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1.
  • Hallin, Nathalie, 1990- (författare)
  • Perceptions of and behaviour toward religious people and atheists in Sweden and the USA
  • 2024
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Religiosity has been present in societies throughout history and several theories hold that religion serves to foster trust and a sense of community within the religious ingroup. In many societies today, it is not uncommon to lack religious beliefs and religion is no longer a natural part of everyday life. The studies included in this thesis investigated how religious groups perceive each other or how generous they are to each other, both in the more secular Sweden and in the more religious USA.  Paper 1 examined Swedes’ perceptions of atheists and religious people. Specifically, how often they associated atheists or religious people with extreme immoral behaviour by making a conjunction error. Previous studies using the same methodological paradigm have found that more people associate atheists, rather than religious people, with immoral behaviour. We found no significant association between target (atheist or religious person) and conjunction errors, indicating that Swedes do not associate immoral behaviour with atheists to a greater degree than they associate immoral behaviour with religious people. We compared the results to those presented in a previous study and found that the Swedish participants in our study made significantly fewer conjunction errors when the target was an atheist than a sample from the USA. They also made significantly more conjunction errors when the target was a religious person than a Finnish sample and the American sample. The results suggests that anti-atheist bias is lower in Sweden compared to the USA, but anti-religious bias is higher than in both Finland and the USA. However, it is also possible that the type of sample used affected the results – we recruited participants from social media while the other two samples were solely or mainly student samples. The study shows that the clear anti-atheist bias found in similar studies is not universal. Paper 2 investigated Christians’ and atheists’ perceptions of Christian, Muslim, and atheist job applicants in four studies, two with Swedish samples (studies 1 and 3) and two with samples from the USA (studies 2 and 4). Participants rated the perceived competence and likeability of a target applicant (Christian, Muslim, or atheist) and a control applicant (with no information about religious affiliation). In the last two studies, participants also specified if they would have hired the target or control applicant. Participants generally rated the control applicant as being more competent (USA) and more likeable (Sweden and USA) than the target applicant. Both Christian and atheist participants rated targets with the same religious affiliation higher in likeability than targets from one or both religious outgroups in two of the studies. The only significant difference in competence ratings between the targets were in study 3, where Christians rated Muslims as less competent than Christians. However, Christians’ likeability ratings in study 3 did not differ between targets. More atheists in study 3 hired the control applicant than the Christian applicant, but no other group differed in which applicant they hired. In conclusion, when people perceived one religious group to be more likeable, it was their ingroup. However, these results do not translate to perceptions of competence and seldom to hiring decisions. Paper 3 investigated generosity toward religious ingroup and outgroup members in three studies conducted in Sweden (study 1), the USA (study 2), and Egypt and Lebanon (study 3), using an adapted Dictator Game. Participants allocated a sum of money between themselves and three potential recipients. In the most relevant round, these were a Christian, a Muslim, and an atheist. We found that in studies 1 and 2, there was no significant difference in overall generosity between religious people, agnostics, and atheists in the rounds where they did not know the religious affiliation of the recipients. In the round where they knew the affiliation of recipients, religious people gave significantly more than atheists (studies 1 and 2) and agnostics (study 2). Study 3 had too few agnostics and atheists to compare their generosity to that of religious people. Christians, Muslims, and atheists in all three studies gave significantly more money to their respective religious ingroups than to the outgroup that was given the largest amount. This ingroup generosity was found in the other rounds as well. However, the ingroup minus outgroup amount was larger in the religion round compared to most other rounds. The exceptions were the ideology round in study 1 and 2, which did not differ significantly from the religion round. In study 2, the difference between ingroup and outgroup generosity was larger for Muslim participants than for Christians and atheists. In conclusion, religious people seem to be more generous only when they know the religious affiliation of recipients, but atheists, Muslims, and Christians are all more generous toward religious ingroup members than toward outgroup members.  The papers together show that religious affiliation is an important group category that affects perceived likeability and generosity in several contexts. 
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2.
  • Andersson, Gerhard, Professor, 1988-, et al. (författare)
  • Individually tailored Internet-delivered cognitive-behavioral therapy for survivors of intimate partner violence : A randomized controlled pilot trial
  • 2021
  • Ingår i: Internet Interventions. - : Elsevier BV. - 2214-7829. ; 26
  • Tidskriftsartikel (refereegranskat)abstract
    • Intimate partner violence (IPV) is a serious public health concern worldwide and defined as behavior performed by spouses or other intimate partners that causes physical, sexual, or psychological harm. Internet-delivered cognitive-behavioral therapy (ICBT) may be particularly useful for survivors of IPV for several reasons, including barriers pertaining to limited community recourses and treatment availability, safety concerns, and issues of stigma, guilt and shame, which may prevent members of this population from seeking help via face-to-face interactions. However, Internet interventions are lacking. The primary aim of the present randomized controlled pilot trial was to explore the feasibility of ICBT as guided self-help individually tailored to the predominant symptomatology of PTSD or depression in survivors of IPV. A second aim was to conduct a preliminary evaluation exploring the short- and long-term effects of the treatment in comparison to a waitlist control condition. Results showed that the treatment was feasible. Attrition rate was low (9.4%), and participants were satisfied with treatment. However, treatment adherence was moderate in terms of completed modules (62.5%). Results of the preliminary evaluation of treatment effects showed large and statistically significant between-group effect sizes (Cohen's d = 0.86–1.08) on some measures of PTSD and depression at post assessment, favoring the treatment condition. However, there were no effects on other measures. At follow-up assessment, when the control condition had received delayed treatment, there were large and statistically significant within-group effect sizes (d = 0.96–1.48) on measures of PTSD, depression and anxiety, and small effects (d = 0.48) on a measure of quality of life. The results of the present pilot study are promising and warrant further research on ICBT for this population.
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3.
  • Bendelin, Nina, 1980- (författare)
  • Internet-Delivered Acceptance and Commitment Therapy for Chronic Pain : Feasibility, patients’ experiences and implementation process
  • 2023
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Chronic pain represents a major burden for individuals and society. Internet-delivered psychological interventions are evidence-based treatments that enable patients to access qualified care at a time and place convenient for them. Internet-delivered Acceptance and commitment therapy (IACT) has shown promising treatment effects for chronic pain patients on pain-related outcomes such as disability, pain intensity, and interference, and on psychological outcomes such as catastrophizing, fear-avoidance and acceptance. Interdisciplinary pain rehabilitation programs (IPRP) are multimodal interventions given by synchronized teams of health care professionals from different disciplines. With moderate treatment effects on many outcomes, IPRP is the best evidence treatment for chronic pain to date.   IACT may add to IPRP’s effectiveness by providing individual psychological treatment via the internet. However, IACT has not yet been implemented in routine care in a larger scale. In this thesis, the aim was to study if IACT may be acceptable for chronic pain patients and if it is feasible and effective as an addition to IPRP. Three methodological approaches were used: qualitative analysis, implementation science and a controlled trial of effectiveness in a clinical context.   Study I showed that an internet-delivered aftercare intervention enabled chronic pain patients to change their perception of their body and pain and their attitude about their future and self. Furthermore, self-motivating goals and acceptance strategies appeared to influence autonomy. The results gave promise to the feasibility of IACT as aftercare following IPRP. Study II showed that chronic pain patients’ experiences of IACT vary, with respect to being in treatment and the consequences of treatment. Specifically, e-therapist feedback and deadlines for homework may have an impact on autonomy and change. Patients’ expectations, motivations, and restraints could explain treatment engagement and experiences. In Study III, IACT added during IPRP enhanced the treatment effects on pain acceptance and affective distress. Furthermore, IACT added as aftercare strengthened the long-term effect of IPRP on psychological flexibility and self-efficacy. However, unsatisfactory completion rates complicated the interpretation of the findings. Study IV showed that implementing IACT in an IPRP setting may be facilitated by contextual alinement and modifications based on patients’ needs. Thorough testing of the application and matching the intervention’s aim with the host’s needs are important not to challenge the process. An implementation framework may ease planning and evaluation of implementation processes.   In conclusion, IACT could be feasible as an addition to IPRP. IACT can help chronic pain patients self-manage their pain and improve pain acceptance and self-efficacy. However, chronic pain patients’ varying experiences may need to be considered to improve treatment engagement and help patients benefit from treatment. In addition, implementation of IACT in IPRP settings is likely to depend on both flexibility to changing host needs and continuity of known pivotal components in IACT.   
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4.
  • Bergvall, Hillevi, et al. (författare)
  • Development of competence in cognitive behavioural therapy and the role of metacognition among clinical psychology and psychotherapy students
  • 2023
  • Ingår i: Behavioural and Cognitive Psychotherapy. - : CAMBRIDGE UNIV PRESS. - 1352-4658 .- 1469-1833. ; 51:3
  • Tidskriftsartikel (refereegranskat)abstract
    • Background:There is a paucity of research on therapist competence development following extensive training in cognitive behavioural therapy (CBT). In addition, metacognitive ability (the knowledge and regulation of ones cognitive processes) has been associated with learning in various domains but its role in learning CBT is unknown. Aims:To investigate to what extent psychology and psychotherapy students acquired competence in CBT following extensive training, and the role of metacognition. Method:CBT competence and metacognitive activity were assessed in 73 psychology and psychotherapy students before and after 1.5 years of CBT training, using role-plays with a standardised patient. Results:Using linear mixed modelling, we found large improvements of CBT competence from pre- to post-assessment. At post-assessment, 72% performed above the competence threshold (36 points on the Cognitive Therapy Scale-Revised). Higher competence was correlated with lower accuracy in self-assessment, a measure of metacognitive ability. The more competent therapists tended to under-estimate their performance, while less competent therapists made more accurate self-assessments. Metacognitive activity did not predict CBT competence development. Participant characteristics (e.g. age, clinical experience) did not moderate competence development. Conclusions:Competence improved over time and most students performed over the threshold post-assessment. The more competent therapists tended to under-rate their competence. In contrast to what has been found in other learning domains, metacognitive ability was not associated with competence development in our study. Hence, metacognition and competence may be unrelated in CBT or perhaps other methods are required to measure metacognition.
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5.
