The focus of this study is on how final-semester students and newly-graduated teachers experience theformal objectives of teacher education, with a particular view of the concepts of learning, responsibilityand collaboration. The ways of experiencing these concepts varied from conceptions in which only onedimension is discerned from in the student teachers group to conceptions in which several dimensions ofthe phenomena are discerned in the graduate teachers group.
Background: Guided internet-delivered CBT for anxiety disorders has received increasing empirical support, but little is known regarding the role of the therapist. Aims: This study addressed therapist factors in guided internet-delivered cognitive behavioural therapy for anxiety disorders. Method: Data from three controlled trials with a total N of 119 were analyzed with attention to differences between eight therapists. Results: No significant mean level differences between therapists appeared in the dataset. However, one significant intraclass correlation between participants was found, suggesting that the outcome on the Beck Anxiety Inventory might have been influenced by the impact of the individual therapists. Conclusion: The therapist can possibly have some influence on the outcome of guided internet-delivered CBT for anxiety disorders, but studies with more statistical power are needed to establish whether therapist effects are present in this modality of psychological treatment. The present study was underpowered to detect minor therapist effects.
A new treatment form has emerged that merges cognitive behaviour therapy with the Internet. By delivering treatment components, mainly in the form of texts presented via web pages, and provide ongoing support using e-mail promising outcomes can be achieved. The literature on this novel form of treatment has grown rapidly over recent years with several controlled trials in the field of anxiety disorders, mood disorders and behavioural medicine. For some of the conditions for which Internet-delivered CBT has been tested, independent replications have shown large effect sizes, for example in the treatment of social anxiety disorder. In some studies, Internet-delivered treatment can achieve similar outcomes as in face-to-face CBT, but the literature thus far is restricted mainly to efficacy trials. This article provides a brief summary of the evidence, comments on the role of the therapist and for which patient and therapist this is suitable. Areas of future research and exploration are identified.
Background: Cognitive behavior therapy (CBT) is widely regarded as an effective treatment for obsessive compulsive disorder (OCD), but access to CBT therapists is limited. Internet-based CBT (ICBT) with therapist support is a way to increase access to CBT but has not been developed or tested for OCD. The aim of this study was to evaluate ICBT for OCD. less thanbrgreater than less thanbrgreater thanMethod: An open trial where patients (N = 23) received a 15-week ICBT program with therapist support consisting of psychoeducation, cognitive restructuring and exposure with response prevention. The primary outcome was the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), which was assessed by a psychiatrist before and immediately after treatment. Secondary outcomes were self-rated measures of OCD symptoms, depressive symptoms, general functioning, anxiety and quality of life. All assessments were made at baseline and post-treatment. less thanbrgreater than less thanbrgreater thanResults: All participants completed the primary outcome measure at all assessment points. There were reductions in OCD symptoms with a large within-group effect size (Cohens d = 1.56). At post-treatment, 61% of participants had a clinically significant improvement and 43% no longer fulfilled the diagnostic criteria of OCD. The treatment also resulted in statistically significant improvements in self-rated OCD symptoms, general functioning and depression. less thanbrgreater than less thanbrgreater thanConclusions: ICBT with therapist support reduces OCD symptoms, depressive symptoms and improves general functioning. Randomized trials are needed to confirm the effectiveness of this new treatment format.
Background: Irritable Bowel Syndrome (IBS) is highly prevalent and is associated with a substantial economic burden. Cognitive behavior therapy (CBT) has been shown to be effective in treating IBS. The aim of this study was to evaluate the cost-effectiveness of a new treatment alternative, internet-delivered CBT based on exposure and mindfulness exercises. Methods: Participants (N = 85) with IBS were recruited through self-referral and were assessed via a telephone interview and self-report measures on the internet. Participants were randomized to internet-delivered CBT or to a discussion forum. Economic data was assessed at pre-, post- and at 3-month and 1 year follow-up. Results: Significant cost reductions were found for the treatment group at $16,806 per successfully treated case. The cost reductions were mainly driven by reduced work loss in the treatment group. Results were sustained at 3-month and 1 year follow-up. Conclusions: Internet-delivered CBT appears to generate health gains in IBS treatment and is associated with cost-savings from a societal perspective.
