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  • 1.
    Andersson, Gerhard
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology. Karolinska Inst, Sweden.
    Carlbring, Per
    Stockholm Univ, Sweden; Univ Southern Denmark, Denmark.
    Titov, Nickolai
    Macquarie Univ, Australia.
    Lindefors, Nils
    Karolinska Inst, Sweden.
    Internet Interventions for Adults with Anxiety and Mood Disorders: A Narrative Umbrella Review of Recent Meta-Analyses2019In: Canadian journal of psychiatry, ISSN 0706-7437, Vol. 64, no 7, p. 465-470Article, review/survey (Refereed)
    Abstract [en]

    Internet-delivered cognitive behaviour therapy (ICBT) has existed for 20 years and there are now several controlled trials for a range of problems. In this paper, we focused on recent meta-analytic reviews of the literature and found moderate to large effects reported for panic disorder, social anxiety disorder, generalized anxiety disorder, posttraumatic stress disorder, and major depression. In total, we reviewed 9 recent meta-analytic reviews out of a total of 618 meta-analytic reviews identified using our search terms. In these selected reviews, 166 studies were included, including overlap in reviews on similar conditions. We also covered a recent review on transdiagnostic treatments and 2 reviews on face-to-face v. internet treatment. The growing number of meta-analytic reviews of studies now suggests that ICBT works and can be as effective as face-to-face therapy.

  • 2.
    Beukes, Eldre W.
    et al.
    Lamar Univ, TX 77710 USA; Anglia Ruskin Univ, England.
    Manchaiah, Vinaya
    Lamar Univ, TX 77710 USA; Manipal Univ, India; Audiol India, India.
    Allen, Peter M.
    Lamar Univ, TX 77710 USA; Anglia Ruskin Univ, England.
    Baguley, David M.
    Nottingham Biomed Res Ctr, England; Univ Nottingham, England; Nottingham Univ Hosp, England.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology. Karolinska Inst, Sweden.
    Internet-Based Interventions for Adults With Hearing Loss, Tinnitus, and Vestibular Disorders: A Systematic Review and Meta-Analysis2019In: TRENDS IN HEARING, ISSN 2331-2165, Vol. 23, article id 2331216519851749Article, review/survey (Refereed)
    Abstract [en]

    Internet-based interventions have been developed to improve access to audiovestibular health care. This review aimed to identify outcomes of Internet interventions for adults with hearing loss, tinnitus, and vestibular disorders. Electronic databases and manual searches were performed to identify studies meeting eligibility for inclusion. Fifteen studies (1,811 participants) met the inclusion criteria, with nine studies targeting tinnitus distress, five considering hearing loss, and one for vestibular difficulties. Only the tinnitus and hearing loss Internet intervention studies were eligible for data synthesis. Internet-based interventions for hearing loss were diverse. Overall, they showed no significant effects, although a statistically significant moderate effect (d = 0.59) was found after removing the study with the highest risk of bias (as a result of high attrition). Most Internet-based interventions for tinnitus provided cognitive behavioural therapy. They yielded statistically significant mean effect sizes for reducing tinnitus distress compared with both inactive (d = 0.59) and active controls (d = 0.32). Significant effects were also present for the secondary outcomes of anxiety, depression, insomnia, and quality of life (combined effect d = 0.28). Only Internet-based interventions for tinnitus evaluated the 1-year postintervention effects indicated that results were maintained long term (d = 0.45). Scientific study quality was appraised using the Grading of Recommendations Assessment, Development and Evaluation approach and found to vary from very low to moderate. This review indicates the potential of Internet interventions for tinnitus to provide evidence-based accessible care. There is a need for additional high-quality evidence before conclusive results can be established regarding the effects of audiovestibular Internet interventions.

  • 3.
    Boersma, Katja
    et al.
    Orebro Univ, Sweden.
    Södermark, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Hesser, Hugo
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology.
    Flink, Ida K.
    Orebro Univ, Sweden.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Linton, Steven J.
    Orebro Univ, Sweden.
    Efficacy of a transdiagnostic emotion-focused exposure treatment for chronic pain patients with comorbid anxiety and depression: a randomized controlled trial2019In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 160, no 8, p. 1708-1718Article in journal (Refereed)
    Abstract [en]

