| 1. |
- Karyotaki, Eirini, et al.
(author)
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Internet-Based Cognitive Behavioral Therapy for Depression : A Systematic Review and Individual Patient Data Network Meta-analysis
- 2021
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In: JAMA psychiatry. - : American Medical Association. - 2168-6238 .- 2168-622X. ; 78:4, s. 361-371
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Research review (peer-reviewed)abstract
- IMPORTANCE: Personalized treatment choices would increase the effectiveness of internet-based cognitive behavioral therapy (iCBT) for depression to the extent that patients differ in interventions that better suit them.OBJECTIVE: To provide personalized estimates of short-term and long-term relative efficacy of guided and unguided iCBT for depression using patient-level information.DATA SOURCES: We searched PubMed, Embase, PsycInfo, and Cochrane Library to identify randomized clinical trials (RCTs) published up to January 1, 2019.STUDY SELECTION: Eligible RCTs were those comparing guided or unguided iCBT against each other or against any control intervention in individuals with depression. Available individual patient data (IPD) was collected from all eligible studies. Depression symptom severity was assessed after treatment, 6 months, and 12 months after randomization.DATA EXTRACTION AND SYNTHESIS: We conducted a systematic review and IPD network meta-analysis and estimated relative treatment effect sizes across different patient characteristics through IPD network meta-regression.MAIN OUTCOMES AND MEASURES: Patient Health Questionnaire-9 (PHQ-9) scores.RESULTS: Of 42 eligible RCTs, 39 studies comprising 9751 participants with depression contributed IPD to the IPD network meta-analysis, of which 8107 IPD were synthesized. Overall, both guided and unguided iCBT were associated with more effectiveness as measured by PHQ-9 scores than control treatments over the short term and the long term. Guided iCBT was associated with more effectiveness than unguided iCBT (mean difference [MD] in posttreatment PHQ-9 scores, -0.8; 95% CI, -1.4 to -0.2), but we found no evidence of a difference at 6 or 12 months following randomization. Baseline depression was found to be the most important modifier of the relative association for efficacy of guided vs unguided iCBT. Differences between unguided and guided iCBT in people with baseline symptoms of subthreshold depression (PHQ-9 scores 5-9) were small, while guided iCBT was associated with overall better outcomes in patients with baseline PHQ-9 greater than 9.CONCLUSIONS AND RELEVANCE: In this network meta-analysis with IPD, guided iCBT was associated with more effectiveness than unguided iCBT for individuals with depression, benefits were more substantial in individuals with moderate to severe depression. Unguided iCBT was associated with similar effectiveness among individuals with symptoms of mild/subthreshold depression. Personalized treatment selection is entirely possible and necessary to ensure the best allocation of treatment resources for depression.
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| 2. |
- Lindner, Philip, et al.
(author)
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Validation of the Internet-Administered Quality of Life Inventory (QOLI) in Different Psychiatric Conditions
- 2013
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In: Cognitive Behaviour Therapy. - : Informa UK Limited. - 1650-6073 .- 1651-2316. ; 42:4, s. 315-327
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Journal article (peer-reviewed)abstract
- The Quality of Life Inventory (QOLI) is an established rating scale of self-perceived quality of life across 16 domains. Norms for different psychiatric conditions when rated via the Internet, responsiveness to change following treatment, and the clinical impact of importance-weighting items have yet to be examined. To investigate these unanswered questions, important for the continued and expanded use of the QOLI, we compiled archival screening and post-treatment data from 20 studies featuring Internet-delivered psychological interventions for seven different psychiatric conditions and an undergraduate sample, totalling over 4000 participants. Disorder-specific norms were indicated by between-group analyses and are reported here, item-by-item. The QOLI showed adequate responsiveness to change and construct validity. Discrepancies were found when conducting between-group analyses with and without weighted items (more significant differences when items were not weighted) on both the screening and post-treatment data, suggesting that weighting is a procedure that is likely to have an impact when analysing QOLI results. Limitations and the needs for future research are discussed.
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| 3. |
- Vlaescu, George, et al.
