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  • 1.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Internet interventions: Past, present and future2018Inngår i: Internet Interventions, ISSN 2214-7829, Vol. 12, s. 181-188Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Internet interventions have been around now for about 20 years. While the field still suffers from a scattered terminology a large number of programs and studies exist. In the present paper I present an overview of my experiences of studying internet-supported cognitive-behaviour therapy (ICBT), but also mention other approaches including the use of smartphones. The paper covers the history of ICBT, short-term effects in controlled trials for a range of conditions, long-term effects, comparisons against face-to-face therapy, effectiveness studies, prediction studies, how the treatment is perceived, critique, and finally future directions. I conclude that we have now reached a stage in which we have numerous evidence-based treatments and procedures, and increasingly internet interventions including ICBT are disseminated.

  • 2.
    Becker, Jan
    et al.
    Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg-University, Untere Zahlbacher Str. 8, 55131 Mainz, Germany.
    Zwerenz, Rüdiger
    Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg-University, Untere Zahlbacher Str. 8, 55131 Mainz, Germany.
    Johansson, Robert
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychiatry, SE-171 77 Stockholm, Sweden.
    Frederick, Ronald J.
    Center for Courageous Living, 9300 Wilshire Boulevard, Suite #520, Beverly Hills, CA 90212, USA.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institute, Stockholm, Sweden.
    Beutel, Manfred E.
    Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg-University, Untere Zahlbacher Str. 8, 55131 Mainz, Germany.
    Using a transdiagnostic, psychodynamic online self-help intervention to maintain inpatient psychosomatic treatment effects: Study protocol of a feasibility study2016Inngår i: Internet Interventions, ISSN 2214-7829, Vol. 5, s. 30-35Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    Online self-help interventions have proven to be effective in treating various specific mental disorders, mainly depression and anxiety. Knowledge regarding their acceptance, efficacy, and usefulness in addition to inpatient or outpatient psychotherapy is limited. Therefore, we plan to evaluate an affect-focused, transdiagnostic, psychodynamic online self-help intervention following inpatient psychotherapy for mixed diagnoses in a feasibility study to determine acceptance, satisfaction, and preliminary estimates of efficacy.

    Methods

    The intervention is based on the book “Living Like You Mean It” by Ronald J. Frederick (2009) and the Swedish adaption by Johansson and colleagues (2013). The book was translated into German and thoroughly revised using parts of the Swedish adaption and additional tasks from their intervention. In a pilot phase, corrections concerning comprehensibility of the content and exercises were made based on patient's feedback. In the second step, we developed a website presenting the German adaption in eight units. In the third step, at least N = 66 patients from the Department of Psychosomatic Medicine and Psychotherapy will be recruited for a feasibility study. Patients are randomized into two groups. The intervention group (IG) will receive ten weeks of access to the online self-help intervention together with weekly therapeutic feedback on their progress. The wait-list control group (WLC) will receive access to the intervention for ten weeks as well, but without therapeutic feedback and with a ten-week delay. We will conduct assessments at the beginning of the intervention of the IG (T0), the end of the intervention of the IG (T1), two months later (only IG, T2), and at the end of the intervention of the WLC (T3). The primary outcome is satisfaction with the treatment as measured by the ZUF-8 at T1 and T3 respectively. Secondary outcome measures include emotional competence, depression, anxiety, and quality of life.

    Conclusion

    We expect insight into the usefulness and acceptance of an online self-help intervention used to maintain inpatient treatment effects. Furthermore, we await both groups to benefit from the participation in the intervention. Pre- post and between subject differences will be used as estimate effect sizes to calculate the necessary sample size for a larger efficacy trial.

  • 3.
    Berg, Matilda
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Rozental, Alexander
    Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden; Institute of Child Health, University College London, London, United Kingdom of Great Britain and Northern Ireland.
    Johansson, Sofie
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Filosofiska fakulteten.
    Liljethorn, Lina
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Filosofiska fakulteten.
    Radvogin, Ella
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Filosofiska fakulteten.
    Topooco, Naira
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Filosofiska fakulteten.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
    The role of knowledge in internet-based cognitive behavioural therapy for adolescent depression: Results from a randomised controlled study2019Inngår i: Internet Interventions, ISSN 2214-7829, Vol. 15, s. 10-17Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background and objectives

    Clients' knowledge about their condition and treatment is considered crucial for general health improvement, and knowledge acquisition is an essential part in internet-based cognitive behavioural therapy (ICBT). Yet, little is known about the role of knowledge and how it influences treatment outcome. This study aimed to examine if explicit knowledgeincreased following ICBT for adolescent depression, if knowledge gainwould be associated with symptom reduction, and if pre-existing knowledge predicted changes in depressive symptoms.

    Methods

    Seventy-one adolescents were randomised to a therapist-supported ICBT or a attention control condition. A measure of depression (BDI-II) and a knowledge test dealing with depression, comorbid anxiety, and its CBT-treatment were administered before and after treatment.

    Results

    Significant improvements in knowledge were observed following ICBT compared to the attention control (between-group Cohen's d = 1.25, 95% CI [0.67–1.79]). On average, participants in the treatment group answered 1.4 more questions correctly at post treatment compared to the control group. No relation between change in knowledge and change in depressive symptoms could be observed. Knowledge scores at baseline were high for both groups, with participants answering approximately 75% of the questions correct. A higher level of initial knowledge level predicted poorer treatment response (Parson's r = −0.38, p = .048).

    Conclusions

    The findings indicate that knowledge about basic concepts and principles about depression, anxiety, and CBT increases following ICBT. This increase in knowledge was not related to change in depressive symptoms, indicating that knowledge is a different construct. The results also suggest that clients who are more knowledgeable prior to treatment might benefit less from ICBT. In sum, the results highlight the need to further examine the role of knowledge in ICBT.

  • 4.
    Beukes, Eldré W.
    et al.
    Department of Vision and Hearing Sciences, Anglia Ruskin University, Cambridge CB1 1PT, United Kingdom.
    Vlaescu, George
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Manchaiah, Vinaya K. C.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten. Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX 77710, USA.
    Baguley, David M.
    Department of Vision and Hearing Sciences, Anglia Ruskin University, Cambridge CB1 1PT, United Kingdom Audiology Department, Cambridge University Hospital NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom.
    Allen, Peter M.
    Department of Vision and Hearing Sciences, Anglia Ruskin University, Cambridge CB1 1PT, United Kingdom Vision and Eye Research Unit, Anglia Ruskin University, Cambridge CB1 1PT, United Kingdom.
    Kaldo, Viktor
    Division of Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institute, Stockholm, Sweden.
    Development and technical functionality of an Internet-based intervention for tinnitus in the UK2016Inngår i: Internet Interventions, ISSN 2214-7829, Vol. 6, s. 6-15Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose

    Creative approaches to improve access to evidence-based tinnitus treatments are required. The purpose of this study was to develop an Internet-based cognitive behavioural therapy (iCBT) intervention, for those experiencing tinnitus in the United Kingdom (UK). Furthermore, it aimed, through technical functionality testing, to identify specific aspects of the iCBT that require improving.

    Method

    An innovative iCBT intervention for treating tinnitus in the UK has been developed using a cognitive-behavioural theoretical framework. This iCBT was evaluated by two user groups during this developmental phase. Initially, five expert reviews evaluated the intervention, prior to evaluation by a group of 29 adults experiencing significant levels of tinnitus distress. Both groups evaluated iCBT in an independent measures design, using a specifically designed satisfaction outcome measure.

    Results

    Overall, similar ratings were given by the expert reviewers and adults with tinnitus, showing a high level of satisfaction regarding the content, suitability, presentation, usability and exercises provided in the intervention. The iCBT intervention has been refined following technical functionality testing.

    Conclusions

    Rigorous testing of the developed iCBT intervention has been undertaken. These evaluations provide confidence that further clinical trials can commence in the UK, to assess the feasibility and effectiveness of this iCBT intervention for tinnitus.

  • 5.
    Boettcher, Johanna
    et al.
    Department of Psychology, Stockholm University, Sweden Department of Clinical Psychology, Freie Universitaet Berlin, Germany.
    Rozental, Alexander
    Department of Psychology, Stockholm University, Sweden.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institute, Stockholm, Sweden.
    Carlbring, Per
    Division of Clinical Psychology, Department of Psychology, Stockholm University, Stockholm, Sweden.
    Side effects in Internet-based interventions for Social Anxiety Disorder2014Inngår i: Internet Interventions, ISSN 2214-7829, Vol. 1, nr 1, s. 3-11Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Internet-based interventions are effective in the treatment of various mental disorders and have already been integrated in routine health care in some countries. Empirical data on potential negative effects of these interventions is lacking. This study investigated side effects in an Internet-based treatment for Social Anxiety Disorder (SAD).

