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  • 1.
    Almlöv, Jonas
    et al.
    Linköping University, Sweden.
    Carlbring, Per
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Källqvist, Karin
    Linköping University, Sweden.
    Paxling, Björn
    Linköping University, Sweden and Vrije Universiteit, Amsterdam, The Netherlands.
    Cuijpers, Pim
    Vrije Universiteit, Amsterdam, The Netherlands.
    Andersson, Gerhard
    Linköping University, Sweden and Karolinska Institutet, Stockholm, Sweden.
    Therapist effects in guided internet-delivered CBT for Anxiety Disorders2011Inngår i: Behavioural and Cognitive Psychotherapy, ISSN 1352-4658, E-ISSN 1469-1833, Vol. 39, nr 3, s. 311-322Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Guided internet-delivered CBT for anxiety disorders has received increasing empirical support, but little is known regarding the role of the therapist.

    Aims: This study addressed therapist factors in guided internet-delivered cognitive behavioural therapy for anxiety disorders.

    Method: Data from three controlled trials with a total N of 119 were analyzed with attention to differences between eight therapists.

    Results: No significant mean level differences between therapists appeared in the dataset. However, one significant intraclass correlation between participants was found, suggesting that the outcome on the Beck Anxiety Inventory might have been influenced by the impact of the individual therapists.

    Conclusion: The therapist can possibly have some influence on the outcome of guided internet-delivered CBT for anxiety disorders, but studies with more statistical power are needed to establish whether therapist effects are present in this modality of psychological treatment. The present study was underpowered to detect minor therapist effects.

  • 2.
    Andersson, Erik
    et al.
    Department of Behavioural Sciences and Learning, Linköping University, Sweden, Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm.
    Walén, Christian
    Department of Behavioural Sciences and Learning, Linköping University, Sweden.
    Hallberg, Jonas
    Department of Behavioural Sciences and Learning, Linköping University, Sweden.
    Paxling, Björn
    Department of Behavioural Sciences and Learning, Linköping University, Sweden.
    Dahlin, Mats
    Department of Behavioural Sciences and Learning, Linköping University, Sweden; Psykologpartners, Linköping, Sweden.
    Almlöv, Jonas
    Department of Behavioural Sciences and Learning, Linköping University, Sweden.
    Källström, Reidar
    Department of Urology, University Hospital Linköping, Linköping, Sweden;.
    Wijma, Klaas
    Department of Clinical and Experimental Medicine, Linköping University, Linköping.
    Carlbring, Per
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Andersson, Gerhard
    Department of Behavioural Sciences and Learning, Linköping University, Sweden, †Swedish Institute for Disability Research, Linköping University, Sweden; Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden; .
    A randomized controlled trial of guided internet-delivered cognitive behavioral therapy for erectile dysfunction2011Inngår i: Journal of Sexual Medicine, ISSN 1743-6095, E-ISSN 1743-6109, Vol. 8, nr 10, s. 2800-2809Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction: Men with erectile dysfunction are often worried about their condition, have interpersonal difficulties, and have a reduced quality of life. Internet-delivered cognitive behavior therapy (ICBT) has been shown effective for a number of health problems but evidence is limited concerning the treatment of erectile dysfunction.

    Aim: The study investigated the effects of ICBT for erectile dysfunction.

    Methods: Seventy-eight men were included in the study and randomized to either ICBT or to a control group, which was an online discussion group. Treatment consisted of a 7-week Web-based program with e-mail-based therapist support. Each therapist spent an average of 55 minutes per participant.

    Main Outcome Measure: The International Index of Erectile Functioning five-item version was administered via the telephone at pretreatment, post-treatment, and 6 months after receiving ICBT.

    Results: At post-treatment, the treatment group had significantly greater improvements with regard to erectile performance compared with the control group. Between-group differences at post-treatment were small (d =0.1), but increased at the 6-month follow-up (d =0.88).

    Conclusions: This study provides support for the use of ICBT as a possible treatment format for erectile dysfunction.

  • 3.
    Andersson, Gerhard
    et al.
    Department of Behavioural Sciences and Learning, Linköping University,Linköping, Sweden.
    Carlbring, Per
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Panic disorder2011Inngår i: Stepped care and e-health: Practical applications to behavioral disorders / [ed] William T. O´Donohue and Crissa Draper, New York: Springer-Verlag New York, 2011, s. 61-76Kapittel i bok, del av antologi (Annet vitenskapelig)
    Abstract [en]

    Panic disorder is an anxiety disorder that is characterized by recurrent and unexpected panic attacks. In this chapter to authors present a stepped care approach to the treatment of panic disorder and provide a comprehensive review of bibliotherapy and recent Internet-delivered treatments.

  • 4.
    Andersson, Gerhard
    et al.
    Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
    Carlbring, Per
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Social Phobia (Social Anxiety Disorder)2011Inngår i: Stepped care and e-Health: Practical applications to behavioral disorders / [ed] William T. O`Donohue and Crissa Draper, New York, Dordrecht, Heidelberg, London: Springer-Verlag New York, 2011, 1, s. 99-113Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 5.
    Andersson, Gerhard
    et al.
    Department of Behavioural Sciences an Learning, Linköpings University, Linköping, Sweden.
    Carlbring, Per
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Using different communication channels to support internet interventions2010Inngår i: Oxford Guide to Low Intensity CBT Interventions / [ed] James Bennett-Levy, David Richards, Paul Farrand, Helen Christensen, Kathy Griffiths, David Kavanagh, Britt Klein, Mark A. Lau, Judy Proudfoot, Lee Ritterband, Chris Williams and Jim White, Oxford: Oxford University Press , 2010, 1Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 6.
    Andersson, Gerhard
    et al.
    Department of Behavioural Sciences and Learning, Swedish Institute for Disability Research, Linköping University, Linkö ping, Sweden and Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, Stockholm, Sweden.
    Carlbring, Per
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Furmark, Tomas
    Department of Psychology, Uppsala University, Uppsala, Sweden.
    Therapist experience and knowledge acquisition in internet-delivered CBT for social anxiety disorder: a randomized controlled trial2012Inngår i: PLOS ONE, E-ISSN 1932-6203, Vol. 7, nr 5, s. e37411-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Guided internet-delivered cognitive behavior therapy (ICBT) has been tested in several trials on social anxiety disorder (SAD) with moderate to large effects. The aims of this study were threefold. First, to compare the effects of ICBT including online discussion forum with a moderated online discussion forum only. Second, to investigate if knowledge about SAD increased following treatment and third to compare the effects of inexperienced versus experienced therapists on patient outcomes.

