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  • 1.
    Persson Asplund, Robert
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Carvallo, Fernanda
    Linköping University.
    Christensson, Hanna
    Linköping University.
    Videsater, Elin
    Linköping University.
    Haggman, Annakarin
    Linköping University.
    Ljotsson, Brjann
    Karolinska Inst, Sweden.
    Carlbring, Per
    Stockholm Univ, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology.
    Learning how to recover from stress: Results from an internet-based randomized controlled pilot trial2023In: Internet Interventions, ISSN 2214-7829, Vol. 34, article id 100681Article in journal (Refereed)
    Abstract [en]

    Introduction: This randomized, controlled pilot trial evaluated the efficacy of a brief internet-based recovery training intervention targeting a clinical sample of distressed employees.

    Method: A sample of 69 employees with elevated symptoms of stress were assigned randomly to a five-week guided recovery training intervention (iRTP, n = 35) or a wait-list control (WLC, n = 34). The study was conducted in Sweden and participants enrolled via an open recruitment strategy. Self-report data were collected preand post-intervention, then six and 12 months after the intervention. The primary outcome measure was the Recovery Experience Questionnaire (REQ. The secondary outcome measures gauged other relevant mental and work-related health outcomes. Participants in the wait-list control group received access to iRTP after the sixmonth follow-up.

    Results: Compared with the controls, participants in the intervention group showed a significant and large overall improvement on the primary outcome REQ (d = 0.93), and small to moderate effects on the secondary outcomes including, perceived stress (d = 0.48), anxiety (d = 0.49), quality of life (d = 0.47), and work ability (d = 0.47) during post-assessment. No significant differences were found at any time point regarding burnout, exhaustion, depression, physical exercise, work experience, or sickness absences.

    Conclusion: This pilot trial is one of the first to examine a brief recovery training programs efficacy, suggesting that employees across a wide range of professions could learn how to recover from elevated stress symptoms. This type of accessible and brief recovery intervention could potentially prevent and reduce the negative effects of stress, as well as improve recovery and quality of life. However, more research is needed with larger samples before further conclusions can be drawn. Trial Registration: The study was registered at Clinical Trials (clinicaltrials.gov) number NCT05220592.

  • 2.
    Persson Asplund, Robert
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Asplund, Sofia
    Department of Psychology, Uppsala University, Uppsala, SE.
    von Buxhoeveden, Helene
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Medicine and Health Sciences.
    Delby, Hanna
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Medicine and Health Sciences.
    Eriksson, Karin
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Medicine and Health Sciences.
    Svenning Gerhardsson, Maurits
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Medicine and Health Sciences.
    Palm, Joachim
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Medicine and Health Sciences.
    Skyttberg, Thea
    Department of Psychology, Uppsala University, Uppsala, SE.
    Torstensson, Julia
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Medicine and Health Sciences.
    Ljótsson, Brjánn
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, SE.
    Carlbring, Per
    Department of Psychology, Stockholm University, Stockholm, SE.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Biomedical and Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology.
    Work-Focused Versus Generic Internet-Based Interventions for Employees With Stress-Related Disorders: Randomized Controlled Trial2023In: Journal of Medical Internet Research, E-ISSN 1438-8871, Vol. 25, article id e34446Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In recent decades, stress-related disorders have received more attention, with an increasing prevalence, especially within the working population. The internet provides new options for broad dissemination, and a growing body of evidence suggests that web-based interventions for stress might be effective. However, few studies have examined the efficacy of interventions in clinical samples and work-related outcomes.

    OBJECTIVE: The aim of this study was to evaluate the efficacy of an internet-based cognitive behavioral intervention for stress-related disorders integrating work-related aspects (work-focused and internet-based cognitive behavioral therapy [W-iCBT]), compared with a generic internet-based cognitive behavioral therapy (iCBT) group and a waitlist control (WLC) group.

