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  • 251.
    Furmark, T
    et al.
    Psyk Inst 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
    Holmström, A
    Sparthan, E
    Tillfors, M
    Örebro universitet.
    Ekselius, L
    Uppsala universitet.
    Andersson, Gerhard
    Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutionen för beteendevetenskap och lärande, Avdelningen för klinisk och socialpsykologi (CS).
    Hur väl fungerar en självhjälpsbok vid social fobi? En randomiserad, kontrollerad studie2006Inngår i: Svenska Läkaresällskapets Rikstämma,2006, Katrieneholm: Hygiena , 2006, s. 84-Konferansepaper (Fagfellevurdert)
  • 252.
    Furmark, Tomas
    et al.
    Uppsala University.
    Carlbring, Per
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Avdelningen för klinisk och socialpsykologi (CS). Linköpings universitet, Filosofiska fakulteten.
    Hammer, Sara
    Uppsala University.
    Wahlgren, Ika
    Uppsala University.
    Ekselius, Lisa
    Uppsala University.
    Eriksson, Elias
    University of Gothenburg.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Avdelningen för klinisk och socialpsykologi (CS). Linköpings universitet, Filosofiska fakulteten.
    Effects of Serotonin Transporter and Tryptophan Hydroxylase-2 Gene Variation on the Response to Cognitive-Behavior Therapy in Individuals with Social Anxiety Disorder in BIOLOGICAL PSYCHIATRY, vol 67, issue 9, pp 114S-114S2010Inngår i: BIOLOGICAL PSYCHIATRY, Elsevier Science B.V., Amsterdam. , 2010, Vol. 67, nr 9, s. 114S-114SKonferansepaper (Fagfellevurdert)
    Abstract [en]

    n/a

  • 253.
    Furmark, Tomas
    et al.
    Uppsala University, Department Psychol, SE-75142 Uppsala, Sweden .
    Carlbring, Per
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Avdelningen för klinisk och socialpsykologi (CS). Linköpings universitet, Filosofiska fakulteten.
    Hedman, Erik
    Karolinska Institute, Department Clin Neurosci, Psychiat Sect, Stockholm, Sweden .
    Sonnenstein, Annika
    Uppsala University, Department Psychol, SE-75142 Uppsala, Sweden .
    Clevberger, Peder
    Uppsala University, Department Psychol, SE-75142 Uppsala, Sweden .
    Bohman, Benjamin
    Uppsala University, Department Psychol, SE-75142 Uppsala, Sweden .
    Eriksson, Anneli
    Uppsala University, Department Psychol, SE-75142 Uppsala, Sweden .
    Hallen, Agneta
    Uppsala University, Department Psychol, SE-75142 Uppsala, Sweden .
    Frykman, Mandus
    Uppsala University, Department Psychol, SE-75142 Uppsala, Sweden .
    Holmstrom, Annelie
    Uppsala University, Department Psychol, SE-75142 Uppsala, Sweden .
    Sparthan, Elisabeth
    Uppsala University, Department Psychol, SE-75142 Uppsala, Sweden .
    Tillfors, Maria
    University Orebro, Department Behav Social and Legal Science, Orebro, Sweden .
    Nilsson Ihrfelt, Elisabeth
    Uppsala University, Department Psychol, SE-75142 Uppsala, Sweden .
    Spak, Maria
    Uppsala University, Department Psychol, SE-75142 Uppsala, Sweden .
    Eriksson, Anna
    Uppsala University, Department Psychol, SE-75142 Uppsala, Sweden .
    Ekselius, Lisa
    Uppsala University, Department Neurosci Psychiat, SE-75142 Uppsala, Sweden .
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Avdelningen för klinisk och socialpsykologi (CS). Linköpings universitet, Filosofiska fakulteten.
    Guided and unguided self-help for social anxiety disorder: randomised controlled trial2009Inngår i: BRITISH JOURNAL OF PSYCHIATRY, ISSN 0007-1250, Vol. 195, nr 5, s. 440-447Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background Internet-delivered self-help programmes with added guidance have shown efficacy in social anxiety disorder, unguided self-help has been insufficiently studied. Aims To evaluate the efficacy of guided and unguided self-help social anxiety disorder. Method Participants followed a cognitive-behavioural self-help programme in the form of either pure bibliotherapy or an internet-based treatment with therapist guidance and online group discussions. A subsequent trial was conducted to evaluate treatment specificity. Participants (n=235) were randomised to one of three conditions in the first trial, or one of four conditions in the second. Results Pure bibliotherapy and the internet-based treatment were better than waiting list on measures of social anxiety, general anxiety, depression and quality of life. The internet-based therapy had the highest effect sizes, but directly comparable effects were noted for bibliotherapy augmented with online group discussions. Gains were well maintained a year later. Conclusions Unguided self-help through bibliotherapy can produce enduring improvement for individuals with social anxiety disorder.

  • 254. Furmark, Tomas
    et al.
    Holmström, Annelie
    Sparthan, Elisabeth
    Carlbring, Per
    Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutionen för beteendevetenskap, Avdelningen för klinisk och socialpsykologi, CS.
    Andersson, Gerhard
    Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutionen för beteendevetenskap, Avdelningen för klinisk och socialpsykologi, CS.
    Social fobi - Effektiv hjälp med kognitiv beteendeterapi2006Bok (Annet (populærvitenskap, debatt, mm))
  • 255.
    Furukawa, Toshi A.
    et al.
    Kyoto University, Japan.
    Weitz, Erica S.
    Vrije University of Amsterdam, Netherlands.
    Tanaka, Shiro
    Kyoto University, Japan.
    Hollon, Steven D.
    Vanderbilt University, TN USA.
    Hofmann, Stefan G.
    Boston University, MA USA.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Karolinska Institute, Sweden.
    Twisk, Jos
    Vrije University of Amsterdam, Netherlands.
    DeRubeis, Robert J.
    University of Penn, PA USA; University of Leipzig, Germany.
    Dimidjian, Sona
    University of Colorado Boulder, CO USA.
    Hegerl, Ulrich
    Mergl, Roland
    University of Texas Southwest Medical Centre, TX USA.
    Jarrett, Robin B.
    The University of Texas Southwestern Medical Center, Dallas, Texas, USA.
    Vittengl, Jeffrey R.
    Truman State University, Kirksville, Missouri, USA.
    Watanabe, Norio
    Truman State University, MO USA; Kyoto University, Japan.
    Cuijpers, Pim
    Vrije University of Amsterdam, Netherlands.
    Initial severity of depression and efficacy of cognitive-behavioural therapy: individual-participant data meta-analysis of pill-placebo-controlled trials2017Inngår i: British Journal of Psychiatry, ISSN 0007-1250, E-ISSN 1472-1465, Vol. 210, nr 3, s. 190-196Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Background The influence of baseline severity has been examined for antidepressant medications but has not been studied properly for cognitive behavioural therapy (CBT) in comparison with pill placebo. Aims To synthesise evidence regarding the influence of initial severity on efficacy of CBT from all randomised controlled trials (RCTs) in which CBT, in face-to-face individual or group format, was compared with pill-placebo control in adults with major depression. Method A systematic review and an individual-participant data meta-analysis using mixed models that included trial effects as random effects. We used multiple imputation to handle missing data. Results We identified five RCTs, and we were given access to individual-level data (n=509) for all five. The analyses revealed that the difference in changes in Hamilton Rating Scale for Depression between CBT and pill placebo was not influenced by baseline severity (interaction P=0.43). Removing the non-significant interaction term from the model, the difference between CBT and pill placebo was a standardised mean difference of 0.22 (95% CI 0.42 to 0.02, P=0.03, l(2)=0%). Conclusions Patients suffering from major depression can expect as much benefit from CBT across the wide range of baseline severity. This finding can help inform individualised treatment decisions by patients and their clinicians.

  • 256.
    Geraghty, Adam W. A.
    et al.
    University of Southampton, England.
    Essery, Rosie
    University of Southampton, England.
    Kirby, Sarah
    University of Southampton, England.
    Stuart, Beth
    University of Southampton, England.
    Turner, David
    University of East Anglia, England.
    Little, Paul
    University of Southampton, England.
    Bronstein, Adolfo
    Imperial Coll London, England.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Karolinska Institute, Sweden.
    Carlbring, Per
    Stockholm University, Sweden.
    Yardley, Lucy
    University of Southampton, England; University of Oxford, England.
    Internet-Based Vestibular Rehabilitation for Older Adults With Chronic Dizziness: A Randomized Controlled Trial in Primary Care2017Inngår i: Annals of family medicine (online), ISSN 1544-1709, E-ISSN 1544-1717, Vol. 15, nr 3, s. 209-216Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    PURPOSE Vestibular rehabilitation is an effective intervention for dizziness due to vestibular dysfunction, but is seldom provided. We aimed to determine the effectiveness of an Internet-based vestibular rehabilitation program for older adults experiencing dizziness in primary care. METHODS We undertook a single-center, single-blind randomized controlled trial comparing an Internet-based vestibular rehabilitation intervention (Balance Retraining, freely available from https://balance. lifeguidehealth. org) with usual primary care in patients from 54 primary care practices in southern England. Patients aged 50 years and older with current dizziness exacerbated by head movements were enrolled. Those in the intervention group accessed an automated Internet-based program that taught vestibular rehabilitation exercises and suggested cognitive behavioral management strategies. Dizziness was measured by the Vertigo Symptom Scale-Short Form (VSS-SF) at baseline, 3 months, and 6 months. The primary outcome was VSS-SF score at 6 months. RESULTS A total of 296 patients were randomized in the trial; 66% were female, and the median age was 67 years. The VSS-SF was completed by 250 patients (84%) at 3 months and 230 patients (78%) at 6 months. Compared with the usual care group, the Internet-based vestibular rehabilitation group had less dizziness on the VSS-SF at 3 months (difference, 2.75 points; 95% CI, 1.39-4.12; P amp;lt; . 001) and at 6 months (difference, 2.26 points; 95% CI, 0.39-4.12; P =.02, respectively). Dizziness-related disability was also lower in the Internet-based vestibular rehabilitation group at 3 months (difference, 6.15 points; 95% CI, 2.81-9.49; P amp;lt;. 001) and 6 months (difference, 5.58 points; 95% CI, 1.19-10.0; P =.01). CONCLUSIONS Internet-based vestibular rehabilitation reduces dizziness and dizziness-related disability in older primary care patients without requiring clinical support. This intervention has potential for wide application in community settings.

