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- Holländare, Fredrik, 1972-, et al.
(författare)
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Therapist behaviours in internet-based cognitive behaviour therapy (ICBT) for depressive symptoms
- 2016
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Ingår i: Internet Interventions. - : Elsevier. - 2214-7829. ; 3:1, s. 1-7
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Tidskriftsartikel (refereegranskat)abstract
- Internet-based cognitive behaviour therapy (ICBT) is efficacious for treating depression, with therapist guidance identified as important for favourable outcomes. We have limited knowledge, however, about the fundamental components of therapist guidance in ICBT. The purpose of this study was to systematically examine therapist messages sent to patients during the course of ICBT for depressive symptoms in order to identify common “therapist behaviours” and the extent to which these behaviours correlate with completion of modules and improvements in symptoms at post-treatment, one- and two-year follow-up. A total of 664 e-mails from 5 therapists to 42 patients were analysed using qualitative content analysis. The most frequent behaviour was encouraging that accounted for 31.5% of the total number of coded behaviours. This was followed by affirming (25.1%), guiding (22.2%) and urging (9.8%). Less frequently the therapists clarified the internet treatment framework, informed about module content, emphasised the importance of patient responsibility, confronted the patient and made self-disclosures. Six of the nine identified therapist behaviours correlated with module completion. Three behaviours correlated with symptom improvement. Affirmingcorrelated significantly (r = .42, p = .005) with improvement in depressive symptoms at post-treatment and after two years (r = .39, p = .014). Encouraging was associated with outcome directly after treatment (r = .52, p = .001). Self-disclosure was correlated with improvement in depressive symptoms at post-treatment (r = .44, p = .003). The study contributes to a better understanding of therapist behaviours in ICBT for depressive symptoms. Future directions for research are discussed.
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- Mechler, Jakob, et al.
(författare)
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Therapist-guided internet-based psychodynamic therapy versus cognitive behavioural therapy for adolescent depression in Sweden : a randomised, clinical, non-inferiority trial
- 2022
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Ingår i: The Lancet Digital Health. - : Elsevier. - 2589-7500. ; 4:8, s. E594-E603
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Tidskriftsartikel (refereegranskat)abstract
- Background Adolescent major depressive disorder (MDD) is highly prevalent and associated with lifelong adversity. Evidence-based treatments exist, but accessible treatment alternatives are needed. We aimed to compare internet-based psychodynamic therapy (IPDT) with an established evidence-based treatment (internet-based cognitive behavioural therapy [ICBT]) for the treatment of adolescents with depression. Methods In this randomised, clinical trial, we tested whether IPDT was non-inferior to ICBT in the treatment of adolescent MDD. Eligible participants were 15-19 years old, presenting with a primary diagnosis of MDD according to DSM-5. Participants were recruited nationwide in Sweden through advertisements on social media, as well as contacts with junior and senior high schools, youth associations, social workers, and health-care providers. Adolescents who scored 9 or higher on the Quick Inventory of Depressive Symptomatology for Adolescents (QIDS-A17-SR) in an initial online screening were contacted by telephone for a diagnostic assessment using the Mini International Neuropsychiatric Interview. Participants were randomly assigned to ICBT or IPDT. Both interventions comprised eight self-help modules delivered over 10 weeks on a secure online platform. The primary outcome was change in depression severity measured weekly by the QIDS-A17-SR. Primary analyses were based on an intention -to-treat sample including all participants randomly assigned. A non-inferiority margin of Cohen's d=0.30 was predefined. The study is registered at ISRCTN, ISRCTN12552584. Findings Between Aug 19, 2019, and Oct 7, 2020, 996 young people completed screening; 516 (52%) were contacted for a diagnostic interview. 272 participants were eligible and randomly assigned to ICBT (n=136) or IPDT (n=136). In the ICBT group, 51 (38%) of 136 participants were classified as remitted, and 54 (40%) of 136 participants were classified as remitted in the IPDT group. Within-group effects were large (ICBT: within-group d=1.75, 95% CI 1.49 to 2.01; IPDT: within-group d=1.93, 1.67 to 2.20; both p<0.0001). No statistically significant treatment difference was found in the intention-to-treat analysis. Non-inferiority for IPDT was shown for the estimated change in depression during treatment (d=-0.18, 90% CI -0.49 to 0.13; p=0.34). All secondary outcomes showed non-significant between-group differences. Interpretation IPDT was non-inferior to ICBT in terms of change in depression for the treatment of adolescents with MDD. This finding increases the range of accessible and effective treatment alternatives for adolescents with depression. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.
