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  • 1.
    Abbass, Allan
    et al.
    Dalhousie University, Canada.
    Bernier, Denise
    Dalhousie University, Canada.
    Kisely, Steve
    University of Queensland, Australia.
    Town, Joel
    Dalhousie University, Canada.
    Johansson, Robert
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Dalhousie University, Canada.
    Sustained reduction in health care costs after adjunctive treatment of graded intensive short-term dynamic psychotherapy in patients with psychotic disorders2015In: Psychiatry Research, ISSN 0165-1781, E-ISSN 1872-7123, Vol. 228, no 3, p. 538-543Article in journal (Refereed)
    Abstract [en]

    The aim of this pilot study was to evaluate the changes in symptom severity and long-term health care cost after intensive short-term dynamic psychotherapy (ISTDP) individually tailored and administered to patients with psychotic disorders undergoing standard psychiatric care. Eleven therapists with different levels of expertise delivered an average of 13 one-hour sessions of graded ISTDP to 38 patients with psychotic disorders. Costs for health care services were compiled for a one-year period prior to the start of ISTDP (baseline) along with four one-year periods after termination. Two validated self-report scales, the Brief Symptom Inventory and the Inventory of Interpersonal Problems, were administered at intake and termination of ISTDP. Results revealed that health care cost reductions were significant for the one-year post-treatment period relative to baseline year, for both physician costs and hospital costs, and the reductions were sustained for the follow-up period of four post-treatment years. Furthermore, at treatment termination self-reported symptoms and interpersonal problems were significantly reduced. These preliminary findings suggest that this brief adjunctive psychotherapy may be beneficial and reduce costs in selected patients with psychotic disorders, and that gains are sustained in long-term follow-up. Future research directions are discussed. (C) 2015 Elsevier Ireland Ltd. All rights reserved.

  • 2.
    Abbass, Allan
    et al.
    Dalhousie University, Canada.
    Johansson, Robert
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Rasic, Daniel
    Dalhousie University, Canada.
    Town, Joel M.
    Dalhousie University, Canada.
    Johansson, Robert
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Long-term healthcare cost reduction with Intensive Short-term Dynamic Psychotherapy in a tertiary psychiatric service2015In: Journal of Psychiatric Research, ISSN 0022-3956, E-ISSN 1879-1379, Vol. 64, p. 114-120Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate whether a mixed population of patients treated with Intensive Short-term Dynamic Psychotherapy (ISTDP) would exhibit reduced healthcare costs in long-term follow-up. Methods: A quasi-experimental design was employed in which data on pre- and post-treatment healthcare cost were compared for all ISTDP cases treated in a tertiary care service over a nine year period. Observed cost changes were compared with those of a control group of patients referred but never treated. Physician and hospital costs were compared to treatment cost estimates and normal population cost figures. Results: 1082 patients were included; 890 treated cases for a broad range of somatic and psychiatric disorders and 192 controls. The treatment averaged 7.3 sessions and measures of symptoms and interpersonal problems significantly improved. The average cost reduction per treated case was $12,628 over 3 follow-up years: this compared favorably with the estimated treatment cost of $708 per patient. Significant differences were seen between groups for follow-up hospital costs. Conclusions: ISTDP in this setting appears to facilitate reductions in healthcare costs, supporting the notion that brief dynamic psychotherapy provided in a tertiary setting can be beneficial to health care systems overall. (C) 2015 Elsevier Ltd. All rights reserved.

  • 3.
    Adeback, Petra
    et al.
    Karolinska Institute, Sweden.
    Schulman, Abbe
    Karolinska Institute, Sweden.
    Nilsson, Doris
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping. Karolinska Institute, Sweden.
    Children exposed to a natural disaster: psychological consequences eight years after 2004 tsunami2018In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 72, no 1, p. 75-81Article, review/survey (Refereed)
    Abstract [en]

    Background: There is a need for studies that follow up children and adolescents for many years post disaster since earlier studies have shown that exposure during natural disasters constitutes a risk factor for poor psychological health.Aims: The main aim was to examine whether there was an association between severity of exposures during a natural disaster experienced in childhood or adolescence and posttraumatic stress symptoms, psychological distress, self-rated health, diagnosis of depression, anxiety or worry, thoughts about or attempted suicide, physical symptoms or daily functioning eight years later in young adulthood. A second aim was to compare psychological distress and self-rated health of exposed young adults with a matched population-based sample.Method: Young adults, who experienced the 2004 tsunami as children between 10 and 15 years of age, responded to a questionnaire eight years post disaster. The results were compared to a matched population sample.Results: The results showed that the likelihood for negative psychological outcomes was higher for those who had been exposed to several types of exposures during this natural disaster.Conclusions: The negative psychological impact on children and adolescents can still be present eight years post-disaster and seems to have association with the type of exposure; loss, physical presence and subjective experience. It is important for clinicians, who meet young adults seeking help, to be conscious about the impact as long as eight years post disaster and to be aware of possible clinical implications associated with severity of exposures.

  • 4.
    Ahlgren, Thorbjörn
    et al.
    Avdelningen för beteendevetenskap och socialt arbete, Hälsohögskolan, Jönköping University.
    Näslund, Johan
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Rosander, Michael
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Ungdomars attityder och beteende när det gäller att köpa och sälja sex: en studie i Jönköpings län våren 20082009Report (Other academic)
    Abstract [sv]

    Kunskapen om i vilken omfattning ungdomar har sålt eller köpt sex är begränsad. Delvis kan det bero på svårigheten med att bestämma vad som omfattas i begreppen sälja och köpa sex. Studier visar också att det i ungdomsrelationer förekommer att gåvor ges efter sexuella aktiviteter.

    I denna studie har totalt 16 personer (1,9 %) uppgett att de i olika omfattning utfört sexuella tjänster mot ersättning och att 79 personer (9,1 %) blivit erbjudna pengar eller annan ersättning för sexuella tjänster. Det är fler killar än tjejer som säljer sex. När det gäller att ha blivit erbjuden sex mot ersättning är det flest tjejer som svarat ja. Resultatet visar också att 131 personer (15,1 %) kan tänka sig att utföra sexuella tjänster mot ersättning. I svaren kan vi också utläsa att 348 personer (40,1%), mestadels killar, accepterar att andra utför sexuella tjänster mot ersättning.

    När det gäller i vilka kretsar de som säljer sex umgås är det tydligt att ungdomarna tittar mer på porr, att det är vanligare att de visar sig i sexuella situationer och att de har mindre tolerans mot homosexuella. Samlagsdebuten var ett år tidigare än hela undersökningsgruppen. Det är vanligare att man blivit utsatt för olika sexuella handlingar mot sin vilja, men man har också utsatt andra för sexuella handlingar mot deras vilja. Sammantaget kan vi se att ungdomarna i denna studie som sålt sex lever ett påtagligt mer sexualiserat liv än vad andra ungdomar i motsvarande ålder gör.

  • 5.
    Ahlström, Christer
    et al.
    Swedish National Rd and Transport Research Institute VTI, S-58195 Linkoping, Sweden.
    Kircher, Katja
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Swedish National Rd and Transport Research Institute VTI, S-58195 Linkoping, Sweden.
    A Generalized Method to Extract Visual Time-Sharing Sequences From Naturalistic Driving Data2017In: IEEE transactions on intelligent transportation systems (Print), ISSN 1524-9050, E-ISSN 1558-0016, Vol. 18, no 11, p. 2929-2938Article in journal (Refereed)
    Abstract [en]

    Indicators based on visual time-sharing have been used to investigate drivers visual behaviour during additional task execution. However, visual time-sharing analyses have been restricted to additional tasks with well-defined temporal start and end points and a dedicated visual target area. We introduce a method to automatically extract visual time-sharing sequences directly from eye tracking data. This facilitates investigations of systems, providing continuous information without well-defined start and end points. Furthermore, it becomes possible to investigate time-sharing behavior with other types of glance targets such as the mirrors. Time-sharing sequences are here extracted based on between-glance durations. If glances to a particular target are separated by less than a time-based threshold value, we assume that they belong to the same information intake event. Our results indicate that a 4-s threshold is appropriate. Examples derived from 12 drivers (about 100 hours of eye tracking data), collected in an on-road investigation of an in-vehicle information system, are provided to illustrate sequence-based analyses. This includes the possibility to investigate human-machine interface designs based on the number of glances in the extracted sequences, and to increase the legibility of transition matrices by deriving them from time-sharing sequences instead of single glances. More object-oriented glance behavior analyses, based on additional sensor and information fusion, are identified as the next future step. This would enable automated extraction of time-sharing sequences not only for targets fixed in the vehicles coordinate system, but also for environmental and traffic targets that move independently of the drivers vehicle.

