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  • 1.
    Andersson, E
    et al.
    Karolinska Institute, Sweden .
    Enander, J
    Karolinska Institute, Sweden Uppsala University, Sweden .
    Andren, P
    Uppsala University, Sweden .
    Hedman, E
    Karolinska Institute, Sweden .
    Ljotsson, B
    Karolinska Institute, Sweden .
    Hursti, T
    Uppsala University, Sweden .
    Bergstrom, J
    Karolinska Institute, Sweden Stockholm University, Sweden .
    Kaldo, V
    Karolinska Institute, Sweden .
    Lindefors, N
    Karolinska Institute, Sweden .
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Ruck, C
    Karolinska Institute, Sweden .
    Internet-based cognitive behaviour therapy for obsessive-compulsive disorder: a randomized controlled trial2012In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 42, no 10, p. 2193-2203Article in journal (Refereed)
    Abstract [en]

    Background. Cognitive behaviour therapy (CBT) is an effective treatment for obsessive-compulsive disorder (OCD) but access to CBT is limited. Internet-based CBT (ICBT) with therapist support is potentially a more accessible treatment. There are no randomized controlled trials testing ICBT for OCD. The aim of this study was to investigate the efficacy of ICBT for OCD in a randomized controlled trial. less thanbrgreater than less thanbrgreater thanMethod. Participants (n=101) diagnosed with OCD were randomized to either 10 weeks of ICBT or to an attention control condition, consisting of online supportive therapy. The primary outcome measure was the Yale-Brown Obsessive Compulsive Scale (YBOCS) administered by blinded assessors. less thanbrgreater than less thanbrgreater thanResults. Both treatments lead to significant improvements in OCD symptoms, but ICBT resulted in larger improvements than the control condition on the YBOCS, with a significant between-group effect size (Cohens d) of 1.12 (95% CI 0.69-1.53) at post-treatment. The proportion of participants showing clinically significant improvement was 60% (95% CI 46-72) in the ICBT group compared to 6% (95% CI 1-17) in the control condition. The results were sustained at follow-up. less thanbrgreater than less thanbrgreater thanConclusions. ICBT is an efficacious treatment for OCD that could substantially increase access to CBT for OCD patients. Replication studies are warranted.

  • 2.
    Andersson, E
    et al.
    Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden .
    Steneby, S
    Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden .
    Karlsson, K
    Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden .
    Ljótsson, B
    Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.
    Hedman, E
    Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden, Osher Center for Integrative Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Enander, J
    Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
    Kaldo, V
    Department of Clinical Neuroscience, Division of Psychiatry, 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, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
    Lindefors, N
    Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
    Rück, C
    Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
    Long-term efficacy of Internet-based cognitive behavior therapy for obsessive-compulsive disorder with or without booster: a randomized controlled trial.2014In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 44, no 13, p. 2877-2887Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: As relapse after completed cognitive behavior therapy (CBT) for obsessive-compulsive disorder (OCD) is common, many treatment protocols include booster programs to improve the long-term effects. However, the effects of booster programs are not well studied. In this study, we investigated the long-term efficacy of Internet-based CBT (ICBT) with therapist support for OCD with or without an Internet-based booster program.

    METHOD: A total of 101 participants were included in the long-term follow-up analysis of ICBT. Of these, 93 were randomized to a booster program or no booster program. Outcome assessments were collected at 4, 7, 12 and 24 months after receiving ICBT.

    RESULTS: The entire sample had sustained long-term effects from pre-treatment to all follow-up assessments, with large within-group effect sizes (Cohen's d = 1.58-2.09). The booster group had a significant mean reduction in OCD symptoms compared to the control condition from booster baseline (4 months) to 7 months, but not at 12 or 24 months. Participants in the booster group improved significantly in terms of general functioning at 7, 12 and 24 months, and had fewer relapses. Kaplan-Meier analysis also indicated a significantly slower relapse rate in the booster group.

    CONCLUSIONS: The results suggest that ICBT has sustained long-term effects and that adding an Internet-based booster program can further improve long-term outcome and prevent relapse for some OCD patients.

