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  • 1.
    Andersson, Gerhard
    et al.
    Department of Behavioural Sciences and Learning, Swedish Institute for Disability Research, Linköping University, Linköping, Sweden and Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, Stockholm, Sweden.
    Estling, Fanny
    Department of Behavioural Sciences and Learning, Swedish Institute for Disability Research, Linköping University, Linköping, Sweden.
    Jakobsson, Ebba
    Department of Behavioural Sciences and Learning, Swedish Institute for Disability Research, Linköping University, Linköping, Sweden.
    Cuijpers, Pim
    Department of Clinical Psychology, Vrjie Universiteit, Amsterdam, the Netherlands.
    Carlbring, Per
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Can the patient decide which modules to endorse?: an open trial of tailored internet treatment of anxiety disorders2011In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 1, no 40, p. 57-64Article in journal (Refereed)
    Abstract [en]

    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.

     

     

  • 2.
    Baldwin, Scott A.
    et al.
    Department of Psychology, Brigham Young University, Provo, Utah, USA.
    Murray, David M.
    Division of Epidemiology, Ohio State University, Columbus, Ohio, USA.
    Shadish, William R.
    School of Social Sciences, Humanities and Arts, University of California, Merced, Merced, California, USA.
    Pals, Sherri L.
    Department of Psychology, University of Memphis, Memphis, Tennessee, USA.
    Holland, Jason M.
    VA Palo Alto Health Care System, Stanford University School of Medicine, Stanford, California, USA .
    Abramowitz, Jonathan S.
    Department of Psychology, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, USA.
    Andersson, Gerhard
    Department of Behavioural Sciences, Linköping, University, Linköping, Sweden.
    Atkins, David C.
    Center for the Study of Health and Risk Behaviors, Department of Psychiatry and Behavioral Science, University of Washington, Seattle, Washington, USA .
    Carlbring, Per
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Carroll, Kathleen M.
    Division of Substance Abuse, Yale School of Medicine, New Haven, Connecticut, USA.
    Christensen, Andrew
    Department of Psychology, University of California, Los Angeles, Los Angeles, California, USA.
    Eddington, M.
    Department of Psychology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA.
    Ehlers, Anke
    Department of Psychology, Institute of Psychiatry, King's College London, London, United Kingdom.
    Feaster, Daniel J.
    Department of Epidemiology and Public Health, Miller School of Medicine, University of Miami, Miami, Florida, USA.
    Keijesers, Ger P. J.
    Behaviour Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands.
    Koch, Ellen
    Department of Psychology, Eastern Michigan University, Ypsilanti, Michigan, USA.
    Kuyken, Willem
    Mood Disorders Centre, School of Psychology University of Exeter, Exeter, United Kingdom.
    Lange, Alfred
    Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands.
    Lincoln, Tania
    Department of Psychology, University of Marburg, Marburg, Germany.
    Stephens, Robert S.
    Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA .
    Taylor, Steven
    Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
    Trepka, Chris
    Bradford District NHS Care Trust, Bradford, United Kingdom.
    Watson, Jeanne
    Department of Adult Education, Community Development and Counselling Psychology, University of.
    Intraclass correlation associated with therapists: estimates and applications in planning psychotherapy research2011In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 40, no 1, p. 15-33Article in journal (Refereed)
    Abstract [en]

    It is essential that outcome research permit clear conclusions to be drawn about the efficacy of interventions. The common practice of nesting therapists within conditions can pose important methodological challenges that affect interpretation, particularly if the study is not powered to account for the nested design. An obstacle to the optimal design of these studies is the lack of data about the intraclass correlation coefficient (ICC), which measures the statistical dependencies introduced by nesting. To begin the development of a public database of ICC estimates, the authors investigated ICCs for a variety outcomes reported in 20 psychotherapy outcome studies. The magnitude of the 495 ICC estimates varied widely across measures and studies. The authors provide recommendations regarding how to select and aggregate ICC estimates for power calculations and show how researchers can use ICC estimates to choose the number of patients and therapists that will optimize power. Attention to these recommendations will strengthen the validity of inferences drawn from psychotherapy studies that nest therapists within conditions.