    Methods: A total of 204 participants with a primary diagnosis of SAD were included and randomized to either guided ICBT or the control condition. ICBT consisted of a 9-week treatment program which was guided by either psychology students at MSc level (n = 6) or by licensed psychologists with previous experience of ICBT (n = 7). A knowledge test dealing with social anxiety was administered before and after treatment. Measures of social anxiety and secondary outcomes dealing with general anxiety, depression, and quality of life were administered before and after treatment. In addition, a 1-year follow-up was conducted on the treated individuals.

    Results: Immediately following treatment, the ICBT group showed superior outcome on the Liebowitz Social Anxiety Scale self-report version with a between group posttreatment Hedges geffect size ofg = 0.75. In addition, significant differences on all the secondary outcomes were observed. Gains were well maintained one year later. Knowledge, as assessed by the knowledge test, increased following treatment with little gain in the control group. Therapist experience did not result in different outcomes, but experienced therapists logged in less frequently compared to the inexperienced therapists, suggesting that they needed less time to support patients.

    Discussion: We conclude that guided ICBT reduce symptoms of SAD, increase knowledge about SAD and that therapist experience does not make a difference apart from the finding that experienced therapist may require less time to guide patients.

    Trial Registration: UMIN.ac.jp UMIN000001383

    Fulltekst (pdf)
    fulltext
  • 7.
    Andersson, Gerhard
    et al.
    Department of Behavioural Scinces and Learning, Linköping University.
    Carlbring, Per
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Kaldo, Viktor
    Cuijpers, Pim
    Challenges and potential solutions in integrating internet-based CBT interventions into spacialist services2010Inngår i: Oxford Guide to Low Intensity CBT Intervantions / [ed] James Bennett-Levy, David a. Richards, Paul Farrand, Helen Christensen, Kathleen M. Griffiths, David J. Kavanagh, Britt Klein, Mark A. Lau, Judy Proudfoot, Lee Ritterband, Jim White, Chris Williams, Oxford: Oxford University Press , 2010, 1Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 8.
    Andersson, Gerhard
    et al.
    Institutionen för beteendevetenskap och lärande, Linköpings universitet, Linköping, Sverige.
    Carlbring, Per
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Svanborg, Cecilia
    Institutionen för klinisk vetenskap, Karolinska institutet, Stockholm, Sverige.
    Bergström, Jan
    Psykologiska institutionen, Stockholms universitet, Stockholm, Sverige.
    Öst, Lars-Göran
    Psykologiska institutionen, Stockholms universitet, Stockholm, Sverige.
    Lindefors, Nils
    Institutionen för klinisk vetenskap, avdelning psykiatri, Karolinska institutet, Stockholm, Sverige.
    Paniksyndrom: ond cirkel av feltolkade kroppsliga signaler2011Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 108, nr 14, s. 795-797Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [sv]

    Attacker av intensiv rädsla utan tydlig yttre orsak som leder till rädsla för nya attacker – det kännetecknar paniksyndrom. Evidensbaserade behandlingsalternativ finns, och det finns inget skäl att avvakta med behandling.

  • 9.
    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 universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Can the patient decide which modules to endorse?: an open trial of tailored internet treatment of anxiety disorders2011Inngår i: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 1, nr 40, s. 57-64Artikkel i tidsskrift (Fagfellevurdert)
    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.

     

     

  • 10. Andersson, Gerhard
    et al.
    Hesser, Hugo
    Hummerdal, Daniel
    Bergman-Nordgren, Lise
    Carlbring, Per
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    A 3.5-year follow-up of Internet-delivered cognitive behavior therapy for major depression2013Inngår i: Journal of Mental Health, ISSN 0963-8237, E-ISSN 1360-0567, Vol. 22, nr 2, s. 155-164Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 11. Andersson, Gerhard
    et al.
    Paxling, Bjorn
    Wiwe, Maria
    Vernmark, Kristofer
    Felix, Christina Bertholds
    Lundborg, Lisa
    Furmark, Tomas
    Cuijpers, Pim
    Carlbring, Per
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Therapeutic alliance in guided internet-delivered cognitive behavioural treatment of depression, generalized anxiety disorder and social anxiety disorder2012Inngår i: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 50, nr 9, s. 544-550Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 12.
    Andersson, Gerhard
    et al.
    Department of Behavioural Sciences and Learning, Swedish Institute for Disability Research, Linköping University, Division of Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet.
    Paxling, Björn
    Department of Clinical Psychology and EMGO Institute, Vrije Universiteit, Amsterdam , The Netherlands and Department of Behavioural Sciences and Learning, Swedish Institute for Disability Research, Linköping University, Linköping.
    Roch-Norlund, Pie
    Department of Psychology, Stockholm University, Stockholm.
    Östman, Gunnar
    Department of Psychology, Stockholm University, Stockholm.
    Norgren, Anna
    Department of Psychology, Stockholm University, Stockholm.
    Almlöv, Jonas
    Department of Behavioural Sciences and Learning, Swedish Institute for Disability Research, Linköping University, Linköping.
    Georén, Lisa
    Department of Psychology, Uppsala University, Uppsala.
    Breitholtz, Elisabeth
    Department of Psychology, Stockholm University, Stockholm.
    Dahlin, Mats
    Psykologpartners, Linköping.
    Cuijpers, Pim
    Department of Clinical Psychology and EMGO Institute, Vrije Universiteit, Amsterdam , The Netherlands.
    Carlbring, Per
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Silverberg, Farrell
    Philadelphia School of Psychoanalysis and Private Practice, Philadelphia, Pa. , USA.
    Internet-based psychodynamic versus cognitive behavioral guided self-help for generalized anxiety disorder: A randomized controlled trial2012Inngår i: Psychotherapy and Psychosomatics, ISSN 0033-3190, E-ISSN 1423-0348, Vol. 81, nr 6, s. 344-355Artikkel i tidsskrift (Fagfellevurdert)
    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