  • 3.
    Ayers, S.
    et al.
    City University of London, England.
    Bond, R.
    University of Sussex, England.
    Bertullies, S.
    City University of London, England.
    Wijma, Klaas
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    The aetiology of post-traumatic stress following childbirth: a meta-analysis and theoretical framework2016In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 46, no 6, p. 1121-1134Article, review/survey (Refereed)
    Abstract [en]

    There is evidence that 3.17% of women report post-traumatic stress disorder (PTSD) after childbirth. This meta-analysis synthesizes research on vulnerability and risk factors for birth-related PTSD and refines a diathesis-stress model of its aetiology. Systematic searches were carried out on PsycINFO, PubMed, Scopus and Web of Science using PTSD terms crossed with childbirth terms. Studies were included if they reported primary research that examined factors associated with birth-related PTSD measured at least 1 month after birth. In all, 50 studies (n = 21 429) from 15 countries fulfilled inclusion criteria. Pre-birth vulnerability factors most strongly associated with PTSD were depression in pregnancy (r = 0.51), fear of childbirth (r = 0.41), poor health or complications in pregnancy (r = 0.38), and a history of PTSD (r = 0.39) and counselling for pregnancy or birth (r = 0.32). Risk factors in birth most strongly associated with PTSD were negative subjective birth experiences (r = 0.59), having an operative birth (assisted vaginal or caesarean, r = 0.48), lack of support (r = -0.38) and dissociation (r = 0.32). After birth, PTSD was associated with poor coping and stress (r = 0.30), and was highly co-morbid with depression (r = 0.60). Moderator analyses showed that the effect of poor health or complications in pregnancy was more apparent in high-risk samples. The results of this meta-analysis are used to update a diathesis-stress model of the aetiology of postpartum PTSD and can be used to inform screening, prevention and intervention in maternity care.

  • 4.
    Cuijpers, P.
    et al.
    Vrije University of Amsterdam, Netherlands EMGO Institute Health and Care Research, Netherlands .
    Turner, E.H.
    Portland VA Medical Centre, OR USA Oregon Health and Science University, OR 97201 USA Oregon Health and Science University, OR 97201 USA .
    C. Mohr, D.
    Northwestern University, IL 60611 USA .
    Hofmann, S.G.
    Boston University, MA 02215 USA .
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Berking, M.
    University of Marburg, Germany .
    Coyne, J.
    University of Groningen, Netherlands .
    Comparison of psychotherapies for adult depression to pill placebo control groups: a meta-analysis2014In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 44, no 4, p. 685-695Article, review/survey (Refereed)
    Abstract [en]

    Background The effects of antidepressants for treating depressive disorders have been overestimated because of selective publication of positive trials. Reanalyses that include unpublished trials have yielded reduced effect sizes. This in turn has led to claims that antidepressants have clinically insignificant advantages over placebo and that psychotherapy is therefore a better alternative. To test this, we conducted a meta-analysis of studies comparing psychotherapy with pill placebo. Method Ten 10 studies comparing psychotherapies with pill placebo were identified. In total, 1240 patients were included in these studies. For each study, Hedges g was calculated. Characteristics of the studies were extracted for subgroup and meta-regression analyses. Results The effect of psychotherapy compared to pill placebo at post-test was g=0.25 [95% confidence interval (CI) 0.14-0.36, I (2)=0%, 95% CI 0-58]. This effect size corresponds to a number needed to treat (NNT) of 7.14 (95% CI 5.00-12.82). The psychotherapy conditions scored 2.66 points lower on the Hamilton Depression Rating Scale (HAMD) than the placebo conditions, and 3.20 points lower on the Beck Depression Inventory (BDI). Some indications for publication bias were found (two missing studies). We found no significant differences between subgroups of the studies and in meta-regression analyses we found no significant association between baseline severity and effect size. Conclusions Although there are differences between the role of placebo in psychotherapy and pharmacotherapy research, psychotherapy has an effect size that is comparable to that of antidepressant medications. Whether these effects should be deemed clinically relevant remains open to debate.