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- Almlöv, Jonas, et al.
(författare)
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Therapist effects in guided internet-delivered CBT for Anxiety Disorders
- 2011
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Ingår i: Behavioural and Cognitive Psychotherapy. - London : Wisepress. - 1352-4658 .- 1469-1833. ; 39:3, s. 311-322
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Tidskriftsartikel (refereegranskat)abstract
- Background: Guided internet-delivered CBT for anxiety disorders has received increasing empirical support, but little is known regarding the role of the therapist. Aims: This study addressed therapist factors in guided internet-delivered cognitive behavioural therapy for anxiety disorders. Method: Data from three controlled trials with a total N of 119 were analyzed with attention to differences between eight therapists. Results: No significant mean level differences between therapists appeared in the dataset. However, one significant intraclass correlation between participants was found, suggesting that the outcome on the Beck Anxiety Inventory might have been influenced by the impact of the individual therapists. Conclusion: The therapist can possibly have some influence on the outcome of guided internet-delivered CBT for anxiety disorders, but studies with more statistical power are needed to establish whether therapist effects are present in this modality of psychological treatment. The present study was underpowered to detect minor therapist effects.
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- Andersson, Gerhard, 1966-, et al.
(författare)
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A primer for the assessment, diagnosis and delivery of Internet interventions for (mainly) panic disorder. Lessons learned from our research groups.
- 2008
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Ingår i: Clinical Psychologist. - : Informa UK Limited. - 1328-4207 .- 1742-9552. ; 12:1, s. 1-8
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Tidskriftsartikel (refereegranskat)abstract
- With the advent of the Internet, delivered assessment applications are likely to make a difference in clinical psychology and in health care in general. The purpose of the present paper was to present an overview of the authors' experience regarding Internet administration of diagnostic interviews, questionnaires, and information processing tests. A conclusion is made that psychiatric assessments via the Internet are not yet to be recommended, but that questionnaire assessments are likely to generate equivalent or even superior data quality than traditional paper and pencil administration. Finally, the use of Internet-delivered tests of information processing is commented upon. Although these tests have been influential in theory development in clinical psychology, large-scale dissemination of tests has been slowed down by the need for laboratory facilities. Internet administration can provide new opportunities to administer tests from the patient's own home.
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7. |
- Andersson, Gerhard, et al.
(författare)
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Can the patient decide which modules to endorse? : an open trial of tailored internet treatment of anxiety disorders
- 2011
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Ingår i: Cognitive Behaviour Therapy. - : Routledge, Taylor and Francis Group. - 1650-6073 .- 1651-2316. ; 1:40, s. 57-64
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Tidskriftsartikel (refereegranskat)abstract
- Internet-delivered cognitive behaviour therapy commonly consists of disorder-specific modules that are based on face-to-face manuals. A recent development in the field is to tailor the treatment according to patient profile, which has the potential to cover comorbid conditions in association with anxiety and mood disorders. However, it could be that the patients themselves are able to decide what modules to use. The authors tested this in an open pilot trial with 27 patients with mixed anxiety disorders. Modules were introduced with a brief description, and patients could choose which modules to use. The exception was the two first modules and the last, which involved psychoeducation and relapse prevention. The treatment period lasted for 10 weeks. Results showed large within-group effect sizes, with an average Cohen’s d of 0.88. In a structured clinical interview, a majority (54%) had significantly improved 10 weeks after commencing treatment. Only one person dropped out. On the basis of results of this preliminary study, the authors suggest that the role of choice and tailoring should be further explored in controlled trials and that patient choice could be incorporated into Internet-delivered treatment packages.
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- Andersson, Gerhard, 1966-, et al.
(författare)
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Cognitive bias via the Internet : A comparison of web-based and standard emotional Stroop tasks in social phobia
- 2006
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Ingår i: Cognitive Behaviour Therapy. - : Informa UK Limited. - 1650-6073 .- 1651-2316. ; 35:1, s. 55-62
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Tidskriftsartikel (refereegranskat)abstract
- There is accumulating evidence to suggest that social phobia is associated with attentional bias for words related to social threat. Information processing in individuals with social phobia (n = 87) was investigated in the present study using 2 versions of the emotional Stroop task. Results from a standard emotional Stroop task indicated delayed colour naming of socially threatening words relative to neutral words, in line with previous research, whereas results from a Web-based emotional Stroop task indicated a facilitation effect, with faster manual indication of colour choice for socially threatening words than for neutral words. Possible explanations for these contrasting findings and issues for further research are discussed. © 2006 Taylor & Francis.
