| 1. |
- Carlbring, Per, et al.
(författare)
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A randomized controlled trial of Internet-based CBT for perfectionism including an investigation of outcome predictors
- 2017
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Ingår i: Program Book. ; , s. 128-128
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Konferensbidrag (refereegranskat)abstract
- Being highly attentive to details can be a positive feature. However, for some individuals, perfectionism can lead to distress and is associated with many psychiatric disorders. Cognitive behavior therapy has been shown to yield many benefits for those experiencing problems with perfectionism, but the access to evidence-based care is limited. The current study investigated the efficacy of guided Internet-based Cognitive Behavior Therapy (ICBT) and predictors of treatment outcome. In total, 156 individuals were included and randomized to an eight-week treatment or wait-list control. Self-report measures of perfectionism, depression, anxiety, self-criticism, self-compassion, and quality of life were distributed during screening and at post-treatment. Intention-to-treat were used for all statistical analyses. Moderate to large between-group effect sizes were obtained for the primary outcome measures, Frost Multidimensional Perfectionism Scale, subscales Concerns over Mistakes and Personal Standards, Cohen’s d = 0.68-1.00, 95% Confidence Interval (CI) [0.36-1.33], with 35 (44.9%) of the patients in treatment being improved. Predictors were also explored, but none were related to treatment outcome. In sum, guided ICBT can be helpful for addressing problems with clinical perfectionism, but research of its long-term benefits is warranted.
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| 2. |
- Andersson, Gerhard, et al.
(författare)
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How well does internet-based CBT work for depression in Sweden? A patient-level meta-analysis
- 2023
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Ingår i: Abstracts and Program Parallel Sessions. ; , s. 50-51
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Konferensbidrag (refereegranskat)abstract
- Background: Several studies and meta-analysis suggest that ICBT works for patients with mild to moderate depression/depressive symptoms. Given the quality of the data is is now possible to conduct IPMAs. Several IPMAs have been published with data from different countries. A problem with that approach is the some studies may be left out as data are not provided. The aim of this IPMA was to study the effects focusing on Swedish data only with less loss of data/studies.Methods: We were able to include data from 16 studies with a total of 2952 participants. Missing data were imputed. The overall effect-size for nine studies compared to wait-list was d = 0.63 95 % CI [0.48, 0.78] and within-group effect-size for 15 studies d = 1.17 95 % CI [1.11, 1.22]. The results were surprisingly similar across different subgroups. Women had on average more symptoms before treatment and also reported a larger symptom decrease after treatment.Conclusions: Results show a large effect of ICBT on depressive symptoms in a Swedish setting, including in routine care. This meta-analysis supports treatment of depressive symptoms with ICBT in Sweden.
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| 3. |
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| 4. |
- Boettcher, Johanna, et al.
(författare)
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Primun non nocere : Side effects in psychological treatments
- 2018
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Psychological treatments help patients overcome mental health problems. Thousands of studies document the positive effects of psychotherapeutic interventions. The potential of these same interventions to cause harm, on the other hand, has scarcely been subject to scientific investigation. The nature and frequency of side effects of psychological treatments are largely unknown. The present symposium aims at shedding light on some important questions concerning negative effects: How should side effects be defined? What are typical side effects? How frequent are side effects in different treatment formats? And how can side effects be effectively measured? In the first presentation, Michael Linden will speak about side effects in group therapy and will report data from two different group therapy formats. Johanna Boettcher will focus on side effects of individual therapy for depression. She will present data from a large trial of Internet-based therapy and will summarize a qualitative analysis of the patients’ experience of negative effects. Steve Hollon will talk specifically about one particular side effect, the deterioration of targeted symptoms. He will report results of an individual patient data meta-analysis and compare rates of deterioration in cognitive-behaviour therapy and pharmacotherapy. Finally, Alexander Rozental will present a new questionnaire for the assessment of negative effects and will demonstrate its psychometric properties in a Rasch analysis.
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| 5. |
- Carlbring, Per, et al.