Introduction. Men with erectile dysfunction are often worried about their condition, have interpersonal difficulties, and have a reduced quality of life. Internet-delivered cognitive behavior therapy (ICBT) has been shown effective for a number of health problems but evidence is limited concerning the treatment of erectile dysfunction. less thanbrgreater than less thanbrgreater thanAim. The study investigated the effects of ICBT for erectile dysfunction. less thanbrgreater than less thanbrgreater thanMethods. Seventy-eight men were included in the study and randomized to either ICBT or to a control group, which was an online discussion group. Treatment consisted of a 7-week Web-based program with e-mail-based therapist support. Each therapist spent an average of 55 minutes per participant. less thanbrgreater than less thanbrgreater thanMain Outcome Measure. The International Index of Erectile Functioning five-item version was administered via the telephone at pretreatment, post-treatment, and 6 months after receiving ICBT. less thanbrgreater than less thanbrgreater thanResults. At post-treatment, the treatment group had significantly greater improvements with regard to erectile performance compared with the control group. Between-group differences at post-treatment were small (d = 0.1), but increased at the 6-month follow-up (d = 0.88). less thanbrgreater than less thanbrgreater thanConclusions. This study provides support for the use of ICBT as a possible treatment format for erectile dysfunction.
Depression is a common condition that can be treated in many different ways. Accumulating evidence suggests that self help, based on cognitive-behavioral principles, is an evidence-based treatment for mild-to-moderate depression. Self help commonly requires some form of guidance, but can still be cost effective and the results are often similar to what can be observed in face-to-face therapy. Recently, the possibility of administering cognitive-behavioral treatment via the internet has been explored. There are several advantages to using the internet, the main one being that it bridges distances and is readily available for an increasing number of people in the world. While few controlled studies have examined the effects of internet-delivered self help for depression, the results are promising for applications that involve brief therapist input. Future possible applications of internet-based self help are discussed. © 2006 Future Drugs Ltd.
Internet-administered cognitive behavior therapy is a promising new way to deliver psychological treatment. There are an increasing number of controlled trials in various fields such as anxiety disorders, mood disorders and health conditions such as headache and insomnia. Among the advantages for the field of cognitive behavior therapy is the dissemination of the treatment, being able to access treatment from a distance, and possibilities to tailor the interventions. To date, studies in which large effects have been obtained have included patient support from a clinician. Recent trials suggest that this support may come from non-clinicians and that therapist effects are minimal. Since studies also suggest that internet-delivered cognitive behavior therapy can be equally effective as face-to-face cognitive behavior therapy, this is a finding that may have implications for CBT practitioners. However, there are other aspects to consider for implementation, as while clinicians may hold positive attitudes towards internet-delivered CBT a recent study suggested that patients are more skeptical and may prefer face-to-face treatment. In the present work, I argue that internet-delivered CBT may help to increase adherence to treatment protocols, that training can be facilitated by means of internet support, and that research on internet interventions can lead to new insights regarding what happens in regular CBT. Moreover, I conclude that internet-delivered CBT works best when support is provided, leaving an important role for clinicians who can incorporate internet treatment in their services. However, I also warn against disseminating internet-delivered CBT to patients for whom it is not suitable, and that clinical skills may suffer if clinicians are trained and practice mainly using the internet.
Health psychology is a rapidly expanding discipline at the interface of psychology and clinical medicine. This new edition is fully reworked and revised, offering an entirely up-to-date, comprehensive, accessible, one-stop resource for clinical psychologists, mental health professionals and specialists in health-related matters. There are two new editors: Susan Ayers from the University of Sussex and Kenneth Wallston from Vanderbilt University Medical Center.
The prestigious editorial team and their international, interdisciplinary cast of authors have reconceptualised their much-acclaimed handbook. The book is now in two parts: part I covers psychological aspects of health and illness, assessments, interventions and healthcare practice. Part II covers medical matters listed in alphabetical order. Among the many new topics added are: diet and health, ethnicity and health, clinical inrterviewing, mood assessment, communicating risk, medical interviewing, diagnostic procedures, organ donation, IVF, MMR, HRT, sleep disorders, skin disorders, depression and anxiety disorders.