    A total of 133 individuals diagnosed with SAD took part in an 11-week guided treatment. Side effects were assessed as open formatted questions after week 2 and at post-treatment after week 11. Answers were independently rated by two coders. In addition, rates of deterioration and non-response were calculated for primary social anxiety and secondary outcome measures (depression and quality of life).

    In total, 19 participants (14%) described unwanted negative events that they related to treatment. The emergence of new symptoms was the most commonly experienced side effect, followed by the deterioration of social anxiety symptoms and negative well-being. The large majority of the described side effects had a temporary but no enduring negative effect on participants' well-being. At post-treatment, none of the participants reported deterioration on social anxiety measures and 0–7% deteriorated on secondary outcome measures. Non-response was frequent with 32–50% for social anxiety measures and 57–90% for secondary outcomes at post-assessment.

    Results suggest that a small proportion of participants in Internet-based interventions experiences negative effects during treatment. Information about potential side effects should be integrated in patient education in the practice of Internet-based treatments.

  • 6.
    Brännström, Jonas
    et al.
    Clinical Sciences Lund, Sweden.
    Öberg, Marie
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Östergötlands Läns Landsting, Sinnescentrum, Öron- näsa- och halskliniken US. Linköpings universitet, Medicinska fakulteten.
    Ingo, Elisabeth
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten.
    Månsson, Kristoffer N T
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Karolinska Institutet, Department of Clinical Neuroscience, Sweden.
    Lunner, Thomas
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutet för handikappvetenskap (IHV). Snekkersten, Oticon A/S, Eriksholm Research Centre, Denmark.
    Laplante-Lévesque, Ariane
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten. Snekkersten, Oticon A/S, Eriksholm Research Centre, Denmark.
    The initial evaluation of an internet-based support system for audiologists and first-time hearing aid clientsThe process of developing an internet-based support system for audiologists and first-time hearing aid clients2016Inngår i: Internet Interventions, ISSN 2214-7829, Vol. 4, nr 1, s. 82-91Artikkel i tidsskrift (Fagfellevurdert)
  • 7.
    Dahlin, Mats
    et al.
    Psykologpartners, Private practice, Linköping, Sweden.
    Ryberg, Marielle
    Psykologpartners, Private practice, Linköping, Sweden.
    Vernmark, Kristofer
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Psykologpartners, Private practice, Linköping, Sweden.
    Annas, Nina
    Psykiatripartners, Private practice, Linköping, Sweden.
    Carlbring, Per
    Division of Clinical Psychology, Department of Psychology, Stockholm University, Stockholm, Sweden.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institute, Stockholm, Sweden.
    Internet-delivered acceptance-based behavior therapy for generalized anxiety disorder: A pilot study2016Inngår i: Internet Interventions, ISSN 2214-7829, Vol. 6, s. 16-21Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective

    Internet-delivered cognitive behavior therapy (ICBT) has been developed and tested for treating persons with generalized anxiety disorder (GAD). A new form of CBT focuses on acceptance (of internal experiences or difficult psychological content), mindfulness and valued actions. To date this form of CBT has not been delivered via the internet for persons with GAD. The aim of this study was to describe the functionality of a new internet-delivered acceptance-based behavior therapy for GAD, and to test the effect of the intervention in an open pilot trial.

    Methods

    Following exclusion of two patients we included 14 patients diagnosed with GAD from two primary care clinics. At 2–3 months follow-up after treatment 10 patients completed the outcome measures. The treatment lasted for an average of 15 weeks and consisted of acceptance-based techniques, behavior therapy components and homework assignments.

    Results

    A majority of participants completed all modules during the treatment. Findings on the Penn State Worry Questionnaire showed a within-group improvement of Cohen's d = 2.14 at posttreatment. At the follow-up results were maintained. Client satisfaction ratings were high.

    Conclusions

    We conclude that internet-delivered acceptance-based behavior therapy potentially can be a promising new treatment for GAD. A controlled trial of the program has already been completed.

  • 8.
    Forsström, D.
    et al.
    Department of Psychology, Stockholm University, Stockholm, Sweden.
    Jansson-Fröjmark, M.
    Department of Psychology, Stockholm University, Stockholm, Sweden; Centre for Psychiatry Research, Department of Clinical Neuroscience, Stockholm, Sweden.
    Hesser, Hugo
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Carlbring, P.
    Department of Psychology, Stockholm University, Stockholm, Sweden.
    Experiences of Playscan: Interviews with users of a responsible gambling tool2017Inngår i: Internet Interventions, ISSN 2214-7829, Vol. 8, s. 53-62Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Online gambling, encompassing a wide variety of activities and around-the-clock access, can be a potential risk factor for gamblers who tend to gamble excessively. Yet, the advent of online gambling has enabled responsible gambling (RG) features that may help individuals to limit their gambling behaviour. One of these features is RG tools that track gamblers’ behaviour, performs risk assessments and provides advice to gamblers. This study investigated users’ views and experiences of the RG tool Playscan from a qualitative perspective using a semi-structured interview. The tool performs a risk assessment on a three-step scale (low, medium and high risk). Users from every risk category were included. Twenty interviews were carried out and analysed using thematic analysis. Two main themes with associated sub-themes were identified: “Usage of Playscan and the gambling site” and “Experiences of Playscan”. Important experiences in the sub-themes were lack of feedback from the tool and confusion when signing up to use Playscan. These experiences counteracted positive attitudes that should have promoted usage of the tool. Providing more feedback directly to users is a suggested solution to increase usage of the RG tool. © 2017 The Authors

  • 9.
    Heinrich, Sarah
    et al.
    Department of Psychology, Stockholm University, Stockholm, Sweden.
    Rozental, Alexander
    Department of Psychology, Stockholm University, Sweden.
    Carlbring, Per
    Division of Clinical Psychology, Department of Psychology, Stockholm University, Stockholm, Sweden.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institute, Stockholm, Sweden.
    Cotter, Katherine
    Department of Psychology, Stockholm University, Stockholm, Sweden.
    Weise, Cornelia
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutet för handikappvetenskap (IHV). Department of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Germany.
    Treating tinnitus distress via the Internet: A mixed methods approach of what makes patients seek help and stay motivated during Internet-based cognitive behavior therapy2016Inngår i: Internet Interventions, ISSN 2214-7829, Vol. 4, nr 2, s. 120-130Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    Internet-based cognitive behavioral therapy (ICBT) has proven to be an effective treatment in improving patients' ability to cope with tinnitus. However, some patients prefer face-to-face therapy to ICBT, and a few studies have shown considerable dropout rates if the treatment is not guided. This renders it important to identify factors that contribute to the commencement and continuation of ICBT programs.

    Aims

    Because treatment motivation and expectations are important factors in psychological treatment, the aim of our study was to investigate what leads tinnitus patients to seek out ICBT, what helps them to keep up with the treatment, and what (if any) impact these factors have on dropout rates and treatment outcomes.

    Method

    112 tinnitus patients taking part in ICBT for tinnitus responded to symptom-related questionnaires at three points in time (pre-treatment, post-treatment, and one-year-follow-up) and to a questionnaire consisting of open-ended questions about their treatment motivation and expectations before beginning treatment. Data were analyzed using qualitative content analysis, and the results were used to divide the participants into groups. The treatment outcomes of these groups were compared using t-tests, χ2-tests, and both one-factorial and mixed ANOVAs.

    Results

    Four main categories emerged as factors conducive to starting treatment: 1) Targets participants wanted to address, 2) circumstances that led to participation, 3) attitudes towards the treatment, and 4) training features. Participants identified six facilitators for continuing the treatment: success, training, individual attitude, hope, evidence, and support. Naming specific tinnitus-associated problems as targets was associated with greater improvement from pre-treatment to 1-year-follow-up. Describing an active involvement in the treatment was related to increased improvement from post-treatment to follow-up.

    Conclusion

    There are several motivational factors that tinnitus patients consider relevant for beginning and continuing ICBT. Particularly, focusing on specific targets that do not involve the tinnitus itself, and encouraging participants to take an active role in treatment may increase treatment effectiveness. However, further hypothesis-guided research is necessary to confirm our explorative results.

