| 1. |
- Aspvall, K., et al.
(författare)
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Implementation of internet-delivered cognitive behaviour therapy for pediatric obsessive-compulsive disorder: Lessons from clinics in Sweden, United Kingdom and Australia
- 2020
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Ingår i: Internet Interventions. - : Elsevier BV. - 2214-7829. ; 20
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Tidskriftsartikel (refereegranskat)abstract
- Obsessive-compulsive disorder (OCD) can be successfully treated with cognitive behaviour therapy (CBT). However, as few patients have access to CBT, there is a strong push to develop and evaluate scalable and cost-effective internet-delivered interventions. BIP OCD is a therapist-guided online CBT intervention for pediatric OCD that has shown promise in trials conducted at a single site in Stockholm, Sweden. In this study, we evaluated if BIP OCD is an acceptable, feasible, and effective treatment in other countries and clinical contexts. Thirty-one patients were recruited at three different sites; a specialist OCD clinic in Gothenburg (Sweden), a specialist OCD clinic in London (United Kingdom), and a university-based clinic in Brisbane (Australia). Acceptability and feasibility measures included treatment adherence and feedback from therapists. Clinician assessments were conducted at baseline, post-treatment, and 3-month follow-up. The average module completion for the participants was 8.1/12 (SD = 3.2) and the majority of patients completed the BIP OCD treatment (100% in Gothenburg, and 55.6% in both London and Brisbane). Pooling data from the three sites, the within-group effect sizes from baseline to post-treatment on the Children's Yale-Brown Obsessive-Compulsive Scale were in the expected range (bootstrapped Cohen's d = 1.78; 95% CI 1.18–2.39), with an additional symptom reduction to the 3-month follow-up (bootstrapped Cohen's d = 0.27; 95% CI 0.02–0.51). Participating therapists identified both advantages and difficulties supporting patients in this digital format. The results of this study suggest that the treatment effects obtained in the original BIP OCD trials can be generalized to other clinical contexts nationally and internationally. Lessons learned provide important information for successful implementation of BIP OCD in regular healthcare contexts. © 2020 The Authors
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| 2. |
- Buhrman, Monica, 1974-, et al.
(författare)
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Treating perfectionism using internet-based cognitive behavior therapy : A study protocol for a randomized controlled trial comparing two types of treatment
- 2020
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Ingår i: Internet Interventions. - : Elsevier BV. - 2214-7829. ; 21
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Tidskriftsartikel (refereegranskat)abstract
- Perfectionism is characterized by setting high standards and striving for achievement, sometimes at the expense of social relationships and wellbeing. Despite sometimes being viewed as a positive feature by others, people with perfectionism tend to be overly concerned about their performance and how they are being perceived by people around them. This tends to create inflexible standards, cognitive biases, and performance-related behaviors that maintain a belief that self-worth is linked to accomplishments. Cognitive behavior therapy has been shown to be a viable treatment for perfectionism, both in terms of reducing levels of perfectionism and improving psychiatric symptoms. Furthermore, a number of recent studies indicate that it can be successfully delivered via the Internet, both with regular support and guidance on demand from a therapist. In the present study protocol, a clinical trial for perfectionism is described and outlined. In total, 128 participants will be recruited and randomized to either a treatment that has already been demonstrated to have many benefits, Internet-based Cognitive Behavior Therapy for perfectionism (iCBT-P), or an active comparison condition, Internet-based Unified Protocol (iUP), targeting the emotions underlying depression and anxiety disorders. The results will be investigated with regard to self-reported outcomes of perfectionism, psychiatric symptoms, self-compassion, and quality of life, at post-treatment and at six- and 12-month follow-up. Both iCBT-P and iUP are expected to have a positive impact, but the difference between the two conditions in terms of their specific effects and adherence are currently unknown and will be explored. The clinical trial is believed to lead to a better understanding of how perfectionism can be treated and the specificity of different treatments.