  • 3.
    Bengtsson, Jonas
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Nordin, Steven
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Carlbring, Per
    Therapists' Experiences of Conducting Cognitive Behavioural Therapy Online vis-a-vis Face-to-Face2015In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 44, no 6, p. 470-479Article in journal (Refereed)
    Abstract [en]

    This study has explored therapists' experiences of conducting cognitive behavioural therapy (CBT) online and face-to-face. Eleven therapists partook in semi-structured interviews, which were thematically analysed using an abductive approach. The results indicate that the therapists viewed face-to-face therapy as a stronger experience than Internet-based CBT (ICBT), and the latter as being more manualised, but providing more work-time control. Several participants also thought that working alliance may be achieved faster and more easily in face-to-face therapy, and might worsen with fewer modalities of communication. Clinical implications in need of investigation are whether working with ICBT might buffer therapist exhaustion, and whether this therapy form can be improved by becoming less manual dependant in order to be easier to individualise.

  • 4. Boettcher, Johanna
    et al.
    Hasselrot, Jonas
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Sund, Erik
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Andersson, Gerhard
    Carlbring, Per
    Combining Attention Training with Internet-Based Cognitive-Behavioural Self-Help for Social Anxiety: A Randomised Controlled Trial2014In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 43, no 1, p. 34-48Article in journal (Refereed)
    Abstract [en]

    Guided Internet-based cognitive-behavioural self-help (ICBT) has been proven to be effective for social anxiety disorder (SAD) by several independent research groups. However, as the proportion of clinical significant change has room for improvement, new treatments should be developed and investigated. A novel treatment is attention bias modification (ABM). This study aimed at evaluating the combination of ABM and ICBT. We compared two groups, one group receiving ICBT and ABM targeting attentional avoidance and the other group receiving ICBT and control training. ABM and control training tasks were both based on the dot-probe paradigm. A total of 133 participants, diagnosed with SAD, were randomised to these two groups. The attention training group (N=66) received 2 weeks of daily attention training followed by 9 weeks of ICBT. The control group (N=67) received 2 weeks of daily control training, also followed by 9 weeks of ICBT. Social anxiety measures as well as the attention bias were assessed at pre-assessment, at week 2, and at post-treatment. Results showed no significant differences between the attention training group and the control group. Both groups improved substantially on social anxiety symptoms from pre- to post-assessment (d(within)=1.39-1.41), but showed no change in attention processes (d(within)=0.10-0.17). In this trial, the attention modification training failed to induce differential change in attention bias. Results demonstrate that the applied ABM procedure with its focus on the reduction of attentional avoidance was ineffective in the Internet-based setting. The results do not suggest that adding ABM targeting attentional avoidance to ICBT results in better outcomes than ICBT alone.

  • 5.
    Carlbring, Per
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Andersson, Gerhard
    Linköping University and Karolinska institutet.
    Succesful self-treatment of a case of writer´s block2011In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 40, no 1, p. 1-4Article in journal (Refereed)
  • 6.
    Carlbring, Per
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Andersson, Gerhard
    Linköping University and Karolinska Institutet.
    Kaldo, Viktor
    Karolinska Institutet.
    State-of-the-Art Treatment via the Internet: an optimistic vision of the future2011In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 40, no 2, p. 79-81Article in journal (Refereed)
  • 7.
    Carlbring, Per
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Degerman, Nicklas
    Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
    Jonsson, Jakob
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Andersson, Gerhard
    Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
    Internet-based treatment of pathological gambling with a three-year follow-up2012In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, ISSN 1651-2316, Vol. 41, no 4, p. 321-34Article in journal (Refereed)
    Abstract [en]