(författare)
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Adverse effects in internet-based cognitive-behavior versus psychodynamic therapy
- 2022
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Ingår i: EABCT 2022: Re-Thinking CBT: providing startegies for a new way of living. ; , s. 66-66
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background: Internet-based psychological treatments provide many benefits for patients with psychiatric disorders, but research also suggests that negative effects might occur from the interventions involved.Methods: A total of 2400 participants presenting with anxiety and/or depression were randomized into 12 subgroups (n=200 each) based on treatment modality (Cognitive Behavior Therapy vs. Psychodynamic Therapy vs. Waitlist), duration (8 vs. 16 weeks), and moderated discussion forum (Yes vs. No). In addition to weekly measurements of the primary outcome measure (PHQ-9 & GAD-7), the Negative Effects Questionnaire was administered post-treatment. The Negative Effects Questionnaire has been proposed as a valuable instrument for investigating the negative effects of psychological treatments. An exploratory factor analysis suggested a six-factor solution: symptoms (“I felt more worried”), quality (“I did not always understand my treatment”), dependency (“I think that I have developed a dependency on my treatment”), stigma (“I became afraid that other people would find out about my treatment”), hopelessness (“I started thinking that the issue I was seeking help for could not be made any better”), and failure (“I lost faith in myself”).Results: All 2400 participants have been recruited. However, all post-assessment data is not yet collected at the time of writing (but will be by the time of the conference). This talk will focus on the occurrence and characteristics of the potential negative effects of internet-based treatment in the 12 subgroups.Discussion: Negative effects of psychotherapy are multifaceted, warranting careful considerations for them to be monitored and reported in research settings and routine care.
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| 6. |
- Carlbring, Per, et al.
(författare)
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Consensus statement on defining and measuring negative effects of Internet interventions
- 2014
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Konferensbidrag (refereegranskat)abstract
- Background: Internet interventions have great potential for alleviating emotional distress, promoting mental health, and enhancing well-being. Numerous clinical trials have demonstrated their effectiveness for a number of psychiatric conditions, and interventions delivered via the Internet will likely become a common alternative to face-to-face treatment. Meanwhile, research has paid little attention to the negative effects associated with treatment, warranting further investigation of the possibility that some patients might deteriorate or encounter adverse events despite receiving best available care. Evidence from research of face-to-face treatment suggests that negative effects afflict 5-10% of all patients undergoing treatment in terms of deterioration.Objective: There is currently a lack of consensus on how to define and measure negative effects in psychotherapy research in general, leaving researchers without practical guidelines for monitoring and reporting negative effects in clinical trials. The current study therefore sought out to provide recommendations that could promote the study of negative effects in Internet interventions with the aim of increasing the knowledge of its occurrence and characteristics.Methods: Ten experts in the field of Internet interventions were invited to participate and share their perspective on how to explore negative effects, using the Delphi technique to facilitate a dialogue and reach an agreement. The authors discuss the importance of conducting research on negative effects in order to further the understanding of its incidence and different features.Results: Suggestions on how to classify and measure negative effects in Internet interventions are proposed, involving methods from both quantitative and qualitative research. Potential mechanisms underlying negative effects are also discussed, differentiating common factors shared with face-to-face treatments from those unique to treatments delivered via the Internet.Conclusions: We conclude that negative effects are to be expected and need to be acknowledged to a greater extent, advising researchers to systematically probe for negative effects whenever conducting clinical trials involving Internet interventions, as well as to share their findings in scientific journals.
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| 7. |
- Carlbring, Per, et al.
(författare)
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Internet-Based vs. Face-to-Face CBT : Systematic Review and Meta-Analysis
- 2018
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Konferensbidrag (refereegranskat)abstract
- During the last two decades, Internet-delivered cognitive behavior therapy (ICBT) has been tested in hundreds of randomized controlled trials, often with promising results. However, the control groups were often waitlist, care-as-usual or attention control. Hence, little is known about the relative efficacy of ICBT as compared to face-to-face cognitive behavior therapy (CBT). In addition, the long-term effects of ICBT is largely unknown.In this presentation a systematic review and meta-analysis, which included 1418 participants, will be presented. Out of the 2078 articles screened, a total of 20 studies met all inclusion criteria. These included studies on social anxiety disorder, panic disorder, depression, body dissatisfaction etc. Results showed a pooled effect size at post-treatment of Hedges g = 0.05 (95% CI, -0.09 to 0.20), indicating that ICBT and face-to-face treatment produced equivalent overall effects.We also reviewed studies in which the long-term effects of guided ICBT were investigated. Following a new set of literature searches in PubMed and other sources meta-analytic statistics were calculated for 14 studies involving a total of 902 participants, and an average follow-up period of three years. The duration of the actual treatments was usually short (8-15 weeks). The pre-to follow-up (>2 yrs) effect size was Hedge’s g = 1.52, but with a significant heterogeneity. The average symptom improvement across studies was 50%.While the overall results indicate equivalence, there have been few studies of the individual psychiatric and somatic conditions so far, and for the majority, guided ICBT has not been compared against face-to-face treatment. Thus, more research, preferably with larger sample sizes, is needed to establish the general equivalence of the two treatment formats. While effects may be overestimated, it is likely that therapist-supported ICBT can have enduring effects.