  • 5.
    Ebert, D. D.
    et al.
    University of Erlangen Nurnberg, Germany.
    Donkin, L.
    University of Sydney, Australia; Vrije University of Amsterdam, Netherlands.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden.
    Andrews, G.
    University of New South Wales, Australia.
    Berger, T.
    University of Bern, Switzerland.
    Carlbring, P.
    Stockholm University, Sweden.
    Rozenthal, A.
    Stockholm University, Sweden.
    Choi, I.
    University of Sydney, Australia.
    Laferton, J. A. C.
    Psychol Hsch Berlin, Germany.
    Johansson, Robert
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden.
    Kleiboer, A.
    Vrije University of Amsterdam, Netherlands.
    Lange, A.
    University of Amsterdam, Netherlands.
    Lehr, D.
    Leuphana University of Luneburg, Germany.
    Reins, J. A.
    Leuphana University of Luneburg, Germany.
    Funk, B.
    Leuphana University of Luneburg, Germany.
    Newby, J.
    University of New South Wales, Australia.
    Perini, S.
    Macquarie University, Australia.
    Riper, H.
    Vrije University of Amsterdam, Netherlands.
    Ruwaard, J.
    Vrije University of Amsterdam, Netherlands.
    Sheeber, L.
    Oregon Research Institute, OR 97403 USA.
    Snoek, F. J.
    Vrije University of Amsterdam, Netherlands; University of Amsterdam, Netherlands.
    Titov, N.
    Macquarie University, Australia; Macquarie University, Australia.
    Unlu Ince, B.
    Vrije University of Amsterdam, Netherlands.
    van Bastelaar, K.
    Vrije University of Amsterdam, Netherlands.
    Vernmark, Kristofer
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    van Straten, A.
    Vrije University of Amsterdam, Netherlands.
    Warmerdam, L.
    Vrije University of Amsterdam, Netherlands.
    Salsman, N.
    Xavier University, OH 45207 USA.
    Cuijpers, P.
    Vrije University of Amsterdam, Netherlands.
    Does Internet-based guided-self-help for depression cause harm? An individual participant data meta-analysis on deterioration rates and its moderators in randomized controlled trials2016In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 46, no 13, p. 2679-2693Article, review/survey (Refereed)
    Abstract [en]

    Background: Almost nothing is known about the potential negative effects of Internet-based psychological treatments for depression. This study aims at investigating deterioration and its moderators within randomized trials on Internet-based guided self-help for adult depression, using an individual patient data meta-analyses (IPDMA) approach.

    Method: Studies were identified through systematic searches (PubMed, PsycINFO, EMBASE, Cochrane Library). Deterioration in participants was defined as a significant symptom increase according to the reliable change index (i.e. 7.68 points in the CES-D; 7.63 points in the BDI). Two-step IPDMA procedures, with a random-effects model were used to pool data.

    Results: A total of 18 studies (21 comparisons, 2079 participants) contributed data to the analysis. The risk for a reliable deterioration from baseline to post-treatment was significantly lower in the intervention v. control conditions (3.36 v. 7.60; relative risk 0.47, 95% confidence interval 0.29-0.75). Education moderated effects on deterioration, with patients with low education displaying a higher risk for deterioration than patients with higher education. Deterioration rates for patients with low education did not differ statistically significantly between intervention and control groups. The benefit-risk ratio for patients with low education indicated that 9.38 patients achieve a treatment response for each patient experiencing a symptom deterioration.

    Conclusions: Internet-based guided self-help is associated with a mean reduced risk for a symptom deterioration compared to controls. Treatment and symptom progress of patients with low education should be closely monitored, as some patients might face an increased risk for symptom deterioration. Future studies should examine predictors of deterioration in patients with low education.

  • 6.
    Hedman, E.
    et al.
    Karolinska Institutet, Stockholm, Sweden .
    Andersson, E.
    Karolinska Institutet, Stockholm, Sweden .
    Lindefors, N.
    Karolinska Institutet, Stockholm, Sweden .
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Rück, C.
    Karolinska Institutet, Stockholm, Sweden .
    Ljótsson, B.
    Karolinska Institutet, Stockholm, Sweden .
    Cost-effectiveness and long-term effectiveness of Internet-based cognitive behaviour therapy for severe health anxiety2013In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 43, no 2, p. 363-374Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Severe health anxiety is a common condition associated with functional disability, making it a costly disorder from a societal perspective. Internet-based cognitive behaviour therapy (ICBT) is a promising treatment but no previous study has assessed the cost-effectiveness or long-term outcome of ICBT for severe health anxiety. The aim of this study was to investigate the cost-effectiveness and 1-year treatment effects of ICBT for severe health anxiety. Method Cost-effectiveness and 1-year follow-up data were obtained from a randomized controlled trial (RCT) comparing ICBT (n = 40) to an attention control condition (CC, n = 41). The primary outcome measure was the Health Anxiety Inventory (HAI). A societal perspective was taken and incremental cost-effectiveness ratios (ICERs) were calculated using bootstrap sampling.

