Even if much is known regarding the effects of internet-delivered cognitive behaviour therapy (ICBT) for depression there are several topics that have not been studied. In this factorial design trial with 197 participants we investigated if clients in ICBT could select treatment modules themselves based on a selection of 15 tailored treatment modules developed for use in ICBT for depression. We contrasted this against clinician-tailored module selection. We also investigated if support on demand (initiated by the client) could work as well as scheduled support. Finally, we tested if clients that were mentioned in supervision would improve more than clients not mentioned (with the exception of acute cases). The treatment period lasted for 10 weeks, and we measured effects at post-treatment and two-year follow-up. Measures of depression and secondary outcomes were collected at pre-treatment, post-treatment and two-year follow-up. Overall, within-group effects were large across con-ditions (e.g., d = 1.73 on the BDI-II). We also found a small but significant difference in favour of self-tailored treatment over clinician-tailored (d = 0.26). Within-group effects for the secondary measures were all moderate to large including a test of knowledge about CBT. The other two contrasts "support on demand" and "supervision" yielded mostly non-significant differences, with the exception of a larger dropout rate in the support on demand condition. There were few negative effects (2.2%). Effects were largely maintained at a two-year follow-up. We conclude that clients can choose treatment modules and that support on demand may work. The role of su-pervision is not yet clear as advice can be transferred across clients.

Background and objectives: Knowledge about a condition and how to treat it is part of most cognitive behavioural therapies. This is particularly relevant for self-help treatments such as internet-based CBT, which is commonly delivered in the form of didactic materials. The role of knowledge acquisition in treatment outcomes is an understudied area. The present study sought to investigate knowledge acquisition as part of an ICBT trial targeting loneliness and discern its role in the outcome of treatment. Methods: We used secondary data from a randomised controlled trial of ICBT targeting loneliness with 73 participants. A knowledge test including certainty ratings was constructed and used to investigate whether knowledge increased for the treatment group in comparison to the control group, whether changes in knowledge predicted changes in loneliness during the treatment phase, and how the acquired knowledge related to outcomes at a two-year follow-up. Multiple linear regression models were used to analyse the data. Results: The treatment group had significantly higher knowledge scores compared to the waitlist group at posttreatment, both in terms of correct answers (Cohens d = 0.73) and certainty-weighted sum scores (Cohens d = 1.20). Acquired knowledge did not predict reductions in loneliness in the short-term, and neither loneliness ratings nor use of treatment techniques in the long-term. Limitations: The sample size was relatively small, which limits the statistical inferences. Conclusions: Knowledge of treatment relevant principles increase as part of the treatment in ICBT for loneliness. This increase was not related to other short- and long-term outcomes.

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Background: Loneliness, or perceived social isolation, is prevalent in both the general population and clinical practice. Although loneliness has repeatedly been associated with mental and physical health, research on interventions that reduce loneliness effectively is still rather scarce. Objective: This study aims to evaluate the efficacy of a guided and an unguided version of the same internet-based cognitive behavioral self-help program for loneliness (SOLUS-D) for adults. Methods: A total of 250 participants will be randomly assigned to 1 of 2 intervention groups (SOLUS-D with guidance or SOLUS-D without guidance) or a wait-list control group (2:2:1 allocation ratio). Adult participants experiencing high levels of loneliness will be recruited from the general population. Individuals currently experiencing at least moderately severe depressive symptoms, an ongoing severe substance use disorder, previous or current bipolar or psychotic disorder, or acute suicidality will be excluded from the trial. Assessments will take place at baseline, 5 weeks (midassessment), and 10 weeks (postassessment). The primary outcome is loneliness assessed using the 9-item University of California, Los Angeles Loneliness Scale at the posttreatment time point. Secondary outcomes include depressive symptoms, symptoms of social anxiety, satisfaction with life, social network size, and variables assessing cognitive bias and social behavior. The maintenance of potentially achieved gains will be assessed and compared at 6 and 12 months after randomization in the 2 active conditions. Potential moderators and mediators will be tested exploratorily. Data will be analyzed on an intention-to-treat basis. Results: Recruitment and data collection started in May 2021 and are expected to be completed by 2022, with the 12-month follow-up to be completed by 2023. As of the time of submission of the manuscript, 134 participants were randomized. Conclusions: This 3-arm randomized controlled trial will add to the existing research on the efficacy of loneliness interventions. Furthermore, it will shed light on the role of human guidance in internet-based treatments for individuals with increased levels of loneliness and the possible mechanisms of change. If SOLUS-D proves effective, it could provide a low-threshold, cost-efficient method of helping and supporting individuals with increased levels of loneliness.

