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  • 1. Andersson, Gerhard
    et al.
    Paxling, Bjorn
    Wiwe, Maria
    Vernmark, Kristofer
    Felix, Christina Bertholds
    Lundborg, Lisa
    Furmark, Tomas
    Cuijpers, Pim
    Carlbring, Per
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Therapeutic alliance in guided internet-delivered cognitive behavioural treatment of depression, generalized anxiety disorder and social anxiety disorder2012In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 50, no 9, p. 544-550Article in journal (Refereed)
    Abstract [en]

    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. (c) 2012 Elsevier Ltd. All rights reserved.

  • 2.
    Carlbring, Per
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Maurin, Linda
    Dept of Behavioural sciences and Learning, Linköping University, Sweden.
    Törngren, Charlotta
    Dept of Behavioural sciences and Learning, Linköping University, Sweden.
    Linna, Emma
    Dept of Behavioural sciences and Learning, Linköping University, Sweden.
    Eriksson, Thomas
    Redakliniken, Linköping.
    Sparthan, Elisabeth
    svenska KBT-institutet, Stockholm, Sweden.
    Strååt, Marcus
    Dept of Behavioural sciences and Learning, Linköping University, Sweden.
    Marquez von Hage, Christian
    Dept of Behavioural sciences and Learning, Linköping University, Sweden.
    Bergman-Nordgren, Lise
    Dept of Behavioural sciences and Learning, Linköping University, Sweden.
    Andersson, Gerhard
    Dept of Behavioural sciences and Learning, Linköping University, Sweden, Swedish Institute for Disability Research, Linköping University, Sweden, Dept of Clinical Neuroscience, Psychiatry Section, Karolinska institutet, Stockholm, Sweden .
    Individually-tailored, Internet-based treatment for anxiety disorders: A rondomized controlled trial2011In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, no 94, p. 18-24Article in journal (Refereed)
    Abstract [en]

     

     

    Previous studies on Internet-based treatment with minimal to moderate therapist guidance have shown promising results for a number of specific diagnoses. The aim of this study was to test a new approach to Internet treatment that involves tailoring the treatment according to the patient’s unique characteristics and comorbidities.

    A total of 54 participants, regardless of specific anxiety diagnosis, were included after an in-person, semi-structured diagnostic interview and randomized to a 10 week treatment program or to a control group. Treatment consisted of a number of individually-prescribed modules in conjunction with online therapist guidance. Significant results were found for all dependent measures both immediately following treatment and at 1 and 2 year intervals. Mean between-group effect size including measures of anxiety, depression and quality of life was Cohen’s d ¼ 0.69 at post-treatment, while the mean withingroup effect size was d ¼ 1.15 at post-treatment and d ¼ 1.13 and d ¼ 1.04 at 1 and 2 year follow-up respectively.

    The tentative conclusion drawn from these results is that tailoring the Internet-based therapy can be a feasible approach in the treatment of anxiety in a homogeneous population. 

     

  • 3. Dahlin, Mats
    et al.
    Andersson, Gerhard
    Magnusson, Kristoffer
    Johansson, Tomas
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Sjögren, Johan
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Håkansson, Andreas
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Pettersson, Magnus
    Kadowaki, Asa
    Cuijpers, Pim
    Carlbring, Per
    Internet-delivered acceptance-based behaviour therapy for generalized anxiety disorder: A randomized controlled trial2016In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 77, p. 86-95Article in journal (Refereed)
    Abstract [en]

    Generalized anxiety disorder (GAD) is a disabling condition which can be treated with cognitive behaviour therapy (CBT). The present study tested the effects of therapist-guided internet-delivered acceptance-based behaviour therapy on symptoms of GAD and quality of life. An audio CD with acceptance and mindfulness exercises and a separate workbook were also included in the treatment. Participants diagnosed with GAD (N = 103) were randomly allocated to immediate therapist-guided internet-delivered acceptance-based behaviour therapy or to a waiting-list control condition. A six month follow-up was also included. Results using hierarchical linear modelling showed moderate to large effects on symptoms of GAD (Cohen's d = 0.70 to 0.98), moderate effects on depressive symptoms (Cohen's d = 0.51 to 0.56), and no effect on quality of life. Follow-up data showed maintained effects. While there was a 20% dropout rate, sensitivity analyses showed that dropouts did not differ in their degree of change during treatment. To conclude, our study suggests that internet-delivered acceptance based behaviour therapy can be effective in reducing the symptoms of GAD.

  • 4. Kuckertz, Jennie M.
    et al.
    Gildebrant, Elena
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Liliequist, Björn
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Karlström, Petra
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Väppling, Camilla
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Bodlund, Owe
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Stenlund, Thérese
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Hofmann, Stefan G.
    Andersson, Gerhard
    Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
    Amir, Nader
    Carlbring, Per
    Department of Psychology, Stockholm University, SE-106 91 Stockholm, Sweden.
    Moderation and mediation of the effect of attention training in social anxiety disorder2014In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 53, p. 30-40Article in journal (Refereed)
    Abstract [en]