    RESULTS: The main ICER was -£1244, indicating the societal economic gain for each additional case of remission when administering ICBT. Baseline to 1-year follow-up effect sizes on the primary outcome measure were large (d = 1.71-1.95).

    CONCLUSIONS: ICBT is a cost-effective treatment for severe health anxiety that can produce substantial and enduring effects.

  • 7.
    Hesser, Hugo
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Hedman, E.
    Karolinska Institute, Sweden.
    Lindfors, P.
    University of Gothenburg, Sweden; Karolinska Institute, Sweden.
    Andersson, E.
    Karolinska Institute, Sweden.
    Ljotsson, B.
    Karolinska Institute, Sweden.
    The specific effect of systematic exposure in irritable bowel syndrome: complier average causal effect analysis using growth mixture modeling2017In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 47, no 15, p. 2653-2662Article in journal (Refereed)
    Abstract [en]

    Background. We reanalyzed data from a previously published randomized component study that aimed to test the incremental effect of systematic exposure in an internet-delivered cognitive behavioral treatment (ICBT) for irritable bowel syndrome (IBS). Methods. Three hundred and nine individuals with IBS were randomly assigned to either the full treatment protocol (experimental condition) or the same treatment protocol without systematic exposure (control). Participants were assessed weekly for IBS symptoms over the active treatment phase. We used a complier average causal effect (CACE) analysis, in the growth mixture modeling framework, to (1) examine the specific effect of exposure among those who received the intervention (i.e. compliers), and (2) explore the associations of pre-treatment patient characteristics with compliance status and outcome changes. Results. Fifty-five per cent of those assigned to the experimental condition were classified as compliers. The CACE analysis that took into account compliance status demonstrated that the magnitude of the incremental effect of systematic exposure on IBS symptoms was larger than the effect observed in an intention-to-treat analysis that ignored compliance status (d = 0.81 v. d = 0.44). Patients with university education showed more improvement during the exposure phase of the treatment. Pre-treatment patient characteristics did not predict compliance status. Conclusions. The effect of systematic exposure on IBS symptoms is of substantial magnitude among those individuals who actually receive the intervention (CACE). Studying the subsample of individuals who discontinue treatment prematurely and tailoring interventions to improve compliance may increase overall improvement rates in ICBT for IBS.

  • 8.
    Johansson Capusan, Andrea
    et al.
    Region Östergötland, Local Health Care Services in Central Östergötland, Department of Psychiatry. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine.
    Kuja-Halkola, R.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Bendtsen, Preben
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Department of Medical Specialist in Motala.
    Viding, E.
    Developmental Risk and Resilience Unit, University College, London UK.
    McCrory, E.
    Developmental Risk and Resilience Unit, University College, London UK.
    Marteinsdottir, Ina
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Psychiatry.
    Larsson, H.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden / Department of Medical Sciences, Örebro University, Örebro, Sweden.
    Childhood maltreatment and attention deficit hyperactivity disorder symptoms in adults: a large twin study2016In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 46, no 12, p. 2637-2646Article in journal (Refereed)
    Abstract [en]

    Background

    Childhood maltreatment (CM) has been associated with increased risk of attention deficit hyperactivity disorder (ADHD) in children and adults. It is, however, unclear whether this association is causal or due to familial confounding.

    Method

    Data from 18 168 adult twins, aged 20–46 years, were drawn from the population-based Swedish twin registry. Retrospective self-ratings of CM (emotional and physical neglect, physical and sexual abuse and witnessing family violence), and self-ratings for DSM-IV ADHD symptoms in adulthood were analysed. Possible familial confounding was investigated using a within twin-pair design based on monozygotic (MZ) and dizygotic (DZ) twins.

    esults

    CM was significantly associated with increased levels of ADHD symptom scores in adults [regression coefficient: 0.40 standard deviations, 95% confidence interval (CI) 0.37–0.43]. Within twin-pair analyses showed attenuated but significant estimates within DZ (0.29, 95% CI 0.21–0.36) and MZ (0.18, 95% CI 0.10–0.25) twin pairs. Similar results emerged for hyperactive/impulsive and inattentive ADHD symptom scores separately in association with CM. We conducted sensitivity analyses for early maltreatment, before age 7, and for abuse and neglect separately, and found similarly reduced estimates in DZ and MZ pairs. Re-traumatization after age 7 did not significantly influence results.