    Effective therapies for pathological gambling exist, but their use is limited to about 10% of the target population. In an attempt to lower the barriers for help, Internet-based cognitive behavioural therapy (ICBT) has been shown to be effective when delivered to a non-depressed sample with pathological gambling. This study sought to extend this finding to a larger, more representative population, and also test a model to predict responder status. Following advertisement, a total of 284 participants started an 8-week ICBT programme with minimal therapist contact via e-mail and weekly telephone calls of less than 15 min. The average time spent on each participant, including telephone conversations, e-mail, and administration, was 4 h. In addition to a mixed effects model to evaluate the effectiveness of the treatment, two logistic regression analyses were performed with the following eight pre-defined response predictor variables: work-life satisfaction, primary gambling activity, debts due to gambling, social support, personal yearly salary, alcohol consumption, stage of change, and dissociative gambling. ICBT resulted in statistically significant reductions in the scores of pathological gambling, anxiety, and depression as well as an increase in quality of life compared to pre-treatment levels. Follow-ups carried out in the treatment group at 6, 18, and 36 months indicated that treatment effects were sustained. Using the eight predictor variable model rendered an acceptable predictive ability to identify responders both at post-test (AUC = .72, p < .01) and at 36-month follow-up (AUC = .70, p < .01). We conclude that ICBT for pathological gamblers, even if depressed, can be effective and that outcome can partly be predicted by pre-treatment characteristics.

  • 8.
    Carlbring, Per
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Maurin, Tommy
    Department of Psychology, Uppsala University, Uppsala, Sweden.
    Sjömark, Josefin
    Department of Psychology, Uppsala University, Uppsala, Sweden;.
    Maurin, Linda
    Department of Psychology, Uppsala University, Uppsala, Sweden.
    Westling, Bengt E.
    Department of Psychology, Uppsala University, Uppsala, Sweden;.
    Ekselius, Lisa
    Department of Psychology, Uppsala University, Uppsala, Sweden.
    Cuijpers, Pim
    Department of Psychology, Vrije University, Department of Psychology, Vrije University.
    Andersson, Gerhard
    Department of Behavioural Sciences and Learning, Linköping, Department of Behavioural Sciences and Learning, Linköping och Karolinska Institutet, Stockholm, Sweden.
    All at once or one at a time?: a randomized controlled trial comparing two ways to deliver bibliotherapy for panic Disorder2011In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 40, no 33, p. 228-235Article in journal (Refereed)
    Abstract [en]

    Bibliotherapy is potentially effective in the treatment of panic disorder (PD). A still unanswered question is whether pacing is important. This study was designed to test whether there is a difference between being assigned a full book as therapy and receiving one individual chapter every week (i.e. pacing). A total of 28 participants were randomized to either 10 paced chapters or one book with 10 chapters. To maximize compliance, short weekly telephone calls were added in both conditions ( M¼17.8 min,SD¼4.2). Both treatments showed promising results, with effects maintained up to 2 years and with within-group effect sizes (Cohen’s d) between 0.95 and 1.11. Pretreatment ratings of credibility were positively correlated with the change scores at both posttest and 2-year follow-up for three panic measures. Pacing of text material in bibliotherapy for PD is not needed, and all material can be provided at once when the treatment is guided by a therapist.

  • 9.
    Nyström, Markus B. T.
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Neely, Gregory
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Hassmén, Peter
    Umeå University, Faculty of Social Sciences, Department of Psychology. Faculty of Health, University of Canberra, Canberra, Australia.
    Carlbring, Per
    Department of Psychology, Stockholm University, Stockholm, Sweden.
    Treating Major Depression with Physical Activity: a Systematic Overview with Recommendations2015In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 44, no 4, p. 341-352Article in journal (Refereed)
    Abstract [en]

    The purpose of this systematic overview was to determine the most effective mode and doseof physical activity (PA) for treating major depressive disorder (MDD), and to suggest guidelines and recommendations for clinicians. The selection process consisted of a comprehensive search that was conducted up until April 2014 in the following databases: sycINFO, Medline, PubMed and Scopus. The inclusion criteria were: (1) a randomized controlled trial (RCT) design, (2) complete description of intensity, duration and frequency of the PA, (3) the participants had to be diagnosed with MDD according to Diagnostic Statistical Manual 4 th edition (DSM-IV) or International Classification of Disease tenth Revision (ICD-10) criteria (4) if the controls received any treatment, it had to be specified, (5) published after 1990, (6) consist of aerobic or anaerobic treatment PA, and (7) not be a pilotor preliminary study. A quality assessment of each study was conducted independently by two reviewers; this stringent selection process resulted in 12 reviewed studies. Conclusion: individually customized PA, for at least 30 minutes, preferably performed under supervision and with a frequency of at least three times per week is recommended when treating MDD. hese recommendations must be viewed in light of the relatively few studies matching the inclusion criteria.

