| 71. |
- Bergman Nordgren, Lise, 1983-, et al.
(författare)
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Tailored internet-administered treatment of anxiety disorders for primary care patients : study protocol for a randomised controlled trial
- 2012
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Ingår i: Trials. - : BioMed Central (BMC). - 1745-6215. ; 13, s. 16-
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Tidskriftsartikel (refereegranskat)abstract
- 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
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| 72. |
- Bergman Nordgren, Lise, et al.
(författare)
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Tailoring CBT-treatments delivered via the internet : Some examples from a Swedish context
- 2017
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Konferensbidrag (refereegranskat)abstract
- Introduction: In mental health comorbidity is common, both physical and psychiatric. Normally studies on cognitive behavior therapy (CBT) protocols do not exclude comorbid patients but leave the comorbidity to improve without being addressed, or remain unchanged without being identified. since most cognitive behavior treatment protocols are diagnosis-specific. Based on the idea that several problems can be targeted at once, individually tailored CBT protocols have developed. Including patients’ specific symptom profile and preferences, and the knowledge from established disorder-specific programs these protocols opens for individualization both before and during treatment based on individual progress. Tailoring can also be done to target different age groups and include for example the interface of the treatment program and the clinical examples used.Methods: Most programs have been tested in randomized controlled trials against active waitlist conditions. Specific symptom measures served as primary outcome measures and measures of life quality as secondary. Some studies also included economic evaluations of cost- effectiveness and ratings of therapeutic alliance. Our samples have been both self-recruited and referred by health care professionals. Most of the studies have measure-points not only directly at post treatment, but also at one- and two-year follow-up.Results: Taken together the tailored programs show, on average, a medium to large effect size (Cohen’s d) on primary outcome measures regarding both anxiety and depressive symptoms, and small effect sizes on life quality measures. Effects were sustained at follow-up. The tailored treatment proved to be cost-effective administered in regular care. We also found patient ratings of therapeutic alliance to correlate with outcome.Discussion: Individually tailored internet-administered CBT show promising results. Based on the available data, it might be a feasible approach in treating anxiety and depression. Acceptability, for whom it is most beneficial, and if some components are more powerful than others, are questions left to be answered.
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| 73. |
- Bergström, Jan, 1976-, et al.
(författare)
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Internet-versus group-administered cognitive behaviour therapy for panic disorder in a psychiatric setting : a randomised trial
- 2010
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Ingår i: BMC Psychiatry. - : BioMed Central Ltd. - 1471-244X. ; 10:54
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 74. |
- Berman, Anne H., et al.
(författare)
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Design and Development of a Telephone-Linked Care (TLC) System to Reduce Impulsivity among Violent Forensic Outpatients and Probationers
- 2012
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Ingår i: Journal of medical systems. - : Springer Netherlands. - 0148-5598 .- 1573-689X. ; 36:3, s. 1031-1042
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 75. |
- Blom, Kerstin, et al.
(författare)
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Effectiveness of two guided Internet treatments in a routine care setting at the eMeistring clinic, Norwegian public health care : Panic disorder and major depression
- 2018
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Ingår i: Abstract book. ; , s. 34-34
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Goals: To investigate the effectiveness of therapist-guided internet treatment for panic disorder (PD), and major depression (MD), in a routine care setting, the eMeistring clinic, within the public health care in Norway. Methods: Approximately 300 patients are included in two effectiveness studies, one per treatment (PD, MD). Assessment points are pretreatment, posttreatment and 6 months follow-up. Within group effect sizes, responder and remission rates are investigated. All analyses are Internet to treat. Results: Effect sizes for PD were large, d = 1.24 pre - post and 1.39 pre - 6 months follow-up. 56 % had recovered or were improved at posttreatment. Results for MD are preliminary and will be presented at the conference. Conclusion: Final conclusions will be presented at the conference. Results so far indicate that the treatments, after implementation into routine care in Norwegian public health care, are equally effective as in preceding effectiveness and randomized efficacy trials. The results so far thereby strengthen the notion that therapist guided Internet-based treatments are a viable alternative to other modes of treatment delivery.
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| 76. |
- Blomkvist, Anna, et al.