Background: Due to the coronavirus disease 2019 (COVID-19) pandemic, people have undermined their mental health. It has been reported that post-COVID conditions at a certain rate. However, information on the mental health of people with post-COVID conditions is limited. Thus, this study investigated the relationship between post-COVID conditions and mental health.

Methods: Design of the present study was an International and collaborative cross-sectional study in Japan and Sweden from March 18 to June 15, 2021. The analyzed data included 763 adults who participated in online surveys in Japan and Sweden and submitted complete data. In addition to demographic data including terms related to COVID-19, psychiatric symptoms such as depression, anxiety, and post-traumatic stress were measured by using the fear of COVID-19 scale (FCV-19S), Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 item (GAD-7), and Impact of Event Scale-Revised (IES-R).

Results: Of the 135 COVID-19 survivors among the 763 total participants, 37.0% (n = 50/135) had COVID-19-related sequelae. First, the results of the Bonferroni-corrected Mann Whitney U test showed that the group infected SARS-CoV-2 with post-COVID conditions scored significantly higher than those without one and the non-infected group on all clinical symptom scales (P <= .05). Next, there was a significant difference that incidence rates of clinical-significant psychiatric symptoms among each group from the results of the Chi-squared test (P <= .001). Finally, the results of the multivariate logistic model revealed that the risk of having more severe clinical symptoms were 2.44-3.48 times higher among participants with post-COVID conditions.

Conclusion: The results showed that approximately half had some physical symptoms after COVID-19 and that post-COVID conditions may lead to the onset of mental disorders.

Loneliness is a significant problem for young people and is associated with a range of physical and mental health difficulties. Meta-analyses have identified that interventions aimed at young people who report loneliness as their primary problem are lacking within the literature. In adults, the most effective interventions for loneliness are those which target the underlying maladaptive social cognitions. Therefore, we have developed a modular Cognitive Behavioural Therapy (CBT) intervention for children and young people. The aim of this study is to conduct a multiple baseline single-case experimental design (SCED) to assess the efficacy, feasibility and acceptability of this intervention. In total 6-8 11-18-year-olds and their families will be recruited. The design consists of AB+ post-intervention, where A is the baseline phase, B is the intervention phase and then a post-intervention phase. Participants will complete a baseline assessment, before being randomised to one of four different baseline lengths (12 days, 19 days, 26 days or 33 days). Participants will then complete an average of 12 sessions of CBT, with the aim being to reduce their feelings of loneliness. Participants will then complete a 12-day post-intervention phase. Participant loneliness will be repeatedly assessed throughout the three phases of the intervention using the Three-item Loneliness Scale, which will be the primary outcome. Secondary outcomes will be reliable and clinically meaningful change on the UCLA Loneliness Scale, Revised Child Anxiety and Depression Scale (RCADS) and Strengths and Difficulties Questionnaire (SDQ). Feasibility and participant satisfaction will also be assessed and reported.

Loneliness is a common experience in populations experiencing mental health problems. Associations with symptoms of psychopathology are prevalent, but little is known about the diversity of symptom profiles in people suffering from prolonged and distressing loneliness. The current study sought to investigate the existence of subgroups of loneliness and common forms of psychopathology in a sample of adults (n = 332) seeking treatment for their loneliness. Using latent profile analysis, five profiles were identified and differences in demographic factors were investigated. The profiles differed mainly in the severity of symptoms of depression, worry, and social anxiety, with the largest profile exhibiting minimal-to-mild symptoms (n = 109) across these indicators. The second largest group was characterized primarily by high ratings of social anxiety (n = 90). Overall, three of the five profiles, encompassing roughly half of the sample, scored at a clinical level on mental health symptom measures. Age was inversely related to symptom severity among the profiles, indicating that the older subgroups of the sample exhibited milder symptoms, particularly on social anxiety. The results provide insight into the heterogeneity of the clinical symptoms of people suffering from loneliness and add important knowledge that could help inform how to best intervene to help this population.

Loneliness is an adverse emotional reaction thought to stem from an unwanted and impoverished social situation. Though it commonly makes brief appearances across the lifespan for most people, it has received increasing attention as a factor relevant to somatic and psychological well-being when assuming a more chronic form. For this reason, developing ways of alleviating loneliness is an important item on the research agenda tied to this phenomenon. Psychological interventions, and cognitive behavioural therapy (CBT) in particular, have been proposed to have potential for this. This thesis sought to evaluate the effects of two different kinds of internet-based interventions targeting loneliness: one based on CBT, and one based on interpersonal psychotherapy (IPT).

