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  • 1.
    Alfonsson, Sven
    et al.
    Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden; Uppsala Univ, Sweden.
    Parling, Thomas
    Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden.
    Spännargård, Asa
    Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden.
    Lundgren, Tobias
    Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden.
    The effects of clinical supervision on supervisees and patients in cognitive behavioral therapy: a systematic review2018In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 47, no 3, p. 206-228Article, review/survey (Refereed)
    Abstract [en]

    Clinical supervision is a central part of psychotherapist training but the empirical support for specific supervision theories or features is unclear. The aims of this study were to systematically review the empirical research literature regarding the effects of clinical supervision on therapists competences and clinical outcomes within Cognitive Behavior Therapy (CBT). A comprehensive database search resulted in 4103 identified publications. Of these, 133 were scrutinized and in the end 5 studies were included in the review for data synthesis. The five studies were heterogeneous in scope and quality and only one provided firm empirical support for the positive effects of clinical supervision on therapists competence. The remaining four studies suffered from methodological weaknesses, but provided some preliminary support that clinical supervision may be beneficiary for novice therapists. No study could show benefits from supervision for patients. The research literature suggests that clinical supervision may have some potential effects on novice therapists competence compared to no supervision but the effects on clinical outcomes are still unclear. While bug-in-the-eye live supervision may be more effective than standard delayed supervision, the effects of specific supervision models or features are also unclear. There is a continued need for high-quality empirical studies on the effects of clinical supervision in psychotherapy.

  • 2.
    Andersson, Gerhard
    et al.
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Behavioural Sciences, Clinical and Social Psychology.
    Asmundson, Gordon
    CBT and religion2006In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 35Article in journal (Other academic)
  • 3.
    Andersson, Gerhard
    et al.
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Behavioural Sciences and Learning, Clinical and Social Psychology.
    Asmundson, Gordon
    Should CBT rest on its success?2008In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 37Article in journal (Other academic)
  • 4.
    Andersson, Gerhard
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Clinical and Social Psychology. Linköping University, Faculty of Arts and Sciences.
    Asmundson, Gordon
    Faculty of Kinesiology and Health Studies University of Regina Regina, Sask. S4S 0A2, Canada.
    Carlbring, Per
    Linköping University, Department of Behavioural Sciences, Clinical and Social Psychology. Linköping University, Faculty of Arts and Sciences.
    Ghaderi, Ata
    Inst f Psykologi Uppsala universitet.
    Hofmann, Stefan
    Department of Psychology Boston University, Boston, MA, United States.
    Stewart, Sherry
    Department of Psychology Dalhousie University, Halifax, NS, Canada.
    Is CBT already the Dominant Paradigm in Psychotherapy Research and Practice?2005In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 34, no 1Article in journal (Refereed)
  • 5.
    Andersson, Gerhard
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institutet, Stockholm, Sweden.
    Carlbring, Per
    Stockholm University, Sweden.
    Holmes, Emily A
    MRC Cognition and Brain Sciences Unit, Cambridge, UK.
    Special Issue in Honour of Lars-Göran Öst2013In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 42, no 4, p. 259-Article in journal (Other academic)
  • 6.
    Andersson, Gerhard
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Clinical and Social Psychology. Linköping University, Faculty of Arts and Sciences.
    Carlbring, Per
    Linköping University, Department of Behavioural Sciences, Clinical and Social Psychology.
    Kaldo, Viktor
    INst f psykologi Uppsala universitet.
    Obituary. Jeff Richards.2005In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 34, p. 128-128Article in journal (Other academic)
  • 7.
    Andersson, Gerhard
    et al.
    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.
    Cima, Rilana F F.
    Maastricht University, Netherlands .
    Weise, Cornelia
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Arts and Sciences. Linköping, Disability Research.
    Autobiographical Memory Specificity in Patients with Tinnitus Versus Patients with Depression and Normal Controls2013In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 42, no 2, p. 116-126Article in journal (Refereed)
    Abstract [en]

    Several studies show that patients with depression and post-traumatic stress disorder respond with fewer specific autobiographical memories in a cued memory task (i.e. the autobiographical memory test; AMT) compared to healthy controls. One previous study found this phenomenon among tinnitus patients as well (Andersson, Ingerholt, andamp; Jansson, 2003). The aim of this study was to replicate the previous study with an additional control group of depressed patients and memory errors as measured with the AMT as an additional outcome. We included 20 normal hearing tinnitus patients, 20 healthy controls and 20 persons diagnosed with clinical depression. The AMT was administered together with self-report measures of depression, anxiety and tinnitus distress. Both the tinnitus and depression groups differed from the healthy control group in that they reported fewer specific autobiographical memories. There were, however, differences between the tinnitus and depression groups in terms of the errors made on the AMT. The depression group had more overgeneral memories than the normal control group, whereas the tinnitus group did not differ from the control group on this memory error. The tinnitus group had more semantic associations and non-memories than the other two groups, suggesting that executive functioning may play a role for the tinnitus group when completing the AMT. Clinical and theoretical implications of the findings are discussed.

  • 8.
    Andersson, Gerhard
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institutet, Stockholm, Sweden.
    Holmes, Emily A.
    MRC Cognition and Brain Sciences Unit, Cambridge, UK.
    Carlbring, Per
    Stockholm University, Sweden.
    Lars-Göran Öst2013In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 42, no 4, p. 260-264Article in journal (Refereed)
    Abstract [en]

    Lars-Göran Öst is one of the most eminent clinical researchers in the field of cognitive behaviour therapy (CBT) and a founder of CBT in Sweden. He has recently retired from his position as professor in clinical psychology at Stockholm University, Sweden. In this paper, we sketch a brief description of the body of work by Öst. Examples of his innovative and pioneering new treatment methods include the one-session treatment for specific phobias, as well as applied relaxation for a range of anxiety disorders and health conditions. While Öst remains active in the field, he has contributed significantly to the development and dissemination of CBT in Sweden as well as in the world.

  • 9.
    Andersson, Gerhard
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institutet, Stockholm, Sweden.
    Waara, Johan
    Uppsala University, Sweden.
    Jonsson, Ulf
    Karolinska Institutet, Stockholm, Sweden.
    Malmaeus, Fredrik
    Uppsala University, Sweden.
    Carlbring, Per
    Stockholm University, Sweden.
    Öst, Lars-Göran
    Karolinska Institutet, Stockholm, Sweden.
    Internet-based exposure treatment versus one-session exposure treatment of snake phobia: a randomized controlled trial2013In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 42, no 4, p. 284-291Article in journal (Refereed)
    Abstract [en]

    In this study, the authors compared guided Internet-delivered self-help with one-session exposure treatment (OST) in a sample of snake phobic patients. A total of 30 patients were included following a screening on the Internet and a structured clinical interview. The Internet treatment consisted of four weekly text modules which were presented on a web page, a video in which exposure was modelled, and support provided via Internet. The OST was delivered in a three-hour session following a brief orientation session. The main outcome was the behavioural approach test (BAT), and as secondary measures questionnaires measuring anxiety symptoms and depression were used. Results showed that the groups did not differ at post-treatment or follow-up, with the exception of a significant interaction for the BAT in favour of the OST. At post-treatment, 61.5% of the Internet group and 84.6% of the OST group achieved a clinically significant improvement on the BAT. At follow-up, the corresponding figures were 90% for the Internet group and 100% for the OST group (completer sample). Within-group effect sizes for the Snake Phobia Questionnaire were large (d = 1.63 and d = 2.31 for the Internet and OST groups, respectively, at post-treatment). It is concluded that guided Internet-delivered exposure treatment is a potential treatment option in the treatment of snake phobia, but that OST probably is better.

