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  • 1.
    Andersson, Gerhard
    et al.
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Behavioural Sciences, Clinical and Social Psychology.
    Asmundson, Gordon J
    Denev, Johanna
    Nilsson, Johanna
    Hans-Christian, Larsen
    A controlled trial of cognitive-behavior therapy combined with vestibular rehabilitation in the treatment of dizziness2006In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 44, no 9, p. 1265-1273Article in journal (Refereed)
    Abstract [en]

    Dizziness is a common and often untreated symptom in the general population. The aim of this study was to investigate the effects of a combined cognitive-behavioral/vestibular rehabilitation (VR) program, using a randomized control design. A total of 29 participants were randomized to treatment consisting of psychoeducation, vestibular exercises, relaxation and cognitive interventions, or to serve as waiting list controls. Measures of dizziness-related handicap, dizziness-provoking movements, and daily diary registrations of dizziness symptoms at pre- and post-treatment showed statistically significant improvements in many domains, which translated to moderate effect sizes. These findings provide preliminary support for the combination of Cognitive-behavioral therapy (CBT) and VR methods in the treatment of dizziness. © 2005 Elsevier Ltd. All rights reserved.

  • 2.
    Andersson, Gerhard
    et al.
    Institutionen för Tillämpad Psykologi, Uppsala universitet.
    Green, Malin
    Institutionen för Tillämpad Psykologi, Uppsala universitet.
    Melin, Lennart
    Institutionen för Tillämpad Psykologi, Uppsala universitet.
    Behavioural hearing tactics.: A controlled trial of a short treatment programme.1997In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, ISSN ISSN 0005-7967, Vol. 35, no 6, p. 523-530Article in journal (Refereed)
    Abstract [en]

    Abstract

    Nineteen elderly hearing impaired subjects participated in an experimental treatment study and received either behavioural hearing tactics or served as untreated controls. Treatment was supplied in the form of a self-help treatment manual supplied with telephone contacts during 4 consecutive weeks. The treatment manual included applied relaxation, communication strategies training, advice to relatives, information, and coping skills. Assessments (pre-post) were conducted in a structured interview measuring coping behaviour. In order to evoke behavioural compensation small acoustic provocations were included in the interview. Pre-post assessments also included questionnaires, daily registered hearing problems, and hours of daily hearing aid use. Results showed significant beneficial effects in favour of the treatment in terms of self-assessed problems and behaviour change.

  • 3.
    Andersson, Gerhard
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Paxling, Björn
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Wiwe, Maria
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Vernmark, Kristofer
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Psykologpartners, Private Practice, Linköping.
    Felix, Christina Bertholds
    Uppsala University.
    Lundborg, Lisa
    Uppsala University.
    Furmark, Tomas
    Uppsala University.
    Cuijpers, Pim
    VU University Amsterdam, and EMGO Institute, The Netherlands.
    Carlbring, Per
    Umeå University.
    Therapeutic alliance in guided internet-delivered cognitive behavioural treatment of depression, generalized anxiety disorder and social anxiety disorder2012In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 50, no 9, p. 544-550Article in journal (Refereed)
    Abstract [en]

    Guided internet-delivered cognitive behaviour therapy (ICBT) has been found to be effective in several controlled trials, but the mechanisms of change are largely unknown. Therapeutic alliance is a factor that has been studied in many psychotherapy trials, but the role of therapeutic alliance in ICBT is less well known. The present study investigated early alliance ratings in three separate samples. Participants from one sample of depressed individuals (N = 49), one sample of individuals with generalized anxiety disorder (N = 35), and one sample with social anxiety disorder (N = 90) completed the Working Alliance Inventory (WAI) modified for ICBT early in the treatment (weeks 3-4) when they took part in guided ICBT for their conditions. Results showed that alliance ratings were high in all three samples and that the WAI including the subscales of Task, Goal and Bond had high internal consistencies. Overall, correlations between the WAI and residualized change scores on the primary outcome measures were small and not statistically significant. We conclude that even if alliance ratings are in line with face-to-face studies, therapeutic alliance as measured by the WAI is probably less important in ICBT than in regular face-to-face psychotherapy.

  • 4.
    Bergman Nordgren, Lise
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Hedman, Erik
    Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, Stockholm, Sweden.
    Etienne, Julie
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Bodin, Jessica
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Kadowaki, Åsa
    Östergötlands Läns Landsting.
    Eriksson, Stina
    Department of Psychology, Umeå University, Umeå, Sweden.
    Lindkvist, Emelie
    Department of Psychology, Umeå University, Umeå, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, Stockholm, Sweden.
    Carlbring, Per
    Department of Psychology, Stockholm University, Stockholm, Sweden.
    Effectiveness and cost-effectiveness of individually tailored Internet-delivered cognitive behavior therapy for anxiety disorders in a primary care population: A randomized controlled rial2014In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 59, p. 1-11Article in journal (Other academic)
    Abstract [en]

    A significant proportion of the general population suffers from anxiety disorders, often with comorbid psychiatric conditions. Internet-delivered cognitive behavior therapy (ICBT) has been found to be a potent treatment for patients with specific psychiatric conditions. The aim of this trial was to investigate the effectiveness and cost-effectiveness of ICBT when tailoring the treatment to address comorbidities and preferences for primary-care patients with a principal anxiety disorder. One hundred participants were recruited through their primary-care contact and randomized to either treatment or an active control group. The treatment consisted of 7–10 weekly individually assigned modules guided by online therapists. At post-treatment, 46% of the treatment group had achieved clinically significant improvement on the primary outcome measure (CORE-OM) and between-group effect sizes at ranged from d = 0.20 to 0.86, with a mean effect of d = 0.59. At one-year follow-up, within-group effect sizes varied between d = 0.53 to 1.00. Cost analysis showed significant reduction of total costs for the ICBT group, the results were maintained at one-year follow-up and the incremental  costeffectiveness ratio favored ICBT compared to control group. Individually tailored ICBT is an effective and cost-effective treatment for primary-care patients with anxiety disorders with or without comorbidities.

  • 5.
    Blom, Kerstin
    et al.
    Karolinska Institute, Sweden.
    Tarkian Tillgren, Hanna
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Wiklund, Tobias
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Danlycke, Ewa
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Forssen, Mattias
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Söderström, Alexandra
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Johansson, Robert
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Hesser, Hugo
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Jernelov, Susanna
    Karolinska Institute, Sweden.
    Lindefors, Nils
    Karolinska Institute, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden.
    Kaldo, Viktor
    Karolinska Institute, Sweden.
    Internet-vs. group-delivered cognitive behavior therapy for insomnia: A randomized controlled non-inferiority trial2015In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 70, p. 47-55Article in journal (Refereed)
    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.

