This article describes the development and empirical status of guided Internet-delivered self-help. The treatment approach combines the benefits of bibliotherapy with book-length text materials and the support given online via web pages and e-mail. Interactive features such as online registrations, tests, and online discussion forums are also included. Cognitive behavior therapy (CBT) guided the research and clinical implementations of this approach, as it lends itself more easily to the self-help format compared with other presently available psychotherapy approaches. We include an overview of the research, current issues and research in service delivery, lessons learned through a program of research, and directions for future investigations.

Purpose of review: The aim of this article is to review the emerging literature on the use of the Internet in the treatment of anxiety disorders. The questions asked are: (1) are Internet-delivered treatments for anxiety disorders supported by the research literature? (2) what is the quality of the evidence as it stands? (3) is there any evidence to suggest that Internet interventions can be harmful? Recent findings: Recent and ongoing trials on panic disorder show that Internet-based self-help with minimal therapist contact is a promising approach in the treatment of panic disorder. However, trials have been small and there is a need for large-scale trials and studies conducted in psychiatric settings as most studies have recruited patients via advertisement. There is no evidence in the literature that Internet intervention is harmful, but most likely a stepped-care approach would be feasible to handle cases who fail to respond. Summary: Internet-delivered interventions for anxiety disorders, and in particular panic disorder, are promising. There is however a need for further research and evaluation and there is also a need to find a proper place for such interventions in the clinical management of anxiety disorders, preferably using a stepped-care approach. © 2005 Lippincott Williams & Wilkins.

Background: Major depression can be treated by means of cognitive-behavioural therapy, but as skilled therapists are in short supply there is a need for self-help approaches. Many individuals with depression use the internet for discussion of symptoms and to share their experience. Aims: To investigate the effects of an internet-administered self-help programme including participation in a monitored, web-based discussion group, compared with participation in web-based discussion group only. Method: A randomised controlled trial was conducted to compare the effects of internet-based cognitive-behavioural therapy with minimal therapist contact (plus participation in a discussion group) with the effects of participation in a discussion group only. Results: Internet-based therapy with minimal therapist contact, combined with activity in a discussion group, resulted in greater reductions of depressive symptoms compared with activity in a discussion group only (waiting-list control group). At 6 months' follow-up, improvement was maintained to a large extent. Conclusions: Internet-delivered cognitive-behavioural therapy should be pursued further as a complement or treatment alternative for mild-to-moderate depression.

In this study, child psychotherapists (N = 31) were asked to retrieve emotionally valenced therapy episodes by using an autobiographical memory approach, with cue words to elicit specific therapy episodes (e.g. irritated, ashamed, loving, and elated). One group of teachers for the disabled (N = 10) and one group of music therapists (N = 9) were also tested and served as comparison groups. Results showed that all participants were able to retrieve memories of episodes. When asked to rate each memory, negative memories were returned to less often, and overall positive memories were rated as more easy to recall and more vivid. Memories derived from positive cue words were also judged to have a more positive compared with negative importance for outcome. Surprisingly, memories derived from the cue word irritated were seen as having more positive than negative importance for outcome. Finally, we checked memory specificity for each memory derived. A high degree of specificity was found overall (72-88%). In conclusion, cue words might be a useful way to generate specific memories of therapy episodes in future research. © 2006 The British Psychological Society.

No abstract is available for this article.

In this commentary, we discuss the implications of the findings by Berger, Hohl, and Casper (this issue) together with the emerging database on the effects of Internet treatment for social anxiety disorder (social phobia). Their article is the third independent replication of guided Internet treatment of social anxiety disorder, and in this article, we comment on future research challenges and if Internet treatment now can be regarded as ready for dissemination into regular clinical settings.

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

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

With the advent of guided self-help via the Internet it has become increasingly important to investigate predictors of treatment outcome. The present study analyzed predictors of outcome using data from a randomized controlled trial on panic disorder [Carlbring, P. et al. (2005). Treatment of panic disorder: Live therapy versus self-help via Internet. Behaviour Research and Therapy, 43, 1321-1333]. Half of the sample received therapist guided Internet treatment (N = 25) and the other half face to face treatment (N = 24) in individual sessions during a 10-week study period. Results showed that agoraphobic avoidance was predictive of outcome in the face to face treatment, but not in the Internet treatment. A self-report screening of personality disorder (anxious cluster) was associated with worse outcome for the Internet treatment, but surprisingly associated with better outcome in face to face treatment. Cognitive capacity as measured by a test of verbal fluency was not predictive of outcome in the Internet group, and neither was a rating of treatment credibility. Overall, we conclude that in relation to face to face treatment different predictors of outcome should be investigated for Internet treatment. Internet treatment might be more suitable for certain clients who might benefit from remote treatment in the early phase of treatment.