    Conclusions

    CM was significantly associated with increased ADHD symptoms in adults. Associations were partly due to familial confounding, but also consistent with a causal interpretation. Our findings support cognitive neuroscience studies investigating neural pathways through which exposure to CM may influence ADHD. Clinicians treating adults with ADHD should be aware of the association with maltreatment.

  • 9.
    Johansson Capusan, Andrea
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Psychiatry.
    Yao, S.
    Karolinska Institute, Sweden.
    Kuja-Halkola, R.
    Karolinska Institute, Sweden.
    Bulik, C. M.
    Karolinska Institute, Sweden; University of North Carolina Chapel Hill, NC USA; University of North Carolina Chapel Hill, NC USA.
    Thornton, L. M.
    University of North Carolina Chapel Hill, NC USA.
    Bendtsen, Preben
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Department of Medical Specialist in Motala.
    Marteinsdottir, Ina
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Psychiatry.
    Thorsell, Annika
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences.
    Larsson, H.
    Karolinska Institute, Sweden; Örebro University, Sweden.
    Genetic and environmental aspects in the association between attention-deficit hyperactivity disorder symptoms and binge-eating behavior in adults: a twin study2017In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 47, no 16, p. 2866-2878Article in journal (Refereed)
    Abstract [en]

    Background Prior research demonstrated that attention-deficit hyperactivity disorder (ADHD) is associated with binge-eating behavior, binge-eating disorder (BED), and bulimia nervosa (BN). The aim of this study was to investigate these associations in an adult twin population, and to determine the extent to which ADHD symptoms and binge-eating behavior share genetic and environmental factors. Methods We used self-reports of current ADHD symptoms and lifetime binge-eating behavior and associated characteristics from a sample of over 18 000 adult twins aged 20-46 years, from the population-based Swedish Twin Registry. Mixed-effects logistic regression was used to examine the association between ADHD and lifetime binge-eating behavior, BED, and BN. Structural equation modeling was used in 13 773 female twins to determine the relative contribution of genetic and environmental factors to the association between ADHD symptoms and binge-eating behavior in female adult twins. Results ADHD symptoms were significantly associated with lifetime binge-eating behavior, BED, and BN. The heritability estimate for current ADHD symptoms was 0.42 [95% confidence interval (CI) 0.41-0.44], and for lifetime binge-eating behavior 0.65 (95% CI 0.54-0.74). The genetic correlation was estimated as 0.35 (95% CI 0.25-0.46) and the covariance between ADHD and binge-eating behavior was primarily explained by genetic factors (91%). Non-shared environmental factors explained the remaining part of the covariance. Conclusions The association between adult ADHD symptoms and binge-eating behavior in females is largely explained by shared genetic risk factors.

  • 10.
    Karyotaki, E.
    et al.
    Vrije University of Amsterdam, Netherlands; Vrije University of Amsterdam, Netherlands.
    Kleiboer, A.
    Vrije University of Amsterdam, Netherlands; Vrije University of Amsterdam, Netherlands.
    Smit, F.
    Vrije University of Amsterdam, Netherlands; Vrije University of Amsterdam, Netherlands; Trimbus Institute Netherlands Institute Mental Health and Addic, Netherlands.
    Turner, D. T.
    Vrije University of Amsterdam, Netherlands; Vrije University of Amsterdam, Netherlands.
    Pastor, A. M.
    Jaume University, Spain.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute Disabil Research, Sweden.
    Berger, T.
    University of Bern, Switzerland.
    Botella, C.
    Jaume University, Spain; Institute Salud Carlos III, Spain.
    Breton, J. M.
    Jaume University, Spain.
    Carlbring, P.
    Stockholm University, Sweden.
    Christensen, H.
    Black Dog Institute, Australia; University of New S Wales, Australia.
    de Graaf, E.
    Maastricht University, Netherlands; Erasmus MC, Netherlands.
    Griffiths, K.
    Australian National University, Australia.
    Donker, T.
    Vrije University of Amsterdam, Netherlands; Vrije University of Amsterdam, Netherlands.
    Farrer, L.
    Australian National University, Australia.
    Huibers, M. J. H.
    Vrije University of Amsterdam, Netherlands; Vrije University of Amsterdam, Netherlands.
    Lenndin, J.
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences. Not .
    Mackinnon, A.
    University of Melbourne, Australia.
    Meyer, B.
    Gaia AG, Germany; City University of London, England.
    Moritz, S.
    University of Medical Centre Hamburg Eppendorf, Germany.
    Riper, H.
    Vrije University of Amsterdam, Netherlands; Vrije University of Amsterdam, Netherlands.
    Spek, V.
    Tilburg University, Netherlands.
    Vernmark, Kristofer
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Psykologpartners, Linkoping, Sweden.
    Cuijpers, P.
    Vrije University of Amsterdam, Netherlands; Vrije University of Amsterdam, Netherlands.
    Predictors of treatment dropout in self-guided web-based interventions for depression: an individual patient data meta-analysis2015In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 45, no 13, p. 2717-2726Article in journal (Refereed)
    Abstract [en]

