| 1. |
- Dirkse, D., et al.
(författare)
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Linguistic Analysis of Communication in Therapist-Assisted Internet-Delivered Cognitive Behavior Therapy for Generalized Anxiety Disorder
- 2015
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Ingår i: Cognitive Behaviour Therapy. - : Routledge. - 1650-6073 .- 1651-2316. ; 44:1, s. 21-32
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Tidskriftsartikel (refereegranskat)abstract
- Therapist-assisted Internet-delivered cognitive behavior therapy (ICBT) involves elements of expressive writing through secure messaging with a therapist. Expressive writing has been associated with psychological and physical health benefits in past research; furthermore, certain linguistic dimensions in expressive writing have been identified as particularly beneficial to health, such as less frequent use of negative emotion words and greater use of positive emotion words. No research, to date, has analyzed linguistic dimensions in client communication over the course of therapist-assisted ICBT for individuals with symptoms of generalized anxiety. This naturalistic study examined messages sent to therapists during the course of ICBT using linguistic analysis, and explored covariation of word use with symptom improvement. Data were obtained from patients with symptoms of generalized anxiety (N=59) who completed 12 modules of therapist-assisted ICBT and rated symptoms of anxiety, depression, and panic at the beginning of each module. Linguistic analysis categorized text submitted to therapists into different word categories. Results found that patients' use of negative emotion, anxiety, causation, and insight words reduced over the course of treatment, while past tense words increased. Furthermore, negative emotion words significantly covaried with symptom ratings over the course of treatment. While causal statements cannot be made, findings improve our understanding of patient communication in ICBT and suggest that the further study of linguistic dimensions as psychological indicators and the potential utility of expressive writing strategies in therapist-assisted ICBT may be worthwhile.
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| 2. |
- Hesser, Hugo, et al.
(författare)
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Predicting Response to Therapist-Assisted Internet-Delivered Cognitive Behavior Therapy for Depression or Anxiety Within an Open Dissemination Trial
- 2016
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Ingår i: Behavior Therapy. - : Elsevier. - 0005-7894 .- 1878-1888. ; 47:2, s. 155-165
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Tidskriftsartikel (refereegranskat)abstract
- Therapist-assisted Internet-delivered cognitive behavior therapy (ICBT) is efficacious for treating anxiety and depression, but predictors of response to treatment when delivered in clinical practice are not well understood. In this study, we explored demographic, clinical, and program variables that predicted modules started and symptom improvement (i.e., Generalized Anxiety Disorder-7 or Patient Health Questionnaire-9 total scores over pre-, mid-, and posttreatment) within a previously published open dissemination trial (Hadjistavropoulos et al., 2014). The sample consisted of 195 patients offered 12 modules of therapist-assisted ICBT for depression or generalized anxiety; ICBT was delivered by therapists working in six geographically dispersed clinics. Consistent across ICBT for depression or generalized anxiety, starting fewer modules was associated with more phone calls from therapists reflecting that therapists tended to call patients who did not start modules as scheduled. Also consistent for both ICBT programs, greater pretreatment condition severity and completion of more modules was associated with superior ICBT-derived benefit. Other predictors of response to treatment varied across the two programs. Younger age, lower education, taking psychotropic medication, being in receipt of psychiatric care and lower comfort with written communication were associated with either fewer program starts or lower symptom improvement in one of the two programs. It is concluded that monitoring response to ICBT may be particularly important in patients with these characteristics. Research directions for identifying patients who are less likely to benefit from ICBT are discussed.
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| 3. |
- Hesser, Hugo, et al.
(författare)
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Therapeutic Alliance in Internet-Delivered Cognitive Behaviour Therapy for Depression or Generalized Anxiety
- 2017
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Ingår i: Clinical Psychology and Psychotherapy. - : John Wiley & Sons. - 1063-3995 .- 1099-0879. ; 24:2, s. 451-461
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Tidskriftsartikel (refereegranskat)abstract
- There has been limited research on therapeutic alliance in the context of therapist-assisted Internet-delivered cognitive behaviour therapy (ICBT) when delivered in clinical practice. The present study investigated therapeutic alliance in ICBT delivered to patients seeking treatment for symptoms of depression (n=83) or generalized anxiety (n=112) as part of an open dissemination trial. ICBT was provided by 27 registered therapists or 28 graduate students working in six geographically dispersed clinics; therapist-assistance was delivered primarily through secure messages and occasionally telephone calls. The Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9 were collected pre-, mid- and post-treatment, and the Therapeutic Alliance Questionnaire was assessed mid- and post-treatment. Therapeutic alliance ratings were high both at mid-treatment and post-treatment (above 80%). There was no relationship between therapeutic alliance ratings and improvement on primary outcomes. Among patients treated for depression, lower ratings of mid-treatment alliance were associated with concurrent treatment by a psychiatrist and fewer phone calls and emails from their therapist. Among patients treated for generalized anxiety, ratings of mid-treatment alliance were higher among registered providers as compared to graduate students. Multiple directions for future research on therapeutic alliance in ICBT are offered, including suggestions for developing a new measure of therapeutic alliance specific to ICBT and measuring therapeutic alliance throughout the treatment process.