  • 257.
    Geraghty, Adam W. A.
    et al.
    University of Southampton, England .
    Kirby, Sarah
    University of Southampton, England .
    Essery, Rosie
    University of Southampton, England .
    Little, Paul
    University of Southampton, England .
    Bronstein, Adolfo
    University of London Imperial Coll Science Technology and Med, England.
    Turner, David
    University of East Anglia, England .
    Stuart, Beth
    University of Southampton, England .
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Carlbring, Per
    Stockholm University, Sweden .
    Yardley, Lucy
    University of Southampton, England .
    Internet-based vestibular rehabilitation for adults aged 50 years and over: a protocol for a randomised controlled trial2014Inngår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 4, nr 7, s. e005871-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction: Dizziness is highly prevalent in older adults and can lead to falls, fear of falling, loss of confidence, anxiety and depression. Vestibular rehabilitation (VR) exercises are effective in reducing dizziness due to vestibular dysfunction, but access to trained therapists is limited. Providing dizzy patients with booklets teaching them how to carry out VR exercises has been shown to be a cost-effective way of managing dizziness in primary care. Internet-based intervention delivery has many advantages over paper-based methods, including the provision of video instructions, automated tailoring and symptom-related feedback. This trial will examine whether an internet-based VR intervention is (1) effective in reducing dizziness and (2) a cost-effective primary care treatment option. Methods/analysis: This will be a single blind, randomised controlled trial carried out in UK primary care. A stand-alone internet-based VR intervention will be compared with routine care in 262 dizzy patients aged 50 years and over. Measures will be taken at baseline, 3 and 6 months. Our primary outcome measure will be the effectiveness of the intervention in reducing dizziness symptoms compared with routine care at 6 months. Cost-effectiveness will be examined along with the effect of the intervention on dizziness-related disability and symptoms of depression and anxiety. Psychological process variables including expectancy, self-efficacy and acceptance will be explored in relation to adherence and symptom reduction. Ethics/dissemination: This trial has undergone ethical scrutiny and been approved by an NHS Research Ethics Committee, Southampton A REC Reference: 13/SC/0119. The findings of this trial will be disseminated to the scientific community through presentations at national and international conferences, and by publishing in peer review journals. Findings will be disseminated to the public through targeted press releases. This trial will provide valuable information on the role of internet interventions in facilitating self-management in older adults.

  • 258.
    Gingnell, Malin
    et al.
    Uppsala University, Sweden.
    Frick, Andreas
    Uppsala University, Sweden.
    Engman, Jonas
    Uppsala University, Sweden.
    Alaie, Iman
    Uppsala University, Sweden.
    Bjorkstrand, Johannes
    Uppsala University, Sweden.
    Faria, Vanda
    Uppsala University, Sweden; Harvard Medical Sch, MA USA.
    Carlbring, Per
    Stockholm University, Sweden.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Karolinska Institute, Sweden.
    Reis, Margareta
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för läkemedelsforskning. Linköpings universitet, Medicinska fakulteten.
    Larsson, Elna-Marie
    Uppsala University, Sweden.
    Wahlstedt, Kurt
    Uppsala University, Sweden.
    Fredrikson, Mats
    Uppsala University, Sweden; Karolinska Institute, Sweden.
    Furmark, Tomas
    Uppsala University, Sweden.
    Combining escitalopram and cognitive-behavioural therapy for social anxiety disorder: randomised controlled fMRI trial2016Inngår i: British Journal of Psychiatry, ISSN 0007-1250, E-ISSN 1472-1465, Vol. 209, nr 3, s. 229-235Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background Selective serotonin reuptake inhibitors (SSRIs) and cognitive behavioural therapy (CBT) are often used concomitantly to treat social anxiety disorder (SAD), but few studies have examined the effect of this combination. Aims To evaluate whether adding escitalopram to internet-delivered CBT (ICBT) improves clinical outcome and alters brain reactivity and connectivity in SAD. Method Double-blind, randomised, placebo-controlled neuroimaging trial of ICBT combined either with escitalopram (n=24) or placebo (n=24), including a 15-month clinical follow-up (trial registration: ISRCTN24929928). Results Escitalopram+ICBT, relative to placebo+ICBT, resulted in significantly more clinical responders, larger reductions in anticipatory speech state anxiety at post-treatment and larger reductions in social anxiety symptom severity at 15-month follow-up and at a trend-level = 0.09) at post-treatment. Right amygdala reactivity to emotional faces also decreased more in the escitalopram+ICBT combination relative to placebo+ICBT, and in treatment responders relative to non-responders. Conclusions Adding escitalopram improves the outcome of ICBT for SAD and decreased amygdala reactivity is important for anxiolytic treatment response.

  • 259.
    Green Landell, Malin
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Onkologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Kirurgi- och onkologicentrum, Onkologiska kliniken US.
    Tillfors, Maria
    Dept. of Behavioural, Social and Legal Sciences Örebro University.
    Furmark, Tomas
    Dept. of Psychology Uppsala University.
    Bohlin, Gunilla
    Dept. of Psychology Uppsala University.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Avdelningen för klinisk och socialpsykologi (CS). Linköpings universitet, Filosofiska fakulteten.
    Göran Svedin, Carl
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet.
    Social phobia in Swedish adolescents: Prevalence and gender differences2009Inngår i: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 44, nr 1, s. 1-7Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background The aim of this study was to investigate the prevalence of self-reported social phobia in a community sample of Swedish adolescents in junior high school, at the risk-period for developing social phobia. Of particular interest was to investigate gender differences in prevalence across ages. Prevalence of sub-threshold social phobia was also studied. Methods Students in grades 6-8 (aged 12-14) from seventeen schools in five Swedish municipalities were screened by means of a self-report questionnaire, the social phobia screening questionnaire-for children (SPSQ-C). Results Data from a sample of 2,128 students were analysed and showed a point-prevalence rate of 4.4% (95% CI 3.5-5.2) and a significant gender difference (6.6% girls vs. 1.8% boys, P < 0.001). No significant differences in prevalence of probable cases emerged across the ages. At sub-threshold level, marked social fear of at least one social situation was reported by 13.8% of the total group. "Speaking in front of class and "calling someone unfamiliar on the phone were the most feared social situations. In the social phobia group, 91.4% reported impairment in the school-domain due to their social fear. Conclusion Social phobia is a common psychiatric condition in Swedish adolescents, especially in girls. As impairment in the school-domain is reported to a high degree, professionals and teachers need to recognize social phobia in adolescents so that help in overcoming the difficulties can be offered.

  • 260.
    Green-Landell, Malin
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Hälsouniversitetet.
    Björklind, Andreas
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Filosofiska fakulteten.
    Tillfors, Maria
    Örebro University, School of Law, Psychology and Social work, Örebro, Sweden.
    Furmark, Tomas
    Uppsala University, Department of Psychology, Uppsala, Sweden.
    Svedin, Carl Göran
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Avdelningen för klinisk och socialpsykologi (CS). Linköpings universitet, Filosofiska fakulteten. Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden.
    Evaluation of the psychometric properties of a modified version of the Social Phobia Screening Questionnaire for use in adolescents.2009Inngår i: Child and Adolescent Psychiatry and Mental Health, ISSN 1753-2000, E-ISSN 1753-2000, Vol. 3, nr 1, s. 36-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    ABSTRACT: BACKGROUND: Social phobia (social anxiety disorder - SAD) is a rather common but often undetected and undertreated psychiatric condition in youths. Screening of SAD in young individuals in community samples is thus important in preventing negative outcomes. The present study is the first report on the psychometric properties of the Social Phobia Screening Questionnaire for Children and adolescents (SPSQ-C). METHODS: The SPSQ-C was administered to a community sample of high-school students. Test-retest reliability over three weeks was evaluated (n = 127) and internal consistency was calculated for items measuring level of fear in eight social situations. To measure concurrent validity, subjects who reported SAD on at least one occasion and randomly selected non-cases were blindly interviewed with the Structured Clinical Interview for DSM-IV Axis-I disorders (SCID-I), as gold standard (n = 51). RESULTS: A moderate test-retest reliability, r = .60 (P < .01), and a satisfactory alpha coefficient of .78 was found. Values of sensitivity and specificity were 71% and 86% respectively, and area under the curve (AUC) was .79. Positive likelihood ratio (LR+) showed that a positive screening result was five times more likely to be correct than to reflect a non-case. Negative likelihood ratio (LR -) was .34. In addition, positive predictive value was 45% and negative predictive value was 95%. The prevalence of self-reported SAD was found to be 7.2% at the first assessment. CONCLUSION: The SPSQ-C is a short and psychometrically sound questionnaire for screening of SAD in adolescents, with the advantage of being based on the DSM-IV criteria.

  • 261.
    Green-Landell, Malin
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet.
    Hesser, Hugo
    Linköpings universitet, Institutet för handikappvetenskap (IHV). Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten.
    Persson, Stefan
    3Örebro University, School of Law, Psychology and Social work, Örebro, Sweden.
    Furmark, Tomas
    Uppsala University, Department of Psychology, Uppsala, Sweden.
    Bohlin, Gunilla
    Uppsala University, Department of Psychology, Uppsala, Sweden.
    Svedin, Carl Göran
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Avdelningen för klinisk och socialpsykologi (CS). Linköpings universitet, Filosofiska fakulteten.
    Tillfors, Maria
    Örebro University, School of Law, Psychology and Social work, Örebro, Sweden.
    Longitudinal associations between social anxiety, depressive symptoms and peer victimization in adolescence: A prospective community studyManuskript (preprint) (Annet vitenskapelig)
    Abstract [en]

    Self-reported social anxiety, depressive symptoms and peer victimization was investigated in 350 students in grade 7 and then in grade 8, 9 and 11. Using latent growth modeling, social anxiety was found to be stable over time and to have a time-invariant association with depressive symptoms. Further, social anxiety predicted subsequent depressive symptoms but not vice versa. Support was found for a meditational model. That is, peer victimization in grade 7 was related to higher level of social anxiety, which in turn was associated with more depressive symptoms in grade 8, 9 and 11. The development of social anxiety and depression symptomatology among adolescents can thus be described as one sequential longitudinal process initiated by peer victimization.

  • 262.
    Gren Landell, Malin
    et al.
    Region Östergötland, Närsjukvården i centrala Östergötland, Barn- och ungdomspsykiatriska kliniken. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten.
    Ekerfelt Allvin, Cornelia
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Filosofiska fakulteten.
    Bradely, Maria
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Filosofiska fakulteten.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
    Teachers' views on risk factors for problematic school absenteeism in Swedish primary school students2015Inngår i: Educational Psychology in Practice, ISSN 0266-7363, E-ISSN 1469-5839, Vol. 31, nr 4, s. 412-423Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In the present online survey, 158 teachers in regular and special education teaching in grades six to nine were asked to rate the importance of probable reasons for problematic school absenteeism. On average, the teachers estimated that among their students, 19 students had presented with problematic school absenteeism over the last five years. Teachers viewed school absenteeism as a multifactorial problem. Family factors were considered to contribute most and low mood or depression were rated as one of the five most contributing factors. Teachers in special education viewed school factors as more influential than teachers in mainstream education did (t156 = −3.94, p < 0.05). The current findings stress the importance of collaboration between the school, parents and the student to be able to address all factors that may lead to problematic school absenteeism.

