| 51. |
- Carlbring, Per, 1972-, et al.
(author)
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Individually-tailored, Internet-based treatment for anxiety disorders: A randomized controlled trial
- 2011
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In: BEHAVIOUR RESEARCH AND THERAPY. - : Elsevier Science B.V., Amsterdam.. - 0005-7967 .- 1873-622X. ; 49:1, s. 18-24
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Journal article (peer-reviewed)abstract
- 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 patients 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 Cohens d = 0.69 at post-treatment, while the mean within-group effect size was d = 1.15 at post-treatment and d = 1.13 and d = 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.
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| 52. |
- Carlbring, Per, et al.
(author)
-
Ingen panik : Fri från panik- och ångestattacker i 10 steg med kognitiv beteendeterapi
- 2013. - 2
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Book (pop. science, debate, etc.)abstract
- Pulsen ökar. Du börjar svettas, darra. Får kvävningskänslor. Känner dig illamående och får svindel ? du blir rädd för att mista kontrollen eller till och med dö. Allt detta är vanliga symtom för de cirka 200 000 svenskar som lider av paniksyndrom. Forskning visar att KBT vid paniksyndrom medför att mellan 80 och 95 procent är diagnosfria efter tio veckors behandling. Eftersom samma goda resultat ses vid självhjälpsbehandling talar mycket för att även den som använder den här boken ska kunna bli fri från sina problem. Denna andra utgåva har uppdaterade forskningsresultat och ett nytt avsnitt om hur man förebygger och hanterar bakslag med hjälp av Acceptance and Commitment Therapy (ACT). Boken är i första hand en självhjälpsbok, men kan med fördel läsas av terapeuter som vill lära sig bedriva KBT-behandling vid paniksyndrom.
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| 53. |
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| 54. |
- Carlbring, Per
(author)
-
Internet and Smartphone Based Treatments Including a New PTSD-Study
- 2014
-
Conference paper (peer-reviewed)abstract
- Our research group has - during the past 15 years - developed and tested internet interventions for more than 20 separate conditions totaling in close to 50 published randomized controlled trials. The studies cover a wide range of diagnoses including depression, social anxiety, panic disorder, generalized anxiety disorder, and pathological gambling. The treatments have mostly been based on cognitive behavior therapy. However, acceptance and commitment therapy, interpersonal psychotherapy and motivational interviewing have also been tested. In addition to the more traditional online therapies psychodynamic internet-based psychotherapy has also been evaluated. In general the effect sizes are large when active treatment is compared to a control group. In fact, in our recent systematic review and meta-analysis that has been accepted for publication, Internet-delivered cognitive behavior therapy was directly compared against face-to-face CBT within the same trial. The results showed a pooled effect size at post-treatment across of Hedges g = -0.01 (95% CI, -0.13 to 0.12), indicating that Internet-delivered cognitive behavior therapy and face-to-face treatment produce equivalent overall effects. In addition to giving an overview of internet-based treatments a new randomized controlled trial will be presented. The aim of this trial was to investigate the effects of guided internet-based cognitive behavior therapy (ICBT) for posttraumatic stress disorder (PTSD). Sixty-two participants with chronic PTSD, as assessed by the Clinician-administered PTSD Scale, were recruited via nationwide advertising and randomized to either treatment (n = 31) or delayed treatment attention control (n = 31). The ICBT treatment consisted of 8 weekly text-based modules containing psychoeducation, breathing retraining, imaginal and in vivo exposure, cognitive restructuring, and relapse prevention. Therapist support and feedback on homework assignment were given weekly via an online contact handling system. Assessments were made at baseline, post-treatment, and at 1-year follow-up. Main outcome measures were the Impact of Events Scale-Revised (IES-R) and the Posttraumatic Stress Diagnostic Scale (PDS). Results showed significant reductions of PTSD symptoms (between group effect on the IES-R Cohen’s d = 1.25, and d = 1.24 for the PDS) compared to the control group. There were also effects on depression symptoms, anxiety symptoms, and quality of life. The results at one-year follow-up showed that treatment gains were maintained. In sum, these results suggest that ICBT with therapist support can reduce PTSD symptoms significantly.
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| 55. |
- Carlbring, Per, et al.
(author)
-
Internet-based behavioral activation and acceptance-based treatment for depression : a randomized controlled trial
- 2013
-
In: Journal of Affective Disorders. - : Elsevier BV. - 0165-0327 .- 1573-2517. ; 148:2-3, s. 331-337
-
Journal article (peer-reviewed)abstract
- BackgroundInternet-based cognitive behavior therapy for depression has been tested in several trials but there are no internet studies on behavioral activation (BA), and no studies on BA over the internet including components of acceptance and commitment therapy (ACT). The aim of this study was to develop and test the effects of internet-delivered BA combined with ACT against a waiting list control condition as a first test of the effects of treatment.MethodsSelection took place with a computerized screening interview and a subsequent semi-structured telephone interview. A total of 80 individuals from the general public were randomized to one of two conditions. The treatment lasted for 8 weeks after which both groups were assessed. We also included a 3 month follow-up. The treatment included interactive elements online and a CD-ROM for mindfulness and acceptance exercises. In addition, written support and feedback was given by a therapist every week.ResultsResults at posttreatment showed a large between group effect size on the Beck Depression inventory IId=0.98 (95%CI=0.51–1.44). In the treated group 25% (10/40) reached remission defined as a BDI score≤10 vs. 5% (2/40) in the control group. Results on secondary measures were smaller. While few dropped out from the study (N=2) at posttreatment, the average number of completed modules was M=5.1 out of the seven modules.LimitationsThe study only included a waiting-list comparison and it is not possible to determine which treatment components were the most effective.ConclusionsWe conclude that there is initial evidence that BA with components of ACT can be effective in reducing symptoms of depression.