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| 4. |
- Hesser, Hugo, et al.
(författare)
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Therapist-assisted Internet-delivered cognitive behavior therapy for depression and anxiety : Translating evidence into clinical practice
- 2014
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Ingår i: Journal of Anxiety Disorders. - : Elsevier. - 0887-6185 .- 1873-7897. ; 28:8, s. 884-893
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Tidskriftsartikel (refereegranskat)abstract
- This dissemination study examined the effectiveness of therapist-assisted Internet-delivered Cognitive Behavior Therapy (ICBT) when offered in clinical practice. A centralized unit screened and coordinated ICBT delivered by newly trained therapists working in six geographically dispersed clinical settings. Using an open trial design, 221 patients were offered 12 modules of ICBT for symptoms of generalized anxiety (n=112), depression (n=83), or panic (n=26). At baseline, midpoint and post-treatment, kpatients completed self-report measures. On average, patients completed 8 of 12 modules. Latent growth curve modeling identified significant reductions in depression, anxiety, stress and impairment (d=.65-.78), and improvements in quality of life (d=.48-.66). Improvements in primary symptoms were large (d=.91-1.25). Overall, therapist-assisted ICBT was effective when coordinated across settings in clinical practice, but further attention should be given to strategies to improve completion of treatment modules.
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| 5. |
- Hesser, Hugo, 1982-, et al.
(författare)
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Special Issue on Tinnitus
- 2013
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Ingår i: Cognitive Behaviour Therapy. - : Routledge. - 1650-6073 .- 1651-2316. ; 42:2, s. 81-83
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Tidskriftsartikel (refereegranskat)
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| 6. |
- Kolbeinsson, Örn, 1991-
(författare)
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I Don’t Want to Hear It : Cognitive Control Strategies in Response to Task-Irrelevant Sound
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- An adequate capacity for cognitive control, the ability to maintain goal-directed behavior despite conflicting environmental demands, is a requirement for effective functioning. Whether it be the capacity to delay gratification or to effectively regulate emotions, various types of cognitive control allow us to function effectively despite the enormous complexity encountered in everyday life. Yet, some forms of cognitive control, such as thought suppression, have been shown to have delayed and potentially adverse consequences. Previous research has largely neglected to study cognitive control in the auditory domain, yet task-irrelevant and potentially distracting sounds are omnipresent, making this a highly interesting area of research.In the current thesis, I present findings from four experimental studies with an overall aim to investigate the use, effectiveness, and delayed consequences of cognitive control in the auditory domain. In Study II and Study IV, the aim was to investigate the use of four common emotion regulation strategies in response to task-irrelevant, potentially distracting sound. Measures of emotional responding were also included to determine whether the use and effectiveness of these strategies was related to subjective emotion. In Study II, participants received either positive or negative information about an inherently neutral sound in an attempt to manipulate their emotional experience of the sound. In contrast, sounds used in Study IV were inherently negative or neutral. Results from both studies showed that all four of the surveyed emotion regulation strategies were used to some degree, and that participants reported use of multiple regulatory strategies. Results also suggest that subjective ratings of negative emotion in response to the sound were related to greater use of mental suppression, in line with findings from other sensory domains. In Study I and Study III, we specifically investigated the delayed consequences of mental suppression. In line with previous research from other sensory modalities, results from the two experiments reported in Study I suggest that mentally suppressing awareness of a task-irrelevant sound results in delayed consequences. However, the nature of these consequences varied between experiments. This may be due to the use of different sound stimuli in the two experiments, where sounds from the first experiment were emotionally neutral and unintrusive, while sounds from the second were inherently aversive. In Study III, the aim was to replicate and expand on the findings from Study I, and specifically test for delayed consequences on perceptual responding. Mental suppression, conceptualized as an experiential avoidance strategy, was compared to an approach focused strategy, with the hypothesis that mental suppression would result in hypervigilance toward previously suppressed stimuli. Results from the two experiments reported in Study III did not provide support for this hypothesis. In conclusion, results from the studies presented in the current thesis suggest that people regularly use cognitive control strategies in response to task-irrelevant sound, and that the use of these strategies may be related to subjective emotional experiences of the sound. Additionally, attempting to mentally suppress awareness of a sound may result in delayed consequences, but the circumstance under which these delayed consequences can be demonstrated are not yet understood. The included studies provide initial indications that developing adaptive strategies of coping with distracting sound can reduce the risk of long-term maladaptive consequences.
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| 7. |
- Wallén, Hugo, et al.