  • Johansson, Peter, 1962-, et al. (författare)
  • The impact of internet-based cognitive behavioral therapy and depressive symptoms on self-care behavior in patients with heart failure : A secondary analysis of a randomised controlled trial
  • 2021
  • Ingår i: International Journal of Nursing Studies. - : Elsevier. - 0020-7489 .- 1873-491X. ; 116
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Patients with chronic heart failure may require treatment of depressive symptoms to improve self-care behaviour.OBJECTIVES: To investigate the impact of internet-based cognitive behavioral therapy (CBT) on self-care behaviour in heart failure patients, and to study the association between changes in depressive symptoms and changes in self-care behaviour.DESIGN: A secondary analysis of data collected in a pilot randomized controlled study.SETTING: 50 heart failure patients with depressive symptoms were recruited from four hospitals in Sweden.METHODS: Patients were randomized to nine weeks of internet-based CBT (n = 25) or to an active control group participating in an online discussion forum (n = 25). In week two and three, those in the internet-based CBT group worked with psychoeducation about heart failure and depression, emphasizing heart failure self-care. During the same weeks those in the on-line discussion forum specifically discussed heart failure self-care. Patient Health Questionnaire-9 was used to measure depressive symptoms at baseline and at the nine-week follow-up. The European Heart Failure Self-care Behaviour Scale-9 was used to measure self-care behaviour (i.e., the summary score and the subscales autonomous based, provider based and consulting behaviour) at baseline, and at the three-week and nine-week follow-ups.RESULTS: No significant differences were found in self-care between the patients in the internet-based CBT and the patients in the online discussion group at the three- and nine-week follow-up. Within-group analysis of the changes in the European Heart Failure Self-care Behaviour Scale showed that from baseline to week three, the summary score increased significantly for the online discussion group (p = 0.04), but not for the internet-based CBT group (p = 0.15). At the nine-week follow-up, these scores had decreased. Similarly, consulting behaviour improved at week three for the online discussion group (p = 0.04), but not for the internet-based CBT group (p = 0.22). Provider-based adherence at the nine-week follow-up had increased from baseline in the internet-based CBT group (p = 0.05) whereas it had decreased in the on-line discussion group. Improvement in symptoms of depression was significantly associated with improvement in autonomy-based self-care (r = 0.34, p = 0.03).CONCLUSION: Improvement in depressive symptoms was associated with improved autonomous-based self-care. ICBT for depression in HF may benefit aspects of self-care that are vital to improve symptoms and prognosis.
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8.
  • Asbrand, Julia, et al. (författare)
  • Clinical Psychology and the COVID-19 Pandemic : A Mixed Methods Survey Among Members of the European Association of Clinical Psychology and Psychological Treatment (EACLIPT).
  • 2023
  • Ingår i: Clinical Psychology in Europe. - : PsychOpen. - 2625-3410. ; 5:1
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: The COVID-19 pandemic has affected people globally both physically and psychologically. The increased demands for mental health interventions provided by clinical psychologists, psychotherapists and mental health care professionals, as well as the rapid change in work setting (e.g., from face-to-face to video therapy) has proven challenging. The current study investigates European clinical psychologists and psychotherapists' views on the changes and impact on mental health care that occurred due to the COVID-19 pandemic. It further aims to explore individual and organizational processes that assist clinical psychologists' and psychotherapists' in their new working conditions, and understand their needs and priorities.METHOD: Members of the European Association of Clinical Psychology and Psychological Treatment (EACLIPT) were invited (N = 698) to participate in a survey with closed and open questions covering their experiences during the first wave of the pandemic from June to September 2020. Participants (n = 92) from 19 European countries, mostly employed in universities or hospitals, completed the online survey.RESULTS: Results of qualitative and quantitative analyses showed that clinical psychologists and psychotherapists throughout the first wave of the COVID-19 pandemic managed to continue to provide treatments for patients who were experiencing emotional distress. The challenges (e.g., maintaining a working relationship through video treatment) and opportunities (e.g., more flexible working hours) of working through this time were identified.CONCLUSIONS: Recommendations for mental health policies and professional organizations are identified, such as clear guidelines regarding data security and workshops on conducting video therapy.
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9.
  • Bendelin, Nina, et al. (författare)
  • Internet-Delivered Acceptance and Commitment Therapy Added to Multimodal Pain Rehabilitation : A Cluster Randomized Controlled Trial
  • 2021
  • Ingår i: Journal of Clinical Medicine. - : MDPI. - 2077-0383. ; 10:24
  • Tidskriftsartikel (refereegranskat)abstract
    • Internet-delivered interventions hold the possibility to make pain rehabilitation more accessible and adaptable by providing qualified individualized psychological care to chronic pain patients in their homes. Acceptance and commitment therapy (ACT) has shown promising results on psychological functioning and pain acceptance. Internet-delivered ACT (IACT) added to multimodal pain rehabilitation program (MMRP) in primary care has, so far, not shown better results than MMRP alone. The aim of this cluster randomized controlled study was to investigate the effects of adding IACT during and after MMRP in specialist care on psychological outcomes. In total, 122 patients who enrolled in a specialist pain clinic were cluster randomized groupwise to either MMRP (n = 12 groups) or to MMRP with added IACT (n = 12 groups). The IACT addition included 6 weeks of treatment during MMRP and 11 weeks of aftercare following MMRP. Online and paper-and-pencil self-report measures of pain acceptance, psychological inflexibility, self-efficacy, and psychosocial consequences of pain, were collected at four occasions: prior to and post MMRP, post aftercare intervention and at 1 year follow-up. Dropout was extensive with 25% dropping out at post treatment, an additional 35% at post aftercare, and 29% at 1 year follow-up. Medium treatment between-group effects were found on pain acceptance in favor of the group who received IACT added to MMRP, at post treatment and at post aftercare. Large effects were seen on psychological inflexibility and self-efficacy at post aftercare. A medium effect size was seen on affective distress at post aftercare. Moreover, a medium effect on self-efficacy was found at 1 year follow-up. The results indicate that IACT added during MMRP may enhance the treatment effects on pain-related psychological outcomes. Results also suggest that IACT as aftercare may strengthen the long-term effect of MMRP. However, adding a second pain treatment, IACT, to an already extensive pain treatment, MMRP, could be perceived as too comprehensive and might hence influence completion negatively. Further research on adverse events and negative effects could be helpful to improve adherence. Next step of implementation trials could focus on adding IACT before MMRP to improve psychological functioning and after MMRP to prolong its effect.
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10.
  • Berg, Matilda, 1989-, et al. (författare)
  • Internet-based CBT for adolescents with low self-esteem : a pilot randomized controlled trial
  • 2022
  • Ingår i: Cognitive Behaviour Therapy. - : Routledge. - 1650-6073 .- 1651-2316. ; 51:5, s. 388-407
  • Tidskriftsartikel (refereegranskat)abstract
    • Low self-esteem is a common problem among adolescents and is related to psychiatric problems such as depression and anxiety. However, effective and available interventions primarily targeting low self-esteem are scarce, in particular for youths. To address this gap, the aim of this pilot study was to evaluate a novel internet-based Cognitive Behavioral Therapy (ICBT) program for low self-esteem in adolescents using a randomized controlled design. Fifty-two participants (15-19 years) were recruited and randomly allocated to seven weeks of therapist-supported ICBT (n=26) or to a waitlist control condition (n=26). The primary outcome was the Rosenberg Self-Esteem Scale (RSES). Secondary outcomes measured domain-specific aspects of self-esteem, self-compassion, quality of life, depression and anxiety. The treatment group showed significantly higher levels of self-rated self-esteem compared to the control group at post-treatment, with a large between-group effect-size (RSES, d = 1.18). Further, the treatment had significant positive impact on secondary measures of self-esteem, self-compassion, quality of life, depression and anxiety. The results of this pilot-RCT suggest that ICBT can be effective for treating low self-esteem in adolescents, decrease depression and anxiety levels, and increasing quality of life. Replication of the results in larger samples is needed.    
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11.
  • Beukes, Eldré W., et al. (författare)
  • Development and technical functionality of an Internet-based intervention for tinnitus in the UK
  • 2016
  • Ingår i: Internet Interventions. - : Elsevier. - 2214-7829. ; 6, s. 6-15
  • Tidskriftsartikel (refereegranskat)abstract
    • PurposeCreative approaches to improve access to evidence-based tinnitus treatments are required. The purpose of this study was to develop an Internet-based cognitive behavioural therapy (iCBT) intervention, for those experiencing tinnitus in the United Kingdom (UK). Furthermore, it aimed, through technical functionality testing, to identify specific aspects of the iCBT that require improving.MethodAn innovative iCBT intervention for treating tinnitus in the UK has been developed using a cognitive-behavioural theoretical framework. This iCBT was evaluated by two user groups during this developmental phase. Initially, five expert reviews evaluated the intervention, prior to evaluation by a group of 29 adults experiencing significant levels of tinnitus distress. Both groups evaluated iCBT in an independent measures design, using a specifically designed satisfaction outcome measure.ResultsOverall, similar ratings were given by the expert reviewers and adults with tinnitus, showing a high level of satisfaction regarding the content, suitability, presentation, usability and exercises provided in the intervention. The iCBT intervention has been refined following technical functionality testing.ConclusionsRigorous testing of the developed iCBT intervention has been undertaken. These evaluations provide confidence that further clinical trials can commence in the UK, to assess the feasibility and effectiveness of this iCBT intervention for tinnitus.
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12.
  • Biliunaite, Ieva, 1992-, et al. (författare)
  • Internet-Based Cognitive Behavioral Therapy for Informal Caregivers : Randomized Controlled Pilot Trial
  • 2021
  • Ingår i: Journal of Medical Internet Research. - : JMIR Publications. - 1438-8871. ; 23:4
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Caregiving for a family member can result in reduced well-being for the caregiver. Internet-delivered cognitive behavioral therapy (ICBT) may be one way to support this population. This is especially the case for caregivers in countries with limited resources, but high demand for psychological services.Objective: In this study we evaluated the effects of a therapist-guided 8-week-long ICBT intervention for informal caregivers.Methods: In total, 63 participants were recruited online and randomized either to the intervention or to the wait-list control group. The main study outcome was the Caregiver Burden Inventory (CBI). Secondary outcomes included measures of caregiver depression, anxiety, stress, and quality of life.Results: Moderate between-group effect sizes were observed for the CBI measure, in favor of the intervention group, with a Cohen d=–0.70 for the intention-to-treat analysis. Analyses of the subscales of the CBI showed significant reductions on the subscales of Development and Physical Health. Moderate reductions were found for depression and anxiety scores as indicated by the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scores. Large between-group effects were observed for reduction in stress and increase in quality of life as indicated by the Perceived Stress Scale-14 (PSS-14), The Brunnsviken Brief Quality of Life Scale (BBQ), and The World Health Organization-Five Well-Being Index (WHO-5). In addition, participants experienced little to no difficulty in using the program and were mostly satisfied with the intervention’s platform and the choice of content.Conclusions: This is the first internet intervention study for informal caregivers in Lithuania. The results suggest that therapist-guided ICBT can be effective in reducing caregiver burden, anxiety, depression, stress, and improving quality of life.Trial Registration: ClinicalTrials.gov NCT04052724; https://clinicaltrials.gov/ct2/show/NCT04052724
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13.