    Background. It is well known that web-based interventions can be effective treatments for depression. However, dropout rates in web-based interventions are typically high, especially in self-guided web-based interventions. Rigorous empirical evidence regarding factors influencing dropout in self-guided web-based interventions is lacking due to small study sample sizes. In this paper we examined predictors of dropout in an individual patient data meta-analysis to gain a better understanding of who may benefit from these interventions. Method. A comprehensive literature search for all randomized controlled trials (RCTs) of psychotherapy for adults with depression from 2006 to January 2013 was conducted. Next, we approached authors to collect the primary data of the selected studies. Predictors of dropout, such as socio-demographic, clinical, and intervention characteristics were examined. Results. Data from 2705 participants across ten RCTs of self-guided web-based interventions for depression were analysed. The multivariate analysis indicated that male gender [relative risk (RR) 1.08], lower educational level (primary education, RR 1.26) and co-morbid anxiety symptoms (RR 1.18) significantly increased the risk of dropping out, while for every additional 4 years of age, the risk of dropping out significantly decreased (RR 0.94). Conclusions. Dropout can be predicted by several variables and is not randomly distributed. This knowledge may inform tailoring of online self-help interventions to prevent dropout in identified groups at risk.

  • 11.
    Karyotaki, Eirini
    et al.
    Vrije Univ Amsterdam, Netherlands; Inst Publ Hlth Res, Netherlands.
    Kemmeren, Lise
    GGZ inGeest, Netherlands; Vrije Univ Amsterdam, Netherlands.
    Riper, Heleen
    Vrije Univ Amsterdam, Netherlands; Inst Publ Hlth Res, Netherlands.
    Twisk, Jos
    Vrije Univ Amsterdam, Netherlands.
    Hoogendoorn, Adriaan
    GGZ inGeest, Netherlands; Vrije Univ Amsterdam, Netherlands.
    Kleiboer, Annet
    Vrije Univ Amsterdam, Netherlands; Inst Publ Hlth Res, Netherlands.
    Mira, Adriana
    Jaume Univ, Spain; Inst Salud Carlos III, Spain.
    Mackinnon, Andrew
    Black Dog Inst, Australia; Univ New South Wales, Australia; Univ Melbourne, Australia.
    Meyer, Bjoern
    Res Dept, Germany; City Univ London, England.
    Botella, Cristina
    Jaume Univ, Spain; Inst Salud Carlos III, Spain.
    Littlewood, Elizabeth
    Univ York, England.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Inst Disabil Res, Sweden.
    Christensen, Helen
    Black Dog Inst, Australia; Univ New South Wales, Australia.
    Klein, Jan P.
    Lubeck Univ, Germany.
    Schroeder, Johanna
    Univ Med Ctr Hamburg Eppendorf, Germany.
    Breton-Lopez, Juana
    Jaume Univ, Spain; Inst Salud Carlos III, Spain.
    Scheider, Justine
    Univ Nottingham, England.
    Griffiths, Kathy
    Australian Natl Univ, Australia.
    Farrer, Louise
    Australian Natl Univ, Australia.
    Huibers, Marcus J. H.
    Vrije Univ Amsterdam, Netherlands; Inst Publ Hlth Res, Netherlands.
    Phillips, Rachel
    Kings Coll London, England.
    Gilbody, Simon
    Univ York, England.
    Moritz, Steffen
    Univ Med Ctr Hamburg Eppendorf, Germany.
    Berger, Thomas
    Univ Bern, Switzerland.
    Pop, Victor
    Tilburg Univ, Netherlands.
    Spek, Viola
    Tilburg Univ, Netherlands.
    Cuijpers, Pim
    Vrije Univ Amsterdam, Netherlands; Inst Publ Hlth Res, Netherlands.
    Is self-guided internet-based cognitive behavioural therapy (iCBT) harmful? An individual participant data meta-analysis2018In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 48, no 15, p. 2456-2466Article, review/survey (Refereed)
    Abstract [en]