  • 10.
    Holländare, Fredrik
    et al.
    Psychiatric Research Centre, School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Gustafsson, Sanna Aila
    Psychiatric Research Centre, School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Berglind, Maria
    School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden.
    Grape, Frida
    School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden.
    Carlbring, Per
    Division of Clinical Psychology, Department of Psychology, Stockholm University, Stockholm, Sweden.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institute, Stockholm, Sweden.
    Hadjistavropoulos, Heather
    Department of Psychology, University of Regina, Regina, Canada.
    Tillfors, Maria
    School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden.
    Therapist behaviours in internet-based cognitive behaviour therapy (ICBT) for depressive symptoms2016Inngår i: Internet Interventions, ISSN 2214-7829, Vol. 3, s. 1-7Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Internet-based cognitive behaviour therapy (ICBT) is efficacious for treating depression, with therapist guidance identified as important for favourable outcomes. We have limited knowledge, however, about the fundamental components of therapist guidance in ICBT. The purpose of this study was to systematically examine therapist messages sent to patients during the course of ICBT for depressive symptoms in order to identify common “therapist behaviours” and the extent to which these behaviours correlate with completion of modules and improvements in symptoms at post-treatment, one- and two-year follow-up. A total of 664 e-mails from 5 therapists to 42 patients were analysed using qualitative content analysis. The most frequent behaviour was encouraging that accounted for 31.5% of the total number of coded behaviours. This was followed by affirming (25.1%), guiding (22.2%) and urging (9.8%). Less frequently the therapists clarified the internet treatment frameworkinformed about module contentemphasised the importance of patient responsibilityconfronted the patient and made self-disclosures. Six of the nine identified therapist behaviours correlated with module completion. Three behaviours correlated with symptom improvement. Affirmingcorrelated significantly (r = .42, p = .005) with improvement in depressive symptoms at post-treatment and after two years (r = .39, p = .014). Encouraging was associated with outcome directly after treatment (r = .52, p = .001). Self-disclosure was correlated with improvement in depressive symptoms at post-treatment (r = .44, p = .003). The study contributes to a better understanding of therapist behaviours in ICBT for depressive symptoms. Future directions for research are discussed.

  • 11.
    Ivarsson, David
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Filosofiska fakulteten.
    Blom, Marie
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Östergötlands Läns Landsting, Sinnescentrum, Rehabiliteringsmedicinska kliniken.
    Hesser, Hugo
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Carlbring, Per
    Department of Psychology, Stockholm University, Stockholm, Sweden.
    Enderby, Pia
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Filosofiska fakulteten.
    Nordberg, Rebecca
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Filosofiska fakulteten.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
    Guided internet-delivered cognitive behavior therapy for post-traumatic stress disorder: A randomized controlled trial2014Inngår i: Internet Interventions, ISSN 2214-7829, Vol. 1, nr 1, s. 33-40Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim of this randomized controlled trial was to investigate the effects of guided internet-based cognitive behavior therapy (ICBT) for posttraumatic stress disorder (PTSD). Sixty-two participants with chronic PTSD, as assessed by the Clinician-administered PTSD Scale, were recruited via nationwide advertising and randomized to either treatment (n= 31) or delayed treatment attention control (n= 31). The ICBT treatment consisted of 8 weekly text-based modules containing psychoeducation, breathing retraining, imaginal and in vivo exposure, cognitive restructuring, and relapse prevention. Therapist support and feedback on homework assignment were given weekly via an online contact handling system. Assessments were made at baseline, post-treatment, and at 1-year follow-up. Main outcome measures were the Impact of Events Scale - Revised (IES-R) and the Posttraumatic Stress Diagnostic Scale (PDS). Results showed significant reductions of PTSD symptoms (between group effect on the IES-R Cohens d= 1.25, and d= 1.24 for the PDS) compared to the control group. There were also effects on depression symptoms, anxiety symptoms, and quality of life. The results at one-year follow-up showed that treatment gains were maintained. In sum, these results suggest that ICBT with therapist support can reduce PTSD symptoms significantly. © 2014 The Authors.

  • 12.
    Jakobsen, H.
    et al.
    Helgeland Hospital HF, Norway; Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Norway.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Department of Clinical Neuroscience, Karolinska Institutet, Sweden.
    Havik, O.E.
    Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Norway.
    Nordgreen, T.
    Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Norway; Division of Psychiatry, Haukeland University Hospital, Norway.
    Guided Internet-based cognitive behavioral therapy for mild and moderate depression: A benchmarking study2017Inngår i: Internet Interventions, ISSN 2214-7829, Vol. 7Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Major depression is among the most common and debilitating disorders worldwide, associated with large societal and individual costs. Effective treatments exist, but accessibility is scarce. Guided Internet-Based Cognitive Behavioral Therapy (guided iCBT) is a promising approach to reach more people in need of help. In the present pilot study, we investigated the outcome of a guided iCBT program for mild and moderate depression when disseminated from Sweden to Norway. The guided iCBT intervention was implemented within a university-based outpatient clinic by six student therapists under supervision. Twenty-two participants with mild and moderate depression were included in the study. Large treatment effects were found for depressive symptoms, whereas small to medium effects were observed for anxiety symptoms. More than half (55%) of the participants were classified as recovered at post-treatment and more than a third (41%) at follow-up. No participants had a significant deterioration from pre- to post-treatment, but two reported a significant deterioration from post-treatment to 6-month follow-up. Benchmarking the present results against those reported in the four original Swedish studies, we found that the treatment effect in the Norwegian study was slightly higher at post-treatment and slightly lower at 6-month follow-up compared to the outcome in the Swedish studies. The results should be interpreted with caution, as our sample was small and had no control group. � 2016 The Authors

  • 13.
    Jasper, Kristine
    et al.
    Johannes Gutenberg-University Mainz, Germany.
    Weise, Cornelia
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutet för handikappvetenskap (IHV). Philipps-University Marburg, Germany.
    Conrad, Isabell
    Johannes Gutenberg-University Mainz, Germany.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutet för handikappvetenskap (IHV).
    Hiller, Wolfgang
    Johannes Gutenberg-University Mainz, Germany.
    Kleinstäuber, Maria
    Philipps-University Marburg, Germany.
    The working alliance in a randomized controlled trial comparing Internet-based self-help and face-to-face cognitive behavior therapy for chronic tinnitus2014Inngår i: Internet Interventions, ISSN 2214-7829, Vol. 1, nr 2, s. 49-57Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective

    This study (ID: NCT01205906) compared the impact of the working alliance between the therapist and the client on treatment outcome in a group and an Internet-based cognitive behavior therapy (GCBT vs. ICBT) for chronic tinnitus.

    Methods

    The Working Alliance Inventory — Short Revised (WAI-SR, scale range: 1–5) was administered to 26 GCBT and 38 ICBT participants after treatment weeks 2, 5, and 9, and the Tinnitus Handicap Inventory (THI) before and after the treatment.

    Results

    High alliance ratings were found in both ICBT (WAI-SR total scores at week 9: M = 3.59, SD = 0.72) and GCBT (WAI-SR total scores at week 9: M = 4.20, SD = 0.49), but significantly higher ratings occurred in GCBT on most WAI-SR scales (ps < .01). Significant time × group interactions for most WAI-SR scales indicated differences in alliance growth patterns between the treatments (ps < .001). Residual gain scores for the therapy outcome measure ‘tinnitus distress’ were significantly correlated with the agreement on treatment tasks between therapist and client in ICBT (r = .40, p = .014) and with the affective therapeutic bond in GCBT (r = .40, p = .043) at mid-treatment (week 5).

    Conclusion

    More time was needed to build a strong alliance in ICBT although GCBT yielded generally higher alliance ratings. Moreover, different aspects of the therapeutic alliance might be important for treatment success in ICBT versus GCBT.

  • 14.
    Johansson, Olof
    et al.
    Lund University, Lund, Sweden.
    Bjärehed, Jonas
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Filosofiska fakulteten.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken. Karolinska Institute, Solna, Sweden.
    Carlbring, Per
    Stockholm University, Stockholm, Sweden; University of Southern Denmark, Odense, Denmark.
    Lundh, Lars-Gunnar
    Lund University, Lund, Sweden.
    Effectiveness of guided internet-delivered cognitive behavior therapy for depression in routine psychiatry: A randomized controlled trial2019Inngår i: Internet Interventions, ISSN 2214-7829, Internet interventions, ISSN 2214-7829, Vol. 17, artikkel-id 100247Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Depression is one of the most common health problems worldwide but is often undertreated. Internet-delivered cognitive behavioral therapy (ICBT) appears to be an effective treatment option, with the potential to reach a larger proportion of individuals suffering from depression. While many studies have examined the efficacy of ICBT for depression in randomized controlled trials, fewer have focused on the effectiveness of ICBT when used as an integral part of routine health care. In this study the effectiveness of an 8-week ICBT program was examined when delivered in a routine psychiatric setting. A total of 108 patients were referred and 54 were then included and randomized to either ICBT or a waitlist control condition. The sample had a lower education level and a higher proportion of individuals were on sick leave than comparable previous efficacy trials of ICBT for depression conducted in Sweden. Measures assessing depression, anxiety and psychiatric symptoms were administered before and after treatment, follow up was performed at 6- and 12 months after treatment had ended. ICBT resulted in significant reductions of depressive symptoms in the treatment group when compared to a waitlist control group with a large effect size (Cohen's d = 1.6). Treatment gains were maintained at 6- and 12 months after the treatment had ended. In terms of clinical significance, 58% of the sample had improved or recovered after treatment. The study was small, and patients received general psychiatric care after the ICBT treatment had ended which limits the implications. We conclude that ICBT appears to be an effective treatment for depression when delivered as an integral part of routine psychiatric care.