(author)
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An E-Platform for Rehabilitation of Persons With Hearing Problems
- 2015
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In: American Journal of Audiology. - : AMER SPEECH-LANGUAGE-HEARING ASSOC. - 1059-0889 .- 1558-9137. ; 24:3, s. 271-275
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Journal article (peer-reviewed)abstract
- Purpose: The aim of this research forum article was to describe a feasible web-based solution for improving the quality of life of persons with hearing problems, such as hearing loss or tinnitus. The online platform was developed at the Department of Behavioural Sciences and Learning at Linköping University, Sweden, and has been running for a number of years and used in numerous studies and treatments. Method: The security aspects of the platform as well as the process flow for running a study or treatment are described, focusing primarily on the technical and practical considerations. Also presented are the design characteristics and the main features and functions available in the platform. Results: We point out the many advantages of running Internet-assisted intervention treatments, the challenges that we have faced, and some intended developments. Many of our research colleagues, both from Sweden and other countries, have already implemented or intend to implement their own studies on this platform. Conclusions: Audiological rehabilitation can be delivered via the Internet using a stable online platform. Security and usability are important factors to have in mind for the design as well as adaptability to the patients. A next development step is to implement and test blended treatments using video conferencing inside the platform.
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| 4. |
- Weineland, Sandra Mikaela, et al.
(author)
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Bridging the Gap Between Hearing Screening and Successful Rehabilitation : Research Protocol of a Randomized Controlled Trial of Motivational Interviewing via Internet
- 2015
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In: American Journal of Audiology. - : American Speech-Language-Hearing Association. - 1059-0889 .- 1558-9137. ; 24:3, s. 302-306
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Journal article (peer-reviewed)abstract
- Purpose: Studies point to low help-seeking after a failed hearing screening. This research forum article presents the research protocol for a randomized controlled trial of motivational interviewing via the Internet to promote help-seeking in people who have failed an online hearing screening. Method: Adults who fail a Swedish online hearing screening, including a speech-in-noise recognition test, will be randomized to either an intervention group (participating in motivational interviewing) or an active control group (reading a book on history of hearing aids). Both of the conditions will be delivered via the Internet. The primary outcome is experience with seeking health care and using hearing aids 9 months after the intervention. Secondary outcomes are changes in before and after measures of self-reported hearing difficulties, anxiety, depression, and quality of life. Stages of change and self-efficacy in hearing help-seeking are measured immediately after intervention and at a 9-month follow-up for the purpose of mediation analysis. Results: The results of this randomized controlled trial may help bridge the gap between hearing screening and successful hearing rehabilitation. Conclusion: Although no large instantaneous benefits are expected, a slow change toward healthy behaviors—seeking health care and using hearing aids—would shed light on how to use the Internet to assist people with hearing impairment.
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| 5. |
- Rafi, Jonas, 1985-
(author)
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A Workplace Prevention Program for Problem Gambling
- 2023
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Doctoral thesis (other academic/artistic)abstract
- Gambling is an activity that may involve harm for the gambler and others close to the gambler. Since workplaces may be negatively affected by employees who gamble during work or are at-risk problem gamblers, this setting has been proposed as a suitable arena for prevention. However, the potential effects of such initiatives have not been evaluated. This thesis explored the effects of a workplace prevention program for problem gambling. The program comprised gambling policy development and skill development training for managers.Study I used pre-intervention measures to explore gambling characteristics of employees (n=3629) in ten organizations, including both private and public sector organizations, and blue- and white-collar workers. About one in 20 employees knew someone who gambled during work, and this proportion was similar for both managers and subordinates. Another finding was that 3.5% of respondents were categorized as at-risk problem gamblers, with a higher prevalence among subordinates (3.8%) than managers (1.3%). A third finding was that 11.4% of employees stated that the organization had a gambling policy, and that this did not differ between managers and subordinates. Gambling policy knowledge was considerably lower than alcohol policy knowledge, as an alcohol policy was believed to exist by 94.3% of managers and 63.3% of subordinates. Lastly, in regression analyses, the two outcomes “knowing about a colleague who gambles during work” and “at-risk/problem gambling” were associated with each other, male gender, and young age. Taken together, the findings offer