  • Budimir, Sanja, et al. (författare)
  • Reasons for Discontinuing Active Participation on the Internet Forum Tinnitus Talk : Mixed Methods Citizen Science Study
  • 2021
  • Ingår i: JMIR Formative Research. - : JMIR Publications. - 2561-326X. ; 5:4
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Tinnitus Talk is a nonprofit online self-help forum. Asking inactive users about their reasons for discontinued usage of health-related online platforms such as Tinnitus Talk is important for quality assurance. Objective: The aim of this study was to explore reasons for discontinued use of Tinnitus Talk, and their associations to the perceptions of Tinnitus Talk and the age of users who ceased logging on to the platform. Methods: Initially, 13,745 users that did not use Tinnitus Talk within the previous 2 months were contacted and the response rate was 20.47% (n=2814). After dataset filtering, a total of 2172 past members of Tinnitus Talk were included in the analyses. Nine predefined reasons for discontinued usage of Tinnitus Talk were included in the survey as well as one open question. Moreover, there were 14 predefined questions focusing on perception of Tinnitus Talk (usefulness, content, community, and quality of members' posts). Mixed methods analyses were performed. Frequencies and correlation coefficients were calculated for quantitative data, and grounded theory methodology was utilized for exploration of the qualitative data. Results: Quantitative analysis revealed reasons for discontinued use of Tinnitus Talk as well as associations of these reasons with perceptions of Tinnitus Talk and age. Among the eight predefined reasons for discontinued use of Tinnitus Talk, the most frequently reported was not finding the information they were looking for (451/2695, 16.7%). Overall, the highest rated perception of Tinnitus Talk was content-related ease of understanding (mean 3.9, SD 0.64). A high number (nearly 40%) of participants provided additional free text explaining why they discontinued use. Qualitative analyses identified a total of 1654 specific reasons, more than 93% of which (n=1544) could be inductively coded. The coding system consisted of 33 thematically labeled codes clustered into 10 categories. The most frequent additional reason for discontinuing use was thinking that there is no cure or help for tinnitus symptoms (375/1544, 24.3%). Significant correlations (P<.001) were observed between reasons for discontinued usage and perception of Tinnitus Talk. Several reasons for discontinued usage were associated with the examined dimensions of perception of Tinnitus Talk (usefulness, content, community, as well as quality of members' posts). Moreover, significant correlations (P<.001) between age and reasons for discontinued use were found. Older age was associated with no longer using Tinnitus Talk because of not finding what they were looking for. In addition, older participants had a generally less positive perception of Tinnitus Talk than younger participants (P<.001). Conclusions: This study contributes to understanding the reasons for discontinued usage of online self-help platforms, which are typically only reported according to the dropout rates. Furthermore, specific groups of users who did not benefit from Tinnitus Talk were identified, and several practical implications for improvement of the structure, content, and goals of Tinnitus Talk were suggested. 
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14.
  • Cawthorne, Tom, et al. (författare)
  • The development and preliminary evaluation of Cognitive Behavioural Therapy (CBT) for Chronic Loneliness in Young People.
  • 2023
  • Ingår i: Behavioural and Cognitive Psychotherapy. - : CAMBRIDGE UNIV PRESS. - 1352-4658 .- 1469-1833. ; 51:5, s. 414-431
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Approximately 10% of young people 'often' feel lonely, with loneliness being predictive of multiple physical and mental health problems. Research has found CBT to be effective for reducing loneliness in adults, but interventions for young people who report loneliness as their primary difficulty are lacking.METHOD: CBT for Chronic Loneliness in Young People was developed as a modular intervention. This was evaluated in a single-case experimental design (SCED) with seven participants aged 11-18 years. The primary outcome was self-reported loneliness on the Three-Item Loneliness Scale. Secondary outcomes were self-reported loneliness on the UCLA-LS-3, and self- and parent-reported RCADS and SDQ impact scores. Feasibility and participant satisfaction were also assessed.RESULTS: At post-intervention, there was a 66.41% reduction in loneliness, with all seven participants reporting a significant reduction on the primary outcome measure (p < .001). There was also a reduction on the UCLA-LS-3 of a large effect (d = 1.53). Reductions of a large effect size were also found for parent-reported total RCADS (d = 2.19) and SDQ impact scores (d = 2.15) and self-reported total RCADS scores (d = 1.81), with a small reduction in self-reported SDQ impact scores (d = 0.41). Participants reported high levels of satisfaction, with the protocol being feasible and acceptable.CONCLUSIONS: We conclude that CBT for Chronic Loneliness in Young People may be an effective intervention for reducing loneliness and co-occurring mental health difficulties in young people. The intervention should now be evaluated further through a randomised controlled trial (RCT).
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15.
  • Ehlers, Anke, et al. (författare)
  • Therapist-assisted online psychological therapies differing in trauma focus for post-traumatic stress disorder (STOP-PTSD) : a UK-based, single-blind, randomised controlled trial
  • 2023
  • Ingår i: The lancet. Psychiatry. - : ELSEVIER SCI LTD. - 2215-0374 .- 2215-0366. ; 10:8, s. 608-622
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Many patients are currently unable to access psychological treatments for post-traumatic stress disorder (PTSD), and it is unclear which types of therapist-assisted internet-based treatments work best. We aimed to investigate whether a novel internet-delivered cognitive therapy for PTSD (iCT-PTSD), which implements all procedures of a first-line, trauma-focused intervention recommended by the UK National Institute for Health and Care Excellence (NICE) for PTSD, is superior to internet-delivered stress management therapy for PTSD (iStress-PTSD), a comprehensive cognitive behavioural treatment programme focusing on a wide range of coping skills.METHODS: We did a single-blind, randomised controlled trial in three locations in the UK. Participants (≥18 years) were recruited from UK National Health Service (NHS) Improving Access to Psychological Therapies (IAPT) services or by self-referral and met DSM-5 criteria for PTSD to single or multiple events. Participants were randomly allocated by a computer programme (3:3:1) to iCT-PTSD, iStress-PTSD, or a 3-month waiting list with usual NHS care, after which patients who still met PTSD criteria were randomly allocated (1:1) to iCT-PTSD or iStress-PTSD. Randomisation was stratified by location, duration of PTSD (<18 months or ≥18 months), and severity of PTSD symptoms (high vs low). iCT-PTSD and iStress-PTSD were delivered online with therapist support by messages and short weekly phone calls over the first 12 weeks (weekly treatment phase), and three phone calls over the next 3 months (booster phase). The primary outcome was the severity of PTSD symptoms at 13 weeks after random assignment, measured by self-report on the PTSD Checklist for DSM-5 (PCL-5), and analysed by intention-to-treat. Safety was assessed in all participants who started treatment. Process analyses investigated acceptability and compliance with treatment, and candidate moderators and mediators of outcome. The trial was prospectively registered with the ISRCTN registry, ISRCTN16806208.FINDINGS: Of the 217 participants, 158 (73%) self-reported as female, 57 (26%) as male, and two (1%) as other; 170 (78%) were White British, 20 (9%) were other White, six (3%) were Asian, ten (5%) were Black, eight (4%) had a mixed ethnic background, and three (1%) had other ethnic backgrounds. Mean age was 36·36 years (SD 12·11; range 18-71 years). 52 (24%) participants met self-reported criteria for ICD-11 complex PTSD. Fewer than 10% of participants dropped out of each treatment group. iCT-PTSD was superior to iStress-PTSD in reducing PTSD symptoms, showing an adjusted difference on the PCL-5 of -4·92 (95% CI -8·92 to -0·92; p=0·016; standardised effect size d=0·38 [0·07 to 0·69]) for immediate allocations and -5·82 (-9·59 to -2·04; p=0·0027; d=0·44 [0·15 to 0·72]) for all treatment allocations. Both treatments were superior to the waiting list for PCL-5 at 13 weeks (d=1·67 [1·23 to 2·10] for iCT-PTSD and 1·29 [0·85 to 1·72] for iStress-PTSD). The advantages in outcome for iCT-PTSD were greater for participants with high dissociation or complex PTSD symptoms, and mediation analyses showed both treatments worked by changing negative meanings of the trauma, unhelpful coping, and flashback memories. No serious adverse events were reported.INTERPRETATION: Trauma-focused iCT-PTSD is effective and acceptable to patients with PTSD, and superior to a non-trauma-focused cognitive behavioural stress management therapy, suggesting that iCT-PTSD is an effective way of delivering the contents of CT-PTSD, one of the NICE-recommended first-line treatments for PTSD, while reducing therapist time compared with face-to-face therapy.FUNDING: Wellcome Trust, UK National Institute for Health and Care Research Oxford Health Biomedical Research Centre.
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16.
  • Eimontas, Jonas, et al. (författare)
  • A tailored Internet-delivered modular intervention based on cognitive behavioral therapy for depressed older adults : a study protocol for a randomized controlled trial
  • 2021
  • Ingår i: Trials. - : BMC. - 1745-6215. ; 22:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Depression is most common among the elderly and is associated with major impairment With limited accessible treatments available, remotely provided interventions are needed. Internet-based interventions have been proven effective for a number of mental and somatic health problems. However, the elderly population has received relatively limited attention in previous studies. This study aims to address this gap by investigating the effectiveness of a tailored Internet-delivered modular intervention based on cognitive behavioral therapy (CBT). Methods: A minimum of 60 participants will be recruited and randomly assigned to groups in a two-armed parallel controlled trial with a waiting list. The intervention group will have access to an 8-week therapist-supported modular intervention. The waiting list group will be instructed to wait for 8 weeks and then granted access to the intervention for 8 weeks. Pre, post, and 3-, 12-, and 24-month follow-up assessments are planned for measuring changes in depression symptoms, anxiety symptoms, and psychological well-being using PHQ-9, GDS, GAD-7, and WHO-5. Primary outcomes of all the participants will be analyzed using the intention-to-treat principle, and withinand between-group effect sizes will be calculated. Discussion: Internet-based interventions could help address the existing treatment gap for depressed older adults. However, to date, the effectiveness of Internet-based CBT (ICBT) for depressed older adults has only been tested in a few studies. This trial will demonstrate if Internet-based CBT is effective for this population when compared to a waiting list control. Further analysis of secondary outcomes and participant behavior in the intervention will potentially reveal effectiveness moderating factors.
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17.