  • 13.
    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 universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    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 research2011Inngår i: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 40, nr 1, s. 15-33Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 14.
    Bendelin, Nina
    et al.
    Department of Behavioural Sciences and Learning, Swedish Institute for Disability Research, Linköping University, Linköping, Sweden.
    Hesser, Hugo
    Department of Behavioural Sciences and Learning, Swedish Institute for Disability Research, Linköping University, Linköping, Sweden.
    Dahl, Johan
    Department of Behavioural Sciences and Learning, Swedish Institute for Disability Research, Linköping University, Linköping, Sweden.
    Carlbring, Per
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Zetterqvist Nelson, Karin
    Department of Behavioural Sciences and Learning, Swedish Institute for Disability Research, Linköping University, Linköping, Sweden.
    Andersson, Gerhard
    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.
    Experiences of guided Internet-based cognitive-behavioural treatment for depression: A qualitative study2011Inngår i: BMC Psychiatry, E-ISSN 1471-244X, Vol. 11, nr 107Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Internet-based self-help treatment with minimal therapist contact has been shown to have an effect in treating various conditions. The objective of this study was to explore participants’ views of Internet administrated guided self-help treatment for depression.

    Methods: In-depth interviews were conducted with 12 strategically selected participants and qualitative methods with components of both thematic analysis and grounded theory were used in the analyses.

    Results: Three distinct change processes relating to how participants worked with the treatment material emerged which were categorized as (a) Readers, (b) Strivers, and (c) Doers. These processes dealt with attitudes towards treatment, views on motivational aspects of the treatment, and perceptions of consequences of the treatment.

    Conclusions: We conclude that the findings correspond with existing theoretical models of face-to-face psychotherapy within qualitative process research. Persons who take responsibility for the treatment and also attribute success to themselves appear to benefit more. Motivation is a crucial aspect of guided self-help in the treatment of depression.

    Fulltekst (pdf)
    fulltext
  • 15. Bergman Nordegren, Lise
    et al.
    Andersson, Gerhard
    Kadowaki, Åsa
    Carlbring, Per
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Tailored internet-administered treatment of anxiety disorders for primary care patients: study protocol for a randomised controlled trial2012Inngår i: Trials, E-ISSN 1745-6215, Vol. 13, s. 16-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Internet-administered cognitive behavioural therapy (ICBT) has been found to be effective for a range of anxiety disorders. However, most studies have focused on one specific primary diagnosis and comorbidity has not been considered. In primary care settings, patients with anxiety often suffer from more than one psychiatric condition, making it difficult to disseminate ICBT for specific conditions. The aim of this study will be to investigate if ICBT tailored according to symptom profile can be a feasible treatment for primary care patients with anxiety disorders. It is a randomised controlled trial aimed to evaluate the treatment against an active control group.

    Methods: Participants with anxiety disorders and co-morbid conditions (N = 128), will be recruited from a primary care population. The Clinical Outcome in Routine Evaluation (CORE-OM) will serve as the primary outcome measure. Secondary measures include self-reported depression, anxiety, quality of life and loss of production and the use of health care. All assessments will be collected via the Internet and measure points will be baseline, post treatment and 12 months post treatment.

    Discussion: This trial will add to the body of knowledge on the effectiveness of ICBT for anxiety disorders in primary care. The trial will also add knowledge on the long term effects of ICBT when delivered for regular clinic patients Trial Registration: ClinicalTrials.gov: NCT01390168

    Fulltekst (pdf)
    Tailored internet
  • 16.
    Bergström, Jan
    et al.
    Karolinska institutet, Department of clinical Neuroscience, Center for Psychiatry Research,Stockholm, Sweden.
    Andersson, Gerhard
    Karolinska institutet, Department of clinical Neuroscience, Center for Psychiatry Research,Stockholm, Sweden, Linköping University, Department of Behaioural Sciences and Learning, Swedish Institute for Disability Research, Linköping, Sweden.
    Ljotsson, Brjann
    Karolinska institutet, Department of clinical Neuroscience, Center for Psychiatry Research,Stockholm, Sweden.
    Ruck, Christian
    Karolinska institutet, Department of clinical Neuroscience, Center for Psychiatry Research,Stockholm, Sweden.
    Andreewitch, Sergej
    Karolinska institutet, Department of clinical Neuroscience, Center for Psychiatry Research,Stockholm, Sweden.
    Karlsson, Andreas
    Mid Sweden University, Department of Social Sciences, Section of Psychology, Östersund, Sweden.
    Carlbring, Per
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Andersson, Erik
    Mid Sweden University, Department of Social Sciences, Section of Psychology, Östersund, Sweden.
    Lindefors, Nils
    Mid Sweden University, Department of Social Sciences, Section of Psychology, Östersund, Sweden.
    Internet-versus group-administered cognitive behaviour therapy for panic disorder in a psychiatric setting: a randomised trial2010Inngår i: BMC Psychiatry, E-ISSN 1471-244X, Vol. 10, nr 54Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Internet administered cognitive behaviour therapy (CBT) is a promising new way to deliver psychological treatment, but its effectiveness in regular care settings and in relation to more traditional CBT group treatment has not yet been determined. The primary aim of this study was to compare the effectiveness of Internetand group administered CBT for panic disorder (with or without agoraphobia) in a randomised trial within a regular psychiatric care setting. The second aim of the study was to establish the cost-effectiveness of these interventions.

    Methods: Patients referred for treatment by their physician, or self-referred, were telephone-screened by a psychiatric nurse. Patients fulfilling screening criteria underwent an in-person structured clinical interview carried out by a psychiatrist. A total of 113 consecutive patients were then randomly assigned to 10 weeks of either guided Internet delivered CBT (n = 53) or group CBT (n = 60). After treatment, and at a 6-month follow-up, patients were again assessed by the psychiatrist, blind to treatment condition.

    Results: Immediately after randomization 9 patients dropped out, leaving 104 patients who started treatment. Patients in both treatment conditions showed  significant improvement on the main outcome measure, the Panic Disorder Severity Scale (PDSS) after treatment. For the Internet treatment the within-group effect size (pre-post) on the PDSS was Cohen's d = 1.73, and for the group treatment it was d = 1.63. Between group effect sizes were low and treatment effects were maintained at 6-months follow-up. We found no statistically significant differences between the two treatment conditions using a mixed models approach to account for missing data. Group CBT utilised considerably more therapist time than did Internet CBT. Defining effect as proportion of PDSS responders, the cost-effectiveness analysis concerning therapist time showed that Internet treatment had superior cost-effectiveness ratios in relation to group treatment both at post-treatment and follow-up.

