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  • 201.
    Cuijpers, Pim
    et al.
    Linköpings universitet, Filosofiska fakulteten. Vrije University of Amsterdam, Netherlands; EMGO Institute Health and Care Research, Netherlands; Karolinska Institute, Sweden.
    De Wit, Leonore
    Vrije University of Amsterdam, Netherlands; EMGO Institute Health and Care Research, Netherlands.
    Weitz, Erica
    Vrije University of Amsterdam, Netherlands; EMGO Institute Health and Care Research, Netherlands.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Karolinska Institute, Sweden.
    Huibers, Marcus J. H.
    Vrije University of Amsterdam, Netherlands; EMGO Institute Health and Care Research, Netherlands.
    THE COMBINATION OF PSYCHOTHERAPY AND PHARMACOTHERAPY IN THE TREATMENT OF ADULT DEPRESSION: A COMPREHENSIVE META-ANALYSIS2015Inngår i: JOURNAL OF EVIDENCE-BASED PSYCHOTHERAPIES, ISSN 2360-0853, Vol. 15, nr 2, s. 147-168Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    No meta-analysis in the field of depression has examined the effects of combined treatment compared with pill placebo, nor has any meta-analysis integrated the comparison of combined treatment against pharmacotherapy alone and psychotherapy alone (i.e., mono treatments). In this comprehensive meta-analysis, we found that combined treatment had a moderate effect on depression compared with pill placebo (g=0.46), and small to moderate effects compared against pharmacotherapy (g=0.38) alone, psychotherapy (g=0.34) alone, and psychotherapy plus placebo (g=0.23). There were some indications for publication bias when combined therapy was compared against placebo (adjusted effect size g=0.31). In multivariate metaregression analyses we found no significant differential predictors for the four comparisons. There were some indications that the use of interpersonal psychotherapy in the combined treatment was associated with a smaller effect size, but this has to be considered with caution, because of the correlational nature of this association. Despite limitations (small number of studies; suboptimal quality of studies) this meta-analysis suggests that combined treatment of depression may be the best treatment available for adult depression, and that it is significantly more effective than placebo, pharmacotherapy alone, psychotherapy alone and the combination of psychotherapy and placebo.

  • 202.
    Cuijpers, Pim
    et al.
    Vrije University Amsterdam.
    Dekker, Jack
    Vrije University Amsterdam.
    Hollon, Steven D
    Vanderbilt University.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Avdelningen för klinisk och socialpsykologi (CS). Linköpings universitet, Filosofiska fakulteten.
    Adding Psychotherapy to Pharmacotherapy in the Treatment of Depressive Disorders in Adults: A Meta-Analysis2009Inngår i: JOURNAL OF CLINICAL PSYCHIATRY, ISSN 0160-6689, Vol. 70, nr 9, s. 1219-1229Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: A considerable number of studies has examined whether adding psychotherapy to pharmacotherapy results in stronger effects than pharmacotherapy alone. However, earlier meta-analyses in this field have included only a limited number of available studies and did not conduct extended subgroup analyses to examine possible sources of heterogeneity. Data Sources: We used a database derived from a comprehensive literature search in Pubmed, PsycINFO, EMBASE, and the Cochrane Central Register of Controlled Trials for studies published from 1966 to January 2008 that examined the psychological treatment of depression. The abstracts of these studies were identified by combining terms indicative of psychological treatment and depression. Study Selection: We included randomized trials in which the effects of a pharmacologic treatment were compared to the effects of a combined pharmacologic and psychological treatment in adults with a depressive disorder. Data Extraction: For each of the studies, we calculated a standardized mean effect size indicating the difference between pharmacotherapy and the combined treatment at posttest. We also coded major characteristics of the population, the interventions, and the quality and design of the study. Data Synthesis: Twenty-five randomized trials, with a total of 2,036 patients, were included. A mean effect size of d=0.31 (95% CI, 0.20 similar to 0.43) was found for the 25 included studies, indicating a small effect in favor of the combined treatment over pharmacotherapy alone. Studies aimed at patients with dysthymia resulted in significantly lower effect sizes compared to studies aimed at patients with major depression, a finding that suggests that the added value of psychotherapy is less in patients with dysthymia. The dropout rate was significantly lower in the combined treatment group compared to the pharmacotherapy only group (OR = 0.65; 95% CI, 0.50 similar to 0.83). Conclusions: Psychotherapy seems to have an additional value compared to pharmacotherapy alone for depression.

  • 203.
    Cuijpers, Pim
    et al.
    Vrije University Amsterdam.
    Donker, Tara
    Vrije University Amsterdam.
    Johansson, Robert
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Filosofiska fakulteten.
    Mohr, David C.
    Northwestern University.
    van Straten, Annemieke
    Vrije University Amsterdam.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Avdelningen för klinisk och socialpsykologi (CS). Linköpings universitet, Filosofiska fakulteten.
    Self-Guided Psychological Treatment for Depressive Symptoms: A Meta-Analysis2011Inngår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 6, nr 6Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: A number of trials have examined the effects of self-guided psychological intervention, without any contact between the participants and a therapist or coach. The results and sizes of these trials have been mixed. This is the first quantitative meta-analysis, aimed at organizing and evaluating the literature, and estimating effect size. Method: We conducted systematic literature searches in PubMed, PsycINFO and Embase up to January 2010, and identified additional studies through earlier meta-analyses, and the references of included studies. We identified seven randomized controlled trials that met our inclusion criteria, with a total of 1,362 respondents. The overall quality of the studies was high. A post-hoc power calculation showed that the studies had sufficient statistical power to detect an effect size of d = 0.19. Results: The overall mean effect size indicating the difference between self-guided psychological treatment and control groups at post-test was d = 0.28 (pless than0.001), which corresponds to a NNT of 6.41. At 4 to 12 months follow-up the effect size was d = 0.23. There was no indication for significant publication bias. Conclusions: We found evidence that self-guided psychological treatment has a small but significant effect on participants with increased levels of depressive symptomatology.

  • 204.
    Cuijpers, Pim
    et al.
    VU University Amsterdam, The Netherlands.
    Driessen, Ellen
    VU University Amsterdam, The Netherlands.
    Hollon, Steven D
    Vanderbilt University, Nashville, USA.
    van Oppen, Patricia
    EMGO Institute for Health and Care Research, The Netherlands.
    Barth, Jürgen
    University of Bern, Switzerland.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    The efficacy of non-directive supportive therapy for adult depression: A meta-analysis2012Inngår i: Clinical Psychology Review, ISSN 0272-7358, E-ISSN 1873-7811, Vol. 32, nr 4, s. 280-291Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The effects of non-directive supportive therapy (NDST) for adult depression have been examined in a considerable number of studies, but no meta-analysis of these studies has been conducted. We selected 31 studies on NDST from a comprehensive database of trials, examining psychotherapies for adult depression, and conducted meta-analyses in which NDST was compared with control groups, other psychotherapies and pharmacotherapy. We found that NDST is effective in the treatment of depression in adults (g=0.58; 95% CI: 0.45-0.72). NDST was less effective than other psychological treatments (differential effect size g=-0.20; 95% CI: -0.32 to -0.08, p<0.01), but these differences were no longer present after controlling for researcher allegiance. We estimated that extra-therapeutic factors (those processes operating in waiting-list and care-as-usual controls) were responsible for 33.3% of the overall improvement, non-specific factors (the effects of NDST compared with control groups) for 49.6%, and specific factors (the effects of NDST compared with other therapies) for 17.1%. NDST has a considerable effect on symptoms of depression. Most of the effect of therapy for adult depression is realized by non-specific factors, and our results suggest that the contribution of specific effects is limited at best.

  • 205.
    Cuijpers, Pim
    et al.
    Vrije University of Amsterdam, Netherlands; Innovat Incubator, NY USA.
    Ebert, David D.
    Innovat Incubator, NY USA; Friedrich Alexander University of Erlangen Nuremberg, Germany.
    Acarturk, Ceren
    Istanbul Sehir University, Turkey.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Karolinska Institute, Sweden.
    Cristea, Ioana A.
    University of Babes Bolyai, Romania; University of Pisa, Italy.
    Personalized Psychotherapy for Adult Depression: A Meta-Analytic Review2016Inngår i: BEHAVIOR THERAPY, ISSN 0005-7894, Vol. 47, nr 6, s. 966-980Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Personalized medicine is aimed at identifying which characteristics of an individual predict the outcome of a specific treatment, in order to get a better match between the individual and the treatment received. We conducted a systematic review and meta-analysis of randomized trials comparing two psychotherapies directly in a group of depressed patients with a specific characteristic. We focused on the six most examined types of psychotherapy for adult depression. Our searches resulted in 41 studies with 2,741 patients who met inclusion criteria. These 41 studies examined 27 specific characteristics of patients. Power calculations indicated that we would need 4 studies for each characteristic to find a clinically relevant effect size set at g = 0.50 and 16 studies for an effect size of 0.24. Only 3 patient characteristics were found to have sufficient power and to significantly moderate treatment outcomes. Cognitive-behavioral therapy was found to be more effective than other therapies in older adults (g= 0.29), in patients with comorbid addictive disorders (g = 0.31), and in university students (g = 0.46). Risk of bias was considerable in most of the included studies. It was estimated that it will take another 326 years to have sufficient statistical power for showing an effect size of g = 0.50 of the 27 characteristics, and 1,372 years to show an effect size of 0.24. Although several dozens of studies have compared the effects of psychotherapies in specific target groups, we will need to develop more powerful alternatives to comparative outcome studies in order to identify personalized treatments for depression.

  • 206.
    Cuijpers, Pim
    et al.
    Vrije University Amsterdam.
    Geraedts, Anna S
    Vrije University Amsterdam.
    van Oppen, Patricia
    Vrije University Amsterdam.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Avdelningen för klinisk och socialpsykologi (CS). Linköpings universitet, Filosofiska fakulteten.
    Markowitz, John C
    External - unknown .
    van Straten, Annemieke
    Vrije University Amsterdam.
    Interpersonal Psychotherapy for Depression: A Meta-Analysis2011Inngår i: AMERICAN JOURNAL OF PSYCHIATRY, ISSN 0002-953X, Vol. 168, nr 6, s. 581-592Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Objective: Interpersonal psychotherapy (IPT), a structured and time-limited therapy, has been studied in many controlled trials. Numerous practice guidelines have recommended IPT as a treatment of choice for unipolar depressive disorders. The authors conducted a meta-analysis to integrate research on the effects of IPT. Method: The authors searched bibliographical databases for randomized controlled trials comparing IPT with no treatment, usual care, other psychological treatments, and pharmacotherapy as well as studies comparing combination treatment using pharmacotherapy and IPT. Maintenance studies were also included. Results: Thirty-eight studies including 4,356 patients met all inclusion criteria. The overall effect size (Cohens d) of the 16 studies that compared IPT and a control group was 0.63 (95% confidence interval [CI]=0.36 to 0.90), corresponding to a number needed to treat of 2.91. Ten studies comparing IPT and other psychological treatments showed a nonsignificant differential effect size of 0.04 (95% CI=-0.14 to 0.21; number needed to treat=45.45) favoring IPT. Pharmacotherapy (after removal of one outlier) was more effective than IPT (d=-0.19, 95% CI=-0.38 to -0.01; number needed to treat=9.43), and combination treatment was not more effective than IPT alone, although the paucity of studies precluded drawing definite conclusions. Combination maintenance treatment with pharmacotherapy and IPT was more effective in preventing relapse than pharmacotherapy alone (odds ratio=0.37; 95% CI=0.19 to 0.73; number needed to treat=7.63). Conclusions: There is no doubt that IPT efficaciously treats depression, both as an independent treatment and in combination with pharmacotherapy. IPT deserves its place in treatment guidelines as one of the most empirically validated treatments for depression.

