| 1. |
- Dahlin, Mats, et al.
(författare)
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Internet-delivered acceptance-based behavior therapy for generalized anxiety disorder : A pilot study
- 2016
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Ingår i: Internet Interventions. - : Elsevier. - 2214-7829. ; 6, s. 16-21
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Internet-delivered cognitive behavior therapy (ICBT) has been developed and tested for treating persons with generalized anxiety disorder (GAD). A new form of CBT focuses on acceptance (of internal experiences or difficult psychological content), mindfulness and valued actions. To date this form of CBT has not been delivered via the internet for persons with GAD. The aim of this study was to describe the functionality of a new internet-delivered acceptance-based behavior therapy for GAD, and to test the effect of the intervention in an open pilot trial. Methods: Following exclusion of two patients we included 14 patients diagnosed with GAD from two primary care clinics. At 2–3 months follow-up after treatment 10 patients completed the outcome measures. The treatment lasted for an average of 15 weeks and consisted of acceptance-based techniques, behavior therapy components and homework assignments. Results: A majority of participants completed all modules during the treatment. Findings on the Penn State Worry Questionnaire showed a within-group improvement of Cohen's d = 2.14 at posttreatment. At the follow-up results were maintained. Client satisfaction ratings were high. Conclusions: We conclude that internet-delivered acceptance-based behavior therapy potentially can be a promising new treatment for GAD. A controlled trial of the program has already been completed.
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| 2. |
- Ebert, D. D., et al.
(författare)
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Does Internet-based guided-self-help for depression cause harm? An individual participant data meta-analysis on deterioration rates and its moderators in randomized controlled trials
- 2016
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Ingår i: Psychological Medicine. - : Cambridge University Press. - 0033-2917 .- 1469-8978. ; 46:13, s. 2679-2693
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Forskningsöversikt (refereegranskat)abstract
- Almost nothing is known about the potential negative effects of Internet-based psychological treatments for depression. This study aims at investigating deterioration and its moderators within randomized trials on Internet-based guided self-help for adult depression, using an individual patient data meta-analyses (IPDMA) approach.Studies were identified through systematic searches (PubMed, PsycINFO, EMBASE, Cochrane Library). Deterioration in participants was defined as a significant symptom increase according to the reliable change index (i.e. 7.68 points in the CES-D; 7.63 points in the BDI). Two-step IPDMA procedures, with a random-effects model were used to pool data.A total of 18 studies (21 comparisons, 2079 participants) contributed data to the analysis. The risk for a reliable deterioration from baseline to post-treatment was significantly lower in the intervention v. control conditions (3.36 v. 7.60; relative risk 0.47, 95% confidence interval 0.29–0.75). Education moderated effects on deterioration, with patients with low education displaying a higher risk for deterioration than patients with higher education. Deterioration rates for patients with low education did not differ statistically significantly between intervention and control groups. The benefit–risk ratio for patients with low education indicated that 9.38 patients achieve a treatment response for each patient experiencing a symptom deterioration.Internet-based guided self-help is associated with a mean reduced risk for a symptom deterioration compared to controls. Treatment and symptom progress of patients with low education should be closely monitored, as some patients might face an increased risk for symptom deterioration. Future studies should examine predictors of deterioration in patients with low education.
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| 3. |
- Ivanova, Ekaterina, et al.
(författare)
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Guided and unguided Acceptance and Commitment Therapy for social anxiety disorder and/or panic disorder provided via the Internet and a smartphone application : A randomized controlled trial
- 2016
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Ingår i: Journal of Anxiety Disorders. - : Elsevier BV. - 0887-6185 .- 1873-7897. ; 44, s. 27-35
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Tidskriftsartikel (refereegranskat)abstract
- Acceptance and Commitment Therapy (ACT) can be effective in treating anxiety disorders, yet there has been no study on Internet-delivered ACT for social anxiety disorder (SAD) and panic disorder (PD), nor any study investigating whether therapist guidance is superior to unguided self-help when supplemented with a smartphone application. In the current trial, n = 152 participants diagnosed with SAD and/or PD were randomized to therapist-guided or unguided treatment, or a waiting-list control group. Both treatment groups used an Internet-delivered ACT-based treatment program and a smartphone application. Outcome measures were self-rated general and social anxiety and panic symptoms. Treatment groups saw reduced general (d = 0.39) and social anxiety (d = 0.70), but not panic symptoms (d = 0.05) compared to the waiting-list group, yet no differences in outcomes were observed between guided and unguided interventions. We conclude that Internet-delivered ACT is appropriate for treating SAD and potentially PD. Smartphone applications may partially compensate for lack of therapist support.