  • 263.
    Gren-Landell, Malin
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet.
    Aho, Nikolas
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Avdelningen för klinisk och socialpsykologi (CS). Linköpings universitet, Filosofiska fakulteten.
    Svedin, Carl Göran
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barn- och ungdomspsykiatri. Linköpings universitet, Hälsouniversitetet.
    Social anxiety disorder and victimization in a community sample of adolescents2011Inngår i: Journal of Adolescence, ISSN 0140-1971, E-ISSN 1095-9254, Vol. 34, nr 3, s. 569-577Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Despite high prevalence rates of social anxiety disorder (SAD) and high rates of victimization in adolescents, studies on the relationship between these phenomena are missing. In the present study we report associations between SAD and multiple victimization experiences in a community sample of adolescents. A cross-sectional study was conducted on 3211 Swedish high-school students. The prevalence rate of self-reported SAD was 10.6% (n=340). Significantly higher rates of lifetime victimization was found in subjects with self-reported SAD compared to non-cases, on the total score on the Juvenile Victimization Questionnaire, and on the subscales maltreatment, sexual victimization and victimization from peer/siblings. Different results emerged due to gender. In females, maltreatment and sexual victimization was associated with an increased risk of SAD and, in males sexual victimization increased the risk of reporting SAD. Further studies are needed to elaborate developmental models on SAD and to add to modification of prevention- and treatment interventions.

  • 264.
    Hadjistavropoulos, H. D.
    et al.
    University of Regina, Canada.
    Pugh, N. E.
    University of Regina, Canada.
    Nugent, M. M.
    University of Regina, Canada.
    Hesser, Hugo
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Ivanov, M.
    University of Regina, Canada.
    Butz, C. G.
    University of Regina, Canada.
    Marchildon, G.
    University of Regina, Canada.
    Asmundson, G. J. G.
    University of Regina, Canada.
    Klein, B.
    Federat University of Australia, Australia; Federat University of Australia, Australia; Australian National University, Australia; Swinburne University of Technology, Australia.
    Austin, D. W.
    Deakin University, Australia.
    Therapist-assisted Internet-delivered cognitive behavior therapy for depression and anxiety: Translating evidence into clinical practice2014Inngår i: Journal of Anxiety Disorders, ISSN 0887-6185, E-ISSN 1873-7897, Vol. 28, nr 8, s. 884-893Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This dissemination study examined the effectiveness of therapist-assisted Internet-delivered Cognitive Behavior Therapy (ICBT) when offered in clinical practice. A centralized unit screened and coordinated ICBT delivered by newly trained therapists working in six geographically dispersed clinical settings. Using an open trial design, 221 patients were offered 12 modules of ICBT for symptoms of generalized anxiety (n=112), depression (n=83), or panic (n=26). At baseline, midpoint and post-treatment, kpatients completed self-report measures. On average, patients completed 8 of 12 modules. Latent growth curve modeling identified significant reductions in depression, anxiety, stress and impairment (d=.65-.78), and improvements in quality of life (d=.48-.66). Improvements in primary symptoms were large (d=.91-1.25). Overall, therapist-assisted ICBT was effective when coordinated across settings in clinical practice, but further attention should be given to strategies to improve completion of treatment modules.

  • 265.
    Hadjistavropoulos, Heather D.
    et al.
    University of Regina, Canada.
    Pugh, Nicole E.
    University of Regina, Canada.
    Hesser, Hugo
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Predicting Response to Therapist-Assisted Internet-Delivered Cognitive Behavior Therapy for Depression or Anxiety Within an Open Dissemination Trial2016Inngår i: Behavior Therapy, ISSN 0005-7894, E-ISSN 1878-1888, Vol. 47, nr 2, s. 155-165Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Therapist-assisted Internet-delivered cognitive behavior therapy (ICBT) is efficacious for treating anxiety and depression, but predictors of response to treatment when delivered in clinical practice are not well understood. In this study, we explored demographic, clinical, and program variables that predicted modules started and symptom improvement (i.e., Generalized Anxiety Disorder-7 or Patient Health Questionnaire-9 total scores over pre-, mid-, and posttreatment) within a previously published open dissemination trial (Hadjistavropoulos et al., 2014). The sample consisted of 195 patients offered 12 modules of therapist-assisted ICBT for depression or generalized anxiety; ICBT was delivered by therapists working in six geographically dispersed clinics. Consistent across ICBT for depression or generalized anxiety, starting fewer modules was associated with more phone calls from therapists reflecting that therapists tended to call patients who did not start modules as scheduled. Also consistent for both ICBT programs, greater pretreatment condition severity and completion of more modules was associated with superior ICBT-derived benefit. Other predictors of response to treatment varied across the two programs. Younger age, lower education, taking psychotropic medication, being in receipt of psychiatric care and lower comfort with written communication were associated with either fewer program starts or lower symptom improvement in one of the two programs. It is concluded that monitoring response to ICBT may be particularly important in patients with these characteristics. Research directions for identifying patients who are less likely to benefit from ICBT are discussed.

  • 266.
    Hadjistavropoulos, Heather D.
    et al.
    University of Regina, Canada.
    Pugh, Nicole E.
    University of Regina, Canada; 715 East 12th Ave, Canada.
    Hesser, Hugo
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Karolinska Institute, Department Clin Neurosci, Stockholm, Sweden.
    Therapeutic Alliance in Internet-Delivered Cognitive Behaviour Therapy for Depression or Generalized Anxiety2017Inngår i: Clinical Psychology and Psychotherapy, ISSN 1063-3995, E-ISSN 1099-0879, Vol. 24, nr 2, s. 451-461Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    There has been limited research on therapeutic alliance in the context of therapist-assisted Internet-delivered cognitive behaviour therapy (ICBT) when delivered in clinical practice. The present study investigated therapeutic alliance in ICBT delivered to patients seeking treatment for symptoms of depression (n=83) or generalized anxiety (n=112) as part of an open dissemination trial. ICBT was provided by 27 registered therapists or 28 graduate students working in six geographically dispersed clinics; therapist-assistance was delivered primarily through secure messages and occasionally telephone calls. The Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9 were collected pre-, mid- and post-treatment, and the Therapeutic Alliance Questionnaire was assessed mid- and post-treatment. Therapeutic alliance ratings were high both at mid-treatment and post-treatment (above 80%). There was no relationship between therapeutic alliance ratings and improvement on primary outcomes. Among patients treated for depression, lower ratings of mid-treatment alliance were associated with concurrent treatment by a psychiatrist and fewer phone calls and emails from their therapist. Among patients treated for generalized anxiety, ratings of mid-treatment alliance were higher among registered providers as compared to graduate students. Multiple directions for future research on therapeutic alliance in ICBT are offered, including suggestions for developing a new measure of therapeutic alliance specific to ICBT and measuring therapeutic alliance throughout the treatment process. Copyright (c) 2016 John Wiley amp; Sons, Ltd.

  • 267.
    Haug, Thomas
    et al.
    Haukeland Hospital, Norway; University of Bergen, Norway.
    Nordgreen, Tine
    Haukeland Hospital, Norway; University of Bergen, Norway.
    Ost, Lars-Goran
    Haukeland Hospital, Norway; University of Stockholm, Sweden; Karolinska Institute, Sweden.
    Kvale, Gerd
    Haukeland Hospital, Norway; University of Bergen, Norway.
    Tangen, Tone
    Haukeland Hospital, Norway; University of Bergen, Norway.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Karolinska Institute, Sweden.
    Carlbring, Per
    University of Stockholm, Sweden.
    Heiervang, Einar R.
    Haukeland Hospital, Norway; University of Oslo, Norway.
    Havik, Odd E.
    Haukeland Hospital, Norway; University of Bergen, Norway.
    Stepped care versus face-to face cognitive behavior therapy for panic disorder and social anxiety disorder: Predictors and moderators of outcome2015Inngår i: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 71, s. 76-89Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To investigate predictors and moderators of treatment outcome by comparing immediate face-to-face cognitive behavioral therapy (FtF-CBT) to a Stepped Care treatment model comprising three steps: Psychoeducation, Internet-delivered CBT, and FtF-CBT for panic disorder (PD) and social anxiety disorder (SAD). Method: Patients (N = 173) were recruited from nine public mental health out-patient clinics and randomized to immediate FtF-CBT or Stepped Care treatment. Characteristics related to social functioning, impairment from the anxiety disorder, and comorbidity was investigated as predictors and moderators by treatment format and diagnosis in multiple regression analyses. Results: Lower social functioning, higher impairment from the anxiety disorder, and a comorbid cluster C personality disorder were associated with significantly less improvement, particularly among patients with PD. Furthermore, having a comorbid anxiety disorder was associated with a better treatment outcome among patients with PD but not patients with SAD. Patients with a comorbid depression had similar outcomes from the different treatments, but patients without comorbid depression had better outcomes from immediate FtF-CBT compared to guided self-help. Conclusions: In general, the same patient characteristics appear to be associated with the treatment outcome for CBT provided in low- and high-intensity formats when treated in public mental health care clinics. The findings suggest that patients with lower social functioning and higher impairment from their anxiety disorder benefit less from these treatments and may require more adapted and extensive (C) 2015 Elsevier Ltd. All rights reserved.

  • 268.
    Hedman, E.
    et al.
    Karolinska Institutet, Stockholm, Sweden .
    Andersson, E.
    Karolinska Institutet, Stockholm, Sweden .
    Lindefors, N.
    Karolinska Institutet, Stockholm, Sweden .
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Rück, C.
    Karolinska Institutet, Stockholm, Sweden .
    Ljótsson, B.
    Karolinska Institutet, Stockholm, Sweden .
    Cost-effectiveness and long-term effectiveness of Internet-based cognitive behaviour therapy for severe health anxiety2013Inngår i: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 43, nr 2, s. 363-374Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Severe health anxiety is a common condition associated with functional disability, making it a costly disorder from a societal perspective. Internet-based cognitive behaviour therapy (ICBT) is a promising treatment but no previous study has assessed the cost-effectiveness or long-term outcome of ICBT for severe health anxiety. The aim of this study was to investigate the cost-effectiveness and 1-year treatment effects of ICBT for severe health anxiety. Method Cost-effectiveness and 1-year follow-up data were obtained from a randomized controlled trial (RCT) comparing ICBT (n = 40) to an attention control condition (CC, n = 41). The primary outcome measure was the Health Anxiety Inventory (HAI). A societal perspective was taken and incremental cost-effectiveness ratios (ICERs) were calculated using bootstrap sampling.

    RESULTS: The main ICER was -£1244, indicating the societal economic gain for each additional case of remission when administering ICBT. Baseline to 1-year follow-up effect sizes on the primary outcome measure were large (d = 1.71-1.95).

    CONCLUSIONS: ICBT is a cost-effective treatment for severe health anxiety that can produce substantial and enduring effects.