    METHODS: In this trial, 182 employees, mainly employed in the health care, IT, or educational sector, who fulfilled the criteria for a stress-related disorder, were randomized to a 10-week W-iCBT (n=61, 33.5%), generic iCBT (n=61, 33.5%), or WLC (n=60, 33%). Self-rated questionnaires on perceived stress, burnout, exhaustion, and other mental health- and work-related outcomes were administered before and after the treatment and at 6- and 12-month follow-ups.

    RESULTS: Compared with the WLC group, participants of the W-iCBT and iCBT groups showed an equal and significant reduction in the primary outcome (Shirom-Melamed Burnout Questionnaire [SMBQ]) from pretreatment to posttreatment assessment (Cohen d=1.00 and 0.83, respectively) and at the 6-month follow-up (Cohen d=0.74 and 0.74, respectively). Significant moderate-to-large effect sizes were also found in the secondary health- and work-related outcomes. The W-iCBT was the only group that exhibited significant effects on work ability and short-term sickness absence. Short-term sickness absence was 445 days lower than the WLC group and 324 days lower than the iCBT intervention group. However, no significant differences were found in terms of work experience or long-term sick leave.

    CONCLUSIONS: The work-focused and generic iCBT interventions proved to be superior compared with the control condition in reducing chronic stress and several other mental health-related symptoms. Interestingly, effects on work ability and short-term sickness absence were only seen between the W-iCBT intervention and the WLC groups. These preliminary results are promising, indicating that treatments that include work aspects may have the potential to accelerate recovery and reduce short-term sickness absence because of stress-related disorders.

    TRIAL REGISTRATION: ClinicalTrials.gov NCT05240495; https://clinicaltrials.gov/ct2/show/NCT05240495 (retrospectively registered).

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  • 3. Order onlineBuy this publication >>
    Persson Asplund, Robert
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Learning how to recover from stress-related disorders via internet-based interventions2021Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Stress has become one of the major challenges of modern society, especially within the working population, causing significant costs and personal problems. However, the range of prevention and treatment is not at all proportionate to the needs of the public. Internet provides new options for broad dissemination and a growing body of evidence suggest that internet-based interventions for stress could be effective. However, few studies have examined the efficacy in clinical samples or how participants experience these new treatment delivery formats. Further, only a limited number of studies have evaluated the efficacy of work-focused stress interventions on work-related outcomes (e.g., absenteeism), and if recovery has the potential in stress-prevention.

    In the present thesis, internet-based cognitive behavioural stress interventions (iCBT), designed to reduce symptoms of stress and increase recovery and workparticipation among 117 managers and 260 employees, were evaluated in three randomized controlled trials (Study I, III and IV) and a qualitative study (Study II). Results of Study I and III indicate that the iCBT for managers and employees with stress-related disorders was effective in reducing symptoms of chronic stress. In Study III effects on work-related outcomes, e.g., work ability and absenteeism, were only seen in the work-focused iCBT. In Study II, participants found the work-focused iCBT to be accessible and feasible and reported positive experiences on stress and well-being in both life and at work. Finally, preliminary results in Study IV suggest that recovery experiences, an important protective factor against chronic stress, could be improved by a brief internet-based recovery intervention.

    In conclusion, if implemented, these relatively brief and accessible interventions could be a feasible way to increase access to treatment and learning distressed employees and others how to prevent and recover from stress-related disorders. 

    List of papers
    1. Internet-based stress management for distressed managers: results from a randomised controlled trial
    Open this publication in new window or tab >>Internet-based stress management for distressed managers: results from a randomised controlled trial
    Show others...
    2018 (English)In: Occupational and Environmental Medicine, ISSN 1351-0711, E-ISSN 1470-7926, Vol. 75, no 2, p. 105-113Article in journal (Refereed) Published
    Abstract [en]