(författare)
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Return on investment of internet delivered exposure therapy for irritable bowel syndrome : a randomized controlled trial
- 2021
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Ingår i: BMC Gastroenterology. - : BioMed Central. - 1471-230X. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Irritable bowel syndrome (IBS) is a debilitating and costly disorder. Cognitive behavior therapy (CBT) is effective in the treatment of IBS, both when delivered over the internet and in face-to-face settings. CBT consists of different components and little is known about their relative importance. We have in an earlier study showed that inclusion of exposure in the CBT for IBS makes it even more effective. In the present study we wanted to evaluate the economic effects for society of inclusion vs exclusion of exposure in an internet delivered CBT for IBS.METHODS: We used data from a previous study with 309 participants with IBS. Participants were randomized to internet delivered CBT with (ICBT) or without exposure (ICBT-WE). We compared direct and indirect costs at baseline, after treatment, and 6 months after treatment (primary endpoint; 6MFU). Data was also collected on symptom severity and time spent by therapists and participants. The relative Incremental Cost Effectiveness Ratio (ICER) was calculated for the two treatment conditions and the return on investment (ROI).RESULTS: Results showed that ICBT cost $213.5 (20%) more than ICBT-WE per participant. However, ICBT was associated with larger reductions regarding both costs and symptoms than ICBT-WE at 6MFU. The ICER was - 301.69, meaning that for every point improvement on the Gastrointestinal Symptom Rating Scale-IBS version in ICBT, societal costs would be reduced with approximately $300. At a willingness to pay for a case of clinically significant improvement in IBS symptoms of $0, there was an 84% probability of cost-effectiveness. ROI analysis showed that for every $1 invested in ICBT rather than ICBT-WE, the return would be $5.64 six months after treatment. Analyses of post-treatment data showed a similar pattern although cost-savings were smaller.CONCLUSIONS: Including exposure in Cognitive Behavior Treatment for IBS is more cost-effective from a societal perspective than not including it, even though it may demand more therapist and patient time in the short term.TRIAL REGISTRATION: This study is reported in accordance with the CONSORT statement for non-pharmacological trials [1]. Clinicaltrials.gov registration ID: NCT01529567 (14/02/2013).
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| 8. |
- Andersson, Erik, et al.
(författare)
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Testing the Mediating Effects of Obsessive Beliefs in Internet-Based Cognitive Behaviour Therapy for Obsessive-Compulsive Disorder : Results from a Randomized Controlled Trial
- 2015
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Ingår i: Clinical Psychology and Psychotherapy. - : Wiley-Blackwell. - 1063-3995 .- 1099-0879. ; 22:6, s. 722-732
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Tidskriftsartikel (refereegranskat)abstract
- Although cognitive interventions for obsessive-compulsive disorder (OCD) have been tested in randomized trials, there are few trials that have tested the specific mechanisms of cognitive interventions, i.e. how they achieve their effects. In this study, we aimed to investigate the mediating effects of a short cognitive intervention in the treatment of OCD and used data from a recently conducted randomized controlled trial where 101 participants were allocated to either Internet-based CBT (ICBT) or to a control condition. Obsessive beliefs were measured at pre-treatment, at the time they had received the cognitive intervention, and also at post-treatment. Weekly OCD symptoms were measured throughout the 10 weeks of treatment. We hypothesized that (1) the ICBT group would have greater reductions in obsessive beliefs (controlling for change in OCD symptoms) after completing the cognitive intervention, and that (2) this reduction would, in turn, predict greater OCD symptom reduction throughout the rest of the treatment period. Contrary to our expectations, the longitudinal mediation analysis indicated that (1) being randomized to ICBT actually increased the degree of obsessive beliefs after receiving the cognitive intervention at weeks 1-3, and (2) increase in obsessive beliefs predicted better outcome later in treatment. However, when repeating the analysis using cross-sectional data at post-treatment, the results were in line with the initial hypotheses. Results were replicated when the control condition received ICBT. We conclude that, although obsessive beliefs were significantly reduced at post-treatment for the ICBT group, early increase rather than decrease in obsessive beliefs predicted favourable outcome. Copyright (C) 2014 John Wiley & Sons, Ltd.
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| 9. |
- Andersson, Gerhard, et al.
(författare)
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Effects of Two Forms of Internet-Delivered Cognitive Behaviour Therapy for Depression on Future Thinking
- 2013
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Ingår i: Cognitive Therapy and Research. - New York, USA : Springer Science and Business Media LLC. - 0147-5916 .- 1573-2819. ; 37:1, s. 29-34
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to investigate if future thinking would change following two forms of Internet-delivered cognitive behavior therapy (ICBT) for major depression. A second aim was to study the association between pre-post changes in future thinking and pre-post changes in depressive symptoms. Effects of psychological treatments are most often tested with self-report inventories and seldom with tests of cognitive function. We included data from 47 persons diagnosed with major depression who received either e-mail therapy or guided self-help during 8 weeks. Participants completed a future thinking task (FTT), in which they were asked to generate positive and negative events that they thought were going to happen in the future and rated the events in terms of emotion and likelihood. The FTT was completed before and after treatment. Data on depressive symptoms were also collected. FTT index scores for negative events were reduced after treatment. There was no increase for the positive events. Change scores for the FTT negative events and depression symptoms were significantly correlated. We conclude that ICBT may lead to decreased negative future thinking and that changes in depression symptoms correlate to some extent with reductions in negative future thinking.
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| 10. |
- Andersson, Gerhard, et al.
(författare)
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Psychological mechanisms and tinnitus
- 2016
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Ingår i: Tinnitus. - San Diego : Plural Publishing, Inc.. - 9781597567213 ; , s. 63-73
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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