  • 10.
    Paxling, Björn
    et al.
    Department of Behavioural Sciences and Learning, Swedish Institute for Disability Research, Linköping University, Linköping, Sweden.
    Almlöv, Jonas
    Department of Behavioural Sciences and Learning, Swedish Institute for Disability Research, Linköping University, Linköping, Sweden.
    Dahlin, Mats
    Psykologpartners, Linköping, Sweden.
    Carlbring, Per
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Breitholz, Elisabeth
    Department of Psychology, Stockholm University, Stockholm, Sweden .
    Eriksson, Thomas
    Redakliniken, Linköping, Sweden;.
    Andersson, Gerhard
    Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, Stockholm, Sweden.
    Guided internet-delivered cognitive behavior therapyfor generalized anxiety: a randomized controlled trial2011In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 40, no 3, p. 159-173Article in journal (Refereed)
    Abstract [en]

    Generalized anxiety disorder (GAD) has been effectively treated with cognitive behavioural therapy (CBT) in face-to face settings. Internet-delivered CBT could be a way to increase the accessibility and affordability of CBT for people suffering from GAD. The aim of this study was to evaluate the efficacy of guided Internet-delivered CBT for GAD in a controlled trial with a wait-list control group. A total of 89 participants were included following online screening and a structured psychiatric telephone interview. Participants were randomized to either an 8-week treatment group (n¼44) or a wait-list control group (n¼45). Treatment consisted of a self-help program based on CBT principles and applied relaxation along with therapist guidance. The main outcome measure was the Penn State Worry Questionnaire. Ratings of clinical improvement and symptoms were included as well as secondary outcome measures dealing with anxiety, depression, and quality of life.

    Among the treatment group participants, 13.6% did not complete the posttreatment measures. The treatment group showed significant improvement compared with the control group on all outcome measures. Large effect sizes (Cohen’s d.0.8) were found both within the treatment group and between the groups in favor of the treatment on all outcome  measures except on a measure of quality of life. Results at 1- and 3-year follow-up indicated that treatment results improved or were maintained. The authors conclude that Internet-delivered CBT with therapist support can reduce symptoms and problems related to GAD.

  • 11.
    Proudfoot, Judith
    et al.
    Black Dog Institute and School of Psychiatry, University of New.
    Klein, Britt
    National eTherapy Centre and the Brain and Psychological.
    Barak, Azy
    Department of Counseling and Human Development, University.
    Carlbring, Per
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Cuijpers, Pim
    Department of Clinical Psychology, Faculty of Psychology and.
    Lange, Alfred
    Department of Clinical Psychology, University of Amsterdam,.
    Ritterband, Lee
    Behavioral Health and Technology, Department of Psychiatry and.
    Andersson, Gerhard
    Department of Behavioural Sciences and Learning, Linköping.
    Establishing guidelines for executing and reporting internet intervention research2011In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 40, no 2, p. 82-97Article in journal (Refereed)
    Abstract [en]

    The field of Internet interventions is growing rapidly. New programs are continually being developed to facilitate health and mental health promotion, disease and emotional distress prevention, risk factor management, treatment, and relapse prevention. However, a clear definition of Internet interventions, guidelines for research, and evidence of effectiveness have been slower to follow. This article focuses on the quality standardization of research on Internet-delivered psychological and behavioural interventions. Although the science underpinning Internet interventions is just starting to be established, across research studies there are often conceptual and methodological difficulties. The authors argue that this situation is due to the lack of universally accepted operational guidelines and evaluation methods. Following a critical appraisal of existing codes of conduct and guidelines for Internet-assisted psychological and health interventions, the authors developed a framework of guidelines for Internet intervention research utilizing aspects of facet theory (Guttman & Greenbaum, 1998). The framework of facets, elements, and guidelines of best practice in reporting Internet intervention research was then sent to several leading researchers in the field for their comment and input, so that a consensus framework could be agreed on. The authors outline 12 key facets to be considered when evaluating and reporting Internet intervention studies. Each facet consists of a range of recommended elements, designed as the minimum features for reporting Internet intervention studies. The authors propose that this framework be utilized when designing and reporting Internet intervention research, so results across  studies can be replicated, extended, compared, and contrasted with greater ease and clarity.

