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Proof of Concept fo...
Proof of Concept for an Adaptive Treatment Strategy to Prevent Failures in Internet-Delivered CBT : A Single-Blind Randomized Clinical Trial With Insomnia Patients
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- Forsell, Erik (författare)
- Karolinska Institutet,Karolinska Inst, Sweden; Huddinge Hosp, Sweden
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- Jernelov, Susanna (författare)
- Karolinska Institutet,Karolinska Inst, Sweden; Huddinge Hosp, Sweden; Karolinska Inst, Sweden
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- Blom, Kerstin (författare)
- Karolinska Institutet,Karolinska Inst, Sweden; Huddinge Hosp, Sweden
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- Kraepelien, Martin (författare)
- Karolinska Institutet,Karolinska Inst, Sweden; Huddinge Hosp, Sweden
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- Svanborg, Cecilia (författare)
- Karolinska Institutet,Karolinska Inst, Sweden; Huddinge Hosp, Sweden
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- Andersson, Gerhard (författare)
- Linköpings universitet,Karolinska Institutet,Psykologi,Filosofiska fakulteten,Karolinska Inst, Sweden; Huddinge Hosp, Sweden
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- Lindefors, Nils (författare)
- Karolinska Institutet,Karolinska Inst, Sweden; Huddinge Hosp, Sweden
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- Kaldo, Viktor (författare)
- Linnéuniversitetet,Institutionen för psykologi (PSY),Karolinska Institutet, Sweden;Huddinge Hospital, Sweden,DISA;DISA-IDP,Karolinska Inst, Sweden; Huddinge Hosp, Sweden; Linnaeus Univ, Sweden
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(creator_code:org_t)
- American Psychiatric Association Publishing, 2019
- 2019
- Engelska.
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Ingår i: American Journal of Psychiatry. - : American Psychiatric Association Publishing. - 0002-953X .- 1535-7228. ; 176:4, s. 315-323
- Relaterad länk:
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https://doi.org/10.1...
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https://ajp.psychiat...
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https://urn.kb.se/re...
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https://doi.org/10.1...
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http://kipublication...
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https://urn.kb.se/re...
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Abstract
Ämnesord
Stäng
- Objective: This study aimed to demonstrate proof of concept for an adaptive treatment strategy in Internet-delivered cognitive-behavioral therapy (ICBT), where risk of treatment failure is assessed early in treatment and treatment for at-risk patients is adapted to prevent treatment failure. Methods: A semiautomated algorithm assessed risk of treatment failure early in treatment in 251 patients undergoing ICBT for insomnia with therapist guidance. At-risk patients were randomly assigned to continue standard ICBT or to receive adapted ICBT. The primary outcome was self-rated insomnia symptoms using the Insomnia Severity Index in a linear mixed-effects model. The main secondary outcome was treatment failure (having neither responded nor remitted at the posttreatment assessment). Results: A total of 102 patients were classified as at risk and randomly assigned to receive adapted ICBT (N=51) or standard ICBT (N=51); 149 patients were classified as not at risk. Patients not at risk had significantly greater score reductions on the Insomnia Severity Index than at-risk patients given standard ICBT. Adapted ICBT for at-risk patients was significantly more successful in reducing symptoms compared with standard ICBT, and it decreased the risk of failing treatment (odds ratio= 0.33). At-risk patients receiving adapted ICBT were not more likely to experience treatment failure than those not at risk (odds ratio= 0.51), though they were less likely to experience remission. Adapted treatment required, on average, 14 more minutes of therapist-patient time per remaining week. Conclusions: An adaptive treatment strategy can increase treatment effects for at-risk patients and reduce the number of failed treatments. Future studies should improve accuracy in classification algorithms and identify key factors that boost the effect of adapted treatments.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Psykiatri (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Psychiatry (hsv//eng)
Nyckelord
- Psychology
- Psykologi
Publikations- och innehållstyp
- ref (ämneskategori)
- art (ämneskategori)
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