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- Andersson, Gerhard, 1966-, et al.
(författare)
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Development of a new approach to guided self-help via the Internet : The Swedish experience
- 2008
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Ingår i: Journal of technology in human services. - : Informa UK Limited. - 1522-8835 .- 1522-8991. ; 26:2-4, s. 161-181
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Tidskriftsartikel (refereegranskat)abstract
- This article describes the development and empirical status of guided Internet-delivered self-help. The treatment approach combines the benefits of bibliotherapy with book-length text materials and the support given online via web pages and e-mail. Interactive features such as online registrations, tests, and online discussion forums are also included. Cognitive behavior therapy (CBT) guided the research and clinical implementations of this approach, as it lends itself more easily to the self-help format compared with other presently available psychotherapy approaches. We include an overview of the research, current issues and research in service delivery, lessons learned through a program of research, and directions for future investigations
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- Andersson, Gerhard, 1966-, et al.
(författare)
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Effects of Internet-delivered cognitive behaviour therapy for anxiety and mood disorders
- 2007
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Ingår i: Review series. Psychiatry. - 1401-9302. ; 9
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Tidskriftsartikel (refereegranskat)abstract
- The Internet has revolutionized access to health information and made communication over long distances easier. This article reviews the use of the Internet for delivery of cognitive behaviour therapy. As a starting point the concept of guided self-help is introduced. We next present the treatment approach and different protocols briefly. Next, Swedish studies on panic disorder, social phobia, and depression are summarized using meta-analytic techniques. Implementation in regular clinical setting is discussed with a focus on efficacy versus effectiveness, training of therapist, combined treatments and cost-effectiveness. We conclude that Internet treatment is likely to become a treatment option for suitable patients in the future.
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- Andersson, Gerhard, 1966-, et al.
(författare)
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Internet-based self-help with therapist feedback and in vivo group exposure for social phobia : A randomized controlled trial
- 2006
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Ingår i: Journal of Consulting and Clinical Psychology. - 0022-006X .- 1939-2117. ; 74:4, s. 677-686
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Tidskriftsartikel (refereegranskat)abstract
- Sixty-four individuals with social phobia (social anxiety disorder) were assigned to a multimodal cognitive-behavioral treatment package or to a waiting list control group. Treatment consisted of a 9-week, Internet-delivered, self-help program that was combined with 2 group exposure sessions in real life and minimal therapist contact via e-mail. Results were analyzed on an intention-to-treat basis, including all randomized participants. From pre- to posttest, treated participants in contrast to controls showed significant improvement on most measured dimensions (social anxiety scales, general anxiety and depression levels, quality of life). The overall within- and between-groups effect sizes were Cohen's d = 0.87 and 0.70, respectively. Treatment gains were maintained at 1-year follow-up. The results from this study support the continued use and development of Internet-distributed, self-help programs for people diagnosed with social phobia.
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- Andersson, Gerhard, et al.
(författare)
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Obituary. Jeff Richards.
- 2005
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Ingår i: Cognitive Behaviour Therapy. - 1650-6073 .- 1651-2316. ; 34, s. 128-128
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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17. |
- Andersson, Gerhard, et al.
(författare)
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Panic disorder
- 2011
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Ingår i: Stepped care and e-health. - New York : Springer-Verlag New York. - 9781441965097 - 9781441965103 ; , s. 61-76
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Panic disorder is an anxiety disorder that is characterized by recurrent and unexpected panic attacks. In this chapter to authors present a stepped care approach to the treatment of panic disorder and provide a comprehensive review of bibliotherapy and recent Internet-delivered treatments.
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- Andersson, Gerhard, et al.