  • 269.
    Hedman, E.
    et al.
    Karolinska University Hospital Huddinge, Sweden Karolinska Institute, Sweden .
    Andersson, E.
    Karolinska University Hospital Huddinge, Sweden .
    Ljotsson, B.
    Karolinska University Hospital Huddinge, Sweden .
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Andersson, E.
    Karolinska University Hospital Huddinge, Sweden .
    Schalling, M.
    Karolinska Institute, Sweden Karolinska Institute, Sweden .
    Lindefors, N.
    Karolinska University Hospital Huddinge, Sweden .
    Ruck, C.
    Karolinska University Hospital Huddinge, Sweden .
    Clinical and genetic outcome determinants of Internet- and group-based cognitive behavior therapy for social anxiety disorder2012Inngår i: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 126, nr 2, s. 126-136Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Hedman E, Andersson E, Ljotsson B, Andersson G, Andersson E, Schalling M, Lindefors N, Ruck C. Clinical and genetic outcome determinants of Internet- and group-based cognitive behavior therapy for social anxiety disorder (SAD). Objective: No study has investigated clinical or genetic predictors and moderators of Internet-based cognitive behavior therapy (ICBT) compared with cognitive behavioral group therapy for (CBGT) for SAD. Identification of predictors and moderators is essential to the clinician in deciding which treatment to recommend for whom. We aimed to identify clinical and genetic (5-HTTLPR, COMTval158met, and BDNFval66met) predictors and moderators of ICBT and CBGT. Method: We performed three types of analyses on data from a sample comprising participants (N = 126) who had undergone ICBT or CBGT in a randomized controlled trial. Outcomes were i) end state symptom severity, ii) SAD diagnosis, and iii) clinically significant improvement. Results: The most stable predictors of better treatment response were working full time, having children, less depressive symptoms, higher expectancy of treatment effectiveness, and adhering to treatment. None of the tested gene polymorphisms were associated with treatment outcome. Comorbid general anxiety and depression were moderators meaning that lower levels were associated with a better treatment response in ICBT but not in CBGT. Conclusion: We conclude that demographic factors, symptom burden, adherence, and expectations may play an important role as predictors of treatment outcome. The investigated gene polymorphisms do not appear to make a difference.

  • 270.
    Hedman, E.
    et al.
    Karolinska Institute, Sweden Karolinska Institute, Sweden Karolinska Institute, Sweden .
    Ljotsson, B.
    Karolinska Institute, Sweden Karolinska Institute, Sweden .
    Ruck, C.
    Karolinska Institute, Sweden .
    Bergstrom, J.
    Stockholm University, Sweden .
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Kaldo, V.
    Karolinska Institute, Sweden .
    Jansson, L.
    Karolinska Institute, Sweden .
    Andersson, E.
    Karolinska Institute, Sweden .
    Andersson, E.
    Karolinska Institute, Sweden .
    Blom, K.
    Karolinska Institute, Sweden .
    El Alaoui, S.
    Karolinska Institute, Sweden .
    Falk, L.
    Karolinska Institute, Sweden .
    Ivarsson, J.
    Karolinska Institute, Sweden .
    Nasri, B.
    Karolinska Institute, Sweden .
    Rydh, S.
    Karolinska Institute, Sweden .
    Lindefors, N.
    Karolinska Institute, Sweden .
    Effectiveness of Internet-based cognitive behaviour therapy for panic disorder in routine psychiatric care2013Inngår i: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 128, nr 6, s. 457-467Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    ObjectiveGuided Internet-based cognitive behaviour therapy (ICBT) for panic disorder has been shown to be efficacious in several randomized controlled trials. However, the effectiveness of the treatment when delivered within routine psychiatric care has not been studied. The aim of this study was to investigate the effectiveness of ICBT for panic disorder within the context of routine psychiatric care. MethodWe conducted a cohort study investigating all patients (n=570) who had received guided ICBT for panic disorder between 2007 and 2012 in a routine care setting at an out-patient psychiatric clinic providing Internet-based treatment. The primary outcome measure was the Panic Disorder Severity Scale-Self-report (PDSS-SR). ResultsParticipants made large improvements from screening and pretreatment assessments to posttreatment (Cohens d range on the PDSS-SR=1.07-1.55). Improvements were sustained at 6-month follow-up. ConclusionThis study suggests that ICBT for panic disorder is as effective when delivered in a routine care context as in the previously published randomized controlled trials.

  • 271.
    Hedman, Erik
    et al.
    Karolinska Institute, Sweden .
    Andersson, Erik
    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 .
    Lekander, Mats
    Karolinska Institute, Sweden .
    Ruck, Christian
    Karolinska Institute, Sweden .
    Ljotsson, Brjann
    Karolinska Institute, Sweden .
    Mediators in Internet-Based Cognitive Behavior Therapy for Severe Health Anxiety2013Inngår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, nr 10Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    According to the cognitive behavioral model of severe health anxiety (hypochondriasis) four central maintaining mechanisms are how the individual perceives the risk of disease and how negative its consequences would be, attention to bodily sensations, and intolerance of uncertainty. The aim of the present study was to investigate the mediating role of these putative mechanisms in Internet-delivered CBT for severe health anxiety. We analyzed data from an RCT where participants were randomized to Internet-delivered CBT (n=40) or to a control condition (n=41). Mediators and outcome, i.e. health anxiety, were assessed weekly throughout the treatment, enabling fulfillment of the criterion of temporal precedence of changes occurring in the mediator in relation to the outcome to be met. The results showed that reduced perceived risk of disease, less attention to bodily symptoms, and reduced intolerance of uncertainty significantly mediated improvement in health anxiety. The study supports the validity of the cognitive behavioral model of health anxiety. The findings have theoretical and clinical implications as they indicate processes that may be causally related to the improvements observed after CBT for health anxiety.

  • 272.
    Hedman, Erik
    et al.
    Karolinska University Hospital.
    Andersson, Erik
    Karolinska University Hospital.
    Ljotsson, Brjann
    Karolinska University Hospital.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Avdelningen för klinisk och socialpsykologi (CS). Linköpings universitet, Filosofiska fakulteten.
    Ruck, Christian
    Karolinska University Hospital.
    Lindefors, Nils
    Karolinska University Hospital.
    Cost-effectiveness of Internet-based cognitive behavior therapy vs. cognitive behavioral group therapy for social anxiety disorder: Results from a randomized controlled trial2011Inngår i: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 49, nr 11, s. 729-736Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Social anxiety disorder (SAD) is highly prevalent and associated with a substantial societal economic burden, primarily due to high costs of productivity loss. Cognitive behavior group therapy (CBGT) is an effective treatment for SAD and the most established in clinical practice. Internet-based cognitive behavior therapy (ICBT) has demonstrated efficacy in several trials in recent years. No study has however investigated the cost-effectiveness of ICBT compared to CBGT from a societal perspective, i.e. an analysis where both direct and indirect costs are included. The aim of the present study was to investigate the cost-effectiveness of ICBT compared to CBGT from a societal perspective using a prospective design. We conducted a randomized controlled trial where participants with SAD were randomized to ICBT (n = 64) or CBGT (n = 62). Economic data were assessed at pre-treatment, immediately following treatment and six months after treatment. Results showed that the gross total costs were significantly reduced at six-month follow-up, compared to pre-treatment in both treatment conditions. As both treatments were equivalent in reducing social anxiety and gross total costs, ICBT was more cost-effective due to lower intervention costs. We conclude that ICBT can be more cost-effective than CBGT in the treatment of SAD and that both treatments reduce societal costs for SAD.

  • 273.
    Hedman, Erik
    et al.
    Karolinska Institute.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Avdelningen för klinisk och socialpsykologi (CS). Linköpings universitet, Filosofiska fakulteten.
    Andersson, Erik
    Karolinska Institute.
    Ljotsson, Brjann
    Karolinska Institute.
    Ruck, Christian
    Karolinska Institute.
    Asmundson, Gordon J G
    University of Regina.
    Lindefors, Nils
    Karolinska Institute.
    Internet-based cognitive-behavioural therapy for severe health anxiety: randomised controlled trial2011Inngår i: British Journal of Psychiatry, ISSN 0007-1250, E-ISSN 1472-1465, Vol. 198, nr 3, s. 230-236Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background Hypochondriasis, characterised by severe health anxiety, is a common condition associated with functional disability. Cognitive-behavioural therapy (CBT) is an effective but not widely disseminated treatment for hypochondriasis. Internet-based CBT, including guidance in the form of minimal therapist contact via email, could be a more accessible treatment, but no study has investigated internet-based CBT for hypochondriasis. less thanbrgreater than less thanbrgreater thanAims To investigate the efficacy of internet-based CBT for hypochondriasis. less thanbrgreater than less thanbrgreater thanMethod A randomised controlled superiority trial with masked assessment comparing internet-based CBT (n = 40) over 12 weeks with an attention control condition (n = 41) for people with hypochondriasis. The primary outcome measure was the Health Anxiety Inventory. This trial is registrated with ClinicalTrials.gov (NCT00828152). less thanbrgreater than less thanbrgreater thanResults Participants receiving internet-based CBT made large and superior improvements compared with the control group on measures of health anxiety (between-group Cohens d range 1.52-1.62). less thanbrgreater than less thanbrgreater thanConclusions Internet-based CBT is an efficacious treatment for hypochondriasis that has the potential to increase accessibility and availability of CBT for hypochodriasis.

  • 274.
    Hedman, Erik
    et al.
    Karolinska Institute, Sweden; Karolinska Institute, Sweden; 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.
    Gustavsson, Petter
    Karolinska Institute, Sweden.
    Lekander, Mats
    Karolinska Institute, Sweden; Stockholm University, Sweden.
    Rueck, Christian
    Karolinska Institute, Sweden.
    Andersson, Erik
    Karolinska Institute, Sweden.
    Ljotsson, Brjann
    Karolinska Institute, Sweden; Karolinska Institute, Sweden.
    Personality Change following Internet-Based Cognitive Behavior Therapy for Severe Health Anxiety2014Inngår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, nr 12, s. e113871-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Personality traits have traditionally been viewed as stable, but recent studies suggest that they could be affected through psychological treatment. Internet-based cognitive behavior therapy (ICBT) for severe health anxiety (DSM-IV hypochondriasis) has been shown to be effective in reducing health anxiety, but its effect on measures of personality traits has not been investigated. The main aim of this study was to investigate the impact of ICBT on personality traits in the three broad dimensions -neuroticism, extraversion and aggression. We hypothesized that participants in ICBT would reduce their level of neuroticism compared to controls that did not receive the active treatment. No specific predictions were made regarding extraversion and aggression. Data from a randomized controlled trial were used in which participants were allocated to 12 weeks of ICBT (n=40) or to a basic attention control condition (n=41). Personality traits were assessed with the Swedish Universities Scales of Personality and the primary outcome of health anxiety was the Health Anxiety Inventory. There was a significant interaction effect of group and time on neuroticism-related scales, indicating larger pre-to post-treatment reductions in the Internet-based CBT group compared to the control condition. Analyses at 6-month follow-up showed that changes were stable. Traits relating to extraversion and aggression were largely unchanged. This study is the first to demonstrate that a brief ICBT intervention for severe health anxiety causes long-term changes in measures of personality traits related to neuroticism. The treatment thus has a broader impact than just reducing health anxiety.