[No abstract available]
Introduction: Mild to moderate depression has been successfully treated with cognitive-behavioural (CBT) bibliotherapy, including minimal therapist contact. More recently, the Internet has been used to deliver the treatment, with obvious gains in terms of cost reduction and increased accessibility. In the present study we analysed pre-treatment predictors of improvement following Internet-based self-help treatment of mild to moderate depression. Patients and Methods: Included were 71 participants from a randomised trial who completed a 6-month follow-up. Change indexes were calculated from the Beck Depression Inventory (BDI) and the Montgomery Åsberg Depression Rating Scale (MADRS). Results: In line with the literature on depression, the number of previous episodes of depression was negatively associated with improvement after treatment. Follow-up scores on the BDI and MADRS were associated with pre-treatment levels of depression, anxiety and low levels of quality of life. Discussion: As indicated by traditional psychotherapy studies, finding predictors of outcome is a difficult task. Patients with repeated episodes of depression might benefit less from self-help over the Internet, but as the correlation is weak, no firm conclusions can be drawn.
This article describes the development and empirical status of guided Internet-delivered self-help. The treatment approach combines the benefits of bibliotherapy with book-length text materials and the support given online via web pages and e-mail. Interactive features such as online registrations, tests, and online discussion forums are also included. Cognitive behavior therapy (CBT) guided the research and clinical implementations of this approach, as it lends itself more easily to the self-help format compared with other presently available psychotherapy approaches. We include an overview of the research, current issues and research in service delivery, lessons learned through a program of research, and directions for future investigations.
No abstract is available for this article.
In this commentary, we discuss the implications of the findings by Berger, Hohl, and Casper (this issue) together with the emerging database on the effects of Internet treatment for social anxiety disorder (social phobia). Their article is the third independent replication of guided Internet treatment of social anxiety disorder, and in this article, we comment on future research challenges and if Internet treatment now can be regarded as ready for dissemination into regular clinical settings.
With the advent of guided self-help via the Internet it has become increasingly important to investigate predictors of treatment outcome. The present study analyzed predictors of outcome using data from a randomized controlled trial on panic disorder [Carlbring, P. et al. (2005). Treatment of panic disorder: Live therapy versus self-help via Internet. Behaviour Research and Therapy, 43, 1321-1333]. Half of the sample received therapist guided Internet treatment (N = 25) and the other half face to face treatment (N = 24) in individual sessions during a 10-week study period. Results showed that agoraphobic avoidance was predictive of outcome in the face to face treatment, but not in the Internet treatment. A self-report screening of personality disorder (anxious cluster) was associated with worse outcome for the Internet treatment, but surprisingly associated with better outcome in face to face treatment. Cognitive capacity as measured by a test of verbal fluency was not predictive of outcome in the Internet group, and neither was a rating of treatment credibility. Overall, we conclude that in relation to face to face treatment different predictors of outcome should be investigated for Internet treatment. Internet treatment might be more suitable for certain clients who might benefit from remote treatment in the early phase of treatment.
The purpose of this review paper is to comment on a suggestion proposed by David Barlow [Barlow, D. H. (2004). Psychological treatments. American Psychologist, 59, 869-878.], that evidence-based psychotherapies with a clear medical objective should go under the name of "psychological treatments". We begin by describing the definition of psychotherapy and the role of common factors. We then briefly present how different "schools of psychotherapy" are differentiated. In the literature it is clear that psychological treatments can be both more broad in terms of the ways of delivery (e. g., Internet-based treatment), but also more narrow than psychotherapies, as psychological treatments are now increasingly regarded as evidence-based medical treatments for specific medical conditions. Psychological treatments are also increasingly recommended in treatment guidelines. Some benefits from using the concept of psychological treatment instead of the equally important but less medically oriented term psychotherapy are presented. As the regular "brand names" of psychotherapy are increasingly integrating procedures from different schools of therapy, and that the objective of psychotherapy often is adjustment and growth, we agree with the suggestion by Barlow that endorsing the term "psychological treatment" could facilitate the further dissemination of evidence-based psychological treatment procedures.