    The comorbidity between chronic pain and emotional problems has proven difficult to address with current treatment options. This study addresses the efficacy of a transdiagnostic emotion-focused exposure treatment ("hybrid") for chronic pain patients with comorbid emotional problems. Adults (n = 115) with chronic musculoskeletal pain and functional and emotional problems were included in a 2-centre, parallel randomized controlled, open-label trial comparing this treatment to an active control condition receiving a guided Internet-delivered pain management treatment based on CBT principles (iCBT). The hybrid treatment (n = 58, 10-16 sessions) integrates exposure in vivo for chronic pain based on the fear-avoidance model with an emotion-regulation approach informed by procedures in Dialectical Behavior Therapy. The iCBT (n = 57; 8 treatment modules) addresses topics such as pain education, coping strategies, relaxation, problem solving, stress, and sleep management using standard CBT techniques. Patient-reported outcomes were assessed before and after treatment as well as at a 9-month primary end point. Across conditions, 78% participants completed post-treatment and 81% follow-up assessment. Intent-to-treat analyses showed that the hybrid had a significantly better post-treatment outcome on pain catastrophizing (d = 0.39) and pain interference (d = 0.63) and significantly better follow-up outcomes on depression (d = 0.43) and pain interference (d = 0.51). There were no differences on anxiety and pain intensity. Observed proportions of clinically significant improvement favoured the hybrid on all but one comparison, but no statistically significant differences were observed. We conclude that the hybrid emotion-focused treatment may be considered an acceptable, credible, and efficacious treatment option for chronic pain patients with comorbid emotional problems.

  • 4.
    Kothari, Radha
    et al.
    UCL, England.
    Barker, Chris
    UCL, England.
    Pistrang, Nancy
    UCL, England.
    Rozental, Alexander
    UCL, England; Karolinska Inst, Sweden.
    Egan, Sarah
    Curtin Univ, Australia.
    Wade, Tracey
    Flinders Univ S Australia, Australia.
    Allcott-Watson, Hannah
    UCL, England.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology. Karolinska Inst, Sweden.
    Shafran, Roz
    UCL, England.
    A randomised controlled trial of guided internet-based cognitive behavioural therapy for perfectionism: Effects on psychopathology and transdiagnostic processes2019In: Journal of Behavior Therapy and Experimental Psychiatry, ISSN 0005-7916, E-ISSN 1873-7943, Vol. 64, p. 113-122Article in journal (Refereed)
    Abstract [en]

    Background and objectives

    Perfectionism is a transdiagnostic process that has been associated with a range of psychopathology and also with other transdiagnostic processes. We have previously shown that guided internet-based cognitive behavioural therapy (ICBT) can reduce symptoms of dysfunctional perfectionism, however, no impact was observed on symptoms of depression and anxiety. Here we explore the impact of guided ICBT for perfectionism on symptoms of other associated psychopathology, specifically obsessive-compulsive disorder (OCD) and eating disorders, and also on other associated transdiagnostic processes (self-esteem, intolerance of uncertainty, and self-compassion).

    Methods

    Participants who presented with clinical levels of perfectionism were randomised to an experimental group that received the intervention (n = 62), or a wait list control group (n = 58). Questionnaires assessing symptoms of OCD, eating disorders, self-esteem, intolerance of uncertainty, and fear of self-compassion were completed pre-intervention, post-intervention (12 weeks), and at follow-up (24 weeks). Between group effect sizes are reported.

    Results

    The intervention led to significant decreases in symptoms of OCD (d = −0.9; CI: -1.4, −0.4) and eating disorders (d = −0.6; CI: -1.0, −0.1), and had an impact on other transdiagnostic processes resulting in increased self-esteem (d = 0.7; CI: 0.2, 1.2), decreases in intolerance of uncertainty (d = −0.9; CI: -1.4, −0.4), and fear of self-compassion (d = −0.8; CI: -1.3, −0.3). At follow-up changes were maintained in symptoms of OCD (d = −1.3; CI: -1.8, −0.8), disordered eating (d = −0.7; CI: -1.2, −0.2), intolerance of uncertainty (d = −0.8; CI: -1.2, −0.3), and fear of self-compassion (d = −1.0; CI: -1.5, −0.5).

    Conclusions

    Guided ICBT for perfectionism improves associated psychopathology and transdiagnostic processes. ClinicalTrials.gov registration no. NCT02756871.