  • 10.
    Andersson, Gerhard
    et al.
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Behavioural Sciences and Learning.
    Westöö, Johan
    Johansson, Linda
    Carlbring, Per
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Behavioural Sciences, Clinical and Social Psychology.
    Cognitive bias via the Internet: A comparison of web-based and standard emotional Stroop tasks in social phobia2006In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 35, no 1, p. 55-62Article in journal (Refereed)
    Abstract [en]

    There is accumulating evidence to suggest that social phobia is associated with attentional bias for words related to social threat. Information processing in individuals with social phobia (n = 87) was investigated in the present study using 2 versions of the emotional Stroop task. Results from a standard emotional Stroop task indicated delayed colour naming of socially threatening words relative to neutral words, in line with previous research, whereas results from a Web-based emotional Stroop task indicated a facilitation effect, with faster manual indication of colour choice for socially threatening words than for neutral words. Possible explanations for these contrasting findings and issues for further research are discussed. © 2006 Taylor & Francis.

  • 11.
    Bjärehed, Jonas
    et al.
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Sarkohi, Ali
    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. Linköping University, Faculty of Arts and Sciences.
    Less positive or more negative? Future-directed thinking in mild to moderate depression2010In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 39, no 1, p. 37-45Article in journal (Refereed)
    Abstract [en]

    Depressed patients have been found to generate fewer anticipated positive future events, but most previous studies have included patients who have either been severely depressed or expressed suicidal thoughts and intents or both. The aim of this study was to compare positive and negative future-directed thinking in persons with mild to moderate depression who did not express suicidal thoughts or intents (n = 20) with a matched group of nondepressed persons (n = 20). The two groups completed the Future-Thinking Task (FTT), in which they were asked to generate positive and negative anticipated future events for three upcoming time periods (1 week, 1 year, and 5-10 years). In the present version of the FTT, both quantitative and qualitative aspects were included (i.e. subjective likelihood and emotional valence). Results showed that depressed persons reported lower scores regarding anticipated future positive events but they did not differ in terms of future negative events. The results are consistent with previous research and further strengthen the notion that reduced anticipation of future positive events is a defining characteristic of depression, even in the absence of suicidal ideation.

  • 12.
    Boettcher, Johanna
    et al.
    Stockholm University, Sweden .
    Hasselrot, Jonas
    Umeå University, Sweden .
    Sund, Erik
    Umeå University, Sweden .
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Carlbring, Per
    Stockholm University, Sweden .
    Combining Attention Training with Internet-Based Cognitive-Behavioural Self-Help for Social Anxiety: A Randomised Controlled Trial2014In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 43, no 1, p. 34-48Article in journal (Refereed)
    Abstract [en]

    Guided Internet-based cognitive-behavioural self-help (ICBT) has been proven to be effective for social anxiety disorder (SAD) by several independent research groups. However, as the proportion of clinical significant change has room for improvement, new treatments should be developed and investigated. A novel treatment is attention bias modification (ABM). This study aimed at evaluating the combination of ABM and ICBT. We compared two groups, one group receiving ICBT and ABM targeting attentional avoidance and the other group receiving ICBT and control training. ABM and control training tasks were both based on the dot-probe paradigm. A total of 133 participants, diagnosed with SAD, were randomised to these two groups. The attention training group (N=66) received 2 weeks of daily attention training followed by 9 weeks of ICBT. The control group (N=67) received 2 weeks of daily control training, also followed by 9 weeks of ICBT. Social anxiety measures as well as the attention bias were assessed at pre-assessment, at week 2, and at post-treatment. Results showed no significant differences between the attention training group and the control group. Both groups improved substantially on social anxiety symptoms from pre- to post-assessment (d(within)=1.39-1.41), but showed no change in attention processes (d(within)=0.10-0.17). In this trial, the attention modification training failed to induce differential change in attention bias. Results demonstrate that the applied ABM procedure with its focus on the reduction of attentional avoidance was ineffective in the Internet-based setting. The results do not suggest that adding ABM targeting attentional avoidance to ICBT results in better outcomes than ICBT alone.

  • 13.
    Bohman, Benjamin
    et al.
    Karolinska Institute, Stockholm, Sweden; Stockholm Health Care Services, Stockholm, Sweden.
    Santi, Alberto
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences. Psykologpartners Private Practice, Linköping, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Stockholm, Sweden.
    Cognitive behavioral therapy in practice: therapist perceptions of techniques, outcome measures, practitioner qualifications, and relation to research.2017In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 46, no 5, p. 391-403Article in journal (Refereed)
    Abstract [en]

    Cognitive behavioral therapy (CBT) has a strong evidence base for several psychiatric disorders, however, it may be argued that currently there is no overall agreement on what counts as 'CBT'. One reason is that CBT is commonly perceived as encompassing a broad range of treatments, from purely cognitive to purely behavioral, making it difficult to arrive at a clear definition. The purpose of the present study was to explore practicing therapists' perceptions of CBT. Three hundred fifty members of two multi-disciplinary interest groups for CBT in Sweden participated. Mean age was 46 years, 68% were females, 63% psychologists and mean number of years of professional experience was 12 years. Participants completed a web-based survey including items covering various aspects of CBT practice. Overall, therapist perceptions of the extent to which different treatment techniques and procedures were consistent with CBT were in line with current evidence-based CBT protocols and practice guidelines, as were therapists' application of the techniques and procedures in their own practice. A majority of participants (78%) agreed that quality of life or level of functioning were the most important outcome measures for evaluating treatment success. Eighty percent of therapists believed that training in CBT at a basic level was a requirement for practicing CBT. There was a medium size Spearman correlation of rs=.46 between the perceived importance of research to practice and the extent to which participants kept themselves updated on research. Implications for training, quality assurance, and the effectiveness of CBT in clinical practice are discussed.

  • 14.
    Bystedt, Samuel
    et al.
    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.
    Boettcher, Johanna
    Free University of Berlin, Germany.
    Carlbring, Per
    Stockholm University, Sweden.
    Clinicians Perspectives on Negative Effects of Psychological Treatments2014In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 43, no 4, p. 319-331Article in journal (Refereed)
    Abstract [en]

    Negative effects of psychological treatments is a fairly unexplored area of clinical research. Previous investigations have indicated that a portion of all patients experience negative effects in terms of deterioration and various adverse events. Meanwhile, evidence suggests that many clinicians are untrained in identifying negative effects and unaware of the current research findings. The objective of the current study is thus to investigate clinicians own perspectives and experiences of possible negative effects of psychological treatments. An invitation to participate in an anonymous online survey consisting of 14 open-ended questions was distributed via three mailing lists used by clinicians that primarily identify themselves as cognitive behavior therapists. The responses were analyzed using a qualitative method based on thematic analysis. In total, 74 participants completed the survey. A majority agreed that negative effects of psychological treatments exist and pose a problem, and many reported having experienced both deterioration and adverse events among patients in their own practice. The thematic analysis resulted in three core themes: characteristics of negative effects, causal factors, as well as methods and criteria for evaluating negative effects. The clinicians recognize that negative effects exist, but many are unaware of the current research findings and are unfamiliar with methods and criteria for identifying and preventing deterioration and adverse events. The results provide evidence for further dissemination of the present knowledge regarding negative effects, particularly during basic clinical training, as well as the need for raising awareness of the available methods for identifying and preventing negative effects.

