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Carlbring, Per
Publications (10 of 49) Show all publications
Andersson, G., Hesser, H., Hummerdal, D., Bergman-Nordgren, L. & Carlbring, P. (2013). A 3.5-year follow-up of Internet-delivered cognitive behavior therapy for major depression. Journal of Mental Health, 22(2), 155-164
Open this publication in new window or tab >>A 3.5-year follow-up of Internet-delivered cognitive behavior therapy for major depression
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2013 (English)In: Journal of Mental Health, ISSN 0963-8237, E-ISSN 1360-0567, Vol. 22, no 2, p. 155-164Article in journal (Refereed) Published
Abstract [en]

Background: Internet-delivered cognitive behavior therapy (ICBT) for major depression has been tested in several trials, but only with follow-ups up to 1.5 years. Aim: The 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. Results: Results 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. Conclusions: People with mild to moderate major depression may benefit from ICBT 3.5-years after treatment completion.

Keywords
internet treatment, major depression, e-mail therapy, guided self-help
National Category
Psychology
Identifiers
urn:nbn:se:umu:diva-71096 (URN)10.3109/09638237.2011.608747 (DOI)000317496600007 ()
Available from: 2013-06-17 Created: 2013-05-20 Last updated: 2018-06-08Bibliographically approved
Mansson, K. N. T., Carlbring, P., Frick, A., Engman, J., Olsson, C.-J., Bodlund, O., . . . Andersson, G. (2013). Amygdala Changes After Cognitive Behavior Therapy and Attention Bias Modification via the Internet: An fMRI-Study. Paper presented at 68th Annual Scientific Meeting of the Society-of-Biological-Psychiatry, MAY 16-18, 2013, San Francisco, CA. Biological Psychiatry, 73(9), 72S-72S
Open this publication in new window or tab >>Amygdala Changes After Cognitive Behavior Therapy and Attention Bias Modification via the Internet: An fMRI-Study
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2013 (English)In: Biological Psychiatry, ISSN 0006-3223, E-ISSN 1873-2402, Vol. 73, no 9, p. 72S-72SArticle in journal (Refereed) Published
Place, publisher, year, edition, pages
New York, NY, USA: Elsevier, 2013
National Category
Neurology Psychiatry Neurosciences
Identifiers
urn:nbn:se:umu:diva-73581 (URN)000318671800222 ()
Conference
68th Annual Scientific Meeting of the Society-of-Biological-Psychiatry, MAY 16-18, 2013, San Francisco, CA
Note

Meeting Abstract: 222.

Available from: 2013-06-25 Created: 2013-06-25 Last updated: 2018-06-08Bibliographically approved
Cernvall, M., Carlbring, P., Ljungman, G. & Von Essen, L. (2013). Guided Self-Help as Intervention for Traumatic Stress in Parents of Children with Cancer: Conceptualization, Intervention Strategies, and a Case Study. Journal of psychosocial oncology, 31(1), 13-29
Open this publication in new window or tab >>Guided Self-Help as Intervention for Traumatic Stress in Parents of Children with Cancer: Conceptualization, Intervention Strategies, and a Case Study
2013 (English)In: Journal of psychosocial oncology, ISSN 0734-7332, E-ISSN 1540-7586, Vol. 31, no 1, p. 13-29Article in journal (Refereed) Published
Abstract [en]

Being a parent of a child diagnosed with cancer poses an enormous stressor. Indeed, several parents have difficulties adjusting to such a situation and react with symptoms of traumatic stress, depression, and reduced quality of life. However, there is little conceptual work on behavioral mechanisms that contribute to suboptimal adaptation in these parents. The authors present a conceptualization in which experiential avoidance and rumination are suggested to contribute to increased levels of traumatic stress and suboptimal adaption. Based on this conceptualization, a recently developed intervention for parents of children with cancer, in the form of guided self-help, is presented. Finally, the authors present a successful case study as an example of the application of this intervention. Clinical implications and suggestions for future research are discussed.