  • 5.
    Lindner, Philip
    et al.
    Stockholm Univ, Sweden; Karolinska Inst, Sweden; Stockholm Cty Council, Sweden.
    Miloff, Alexander
    Stockholm Univ, Sweden.
    Fagernas, Simon
    Uppsala Univ, Sweden.
    Andersen, Joel
    Stockholm Univ, Sweden.
    Sigeman, Martin
    Stockholm Univ, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology. Karolinska Inst, Sweden; Stockholm Cty Council, Sweden.
    Furmark, Tomas
    Uppsala Univ, Sweden.
    Carlbring, Per
    Stockholm Univ, Sweden; Univ Southern Denmark, Denmark.
    Therapist-led and self-led one-session virtual reality exposure therapy for public speaking anxiety with consumer hardware and software: A randomized controlled trial (vol 61, pg 45, 2019)2019In: Journal of Anxiety Disorders, ISSN 0887-6185, E-ISSN 1873-7897, Vol. 64, p. 90-90Article in journal (Refereed)
    Abstract [en]

    n/a

  • 6.
    Magnusson, Kristoffer
    et al.
    Karolinska Inst, Sweden.
    Nilsson, Anders
    Karolinska Inst, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology. Karolinska Inst, Sweden.
    Hellner, Clara
    Karolinska Inst, Sweden.
    Carlbring, Per
    Stockholm Univ, Sweden; Univ Southern Denmark, Denmark.
    Internet-Delivered Cognitive-Behavioral Therapy for Significant Others of Treatment-Refusing Problem Gamblers: A Randomized Wait-List Controlled Trial2019In: Journal of Consulting and Clinical Psychology, ISSN 0022-006X, E-ISSN 1939-2117, Vol. 87, no 9, p. 802-814Article in journal (Refereed)
    Abstract [en]

    Objective: Problem gambling can cause severe harm to concerned significant others (CSOs) in the form of, for example, relationship problems, financial difficulties, and mental and physical illness. CSOs are important for their ability to support problem gamblers and motivate them to change. This study investigated the effect of an Internet-based intervention for CSOs of treatment-refusing problem gamblers on (a) gambling-related harm, (b) the gamblers’ treatment-seeking rate, and (c) the relationship satisfaction and mental health of the CSOs. 

    Method: A total of 100 CSOs of problem gamblers were randomized into one of two conditions: Internet-delivered cognitive–behavioral therapy for CSOs or a wait-list control group. The intervention group was given Internet-based treatment consisting of nine modules with therapist support available via telephone and e-mail. Outcome measures were collected up 12 months posttreatment. 

    Results: The intervention improved the psychological well-being of the CSOs compared to the wait-list group at the posttest (CSO’s emotional consequences: d= −0.90, 95% CI [−1.47, −0.33]; relationship satisfaction: d = 0.41, 95% CI [0.05, 0.76]; anxiety: d = −0.45, 95% CI [−0.81, −0.09]; depression: d = −0.49, 95% CI [−0.82, −0.16]). However, the effects on the gambling outcomes were small and inconclusive (gambling losses: multiplicative effect = 0.73, 95% CI [0.29, 1.85]; treatment-seeking: hazard ratio = 0.86, 95% CI [0.31, 2.38]). 

    Conclusion: The results confirm earlier studies’ findings that affecting the gambler via a CSO is challenging, but it is possible to increase the CSO’s coping and well-being. The trial’s outcome data and scripts are available for download (https://osf.io/awtg7/).

  • 7.
    Manchaiah, Vinaya
    et al.
    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. Lamar Univ, TX 77710 USA; Audiol India, India; Manipal Univ, India.
    Abrams, Harvey
    Univ S Florida, FL USA.
    Bailey, Abram
    Hearing Tracker Inc, TX USA.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology. Karolinska Inst, Sweden.
    Negative Side Effects Associated with Hearing Aid Use in Adults with Hearing Loss2019In: Journal of american academy of audiology, ISSN 1050-0545, E-ISSN 2157-3107, Vol. 30, no 6, p. 472-481Article in journal (Refereed)
    Abstract [en]

    Background:

    The low uptake of hearing aids in the United States has been attributed to a number of reasons, including low perceived hearing disability, limited perceived benefit and cost. Another possible reason may be related to negative side effects associated with hearing aid use.

    Purpose:

    The present study was aimed at determining and classifying the negative side effects associated with hearing aid use in adults with hearing loss.

    Research Design:

    The study used a cross-sectional survey design.

    Study Sample:

    Five hundred and twelve participants completed an electronic survey.

    Data Collection and Analysis:

    The data was collected using the negative side effects of hearing aids (NSE-HAs) questionnaire. Data were analyzed using Chi square analysis, principal components analysis, and calculation of Cronbach’s alpha.

    Results:

    Some individuals reported negative side effects for all 32 items. However, careful examination of results suggests that, as a whole, reported negative side effects tend to be mild with mean scores falling close to the lower quartile of the total scores. Chi square test results suggest that the variables of age, gender, duration of hearing loss, self-reported hearing disability, and duration of hearing aid use seem to be significantly associated with the reported negative side effects. The NSE-HAs questionnaire was found to have a complex structure as indicated by the principal components analysis. However, good internal consistency was found in both the full scale and subscales.