  • 6.
    Ahlström, Christer
    et al.
    Swedish National Rd and Transport Research Institute VTI, S-58195 Linkoping, Sweden.
    Kircher, Katja
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Swedish National Rd and Transport Research Institute VTI, S-58195 Linkoping, Sweden.
    Changes in glance behaviour when using a visual eco-driving system - A field study2017In: Applied Ergonomics, ISSN 0003-6870, E-ISSN 1872-9126, Vol. 58, p. 414-423Article in journal (Refereed)
    Abstract [en]

    While in-vehicle eco-driving support systems have the potential to reduce greenhouse gas emissions and save fuel, they may also distract drivers, especially if the system makes use of a visual interface. The objective of this study is to investigate the visual behaviour of drivers interacting with such a system, implemented on a five-inch screen mounted above the middle console. Ten drivers participated in a real world, on-road driving study where they drove a route nine times (2 pre-baseline drives, 5 treatment drives, 2 post-baseline drives). The route was 96 km long and consisted of rural roads, urban roads and a dual-lane motorway. The results show that drivers look at the system for 5-8% of the time, depending on road type, with a glance duration of about 0.6 s, and with 0.05% long glances (amp;gt;2s) per kilometre. These figures are comparable to what was found for glances to the speedometer in this study. Glance behaviour away from the windscreen is slightly increased in treatment as compared to pre- and post-baseline, mirror glances decreased in treatment and post-baseline compared to pre-baseline, and speedometer glances increased compared to pre-baseline. The eco-driving support system provided continuous information interspersed with additional advice pop-ups (announced by a beep) and feedback pop-ups (no auditory cue). About 20% of sound initiated advice pop-ups were disregarded, and the remaining cases were usually looked at within the first two seconds. About 40% of the feedback pop-ups were disregarded. The amount of glances to the system immediately before the onset of a pop-up was clearly higher for feedback than for advice. All in all, the eco-driving support system under investigation is not likely to have a strong negative impact on glance behaviour. However, there is room for improvements. We recommend that eco-driving information is integrated with the speedometer, that optional activation of sound alerts for intermittent information is made available, and that the pop-up duration should be extended to facilitate self-regulation of information intake. (C) 2016 Elsevier Ltd. All rights reserved.

  • 7.
    Alfonsson, Sven
    et al.
    Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden; Uppsala Univ, Sweden.
    Parling, Thomas
    Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden.
    Spännargård, Asa
    Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden.
    Lundgren, Tobias
    Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden.
    The effects of clinical supervision on supervisees and patients in cognitive behavioral therapy: a systematic review2018In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 47, no 3, p. 206-228Article, review/survey (Refereed)
    Abstract [en]

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

  • 8.
    Alfonsson, Sven
    et al.
    Karolinska Institutet, Sweden; Stockholm Health Care Services, Sweden; Uppsala University, Uppsala, Sweden.
    Spännargård, Åsa
    Karolinska Institutet, Sweden; Stockholm Health Care Services, Sweden.
    Parling, Thomas
    Karolinska Institutet, Sweden; Stockholm Health Care Services, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institutet, Sweden; Stockholm Health Care Services, Sweden.
    Lundgren, Tobias
    Karolinska Institutet, Sweden; Stockholm Health Care Services, Sweden.
    The effects of clinical supervision on supervisees and patients in cognitive-behavioral therapy: a study protocol for a systematic review.2017In: Systematic Reviews, E-ISSN 2046-4053, Vol. 6, no 1, article id 94Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Clinical supervision by a senior therapist is a very common practice in psychotherapist training and psychiatric care settings. Though clinical supervision is advocated by most educational and governing institutions, the effects of clinical supervision on the supervisees' competence, e.g., attitudes, behaviors, and skills, as well as on treatment outcomes and other patient variables are debated and largely unknown. Evidence-based practice is advocated in clinical settings but has not yet been fully implemented in educational or clinical training settings. The aim of this systematic review is to synthesize and present the empirical literature regarding effects of clinical supervision in cognitive-behavioral therapy.

    METHODS: This study will include a systematic review of the literature to identify studies that have empirically investigated the effects of supervision on supervised psychotherapists and/or the supervisees' patients. A comprehensive search strategy will be conducted to identify published controlled studies indexed in the MEDLINE, EMBASE, PsycINFO, and Cochrane Library databases. Data on supervision outcomes in both psychotherapists and their patients will be extracted, synthesized, and reported. Risk of bias and quality of the included studies will be assessed systematically.

    DISCUSSION: This systematic review will rigorously follow established guidelines for systematic reviews in order to summarize and present the evidence base for clinical supervision in cognitive-behavioral therapy and may aid further research and discussion in this area.

    SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42016046834.

  • 9.
    Alm, Fredrik
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Learning and Didactic Science in Education and School (PeDiUS). Linköping University, Faculty of Educational Sciences.
    Jungert, Tomas
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Thornberg, Robert
    Linköping University, Department of Behavioural Sciences and Learning, Education, Teaching and Learning. Linköping University, Faculty of Educational Sciences.
    Academic commitment and self-determination among teacher students2011Conference paper (Refereed)
  • 10.
    Alm, Fredrik
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Education, Teaching and Learning. Linköping University, Faculty of Educational Sciences.
    Jungert, Tomas
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Thornberg, Robert
    Linköping University, Department of Behavioural Sciences and Learning, Education, Teaching and Learning. Linköping University, Faculty of Educational Sciences.
    Nyantagna lärarstudenters motiv, motivation, självtillit och akademiska engagemang2014Report (Other academic)
    Abstract [sv]

    Det första studieåret vid universitet eller högskola har visat sig utgöra en kritisk period för nya studenter och en stor del av alla avhopp sker under den här perioden. Forskning har visat att hög studiemotivation, självtillit och högt akademiskt engagemang hos studenter predicerar goda studieresultat och motverkar avhopp.

    I den här rapporten redogör vi för en studie av nyantagna lä-rarstudenters motiv för studieval, akademiska självtillit, studiemo-tivation och akademiska engagemang. I rapporten beskrivs även relationerna mellan dessa variabler och deras koppling till kön och lärarkategori. Studieavhopp analyseras i relation till kön, lärarkategori och studenternas initiala motiv för att läsa till lärare. En central teoribildning som forskningsprojektet utgår ifrån är teorin om själv-beslutsamhet (”self-determination theory”). Urvalet utgörs av stu-denter vid Linköpings universitet som avser att studera till grundskol- och gymnasielärare. Data har samlats in med enkäter och bearbetats med deskriptiv och analytisk statistisk.

    Av resultaten framgår att studenterna rapporterar att de i första hand har valt att läsa till lärare till följd av altruistiska och inre skäl, och att de i högre grad motiveras av autonom motivation än kontrollerad motivation i sina studier. De blivande lärarna i grundskolans senare år och gymnasiet (senarelärare) uppvisade en högre akademisk självtillit än de blivande lärarna i grundskolans tidigare år (tidigarelärare). För akademiskt engagemang var resul-tatet det omvända. Medelvärdena för självbeslutsamhet, akademisk självtillit och akademiskt engagemang i studien är dock inte högre än att det finns utrymme för att försöka höja dem för kommande kohorter av lärarstudenter. Andelen avhopp bland lärarstudenterna som ingår i studien ligger på drygt 40%. Andelen avhopp var större för senarelärarna än för tidigarelärarna. Resultaten visar också att altruistiska motiv bakom valet att studera till lärare sammanhänger med en lägre benägenhet till avhopp via akademiskt engagemang som medierande variabel. Avslutningsvis diskuteras pedagogiska implikationer av studien för lärarutbildningen.