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| 4. |
- Ivanova, Ekaterina, et al.
(författare)
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Guided and unguided transdiagnostic Acceptance and Commitment Therapy for anxiety disorders provided via a computer and a smartphone application : A randomized controlled trial
- 2016
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Ingår i: EABCT 2016 Abstract Book. ; , s. 530-530
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Konferensbidrag (refereegranskat)abstract
- Technology-assisted psychological treatments are becoming well-known in the scientific networks throughout the world and are being implemented into routine health care in a number of countries. The interest in evaluating the potential of different devices is growing. The main objective of the current study was to evaluate the effects of guided and unguided computerand smartphone-based Acceptance and Commitment Therapy (ACT) for social anxiety disorder (SAD) and panic disorder (PD).A total of 152 participants were randomized into a guided treatment group, an unguided treatment group and a waiting list control group. Both treatment groups got access to a computer-based ACT-treatment and a smartphone application (app) with corresponding content. The eight modules treatment program covered a number of topics such as the nature of anxiety, functional analyses, acceptance, mindfulness and valued actions. The purpose of the app was to make it easier for the participants to access the key points of the program and to do homework assignments in their everyday life. Automatic messages in the app aimed to give feedback to the participants on their work as well as to prompt them to continue with the program. In addition to that, the participants in the guided group got therapist support via the app. The therapists were encouraged to work with each of their patient 15 min/week during the 10 weeks treatment period and focus on motivating, validating and correcting mistakes. On the whole group level GAD-7 was used as the primary outcome measure. LSAS and PDSS-SR were used for subgroup analyses in SAD and PD participants respectively. The measurements were collected at pre-, mid- and post-treatment and at 12-months follow-up.There were no significant differences in adherence between the treatment groups except for significantly higher rates of smartphone usage in the guided group. No significant differences in treatment outcome were found between the treatment groups with moderate within-group effects (Cohen’s d = 0.75 for the guided and Cohen’s d = 0.66 for the unguided group). The treated participants improved significantly in comparison to the control group both on the whole group level (between group Cohen’s d = 0.39) and for the participants suffering primarily from SAD (between group Cohen’s d = 0.70). Within group effect sizes were large for the PD-participants (Cohen’s d = 1.00) but the study was very underpowered in this part.Discussion. The treatment program as it was used in the present study appeared to be effective in treating social anxiety disorder and decreasing general anxiety symptoms, but the effects are smaller than seen in previous studies. The guided treatment was not clearly superior to the unguided one. The study contributes to the growing body of evidence on technology-assisted ACT.Conclusion. Computer- and smartphone-based ACT can be made into an effective treatment for anxiety disorders. A smartphone application seems to have a clear potential to partly compensate for the absence of therapist support which needs to be studied further.
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| 5. |
- Karyotaki, Eirini, et al.