    Objective The aim of this randomised controlled trial (RCT) was to evaluate the efficacy of a guided internet-based stress management intervention (iSMI) among distressed managers compared with a attention control group (AC) with full access to treatment-as-usual. Method A total sample of 117 distressed managers, mainly employed in the healthcare, IT, communication and educational sector, were randomised to either iSMI (n=59) or an AC group (n=58). The iSMI consisted of eight modules including cognitive behavioural stress management and positive management techniques. Participants received a minimal and weekly guidance from a psychologist or master-level psychology student focusing on support, feedback and adherence to the intervention. Self-report data were assessed at pre, post and 6 months after the intervention. The primary outcome was perceived stress (Perceived Stress Scale-14). The secondary outcomes included mental and work-related health outcomes. Results Participants in the iSMI intervention reported significantly less symptoms of perceived stress (d=0.74, 95% CI 0.30 to 1.19) and burnout (d=0.95, 95% CI 0.53 to 1.37) compared with controls, at postassessment. Significant medium-to-large effect sizes were also found for depression, insomnia and job satisfaction. Longterm effects (6 months) were seen on the mental health outcomes. Conclusion This is one of the first studies showing that iSMIs can be an effective, accessible and potentially time-effective approach of reducing stress and other mental-related and work-related health symptoms among distressed managers. Future studies are needed addressing distressed managers and the potential of indirect effects on employee stress and satisfaction at work.

    Place, publisher, year, edition, pages
    BMJ PUBLISHING GROUP, 2018
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:liu:diva-144878 (URN)10.1136/oemed-2017-104458 (DOI)000419995000004 ()28855344 (PubMedID)
    Available from: 2018-02-09 Created: 2018-02-09 Last updated: 2021-01-18
    2. Experiences of internet-delivered and work-focused cognitive behavioral therapy for stress: A qualitative study
    Open this publication in new window or tab >>Experiences of internet-delivered and work-focused cognitive behavioral therapy for stress: A qualitative study
    Show others...
    2019 (English)In: Internet Interventions, ISSN 2214-7829, INTERNET INTERVENTIONS-THE APPLICATION OF INFORMATION TECHNOLOGY IN MENTAL AND BEHAVIOURAL HEALTH, Vol. 18, article id 100282Article in journal (Refereed) Published
    Abstract [en]

    Introduction

    Stress is one of the major challenges of modern society, causing significant costs and personal problems. In the recent decade a growing body of research has provided support for the efficacy of internet interventions for stress. However, few studies have focused on how participants experience internet interventions for stress.

    Method

    The current study was a qualitative follow-up study of an internet-delivered and work-focused cognitive behavioral treatment for stress. The aim was to capture participants' experiences of the treatment and their views on effects on health and well-being. Participants were selected from a controlled study (n = 27), using a criterion-based sampling approach selecting those participants who had completed all treatment modules. Nine semi-structured interviews were held, and the material was analyzed using Thematic Analysis.

    Results

    The results indicated that most of the participants experienced positive effects on their mental health and well-being in both life and at work. All participants emphasized the importance of having access to therapist support. In line with previous research, participants found the intervention to be extensive and demanding and expressed the need for extended treatment time and therapist support.

    Conclusions

    Considering the limitations of the present study, future research could examine the feasibility of reducing the length of each session, extending deadlines and increasing therapist support. This could improve treatment efficacy and further enhance utilization in the target population.

    Place, publisher, year, edition, pages
    Elsevier, 2019
    Keywords
    Stress; Experiences; Internet; Cognitive behavior therapy; Work
    National Category
    Applied Psychology
    Identifiers
    urn:nbn:se:liu:diva-162876 (URN)10.1016/j.invent.2019.100282 (DOI)000500917500026 ()31737490 (PubMedID)2-s2.0-85074567848 (Scopus ID)
    Note

    Funding Agencies|Swedish Council for Working and Life Research (FORTE); Swedens Municipalities and County Councils (SKL)