  • 207.
    Cuijpers, Pim
    et al.
    Vrije University of Amsterdam, Netherlands EMGO Institute Health and Care Research, Netherlands .
    Hollon, Steven D.
    Vanderbilt University, TN 37235 USA .
    van Straten, Annemieke
    Vrije University of Amsterdam, Netherlands EMGO Institute Health and Care Research, Netherlands .
    Bockting, Claudi
    University of Groningen, Netherlands .
    Berking, Matthias
    University of Marburg, Germany .
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Does cognitive behaviour therapy have an enduring effect that is superior to keeping patients on continuation pharmacotherapy? A meta-analysis2013Inngår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 3, nr 4, s. 2542-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives Although cognitive behaviour therapy (CBT) and pharmacotherapy are equally effective in the acute treatment of adult depression, it is not known how they compare across the longer term. In this meta-analysis, we compared the effects of acute phase CBT without any subsequent treatment with the effects of pharmacotherapy that either were continued or discontinued across 6-18 months of follow-up. Design We conducted systematic searches in bibliographical databases to identify relevant studies, and conducted a meta-analysis of studies meeting inclusion criteria. Setting Mental healthcare. Participants Patients with depressive disorders. Interventions CBT and pharmacotherapy for depression. Outcome measures Relapse rates at long-term follow-up. Results 9 studies with 506 patients were included. The quality was relatively high. Short-term outcomes of CBT and pharmacotherapy were comparable, although drop out from treatment was significantly lower in CBT. Acute phase CBT was compared with pharmacotherapy discontinuation during follow-up in eight studies. Patients who received acute phase CBT were significantly less likely to relapse than patients who were withdrawn from pharmacotherapy (OR=2.61, 95% CI 1.58 to 4.31, pless than0.001; numbers-needed-to-be-treated, NNT=5). The acute phase CBT was compared with continued pharmacotherapy at follow-up in five studies. There was no significant difference between acute phase CBT and continued pharmacotherapy, although there was a trend (pless than0.1) indicating that patients who received acute phase CBT may be less likely to relapse following acute treatment termination than patients who were continued on pharmacotherapy (OR=1.62, 95% CI 0.97 to 2.72; NNT=10). Conclusions We found that CBT has an enduring effect following termination of the acute treatment. We found no significant difference in relapse after the acute phase CBT versus continuation of pharmacotherapy after remission. Given the small number of studies, this finding should be interpreted with caution pending replication.

  • 208.
    Cuijpers, Pim
    et al.
    Vrije University of Amsterdam, Netherlands .
    Huibers, Marcus
    Vrije University of Amsterdam, Netherlands .
    Daniel Ebert, David
    Leuphana University, Germany .
    Koole, Sander L.
    Vrije University of Amsterdam, Netherlands .
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    How much psychotherapy is needed to treat depression? A metaregression analysis2013Inngår i: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 149, nr 1-3, s. 1-13Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Background: Although psychotherapies are effective in the treatment of adult depression it is not clear how this treatment effect is related to amount, frequency and intensity of therapy. less thanbrgreater than less thanbrgreater thanMethods: To fill this gap in knowledge, the present metaregression analysis examined the association between the effects of psychotherapy for adult depression and several indicators of amount, frequency and intensity of therapy. The analysis included 70 studies (92 comparisons) with 5403 patients, in which individual psychotherapy was compared with a control group (e.g. waiting list, care-as-usual). less thanbrgreater than less thanbrgreater thanResults: There was only a small association between number of therapy sessions and effect size, and this association was no longer significant when the analysis adjusted for other characteristics of the studies. The multivariable analyses also found no significant association with the total contact time or duration of the therapy. However, there was a strong association between number of sessions per week and effect size. An increase from one to two sessions per week increased the effect size with g=0.45, while keeping the total number of treatment sessions constant. less thanbrgreater than less thanbrgreater thanDiscussion: More research is needed to establish the robustness of this finding. Based on these findings, it may be advisable to concentrate psychotherapy sessions within a brief time frame.

  • 209.
    Cuijpers, Pim
    et al.
    Vrije University of Amsterdam, Netherlands Vrije University of Amsterdam, Netherlands Vrije University of Amsterdam, Netherlands Leuphana University, Germany .
    Karyotaki, Eirini
    Vrije University of Amsterdam, Netherlands Vrije University of Amsterdam, Netherlands Vrije University of Amsterdam, Netherlands .
    Weitz, Erica
    Vrije University of Amsterdam, Netherlands Vrije University of Amsterdam, Netherlands Vrije University of Amsterdam, Netherlands .
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Hollon, Steven D.
    Vanderbilt University, TN 37235 USA .
    van Straten, Annemieke
    Vrije University of Amsterdam, Netherlands Vrije University of Amsterdam, Netherlands Vrije University of Amsterdam, Netherlands .
    The effects of psychotherapies for major depression in adults on remission, recovery and improvement: A meta-analysis2014Inngår i: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 159, s. 118-126Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Background: Standardised effect sizes have been criticized because they are difficult to interpret and offer little clinical information. This meta-analyses examine the extent of actual improvement, the absolute numbers of patients no longer meeting criteria for major depression, and absolute rates of response and remission. Methods: We conducted a meta-analysis of 92 studies with 181 conditions (134 psychotherapy and 47 control conditions) with 6937 patients meeting criteria for major depressive disorder. Within these conditions, we calculated the absolute number of patients no longer meeting criteria for major depression, rates of response and remission, and the absolute reduction on the BDI, BDI-II and HAM-D. Results: After treatment, 62% of patients no longer met criteria for MDD in the psychotherapy conditions. However, 43% of participants in the control conditions and 48% of people in the care-as-usual conditions no longer met criteria for MDD, suggesting that the additional value of psychotherapy compared to care-as-usual would be 14%. For response and remission, comparable results were found, with less than half of the patients meeting criteria for response and remission after psychotherapy. Additionally, a considerable proportion of response and remission was also found in control conditions. In the psychotherapy conditions, scores on the BDl were reduced by 13.42 points, 15.12 points on the BDI-II, and 10.28 points on the HAM-D. In the control conditions, these reductions were 4.56, 4.68, and 5.29. Discussion: Psychotherapy contributes to improvement in depressed patients, but improvement in control conditions is also considerable.

  • 210.
    Cuijpers, Pim
    et al.
    Vrije University Amsterdam.
    Li, Juan
    Chinese Academy of Science.
    Hofmann, Stefan G
    Boston University.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Avdelningen för klinisk och socialpsykologi (CS). Linköpings universitet, Filosofiska fakulteten.
    Self-reported versus clinician-rated symptoms of depression as outcome measures in psychotherapy research on depression: A meta-analysis2010Inngår i: CLINICAL PSYCHOLOGY REVIEW, ISSN 0272-7358, Vol. 30, nr 6, s. 768-778Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    It is not well-known whether self-report measures and clinician-rated instruments for depression result in comparable outcomes in research on psychotherapy. We conducted a meta-analysis in which randomized controlled trials were included examining the effects of psychotherapy for adult depression. Only studies were included in which both a self-report and a clinician-rated instrument were used. We calculated the effect size (Hedges g) based on the self-report measures, the effect size based on the clinician-rated instruments, and the difference between these two effect sizes (Delta g). A total of 48 studies including a total of 2462 participants was included in the meta-analysis. The differential effect size was Delta g=0.20 (95% CI: 0.10-0.30), indicating that clinician-rated instruments resulted in a significantly higher effect size than self-report instruments from the same studies. When we limited the effect size analysis to those studies comparing the HRSD with the BDI, the differential effect was somewhat smaller, but still statistically significant (Delta g=0.15; 95% CI: 0.03-0.27). This meta-analysis has made it clear that clinician-rated and self-report measures of improvement following psychotherapy for depression are not equivalent. Different symptoms may be more suitable for self-report or ratings by clinicians and in clinical trials it is probably best to include both.

  • 211.
    Cuijpers, Pim
    et al.
    Vrije University, Amsterdam, the Netherlands.
    Reynolds, Charles F.
    University of Pittsburgh School of Medicine, Pennsylvania, USA.
    Donker, Tara
    Vrije University, Amsterdam, the Netherlands.
    Li, Juan
    Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Beekman, Aartjan
    Vrije University Medical Center Amsterdam, The Netherlands.
    Personalized treatment of adult depression: medication, psychotherapy, or both? A systematic review2012Inngår i: Depression and anxiety (Print), ISSN 1091-4269, E-ISSN 1520-6394, Vol. 29, nr 10, s. 855-864Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Personalized medicine aims to identify which characteristics of an individual predict the outcome of a specific treatment, in order to get a better match between the individual and the treatment received. We conducted a systematic review and meta-analysis of randomized trials comparing two treatments directly in a group of patients with a specific characteristic.

    METHODS: We searched relevant studies from bibliographical databases and included trials comparing (1) medication with psychotherapy, (2) medication with combined treatment, and (3) psychotherapy with combined treatment, in specific target groups (a) with a predefined sociodemographic characteristic, (b) a specific type of depression, (c) a comorbid mental or somatic disorder, or (d) from a specific setting (outpatients, primary care).

    RESULTS: We included 52 studies with 4,734 depressed patients. In these studies, 20 characteristics of the target groups were examined. The results showed that medication is probably the best treatment for dysthymia, and combined treatments are more effective in depressed outpatients, as well as in depressed older adults. However, in order to examine the 20 characteristics in the three categories of comparisons, 254 studies would be needed for having sufficient statistical power to show an effect size of g = 0.5. Currently, only 20.1% of these studies have been conducted.

    CONCLUSIONS: Although a considerable number of studies have compared medication, psychotherapy, and combined treatments, and some preliminary results are useful for deciding which treatment is best for which patient, the development of personalized treatment of depression has only just begun.

  • 212.
    Cuijpers, Pim
    et al.
    VU University Amsterdam, The Netherlands.
    Sijbrandij, Marit
    VU University Amsterdam, The Netherlands.
    Koole, Sander
    VU University Amsterdam, The Netherlands.
    Huibers, Marcus
    VU University Amsterdam, The Netherlands.
    Berking, Matthias
    Leuphana University, Lueneburg, Germany.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Karolinska Institutet, Stockholm, Sweden.
    Psychological treatment of generalized anxiety disorder: A meta-analysis2014Inngår i: Clinical Psychology Review, ISSN 0272-7358, E-ISSN 1873-7811, Vol. 34, nr 2, s. 130-140Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Recent years have seen a near-doubling of the number of studies examining the effects of psychotherapies for generalized anxiety disorder (GAD) in adults. The present article integrates this new evidence with the older literature through a quantitative meta-analysis. A total of 41 studies (with 2132 patients meeting diagnostic criteria for GAD) were identified through systematic searches in bibliographical databases, and were included in the meta-analysis. Most studies examined the effects of cognitive behavior therapy (CBT). The majority of studies used waiting lists as control condition. The pooled effect of the 38 comparisons (from 28 studies) of psychotherapy versus a control group was large (g=0.84; 95% CI: 0.71-0.97) with low to moderate heterogeneity. The effects based on self-report measures were somewhat lower than those based on clinician-rated instruments. The effects on depression were also large (g=0.71; 95% CI: 0.59-0.82). There were some indications for publication bias. The number of studies comparing CBT with other psychotherapies (e.g., applied relaxation) or pharmacotherapy was too small to draw conclusions about comparative effectiveness or the long-term effects. There were some indications that CBT was also effective at follow-up and that CBT was more effective than applied relaxation in the longer term.