(författare)
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Should I Stay or Should I Go? Relationship satisfaction and the influence of attachment
- 2019
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Romantic relationships have been argued to function as attachment relationships, and the level of satisfaction with the relationship have been associated with one’s attachment style. Both attachment avoidance and anxiety have shown to be reliable predictors of relationship dissatisfaction. In this study, which were part of a screening process for couples’ therapy, 660 participants (330 both heterosexual and homosexual couples) completed a questionnaire regarding their attachment style (Experience of Close Relationships) and relationship satisfaction (Dyadic Adjustment Scale). Through structural equation modelling we found that relationship satisfaction was linked to both attachment avoidance (? = -.26) and anxiety (? = -.15) of one own, but only to partner avoidance (? = -.12). These findings are to some extent contradictory to previous research regarding the effect of partner attachment, by showing that specifically avoidance but not anxiety is linked to dissatisfaction.
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| 77. |
- Boettcher, Johanna, et al.
(författare)
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Combining attention training with cognitive-behavior therapy in Internet-based self-help for social anxiety : study protocol for a randomized controlled trial
- 2013
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Ingår i: Trials. - : Springer Science and Business Media LLC. - 1745-6215. ; 14:68
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Tidskriftsartikel (refereegranskat)abstract
- Background: Guided Internet-based cognitive-behavioral therapy (ICBT) has been found to be effective for social anxiety disorder (SAD) by several independent research groups. However, since the extent of clinically significant change demonstrated leaves room for improvement, new treatments should be developed and investigated. A novel treatment, which has generally been found to be effective, is cognitive bias modification (CBM). This study aims to evaluate the combination of CBM and ICBT. It is intended that two groups will be compared; one group randomized to receiving ICBT and CBM towards threat cues and one group receiving ICBT and control training. We hypothesize that the group receiving ICBT plus CBM will show superior treatment outcomes.Methods/design: Participants with SAD (N = 128), will be recruited from the general population. A composite score combining the scores obtained from three social anxiety questionnaires will serve as the primary outcome measure. Secondary measures include self-reported depression and quality of life. All treatments and assessments will be conducted via the Internet and measurement points will be baseline, Week 2, post-treatment, and 4 months post-treatment.Discussion: There is no direct evidence of the effects of combining CBM and ICBT in SAD. Adding attention-training sessions to ICBT protocols could increase the proportion of participants who improve and recover through Internet-based self-help.
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| 78. |
- Boettcher, Johanna, et al.
(författare)
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Combining attention training with Internet-based cognitive-behavioural self-help for social anxiety : a randomised controlled trial
- 2014
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Ingår i: Cognitive Behaviour Therapy. - : Taylor & Francis Group. - 1650-6073 .- 1651-2316. ; 43:1, s. 34-48
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Tidskriftsartikel (refereegranskat)abstract
- Guided Internet-based cognitive-behavioural self-help (ICBT) has been proven to be effective for social anxiety disorder (SAD) by several independent research groups. However, as the proportion of clinical significant change has room for improvement, new treatments should be developed and investigated. A novel treatment is attention bias modification (ABM). This study aimed at evaluating the combination of ABM and ICBT. We compared two groups, one group receiving ICBT and ABM targeting attentional avoidance and the other group receiving ICBT and control training. ABM and control training tasks were both based on the dot-probe paradigm. A total of 133 participants, diagnosed with SAD, were randomised to these two groups. The attention training group (N = 66) received 2 weeks of daily attention training followed by 9 weeks of ICBT. The control group (N = 67) received 2 weeks of daily control training, also followed by 9 weeks of ICBT. Social anxiety measures as well as the attention bias were assessed at pre-assessment, at week 2, and at post-treatment. Results showed no significant differences between the attention training group and the control group. Both groups improved substantially on social anxiety symptoms from pre- to post-assessment (dwithin = 1.39–1.41), but showed no change in attention processes (dwithin = 0.10–0.17). In this trial, the attention modification training failed to induce differential change in attention bias. Results demonstrate that the applied ABM procedure with its focus on the reduction of attentional avoidance was ineffective in the Internet-based setting. The results do not suggest that adding ABM targeting attentional avoidance to ICBT results in better outcomes than ICBT alone.
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| 79. |
- Boettcher, Johanna, et al.