Online cognitive-behavioural therapy (CBT) for depression has the potential to serve as an important addition to the care of people with mild to moderate depression. Although some studies show promising results, the need for proper diagnoses and human guidance must be considered when interpreting the modest effects found in studies with little or no guidance from a therapist.
The relation between tinnitus and short-term memory performance in varying background sounds is not well understood. In the present study a sample of 18 persons with tinnitus completed a serial recall test in three conditions, silence, masking and intermittent masking. The performance of a matched control group without tinnitus was also investigated. Based on the literature on the "irrelevant sound effect" we expected that the tinnitus group would perform worse during intermittent masking and that they would score lower overall compared to the control group. Results revealed no statistically significant differences between the groups, nor any group interaction within sound conditions for the serial recall test. Groups did however differ regarding subjective measures of concentration problems, anxiety and depression. Results are discussed in relation to thought suppression and distraction from tinnitus.
Background: While several studies have investigated the presence and annoyance of tinnitus in cochlear implant (CI) recipients, few studies have probed the handicap experienced in association with tinnitus in this population. Purpose: The aim of this study was to use validated self-report measures in a consecutive sample of Cl patients who reported tinnitus in order to determine the extent of tinnitus handicap. Research Design: In a retrospective design, a total of 151 patients (80% response rate) responded to a postal questionnaire, and of these, 111 (74%) reported that they currently experienced tinnitus and were asked to complete the full questionnaire. Sampling was performed at a point of a mean 2.9 years postsurgery (SD = 1.8 years). Three established self-report questionnaires were included measuring tinnitus handicap (Tinnitus Handicap Inventory [THI]) hearing problems (Gothenburg Profile), and finally, a measure of anxiety and depression (Hospital Anxiety and Depression Scale). We analyzed the data by means of Pearson product moment correlations, Mests, ANOVAs, and chi-square. Results: Data from the validated questionnaires showed relatively low levels of tinnitus distress, moderate levels of hearing problems, and low scores on the anxiety and depression scales. Using the criteria proposed for the THI (which was completed by 107 patients), 35% (N = 38) had a score indicating "no handicap," 30% (N = 32) "mild handicap" 18% (N = 19) "moderate handicap", and 17% (N = 18) "severe handicap." Thus 37 individuals from the total series of 151 reported moderate to severe tinnitus handicap (24.5%). Tinnitus distress was associated with increased hearing problems, anxiety, and depression. Conclusion: Tinnitus can be a significant problem following Cl, but that the experienced distress is often moderate. However, a quarter of Cl recipients do demonstrate moderate/severe tinnitus handicap, and thus are candidates for tinnitus specific therapy. The level of tinnitus handicap is associated with hearing problems and psychological distress.
Tinnitus innebär ljudperception utan extern ljudkälla. Med objektivt tinnitus avses fysikaliskt ljud eller vibrationer som alstras i huvudet, t ex på grund av turbulent flöde i ett blodkärl nära örat eller på grund av spasmer eller tremor i öronnära muskler. Objektiv kan ofta höras genom auskultation med stetoskop eller registreras med probmikrofon i hörselgången. Subjektiv tinnitus representerar den variant då hörselupplevelsen uppstår i sinnesorganets sensorineurala delar och därmed inte kan registreras objektivt. Detta är den vanligaste formen av tinnitus och uppträder som inslag i många hörselskador med helt olika orsak: vaxpropp i hörselgången, mellanöresjukdomar såsom otoskleros, cochleära skador beroende på åldersförändringar, buller eller Meniers sjukdom, och retrocochleära skador bl a ponsvinkelåkommor.