evidence that gambling may be an important topic to target in workplace settings, although more research is needed to pinpoint specific workplace harms and whether certain gambling types are associated with more workplace harms than others.Study II used a cluster-randomized design to investigate the effects of a prevention program. Ten organizations were randomized to an intervention group or a waitlist group. Individuals who were employed on any of three measurement occasions were eligible to participate. A total of n=490 (response rate 73%) managers and n = 4146 (response rate 43.3%) subordinates participated in the study by providing informed consent and responding to the survey at least once. The prevention program included two main components: policy development and skill development training for managers. The main outcome was managers’ inclination to act when worried about an employee regarding gambling or other harmful use (e.g., alcohol), together with a range of secondary outcome measures. The results showed that managers who participated in the skill development training significantly increased their inclination to act compared to the waitlist group, but this finding was not generalized to the whole intervention group. Thus, including managers in the intervention group who did not participate in the skill development training when calculating intervention effects resulted in non-significant effects. The results of secondary outcome measures showed that there were significant intervention effects regarding managers’ knowledge of a gambling policy, their confidence in how to act when concerned about an employee’s possible problem gambling or other harmful use, and the proportion of managers who had acted to provide support. Study III included semi-structured interviews with skill development participants (n=23) to inquire about their experiences of the prevention program. Interviews were transcribed and analyzed using qualitative content analysis, which yielded six distinct themes related to the participants, namely: 1) their expectations, 2) aspects of the skill development training they appreciated, 3) their experiences of PG, 4) their proposed areas of improvement, 5) whether they felt they had received a good basis for PG and other harmful use, and 6) their thoughts about the so-called “difficult conversation”. Taken together, the findings provide ideas for improving gambling-specific interventions for the workplace and corroborate earlier research findings on workplace interventions in general.To conclude, the thesis shows that a workplace preventive intervention for gambling can have positive effects on managers’ intended and performed actions to help an employee who they suspect has a problem with gambling or other harmful use. However, further program improvements and in-depth studies are needed to draw conclusions on explanations, robustness, and mechanisms of change.
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| 6. |
- Berman, Anne H., et al.
(author)
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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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In: Journal of medical systems. - : Springer Netherlands. - 0148-5598 .- 1573-689X. ; 36:3, s. 1031-1042
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Journal article (peer-reviewed)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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| 7. |
- Böttcher, Johanna, et al.
(author)
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Adding a smartphone app to internet-based self-help for social anxiety : A randomized controlled trial
- 2018
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In: Computers in human behavior. - : Elsevier BV. - 0747-5632 .- 1873-7692. ; 87, s. 98-108
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Journal article (peer-reviewed)abstract
- Background: Increasing access to treatment via smartphone apps is an important topic in Social Anxiety Disorder (SAD). ‘Challenger’ is an app promoting exposure exercises in daily life. The present study evaluated the additional benefit of using the app as adjunct to Internet-based unguided self-help for SAD. In a second step, we also tested how the app and the self-help programme (SH) should best be combined.Method: 209 patients diagnosed with SAD were randomly allocated to three groups. Group 1 received the app and the self-help programme for six weeks (parallel treatment), group 2 first received SH for six weeks and then the app for six weeks (sequential treatment). Group 3 was a wait-list group. Comparisons were made at week 7 evaluating the potential add-on effect of the app (SH plus app versus SH only) and at week 14 comparing the parallel to the sequential treatment. Participants filled in questionnaires prior, during, and post treatment, and at 4- and 12- months follow-up.Results: Intention-to-treat analyses showed no significant effect of adding the app to Internet-based self-help. However, among participants actively using the app, adding Challenger to self-help resulted in significantly less social anxiety (d = 0.30). At week 14, decreases in social anxiety were large for both the parallel and the sequential group with no differences between the active groups (dwithin = 1.12–1.19). Changes were maintained throughout the follow-up period.Conclusion: Results of the current study cautiously support the notion of adding a smartphone app to unguided self-help for SAD. Future studies should investigate how patients can be motivated to use the app more frequently.
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| 8. |
- Ma, Lichen, et al.