(författare)
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Innovations in the Treatment of Social Anxiety Disorder
- 2017
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Social anxiety disorder (SAD) is a very common and disabling mental disorder. Cognitive-behaviour therapy (CBT) is first-line treatment and has a strong empirical basis. However, not all patients benefit from CBT. About one third of the treated patients do not respond to a sufficient degree (Rodebaugh, Holaway, & Heimberg, 2004). Additionally, access to CBT is often limited. Only a small minority of patients with SAD receives adequate, evidence-based treatment (e.g. Issakidis & Andrews, 2002). Hence, there is a pressing need to optimize existing treatment approaches and to lower treatment barriers. The planned symposium will present different approaches on how to make CBT more efficient and more available for patients with SAD. Treatments that are facilitated via the Internet have the potential to reach patients who are otherwise unlikely to receive adequate treatment (e.g. patients in remote areas, patients fearing stigmatization, patients too shy to initiate face-to-face contact). At the same time, technology-based interventions also help to bring important therapeutic techniques into practice. The first two talks will therefore focus on innovations in the field of Internet-based CBT for SAD and will present strategies to facilitate exposure exercises. Johanna Boettcher will present two studies on a newly developed app for SAD. In a gamified approach, the app guides and motivates patients to conduct exposure exercises in their natural environment. The second presentation will introduce virtual reality (VR) exposure therapy for social fears. Per Carlbring will present data on a RCT, evaluating the impact of a three-hour VR exposure session on public speaking anxiety. The third talk will present a different angle on how to improve treatment outcomes. Emma Warnock- Parks will outline how video-feedback can be optimized in the treatment of socially anxious patients in order to increase its impact on patients’ symptomatology. She will present data on the beneficial effect of video feedback on patients’ distorted self-images and will show ways how to make this technique even more powerful. Optimizing intervention techniques and contexts is one way to improve treatment of SAD. It is also important to consider external factors that may influence treatment adherence or outcome. In the last talk, Ulrike Willutzki will present data on a long-time neglected topic in SAD. She will demonstrate how the well-meant support of patients’ spouses can contribute to the maintenance of the disorder. She will discuss how partners can be educated and become involved in treatment helping the patient to overcome anxiety in difficult social situations. The planned symposium will offer four different strategies that can be implemented to improve cognitive-behavioural treatment techniques and to further the access to CBT. The symposium therefore contributes to a better understanding on how CBT for SAD can become more efficient in alleviating patients’ suffering.
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| 80. |
- Boettcher, Johanna, et al.
(författare)
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Internet-Based Attention Bias Modification for Social Anxiety: A Randomised Controlled Comparison of Training towards Negative and Training Towards Positive Cues
- 2013
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Ingår i: PLOS ONE. - : Public Library of Science. - 1932-6203. ; 8:9
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Tidskriftsartikel (refereegranskat)abstract
- Biases in attention processes are thought to play a crucial role in the aetiology and maintenance of Social Anxiety Disorder (SAD). The goal of the present study was to examine the efficacy of a programme intended to train attention towards positive cues and a programme intended to train attention towards negative cues. In a randomised, controlled, double-blind design, the impact of these two training conditions on both selective attention and social anxiety were compared to that of a control training condition. A modified dot probe task was used, and delivered via the internet. A total of 129 individuals, diagnosed with SAD, were randomly assigned to one of these three conditions and took part in a 14-day programme with daily training/control sessions. Participants in all three groups did not on average display an attentional bias prior to the training. Critically, results on change in attention bias implied that significantly differential change in selective attention to threat was not detected in the three conditions. However, symptoms of social anxiety reduced significantly from pre- to follow-up-assessment in all three conditions (d(within) = 0.63-1.24), with the procedure intended to train attention towards threat cues producing, relative to the control condition, a significantly greater reduction of social fears. There were no significant differences in social anxiety outcome between the training condition intended to induce attentional bias towards positive cues and the control condition. To our knowledge, this is the first RCT where a condition intended to induce attention bias to negative cues yielded greater emotional benefits than a control condition. Intriguingly, changes in symptoms are unlikely to be by the mechanism of change in attention processes since there was no change detected in bias per se. Implications of this finding for future research on attention bias modification in social anxiety are discussed. less thanbrgreater than less thanbrgreater thanTrial Registration: ClinicalTrials.gov NCT01463137
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