  • 213.
    Cuijpers, Pim
    et al.
    VU University and VU University Medical Center Amsterdam, The Netherlands.
    Sijbrandij, Marit
    VU University and VU University Medical Center Amsterdam, The Netherlands.
    Koole, Sander L
    VU University and VU University Medical Center Amsterdam, The Netherlands.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Karolinska Institutet, Stockholm, Sweden.
    Beekman, Aartjan T
    VU University and VU University Medical Center Amsterdam, The Netherlands.
    Reynolds, Charles F
    University of Pittsburgh School of Medicine, PA, USA.
    Adding psychotherapy to antidepressant medication in depression and anxiety disorders: a meta-analysis2014Inngår i: World Psychiatry, ISSN 1723-8617, E-ISSN 2051-5545, Vol. 13, nr 1, s. 56-67Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    We conducted a meta-analysis of randomized trials in which the effects of treatment with antidepressant medication were compared to the effects of combined pharmacotherapy and psychotherapy in adults with a diagnosed depressive or anxiety disorder. A total of 52 studies (with 3,623 patients) met inclusion criteria, 32 on depressive disorders and 21 on anxiety disorders (one on both depressive and anxiety disorders). The overall difference between pharmacotherapy and combined treatment was Hedges' g = 0.43 (95% CI: 0.31-0.56), indicating a moderately large effect and clinically meaningful difference in favor of combined treatment, which corresponds to a number needed to treat (NNT) of 4.20. There was sufficient evidence that combined treatment is superior for major depression, panic disorder, and obsessive-compulsive disorder (OCD). The effects of combined treatment compared with placebo only were about twice as large as those of pharmacotherapy compared with placebo only, underscoring the clinical advantage of combined treatment. The results also suggest that the effects of pharmacotherapy and those of psychotherapy are largely independent from each other, with both contributing about equally to the effects of combined treatment. We conclude that combined treatment appears to be more effective than treatment with antidepressant medication alone in major depression, panic disorder, and OCD. These effects remain strong and significant up to two years after treatment. Monotherapy with psychotropic medication may not constitute optimal care for common mental disorders.

  • 214.
    Cuijpers, Pim
    et al.
    Vrije University of Amsterdam, Netherlands Vrije University of Amsterdam, Netherlands Vrije University of Amsterdam Medical Centre, Netherlands Leuphana University, Germany .
    Sijbrandij, Marit
    Vrije University of Amsterdam, Netherlands Vrije University of Amsterdam, Netherlands Vrije University of Amsterdam Medical Centre, Netherlands .
    Koole, Sander L.
    Vrije University of Amsterdam, Netherlands Vrije University of Amsterdam, Netherlands Vrije University of Amsterdam Medical Centre, Netherlands .
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Östergötlands Läns Landsting, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Beekman, Aartjan T.
    Vrije University of Amsterdam, Netherlands Vrije University of Amsterdam Medical Centre, Netherlands Vrije University of Amsterdam Medical Centre, Netherlands .
    Reynolds, Charles F.
    University of Pittsburgh, PA USA .
    The efficacy of psychotherapy and pharmacotherapy in treating depressive and anxiety disorders: a meta-analysis of direct comparisons2013Inngår i: World Psychiatry, ISSN 1723-8617, E-ISSN 2051-5545, Vol. 12, nr 2, s. 137-148Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Although psychotherapy and antidepressant medication are efficacious in the treatment of depressive and anxiety disorders, it is not known whether they are equally efficacious for all types of disorders, and whether all types of psychotherapy and antidepressants are equally efficacious for each disorder. We conducted a meta-analysis of studies in which psychotherapy and antidepressant medication were directly compared in the treatment of depressive and anxiety disorders. Systematic searches in bibliographical databases resulted in 67 randomized trials, including 5,993 patients that met inclusion criteria, 40 studies focusing on depressive disorders and 27 focusing on anxiety disorders. The overall effect size indicating the difference between psychotherapy and pharmacotherapy after treatment in all disorders was g=0.02 (95% CI: -0.07 to 0.10), which was not statistically significant. Pharmacotherapy was significantly more efficacious than psychotherapy in dysthymia (g=0.30), and psychotherapy was significantly more efficacious than pharmacotherapy in obsessive-compulsive disorder (g=0.64). Furthermore, pharmacotherapy was significantly more efficacious than non-directive counseling (g=0.33), and psychotherapy was significantly more efficacious than pharmacotherapy with tricyclic antidepressants (g=0.21). These results remained significant when we controlled for other characteristics of the studies in multivariate meta-regression analysis, except for the differential effects in dysthymia, which were no longer statistically significant.

  • 215.
    Cuijpers, Pim
    et al.
    Vrije University Amsterdam.
    Smit, Filip
    Vrije University Amsterdam.
    Bohlmeijer, Ernst
    Technical University of Twente.
    Hollon, Steven D
    Vanderbilt University.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Avdelningen för klinisk och socialpsykologi (CS). Linköpings universitet, Filosofiska fakulteten.
    Efficacy of cognitive-behavioural therapy and other psychological treatments for adult depression: meta-analytic study of publication bias2010Inngår i: British Journal of Psychiatry, ISSN 0007-1250, E-ISSN 1472-1465, Vol. 196, nr 3, s. 173-178Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Background: It is not clear whether the effects of cognitive-behavioural therapy and other psychotherapies have been overestimated because of publication bias. Aims: To examine indicators of publication bias in randomised controlled trials of psychotherapy for adult depression. Method: We examined effect sizes of 117 trials with 175 comparisons between psychotherapy and control conditions. As indicators of publication bias we examined funnel plots, calculated adjusted effect sizes after publication had been taken into account using Duval & Tweedies procedure, and tested the symmetry of the funnel plots using the Begg & Mazumdar rank correlation test and Eggers test. Results The mean effect size was 0.67, which was reduced after adjustment for publication bias to 0.42 (51 imputed studies). Both Begg & Mazumbars test and Eggers test were highly significant (Pandlt;0.001). Conclusions: The effects of psychotherapy for adult depression seem to be overestimated considerably because of publication bias. Declaration of interest: None.

  • 216.
    Cuijpers, Pim
    et al.
    Vrije University Amsterdam.
    Smit, Filip
    Vrije University Amsterdam.
    Hollon, Steven D
    Vanderbilt University.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Avdelningen för klinisk och socialpsykologi (CS). Linköpings universitet, Filosofiska fakulteten.
    Continuous and dichotomous outcomes in studies of psychotherapy for adult depression: A meta-analytic comparison2010Inngår i: JOURNAL OF AFFECTIVE DISORDERS, ISSN 0165-0327, Vol. 126, nr 3, s. 349-357Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Background: In treatment research on depressive disorders, outcomes can be based on continuous outcomes but also on dichotomous outcomes. Although it is possible to convert the two types of outcomes to each other, it has not been tested whether this results in systematic differences. Method: We selected studies on psychotherapy for adult depression from an existing database, in which both continuous and dichotomous outcomes were presented. We calculated effect sizes using both types of outcomes, and compared the results. Results: Although there were considerable differences between the two types of outcomes in individual studies, both types of outcomes resulted in very similar pooled effect sizes. The pooled effect size based on the continuous outcome were somewhat more conservative (d = 0.59: OR = 2.92) than the one based on the dichotomous outcome (d = 0.64; OR = 3.17). Heterogeneity was higher in the analyses based on the continuous outcomes than in those based on the dichotomous outcomes. Sensitivity analyses and subgroup analyses confirmed that the pooled effect sizes were very similar, that the effect sizes were somewhat smaller when the continuous outcomes are used, and that heterogeneity was higher in the analyses based on the continuous outcomes. Conclusion: Overall, the two types of outcomes result in comparable pooled effect sizes and can both be used in meta-analyses. However, the results of the two types of outcomes should not be used interchangeably, because there may be systematic differences in heterogeneity and subgroup analyses.

  • 217.
    Cuijpers, Pim
    et al.
    Vrije University Amsterdam.
    van Straten, Annemicke
    Vrije University Amsterdam.
    Warmerdam, Lisanne
    Vrije University Amsterdam.
    Andersson , Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Avdelningen för klinisk och socialpsykologi (CS). Linköpings universitet, Filosofiska fakulteten.
    Psychotherapy versus the combination of psychotherapy and pharmacotherapy in the treatment of depression: A meta-analysis2009Inngår i: Depression and anxiety (Print), ISSN 1091-4269, E-ISSN 1520-6394, Vol. 26, nr 3, s. 279-288Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: A large number of studies have shown that psychological treatments have significant effects on depression. Although several studies have examined the relative effects of psychological and combined treatments, this has not been studied satisfactorily in recent statistical meta-analyses.

    Method: We conducted a meta-analysis of randomized studies in which a psychological treatment was compared to a combined treatment consisting of the same psychological treatment with a pharmacological therapy. For each of these studies we calculated the effect size indicating the difference between the psychological and the combined treatment.

    Results: All inclusion criteria were met by 18 studies, with a total of 1,838 subjects. The mean effect, size indicating the difference between psychological and combined treatment was 0.35 (95% CL 0.24 similar to 0.45; P<0.001), with low heterogeneity. Subgroup analyses indicated that the difference between psychological and combined treatments was significantly smaller in studies in which cognitive behavior therapy was examined. Me also found a trend (P<0.1) indicating that the difference between psychological and combined treatment was somewhat larger in studies aimed at specific populations (older adults, chronic depression, HIV patients) than in studies with adults, and in studies in which Trycyclic antidepressants or SSRIs were examined, compared to studies in which a medication protocol or another antidepressant was used. At follow-up, no difference between psychological and combined treatments was found.

    Conclusion: We conclude that combined treatment is more effective than psychological treatment alone. However, it is not clear whether this difference is relevant from a clinical perspective.

  • 218. Cuijpers, Pim
    et al.
    van Straten, Anne-Mieke
    Andersson, Gerhard
    Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutionen för beteendevetenskap och lärande, Avdelningen för klinisk och socialpsykologi (CS).
    Internet-administered cognitive behavior therapy for health problems: A systematic review2008Inngår i: Journal of behavioral medicine, ISSN 0160-7715, E-ISSN 1573-3521, Vol. 31, nr 2, s. 169-177Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Cognitive-behavioral interventions are the most extensively researched form of psychological treatment and are increasingly offered through the Internet. Internet-based interventions may save therapist time, reduce waiting-lists, cut traveling time, and reach populations with health problems who can not easily access other more traditional forms of treatments. We conducted a systematic review of twelve randomized controlled or comparative trials. Studies were identified through systematic searches in major bibliographical databases. Three studies focused on patients suffering from pain, three on headache, and six on other health problems. The effects found for Internet interventions targeting pain were comparable to the effects found for face-to-face treatments, and the same was true for interventions aimed at headache. The other interventions also showed some effects, although effects differed across target conditions. Internet-delivered cognitive-behavioral interventions are a promising addition and complement to existing treatments. The Internet will most likely assume a major role in the future delivery of cognitive-behavioral interventions to patients with health problems. © 2007 The Author(s).

  • 219.
    Cuijpers, Pim
    et al.
    VU University Amsterdam and EMGO Institute.
    van Straten, Annemieke
    VU University Amsterdam and EMGO Institute.
    Andersson, Gerhard
    Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutionen för beteendevetenskap och lärande, Avdelningen för klinisk och socialpsykologi (CS).
    van Oppen, Patricia
    VU University Amsterdam and EMGO Institute.
    Psychotherapy for Depression in Adults: A Meta-Analysis of Comparative Outcome Studies2008Inngår i: Journal of Consulting and Clinical Psychology, ISSN 0022-006X, E-ISSN 1939-2117, Vol. 76, nr 6, s. 909-922Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Although the subject has been debated and examined for more than 3 decades, it is si ill not clear whether all psychotherapies are equally efficacious. The authors conducted 7 meta-analyses (with a total of 53 studies) in which 7 major types of psychological treatment for mild to moderate adult depression (cognitive-behavior therapy, nondirective supportive treatment, behavioral activation treatment, psychodynamic treatment. problem-solving therapy, interpersonal psychotherapy, and social skills training) were directly compared with other psychological treatments. Each major type of treatment had been examined in at least 5 randomized comparative trials. There was no indication that I of the treatments was more or less efficacious, with the exception of interpersonal psychotherapy (which was somewhat more efficacious; d = 0.20) and nondirective supportive treatment (which was somewhat less efficacious than the other treatments: d = -0.13). The drop-out rate was significantly higher in cognitive-behavior therapy than in the other therapies, whereas it was significantly lower in problem-solving therapy. This study suggests that there are no large differences in efficacy between the major psychotherapies for mild to moderate depression.