Background: Chronic pain is a common condition among older adults. While cognitive behaviour therapy (CBT) has been tested in numerous studies on adults and children there are fewer studies on older persons. The objective of this study was to investigate the effects of a six-session CBT group treatment for older persons with chronic pain. As a secondary aim we investigated whether treatment credibility was associated with outcome. Method: We included 21 persons (mean age = 72.0 years) who were randomly allocated to either a waitlist condition or treatment consisting of applied relaxation, with the addition of problem solving, assertiveness, communication strategies, sleep management, and relapse prevention. Results: Few statistically significant effects were found on measures of pain, mood, anxiety, and quality of life; however, a significant treatment effect with a between group effect size of d = 1.0 was observed with respect to perceived ability to function despite the discomfort of pain. Conclusion: The study provides some preliminary support for the use of group-based CBT with a focus on applied relaxation for older adults with chronic pain.
Objective: The purpose of the study was to investigate future thinking in a group of tinnitus patients. It was predicted that participants in the tinnitus group would report fewer positive future events. Methods: A cross-sectional design was used. Two groups of participants completed the test session: tinnitus patients (n=20) and healthy controls (n=20) without tinnitus. Participants completed measures of anticipation of future positive and negative experiences, anxiety and depression. In addition, participants with tinnitus completed a test of tinnitus annoyance. Results: Tinnitus participants generated a greater number of negative future events compared to the controls. There was no difference between the groups on positive future events or on self-reported anxiety, but the tinnitus group scored higher on a depression measure. Controlling for depression scores removed the group difference. Conclusions: While the groups differed on future thinking, the difference concerned negative events, which suggests that anxious information processing might be important in explaining tinnitus annoyance. Levels of depressive symptoms should, however, be considered. © 2007 Elsevier Inc. All rights reserved.
Purpose of review The aim of this paper is to provide an updated review of recent controlled trials of Internet interventions for health conditions and how the Internet is used to promote health. Recent findings We identified 18 published trials including studies on diabetes, cancer, pain conditions, obesity, irritable bowel syndrome, stress management, hypertension, metabolic syndrome, cerebral palsy, infertility, HIV infection, and fruit/vegetable consumption. Of the 18 trials, one-third targeted children and adolescents. Two cancer studies investigated the role of peer support in an online environment that failed to result in any major improvements. Overall, several trials did not result in any substantial significant improvements, but there are exceptions, such as treatment of irritable bowel syndrome, headache, and chronic pain. Although a few of the reviewed studies had sufficient sample sizes, the majority were small and underpowered. In particular, this was the case for the studies on children and adolescents. Summary This review suggests that Internet interventions hold some promise as a complement to other treatments such as cognitive behavior therapy. The benefits from participating in online peer support groups are not clear. Although studies on children and adolescents have emerged, there is a lack of studies on older adults with health problems.
The present study investigated the role of overprediction in patients with vestibular disorders. The study was set up to investigate if the match/mismatch model is applicable for vestibular disorders. This model suggests that a tendency to overestimate the subjective impact of aversive events exists, and that this is a common psychological phenomenon. A group of 20 patients with dizziness and 20 normal controls participated in the experiment. The first part of the experiment consisted of nine spontaneous predictions. During all trials, vibratory calf stimulation of 80 Hz was provided to affect balance. In the second part of the experiment each group was split (randomly assigned) into one overprediction and one underprediction group, who received either 40 or 100 Hz calf stimulation with the change occurring in the fourth trial. Body sway was measured by a force platform. Included also were self-report inventories and measures of predicted and experienced body sway and risk of losing balance. The results showed that the patients overpredicted the first trial to a lesser degree than the controls. In the control group a repeated measures effect was found, but not in the patient group. However, in terms of percentages of correct predictions both groups improved as the trials proceeded. Induced under- or over-prediction was obtained for perceived body sway, but not for the prediction of risk of losing balance, where the overprediction groups instead underpredicted. Body sway data did not result in any interactions, but controls became more stable over trials. Implications for the proposed link between vestibular dysfunction and panic disorder are discussed. © 2008 Informa UK Ltd. (Informa Healthcare, Taylor & Francis As).