    Background. Little is known about potential harmful effects as a consequence of self-guided internet-based cognitive behaviour therapy (iCBT), such as symptom deterioration rates. Thus, safety concerns remain and hamper the implementation of self-guided iCBT into clinical practice. We aimed to conduct an individual participant data (IPD) meta-analysis to determine the prevalence of clinically significant deterioration (symptom worsening) in adults with depressive symptoms who received self-guided iCBT compared with control conditions. Several socio-demographic, clinical and study-level variables were tested as potential moderators of deterioration. Methods. Randomised controlled trials that reported results of self-guided iCBT compared with control conditions in adults with symptoms of depression were selected. Mixed effects models with participants nested within studies were used to examine possible clinically significant deterioration rates. Results. Thirteen out of 16 eligible trials were included in the present IPD meta-analysis. Of the 3805 participants analysed, 7.2% showed clinically significant deterioration (5.8% and 9.1% of participants in the intervention and control groups, respectively). Participants in self-guided iCBT were less likely to deteriorate (OR 0.62, p amp;lt; 0.001) compared with control conditions. None of the examined participant- and study-level moderators were significantly associated with deterioration rates. Conclusions. Self-guided iCBT has a lower rate of negative outcomes on symptoms than control conditions and could be a first step treatment approach for adult depression as well as an alternative to watchful waiting in general practice.

  • 12. Nilsson, L-G.
    et al.
    Bäckman, L.
    Karlsson, Thomas
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Behavioural Sciences, Cognition, Development and Disability.
    Priming and cued recall in elderly, alcohol intoxicated and sleep deprived subjects: a case of functionally similar memory deficits1989In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 19, p. 423-433Article in journal (Refereed)
  • 13.
    van Straten, A.
    et al.
    VU University Amsterdam, The Netherlands ; EMGO Institute Health and Care Research, The Netherlands .
    Emmelkamp, J.
    VU University Amsterdam, The Netherlands; EMGO Institute Health and Care Research, The Netherlands .
    de Wit, J.
    VU University Amsterdam, The Netherlands; EMGO Institute Health and Care Research, The Netherlands .
    Lancee, J.
    University of Amsterdam, The Netherlands .
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research.
    van Someren, E. J. W.
    Institute Royal Netherlands Academic Arts and Science, Amsterdam; VU University and Medical Centre, Amsterdam, The Netherlands.
    Cuijpers, P.
    VU University Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, The Netherlands .
    Guided Internet-delivered cognitive behavioural treatment for insomnia: a randomized trial2014In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 44, no 7, p. 1521-1532Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Insomnia is a prevalent problem with a high burden of disease (e.g. reduced quality of life, reduced work capacity) and a high co-morbidity with other mental and somatic disorders. Cognitive behavioural therapy (CBT) is effective in the treatment of insomnia but is seldom offered. CBT delivered through the Internet might be a more accessible alternative. In this study we examined the effectiveness of a guided Internet-delivered CBT for adults with insomnia using a randomized controlled trial (RCT).

    METHOD:

    A total of 118 patients, recruited from the general population, were randomized to the 6-week guided Internet intervention (n = 59) or to a wait-list control group (n = 59). Patients filled out an online questionnaire and a 7-day sleep diary before (T0) and after (T1) the 6-week period. The intervention group received a follow-up questionnaire 3 months after baseline (T2).

    RESULTS:

    Almost three-quarters (72.9%) of the patients completed the whole intervention. Intention-to-treat (ITT) analysis showed that the treatment had statistically significant medium to large effects (p < 0.05; Cohen's d between 0.40 and 1.06), and resulted more often in clinically relevant changes, on all sleep and secondary outcomes with the exception of sleep onset latency (SOL) and number of awakenings (NA). There was a non-significant difference in the reduction in sleep medication between the intervention (a decrease of 6.8%) and control (an increase of 1.8%) groups (p = 0.20). Data on longer-term effects were inconclusive.

    CONCLUSIONS:

    This study adds to the growing body of literature that indicates that guided CBT for insomnia can be delivered through the Internet. Patients accept the format and their sleep improves.

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