  • 6.
    Brinkborg, Hillevi
    et al.
    Stockholm University.
    Michanek, Josefin
    Stockholm University.
    Hesser, Hugo
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Berglund, Gunilla
    Stockholm University.
    Acceptance and commitment therapy for the treatment of stress among social workers: A randomized controlled trial2011In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 49, no 07-jun, p. 389-398Article in journal (Refereed)
    Abstract [en]

    Chronic stress increases the risk of health problems and absenteeism, with negative consequences for individuals, organizations and society. The aim of the present study was to examine the effect of a brief stress management intervention based on the principles of Acceptance and Commitment Therapy (ACT) on stress and general mental health for Swedish social workers (n = 106) in a randomized, controlled trial. Participants were stratified according to stress level at baseline in order to examine whether initial stress level moderated the effect of the intervention. Two thirds of the participants had high stress levels at baseline (Perceived Stress Scale; score of greater than= 25). The results showed that the intervention significantly decreased levels of stress and burnout, and increased general mental health compared to a waiting list control. No statistically significant effects were, however, found for those with low levels of stress at baseline. Among participants with high stress, a substantial proportion (42%) reached criteria for clinically significant change. We concluded that the intervention successfully decreased stress and symptoms of burnout, and increased general mental health. Evidence is, thus, provided supporting ACT as brief, stress management intervention for social workers.

  • 7.
    Buhrman, Monica
    et al.
    Uppsala University, Sweden .
    Skoglund, Astrid
    Uppsala University, Sweden .
    Husell, Josefin
    Uppsala University, Sweden .
    Bergstrom, Kristina
    Uppsala University, Sweden .
    Gordh, Torsten
    Uppsala University, Sweden .
    Hursti, Timo
    Uppsala University, Sweden .
    Bendelin, Nina
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Furmark, Tomas
    Uppsala University, Sweden .
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Guided internet-delivered acceptance and commitment therapy for chronic pain patients: A randomized controlled trial2013In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 51, no 6, p. 307-315Article in journal (Refereed)
    Abstract [en]

    Acceptance and commitment therapy (ACT) interventions for persons with chronic pain have recently received empirical support. ACT focuses on reducing the disabling influences of pain through targeting ineffective control strategies and teaches people to stay in contact with unpleasant emotions, sensations, and thoughts. The aim of the present study was to investigate the effect of a guided internet-delivered ACT intervention for persons with chronic pain. A total of 76 patients with chronic pain were included in the study and randomized to either treatment for 7 weeks or to a control group that participated in a moderated online discussion forum. Intent-to-treat analyses showed significant increases regarding activity engagement and pain willingness. Measurements were provided with the primary outcome variable Chronic Pain Acceptance Questionnaire which was in favour of the treatment group. Reductions were found on other measures of pain-related distress, anxiety and depressive symptoms. A six month follow-up showed maintenance of improvements. We conclude that an acceptance based internet-delivered treatment can be effective for persons with chronic pain.

  • 8.
    Carlbring, Per
    et al.
    Linköping University, Department of Behavioural Sciences, Clinical and Social Psychology. Linköping University, Faculty of Arts and Sciences.
    Nilsson-Ihrfelt, Elisabeth
    Waara, Johan
    Kollenstam, Cecilia
    Buhrman, Monica
    Kaldo, Viktor
    Söderberg, Marie
    Ekselius, Lisa
    Andersson, Gerhard
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Behavioural Sciences, Clinical and Social Psychology.
    Treatment of panic disorder: Live therapy vs. self-help via the Internet2005In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 43, no 10, p. 1321-1333Article in journal (Refereed)
    Abstract [en]

    A randomized trial was conducted comparing 10 individual weekly sessions of cognitive behaviour therapy for panic disorder (PD) with or without agoraphobia with a 10-module self-help program on the Internet. After confirming the PD diagnosis with an in-person structured clinical interview (SCID) 49 participants were randomized. Overall, the results suggest that Internet-administered self-help plus minimal therapist contact via e-mail can be equally effective as traditional individual cognitive behaviour therapy. Composite within-group effect sizes were high in both groups, while the between-group effect size was small (Cohen's d=16). One-year follow-up confirmed the results, with a within-group effect size of Cohen's d=0.80 for the Internet group and d=0.93 for the live group. The results from this study generally provide evidence to support the continued use and development of Internet-distributed self-help programs. © 2004 Elsevier Ltd. All rights reserved.

  • 9.
    Dahlin, Mats
    et al.
    Psykologpartners, Private Practice, Linköping, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden.
    Magnusson, Kristoffer
    Karolinska Institute, Sweden.
    Johansson, Tomas
    Umeå University, Sweden.
    Sjögren, Johan
    Umeå University, Sweden.
    Håkansson, Andreas
    Umeå University, Sweden.
    Pettersson, Magnus
    Umeå University, Sweden.
    Kadowaki, Åsa
    Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Psychiatry.
    Cuijpers, Pim
    Vrije University of Amsterdam, Netherlands; EMGO Institute Health and Care Research, Netherlands.
    Carlbring, Per
    Stockholm University, Sweden.
    Internet-delivered acceptance-based behaviour therapy for generalized anxiety disorder: A randomized controlled trial2016In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 77, p. 86-95Article in journal (Refereed)
    Abstract [en]

    Generalized anxiety disorder (GAD) is a disabling condition which can be treated with cognitive behaviour therapy (CBT). The present study tested the effects of therapist-guided internet-delivered acceptance-based behaviour therapy on symptoms of GAD and quality of life. An audio CD with acceptance and mindfulness exercises and a separate workbook were also included in the treatment. Participants diagnosed with GAD (N = 103) were randomly allocated to immediate therapist-guided internet-delivered acceptance-based behaviour therapy or to a waiting-list control condition. A six month follow-up was also included. Results using hierarchical linear modelling showed moderate to large effects on symptoms of GAD (Cohens d = 0.70 to 0.98), moderate effects on depressive symptoms (Cohens d = 0.51 to 0.56), and no effect on quality of life. Follow-up data showed maintained effects. While there was a 20% dropout rate, sensitivity analyses showed that dropouts did not differ in their degree of change during treatment. To conclude, our study suggests that internet-delivered acceptance based behaviour therapy can be effective in reducing the symptoms of GAD. (C) 2015 Elsevier Ltd. All rights reserved.