  • 15.
    Carlbring, Per
    et al.
    Department of Psychology, Stockholm University, Stockholm, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Cuijpers, Pim
    Department of Clinical, Neuro and Developmental Psychology, Section of Clinical Psychology, Vrije Universiteit, Amsterdam, The Netherlands.
    Riper, Heleen
    Department of Clinical, Neuro and Developmental Psychology, Section of Clinical Psychology, Vrije Universiteit, Amsterdam, The Netherlands; VU University Medical Centre/GGZ inGeest, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Amsterdam, The Netherlands; Faculty of Health Science, Telepsychiatric Unit, University of Southern Denmark, University Hospital, Odense, Denmark.
    Hedman-Lagerlöf, Erik
    Department of Clinical Neuroscience, Osher Center for Integrative Medicine and Division of Psychology, Karolinska Institutet, Stockholm, Sweden.
    Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: an updated systematic review and meta-analysis2018In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 47, no 1, p. 1-18Article, review/survey (Refereed)
    Abstract [en]

    During the last two decades, Internet-delivered cognitive behavior therapy (ICBT) has been tested in hundreds of randomized controlled trials, often with promising results. However, the control groups were often waitlisted, care-as-usual or attention control. Hence, little is known about the relative efficacy of ICBT as compared to face-to-face cognitive behavior therapy (CBT). In the present systematic review and meta-analysis, which included 1418 participants, guided ICBT for psychiatric and somatic conditions were directly compared to face-to-face CBT within the same trial. Out of the 2078 articles screened, a total of 20 studies met all inclusion criteria. Results showed a pooled effect size at post-treatment of Hedges g = .05 (95% CI, -.09 to .20), indicating that ICBT and face-to-face treatment produced equivalent overall effects. Study quality did not affect outcomes. While the overall results indicate equivalence, there have been few studies of the individual psychiatric and somatic conditions so far, and for the majority, guided ICBT has not been compared against face-to-face treatment. Thus, more research, preferably with larger sample sizes, is needed to establish the general equivalence of the two treatment formats.

  • 16.
    Dettore, Davide
    et al.
    University of Florence, Italy; Miller Institute Behav and Cognit Psychotherapy, Italy.
    Pozza, Andrea
    Miller Institute Behav and Cognit Psychotherapy, Italy; University of Florence, Italy.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden.
    Efficacy of Technology-delivered Cognitive Behavioural Therapy for OCD Versus Control Conditions, and in Comparison with Therapist-Administered CBT: Meta-Analysis of Randomized Controlled Trials2015In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 44, no 3, p. 190-211Article, review/survey (Refereed)
    Abstract [en]

    Cognitive behavioural therapy (CBT) is a well-established treatment for obsessive-compulsive disorder (OCD). However, few patients receive CBT, due to factors such as geographic limitations, perceived stigmatization, and lack of CBT services. Technology-delivered cognitive behavioural therapy (T-CBT) could be an effective strategy to improve patients access to CBT. To date, a meta-analysis on the effectiveness of T-CBT for OCD has not been conducted. This study used meta-analytic techniques to summarize evidence on the efficacy of T-CBT for OCD versus control conditions and therapist-administered CBT. A meta-analysis according to Prisma guidelines was conducted on randomized controlled trials (RCTs) of T-CBT for OCD. Treatment was classified as T-CBT if evidence-based CBT active ingredients for OCD were included (psychoeducation, ERP, and cognitive restructuring), delivered through health technologies (e.g. self-help books, leaflets, and other forms of bibliotherapy) or remote communication technologies (e.g. the Internet, web-cameras, telephones, telephone-interactive voice response systems, and CD-ROMS). Studies using validated outcomes for OCD or depression were included. Eight trials were included (N=420). Two trials were classified as at high risk of bias. T-CBT seemed to be superior to control conditions on OCD symptom outcomes at post-treatment (d=0.82, 99% CI=0.55-1.08, p=0.001), but not on comorbid depression (d=0.33, 99% CI=-0.01-0.67, p=0.020). Difference in the efficacy on OCD symptoms between T-CBT and therapist-administered CBT was not significant, despite a trend favouring therapist-administered CBT emerged (d=0.45, 95% CI=0.03-0.87, p=0.033). Directions for research are discussed. Further RCTs are warranted to examine the efficacy of T-CBT for OCD.

  • 17.
    Dirkse, Dale
    et al.
    University of Regina, Canada.
    Hadjistavropoulos, Heather D.
    University of Regina, Canada.
    Hesser, Hugo
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Barak, Azy
    University of Haifa, Israel.
    Linguistic Analysis of Communication in Therapist-Assisted Internet-Delivered Cognitive Behavior Therapy for Generalized Anxiety Disorder2015In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 44, no 1, p. 21-32Article in journal (Refereed)
    Abstract [en]

    Therapist-assisted Internet-delivered cognitive behavior therapy (ICBT) involves elements of expressive writing through secure messaging with a therapist. Expressive writing has been associated with psychological and physical health benefits in past research; furthermore, certain linguistic dimensions in expressive writing have been identified as particularly beneficial to health, such as less frequent use of negative emotion words and greater use of positive emotion words. No research, to date, has analyzed linguistic dimensions in client communication over the course of therapist-assisted ICBT for individuals with symptoms of generalized anxiety. This naturalistic study examined messages sent to therapists during the course of ICBT using linguistic analysis, and explored covariation of word use with symptom improvement. Data were obtained from patients with symptoms of generalized anxiety (N=59) who completed 12 modules of therapist-assisted ICBT and rated symptoms of anxiety, depression, and panic at the beginning of each module. Linguistic analysis categorized text submitted to therapists into different word categories. Results found that patients use of negative emotion, anxiety, causation, and insight words reduced over the course of treatment, while past tense words increased. Furthermore, negative emotion words significantly covaried with symptom ratings over the course of treatment. While causal statements cannot be made, findings improve our understanding of patient communication in ICBT and suggest that the further study of linguistic dimensions as psychological indicators and the potential utility of expressive writing strategies in therapist-assisted ICBT may be worthwhile.