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| 3. |
- Flygare, Anna-Lena, et al.
(författare)
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Internet-based CBT for patients with depressive disorders in primary and psychiatric care : Is it effective and does comorbidity affect outcome?
- 2020
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Ingår i: Internet Interventions. - : Elsevier. - 2214-7829. ; 19
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Tidskriftsartikel (refereegranskat)abstract
- Internet-based cognitive behavior therapy (ICBT) has proved effective in reducing mild to moderate depressive symptoms. However, only a few studies have been conducted in a regular healthcare setting which limits the generalizability of the results. The influence of psychiatric comorbidity on outcome is not well understood. In the current study, patients with mild to moderate depressive symptoms in primary and psychiatric care were interviewed using the SCID-I and SCID-II to assess psychiatric diagnoses. Those included were randomly allocated to ICBT (n = 48) or to an active control condition (n = 47). Both groups received therapist support. At post-treatment, ICBT had reduced depressive symptoms on the BDI-II more than the active control intervention (p = .021). However, the difference between groups was no longer significant at the 6-, 12- or 24-month followups. The within-group effect size after ICBT (BDI-II) was large (d = 1.4). A comorbid anxiety disorder didn't moderate the outcome, while the presence of a personality disorder predicted significantly less improvement in depressive symptoms. ICBT had a large effect on depressive symptoms in a sample from regular healthcare. It is possible to obtain a large effect from ICBT despite comorbid anxiety, however, including patients with a comorbid personality disorder in the current form of ICBT seems questionable.
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| 4. |
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| 5. |
- Hesser, Hugo, 1982-
(författare)
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Estimating causal effects of internet interventions in the context of nonadherence
- 2020
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Ingår i: Internet Interventions. - : Elsevier. - 2214-7829. ; 21
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Tidskriftsartikel (refereegranskat)abstract
- A substantial proportion of participants who are offered internet-based psychological treatments in randomized trials do not adhere and may therefore not receive treatment. Despite the availability of justified statistical methods for causal inference in such situations, researchers often rely on analytical strategies that either ignore adherence altogether or fail to provide causal estimands. The objective of this paper is to provide a gentle nontechnical introduction to complier average causal effect (CACE) analysis, which, under clear assumptions, can provide a causal estimate of the effect of treatment for a subsample of compliers. The article begins with a brief review of the potential outcome model for causal inference. After clarifying assumptions and model specifications for CACE in the latent variable framework, data from a previously published trial of an internet-based psychological treatment for irritable bowel syndrome are used to demonstrate CACE-analysis. Several model extensions are then briefly reviewed. The paper offers practical recommendations on how to analyze randomized trials of internet interventions in the context of nonadherence. It is argued that CACE-analysis, whenever it is considered appropriate, should be carried out as a complement to the standard intention-to-treat analysis and that the format of internet-based treatments is particularly well suited to such an analytical approach.
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| 6. |
- Käll, Anton, et al.
(författare)
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Lonesome no more? : A two-year follow-up of internet-administered cognitive behavioral therapy for loneliness
- 2020
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Ingår i: Internet Interventions. - : Elsevier BV. - 2214-7829. ; 19
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Tidskriftsartikel (refereegranskat)abstract
- The current study sought to investigate the long-term effects of an internet-administered programme based on CBT principles for which the initial efficacy has been reported in Kall, Jagholm, et al. (In press). Seventy-three participants who were recruited on the basis of experiencing frequent and prolonged loneliness were contacted to complete questionnaires measuring loneliness, quality of life, and symptoms of psychopathology two years after the conclusion of the initial treatment period. Additional items regarding use of the treatment techniques and strategies contained in the programme during the follow-up period was included. In total, 44 participants provided data for the loneliness measure at follow-up. The outcome data were analyzed with a piecewise mixed effects model to provide estimates of change for the continuous measures. Linear multiple regression analysis was used to investigate the relationship between use of treatment techniques and reliable change on the primary outcome measure. The results showed decreases in loneliness during the follow-up period for the sample as a whole. Additionally, an increase in quality of life and a decrease in social anxiety were noted, but no significant changes of depressive symptoms or generalized anxiety. Effect sizes for the observed changes from baseline to follow-up were in the moderate to large range for all measures. Reported use of the treatment techniques was not significantly related to reliable change in loneliness after the two-year period. In conclusion, the results of the study support the utility of internet-based CBT targeting loneliness and indicate that the benefits from the intervention can be enduring.