  • Fischer, Vinicius Jobim, et al. (författare)
  • A randomized controlled trial of an Internet-based emotion regulation intervention for sexual health : study protocol
  • 2021
  • Ingår i: Trials. - : BMC. - 1745-6215. ; 22:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction Emotion regulation difficulties have been associated with mental disorders and sexual dysfunctions. Traditional face-to-face transdiagnostic emotion regulation interventions have shown positive results for emotional and personality disorders. Only recently have the effects of these interventions on sexual health started to be investigated. Internet-delivered psychological interventions have several advantages over face-to-face interventions, such as cost-effectiveness, accessibility, and suitability for people who experience shame because of their stigmatized problematic behaviors and those who avoid seeking help. The aims of the SHER 2-TREpS (Portuguese acronym for Emotion Regulation training for sexual health) project are as follows: (a) determine the efficacy of an Internet-based emotion regulation intervention for sexual health and sexual satisfaction and (b) explore the effects of the intervention on (1) emotion regulation skills, (2) mental health, and (3) sexual self-perception. Methods and analysis The study will use a randomized controlled trial design. Eligible participants will be randomly allocated to one of two groups: intervention (Internet-based emotion regulation training) or waitlist control. Assessments will take place before the start of the trial, at the end of the trial, and at 6-month follow up, after which participants assigned to the waitlist control condition will receive the same intervention. Primary outcomes include sexual function and satisfaction and secondary outcomes self-report measures of depression, anxiety, difficulties in emotion regulation, and sexual self-perception. This intervention study is financed by the Luxembourg National Research Fund (FNS). Ethics and dissemination Ethics approval was obtained from the Ethics Review Panel of the University of Luxembourg. Findings will be disseminated via peer-reviewed publications and conference presentations.
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18.
  • Fischer, Vinicius Jobim, et al. (författare)
  • The Relationship Between Emotion Regulation and Sexual Function and Satisfaction: A Scoping Review
  • 2022
  • Ingår i: Sexual Medicine Reviews. - : Elsevier. - 2050-0521. ; 10:2, s. 195-208
  • Forskningsöversikt (refereegranskat)abstract
    • Introduction: Sexual problems are characterized by difficulties in the ability to respond sexually or to obtain sexual pleasure. Their etiology is assumed to be multifactorial, demanding a biopsychosocial treatment approach. Positive sexual experiences involve the dynamic interplay between cognitive, emotional, and motivational factors. Difficulties in emotion identification or impairment in emotion regulation may thus play a pivotal role in the development and maintenance of sexual problems.Objectives: To conduct a scoping review of the literature on the effects of emotion regulation on sexual function and satisfaction.Methods: We conducted a scoping review using Cinahl, Lilacs, Scielo, Scopus, PsycInfo and Pubmed electronic databases using search terms related to emotion regulation and sexual function and satisfaction.Results: 27 articles met the inclusion criteria and were further analyzed. Overall, emotion regulation difficulties were associated with poorer sexual health outcomes, difficulties in the sexual response cycle and overall lower sexual satisfaction. Laboratory studies and intervention trials found positive effects of promoting emotion regulation change on sexual function and satisfaction.Conclusions: Despite the methodological diversity of studies, it can be concluded from this review that difficulties in emotion regulation are related to sexual difficulties and sexual dissatisfaction. Future research should consider emotion regulation-focused interventions to mitigate sexual health problems.
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19.
  • Halaj, Asala, et al. (författare)
  • Examining the relationship between cognitive factors and insight in panic disorder before and during treatment
  • 2023
  • Ingår i: Cognitive Behaviour Therapy. - : ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD. - 1650-6073 .- 1651-2316. ; 52:4, s. 331-346
  • Tidskriftsartikel (refereegranskat)abstract
    • Individuals with Panic Disorder (PD) often have impaired insight, which can impede their willingness to seek treatment. Cognitive processes, including metacognitive beliefs, cognitive flexibility, and jumping to conclusions (JTC) may influence the degree of insight. By understanding the relationship between insight and these cognitive factors in PD, we can better identify individuals with such vulnerabilities to improve their insight. The aim of this study is to examine the relationships between metacognition, cognitive flexibility, and JTC with clinical and cognitive insight at pretreatment. We investigate the association among those factors changes and changes in insight over treatment. Eighty-three patients diagnosed with PD received internet-based cognitive behavior therapy. Analyses revealed that metacognition was related to both clinical and cognitive insight, and cognitive flexibility was related to clinical insight at pre-treatment. Greater changes in metacognition were correlated with greater changes in clinical insight. Also, greater changes in cognitive flexibility were related to greater changes in cognitive insight. The current study extends previous studies suggesting potential relationships among insight, metacognition, and cognitive flexibility in PD. Determining the role of cognitive concepts in relation to insight may lead to new avenues for improving insight and can have implications for engagement and treatment-seeking behaviors.
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20.
  • Hallin, Nathalie, 1990-, et al. (författare)
  • Bias against Atheists and Religious Persons in Sweden
  • 2020
  • Ingår i: Journal for the Cognitive Science of Religion. - : Equinox Publishing. - 2049-7563 .- 2049-7555. ; 5:2
  • Tidskriftsartikel (refereegranskat)abstract
    • Religion is viewed as necessary for moral behaviour in many parts of the world. Today, however, many societies are becoming more secular and the view of atheists as immoral might therefore change. This study investigated anti-atheist and anti-religious bias in Sweden, by replicating Gervais et al. (2017). The study used an online version of the conjunction fallacy test, which investigates whether a description, in this case of extremely immoral behaviour, is viewed as representative of a category or group. In this study we chose atheists and religious believers as targets. The sample consisted of 268 Swedish participants. The results showed no significant difference between conditions. However, the anti-atheist bias was lower than in the original American sample from the replicated study, while the anti-religious bias was higher. Further research can investigate differences between cultures, using the conjunction fallacy test.
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21.
  • Hedman‐Lagerlöf, Erik, et al. (författare)
  • Therapist‐supported Internet‐based cognitive behaviour therapy yields similar effects as face‐to‐face therapy for psychiatric and somatic disorders : an updated systematic review and meta‐analysis
  • 2023
  • Ingår i: World Psychiatry. - : John Wiley & Sons. - 1723-8617 .- 2051-5545. ; 22:2, s. 305-314
  • Tidskriftsartikel (refereegranskat)abstract
    • Providing therapist-guided cognitive behaviour therapy via the Internet (ICBT) has advantages, but a central research question is to what extent similar clinical effects can be obtained as with gold-standard face-to-face cognitive behaviour therapy (CBT). In a previous meta-analysis published in this journal, which was updated in 2018, we found evidence that the pooled effects for the two formats were equivalent in the treatment of psychiatric and somatic disorders, but the number of published randomized trials was relatively low (n=20). As this is a field that moves rapidly, the aim of the current study was to conduct an update of our systematic review and meta-analysis of the clinical effects of ICBT vs. face-to-face CBT for psychiatric and somatic disorders in adults. We searched the PubMed database for relevant studies published from 2016 to 2022. The main inclusion criteria were that studies had to compare ICBT to face-to-face CBT using a randomized controlled design and targeting adult populations. Quality assessment was made using the Cochrane risk of bias criteria (Version 1), and the main outcome estimate was the pooled standardized effect size (Hedges’ g) using a random effects model. We screened 5,601 records and included 11 new randomized trials, adding them to the 20 previously identified ones (total n=31). Sixteen different clinical conditions were targeted in the included studies. Half of the trials were in the fields of depression/depressive symptoms or some form of anxiety disorder. The pooled effect size across all disorders was g=0.02 (95% CI: –0.09 to 0.14) and the quality of the included studies was acceptable. This meta-analysis further supports the notion that therapist-supported ICBT yields similar effects as face-to-face CBT.
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22.
  • Johansson, Peter, 1962-, et al. (författare)
  • Internet-Based Cognitive Behavioral Therapy and its Association With Self-efficacy, Depressive Symptoms, and Physical Activity : Secondary Analysis of a Randomized Controlled Trial in Patients With Cardiovascular Disease
  • 2022
  • Ingår i: JMIR Cardio. - Toronto, Canada : JMIR Publications, Inc.. - 2561-1011. ; 6:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: In patients with cardiovascular disease (CVD), knowledge about the associations among changes in depressivesymptoms, self-efficacy, and self-care activities has been requested. This is because such knowledge can be helpful in the designof behavioral interventions aimed to improve self-efficacy, reduce depressive symptoms, and improve performance of self-careactivities in CVD patients.Objective: We aim to evaluate if internet-based cognitive behavioral therapy (iCBT) improves self-efficacy and explore therelationships among changes in depressive symptoms, self-efficacy, and physical activity, as well as the influence of iCBT onthese relationships.Methods: This study received funding in January 2015. Participant recruitment took place between January 2017 and February2018, and the main findings were published in 2019. This study is a secondary analysis of data collected in a randomized controlledstudy evaluating the effects of a 9-week iCBT program compared to an online discussion forum (ODF) on depressive symptomsin patients with CVD (N=144). Data were collected at baseline and at the 9-week follow-up. Analysis of covariance was used toevaluate the differences in self-efficacy between the iCBT and ODF groups. Structural equation modeling explored the relationshipsamong changes in depressive symptoms, self-efficacy, and physical activity, as well as the influence of iCBT on these relationships.Results: At follow-up, a significant difference in the increase in self-efficacy favoring iCBT was found (P=.04, Cohen d=0.27).We found an indirect association between changes in depressive symptoms and physical activity (ß=–.24, P<.01), with the changein self-efficacy acting as a mediator. iCBT had a direct effect on the changes in depressive symptoms, which in turn influencedthe changes in self-efficacy (ß=.23, P<.001) and physical activity (ß=.12, P<.001).Conclusions: Self-efficacy was improved by iCBT. However, the influence of iCBT on self-efficacy and physical activity wasmostly mediated by improvements in depressive symptoms.Trial Registration: ClinicalTrials.gov NCT02778074; https://clinicaltrials.gov/ct2/show/NCT02778074
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23.
  • Jovarauskaite, Lina, et al. (författare)
  • Internet-based stress recovery intervention FOREST for healthcare staff amid COVID-19 pandemic: study protocol for a randomized controlled trial
  • 2021
  • Ingår i: Trials. - : BMC. - 1745-6215. ; 22:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The demand for care during the COVID-19 pandemic has affected the mental health of healthcare workers (HCWs), thus increasing the need for psychosocial support services. Internet-based interventions have previously been found to reduce occupational stress. The study aims to test the effects of an Internet-based stress recovery intervention-FOREST-among HCWs. Methods: A randomized controlled trial (RCT) parallel group design with three measurement points will be conducted to assess the efficacy of an Internet-based stress recovery intervention FOREST for nurses. The FOREST intervention is a 6-week Internet-based CBT and mindfulness-based program which comprises of six modules: (1) Introduction, (2) Detachment (relaxation and sleep), (3) Distancing, (4) Mastery (challenge), (5) Control, and (6) Keeping the change alive. We will compare the intervention against a waiting list group at pre-test, post-test, and follow-up. Stress recovery, PTSD, complex PTSD, moral injury, the level of stress, depression, anxiety, and psychological well-being will be measured. Discussion: The study will contribute to the development of mental healthcare programs for the HCWs. Based on the outcomes of the study, the FOREST intervention can be further developed or offered to healthcare staff as a tool to cope with occupational stress.
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24.