  • 11.
    Andersen Helland, Wenche
    et al.
    Universitetet i Bergen, Norge.
    Helland, Turid
    Universitetet i Bergen, Norge.
    Heimann, Mikael
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Language profiles and mental health problems in children with specific language imapirment and children with AD/HD2014In: Journal of Attention Disorders, ISSN 1087-0547, E-ISSN 1557-1246, Vol. 18, no 3, p. 226-235Article in journal (Refereed)
    Abstract [en]

    Objective: This study aimed to explore whether children with specific language impairment (SLI) and children with ADHDcan be differentiated from each other in terms of their language profiles, and also to investigate whether these two clinicalgroups differ regarding mental health problems. Method: A total of 59 children in the age range 6 to 12 years participatedin the study. The parents completed the Children’s Communication Checklist–Second Edition and the Strengths andDifficulties Questionnaire. Results: Communication impairments were as prominent in the ADHD group as in the SLIgroup; however, the groups were separable from each other in terms of their language profiles. Furthermore, the ADHDgroup experienced significantly more mental health problems compared with the SLI group. Conclusion: Language shouldbe assessed in children with ADHD and instruments sensitive to ADHD should be included when assessing children withSLI. Mental health should be an area of concern to be addressed in both groups. (J. of Att. Dis. 2012; XX(X) 1-XX)

  • 12.
    Andersen Helland, Wenche
    et al.
    Stord Hospital, Norway; University of Bergen, Norway.
    Lundervold, Astri
    University of Bergen, Norway.
    Heimann, Mikael
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research.
    Posserud, Maj-Britt
    Haukeland University Hospital, Bergen, Norway.
    Stable associations between behavioral problems and language impairments across childhood - the importance of pragmatic language problems2014In: Research in Developmental Disabilities, ISSN 0891-4222, E-ISSN 1873-3379, Vol. 35, no 5, p. 943-951Article in journal (Refereed)
    Abstract [en]

    This study investigated language function associated with behavior problems, focusing on pragmatics. Scores on the Children’s Communication Checklist Second Edition (CCC-2) in a group of 40 adolescents (12–15 years) identified with externalizing behavior problems (BP) in childhood was compared to the CCC-2 scores in a typically developing comparison group (n=37). Behavioral, emotional and language problems were assessed by the Strengths and Difficulties Questionnaire (SDQ) and 4 language items, when the children in the BP group were 7–9 years (T1). They were then assessed with the SDQ and the CCC-2 when they were 12–15 years (T2). The BP group obtained poorer scores on 9/10 subscales on the CCC-2, and 70% showed language impairments in the clinical range. Language, emotional and peer problems at T1 were strongly correlated with pragmatic language impairments in adolescence. The findings indicate that assessment of language, especially pragmatics, is vital for follow-up and treatment of behavioral problems in children and adolescents.

  • 13.
    Andersson, E
    et al.
    Karolinska Institute, Sweden .
    Enander, J
    Karolinska Institute, Sweden Uppsala University, Sweden .
    Andren, P
    Uppsala University, Sweden .
    Hedman, E
    Karolinska Institute, Sweden .
    Ljotsson, B
    Karolinska Institute, Sweden .
    Hursti, T
    Uppsala University, Sweden .
    Bergstrom, J
    Karolinska Institute, Sweden Stockholm University, Sweden .
    Kaldo, V
    Karolinska Institute, Sweden .
    Lindefors, N
    Karolinska Institute, Sweden .
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Ruck, C
    Karolinska Institute, Sweden .
    Internet-based cognitive behaviour therapy for obsessive-compulsive disorder: a randomized controlled trial2012In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 42, no 10, p. 2193-2203Article in journal (Refereed)
    Abstract [en]

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

  • 14.
    Andersson, E
    et al.
    Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden .
    Steneby, S
    Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden .
    Karlsson, K
    Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden .
    Ljótsson, B
    Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.
    Hedman, E
    Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden, Osher Center for Integrative Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Enander, J
    Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
    Kaldo, V
    Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
    Lindefors, N
    Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
    Rück, C
    Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
    Long-term efficacy of Internet-based cognitive behavior therapy for obsessive-compulsive disorder with or without booster: a randomized controlled trial.2014In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 44, no 13, p. 2877-2887Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 15.
    Andersson, Erik
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Hedman, Erik
    Karolinska Institutet, Stockholm, Sweden.
    Enander, Jesper
    Karolinska Institutet, Stockholm, Sweden.
    Radu Djurfeldt, Diana
    Karolinska Institutet, Stockholm, Sweden.
    Ljótsson, Brjánn
    Karolinska Institutet, Stockholm, Sweden.
    Cervenka, Simon
    Karolinska Institutet, Stockholm, Sweden.
    Isung, Josef
    Karolinska Institutet, Stockholm, Sweden.
    Svanborg, Cecilia
    Karolinska Institutet, Stockholm, Sweden.
    Mataix-Cols, David
    Karolinska Institutet, Stockholm, Sweden.
    Kaldo, Viktor
    Karolinska Institutet, Stockholm, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Inst, Div Psychiat, Dept Clin Neurosci, Stockholm, Sweden.
    Lindefors, Nils
    Karolinska Institutet, Stockholm, Sweden.
    Rück, Christian
    Karolinska Institutet, Stockholm, Sweden.
    D-Cycloserine vs Placebo as Adjunct to Cognitive Behavioral Therapy for Obsessive-Compulsive Disorder and Interaction With Antidepressants: A Randomized Clinical Trial.2015In: JAMA psychiatry, ISSN 2168-6238, E-ISSN 2168-622X, Vol. 72, no 7, p. 659-667Article in journal (Refereed)
    Abstract [en]

    IMPORTANCE: It is unclear whether d-cycloserine (DCS), a partial N-methyl-d-aspartate agonist that enhances fear extinction, can augment the effects of exposure-based cognitive behavioral therapy (CBT) for obsessive-compulsive disorder (OCD).

    OBJECTIVES: To examine whether DCS augments the effects of CBT for OCD and to explore (post hoc) whether concomitant antidepressant medication moderates the effects of DCS.

    DESIGN, SETTING, AND PARTICIPANTS: A 12-week, double-blind randomized clinical trial with 3-month follow-up conducted at an academic medical center between September 4, 2012, and September 26, 2013. Participants included 128 adult outpatients with a primary diagnosis of OCD and a Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score of 16 or higher. Concurrent antidepressant medication was permitted if the dose had been stable for at least 2 months prior to enrollment and remained unchanged during the trial. The main analysis was by intention-to-treat population.

    INTERVENTIONS: All participants received a previously validated Internet-based CBT protocol over 12 weeks and were randomized to receive either 50 mg of DCS or placebo, administered 1 hour before each of 5 exposure and response prevention tasks.

    MAIN OUTCOMES AND MEASURES: Clinician-administered Y-BOCS score at week 12 and at 3-month follow-up. Remission was defined as a score of 12 or lower on the Y-BOCS.

    RESULTS: In the primary intention-to-treat analyses, DCS did not augment the effects of CBT compared with placebo (mean [SD] clinician-rated Y-BOCS score, DCS: 13.86 [6.50] at week 12 and 12.35 [7.75] at 3-month follow-up; placebo: 11.77 [5.95] at week 12 and 12.37 [6.68] at 3-month follow-up) but showed a significant interaction with antidepressants (clinician-rated Y-BOCS, B = -1.08; Z = -2.79; P = .005). Post hoc analyses revealed that antidepressants significantly impaired treatment response in the DCS group but not the placebo group, at both posttreatment and follow-up (clinician-rated Y-BOCS: t62 = -3.00; P = .004; and t61 = -3.49; P < .001, respectively). In the DCS group, a significantly greater proportion of antidepressant-free patients achieved remission status at follow-up (60% [95% CI, 45%-74%]) than antidepressant-medicated patients (24% [95% CI, 9%-48%]) (P = .008). Antidepressants had no effect in the placebo group (50% [95% CI, 36%-64%] remission rate in both groups).

    CONCLUSIONS AND RELEVANCE: The findings suggest that antidepressants may interact with DCS to block its facilitating effect on fear extinction. Use of DCS may be a promising CBT augmentation strategy but only in antidepressant-free patients with OCD.

    TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01649895.

  • 16.
    Andersson, Erik
    et al.
    Karolinska Institute, Sweden; Karolinska Institute, Sweden.
    Hedman, Erik
    Karolinska Institute, Sweden; Karolinska Institute, Sweden.
    Ljotsson, Brjann
    Karolinska Institute, Sweden.
    Wikstrom, Maja
    Karolinska Institute, Sweden.
    Elveling, Elin
    Karolinska Institute, Sweden.
    Lindefors, Nils
    Karolinska Institute, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden.
    Kaldo, Viktor
    Karolinska Institute, Sweden.
    Ruck, Christian
    Karolinska Institute, Sweden.
    Cost-effectiveness of internet-based cognitive behavior therapy for obsessive-compulsive disorder: results from a randomized controlled trial2015In: Journal of Obsessive-Compulsive and Related Disorders, ISSN 2211-3649, E-ISSN 2211-3657, Vol. 4, p. 47-53Article in journal (Refereed)
    Abstract [en]

    Obsessive-compulsive disorder (OCD) is a common and disabling disorder. Although evidence-based psychological treatments exists, such as cognitive behavior therapy (CBT), the cost-effectiveness of CBT has not been properly investigated. In this trial, we used health economic data from a recently conducted randomized controlled trial, where 101 OCD patients were allocated to either internet-based CBT (ICBT) or control condition (online support therapy). We analyzed treatment effectiveness in relation to costs, using both a societal- (including all direct and indirect costs) and a health care unit perspective (including only the direct treatment costs). Bootstrapped net benefit regression analyses were also conducted, comparing the difference in costs and effects between ICBT and control condition, with different willingness-to-pay scenarios. Results showed that ICBT produced one additional remission for an average societal cost of $931 and this figure was even lower ($672) when narrowing the perspective to treatment costs only. The cost-utility analysis also showed that ICBT generated one additional QALY to an average price of $7186 from a societal perspective and $4800 when just analyzing the treatment costs. We conclude that ICBT is a cost-effective treatment and the next step in this line of research is to compare the cost-effectiveness of ICBT with face-to-face CBT. (C) 2014 Elsevier Inc. All rights reserved.