  • 18.
    Engman, Maria
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Gender and medicine. Linköping University, Faculty of Health Sciences.
    Wijma, Klaas
    Linköping University, Department of Clinical and Experimental Medicine, Medical Psychology. Linköping University, Faculty of Health Sciences.
    Wijma, Barbro
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Long-term coital behaviour in women treated with cognitive behaviour therapy for superficial coital pain and vaginismus2010In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 39, no 3, p. 193-202Article in journal (Refereed)
    Abstract [en]

    The purpose of the present study was to investigate long-term coital behaviour in women treated with cognitive behaviour therapy (CBT) for superficial coital pain and vaginismus. Data were taken from a questionnaire concerning long-term coital behaviour sent to 59 women who presented to Linköping University Hospital because of superficial coital pain, had been diagnosed with vaginismus, and had been treated with CBT. Data were also traced from therapy records: mean follow-up time was 39 months, the women had suffered for an average of almost 4 years, and required a mean of 14 treatment sessions. Forty-four of the 59 women returned the questionnaire, for a response rate of 74.6%. At follow-up, 81% of the treated women had had intercourse. A majority (61%) rated their ability to have intercourse without pain as 6 or higher (on a scale from 0-10), and 61% rated their ability to enjoy intercourse as 6 or higher (on a scale from 0-10). The proportion of women with positive treatment outcome at follow-up ranged from 81% (able to have intercourse) to 6% (able to have pain-free intercourse). An ability to have intercourse at end of therapy was maintained at follow-up. Two-thirds of the women reported high fulfillment of individual treatment goals. At follow-up, the women estimated a significantly higher self-worth as sex partners, and as women and human beings, than before treatment. Twelve per cent of the original sample had healed after a few assessment sessions and without treatment.

  • 19.
    Johansson, Linda
    et al.
    Department of Psychology , Uppsala University , Uppsala, Sweden.
    Ghaderi, Ata
    Department of Psychology , Uppsala University , Uppsala, Sweden.
    Hällgren, Mathias
    Linköping University, Department of Neuroscience and Locomotion, Technical Audiology. Linköping University, Faculty of Health Sciences.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Clinical and Social Psychology. Linköping University, Faculty of Arts and Sciences. Department of Clinical Neuroscience , Psychiatry Section , Karolinska Institutet , Stockholm, Sweden.
    Implicit memory bias for eating- and body appearance-related sentences in eating disorders: An application of Jacoby's white noise task2008In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 37, no 3, p. 135-145Article in journal (Refereed)
    Abstract [en]

    Jacoby's white noise task and an explicit recognition task were used to investigate whether individuals with eating disorders demonstrate implicit memory bias and explicit memory bias, respectively, for information related to eating and body appearance. Included were 33 women with eating disorders (seven with anorexia nervosa and 26 with bulimia nervosa), 29 with nonclinical eating disorder‐related concerns, and 36 healthy controls. Results showed partial support for implicit memory bias but no support for explicit memory bias. These findings suggest that eating disorders may be characterized by relative initial automatic bias for eating disorder‐relevant information but not by bias at later stages of information processing. However, previous studies have demonstrated explicit memory bias in eating disorders, which is inconsistent with this interpretation. Future research is required to clarify the precise cognitive biases associated with eating disorders.

  • 20.
    Kaldo, Viktor
    et al.
    Karolinska Institute, Sweden .
    Haak, Thomas
    University of Uppsala Hospital, Sweden .
    Buhrman, Monica
    Uppsala University, Sweden .
    Alfonsson, Sven
    Uppsala University, Sweden .
    Larsen, Hans-Christian
    University of Uppsala Hospital, Sweden .
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Internet-Based Cognitive Behaviour Therapy for Tinnitus Patients Delivered in a Regular Clinical Setting: Outcome and Analysis of Treatment Dropout2013In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 42, no 2, p. 146-158Article in journal (Refereed)
    Abstract [en]

    Cognitive behaviour therapy (CBT) can reduce tinnitus distress but is not available for most patients. Therapist guided, internet-based CBT (ICBT) increase availability and has been shown to be effective. However, the initial positive results need to be replicated in larger samples, and treatment dropout has not been thoroughly studied. Moreover, it has not been evaluated if a low-intensity version of ICBT without therapist contact could be an alternative for patients who do not need or are able to manage the full ICBT-program. This study evaluated two parallel interventions delivered in regular care: ICBT for tinnitus distress (n=293) and a low-intensity version of ICBT (n=81) for patients with lower levels of tinnitus distress. We also explored predictors of dropout from ICBT and if dropout influences outcome. Tinnitus Reaction Questionnaire (Wilson, Henry, Bowen, andamp; Haralambous, 1991) was used as the primary outcome. Secondary outcomes were measures of depression, anxiety, sleep, and sound sensitivity. Significant reductions following ICBT were found on all measures after treatment and also at a three-month follow-up. Patients receiving low-intensity ICBT showed a significant reduction in distress, even when they had low levels of distress initially. Treatment dropout was preceded by an increase in days spent at each treatment step but not by an increased distress. Early dropout was related to worse outcome. ICBT can be used in a regular clinical setting to reduce tinnitus distress. Early dropouts may need additional management. For help-seeking patients with lower distress, a low-intensity version of ICBT can be used.

  • 21.
    Kleinstaeuber, Maria
    et al.
    Johannes Gutenberg University of Mainz, Germany.
    Jasper, Kristine
    Johannes Gutenberg University of Mainz, Germany.
    Schweda, Isabell
    Johannes Gutenberg University of Mainz, Germany.
    Hiller, Wolfgang
    Johannes Gutenberg University of Mainz, Germany.
    Andersson, Gerhard
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Health Sciences.
    Weise, Cornelia
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Health Sciences.
    The Role of Fear-Avoidance Cognitions and Behaviors in Patients with Chronic Tinnitus2013In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 42, no 2, p. 84-99Article in journal (Refereed)
    Abstract [en]

    The current study investigated the role of fear-avoidance—a concept from chronic pain research—in chronic tinnitus. A self-report measure the “Tinnitus Fear-Avoidance Cognitions and Behaviors Scale (T-FAS)” was developed and validated. Furthermore, the role of fear-avoidance behavior as mediator of the relationship between anxiety sensitivity and tinnitus handicap was investigated. From a clinical setting, N = 373 patients with chronic tinnitus completed questionnaires assessing tinnitus handicap (Tinnitus Handicap Inventory), anxiety, depression (Hospital Anxiety and Depression Scale), anxiety sensitivity (Anxiety Sensitivity Index-3), personality factors (Big Five Inventory-10), and fear-avoidance. To analyze the psychometric properties, principal component analysis with parallel component extraction and correlational analyses were used. To examine a possible mediating effect, hierarchical regression analysis was applied. The principal component analysis resulted in a three-factor solution: Fear-avoidance Cognitions, Tinnitus-related Fear-Avoidance Behavior, and Ear-related Fear-Avoidance Behavior. Internal consistency was satisfactory for the total scale and all subscales. High correlations between tinnitus-related handicap scales, depressive and anxiety symptoms, and the T-FAS were found, whereas associations with personality factors were low. Moreover, results indicate a significant partial mediation of fear-avoidance behaviors in the relationship between anxiety sensitivity and the cognitive dimension of tinnitus handicap. Results show that fear-avoidance behavior plays an important role in tinnitus handicap. More attention should be paid to this concept in research and clinical practice of psychotherapy for chronic tinnitus.