    Conclusions:

    The present study suggests that, although a large number of adults with hearing loss who use hearing aids experience some degree of negative side effects, those effects tend to be mild.

  • 8.
    Manchaiah, Vinaya
    et al.
    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. Lamar Univ, TX 77710 USA; Audiol India, India; Manipal Univ, India.
    Beukes, Eldre W.
    Anglia Ruskin Univ, England.
    Granberg, Sarah
    Orebro Univ, Sweden; Orebro Univ Hosp, Sweden.
    Durisala, Naresh
    GN Hearing Pte Ltd, Singapore.
    Baguley, David M.
    Anglia Ruskin Univ, England; Univ Nottingham, England; Univ Nottingham, England.
    Allen, Peter M.
    Anglia Ruskin Univ, England; Anglia Ruskin Univ, England.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology. Karolinska Inst, Sweden.
    Problems and Life Effects Experienced by Tinnitus Research Study Volunteers: An Exploratory Study Using the ICF Classification2018In: Journal of american academy of audiology, ISSN 1050-0545, E-ISSN 2157-3107, Vol. 29, no 10, p. 936-947Article in journal (Refereed)
    Abstract [en]

    Background: Tinnitus is one of the most distressing hearing-related symptoms. It is often associated with a range of physiological and psychological complications, such as depression, anxiety, and insomnia. Hence, approaching tinnitus from a biopsychological perspective may be more appropriate than from purely a biomedical model. Objective: The present study was aimed at determining the relationship between tinnitus and the problems and life effects experienced by UK-based tinnitus research study volunteers. Open-ended questions were used. Responses were classified using the International Classification of Functioning, Disability and Health (ICF) framework to understand the impact of tinnitus in a multidimensional manner using a biopsychosocial perspective. Research Design: A cross-sectional survey design was used. Study Sample: Study sample included a sample of 240 adults with tinnitus who were interested in undertaking an Internet-based intervention for tinnitus. Data Collection and Analysis: The data were collated using two open-ended questions. The first focused on problems related to having tinnitus and the second to life effects as a result of tinnitus. Responses were analyzed using a simplified content analysis approach to link concepts to ICF categories in accordance with established linking rules. A Wilcoxon signed-rank test was performed to compare the number of responses between the two questions. Results: There were 764 responses related to problems identified, 797 responses associated with life effects due to tinnitus, and 37 responses that did not fit into any ICF category. No significant differences were observed in the number of responses between the two questions. In addition, no significant association between the number of responses reported and demographic variables was found. Most of the problems and life effects experienced by tinnitus sufferers were related to body function, followed by activity limitations, and participation restrictions. Only a few responses were related to environmental and personal factors. The most frequent responses related to body function involved "emotional functions" (b152), "sleep functions" (b134), "hearing functions" (b230), "sustaining attention" (b1400), and "energy level" (b1300). For activity limitations and participation restrictions they were "communicating with-receiving-spoken messages" (d310), "socialization" (d9205), "handling stress and other psychological demands" (d240), and "recreation and leisure" (d920). The most frequently occurring responses related to environmental factors were "sound intensity" (e2500), "sound quality" (e2501), and "general products and technology for communication" (e1250). "Coping styles" was the most frequently occurring personal factor. Conclusions: The study highlights the use of open-ended questions in gathering useful information about the impact of tinnitus. The responses coded to ICF show that tinnitus impacts many domains, not only particularly body function, but also activity limitations and participation restrictions. The results demonstrate the heterogeneous nature of the impact of tinnitus on people affected.

  • 9.
    Manchaiah, Vinaya
    et al.
    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. Lamar Univ, TX 77710 USA; Audiol India, India; Manipal Univ, India.
    Dockens, Ashley L.
    Lamar Univ, TX 77710 USA.
    Flagge, Ashley
    Lamar Univ, TX 77710 USA.
    Bellon-Harn, Monica
    Lamar Univ, TX 77710 USA.
    Azios, Jamie Hartwell
    Lamar Univ, TX 77710 USA.
    Kelly-Campbell, Rebecca J.
    Univ Canterbury, New Zealand.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology. Karolinska Inst, Sweden.
    Quality and Readability of English-Language Internet Information for Tinnitus2019In: Journal of american academy of audiology, ISSN 1050-0545, E-ISSN 2157-3107, Vol. 30, no 1, p. 31-40Article in journal (Refereed)
    Abstract [en]

    Background:

    Because of the wealth of information available on the internet and increasing numbers of individuals relying on websites as a primary source of information for health-related questions, it is important that the readability of their content is within the comprehension level of most readers.

    Objective:

    The study evaluated the quality and readability of English-language Internet information for tinnitus.