    Conclusions: This study provides support for the effectiveness of Internet CBT in a psychiatric setting for patients with panic disorder, and suggests that it is equally effective as the more widely used group administered CBT in reducing panic-and agoraphobic symptoms, as well as being more cost effective with respect to therapist time.

  • 17.
    Berman, Anne H.
    et al.
    Karolinska Institutet, Department of Clinical Neuroscience, Center for Psychiatric Research, Stockholm, Sweden.
    Farzanfar, Ramesh
    Medical Information Systems Unit (MISU), Boston University Medical Campus, Boston, MA, USA .
    Kristiansson, Marianne
    Department of Clinical Neuroscience, Center for Research in Psychiatry, Social and Forensic Psychiatry Research Program Karolinska Institutet/National Board of Forensic, Medicine, Dept of Forensic Psychiatry in Stockholm, Huddinge, Sweden .
    Carlbring, Per
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Friedman, Robert H.
    Medical Information Systems Unit (MISU), Boston University Medical Campus, Boston, MA, USA .
    Design and Development of a Telephone-Linked Care (TLC) System to Reduce Impulsivity among Violent Forensic Outpatients and Probationers2012Inngår i: Journal of medical systems, ISSN 0148-5598, E-ISSN 1573-689X, Vol. 36, nr 3, s. 1031-1042Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 18.
    Carlbring, Per
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Andersson, Gerhard
    Linköping University and Karolinska institutet.
    Succesful self-treatment of a case of writer´s block2011Inngår i: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 40, nr 1, s. 1-4Artikkel i tidsskrift (Fagfellevurdert)
  • 19.
    Carlbring, Per
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Andersson, Gerhard
    Linköping University and Karolinska Institutet.
    Kaldo, Viktor
    Karolinska Institutet.
    State-of-the-Art Treatment via the Internet: an optimistic vision of the future2011Inngår i: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 40, nr 2, s. 79-81Artikkel i tidsskrift (Fagfellevurdert)
  • 20.
    Carlbring, Per
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Apelstrand, Maria
    Linköping, Sweden .
    Sehlin, Helena
    Linköping, Sweden .
    Amir, Nader
    San Diego, USA .
    Rousseau, Andreas
    Linköping, Sweden .
    Hofman, Stefan
    Boston, USA .
    Andersson, Gerhard
    Linköping, Sweden; Stockholm, Sweden .
    Internet-delivered attention bias modification training in individuals with social anxiety disorder: a double blind randomized controlled trial2012Inngår i: BMC Psychiatry, E-ISSN 1471-244X, Vol. 12, s. 66-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background:

    Computerized cognitive bias modification for social anxiety disorder has in several well conducted trials shown great promise with as many as 72% no longer fulfilling diagnostic criteria after a 4 week training program. To test if the same program can be transferred from a clinical setting to an internet delivered home based treatment the authors conducted a randomized, double-blind placebo-controlled trial.

    Methods:

    After a diagnostic interview 79 participants were randomized to one of two attention training programs using a probe detection task. In the active condition the participant was trained to direct attention away from threat, whereas in the placebo condition the probe appeared with equal frequency in the position of the threatening and neutral faces.

    Results:

    Results were analyzed on an intention-to-treat basis, including all randomized participants. Immediate and 4-month follow-up results revealed a significant time effect on all measured dimensions (social anxiety scales, general anxiety and depression levels, quality of life). However, there were no time x group interactions. The lack of differences in the two groups was also mirrored by the infinitesimal between group effect size both at post test and at 4-month follow-up.

    Conclusion:

    We conclude that computerized attention bias modification may need to be altered before dissemination for the Internet.

    Trial registration:

    ISRCTN01715124

    Fulltekst (pdf)
    fulltext
  • 21.
    Carlbring, Per
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Asmundson, Gordon J.G.Department of Psychology, University of Regina, Saskatchewan, Canada.
    40-year anniversary cognitive behaviour therapy2011Konferanseproceedings (Fagfellevurdert)
  • 22.
    Carlbring, Per
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Asmundson, Gordon JGUniversity of Regina, Saskatchewan, Canada .
    Cognitive behaviour therapy2011Konferanseproceedings (Fagfellevurdert)
  • 23.
    Carlbring, Per
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Degerman, Nicklas
    Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
    Jonsson, Jakob
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Andersson, Gerhard
    Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
    Internet-based treatment of pathological gambling with a three-year follow-up2012Inngår i: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, ISSN 1651-2316, Vol. 41, nr 4, s. 321-34Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 24.
    Carlbring, Per
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Hanell, Åsa
    Journalist på Folkbladet, Norrköping.
    Ingen panik: fri från panik- och ångestattacker i 10 steg med kognitiv beteendeterapi2011 (oppl. 2)Bok (Annet vitenskapelig)
  • 25.
    Carlbring, Per
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    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 trial2011Inngår i: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, nr 94, s. 18-24Artikkel i tidsskrift (Fagfellevurdert)
    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. 

     

  • 26.
    Carlbring, Per
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    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 Disorder2011Inngår i: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 40, nr 33, s. 228-235Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 27. Cernvall, Martin
    et al.
    Carlbring, Per
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Ljungman, Gustaf
    Von Essen, Louise
    Guided Self-Help as Intervention for Traumatic Stress in Parents of Children with Cancer: Conceptualization, Intervention Strategies, and a Case Study2013Inngår i: Journal of psychosocial oncology, ISSN 0734-7332, E-ISSN 1540-7586, Vol. 31, nr 1, s. 13-29Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 28.
    Hedman, Erik
    et al.
    Department of Clinical Neuroscience, Karolinska institutet, Stockholm, Sweden.
    Furmark, Thomas
    Department of Psychology, Uppsala University, Uppsala, Sweden.
    Carlbring, Per
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Ljotsson, Brjánn
    Department of Clinical Neuroscience, Karolinska institutet, Stockholm, Sweden.
    Ruck, Christian
    Department of Clinical Neuroscience, Karolinska institutet, Stockholm, Sweden.
    Lindefors, Nils
    Department of Clinical Neuroscience, Karolinska institutet, Stockholm, Sweden.
    Andersson, Gerhard
    Department of Clinical Neuroscience, Karolinska institutet, Stockholm, Sweden, Swedish Institute for Disability Research, Linköping University, Linköping, Sweden, Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
    A 5-year follow-up of internet-based cognitive behavior therapy for Social Anxiety Disorder2011Inngår i: Journal of Medical Internet Research, E-ISSN 1438-8871, Vol. 13, nr 2Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Internet-basedcognitive behavior therapy (CBT) has been shown to be a promising method todisseminate cognitive behavior therapy for social anxiety disorder (SAD).Several trials have demonstrated that Internet-based CBT can be effective forSAD in the shorter term. However, the long-term effects of Internet-based CBTfor SAD are less well known.