  • Kullgard, Niclas, et al. (författare)
  • Premature Dropout From Psychotherapy: Prevalence, Perceived Reasons and Consequences as Rated by Clinicians
  • 2022
  • Ingår i: Clinical Psychology in Europe. - : PsychOpen. - 2625-3410. ; 42:2
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Why clients discontinue their psychotherapies has attracted more attention recently as it is a major problem for many healthcare services. Studies suggest that dropout rates may be affected by the mode of therapy, low-quality therapeutic alliance, low SES, and by conditions such personality disorders or substance abuse. The aims of the study were to investigate what happens in therapies which end in a dropout, and to estimate how common dropout is as reported by practicing clinicians. Method: An online questionnaire was developed and completed by 116 therapists working in clinical settings. They were recruited via social media (Facebook and different online psychotherapy groups) in Sweden and worked with Cognitive Behavioural Therapy (CBT), Psychodynamic Therapy (PDT), Interpersonal Psychotherapy (IPT) and Integrative Psychotherapy (IP). Results: Psychotherapists rated the frequency of premature dropout in psychotherapy to be on average 8.89% (MD = 5, SD = 8.34, Range = 0-50%). The most common reasons for a dropout, as stated by the therapists, were that clients were not satisfied with the type of intervention offered, or that clients did not benefit from the treatment as they had expected. The most common feeling following a dropout was self-doubt. Conclusion: In conclusion, premature dropout is common in clinical practice and has negative emotional consequences for therapists. Premature dropout may lead to feelings of self-doubt and powerlessness among therapists. The therapeutic alliance was mostly rated as good in dropout therapies. Further research is needed to validate the findings with data on the prevalence and subjective reasons behind a dropout from point of view of clients. © Lublin Studies in Modern Languages and Literature.All rights reserved.
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25.
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26.
  • Käll, Anton, 1992-, et al. (författare)
  • Internet-based cognitive behavioral therapy for loneliness
  • 2023
  • Ingår i: Handbook of Cognitive Behavioral Therapy by Disorder. - San Diego : Elsevier. - 9780323857260 ; , s. 175-183
  • Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
    • Feelings of loneliness are common in persons with mental health problems. Studies indicate that loneliness is related to both adverse somatic and psychiatric outcomes. Longitudinal examinations also suggest that loneliness may contribute to increased and maintained symptoms of depression and social anxiety. Even if there is no gold-standard intervention for helping persons experiencing clinically significant levels of loneliness, cognitive behavior therapy (CBT) has been suggested as an option. The interest in CBT partially stems from earlier trials, but also from studies investigating cognitive and behavioral correlates of frequent feelings of loneliness. In this chapter, we outline suggestions for developing and disseminating internet-based interventions targeting loneliness based on our experiences from developing a treatment and testing it in two randomized controlled trials. The initial results suggest that internet-based CBT (ICBT) can be a feasible approach to alleviate clinically relevant feelings of loneliness.
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27.
  • Käll, Anton, 1992-, et al. (författare)
  • Scheduled Support Versus Support on Demand in Internet-Delivered Cognitive Behavioral Therapy for Social Anxiety Disorder : Randomized Controlled Trial
  • 2023
  • Ingår i: Clinical Psychology in Europe. - : PsychOpen. - 2625-3410. ; 5:3
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: Clinician-supported internet-delivered cognitive behavioral therapy (ICBT) can be an effective treatment option when treating social anxiety disorder (SAD). Unguided ICBT is often found to be less effective. One possible solution to reduce the costs of clinician support is to provide support on demand. In this format of guidance, participants have the option to contact their clinician if needed. In a few studies, this mode of support has been compared favorably to scheduled support.Method: Participants in a previously reported controlled trial on SAD who had been in a waitlist control group were randomly allocated to ICBT with either on-demand guidance or scheduled weekly therapist guidance. A total of 99 participants were included. Data were collected weekly on the primary outcome measure, the Liebowitz Social Anxiety Scale self-report (LSAS-SR), and at pre- and post-treatment for secondary measures. Data were analyzed in accordance with the intention-to-treat principle using mixed-effects models.Results: Both groups improved significantly during the treatment according to the LSAS-SR ratings. The groups did not differ in their estimated change during the treatment period, with a between-group effect of d = 0.02, 95% CI [-0.37, 0.43]. Both groups experienced similar improvement also on the secondary outcome measures, with small between-group effect sizes on all outcomes.Conclusions: The findings indicate that support on demand can be an effective way of providing guidance in ICBT for SAD, although more research on this topic is needed. A limitation of the study is that it was conducted in 2009, and the findings were in the file drawer. Subsequent published studies support our initial findings, but more research is needed.
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28.
  • Käll, Anton, et al. (författare)
  • Therapist-Guided Internet-Based Treatments for Loneliness : A Randomized Controlled Three-Arm Trial Comparing Cognitive Behavioral Therapy and Interpersonal Psychotherapy
  • 2021
  • Ingår i: Psychotherapy and Psychosomatics. - : Karger. - 0033-3190 .- 1423-0348. ; 90:5, s. 351-358
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Chronic loneliness has been linked to many adverse outcomes, including mental health problems. Psychological treatment of loneliness can be effective, but the evidence base is limited. Objective: To investigate the efficacy of 2 internet-based interventions based on cognitive behavioral therapy (ICBT) and interpersonal psychotherapy (IIPT) relative to a wait-list control group and each other. Methods: A total of 170 participants were recruited and randomized to either 9 weeks of ICBT (n = 68), IIPT (n = 68), or a wait-list condition (n = 34). The primary outcome was loneliness, measured using the UCLA Loneliness Scale before, during, and after treatment. Secondary measures of psychiatric disorders and quality of life were administered before and after treatment. Follow-up was conducted 4 months after the treatment had ended. Primary outcome data were analyzed using growth curve modeling. Secondary outcomes were analyzed using robust regression models. The trial was preregistered (ClinicalTrials.gov ID: NCT03807154). Results: The ICBT condition had a significantly greater impact on loneliness compared to the wait-list and IIPT conditions. Effect sizes were moderate to large (Cohen d = 0.71) compared to the wait-list and moderate (d = 0.53) compared to IIPT. The IIPT condition did not differ significantly from the wait-list. Both active treatments led to significant increases in quality of life. Only the ICBT group had significantly lower symptoms of depression and generalized anxiety compared to the wait-list group. Treatment gains were maintained but not improved at follow-up. Conclusions: ICBT can be an efficacious option for alleviating loneliness. The IIPT intervention was not as effective.
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29.
  • Lindegaard, Tomas, et al. (författare)
  • Efficacy of Internet-Delivered Psychodynamic Therapy: Systematic Review and Meta-Analysis
  • 2020
  • Ingår i: Psychodynamic Psychiatry. - : Guilford Press. - 2162-2590 .- 2162-2604. ; 48:4, s. 437-454
  • Tidskriftsartikel (refereegranskat)abstract
    • Recent years have seen an increase of internet-delivered interventions based on psychodynamic treatment models. To test the efficacy of internet-delivered psychodynamic therapy (IPDT), we conducted a systematic review and meta-analysis of randomized controlled trials. Following literature searches, we identified seven studies meeting inclusion criteria. The total number of participants was 528 in the treatment group and 552 in the control conditions. We found small effects favoring IPDT compared to inactive control conditions for main outcomes (g = 0.44), depression (g = 0.46), anxiety (g = 0.20), and quality of life (g = 0.40). There was significant heterogeneity between studies for main outcomes and depression. Within-group effects ranged from Hedges's g = 0.32–0.99. The effects of IPDT were maintained or increased at follow-up. Study quality varied but was generally high. No indications of publication bias were found. In conclusion, IPDT is a promising treatment alternative, especially for depression, although the small number of studies limits the generalizability of the findings.
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30.
  • Lindegaard, Tomas, et al. (författare)
  • Experiences of internet-based cognitive behavioural therapy for depression and anxiety among Arabic-speaking individuals in Sweden : a qualitative study
  • 2021
  • Ingår i: BMC Psychiatry. - : BMC. - 1471-244X. ; 21:1
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundInternet-delivered cognitive behavioural therapy (ICBT) is a promising treatment for refugee and immigrant populations suffering from common mental disorders. The aim of the present study was to investigate experiences of participating in a guided ICBT program among resettled Arabic-speaking individuals suffering from symptoms of anxiety and depression.MethodsTen individuals who had previously received ICBT consented to participate and were interviewed using semi-structured telephone interviews. The interviews were conducted 10months after treatment termination. Data were transcribed and analysed using a Thematic Analysis framework.ResultsThe Thematic Analysis resulted in five overarching themes 1) The importance of being seen, 2) New ways of knowing and doing, 3) Treatment format not for everyone, 4) Changing attitudes towards mental health and help-seeking and 5) The healthcare system as a complex puzzle. Participants described varying levels of success in applying the new information learned from the treatment in their everyday lives. The results also indicate that participation in the ICBT program to some extent mitigated mental health stigma and acted as a precursor to other forms of treatment seeking.ConclusionsThe findings in the present study are largely in line with previous qualitative research studies on ICBT participants. Future research should investigate whether a more explicit focus on refugee-specific stressors and barriers to treatment engagement and implementation can increase adherence to ICBT programs in this population.
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31.
  • Lindner, Philip, et al. (författare)
  • Is Continued Improvement After Automated Virtual Reality Exposure Therapy for Spider Phobia Explained by Subsequent in-vivo Exposure? : A First Test of the Lowered Threshold Hypothesis
  • 2021
  • Ingår i: Frontiers in Psychiatry. - : Frontiers Media SA. - 1664-0640. ; 12
  • Tidskriftsartikel (refereegranskat)abstract
    • Consumer Virtual Reality (VR) technology offers a powerful, immersive medium for scalable dissemination of mental health interventions. Decades of research has shown VR exposure therapy to be efficacious in the treatment of anxiety disorders and that the fear reduction generalizes to real-world stimuli. Many studies also report continued improvement over time, after discontinuing VR use. The lowered threshold hypothesis states that this continued improvement is moderated by lowering the threshold to conduct subsequent in-vivo exposure. The current study is the first to formally test this hypothesis, using data from a recent trial on automated VR exposure therapy for spider phobia, in which participants (n = 49) were followed for 1 year, completing assessments 1 week, 3 and 12 months post-treatment. The assessment included validated self-report of phobia symptoms, a standardized behavioral approach test featuring a real spider, and a questionnaire for self-reporting frequency of in-vivo exposures since last assessment. Number of in-vivo exposures was found to be independently associated with greater symptom decrease in longitudinal outcome models. In sequential structural equation models, immediate post-treatment symptom reduction was associated with subsequent in-vivo exposures, which in turn was associated with continued symptom reduction. However, this applied only to self-reported phobia symptoms (not behavioral avoidance) and no associations were found past 3 months. Our findings offer preliminary, partial support for the lowered threshold hypothesis, suggesting that VR exposure interventions may benefit from including explicit in-virtuo to in-vivotransitioning components.