    Research Design:

    Analysis of Internet websites on tinnitus.

    Study Sample:

    A total of 134 websites with tinnitus information.

    Data Collection and Analysis:

    Three key words (i.e., tinnitus, ringing in the ear, and buzzing in the ear) were entered in five country-specific versions of the most commonly used internet search engine in August 2016. For each of the 15 searches, the first 20 relevant websites were examined. After removing duplicates, a total of 134 websites were assessed. Their origin (commercial, nonprofit organization, government, personal, or university), quality (Health On the Net [HON] certification and DISCERN scores), and readability (Flesch Reading Ease score, Flesch-Kincaid Reading Grade Level Formula, and Simple Measure of Gobbledygook) were assessed.

    Results:

    Most websites were of commercial (49.3%) or nonprofit organization (38.8%) origin. Their quality and readability was highly variable. Only 13.5% of websites had HON certification. χ2 analysis showed that there was significant association between website origin and HON certification [χ2(4) = 132.9, p < 0.0001]. The mean DISCERN scores were 2.39. No association between DISCERN scores and website origin was found. Readability measures showed that on average, only people with at least 10‐12 yr of education could read and understand the internet information for tinnitus in websites. Almost all the websites exceeded the most stringent reading level recommended for health information.

    Conclusions:

    The results highlight great variability in the quality and readability of health information, specifically for tinnitus in the internet. These findings underscores the need for stakeholders (e.g., web-developers, clinicians) to be aware of this and to develop more user-friendly health information on websites to make it more accessible for people with low literacy.

  • 10.
    Miloff, Alexander
    et al.
    Stockholm Univ, Sweden.
    Lindner, Philip
    Stockholm Univ, Sweden; Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden.
    Dafgard, Peter
    Stockholm Univ, Sweden.
    Deak, Stefan
    Stockholm Univ, Sweden.
    Garke, Maria
    Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden.
    Hamilton, William
    Mimerse AB, Sweden.
    Heinsoo, Julia
    Stockholm Univ, Sweden.
    Kristoffersson, Glenn
    Stockholm Univ, Sweden.
    Rafi, Jonas
    Stockholm Univ, Sweden.
    Sindemark, Kerstin
    Stockholm Univ, Sweden.
    Sjolund, Jessica
    Stockholm Univ, Sweden.
    Zenger, Maria
    Stockholm Univ, Sweden.
    Reuterskiold, Lena
    Stockholm Univ, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology. Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden.
    Carlbring, Per
    Stockholm Univ, Sweden; Univ Southern Denmark, Denmark.
    Automated virtual reality exposure therapy for spider phobia vs. in-vivo one-session treatment: A randomized non-inferiority trial2019In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 118, p. 130-140Article in journal (Refereed)
    Abstract [en]

    Objective This study compared the efficacy of a technician-assisted single-session virtual reality exposure therapy (VRET) for the treatment of spider phobia featuring low-cost consumer-available hardware and novel automated software to gold-standard in-vivo one-session treatment (OST), using a parallel group randomized non-inferiority design.

    Method Participants (N = 100) were randomized to VRET and OST arms. Assessors blinded to treatment allocation evaluated participants at pre- and post-treatment as well follow-up (3 and 12 months) using a behavioral approach test (BAT) and self-rated fear of spider, anxiety, depression and quality-of-life scales. A maximum post-treatment difference of 2-points on the BAT qualified as non-inferiority margin.

    Results Linear mixed models noted large, significant reductions in behavioral avoidance and self-reported fear in both groups at post-treatment, with VRET approaching the strong treatment benefits of OST over time. Non-inferiority was identified at 3- and 12- months follow-up but was significantly worse until 12-months. There was no significant difference on a questionnaire measuring negative effects.

    Conclusions Automated VRET efficaciously reduced spider phobia symptoms in the short-term and was non-inferior to in-vivo exposure therapy in the long-term. VRET effectiveness trials are warranted to evaluate real-world benefits and non-specific therapeutic factors accruing from the presence of a technician during treatment.