  • 22.
    Lindner, Philip
    et al.
    Stockholm University /Karolinska Institutet ,Stockholm ,Sweden.
    Frykheden, Ola
    Stockholm University, Sweden.
    Forsström, David
    Karolinska Institutet , Stockholm, Sweden.
    Andersson, Erik
    Karolinska Institutet , Stockholm, Sweden .
    Ljótsson, Brjánn
    Karolinska Institutet , Stockholm, Sweden.
    Hedman, 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 .
    Carlbring, Per
    Stockholm University, Sweden .
    The Brunnsviken Brief Quality of Life Scale (BBQ): Development and Psychometric Evaluation.2016In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 45, no 3, p. 182-195Article in journal (Refereed)
    Abstract [en]

    Measurements of subjective quality of life (QoL) are an important complement to symptom ratings in clinical research and practice. Despite there being several established QoL self-rating scales, we identified a need for a freely accessible, easy-to-use inventory, validated for use with both clinical and non-clinical samples, based on the overall life satisfaction conceptualization of QoL. The Brunnsviken Brief Quality of life scale (BBQ) was designed to meet these requirements. Items were selected by performing a factor analysis on a large data-set of QoL ratings collected previously. Six life areas (Leisure time, View on life, Creativity, Learning, Friends and Friendship, and View of self) were identified as important for overall QoL and were included in the BBQ. A psychometric evaluation was performed using two independent samples: healthy undergraduate students (n = 163), and a sample seeking treatment for social anxiety disorder (n = 568). Results suggested a unifactorial structure, with good concurrent and convergent validity, high internal and test-retest reliability, and accurate classification ability. We conclude that the BBQ is a valid and reliable measure of subjective QoL for use in clinical and research settings. The BBQ is presently available in 31 languages and can be freely downloaded from www.bbqscale.com .

  • 23.
    Lindner, Philip
    et al.
    Stockholm University, Sweden; Karolinska Institute, Sweden.
    Miloff, Alexander
    Stockholm University, Sweden.
    Hamilton, William
    Stockholm University, Sweden; Mimerse, Sweden.
    Reuterskiöld, Lena
    Stockholm University, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden.
    Powers, Mark B.
    University of Texas Austin, TX 78712 USA; Baylor University, TX USA.
    Carlbring, Per
    Stockholm University, Sweden.
    Creating state of the art, next-generation Virtual Reality exposure therapies for anxiety disorders using consumer hardware platforms: design considerations and future directions2017In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 46, no 5, p. 404-420Article, review/survey (Refereed)
    Abstract [en]

    Decades of research and more than 20 randomized controlled trials show that Virtual Reality exposure therapy (VRET) is effective in reducing fear and anxiety. Unfortunately, few providers or patients have had access to the costly and technical equipment previously required. Recent technological advances in the form of consumer Virtual Reality (VR) systems (e.g. Oculus Rift and Samsung Gear), however, now make widespread use of VRET in clinical settings and as self-help applications possible. In this literature review, we detail the current state of VR technology and discuss important therapeutic considerations in designing self-help and clinician-led VRETs, such as platform choice, exposure progression design, inhibitory learning strategies, stimuli tailoring, gamification, virtual social learning and more. We illustrate how these therapeutic components can be incorporated and utilized in VRET applications, taking full advantage of the unique capabilities of virtual environments, and showcase some of these features by describing the development of a consumer-ready, gamified self-help VRET application for low-cost commercially available VR hardware. We also raise and discuss challenges in the planning, development, evaluation, and dissemination of VRET applications, including the need for more high-quality research. We conclude by discussing how new technology (e.g. eye-tracking) can be incorporated into future VRETs and how widespread use of VRET self-help applications will enable collection of naturalistic Big Data that promises to inform learning theory and behavioral therapy in general.

  • 24.
    Molander, Peter
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. 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.
    Weineland, Sandra
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences. Narhalsan, Sweden.
    Bergwall, Kajsa
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Buck, Sonia
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Jäder Malmlöf, Johan
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Lantz, Henning
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Lunner, Thomas
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research. Oticon AS, Denmark.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Inst, Sweden.
    Internet-based acceptance and commitment therapy for psychological distress experienced by people with hearing problems: a pilot randomized controlled trial2018In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 47, no 2, p. 169-184Article in journal (Refereed)
    Abstract [en]

    Psychological distress is common among people with hearing problems, but treatments that specifically target this aspect have been almost non-existent. In this pilot randomized controlled trial, an eight-week long Internet-based treatment, informed by Acceptance and Commitment Therapy, was administered to explore the feasibility and efficacy of such a treatment. Included participants were randomized to either treatment (n=31) or wait-list control (n=30) condition. All participants were measured prior to randomization and immediately after treatment ended using standardized self-report instruments measuring hearing-related emotional and social adjustment (Hearing Handicap Inventory for the Elderly - S, HHIE-S), quality of life (Quality of Life Inventory, QOLI), and symptoms of depression and anxiety (Patient health Questionnaire, PHQ-9 and Generalized Anxiety Disorder scale, GAD-7). Linear mixed effects regression analysis using the full intention-to-treat sample demonstrated that the treatment had superior outcomes on the main outcome measure as compared with the control group, Cohens d=0.93, 95% CI [0.24, 1.63]. The benefits of treatment over control were also evident in scores of depression, Cohens d=0.61, 95% CI [0.04, 1.19], and quality of life, Cohens d=0.88, 95% CI [0.14, 1.61]. The results provide preliminary support for Internet-delivered acceptance and commitment therapy as a potentially effective treatment of psychological symptoms associated with hearing problems.

  • 25.
    Nieminen, Katri
    et al.
    Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Norrköping. Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Berg, Ida
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Educational Sciences.
    Frankenstein, Katri
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Educational Sciences.
    Viita, Lina
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Educational Sciences.
    Larsson, Kamilla
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Educational Sciences.
    Persson, Ulrika
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Educational Sciences.
    Spånberger, Loviisa
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Educational Sciences.
    Wretman, Anna
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    Silfvernagel, Kristin
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. 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.
    Wijma, Klaas
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Internet-provided cognitive behaviour therapy of posttraumatic stress symptoms following childbirth—a randomized controlled trial2016In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 45, no 4, p. 287-306Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to analyse the effects of trauma-focused guided Internet-based cognitive behaviour therapy for relieving posttraumatic stress disorder (PTSD) symptoms following childbirth, a problem that about 3% women encounter postpartum. Following inclusion, 56 traumatized women were randomized to either treatment or to a waiting list control group. Primary outcome measures were the Traumatic Event Scale (TES) and Impact of Event Scale—Reversed (IES-R). Secondary measures were Beck depression inventory II, Patient Health Questionnaire (PHQ-9), Beck Anxiety Inventory, Quality Of Life Inventory and the EuroQol 5 Dimensions. The treatment was guided by a clinician and lasted eight weeks and comprised eight modules of written text. The between-group effect size (ES) was d = .82 (p < .0001) for the IES-R. The ES for the TES was small (d = .36) and not statistically significant (p = .09). A small between-group ES (d = .20; p = .02) was found for the PHQ-9. The results from pre- to post-treatment showed large within-group ESs for PTSD symptoms in the treatment group both on the TES (d = 1.42) and the IES-R (d = 1.30), but smaller ESs in the control group from inclusion to after deferred treatment (TES, d = .80; IES-R d = .45). In both groups, the treatment had positive effects on comorbid depression and anxiety, and in the treatment group also on quality of life. The results need to be verified in larger trials. Further studies are also needed to examine long-term effects.