Sixty-four individuals with social phobia (social anxiety disorder) were assigned to a multimodal cognitive-behavioral treatment package or to a waiting list control group. Treatment consisted of a 9-week, Internet-delivered, self-help program that was combined with 2 group exposure sessions in real life and minimal therapist contact via e-mail. Results were analyzed on an intention-to-treat basis, including all randomized participants. From pre- to posttest, treated participants in contrast to controls showed significant improvement on most measured dimensions (social anxiety scales, general anxiety and depression levels, quality of life). The overall within- and between-groups effect sizes were Cohen's d = 0.87 and 0.70, respectively. Treatment gains were maintained at 1-year follow-up. The results from this study support the continued use and development of Internet-distributed, self-help programs for people diagnosed with social phobia. Copyright 2006 by the American Psychological Association.

Tinnitus has been associated with psychiatric disorders and more recently diagnostic tools have been used in a systematic manner. In the present study, we administered the World Health Organisation's Composite International Diagnostic Interview - Short form (CIDI-SF) in a computerized Internet-based version to a self-selected sample of tinnitus patients (n=48). Using the cut-off for 'probable case' (12-month prevalence), 69% of the tinnitus patients fulfilled the criteria for depression, 60% for generalized anxiety disorder, 83% for specific phobia, 67% for social phobia, 58% for agoraphobia, 21% panic attack, 83% obsessive - compulsive disorder, 2% alcohol dependence and 0% drug dependence. Decreased percentages were found for depression (4%), specific phobia (62%) and social phobia (27%) when applying a more conservative criteria (maximum case criteria). In conclusion, the findings suggest that the Internet version of CIDI-SF can be used as a screening tool for psychiatric disturbance in somatic patients, but that diagnostic criteria need to be adjusted for Internet use.

Background: Internet-delivered cognitive behavior therapy (ICBT) was developed over 20 years ago and has since undergone a number of controlled trials, as well as several systematic reviews and meta-analyses. However, the crucial question of response rates remains to be systematically investigated. The aim of this individual patient meta-analysis (IPDMA) was to use a large dataset of trials conducted in Sweden to determine reliable change and recovery rates across trials for a range of conditions.

Methods: We used previously collected and aggregated data from 2,866 patients in 29 Swedish clinical trials of ICBT for three categories of conditions: anxiety disorders, depression, and others. Raw scores at pre-treatment and post-treatment were used in an IPDMA to determine the rate of reliable change and recovery. Jacobson and Truax’s, (1991) reliable change index (RCI) was calculated for each primary outcome measure in the trials as well as the recovery rates for each patient, with the additional requirement of having improved substantially. We subsequently explored potential predictors using binomial logistic regression.

Results: In applying an RCI of z = 1.96, 1,162 (65.6%) of the patients receiving treatment were classified as achieving recovery, and 620 (35.0%) were classified as reaching remission. In terms of predictors, patients with higher symptom severity on the primary outcome measure at baseline [odds ratio (OR) = 1.36] and being female (OR = 2.22) increased the odds of responding to treatment. Having an anxiety disorder was found to decrease the response to treatment (OR = 0.51). Remission was predicted by diagnosis in the same direction (OR = 0.28), whereas symptom severity was inversely predictive of worse outcome (OR = 0.81). Conclusions: Response seems to occur among approximately half of all clients administered ICBT, whereas about a third reach remission. This indicates that the efficacy of ICBT is in line with that of CBT based in prior trials, with a possible caveat being the lower remission rates. Having more symptoms and being female might increase the chances of improvement, and a small negative effect of having anxiety disorder versus depression and other conditions may also exist. A limitation of the IPDMA was that only studies conducted in Sweden were included.