  • 15.
    Johansson, Olof
    et al.
    Department of Psychology, Lund University, Sweden.
    Michel, Teresa
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institute, Stockholm, Sweden.
    Paxling, Björn
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Experiences of non-adherence to Internet-delivered cognitive behavior therapy: A qualitative study2015Inngår i: Internet Interventions, ISSN 2214-7829, Vol. 2, nr 2, s. 137-142Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Many trials on Internet-delivered psychological treatments have had problems with nonadherence, but not much is known about the subjective reasons for non-adhering. The aim of this study was to explore participants' experiences of non-adherence to Internet-delivered psychological treatment. Grounded theory was used to analyze data from seven in-depth interviews with persons who had non-adhered to a study on Internet-delivered cognitive behavioral therapy for generalized anxiety disorder. The process of non-adherence is described as an interaction between patient factors and treatment factors. A working model theory was generated to illustrate the experience of nonadherence. The model describes a process where treatment features such as workload, text-content complexity and treatment process don't match personal prerequisites regarding daily routines, perceived language skills and treatment expectations respectively, resulting in the decision to nonadhere. Negative effects were also stated as a reason for non-adherence. Several common strategies used for increasing adherence to Internet-delivered therapy in general are by these non-completers regarded as factors directly related to their reason for non-adherence.

  • 16.
    Lin, Jiaxi
    et al.
    Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Germany Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Germany.
    Lüking, Marianne
    Interdisciplinary Pain Center, University Medical Center, Freiburg, Germany.
    Ebert, David Daniel
    Innovation Incubator, Division Health Trainings Online, Leuphana University Lueneburg, Germany Department of Psychology, Clinical Psychology and Psychotherapy, Philipps University Marburg, Germany.
    Buhrman, Monica
    Department of Psychology, Uppsala University, Sweden.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institute, Stockholm, Sweden.
    Baumeister, Harald
    Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Germany Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Germany.
    Effectiveness and cost-effectiveness of a guided and unguided internet-based Acceptance and Commitment Therapy for chronic pain: Study protocol for a three-armed randomised controlled trial2015Inngår i: Internet Interventions, ISSN 2214-7829, Vol. 2, nr 1, s. 7-16Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    Acceptance and Commitment Therapy (ACT) is an effective intervention for the treatment of chronic pain. Internet-based pain interventions might be an effective and cost-effective way to overcome treatment barriers of traditional face-to-face pain interventions such as the lack of availability and accessibility. However, little is known about the general (cost-)effectiveness of internet-based pain interventions and the specific (cost-) effectiveness of guided and unguided pain interventions. Therefore, the aim of this study is to investigate the effectiveness and cost-effectiveness of a guided and unguided ACT-based online intervention for persons with chronic pain (ACTonPain).

    Methods

    ACTonPain is a pragmatic three-armed randomised controlled trial comparing ACTonPain with or without therapist guidance against a waitlist control group. Both active conditions differ only with regard to guidance provided by an eCoach, who sends feedback after each module. This study aims to include 300 participants. Randomisation and allocation will be performed using permuted block randomisation with variable block sizes. The intervention contains seven ACT-based modules with interactive exercises, and audio and video clips. Furthermore, the participants have the opportunity to receive daily text messages. Online self-assessments will take place at pre- and post-treatment, as well as at 6 month follow-up. The primary outcome is pain interference. Secondary outcomes include physical and emotional functioning, pain intensity, ACT-related variables as well as health-related quality of life. Moreover, a cost-effectiveness analysis will be conducted from a societal perspective. Demographic and medical variables will be assessed on the basis of self-reports in order to detect potential moderators or mediators of the effects. The data will be analysed on an intention-to-treat basis and also using per-protocol analyses.

    Discussion

    This study will contribute to the evidence base of internet-based pain interventions and provide valuable information about the treatment success and cost-effectiveness regarding the intervention's level of guidance (self-help only vs. guided self-help). If ACTonPain is shown to be effective, investigations in different healthcare settings should follow, to examine possible ways of implementing ACTonPain into existing healthcare systems. The implementation of ACTonPain could help to shorten waiting times, expand access to pain treatment and, potentially, also reduce treatment costs.

  • 17.
    Lindner, P.
    et al.
    Department of Clinical Neuroscience, Karolinska InstitutetStockholm, Sweden.
    Olsson, E.L.
    Department of Psychology, Umeå UniversityUmeå, Sweden.
    Johnsson, A.
    Department of Psychology, Umeå UniversityUmeå, Sweden.
    Dahlin, M.
    PsykologpartnersLinköping, Sweden.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Department of Clinical Neuroscience, Karolinska InstitutetStockholm, Sweden.
    Carlbring, P.
    Department of Psychology, Stockholm UniversityStockholm, Sweden.
    The impact of telephone versus e-mail therapist guidance on treatment outcomes, therapeutic alliance and treatment engagement in Internet-delivered CBT for depression: A randomised pilot trial2014Inngår i: Internet Interventions, ISSN 2214-7829, Vol. 1, nr 4, s. 182-187Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Internet-administered cognitive behavioural therapy (iCBT) is an effective treatment of depression, yet much remains to be learned about the specific mechanisms influencing symptom reduction. Although previous research has consistently shown that therapist-guided iCBT is more effective than unguided iCBT, it is unknown whether the medium used for therapist-client communication has an impact on results. Methods: Thirty-eight subjects with major depression were recruited from the waiting list of another iCBT study and randomised to a guided iCBT program with therapist guidance either by telephone calls (. n=. 19) or e-mail correspondence (. n=. 19). Outcome measures were self-rated measures of depression, anxiety and quality of life. Results: At post-treatment, both groups showed significant and large symptom reductions yet did not differ from each other. Neither was there any between-group difference in client-rated therapeutic alliance or treatment engagement. Symptom reductions were maintained at a three-month follow-up. Conclusion: Therapist guidance by telephone does not appear to differ from therapist guidance by e-mail in iCBT for depression, although further research featuring larger samples is necessary to draw more definite conclusions.Trial registration: None.

  • 18.
    Lindner, Philip
    et al.
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden Department of Psychology, Stockholm University, Stockholm, Sweden.
    Nyström, Markus B.T.
    Department of Psychology, Umeå University, Umeå, Sweden.
    Hassmén, Peter
    Department of Psychology, Umeå University, Umeå, Sweden Discipline of Psychology and Research Institute for Sport and Exercise, University of Canberra, Australia.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institute, Stockholm, Sweden.
    Carlbring, Per
    Division of Clinical Psychology, Department of Psychology, Stockholm University, Stockholm, Sweden.
    Who seeks ICBT for depression and how do they get there?: Effects of recruitment source on patient demographics and clinical characteristics2015Inngår i: Internet Interventions, ISSN 2214-7829, Vol. 2, nr 2, s. 221-225Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Studies on internet-administered cognitive behavior therapy (ICBT) frequently use several different sources of recruitment, yet no study has investigated whether different recruitment sources produce different clinical and demographic profiles among participants. Using data from a large sample (n = 982) seeking ICBT for depression, we compared these characteristics on the basis of self-reported recruitment source. Recruitment sources that imply more active treatment-seeking behaviors (Google searches, viewing postings on mental health websites) presented more severe depression and anxiety than those recruited through more passive sources of information (newspaper advertisements, referrals by friends and family). In addition, a number of demographic differences between groups were found. These findings have important implications for ICBT research projects and clinical programs who employ open recruitment procedures and multi-modal recruitment strategies, and who wish to recruit representative samples or target specific subgroups. Replications in other countries will however be required to establish cross-cultural patterns.