(författare)
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Do guided internet-based interventions result in clinically relevant changes for patients with depression? : An individual participant data meta-analysis
- 2018
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Ingår i: Clinical Psychology Review. - : Elsevier. - 0272-7358 .- 1873-7811. ; 63, s. 80-92
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Forskningsöversikt (refereegranskat)abstract
- Little is known about clinically relevant changes in guided Internet-based interventions for depression. Moreover, methodological and power limitations preclude the identification of patients' groups that may benefit more from these interventions. This study aimed to investigate response rates, remission rates, and their moderators in randomized controlled trials (RCTs) comparing the effect of guided Internet-based interventions for adult depression to control groups using an individual patient data meta-analysis approach. Literature searches in PubMed, Embase, PsycINFO and Cochrane Library resulted in 13,384 abstracts from database inception to January 1, 2016. Twenty-four RCTs (4889 participants) comparing a guided Internet-based intervention with a control group contributed data to the analysis. Missing data were multiply imputed. To examine treatment outcome on response and remission, mixed-effects models with participants nested within studies were used. Response and remission rates were calculated using the Reliable Change Index. The intervention group obtained significantly higher response rates (OR = 2.49, 95% CI 2.17-2.85) and remission rates compared to controls (OR = 2.41, 95% CI 2.07-2.79). The moderator analysis indicated that older participants (OR = 1.01) and native-born participants (1.66) were more likely to respond to treatment compared to younger participants and ethnic minorities respectively. Age (OR = 1.01) and ethnicity (1.73) also moderated the effects of treatment on remission.Moreover, adults with more severe depressive symptoms at baseline were more likely to remit after receiving intemet-based treatment (OR = 1.19). Guided Internet-based interventions lead to substantial positive treatment effects on treatment response and remission at post-treatment. Thus, such interventions may complement existing services for depression and potentially reduce the gap between the need and provision of evidence-based treatments.
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| 6. |
- Karyotaki, E., et al.
(författare)
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Predictors of treatment dropout in self-guided web-based interventions for depression: an individual patient data meta-analysis
- 2015
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Ingår i: Psychological Medicine. - : CAMBRIDGE UNIV PRESS. - 0033-2917 .- 1469-8978. ; 45:13, s. 2717-2726
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Tidskriftsartikel (refereegranskat)abstract
- Background. It is well known that web-based interventions can be effective treatments for depression. However, dropout rates in web-based interventions are typically high, especially in self-guided web-based interventions. Rigorous empirical evidence regarding factors influencing dropout in self-guided web-based interventions is lacking due to small study sample sizes. In this paper we examined predictors of dropout in an individual patient data meta-analysis to gain a better understanding of who may benefit from these interventions. Method. A comprehensive literature search for all randomized controlled trials (RCTs) of psychotherapy for adults with depression from 2006 to January 2013 was conducted. Next, we approached authors to collect the primary data of the selected studies. Predictors of dropout, such as socio-demographic, clinical, and intervention characteristics were examined. Results. Data from 2705 participants across ten RCTs of self-guided web-based interventions for depression were analysed. The multivariate analysis indicated that male gender [relative risk (RR) 1.08], lower educational level (primary education, RR 1.26) and co-morbid anxiety symptoms (RR 1.18) significantly increased the risk of dropping out, while for every additional 4 years of age, the risk of dropping out significantly decreased (RR 0.94). Conclusions. Dropout can be predicted by several variables and is not randomly distributed. This knowledge may inform tailoring of online self-help interventions to prevent dropout in identified groups at risk.
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| 7. |
- van Breda, Ward, et al.
(författare)
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A feature representation learning method for temporal datasets
- 2016
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Ingår i: PROCEEDINGS OF 2016 IEEE SYMPOSIUM SERIES ON COMPUTATIONAL INTELLIGENCE (SSCI). - : IEEE. - 9781509042401
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Konferensbidrag (refereegranskat)abstract
- Predictive modeling of future health states can greatly contribute to more effective health care. Healthcare professionals can for example act in a more proactive way or predictions can drive more automated ways of therapy. However, the task is very challenging. Future developments likely depend on observations in the (recent) past, but how can we capture this history in features to generate accurate predictive models? And what length of history should we consider? We propose a framework that is able to generate patient tailored features from observations of the recent history that maximize predictive performance. For a case study in the domain of depression we find that using this method new data representations can be generated that increase the predictive performance significantly.
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| 8. |
- Vernmark, Kristofer, et al.