(författare)
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Paniksyndrom : ond cirkel av feltolkade kroppsliga signaler
- 2011
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Ingår i: Läkartidningen. - : Läkartidningen förlag AB. - 0023-7205 .- 1652-7518. ; 108:14, s. 795-797
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Tidskriftsartikel (refereegranskat)abstract
- Attacker av intensiv rädsla utan tydlig yttre orsak som leder till rädsla för nya attacker – det kännetecknar paniksyndrom. Evidensbaserade behandlingsalternativ finns, och det finns inget skäl att avvakta med behandling.
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- Andersson, Gerhard, 1966-, et al.
(författare)
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Predicting treatment outcome in Internet versus face to face treatment of panic disorder
- 2008
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Ingår i: Computers in human behavior. - : Elsevier BV. - 0747-5632 .- 1873-7692. ; 24:5, s. 1790-1801
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Tidskriftsartikel (refereegranskat)abstract
- With the advent of guided self-help via the Internet it has become increasingly important to investigate predictors of treatment outcome. The present study analyzed predictors of outcome using data from a randomized controlled trial on panic disorder [Carlbring, P. et al. (2005). Treatment of panic disorder: Live therapy versus self-help via Internet. Behaviour Research and Therapy, 43, 1321-1333]. Half of the sample received therapist guided Internet treatment (N = 25) and the other half face to face treatment (N = 24) in individual sessions during a 10-week study period. Results showed that agoraphobic avoidance was predictive of outcome in the face to face treatment, but not in the Internet treatment. A self-report screening of personality disorder (anxious cluster) was associated with worse outcome for the Internet treatment, but surprisingly associated with better outcome in face to face treatment. Cognitive capacity as measured by a test of verbal fluency was not predictive of outcome in the Internet group, and neither was a rating of treatment credibility. Overall, we conclude that in relation to face to face treatment different predictors of outcome should be investigated for Internet treatment. Internet treatment might be more suitable for certain clients who might benefit from remote treatment in the early phase of treatment.
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- Andersson, Gerhard, et al.
(författare)
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Social Phobia (Social Anxiety Disorder)
- 2011. - 1
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Ingår i: Stepped care and e-Health. - New York, Dordrecht, Heidelberg, London : Springer-Verlag New York. - 9781441965097 - 9781441965103 ; , s. 99-113
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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22. |
- Andersson, Gerhard, 1966-, et al.
(författare)
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Stroop facilitation in tinnitus patients : An experiment conducted via the World Wide Web
- 2005
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Ingår i: Cyberpsychology & Behavior. - : Mary Ann Liebert Inc. - 1094-9313 .- 1557-8364. ; 8:1, s. 32-38
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Tidskriftsartikel (refereegranskat)abstract
- Cognitive mechanisms have been proposed to play an important role in tinnitus. In the present study, tinnitus participants were administered an emotional Stroop test via the Internet, incorporating words related to tinnitus concerns. In line with previous research using this Web-based version of the emotional Stroop test, faster color naming was demonstrated for concern-relevant words relative to neutral words. The present results thus provided support for a role for cognitive factors that are important for the understanding of tinnitus. However, future research is warranted in order to clarify the precise mechanisms involved in tinnitus-related Stroop effects. 1© Mary Ann Liebert, Inc.
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- Andersson, Gerhard, 1966-, et al.
(författare)
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The use of the internet in the treatment of anxiety disorders
- 2005
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Ingår i: Current Opinion in Psychiatry. - 0951-7367 .- 1473-6578. ; 18:1, s. 73-77
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Tidskriftsartikel (refereegranskat)abstract
- Purpose of review: The aim of this article is to review the emerging literature on the use of the Internet in the treatment of anxiety disorders. The questions asked are: (1) are Internet-delivered treatments for anxiety disorders supported by the research literature? (2) what is the quality of the evidence as it stands? (3) is there any evidence to suggest that Internet interventions can be harmful? Recent findings: Recent and ongoing trials on panic disorder show that Internet-based self-help with minimal therapist contact is a promising approach in the treatment of panic disorder. However, trials have been small and there is a need for large-scale trials and studies conducted in psychiatric settings as most studies have recruited patients via advertisement. There is no evidence in the literature that Internet intervention is harmful, but most likely a stepped-care approach would be feasible to handle cases who fail to respond. Summary: Internet-delivered interventions for anxiety disorders, and in particular panic disorder, are promising. There is however a need for further research and evaluation and there is also a need to find a proper place for such interventions in the clinical management of anxiety disorders, preferably using a stepped-care approach. © 2005 Lippincott Williams & Wilkins.
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