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32.
  • Lindqvist, Karin, et al. (författare)
  • Therapeutic alliance is calming and curing - The interplay between alliance and emotion regulation as predictors of outcome in Internet-based treatments for adolescent depression
  • 2023
  • Ingår i: Journal of Consulting and Clinical Psychology. - : American Psychological Association (APA). - 0022-006X .- 1939-2117. ; 91:7, s. 426-437
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: Therapeutic alliance is one of the most stable predictors of outcome in psychotherapy, regardless of theoretical orientation. The alliance–outcome relationship in internet-based treatments has been investigated with mixed results. There is preliminary evidence that emotion regulation can work as a mediator for the alliance–outcome relationship. The present study aimed to investigate whether alliance predicted outcome session by session in two internet-based treatments for adolescent depression, and whether this relationship was mediated by emotion regulation.Method: Two hundred and seventy-two participants aged 15–19 years and diagnosed with depression were randomized to 10 weeks of internet-based psychodynamic or cognitive behavioral treatment. Both therapists and patients rated the alliance weekly. Patients also rated depressive symptoms and emotion regulation weekly. Analyses were made using cross-lagged panel modeling.Results: Alliance, as rated by both therapist and patient, predicted depression scores the following week. Emotion regulation rated by the patient also predicted depression scores the following week. Furthermore, alliance scores predicted emotion regulation scores the following week, which in turn predicted depression scores the week after, supporting the hypothesis that alliance influences outcome partly through emotion regulation. There were no group differences in any of these relationships.Conclusion: Alliance seems to play an important role in internet-based treatments, partly through emotion regulation. Clinicians working with text-based treatments should pay attention to the working alliance.
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33.
  • Maj, Anna, et al. (författare)
  • The effect of internet-delivered cognitive behavioral therapy for depression and anxiety on quality of life : A meta-analysis of randomized controlled trials.
  • 2023
  • Ingår i: Internet interventions. - 2214-7829. ; 33
  • Tidskriftsartikel (refereegranskat)abstract
    • Although numerous studies have examined the effects of internet-delivered cognitive behavioral therapy (iCBT) for depression and anxiety on quality of life, no meta-analysis has yet been conducted to integrate the results of these studies. We conducted systematic searches in PubMed, Cochrane, and PsycInfo, which included terms for treatment type, modality of delivery, condition, and main outcome. We included studies that met the following inclusion criteria: (a) randomized controlled trials, (b) patients allocated to some form of the control condition, (c) patients receiving some type of treatment of anxiety and/or depression involving Internet-delivered Cognitive Behavioral Therapy, (d) use of a validated outcome measure assessing the level of quality of life, (e) conducted with adult participants diagnosed with anxiety disorder and/or unipolar depression, (f) papers written in English. We analyzed 40 randomized controlled trials with a total of 4289 participants that met inclusion criteria. The pooled between-group effect size for the quality of life overall score was small (g = 0.35, 95 % CI: 0.26-0.44, p = .0001), favoring iCBT over the control conditions. Regarding the distinct quality of life domains measured by the World Health Organization Quality of Life Assessment, a statistically significant difference between iCBT and control conditions was found only for the physical health domain (g = 0.56, 95 % CI: 0.06-1.07, p = .029), in favor of iCBT. In both cases, heterogeneity was moderate. While the effect on the quality of life is small (the overall quality of life score) to moderate (the physical health domain score), we conclude that iCBT for depression and anxiety may be a promising approach for improving the quality of life of patients.
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34.
  • Manchaiah, Vinaya, et al. (författare)
  • Social Representations of "Tinnitus" and "Health" among Individuals with Tinnitus Seeking Online Psychological Interventions.
  • 2023
  • Ingår i: Audiology Research. - : MDPI. - 2039-4330 .- 2039-4349. ; 13:2, s. 207-220
  • Tidskriftsartikel (refereegranskat)abstract
    • (1) Objective: Social representations theory (SRT) is a body of theory within social psychology concerned with how individuals, groups, and communities collectively make sense of socially relevant or problematic issues, ideas, and practices. SRT has been increasingly sued in the area of health and disability. The current study examined the social representations of "tinnitus" and "health" among individuals with tinnitus who are seeking online psychological interventions. (2) Materials/Method: The data were gathered using a free association task about their "tinnitus" and "health" from 399 individuals with tinnitus. The data were analyzed using both qualitative and quantitative analyses methods. (3) Results: The responses resulted in 39 and 30 categories respectively, for "tinnitus" and "health". The most commonly occurring categories for tinnitus included: descriptions of tinnitus (18%), annoying (13.5%), persistent (8%), and distracting (5%). The most commonly occurring categories for health included: content (12%), conditions (8%), active (7%), take control (6%), and overweight (5%). The responses to tinnitus had predominantly negative connotations (i.e., 76.9%) whereas a larger proportion of responses toward their health was related to positive connotations (i.e., 46.4%). These frequently occurring items were also dominant in similarities analysis. Prototypical analysis of tinnitus responses identified categories horrible and bothersome to be key items in the central zone. The categories in central zone of health responses included: content, active, healthy, grateful, and overweight. (4) Conclusions: Individuals with tinnitus have very negative view of their tinnitus impacting their psychological status. Tinnitus management should focus on reducing the negative associations toward their tinnitus and strengthen the positive aspects related to their general health.
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35.
  • Mendes Santos, Cristina, 1985-, et al. (författare)
  • Breast Cancer Survivors' Attitudes toward eMental Health : A Cross-Sectional Study
  • 2023
  • Ingår i: Healthcare. - : MDPI. - 2227-9032. ; 11:13
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Breast cancer survivors' (BCS) attitudes toward eMental Health (eMH) are largely unknown, and adoption predictors and their interrelationships remain unclear. This study aimed to explore BCS' attitudes toward eMH and investigate associated variables.METHODS: A cross-sectional study involving 336 Portuguese BCS was conducted. Attitudes toward eMH, depression and anxiety symptoms, health-related quality of life, and sociodemographic, clinical, and internet-related variables were assessed using validated questionnaires. Spearman-ranked correlations, χ2, and multiple regression analyses were computed to explore associations between attitudes and collected variables.RESULTS: BCS held a neutral stance toward eMH. In models adjusted for age and education, positive attitudes were statistically significantly associated with increased depressive symptoms and worse emotional, cognitive, and body image functioning. Social network use, online health information and mental healthcare seeking, higher self-reported knowledge of eMH, and previous use of remote healthcare were positively associated with better attitudes toward eMH.CONCLUSIONS: eMH programs targeting BCS seem to be a promising strategy for providing supportive psychosocial care to BCS. However, increasing awareness about eMH efficacy and security may be necessary to improve its acceptance and use among BCS. Additional research is necessary to understand how BCS' unmet care needs, and specifically their psychological distress severity, may impact BCS' acceptance and use of eMH.
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36.
  • Micklitz, Hannah M, et al. (författare)
  • Digital self-help for people experiencing intimate partner violence : a qualitative study on user experiences and needs including people with lived experiences and services providers.
  • 2023
  • Ingår i: BMC Public Health. - : BMC. - 1471-2458. ; 23:1
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Intimate partner violence (IPV) is a prevalent public health issue associated with multiple physical and mental health consequences for survivors. Digital interventions can provide low-threshold support to those experiencing IPV, but existing digital interventions have limited efficacy in improving the safety and mental health of IPV survivors. Digitally adapting an integrative intervention with advocacy-based and psychological content holds promise for increasing the efficacy of digital interventions in the context of IPV.METHODS: This study examines the needs, acceptability and usability of an integrative digital intervention for people affected by IPV. We used the think-aloud method and semi-structured interviews with a sample of six people with lived experiences of IPV and six service providers. We analyzed the data using thematic analysis.RESULTS: We identified the increasing general acceptance of digital support tools and the limited capacity of the current support system as societal context factors influencing the acceptance of and needs regarding digital interventions in the context of IPV. An integrative digital self-help intervention offers several opportunities to complement the current support system and to meet the needs of people affected by IPV, including the reduction of social isolation, a space for self-reflection and coping strategies to alleviate the situation. However, potentially ongoing violence, varying stages of awareness and psychological capacities, and as well as the diversity of IPV survivors make it challenging to develop a digital intervention suitable for the target group. We received feedback on the content of the intervention and identified design features required for intervention usability.CONCLUSION: An integrative digital self-help approach, with appropriate security measures and trauma-informed design, has the potential to provide well-accepted, comprehensive and continuous psychosocial support to people experiencing IPV. A multi-modular intervention that covers different topics and can be personalized to individual user needs could address the diversity of the target population. Providing guidance for the digital intervention is critical to spontaneously address individual needs. Further research is needed to evaluate the efficacy of an integrative digital self-help intervention and to explore its feasibility it in different settings and populations.
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37.
  • Mourad, Ghassan, 1974-, et al. (författare)
  • Cost-effectiveness of internet-delivered cognitive behavioural therapy in patients with cardiovascular disease and depressive symptoms: secondary analysis of an RCT
  • 2022
  • Ingår i: BMJ Open. - London, United Kingdom : BMJ Publishing Group Ltd. - 2044-6055. ; 12:4
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction Cost-effectiveness evaluations of psychological interventions, such as internet-delivered cognitive behavioural therapy (iCBT) programmes, in patients with cardiovascular disease (CVD) are rare. We recently reported moderate to large effect sizes on depressive symptoms in CVD outpatients following a 9-week iCBT programme compared with an online discussion forum (ODF), in favour of iCBT. In this paper, we evaluate the cost-effectiveness of this intervention.Methods Cost-effectiveness analysis of a randomised controlled trial. The EQ-5D-3L was used to calculate quality-adjusted life-years (QALYs). Data on healthcare costs were retrieved from healthcare registries.Results At 12-month follow-up, the QALY was significantly higher in iCBT compared with the ODF group (0.713 vs 0.598, p=0.007). The mean difference of 0.115 corresponds with 42 extra days in best imaginable health status in favour of the iCBT group over the course of 1 year. Incremental cost-effectiveness ratio (ICER) for iCBT versus ODF was euro18 865 per QALY saved. The cost-effectiveness plane indicated that iCBT is a cheaper and more effective intervention in 24.5% of the cases, and in 75% a costlier and more effective intervention than ODF. Only in about 0.5% of the cases, there was an indication of a costlier, but less effective intervention compared with ODF.Conclusions The ICER of euro18 865 was lower than the cost-effectiveness threshold range of euro23 400-euro35 100 as proposed by the NICE guidelines, suggesting that the iCBT treatment of depressive symptoms in patients with CVD is cost-effective.
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38.