Keywords
intervention, parents, pediatric oncology, self-help, traumatic stress
National Category
Psychology
Identifiers
urn:nbn:se:umu:diva-68274 (URN)10.1080/07347332.2012.741095 (DOI)000315983500002 ()
Available from: 2013-04-15 Created: 2013-04-15 Last updated: 2018-06-08Bibliographically approved
Paxling, B., Lundgren, S., Norman, A., Almlov, J., Carlbring, P., Cuijpers, P. & Andersson, G. (2013). Therapist Behaviours in Internet-Delivered Cognitive Behaviour Therapy: Analyses of E-Mail Correspondence in the Treatment of Generalized Anxiety Disorder. Behavioural and Cognitive Psychotherapy, 41(3), 280-289
Open this publication in new window or tab >>Therapist Behaviours in Internet-Delivered Cognitive Behaviour Therapy: Analyses of E-Mail Correspondence in the Treatment of Generalized Anxiety Disorder
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2013 (English)In: Behavioural and Cognitive Psychotherapy, ISSN 1352-4658, E-ISSN 1469-1833, Vol. 41, no 3, p. 280-289Article in journal (Refereed) Published
Abstract [en]

Background: Internet-delivered cognitive behaviour therapy (iCBT) has been found to be an effective way to disseminate psychological treatment, and support given by a therapist seems to be important in order to achieve good outcomes. Little is known about what the therapists actually do when they provide support in iCBT and whether their behaviour influences treatment outcome. Aims: This study addressed the content of therapist e-mails in guided iCBT for generalized anxiety disorder. Method: We examined 490 e-mails from three therapists providing support to 44 patients who participated in a controlled trial on iCBT for generalized anxiety disorder. Results: Through content analysis of the written correspondence, eight distinguishable therapist behaviours were derived: deadline flexibility, task reinforcement, alliance bolstering, task prompting, psychoeducation, self-disclosure, self-efficacy shaping, and empathetic utterances. We found that task reinforcement, task prompting, self-efficacy shaping and empathetic utterances correlated with module completion. Deadline flexibility was negatively associated with outcome and task reinforcement positively correlated with changes on the Penn State Worry Questionnaire. Conclusions: Different types of therapist behaviours can be identified in iCBT, and though many of these behaviours are correlated to each other, different behaviours have an impact on change in symptoms and module completion.

Place, publisher, year, edition, pages
Cambridge University Press, 2013
Keywords
Internet-delivered therapy, CBT, therapist behaviour, GAD, attrition
National Category
Applied Psychology Psychiatry
Identifiers
urn:nbn:se:umu:diva-70331 (URN)10.1017/S1352465812000240 (DOI)000317069300003 ()
Available from: 2013-05-14 Created: 2013-05-14 Last updated: 2018-06-08Bibliographically approved
Hesser, H., Gustafsson, T., Lundén, C., Henrikson, O., Fattahi, K., Johnsson, E., . . . Andersson, G. (2012). A Randomized Controlled Trial of Internet-Delivered Cognitive Behavior Therapy and Acceptance and Commitment Therapy in the Treatment of Tinnitus. Journal of Consulting and Clinical Psychology, 80(4), 649-661
Open this publication in new window or tab >>A Randomized Controlled Trial of Internet-Delivered Cognitive Behavior Therapy and Acceptance and Commitment Therapy in the Treatment of Tinnitus
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2012 (English)In: Journal of Consulting and Clinical Psychology, ISSN 0022-006X, E-ISSN 1939-2117, Vol. 80, no 4, p. 649-661Article in journal (Refereed) Published
Abstract [en]

Objective:

Our aim in this randomized controlled trial was to investigate the effects on global tinnitus severity of 2 Internet-delivered psychological treatments, acceptance and commitment therapy (ACT) and cognitive behavior therapy (CBT), in guided self-help format.