    Objective: Our objectivewas to investigate the effect of Internet-based CBT for SAD 5 years aftercompleted treatment.

    Method: We conducted a 5-yearfollow-up study of 80 persons with SAD who had undergone Internet-based CBT.The assessment comprised a diagnostic interview and self-report questionnaires.The main outcome measure was the Liebowitz Social Anxiety Scale-Self-Report (LSAS-SR). Additional measures of social anxiety were the Social InteractionAnxiety Scale (SIAS) and the Social Phobia Scale (SPS). Attrition rates werelow: 89% (71/80) of the participants completed the diagnostic interview and 80% (64/80) responded to the questionnaires.

    Results: Mixed-effect models analysisshowed a significant effect of time on the three social anxiety measures,LSAS-SR, SIAS, and SPS (F3,98-102 = 16.05 -29.20, P < .001)indicating improvement. From baseline to 5-year follow-up, participants’ meanscores on the LSAS-SR were reduced from 71.3 (95% confidence interval [CI]66.1-76.5) to 40.3 (95% CI 35.2 - 45.3).

    The effect sizes of the LSAS-SR were large (Cohen’s d range 1.30 - 1.40, 95% CI 0.77 - 1.90). Improvementsgained at the 1-year follow-up were sustained 5 years after completedtreatment.

    Conclusions: Internet-basedCBT for SAD is a treatment that can result in large and enduring effects.

    Trial registration: Clinicaltrials.govNCT01145690; http://clinicaltrials.gov/ct2/show/NCT01145690 (Archived byWebCite athttp://www.webcitation.org/5ygRxDLfK)

  • 29.
    Hesser, Hugo
    et al.
    Linköping University.
    Gustafsson, Tore
    Linköping Uiversity.
    Lundén, Charlotte
    Linköping University.
    Henrikson, Oskar
    Linköping University.
    Fattahi, Kidjan
    Linköping University.
    Johnsson, Erik
    Linköping University.
    Zetterqvist Westin, Vendela
    Linköping University.
    Carlbring, Per
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Mäki-Torkko, Elina
    Linköping University.
    Kaldo, Viktor
    Karolinska Institutet, Stockholm.
    Andersson, Gerhard
    Linköping University and Karolinska Institutet.
    A Randomized Controlled Trial of Internet-Delivered Cognitive Behavior Therapy and Acceptance and Commitment Therapy in the Treatment of Tinnitus2012Inngår i: Journal of Consulting and Clinical Psychology, ISSN 0022-006X, E-ISSN 1939-2117, Vol. 80, nr 4, s. 649-661Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 30.
    Hoa Ly, Kien
    et al.
    Department of Behavioural Sciences and Learning, Linköping University,Campus Valla, 581 83 Linköping, Sweden and Department of Psychology, Uppsala University, von Kraemers allé 1A-C, 751 42 Uppsala, Sweden.
    Dahl, Joanne
    Department of Psychology, Uppsala University, von Kraemers allé 1A-C, 751 42 Uppsala, Sweden.
    Carlbring, Per
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Andersson, Gerhard
    Department of Behavioural Sciences and Learning, Linköping University,Campus Valla, 581 83 Linköping, Sweden .
    Development and initial evaluation of a smartphone application based on acceptance and commitment therapy2012Inngår i: SpringerPlus, E-ISSN 2193-1801, Vol. 1, artikkel-id 11Artikkel i tidsskrift (Fagfellevurdert)
    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.

    Fulltekst (pdf)
    fulltext
  • 31.
    Holländare, F
    et al.
    School of Health and Medical Sciences, Psychiatric Research Centre.
    Johnsson, S
    School of Law, Psychology and Social Work, Örebro University, Örebro.
    Randestad, M
    School of Law, Psychology and Social Work, Örebro University, Örebro.
    Tillfors, M
    School of Law, Psychology and Social Work, Örebro University, Örebro.
    Carlbring, Per
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Andersson, G
    Department of Behavioural Sciences and Learning, Swedish Institute of Disability Research, Linkçping University, Linkçping and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Engström, I
    School of Health and Medical Sciences, Psychiatric Research Centre.
    Randomized trial of Internet-based relapse prevention for partially remitted depression2011Inngår i: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 124, s. 285-294Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To investigate whether Internet-based cognitive behaviour therapy (CBT) can prevent relapse in persons with partially remitted major depression after previous treatment.

    Method: Seventy-one women and 13 men (N= 84) with partially remitted major depression after treatment were randomly assigned to either 10 weeks of Internet-based CBT or to a control group. Self-help material was used in combination with e-mail contact with a personal therapist. Monthly self-ratings of depressive symptoms were made, and diagnostic interviews were conducted before and after the treatment period, as well as 6 months later.

    Results: Significantly fewer participants in the CBT group experienced relapse (4 ⁄38 or 10.5%) compared with those in the control group (14 ⁄37 or 37.8%). The difference in relapse rates between groups occurred early in the study period and was still apparent after 6 months. A trend towards a larger reduction in depressive symptoms was observed at post-treatment in the participants who received CBT compared with controls. Reduction in epressive symptoms reduced the risk of relapse. A trend towards a higher remission rate was found in the CBT group at the 6 month follow-up.

    Conclusion: Internet-based CBT seems promising in preventing relapse in persons with partially remitted major depression after previous treatment.