  • Nilsson, Kristina, et al. (författare)
  • Waiting for kidney transplantation from deceased donors: Experiences and support needs during the waiting time -A qualitative study
  • 2022
  • Ingår i: Patient Education and Counseling. - Shannon, Ireland : Elsevier. - 0738-3991 .- 1873-5134. ; 105:7, s. 2422-2428
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: The study aimed to explore and describe patients’ experiences of the transplantation process and the support they had received during the waiting time.Method: Semi-structured interviews were conducted with 14 patients currently waiting for kidney transplantation from deceased donors (n = 7) or recently having received kidney transplantation (n = 7). Interviews were transcribed, anonymized and analysed inductively using thematic analysis.Results: Two themes and seven sub-themes were identified. The first theme, “Swaying between hope and despair” describes patients’ perceptions of waiting for transplantation as a struggle, their expectations for life after the upcoming transplantation and experienced disappointments. The second theme, “Making your way through the waiting time”, describes support, strategies and behaviours used to manage the waiting time.Conclusion: Patients described life while waiting for kidney transplantation as challenging, involving unexpected events, not understanding the transplantation process and having unrealistic expectations on life after transplantation. They also described support, strategies and behaviours used, some of which led to unwanted consequences.Practice implications: Patients waiting for kidney transplantation from deceased donors need continuous and easily available education, practical and emotional support to manage the waiting time. Transplantation specific education is also needed to facilitate preparation for transplantation and adjustment to life after transplantation.
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39.
  • Nomeikaite, Auguste, et al. (författare)
  • The role of therapist support on the efficacy of an internet-delivered stress recovery intervention for healthcare workers: a randomized control trial
  • 2023
  • Ingår i: Cognitive Behaviour Therapy. - : ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD. - 1650-6073 .- 1651-2316. ; 52:5, s. 488-507
  • Tidskriftsartikel (refereegranskat)abstract
    • Internet-delivered CBT interventions effectively improve different aspects of mental health, although the therapists role remains unclear. The aim of this trial was to evaluate the efficacy of a therapist-supported 6-week internet-delivered intervention in improving stress recovery among healthcare workers compared to a group with optional therapist support. A total of 196 participants were recruited and randomly allocated to regular therapists support or optional therapists support groups. The primary outcome measure was the Recovery Experiences Questionnaire (REQ), developed to assess four components of stress recovery: psychological detachment, relaxation, mastery, and control. Secondary outcomes measured perceived stress (PSS-10), anxiety (GAD-7), depression (PHQ-9), and psychological well-being (WHO-5). All four stress recovery skills improved significantly after participating in the intervention at a 3-month follow-up, with small to medium effects (0.27-0.65) in both groups. At follow-up, we also found a significant reduction in perceived stress, depression, and anxiety in both groups, as well as an improvement in psychological well-being. The results indicate that ICBT can be effective in improving stress recovery skills among healthcare workers with optional support from the therapist, provided at the participants request. This RCT suggests that optional therapist support could meet participants needs and reduce resources needed in routine care.
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40.
  • Pahnke, Johan, et al. (författare)
  • Acceptance and commitment therapy for autistic adults : a randomized controlled pilot study in a psychiatric outpatient setting
  • 2023
  • Ingår i: Autism. - : Sage Publications. - 1362-3613 .- 1461-7005. ; 27:5, s. 1461-1476
  • Tidskriftsartikel (refereegranskat)abstract
    • Autistic adults are at risk of stress-related psychiatric disorders and reduced life quality due to social, cognitive, and perceptual challenges. Mental health interventions adapted to autistic adults are scarce. Acceptance and commitment therapy has preliminarily indicated health benefits in autistic adults, although it has not been robustly evaluated. Overall, 39 adults (21 males; 21–72 years) with autism spectrum disorder and normal intellectual ability (IQ M = 108.5; SD = 13.5) were randomized to 14 weeks of adapted acceptance and commitment therapy group treatment (NeuroACT) or treatment as usual. The intervention was feasible. Perceived stress and quality of life (primary outcomes), alongside psychological inflexibility, cognitive fusion, cognitive and behavioral avoidance, and autistic mannerism were statistically significantly improved in NeuroACT compared with treatment as usual (d = 0.70–0.90). Clinically significant changes in perceived stress and quality of life were in favor of NeuroACT. Between-group altered depression, anxiety, sleep problems, one quality of life measure, functional impairment, social aspects of autism, and executive difficulties were statistically non-significant. Dropout was slightly higher in NeuroACT. NeuroACT may be a promising treatment for autistic adults with co-existing stress and reduced quality of life. More extensive studies are warranted to evaluate NeuroACT further. 
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41.
  • Pasarelu, Costina-Ruxandra, et al. (författare)
  • Feasibility and clinical utility of a transdiagnostic Internet-delivered rational emotive and behavioral intervention for adolescents with anxiety and depressive disorders
  • 2021
  • Ingår i: Internet Interventions. - : Elsevier. - 2214-7829. ; 26
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Transdiagnostic interventions delivered for children and adolescents show promising results. In order to increase access to treatment, recent developments in technology have led to alternatives to face-to-face interventions. Transdiagnostic Internet-delivered interventions can be effective for adult anxiety and depressive disorders, but research is more limited regarding the efficacy of such treatments for young populations diagnosed with anxiety and or depressive disorders. Objective: This study aims to investigate the feasibility and clinical utility of a transdiagnostic Internet-delivered intervention based on Rational emotive behavior therapy for adolescents diagnosed with anxiety and depressive disorders. Methods: We tested the preliminary efficacy of a six-week intervention in an open trial, pre-post design. Results: Our results suggest that the intervention is feasible and can be included as a treatment for adolescents with anxiety and depressive disorders, being associated with moderate to large pre-post effect sizes on self-reported anxiety and depressive symptoms, as well as on negative patterns of thinking and knowledge acquisition. Satisfaction with the intervention was high. Conclusions: Transdiagnostic Internet-delivered interventions for adolescents with anxiety and depressive symptoms are feasible. Future testing of the efficacy of such interventions in randomized controlled trials should be conducted.
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42.
  • Pearce, Eiluned, et al. (författare)
  • Loneliness as an active ingredient in preventing or alleviating youth anxiety and depression : a critical interpretative synthesis incorporating principles from rapid realist reviews
  • 2021
  • Ingår i: Translational Psychiatry. - : Springer Nature. - 2158-3188. ; 11:1
  • Forskningsöversikt (refereegranskat)abstract
    • Loneliness is a relatively common problem in young people (14-24 years) and predicts the onset of depression and anxiety. Interventions to reduce loneliness thus have significant potential as active ingredients in strategies to prevent or alleviate anxiety and depression among young people. Previous reviews have focused on quantitative evidence and have not examined potential mechanisms that could be targets for intervention strategies. To build on this work, in this review we aimed to combine qualitative and quantitative evidence with stakeholder views to identify interventions that appear worth testing for their potential effectiveness in reducing loneliness, anxiety and depression in young people aged 14-24 years, and provide insights into the potential mechanisms of action. We conducted a Critical Interpretative Synthesis, a systematic review method that iteratively synthesises qualitative and quantitative evidence and is explicitly focused on building theory through a critical approach to the evidence that questions underlying assumptions. Literature searches were performed using nine databases, and eight additional databases were searched for theses and grey literature. Charity and policy websites were searched for content relevant to interventions for youth loneliness. We incorporated elements of Rapid Realistic Review approaches by consulting with young people and academic experts to feed into search strategies and the resulting conceptual framework, in which we aimed to set out which interventions appear potentially promising in terms of theoretical and empirical underpinnings and which fit with stakeholder views. We reviewed effectiveness data and quality ratings for the included randomised controlled trials only. Through synthesising 27 studies (total participants n = 105,649; range 1-102,072 in different studies) and grey literature, and iteratively consulting with stakeholders, a conceptual framework was developed. A range of Intrapersonal (e.g. therapy that changes thinking and behaviour), Interpersonal (e.g. improving social skills), and Social Strategies (e.g. enhancing social support, and providing opportunities for social contact) seem worth testing further for their potential to help young people address loneliness, thereby preventing or alleviating depression and/or anxiety. Such strategies should be co-designed with young people and personalised to fit individual needs. Plausible mechanisms of action are facilitating sustained social support, providing opportunities for young people to socialise with peers who share similar experiences, and changing thinking and behaviour, for instance through building positive attitudes to themselves and others. The most convincing evidence of effectiveness was found in support of Intrapersonal Strategies: two randomised controlled studies quality-rated as good found decreases in loneliness associated with different forms of therapy (Cognitive Behavioural Therapy or peer network counselling), although power calculations were not reported, and effect sizes were small or missing. Strategies to address loneliness and prevent or alleviate anxiety and depression need to be co-designed and personalised. Promising elements to incorporate into these strategies are social support, including from peers with similar experiences, and psychological therapy.
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43.
  • Persson Asplund, Robert, 1977-, et al. (författare)
  • Work-Focused Versus Generic Internet-Based Interventions for Employees With Stress-Related Disorders : Randomized Controlled Trial
  • 2023
  • Ingår i: Journal of Medical Internet Research. - : JMIR Publications. - 1438-8871. ; 25
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: In recent decades, stress-related disorders have received more attention, with an increasing prevalence, especially within the working population. The internet provides new options for broad dissemination, and a growing body of evidence suggests that web-based interventions for stress might be effective. However, few studies have examined the efficacy of interventions in clinical samples and work-related outcomes.Objective: The aim of this study was to evaluate the efficacy of an internet-based cognitive behavioral intervention for stress-related disorders integrating work-related aspects (work-focused and internet-based cognitive behavioral therapy [W-iCBT]), compared with a generic internet-based cognitive behavioral therapy (iCBT) group and a waitlist control (WLC) group.Methods: In this trial, 182 employees, mainly employed in the health care, IT, or educational sector, who fulfilled the criteria for a stress-related disorder, were randomized to a 10-week W-iCBT (n=61, 33.5%), generic iCBT (n=61, 33.5%), or WLC (n=60, 33%). Self-rated questionnaires on perceived stress, burnout, exhaustion, and other mental health– and work-related outcomes were administered before and after the treatment and at 6- and 12-month follow-ups.Results: Compared with the WLC group, participants of the W-iCBT and iCBT groups showed an equal and significant reduction in the primary outcome (Shirom-Melamed Burnout Questionnaire [SMBQ]) from pretreatment to posttreatment assessment (Cohen d=1.00 and 0.83, respectively) and at the 6-month follow-up (Cohen d=0.74 and 0.74, respectively). Significant moderate-to-large effect sizes were also found in the secondary health- and work-related outcomes. The W-iCBT was the only group that exhibited significant effects on work ability and short-term sickness absence. Short-term sickness absence was 445 days lower than the WLC group and 324 days lower than the iCBT intervention group. However, no significant differences were found in terms of work experience or long-term sick leave.Conclusions: The work-focused and generic iCBT interventions proved to be superior compared with the control condition in reducing chronic stress and several other mental health–related symptoms. Interestingly, effects on work ability and short-term sickness absence were only seen between the W-iCBT intervention and the WLC groups. These preliminary results are promising, indicating that treatments that include work aspects may have the potential to accelerate recovery and reduce short-term sickness absence because of stress-related disorders.Trial Registration: ClinicalTrials.gov NCT05240495
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44.