  • 10.
    Haug, Thomas
    et al.
    Haukeland Hospital, Norway; University of Bergen, Norway.
    Nordgreen, Tine
    Haukeland Hospital, Norway; University of Bergen, Norway.
    Ost, Lars-Goran
    Haukeland Hospital, Norway; University of Stockholm, Sweden; Karolinska Institute, Sweden.
    Kvale, Gerd
    Haukeland Hospital, Norway; University of Bergen, Norway.
    Tangen, Tone
    Haukeland Hospital, Norway; University of Bergen, Norway.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden.
    Carlbring, Per
    University of Stockholm, Sweden.
    Heiervang, Einar R.
    Haukeland Hospital, Norway; University of Oslo, Norway.
    Havik, Odd E.
    Haukeland Hospital, Norway; University of Bergen, Norway.
    Stepped care versus face-to face cognitive behavior therapy for panic disorder and social anxiety disorder: Predictors and moderators of outcome2015In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 71, p. 76-89Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate predictors and moderators of treatment outcome by comparing immediate face-to-face cognitive behavioral therapy (FtF-CBT) to a Stepped Care treatment model comprising three steps: Psychoeducation, Internet-delivered CBT, and FtF-CBT for panic disorder (PD) and social anxiety disorder (SAD). Method: Patients (N = 173) were recruited from nine public mental health out-patient clinics and randomized to immediate FtF-CBT or Stepped Care treatment. Characteristics related to social functioning, impairment from the anxiety disorder, and comorbidity was investigated as predictors and moderators by treatment format and diagnosis in multiple regression analyses. Results: Lower social functioning, higher impairment from the anxiety disorder, and a comorbid cluster C personality disorder were associated with significantly less improvement, particularly among patients with PD. Furthermore, having a comorbid anxiety disorder was associated with a better treatment outcome among patients with PD but not patients with SAD. Patients with a comorbid depression had similar outcomes from the different treatments, but patients without comorbid depression had better outcomes from immediate FtF-CBT compared to guided self-help. Conclusions: In general, the same patient characteristics appear to be associated with the treatment outcome for CBT provided in low- and high-intensity formats when treated in public mental health care clinics. The findings suggest that patients with lower social functioning and higher impairment from their anxiety disorder benefit less from these treatments and may require more adapted and extensive (C) 2015 Elsevier Ltd. All rights reserved.

  • 11.
    Hedman, Erik
    et al.
    Karolinska University Hospital.
    Andersson, Erik
    Karolinska University Hospital.
    Ljotsson, Brjann
    Karolinska University Hospital.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Clinical and Social Psychology. Linköping University, Faculty of Arts and Sciences.
    Ruck, Christian
    Karolinska University Hospital.
    Lindefors, Nils
    Karolinska University Hospital.
    Cost-effectiveness of Internet-based cognitive behavior therapy vs. cognitive behavioral group therapy for social anxiety disorder: Results from a randomized controlled trial2011In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 49, no 11, p. 729-736Article in journal (Refereed)
    Abstract [en]

    Social anxiety disorder (SAD) is highly prevalent and associated with a substantial societal economic burden, primarily due to high costs of productivity loss. Cognitive behavior group therapy (CBGT) is an effective treatment for SAD and the most established in clinical practice. Internet-based cognitive behavior therapy (ICBT) has demonstrated efficacy in several trials in recent years. No study has however investigated the cost-effectiveness of ICBT compared to CBGT from a societal perspective, i.e. an analysis where both direct and indirect costs are included. The aim of the present study was to investigate the cost-effectiveness of ICBT compared to CBGT from a societal perspective using a prospective design. We conducted a randomized controlled trial where participants with SAD were randomized to ICBT (n = 64) or CBGT (n = 62). Economic data were assessed at pre-treatment, immediately following treatment and six months after treatment. Results showed that the gross total costs were significantly reduced at six-month follow-up, compared to pre-treatment in both treatment conditions. As both treatments were equivalent in reducing social anxiety and gross total costs, ICBT was more cost-effective due to lower intervention costs. We conclude that ICBT can be more cost-effective than CBGT in the treatment of SAD and that both treatments reduce societal costs for SAD.

  • 12.
    Hedman, Erik
    et al.
    Karolinska Institute, Sweden Karolinska Institute, Sweden .
    El Alaoui, Samir
    Karolinska Institute, Sweden .
    Lindefors, Nils
    Karolinska Institute, Sweden .
    Andersson, Erik
    Karolinska Institute, Sweden .
    Ruck, Christian
    Karolinska Institute, Sweden .
    Ghaderi, Ata
    Karolinska Institute, Sweden .
    Kaldo, Viktor
    Karolinska Institute, Sweden .
    Lekander, Mats
    Karolinska Institute, Sweden Karolinska Institute, Sweden Stockholm University, Sweden .
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Ljotsson, Brjann
    Karolinska Institute, Sweden .
    Clinical effectiveness and cost-effectiveness of Internet- vs. group-based cognitive behavior therapy for social anxiety disorder: 4-Year follow-up of a randomized trial2014In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 59, p. 20-29Article in journal (Refereed)
    Abstract [en]

    Social anxiety disorder (SAD) is common, debilitating and associated with high societal costs. The disorder can be effectively treated with Internet-based cognitive behavior therapy (ICBT), but no previous study has investigated the long-term clinical or health economic effects of ICBT for SAD in comparison to an evidence-based control treatment. The aim of the study was to investigate the clinical effectiveness and cost-effectiveness of ICBT compared to cognitive behavioral group therapy (CBGT) four years post-treatment. We conducted a 4-year follow-up study of participants who had received ICBT or CBGT for SAD within the context of a randomized controlled non-inferiority trial. The cost-effectiveness analyses were conducted taking a societal perspective. Participants in both treatment groups made large improvements from baseline to 4-year follow-up on the primary outcome measure (d = 1.34-1.48) and the 95% CI of the mean difference on the primary outcome was well within the non-inferiority margin. ICBT and CBGT were similarly cost-effective and both groups reduced their indirect costs. We conclude that ICBT for SAD yields large sustainable effects and is at least as long-term effective as CBGT. Intervention costs of both treatments are offset by net societal cost reductions in a short time.

  • 13.
    Hedman, Erik
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Lekander, Mats
    Karolinska Institutet, Stockholm, Sweden.
    Ljótsson, Brjánn
    Karolinska Institutet, Stockholm, Sweden.
    Lindefors, Nils
    Karolinska Institutet, Stockholm, Sweden.
    Rück, Christian
    Karolinska Institutet, Stockholm, Sweden.
    Hofmann, Stefan G
    Boston University, MA, USA.
    Andersson, Erik
    Karolinska Institutet, Stockholm, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institutet, Stockholm, Sweden.
    Schulz, Stefan M
    University of Würzburg, Germany.
    Sudden gains in internet-based cognitive behaviour therapy for severe health anxiety2014In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 54, p. 22-29Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: A sudden gain is defined as a large and stable individual improvement occurring between two consecutive treatment sessions. Sudden gains have been shown to predict better long-term improvement in several treatment studies, including cognitive behavioural therapy for depression and anxiety disorders, but have not been studied in the treatment of health anxiety or any form of internet-based cognitive behavioural therapy. The aim of this study was to investigate the role of sudden gains in internet-based cognitive behavioural therapy for severe health anxiety.