  • 17.
    Andersson, Erik
    et al.
    Karolinska Institute, Sweden; Karolinska Institute, Sweden.
    Ljotsson, Brjann
    Karolinska Institute, Sweden.
    Hedman, Erik
    Karolinska Institute, Sweden; Karolinska Institute, Sweden.
    Enander, Jesper
    Karolinska Institute, Sweden.
    Kaldo, Viktor
    Karolinska Institute, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden.
    Lindefors, Nils
    Karolinska Institute, Sweden.
    Ruck, Christian
    Karolinska Institute, Sweden.
    Predictors and moderators of Internet-based cognitive behavior therapy for obsessive-compulsive disorder: Results from a randomized trial2015In: Journal of Obsessive-Compulsive and Related Disorders, ISSN 2211-3649, E-ISSN 2211-3657, Vol. 4Article in journal (Refereed)
    Abstract [en]

    Internet-based cognitive behavior therapy (ICBT) for obsessive-compulsive disorder (OCD) has shown efficacy in randomized trials but many patients do not respond to the treatment, we therefore need to find predictors and moderators of treatment response. In this study, we analyzed predictors of ICBT response using both post-treatment as well as 24-month outcome data. As half of the participants were randomized to receive an Internet-based booster program as an adjunct to ICBT, we also investigated moderators of ICBT with or without booster. Results showed that more severe baseline OCD symptoms predicted worse end state outcome but also higher degree of change. Furthermore, high degree of working alliance predicted better outcome but patients with primary disgust emotions had worse treatment effects. The moderator analysis also indicated that scoring high on the obsessing subscale on the Obsessive-Compulsive Inventory-Revised predicted worse treatment outcome in the booster group. In conclusion, there are some possible predictors and moderators of ICBT for OCD but more research is needed with larger and clinically representative samples. (C) 2014 Elsevier Inc. All rights reserved.

  • 18.
    Andersson, Erik
    et al.
    Karolinska Institute, Sweden.
    Ljotsson, Brjann
    Karolinska Institute, Sweden.
    Hedman, Erik
    Karolinska Institute, Sweden.
    Hesser, Hugo
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Enander, Jesper
    Karolinska Institute, Sweden.
    Kaldo, Viktor
    Karolinska Institute, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden.
    Lindefors, Nils
    Karolinska Institute, Sweden.
    Ruck, Christian
    Karolinska Institute, Sweden.
    Testing the Mediating Effects of Obsessive Beliefs in Internet-Based Cognitive Behaviour Therapy for Obsessive-Compulsive Disorder: Results from a Randomized Controlled Trial2015In: Clinical Psychology and Psychotherapy, ISSN 1063-3995, E-ISSN 1099-0879, Vol. 22, no 6, p. 722-732Article in journal (Refereed)
    Abstract [en]

    Although cognitive interventions for obsessive-compulsive disorder (OCD) have been tested in randomized trials, there are few trials that have tested the specific mechanisms of cognitive interventions, i.e. how they achieve their effects. In this study, we aimed to investigate the mediating effects of a short cognitive intervention in the treatment of OCD and used data from a recently conducted randomized controlled trial where 101 participants were allocated to either Internet-based CBT (ICBT) or to a control condition. Obsessive beliefs were measured at pre-treatment, at the time they had received the cognitive intervention, and also at post-treatment. Weekly OCD symptoms were measured throughout the 10 weeks of treatment. We hypothesized that (1) the ICBT group would have greater reductions in obsessive beliefs (controlling for change in OCD symptoms) after completing the cognitive intervention, and that (2) this reduction would, in turn, predict greater OCD symptom reduction throughout the rest of the treatment period. Contrary to our expectations, the longitudinal mediation analysis indicated that (1) being randomized to ICBT actually increased the degree of obsessive beliefs after receiving the cognitive intervention at weeks 1-3, and (2) increase in obsessive beliefs predicted better outcome later in treatment. However, when repeating the analysis using cross-sectional data at post-treatment, the results were in line with the initial hypotheses. Results were replicated when the control condition received ICBT. We conclude that, although obsessive beliefs were significantly reduced at post-treatment for the ICBT group, early increase rather than decrease in obsessive beliefs predicted favourable outcome. Copyright (C) 2014 John Wiley & Sons, Ltd.

  • 19.
    Andersson, Erik
    et al.
    Karolinska Institute, Sweden; Karolinska Institute, Sweden.
    Ljotsson, Brjann
    Karolinska Institute, Sweden.
    Hedman, Erik
    Karolinska Institute, Sweden; Karolinska Institute, Sweden.
    Mattson, Simon
    Karolinska Institute, Sweden.
    Enander, Jesper
    Karolinska Institute, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden.
    Kaldo, Viktor
    Karolinska Institute, Sweden.
    Lindefors, Nils
    Karolinska Institute, Sweden.
    Ruck, Christian
    Karolinska Institute, Sweden.
    Cost-effectiveness of an internet-based booster program for patients with obsessive-compulsive disorder: Results from a randomized controlled trial2015In: Journal of Obsessive-Compulsive and Related Disorders, ISSN 2211-3649, E-ISSN 2211-3657, Vol. 4, p. 14-19Article in journal (Refereed)
    Abstract [en]

    Cognitive behavior therapy (CBT) is an effective treatment for OCD when delivered face-to-face, in group-format and also via the internet. However, despite overall large effect sizes, a considerable amount of the patients relapse. One intervention that has the potential to reduce these relapse rates is booster programs, but if booster program is a cost-effective method of preventing relapse is still unknown. We used health economical data from a recent randomized controlled trial, where patients who had undergone an internet-based CBT were randomly allocated to receive an additional booster program. Assessment points were 4-, 7-, 12- and 24-month. Health economical data were primarily analyzed using a societal perspective. Results showed that the booster program was effective in preventing relapse, and the cost of one avoided relapse was estimated to $1066-1489. Cost-effectiveness acceptability curves showed that the booster program had a 90% probability of being cost-effective given a willingness to pay of $1000-1050 the first year, but this figure grew considerably after two years ($2500-5500). We conclude that internet-based booster programs are probably a cost-effective alternative within one-year time frame and that more treatment may be needed to maintain adequate cost-effectiveness up to two years. (C) 2014 Elsevier Inc. All rights reserved.

  • 20.
    Andersson, Evelyn
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Rück, Christian
    Karolinska Institutet, Stockholm, Sweden.
    Lavebratt, Catharina
    Karolinska Institutet, Stockholm, Sweden.
    Hedman, Erik
    Karolinska Institutet, Stockholm, Sweden.
    Schalling, Martin
    Karolinska Institutet, Stockholm, Sweden.
    Lindefors, Nils
    Karolinska Institutet, Stockholm, Sweden.
    Eriksson, Elias
    Sahlgrenska Academy, University of Gothenburg, Sweden.
    Carlbring, Per
    Stockholm University, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institutet, Stockholm, Sweden.
    Furmark, Tomas
    Uppsala University, Sweden.
    Genetic polymorphisms in monoamine systems and outcome of cognitive behavior therapy for social anxiety disorder2013In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 11, p. e79015-Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The role of genetics for predicting the response to cognitive behavior therapy (CBT) for social anxiety disorder (SAD) has only been studied in one previous investigation. The serotonin transporter (5-HTTLPR), the catechol-o-methyltransferase (COMT) val158met, and the tryptophan hydroxylase-2 (TPH2) G-703Tpolymorphisms are implicated in the regulation of amygdala reactivity and fear extinction and therefore might be of relevance for CBT outcome. The aim of the present study was to investigate if these three gene variants predicted response to CBT in a large sample of SAD patients.

    METHOD: Participants were recruited from two separate randomized controlled CBT trials (trial 1: n = 112, trial 2: n = 202). Genotyping were performed on DNA extracted from blood or saliva samples. Effects were analyzed at follow-up (6 or 12 months after treatment) for both groups and for each group separately at post-treatment. The main outcome measure was the Liebowitz Social Anxiety Scale Self-Report.