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| 7. |
- Lin, Chung-Ying, et al.
(författare)
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Investigating mediated effects of fear of COVID-19 and COVID-19 misunderstanding in the association between problematic social media use, psychological distress, and insomnia
- 2020
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Ingår i: Internet Interventions. - : Elsevier. - 2214-7829. ; 21
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Due to the serious situation of the novel coronavirus disease 2019 (COVID-19) worldwide, many countries have implemented policies to minimize the spread of COVID-19 infection. However, some of these policies prevent people from physical contact. Consequently, many individuals may rely on social media to obtain information concerning COVID-19. Unfortunately, social media use (especially problematic social media use) may give rise to psychological distress. Therefore, this study thus examined potential psychopathology to explain the association between problematic social media use, psychological distress, and insomnia.Methods: Utilizing an online survey, a sample of Iranian young adults (n = 1078 with 628 males; mean age = 26.24 years [SD ± 7.41]) completed questions and psychometric scales concerning psychological distress, insomnia, problematic social media use, fear of COVID-19, and COVID-19 misunderstanding.Results: Problematic social media use was significantly associated with psychological distress both directly and indirectly. The indirect effects were through fear of COVID-19 (unstandardized coefficient [B] = 0.177; Bootstrapping SE = 0.026) and COVID-19 misunderstanding (B = 0.060; Bootstrapping SE = 0.014). Problematic social media use was significantly associated with insomnia both directly and indirectly. The indirect effect was through fear of COVID-19 (B = 0.062; Bootstrapping SE = 0.019) but not COVID-19 misunderstanding (B = 0.012; Bootstrapping SE = 0.014).Discussion/conclusion: Due to the pressure of the COVID-19 outbreak, individuals are highly likely to develop psychological distress and insomnia. Apart from developing appropriate health policies to minimize the spread of COVID-19 infection, healthcare providers should design appropriate online campaigns to eliminate people's fear of COVID-19 and to diminish misunderstanding concerning COVID-19.
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| 8. |
- Lindegaard, Tomas, et al.
(författare)
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Internet-based psychodynamic therapy vs cognitive behavioural therapy for social anxiety disorder : A preference study
- 2020
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Ingår i: Internet Interventions. - : Elsevier BV. - 2214-7829. ; 20
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Both Internet-delivered cognitive behavioural therapy (ICBT) and Internet-delivered psychodynamic psychotherapy (IPDT) have shown promise in the treatment of social anxiety disorder (SAD). However, little is known about client preferences and what predicts treatment outcome. The objective of the present pilot study was to examine preference for ICBT versus IPDT in the treatment of SAD and whether participants' preference strength and therapeutic alliance predicted treatment response. Further, we also investigated the effect of the two treatments, including 6-months follow-up.Method: Thirty-six participants were instructed to choose between either IPDT or ICBT based on a brief description. Both treatments were 10 weeks long. Liebowitz Social Anxiety Scale – Self Report was used as the primary outcome measure.Results: IPDT (N = 23; 63.9%) was preferred more often than ICBT (N = 13; 36.1%), but the difference did not reach statistical significance (p = .10). Preference strength did not predict the treatment effect but therapeutic alliance did. The observed within-group effects for the treatment period were d = 0.40 [−0.21, 0.99] for the IPDT group and d = 0.53 [−0.29, 1.31] for the ICBT group. An intention-to-treat (ITT) analysis revealed no significant difference between the two treatments on any outcome measure at either post-treatment or at six months follow-up.Conclusion: The present pilot study did not find a difference in preference for IPDT or ICBT in the treatment of SAD and both treatments resulted in small to moderate improvements in symptoms of SAD. Preference strength might not predict treatment effect, but this needs to be tested in larger studies.