(author)
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Attentional Bias Modification in Virtual Reality : A VR-Based Dot-Probe Task With 2D and 3D Stimuli
- 2019
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In: Frontiers in Psychology. - : Frontiers Media SA. - 1664-1078. ; 10
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Journal article (peer-reviewed)abstract
- Background: Attentional bias modification (ABM) aims to reduce anxiety by attenuating bias toward threatening information. The current study incorporated virtual reality (VR) technology and three-dimensional stimuli with a dot-probe task to evaluate the effects of a VR-based ABM training on attentional bias and anxiety symptoms.Methods: A total of 100 participants were randomized to four training groups. Attentional bias was assessed at pre- and post-training, and anxiety symptoms were assessed at pre-training, post-training, 1-week follow-up, and 3-months follow-up.Results: Change in anxiety did not correlate with change in bias (p = 0.24). A repeated-measures ANOVA showed no significant difference in bias from pre- to post-ABM (p = 0.144), or between groups (p = 0.976). For anxiety symptoms, a linear mixed-effects model analysis revealed a significant effect of time. Participants showed reduction in anxiety score at each successive assessment (p < 0.001). However, no other significant main effect or interactions were found. A clinically significant change analysis revealed that 9% of participants were classified as ‘recovered’ at 3-months follow-up.Conclusion: A single session of VR-based ABM did not change attentional bias. The significant reduction in anxiety was not specific to active training, and the majority of participants remained clinically unchanged.
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| 9. |
- Molander, Olof, et al.
(author)
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Internet-based cognitive behavior therapy for problem gambling in routine care : protocol for a non-randomized pilot and feasibility trial
- 2020
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In: Pilot and Feasibility Studies. - : Springer Science and Business Media LLC. - 2055-5784. ; 6
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Journal article (peer-reviewed)abstract
- Background: Problem gambling and gambling disorder are major public health concerns worldwide, and awareness of associated negative consequences is rising. In parallel, treatment demand has increased, and Internet interventions offer a promising alternative for providing evidence-based treatment at scale to a low cost.Method: We developed a novel Internet-delivered cognitive behavioral treatment for gambling, based on qualitative interviews with treatment-seeking gamblers, behavioral research on gambling behavior, and the pathway model for problem gambling. This research protocol describes a non-randomized pilot and feasibility trial conducted in routine addiction care with adult treatment-seeking patients (max N = 25) with problem gambling. The primary aim is to ensure acceptability and safety, measured by satisfaction, credibility, working alliance, and possible negative effects. Secondary aims are feasibility of study procedures in terms of recruitment and measurement procedures as well as potential effectiveness measured weekly by gambling symptoms as primary outcome and gambling behavior, quality of life, symptoms of depression and anxiety, alcohol, and drug use as secondary outcomes. Potential mediators measured weekly are loss of control, verbal rules, and well-being.Discussion: This study is innovative in several respects, regarding both treatment development and implementation. The results of the study will guide a future randomized controlled trial, as well as the development of the intervention and intervention implementation within ordinary addiction care.Trial registration: Clinical trials.gov, NCT ID: NCT03946098. Registered 10 May 2019
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| 10. |
- Månsson, Viktor, et al.
(author)
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Emotion regulation-enhanced group treatment for gambling disorder : a non-randomized pilot trial
- 2022
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In: BMC Psychiatry. - : Springer Science and Business Media LLC. - 1471-244X. ; 22:1
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Journal article (peer-reviewed)abstract
- Background: Despite the association of Gambling Disorder (GD) with poor mental health, treatment options generally lack components targeting emotional difficulties. This study investigated the feasibility and acceptability of adding strategies of emotion regulation to an eight-session weekly group treatment.Method: This non-randomized pilot study recruited 21 treatment-seeking adults with GD, (mean age = 36.3, 19% females) from addiction care. In a mixed methods design, measures of within-group changes in self-reported symptoms of GD were complemented with thematic analysis of post-treatment interviews regarding the feasibility of the treatment.Results: Within-group scores on the Gambling Symptoms Assessment Scale (G-SAS) showed a 47% decrease (β: -0.1599, 95% CI: − 0.2526 to − 0.0500) from pre-treatment to 12-month follow-up, with Hedges’ g = 1.07 (CI: 0.57–1.60).The number of GD-symptoms according to the Structured Clinical Interview for Gambling Disorder (SCI-GD) decreased from 7.0 (SD = 1.60) at pre-treatment to 2.1 (SD = 2.36) at 12-month follow-up. Participants completed an average of 6.3 sessions and rated the intervention high in satisfaction and acceptability. Feasibility interviews showed no noticeable negative effects or ethical issues. Furthermore, helpful components in the treatment were: increased awareness of emotional processes and strategies to deal with difficult emotions.Conclusions: Adding emotion regulation strategies in the treatment of GD is feasible and acceptable and warrants further investigation in a controlled trial.Trial registration: This study was registered with ClinicalTrials.gov (Identifier NCT03725735).
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