    RESULTS: At long-term follow-up, there was no effect of any genotype, or gene × gene interactions, on treatment response. In the subsamples, there was time by genotype interaction effects indicating an influence of the TPH2 G-703T-polymorphism on CBT short-term response, however the direction of the effect was not consistent across trials.

    CONCLUSIONS: None of the three gene variants, 5-HTTLPR, COMTval158met and TPH2 G-703T, was associated with long-term response to CBT for SAD.

     

  • 21.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Stockholm, Sweden .
    Age may moderate response to different unguided Internet-delivered interventions for depression2014In: Evidence-Based Mental Health, ISSN 1362-0347, E-ISSN 1468-960X, Vol. 17, no 1, p. 29-Article in journal (Refereed)
  • 22.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden.
    Atheism and how it is perceived: Manipulation of, bias against and ways to reduce the bias2016In: Nordic Psychology, ISSN 1901-2276, E-ISSN 1904-0016, Vol. 68, no 3, p. 194-203Article, review/survey (Refereed)
    Abstract [en]

    In recent years, there has been an increased interest in the cognitive foundations of religion and experimental methods have been used to explain religious behaviours. However, in the world, there are a substantial number of non-believers (atheists), and this has been a largely unknown field for experimental and more basic research informed by cognitive science. This has now changed and in this review, I cover three domains of study. First, studies in which belief in God has been manipulated in the direction of showing less belief are reviewed. For example, it is shown that analytical thinking reduces religious belief. Second, recent studies on cognitive bias against atheists are covered showing that atheists are distrusted, elicit disgust and are viewed as immoral both explicitly and implicitly. Third, I review studies in which prejudice against atheists has been experimentally manipulated showing that it is possible to reduce bias against atheists. I conclude the paper arguing that the bias against atheists need to be investigated in the Scan-dinavian countries.

  • 23.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden.
    Clinician-Supported Internet-Delivered Psychological Treatment of Tinnitus2015In: American Journal of Audiology, ISSN 1059-0889, E-ISSN 1558-9137, Vol. 24, no 3, p. 299-301Article in journal (Refereed)
    Abstract [en]

    Purpose: Internet-delivered psychological treatments for tinnitus distress have existed for more than 15 years, and there are a slowly growing number of studies. The aim of this brief report is to review the evidence and to comment on the future potentials of Internet treatments for tinnitus. Method: Studies were retrieved, and in total 6 controlled studies were included in the review with 9 different comparisons (6 in which the treatment was compared against a control group and 3 in which Internet treatment was compared against group treatment). Moreover, 2 open studies based on clinical samples in regular care were also included in the review. The outcomes for the 2 controlled sets of studies were analyzed using meta-analytic methods. Results: For the 6 studies comparing Internet treatment against a no-treatment control condition, a moderate effect size was found (Hedgess g = 0.58). The 3 studies comparing Internet treatment against face-to-face group treatments showed a small difference of Hedgess g = 0.13. Conclusions: Internet-delivered psychological treatment holds promise as a treatment alternative to other standard forms of treatment delivery, including group treatment. Larger studies are needed as well as ways to blend information technology with regular services.

  • 24.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Guided internet treatment for anxiety disorders. As effective as face-to-face therapies?2012In: Studies in Health Technology and Informatics, ISSN 0926-9630, E-ISSN 1879-8365, Vol. 181, p. 3-7Article in journal (Refereed)
    Abstract [en]

    Introduction: Guided Internet-delivered treatments were developed in the late 1990s and have since been tested in numerous controlled trials. While promising, there are yet few direct comparisons between Internet treatments and traditional face-to-face treatments. The aim of the present study is to present an overview of the evidence in the field of anxiety disorders. Method: Studies were located, including unpublished trials from our research group in Sweden. Results: Results of direct comparative trials on panic disorder (n=3) and social anxiety disorder (n=3) show equivalent outcomes. One study on specific phobia did not show equivalent outcomes with an advantage for face-to-face treatment. However, a systematic review by Cuijpers et al. (2010) found equivalent outcomes across several self-help formats, suggesting that guided self-help overall can be as affective as face-to-face treatments. Conclusion: Overall, there are still few large-scale trials and statistical power is often limited. A preliminary conclusion is that guided Internet treatment can be as effective as face-to-face treatments, but there is a need to investigate moderators and mediators of the outcome.

  • 25.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Internet-based CBT improves fatigue severity, physical function and school attendance in adolescents with chronic fatigue syndrome2012In: Evidence-Based Mental Health, ISSN 1362-0347, E-ISSN 1468-960X, Vol. 15, no 3, p. 81-Article in journal (Refereed)
  • 26.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Internet-Delivered Psychological Treatments.2016In: Annual Review of Clinical Psychology, ISSN 1548-5943, E-ISSN 1548-5951, Vol. 12, p. 157-179Article in journal (Refereed)
    Abstract [en]

    During the past 15 years, much progress has been made in developing and testing Internet-delivered psychological treatments. In particular, therapist-guided Internet treatments have been found to be effective for a wide range of psychiatric and somatic conditions in well over 100 controlled trials. These treatments require (a) a secure web platform, (b) robust assessment procedures, (c) treatment contents that can be text based or offered in other formats, and (d) a therapist role that differs from that in face-to-face therapy. Studies suggest that guided Internet treatments can be as effective as face-to-face treatments, lead to sustained improvements, work in clinically representative conditions, and probably are cost-effective. Despite these research findings, Internet treatment is not yet disseminated in most places, and clinical psychologists should consider using modern information technology and evidence-based treatment programs as a complement to their other services, even though there will always be clients for whom face-to-face treatment is the best option.

  • 27.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Psykologisk behandling vid depression: teorier, terapimetoder och forskning2012 (ed. 1)Book (Other academic)
    Abstract [sv]

    Unikt för depressionsområdet är att flera psykologiska behandlingsmetoder visat sig hjälpsamma. Den här boken ger en fördjupning i de mest etablerade psykoterapiformerna  psykodynamisk, humanistisk och interpersonell psykoterapi, samt kognitiv beteendeterapi. För varje metod beskrivs teoribakgrund, behandlingens upplägg, forskningseffekter och vem metoden passar för. Boken är skriven för studenter på vårdutbildningar, de som arbetar med depressionsbehandling och alla med intresse för psykoterapiforskning.

  • 28.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Psykoterapi och psykologisk behandling2016In: Psykiatri / [ed] Jörgen Herlofson, Lund: Studentlitteratur, 2016, 2, p. 669-681Chapter in book (Other academic)
    Abstract [en]

    I den här delen av kapitlet går vi igenom psykoterapi och psykologisk behandling. Avsnittet belyser olika terapiformer och format, och en slutsats är att psykologisk behandling fungerar, samt att kombinerad behandling med samtidig läkemedelsbehandling kan vara mer effektiv än att endast erbjuda läkemedel eller psykologisk behandling. Olika psykoterapier har effekt men det finns än så länge mest stöd för kognitiv beteendeterapi.

  • 29.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology.
    Smartphone applications can help in treatment for alcoholism.2015In: Evidence-Based Mental Health, ISSN 1362-0347, E-ISSN 1468-960X, Vol. 18, no 1, p. 27-Article in journal (Refereed)
  • 30.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    The internet and CBT: a clinical guide2014 (ed. 1)Book (Refereed)
    Abstract [en]

    Comprehensive and practical, The Internet and CBT: A Clinical Guide describes how cognitive behavioural therapy can be delivered via the Internet, email, open access programmes, online communities and via smartphone. Detailing how these alternative methods of CBT support can be integrated within a busy practice, it is invaluable for all CBT clinicians and students wishing to find out more about assessing and supporting people in innovative ways. This book enables you to:

    • Learn how to best give advice concerning online support communities and when to recommend guided self help online
    • Understand how to integrate online and smartphone CBT delivery into your daily practice
    • Explore the resources and treatment programmes available
    • Perform online assessments
    • Guide and supervise the people in your care
    • Comprehend issues of patient confidentiality and what you need to do to ensure safe and ethical practice

    With its no-nonsense and down-to-earth approach, this book covers the dos and don'ts of CBT delivery online and via smartphone and provides a highly accessible guide for students and practitioners wishing to incorporate online CBT into their work. It will be of great interest to CBT clinicians, psychologists, psychotherapists, counsellors and mental health nurses.