  • 11.
    Nygren, Tomas
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Brohede, David
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences. ing, SE-58183 Linkoping, Sweden.
    Koshnaw, Kocher
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Osman, Shevan Sherzad
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Johansson, Robert
    Stockholm Univ, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology. Karolinska Inst, Sweden.
    Internet-based treatment of depressive symptoms in a Kurdish population: A randomized controlled trial2019In: Journal of Clinical Psychology, ISSN 0021-9762, E-ISSN 1097-4679, Vol. 75, no 6, p. 985-998Article in journal (Refereed)
    Abstract [en]

    Objective Kurdish immigrants in Sweden have a doubled risk of mental health problems, and refugee and immigrant populations underutilize mental health services. The present study investigated the efficacy of culturally adapted guided internet-based cognitive behavior therapy (ICBT) for depressive symptoms in a Kurdish population. Method We included 50 individuals who were randomized to either an 8-week treatment or a wait-list. The Beck Depression Inventory-II was the primary outcome measure, and measures of anxiety and insomnia were secondary outcomes. Results Depressive symptoms were significantly reduced (intention-to-treat analysis) in the treatment group, with a between-group effect size at posttreatment of Cohens d = 1.27. Moderate to large between-group effects were also observed on all secondary outcome measures. Treatment effects were sustained at 11-month follow-up. Conclusion The results provide preliminary support for culturally adapted ICBT as a complement to other treatment formats for treating symptoms of depression in a Kurdish population.

  • 12.
    Nystrom, Markus B. T.
    et al.
    Umea Univ, Sweden.
    Hassmen, Peter
    Umea Univ, Sweden; Southern Cross Univ, Australia.
    Sorman, Daniel E.
    Umea Univ, Sweden.
    Wigforss, Thomas
    Umea Univ, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology. Karolinska Inst, Sweden.
    Carlbring, Per
    Stockholm Univ, Sweden.
    Are physical activity and sedentary behavior related to depression?2019In: COGENT PSYCHOLOGY, ISSN 2331-1908, Vol. 6, no 1, article id 1633810Article in journal (Refereed)
    Abstract [en]

    Depression is an increasing public health concern with rising prevalence. Nevertheless, far from everyone seeks help or receives adequate treatment. Although psychotherapy and antidepressants still constitute the bulk of treatments offered, recent research suggests that physical activity (PA) can be a powerful adjunct therapy while sedentary behavior (SB) is a definite risk factor for developing depression. The aim of the present study was to investigate the relationship between PA, SB and depressive symptoms in a population (n = 962) of applicants for an online treatment study. This study hypothesised that there will be; (1) a positive relationship between SB and depressive symptoms, and (2) a negative relationship between PA and depressive symptoms. In addition we investigated whether the combination of a sedentary lifestyle and physical inactivity increased the risk for depressive symptoms. Finally, we also examined whether gender, age, marital status, educational level, or medication affected the relationship between PA, SB, and depressive symptoms. The results showed a positive correlation between SB and depression. There was, however, no statistically significant support for a negative relation between PA and depressive symptoms. Even though no conclusions about causality can be drawn, our results suggest that high SB, being a woman, being young, not being in a stable relationship, and current or previous medication are risk factors for depression. To be able to determine the causal direction, that is, whether high SB increases the risk for depressive symptoms, or if depressive symptoms increase the likelihood of high SB, further research is needed.

  • 13.
    Santoft, Fredrik
    et al.
    Karolinska Inst, Sweden.
    Salomonsson, Sigrid
    Karolinska Inst, Sweden.
    Hesser, Hugo
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology.
    Lindsater, Elin
    Karolinska Inst, Sweden.
    Ljotsson, Brjann
    Karolinska Inst, Sweden.
    Lekander, Mats
    Karolinska Inst, Sweden; Stockholm Univ, Sweden.
    Kecklund, Goran
    Stockholm Univ, Sweden; Radboud Univ Nijmegen, Netherlands.
    Ost, Lars-Goran
    Karolinska Inst, Sweden; Stockholm Univ, Sweden.
    Hedman-Lagerlof, Erik
    Karolinska Inst, Sweden.
    Mediators of Change in Cognitive Behavior Therapy for Clinical Burnout2019In: Behavior Therapy, ISSN 0005-7894, E-ISSN 1878-1888, Vol. 50, no 3, p. 475-488Article in journal (Refereed)
    Abstract [en]

    Evidence supporting the effectiveness of cognitive behavior therapy (CBT) for stress-related illness is growing, but little is known about its mechanisms of change. The aim of this study was to investigate potential mediators of CBT for severe stress in form of clinical burnout, using an active psychological treatment as comparator. We used linear mixed models to analyze data from patients (N = 82) with clinical burnout who received either CBT or another psychological treatment in a randomized controlled trial. Potential mediators (i.e., sleep quality, behavioral activation, perceived competence, and therapeutic alliance) and outcome (i.e., symptoms of burnout) were assessed weekly during treatment. The results showed that the positive treatment effects on symptoms of burnout favoring CBT (estimated between-group d = 0.93) were mediated by improvements in sleep quality, ab = -0.017,95% CIasymmetric [-0.037, -0.002], and increase in perceived competence, ab = -0.037, 95% CIasymmetric [-0.070, -0.010]. Behavioral activation, ab = -0.004 [-0.016, 0.007], and therapeutic alliance, ab = 0.002 [-0.006, 0.011], did not significantly mediate the difference in effects between the treatments. Improving sleep quality and increasing perceived competence may thus constitute important process goals in order to attain symptom reduction in CBT for clinical burnout.