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

The purpose of this review paper is to comment on a suggestion proposed by David Barlow [Barlow, D. H. (2004). Psychological treatments. American Psychologist, 59, 869-878.], that evidence-based psychotherapies with a clear medical objective should go under the name of "psychological treatments". We begin by describing the definition of psychotherapy and the role of common factors. We then briefly present how different "schools of psychotherapy" are differentiated. In the literature it is clear that psychological treatments can be both more broad in terms of the ways of delivery (e. g., Internet-based treatment), but also more narrow than psychotherapies, as psychological treatments are now increasingly regarded as evidence-based medical treatments for specific medical conditions. Psychological treatments are also increasingly recommended in treatment guidelines. Some benefits from using the concept of psychological treatment instead of the equally important but less medically oriented term psychotherapy are presented. As the regular "brand names" of psychotherapy are increasingly integrating procedures from different schools of therapy, and that the objective of psychotherapy often is adjustment and growth, we agree with the suggestion by Barlow that endorsing the term "psychological treatment" could facilitate the further dissemination of evidence-based psychological treatment procedures.

The Internet has revolutionized access to health information and made communication over long distances easier. This article reviews the use of the Internet for delivery of cognitive behaviour therapy. As a starting point the concept of guided self-help is introduced. We next present the treatment approach and different protocols briefly. Next, Swedish studies on panic disorder, social phobia, and depression are summarized using meta-analytic techniques. Implementation in regular clinical setting is discussed with a focus on efficacy versus effectiveness, training of therapist, combined treatments and cost-effectiveness. We conclude that Internet treatment is likely to become a treatment option for suitable patients in the future.

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

Online cognitive-behavioural therapy (CBT) for depression has the potential to serve as an important addition to the care of people with mild to moderate depression. Although some studies show promising results, the need for proper diagnoses and human guidance must be considered when interpreting the modest effects found in studies with little or no guidance from a therapist.

The relation between tinnitus and short-term memory performance in varying background sounds is not well understood. In the present study a sample of 18 persons with tinnitus completed a serial recall test in three conditions, silence, masking and intermittent masking. The performance of a matched control group without tinnitus was also investigated. Based on the literature on the "irrelevant sound effect" we expected that the tinnitus group would perform worse during intermittent masking and that they would score lower overall compared to the control group. Results revealed no statistically significant differences between the groups, nor any group interaction within sound conditions for the serial recall test. Groups did however differ regarding subjective measures of concentration problems, anxiety and depression. Results are discussed in relation to thought suppression and distraction from tinnitus.

The aim of this qualitative study was to interview a group of tinnitus patients (n = 7) who were or had been involved in psychological treatment for their tinnitus. Following semi-structured interviews all conversations were transcribed and later categorized using methods inspired by grounded theory. Results revealed a higher order concept labelled ‘Mixed feelings about living with tinnitus’. Three descriptive categories were derived: 1) Consequences; 2) Treatment experiences; and 3) Tinnitus identity. Results are discussed in relation to the literature on tinnitus, and the future application of qualitative methods in tinnitus research is encouraged.

Internet-delivered cognitive behaviour therapy commonly consists of disorder-specific modules that are based on face-to-face manuals. A recent development in the field is to tailor the treatment according to patient profile, which has the potential to cover comorbid conditions in association with anxiety and mood disorders. However, it could be that the patients themselves are able to decide what modules to use. The authors tested this in an open pilot trial with 27 patients with mixed anxiety disorders. Modules were introduced with a brief description, and patients could choose which modules to use. The exception was the two first modules and the last, which involved psychoeducation and relapse prevention. The treatment period lasted for 10 weeks. Results showed large within-group effect sizes, with an average Cohen's d of 0.88. In a structured clinical interview, a majority (54%) had significantly improved 10 weeks after commencing treatment. Only one person dropped out. On the basis of results of this preliminary study, the authors suggest that the role of choice and tailoring should be further explored in controlled trials and that patient choice could be incorporated into Internet-delivered treatment packages.

Dizziness is commonly associated with anxiety, and is often caused by a dysfunction of the balance system. While a link between dizziness and both anxiety disorders and depression has been established, less is known about information processing in dizziness. In the first experiment we tested whether 15 patients with dizziness would display an emotional Stroop effect for panic-related words. Also included was a control group of 15 persons. The Stroop task was preceded by ratings of personal relevance of the Stroop words and followed by a surprise free recall of the words. Results showed a Stroop effect for panic-related words in the dizziness group, but the interaction did not reach significance (p = 0.08). Separate analysis of dizziness-related panic words however resulted in a significant group × condition interaction. In the free recall of Stroop words a main effect of word category was found, with more panic-related words being recalled. The second experiment investigated autobiographical memories in 14 patients with dizziness and 14 matched controls. Results showed a group × condition interaction with less specific memories being recalled following positive cue-words in the dizziness group. The overall pattern of results suggests that dizziness is related to deficits in information processing, which could be targeted in treatment.