    METHOD: We examined the occurrence and significance of sudden gains in measures of health anxiety in 81 participants receiving internet-based cognitive behavioural therapy. We compared patients with sudden gains, patients without sudden gains, and patients with gradual gains.

    RESULTS: Thirteen participants (16%) experienced one sudden gain in health anxiety with individual sudden gains distributed across the treatment. As expected, patients with a sudden gain showed larger improvements than patients without a sudden gain at post-treatment (d = 1.04) and at one-year follow-up (d = 0.91) on measures of health anxiety.

    CONCLUSIONS: Consistent with previous studies, sudden gains in internet-based cognitive behavioural therapy are associated with significantly larger and stable treatment effects up to one-year follow-up.

  • 14.
    Hedman, Erik
    et al.
    Karolinska Institute, Sweden .
    Lindefors, Nils
    Karolinska Institute, Sweden .
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden .
    Andersson, Erik
    Karolinska Institute, Sweden .
    Lekander, Mats
    Karolinska Institute, Sweden .
    Ruck, Christian
    Karolinska Institute, Sweden .
    Ljotsson, Brjann
    Karolinska Institute, Sweden .
    Predictors of outcome in Internet-based cognitive behavior therapy for severe health anxiety2013In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 51, no 10, p. 711-717Article in journal (Refereed)
    Abstract [en]

    Internet-based cognitive behavior therapy (CBT) for severe health anxiety can be effective, but not all patients achieve full remission. Under these circumstances, knowledge about predictors is essential for the clinician in order to make reliable treatment recommendations. The primary aim of this study was to investigate clinical, demographic, and therapy process-related predictors of Internet-based CBT for severe health anxiety. We performed three types of analyses on data from a sample comprising participants (N = 81) who had received Internet-based CBT in a randomized controlled trial. Outcomes were a) end state health anxiety, b) improvement in health anxiety (continuous change scores), and c) clinically significant improvement. Outcomes were assessed at six-month follow-up. The results showed that the most stable predictors of both end state health anxiety and improvement were baseline health anxiety and depressive symptoms. Treatment adherence, i.e. the number of completed treatment modules, also significantly predicted outcome. Notably, health anxiety at baseline was positively associated with symptom improvement while depressive symptoms was negatively related to improvement. Demographic factors were largely without significant impact on end state symptoms or improvement. We conclude that baseline symptom burden and adherence to treatment have strong predictive effects in Internet-based CBT for severe health anxiety.

  • 15.
    Hedman, Erik
    et al.
    Karolinska Institute, Sweden .
    Mortberg, Ewa
    Stockholm University, Sweden .
    Hesser, Hugo
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Clark, David M.
    University of Oxford, England .
    Lekander, Mats
    Karolinska Institute, Sweden .
    Andersson, Erik
    Karolinska Institute, Sweden .
    Ljotsson, Brjann
    Karolinska Institute, Sweden .
    Mediators in psychological treatment of social anxiety disorder: Individual cognitive therapy compared to cognitive behavioral group therapy2013In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 51, no 10, p. 696-705Article in journal (Refereed)
    Abstract [en]

    According to cognitive-behavioral models of social anxiety disorder (SAD), four of the important maintaining mechanisms are avoidance, self-focused attention, anticipatory processing and post-event cognitive processing. Individual cognitive therapy (ICT) and cognitive behavioral group therapy (CBGT) both have substantial empirical support. However, it is unclear whether they achieve their effects by similar or different mechanisms. The aim of this study was to investigate whether changes in the four maintenance processes mediate clinical improvement in la and CBGT for SAD. We analyzed data from participants (N = 94) who received either ICT or CBGT in two separate RCTs. The results showed that ICT had larger effects than CBGT on social anxiety and each of the four potential mediators. More pertinently, moderated mediation analyses revealed significant between-treatment differences. Whereas improvement in ICT was mainly mediated by reductions in avoidance and self-focused attention, improvement in CBGT was mediated by changes in self-focused attention and in anticipatory and post-event processing. These results support the importance of the putative mediators, but suggest that their relative weights are moderated by treatment type.

  • 16.
    Hesser, Hugo
    et al.
    Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning, Disability Research.
    Westin, Vendela
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    Hayes, Steven C
    University of Nevada.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Clinical and Social Psychology. Linköping University, Faculty of Arts and Sciences.
    Clients' in-session acceptance and cognitive defusion behaviors in acceptance-based treatment of tinnitus distress.2009In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 47, no 6, p. 523-8Article in journal (Refereed)
    Abstract [en]

    Cognitive-behavioral treatment (CBT) is considered to be an effective treatment of distress associated with tinnitus (perception of internal noises without any outer auditory stimulation), but the processes by which the therapy works remain unclear. Mindfulness and acceptance is receiving increased attention in the treatment literature for chronic medical conditions. However, few studies have examined these and related processes with behavioral or observer measures. In the present study 57 videotapes (a total of 1710min) from 19 clients who participated in a controlled trial of an acceptance-based treatment for tinnitus distress, were coded for frequency and peak level of verbal behaviors expressing either acceptance or cognitive defusion. Frequency of cognitive defusion behaviors and peak level of cognitive defusion as well as peak level of acceptance rated in Session 2, predicted symptom reduction 6 month following treatment. These relationships were not accounted for by the improvement that had occurred prior to the measurement point of the process variables. Moreover, prior symptom changes could not predict process variables rated later in therapy (after most of the improvement in therapy had occurred). Thus, clients' in-session acceptance and cognitive defusion behaviors appear to play an important role in the reduction of negative impact of tinnitus.

  • 17. Holländare, Fredrik
    et al.
    Anthony, Susanne A
    Randestad, Mia
    Tillfors, Maria
    Carlbring, Per
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institutet, Stockholm, Sweden.
    Engström, Ingemar
    Two-year outcome of internet-based relapse prevention for partially remitted depression2013In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 51, no 11, p. 719-722Article in journal (Refereed)
    Abstract [en]

    The objective of the study was to investigate the long-term effects of internet-based relapse prevention for sufferers of partially remitted depression. Eighty-four individuals with partially remitted unipolar depression were randomized to either internet-based CBT (iCBT) or to a control group. After the ten week intervention period the participants were followed for 24 months and diagnostic interviews conducted to detect relapse. The intervention and monthly self-ratings of depressive symptoms were administered via an internet-based platform that ensured secure communication with all participants. Significantly fewer participants in the iCBT group had experienced a relapse compared with those in the control group two years after the internet-based intervention. The relapse rate in the iCBT group was 13.7% (CI 95%=2.5-24.9) and in the control group it was 60.9% (CI 95%=44.8-77). Furthermore, a significantly larger proportion of the iCBT group experienced remission two years after the intervention compared with the control group. Internet-based CBT seems promising for preventing relapse in sufferers of partially remitted depression.