  • 32.
    Johansson, Robert
    et al.
    Department of Behavioural Sciences and Learning, Linköping University, Linköping,.
    Ekbladh, Sigrid
    Department of Behavioural Sciences and Learning, Linköping University, Linköping,.
    Herbert, Amanda
    Department of Behavioural Sciences and Learning, Linköping University, Linköping,.
    Lindström, Malin
    Department of Behavioural Sciences and Learning, Linköping University, Linköping,.
    Möller, Sara
    Department of Behavioural Sciences and Learning, Linköping University, Linköping,.
    Petitt, Eleanor
    Department of Behavioural Sciences and Learning, Linköping University, Linköping,.
    Poysti, Stephanie
    Department of Behavioural Sciences and Learning, Linköping University, Linköping,.
    Holmqvist Larsson, Mattias
    Department of Behavioural Sciences and Learning, Linköping University, Linköping,.
    Rousseau, Andréas
    Psychiatric Clinic, University Hospital of Linköping, Linköping, Sweden,.
    Carlbring, Per
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Cuijpers, Pim
    Department of Clinical Psychology and EMGO Institute, Vrije Universiteit, Amsterdam, The Netherlands.
    Andersson, Gerhard
    Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden, Swedish Institute for Disability Research, Linköping University, Linköping, Sweden, Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, Stockholm, Sweden.
    Psychodynamic Guided Self-Help for Adult Depression through the Internet: A Randomised Controlled Trial2012Inngår i: PLOS ONE, E-ISSN 1932-6203, Vol. 7, nr 5, s. e38021-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Abstract

    Background and aims: Psychodynamic psychotherapy (PDT) is an effective treatment for major depressive disorder (MDD), but not all clients with MDD can receive psychotherapy. Using the Internet to provide psychodynamic treatments is one way of improving access to psychological treatments for MDD. The aim of this randomised controlled trial was to investigate the efficacy of an Internet-based psychodynamic guided self-help treatment for MDD.

    Methods: Ninety-two participants who were diagnosed with MDD according to the Mini-International Neuropsychiatric Interview were randomised to treatment or an active control. The treatment consisted of nine treatment modules based on psychodynamic principles with online therapist contact. The active control condition was a structured support intervention and contained psychoeducation and scheduled weekly contacts online. Both interventions lasted for 10 weeks. The primary outcome measure was the Beck Depression Inventory-II (BDI-II).

    Results: Mixed-effects model analyses of all randomised participants showed that participants receiving Internet-based PDT made large and superior improvements compared with the active control group on the BDI-II (between-group Cohen’s d = 1.11). Treatment effects were maintained at a 10-month follow-up.

    Conclusions: Internet-based psychodynamic guided self-help is an efficacious treatment for MDD that has the potential to increase accessibility and availability of PDT for MDD.

    Fulltekst (pdf)
    fulltext
  • 33.
    Johansson, Robert
    et al.
    Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden,.
    Sjöberg, Elin
    Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden,.
    Sjögren, Magnus
    Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden,.
    Johansson, Erik
    Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden,.
    Carlbring, Per
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Andersson, Therese
    Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden .
    Rousseau, Andréas
    Psychiatric Clinic, University Hospital of Linköping, Linköping, Sweden.
    Andersson, Gerhard
    Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden; Swedish Institute for Disability Research, Linköping University, Linköping, Sweden; Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, Stockholm, Sweden .
    Tailored vs. Standardized Internet-Based Cognitive Behavior Therapy for Depression and Comorbid Symptoms: A Randomized Controlled Trial2012Inngår i: PLOS ONE, E-ISSN 1932-6203, Vol. 7, nr 5, s. e36905-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background and Aims:Major depression can be treated by means of cognitive behavior therapy, delivered via the Internet as guided self-help. Individually tailored guided self-help treatments have shown promising results in the treatment of anxiety disorders. This randomized controlled trial tested the efficacy of an Internet-based individually tailored guided selfhelp treatment which specifically targeted depression with comorbid symptoms. The treatment was compared both to standardized (non-tailored) Internet-based treatment and to an active control group in the form of a monitored online discussion group. Both guided self-help treatments were based on cognitive behavior therapy and lasted for 10 weeks. The discussion group consisted of weekly discussion themes related to depression and the treatment of depression.

    Methods:A total of 121 participants with diagnosed major depressive disorder and with a range of comorbid symptoms were randomized to three groups. The tailored treatment consisted of a prescribed set of modules targeting depression as well as comorbid problems. The standardized treatment was a previously tested guided self-help program for depression.

    Results:From pre-treatment to post-treatment, both treatment groups improved on measures of depression, anxiety and quality of life. The results were maintained at a 6-month follow-up. Subgroup analyses showed that the tailored treatment was more effective than the standardized treatment among participants with higher levels of depression at baseline and more comorbidity, both in terms of reduction of depressive symptoms and on recovery rates. In the subgroup with lower baseline scores of depression, few differences were seen between treatments and the discussion group.

    Conclusions:This study shows that tailored Internet-based treatment for depression is effective and that addressing comorbidity by tailoring may be one way of making guided self-help treatments more effective than standardized approaches in the treatment of more severe depression.

    Fulltekst (pdf)
    fulltext
  • 34. Lithander, Anna
    et al.
    Carlbring, Per
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Jag är inte galen: en bok om panikångest2010 (oppl. 1)Bok (Annet (populærvitenskap, debatt, mm))
    Abstract [en]

    Om en dold folksjukdom "Jag trodde på fullt allvar att jag hade blivit galen. Fullständigt knäpp. Det som hände den där dagen för nästan tjugo år sedan var så fruktansvärt att jag trodde att mitt liv var över." Så beskriver journalisten Anna Lithander sin reaktion när hon plötsligt drabbades av panikångest. Ben som darrade, yrsel, tryck över bröstet, en känsla av att inte längre vara med i verkligheten. En skrämmande upplevelse. Att leva med panikångest och den ständiga rädslan för nya attacker inskränker livet.

    Men vad sker egentligen i kroppen vid en panikattack? Varför drabbas kvinnor oftare än män? Och är symtomen en reaktion på vårt sätt att leva idag?

    Anna Lithander har skrivit en bok om panikångest, som numera klassas som en folksjukdom. Över 200 000 svenskar lider av återkommande panikattacker. Bokens medförfattare, Per Carlbring är professor i psykologi vid Umeå universitet och en av Sveriges ledande experter på panikattacker. Här delar han med sig av sina erfarenheter och tipsar om hur man kan hantera panikångest med kognitiv beteendeterapi. Dessutom bidrar en rad kunniga personer i boken med kunskap, tankar och reflektioner kring en av vår tids mer skambelagda sjukdomar.