Conclusions: The role of cognition in tinnitus is difficult to ignore. First, tinnitus is likely to disrupt cognitive functioning, and there are some indications that tinnitus patients have impaired capacity to perform certain cognitive tasks. Second, evidence is emerging that tinnitus patients show cognitive bias in the way they handle information. Such information processing style suggests either depressive functioning, or anxious vigilance, or both. Finally, self-report measures of tinnitus distress all require conscious recollection of how tinnitus is perceived and the consequences of tinnitus. Such reports necessitate cognitive capacity. Objectives: To review the literature on the interface between cognitive function and tinnitus with special regard to the role of different levels of information processing. Materials and methods: A selective systematic literature search was conducted using the search engines of Medline and Psychological Abstracts, and by hand search of conference proceedings. Results: There are yet relatively few published studies on cognitive functioning in tinnitus patients. Most research has been conducted by a few separate research groups. However, the available studies clearly implicate an important role of cognitive processes at different levels from basic cognitive function to more conscious appraisal of the consequences of tinnitus. Finally, a tentative model of the road from tinnitus generation to annoyance via cognitive function is suggested.
With the advent of the Internet, delivered assessment applications are likely to make a difference in clinical psychology and in health care in general. The purpose of the present paper was to present an overview of the authors' experience regarding Internet administration of diagnostic interviews, questionnaires, and information processing tests. A conclusion is made that psychiatric assessments via the Internet are not yet to be recommended, but that questionnaire assessments are likely to generate equivalent or even superior data quality than traditional paper and pencil administration. Finally, the use of Internet-delivered tests of information processing is commented upon. Although these tests have been influential in theory development in clinical psychology, large-scale dissemination of tests has been slowed down by the need for laboratory facilities. Internet administration can provide new opportunities to administer tests from the patient's own home.
We focus this theoretical paper on a neglected distinction in tinnitus research between moderators and mediators of tinnitus distress. A moderator variable is one that influences the strength of a relationship between two other variables. In the paper we propose that several variables might act as moderators of tinnitus distress. Degree of hearing loss, arousal, insomnia, characteristics of tinnitus, noise sensitivity, and a range of psychological factors such as personality and perceived control are discussed as potential moderators. We then move on to mediator variables. A mediator variable is one that explains the relationship between the two other variables, and must by definition be caused by a predictor, and then mediate between the predictor and the dependent variable. We propose that stress levels (caused by tinnitus), classical conditioning, selective attention towards tinnitus, and psychological acceptance of tinnitus (versus experiential avoidance) might be mediators of distress. We encourage more research on moderators and mediators of tinnitus distress, as these will help illuminate treatment protocols and how they might work.
Baguley and Andersson have created a definitive resource on hyperacusis which summarizes present knowledge from both psychological and auditory neuroscience perspectives for a clinical audiology audience. Hyperacusis is a troublesome symptom which is attracting increasing interest from clinicians and researchers alike. Hyperacusis: Mechanisms, Diagnosis, and Therapies summarizes and critically reflects upon present knowledge, including insights from auditory neuroscience, psychology and clinical audiology. The implications for therapy are made explicit, and the treatment options available are discussed. The authors, Dr. David Baguley (Cambridge, UK) and Professor Gerhard Andersson (Linkoping, Sweden), are well-known experts in the field, and have published widely on hyperacusis and related topics. Their multi-disciplinary collaboration considers hyperacusis in a reflective and innovative manner.Show more Show less Hyperacusis is a troublesome symptom which is attracting increasing interest from clinicians and researchers alike. Hyperacusis: Mechanisms, Diagnosis, and Therapies summarizes and critically reflects upon present knowledge, including insights from auditory neuroscience, psychology and clinical audiology. The implications for therapy are made explicit, and the treatment options available are discussed. The authors, Dr. David Baguley (Cambridge, UK) and Professor Gerhard Andersson (Linköping, Sweden), are well-known experts in the field, and have published widely on hyperacusis and related topics. Their multi-disciplinary collaboration considers hyperacusis in a reflective and innovative manner.