Method:

Ninety-nine participants (mean age 48.5 years; 43% female) who were significantly distressed by tinnitus were recruited from the community. Participants were randomly assigned to CBT (n 32), ACT (n 35), or a control condition (monitored Internet discussion forum; n 32), and they were assessed with standardized self-report measures (Tinnitus Handicap Inventory; Hospital Anxiety and Depression Scale; Quality of Life Inventory; Perceived Stress Scale; Tinnitus Acceptance Questionnaire) at pre-, posttreatment (8 weeks), and 1-year follow-up.

Results:

Mixed-effects linear regression analysis of all randomized participants showed significant effects on the primary outcome (Tinnitus Handicap Inventory) for CBT and for ACT compared with control at posttreatment (95% CI [17.03, 2.94], d 0.70, and 95% CI [16.29, 2.53], d 0.68, respectively). Within-group effects were substantial from pretreatment through 1-year-follow-up for both treatments (95% CI [44.65, 20.45], d 1.34), with no significant difference between treatments (95% CI [14.87, 11.21], d 0.16).

Conclusions:

Acceptance-based procedures may be a viable alternative to traditional CBT techniques in the management of tinnitus. The Internet can improve access to psychological interventions for tinnitus.

Keywords
tinnitus, cognitive behavior therapy, acceptance and commitment therapy, acceptance, randomized controlled trial
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:umu:diva-58175 (URN)10.1037/a0027021 (DOI)
Available from: 2012-08-27 Created: 2012-08-27 Last updated: 2018-06-08Bibliographically approved
Ly, K. H., Carlbring, P. & Andersson, G. (2012). Behavioral activation-based guided self-help treatment administered through a smartphone application: study protocol for a randomized controlled trial. Trials, 13, art.nr. 62
Open this publication in new window or tab >>Behavioral activation-based guided self-help treatment administered through a smartphone application: study protocol for a randomized controlled trial
2012 (English)In: Trials, ISSN 1745-6215, Vol. 13, p. art.nr. 62-Article in journal (Refereed) Published
Abstract [en]

Background: The need for cost-effective interventions for people suffering from major depressive disorders is essential. Behavioral activation is an intervention that can largely benefit from the use of new mobile technologies (for example smartphones). Therefore, developing smartphone-based behavioral activation interventions might be a way to develop cost-effective treatments for people suffering from major depressive disorders. The aim of this study will be to test the effects of a smartphone-delivered behavioral activation treatment.

Methods:The study will be a randomized controlled trial with a sample size of 120 participants, with 60 patients in each group. The treatment group includes an 8-week smartphone-based behavioral activation intervention, with minimal therapist contact. The smartphone-based intervention consists of a web-based psychoeducation, and a smartphone application. There is also a back-end system where the therapist can see reports from the patients or activities being reported. In the attention control group, we will include brief online education and then recommend use of a smartphone application that is not directly aimed at depression (for example, ‘ Effective meditation’). The duration of the control condition will also be 8 weeks. For ethical reasons we will give the participants in the control group access to the behavioral activation treatment following the 8-week treatment period.

Discussions: We believe that this trial has at least three important implications. First, we believe that smartphones can be integrated even further into society and therefore may serve an important role in health care. Second, while behavioral activation is a psychological treatment approach for which there is empirical support, the use of a smartphone application could serve as the therapist ’ s prolonged arm into the daily life of the patient. Third, as we have been doing trials on guided Internet treatment for more than 10 years it is now time to move to the next generation of information technology - smartphones - which are not only relevant for Swedish conditions but also for developing countries in the world which are increasingly empowered by mobile phones with Internet connection.