    Det är viktigt att avdramatisera. Problemet med panikattacker är faktiskt både ofarligt och behandlingsbart. Man behöver inte skämmas för att ha blivit drabbad. Boken visar att det går att bli av med panikångest.

  • 35.
    Ly, Kien Hoa
    et al.
    Department of Behavioral Sciences and Learning, Swedish Institute for Disability Research, Linköping University, Linköping, Sweden.
    Carlbring, Per
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Andersson, Gerhard
    Department of Behavioral Sciences and Learning, Swedish Institute for Disability Research, Linköping University, Linköping, Sweden .
    Behavioral activation-based guided self-help treatment administered through a smartphone application: study protocol for a randomized controlled trial2012Inngår i: Trials, E-ISSN 1745-6215, Vol. 13, s. art.nr. 62-Artikkel i tidsskrift (Fagfellevurdert)
    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

    Fulltekst (pdf)
    075 Behavioral
  • 36. Mansson, Kristoffer N. T.
    et al.
    Carlbring, Per
    Stockholm Univ, Dept Psychol, S-10691 Stockholm, Sweden.
    Frick, Andreas
    Engman, Jonas
    Olsson, Carl-Johan
    Umeå universitet, Samhällsvetenskapliga fakulteten, Centrum för befolkningsstudier (CBS). Umeå universitet, Medicinska fakulteten, Umeå centrum för funktionell hjärnavbildning (UFBI).
    Bodlund, Owe
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Furmark, Tomas
    Andersson, Gerhard
    Amygdala Changes After Cognitive Behavior Therapy and Attention Bias Modification via the Internet: An fMRI-Study2013Inngår i: Biological Psychiatry, ISSN 0006-3223, E-ISSN 1873-2402, Vol. 73, nr 9, s. 72S-72SArtikkel i tidsskrift (Fagfellevurdert)
  • 37.
    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 universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    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 disorder2012Inngår i: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 50, nr 1, s. 12-21Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 38.
    Nordin, Sara
    et al.
    Linköpings universitet.
    Carlbring, Per
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi. Linköping University.
    Cuijpers, Pim
    Vrije Universiteit.
    Andersson, Gerhard
    Linköping University and Karolinska Institutet.
    Expanding the limits of bibliotherapy for panic disorder: Randomized trial of self-help without support but with a clear deadline2010Inngår i: Behavior Therapy, ISSN 0005-7894, E-ISSN 1878-1888, Vol. 41, nr 3, s. 267-276Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Cognitive behavioral bibliotherapy for panic disorder has been found to be less effective without therapist support. In this study, participants were randomized to either unassisted bibliotherapy (n = 20) with a scheduled follow-up telephone interview or to a waiting list control group (n = 19). Following a structured psychiatric interview, participants in the treatment group were sent a self-help book consisting of 10 chapters based on cognitive behavioral strategies for the treatment of panic disorder. No therapist contact of any kind was provided during the treatment phase, which lasted for 10 weeks. Results showed that the treatment group had, in comparison to the control group, improved on all outcome measures at posttreatment and at 3-month follow-up. The tentative conclusion drawn from these results is that pure bibliotherapy with a clear deadline can be effective for people suffering from panic disorder with or without agoraphobia.

  • 39.
    Olsson, Erik M G
    et al.
    Department of Psychology, Uppsala University, Sweden .
    El Alaoui, Samir
    Department of Psychology, Uppsala University, Sweden .
    Carlberg, Bo
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Carlbring, Per
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Ghaderi, Ata
    Department of Psychology, Uppsala University, Sweden .
    Internet-based biofeedback-assisted relaxation training in the treatment of hypertension: a pilot study2010Inngår i: Applied Psychophysiology and Biofeedback, ISSN 1090-0586, E-ISSN 1573-3270, Vol. 35, nr 2, s. 163-170Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The effectiveness of biofeedback-assisted behavioral treatment with Internet-based client-therapist contact for hypertension was tested in outpatient settings. A pilot study with a randomized controlled design was adopted with two conditions (treatment versus passive controls), lasting for 8 weeks. There were two assessment time points (pre-treatment and post-treatment) measuring clinic systolic and diastolic blood pressure (SBP and DBP) and administration of a questionnaire collecting demographic and subjective data. Participants included 19 Swedish adults diagnosed with hypertension. The treatment group lowered their SBP 5.9 mm Hg and their DBP 7.6 mm Hg while the control group lowered their SBP 0.8 mm Hg and DBP 3.0 mm Hg. The effect of treatment was significant for DBP but not for SBP. There were no other significant effects of treatment. This pilot study shows encouraging results regarding Internet-based biofeedback treatment for hypertensive adults. However, further research using a larger sample is needed.

  • 40.
    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 universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    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 trial2011Inngår i: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 40, nr 3, s. 159-173Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 41. Paxling, Björn
    et al.
    Lundgren, Susanne
    Norman, Anita
    Almlov, Jonas
    Carlbring, Per
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Cuijpers, Pim
    Andersson, Gerhard
    Therapist Behaviours in Internet-Delivered Cognitive Behaviour Therapy: Analyses of E-Mail Correspondence in the Treatment of Generalized Anxiety Disorder2013Inngår i: Behavioural and Cognitive Psychotherapy, ISSN 1352-4658, E-ISSN 1469-1833, Vol. 41, nr 3, s. 280-289Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 42.
    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 universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    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 research2011Inngår i: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 40, nr 2, s. 82-97Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 43. Proudfoot, Judy
    et al.
    Klein, Britt
    Andersson, Gerhard
    Carlbring, Per
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Kyrios, Michael
    Munro, Calum
    Lauder, Sue
    Palermo, Tonya
    Riper, Heleen
    Blankers, Matthijs
    Guided CBT internet interventions: specific issues in supporting clients with depression, anxiety and co-morbid conditions2010Inngår i: Oxford Guide to Low Intensity CBT Interventions, Oxford: Oxford University Press , 2010, 1Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 44. Samuelsson, Hanna
    et al.
    Jarnvik, Karl
    Henningsson, Hanna
    Andersson, Josefin
    Carlbring, Per
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    The Umea University Database of Facial Expressions: A Validation Study2012Inngår i: Journal of Medical Internet Research, E-ISSN 1438-8871, Vol. 14, nr 5, s. e136-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: A set of face stimuli, called the Umea University Database of Facial Expressions, is described. The set consists of 30 female and 30 male models aged 17-67 years (M = 30.19, SD = 10.66). Each model shows seven different facial expressions (angry, surprised, happy, sad, neutral, afraid, and disgusted). Most models are ethnic Swedes but models of Central European, Arabic, and Asian origin are also included. Objective: Creating and validating a new database of facial expressions that can be used for scientific experiments. Methods: The images, presented in random order one at a time, were validated by 526 volunteers rating on average 125 images on seven 10-point Likert-type scales ranging from "completely disagree" to "completely agree" for each emotion. Results: The proportion of the aggregated results that were correctly classified was considered to be high (M = 88%). Conclusions: The results lend empirical support for the validity of this set of facial expressions. The set can be used freely by the scientific community. (J Med Internet Res 2012;14(5):e136) doi:10.2196/jmir.2196