ackground: Internet-based self-help treatment with minimal therapist contact has been shown to have an effect in treating various conditions. The objective of this study was to explore participants views of Internet administrated guided self-help treatment for depression. less thanbrgreater than less thanbrgreater thanMethods: In-depth interviews were conducted with 12 strategically selected participants and qualitative methods with components of both thematic analysis and grounded theory were used in the analyses. less thanbrgreater than less thanbrgreater thanResults: Three distinct change processes relating to how participants worked with the treatment material emerged which were categorized as (a) Readers, (b) Strivers, and (c) Doers. These processes dealt with attitudes towards treatment, views on motivational aspects of the treatment, and perceptions of consequences of the treatment. less thanbrgreater than less thanbrgreater thanConclusions: We conclude that the findings correspond with existing theoretical models of face-to-face psychotherapy within qualitative process research. Persons who take responsibility for the treatment and also attribute success to themselves appear to benefit more. Motivation is a crucial aspect of guided self-help in the treatment of depression.
Internet-based self-help for social phobia with minimal therapist support via email have shown efficacy in several controlled trials by independent research teams. The role and necessity of therapist guidance is, however, still largely unclear. The present study compared the benefits of a 10-week web-based unguided self-help treatment for social phobia with the same intervention complemented with minimal, although weekly, therapist support via email. Further, a third treatment arm was included, in which the level of support was flexibly stepped up, from no support to email or telephone contact, on demand of the participants. Eighty-one individuals meeting diagnostic criteria for social phobia were randomly assigned to one of the three conditions. Primary outcome measures were self-report measures of symptoms of social phobia. Secondary outcome measures included symptoms of depression, interpersonal problems, and general symptomatology. Measures were taken at baseline, post-treatment, and at 6-month follow-up. Data from a telephone-administered diagnostic interview conducted at post-treatment were also included. Results showed significant symptom reductions in all three treatment groups with large effect sizes for primary social phobia measures (Cohens d=1.47) and for secondary outcome measures (d=1.16). No substantial and significant between-groups effects were found on any of the measures (Cohens d=00-.36). Moreover, no difference between the three conditions was found regarding diagnosis-free status, clinically significant change, dropout rates, or adherence measures such as lessons or exercises completed. These findings indicate that Internet-delivered treatment for social phobia is a promising treatment option, whether no support is provided or with two different types of therapist guidance.
Internet-delivered self-help for depression with therapist guidance has shown efficacy in several trials. Results from meta-analyses suggest that guidance is important and that self-help programs without support are less effective. However, there are no direct experimental comparisons between guided and unguided internet-based treatments for depression. The present study compared the benefits of a 10-week web-based unguided self-help treatment with the same intervention complemented with weekly therapist support via e-mail. A waiting-list control group was also included. Seventy-six individuals meeting the diagnostic criteria of major depression or dysthymia were randomly assigned to one of the three conditions. The Beck Depression Inventory (BDI-II) was used as the primary outcome measure. Secondary outcomes included general psychopathology, interpersonal problems, and quality of life. Sixty-nine participants (91%) completed the assessment at posttreatment and 59 (78%) at 6-month follow-up. Results showed significant symptom reductions in both treatment groups compared to the waiting-list control group. At posttreatment, between-group effect sizes on the BDI-II were d = .66 for unguided self-help versus waiting-list and d = 1.14 for guided self-help versus waiting-list controls. In the comparison of the two active treatments, small-to-moderate, but not statistically significant effects in favor of the guided condition were found on all measured dimensions. In both groups, treatment gains were maintained at 6-month follow-up. The findings provide evidence that internet-delivered treatments for depression can be effective whether support is added or not. However, all participants were interviewed in a structured diagnostic telephone interview before inclusion, which prohibits conclusions regarding unguided treatments that are without any human contact.
