| 1. |
- Karyotaki, Eirini, et al.
(författare)
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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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Ingår i: JAMA psychiatry. - : American Medical Association. - 2168-6238 .- 2168-622X. ; 78:4, s. 361-371
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Forskningsöversikt (refereegranskat)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.
(författare)
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Validation of the Internet-Administered Quality of Life Inventory (QOLI) in Different Psychiatric Conditions
- 2013
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Ingår i: Cognitive Behaviour Therapy. - : Informa UK Limited. - 1650-6073 .- 1651-2316. ; 42:4, s. 315-327
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Tidskriftsartikel (refereegranskat)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.
(författare)
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An E-Platform for Rehabilitation of Persons With Hearing Problems
- 2015
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Ingår i: American Journal of Audiology. - : AMER SPEECH-LANGUAGE-HEARING ASSOC. - 1059-0889 .- 1558-9137. ; 24:3, s. 271-275
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Tidskriftsartikel (refereegranskat)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.
(författare)
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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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Ingår i: American Journal of Audiology. - : American Speech-Language-Hearing Association. - 1059-0889 .- 1558-9137. ; 24:3, s. 302-306
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Tidskriftsartikel (refereegranskat)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-
(författare)
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A Workplace Prevention Program for Problem Gambling
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)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. |
- Andersson, Evelyn, et al.
(författare)
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Genetic Polymorphisms in Monoamine Systems and Outcome of Cognitive Behavior Therapy for Social Anxiety Disorder
- 2013
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 8:11
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveThe role of genetics for predicting the response to cognitive behavior therapy (CBT) for social anxiety disorder (SAD) has only been studied in one previous investigation. The serotonin transporter (5-HTTLPR), the catechol-o-methyltransferase (COMT) val158met, and the tryptophan hydroxylase-2 (TPH2) G-703Tpolymorphisms are implicated in the regulation of amygdala reactivity and fear extinction and therefore might be of relevance for CBT outcome. The aim of the present study was to investigate if these three gene variants predicted response to CBT in a large sample of SAD patients.MethodParticipants were recruited from two separate randomized controlled CBT trials (trial 1: n = 112, trial 2: n = 202). Genotyping were performed on DNA extracted from blood or saliva samples. Effects were analyzed at follow-up (6 or 12 months after treatment) for both groups and for each group separately at post-treatment. The main outcome measure was the Liebowitz Social Anxiety Scale Self-Report.ResultsAt long-term follow-up, there was no effect of any genotype, or gene × gene interactions, on treatment response. In the subsamples, there was time by genotype interaction effects indicating an influence of the TPH2 G-703T-polymorphism on CBT short-term response, however the direction of the effect was not consistent across trials.ConclusionsNone of the three gene variants, 5-HTTLPR, COMTval158met and TPH2 G-703T, was associated with long-term response to CBT for SAD.
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| 7. |
- Andersson, Gerhard, et al.
(författare)
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A 3.5-year follow-up of Internet-delivered cognitive behavior therapy for major depression
- 2013
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Ingår i: Journal of Mental Health. - London, UK : Informa Healthcare. - 0963-8237 .- 1360-0567. ; 22:2, s. 155-164
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundInternet-delivered cognitive behavior therapy (ICBT) for major depression has been tested in several trials, but only with follow-ups up to 1.5 years.AimThe aim of this study was to evaluate the outcome of ICBT 3.5 years after treatment completion.MethodsA total of 88 people with major depression were randomized to either guided self-help or e-mail therapy in the original trial. One-third was initially on a waiting-list. Treatment was provided for eight weeks and in this report long-term follow-up data were collected. Also included were data from post-treatment and six-month follow-up. A total of 58% (51/88) completed the 3.5-year follow-up. Analyses were performed using a random effects repeated measures piecewise growth model to estimate trajectory shape over time and account for missing data.ResultsResults showed continued lowered scores on the Beck Depression Inventory (BDI). No differences were found between the treatment conditions. A large proportion of participants (55%) had sought and received additional treatments in the follow-up period. A majority (56.9%) of participants had a BDI score lower than 10 at the 3.5-year follow-up.ConclusionsPeople with mild to moderate major depression may benefit from ICBT 3.5-years after treatment completion.
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| 8. |
- Andersson, Gerhard, 1966-, et al.
(författare)
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Lars-Göran Öst
- 2013
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Ingår i: Cognitive Behaviour Therapy. - : Informa UK Limited. - 1650-6073 .- 1651-2316. ; 42:4, s. 260-264
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Tidskriftsartikel (refereegranskat)abstract
- Lars-Göran Öst is one of the most eminent clinical researchers in the field of cognitive behaviour therapy (CBT) and a founder of CBT in Sweden. He has recently retired from his position as professor in clinical psychology at Stockholm University, Sweden. In this paper, we sketch a brief description of the body of work by Öst. Examples of his innovative and pioneering new treatment methods include the one-session treatment for specific phobias, as well as applied relaxation for a range of anxiety disorders and health conditions. While Öst remains active in the field, he has contributed significantly to the development and dissemination of CBT in Sweden as well as in the world.
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| 9. |
- Andersson, Gerhard, et al.
(författare)
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Randomised controlled non-inferiority trial with 3-year follow-up of internet-delivered versus face-to-face group cognitive behavioural therapy for depression
- 2013
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Ingår i: Journal of Affective Disorders. - : Elsevier. - 0165-0327 .- 1573-2517. ; 151:3, s. 986-994
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Tidskriftsartikel (refereegranskat)abstract
- Background: Guided internet-delivered cognitive behaviour therapy (ICBT) has been found to be effective in the treatment of mild to moderate depression, but there have been no direct comparisons with the more established group-based CBT with a long-term follow-up. less thanbrgreater than less thanbrgreater thanMethod: Participants with mild to moderate depression were recruited from the general population and randomized to either guided ICBT (n =33) or to live group treatment (n=36). Measures were completed before and after the intervention to assess depression, anxiety, and quality of life. Follow-ups were conducted at one-year and three-year after the treatment had ended. Results: Data were analysed on an intention-to-treat basis using linear mixed-effects regression analysis. less thanbrgreater than less thanbrgreater thanResults on the self-rated version of the Montgomery-Asberg Depression Scale showed significant improvements in both groups across time indicating non-inferiority of guided ICBT, and there was even a tendency for the guided ICBT group to be superior to group-based CBT at three year follow-up. Within-group effect sizes for the ICBT condition at post treatment showed a Cohens d=1.46, with a similar large effect at 3-year follow-up, d=1.78. For the group CBT the corresponding within group effects were d =0.99 and d=1.34, respectively. less thanbrgreater than less thanbrgreater thanLimitations: The study was small with two active treatments and there was no placebo or credible control condition. less thanbrgreater than less thanbrgreater thanConclusions: Guided ICBT is at least as effective as group based CBT and long-term effects can be sustained up to 3 years after treatment.
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| 10. |
- Andersson, Gerhard, 1966-, et al.
(författare)
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Special Issue in Honour of Lars-Göran Öst : Editorial
- 2013
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Ingår i: Cognitive Behaviour Therapy. - : Informa UK Limited. - 1650-6073 .- 1651-2316. ; 42:4, s. 259-259
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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