  • 19.
    Ly, Kien Hoa
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Asplund, Kajsa
    Department of Management and Organization, Stockholm School of Economics, Stockholm, Sweden.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institute, Stockholm, Sweden.
    Stress management for middle managers via an acceptance and commitment-based smartphone application: A randomized controlled trial2014Inngår i: Internet Interventions, ISSN 2214-7829, Vol. 1, nr 3, s. 95-101Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Stress is a major health problem in today's workplace. Recent studies suggest that acceptance and commitment therapy (ACT) is effective for reducing stress at work, specifically among managers. Moreover, smartphone-delivered treatments have been developed and increasingly used in research. The objective of our study was to evaluate the efficacy of an ACT-based smartphone treatment among middle managers at medium- and large-sized companies (> 50 employees) in Sweden. A total of 73 participants were randomized to either receive the six-week stress intervention (n = 36) or to a waitlist control group (n = 37). Results showed small to moderate within-group effect sizes (Cohen's d range 0.37–0.62) for the treatment group, and small to moderate between group effects (Cohen's d range 0.41–0.50). In conclusion, the study indicates that a smartphone administered stress intervention based on ACT can reduce perceived stress and increase general health among Swedish middle managers in the private sector.

  • 20.
    Ly, Kien Hoa
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Janni, Elsa
    Department of Psychology, Stockholm University, Stockholm, Sweden.
    Wrede, Richard
    Department of Psychology, Stockholm University, Stockholm, Sweden.
    Sedem, Mina
    Department of Psychology, Stockholm University, Stockholm, Sweden.
    Donker, Tara
    Department of Clinical Psychology, VU University, Amsterdam, The Netherlands.
    Carlbring, Per
    Department of Psychology, Stockholm University, Stockholm, Sweden.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
    Experiences of a guided smartphone-based behavioral activation therapy for depression: A qualitative study2015Inngår i: Internet Interventions, ISSN 2214-7829, Vol. 2, nr 1, s. 60-68Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Recently, a number of studies have investigated treatments administered via smartphones showing that this treatment format has a potential to be effective. However, we still have limited knowledge of how patients experience this treatment format. The objective of this study was to explore participants' views of a smartphone-based behavioral activation treatment. In-depth interviews were conducted with 12 strategically (participants with different overall experiences) selected participants, suffering from major depression according to the DSM-IV. The interview data were processed with the aid of thematic analysis. The analysis generated the three main themes: Commitment, Treatment and Lack of important components, with attached subthemes. In conclusion, the findings from the current study correspond with existing knowledge in the field of internet-based treatment. Considering that this kind of treatment is still quite new, the need for further research and development is considerable. Nevertheless, its availability, assimilation into users' everyday lives and possible motivational qualities speak of its potential.

  • 21.
    Ly, Kien Hoa
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Ly, Ann-Marie
    Department of Psychology, Mittuniversitetet, Östersund, Sweden.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.
    A fully automated conversational agent for promoting mental well-being: A pilot RCT using mixed methods2017Inngår i: Internet Interventions, ISSN 2214-7829, Vol. 10, s. 39-46Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Fully automated self-help interventions can serve as highly cost-effective mental health promotion tools for massive amounts of people. However, these interventions are often characterised by poor adherence. One way to address this problem is to mimic therapy support by a conversational agent. The objectives of this study were to assess the effectiveness and adherence of a smartphone app, delivering strategies used in positive psychology and CBT interventions via an automated chatbot (Shim) for a non-clinical population — as well as to explore participants views and experiences of interacting with this chatbot. A total of 28 participants were randomized to either receive the chatbot intervention (n = 14) or to a wait-list control group (n = 14). Findings revealed that participants who adhered to the intervention (n = 13) showed significant interaction effects of group and time on psychological well-being (FS) and perceived stress (PSS-10) compared to the wait-list control group, with small to large between effect sizes (Cohens d range 0.14–1.06). Also, the participants showed high engagement during the 2-week long intervention, with an average open app ratio of 17.71 times for the whole period. This is higher compared to other studies on fully automated interventions claiming to be highly engaging, such as Woebot and the Panoply app. The qualitative data revealed sub-themes which, to our knowledge, have not been found previously, such as the moderating format of the chatbot. The results of this study, in particular the good adherence rate, validated the usefulness of replicating this study in the future with a larger sample size and an active control group. This is important, as the search for fully automated, yet highly engaging and effective digital self-help interventions for promoting mental health is crucial for the public health. © 2017 The Authors

  • 22.
    Mendes-Santos, Cristina
    et al.
    Linköpings universitet, Institutionen för kultur och kommunikation, Avdelningen för kultur och estetik. Linköpings universitet, Tekniska fakulteten. Universidade Nova de Lisboa, Lisboa, Portugal.
    Weiderpass, Elisabete
    Institute of Population-Based Cancer Research, Oslo, Norway; University of Tromsø, The Arctic University of Norway, Tromsø, Norway; Karolinska Institutet, Stockholm, Sweden; University of Helsinki, Helsinki, Finland.
    Santana, Rui
    Universidade Nova de Lisboa, Lisboa, Portugal.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken. Karolinska Institutet, Stockholm, Sweden.
    A guided internet-delivered individually-tailored ACT-influenced cognitive behavioural intervention to improve psychosocial outcomes in breast cancer survivors (iNNOVBC): Study protocol2019Inngår i: Internet Interventions, ISSN 2214-7829, Internet interventions, ISSN 2214-7829, Vol. 17, artikkel-id 100236Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Internet-delivered interventions can provide remarkable opportunities in addressing breast cancer survivors' unmet support care needs, as they present an effective strategy to improve care coordination and provide access to efficacious, cost-efficient and convenient survivorship care. Nevertheless, research focusing on improving survivors' psychosocial needs using internet-based tools is scarce and its practical implementation is limited.

    Objectives: To study the acceptability, feasibility, efficacy and cost-effectiveness of iNNOVBC, a 10 weeks guided internet-delivered individually-tailored Acceptance and Commitment Therapy (ACT)-influenced cognitive behavioural (CBT) intervention developed to improve mild to moderate anxiety and depression in Breast cancer survivors when compared to treatment as usual (TAU) in a waiting list control group (WLC).

    Methods: A two-arm, parallel, open label, multicentre, waiting list randomized controlled trial will be conducted to investigate the efficacy and cost-effectiveness of INNOVBC. The primary outcomes in this research will be anxiety and depression. Secondary outcomes will include psychological flexibility, fatigue, insomnia, sexual dysfunction and Health Related Quality of Life (HRQoL).

    Ethical approval: This study has been reviewed and approved by Comissão Nacional de Proteção de Dados; Instituto Português de Oncologia do Porto Francisco Gentil; Unidade Local de Saúde de Matosinhos, EPE; Centro Hospitalar de São João and Ordem dos Psicólogos ethical committees.

    Expected results: It is anticipated that iNNOVBC will show to be an efficacious and cost-effective program in improving the outcomes of interest in this study, as opposed to a WLC under TAU. The results of this research will be published in accordance with CONSORT-EHEALTH guidelines.

    Conclusions: This study will inform on the acceptability, feasibility, efficacy and cost-effectiveness of iNNOVBC, in improving psychosocial outcomes in breast cancer survivors when compared to TAU in a WLC. Its conclusions will contribute to understand the idiosyncrasies of designing and implementing internet-delivered interventions in breast cancer survivors.Trial Registration code: INNOVBC (NCT03275727).

  • 23.
    Meyer, Björn
    et al.
    Research Department, Gaia, Hamburg, Germany Department of Psychology, City University London, United Kingdom.
    Bierbrodt, Julia
    Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
    Schröder, Johanna
    Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
    Berger, Thomas
    Department of Clinical Psychology and Psychotherapy, University of Bern, Switzerland.
    Beevers, Christopher G.
    Institute for Mental Health Research, University of Texas at Austin, Austin, USA.
    Weiss, Mario
    Research Department, Gaia, Hamburg, Germany.
    Jacob, Gitta
    Research Department, Gaia, Hamburg, Germany Department of Clinical Psychology and Psychotherapy, University of Freiburg, Germany.
    Späth, Christina
    Department of Psychiatry and Psychotherapy, University of Luebeck, Germany.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institute, Stockholm, Sweden.
    Lutz, Wolfgang
    Department of Clinical Psychology and Psychotherapy, University of Trier, Germany.
    Hautzinger, Martin
    Department of Psychology, Clinical Psychology and Psychotherapy, Eberhard Karls University Tuebingen, Tuebingen, Germany.
    Löwe, Bernd
    Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany Schön Klinik Hamburg Eilbek, Germany.
    Rose, Matthias
    Department of Psychosomatic Medicine, Charité University Medical Center, Berlin, Germany Department of Quantitative Health Sciences, University of Massachusetts Medical School, USA.
    Hohagen, Fritz
    Department of Psychiatry and Psychotherapy, University of Luebeck, Germany.
    Caspar, Franz
    Department of Clinical Psychology and Psychotherapy, University of Bern, Switzerland.
    Greiner, Wolfgang
    Department of Health Economics and Health Care Management, Bielefeld University, Bielefeld, Germany.
    Moritz, Steffen
    Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
    Klein, Jan Philipp
    Department of Psychiatry and Psychotherapy, University of Luebeck, Germany.
    Effects of an Internet intervention (Deprexis) on severe depression symptoms: Randomized controlled trial2015Inngår i: Internet Interventions, ISSN 2214-7829, Vol. 2, nr 1, s. 48-59Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    Studies have shown that certain Internet interventions can help alleviate depression. However, many such interventions contain personal support elements, making it difficult to ascertain whether the program or the support drives the effects. Studies are needed to investigate whether Internet interventions contribute to symptom reduction even when they are delivered without personal support, and even among severely depressed individuals who often receive other forms of treatment.