    While attention modification programs (AMP) have shown promise as laboratory-based treatments for social anxiety disorder, trials of internet-delivered AMP have not yielded significant differences between active and control conditions. To address these inconsistencies, we examined the moderational and mediational role of attention bias in the efficacy of attention training. We compared data reported by Carlbring et al. (2012) to an identical AMP condition, with the exception that participants were instructed to activate social anxiety fears prior to each attention training session (AMP + FACT; n = 39). We also compared all attention training groups to an internet-delivered cognitive-behavioral therapy (iCBT) condition (n = 40). Participants in the AMP + FACT group experienced greater reductions in social anxiety symptoms than both active (n = 40) and control (n = 39) groups reported by Carlbring et al., and did not differ in symptom reductions from the iCBT group. Higher attention bias predicted greater symptom reductions for participants who completed AMP, but not for the control group. Moreover, change in attention bias mediated the relationship between AMP group (active condition reported by Carlbring et al. versus AMP + FACT) and change in social anxiety symptoms. These results suggest the importance of interpreting findings related to symptom change in attention training studies in the context of bias effects. (C) 2013 The Authors. Published by Elsevier Ltd. All rights reserved.

  • 5.
    Nordegreen, Tine
    et al.
    Department of Clinical Psychology, University of Bergen, Norway and Anxiety Disorders research Network, Haukeland University Hospital, Norway.
    Havik, O.E.
    Department of Clinical Psychology, University of Bergen, Norway and Anxiety Disorders research Network, Haukeland University Hospital, Norway.
    Öst, L.G.
    Department of Clinical Psychology, University of Bergen, Norway and Anxiety Disorders research Network, Haukeland University Hospital, Norway och Department of Psychology, Stockholm University, Sweden.
    Furmark, T
    Department of Psychology, Uppsala University, Sweden.
    Carlbring, Per
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Andersson, G
    Department of behavioural Sciences and Learning, Linköping University, Sweden and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Outcome predictors in guided and unguided self-help for social anxiety disorder2012In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 50, no 1, p. 12-21Article in journal (Refereed)
    Abstract [en]

    Internet-based self-help with therapist guidance has shown promise as an effective treatment and may increase access to evidence-based psychological treatment for social anxiety disorder (SAD). Although unguided self-help has been suggested primarily as a population-based preventive intervention, some studies indicate that patients with SAD may profit from unguided self-help. Gaining knowledge about predictors of outcome in guided and unguided self-help for SAD is important to ensure that these interventions can be offered to those who are most likely to respond. Utilizing a sample of 245 patients who received either guided or unguided self-help for SAD, the present study examined pre-treatment symptoms and program factors as predictors of treatment adherence and outcome. The results were in line with previous findings from the face-to-face treatment literature: namely, the intensity of baseline SAD symptoms, but not depressive symptoms, predicted treatment outcomes in both unguided and guided self-help groups. Outcomes were unrelated to whether a participant has generalized versus specific SAD. Furthermore, for the unguided self-help group, higher credibility ratings of the treatment program were associated with increased treatment adherence. The findings suggest that guided and unguided self-help may increase access to SAD treatment in a population that is more heterogeneous than previously assumed.

  • 6.
    Nordgren, Lise Bergman
    et al.
    Department of Behavioural Sciences and Learning, Linköping University, SE-581 83 Linköping, Sweden.
    Hedman, Erik
    Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, 171 77 Stockholm, Sweden.
    Etienne, Julie
    Department of Behavioural Sciences and Learning, Linköping University, SE-581 83 Linköping, Sweden.
    Bodin, Jessica
    Department of Behavioural Sciences and Learning, Linköping University, SE-581 83 Linköping, Sweden.
    Kadowaki, Åsa
    County Council of Östergötland, 581 91 Linköping, Sweden.
    Eriksson, Stina
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Lindkvist, Emelie
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Andersson, Gerhard
    Department of Behavioural Sciences and Learning, Linköping University, SE-581 83 Linköping, Sweden and Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, 171 77 Stockholm, Sweden.
    Carlbring, Per
    Department of Psychology, Stockholm University, 106 91 Stockholm, Sweden.
    Effectiveness and cost-effectiveness of individually tailored Internet-delivered cognitive behavior therapy for anxiety disorders in a primary care population: A randomized controlled trial2014In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 59, p. 1-11Article in journal (Refereed)
    Abstract [en]

    A significant proportion of the general population suffers from anxiety disorders, often with comorbid psychiatric conditions. Internet-delivered cognitive behavior therapy (ICBT) has been found to be a potent treatment for patients with specific psychiatric conditions. The aim of this trial was to investigate the effectiveness and cost-effectiveness of ICBT when tailoring the treatment to address comorbidities and preferences for primary-care patients with a principal anxiety disorder. One hundred participants were recruited through their primary-care contact and randomized to either treatment or an active control group. The treatment consisted of 7-10 weekly individually assigned modules guided by online therapists. At post-treatment, 46% of the treatment group had achieved clinically significant improvement on the primary outcome measure (CORE-OM) and between-group effect sizes ranged from d = 0.20 to 0.86, with a mean effect of d = 0.59. At one-year follow-up, within-group effect sizes varied between d = 0.53 to 1.00. Cost analysis showed significant reduction of total costs for the ICBT group, the results were maintained at one-year follow-up and the incremental cost-effectiveness ratio favored ICBT compared to control group. Individually tailored ICBT is an effective and cost-effective treatment for primary-care patients with anxiety disorders with or without comorbidities. Trial Registration: Clinicaltrials.gov: NCT01390168. (C) 2014 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/).

1 - 6 of 6
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