  • 18.
    Jüris, Linda
    et al.
    Uppsala University, Uppsala University Hospital, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institutet, Huddinge, Sweden.
    Larsen, Hans Christian
    Uppsala University, Uppsala University Hospital, Sweden.
    Ekselius, Lisa
    Uppsala University, Uppsala University Hospital, Sweden.
    Cognitive behaviour therapy for hyperacusis: A randomized controlled trial2014In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 54, p. 30-37Article in journal (Refereed)
    Abstract [en]

    Hyperacusis, defined as unusual intolerance to ordinary environmental sounds, is a common problem for which there are no controlled trials on psychological treatment. Given the avoidance strategies present in hyperacusis, and similarities with problems such as tinnitus and chronic pain, cognitive behaviour therapy (CBT) is hypothesized to be helpful for patients with hyperacusis. In this randomized controlled study of 60 patients with hyperacusis, CBT was compared with a waiting list control group using the Loudness Discomfort Level test (LDL), the Hyperacusis Questionnaire, the Hospital Anxiety and Depression Scales, the Quality of Life Inventory and an adapted version of the Tampa Scale of Kinesiophobia. There were significant between-group effects in favour of the CBT group on all measures except for the HADS anxiety scale. Between-group effect sizes were moderate to high, with Cohen's d = 0.67 and 0.69 per ear, respectively, for the primary measure LDL, and ranging from d = 0.32 to 1.36 for the secondary measures. The differences between groups ceased to exist when the waiting list group was treated later with CBT, and the treatment results were largely maintained after 12 months. In conclusion, CBT is a promising treatment for hyperacusis, although more research is necessary.

  • 19.
    Klein, JP
    et al.
    Department of Psychiatry and Psychotherapy, Lübeck University, Lübeck, Germany. Electronic address: philipp.klein@uksh.de..
    Späth, C
    Department of Psychiatry and Psychotherapy, Lübeck University, Lübeck, Germany..
    Schröder, J
    Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany..
    Meyer, B
    GAIA AG, Hamburg, Germany; Department of Psychology, City, University of London, London, United Kingdom..
    Greiner, W
    Department of Health Economics and Health Care Management, Bielefeld University, Bielefeld, Germany..
    Hautzinger, M
    Eberhard Karls University Tübingen, Department of Psychology, Clinical Psychology and Psychotherapy, Tübingen, Germany..
    Lutz, W
    Department of Psychology, University of Trier, Germany..
    Rose, M
    Department of Psychosomatic Medicine, Charité University Medical Center, Berlin, Germany; Quantitative Health Sciences, Outcomes Measurement Science, University of Massachusetts Medical School, Worcester, MA, USA..
    Vettorazzi, E
    Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany..
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden..
    Hohagen, F
    Department of Psychiatry and Psychotherapy, Lübeck University, Lübeck, Germany..
    Moritz, S
    Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany..
    Berger, T
    Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland..
    Time to remission from mild to moderate depressive symptoms: One year results from the EVIDENT-study, an RCT of an internet intervention for depression.2017In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 97, p. 154-162Article in journal (Refereed)
    Abstract [en]

    Background: Internet interventions are effective in treating depressive symptoms but few studies conducted a long-term follow-up. The aim of this study was to test the effectiveness of an internet intervention in increasing the remission rate over a twelve months period.less thanbr /greater thanMethods: A total of 1013 participants with mild to moderate depressive symptoms were randomized to either care as usual alone or a 12-week internet intervention (Deprexis) plus usual care. Self-rated depression severity (PHQ-9) was assessed regularly over twelve months.less thanbr /greater thanResults: Remission rates over time were significantly higher in the intervention group (Cox regression: hazard ratio [HR] 1.31; p = 0.009). The intervention was more effective in the subgroup not taking antidepressant medication (Cox regression: HR 1.88; p less than 0.001). PHQ-change from baseline was greater in the intervention group (linear mixed model [LMM]: p less than 0.001) with the between-group effect gradually decreasing from d = 0.36 at three months to d = 0.13 at twelve months (LMM: group by time interaction: p less than 0.001).less thanbr /greater thanConclusion: This internet intervention can contribute to achieving remission in people with mild to moderate depressive symptoms, especially if they are not on antidepressant medication (Trial Registration: NCT01636752).less thanbr /greater than (Copyright © 2017 Elsevier Ltd. All rights reserved.)

  • 20.
    Kuckertz, Jennie M
    et al.
    San Diego State University/University of California, San Diego, CA, USA.
    Gildebrant, Elena
    Umeå University, Sweden.
    Liliequist, Björn
    Umeå University, Sweden.
    Karlström, Petra
    Umeå University, Sweden.
    Väppling, Camilla
    Umeå University, Sweden.
    Bodlund, Owe
    Umeå University, Sweden.
    Stenlund, Therése
    Umeå University, Sweden.
    Hofmann, Stefan G
    Boston University, MA, USA.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Amir, Nader
    San Diego State University/University of California, San Diego, CA, USA.
    Carlbring, Per
    Stockholm University, Sweden.
    Moderation and mediation of the effect of attention training in social anxiety disorder2014In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 53, p. 30-40Article in journal (Refereed)
    Abstract [en]

    While attention modification programs (AMP) have shown promise as laboratory-based treatments for social anxiety disorder, trials of internet-delivered AMP have not yielded significant differences between active and control conditions. To address these inconsistencies, we examined the moderational and mediational role of attention bias in the efficacy of attention training. We compared data reported by Carlbring et al. (2012) to an identical AMP condition, with the exception that participants were instructed to activate social anxiety fears prior to each attention training session (AMP + FACT; n = 39). We also compared all attention training groups to an internet-delivered cognitive-behavioral therapy (iCBT) condition (n = 40). Participants in the AMP + FACT group experienced greater reductions in social anxiety symptoms than both active (n = 40) and control (n = 39) groups reported by Carlbring et al., and did not differ in symptom reductions from the iCBT group. Higher attention bias predicted greater symptom reductions for participants who completed AMP, but not for the control group. Moreover, change in attention bias mediated the relationship between AMP group (active condition reported by Carlbring et al. versus AMP + FACT) and change in social anxiety symptoms. These results suggest the importance of interpreting findings related to symptom change in attention training studies in the context of bias effects. Trial registration: ISRCTN01715124.