In addition to this general aim, Study I also investigated the presence of different subgroups in the sample of people seeking help within the framework of projects. Using the statistical method known as Latent Profile Analysis we discovered five profiles consisting of symptoms of common psychiatric disorders and loneliness. The profiles mainly differed as a function of symptom severity, though one of the larger groups was also characterised primarily by their high ratings of social anxiety. The results suggest that the sample seeking help for their loneliness can exhibit both clinical and non-clinical levels of common mental health problems.

Study II served as the pilot evaluation of an ICBT programme for loneliness. A total of 73 participants were included in a randomised controlled trial where the participants were randomised to either 8 weeks of active treatment or a wait-list control group. The results indicated significantly lower loneliness ratings after the treatment phase for the ICBT condition with a moderate-to-large effect size compared to the control group. Significant differences favouring the ICBT condition were also noted for two of the four secondary measures.

Study III followed up on the participants two years after the conclusion of the initial treatment period. At this point, the control group had also received access to a version of the ICBT programme with therapist support on-demand. The results indicated that the decrease in loneliness was sustained, along with similarly lasting effects on the secondary outcomes of interest.

Study IV aimed to replicate the findings from the second study with a similar ICBT programme. However, this study also employed an internet-based IPT intervention to allow for conclusions regarding the possibility of reducing loneliness by other means than CBT. A sample of 170 participants were recruited and randomised to one the treatment conditions or to a waitlist control group. The results indicated that the ICBT condition had a significantly steeper reduction in loneliness than both the waitlist and the IPT condition after the conclusion of the treatment. Both active conditions produced a significant increase in quality of life.

In conclusion, internet-based psychological interventions can be efficacious for reducing loneliness, though the efficacy was only found for participants who received access to the ICBT condition in Study II and IV. The benefits from this treatment programme were sustained up to two years after the conclusion of the intervention. For these reasons, ICBT is proposed to be a good candidate for offering help to people experiencing distressing feelings of loneliness.

Chronic loneliness is associated with a range of mental health difficulties. Previous theory and research indicate that psychological interventions show promise for reducing loneliness, however, there have been no systematic reviews or meta-analyses to ascertain the efficacy of these interventions across the lifespan. The aim of this study was to synthesise, meta-analyse and explore the heterogeneity in RCTs of psychological interventions for loneliness in order to establish their efficacy. Five databases (Ovid Embase, Ovid Medline, PsycINFO, Web of Science and CINAHL) were systematically searched in order to identify relevant studies. Included studies were required to be peer-reviewed RCTs examining psychological interventions for loneliness. Two independent coders examined the abstracts of the 3973 studies and 103 full texts, finding 31 studies that met inclusion criteria, 28 of which contained sufficient statistical information to be included in the meta-analysis. The quality of included studies was assessed using the Cochrane Risk of Bias Tool. The 31 studies (N = 3959) that were included in the systematic review were conducted with participants from a diverse range of cultures, age groups and populations. The interventions were of mixed quality and were mostly face to face, group-based and delivered weekly. The most common type of intervention was Cognitive Behavioural Therapy (CBT). 28 studies (N = 3039) were included in a meta-analysis which found that psychological interventions significantly reduced loneliness compared to control groups, yielding a small to medium effect size (g = 0.43). Subgroup analysis and meta-regressions were conducted in order to explore heterogeneity and found that type of psychological intervention was approaching significance as a moderator of the effectiveness of psychological interventions for loneliness. In conclusion, psychological interventions for loneliness across the lifespan are effective. This finding should inform policy makers, researchers and clinicians going forward, especially in the context of increased loneliness due to the COVID-19 pandemic. There was considerable heterogeneity in the effectiveness of the interventions, suggesting that future research should also explore what works for whom and consider personalising psychological treatment.