  • Rheker, Julia, et al. (författare)
  • The role of “on demand” therapist guidance vs. no support in the treatment of tinnitus via the internet : A randomized controlled trial
  • 2015
  • Ingår i: Internet Interventions. - : Elsevier. - 2214-7829. ; 2:2, s. 189-199
  • Tidskriftsartikel (refereegranskat)abstract
    • ObjectiveInternet-based cognitive behavioral self-help treatments (iCBT) have been shown to successfully reduce the distress associated with tinnitus. Despite this success, little is known about the mechanisms that make iCBT for tinnitus sufferers work. Availability of minimal therapeutic support is assumed to positively influence treatment outcome in iCBT, but the lower limit of required support is not known. In face-to-face therapy, patients' positive outcome expectations have demonstrated an advantageous effect on outcome. The first aim of our study was thus to investigate the role of ‘on demand’ therapeutic guidance vs. no therapeutic support on treatment outcome in an iCBT for tinnitus sufferers. Our second aim was to investigate whether positive outcome expectations can predict treatment outcome.MethodsA total of 112 tinnitus patients were randomly assigned to one of two groups (support-on-demand or non-support). Both groups received an established iCBT treatment for tinnitus. While participants in the support group (n = 56) could ask a therapist for additional support, those in the other (n = 56) received no therapeutic guidance. Tinnitus distress was assessed pre- and post-treatment via the Tinnitus Handicap Inventory (THI) and the Mini-Tinnitus Questionnaire (Mini-TQ). Pre-treatment outcome expectations were assessed using the Patient Questionnaire on Therapy Expectation and Evaluation (PATHEV).ResultsWe observed significantly less tinnitus distress in the THI (support: t(55) = 7.51, p ≤ .001; non-support: t(55) = 7.68, p ≤ .001) and Mini-TQ (support: t(55) = 8.24, p ≤ .001; non-support: t(55) = 8.46, p ≤ .001) in both groups from pre- to post-treatment, but no significant differences between the groups or interactions. The PATHEV subscale “Hope of Improvement” significantly predicted treatment outcome as measured by the THI (β = 0.28, p = .027).ConclusionsThe iCBT self-help program is a good treatment option for tinnitus sufferers whether or not support-on-demand is provided. Furthermore, our results show the importance of outcome expectations to the efficacy of iCBT in tinnitus patients. Future research should focus on discovering further predictors of treatment outcome.
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45.
  •  
46.
  • Störe, Siri Jakobsson, et al. (författare)
  • Mind, Body and Machine : Preliminary Study to Explore Predictors of Treatment Response After a Sleep Robot Intervention for Adults with Insomnia
  • 2023
  • Ingår i: Nature and Science of Sleep. - : Dove Medical Press. - 1179-1608. ; 15, s. 567-577
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: The study aimed to explore characteristics of responders to a sleep robot intervention for adults with insomnia, and the likelihood that participants responded to the intervention. Methods: Data from the intervention and the control group in a randomized waitlist-controlled trial (n = 44) were pooled together after both had undergone the intervention. A repeated measures ANOVA and Friedman tests were used to explore changes over time. Differences in baseline characteristics between responders (n = 13), defined as a reduction of -5 on the Insomnia Severity Index from pre- to post-intervention, and non-responders (n = 31) were analyzed with t-tests and chi-square tests. Finally, logistic regression models were estimated.Results: Baseline anxiety was the only statistically significant difference between responders and non-responders (p = 0.03). A logistic regression model with anxiety and sleep quality as predictors was statistically significant, correctly classifying 83.3% of cases. Discussion: The results imply that people with lower anxiety and higher sleep quality at baseline are more likely to report clinically significant improvements in insomnia from the sleep robot intervention.
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47.
  • Störe, Siri Jakobsson, et al. (författare)
  • The effects of a sleep robot intervention on sleep, depression and anxiety in adults with insomnia : A randomized waitlist-controlled trial
  • 2022
  • Ingår i: Journal of Sleep Research. - : John Wiley & Sons. - 0962-1105 .- 1365-2869. ; 32:3
  • Tidskriftsartikel (refereegranskat)abstract
    • The study objective was to assess if a 3-week intervention with the Somnox sleep robot had effects on symptoms of insomnia, somatic arousal, and/or concurrent symptoms of depression and anxiety in adults with insomnia, compared with a waitlist-control group. The participants (n = 44) were randomized to a 3-week intervention with the sleep robot (n = 22), or to a waitlist-control group (n = 22). The primary outcome measure was the Insomnia Severity Index administered at baseline, mid-intervention, post-intervention and at 1-month follow-up. Secondary outcome measures were the Pre-Sleep Arousal Scale, and the Hospital Anxiety and Depression Scale. Additionally, sleep-onset latency, wake time after sleep onset, total sleep time and sleep efficiency were measured the week prior to and the last week of the intervention, both subjectively with the Consensus Sleep Diary and objectively with wrist actigraphy. Mixed-effects models were used to analyse data. The effect of the sleep robot on the participants' insomnia severity was not statistically significant. The differences between the intervention group and the control group on the measures of arousal, anxiety and depression were also not statistically significant, and neither were the sleep diary and actigraphy variables. In conclusion, a 3-week intervention with daily at-home use of the robot was not found to be an effective method to relieve the symptom burden in adults with insomnia.
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48.
  • Sunnhed, Rikard, 1979-, et al. (författare)
  • Mediators of Cognitive Therapy and Behavior Therapy for Insomnia Disorder : A Test of the Processes in the Cognitive Model
  • 2022
  • Ingår i: Journal of Consulting and Clinical Psychology. - : American Psychological Association (APA). - 0022-006X .- 1939-2117. ; 90:9, s. 696-708
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: To examine if the processes in the cognitive model mediate cognitive therapy (CT) and behavior therapy (BT) for insomnia. Method: Individuals diagnosed with insomnia disorder (n = 219) were randomized to telephone-supported internet-delivered CT (n = 72), BT (n = 73), or a wait-list (WL; n = 74). Cognitive processes (worry, dysfunctional beliefs, monitoring, and safety behaviors) proposed to maintain insomnia and treatment outcome (insomnia severity index) were assessed biweekly. Criteria for evaluating mediators were assessed via parallel process growth modeling and cross-lagged panel models. Results: Parallel process growth modeling showed that dysfunctional beliefs, monitoring, and safety behaviors significantly mediated the effects of both CT and BT. Cross-lagged panel models confirmed that dysfunctional beliefs and monitoring (approaching significance) influenced subsequent within-individual change in insomnia severity in CT. In BT, however, prior changes in insomnia severity predicted subsequent changes in worry and monitoring, and reciprocal influences among processes and outcomes were observed for dysfunctional beliefs and safety behaviors. Furthermore, the effect of safety behaviors on outcome was significantly larger for BT compared to CT. Conclusion: Together, the findings support the role of dysfunctional beliefs and monitoring as processes of change in CT and safety behaviors as a specific mediator in BT. Limited evidence was provided for worry as a mediator. The findings could improve clinical management and increase our conceptual understanding of insomnia and its maintaining factors by underscoring the relevance of these three processes for insomnia, as well as indicate important routes for future research, such as investigating how baseline presentations might moderate these mediations, for example moderated mediation.
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49.
  • Truskauskaite, Inga, et al. (författare)
  • ICD-11 PTSD and Complex PTSD in Lithuanian University Students: Prevalence and Associations With Trauma Exposure
  • 2023
  • Ingår i: Psychological Trauma. - : EDUCATIONAL PUBLISHING FOUNDATION-AMERICAN PSYCHOLOGICAL ASSOC. - 1942-9681 .- 1942-969X. ; 15:5, s. 772-780
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: Young adults are at high risk for developing mental disorders. Moreover, trauma exposure and trauma-related disorders in emerging adulthood are highly prevalent. The study aimed to explore the prevalence of traumatic experiences, probable ICD-11 posttraumatic stress disorder (PTSD), probable complex PTSD (CPTSD), and links between trauma exposure and traumatic stress reactions among first-year university students in Lithuania. Method: In total, 1,626 university students from Lithuania, 68.2% female, mean age 19.09 (SD = 1.05) years, were recruited for the study. Probable ICD-11 PTSDs were measured using the self-report International Trauma Questionnaire (ITQ). Results: A majority (77.2%) of young adults had been exposed to traumatic experiences. The prevalence of probable ICD-11 PTSD and CPTSD in the total sample was 4.6% and 3.4%, respectively. Both PTSD and CPTSD were associated with cumulative lifetime trauma experiences. CPTSD was related to sexual trauma, whereas PTSD was linked to single traumatic incidents, like a physical assault. Both probable PTSD and probable CPTSD were associated with physical and sexual abuse in childhood. Conclusion: The findings of our study show that nearly 8 in 10 university students were exposed to trauma at the beginning of their studies. The prevalence of probable PTSD/CPTSD was comparable to other studies conducted on the general population and university students.
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50.
  • Werther, Louise, 1991-, et al. (författare)
  • Hearing impaired persons' experiences with the online Swedish Individualized Active Communication Education (I-ACE) program : A feasibility study
  • 2024
  • Ingår i: Internet interventions. - : ELSEVIER. - 2214-7829. ; 36
  • Tidskriftsartikel (refereegranskat)abstract
    • Even with optimally fitted hearing aids, many individuals with hearing impairment struggle to hear in situations with difficult listening conditions. Active Communication Education (ACE) is an interactive group rehabilitation program aimed at helping people with hearing loss communicate more effectively using communication strategies to better cope with everyday life. To increase accessibility and allow more people to benefit from the ACE program, a modified individualized version was created. The purpose of this study was to examine the feasibility of providing the Swedish Individualized Active Communication Education (I-ACE) program via an online platform and to explore hearing impaired persons' experiences with the program. For five weeks, ten participants completed the Swedish I-ACE through an online platform. The participants were assigned a new chapter to complete each week and later received individual feedback on their work via the platform. The participants were asked to complete an evaluation form regarding the content and their experiences during and after completing the I-ACE. They were later interviewed to provide more detailed information on their experiences with the program. The program completion rate was 80 %. Participants found the I-ACE program to be informative and relevant but somewhat repetitive. However, only a few participants thought of the repetitiveness as negative. Few participants reported difficulties using the platform. This study indicated that it is feasible to provide the I-ACE program via an online platform and that the content of the program is informative, relevant, and comprehensible. Further research evaluating the effects of the I-ACE is warranted.
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