  • 21.
    Ljotsson, Brjann
    et al.
    Karolinska Institute.
    Falk, Lisa
    Uppsala University.
    Wibron Vesterlund, Amanda
    Uppsala University.
    Hedman, Erik
    Karolinska Institutet.
    Lindfors, Perjohan
    Sabbatsbergs Hospital.
    Ruck, Christian
    Karolinska Institutet.
    Hursti, Timo
    Uppsala University.
    Andreewitch, Sergej
    Karolinska Institutet.
    Jansson, Liselotte
    Karolinska Institutet.
    Lindefors, Nils
    Karolinska Institutet.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Clinical and Social Psychology. Linköping University, Faculty of Arts and Sciences.
    Internet-delivered exposure and mindfulness based therapy for irritable bowel syndrome - A randomized controlled trial2010In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 48, no 6, p. 531-539Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate if cognitive behavior therapy (cc based on exposure and mindfulness exercises delivered via the Internet would be effective in treating participants with irritable bowel syndrome (IBS). Participants were recruited through self-referral. Eighty-six participants were included in the study and randomized to treatment or control condition (an online discussion forum). One participant was excluded after randomization. The main outcome measure was IBS-symptom severity and secondary measures included IBS-related quality of life. GI-specific anxiety, depression and general functioning. Participants were assessed at pre-treatment, post-treatment and 3 month follow-up (treatment condition only). Four participants (5% of total sample) in the treatment condition did not participate in post-treatment assessment. Participants in the treatment condition reported a 42% decrease and participants in the control group reported a 12% increase in primary IBS-symptoms. Compared to the control condition, participants in the treatment group improved on all secondary outcome measures with a large between group effect size on quality of life (Cohens d - 1.21). We conclude that CBT-based on exposure and mindfulness delivered via the Internet can be effective in treating IBS-patients, alleviating the total burden of symptoms and increasing quality of life.

  • 22.
    Ljotsson, Brjann
    et al.
    Karolinska Institute, Sweden .
    Hesser, Hugo
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Andersson, Erik
    Karolinska University of Sjukhuset Huddinge, Sweden .
    Lackner, Jeffrey M.
    SUNY Buffalo, NY 14215 USA .
    El Alaoui, Samir
    Karolinska University of Sjukhuset Huddinge, Sweden .
    Falk, Lisa
    Sabbatsbergs Hospital, Sweden .
    Aspvall, Kristina
    Karolinska Institute, Sweden .
    Fransson, Josefin
    Karolinska Institute, Sweden .
    Hammarlund, Klara
    Karolinska Institute, Sweden .
    Lofstrom, Anna
    Karolinska Institute, Sweden .
    Nowinski, Sanna
    Karolinska Institute, Sweden .
    Lindfors, Perjohan
    Sabbatsbergs Hospital, Sweden Karolinska University of Sjukhuset Huddinge, Sweden .
    Hedman, Erik
    Karolinska Institute, Sweden Karolinska Institute, Sweden .
    Provoking symptoms to relieve symptoms: A randomized controlled dismantling study of exposure therapy in irritable bowel syndrome2014In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 55, p. 27-39Article in journal (Refereed)
    Abstract [en]

    An internet-delivered cognitive behavioral treatment (ICBT) based on systematic exposure exercises has previously shown beneficial effects for patients with irritable bowel syndrome (IBS). Exposure exercises may be perceived as difficult for patients to perform because of the elicited short-term distress and clinicians may be reluctant to use these interventions. The aim of this study was to compare ICBT with the same protocol without systematic exposure (ICBT-WE) to assess if exposure had any incremental value. This randomized controlled dismantling study included 309 participants diagnosed with IBS. The treatment interventions lasted for 10 weeks and included online therapist contact. ICBT-WE comprised mindfulness, work with life values, acceptance, and encouraged reduced avoidance behaviors, while ICBT also included systematic exposure to IBS symptoms and related situations. Severity of IBS symptoms was measured with the Gastrointestinal Symptom Rating Scale-IBS version (GSRS-IBS). The between-group Cohens don GSRS-IBS was 0.47(95% CI: 0.23-0.70) at post-treatment and 0.48 (95% CI: 0.20-0.76) at 6-month follow-up, favoring ICBT. We conclude that the systematic exposure included in the ICBT protocol has incremental effects over the other components in the protocol. This study provides evidence for the utility of exposure exercises in psychological treatments for IBS.

  • 23.
    Ljótsson, B
    et al.
    Uppsala universitet.
    Mitsell, K
    Uppsala universitet.
    Lundin, C
    Uppsala universitet.
    Carlbring, Per
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Behavioural Sciences, Clinical and Social Psychology.
    Ramklint, M
    Uppsala universitet.
    Ghaderi, A
    Uppsala universitet.
    Remote treatment of bulimia nervosa and binge eating disorder: A randomized trial of Internet-assisted cognitive behavioural therapy2007In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 45, no 4, p. 649-661Article in journal (Refereed)
    Abstract [en]

    The present study investigated the efficacy of self-help based on cognitive behaviour therapy in combination with Internet support in the treatment of bulimia nervosa and binge eating disorder. After confirming the diagnosis with an in-person interview, 73 patients were randomly allocated to treatment or a waiting list control group. Treated individuals showed marked improvement after 12 weeks of self-help compared to the control group on both primary and secondary outcome measures. Intent-to-treat analyses revealed that 37% (46% among completers) had no binge eating or purging at the end of the treatment and a considerable number of patients achieved clinically significant improvement on most of the other measures as well. The results were maintained at the 6-month follow-up, and provide evidence to support the continued use and development of self-help programmes. © 2006 Elsevier Ltd. All rights reserved.

  • 24.
    Miloff, Alexander
    et al.
    Stockholm Univ, Sweden.
    Lindner, Philip
    Stockholm Univ, Sweden; Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden.
    Dafgard, Peter
    Stockholm Univ, Sweden.
    Deak, Stefan
    Stockholm Univ, Sweden.
    Garke, Maria
    Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden.
    Hamilton, William
    Mimerse AB, Sweden.
    Heinsoo, Julia
    Stockholm Univ, Sweden.
    Kristoffersson, Glenn
    Stockholm Univ, Sweden.
    Rafi, Jonas
    Stockholm Univ, Sweden.
    Sindemark, Kerstin
    Stockholm Univ, Sweden.
    Sjolund, Jessica
    Stockholm Univ, Sweden.
    Zenger, Maria
    Stockholm Univ, Sweden.
    Reuterskiold, Lena
    Stockholm Univ, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology. Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden.
    Carlbring, Per
    Stockholm Univ, Sweden; Univ Southern Denmark, Denmark.
    Automated virtual reality exposure therapy for spider phobia vs. in-vivo one-session treatment: A randomized non-inferiority trial2019In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 118, p. 130-140Article in journal (Refereed)
    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.