  • 220.
    Cuijpers, Pim
    et al.
    Vrije University Amsterdam.
    van Straten, Annemieke
    Vrije University Amsterdam.
    Schuurmans, Josien
    Vrije University Amsterdam.
    van Oppen, Patricia
    Vrije University Amsterdam.
    Hollon, Steven D
    Vanderbilt University.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Avdelningen för klinisk och socialpsykologi (CS). Linköpings universitet, Filosofiska fakulteten.
    Psychotherapy for chronic major depression and dysthymia: A meta-analysis2010Inngår i: Clinical Psychology Review, ISSN 0272-7358, E-ISSN 1873-7811, Vol. 30, nr 1, s. 51-62Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Although several studies have examined the effects of psychotherapy on chronic depression and dysthymia, no meta-analysis has been conducted to integrate results of these studies. We conducted a meta-analysis of 16 randomized trials examining the effects of psychotherapy on chronic depression and dysthymia. We found that psychotherapy had a small but significant effect (d=0.23) on depression when compared to control groups. Psychotherapy was significantly less effective than pharmacotherapy in direct comparisons (d=-031), especially SSRIs, but that this finding was wholly attributable to dysthymic patients (the studies examining dysthymia patients were the same studies that examined SSRIs). Combined treatment was more effective than pharmacotherapy alone (d=0.23) but even more so with respect to psychotherapy alone (d=0.45), although again this difference may have reflected the greater proportion of dysthymic samples in the latter. No significant differences were found in drop-out rates between psychotherapy and the other conditions. We found indications that at least 18 treatment sessions are needed to realize optimal effects of psychotherapy. We conclude that psychotherapy is effective in the treatment of chronic depression and dysthymia but probably not as effective as pharmacotherapy (particularly the SSRIs).

  • 221.
    Cuijpers, Pim
    et al.
    Vrije University Amsterdam.
    van Straten, Annemieke
    Vrije University Amsterdam.
    Smit, Filip
    Vrije University Amsterdam.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Avdelningen för klinisk och socialpsykologi (CS). Linköpings universitet, Filosofiska fakulteten.
    Is psychotherapy for depression equally effective in younger and older adults? A meta-regression analysis2009Inngår i: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 21, nr 1, s. 16-24Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Background: It is well established that psychotherapy is effective in the treatment of depression in younger as well as in older adults. Whether these psychotherapies are equally effective in younger and older age groups has not been examined in meta-analytic research.

    Methods: We conducted a systematic literature search and included 112 studies with 170 comparisons between a psychotherapy and a control group (with a total of 7,845 participants). Twenty studies with 26 comparisons were aimed at older adults.

    Results: We found no indication that psychotherapies were more or less effective for older adults compared to younger adults. The effect sizes of both groups of comparisons did not differ significantly from each other (older adults: d = 0.74; 95% CI: 0.49 similar to 0.99; younger adults: d = 0.67; 95% CI: 0.58 similar to 0.76). In a multivariate metaregression analysis, in which we controlled for major characteristics of the participants, the interventions and the study designs, no indication of a difference between psychotherapy in younger and older adults was found.

    Conclusions: There appears to be no significant difference between psychotherapy in younger and older adults, although it is not clear whether this is also true for clinical samples, patients with more severe depression, and the older old.

  • 222.
    Cuijpers, Pim
    et al.
    Vrije University.
    van Straten, Annemieke
    Vrije University.
    van Oppen, Patricia
    Vrije University.
    Andersson , Gerhard
    Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutionen för beteendevetenskap och lärande, Avdelningen för klinisk och socialpsykologi (CS).
    Are Psychological and Pharmacologic Interventions Equally Effective in the Treatment of Adult Depressive Disorders?: A Meta-Analysis of Comparative Studies2008Inngår i: Journal of Clinical Psychiatry, ISSN 0160-6689, E-ISSN 1555-2101, Vol. 69, nr 11, s. 1675-1685Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: A large number of studies suggest that both psychological and pharmacologic therapies are effective in the treatment of mild-to-moderate depressive disorders. Whether both types of intervention are equally effective has not been established definitively.

    Data Sources: A database was developed through a comprehensive literature search (from 1966 to May 2007) in which 6947 abstracts in PubMed (1244 abstracts), PsycINFO (1736), EMBASE (1911), and the Cochrane Central Register of Controlled Trials (2056) were examined. Abstracts were identified by combining terms indicative of psychological treatment and depression (both MeSH terms and text words). For this database, the primary studies from 22 meta-analyses of psychological treatment for depression were also collected.

    Study Selection: For the current study, the abstracts of 832 studies were examined.

    Data Extraction: Thirty randomized trials were included in a meta-analysis that compared the effects of a psychological treatment for 3178 adults with a diagnosed depressive disorder (major depressive disorder, dysthymia, minor depressive disorder) with the effects of a pharmacologic treatment.

    Data Synthesis: In studies of patients with dysthymia, pharmacotherapy was significantly more effective than psychotherapy (d = -0.28, 95% CI = -0.47 to -0.10). In patients with major depressive disorder, treatments with selective serotonin reuptake inhibitors (SSRIs) were significantly more effective than psychological treatments, while treatment with other antidepressants did not differ significantly. Subgroup and metaregression analyses did not show that pretest severity of depressive symptoms was associated with differential effects of psychological and pharmacologic treatments of major depressive disorder. Dropout rates were smaller in psychological interventions compared with pharmacologic treatments (odds ratio = 0.66, 95% CI = 0.47 to 0.92).

    Conclusions: Pharmacologic treatments may be more effective than psychological interventions in the treatment of dysthymia. Pharmacologic treatment with SSRIs may also be more effective in the treatment of major depressive disorder, although these differences are small and probably have little meaning from a clinical point of view. We can conclude that both psychological and pharmacologic therapies are effective in the treatment of depressive disorders and that each has its own merits.

  • 223.
    Cuijpers, Pim
    et al.
    Vrije University Amsterdam.
    van Straten, Annemieke
    Vrije University Amsterdam.
    van Oppen, Patricia
    Vrije University Amsterdam Medical Centre.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Avdelningen för klinisk och socialpsykologi (CS). Linköpings universitet, Filosofiska fakulteten.
    Letter: Comparing Psychotherapy and Pharmacotherapy for Adult Depression: Adjusting for Differential Dropout Rates2010Inngår i: Journal of Clinical Psychiatry, ISSN 0160-6689, E-ISSN 1555-2101, Vol. 71, nr 9, s. 1246-1246Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    n/a

  • 224.
    Cuijpers, Pim
    et al.
    Vrije University Amsterdam.
    van Straten, Annemieke
    Vrije University Amsterdam.
    van Oppen, Patricia
    Vrije University Amsterdam.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Avdelningen för klinisk och socialpsykologi (CS). Linköpings universitet, Filosofiska fakulteten.
    Letter: Premature Conclusions About Psychotherapy for Dysthymia Reply2009Inngår i: Journal of Clinical Psychiatry, ISSN 0160-6689, E-ISSN 1555-2101, Vol. 70, nr 8, s. 1188-1189Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    n/a

  • 225.
    Cuijpers, Pim
    et al.
    Vrije University Amsterdam.
    van Straten, Annemieke
    Vrije University Amsterdam.
    van Schaik, Anneke
    Vrije University Amsterdam.
    Andersson , Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Avdelningen för klinisk och socialpsykologi (CS). Linköpings universitet, Filosofiska fakulteten.
    Psychological treatment of depression in primary care: a meta-analysis2009Inngår i: British Journal of General Practice, ISSN 0960-1643, E-ISSN 1478-5242, Vol. 59, nr 559, s. 120-127Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Although most depressive disorders are treated in primary care and several studies have examined the effects of psychological treatment in primary care, hardly any meta-analytic research has been conducted in which the results of these studies are integrated.

    Aim: To integrate the results of randomised controlled trials of psychological treatment of depression in adults in primary care, and to compare these results to psychological treatments in other settings.

    Design of study: A meta-analysis of studies examining the effects of psychological treatments of adult depression in primary care.

    Setting: Primary care.

    Method: An existing database of studies on psychological treatments of adult depression that was built on systematic searches in PubMed, PsychINFO, EMBASE, and Dissertation Abstracts International was used. Randomised trials were included in which the effects of psychological treatments on adult primary care patients with depression were compared to a control condition

    Results: In the 15 included studies, the standardised mean effect size of psychological treatment versus control groups was 0.31 (95% CI = 0.17 to 0.45), which corresponds with a numbers-needed-to-treat (NNT) of 5.75. Studies in which patients were referred by their GP for treatment had significantly higher effect sizes (d = 0.43; NNT = 4.20) than studies in which patients were recruited through systematic screening (d = 0.13, not significantly different from zero; NNT = 13.51).

    Conclusions: Although the number of studies was relatively low and the quality varied, psychological treatment of depression was found to be effective in primary care, especially when GPs refer patients with depression for treatment.

  • 226.
    Cuijpers, Pim
    et al.
    Vrije Univ Amsterdam, Dept Clin Psychol, Amsterdam, Netherlands; Vrije Univ Amsterdam Med Ctr, EMGO Inst, Amsterdam, Netherlands.
    van Straten, Anne-Mieke
    Vrije Univ Amsterdam, Dept Clin Psychol, Amsterdam, Netherlands; Vrije Univ Amsterdam Med Ctr, EMGO Inst, Amsterdam, Netherlands.
    Warmerdam, Lisa
    Vrije Univ Amsterdam, Dept Clin Psychol, Amsterdam, Netherlands; Vrije Univ Amsterdam Med Ctr, EMGO Inst, Amsterdam, Netherlands.
    Andersson, Gerhard
    Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutionen för beteendevetenskap och lärande, Avdelningen för klinisk och socialpsykologi (CS). Karolinska Inst, Dept Clin Neurosci, Psychiat Sect, Stockholm, Sweden.
    Psychological treatment of depression: A meta-analytic database of randomized studies2008Inngår i: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 8, artikkel-id 36Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    Background: A large number of randomized controlled studies have clearly demonstrated that psychological interventions are effective in the treatment of depression. The number of studies in this area is increasing rapidly. In this paper, we present a database of controlled and comparative outcome studies on psychological treatments of depression, based on a series of meta-analyses published by our group. The database can be accessed freely through the Internet. Description: We conducted a comprehensive literature search of the major bibliographical databases (Pubmed, Psycinfo, Embase, Cochrane Central Register of Controlled Trials) and we examined the references of 22 earlier meta-analyses of psychological treatment of depression. We included randomized studies in which the effects of a psychological therapy on adults with depression were compared to a control condition, another psychological intervention, or a combined treatment (psychological plus pharmacological). We conducted nine meta-analyses of subgroups of studies taken from this dataset. The 149 studies included in these 9 meta-analyses are included in the current database. In the 149 included studies, a total of 11,369 patients participated. In the database, we present selected characteristics of each study, including characteristics of the patients (the study population, recruitment method, definition of depression), characteristics of the experimental conditions and interventions (the experimental conditions, N per condition, format, number of sessions), and study characteristics (measurement times, measures used, attrition, type of analysis and country). Conclusion: The data on the 149 included studies are presented in order to give other researchers access to the studies we collected, and to give background information about the meta-analyses we have published using this dataset. The number of studies examining the effects of psychological treatments of depression has increased considerably in the past decades, and this will continue in the future. The database we have presented in this paper can help to integrate the results of these studies in future meta-analyses and systematic reviews on psychological treatments for depression. © 2008 Cuijpers et al, licensee BioMed Central Ltd.