  • 12. Sahlin, Hanna
    et al.
    Bjureberg, Johan
    Gratz, Kim L.
    Tull, Matthew T.
    Hedman-Lagerlöf, Erik
    Bjärehed, Jonas
    Jokinen, Jussi
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
    Lundh, Lars-Gunnar
    Hellner, Clara
    Ljotsson, Brjann
    Predictors of improvement in an open-trial multisite evaluation of emotion regulation group therapy2019In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 48, no 4, p. 322-336Article in journal (Refereed)
    Abstract [en]

    Emotion regulation group therapy (ERGT) is a novel treatment specifically targeting deliberate non-suicidal self-harm (DSH) in individuals with borderline personality disorder (BPD). Identifying robust predictors of positive response to ERGT could aid clinicians in treatment selection; however, to date, only one such study has been conducted. Thus, we aimed to replicate previously identified predictors of treatment response to ERGT by investigating demographic, clinical, and diagnostic predictors in 95 women with BPD or subclinical BPD who had participated in an open-trial evaluation of ERGT. Outcomes evaluated were frequency of DSH and emotion dysregulation. Assessments were conducted at pretreatment, post-treatment, and 6-month follow-up. Multilevel mixed linear models and multilevel negative binomial generalized estimated equations were used to identify significant interactions between the predictors and outcomes.

    We found that greater pretreatment DSH frequency was associated with greater improvements in DSH during treatment (b = 0.998, SE = 0.00, p = 0.03) and follow-up (b = 0.997, SE = 0.00, p < 0.01) and that greater BPD severity was associated with greater improvements in DSH during treatment (b = 0.84, SE = 0.06, p = 0.02) and in emotion dysregulation at follow-up (b = −3.05, SE = 1.47, p = 0.04). Co-occurring disorders were associated with poorer treatment response during follow-up. Results were generally consistent with a previous study of the predictors of response to ERGT. The findings provide further support for the utility of this treatment across a range of BPD patients, including patients with severe DSH and BPD.

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  • 13.
    Tillfors, Maria
    et al.
    School of Law, Psychology and Social Work, Örebro University,.
    Andersson, Gerhard
    Department of Behavioural Sciences and Learning, Linköping and Department of Clinical Neuroscience, Psychiatry Section,.
    Ekselius, Lisa
    Department of Neuroscience, Psychiatry, Uppsala University.
    Furmark, Tomas
    Department of Psychology, Uppsala University, Uppsala.
    Lewenhaupt, Susanne
    Department of Psychology, Uppsala University, Uppsala.
    Karlsson, Anders
    Department of Behavioural Sciences and Learning, Linköping.
    Carlbring, Per
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    A randomized trial of internet-delivered treatment for social anxiety disorder in high school students2011In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 40, no 2, p. 147-157Article in journal (Refereed)
    Abstract [en]

    Internet-based cognitive behavior therapy (CBT) has been shown effective for university students with social anxiety disorder (SAD) and public speaking fears. The aim of this study was to investigate whether the promising results can be transferred to high school students suffering from this condition. A total of 19 speech-anxious high school students with SAD were randomized either into 9 weeks of Internet-delivered CBT or to a wait-list control group. Significant improvements were found on measures of social anxiety, general anxiety, and depression. Effects were maintained at 1- year follow-up. The average within- and between-group effect sizes (Cohen’s d) for the primary social anxiety scales at posttest were 0.98 and 1.38, respectively. However, the average number of completed modules in the CBT program was low. Although compliance can be improved, the results suggest that Internet-based guided self-help is effective in the treatment of high school students with SAD.

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