  • 275.
    Hedman, Erik
    et al.
    Karolinska Institute.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Avdelningen för klinisk och socialpsykologi (CS). Linköpings universitet, Filosofiska fakulteten.
    Ljotsson, Brjann
    Karolinska Institute.
    Andersson, Erik
    Karolinska Institute.
    Ruck, Christian
    Karolinska Institute.
    Mortberg, Ewa
    Stockholm University.
    Lindefors, Nils
    Karolinska Institute.
    Internet-Based Cognitive Behavior Therapy vs. Cognitive Behavioral Group Therapy for Social Anxiety Disorder: A Randomized Controlled Non-inferiority Trial2011Inngår i: PLOS ONE, ISSN 1932-6203, Vol. 6, nr 3Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background and Aims: Cognitive behavioral group therapy (CBGT) is an effective, well-established, but not widely available treatment for social anxiety disorder (SAD). Internet-based cognitive behavior therapy (ICBT) has the potential to increase availability and facilitate dissemination of therapeutic services for SAD. However, ICBT for SAD has not been directly compared with in-person treatments such as CBGT and few studies investigating ICBT have been conducted in clinical settings. Our aim was to investigate if ICBT is at least as effective as CBGT for SAD when treatments are delivered in a psychiatric setting. Methods: We conducted a randomized controlled non-inferiority trial with allocation to ICBT (n = 64) or CBGT (n = 62) with blinded assessment immediately following treatment and six months post-treatment. Participants were 126 individuals with SAD who received CBGT or ICBT for a duration of 15 weeks. The Liebowitz Social Anxiety Scale (LSAS) was the main outcome measure. The following non-inferiority margin was set: following treatment, the lower bound of the 95 % confidence interval (CI) of the mean difference between groups should be less than 10 LSAS-points. Results: Both groups made large improvements. At follow-up, 41 (64%) participants in the ICBT group were classified as responders (95% CI, 52%-76%). In the CBGT group, 28 participants (45%) responded to the treatment (95% CI, 33%-58%). At post-treatment and follow-up respectively, the 95 % CI of the LSAS mean difference was 0.68-17.66 (Cohens d between group = 0.41) and -22.51-15.69 (Cohens d between group = 0.36) favoring ICBT, which was well within the non-inferiority margin. Mixed effects models analyses showed no significant interaction effect for LSAS, indicating similar improvement across treatments (F = 1.58; df = 2, 219; p = .21). Conclusions: ICBT delivered in a psychiatric setting can be as effective as CBGT in the treatment of SAD and could be used to increase availability to CBT.

  • 276.
    Hedman, Erik
    et al.
    Karolinska Institute, Sweden Karolinska Institute, Sweden .
    El Alaoui, Samir
    Karolinska Institute, Sweden .
    Lindefors, Nils
    Karolinska Institute, Sweden .
    Andersson, Erik
    Karolinska Institute, Sweden .
    Ruck, Christian
    Karolinska Institute, Sweden .
    Ghaderi, Ata
    Karolinska Institute, Sweden .
    Kaldo, Viktor
    Karolinska Institute, Sweden .
    Lekander, Mats
    Karolinska Institute, Sweden Karolinska Institute, Sweden Stockholm University, Sweden .
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Ljotsson, Brjann
    Karolinska Institute, Sweden .
    Clinical effectiveness and cost-effectiveness of Internet- vs. group-based cognitive behavior therapy for social anxiety disorder: 4-Year follow-up of a randomized trial2014Inngår i: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 59, s. 20-29Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Social anxiety disorder (SAD) is common, debilitating and associated with high societal costs. The disorder can be effectively treated with Internet-based cognitive behavior therapy (ICBT), but no previous study has investigated the long-term clinical or health economic effects of ICBT for SAD in comparison to an evidence-based control treatment. The aim of the study was to investigate the clinical effectiveness and cost-effectiveness of ICBT compared to cognitive behavioral group therapy (CBGT) four years post-treatment. We conducted a 4-year follow-up study of participants who had received ICBT or CBGT for SAD within the context of a randomized controlled non-inferiority trial. The cost-effectiveness analyses were conducted taking a societal perspective. Participants in both treatment groups made large improvements from baseline to 4-year follow-up on the primary outcome measure (d = 1.34-1.48) and the 95% CI of the mean difference on the primary outcome was well within the non-inferiority margin. ICBT and CBGT were similarly cost-effective and both groups reduced their indirect costs. We conclude that ICBT for SAD yields large sustainable effects and is at least as long-term effective as CBGT. Intervention costs of both treatments are offset by net societal cost reductions in a short time.

  • 277.
    Hedman, Erik
    et al.
    Karolinska University Hospital.
    Furmark, Tomas
    Uppsala University.
    Carlbring, Per
    Umea University.
    Ljotsson, Brjann
    Karolinska University Hospital.
    Ruck, Christian
    Karolinska University Hospital.
    Lindefors, Nils
    Karolinska University Hospital.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Avdelningen för klinisk och socialpsykologi (CS). Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi.
    A 5-Year Follow-up of Internet-Based Cognitive Behavior Therapy for Social Anxiety Disorder2011Inngår i: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 13, nr 2Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Internet-based cognitive behavior therapy (CBT) has been shown to be a promising method to disseminate cognitive behavior therapy for social anxiety disorder (SAD). Several trials have demonstrated that Internet-based CBT can be effective for SAD in the shorter term. However, the long-term effects of Internet-based CBT for SAD are less well known. less thanbrgreater than less thanbrgreater thanObjective: Our objective was to investigate the effect of Internet-based CBT for SAD 5 years after completed treatment. less thanbrgreater than less thanbrgreater thanMethod: We conducted a 5-year follow-up study of 80 persons with SAD who had undergone Internet-based CBT. The assessment comprised a diagnostic interview and self-report questionnaires. The main outcome measure was the Liebowitz Social Anxiety Scale-Self-Report (LSAS-SR). Additional measures of social anxiety were the Social Interaction Anxiety Scale (SIAS) and the Social Phobia Scale (SPS). Attrition rates were low: 89% (71/80) of the participants completed the diagnostic interview and 80% (64/80) responded to the questionnaires. less thanbrgreater than less thanbrgreater thanResults: Mixed-effect models analysis showed a significant effect of time on the three social anxiety measures, LSAS-SR, SIAS, and SPS (F(3,98-102) = 16.05 -29.20, P andlt; .001) indicating improvement. From baseline to 5-year follow-up, participants mean scores on the LSAS-SR were reduced from 71.3 (95% confidence interval [CI] 66.1-76.5) to 40.3 (95% CI 35.2 - 45.3). The effect sizes of the LSAS-SR were large (Cohens d range 1.30 - 1.40, 95% CI 0.77 - 1.90). Improvements gained at the 1-year follow-up were sustained 5 years after completed treatment. less thanbrgreater than less thanbrgreater thanConclusions: Internet-based CBT for SAD is a treatment that can result in large and enduring effects. Trial registration: Clinicaltrials.gov NCT01145690; http://clinicaltrials.gov/ct2/show/NCT01145690 (Archived by WebCite at http://www.webcitation.org/5ygRxDLfK)

  • 278.
    Hedman, Erik
    et al.
    Karolinska Institute, Sweden; Karolinska Institute, Sweden.
    Lekander, Mats
    Karolinska Institute, Sweden; Stockholm University, Sweden.
    Ljotsson, Brjann
    Karolinska Institute, Sweden.
    Lindefors, Nils
    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.
    Andersson, Erik
    Karolinska Institute, Sweden; Karolinska Institute, Sweden.
    Optimal Cut-Off Points on the Health Anxiety Inventory, Illness Attitude Scales and Whiteley Index to Identify Severe Health Anxiety2015Inngår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, nr 4, s. e0123412-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background Health anxiety can be viewed as a dimensional phenomenon where severe health anxiety in form of DSM-IV hypochondriasis represents a cut-off where the health anxiety becomes clinically significant. Three of the most reliable and used self-report measures of health anxiety are the Health Anxiety Inventory (HAI), the Illness Attitude Scales (IAS) and the Whiteley Index (WI). Identifying the optimal cut-offs for classification of presence of a diagnosis of severe health anxiety on these measures has several advantages in clinical and research settings. The aim of this study was therefore to investigate the HAI, IAS and WI as proximal diagnostic instruments for severe health anxiety defined as DSM-IV hypochondriasis. Methods We investigated sensitivity, specificity and predictive value on the HAI, IAS and WI using a total of 347 adult participants of whom 158 had a diagnosis of severe health anxiety, 97 had obsessive-compulsive disorder and 92 were healthy non-clinical controls. Diagnostic assessments were conducted using the Anxiety Disorder Interview Schedule. Results Optimal cut-offs for identifying a diagnosis of severe health anxiety was 67 on the HAI, 47 on the IAS, and 5 on the WI. Sensitivity and specificity were high, ranging from 92.6 to 99.4%. Positive and negative predictive values ranged from 91.6 to 99.4% using unadjusted prevalence rates. Conclusions The HAI, IAS and WI have very good properties as diagnostic indicators of severe health anxiety and can be used as cost-efficient proximal estimates of the diagnosis.

  • 279.
    Hedman, Erik
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Lekander, Mats
    Karolinska Institutet, Stockholm, Sweden.
    Ljótsson, Brjánn
    Karolinska Institutet, Stockholm, Sweden.
    Lindefors, Nils
    Karolinska Institutet, Stockholm, Sweden.
    Rück, Christian
    Karolinska Institutet, Stockholm, Sweden.
    Hofmann, Stefan G
    Boston University, MA, USA.
    Andersson, Erik
    Karolinska Institutet, Stockholm, Sweden.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Karolinska Institutet, Stockholm, Sweden.
    Schulz, Stefan M
    University of Würzburg, Germany.
    Sudden gains in internet-based cognitive behaviour therapy for severe health anxiety2014Inngår i: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 54, s. 22-29Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: A sudden gain is defined as a large and stable individual improvement occurring between two consecutive treatment sessions. Sudden gains have been shown to predict better long-term improvement in several treatment studies, including cognitive behavioural therapy for depression and anxiety disorders, but have not been studied in the treatment of health anxiety or any form of internet-based cognitive behavioural therapy. The aim of this study was to investigate the role of sudden gains in internet-based cognitive behavioural therapy for severe health anxiety.

    METHOD: We examined the occurrence and significance of sudden gains in measures of health anxiety in 81 participants receiving internet-based cognitive behavioural therapy. We compared patients with sudden gains, patients without sudden gains, and patients with gradual gains.

    RESULTS: Thirteen participants (16%) experienced one sudden gain in health anxiety with individual sudden gains distributed across the treatment. As expected, patients with a sudden gain showed larger improvements than patients without a sudden gain at post-treatment (d = 1.04) and at one-year follow-up (d = 0.91) on measures of health anxiety.

    CONCLUSIONS: Consistent with previous studies, sudden gains in internet-based cognitive behavioural therapy are associated with significantly larger and stable treatment effects up to one-year follow-up.

