conducted on the pooled data from the eight countries (n = 1200 in total, 150 participants in each country).

Discussion: The E-COMPARED project will provide mental health care stakeholders with evidence-based information and recommendations on the clinical and cost-effectiveness of blended depression treatment.

Trial Registration: France: ClinicalTrials.gov NCT02542891 . Registered on 4 September 2015; Germany: German Clinical Trials Register DRKS00006866 . Registered on 2 December 2014; The Netherlands: Netherlands Trials Register NTR4962 . Registered on 5 January 2015; Poland: ClinicalTrials.Gov NCT02389660 . Registered on 18 February 2015; Spain: ClinicalTrials.gov NCT02361684 . Registered on 8 January 2015; Sweden: ClinicalTrials.gov NCT02449447 . Registered on 30 March 2015; Switzerland: ClinicalTrials.gov NCT02410616 . Registered on 2 April 2015; United Kingdom: ISRCTN registry, ISRCTN12388725 . Registered on 20 March 2015.

Place, publisher, year, edition, pages
London: BioMed Central, 2016
Keywords
Internet-based treatment, Depression, Cognitive behavioral treatment (CBT), Blended treatment, Comparative effectiveness research (CER), Cost-effectiveness, Randomized controlled trial (RCT), Adults, iCBT, eHealth
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-130960 (URN)10.1186/s13063-016-1511-1 (DOI)000381077400002 ()27488181 (PubMedID)
Projects
E-COMPARED
Funder
EU, FP7, Seventh Framework Programme
Note

Funding agencies: European Commission [603098]

Available from: 2016-09-01 Created: 2016-09-01 Last updated: 2018-12-12Bibliographically approved
Ly, K. H., Topooco, N., Cederlund, H., Wallin, A., Bergström, J., Molander, O., . . . Andersson, G. (2015). Smartphone-supported versus full behavioural activation for depression: a randomised controlled trial. PLoS ONE, 10(5), Article ID e0126559.
Open this publication in new window or tab >>Smartphone-supported versus full behavioural activation for depression: a randomised controlled trial
Show others...
2015 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 5, article id e0126559Article in journal (Refereed) Published
Abstract [en]

Background

There is need for more cost and time effective treatments for depression. This is the first randomised controlled trial in which a blended treatment - including four face-to-face sessions and a smartphone application - was compared against a full behavioural treatment. Hence, the aim of the current paper was to examine whether a blended smartphone treatment was non-inferior to a full behavioural activation treatment for depression.

Methods

This was a randomised controlled non-inferiority trial (NCT01819025) comparing a blended treatment (n=46) against a full ten-session treatment (n=47) for people suffering from major depression. Primary outcome measure was the BDI-II, that was administered at pre- and post-treatment, as well as six months after the treatment.

Results

Results showed significant improvements in both groups across time on the primary outcome measures (within-group Cohen’s d=1.35; CI [−0.82, 3.52] to d=1.58; CI [0.51, 2.65]; between group d=−0.13 CI [−2.37, 2.09] to d=0.05 CI [−1.18, 1.27]). At the same time, the blended treatment reduced the therapist time with an average of 47%.

Conclusions

We could not establish whether the blended treatment was non-inferior to a full BA treatment. Nevertheless, this study points to that the blended treatment approach could possibly treat nearly twice as many patients suffering from depression by using a smartphone applica¬tion as add-on. More studies are needed before we can suggest that the blended treatment method is a promising cost-effective alternative to regular face-to-face treatment for depression.

Place, publisher, year, edition, pages
Public Library of Science, 2015
Keywords
Behavioural activation, major depression, smartphone application, mobile app, blended treatment
National Category
Psychology Interaction Technologies
Identifiers
urn:nbn:se:liu:diva-113994 (URN)10.1371/journal.pone.0126559 (DOI)000355183900033 ()26010890 (PubMedID)
Funder
Swedish Research Council, 2011-2476EU, FP7, Seventh Framework Programme, ICT4Depression Consortium
Available from: 2015-02-05 Created: 2015-02-05 Last updated: 2018-12-12Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-5972-3041

Search in DiVA

Show all publications