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| 56. |
- Carlbring, Per, et al.
(author)
-
Internet-Based Interventions for Social Anxiety Disorder – an Overview
- 2014
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In: Abstracts from the 44th Congress of the European Association for Behavioural & Cognitive Therapies.
-
Conference paper (peer-reviewed)abstract
- Internet-based interventions hold specific advantagesand disadvantages in the treatment of social anxiety disorder(SAD). The present review examines different approachesin the internet-based treatment of SAD and reviewstheir efficacy and effectiveness. At least 21 studies investigated the potential of guided and unguided internetbasedcognitive-behavioral treatments (ICBT) for SAD,comprising a total of at least N = 1,801 socially anxious individuals.The large majority of these trials reported substantialreductions of social anxiety symptoms through ICBTprograms. Within effect sizes were mostly large and comparisons to waitlist and more active control groupswere positive. Treatment gains were stable from 3months to 5 years after treatment termination. In conclusion, ICBT is effective in the reduction of social anxietysymptoms. At the same time, not all participants benefit from these treatments to a sufficient degree. Future research should focus on what makes these interventions work in which patient populations, and at the same time,examine ways to implement internet-based treatment inthe routine care for socially anxious patients.
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| 57. |
- Carlbring, Per, 1972-, et al.
(author)
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Internet-based treatment of pathological gambling with a three-year follow-up
- 2012
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In: Cognitive Behaviour Therapy. - : Routledge. - 1650-6073 .- 1651-2316. ; 41:4, s. 321-34
-
Journal article (peer-reviewed)abstract
- 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.
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| 58. |
- Carlbring, Per, 1967-, et al.
(author)
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Internet-delivered attention bias modification training in individuals with social anxiety disorder : a double blind randomized controlled trial
- 2012
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In: BMC Psychiatry. - : BioMed Central (BMC). - 1471-244X. ; 12, s. 66-
-
Journal article (peer-reviewed)abstract
- 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
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| 59. |
- Carlbring, Per, et al.
(author)
-
Internet-Delivered Attention Training for SAD : who Responds and Why
- 2014
-
In: Abstracts from the 48th Annual Convention of the Association for Behavioral and Cognitive Therapies.
-
Conference paper (other academic/artistic)abstract
- While attention modification programs (AMP) have shown promise as laboratory-based treatments for social anxiety disorder, trials of internet-delivered AMP have not yielded significant differences between active and control conditions. To address these inconsistencies, we examined the moderational and mediational role of attention bias in the efficacy of attention training. We compared data reported by Carlbring et al. (2012) to an identical AMP condition, with the exception that participants were instructed to activate social anxiety fears prior to each attention training session (AMP+FACT; n=39). We also compared all attention training groups to an internet-delivered cognitive-behavioral therapy (iCBT) condition (n=40). Participants in the AMP+FACT group experienced greater reductions in social anxiety symptoms than both active (n=40) and control (n=39) groups reported by Carlbring et al., and did not differ in symptom reductions from the iCBT group. Higher attention bias predicted greater symptom reductions for participants who completed AMP, but not for the control group. Moreover, change in attention bias mediated the relationship between AMP group (active condition reported by Carlbring et al. versus AMP+FACT) and change in social anxiety symptoms. These results suggest the importance of interpreting findings related to symptom change in attention training studies in the context of bias effects.
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| 60. |
- Carlbring, Per
(author)
-
Is internet-delivered CBT as effective as regular CBT?
- 2014
-
In: Abstract from the 33rd congress of the Flemish section of our Association for (Cognitive) Behaviour Therapy..
-
Conference paper (other academic/artistic)abstract
- A treatment form has now been established that merges cognitive behavior therapy (CBT) with the internet. By delivering treatment components, mainly in the form of texts presented via web pages, video and audio files, and by providing ongoing support using email, promising outcomes can be achieved. The literature on this form of treatment has grown rapidly over recent years with more than 70 controlled trials in the field of anxiety disorders, mood disorders and behavioral medicine. For some of the conditions for which internet-delivered CBT has been tested, independent replications have shown large effect sizes, for example, in the treatment of social anxiety disorder and major depression. In some studies, internet-delivered treatment can achieve similar outcomes as in face-to-face CBT. There are also efficacy trials showing that the treatment works in clinical settings. This talk will provide a summary of the evidence. Recent advances in information technology, such as the use of smart-phones will be covered. It is likely that information technology and CBT will merge in the future, and that combined treatments with both face-to-face and online delivery will be common.
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