  • 26.
    Nordgreen, Tine
    et al.
    eMeistring, Bjørgvin DPS, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Faculty of Psychology, Department of Clinical Psychology, University of Bergen, Bergen, Norway.
    Gjestad, Rolf
    Research Department, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway.
    Andersson, Gerhard
    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.
    Havik, Odd E
    Faculty of Psychology, Department of Clinical Psychology, University of Bergen, Bergen, Norway.
    The implementation of guided Internet-based cognitive behaviour therapy for panic disorder in a routine-care setting: effectiveness and implementation efforts2018In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 47, no 1, p. 62-75Article in journal (Refereed)
    Abstract [en]

    Panic disorder is a common mental disorder. Guided Internet-based cognitive behavioural therapy (Guided Internet-based cognitive behaviour therapy (ICBT)) is a promising approach to reach more people in need of help. In the present effectiveness study, we investigated the outcome of guided ICBT for panic disorder after implementation in routine care. A total of 124 patients were included in the study, of which 114 started the treatment. Large within-group effect sizes were observed on the primary panic disorder symptoms (post-treatment: d = 1.24; 6-month follow-up: d = 1.39) and moderate and large effects on secondary panic disorder symptoms and depressive symptoms at post-treatment and follow-up (d = .55-1.13). More than half (56.1%) of the patients who started treatment recovered or improved at post-treatment. Among treatment takers (completed at least five of the nine modules), 69.9% recovered or improved. The effectiveness reported in the present trial is in line with previous effectiveness and efficacy trials of guided ICBT for panic disorder. This provides additional support for guided ICBT as a treatment alternative in routine care.

  • 27.
    Nyenhuis, Nele
    et al.
    University of Göttingen, Germany.
    Zastrutzki, Sarah
    Hannover Medical School, Germany.
    Weise, Cornelia
    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.
    Jäger, Burkard
    Hannover Medical School, Germany.
    Kröner-Herwig, Birgit
    University of Göttingen, Germany.
    The efficacy of minimal contact interventions for acute tinnitus: a randomised controlled trial2013In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 42, no 2, p. 127-138Article in journal (Refereed)
    Abstract [en]

    Acute tinnitus can lead to substantial distress and eventually result in long-lasting impairment. The aim of this study was to compare the efficacy of a cognitive-behavioural intervention (delivered as Internet self-management, bibliotherapy or group training) to the information-only control condition. Applicants suffered from subjective tinnitus for up to six months, were between 18 and 75 years old and received no other tinnitus-related psychological treatment. A total of 304 participants were randomly assigned to one of the four study arms. Tinnitus distress, depressive symptoms, psychosomatic discomfort and treatment satisfaction were assessed. At the post-assessment tinnitus distress was significantly lower in the Internet and the group training conditions compared to the control condition. Inter-group effect sizes were moderate to large. At follow-up, all active training conditions showed significantly reduced tinnitus distress compared to the control condition (intention-to-treat analysis). An additional completer analysis showed a significant reduction in tinnitus distress only for the group condition. All effect sizes were moderate. There were no differences regarding psychosomatic discomfort, but depressive symptoms were reduced in the group condition at the post-assessment (intention-to-treat analysis). Treatment satisfaction was significantly higher in the training conditions. The dropout rate was 39%. The present study shows that distress can be reduced as early as the acute stadium and that minimal-contact interventions are a promising way to do this. In particular, the Internet and group conditions led to a large, immediate decrease in distress, and the participants were highly satisfied with the training.

  • 28.
    Pankowski, Sara
    et al.
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Adler, Mats
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    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.
    Lindefors, Nils
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Svanborg, Cecilia
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Group acceptance and commitment therapy (ACT) for bipolar disorder and co-existing anxiety - an open pilot study.2017In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 46, no 2, p. 114-128Article in journal (Refereed)
    Abstract [en]

    Previous studies have supported acceptance and commitment therapy (ACT) for reducing impairment related to various chronic conditions. ACT may possibly be beneficial for bipolar disorder (BD) with co-existing anxiety, which is associated with a poorer treatment outcome. Efforts are needed to identify suitable psychological interventions for BD and co-existing anxiety. In this open clinical trial, we included 26 patients with BD type 1 or 2 at an outpatient psychiatric unit specializing in affective disorders. The intervention consisted of a 12-session manualized group treatment that included psychoeducation, mindfulness, engaging in values-based behaviour, cognitive defusion, acceptance and relapse prevention modules. Participants completed four self-report questionnaires covering anxiety symptoms (Beck Anxiety Inventory - BAI), depressive symptoms (Beck Depression Inventory - BDI-II), quality of life (Quality of Life Inventory - QOLI) and psychological flexibility (Acceptance and Action Questionnaire - AAQ-2) before, during and after the treatment. At post-treatment, the participants reported significant improvements in all outcome measures, with large effects (Cohen's d between 0.73 and 1.98). The mean reduction in anxiety symptoms was 45%. At post-treatment, 96% of the patients were classified as responders on at least one of the outcome measures. A limitation is that the trial is uncontrolled. The results suggest that ACT has the potential to be an effective treatment for BD patients with co-existing anxiety. Further randomized studies are warranted.

  • 29.
    Probst, Thomas
    et al.
    Danube Univ Krems, Austria.
    Weise, Cornelia
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research. Philipps Univ, Germany.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Inst, Sweden.
    Kleinstaeuber, Maria
    Philipps Univ, Germany; Univ Auckland, New Zealand.
    Differences in baseline and process variables between non-responders and responders in Internet-based cognitive behavior therapy for chronic tinnitus2019In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 48, no 1, p. 52-64Article in journal (Refereed)
    Abstract [en]

    Although Internet-based cognitive behavior therapy (iCBT) is an effective treatment for chronic tinnitus, several patients do not improve. In the current study, baseline and process variables were compared between non-responders and responders. Data from patients participating in two randomized controlled trials on iCBT for chronic tinnitus were re-analyzed. Based on the literature, a pre-post difference on the Tinnitus Handicap Inventory (THI) of less than seven points improvement was used to operationalize non-response. Associations between non-response and baseline variables (age, gender, and questionnaire scores), patient progress (THI), the process of the therapeutic alliance (Working Alliance Inventory-Short Revised; WAI-SR), as well as other process variables (number of logins, amount of messages sent from therapists to patients) were investigated. The results showed that non-responders had a less favorable change on the THI than responders already at mid-treatment (pamp;lt;.05). The alliance (WAI-SR) during iCBT was not associated with non-response. Non-responders showed more severe sleep disturbances, logged in less in the iCBT platform, and received fewer messages from the therapists than responders, but these differences were mostly not significant anymore when correcting for multiple testing. To conclude, no symptom change in the first half of iCBT for chronic tinnitus patients is a risk factor of not benefiting from iCBT.