Introduction: Chronic loneliness has been linked to many adverse outcomes, including mental health problems. Psychological treatment of loneliness can be effective, but the evidence base is limited. Objective: To investigate the efficacy of 2 internet-based interventions based on cognitive behavioral therapy (ICBT) and interpersonal psychotherapy (IIPT) relative to a wait-list control group and each other. Methods: A total of 170 participants were recruited and randomized to either 9 weeks of ICBT (n = 68), IIPT (n = 68), or a wait-list condition (n = 34). The primary outcome was loneliness, measured using the UCLA Loneliness Scale before, during, and after treatment. Secondary measures of psychiatric disorders and quality of life were administered before and after treatment. Follow-up was conducted 4 months after the treatment had ended. Primary outcome data were analyzed using growth curve modeling. Secondary outcomes were analyzed using robust regression models. The trial was preregistered (ClinicalTrials.gov ID: NCT03807154). Results: The ICBT condition had a significantly greater impact on loneliness compared to the wait-list and IIPT conditions. Effect sizes were moderate to large (Cohen d = 0.71) compared to the wait-list and moderate (d = 0.53) compared to IIPT. The IIPT condition did not differ significantly from the wait-list. Both active treatments led to significant increases in quality of life. Only the ICBT group had significantly lower symptoms of depression and generalized anxiety compared to the wait-list group. Treatment gains were maintained but not improved at follow-up. Conclusions: ICBT can be an efficacious option for alleviating loneliness. The IIPT intervention was not as effective.

Background: Loneliness is a transdiagnostic clinical phenomenon that can significantly impact mental health and well-being across the lifespan. Objective: The aim was to combine existing theory and evidence-based treatment approaches to propose a comprehensive transdiagnostic cognitive-behavioral analysis of the maintenance of chronic loneliness relevant across disorders, age groups, and populations. Method: A distillation and matching model-framework approach was taken to identify interventions designed to reduce loneliness. Eligible studies were coded for the presence of practice elements. The findings were combined with an analysis of the broader literature on loneliness and psychopathology to derive a comprehensive cognitive-behavioral analysis of the maintenance of loneliness over time across populations. Results: The search yielded 11 studies containing 14 practice elements with relative frequencies ranging from 7% to 64%. The identified practice elements target putative mechanisms such as negative interpersonal appraisals. anxiety, and social skills deficits. Counterproductive behavior and cognitive processes such as sell-focused attention were identified as maintenance factors based on the broader literature. A modular transdiagnostic model with multiple pathways is proposed to be consistent with the existing theoretical and treatment literature. Conclusions: Combining the distillation and matching model framework with existing theory from the literature is a novel approach for developing a model of factors that maintain loneliness over time. The model has varying treatment implications for different populations including children with autism spectrum disorders and bereaved older adults. Targeting transdiagnostic processes has the potential to transform interventions for loneliness across a range of formats and settings.

Loneliness has been described as a common source of discomfort based on a subjective discrepancy between the actual and desired social situation. For some people this feeling may become a sustained state that is associated with a wide range of psychiatric and psychosocial problems. While there are few existing treatment protocols, interventions based on cognitive behavioral therapy (CBT) have shown positive effects. The current study investigated the efficacy of an 8-week internet-based treatment containing CBT components aimed at reducing feelings of loneliness. Seventy-three participants were recruited from the general public and randomly allocated to treatment or a wait-list control condition. Participants were assessed with standardized self-report measures of loneliness, depression, social anxiety, worry, and quality of life at pretreatment and posttreatment. Robust linear regression analysis of all randomized participants showed significant treatment effects on the primary outcome measure of loneliness (between group Cohens d = 0.77), and on secondary outcomes measuring quality of life and social anxiety relative to control at postassessment. The results suggest the potential utility of internet-based CBT in alleviating loneliness but more research on the long-term effects and the mechanisms underlying the effects is needed.

The current study sought to investigate the long-term effects of an internet-administered programme based on CBT principles for which the initial efficacy has been reported in Kall, Jagholm, et al. (In press). Seventy-three participants who were recruited on the basis of experiencing frequent and prolonged loneliness were contacted to complete questionnaires measuring loneliness, quality of life, and symptoms of psychopathology two years after the conclusion of the initial treatment period. Additional items regarding use of the treatment techniques and strategies contained in the programme during the follow-up period was included. In total, 44 participants provided data for the loneliness measure at follow-up. The outcome data were analyzed with a piecewise mixed effects model to provide estimates of change for the continuous measures. Linear multiple regression analysis was used to investigate the relationship between use of treatment techniques and reliable change on the primary outcome measure. The results showed decreases in loneliness during the follow-up period for the sample as a whole. Additionally, an increase in quality of life and a decrease in social anxiety were noted, but no significant changes of depressive symptoms or generalized anxiety. Effect sizes for the observed changes from baseline to follow-up were in the moderate to large range for all measures. Reported use of the treatment techniques was not significantly related to reliable change in loneliness after the two-year period. In conclusion, the results of the study support the utility of internet-based CBT targeting loneliness and indicate that the benefits from the intervention can be enduring.