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| 8. |
- Carlbring, Per, et al.
(författare)
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Practicing clinicians' understanding and experiences of negative effects in psychotherapy
- 2014
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Konferensbidrag (refereegranskat)abstract
- Introduction: Research of psychotherapy has primarily focused on examining its efficacy and effectiveness for different psychiatric disorders. Hence, little is known about its potential for generating negative effects among patients undergoing treatment, even though some evidence suggest that 5-10% of all patients experience negative effects in terms of deterioration alone. Meanwhile, other types of adverse events might exist as well, e.g., social stigma, lower self-esteem, and less self-reliance. However, the knowledge of negative effects is currently scarce, and research has found that many practicing clinicians do not acknowledge that some patients might fare worse during treatment. Investigating practicing clinicians’ understanding and experiences of negative effects is therefore important in order to raise awareness of its occurrence and characteristics.Method: Participants were recruited through the Swedish Society for Behavior Therapy, the Section for Cognitive Behavior Therapy within the Swedish Psychological Association, and students attending the psychotherapist program at Stockholm University. Seventy four participants completed an online survey regarding negative effects of psychotherapy. The responses were analyzed using thematic analysis.Results: A majority of the participants believed that negative effects of psychotherapy exist, and some had personal experiences of patients encountering adverse events during treatment. Few received information about negative effects during their basic training in psychotherapy. Common negative effects were described as discomfort, lack of treatment effect, deterioration, dependency, and invasiveness. Possible causal factors were incompetence or inadequately applied methods, harmful treatment interventions, insufficient working alliance, among others. Only one participant was able to mention methods for monitoring negative effects during treatment.Conclusion: Practicing clinicians recognize that negative effects could pose a problem, but few were informed of its existence during their basic training in psychotherapy or know who to monitor it during treatment, warranting an increased awareness of negative effects among future clinicians.
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| 9. |
- Carlbring, Per, et al.
(författare)
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Side effects in Internet-based interventions for social anxiety disorder
- 2014
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Konferensbidrag (refereegranskat)abstract
- Background: Internet-based interventions are effective in the treatment of various mental disorders and have already been integrated in routine health care in some countries. Empirical data on potential negative effects of these interventions is lacking.Objective: This study investigated side effects in an Internet-based treatment for Social Anxiety Disorder (SAD).Methods: A total of 133 individuals diagnosed with SAD took part in an 11-week guided treatment. Side effects were assessed as open formatted questions after week 2 and at post-treatment after week 11. Answers were independently rated by two coders. In addition, rates of deterioration and non-response were calculated for primary social anxiety and secondary outcome measures (depression and quality of life).Results: In total, 19 participants (14%) described unwanted negative events that they related to treatment. The emergence of new symptoms was the most commonly experienced side effect, followed by the deterioration of social anxiety symptoms and negative well-being. The large majority of the described side effects had a temporary but no enduring negative effect on participants’ well-being. At post-treatment, none of the participants reported deterioration on social anxiety measures and 0-7% deteriorated on secondary outcome measures. Non-response was frequent with 32-50% for social anxiety measures and 57-90% for secondary outcomes at post-assessment.Conclusions: Results suggest that a small proportion of participants in Internet-based interventions experiences negative effects during treatment. Information about potential side effects should be integrated in patient education in the practice of Internet-based treatments.
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| 10. |
- Fernández-Alvarez, J., et al.
(författare)
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Deterioration rates in virtual reality therapy : An individual patient data meta-analysis and implications for research and practice
- 2018
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Ample evidence supports the use of Virtual Reality for anxiety disorders. Throughout 20 years of research there have continuous advancements, not only in the quality of studies but also in the diversity of populations included as well as the technological progresses developed. All those steps forwards are accurately compiled in several meta-analysis, reviews and chapters. Nonetheless, there is no evidence yet on the potential negative effects and its moderators that Virtual Reality treatment strategies can provoke.From the diversity of negative effects’ operationalizations, this study uses the deterioration rates concept defined as the worsening of the clinical symptomatology from the pre-test scores to the post-test scores using the Reliable Change Index (RCI). An individual patient data meta-analyses (IPDMA) approach that systematically reviewed all the randomized control trials in Virtual Reality and gathered 16 datasets from the total 35 studies conducted within the field of research. A total of 846 patients constitutes the sample of the study. RCI’s for each primary outcome measure is performed as well as moderator analyses for demographic variables. In this talk the results will be discussed in terms of their clinical and research implications regarding the current status and future challenges of Virtual Reality therapy in the clinical psychology realm.
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