  • 280.
    Hedman, Erik
    et al.
    Karolinska Institute, Sweden .
    Lindefors, Nils
    Karolinska Institute, Sweden .
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Karolinska Institute, Sweden .
    Andersson, Erik
    Karolinska Institute, Sweden .
    Lekander, Mats
    Karolinska Institute, Sweden .
    Ruck, Christian
    Karolinska Institute, Sweden .
    Ljotsson, Brjann
    Karolinska Institute, Sweden .
    Predictors of outcome in Internet-based cognitive behavior therapy for severe health anxiety2013Inngår i: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 51, nr 10, s. 711-717Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Internet-based cognitive behavior therapy (CBT) for severe health anxiety can be effective, but not all patients achieve full remission. Under these circumstances, knowledge about predictors is essential for the clinician in order to make reliable treatment recommendations. The primary aim of this study was to investigate clinical, demographic, and therapy process-related predictors of Internet-based CBT for severe health anxiety. We performed three types of analyses on data from a sample comprising participants (N = 81) who had received Internet-based CBT in a randomized controlled trial. Outcomes were a) end state health anxiety, b) improvement in health anxiety (continuous change scores), and c) clinically significant improvement. Outcomes were assessed at six-month follow-up. The results showed that the most stable predictors of both end state health anxiety and improvement were baseline health anxiety and depressive symptoms. Treatment adherence, i.e. the number of completed treatment modules, also significantly predicted outcome. Notably, health anxiety at baseline was positively associated with symptom improvement while depressive symptoms was negatively related to improvement. Demographic factors were largely without significant impact on end state symptoms or improvement. We conclude that baseline symptom burden and adherence to treatment have strong predictive effects in Internet-based CBT for severe health anxiety.

  • 281.
    Hedman, Erik
    et al.
    Karolinska University Hospital.
    Ljotsson, Brjann
    Uppsala University.
    Carlbring, Per
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Avdelningen för klinisk och socialpsykologi (CS). Linköpings universitet, Filosofiska fakulteten.
    Lindefors, Nils
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Filosofiska fakulteten.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Avdelningen för klinisk och socialpsykologi (CS). Linköpings universitet, Filosofiska fakulteten.
    Internet administration of self-report measures commonly used in research on social anxiety disorder: A psychometric evaluation2010Inngår i: COMPUTERS IN HUMAN BEHAVIOR, ISSN 0747-5632, Vol. 26, nr 4, s. 736-740Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The Internet has become increasingly popular as a way to administer self-report questionnaires, especially in the field of Internet delivered psychological treatments. Collecting questionnaire data over the Internet has advantages, such as ease of administration, and automated scoring. However, psychometric properties cannot be assumed to be identical to the paper-and-pencil versions. The aim of this study was to test the equivalence of paper-and-pencil and Internet administered versions of self-report questionnaires used in social phobia research. We analyzed data from two trials in which samples were recruited in a similar manner. One sample (N = 64) completed the paper-and-pencil version of questionnaires and the second sample (N = 57) completed the same measures online. We included the Liebowitz Social Anxiety Scale-self-assessment (LSAS-SR), the Social Interaction and Anxiety Scale (SIAS), and the Social Phobia Scale (SPS) as measures of social anxiety. Also included were the Montgomery Asberg Depression Rating Scale-self-assessment (MADRS-S), the Beck Anxiety Inventory (BAT), and the Quality of Life Inventory (QOLI). Results showed equivalent psychometric properties across administration formats. Cronbachs alpha ranged between 0.77 and 0.94. There was an indication of a somewhat higher construct validity when participants filled out questionnaires using paper-and-pencil. We conclude that the LSAS-SR, SIPS, and SPS can be administered via the Internet with maintained psychometric properties.

  • 282.
    Hedman, Erik
    et al.
    Karolinska Institute, Sweden Karolinska Institute, Sweden Karolinska Institute, Sweden .
    Ljotsson, Brjann
    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.
    El Alaoui, Samir
    Karolinska Institute, Sweden .
    Kraepelien, Martin
    Karolinska Institute, Sweden .
    Andersson, Evelyn
    Karolinska Institute, Sweden .
    Ruck, Christian
    Karolinska Institute, Sweden .
    Svanborg, Cecilia
    Karolinska Institute, Sweden .
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Lindefors, Nils
    Karolinska Institute, Sweden .
    Effectiveness of Internet-based cognitive behaviour therapy for depression in routine psychiatric care2014Inngår i: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 155, s. 49-58Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Efficacy of guided Internet-based cognitive behaviour therapy (ICBT) for depression has been demonstrated in several randomised controlled trials. Knowledge on the effectiveness of the treatment, i.e. how it works when delivered within routine care, is however scarce. The aim of this study was to investigate the effectiveness of ICBT for depression. Methods: We conducted a cohort study investigating all patients (N =1203) who had received guided ICBT for depression between 2007 and 2013 in a routine care setting at an outpatient psychiatric clinic providing Internet-based treatment The primary outcome measure was the Montgomery Asberg Depression Rating Scale-Self rated (MADRS-S). Results: Patients made large improvements from pre-treatment assessments to post-treatment on the primary outcome (effect size d on the MADRS-S = 1.27, 99% CI, 1.14-1.39). Participants were significantly improved in terms of suicidal ideation and sleep difficulties improvements were sustained at 6-month follow-up. Limitations: Attrition was rather large at 6-month follow-up. However, additional data was collected through telephone interviews with dropouts and advanced statistical models indicated that missing data did not bias the findings. Conclusions: ICBT for depression can be highly effective when delivered within the context of routine psychiatric care. This study suggests that the effect sizes are at least as high when the treatment is delivered in routine psychiatric care by qualified staff as when delivered in a controlled trial setting.

  • 283.
    Hedman, Erik
    et al.
    Division of Psychology, Karolinska Institutet, Stockholm, Sweden; Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden.
    Ljótsson, Brjánn
    Osher Center for Integrative Medicine, Stockholm, Sweden.
    Andersson, Erik
    Division of Psychology, Karolinska Institutet, Stockholm, Sweden; Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden; Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Lindefors, Nils
    Division of Psychiatry, Stockholm, Sweden.
    Rück, Christian
    Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
    Axelsson, Erland
    Division of Psychology, Karolinska Institutet, Stockholm, Sweden.
    Lekander, Mats
    Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden; Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Psychometric properties of Internet-administered measures of health anxiety: An investigation of the Health Anxiety Inventory, the Illness Attitude Scales, and the Whiteley Index.2015Inngår i: Journal of Anxiety Disorders, ISSN 0887-6185, E-ISSN 1873-7897, Vol. 31, s. 32-37Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: The Health Anxiety Inventory (HAI), the Illness Attitude Scales (IAS), and the Whiteley Index (WI) are three of the most widely used health anxiety measures, but their psychometric properties have not been investigated when administered via the Internet.

    METHODS: We investigated the three instruments' test-retest reliability, internal consistency, convergent, and discriminant validity and sensitivity to change using one sample (n=111) of participants with severe health anxiety and one sample of healthy controls (n=92).

    RESULTS: The HAI, IAS, and WI showed high test-retest reliability (rs≥.80), good convergent, and discriminant validity and were sensitive to detect change. The HAI and IAS (αs≥.85), but not the WI (αs≤.60) demonstrated high internal consistency.

    CONCLUSIONS: The HAI, IAS, and WI have good psychometric properties, except for the low internal consistency of WI, when used as Internet-administered measures of health anxiety. Using these measures over the Internet offers highly important advantages such as increased ease of administration, reduced attrition, and cost-efficient treatment evaluation.

  • 284.
    Hedman, Erik
    et al.
    Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychology, Stockholm, Sweden.
    Ljótsson, Brjánn
    Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychology, Stockholm, Sweden.
    Axelsson, Erland
    Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychology, Stockholm, Sweden.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychiatry, Stockholm, Sweden.
    Rück, Christian
    Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychiatry, Stockholm, Sweden.
    Andersson, Erik
    Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychology, Stockholm, Sweden.
    Health anxiety in obsessive compulsive disorder and obsessive compulsive symptoms in severe health anxiety: An investigation of symptom profiles.2017Inngår i: Journal of Anxiety Disorders, ISSN 0887-6185, E-ISSN 1873-7897, Vol. 45, s. 80-86Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Severe health anxiety (SHA) shares features with obsessive-compulsive disorder (OCD) and in recent years there has been a debate as to whether the two disorders may represent two facets of the same condition. Few studies have however investigated the overlap and differences in symptom profiles between the disorders. The primary aim of the present study was to investigate these aspects using one sample of participants with a principal diagnosis of SHA and one sample of participants with a principal OCD diagnosis. The second aim was to examine differences in improvement trajectories on measures of health anxiety and OCD symptoms in patients with SHA receiving treatment with exposure and response prevention. We compared persons participating in clinical trials with a principal diagnosis of SHA (N=290) to persons with a principal diagnosis of OCD (n=95) on measures of health anxiety, OCD symptoms, and depressive symptoms. A subsample of SHA participants (n=99) received exposure and response prevention (ERP) for SHA over 12 weeks and was assessed at baseline and post-treatment. The results showed large and significant differences between SHA and OCD patients on measures of health anxiety (ds=2.99-3.09) and OCD symptoms (ds=1.64-2.14), while they had equivalent levels of depressive symptoms (d=0.19, 95% CI [-0.04, 0.43]). In the SHA sample 7.6% had comorbid OCD, and in the OCD sample 9.5% had SHA. For participants with a principal diagnosis of SHA, ERP led to large reductions of health anxiety, but effects on OCD symptoms were small to moderate. Among participants with comorbid OCD, effect sizes were large on measures of health anxiety and moderate to large on OCD measures. We conclude that SHA and OCD are separate psychiatric disorders with limited overlap in symptom profiles.

  • 285.
    Hedman, Erik
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Ljótsson, Brjánn
    Karolinska Institutet, Stockholm, Sweden.
    Blom, Kerstin
    Karolinska Institutet, Stockholm, Sweden.
    El Alaoui, Samir
    Karolinska Institutet, Stockholm, Sweden.
    Kraepelien, Martin
    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.
    Svanborg, Cecilia
    Karolinska Institutet, Stockholm, Sweden.
    Lindefors, Nils
    Karolinska Institutet, Stockholm, Sweden.
    Kaldo, Viktor
    Karolinska Institutet, Stockholm, Sweden.
    Telephone versus internet administration of self-report measures of social anxiety, depressive symptoms, and insomnia: psychometric evaluation of a method to reduce the impact of missing data2013Inngår i: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 15, nr 10, s. e229-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Internet-administered self-report measures of social anxiety, depressive symptoms, and sleep difficulties are widely used in clinical trials and in clinical routine care, but data loss is a common problem that could render skewed estimates of symptom levels and treatment effects. One way of reducing the negative impact of missing data could be to use telephone administration of self-report measures as a means to complete the data missing from the online data collection.

    OBJECTIVE: The aim of the study was to compare the convergence of telephone and Internet administration of self-report measures of social anxiety, depressive symptoms, and sleep difficulties.

    METHODS: The Liebowitz Social Anxiety Scale-Self-Report (LSAS-SR), Montgomery-Åsberg Depression Rating Scale-Self-Rated (MADRS-S), and the Insomnia Severity Index (ISI) were administered over the telephone and via the Internet to a clinical sample (N=82) of psychiatric patients at a clinic specializing in Internet-delivered treatment. Shortened versions of the LSAS-SR and the ISI were used when administered via telephone.