(författare)
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The role of therapeutic alliance in blended treatment for depression
- 2017
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Konferensbidrag (refereegranskat)abstract
- Introduction: Blended Cognitive Behaviour Therapy (bCBT) uses a combination of face-to-face sessions and online material, such as self-help modules, and can be used in the treatment of depression. The blended format has the potential of integrating internet-based components into treatment without completely removing the traditional face-to-face setting. This way of delivery can lower the threshold when it comes to using digital components in CBT. The role of therapeutic alliance in this format is yet to be explored, specifically the role of therapist rated alliance, as most studies only include patient rated measurements of alliance. Methods: Working alliance and depression ratings from 73 participants in a study on bCBT for depression (part of the E-COMPARED project) was analysed using growth curve models. Results: High ratings for both patient-and therapist rated working alliance were found. Therapist rated alliance predicted a positive change (decreased PHQ-9 scores) in depression during treatment. Discussion: Ratings of therapeutic alliance was similar to what have been seen in face-to-face and internet-based treatment. Patient rated alliance could not predict change rate in depression, which is a common finding in ICBT-studies. However, therapist rated alliance had a significant correlation with change rate and predicted a decrease in depression during treatment. These results sheds more light on the concept and role of therapeutic alliance in internet-based and blended treatments.
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| 9. |
- Vernmark, Kristofer, 1976-
(författare)
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Therapeutic alliance and different treatment formats when delivering internet-based CBT for depression
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Depression är en funktionsnedsättande problematik som påverkar en stor del av den vuxna populationen varje år. Trots ett omfattande behov av hjälp så råder det brist på tillgång till effektiv behandling. Kognitiv Beteendeterapi (KBT) är en evidensbaserad metod som har stöd vid behandling av depression och förmedlad via internet skulle metoden kunna tillgängliggöras för fler. Dock är det i dagsläget oklart vilka format och vilket innehåll som kan användas när behandlingen förmedlas via internet, samt vilken betydelse den terapeutiska alliansen har för en behandling som till största del sker på distans. Syftet med denna avhandling var att undersöka effekterna för olika format av internetbehandling (epostterapi, guidad självhjälp och blended treatment) vid depression, samt alliansens roll i dessa format.Studiernas resultat visar på att epostterapi och internetförmedlade självhjälpsprogram med behandlarstöd var effektiva metoder för att behandla depression. Alliansskattningar var höga, vilket visar att en positiv terapeutisk allians kan uppnås i internetbehandling. Patientskattningar av allians kunde inte predicera utfallet i någon av behandlingarna, men behandlarskattad allians predicerade förbättring på depressionsskattningar i blended treatment. Den här avhandlingen innehåller den första randomiserade kontrollerade studien på KBT-baserad epostterapi vid depression, samt det första internet-förmedlade självhjälpsprogrammet baserat på beteendeaktivering och ACT.
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| 10. |
- Vernmark, Kristofer, 1976-, et al.
(författare)
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Working alliance as a predictor of change in depression during blended cognitive behaviour therapy
- 2019
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Ingår i: Cognitive Behaviour Therapy. - : Informa UK Limited. - 1650-6073 .- 1651-2316. ; 48:4, s. 285-299
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Tidskriftsartikel (refereegranskat)abstract
- Blended Cognitive Behaviour Therapy (bCBT) is a new form of treatment, mixing internet-based modules and face-to-face therapist sessions. How participants rate the therapeutic alliance in bCBT has not yet been thoroughly explored, and neither is it clear whether therapist- and patient-rated alliances are predictors of change in depression during treatment. Depression and alliance ratings from 73 participants in a treatment study on bCBT (part of the E-COMPARED project) were analysed using growth curve models. Alliance, as rated by both patients and therapists, was high. The therapist-rated working alliance was predictive of subsequent changes in depression scores during treatment, whereas the patient-rated alliance was not. A therapeutic alliance can be established in bCBT. The role of the therapist-rated alliance seems to be of particular importance and should be carefully considered when collecting data in future studies on bCBT.
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