BACKGROUND: Internet-administered cognitive behavioural therapy (ICBT) has been found to be effective for a range of anxiety disorders. However, most studies have focused on one specific primary diagnosis and co-morbidity has not been considered. In primary care settings, patients with anxiety often suffer from more than one psychiatric condition, making it difficult to disseminate ICBT for specific conditions. The aim of this study will be to investigate if ICBT tailored according to symptom profile can be a feasible treatment for primary care patients with anxiety disorders. It is a randomised controlled trial aimed to evaluate the treatment against an active control group. METHODS: Participants with anxiety disorders and co-morbid conditions (N = 128), will be recruited from a primary care population. The Clinical Outcome in Routine Evaluation (CORE-OM) will serve as the primary outcome measure. Secondary measures include self-reported depression, anxiety, quality of life and loss of production and the use of health care. All assessments will be collected via the Internet and measure points will be baseline, post treatment and 12 months post treatment. DISCUSSION: This trial will add to the body of knowledge on the effectiveness of ICBT for anxiety disorders in primary care. The trial will also add knowledge on the long term effects of ICBT when delivered for regular clinic patients Trial registration: Clinical trials identifier NCT01390168.
Panic disorder with or without agoraphobia (PD/A) is common and can be treated effectively with selective serotonin reuptake inhibitor (SSRI) medication or cognitive-behaviour therapy (CBT). However, the lack of access to CBT services has motivated the development of self-help approaches requiring less therapist contact. A novel treatment modality in this field, showing efficacy in several randomized trials but until now not evaluated within the context of regular psychiatric care, is Internet-based treatment. The aim of the present study was to evaluate the effectiveness of Internet-based CBT for patients in a psychiatric setting. Twenty consecutively referred patients with PD were included in the study. A structured clinical interview with a psychiatrist was conducted for inclusion, as well as at post-treatment and at the 6-month follow-up. The treatment consisted of a 10-week CBT-based self-help programme, including minimal therapist support by e-mail. At post-treatment, 94% of patients no longer met DSM-IV criteria for PD (82% at 6-month follow-up). The within-group effect sizes (for the main outcome PDSS; Panic Disorder Severity Scale) were Cohens d=2.5 (pre- to post-treatment) and 2.8 (pre-treatment to follow-up), respectively. The proportion of responders on the PDSS was 75% at post-treatment and 70% at 6-month follow-up. The results supports earlier efficacy data on Internet-based CBT for PD and indicates that it is effective also within a regular psychiatric setting. However, a larger randomized controlled trial should be conducted, directly comparing Internet-based CBT with traditionally administered CBT within such a setting.
Background: Internet administered cognitive behaviour therapy (CBT) is a promising new way to deliver psychological treatment, but its effectiveness in regular care settings and in relation to more traditional CBT group treatment has not yet been determined. The primary aim of this study was to compare the effectiveness of Internet- and group administered CBT for panic disorder (with or without agoraphobia) in a randomised trial within a regular psychiatric care setting. The second aim of the study was to establish the cost-effectiveness of these interventions. Methods: Patients referred for treatment by their physician, or self-referred, were telephone-screened by a psychiatric nurse. Patients fulfilling screening criteria underwent an in-person structured clinical interview carried out by a psychiatrist. A total of 113 consecutive patients were then randomly assigned to 10 weeks of either guided Internet delivered CBT (n = 53) or group CBT (n = 60). After treatment, and at a 6-month follow-up, patients were again assessed by the psychiatrist, blind to treatment condition. Results: Immediately after randomization 9 patients dropped out, leaving 104 patients who started treatment. Patients in both treatment conditions showed significant improvement on the main outcome measure, the Panic Disorder Severity Scale (PDSS) after treatment. For the Internet treatment the within-group effect size (pre-post) on the PDSS was Cohens d = 1.73, and for the group treatment it was d = 1.63. Between group effect sizes were low and treatment effects were maintained at 6-months follow-up. We found no statistically significant differences between the two treatment conditions using a mixed models approach to account for missing data. Group CBT utilised considerably more therapist time than did Internet CBT. Defining effect as proportion of PDSS responders, the cost-effectiveness analysis concerning therapist time showed that Internet treatment had superior cost-effectiveness ratios in relation to group treatment both at post-treatment and follow-up. Conclusions: This study provides support for the effectiveness of Internet CBT in a psychiatric setting for patients with panic disorder, and suggests that it is equally effective as the more widely used group administered CBT in reducing panic-and agoraphobic symptoms, as well as being more cost effective with respect to therapist time.