  • 25.
    Nordgreen, T.
    et al.
    University of Bergen, Norway.
    Havik, O. E.
    University of Bergen, Norway.
    Öst, L. G.
    University of Bergen, Norway.
    Furmark, T.
    Uppsala University, Sweden.
    Carlbring, P.
    Umeå University, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Clinical and Social Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institutet, Sweden.
    Outcome predictors in guided and unguided self-help for social anxiety disorder2012In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 50, no 1, p. 13-21Article in journal (Refereed)
    Abstract [en]

    Internet-based self-help with therapist guidance has shown promise as an effective treatment and may increase access to evidence-based psychological treatment for social anxiety disorder (SAD). Although unguided self-help has been suggested primarily as a population-based preventive intervention, some studies indicate that patients with SAD may profit from unguided self-help. Gaining knowledge about predictors of outcome in guided and unguided self-help for SAD is important to ensure that these interventions can be offered to those who are most likely to respond. Utilizing a sample of 245 patients who received either guided or unguided self-help for SAD, the present study examined pre-treatment symptoms and program factors as predictors of treatment adherence and outcome. The results were in line with previous findings from the face-to-face treatment literature: namely, the intensity of baseline SAD symptoms, but not depressive symptoms, predicted treatment outcomes in both unguided and guided self-help groups. Outcomes were unrelated to whether a participant has generalized versus specific SAD. Furthermore, for the unguided self-help group, higher credibility ratings of the treatment program were associated with increased treatment adherence. The findings suggest that guided and unguided self-help may increase access to SAD treatment in a population that is more heterogeneous than previously assumed.

  • 26.
    Rozental, Alexander
    et al.
    Department of Psychology, Stockholm University, Stockholm, Sweden.
    Shafran, Roz
    Institute of Child Health, University College London, London, England, United Kingdom.
    Wade, Tracey
    School of Psychology, Flinders University, Adelaide, Australia.
    Egan, Sarah
    School of Psychology and Speech Pathology, Curtin University, Perth, Australia.
    Bergman Nordgren, Lise
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Carlbring, Per
    Department of Psychology, Stockholm University, Stockholm, Sweden.
    Landström, Andreas
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Roos, Stina
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Skoglund, Malin
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Thelander, Elisabet
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Trosell, Linnea
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Örtenholm, Alexander
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    A randomized controlled trial of Internet-Based Cognitive Behavior Therapy for perfectionism including an investigation of outcome predictors2017In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 95, p. 79-86Article in journal (Refereed)
    Abstract [en]

    Being highly attentive to details can be a positive feature. However, for some individuals, perfectionism can lead to distress and is associated with many psychiatric disorders. Cognitive behavior therapy has been shown to yield many benefits for those experiencing problems with perfectionism, but the access to evidence-based care is limited. The current study investigated the efficacy of guided Internet-based Cognitive Behavior Therapy (ICBT) and predictors of treatment outcome. In total, 156 individuals were included and randomized to an eight-week treatment or wait-list control. Self-report measures of perfectionism, depression, anxiety, self-criticism, self-compassion, and quality of life were distributed during screening and at post-treatment. Intention-to-treat were used for all statistical analyses. Moderate to large between-group effect sizes were obtained for the primary outcome measures, Frost Multidimensional Perfectionism Scale, subscales Concerns over Mistakes and Personal Standards, Cohens d = 0.68-1.00, 95% Confidence Interval (CI) [0.36-1.33], with 35 (44.9%) of the patients in treatment being improved. Predictors were also explored, but none were related to treatment outcome. In sum, guided ICBT can be helpful for addressing problems with clinical perfectionism, but research of its long-term benefits is warranted. (C) 2017 Elsevier Ltd. All rights reserved.

  • 27.
    Schulz, Ava
    et al.
    Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland.
    Stolz, Timo
    Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland.
    Vincent, Alessia
    Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland.
    Krieger, Tobias
    Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, Stockholm, Sweden.
    Berger, Thomas
    Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland.
    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.2016In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 84, p. 14-26Article in journal (Refereed)
    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.

  • 28.
    Shafran, Roz
    et al.
    UCL, England.
    Wade, Tracey D.
    Flinders University of S Australia, Australia.
    Egan, Sarah J.
    Curtin University, Australia.
    Kothari, Radha
    UCL, England.
    Allcott-Watson, Hannah
    UCL, England.
    Carlbring, Per
    Stockholm University, Sweden.
    Rozental, Alexander
    Stockholm University, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden.
    Is the devil in the detail? A randomised controlled trial of guided internet-based CBT for perfectionism2017In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 95, p. 99-106Article in journal (Refereed)
    Abstract [en]

    An Internet guided self-help cognitive-behavioural treatment (ICBT) for perfectionism was recently found to be effective (see this issue). Such studies stand in need of replication. The aim of this study was to report the outcomes and predictors of change when the treatment is delivered in a UK setting. A total of 120 people (Mean = 28.9 years; 79% female) were randomised to receive ICBT or wait-list control over 12 weeks (trial registration: NCT02756871). While there were strong similarities between the current study and its Swedish counterpart, there were also important differences in procedural details. There was a significant impact of the intervention on the primary outcome measure (Frost Multidimensional Perfectionism Scale, Concern over Mistakes subscale) and also on the Clinical Perfectionism Questionnaire (between group effect sizes d = 0.98 (95% CI: 0.60-1.36) and d = 1.04 (95% CI: 0.66-1.43) respectively using intent-to-treat analyses). Unlike the Swedish study, there was significant non engagement and non-completion of modules with 71% of participants completing fewer than half the modules. The number of modules completed moderated the rate of change in clinical perfectionism over time. In conclusion, the study indicates the intervention is effective in a UK setting but highlighted the importance of procedural details to optimise retention. (C) 2017 Elsevier Ltd. All rights reserved.