  • 14.
    Sarkohi, Ali
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Andersson, GerhardLinköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology.
    Somatisk sjukdom: ett biopsykosocialt perspektiv2019Collection (editor) (Other academic)
    Abstract [sv]

    Människans nyfikenhet och kreativitet har banat väg för att bättre förstå och förklara olika fenomen, bland annat vad som påverkar och vidmakthåller vår hälsa och ohälsa. Tydligt är att synen på hälsa och ohälsa har förändrats över tid. I dag finns en insikt i att kropp och själ hänger samman och att psykologiska faktorer har stor betydelse även för vår somatiska hälsa.

    I det biopsykosociala perspektivet, som presenteras i denna bok, vidgas förståelsen av den komplexa människan och av begreppen hälsa och ohälsa. Hälsa och ohälsa måste förstås inte bara som biologiska fenomen, utan också som psykologiska och sociala. I boken integreras således evidensbaserad psykologisk kunskap med etablerad kunskap om medicinska och sociala faktorers betydelse för somatisk ohälsa. På så sätt ger den stöd till främst personal inom hälso- och sjukvården i att inhämta och tillämpa kunskap från olika ämnesområden vid bedömning, förklaring och behandling av somatisk ohälsa, men också i arbetet att förebygga ohälsa.

    Bokens främsta målgrupper är yrkesverksamma inom hälso- och sjukvård samt studenter inom vård och psykologi, särskilt med inriktningen hälsopsykologi.

  • 15.
    Sjöholm, Hanna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Rehabilitation Centre, Region Jönköping County, Jönköping, Sweden.
    Hägg, Staffan
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Pharmacology. Futurum, Region Jönköping County, Jönköping, Sweden.
    Nyberg, Lars
    Department of Health Sciences, Luleå University of Technology, Luleå, Sweden.
    Rolander, Bo
    Futurum, Region Jönköping County, Jönköping, Sweden.
    Kammerlind, Ann-Sofi
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology. Futurum, Region Jönköping County, Jönköping, Sweden.
    The Cone Evasion Walk test: Reliability and validity in acute stroke2019In: Physiotherapy Research International, ISSN 1358-2267, E-ISSN 1471-2865, Vol. 24, no 1, article id e1744Article in journal (Refereed)
    Abstract [en]

    Objective

    To estimate the reliability and validity of the Cone Evasion Walk test (CEW), a new test assessing the ability to evade obstacles, in people with acute stroke.

    Methods

    To estimate the reliability of the CEW, video recordings of 20 people with acute stroke performing the test were assessed by 10 physiotherapists on two occasions, resulting in a total of 400 ratings. Patients performed the CEW (n = 221), functional ambulation classification (FAC; n = 204), Timed Up and Go (TUG; n = 173), TUG cognitive (TUG‐cog; n = 139), Serial 7s attention task from the Montreal Cognitive Assessment (MoCA‐S7; n = 127), and the Star Cancellation Test (SCT; n = 151). These tests and side of lesion (n = 143) were used to examine construct validity. The predictive validity was evaluated in relation to falls during the following 6 months (n = 203).

    Results

    The intraclass correlation coefficients for intrarater and interrater reliability were 0.88–0.98. For validity, there were significant correlations between the CEW and FAC (rs = −0.67), TUG (rs = 0.45), MoCA‐S7 (rs = −0.36), and SCT total score (rs = −0.36). There was a significant correlation between the number of cones touched on the left side and the proportion of cancelled stars on the left (rs = −0.23) and right (rs = 0.23) side in the SCT. Among right hemisphere stroke participants (n = 79), significantly more persons hit cones on the left side (n = 25) than the right side (n = 8), whereas among those with a left hemisphere stroke (n = 64) significantly more persons hit cones on the right side (n = 11) than the left (n = 3). Cox regression showed that participants who touched four to eight cones had an increased risk of falls over time (hazard ratio 2.11, 95% CI [1.07, 4.17]) compared with those who touched none.

    Conclusion

    The new CEW test was reliable and valid in assessing the ability to evade obstacles while walking and to predict falls in patients with acute stroke.