    Available from: 2019-12-28 Created: 2019-12-28 Last updated: 2021-01-18Bibliographically approved
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  • 4.
    Persson Asplund, Robert
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Jaderlind, Anna
    Karolinska Inst, Sweden.
    Hoijer Bjork, Isabel
    Karolinska Inst, Sweden.
    Ljotsson, Brjann
    Karolinska Inst, Sweden.
    Carlbring, Per
    Stockholm Univ, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Inst, Sweden.
    Experiences of internet-delivered and work-focused cognitive behavioral therapy for stress: A qualitative study2019In: Internet Interventions, ISSN 2214-7829, INTERNET INTERVENTIONS-THE APPLICATION OF INFORMATION TECHNOLOGY IN MENTAL AND BEHAVIOURAL HEALTH, Vol. 18, article id 100282Article in journal (Refereed)
    Abstract [en]

    Introduction

    Stress is one of the major challenges of modern society, causing significant costs and personal problems. In the recent decade a growing body of research has provided support for the efficacy of internet interventions for stress. However, few studies have focused on how participants experience internet interventions for stress.

    Method

    The current study was a qualitative follow-up study of an internet-delivered and work-focused cognitive behavioral treatment for stress. The aim was to capture participants' experiences of the treatment and their views on effects on health and well-being. Participants were selected from a controlled study (n = 27), using a criterion-based sampling approach selecting those participants who had completed all treatment modules. Nine semi-structured interviews were held, and the material was analyzed using Thematic Analysis.

    Results

    The results indicated that most of the participants experienced positive effects on their mental health and well-being in both life and at work. All participants emphasized the importance of having access to therapist support. In line with previous research, participants found the intervention to be extensive and demanding and expressed the need for extended treatment time and therapist support.

    Conclusions

    Considering the limitations of the present study, future research could examine the feasibility of reducing the length of each session, extending deadlines and increasing therapist support. This could improve treatment efficacy and further enhance utilization in the target population.

    Download full text (pdf)
    fulltext
  • 5.
    Persson Asplund, Robert
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Stress2019In: Somatisk sjukdom: ett biopsykosocialt perspektiv / [ed] Ali Sarkohi, Gerard Andersson, Lund: Studentlitteratur AB, 2019, 1, p. 35-64Chapter in book (Other academic)
  • 6.
    Persson Asplund, Robert
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Dagöö, Jesper
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Fjellström, Ida
    Karolinska Inst, Sweden.
    Niemi, Linnea
    Karolinska Inst, Sweden.
    Hansson, Katja
    Uppsala Univ, Sweden.
    Zeraati, Forough
    Uppsala Univ, Sweden.
    Ziuzina, Masha
    Uppsala Univ, Sweden.
    Geraedts, Anna
    Vrije Univ Amsterdam, Netherlands.
    Ljotsson, Brjann
    Karolinska Inst, Sweden.
    Carlbring, Per
    Stockholms Univ, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden.
    Internet-based stress management for distressed managers: results from a randomised controlled trial2018In: Occupational and Environmental Medicine, ISSN 1351-0711, E-ISSN 1470-7926, Vol. 75, no 2, p. 105-113Article in journal (Refereed)
    Abstract [en]

    Objective The aim of this randomised controlled trial (RCT) was to evaluate the efficacy of a guided internet-based stress management intervention (iSMI) among distressed managers compared with a attention control group (AC) with full access to treatment-as-usual. Method A total sample of 117 distressed managers, mainly employed in the healthcare, IT, communication and educational sector, were randomised to either iSMI (n=59) or an AC group (n=58). The iSMI consisted of eight modules including cognitive behavioural stress management and positive management techniques. Participants received a minimal and weekly guidance from a psychologist or master-level psychology student focusing on support, feedback and adherence to the intervention. Self-report data were assessed at pre, post and 6 months after the intervention. The primary outcome was perceived stress (Perceived Stress Scale-14). The secondary outcomes included mental and work-related health outcomes. Results Participants in the iSMI intervention reported significantly less symptoms of perceived stress (d=0.74, 95% CI 0.30 to 1.19) and burnout (d=0.95, 95% CI 0.53 to 1.37) compared with controls, at postassessment. Significant medium-to-large effect sizes were also found for depression, insomnia and job satisfaction. Longterm effects (6 months) were seen on the mental health outcomes. Conclusion This is one of the first studies showing that iSMIs can be an effective, accessible and potentially time-effective approach of reducing stress and other mental-related and work-related health symptoms among distressed managers. Future studies are needed addressing distressed managers and the potential of indirect effects on employee stress and satisfaction at work.