    Objective

    This randomized controlled trial aimed to examine the effect of an Internet intervention that was deployed without personal support (“Deprexis”) among adults with initially severe depression symptoms.

    Methods

    Adults recruited from a range of sources who had exceeded the threshold for severe depression (PHQ-9 ≥ 15) in a pre-screening assessment and met inclusion criteria were randomized (N = 163) to the intervention (3 months program access; n = 78) or care-as-usual/waitlist control (n = 85). A diagnostic screening interview was administered by telephone at baseline to all participants. Online assessments were administered at baseline, 3 months (post-treatment), and 6 months (follow-up). The main outcome was the Patient Health Questionnaire (PHQ-9) between baseline and post-treatment.

    Results

    Eighty-two percent of randomized participants were reached for the post-treatment assessment. Results for the intention-to-treat (ITT) sample showed significant intervention effects on depression reduction between baseline and post-treatment (linear mixed model [MM], F1,155.6 = 9.00, p < .01, for the time by condition interaction), with a medium between-group effect size, Cohen's d = 0.57 (95% CI: 0.22–0.92). Group differences in depression severity at follow-up were marginally significant in the ITT sample, t (119) = 1.83, p = 0.07, and smaller than at post-treatment (PHQ-9, d = 0.33, 95% CI: − 0.03–0.69). The number needed to treat (NNT) at post-treatment was 5, with 38% of participants in the intervention group achieving response (at least 50% PHQ-9 symptom change, plus post-treatment score < 10), compared to 17% in the control group, p < 0.01. Effects on secondary outcomes, including anxiety, health-related quality of life, and somatic symptoms, were not significant, with the exception of significant effects on anxiety reduction in PP analyses. Early ratings of program helpfulness/alliance (after 3 weeks) predicted pre–post depression reduction, controlling for baseline severity and early symptom change.

    Conclusions

    These results replicate and extend previous findings by showing that Deprexis can facilitate symptomatic improvement over 3 months and, perhaps to a lesser degree, up until 6 months among adults with initially severe depression.

  • 24.
    Monica, Buhrman
    et al.
    Department of Psychology, Uppsala University, Uppsala, Sweden.
    Gordh, Torsten
    Department of Surgical Sciences, Pain Research, Uppsala University, Sweden.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutionen för beteendevetenskap, Institutet för handikappvetenskap, IHV.
    Internet interventions for chronic pain including headache: a systematic review2016Inngår i: Internet Interventions, ISSN 2214-7829, Vol. 4, s. 17-34Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Chronic pain is a major health problem and behavioral based treatments have been shown to be effective. However, the availability of these kinds of treatments is scarce and internet-based treatments have been shown to be promising in this area. The objective of the present systematic review is to evaluate internet-based interventions for persons with chronic pain. The specific aims are to do an updated review with a broad inclusion of different chronic pain diagnoses and to assess disability and pain and also measures of catastrophizing, depression and anxiety. A systematic search identified 891 studies and 22 trials were selected as eligible for review. Two of the selected trials included children/youth and five included individuals with chronic headache and/or migraine. The most frequently measured domain reflected in the primary outcomes was interference/disability, followed by catastrophizing. Result across the studies showed a number of beneficial effects. Twelve trials reported significant effects on disability/interference outcomes and pain intensity. Positive effects were also found on psychological variable such as catastrophizing, depression and anxiety. Several studies (n = 12) were assessed to have an unclear level of risk bias. The attrition levels ranged from 4% to 54% where the headache trials had the highest drop-out levels. However, findings suggest that internet-based treatments based on cognitive behavioural therapy (CBT) are efficacious measured with different outcome variables. Results are in line with trials in clinical settings. Meta-analytic statistics were calculated for interference/disability, pain intensity, catastrophizing and mood ratings. Results showed that the effect size for interference/disability was Hedge's g = − 0.39, for pain intensity Hedge's g = − 0.33, for catastrophizing Hedge's g = − 0.49 and for mood variables (depression) Hedge's g = − 0.26.

  • 25.
    Nordmo, Magnus
    et al.
    Department of Clinical Psychology, University of Bergen, Norway.
    Sinding, Aksel Inge
    Department of Clinical Psychology, University of Bergen, Norway.
    Carlbring, Per
    Division of Clinical Psychology, Department of Psychology, Stockholm University, Stockholm, Sweden.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institute, Stockholm, Sweden.
    Havik, Odd E.
    Department of Clinical Psychology, University of Bergen, Norway Anxiety Disorders Research Network, Haukeland University Hospital, Norway.
    Nordgreen, Tine
    Department of Clinical Psychology, University of Bergen, Norway Anxiety Disorders Research Network, Haukeland University Hospital, Norway.
    Internet-delivered cognitive behavioural therapy with and without an initial face-to-face psychoeducation session for social anxiety disorder: A pilot randomized controlled trial2015Inngår i: Internet Interventions, ISSN 2214-7829, Vol. 2, nr 4, s. 429-436Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    Guided Internet-delivered cognitive behavioural therapy (ICBT) is an effective treatment of social anxiety disorder (SAD). However, the treatment is not effective for all. The amount and type of therapist contact have been highlighted as a possible moderator of treatment outcome.

    Objective

    The aim of this study was to examine whether treatment effects of ICBT are enhanced with an initial 90 min face-to-face psychoeducation (PE) session for university students with SAD.

    Method

    University students with SAD (N = 37) were randomized into one out of two conditions: 1) an initial therapist-led face-to-face PE session followed by guided ICBT, 2) guided ICBT without an initial PE session. Data was analysed with an intent-to-treat approach.

    Results

    Eight participants (21.6%) dropped out of treatment. A statistically significant reduction in symptoms was found for all outcome measures for both groups. There were no significant additional effects of adding the initial face-to-face PE. Moderate to large within-group effect sizes on self-rated social anxiety symptoms were found at post-treatment (d = 0.70–0.95) and at a six month follow-up (d = 0.70–1.00). Nearly half of the participants were classified as recovered.

    Conclusions

    Notwithstanding limitations due to the small sample size, the findings indicate that guided ICBT is an effective treatment for students with SAD. Adding an initial face-to-face PE session to the guided ICBT did not lead to enhanced outcomes in the present study.

  • 26.
    Olsson Halmetoja, Camilla
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Filosofiska fakulteten.
    Malmquist, Anna
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Carlbring, Per
    Department of Psychology, Stockholm University, Sweden.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
    Experiences of internet-delivered cognitive behavior therapy for social anxiety disorder four years later: A qualitative study2014Inngår i: Internet Interventions, ISSN 2214-7829, Vol. 1, nr 3, s. 158-163Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The current study is a qualitative follow-up of a study on guided internet-delivered cognitive behavior therapy (ICBT) for social anxiety disorder (SAD), conducted four years after treatment completion. The main aim was to capture participants' description of their experiences of the treatment, their view on treatment effects, memories of the treatment, and whether they continued using the gained knowledge after treatment. Sixty participants were selected from the original study's treatment group. A criterion based sampling approach was used based on the obtained treatment effect, and with a minimum of five completed treatment modules. E-mail invitations were sent, with information about the follow-up and the instruction to respond if interested in participating. Twelve semi-structured interviews were made and the material was analyzed using an approach based on grounded theory. The results showed that all participants found the treatment to have some effect, but they also found it to be demanding, difficult, and hard. Many appreciated to hear of the experiences of other participants in the online forum. Under the theme of memory, most could describe the setup of the treatment in general terms. The exposure module was mentioned by all, cognitive restructuring by most, and some also reported memories of the psychoeducation. A core process was identified which involved how the attained treatment effect was viewed over the time, and how this view changed from treatment completion to current time. The findings outlined in this study describe how treatment effects can be sustained via an active approach to the treatment and the symptoms of SAD.