  • 45. Samuelsson, Hanna
    et al.
    Jarnvik, Karl
    Henningsson, Hanna
    Andersson, Josefine
    Carlbring, Per
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    The Umeå University Database of Facial Expressions: A Validation Study2012Inngår i: Journal of Medical Internet Research, E-ISSN 1438-8871, Vol. 14, nr 5, s. e136-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background:

    A set of face stimuli, called the Umeå University Database of Facial Expressions, is described. The set consists of 30 female and 30 male models aged 17–67 years (M = 30.19, SD = 10.66). Each model shows seven different facial expressions (angry, surprised, happy, sad, neutral, afraid, and disgusted). Most models are ethnic Swedes but models of Central European, Arabic, and Asian origin are also included.

    Objective:

    Creating and validating a new database of facial expressions that can be used for scientific experiments.

    Methods:

    The images, presented in random order one at a time, were validated by 526 volunteers rating on average 125 images on seven 10-point Likert-type scales ranging from “completely disagree” to “completely agree” for each emotion.

    Results:

    The proportion of the aggregated results that were correctly classified was considered to be high (M = 88%).

    Conclusions:

    The results lend empirical support for the validity of this set of facial expressions. The set can be used freely by the scientific community.

    http://www.jmir.org/2012/5/e136/

  • 46.
    Silfvernagel, Kristin
    et al.
    Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
    Carlbring, Per
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Kabo, Julia
    Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
    Edström, Sara
    Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
    Eriksson, Jenny
    Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
    Månson, Lisa
    Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
    Andersson, Gerhard
    Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden and Swedish Institute for Disability Reserach, Linköping University, Linköping, Sweden and Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, Stockholm, Sweden.
    Individually Tailored Internet-Based Treatment for Young Adults and Adults With Panic Attacks: Randomized Controlled Trial2012Inngår i: Journal of Medical Internet Research, E-ISSN 1438-8871, Vol. 14, nr 3, s. e65-Artikkel i tidsskrift (Fagfellevurdert)
    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)

  • 47.
    Sjöström, M
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Umefjord, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Stenlund, H
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Carlbring, Per
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Andersson, G
    Samuelsson, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Internet-based treatment of stress urinary incontinence: a randomised controlled study2012Inngår i: Neurourology and Urodynamics, ISSN 0733-2467, E-ISSN 1520-6777, Vol. 31, nr 6, s. 734-736Artikkel i tidsskrift (Annet vitenskapelig)
  • 48.
    Thorén, Elisabet
    et al.
    Department of Clinical and Experimental Medicine, Linko¨ping University; Research Centre Eriksholm, Oticon A/S.
    Svensson, Monica
    Department of Clinical Sciences, Logopedics, Phoniatrics, Audiology, Lund University;.
    Törnqvist, Anna
    Department of Clinical Sciences, Logopedics, Phoniatrics, Audiology, Lund University.
    Andersson, Gerhard
    Department of Behavioural Sciences and Learning, Linko¨ping University; Department of Clinical Neuroscience, Karolinska Institutet.
    Carlbring, Per
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Lunner, Thomas
    Department of Clinical and Experimental Medicine, Linko¨ping University; Research Centre Eriksholm, Oticon A/S and Swedish Institute for Disability Research, Linköping and Örebro University;.
    Rehabilitative online education versus internet discussion group for hearing aid users: a randomized controlled trial2011Inngår i: Journal of the American Academi of Audiologi, Vol. 22, nr 5, s. 274-285Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: By using the Internet in the audiological rehabilitation process, it might be possible in a cost-effective way to include additional rehabilitation components by informing and guiding hearing aid users about such topics as communication strategies, hearing tactics, and how to handle hearing aids.

    Purpose: To evaluate the effectiveness of an online education program for adult experienced hearing aid users including professional guidance by an audiologist and compare it with the effects of participation in an online discussion forum without any professional contact.

    Research Design: A randomized controlled study with two groups of participants. Repeated measures at prestudy, immediate follow-up, and a 6 mo follow-up.

    Study Sample: Fifty-nine experienced hearing aid users participated in the study, ranging in age from 24 to 84 yr (mean 63.5 yr).

    Intervention: The intervention group (N529) underwent a five-week rehabilitative online education in which activities for each week included information, tasks, and assignments, and contact with a professional audiologist was included. The participants in the control group (N530) were referred to an online discussion forum without any audiologist contact.

    Data Collection and Analysis: A set of questionnaires administered online were used as outcome measures: (1) Hearing Handicap Inventory for the Elderly, (2) International Outcome Inventory for Hearing Aids, (3) Satisfaction with Amplification in Daily Life, and (4) Hospital Anxiety and Depression Scale.

    Results: Significant improvements measured by the Hearing Handicap Inventory for the Elderly were found in both groups of participants, and the effects were maintained at the 6mo follow-up. The results on the Hospital Anxiety and Depression Scale showed that the participants in the intervention group showed reduced symptoms of depression immediately/6 mo after the intervention. At the 6 mo follow-up participants in the control group reported fewer symptoms of anxiety than they did before the intervention started.

    Conclusions: This study provides preliminary evidence that the Internet can be used to deliver education to experienced hearing aid users who report residual hearing problems such that their problems are reduced by the intervention. The study also suggests that online discussion forums could be used in rehabilitation. A combination of online professional supervised education and online informal discussions could be a promising rehabilitation tool.

  • 49.
    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 universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    A randomized trial of internet-delivered treatment for social anxiety disorder in high school students2011Inngår i: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 40, nr 2, s. 147-157Artikkel i tidsskrift (Fagfellevurdert)
    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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