  • 227.
    Cuijpers, Pim
    et al.
    Vrije Univ Amsterdam, NL-1081 BT Amsterdam, Netherlands Leuphana Univ, Luneburg, Germany.
    Weitz, Erica
    Vrije Univ Amsterdam, NL-1081 BT Amsterdam, Netherlands..
    Karyotaki, Eirini
    Vrije Univ Amsterdam, NL-1081 BT Amsterdam, Netherlands.
    Garber, Judy
    Vanderbilt Univ, Dept Psychol & Human Dev, Nashville, TN 37235 USA.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutet för handikappvetenskap (IHV). Karolinska Inst, Psychiat Sect, Dept Clin Neurosci, Stockholm, Sweden.
    The effects of psychological treatment of maternal depression on children and parental functioning: a meta-analysis.2015Inngår i: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 24, nr 2, s. 237-245Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Successful treatment of parental depression may have a positive effect on the functioning and psychopathology of their children. We conducted a meta-analysis to examine the effects of psychotherapy for depressed mothers on their children and parental functioning. We used a database of randomized controlled trials examining the effects of psychotherapy for adult depression and selected trials comparing psychotherapy and control conditions in depressed mothers and reporting outcomes in their children and parental functioning. Nine studies were included. The quality of these studies was not optimal and the outcome instruments differed considerably from each other. The therapies resulted in significantly decreased levels of depression (g = 0.66) in the mothers. In the seven studies that reported outcomes on the mental health of children, a significant effect size was also found (g = 0.40). The eight studies examining mother-child interactions resulted in a significant effect size of g = 0.35, and the five studies examining parenting/marital distress had a pooled effect size of g = 0.67. We found that psychotherapy leads to decreased levels of depression in depressed mothers and also found indications that psychotherapy may have a positive effect on the mental health of their children and parenting/marital distress. However, more high-quality research is needed before a definite answer can be given.

  • 228.
    Dagöö, Jesper
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Persson Asplund, Robert
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Andersson Bsenko, Helene
    Umeå University, Sweden .
    Hjerling, Sofia
    Uppsala University, Sweden .
    Holmberg, Anna
    Mid Sweden University, Sweden .
    Westh, Susanne
    Mid Sweden University, Sweden .
    Oberg, Louise
    Lund University, Sweden .
    Ljotsson, Brjann
    Karolinska Institute, Sweden .
    Carlbring, Per
    Stockholm University, Sweden .
    Furmark, Tomas
    Uppsala University, Sweden .
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Cognitive behavior therapy versus interpersonal psychotherapy for social anxiety disorder delivered via smartphone and computer: A randomized controlled trial2014Inngår i: Journal of Anxiety Disorders, ISSN 0887-6185, E-ISSN 1873-7897, Vol. 28, nr 4, s. 410-417Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In this study, a previously evaluated guided Internet-based cognitive behavior therapy for social anxiety disorder (SAD) was adapted for mobile phone administration (mCBT). The treatment was compared with a guided self-help treatment based on interpersonal psychotherapy (mIPT). The treatment platform could be accessed through smartphones, tablet computers, and standard computers. A total of 52 participants were diagnosed with SAD and randomized to either mCBT (n = 27) or mIPT (n = 25). Measures were collected at pre-treatment, during the treatment, post-treatment and 3-month follow-up. On the primary outcome measure, the Liebowitz Social Anxiety Scale - self-rated, both groups showed statistically significant improvements. However, mCBT performed significantly better than mIPT (between group Cohens d = 0.64 in favor of mCBT). A larger proportion of the mCBT group was classified as responders at post-treatment (55.6% versus 8.0% in the mIPT group). We conclude that CBT for SAD can be delivered using modern information technology. IPT delivered as a guided self-help treatment may be less effective in this format.

  • 229.
    Dahlin, Mats
    et al.
    Psykologpartners, Private Practice, Linköping, Sweden.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Karolinska Institute, Sweden.
    Magnusson, Kristoffer
    Karolinska Institute, Sweden.
    Johansson, Tomas
    Umeå University, Sweden.
    Sjögren, Johan
    Umeå University, Sweden.
    Håkansson, Andreas
    Umeå University, Sweden.
    Pettersson, Magnus
    Umeå University, Sweden.
    Kadowaki, Åsa
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Psykiatriska kliniken.
    Cuijpers, Pim
    Vrije University of Amsterdam, Netherlands; EMGO Institute Health and Care Research, Netherlands.
    Carlbring, Per
    Stockholm University, Sweden.
    Internet-delivered acceptance-based behaviour therapy for generalized anxiety disorder: A randomized controlled trial2016Inngår i: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 77, s. 86-95Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Generalized anxiety disorder (GAD) is a disabling condition which can be treated with cognitive behaviour therapy (CBT). The present study tested the effects of therapist-guided internet-delivered acceptance-based behaviour therapy on symptoms of GAD and quality of life. An audio CD with acceptance and mindfulness exercises and a separate workbook were also included in the treatment. Participants diagnosed with GAD (N = 103) were randomly allocated to immediate therapist-guided internet-delivered acceptance-based behaviour therapy or to a waiting-list control condition. A six month follow-up was also included. Results using hierarchical linear modelling showed moderate to large effects on symptoms of GAD (Cohens d = 0.70 to 0.98), moderate effects on depressive symptoms (Cohens d = 0.51 to 0.56), and no effect on quality of life. Follow-up data showed maintained effects. While there was a 20% dropout rate, sensitivity analyses showed that dropouts did not differ in their degree of change during treatment. To conclude, our study suggests that internet-delivered acceptance based behaviour therapy can be effective in reducing the symptoms of GAD. (C) 2015 Elsevier Ltd. All rights reserved.

  • 230.
    Dahlin, Mats
    et al.
    Psykologpartners, Private practice, Linköping, Sweden.
    Ryberg, Marielle
    Psykologpartners, Private practice, Linköping, Sweden.
    Vernmark, Kristofer
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Psykologpartners, Private practice, Linköping, Sweden.
    Annas, Nina
    Psykiatripartners, Private practice, Linköping, Sweden.
    Carlbring, Per
    Division of Clinical Psychology, Department of Psychology, Stockholm University, Stockholm, Sweden.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institute, Stockholm, Sweden.
    Internet-delivered acceptance-based behavior therapy for generalized anxiety disorder: A pilot study2016Inngår i: Internet Interventions, ISSN 2214-7829, Vol. 6, s. 16-21Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective

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

    Methods

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

    Results

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

    Conclusions

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

  • 231.
    Dahlström, Örjan
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutet för handikappvetenskap (IHV).
    Signoret, Carine
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutet för handikappvetenskap (IHV).
    Dahl, Jakob
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutet för handikappvetenskap (IHV).
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutet för handikappvetenskap (IHV).
    Rönnberg, Jerker
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutet för handikappvetenskap (IHV).
    Effects of cognitive load on neurophysiological activity among persons with tinnitus2017Konferansepaper (Annet vitenskapelig)
  • 232.
    Dettore, Davide
    et al.
    University of Florence, Italy; Miller Institute Behav and Cognit Psychotherapy, Italy.
    Pozza, Andrea
    Miller Institute Behav and Cognit Psychotherapy, Italy; University of Florence, Italy.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Karolinska Institute, Sweden.
    Efficacy of Technology-delivered Cognitive Behavioural Therapy for OCD Versus Control Conditions, and in Comparison with Therapist-Administered CBT: Meta-Analysis of Randomized Controlled Trials2015Inngår i: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 44, nr 3, s. 190-211Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Cognitive behavioural therapy (CBT) is a well-established treatment for obsessive-compulsive disorder (OCD). However, few patients receive CBT, due to factors such as geographic limitations, perceived stigmatization, and lack of CBT services. Technology-delivered cognitive behavioural therapy (T-CBT) could be an effective strategy to improve patients access to CBT. To date, a meta-analysis on the effectiveness of T-CBT for OCD has not been conducted. This study used meta-analytic techniques to summarize evidence on the efficacy of T-CBT for OCD versus control conditions and therapist-administered CBT. A meta-analysis according to Prisma guidelines was conducted on randomized controlled trials (RCTs) of T-CBT for OCD. Treatment was classified as T-CBT if evidence-based CBT active ingredients for OCD were included (psychoeducation, ERP, and cognitive restructuring), delivered through health technologies (e.g. self-help books, leaflets, and other forms of bibliotherapy) or remote communication technologies (e.g. the Internet, web-cameras, telephones, telephone-interactive voice response systems, and CD-ROMS). Studies using validated outcomes for OCD or depression were included. Eight trials were included (N=420). Two trials were classified as at high risk of bias. T-CBT seemed to be superior to control conditions on OCD symptom outcomes at post-treatment (d=0.82, 99% CI=0.55-1.08, p=0.001), but not on comorbid depression (d=0.33, 99% CI=-0.01-0.67, p=0.020). Difference in the efficacy on OCD symptoms between T-CBT and therapist-administered CBT was not significant, despite a trend favouring therapist-administered CBT emerged (d=0.45, 95% CI=0.03-0.87, p=0.033). Directions for research are discussed. Further RCTs are warranted to examine the efficacy of T-CBT for OCD.

  • 233.
    Donker, Tara
    et al.
    Vrije University Amsterdam.
    van Straten, Annemieke
    Vrije University Amsterdam.
    Riper, Heleen
    Vrije University Amsterdam.
    Marks, Isaac
    Kings College London.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Avdelningen för klinisk och socialpsykologi (CS). Linköpings universitet, Filosofiska fakulteten.
    Cuijpers, Pim
    Vrije University Amsterdam.
    Implementation of Internet-based preventive interventions for depression and anxiety: role of support? The design of a randomized controlled trial2009Inngår i: TRIALS, ISSN 1745-6215, Vol. 10, nr 59Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Internet-based self-help is an effective preventive intervention for highly prevalent disorders, such as depression and anxiety. It is not clear, however, whether it is necessary to offer these interventions with professional support or if they work without any guidance. In case support is necessary, it is not clear which level of support is needed. This study examines whether an internet-based self-help intervention with a coach is more effective than the same intervention without a coach in terms of clinical outcomes, drop-out and economic costs. Moreover, we will investigate which level of support by a coach is more effective compared to other levels of support. Methods: In this randomized controlled trial, a total of 500 subjects (18 year and older) from the general population with mild to moderate depression and/or anxiety will be assigned to one of five conditions: (1) web-based problem solving through the internet (self-examination therapy) without a coach; (2) the same as 1, but with the possibility to ask help from a coach on the initiative of the respondent (on demand, by email); (3) the same as 1, but with weekly scheduled contacts initiated by a coach (once per week, by email); (4) weekly scheduled contacts initiated by a coach, but no web-based intervention; (5) information only (through the internet). The interventions will consist of five weekly lessons. Primary outcome measures are symptoms of depression and anxiety. Secondary outcome measures are drop-out from the intervention, quality of life, and economic costs. Other secondary outcome measures that may predict outcome are also studied, e. g. client satisfaction and problem-solving skills. Measures are taken at baseline (pre-test), directly after the intervention (post-test, five weeks after baseline), 3 months later, and 12 months later. Analysis will be conducted on the intention-to-treat sample. Discussion: This study aims to provide more insight into the clinical effectiveness, differences in drop-out rate and costs between interventions with and without support, and in particular different levels of support. This is important to know in relation to the dissemination of internet-based self-help interventions.