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| 9. |
- Ma, Lichen, et al.
(författare)
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Seeking neutral : A VR-based person-identity-matching task for attentional bias modification – A randomised controlled experiment
- 2020
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Ingår i: Internet Interventions. - : Elsevier BV. - 2214-7829. ; 21
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Tidskriftsartikel (refereegranskat)abstract
- Background: Attentional bias modification (ABM) aims to reduce anxiety by attenuating bias towards threatening information. The current study incorporated virtual reality (VR) technology and 3-dimensional stimuli with a person-identity-matching (PIM) task to evaluate the effects of a VR-based ABM training on attentional bias and anxiety symptoms.Methods: One hundred participants with elevated social anxiety were randomised to four training groups. Attentional bias was assessed at pre- and post-training, and anxiety symptoms were assessed at pre-training, post-training, 1-week follow-up, and 3-month follow-up.Results: Change in anxiety did not correlate with change in bias (r = −0.08). A repeated-measures ANOVA showed no significant difference in bias from pre- to post-ABM, or between groups. For anxiety symptoms, a linear mixed-effects model analysis revealed a significant effect of time. Participants showed reduction in anxiety score at each successive assessment (p < .001, Nagelkerke's pseudo r2 = 0.65). However, no other significant main effect or interactions were found. A clinically significant change analysis revealed that 4% of participants were classified as ‘recovered’ at 3-month follow-up.Conclusions: A single session of VR-based PIM task did not change attentional bias. The significant reduction in anxiety was not specific to active training, and the majority of participants remained clinically unchanged.
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| 10. |
- Rogala, Anna, et al.
(författare)
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Internet-based self-help intervention aimed at increasing social self-efficacy among internal migrants in Poland : Study protocol for a randomized controlled trial.
- 2020
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Ingår i: Internet Interventions. - : Elsevier. - 2214-7829. ; 21
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Tidskriftsartikel (refereegranskat)abstract
- Background: Migration is a challenging life transition that may be a source of various problems related to well-being and mental health. However, the psychological adaptation of migrants may be potentially facilitated by social self-efficacy-the beliefs in one's ability to initiate and maintain interpersonal relationships. Previous research suggests that social self-efficacy is positively related to adjustment and negatively related to loneliness, depression, and psychological distress. Research also confirms that self-efficacy beliefs can be effectively enhanced using Internet-based interventions. These results served as a background for creating the New in Town, a self-help Internet-based intervention for internal migrants in Poland that aims at increasing social self-efficacy. Exercises in the intervention are based on the principles of Cognitive Behavioral Therapy and relate to sources of self-efficacy beliefs: mastery experiences, vicarious experiences, verbal persuasions, and emotional and physiological states. Users complete increasingly challenging tasks that encourage them to interact with their environment. The aim of this trial was to investigate the efficacy of the New in Town intervention.Methods: The efficacy of the New in Town intervention will be tested in a two-arm randomized controlled trial with a waitlist control group. Social self-efficacy will be the primary outcome. Secondary outcomes will include loneliness, perceived social support, and satisfaction with life. Additionally, we will measure user experience among participants allocated to the experimental group. We aim to recruit a total of N = 280 participants aged at least 18 years who have changed their place of residence in the last 6 months and have an Internet connection. Participants will be assessed at baseline, 3-week post-test, and 8-week follow-up.Discussion: The trial will provide insights into the efficacy of Internet-based self-help interventions in increasing social self-efficacy. Given that the intervention works, New in Town could provide an easily accessible support option for internal migrants in Poland.Trial registration: The trial was registered with ClinicalTrials.gov (identifier: NCT04088487) on 11th September 2019.
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