  • 31.
    Andersson, Gerhard
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Department of Clinical Neuroscience, Division of Psychiatry, Karolinska InstitutetStockholm, Sweden.
    Bergman Nordgren, Lise
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Buhrman, M.
    Department of Psychology, Uppsala University, Box 12 25Uppsala, Sweden.
    Carlbring, P.
    Department of Psychology, Stockholm UniversityStockholm, Sweden.
    Psychological treatments for depression delivered via the internet and supported by a clinician: An update2014In: Revista de Psicopatologia y Psicologia Clinica, ISSN 1136-5420, Vol. 19, no 3, p. 217-225Article in journal (Refereed)
    Abstract [en]

    Guided internet-delivered cognitive behaviour therapy (ICBT) has been tested in many trials since the early studies dating back to the late 1990s. The aim of this review was to investigate the most recent literature on guided ICBT for depression. We identified 11 controlled studies published between January 2013 and September 2014. Overall, large treatment effects were observed with a few exceptions. A majority (7 studies) provided some information regarding unwanted effects such as deterioration. Three studies directly compared guided ICBT against face-to-face CBT. We added an earlier study and calculated meta-analytic summary statistics for the four studies involving a total of 336 participants. The average effect size difference was Hedges g = 0.12 (95% CI: -0.08∼0.32) in the direction of favouring guided ICBT, but with no practical importance. We conclude that guided ICBT is a promising treatment for depression and mood disorders and that the research is rapidly expanding.

  • 32.
    Andersson, Gerhard
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden.
    Carlbring, Per
    Stockholm University, Sweden.
    Internet-Assisted Cognitive Behavioral Therapy2017In: Psychiatric Clinics of North America, ISSN 0193-953X, E-ISSN 1558-3147, Vol. 40, no 4, p. 689-+Article in journal (Refereed)
    Abstract [en]

    Internet-assisted cognitive behavioral therapy (ICBT) is a way to deliver cognitive behavioral therapy (CBT) that has been found to generate similar effects as face-to-face CBT in some studies. Results have been replicated by different research groups. This article presents the treatment format and reviews evidence for mood and anxiety disorders. Future developments are discussed, including the lack of theories specific for the treatment format and ways to handle comorbidity. Although some programs have been implemented, there is a need for further studies in clinical settings. Overall, clinician-assisted ICBT is becoming one of the most evidence-based forms of psychological treatment.

  • 33.
    Andersson, Gerhard
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Carlbring, Per
    Umeå University.
    Furmark, Tomas
    Uppsala University.
    Therapist Experience and Knowledge Acquisition in Internet-Delivered CBT for Social Anxiety Disorder: A Randomized Controlled Trial2012In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 7, no 5, p. e37411-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Guided internet-delivered cognitive behavior therapy (ICBT) has been tested in several trials on social anxiety disorder (SAD) with moderate to large effects. The aims of this study were threefold. First, to compare the effects of ICBT including online discussion forum with a moderated online discussion forum only. Second, to investigate if knowledge about SAD increased following treatment and third to compare the effects of inexperienced versus experienced therapists on patient outcomes. METHODS: A total of 204 participants with a primary diagnosis of SAD were included and randomized to either guided ICBT or the control condition. ICBT consisted of a 9-week treatment program which was guided by either psychology students at MSc level (n = 6) or by licensed psychologists with previous experience of ICBT (n = 7). A knowledge test dealing with social anxiety was administered before and after treatment. Measures of social anxiety and secondary outcomes dealing with general anxiety, depression, and quality of life were administered before and after treatment. In addition, a 1-year follow-up was conducted on the treated individuals. RESULTS: Immediately following treatment, the ICBT group showed superior outcome on the Liebowitz Social Anxiety Scale self-report version with a between group posttreatment Hedges g effect size of g = 0.75. In addition, significant differences on all the secondary outcomes were observed. Gains were well maintained one year later. Knowledge, as assessed by the knowledge test, increased following treatment with little gain in the control group. Therapist experience did not result in different outcomes, but experienced therapists logged in less frequently compared to the inexperienced therapists, suggesting that they needed less time to support patients. DISCUSSION: We conclude that guided ICBT reduce symptoms of SAD, increase knowledge about SAD and that therapist experience does not make a difference apart from the finding that experienced therapist may require less time to guide patients. TRIAL REGISTRATION: UMIN.ac.jp UMIN000001383.

  • 34.
    Andersson, Gerhard
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institutet, Stockholm, Sweden.
    Carlbring, Per
    Stockholm University, Sweden.
    Holmes, Emily A
    MRC Cognition and Brain Sciences Unit, Cambridge, UK.
    Special Issue in Honour of Lars-Göran Öst2013In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 42, no 4, p. 259-Article in journal (Other academic)
  • 35.
    Andersson, Gerhard
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research. Karolinska Institutet, Stockholm, Sweden.
    Cuijpers, Pim
    VU University Amsterdam, The Netherlands.
    Carlbring, Per
    University of Stockholm, Sweden.
    Riper, Heleen
    VU University Amsterdam, The Netherlands; Leuphana University, Lünebrug, Germany.
    Hedman, Erik
    Karolinska Institutet, Stockholm, Sweden.
    Guided Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: a systematic review and meta-analysis2014In: World Psychiatry, ISSN 1723-8617, E-ISSN 2051-5545, Vol. 13, no 3, p. 288-295Article in journal (Refereed)
    Abstract [en]

    Internet-delivered cognitive behavior therapy (ICBT) has been tested in many research trials, but to a lesser extent directly compared to face-to-face delivered cognitive behavior therapy (CBT). We conducted a systematic review and meta-analysis of trials in which guided ICBT was directly compared to face-to-face CBT. Studies on psychiatric and somatic conditions were included. Systematic searches resulted in 13 studies (total N=1053) that met all criteria and were included in the review. There were three studies on social anxiety disorder, three on panic disorder, two on depressive symptoms, two on body dissatisfaction, one on tinnitus, one on male sexual dysfunction, and one on spider phobia. Face-to-face CBT was either in the individual format (n=6) or in the group format (n=7). We also assessed quality and risk of bias. Results showed a pooled effect size (Hedges' g) at post-treatment of -0.01 (95% CI: -0.13 to 0.12), indicating that guided ICBT and face-to-face treatment produce equivalent overall effects. Study quality did not affect outcomes. While the overall results indicate equivalence, there are still few studies for each psychiatric and somatic condition and many conditions for which guided ICBT has not been compared to face-to-face treatment. Thus, more research is needed to establish equivalence of the two treatment formats.

  • 36.
    Andersson, Gerhard
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Hedman, Erik
    Karolinska Institute, Sweden .
    Effectiveness of Guided Internet-Based Cognitive Behavior Therapy in Regular Clinical Settings2013In: Verhaltenstherapie (Basel), ISSN 1016-6262, E-ISSN 1423-0402, Vol. 23, no 3, p. 140-148Article, review/survey (Refereed)
    Abstract [en]

    Therapist-guided internet-based cognitive behavior therapy (ICBT) has been tested in numerous controlled trials conducted in research settings. It is now established that this novel treatment format works for a range of clinical conditions. It is less well known if the promising results from efficacy studies can be transferred to routine clinical practice. In this paper we review the evidence from effectiveness studies and highlight challenges when implementing ICBT. Following literature searches we identified 4 controlled trials and 8 open studies, involving a total of 3,888 patients. There is now an increasing number of effectiveness studies on ICBT with studies on panic disorder, social anxiety disorder, generalized anxiety disorder, post-traumatic stress disorder, depression, tinnitus, and irritable bowel syndrome. All indicate that it is possible to transfer ICBT to clinical practice with sustained effects and moderate to large effect sizes. However, it is not clear which model to use for service delivery, and more work remains to be done on dissemination of ICBT. Moreover, the knowledge about outcome predictors from controlled efficacy trials is probably less relevant, and studies with large clinically representative samples are needed to investigate for which patients ICBT is suitable. In this work existing data could be combined and reanalyzed to study predictors of outcome.

  • 37.
    Andersson, Gerhard
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Hesser, Hugo
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Cima, Rilana F F.
    Maastricht University, Netherlands .
    Weise, Cornelia
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Arts and Sciences. Linköping, Disability Research.
    Autobiographical Memory Specificity in Patients with Tinnitus Versus Patients with Depression and Normal Controls2013In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 42, no 2, p. 116-126Article in journal (Refereed)
    Abstract [en]

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

  • 38.
    Andersson, Gerhard
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Hesser, Hugo
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Hummerdal, Daniel
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Bergman Nordgren, Lise
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Carlbring, Per
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Faculty of Arts and Sciences. Department of Psychology , Umeå University, Umeå, Sweden.
    A 3.5-year follow-up of Internet-delivered cognitive behavior therapy for major depression2013In: Journal of Mental Health, ISSN 0963-8237, E-ISSN 1360-0567, Vol. 22, no 2, p. 155-164Article in journal (Refereed)
    Abstract [en]

    BackgroundInternet-delivered cognitive behavior therapy (ICBT) for major depression has been tested in several trials, but only with follow-ups up to 1.5 years.