  • 234.
    Ebert, D. D.
    et al.
    University of Erlangen Nurnberg, Germany.
    Donkin, L.
    University of Sydney, Australia; Vrije University of Amsterdam, Netherlands.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Karolinska Institute, Sweden.
    Andrews, G.
    University of New South Wales, Australia.
    Berger, T.
    University of Bern, Switzerland.
    Carlbring, P.
    Stockholm University, Sweden.
    Rozenthal, A.
    Stockholm University, Sweden.
    Choi, I.
    University of Sydney, Australia.
    Laferton, J. A. C.
    Psychol Hsch Berlin, Germany.
    Johansson, Robert
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Filosofiska fakulteten. Karolinska Institute, Sweden.
    Kleiboer, A.
    Vrije University of Amsterdam, Netherlands.
    Lange, A.
    University of Amsterdam, Netherlands.
    Lehr, D.
    Leuphana University of Luneburg, Germany.
    Reins, J. A.
    Leuphana University of Luneburg, Germany.
    Funk, B.
    Leuphana University of Luneburg, Germany.
    Newby, J.
    University of New South Wales, Australia.
    Perini, S.
    Macquarie University, Australia.
    Riper, H.
    Vrije University of Amsterdam, Netherlands.
    Ruwaard, J.
    Vrije University of Amsterdam, Netherlands.
    Sheeber, L.
    Oregon Research Institute, OR 97403 USA.
    Snoek, F. J.
    Vrije University of Amsterdam, Netherlands; University of Amsterdam, Netherlands.
    Titov, N.
    Macquarie University, Australia; Macquarie University, Australia.
    Unlu Ince, B.
    Vrije University of Amsterdam, Netherlands.
    van Bastelaar, K.
    Vrije University of Amsterdam, Netherlands.
    Vernmark, Kristofer
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    van Straten, A.
    Vrije University of Amsterdam, Netherlands.
    Warmerdam, L.
    Vrije University of Amsterdam, Netherlands.
    Salsman, N.
    Xavier University, OH 45207 USA.
    Cuijpers, P.
    Vrije University of Amsterdam, Netherlands.
    Does Internet-based guided-self-help for depression cause harm? An individual participant data meta-analysis on deterioration rates and its moderators in randomized controlled trials2016Inngår i: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 46, nr 13, s. 2679-2693Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

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

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

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

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

  • 235.
    Ebert, David Daniel
    et al.
    University of Luneburg, Germany; University of Marburg, Germany; University of Erlangen Nurnberg, Germany.
    Lehr, Dirk
    University of Luneburg, Germany.
    Boss, Leif
    University of Luneburg, Germany.
    Riper, Heleen
    University of Luneburg, Germany; Vrije University of Amsterdam, Netherlands; Vrije University of Amsterdam, Netherlands.
    Cuijpers, Pim
    Vrije University of Amsterdam, Netherlands.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Thiart, Hanne
    University of Luneburg, Germany.
    Heber, Elena
    University of Luneburg, Germany.
    Berking, Matthias
    University of Luneburg, Germany; University of Erlangen Nurnberg, Germany.
    Efficacy of an internet-based problem-solving training for teachers: results of a randomized controlled trial2014Inngår i: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 40, nr 6, s. 582-596Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective The primary purpose of this randomized controlled trial (RCT) was to evaluate the efficacy of internet-based problem-solving training (iPST) for employees in the educational sector (teachers) with depressive symptoms. The results of training were compared to those of a waitlist control group (WLC). Methods One-hundred and fifty teachers with elevated depressive symptoms (Center for Epidemiologic Studies Depression Scale, CES-D greater than= 16) were assigned to either the iPST or WLC group. The iPST consisted of five lessons, including problem-solving and rumination techniques. Symptoms were assessed before the intervention began and in follow-up assessments after seven weeks, three months, and six months. The primary outcome was depressive symptom severity (CES-D). Secondary outcomes included general and work-specific self-efficacy, perceived stress, pathological worries, burnout symptoms, general physical and mental health, and absenteeism. Results iPST participants displayed a significantly greater reduction in depressive symptoms after the intervention (d=0.59, 95% CI 0.26-0.92), after three months (d=0.37, 95% CI 0.05-0.70) and after six months (d=0.38, 95% CI 0.05-0.70) compared to the control group. The iPST participants also displayed significantly higher improvements in secondary outcomes. However, workplace absenteeism was not significantly affected. Conclusion iPST is effective in reducing symptoms of depression among teachers. Disseminated on a large scale, iPST could contribute to reducing the burden of stress-related mental health problems among teachers. Future studies should evaluate iPST approaches for use in other working populations.

  • 236.
    Ekeblad, Annika
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Filosofiska fakulteten. Vasternorrland County Council, Sweden.
    Falkenström, Fredrik
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Filosofiska fakulteten. Uppsala University, Sweden.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Karolinska Institute, Sweden.
    Vestberg, Robert
    Vasternorrland County Council, Sweden.
    Holmqvist, Rolf
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Randomized Trial of Interpersonal Psychotherapy and Cognitive Behavioral Therapy for Major Depressive Disorder in a Community-Based Psychiatric Outpatient Clinic2016Inngår i: Depression and anxiety (Print), ISSN 1091-4269, E-ISSN 1520-6394, Vol. 33, nr 12, s. 1090-1098Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BackgroundInterpersonal psychotherapy (IPT) and cognitive behavioral therapy (CBT) are both evidence-based treatments for major depressive disorder (MDD). Several head-to-head comparisons have been made, mostly in the United States. In this trial, we compared the two treatments in a small-town outpatient psychiatric clinic in Sweden. The patients had failed previous primary care treatment and had extensive Axis-II comorbidity. Outcome measures were reduction of depressive symptoms and attrition rate. MethodsNinety-six psychiatric patients with MDD (DSM-IV) were randomized to 14 sessions of CBT (n = 48) or IPT (n = 48). A noninferiority design was used with the hypothesis that IPT would be noninferior to CBT. A three-point difference on the Beck Depression Inventory-II (BDI-II) was used as noninferiority margin. ResultsIPT passed the noninferiority test. In the ITT group, 53.5% (23/43) of the IPT patients and 51.0% (24/47) of the CBT patients were reliably improved, and 20.9% (9/43) and 19.1% (9/47), respectively, were recovered (last BDI score amp;lt;10). The dropout rate was significantly higher in CBT (40%; 19/47) compared to IPT (19%; 8/43). Statistically controlling for antidepressant medication use did not change the results. ConclusionsIPT was noninferior to CBT in a sample of depressed psychiatric patients in a community-based outpatient clinic. CBT had significantly more dropouts than IPT, indicating that CBT may be experienced as too demanding. Since about half the patients did not recover, there is a need for further treatment development for these patients. The study should be considered an effectiveness trial, with strong external validity but some limitations in internal validity.

  • 237.
    El Alaoui, Samir
    et al.
    Karolinska Institute, Sweden.
    Hedman, Erik
    Karolinska Institute, Sweden; Karolinska Institute, Sweden.
    Kaldo, Viktor
    Karolinska Institute, Sweden.
    Hesser, Hugo
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Kraepelien, Martin
    Karolinska Institute, Sweden.
    Andersson, Evelyn
    Karolinska Institute, Sweden.
    Ruck, Christian
    Karolinska Institute, Sweden.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Karolinska Institute, Sweden.
    Ljotsson, Brjann
    Karolinska Institute, Sweden.
    Lindefors, Nils
    Karolinska Institute, Sweden.
    Effectiveness of Internet-Based Cognitive-Behavior Therapy for Social Anxiety Disorder in Clinical Psychiatry2015Inngår i: Journal of Consulting and Clinical Psychology, ISSN 0022-006X, E-ISSN 1939-2117, Vol. 83, nr 5, s. 902-914Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: Internet-based cognitive-behavioral therapy (ICBT) has received increased attention as an innovative approach to improve access to evidence-based psychological treatments. Although the efficacy of ICBT for social anxiety disorder has been established in several studies, there is limited knowledge of its effectiveness and application in clinical psychiatric care. The purpose of this study was to evaluate the effectiveness of ICBT in the treatment of social anxiety disorder and to determine the significance of patient adherence and the clinics years of experience in delivering ICBT. Method: A longitudinal cohort study was conducted using latent growth curve modeling of patients (N = 654) treated with ICBT at an outpatient psychiatric clinic between 2009 and 2013. The primary outcome measure was the Liebowitz Social Anxiety Scale-Self-Rated. Results: Significant reductions in symptoms of social anxiety were observed after treatment (effect size d = 0.86, 99% CI [0.74, 0.98]). Improvements were sustained at 6-month follow-up (d = 1.15, 99% CI [0.99, 1.32]). Patient adherence had a positive effect on the rate of improvement. A positive association between the clinics years of experience with ICBT and treatment outcome was also observed. Conclusions: This study suggests that ICBT for social anxiety disorder is effective when delivered within the context of a unit specialized in Internet-based psychiatric care and may be considered as a treatment alternative for implementation within the mental health care system.

  • 238.
    El Alaoui, Samir
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Hedman, Erik
    Karolinska Institutet, Stockholm, Sweden.
    Ljótsson, Brjánn
    Karolinska Institutet, Stockholm, Sweden.
    Bergström, Jan
    Karolinska Institutet, Stockholm, Sweden.
    Andersson, Erik
    Karolinska Institutet, Stockholm, Sweden.
    Rück, Christian
    Karolinska Institutet, Stockholm, Sweden.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Karolinska Institutet, Stockholm, Sweden.
    Lindefors, Nils
    Karolinska Institutet, Stockholm, Sweden.
    Predictors and moderators of internet- and group-based cognitive behaviour therapy for panic disorder2013Inngår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, nr 11, s. e79024-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Internet-based cognitive behaviour therapy (ICBT) can be equally effective as traditional face-to-face cognitive behaviour therapy (CBT) for treating panic disorder (PD). However, little is known about the predictors and moderators of outcome of ICBT when delivered in psychiatric outpatient settings. This study investigated a selection of outcome predictors and moderators of ICBT for panic disorder based on data from a randomised controlled trial where therapist-guided ICBT was compared with group CBT (GCBT) for panic disorder. Participants (N = 104) received 10 weeks of ICBT or GCBT and were assessed before and after treatment, and after six months. Multiple regression analyses were used to test for significant predictors of treatment outcome. Predictors of positive treatment response for both modalities were having low levels of symptom severity and work impairment. In addition, anxiety sensitivity was found to have a small negative relationship with treatment outcome, suggesting that anxiety sensitivity may slightly enhance treatment response. Treatment modality had a moderating effect on the relationship between domestic impairment and outcome and on the relationship between initial age of onset of panic symptoms and treatment outcome, favouring ICBT for patients having had an early onset of PD symptoms and for patients having a high domestic functional impairment. These results suggest that both ICBT and GCBT are effective treatment modalities for PD and that it is possible to predict a significant proportion of the long-term outcome variance based on clinical variables.