  • 27.
    Rheker, Julia
    et al.
    Department of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Germany.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institute, Stockholm, Sweden.
    Weise, Cornelia
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutet för handikappvetenskap (IHV). Department of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Germany.
    The role of “on demand” therapist guidance vs. no support in the treatment of tinnitus via the internet: A randomized controlled trial2015Inngår i: Internet Interventions, ISSN 2214-7829, Vol. 2, nr 2, s. 189-199Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective

    Internet-based cognitive behavioral self-help treatments (iCBT) have been shown to successfully reduce the distress associated with tinnitus. Despite this success, little is known about the mechanisms that make iCBT for tinnitus sufferers work. Availability of minimal therapeutic support is assumed to positively influence treatment outcome in iCBT, but the lower limit of required support is not known. In face-to-face therapy, patients' positive outcome expectations have demonstrated an advantageous effect on outcome. The first aim of our study was thus to investigate the role of ‘on demand’ therapeutic guidance vs. no therapeutic support on treatment outcome in an iCBT for tinnitus sufferers. Our second aim was to investigate whether positive outcome expectations can predict treatment outcome.

    Methods

    A total of 112 tinnitus patients were randomly assigned to one of two groups (support-on-demand or non-support). Both groups received an established iCBT treatment for tinnitus. While participants in the support group (n = 56) could ask a therapist for additional support, those in the other (n = 56) received no therapeutic guidance. Tinnitus distress was assessed pre- and post-treatment via the Tinnitus Handicap Inventory (THI) and the Mini-Tinnitus Questionnaire (Mini-TQ). Pre-treatment outcome expectations were assessed using the Patient Questionnaire on Therapy Expectation and Evaluation (PATHEV).

    Results

    We observed significantly less tinnitus distress in the THI (support: t(55) = 7.51, p ≤ .001; non-support: t(55) = 7.68, p ≤ .001) and Mini-TQ (support: t(55) = 8.24, p ≤ .001; non-support: t(55) = 8.46, p ≤ .001) in both groups from pre- to post-treatment, but no significant differences between the groups or interactions. The PATHEV subscale “Hope of Improvement” significantly predicted treatment outcome as measured by the THI (β = 0.28, p = .027).

    Conclusions

    The iCBT self-help program is a good treatment option for tinnitus sufferers whether or not support-on-demand is provided. Furthermore, our results show the importance of outcome expectations to the efficacy of iCBT in tinnitus patients. Future research should focus on discovering further predictors of treatment outcome.

  • 28.
    Rozental, Alexander
    et al.
    Division of Clinical Psychology, Department of Psychology, Stockholm University, Stockholm, Sweden.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Division of Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Boettcher, Johanna
    Department of Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany.
    Ebert, David Daniel
    Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps University Marburg, Marburg Germany.
    Cuijpers, Pim
    Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
    Knaevelsrud, Christine
    Department of Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany.
    Ljótsson, Brjánn
    Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Kaldo, Viktor
    Division of Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Titov, Nickolai
    MindSpot Clinic, eCentreClinic, Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia.
    Carlbring, Per
    Division of Clinical Psychology, Department of Psychology, Stockholm University, Stockholm, Sweden.
    Consensus statement on defining and measuring negative effects of Internet interventions2014Inngår i: Internet Interventions, ISSN 2214-7829, Vol. 1, nr 1, s. 12-19Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Internet interventions have great potential for alleviating emotional distress, promoting mental health, and enhancing well-being. Numerous clinical trials have demonstrated their efficacy for a number of psychiatric conditions, and interventions delivered via the Internet will likely become a common alternative to face-to-face treatment. Meanwhile, research has paid little attention to the negative effects associated with treatment, warranting further investigation of the possibility that some patients might deteriorate or encounter adverse events despite receiving best available care. Evidence from research of face-to-face treatment suggests that negative effects afflict 5–10% of all patients undergoing treatment in terms of deterioration. However, there is currently a lack of consensus on how to define and measure negative effects in psychotherapy research in general, leaving researchers without practical guidelines for monitoring and reporting negative effects in clinical trials. The current paper therefore seeks to provide recommendations that could promote the study of negative effects in Internet interventions with the aim of increasing the knowledge of its occurrence and characteristics. Ten leading experts in the field of Internet interventions were invited to participate and share their perspective on how to explore negative effects, using the Delphi technique to facilitate a dialog and reach an agreement. The authors discuss the importance of conducting research on negative effects in order to further the understanding of its incidence and different features. Suggestions on how to classify and measure negative effects in Internet interventions are proposed, involving methods from both quantitative and qualitative research. Potential mechanisms underlying negative effects are also discussed, differentiating common factors shared with face-to-face treatments from those unique to treatments delivered via the Internet. The authors conclude that negative effects are to be expected and need to be acknowledged to a greater extent, advising researchers to systematically probe for negative effects whenever conducting clinical trials involving Internet interventions, as well as to share their findings in scientific journals.

  • 29.
    Silfvernagel, Kristin
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Gren Landell, Malin
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Östergötlands Läns Landsting, Barn- och kvinnocentrum, Barn- och ungdomskliniken i Linköping. Linköpings universitet, Medicinska fakulteten.
    Emanuelsson, Marie
    Linköpings universitet, Institutionen för beteendevetenskap och lärande.
    Carlbring, Per
    Department of Psychology, Stockholm University, Stockholm, Sweden.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Individually tailored internet-based cognitive behavior therapy for adolescents with anxiety disorders: A pilot effectiveness study2015Inngår i: Internet Interventions, ISSN 2214-7829, Vol. 2, nr 3, s. 297-302Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This is the first study of adolescents suffering from anxiety disorder in Sweden to receive individually tailored internet-based treatment within a child and adolescent psychiatric clinic. The primary aim of this effectiveness study was to examine the effects of tailored internet-based cognitive behaviour therapy for adolescents.

    11 adolescents, aged 15-19 years, were allocated to treatment after assessment. Screening consisted of online questionnaires followed by a diagnostic face-to-face interview at the clinic. Treatment consisted of individually prescribed cognitive behaviour therapy (CBT) text modules adapted for the age group. Therapist guidance was via an online platform along with telephone support and face-to-face sessions if needed.

    Statistically significant improvements were found on all dependent measures immediately following treatment for the 8 adolescents who completed treatment. The within-group effect size on the Beck Anxiety Inventory, the primary outcome measure, was d = 2.51 at post-treatment and 80 percent (4/5) adolescents no longer met DSM-IV criteria for their primary anxiety disorder as measured by the Anxiety Disorders Interview Schedule for DSM- IV: Child and Parent Versions.

    Based on the results from this pilot study the tentative conclusion might be that tailored internet delivered CBT could be useful for adolescents with anxiety disorders along with standard treatment delivered in child and adolescent psychiatric clinics.

  • 30.
    Silfvernagel, Kristin
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Wassermann, Carolina
    Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
    Individually tailored internet-based cognitive behavioural therapy for young adults with anxiety disorders: A pilot effectiveness study2017Inngår i: Internet Interventions, ISSN 2214-7829, Vol. 8, s. 5s. 48-52Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The mental health of young people is decreasing. It is therefore important to develop early interventions for young people with mental health problems. One previous randomized controlled trial on tailored Internet-based treatment for young adults with minimal therapist guidance has shown promising results for anxiety symptoms. The purpose of this study was to investigate the effects of tailored internet-administered CBT for young adults (16–25 years old) with anxiety, depression and possible comorbidity in regular care. Participants were recruited from a youth health care centre (n=15). Screening consisted of online questionnaires followed by a semi-structured interview. A total of 10 participants completed pre and post measurement. The treatment consisted of individually prescribed CBT text modules with online therapist guidance. All dependent measures improved significantly immediately following treatment and the within-group effect based on pre- to post measurement on the primary outcome measure, the Beck Anxiety Inventory, was d=1.50, the within-group effect on the secondary outcome measures, Montgomery Åsberg Depression Rating Scale-Self-Rated, Clinical Outcomes in Routine Evaluation and Quality of Life Inventory showed large improvement. Tailored internet-based treatment can be an approach in the treatment of anxiety symptoms and comorbid depressive symptoms in youth care.