    AimThe aim of this study was to evaluate the outcome of ICBT 3.5 years after treatment completion.Methods

    A total of 88 people with major depression were randomized to either guided self-help or e-mail therapy in the original trial. One-third was initially on a waiting-list. Treatment was provided for eight weeks and in this report long-term follow-up data were collected. Also included were data from post-treatment and six-month follow-up. A total of 58% (51/88) completed the 3.5-year follow-up. Analyses were performed using a random effects repeated measures piecewise growth model to estimate trajectory shape over time and account for missing data.

    ResultsResults showed continued lowered scores on the Beck Depression Inventory (BDI). No differences were found between the treatment conditions. A large proportion of participants (55%) had sought and received additional treatments in the follow-up period. A majority (56.9%) of participants had a BDI score lower than 10 at the 3.5-year follow-up.

    ConclusionsPeople with mild to moderate major depression may benefit from ICBT 3.5-years after treatment completion.

  • 39.
    Andersson, Gerhard
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Hesser, Hugo
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Veilord, Andrea
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Svedling, Linn
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Andersson, Fredrik
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Sleman, Owe
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Mauritzson, Lena
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Sarkohi, Ali
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Claesson, Elisabet
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Zetterqvist, Vendela
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Lamminen, Mailen
    Redakliniken, Linkoping, Sweden .
    Eriksson, Thomas
    Redakliniken, Linkoping, Sweden .
    Carlbring, Per
    Stockholm University, Sweden .
    Randomised controlled non-inferiority trial with 3-year follow-up of internet-delivered versus face-to-face group cognitive behavioural therapy for depression2013In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 151, no 3, p. 986-994Article in journal (Refereed)
    Abstract [en]

    Background: Guided internet-delivered cognitive behaviour therapy (ICBT) has been found to be effective in the treatment of mild to moderate depression, but there have been no direct comparisons with the more established group-based CBT with a long-term follow-up. less thanbrgreater than less thanbrgreater thanMethod: Participants with mild to moderate depression were recruited from the general population and randomized to either guided ICBT (n =33) or to live group treatment (n=36). Measures were completed before and after the intervention to assess depression, anxiety, and quality of life. Follow-ups were conducted at one-year and three-year after the treatment had ended. Results: Data were analysed on an intention-to-treat basis using linear mixed-effects regression analysis. less thanbrgreater than less thanbrgreater thanResults on the self-rated version of the Montgomery-Asberg Depression Scale showed significant improvements in both groups across time indicating non-inferiority of guided ICBT, and there was even a tendency for the guided ICBT group to be superior to group-based CBT at three year follow-up. Within-group effect sizes for the ICBT condition at post treatment showed a Cohens d=1.46, with a similar large effect at 3-year follow-up, d=1.78. For the group CBT the corresponding within group effects were d =0.99 and d=1.34, respectively. less thanbrgreater than less thanbrgreater thanLimitations: The study was small with two active treatments and there was no placebo or credible control condition. less thanbrgreater than less thanbrgreater thanConclusions: Guided ICBT is at least as effective as group based CBT and long-term effects can be sustained up to 3 years after treatment.

  • 40.
    Andersson, Gerhard
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institutet, Stockholm, Sweden.
    Holmes, Emily A.
    MRC Cognition and Brain Sciences Unit, Cambridge, UK.
    Carlbring, Per
    Stockholm University, Sweden.
    Lars-Göran Öst2013In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 42, no 4, p. 260-264Article in journal (Refereed)
    Abstract [en]

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

  • 41.
    Andersson, Gerhard
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Oticon AS, Denmark; Karolinska Institute, Sweden.
    Lunner, Thomas
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research. Oticon AS, Denmark.
    Laplante-Lévesque, Ariane
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Oticon AS, Denmark.
    Preminger, Jill E.
    University of Louisville, KY 40292 USA.
    Internet and Audiology: A Review of the First International Meeting2015In: American Journal of Audiology, ISSN 1059-0889, E-ISSN 1558-9137, Vol. 24, no 3, p. 269-270Article, review/survey (Refereed)
    Abstract [en]

    Purpose: The purpose of this research forum article is to describe the impetus for holding the First International Meeting on Internet and Audiology (October 2014) and to introduce the special research forum that arose from the meeting. Method: The rationale for the First International Meeting on Internet and Audiology is described. This is followed by a short description of the research sections and articles appearing in the special issue. Six articles consider the process of health care delivery over the Internet; this includes health care specific to hearing, tinnitus, and balance. Four articles discuss the development of effective Internet-based treatment programs. Six articles describe and evaluate Internet-based interventions specific to adult hearing aid users. Conclusion: The fledgling field of Internet and audiology is remarkably broad. The Second International Meeting on Internet and Audiology ocurred in September 2015.

  • 42.
    Andersson, Gerhard
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Paxling, Björn
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Roch-Norlund, Pie
    Department of Psychology, Stockholm University.
    Östman, Gunnar
    Department of Psychology, Stockholm University.
    Norgren, Anna
    Department of Psychology, Stockholm University.
    Almlöv, Jonas
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Georén, Lisa
    Department of Psychology, Uppsala University.
    Breitholtz, Elisabeth
    Department of Psychology, Stockholm University.
    Dahlin, Mats
    Psykologpartners, Linköping.
    Cuijpers, Pim
    Vrije University, Amsterdam, The Netherlands .
    Carlbring, Per
    Umeå University.
    Silverberg, Farrell
    Philadelphia School of Psychoanalysis and Private Practice, Philadelphia, USA.
    Internet-Based Psychodynamic versus Cognitive Behavioral Guided Self-Help for Generalized Anxiety Disorder: A Randomized Controlled Trial2012In: Psychotherapy and Psychosomatics, ISSN 0033-3190, E-ISSN 1423-0348, Vol. 81, no 6, p. 344-355Article in journal (Refereed)
    Abstract [en]

    Background: Guided Internet-based cognitive behavior therapy (ICBT) has been tested in many trials and found to be effective in the treatment of anxiety and mood disorders. Generalized anxiety disorder (GAD) has also been treated with ICBT, but there are no controlled trials on guided Internet-based psychodynamic treatment (IPDT). Since there is preliminary support for psychodynamic treatment for GAD, we decided to test if a psychodynamically informed self-help treatment could be delivered via the Internet. The aim of the study was to investigate the efficacy of IPDT for GAD and to compare against ICBT and a waiting list control group. Method: A randomized controlled superiority trial with individuals diagnosed with GAD comparing guided ICBT (n = 27) and IPDT (n = 27) against a no treatment waiting list control group (n = 27). The primary outcome measure was the Penn State Worry Questionnaire. Results: While there were no significant between-group differences immediately after treatment on the main outcome measure, both IPDT and ICBT resulted in improvements with moderate to large within-group effect sizes at 3 and 18 months follow-up on the primary measure in the completer analyses. The differences against the control group, although smaller, were still significant for both PDT and CBT when conforming to the criteria of clinically significant improvement. The active treatments did not differ significantly. There was a significant group by time interaction regarding GAD symptoms, but not immediately after treatment. Conclusions: IPDT and ICBT both led to modest symptom reduction in GAD, and more research is needed.

  • 43.
    Andersson, Gerhard
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Paxling, Björn
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Wiwe, Maria
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Vernmark, Kristofer
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Psykologpartners, Private Practice, Linköping.
    Felix, Christina Bertholds
    Uppsala University.
    Lundborg, Lisa
    Uppsala University.
    Furmark, Tomas
    Uppsala University.
    Cuijpers, Pim
    VU University Amsterdam, and EMGO Institute, The Netherlands.
    Carlbring, Per
    Umeå University.
    Therapeutic alliance in guided internet-delivered cognitive behavioural treatment of depression, generalized anxiety disorder and social anxiety disorder2012In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 50, no 9, p. 544-550Article in journal (Refereed)
    Abstract [en]

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

  • 44.
    Andersson, Gerhard
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden.
    Rozental, Alexander
    Stockholm University, Sweden; UCL, England.
    Shafran, Roz
    UCL, England.
    Carlbring, Per
    Stockholm University, Sweden; UCL, England.
    Long-term effects of internet-supported cognitive behaviour therapy2018In: Expert Review of Neurotherapeutics, ISSN 1473-7175, E-ISSN 1744-8360, Vol. 18, no 1, p. 21-28Article, review/survey (Refereed)
    Abstract [en]

    Introduction: Internet-supported and therapist-guided cognitive behaviour therapy (ICBT) is effective for a range of problems in the short run, but less is known about the long-term effects with follow-ups of two years or longer.Areas covered: This paper reviews studies in which the long-term effects of guided ICBT were investigated. Following literature searches in PubMed and other sources meta-analytic statistics were calculated for 14 studies involving a total of 902 participants, and an average follow-up period of three years. Studies were from Sweden (n=11) or the Netherlands (n=3). Long-term outcome studies were found for panic disorder, social anxiety disorder, generalized anxiety disorder, depression, mixed anxiety and depression, obsessive-compulsive disorder, pathological gambling, stress and chronic fatigue. The duration of the treatments was usually short (8-15weeks). The pre-to follow-up effect size was Hedges g=1.52, but with a significant heterogeneity. The average symptom improvement across studies was 50%. Treatment seeking in the follow-up period was not documented and few studies mentioned negative effects.Expert commentary: While effects may be overestimated, it is likely that therapist-supported ICBT can have enduring effects. Long-term follow-up data should be collected for more conditions and new technologies like smartphone-delivered treatments.