    RESULTS: As predicted, the results showed that the estimates produced by the two administration formats were highly correlated (r=.82-.91; P<.001) and internal consistencies were high in both administration formats (telephone: Cronbach alpha=.76-.86 and Internet: Cronbach alpha=.79-.93). The correlation coefficients were similar across questionnaires and the shorter versions of the questionnaires used in the telephone administration of the LSAS-SR and ISI performed in general equally well compared to when the full scale was used, as was the case with the MADRS-S.

    CONCLUSIONS: Telephone administration of self-report questionnaires is a valid method that can be used to reduce data loss in routine psychiatric practice as well as in clinical trials, thereby contributing to more accurate symptom estimates.

  • 286.
    Heinrich, Sarah
    et al.
    Department of Psychology, Stockholm University, Stockholm, Sweden.
    Rozental, Alexander
    Department of Psychology, Stockholm University, Sweden.
    Carlbring, Per
    Division of Clinical Psychology, Department of Psychology, Stockholm University, Stockholm, Sweden.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institute, Stockholm, Sweden.
    Cotter, Katherine
    Department of Psychology, Stockholm University, Stockholm, Sweden.
    Weise, Cornelia
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutet för handikappvetenskap (IHV). Department of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Germany.
    Treating tinnitus distress via the Internet: A mixed methods approach of what makes patients seek help and stay motivated during Internet-based cognitive behavior therapy2016Inngår i: Internet Interventions, ISSN 2214-7829, Vol. 4, nr 2, s. 120-130Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

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

    Aims

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

    Method

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

    Results

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

    Conclusion

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

  • 287.
    Hesser, Hugo
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Dimensional or Categorical Approach to Tinnitus Severity: an Item Response Mixture Modeling Analysis of Tinnitus Handicap2014Inngår i: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 21, nr 6, s. 982-988Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background Whether handicap due to tinnitus-sound(s) in the ears and/or in the head in the absence of an external auditory source-is best conceived as dimensional or categorical remains an unanswered empirical question. Purpose The objective was to investigate whether tinnitus severity was best conceptualized as qualitatively distinct subtypes, quantitative differences varying along a single continuum, or as severity differences within subtypes. Methods Various forms of item response mixture models (latent class models, factor analysis models, and hybrid models) that corresponded to the competing hypotheses were fitted to item responses on the Tinnitus Handicap Inventory in a Swedish sample of individuals with tinnitus (N = 362). Results A latent class model could be fitted to the data with a high probability of correctly classifying individuals into three different classes: high-, moderate-, and low-severity classes. However, a comparison of models showed that a unidimensional factor analysis model with a single class provided the best fit to the data. Conclusions The analysis provided evidence that tinnitus severity varies along a single severity continuum from mild to moderate to severe tinnitus-related handicap. The result that tinnitus severity exists on a continuum rather than as discrete categories has important implications for clinical research.

  • 288.
    Hesser, Hugo
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Filosofiska fakulteten.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Avdelningen för klinisk och socialpsykologi (CS). Linköpings universitet, Filosofiska fakulteten.
    The role of anxiety sensitivity and behavioral avoidance in tinnitus disability2009Inngår i: INTERNATIONAL JOURNAL OF AUDIOLOGY, ISSN 1499-2027, Vol. 48, nr 5, s. 295-299Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The purpose of this study was to investigate the role of anxiety sensitivity and behavioral avoidance in tinnitus distress and functioning. A cross-sectional sample of 283 individuals experiencing tinnitus was obtained from an epidemiological national survey study on hearing loss, dizziness, and tinnitus. The subjects completed a series of questionnaires measuring anxiety sensitivity, anxiety, and depression. They also answered questions regarding tinnitus distress, functioning, and avoidance. Results revealed a positive significant correlation between anxiety sensitivity and tinnitus distress. This relationship was not better explained by anxiety and depression symptoms. In addition, the findings provided support for a model where behavioral avoidance fully mediated the relationship between anxiety sensitivity and tinnitus functioning, and partially mediated the relationship between anxiety sensitivity and tinnitus distress. Implications for the role of anxiety sensitivity and behavioral avoidance in tinnitus research are discussed

  • 289.
    Hesser, Hugo
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Axelsson, Sandra
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Filosofiska fakulteten.
    Backe, Victoria
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Filosofiska fakulteten.
    Engstrand, Jonna
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Filosofiska fakulteten.
    Gustafsson, Tina
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Filosofiska fakulteten.
    Holmgren, Elin
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Filosofiska fakulteten.
    Jeppsson, Ulrika
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Filosofiska fakulteten.
    Pollack, Maria
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Filosofiska fakulteten.
    Norden, Kjell
    Alternat Violence, Sweden.
    Rosenqvist, Dan
    Alternat Violence, Sweden.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Karolinska Institute, Sweden.
    Preventing intimate partner violence via the Internet: A randomized controlled trial of emotion-regulation and conflict-management training for individuals with aggression problems2017Inngår i: Clinical Psychology and Psychotherapy, ISSN 1063-3995, E-ISSN 1099-0879, Vol. 24, nr 5, s. 1163-1177Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective

    The aim of this randomized controlled trial was to investigate the effect of an Internet-delivered cognitive behaviour therapy (iCBT), which incorporated emotion-regulation and conflict-resolution techniques, on intimate partner violence (IPV). Another aim was to test the theoretical underpinnings of the treatment model using mediation analysis.

    Method

    Sixty-five participants with aggression problems in intimate adult relationships were recruited from the community and were randomly assigned to iCBT or to a monitored waitlist control. Participants were assessed with standardized self-report measures of IPV or aggression (Multidimensional Measure of Emotional Abuse, Revised Conflict Tactics Scale, and Aggression Questionnaire), relationship quality (Dyadic Adjustment Scale), anxiety or depression symptomatology (Patient Health Questionnaire; Generalized Anxiety Disorder Screener), at pretreatment, posttreatment (8 weeks), and 1-year follow-up. Process variables (subscales of Dysfunctional and Emotional Regulation Scale and Anger Rumination Scale) were assessed weekly over the active treatment phase.

    Results

    Robust linear regression analysis of all randomized participants showed significant treatment effects on emotional abuse relative to control at postassessment. Mediation analysis using growth curve modeling revealed that the treatment effect was partially mediated by changes in emotion-regulation ability. Controlled effects on secondary outcomes were also observed. Analyses of uncontrolled effects indicted that gains on IPV were maintained at 1-year follow-up.

    Conclusions

    iCBT focusing on enhancing conflict-resolution skills and emotion-regulation ability has the potential to reduce IPV among self-recruited individuals with mild forms of abusive behaviour in intimate relationships. Emotion-regulation ability is potentially a key therapeutic process of change.

    Key Practitioner Message

    • Internet-delivered clinician-guided cognitive behaviour therapy is a viable treatment option for reducing intimate partner violence among self-recruited individuals with mild forms of abusive behaviour.
    • For persons who display patterns of frequent and severe violence, other treatments are most likely needed.
    • Emotion-regulation training is potentially a key therapeutic component that ought to be incorporated in interventions targeting IPV.
  • 290.
    Hesser, Hugo
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Bånkestad, Ellinor
    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. Karolinska Institute, Sweden.
    Acceptance of Tinnitus As an Independent Correlate of Tinnitus Severity2015Inngår i: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, Vol. 36, nr 4, s. e176-e182Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: Tinnitus is the experience of sounds without an identified external source, and for some the experience is associated with significant severity (i.e., perceived negative affect, activity limitation, and participation restriction due to tinnitus). Acceptance of tinnitus has recently been proposed to play an important role in explaining heterogeneity in tinnitus severity. The purpose of the present study was to extend previous investigations of acceptance in relation to tinnitus by examining the unique contribution of acceptance in accounting for tinnitus severity, beyond anxiety and depression symptoms. Design: In a cross-sectional study, 362 participants with tinnitus attending an ENT clinic in Sweden completed a standard set of psychometrically examined measures of acceptance of tinnitus, tinnitus severity, and anxiety and depression symptoms. Participants also completed a background form on which they provided information about the experience of tinnitus (loudness, localization, sound characteristics), other auditory-related problems (hearing problems and sound sensitivity), and personal characteristics. Results: Correlational analyses showed that acceptance was strongly and inversely related to tinnitus severity and anxiety and depression symptoms. Multivariate regression analysis, in which relevant patient characteristics were controlled, revealed that acceptance accounted for unique variance beyond anxiety and depression symptoms. Acceptance accounted for more of the variance than anxiety and depression symptoms combined. In addition, mediation analysis revealed that acceptance of tinnitus mediated the direct association between self-rated loudness and tinnitus severity, even after anxiety and depression symptoms were taken into account. Conclusions: Findings add to the growing body of work, supporting the unique and important role of acceptance in tinnitus severity. The utility of the concept is discussed in relation to the development of new psychological models and interventions for tinnitus severity.

  • 291.
    Hesser, Hugo
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Engstrand, Jonna
    Jeppsson, Ulrika
    Gustafsson, Tina
    Axelsson, Sandra
    Pollack, Maria
    Bäcke, Viktoria
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Internet-delivered acceptance-based skills training for the prevention of interpersonal violence2014Konferansepaper (Fagfellevurdert)
  • 292.
    Hesser, Hugo
    et al.
    Linköpings universitet, Institutet för handikappvetenskap (IHV). Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Gustafsson, Tore
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Filosofiska fakulteten.
    Lundén, Charlotte
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Filosofiska fakulteten.
    Henrikson, Oskar
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Filosofiska fakulteten.
    Fattahi, Kidjan
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Filosofiska fakulteten.
    Johnsson, Erik
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Filosofiska fakulteten.
    Westin Zetterqvist, Vendela
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Utbildningsvetenskap.
    Carlbring, Per
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Mäki-Torkko, Elina
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Teknisk audiologi. Linköpings universitet, Hälsouniversitetet.
    Kaldo, Viktor
    Department of Clinical Neuroscience, Psychiatric Section, Karolinska Institutet, Stockholm, Sweden.
    Andersson, Gerhard
    Linköpings universitet, Institutet för handikappvetenskap (IHV). Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    A Randomized Controlled Trial of Internet-Delivered Cognitive Behavior Therapy and Acceptance and Commitment Therapy in the Treatment of Tinnitus2012Inngår i: Journal of Consulting and Clinical Psychology, ISSN 0022-006X, E-ISSN 1939-2117, Vol. 80, nr 4, s. 649-661Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: Our aim in this randomized controlled trial was to investigate the effects on global tinnitus severity of 2 Internet-delivered psychological treatments, acceptance and commitment therapy (ACT) and cognitive behavior therapy (CBT), in guided self-help format. Method: Ninety-nine participants (mean age = 48.5 years; 43% female) who were significantly distressed by tinnitus were recruited from the community. Participants were randomly assigned to CBT (n = 32), ACT (n = 35), or a control condition (monitored Internet discussion forum; n = 32), and they were assessed with standardized self-report measures (Tinnitus Handicap Inventory; Hospital Anxiety and Depression Scale; Quality of Life Inventory; Perceived Stress Scale; Tinnitus Acceptance Questionnaire) at pre-, posttreatment (8 weeks), and 1-year follow-up. Results: Mixed-effects linear regression analysis of all randomized participants showed significant effects on the primary outcome (Tinnitus Handicap Inventory) for CBT and for ACT compared with control at posttreatment (95% CI [-17.03, -2.94], d = 0.70, and 95% CI [-16.29, -2.53], d = 0.68, respectively). Within-group effects were substantial from pretreatment through 1-year-follow-up for both treatments (95% CI [-44.65, -20.45], d = 1.34), with no significant difference between treatments (95% CI [-14.87, 11.21], d = 0.16). Conclusions: Acceptance-based procedures may be a viable alternative to traditional CBT techniques in the management of tinnitus. The Internet can improve access to psychological interventions for tinnitus.