  • 30.
    Rozental, Alexander
    et al.
    Stockholm University, Sweden.
    Boettcher, Johanna
    Free University of Berlin, Germany.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden.
    Schmidt, Brad
    Florida State University, FL 32306 USA.
    Carlbring, Per
    Stockholm University, Sweden.
    Negative Effects of Internet Interventions: A Qualitative Content Analysis of Patients Experiences with Treatments Delivered Online2015In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 44, no 3, p. 223-236Article in journal (Refereed)
    Abstract [en]

    Internet interventions are defined as the delivery of health care-related treatments via an online or a smartphone interface, and have been shown to be a viable alternative to face-to-face treatments. However, not all patients benefit from such treatments, and it is possible that some may experience negative effects. Investigations of face-to-face treatments indicate that deterioration occurs in 5-10% of all patients. The nature and scope of other negative effects of Internet interventions is, however, largely unknown. Hence, the current study explored patients reported negative experiences while undergoing treatments delivered via the Internet. Data from four large clinical trials (total N=558) revealed that 9.3% of patients reported some type of negative effects. Qualitative content analysis was used to explore the patients responses to open-ended questions regarding their negative experiences. Results yielded two broad categories and four subcategories of negative effects: patient-related negative effects (insight and symptom) and treatment-related negative effects (implementation and format). Results emphasize the importance of always considering negative effects in Internet-based interventions, and point to several ways of preventing such experiences, including regular assessment of negative events, increasing the flexibility of treatment schedules and therapist contact, as well as prolonging the treatment duration.

  • 31.
    Rozental, Alexander
    et al.
    Stockholm University, Sweden.
    Forsell, Erik
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences. Not Found:Linkoping Univ, Dept Behav Sci and Learning, Linkoping, Sweden.
    Svensson, Andreas
    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. Karolinska Institute, Sweden.
    Carlbring, Per
    Stockholm University, Sweden.
    Overcoming procrastination: one-year follow-up and predictors of change in a randomized controlled trial of Internet-based cognitive behavior therapy2017In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 46, no 3, p. 177-195Article in journal (Refereed)
    Abstract [en]

    Procrastination is a common self-regulatory failure that can have a negative impact on well-being and performance. However, few clinical trials have been conducted, and no follow-up has ever been performed. The current study therefore aimed to provide evidence for the long-term benefits and investigate predictors of a positive treatment outcome among patients receiving Internet-based cognitive behavior therapy (ICBT). A total of 150 self-recruited participants were randomized to guided or unguided ICBT. Self-report measures of procrastination, depression, anxiety, and quality of life were distributed at pre-treatment assessment, post-treatment assessment, and one-year follow-up. Mixed effects models were used to investigate the long-term gains, and multiple linear regression for predictors of a positive treatment outcome, using the change score on the Irrational Procrastination Scale as the dependent variable. Intention-to-treat was implemented for all statistical analyses. Large within-group effect sizes for guided and unguided ICBT, Cohens d = .97-1.64, were found for self-report measures of procrastination, together with d = .56-.66 for depression and anxiety. Gains were maintained, and, in some cases, improved at follow-up. Guided and unguided ICBT did not differ from each other, mean differences -.31-1.17, 95% CIs [-2.59-3.22], and none of the predictors were associated with a better result, bs - 1.45-1.61, 95% CIs [-3.14-4.26]. In sum, ICBT could be useful and beneficial in relation to managing procrastination, yielding great benefits up to one year after the treatment period has ended, with comparable results between guided and unguided ICBT.

  • 32.
    Rozental, Alexander
    et al.
    Stockholm University, Sweden.
    Forsell, Erik
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden.
    Svensson, Andreas
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Forsstrom, David
    Stockholm University, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden.
    Carlbring, Per
    Stockholm University, Sweden.
    Differentiating Procrastinators from Each Other: A Cluster Analysis2015In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 44, no 6, p. 480-490Article in journal (Refereed)
    Abstract [en]

    Procrastination refers to the tendency to postpone the initiation and completion of a given course of action. Approximately one-fifth of the adult population and half of the student population perceive themselves as being severe and chronic procrastinators. Albeit not a psychiatric diagnosis, procrastination has been shown to be associated with increased stress and anxiety, exacerbation of illness, and poorer performance in school and work. However, despite being severely debilitating, little is known about the population of procrastinators in terms of possible subgroups, and previous research has mainly investigated procrastination among university students. The current study examined data from a screening process recruiting participants to a randomized controlled trial of Internet-based cognitive behavior therapy for procrastination (Rozental et al., in press). In total, 710 treatment-seeking individuals completed self-report measures of procrastination, depression, anxiety, and quality of life. The results suggest that there might exist five separate subgroups, or clusters, of procrastinators: Mild procrastinators (24.93%), Average procrastinators (27.89%), Well-adjusted procrastinators (13.94%), Severe procrastinators (21.69%), and Primarily depressed (11.55%). Hence, there seems to be marked differences among procrastinators in terms of levels of severity, as well as a possible subgroup for which procrastinatory problems are primarily related to depression. Tailoring the treatment interventions to the specific procrastination profile of the individual could thus become important, as well as screening for comorbid psychiatric diagnoses in order to target difficulties associated with, for instance, depression.

  • 33.
    Ruxandra Pasarelu, Costina
    et al.
    University of Babes Bolyai, Romania.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden.
    Bergman Nordgren, Lise
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Dobrean, Anca
    University of Babes Bolyai, Romania.
    Internet-delivered transdiagnostic and tailored cognitive behavioral therapy for anxiety and depression: a systematic review and meta-analysis of randomized controlled trials2016In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 46, no 1Article, review/survey (Refereed)
    Abstract [en]

    Anxiety and depressive disorders are often comorbid. Transdiagnostic and tailored treatments seem to be promising approaches in dealing with comorbidity. Although several primary studies have examined the effects of Internet-delivered cognitive behavior therapy (iCBT) for anxiety and depression, no meta-analysis including different types of iCBT that address comorbidity has been conducted so far. We conducted systematic searches in databases up to 1 July 2016. Only randomized trials comparing transdiagnostic/tailored iCBT for adult anxiety and/or depression with control groups were included. Nineteen randomized trials with a total of 2952 participants that met inclusion criteria were analyzed. The quality of the studies was high, however the blinding criteria were not fulfilled. The uncontrolled effect size (Hedges g) of transdiagnostic/tailored iCBT on anxiety and depression outcomes was large and medium for quality of life. The controlled effect size for iCBT on anxiety and depression outcomes was medium to large (anxiety: g=.82, 95% CI: .58-1.05, depression: g=.79, 95% CI: .59-1.00) and medium on quality of life (g=.56, 95% CI: .37-.73). Heterogeneity was small (quality of life) to moderate (anxiety, depression). There was a large effect on generic outcome measures and a moderate effect on comorbidities. When compared to disorder-specific treatments there were no differences on anxiety and quality of life outcomes, however there were differences in depression outcomes. Transdiagnostic and tailored iCBT are effective interventions for anxiety disorders and depression. Future studies should investigate mechanisms of change and develop outcome measures for these interventions.