  • 239.
    El Alaoui, Samir
    et al.
    Karolinska Institute, Sweden.
    Ljotsson, Brjann
    Karolinska Institute, Sweden; Karolinska Institute, Sweden.
    Hedman, Erik
    Karolinska Institute, Sweden; Karolinska Institute, Sweden; Karolinska Institute, Sweden.
    Kaldo, Viktor
    Karolinska Institute, Sweden.
    Andersson, Evelyn
    Karolinska Institute, Sweden.
    Ruck, Christian
    Karolinska Institute, Sweden.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Karolinska Institute, Sweden.
    Lindefors, Nils
    Karolinska Institute, Sweden.
    Predictors of Symptomatic Change and Adherence in Internet-Based Cognitive Behaviour Therapy for Social Anxiety Disorder in Routine Psychiatric Care2015Inngår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, nr 4, s. e0124258-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective A central goal of health care is to improve patient outcomes. Although several studies have demonstrated the effectiveness of therapist guided internet-based cognitive behaviour therapy (ICBT) for social anxiety disorder (SAD), a significant proportion of patients do not respond to treatment. Consequently, the aim of this study was to identify individual characteristics and treatment program related factors that could help clinicians predict treatment outcomes and adherence for individuals with SAD. Method The sample comprised longitudinal data collected during a 4-year period of adult individuals (N = 764) treated for SAD at a public service psychiatric clinic. Weekly self-rated Liebowitz Social Anxiety Scale (LSAS-SR) scores were provided. Rates of symptomatic change during treatment and adherence levels were analysed using multilevel modelling. The following domains of prognostic variables were examined: (a) socio-demographic variables; (b) clinical characteristics; (c) family history of mental illness; and (d) treatment-related factors. Results Higher treatment credibility and adherence predicted a faster rate of improvement during treatment, whereas higher overall functioning level evidenced a slower rate of improvement. Treatment credibility was the strongest predictor of greater adherence. Having a family history of SAD-like symptoms was also associated with greater adherence, whereas Attention-Deficit/Hyperactivity Disorder (ADHD)-like symptoms, male gender, and family history of minor depression predicted lower adherence. Also, the amount of therapist time spent per treatment module was negatively associated with adherence. Conclusions Results from a large clinical sample indicate that the credibility of ICBT is the strongest prognostic factor explaining individual differences in both adherence level and symptomatic improvement. Early screening of ADHD-like symptoms may help clinicians identify patients who might need extra support or an adjusted treatment. Therapist behaviours that promote adherence may be important for treatment response, although more research is needed in order to determine what type of support would be most beneficial.

  • 240.
    Elisabet, Sundewall Thorén
    et al.
    Eriksholm Reserach Centre, Denmark.
    Öberg, Marie
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Teknisk audiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Öron- näsa- och halskliniken US.
    Wänström, Gunilla
    Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Hälsouniversitetet.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Lunner, Thomas
    Eriksholm Research Centre, Denmark.
    Rehabiliteringsprogram för vuxna hörapparatanvändare2012Konferansepaper (Annet vitenskapelig)
  • 241.
    Ellis, Rachel
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten.
    Molander, Peter
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten.
    Rönnberg, Jerker
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten.
    Lyxell, Björn
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Karolinska Institutet, Department of Clinical Neuroscience.
    Lunner, Thomas
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten. Snekkersten, Oticon A/S, Eriksholm Research Centre.
    Predicting speech-in-noise perception using the trail making task: Results from a large-scale internet study2015Konferansepaper (Fagfellevurdert)
    Abstract [en]

    The purpose of this study was to investigate the utility of an internet-based version of the trail making test (TMT) to predict performance on a speech-in-noise perception task. Computerised versions of the tests were completed, via the internet, by a large (1500+) sample of listeners aged between 18 and 91 years old, both with and without hearing loss. The results show that better performance on both the simple and complex versions of the TMT are associated with better speech-in-noise recognition scores. The findings suggest that the relation between performance in the TMT and speech recognition test may be due to the capacity of the TMT to index perceptual speed, as opposed to the more complex cognitive abilities also implicated in TMT performance.

  • 242.
    Ellis, Rachel
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten.
    Molander, Peter
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten.
    Rönnberg, Jerker
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten.
    Lyxell, Björn
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten. Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden..
    Lunner, Thomas
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten. Eriksholm Research Centre, Oticon A/S, Snekkersten, Denmark..
    Predicting Speech-in-Noise Recognition from Performance on the Trail Making Test: Results from a Large-Scale Internet Study2016Inngår i: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, Vol. 37, nr 1, s. 73-79Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: The aim of the study was to investigate the utility of an internet-based version of the trail making test (TMT) to predict performance on a speech-in-noise perception task.

    Design: Data were taken from a sample of 1509 listeners aged between 18 and 91 years old. Participants completed computerized versions of the TMT and an adaptive speech-in-noise recognition test. All testing was conducted via the internet.

    Results: The results indicate that better performance on both the simple and complex subtests of the TMT are associated with better speech-in-noise recognition scores. Thirty-eight percent of the participants had scores on the speech-in-noise test that indicated the presence of a hearing loss.

    Conclusions: The findings suggest that the TMT may be a useful tool in the assessment, and possibly the treatment, of speech-recognition difficulties. The results indicate that the relation between speech-in-noise recognition and TMT performance relates both to the capacity of the TMT to index processing speed and to the more complex cognitive abilities also implicated in TMT performance.

  • 243.
    Ellis, Rachel
    et al.
    Linköpings universitet, Institutet för handikappvetenskap (IHV). Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten.
    Molander, Peter
    Linköpings universitet, Institutet för handikappvetenskap (IHV). Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Filosofiska fakulteten.
    Rönnberg, Jerker
    Linköpings universitet, Institutet för handikappvetenskap (IHV). Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten.
    Lyxell, Björn
    Linköpings universitet, Institutet för handikappvetenskap (IHV). Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten.
    Andersson, Gerhard
    Linköpings universitet, Institutet för handikappvetenskap (IHV). Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten. Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
    Lunner, Thomas
    Linköpings universitet, Institutet för handikappvetenskap (IHV). Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutionen för klinisk och experimentell medicin. Eriksholm Research Centre, Snekkersten, Denmark.
    Predicting Speech-in-Noise Recognition from Performance on the Trail Making Test: Results from a Large-Scale Internet Study2013Konferansepaper (Fagfellevurdert)
  • 244.
    Emmelkamp, Paul M. G.
    et al.
    University of Amsterdam, Netherlands King Abdulaziz University, Saudi Arabia .
    David, Daniel
    University of Babes Bolyai, Romania Mt Sinai School Med, NY USA .
    Beckers, Tom
    Katholieke University of Leuven, Belgium University of Amsterdam, Netherlands .
    Muris, Peter
    Maastricht University, Netherlands .
    Cuijpers, Pim
    Vrije University of Amsterdam, Netherlands Vrije University of Amsterdam, Netherlands Vrije University of Amsterdam Medical Centre, Netherlands Leuphana University, Germany .
    Lutz, Wolfgang
    University of Trier, Germany .
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Araya, Ricardo
    University of Bristol, England .
    Banos Rivera, Rosa M.
    University of Valencia, Spain .
    Barkham, Michael
    University of Sheffield, England .
    Berking, Matthias
    Leuphana University, Germany University of Marburg, Germany University of Marburg, Germany .
    Berger, Thomas
    University of Bern, Switzerland .
    Botella, Christina
    Jaume I University, Spain .
    Carlbring, Per
    Stockholm University, Sweden .
    Colom, Francesc
    Hospital Clin Barcelona, Spain .
    Essau, Cecilia
    Roehampton University, England .
    Hermans, Dirk
    Katholieke University of Leuven, Belgium .
    Hofmann, Stefan G.
    Boston University, MA 02215 USA .
    Knappe, Susanne
    Technical University of Dresden, Germany .
    Ollendick, Thomas H.
    Virginia Technical University, VA USA .
    Raes, Filip
    Katholieke University of Leuven, Belgium .
    Rief, Winfried
    University of Marburg, Germany University of Marburg, Germany .
    Riper, Heleen
    Vrije University of Amsterdam, Netherlands Vrije University of Amsterdam, Netherlands Vrije University of Amsterdam Medical Centre, Netherlands Vrije University of Amsterdam Medical Centre, Netherlands .
    Van der Oord, Saskia
    Katholieke University of Leuven, Belgium University of Amsterdam, Netherlands .
    Vervliet, Bram
    Katholieke University of Leuven, Belgium .
    Advancing psychotherapy and evidence-based psychological interventions2014Inngår i: International Journal of Methods in Psychiatric Research, ISSN 1049-8931, E-ISSN 1557-0657, Vol. 23, nr S1, s. 58-91Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Psychological models of mental disorders guide research into psychological and environmental factors that elicit and maintain mental disorders as well as interventions to reduce them. This paper addresses four areas. (1) Psychological models of mental disorders have become increasingly transdiagnostic, focusing on core cognitive endophenotypes of psychopathology from an integrative cognitive psychology perspective rather than offering explanations for unitary mental disorders. It is argued that psychological interventions for mental disorders will increasingly target specific cognitive dysfunctions rather than symptom-based mental disorders as a result. (2) Psychotherapy research still lacks a comprehensive conceptual framework that brings together the wide variety of findings, models and perspectives. Analysing the state-of-the-art in psychotherapy treatment research, component analyses aiming at an optimal identification of core ingredients and the mechanisms of change is highlighted as the core need towards improved efficacy and effectiveness of psychotherapy, and improved translation to routine care. (3) In order to provide more effective psychological interventions to children and adolescents, there is a need to develop new and/or improved psychotherapeutic interventions on the basis of developmental psychopathology research taking into account knowledge of mediators and moderators. Developmental neuroscience research might be instrumental to uncover associated aberrant brain processes in children and adolescents with mental health problems and to better examine mechanisms of their correction by means of psychotherapy and psychological interventions. (4) Psychotherapy research needs to broaden in terms of adoption of large-scale public health strategies and treatments that can be applied to more patients in a simpler and cost-effective way. Increased research on efficacy and moderators of Internet-based treatments and e-mental health tools (e.g. to support real time clinical decision-making to prevent treatment failure or relapse) might be one promising way forward.

  • 245.
    Enander, J
    et al.
    Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
    Andersson, E
    Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
    Kaldo, V
    Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
    Lindefors, N
    Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Ruck, C
    Rück, C., Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
    Internet administration of the Dimensional Obsessive-Compulsive Scale: A psychometric evaluation2012Inngår i: Journal of Obsessive-Compulsive and Related Disorders, ISSN 2211-3649, Vol. 1, nr 4, s. 325-330Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The Dimensional Obsessive-Compulsive Scale (DOCS) was designed to address the current limitations of existing obsessive-compulsive (OC) symptom measures and is a self-report questionnaire that assesses the severity of the four most empirically supported OC symptom dimensions. The aim of this study was to examine the psychometric properties of a Swedish version of the DOCS when administered via the Internet. Internal consistency, factor structure, and convergent and discriminant validity were examined in a sample consisting of 101 patients diagnosed with obsessive-compulsive disorder. The DOCS sensitivity to treatment effects were examined in a sample consisting of 48 patients treated with Internet-delivered cognitive behavioral therapy were the main intervention was exposure with response prevention. Results showed that the internal consistency was high. The DOCS also showed adequate convergent and discriminant validity, as well as fair sensitivity to treatment effects. The factor analysis supported the DOCS four-factor solution. In summary, the results from the present study give initial support that the DOCS can be administered via the Internet with adequate psychometric properties. © 2012 Elsevier Ltd.