  • 29.
    Vigerland, Sarah
    et al.
    Karolinska Institute, Sweden.
    Ljotsson, Brjann
    Karolinska Institute, Sweden.
    Thulin, Ulrika
    Karolinska Institute, Sweden.
    Ost, Lars-Goran
    Karolinska Institute, Sweden; Stockholm University, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden.
    Serlachius, Eva
    Karolinska Institute, Sweden.
    Internet-delivered cognitive behavioural therapy for children with anxiety disorders: A randomised controlled trial2016In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 76, p. 47-56Article in journal (Refereed)
    Abstract [en]

    Background: Cognitive behaviour therapy (CBT) has been shown to be an effective treatment for anxiety disorders in children, but few affected seek or receive treatment. Internet-delivered CBT (ICBT) could be a way to increase the availability of empirically supported treatments. Aims: A randomised controlled trial was conducted to evaluate ICBT for children with anxiety disorders. Method: Families (N = 93) with a child aged 8-12 years with a principal diagnosis of generalised anxiety disorder, panic disorder, separation anxiety, social phobia or specific phobia were recruited through media advertisement Participants were randomised to 10 weeks of ICBT with therapist support, or to a waitlist control condition. The primary outcome measure was the Clinician Severity Rating (CSR) and secondary measures included child-and parent-reported anxiety. Assessments were made at pre-treatment, post-treatment and at three-month follow-up. Results: At post-treatment, there were significant reductions on CSR in the treatment group, with a large between-group effect size (Cohens d = 1.66). Twenty per cent of children in the treatment group no longer met criteria for their principal diagnosis at post-treatment and at follow-up this number had increased to 50%. Parent-reported child anxiety was significantly lower in the treatment group than in the waitlist group at post-treatment, with a small between-group effect size (Cohens d = 0.45). There were no significant differences between the groups regarding child-ratings of anxiety at post-treatment. Improvements were maintained at three-month follow-up, although this should be interpreted cautiously due to missing data. Conclusions: Within the limitations of this study, results suggest that ICBT with therapist support for children with anxiety disorders can reduce clinician-and parent-rated anxiety symptoms. Trial registration: Clinicaltrials.gov: NCT01533402. (C) 2015 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licensesiby-nc-nd/4.0/).

  • 30.
    Vigerland, Sarah
    et al.
    Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.
    Serlachius, Eva
    Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.
    Thulin, Ulrika
    Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. e, Division of PsychDepartment of Clinical Neurosciencology, Karolinska Institutet, Stockholm, Sweden.
    Larsson, Jan-Olov
    Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
    Ljótsson, Brjánn
    Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.
    Long-term outcomes and predictors of internet-delivered cognitive behavioral therapy for childhood anxiety disorders.2017In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 90, p. 67-75Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: This study investigated the long-term outcomes of internet-delivered cognitive behavior therapy (ICBT) for children with anxiety disorders, and potential pre-treatment predictors of treatment outcome.

    METHOD: The sample included eighty-four children (8-12 years old) with anxiety disorders, from both a treatment group and a waitlist control (after participants had crossed over to treatment) of a previous randomized controlled study. Participants were assessed at post-treatment and three- and twelve-months after treatment using a semi-structured interview and parent ratings. Pre-treatment data were used to investigate predictors of treatment outcome at three-month follow-up.

    RESULTS: Intention-to-treat analysis showed that treatment gains were maintained at twelve-month follow-up, including clinician rated severity of the principal anxiety disorder, parent rated anxiety symptoms and global functioning, with mainly large effect sizes (Cohen's d = 0.63-2.35). Completer analyses showed that suspected autism spectrum disorder was associated with less change in symptom severity. No other pre-treatment measures significantly predicted treatment outcome.

    CONCLUSION: This study suggests that internet-delivered CBT can have long-term beneficial effects for children with anxiety disorders. Predictors of treatment outcome need to be evaluated further.

    TRIAL REGISTRATION: Clinicaltrials.gov; NCT01533402.

  • 31.
    Westin, Vendela
    et al.
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    C Hayes, Steven
    University of Nevada.
    Andersson , Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Clinical and Social Psychology. Linköping University, Faculty of Arts and Sciences.
    Is it the sound or your relationship to it? The role of acceptance in predicting tinnitus impact2008In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 46, no 12, p. 1259-1265Article in journal (Refereed)
    Abstract [en]

    Tinnitus is an experience of sound in the absence of an appropriate external source. A symptom that can accompany most central or peripheral dysfunctions of the auditory system, tinnitus can lead to significant distress, depression, anxiety, and decreases in life quality. This paper investigated the construct of psychological acceptance in a population of tinnitus patients. First, a cross-sectional Study (N = 77) was conducted in which a tinnitus specific acceptance questionnaire was developed. Results showed that a Tinnitus Acceptance Questionnaire (TAQ) generated good internal consistency. A factor Solution was derived with two factors: activity engagement and tinnitus supression, Second, a longitudinal study (N = 47) investigated the mediating role of acceptance on the relationship between tinnitus distress at baseline and tinnitus distress, anxiety, life quality, and depression at a 7-month follow-up The results. showed full mediation of activity engagement for depression and life quality at follow-up, partial mediation for tinnitus distress, and no mediation for anxiety. The role of acceptance in the negative impact of tinnitus distress merits further investigation.

  • 32.
    Zetterqvist Westin, Vendela
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Clinical and Social Psychology. Linköping University, Faculty of Educational Sciences.
    Schulin, Mikael
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of ENT - Head and Neck Surgery UHL.
    Hesser, Hugo
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research.
    Karlsson, Marianne
    Vrinnevisjukhuset, Norrköping.
    Zare Noe, Reza
    Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of ENT - Head and Neck Surgery UHL. Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery.
    Olofsson, Ulrike
    Östergötlands Läns Landsting, Sinnescentrum, Department of ENT - Head and Neck Surgery UHL.
    Stalby, Magnus
    Psykologpartners, Linköping.
    Wisung, Gisela
    Psykologpartners, Linköping.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Clinical and Social Psychology. Linköping University, Faculty of Arts and Sciences.
    Acceptance and Commitment Therapy versus Tinnitus Retraining Therapy in the treatment of tinnitus: A randomised controlled trial2011In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 49, no 11, p. 737-747Article in journal (Refereed)
    Abstract [en]

    The study compared the effects of Acceptance and Commitment Therapy (ACT) with Tinnitus Retraining Therapy (TRT) on tinnitus impact in a randomised controlled trial. Sixty-four normal hearing subjects with tinnitus were randomised to one of the active treatments or a wait-list control (WLC). The ACT treatment consisted of 10 weekly 60min sessions. The TRT treatment consisted of one 150min session, one 30min follow-up and continued daily use of wearable sound generators for a recommended period of at least 8h/day for 18 months. Assessments were made at baseline, 10 weeks, 6 months and 18 months. At 10 weeks, results showed a superior effect of ACT in comparison with the WLC regarding tinnitus impact (Cohen's d=1.04), problems with sleep and anxiety. The results were mediated by tinnitus acceptance. A comparison between the active treatments, including all assessment points, revealed significant differences in favour of ACT regarding tinnitus impact (Cohen's d=0.75) and problems with sleep. At 6 months, reliable improvement on the main outcome measure was found for 54.5% in the ACT condition and 20% in the TRT condition. The results suggest that ACT can reduce tinnitus distress and impact in a group of normal hearing tinnitus patients.

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