Background: While several studies have investigated the presence and annoyance of tinnitus in cochlear implant (CI) recipients, few studies have probed the handicap experienced in association with tinnitus in this population. Purpose: The aim of this study was to use validated self-report measures in a consecutive sample of Cl patients who reported tinnitus in order to determine the extent of tinnitus handicap. Research Design: In a retrospective design, a total of 151 patients (80% response rate) responded to a postal questionnaire, and of these, 111 (74%) reported that they currently experienced tinnitus and were asked to complete the full questionnaire. Sampling was performed at a point of a mean 2.9 years postsurgery (SD = 1.8 years). Three established self-report questionnaires were included measuring tinnitus handicap (Tinnitus Handicap Inventory [THI]) hearing problems (Gothenburg Profile), and finally, a measure of anxiety and depression (Hospital Anxiety and Depression Scale). We analyzed the data by means of Pearson product moment correlations, Mests, ANOVAs, and chi-square. Results: Data from the validated questionnaires showed relatively low levels of tinnitus distress, moderate levels of hearing problems, and low scores on the anxiety and depression scales. Using the criteria proposed for the THI (which was completed by 107 patients), 35% (N = 38) had a score indicating "no handicap," 30% (N = 32) "mild handicap" 18% (N = 19) "moderate handicap", and 17% (N = 18) "severe handicap." Thus 37 individuals from the total series of 151 reported moderate to severe tinnitus handicap (24.5%). Tinnitus distress was associated with increased hearing problems, anxiety, and depression. Conclusion: Tinnitus can be a significant problem following Cl, but that the experienced distress is often moderate. However, a quarter of Cl recipients do demonstrate moderate/severe tinnitus handicap, and thus are candidates for tinnitus specific therapy. The level of tinnitus handicap is associated with hearing problems and psychological distress.

 While a majority of cognitive-behavioural researchers and clinicians adhere to the classification system provided in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994, 2000), strong objections have been voiced among behaviourists who find the dichotomous allocation of patients into psychiatric diagnoses incompatible with the philosophy of behaviorism and practice of functional analysis. The aim of this paper is to give an overview of the current debate and to analyze the tension between the DSM-IV and functional analysis along the following contrasts: Inductive vs. Deductive, Idiographic vs. Nomothetic, Contextualism vs. Mechanism, Social constructions vs. Real Entities, and Dimensions vs. Categories. Finally, some suggested alternatives are discussed. It is concluded that there is a need for alternative systems to the DSM with treatment utility.

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

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

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

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

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

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

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

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

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

Background: Chronic pain is a common condition among older adults. While cognitive behaviour therapy (CBT) has been tested in numerous studies on adults and children there are fewer studies on older persons. The objective of this study was to investigate the effects of a six-session CBT group treatment for older persons with chronic pain. As a secondary aim we investigated whether treatment credibility was associated with outcome. Method: We included 21 persons (mean age = 72.0 years) who were randomly allocated to either a waitlist condition or treatment consisting of applied relaxation, with the addition of problem solving, assertiveness, communication strategies, sleep management, and relapse prevention. Results: Few statistically significant effects were found on measures of pain, mood, anxiety, and quality of life; however, a significant treatment effect with a between group effect size of d = 1.0 was observed with respect to perceived ability to function despite the discomfort of pain. Conclusion: The study provides some preliminary support for the use of group-based CBT with a focus on applied relaxation for older adults with chronic pain.

Tinnitus is the perception of sound in the absence of any appropriate external stimulus. Based on the clinical observation that tinnitus patients may distract themselves from their sounds, we performed an experimental test on the effects of suppressing thoughts about tinnitus with 45 tinnitus patients, to systematically evaluate the immediate consequences of suppressing thought vs. attending to tinnitus. Suppression instructions tended to lead to a subsequent decrease in tinnitus-related thoughts, whereas attention to tinnitus resulted in an increase in such thoughts. No effects were seen in a control group who neither suppressed nor attended to their tinnitus. In an independent positron emission tomography study of cerebral blood flow with 8 patients we found that silent backward counting ('serial sevens test') led to a decrease in neural activity in auditory cortex, as well as perceived decrease of tinnitus loudness and annoyance. Thus, distraction that altered the tinnitus experience seemed to attenuate auditory cortex activity. Copyright © 2006 S. Karger AG.