  • 293.
    Hesser, Hugo
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Institutet för handikappvetenskap (IHV). Linköpings universitet, Filosofiska fakulteten.
    Molander, Peter
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Jungermann, Mikael
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Filosofiska fakulteten.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Institutet för handikappvetenskap (IHV). Linköpings universitet, Filosofiska fakulteten.
    Costs of Suppressing Emotional Sound and Countereffects of a Mindfulness Induction: An Experimental Analog of Tinnitus Impact2013Inngår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, nr 5, s. e64540-Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    Tinnitus is the experience of sounds without an appropriate external auditory source. These auditory sensations are intertwined with emotional and attentional processing. Drawing on theories of mental control, we predicted that suppressing an affectively negative sound mimicking the psychoacoustic features of tinnitus would result in decreased persistence in a mentally challenging task (mental arithmetic) that required participants to ignore the same sound, but that receiving a mindfulness exercise would reduce this effect. Normal hearing participants (N = 119) were instructed to suppress an affectively negative sound under cognitive load or were given no such instructions. Next, participants received either a mindfulness induction or an attention control task. Finally, all participants worked with mental arithmetic while exposed to the same sound. The length of time participants could persist in the second task served as the dependent variable. As hypothesized, results indicated that an auditory suppression rationale reduced time of persistence relative to no such rationale, and that a mindfulness induction counteracted this detrimental effect. The study may offer new insights into the mechanisms involved in the development of tinnitus interference. Implications are also discussed in the broader context of attention control strategies and the effects of emotional sound on task performance. The ironic processes of mental control may have an analog in the experience of sounds.

  • 294.
    Hesser, Hugo
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Filosofiska fakulteten.
    Pereswetoff-Morath, Carl Emil
    Uppsala University, Department Psychol, Uppsala, Sweden .
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Avdelningen för klinisk och socialpsykologi (CS). Linköpings universitet, Filosofiska fakulteten.
    Consequences of Controlling Background Sounds: The Effect of Experiential Avoidance on Tinnitus Interference2009Inngår i: REHABILITATION PSYCHOLOGY, ISSN 0090-5550, Vol. 54, nr 4, s. 381-389Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: Masking by the use of sounds has been one of the most commonly applied means of coping with tinnitus. The ability to control auditory stimulation represents a potentially important process involved in tinnitus masking strategies. Little is, however, known about the consequences of control on tinnitus experience. The present study investigated the effects of control of background sounds (type and loudness) on perceived intrusiveness of tinnitus and cognitive performance. Design: Using an experimental design with a series of trials, participants with clinically significant tinnitus (N = 35) were randomly assigned to I of 2 experimental manipulation conditions (control of sounds vs. no control of sounds). Measures: Self-reported tinnitus interference and the Digit-Symbol subtest served as dependent measures. Results: Latent growth curve modeling showed that individuals assigned to the condition with control exhibited faster growth rates on tinnitus interference (increased interference) and demonstrated slower rates of improvement on cognitive performance measures over trials compared to individuals assigned to the condition with no control. Conclusion: These results suggest that efforts to control tinnitus through sounds can be associated with increased disability in individuals with tinnitus.

  • 295.
    Hesser, Hugo
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Filosofiska fakulteten.
    Weise, Cornelia
    Linköpings universitet, Institutet för handikappvetenskap (IHV). Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten.
    Rief, Winfried
    University of Marburg.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Avdelningen för klinisk och socialpsykologi (CS). Linköpings universitet, Filosofiska fakulteten.
    The effect of waiting: A meta-analysis of wait-list control groups in trials for tinnitus distress2011Inngår i: JOURNAL OF PSYCHOSOMATIC RESEARCH, ISSN 0022-3999, Vol. 70, nr 4, s. 378-384Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Objective: The response rates and effects of being placed on a wait-list control condition are well documented in psychiatric populations. Despite the usefulness of such estimates and the frequent use of no-treatment controls in clinical trials for tinnitus, the effect of waiting in a tinnitus trial has not been investigated systematically. The aim of the present study was to quantify the overall effect of wait-list control groups on tinnitus distress. Methods: Studies were retrieved via a systematic review of randomised controlled trials of cognitive behaviour therapy for tinnitus distress. Outcomes of psychometrically robust tinnitus-specific measures (Tinnitus Handicap Inventory, Tinnitus Questionnaire, Tinnitus Reaction Questionnaire) from wait-list control groups were quantified using meta-analytic techniques. Percentage of change and standard mean difference effect sizes were calculated using the pre and post wait period. Results: Eleven studies involving 314 wait-list subjects with tinnitus were located. The analysis for a waiting period of 6 to 12 weeks revealed a mean decrease in scores on tinnitus-specific measures of 3% to 8%. Across studies, a statically significant small mean within-group effect size was obtained (Hedges g=.17). The effects were moderated by methodological quality of the trial, sample characteristics (i.e., age, tinnitus duration), time of the wait-list and how diagnosis was established. Conclusion: Subjects in a tinnitus trial improve in tinnitus distress over a short waiting phase. The effects of waiting are highly variable and depend on the characteristics of the sample and of the trial.

  • 296.
    Hesser, Hugo
    et al.
    Linköpings universitet, Institutet för handikappvetenskap (IHV). Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten.
    Weise, Cornelia
    Linköpings universitet, Institutet för handikappvetenskap (IHV). Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten.
    Zetterqvist Westin, Vendela
    Linköpings universitet, Institutet för handikappvetenskap (IHV). Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Utbildningsvetenskap.
    Andersson, Gerhard
    Linköpings universitet, Institutet för handikappvetenskap (IHV). Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten.
    A Systematic Review and Meta-Analysis of Cognitive-Behavioral Therapy for Tinnitus Distress2010Konferansepaper (Annet vitenskapelig)
  • 297.
    Hesser, Hugo
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Filosofiska fakulteten.
    Weise, Cornelia
    Linköpings universitet, Institutet för handikappvetenskap (IHV). Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten.
    Zetterqvist Westin, Vendela
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Utbildningsvetenskap.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Avdelningen för klinisk och socialpsykologi (CS). Linköpings universitet, Filosofiska fakulteten.
    A systematic review and meta-analysis of randomized controlled trials of cognitive-behavioral therapy for tinnitus distress2011Inngår i: CLINICAL PSYCHOLOGY REVIEW, ISSN 0272-7358, Vol. 31, nr 4, s. 545-553Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Tinnitus is defined as a sound in the ear(s) and/or head without external origin and is a serious health concern for millions worldwide. The aim of the present study was to determine whether Cognitive Behavior Therapy (CBT) is effective in reducing distress associated with tinnitus. Randomized, controlled trials that assessed the efficacy of CBT for tinnitus-related distress in adults were identified by searching electronic databases (PsychINFO, PubMed, the Cochrane Library), and by manual searches. Fifteen studies (total of 1091 participants) were included in the meta-analysis. CBT compared with a passive and active control at post-assessment yielded statistically significant mean effect sizes for tinnitus-specific measures (Hedgess g = 0.70. and Hedgess g = 0.44, respectively). The average weighted pre-to-follow-up effect size for the CBT group suggested that these effects were maintained over time. Smaller but yet statistically significant effects of CBT were found for mood outcome measures. Characteristics of the studies were unrelated to effect sizes. Methodological rigor, publication bias, and a series of sensitivity analyses did not influence the findings. The results suggest that CBT is an effective treatment of tinnitus distress. However, caution is warranted given that few large-scale, well-controlled trials were identified.

  • 298.
    Hesser, Hugo
    et al.
    Linköpings universitet, Institutet för handikappvetenskap (IHV). Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten.
    Weise, Cornelia
    Linköpings universitet, Institutet för handikappvetenskap (IHV). Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten.
    Zetterqvist Westin, Vendela
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Utbildningsvetenskap.
    Andersson, Gerhard
    Linköpings universitet, Institutet för handikappvetenskap (IHV). Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten.
    Is CBT effective in the treatment of distress associated with tinnitus?: A systematic review and meta-analysis2011Konferansepaper (Annet vitenskapelig)
  • 299.
    Hesser, Hugo
    et al.
    Linköpings universitet, Institutet för handikappvetenskap (IHV). Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten.
    Westin, Vendela
    Linköpings universitet, Institutet för handikappvetenskap (IHV). Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Utbildningsvetenskap.
    Hayes, Steven
    University of Nevada, Reno, NV, USA.
    Andersson, Gerhard
    Linköpings universitet, Institutet för handikappvetenskap (IHV). Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten.
    Clients’ in-session acceptance and cognitive defusion behaviors in ACT treatment of tinnitus distress2009Konferansepaper (Annet vitenskapelig)
  • 300.
    Hesser, Hugo
    et al.
    Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutet för handikappvetenskap (IHV). Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap.
    Westin, Vendela
    Linköpings universitet, Institutet för handikappvetenskap (IHV). Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten.
    Hayes, Steven C
    University of Nevada.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Avdelningen för klinisk och socialpsykologi (CS). Linköpings universitet, Filosofiska fakulteten.
    Clients' in-session acceptance and cognitive defusion behaviors in acceptance-based treatment of tinnitus distress.2009Inngår i: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 47, nr 6, s. 523-8Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Cognitive-behavioral treatment (CBT) is considered to be an effective treatment of distress associated with tinnitus (perception of internal noises without any outer auditory stimulation), but the processes by which the therapy works remain unclear. Mindfulness and acceptance is receiving increased attention in the treatment literature for chronic medical conditions. However, few studies have examined these and related processes with behavioral or observer measures. In the present study 57 videotapes (a total of 1710min) from 19 clients who participated in a controlled trial of an acceptance-based treatment for tinnitus distress, were coded for frequency and peak level of verbal behaviors expressing either acceptance or cognitive defusion. Frequency of cognitive defusion behaviors and peak level of cognitive defusion as well as peak level of acceptance rated in Session 2, predicted symptom reduction 6 month following treatment. These relationships were not accounted for by the improvement that had occurred prior to the measurement point of the process variables. Moreover, prior symptom changes could not predict process variables rated later in therapy (after most of the improvement in therapy had occurred). Thus, clients' in-session acceptance and cognitive defusion behaviors appear to play an important role in the reduction of negative impact of tinnitus.

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