  • 31.
    Topooco, Naira
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Riper, H.
    Department of Clinical, Neuro-, and Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, Netherlands.
    Araya, R.
    Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
    Berking, M.
    Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.
    Brunn, M.
    ECEVE, Inserm, Univ. Paris Diderot, Paris, France.
    Chevreul, K.
    URC Eco Ile-de-France (AP-HP), Paris, France.
    Cieslak, R.
    Department of Psychology, SWPS University of Social Sciences and Humanities, Warszawa, Poland.
    Ebert, D.D.
    Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.
    Etchmendy, E.
    CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Spain.
    Herrero, R.
    CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Universitat Jaume I, Castellón, Spain.
    Kleiboer, A.
    Department of Clinical, Neuro-, and Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, Netherlands.
    Krieger, T.
    Department of Psychology, University of Bern, Bern, Switzerland.
    García-Palacios, A.
    CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Universitat Jaume I, Castellón, Spain.
    Cerga-Pashoja, A.
    Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
    Smoktunowicz, E.
    Department of Psychology, SWPS University of Social Sciences and Humanities, Warszawa, Poland.
    Urech, A.
    Department of Psychology, University of Bern, Bern, Switzerland.
    Vis, C.
    Department of Clinical, Neuro-, and Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, Netherlands; EMGO + Institute, VU Medical Centre Amsterdam, Amsterdam, VU, Netherlands.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, Stockholm, Sweden.
    Attitudes towards digital treatment for depression: A European stakeholder survey2017Inngår i: Internet Interventions, ISSN 2214-7829, Vol. 8Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background The integration of digital treatments into national mental health services is on the agenda in the European Union. The E-COMPARED consortium conducted a survey aimed at exploring stakeholders’ knowledge, acceptance and expectations of digital treatments for depression, and at identifying factors that might influence their opinions when considering the implementation of these approaches. Method An online survey was conducted in eight European countries: France, Germany, Netherlands, Poland, Spain, Sweden, Switzerland and The United Kingdom. Organisations representing government bodies, care providers, service-users, funding/insurance bodies, technical developers and researchers were invited to participate in the survey. The participating countries and organisations reflect the diversity in health care infrastructures and e-health implementation across Europe. Results A total of 764 organisations were invited to the survey during the period March–June 2014, with 175 of these organisations participating in our survey. The participating stakeholders reported moderate knowledge of digital treatments and considered cost-effectiveness to be the primary incentive for integration into care services. Low feasibility of delivery within existing care services was considered to be a primary barrier. Digital treatments were regarded more suitable for milder forms of depression. Stakeholders showed greater acceptability towards blended treatment (the integration of face-to-face and internet sessions within the same treatment protocol) compared to standalone internet treatments. Organisations in countries with developed e-health solutions reported greater knowledge and acceptability of digital treatments. Conclusion Mental health stakeholders in Europe are aware of the potential benefits of digital interventions. However, there are variations between countries and stakeholders in terms of level of knowledge about such interventions and their feasibility within routine care services. The high acceptance of blended treatments is an interesting finding that indicates a gradual integration of technology into clinical practice may fit the attitudes and needs of stakeholders. The potential of the blended treatment approach, in terms of enhancing acceptance of digital treatment while retaining the benefit of cost-effectiveness in delivery, should be further explored. Funding The E-COMPARED project has received funding from the European Union Seventh Framework Programme (FP7/2007–2013) under grant agreement no. 603098. © 2017 The Authors

  • 32.
    Vigerland, Sarah
    et al.
    Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Stockholm, Sweden.
    Ljótsson, Brjánn
    Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Stockholm, Sweden.
    Bergdahl Gustafsson, Fanny
    Department of Psychology, Stockholm University, Sweden.
    Sandra, Hagert
    Department of Psychology, Stockholm University, Sweden.
    Thulin, Ulrika
    Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Stockholm, Sweden.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Serlachius, Eva
    Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Stockholm, Sweden.
    Attitudes towards the use of computerized cognitive behavior therapy (cCBT) with children and adolescents: A survey among Swedish mental health professionals2014Inngår i: Internet Interventions, ISSN 2214-7829, Vol. 1, nr 3, s. 111-117Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    Research has shown that computerized cognitive behavior therapy (cCBT), including internet-delivered CBT), can be effective. However, less is known about clinicians' attitudes towards this mode of treatment delivery. The aim of this study was to explore the attitudes of clinicians within child- and adolescent psychiatry towards cCBT and to explore if attitudes differed depending on rurality or theoretical orientation.

    Methods

    A random sample of Swedish child- and adolescent mental health services was selected for a survey study (N = 15). A total number of 156 surveys were collected.

    Results

    Results showed a generally low knowledge of cCBT. A majority of clinicians were positive to cCBT as a prevention program (73%), and as treatment for mild to moderate problems (75%). More caution was reported with regard to more severe mental health problems. Treatment orientation, but not rurality, had a significant effect on several ratings. Thematic analyses showed concerns regarding for example lack of human support and the restricted usefulness of cCBT regarding age and complexity of symptoms. Perceived advantages were for example increased availability and possibility of an alternative way of communication.

    Conclusions

    This study adds to the limited literature on attitudes towards cCBT. The emerging picture is of a mainly positive attitude and prerequisites for dissemination are promising.

  • 33.
    Vlaescu, George
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Alasjö, Alexander
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Miloff, Alexander
    Department of Psychology, Stockholm University, Stockholm, Sweden.
    Carlbring, Per
    Division of Clinical Psychology, Department of Psychology, Stockholm University, Stockholm, Sweden.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institute, Stockholm, Sweden.
    Features and functionality of the Iterapi platform for internet-based psychological treatment2016Inngår i: Internet Interventions, ISSN 2214-7829, Vol. 6, s. 107-114Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The purpose of this article is to describe an internet-based platform for improving symptoms and quality of life for people with psychological and behavioural health problems such as depression, anxiety, phobia, psychological trauma, hearing loss and tinnitus. The online platform, called Iterapi, was developed at the Department of Behavioural Sciences and Learning at Linköping University, Sweden and has been running for nearly two decades and used in many randomized controlled trials and outpatient treatments.

    The intention of this article is to share our experience with developing such a treatment solution and the process flow and elements of running internet-based psychological interventions. This will likely be of use to developers building similar services, therapists considering integrating such approaches in their practices and institutions, as well as researchers curious about the functions included on the platform and methodology used for running studies.

    We describe the security aspects of the platform, central concepts underlying its development, how the platform can be used in a study or treatment and the main features and functions the platform offers. We comment on practical considerations regarding blending of methods within the platform, such as self-help treatments with asynchronous communication and real-time text chat and video conversations. We also point out the advantages of using Internet-assisted treatments, the challenges that we have faced and future planned upgrades.

    Due to continuous development of the platform, its user-friendliness, accessibility across devices and numerous features, many research colleagues from Sweden as well as other countries such as Germany, United Kingdom, Romania and Israel have chosen to implement their own studies on the platform.

  • 34.
    Zetterberg, Molly
    et al.
    Stockholm Univ, Sweden.
    Carlbring, Per
    Stockholm Univ, Sweden; Univ Southern Denmark, Denmark.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken. Karolinska Inst, Sweden.
    Berg, Matilda
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Shafran, Roz
    UCL, England.
    Rozental, Alexander
    Karolinska Inst, Sweden; UCL, England.
    Internet-based cognitive behavioral therapy of perfectionism: Comparing regular therapist support and support upon request2019Inngår i: Internet Interventions, ISSN 2214-7829, INTERNET INTERVENTIONS-THE APPLICATION OF INFORMATION TECHNOLOGY IN MENTAL AND BEHAVIOURAL HEALTH, Vol. 17, artikkel-id 100237Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Perfectionism may be a clinically relevant problem on its own or as part of the etiology and maintenance of psychiatric disorders, e.g., anxiety disorders, depression, and eating disorders. Cognitive behavior therapy has been shown to be a promising treatment for managing perfectionism and its associated problems, including when being administered via the Internet, i.e., Internet-based cognitive behavioral therapy (ICBT). In the current study, seventy-eight self-referred participants underwent ICBT after an initial eight-week wait-list period, i.e., second wave of treatment. These were randomized to receive regular support from a therapist (ICBT-support) or ICBT with support on request (ICBT-request), in an eight-week treatment of perfectionism. Assessments of perfectionism were made at pre-, mid-, and post-treatment, as well as six-month follow-up, using the Frost Multidimensional Perfectionism Scale, subscale Concern over Mistakes. Mixed effects models revealed large symptom reductions for both conditions; Concern over Mistakes, Cohens d = 1.40, 95% Confidence Interval (CI) [0.85, 1.95] for ICBT-support, and d = 1.00, 95% CI [0.51, 1.47] for ICBT-request. The effects were maintained at six-month follow-up and there were no differences between the conditions in terms of the results, opened modules, or completed exercises. A total of 28 out of 70 participants (42.4%; ICBT-support, 37.8%; ICBT-request) were classified as improved at post-treatment. Both types of ICBT may thus be beneficial in treating perfectionism, suggesting that just having the opportunity to ask for support from a therapist, when regular support is not provided, could be sufficient for many participants undergoing ICBT. However, the study was underpowered to detect differences between the conditions. The lack of a cutoff also makes it difficult to differentiate a dysfunctional from a functional population in terms of perfectionism. In addition, the study design could have affected the participants motivational level from start, given their initial eight-week wait-list period. Recommendations for future studies include recruiting a larger sample size, a clearer cutoff for perfectionism, and the use of a non-inferiority test with a predetermined margin of change.

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