Hyperacusis innebär extrem känslighet för vardagens ljud är ett problem som drabbar cirka 8% av befolkningen. I svåra fall uppstår undvikande av många situationer samt en vana att skydda öronen med hörselskydd även i situationer där det inte behövs. Orsakerna till hyperacusis är till viss del kända, men många frågetecken kvarstår. För hyperacusis finns ingen dokumenterat botande behandling, men kognitiv beteendeterapi, samt eventuellt även tinnitus retraining therapy med brusgenerator, kan minska besvären,. Gott omhändertagande och en multidisciplinär utredning är att rekommendera i svåra fall. En av de viktigaste uppgifterna för framtida forskning är att kartlägga naturalförloppet vad gäller hyperacusis, då detta är i stort okänt. Det finns även ett stort behov av kontrollerade behandlingsstudier.

Most clinicians have little experience with tinnitus treatments, and are unsure of how to help a patient suffering from the condition. Filling a significant gap in literature, this book offers a variety of in-depth protocols to treat tinnitus. Beginning with a review of several neurophysiological and psychological models of tinnitus, the book goes on to cover evaluation tools; counseling options and methods; treatment with hearing aids, wearable and non-wearable noise generators, and music; tinnitus-related insomnia; quality-of-life issues; and much more. Highly experienced clinicians give you the practical strategies to apply such therapeutic modalities as cognitive-behavioral therapy, individual and group sessions, sound therapy, habituation therapy, and narrative therapy. You will also find sample handouts to allow for effective communication with patients. With key clinical information for implementing all current therapies, this text is an essential professional tool for audiologists, psychologists, and other practitioners involved in managing otologic disorders.

Richard Tyler, PhD, is a professor in the Department of Otolaryngology-Head Neck Surgery and in the Department of Speech Pathology and Audiology at the University of Iowa. Tyler and Sergei Kochkin, PhD recently sat down to talk about the results of a survey they conducted about tinnitus treatment and the effectiveness of hearing aids, which was published in the December 2008 edition of The Hearing Review. Click here to learn more and to watch a podcast that examines the survey results: http://www.hearingreview.com/podcast/files/ST20081218.asp.

Most clinicians have little experience with tinnitus treatments, and are unsure of how to help a patient suffering from the condition. Filling a significant gap in literature, this book offers a variety of in-depth protocols to treat tinnitus. Beginning with a review of several neurophysiological and psychological models of tinnitus, the book goes on to cover evaluation tools; counseling options and methods; treatment with hearing aids, wearable and non-wearable noise generators, and music; tinnitus-related insomnia; quality-of-life issues; and much more. Highly experienced clinicians give you the practical strategies to apply such therapeutic modalities as cognitive-behavioral therapy, individual and group sessions, sound therapy, habituation therapy, and narrative therapy. You will also find sample handouts to allow for effective communication with patients. With key clinical information for implementing all current therapies, this text is an essential professional tool for audiologists, psychologists, and other practitioners involved in managing otologic disorders

This questionnaire study investigated the role of coping strategies in tinnitus. The Tinnitus Coping Strategy Questionnaire (12) was administered via the internet to a sample of 157 persons with tinnitus who were recruited for participation in a treatment trial. Also included were the Tinnitus Reaction Questionnaire, the Anxiety Sensitivity Index, and the Hospital Anxiety and Depression Scale. Results showed a significant positive correlation between use of coping strategies and tinnitus distress, even when controlling for anxiety sensitivity, and anxiety and depression levels in a multiple regression analysis. In line with previous studies, the role of coping strategies is not uniformly positive for tinnitus patients, and might even be associated with increased distress. Treatment implications are discussed and a possible role of acceptance strategies is put forward.

Objective: The purpose of the study was to investigate future thinking in a group of tinnitus patients. It was predicted that participants in the tinnitus group would report fewer positive future events. Methods: A cross-sectional design was used. Two groups of participants completed the test session: tinnitus patients (n=20) and healthy controls (n=20) without tinnitus. Participants completed measures of anticipation of future positive and negative experiences, anxiety and depression. In addition, participants with tinnitus completed a test of tinnitus annoyance. Results: Tinnitus participants generated a greater number of negative future events compared to the controls. There was no difference between the groups on positive future events or on self-reported anxiety, but the tinnitus group scored higher on a depression measure. Controlling for depression scores removed the group difference. Conclusions: While the groups differed on future thinking, the difference concerned negative events, which suggests that anxious information processing might be important in explaining tinnitus annoyance. Levels of depressive symptoms should, however, be considered. © 2007 Elsevier Inc. All rights reserved.