  • 45.
    Andersson, Gerhard
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Sarkohi, Ali
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Karlsson, Johan
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Faculty of Arts and Sciences.
    Bjärehed, Jonas
    Department of Psychology, Lund University, Lund, Sweden.
    Hesser, Hugo
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Effects of Two Forms of Internet-Delivered Cognitive Behaviour Therapy for Depression on Future Thinking2013In: Cognitive Therapy and Research, ISSN 0147-5916, E-ISSN 1573-2819, Vol. 37, no 1, p. 29-34Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to investigate if future thinking would change following two forms of Internet-delivered cognitive behavior therapy (ICBT) for major depression. A second aim was to study the association between pre-post changes in future thinking and prepost changes in depressive symptoms.

    Background: Effects of psychological treatments are most often tested with self-report inventories and seldom with tests of cognitive function.

    Method: We included data from 47 persons diagnosed with major depression who received either e-mail therapy or guided self-help during 8 weeks. Participants completed the future thinking task (FTT), in which they were asked to generate positive and negative events that they thought were going to happen in the future and rated the events in terms of emotion and likelihood. The FTT was completed before and after treatment. Data on depressive symptoms were also collected.

    Results: FTT index scores for negative events were reduced after  treatment. There was no increase for the positive events. Change scores for the FTT negative events and depression symptoms were significantly correlated.

    Conclusions: We conclude that ICBT may lead to decreased negative future thinking and that changes in depression symptoms correlate to some extent with reductions in negative future thinking.

  • 46.
    Andersson, Gerhard
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institutet, Stockholm, Sweden.
    Titov, Nickolai
    Macquarie University, Sydney, Australia.
    Advantages and limitations of Internet-based interventions for common mental disorders2014In: World Psychiatry, ISSN 1723-8617, E-ISSN 2051-5545, Vol. 13, no 1, p. 4-11Article in journal (Refereed)
    Abstract [en]

    Several Internet interventions have been developed and tested for common mental disorders, and the evidence to date shows that these treatments often result in similar outcomes as in face-to-face psychotherapy and that they are cost-effective. In this paper, we first review the pros and cons of how participants in Internet treatment trials have been recruited. We then comment on the assessment procedures often involved in Internet interventions and conclude that, while online questionnaires yield robust results, diagnoses cannot be determined without any contact with the patient. We then review the role of the therapist and conclude that, although treatments including guidance seem to lead to better outcomes than unguided treatments, this guidance can be mainly practical and supportive rather than explicitly therapeutic in orientation. Then we briefly describe the advantages and disadvantages of treatments for mood and anxiety disorders and comment on ways to handle comorbidity often associated with these disorders. Finally we discuss challenges when disseminating Internet interventions. In conclusion, there is now a large body of evidence suggesting that Internet interventions work. Several research questions remain open, including how Internet interventions can be blended with traditional forms of care.

  • 47.
    Andersson, Gerhard
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden.
    Topooco, Naira
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Havik, Odd
    University of Bergen, Norway; Haukeland Hospital, Norway.
    Nordgreen, Tine
    University of Bergen, Norway; Haukeland Hospital, Norway.
    6 Internet-supported versus face-to-face cognitive behavior therapy for depression2016In: Expert Review of Neurotherapeutics, ISSN 1473-7175, E-ISSN 1744-8360, Vol. 16, no 1, p. 55-60Article, review/survey (Refereed)
    Abstract [en]

    Major depression and depressive symptoms are highly prevalent and there is a need for different forms of psychological treatments that can be delivered from a distance at a low cost. In the present review the authors contrast face-to-face and Internet-delivered cognitive behavior therapy (ICBT) for depression. A total of five studies are reviewed in which guided ICBT was directly compared against face-to-face CBT. Meta-analytic summary statistics were calculated for the five studies involving a total of 429 participants. The average effect size difference was Hedges g=0.12 (95% CI: -0.06-0.30) in the direction of favoring guided ICBT. The small difference in effect has no implication for clinical practice. The overall empirical status of clinician-guided ICBT for depression is commented on and future challenges are highlighted. Among these are developing treatments for patients with more severe and long-standing depression and for children, adolescents and the elderly. Also, there is a need to investigate mechanisms of change.

  • 48.
    Andersson, Gerhard
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institutet, Stockholm, Sweden.
    Waara, Johan
    Uppsala University, Sweden.
    Jonsson, Ulf
    Karolinska Institutet, Stockholm, Sweden.
    Malmaeus, Fredrik
    Uppsala University, Sweden.
    Carlbring, Per
    Stockholm University, Sweden.
    Öst, Lars-Göran
    Karolinska Institutet, Stockholm, Sweden.
    Internet-based exposure treatment versus one-session exposure treatment of snake phobia: a randomized controlled trial2013In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 42, no 4, p. 284-291Article in journal (Refereed)
    Abstract [en]

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

  • 49.
    Andersson, Ulf
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Skagerlund, Kenny
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Olsson, Linda
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Östergren, Rickard
    Linköping University, Department of Behavioural Sciences and Learning, Education, Teaching and Learning. Linköping University, Faculty of Educational Sciences.
    Pathways to arithmetic fact retrieval and percentage calculation in adolescents2017In: British Journal of Educational Psychology, ISSN 0007-0998, E-ISSN 2044-8279, Vol. 87, no 4, p. 647-663Article in journal (Refereed)
    Abstract [en]

    Background

    Developing sufficient mathematical skills is a prerequisite to function adequately in society today. Given this, an important task is to increase our understanding regarding the cognitive mechanisms underlying young people's acquisition of early number skills and formal mathematical knowledge.

    Aims

    The purpose was to examine whether the pathways to mathematics model provides a valid account of the cognitive mechanisms underlying symbolic-number processing and mathematics in adolescents. The pathways model states that the three pathways should provide independent support to symbolic-number skill. Each pathway's unique contribution to formal mathematics varies depending on the complexity and demand of the tasks.

    Sample

    The study used a sample of 114 adolescents (71 girls). Their mean age was 14.60 years (SD = 1.00).

    Methods

    The adolescents were assessed on tests tapping the three pathways and general cognitive abilities (e.g., working memory). A structural equation path analysis was computed.

    Results

    Symbolic-number comparison was predicted by the linguistic pathway, the quantitative pathway, and processing speed. The linguistic pathway, quantitative pathways, and symbolic-number comparison predicted arithmetic fact retrieval. The linguistic pathway, working memory, visual analogies, and symbolic-number comparison predicted percentage calculation.

    Conclusions

    There are both similarities and differences in the cognitive mechanisms underlying arithmetic fact retrieval and percentage calculation in adolescents. Adolescents’ symbolic-number processing, arithmetic fact retrieval, and percentage calculation continue to rely on the linguistic pathways, whereas the reliance upon the spatial pathway has ceased. The reliance upon the quantitative pathway varies depending on the task.

  • 50.
    Andersson, Ulf
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Östergren, Rickard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Number magnitude processing and basic cognitive functions in children with mathematical learning disabilities2012In: Learning and individual differences, ISSN 1041-6080, E-ISSN 1873-3425, Vol. 22, no 6, p. 701-714Article in journal (Refereed)
    Abstract [en]

    The study sought out to extend our knowledge regarding the origin ofmathematical learning disabilities (MLD) in children by testing different hypotheses in the same samples of children. Different aspects of cognitive functions and number processing were assessed in fifth- and sixth-graders (1113 years old) withMLD and compared to controls. The MLD group displayed weaknesses withmost aspects of number processing (e.g., subitizing, symbolic number comparison, number-line estimation) and two cognitive functions (e.g., visualspatial working memory). These findings favor the defective approximate number system (ANS) hypothesis, but do not fit well with the access deficit hypothesis. Support is also provided for the defective object-tracking system (OTS) hypothesis, the domain general cognitive deficit hypothesis and to some extent the defective numerosity-coding hypothesis. The study suggests that MLD might be caused by multiple deficits and not a single core deficit.

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