Trial registration: ClinicalTrials.gov NCT01463020

Place, publisher, year, edition, pages
BioMed Central, 2012
Keywords
Depression, Behavioral activation, Smartphone application, Cost-effectiveness, Randomized, Controlled
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:umu:diva-57883 (URN)10.1186/1745-6215-13-62 (DOI)
Available from: 2012-08-21 Created: 2012-08-20 Last updated: 2018-06-08Bibliographically approved
Berman, A. H., Farzanfar, R., Kristiansson, M., Carlbring, P. & Friedman, R. H. (2012). Design and Development of a Telephone-Linked Care (TLC) System to Reduce Impulsivity among Violent Forensic Outpatients and Probationers. Journal of medical systems, 36(3), 1031-1042
Open this publication in new window or tab >>Design and Development of a Telephone-Linked Care (TLC) System to Reduce Impulsivity among Violent Forensic Outpatients and Probationers
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2012 (English)In: Journal of medical systems, ISSN 0148-5598, E-ISSN 1573-689X, Vol. 36, no 3, p. 1031-1042Article in journal (Refereed) Published
Abstract [en]

Forensic services face the challenge of reducing relapse among clients with a history of violent crime. An automated interactive voice response (IVR) service of the complex Telephone-Linked Care (TLC) type, with a focus on reducing impulsivity, could improve the adequacy of service responses to client needs. Theoretically based in Dialectical Behavior Therapy (DBT), Cognitive Behavior Therapy (CBT) and Motivational Interviewing (MI), the forensic TLC system offers interactive conversations on coping with the emotions of anger, shame and loneliness; activities of daily life such as getting out of bed, asking for help, visiting social services and taking medication; and other areas such as hearing voices, drinking alcohol and self-critical thoughts. We describe the user´s flow through the system, with an in-depth synopsis of the hearing voices intervention. Issues regarding voluntary versus mandatory use of the system are addressed in connection with prospective introduction of the system in forensic settings.

Place, publisher, year, edition, pages
Springer Netherlands, 2012
Keywords
IVR systems, System design, Forensic, psychiatry, Criminal justice, Impulsivity, Telemedicine
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:umu:diva-55211 (URN)10.1007/s10916-010-9565-1 (DOI)
Available from: 2012-05-14 Created: 2012-05-14 Last updated: 2018-06-08Bibliographically approved
Hoa Ly, K., Dahl, J., Carlbring, P. & Andersson, G. (2012). Development and initial evaluation of a smartphone application based on acceptance and commitment therapy. SpringerPlus, 1, Article ID 11.
Open this publication in new window or tab >>Development and initial evaluation of a smartphone application based on acceptance and commitment therapy
2012 (English)In: SpringerPlus, E-ISSN 2193-1801, Vol. 1, article id 11Article in journal (Refereed) Published
Abstract [en]

Background: An intervention, consisting of an ACT-based smartphone-application and a web-based psychoeducation, has been developed. The smartphone-application, together with the psychoeducation, aims to function as a self-help intervention for living consistently with one's values. The study is an exploratory investigation of this new smartphone-based tool.

Case description: Primarily, the study aims at investigating a new field, providing a basis for generating hypotheses for further research. The first aim of this initial, exploratory study was to examine if this intervention had an effect on the variables of: valued actions, psychological flexibility, and life satisfaction as well as the states of depression, anxiety and stress, for a non-clinical sample of 11 Swedish Iphone users. This was made with a quasi-experimental pretest-posttest design without control group. The second aim was to investigate how the participants experienced the intervention, as measured by a qualitative questionnaire.

Discussion and evaluation: The group analyses showed that the participants increased their valued action and psychological flexibility significantly during the intervention. Furthermore, value-based actions and psychological flexibility showed small effect sizes when comparing pretest and posttest score. However, the design of the study makes it impossible to draw any certain conclusions. The qualitative questionnaire showed a general positive experience of the intervention.

Conclusions: The results from the present study indicated that the intervention should be studied further. The findings also generated a number of hypotheses that could be investigated in further research.