    Download full text (pdf)
    fulltext
  • 7.
    Lehr, Dirk
    et al.
    Institute of Psychology, Leuphana University, Lüneburg, Germany.
    Geraedts, Anna
    ArboNed, Utrecht, The Netherlands.
    Persson Asplund, Robert
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Khadjesari, Zarnie
    Addiction Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, UK.
    Heber, Elena
    Division of Health Training Online, Leuphana University, Lüneburg, Gemany.
    de Bloom, Jessica
    School of Social Science and Humanities, University of Tampere, Finland.
    Ebert, David Daniel
    Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University, Erlangen, Germany.
    Angerer, Peter
    Institute of Occupational and Social Medicine, Heinrich-Heine University, Düsseldorf, Germany.
    Funk, Burkhardt
    Department of Information Systems Research, Leuphana University, Lüneburg, Germany.
    Occupational e-mental health: current approaches and promising perspectives for promoting mental health in workers2016In: Healthy at work: interdisciplinary perspectives. Part IV / [ed] Markus Wiencke, Mirella Cacace, Sebastian Fischer, Cham: Springer, 2016, p. 257-281Chapter in book (Refereed)
    Abstract [en]

    During the past few years, the Internet has started to change lifestyles and affect all life domains, including working life. It is also increasingly used for targeting mental health issues. The “application of information technology in mental and behavioral health” (Andersson G, Riper H, Carlbring P (2014) Editorial: Introducing Internet interventions—a new open access journal. Internet Intervent 1:1–2) is becoming common in health-care; interventions have already been incorporated into routine care in countries such as the Netherlands, Sweden, the UK, Australia, and the USA. As a next step, Internet interventions in the area of occupational health are progressively emerging. They may offer an evidence-based, cost-effective, and convenient way of promoting workers’ mental health on a large scale. Currently, Internet interventions for workers are the most promising approach in the field of occupational e-mental health. The evolution of occupational e-mental health is embedded in interdisciplinary research, practice, and policy. In the first section of this chapter, the origins of occupational e-mental health will be outlined and a definition proposed. Following this, different approaches to occupational e-mental health will be described and their potentials elucidated. A comparison between Internet interventions and traditional stress-management trainings will provide further insights into the design and characteristics of the most elaborated approach in occupational e-mental health. Subsequently, various Internet training programs will be introduced and the evidence for their efficacy summarized. Finally, important topics for further research and implementation will be outlined.

  • 8.
    Dagöö, Jesper
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Persson Asplund, Robert
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Andersson Bsenko, Helene
    Umeå University, Sweden .
    Hjerling, Sofia
    Uppsala University, Sweden .
    Holmberg, Anna
    Mid Sweden University, Sweden .
    Westh, Susanne
    Mid Sweden University, Sweden .
    Oberg, Louise
    Lund University, Sweden .
    Ljotsson, Brjann
    Karolinska Institute, Sweden .
    Carlbring, Per
    Stockholm University, Sweden .
    Furmark, Tomas
    Uppsala University, Sweden .
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Cognitive behavior therapy versus interpersonal psychotherapy for social anxiety disorder delivered via smartphone and computer: A randomized controlled trial2014In: Journal of Anxiety Disorders, ISSN 0887-6185, E-ISSN 1873-7897, Vol. 28, no 4, p. 410-417Article in journal (Refereed)
    Abstract [en]

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

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