  • 34.
    Silfvernagel, Kristin
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Westlinder, Anna
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Andersson, Stina
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Bergman, Kajsa
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Hernandez, Rosario Diaz
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Fallhagen, Line
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Lundqvist, Ida
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Masri, Nicole
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Viberg, Linda
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Forsberg, Marie-Louise
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Lind, Maria
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Berger, Thomas
    Bern Univ, Switzerland.
    Carlbring, Per
    Stockholm Univ, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Inst, Sweden.
    Individually tailored internet-based cognitive behaviour therapy for older adults with anxiety and depression: a randomised controlled trial2018In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 47, no 4, p. 286-300Article in journal (Refereed)
    Abstract [en]

    Mixed anxiety and depression is common among older adults. The aim of the study was to compare the effects of an eight-week-long tailored internet-supported cognitive behaviour therapy (ICBT) programme and to compare against the provision of weekly general support. A second aim was to investigate if pre-treatment cognitive flexibility and self-reported cognitive problems would predict outcome. We included 66 older adults (aged over 60 years) with mixed anxiety/depression following media recruitment and randomised them into treatment and control groups. We also included a one-year follow-up. As a measure of executive function, we used the Wisconsin Card Sorting Test (perseverative errors) and the Cognitive Failures Questionnaire during the pre-treatment phase. Results showed a moderate between-group effect on the main outcome measure, the Beck Anxiety Inventory (BAI) (d= .50), favouring the treatment group. Nearly half (45.5%) of that group were classified as responders. One person (3%) in the treatment group deteriorated. There were significant correlations between perseverative errors and outcome (on the BAI r = -.45), but not among self-reported cognitive function. We conclude that guided, tailored ICBT may be effective for some older adults and that the role of cognitive function needs to be investigated further.

  • 35.
    Thulin, Ulrika
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Svirsky, Liv
    Karolinska Institutet, Stockholm, Sweden.
    Serlachius, Eva
    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.
    Öst, Lars-Göran
    Stockholm University, Sweden; Karolinska Institutet, Stockholm, Sweden.
    The Effect of Parent Involvement in the Treatment of Anxiety Disorders in Children: A Meta-Analysis2014In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 43, no 3, p. 185-200Article in journal (Refereed)
    Abstract [en]

    Among clinicians, it is common practice to include parents in treatment, and it has been taken for granted that parents involvement in their childrens treatment is beneficial for therapy outcome, although research on this issue is far from clear. A meta-analysis was carried out in order to investigate whether parent involvement potentiates the outcome for children with anxiety disorders when treated with cognitive-behavior therapy. Sixteen studies, which directly compared parent-involved treatments with child-only treatments, were included in the meta-analysis. The results showed a small, nonsignificant effect size of -0.10 in favor of the child-only treatments. There was no indication of publication bias in the analysis. Implications of the results are discussed.

  • 36.
    Vernmark, Kristofer
    et al.
    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.
    Topooco, Naira
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Berger, Thomas
    Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland.
    Riper, Heleen
    Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, Amsterdam, The Netherlands.
    Luuk, Liisa
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Backlund, Lisa
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Carlbring, Per
    Department of Psychology, Stockholm University, Stockholm, Sweden; Department of Psychology, University of Southern Denmark, Denmark.
    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.
    Working alliance as a predictor of change in depression during blended cognitive behaviour therapy2019In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 48, no 4, p. 285-299Article in journal (Refereed)
    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.

  • 37.
    Vigerland, Sarah
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Thulin, Ulrika
    Karolinska Institutet, Stockholm, Sweden.
    Ljótsson, Brjánn
    Karolinska Institutet, Stockholm, Sweden.
    Svirsky, Liv
    Karolinska Institutet, Stockholm, Sweden.
    Öst, Lars-Göran
    Stockholm University, Sweden.
    Lindefors, Nils
    Karolinska Institutet, Stockholm, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Serlachius, Eva
    Karolinska Institutet, Stockholm, Sweden.
    Internet-Delivered CBT for Children with Specific Phobia: A Pilot Study2013In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 42, no 4, p. 303-314Article in journal (Refereed)
    Abstract [en]

    Background: Cognitive behavior therapy (CBT) has been shown to be an effective treatment for specific phobia in youth, but not all affected seek or receive treatment. Internet-delivered CBT could be a way to increase the availability of empirically supported treatments. Aims: An open trial was conducted to evaluate Internet-delivered CBT for children with specific phobia. Method: Children (N = 30) aged 8-12, and their parents, with a principal diagnosis of specific phobia were recruited through media advertisement. Participants received six weeks of Internet-delivered CBT with therapist support. The treatment was aimed for the parents and the children, with the first part being only for the parents. The primary outcome measure was the Clinician Severity Rating (CSR), and secondary measures included clinician-rated global functioning and child- and parent-reported anxiety and quality of life. All assessments were made at pretreatment, posttreatment, and three-month follow-up. Results: At posttreatment, there were significant reductions on the CSR, with a large within-group effect size (Cohen's d = 1.0) and 35% of children no longer meeting criteria for specific phobia. Self-report measures from parents and children showed significant effects on anxiety, with small to moderate effect sizes. Effects were maintained at three-month follow-up. Conclusions: Results show that Internet-delivered CBT with therapist support for children with specific phobia has the potential to reduce symptom severity. Randomized controlled trials are needed to further evaluate this treatment format.

  • 38.
    Weise, Cornelia
    et al.
    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.
    Kleinstäuber, Maria
    Johannes Gutenberg University of Mainz, Germany.
    Hesser, Hugo
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Health Sciences.
    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.
    Andersson, Gerhard
    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.
    Acceptance of Tinnitus: Validation of the Tinnitus Acceptance Questionnaire2013In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 42, no 2, p. 100-115Article in journal (Refereed)
    Abstract [en]

    The concept of acceptance has recently received growing attention within tinnitus research due to the fact that tinnitus acceptance is one of the major targets of psychotherapeutic treatments. Accordingly, acceptance-based treatments will most likely be increasingly offered to tinnitus patients and assessments of acceptance-related behaviours will thus be needed. The current study investigated the factorial structure of the Tinnitus Acceptance Questionnaire (TAQ) and the role of tinnitus acceptance as mediating link between sound perception (i.e. subjective loudness of tinnitus) and tinnitus distress. In total, 424 patients with chronic tinnitus completed the TAQ and validated measures of tinnitus distress, anxiety, and depression online. Confirmatory factor analysis provided support to a good fit of the data to the hypothesised bifactor model (root-mean-square-error of approximation = .065; Comparative Fit Index = .974; Tucker–Lewis Index = .958; standardised root mean square residual = .032). In addition, mediation analysis, using a non-parametric joint coefficient approach, revealed that tinnitus-specific acceptance partially mediated the relation between subjective tinnitus loudness and tinnitus distress (path ab = 5.96; 95% CI: 4.49, 7.69). In a multiple mediator model, tinnitus acceptance had a significantly stronger indirect effect than anxiety. The results confirm the factorial structure of the TAQ and suggest the importance of a general acceptance factor that contributes important unique variance beyond that of the first-order factors activity engagement and tinnitus suppression. Tinnitus acceptance as measured with the TAQ is proposed to be a key construct in tinnitus research and should be further implemented into treatment concepts to reduce tinnitus distress.

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