National Category
Applied Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:umu:diva-59409 (URN)10.1186/2193-1801-1-11 (DOI)000209459000011 ()
Available from: 2012-09-14 Created: 2012-09-13 Last updated: 2018-06-08Bibliographically approved
Silfvernagel, K., Carlbring, P., Kabo, J., Edström, S., Eriksson, J., Månson, L. & Andersson, G. (2012). Individually Tailored Internet-Based Treatment for Young Adults and Adults With Panic Attacks: Randomized Controlled Trial. Journal of Medical Internet Research, 14(3), e65
Open this publication in new window or tab >>Individually Tailored Internet-Based Treatment for Young Adults and Adults With Panic Attacks: Randomized Controlled Trial
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2012 (English)In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 14, no 3, p. e65-Article in journal (Refereed) Published
Abstract [en]

Background:

Previous studies on Internet-based treatment with minimal therapist guidance have shown promising results for several specific diagnoses.

Objective:

To (1) investigate the effects of a tailored, therapist-guided, Internet-based treatment for individuals with reoccurring panic attacks, and (2) to examine whether people in different age groups (18–30 years and 31–45 years) would respond differently to the treatment.

Methods:

We recruited 149 participants from an online list of individuals having expressed an interest in Internet treatment.

Screening consisted of online questionnaires followed by a telephone interview. A total of 57 participants were included after a semistructured diagnostic interview, and they were randomly assigned to an 8-week treatment program (n = 29) or to a control

condition (n = 28). Treatment consisted of individually prescribed cognitive behavior therapy text modules in conjunction with online therapist guidance. The control group consisted of people on a waitlist who later received treatment.

Results:

All dependent measures improved significantly immediately following treatment and at the 12-month follow-up. The between-group effect size on the primary outcome measure, the Panic Disorder Severity Scale, was d = 1.41 (95% confidence interval 0.81–1.95) at posttreatment. The within-group effect size from pretreatment to 12-month follow-up was d = 1.66 (95% confidence interval 1.14–2.35). Age group had no effect, suggesting that age did not influence the outcome.

Conclusions:

Tailoring an Internet-based treatment can be a feasible approach in the treatment of panic symptoms and comorbid anxiety and depressive symptoms. Younger adults benefit as much as adults over 30 years and up to 45 years of age.

Trial Registration:

Clinicaltrials.gov NCT01296321; http://www.clinicaltrials.gov/ct2/show/NCT01296321 (Archived by WebCite at http://www.webcitation.org/65wddsqlL)

Keywords
Anxiety, depression, effectiveness, Internet-based treatment, cognitive behavior therapy
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:umu:diva-57567 (URN)10.2196/jmir.1853 (DOI)
Available from: 2012-08-07 Created: 2012-08-07 Last updated: 2018-06-08Bibliographically approved
Andersson, G., Paxling, B., Roch-Norlund, P., Östman, G., Norgren, A., Almlöv, J., . . . Silverberg, F. (2012). Internet-based psychodynamic versus cognitive behavioral guided self-help for generalized anxiety disorder: A randomized controlled trial. Psychotherapy and Psychosomatics, 81(6), 344-355
Open this publication in new window or tab >>Internet-based psychodynamic versus cognitive behavioral guided self-help for generalized anxiety disorder: A randomized controlled trial
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2012 (English)In: Psychotherapy and Psychosomatics, ISSN 0033-3190, E-ISSN 1423-0348, Vol. 81, no 6, p. 344-355Article in journal (Refereed) Published
Abstract [en]

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.

Copyright (C) 2012 S. Karger AG, Basel

Place, publisher, year, edition, pages
Basel, Switzerland: Karger, 2012
Keywords
Guided self-help, Generalized anxiety disorder, Psychodynamic therapy, Cognitive behavior therapy
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:umu:diva-61581 (URN)10.1159/000339371 (DOI)000309791900003 ()
Available from: 2012-11-27 Created: 2012-11-20 Last updated: 2018-06-08Bibliographically approved

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