Purpose of review The aim of this paper is to provide an updated review of recent controlled trials of Internet interventions for health conditions and how the Internet is used to promote health. Recent findings We identified 18 published trials including studies on diabetes, cancer, pain conditions, obesity, irritable bowel syndrome, stress management, hypertension, metabolic syndrome, cerebral palsy, infertility, HIV infection, and fruit/vegetable consumption. Of the 18 trials, one-third targeted children and adolescents. Two cancer studies investigated the role of peer support in an online environment that failed to result in any major improvements. Overall, several trials did not result in any substantial significant improvements, but there are exceptions, such as treatment of irritable bowel syndrome, headache, and chronic pain. Although a few of the reviewed studies had sufficient sample sizes, the majority were small and underpowered. In particular, this was the case for the studies on children and adolescents. Summary This review suggests that Internet interventions hold some promise as a complement to other treatments such as cognitive behavior therapy. The benefits from participating in online peer support groups are not clear. Although studies on children and adolescents have emerged, there is a lack of studies on older adults with health problems.

The present study investigated the role of overprediction in patients with vestibular disorders. The study was set up to investigate if the match/mismatch model is applicable for vestibular disorders. This model suggests that a tendency to overestimate the subjective impact of aversive events exists, and that this is a common psychological phenomenon. A group of 20 patients with dizziness and 20 normal controls participated in the experiment. The first part of the experiment consisted of nine spontaneous predictions. During all trials, vibratory calf stimulation of 80 Hz was provided to affect balance. In the second part of the experiment each group was split (randomly assigned) into one overprediction and one underprediction group, who received either 40 or 100 Hz calf stimulation with the change occurring in the fourth trial. Body sway was measured by a force platform. Included also were self-report inventories and measures of predicted and experienced body sway and risk of losing balance. The results showed that the patients overpredicted the first trial to a lesser degree than the controls. In the control group a repeated measures effect was found, but not in the patient group. However, in terms of percentages of correct predictions both groups improved as the trials proceeded. Induced under- or over-prediction was obtained for perceived body sway, but not for the prediction of risk of losing balance, where the overprediction groups instead underpredicted. Body sway data did not result in any interactions, but controls became more stable over trials. Implications for the proposed link between vestibular dysfunction and panic disorder are discussed. © 2008 Informa UK Ltd. (Informa Healthcare, Taylor & Francis As).

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

Conclusions: The role of cognition in tinnitus is difficult to ignore. First, tinnitus is likely to disrupt cognitive functioning, and there are some indications that tinnitus patients have impaired capacity to perform certain cognitive tasks. Second, evidence is emerging that tinnitus patients show cognitive bias in the way they handle information. Such information processing style suggests either depressive functioning, or anxious vigilance, or both. Finally, self-report measures of tinnitus distress all require conscious recollection of how tinnitus is perceived and the consequences of tinnitus. Such reports necessitate cognitive capacity. Objectives: To review the literature on the interface between cognitive function and tinnitus with special regard to the role of different levels of information processing. Materials and methods: A selective systematic literature search was conducted using the search engines of Medline and Psychological Abstracts, and by hand search of conference proceedings. Results: There are yet relatively few published studies on cognitive functioning in tinnitus patients. Most research has been conducted by a few separate research groups. However, the available studies clearly implicate an important role of cognitive processes at different levels from basic cognitive function to more conscious appraisal of the consequences of tinnitus. Finally, a tentative model of the road from tinnitus generation to annoyance via cognitive function is suggested.

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

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

The aim of the study was to investigate the effects of cognitive behavioral therapy (CBT) in elderly people with tinnitus (<65 years). Thirty-seven patients were called in for a structured interview. Following exclusion, twenty-three participated in the trial. All participants underwent medical ear, nose, and throat (ENT) examination, audiometry, and tinnitus matchings. A randomized controlled design with a waiting list control group was used. A CBT treatment package was delivered in six weekly two hour group sessions. Outcome was measured using validated self-report inventories and daily diary ratings of annoyance, loudness and sleep quality for one week pre-treatment, post-treatment. A three month follow-up was included at which time all participants had received treatment, but in a shorter format for the control group. Results showed statistically significant reductions of tinnitus-related distress. Thus, CBT was better than no treatment, but the particular aspects of CBT that contributed to the effects can not be established. In conclusion, the findings give some support for the use of group CBT for elderly people with tinnitus. © 2005 British Society of Audiology, International Society of Audiology, and Nordic Audiological Society.