  • 246.
    Enander, Jesper
    et al.
    Karolinska Institute, Sweden.
    Andersson, Erik
    Karolinska Institute, Sweden.
    Mataix-Cols, David
    Karolinska Institute, Sweden; Kings Coll London, England.
    Lichtenstein, Linn
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Filosofiska fakulteten.
    Alstroem, Katarina
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Filosofiska fakulteten.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Ljotsson, Brjann
    Karolinska Institute, Sweden.
    Rueck, Christian
    Karolinska Institute, Sweden.
    Therapist guided internet based cognitive behavioural therapy for body dysmorphic disorder: single blind randomised controlled trial2016Inngår i: BMJ-BRITISH MEDICAL JOURNAL, ISSN 1756-1833, Vol. 352, nr i241Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES To evaluate the efficacy of therapist guided internet based cognitive behavioural therapy (CBT) programme for body dysmorphic disorder (BDD-NET) compared with online supportive therapy. DESIGN A 12 week single blind parallel group randomised controlled trial. SETTING Academic medical centre. PARTICIPANTS 94 self referred adult outpatients with a diagnosis of body dysmorphic disorder and a modified Yale-Brown obsessive compulsive scale (BDD-YBOCS) score of &gt;= 20. Concurrent psychotropic drug treatment was permitted if the dose had been stable for at least two months before enrolment and remained unchanged during the trial. INTERVENTIONS Participants received either BDD-NET (n=47) or supportive therapy (n=47) delivered via the internet for 12 weeks. MAIN OUTCOME MEASURES The primary outcome was the BDD-YBOCS score after treatment and follow-up (three and six months from baseline) as evaluated by a masked assessor. Responder status was defined as a &gt;= 30% reduction in symptoms on the scale. Secondary outcomes were measures of depression (MADRS-S), global functioning (GAF), clinical global improvement (CGI-I), and quality of life (EQ5D). The six month follow-up time and all outcomes other than BDD-YBOCS and MADRS-S at 3 months were not pre-specified in the registration at clinicaltrials.gov because of an administrative error but were included in the original trial protocol approved by the regional ethics committee before the start of the trial. RESULTS BDD-NET was superior to supportive therapy and was associated with significant improvements in severity of symptoms of body dysmorphic disorder (BDD-YBOCS group difference -7.1 points, 95% confidence interval -9.8 to -4.4), depression (MADRS-S group difference -4.5 points, -7.5 to -1.4), and other secondary measures. At follow-up, 56% of those receiving BDD-NET were classed as responders, compared with 13% receiving supportive therapy. The number needed to treat was 2.34 (1.71 to 4.35). Self reported satisfaction was high. CONCLUSIONS CBT can be delivered safely via the internet to patients with body dysmorphic disorder. BDD-NET has the potential to increase access to evidence based psychiatric care for this mental disorder, in line with NICE priority recommendations. It could be particularly useful in a stepped care approach, in which general practitioner or other mental health professionals can offer treatment to people with mild to moderate symptoms at low risk of suicide.

  • 247.
    Essery, Rosie
    et al.
    University of Southampton, England.
    Kirby, Sarah
    University of Southampton, England.
    Geraghty, Adam W. A.
    University of Southampton, England.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Karolinska Institute, Sweden.
    Carlbring, Per
    University of Stockholm, Sweden.
    Bronstein, Adolfo
    University of London Imperial Coll Science Technology and Med, England.
    Little, Paul
    University of Southampton, England.
    Yardley, Lucy
    University of Southampton, England.
    The Development of Balance Retraining: An Online Intervention for Dizziness in Adults Aged 50 Years and Older2015Inngår i: American Journal of Audiology, ISSN 1059-0889, E-ISSN 1558-9137, Vol. 24, nr 3, s. 276-279Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: This article outlines the rationale and development process for an online intervention based on vestibular rehabilitation therapy (VRT). The intervention aims to assist adults aged 50 years and older to self-manage and reduce dizziness symptoms. Method: The intervention was developed according to the person-based approach to digital intervention design focused on accommodating perspectives of target users. A prototype version of the intervention was provided to 18 adults (11 women, 7 men) aged 50 years and older with dizziness. These adults were invited to use the intervention over a 6-week period and, during this time, took part in a think-aloud session. This session sought to understand users perceptions of how acceptable, engaging, and easy to use they found the online intervention. Results: Users were extremely positive regarding how easy to navigate, visually appealing, and informative they found the intervention. Think-aloud sessions provided valuable data for informing small amendments to further enhance acceptability of the intervention for target users. Conclusions: Informed by these development-phase data, a finalized version of the intervention is now being investigated in a primary care-based randomized controlled trial. Results should provide an understanding of whether VRT can be effectively-especially, cost-effectively-delivered via an online intervention to adults aged 50 years and older.

  • 248.
    Faria, Vanda
    et al.
    Uppsala University, Sweden; Harvard Medical Sch, MA USA.
    Gingnell, Malin
    Uppsala University, Sweden.
    Hoppe, Johanna M.
    Uppsala University, Sweden.
    Hjorth, Olof
    Uppsala University, Sweden.
    Alaie, Iman
    Uppsala University, Sweden.
    Frick, Andreas
    Uppsala University, Sweden; Karolinska Institute, Sweden.
    Hultberg, Sara
    Uppsala University, Sweden.
    Wahlstedt, Kurt
    Uppsala University, Sweden.
    Engman, Jonas
    Uppsala University, Sweden.
    Mansson, Kristoffer N. T.
    Uppsala University, Sweden; Karolinska Institute, Sweden; Stockholm University, Sweden.
    Carlbring, Per
    Stockholm University, Sweden.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Reis, Margareta
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för läkemedelsforskning. Linköpings universitet, Medicinska fakulteten.
    Larsson, Elna-Marie
    Uppsala University, Sweden.
    Fredrikson, Mats
    Uppsala University, Sweden; Karolinska Institute, Sweden.
    Furmark, Tomas
    Uppsala University, Sweden.
    Do You Believe It? Verbal Suggestions Influence the Clinical and Neural Effects of Escitalopram in Social Anxiety Disorder: A Randomized Trial2017Inngår i: EBioMedicine, ISSN 0360-0637, E-ISSN 2352-3964, Vol. 24, s. 179-188Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed for depression and anxiety, but their efficacy relative to placebo has been questioned. We aimed to test how manipulation of verbally induced expectancies, central for placebo, influences SSRI treatment outcome and brain activity in patients with social anxiety disorder (SAD). Methods: Wedid a randomized clinical trial, within an academicmedical center (Uppsala, Sweden), of individuals fulfilling the DSM-IV criteria for SAD, recruited through media advertising. Participants were 18 years or older and randomized in blocks, through a computer-generated sequence by an independent party, to nine weeks of overt or covert treatment with escitalopram(20mg daily). The overt group received correct treatment information whereas the covert group was treated deceptively with the SSRI described, by the psychiatrist, as active placebo. The treating psychiatrist was necessarily unmasked while the research staff was masked from intervention assignment. Treatment efficacy was assessed primarily with the self-rated Liebowitz Social Anxiety Scale (LSASSR), administered at week 0, 1, 3, 6 and 9, also yielding a dichotomous estimate of responder status (clinically significant improvement). Before and at the last week of treatment, brain activity during an emotional face matching task was assessed with functional magnetic resonance imaging (fMRI) and during fMRI sessions, anticipatory speech anxiety was also assessed with the Spielberger State-Trait Anxiety Inventory-State version (STAI-S). Analyses included all randomized patients with outcome data at posttreatment. This study is registered at ISRCTN, number 98890605. Findings: Between March 17th 2014 and May 22nd 2015, 47 patients were recruited. One patient in the covert group dropped out after a few days of treatment and did not provide fMRI data, leaving 46 patients with complete outcome data. After nine weeks of treatment, overt (n - 24) as compared to covert (n - 22) SSRI administration yielded significantly better outcome on the LSAS-SR (adjusted difference 21.17, 95% CI 10.69-31.65, p amp;lt; 0.0001) with more than three times higher response rate (50% vs. 14%;chi(2)(1)= 6.91, p= 0.009) and twice the effect size (d= 2.24 vs. d= 1.13) from pre-to posttreatment. There was no significant between-group difference on anticipatory speech anxiety (STAI-S), both groups improving with treatment. No serious adverse reactions were recorded. On fMRI outcomes, there was suggestive evidence for a differential neural response to treatment between groups in the posterior cingulate, superior temporal and inferior frontal gyri (all z thresholds exceeding 3.68, p amp;lt;= 0.001). Reduced social anxiety with treatment correlated significantly with enhanced posterior cingulate (z threshold 3.24, p - 0.0006) and attenuated amygdala (z threshold 2.70, p - 0.003) activity. Interpretation: The clinical and neural effects of escitalopram were markedly influenced by verbal suggestions. This points to a pronounced placebo component in SSRI-treatment of SAD and favors a biopsychosocial over a biomedical explanatory model for SSRI efficacy. (C) 2017 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license.

  • 249.
    Forsell, Erik
    et al.
    Karolinska Inst, Sweden; Huddinge Hosp, Sweden.
    Jernelov, Susanna
    Karolinska Inst, Sweden; Huddinge Hosp, Sweden; Karolinska Inst, Sweden.
    Blom, Kerstin
    Karolinska Inst, Sweden; Huddinge Hosp, Sweden.
    Kraepelien, Martin
    Karolinska Inst, Sweden; Huddinge Hosp, Sweden.
    Svanborg, Cecilia
    Karolinska Inst, Sweden; Huddinge Hosp, Sweden.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Karolinska Inst, Sweden; Huddinge Hosp, Sweden.
    Lindefors, Nils
    Karolinska Inst, Sweden; Huddinge Hosp, Sweden.
    Kaldo, Viktor
    Karolinska Inst, Sweden; Huddinge Hosp, Sweden; Linnaeus Univ, Sweden.
    Proof of Concept for an Adaptive Treatment Strategy to Prevent Failures in Internet-Delivered CBT: A Single-Blind Randomized Clinical Trial With Insomnia Patients2019Inngår i: American Journal of Psychiatry, ISSN 0002-953X, E-ISSN 1535-7228, Vol. 176, nr 4, s. 315-323Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: This study aimed to demonstrate proof of concept for an adaptive treatment strategy in Internet-delivered cognitive-behavioral therapy (ICBT), where risk of treatment failure is assessed early in treatment and treatment for at-risk patients is adapted to prevent treatment failure. Methods: A semiautomated algorithm assessed risk of treatment failure early in treatment in 251 patients undergoing ICBT for insomnia with therapist guidance. At-risk patients were randomly assigned to continue standard ICBT or to receive adapted ICBT. The primary outcome was self-rated insomnia symptoms using the Insomnia Severity Index in a linear mixed-effects model. The main secondary outcome was treatment failure (having neither responded nor remitted at the posttreatment assessment). Results: A total of 102 patients were classified as at risk and randomly assigned to receive adapted ICBT (N=51) or standard ICBT (N=51); 149 patients were classified as not at risk. Patients not at risk had significantly greater score reductions on the Insomnia Severity Index than at-risk patients given standard ICBT. Adapted ICBT for at-risk patients was significantly more successful in reducing symptoms compared with standard ICBT, and it decreased the risk of failing treatment (odds ratio= 0.33). At-risk patients receiving adapted ICBT were not more likely to experience treatment failure than those not at risk (odds ratio= 0.51), though they were less likely to experience remission. Adapted treatment required, on average, 14 more minutes of therapist-patient time per remaining week. Conclusions: An adaptive treatment strategy can increase treatment effects for at-risk patients and reduce the number of failed treatments. Future studies should improve accuracy in classification algorithms and identify key factors that boost the effect of adapted treatments.

  • 250.
    Furmark, T
    et al.
    Uppsala univ.
    Carlbring, Per
    Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutionen för beteendevetenskap och lärande, Avdelningen för klinisk och socialpsykologi (CS).
    Hedman, E
    Sonnenstein, A
    Clevberger, P
    Ekselius, L
    Uppsala univ.
    Andersson, Gerhard
    Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutionen för beteendevetenskap och lärande, Avdelningen för klinisk och socialpsykologi (CS).
    Bibliotherapy vs. Internet-based self-help with therapist feedback in the treatment of social phobia: A randomized controlled study2006Inngår i: Second international meeting of the International Society for Research on Internet Interventions,2006, Charlottesville: ISRII , 2006Konferansepaper (Fagfellevurdert)
2345678 201 - 250 of 613
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