  • 16.
    Smoktunowicz, Ewelina
    et al.
    SWPS Univ Social Sci and Humanities, Poland.
    Lesnierowska, Magdalena
    SWPS Univ Social Sci and Humanities, Poland.
    Cieslak, Roman
    SWPS Univ Social Sci and Humanities, Poland; Univ Colorado, CO 80907 USA.
    Carlbring, Per
    Stockholm Univ, Sweden; Univ Southern Denmark, Denmark.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology. Karolinska Inst, Sweden.
    Efficacy of an Internet-based intervention for job stress and burnout among medical professionals: study protocol for a randomized controlled trial2019In: Trials, ISSN 1745-6215, E-ISSN 1745-6215, Vol. 20, article id 338Article in journal (Refereed)
    Abstract [en]

    BackgroundMedical professionals are at high risk of job stress and burnout. Research shows that work-related stress can be reduced through enhancing psychological resources, in particular, self-efficacy and perceived social support. These psychological resources can operate either individually or sequentially: in line with the cultivation hypothesis, self-efficacy precedes and cultivates perceived social support, whereas according to the enabling hypothesis it is perceived social support that comes first and enables self-efficacy. Based on this theoretical framework we developed an internet-based intervention, Med-Stress, dedicated to healthcare providers and aimed at reducing job stress and burnout. Med-Stress contains two modules that enhance self-efficacy and perceived social support, which are tested in four variants reflected in four study conditions. We expect that sequential enhancement of resources: self-efficacy and social support or social support and self-efficacy will yield larger posttest results than individual enhancement.MethodsIn this four-arm randomized controlled trial we will test four variants of the Med-Stress intervention. The trial is open for professionally active medical providers aged at least 18 years (N=1200) with access to an Internet-connected device. We will compare the effects of two experimental conditions reflecting cultivation and enabling effects of self-efficacy and perceived social support (sequential enhancement of resources), and two active controls strengthening self-efficacy or perceived social support. Job stress and job burnout will be the primary outcomes, whereas depression, job-related traumatic stress, and work engagement will be secondary ones. Additionally, we will measure perceived social support, self-efficacy to manage job stress and burnout, and the ability to obtain social support, exposure to traumatic events, and users expectancy and credibility of the intervention. All assessments will be applied before the intervention, atposttest (at 3 or 6weeks depending on the study condition), and at 6-month and 12-month follow up. In the case of experimental groups, additional measurements will be taken after enhancing each resource.DiscussionResource-based interventions are relatively context-free and could potentially benefit medical professionals across the field. If Med-Stress is successful, its most effective variant could be implemented in the healthcare system as a standalone, supportive tool for employees.Trial registrationClinicalTrials.gov, NCT03475290 Registered on 23 March 2018.

  • 17.
    Wade, Tracey D.
    et al.
    Flinders Univ S Australia, Australia.
    Kay, Enola
    Flinders Univ S Australia, Australia.
    de Valle, Madelaine K.
    Flinders Univ S Australia, Australia.
    Egan, Sarah J.
    Curtin Univ, Australia.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology. Karolinska Inst, Sweden.
    Carlbring, Per
    Stockholm Univ, Sweden; Univ Southern Denmark, Denmark.
    Shafran, Roz
    UCL, England.
    Internet-based cognitive behaviour therapy for perfectionism: More is better but no need to be prescriptive2019In: Clinical Psychologist, ISSN 1328-4207, E-ISSN 1742-9552Article in journal (Refereed)
    Abstract [en]

    Background

    The current study explored whether higher‐ (up to 8 modules) versus lower‐dose (3 or less modules) unguided internet Cognitive Behaviour Therapy for perfectionism (ICBT‐P) was more effective, and the best method to promote higher dosage.

    Methods

    Two sequential randomised ICBT‐P studies were conducted with participants who self‐identified as having difficulties with perfectionism; in the first participants (N = 51) received 3‐module ICBT‐P or wait‐list, and in the second participants (N = 55) received fixed (asked to complete all 8 modules two per week over 4‐weeks) or flexible format (after completing the first psychoeducational module, participants decided how many/in what order they completed the modules). We examined impact on our primary variables, perfectionistic concerns and standards, and secondary outcomes of negative affect, body image flexibility, and self‐efficacy.

    Results

    More modules were completed in the higher‐ (M modules = 4.36, SD = 3.29) versus lower‐dose (M = 1.96, SD = 1.23) ICBT‐P, d = 0.86 (95% confidence interval: 0.39, 1.34). The latter impacted perfectionism but not secondary outcomes; the former impacted all outcomes (except for self‐efficacy), and within‐group effect size improvements were double in the high‐ compared to low‐dose ICBT‐P. There was no difference between the fixed and flexible formats in terms of the number of modules completed or impact.

    Conclusions

    We can offer a patient‐centred approach to ICBT‐P that is effective, while suggesting completion of more modules can result in larger, more pervasive improvements.

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