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Sökning: WFRF:(Burell Gunilla) > (2015-2019) > Wallin Emma

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1.
  • Norlund, Fredrika, et al. (författare)
  • Internet-based Cognitive Behavior Therapy for Symptoms of Depression and Anxiety among Patients with a Recent Myocardial Infarction : The U-CARE Heart Randomized Trial
  • 2018
  • Ingår i: Journal of Medical Internet Research. - : JMIR Publications Inc.. - 1438-8871. ; 20:3
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Symptoms of depression and anxiety are common after a myocardial infarction (MI). Internet-based cognitivebehavioral therapy (iCBT) has shown good results in other patient groups.Objective: The aim of this study was to evaluate the effectiveness of an iCBT treatment to reduce self-reported symptoms ofdepression and anxiety among patients with a recent MI.Methods: In total, 3928 patients were screened for eligibility in 25 Swedish hospitals. Of these, 239 patients (33.5%, 80/239women, mean age 60 years) with a recent MI and symptoms of depression or anxiety were randomly allocated to a therapist-guided,14-week iCBT treatment (n=117), or treatment as usual (TAU; n=122). The iCBT treatment was designed for post-MI patients.The primary outcome was the total score of the Hospital Anxiety and Depression Scale (HADS) 14 weeks post baseline, assessedover the internet. Treatment effect was evaluated according to the intention-to-treat principle, with multiple imputations. For themain analysis, a pooled treatment effect was estimated, controlling for age, sex, and baseline HADS.Results: There was a reduction in HADS scores over time in the total study sample (mean delta=−5.1, P<.001) but no differencebetween the study groups at follow-up (beta=−0.47, 95% CI −1.95 to 1.00, P=.53). Treatment adherence was low. A total of46.2% (54/117) of the iCBT group did not complete the introductory module.Conclusions: iCBT treatment for an MI population did not result in lower levels of symptoms of depression or anxiety comparedwith TAU. Low treatment adherence might have influenced the result.Trial Registration: ClinicalTrials.gov NCT01504191; https://clinicaltrials.gov/ct2/show/NCT01504191 (Archived at Webciteat http://www.webcitation.org/6xWWSEQ22)
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3.
  • Norlund, Fredrika, et al. (författare)
  • Treatment of depression and anxiety with internet-based cognitive behavior therapy in patients with a recent myocardial infarction (U-CARE Heart) : study protocol for a randomized controlled trial
  • 2015
  • Ingår i: Trials. - : Springer Science and Business Media LLC. - 1745-6215. ; 16
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Major depression and depressive symptoms are common in patients with a recent myocardial infarction (MI), and depression is associated with adverse cardiovascular outcomes. Anxiety post-MI is less studied, but occurs commonly in patients with heart disease, and is also considered a risk factor for recurrence of cardiac events. Cognitive behavior therapy (CBT) is an established therapy for depression and anxiety disorders. To the best of our knowledge, there have not been any studies to determine if internet-based CBT (iCBT) can reduce the symptoms of depression and anxiety in patients with a recent MI. The main aim of the U-CARE Heart trial is to evaluate an iCBT intervention for patients with a recent MI. Methods/design: This is a randomized, controlled, prospective study with a multicenter design. A total of 500 participants will be randomized at a 1:1 ratio, around two months after an acute MI, to either iCBT or to a control group. Both groups will receive an optimal standard of care according to guidelines. The intervention consists of a self-help program delivered via the internet with individual online support from a psychologist. Treatment duration is 14 weeks. The primary outcome is change in patients' self-rated anxiety and depression symptoms from baseline to end of treatment. An internal pilot study was conducted indicating sufficient levels of study acceptability and engagement in treatment. Discussion: The present study is designed to evaluate an iCBT intervention targeting symptoms of depression and anxiety in a post-MI population. If effective, iCBT has several advantages, and will potentially be implemented as an easily accessible treatment option added to modern standard of care.
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4.
  • Norlund, Fredrika, et al. (författare)
  • Web-Based Cognitive Behavior Therapy for Depression and Anxiety among Patients with a recent Myocardial Infarction : The U-CARE Heart Randomized Trial
  • 2018
  • Ingår i: Journal of the American College of Cardiology. - : ELSEVIER SCIENCE INC. - 0735-1097 .- 1558-3597. ; 71:11, s. 1884-1884
  • Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
    • BackgroundSymptoms of depression and anxiety are common after a myocardial infarction (MI). Web-based cognitive behavioral therapy (wCBT) may improve access to effective psychological treatment to reduce these symptoms. The aim of this prospective randomized trial was to evaluate the effectiveness of a wCBT intervention to reduce self-reported symptoms of depression and anxiety among patients with a recent MI.MethodsIn total, 3928 patients were assessed for eligibility in routine care setting at 25 hospitals. Of these, 239 patients (33% women, mean age 60 years) with a recent MI (< 3 months) and symptoms of depression and/or anxiety assessed with Hospital Anxiety and Depression Scale (HADS) were randomly allocated to a therapist-supported 14 week wCBT program (n=117) or standard of care (n=122). The wCBT program was a tailored intervention with 10 different eligible modules, especially designed for MI patients. Treatment was evaluated according to the intention-to-treat principle. The primary outcome was group difference in HADS total score (HADS-T) at follow-up. Multiple imputation was performed. The pooled treatment effect was thereafter estimated in a multiple linear model, controlling for baseline HADS, age and sex.ResultsThere was a reduction in HADS-T over time in the total study sample (delta = -5.1; P < .0001). The difference at follow-up between the wCBT group and the control group with regard to HADS-T was non-significant (-0.47, [-1.95, 1.00], P=0.53). Treatment adherence was low. In the treatment group, 54% completed the introductory module and 15% completed additional modules.ConclusionThis wCBT program did not reduce symptoms of depression and/or anxiety in post-MI patients as compared to standard of care. Low treatment adherence was observed and reasons for this needs to be further explored.
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5.
  • Wallin, Emma, et al. (författare)
  • Treatment Activity, User Satisfaction, and Experienced Usability of Internet-Based Cognitive Behavioral Therapy for Adults With Depression and Anxiety After a Myocardial Infarction : Mixed-Methods Study
  • 2018
  • Ingår i: Journal of Medical Internet Research. - : JMIR Publications Inc.. - 1438-8871. ; 20:3
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND:Knowledge about user experiences may lead to insights about how to improve treatment activity in Internet-based cognitive behavioral therapy (iCBT) to reduce symptoms of depression and anxiety among people with a somatic disease. There is a need for studies conducted alongside randomized trials, to explore treatment activity and user experiences related to such interventions, especially among people with older age who are recruited in routine care.OBJECTIVE:The aim of the study was to explore treatment activity, user satisfaction, and usability experiences among patients allocated to treatment in the U-CARE Heart study, a randomized clinical trial of an iCBT intervention for treatment of depression and anxiety following a recent myocardial infarction.METHODS:This was a mixed methods study where quantitative and qualitative approaches were used. Patients were recruited consecutively from 25 cardiac clinics in Sweden. The study included 117 patients allocated to 14 weeks of an iCBT intervention in the U-CARE Heart study. Quantitative data about treatment activity and therapist communication were collected through logged user patterns, which were analyzed with descriptive statistics. Qualitative data with regard to positive and negative experiences, and suggestions for improvements concerning the intervention, were collected through semistructured interviews with 21 patients in the treatment arm after follow-up. The interviews were analyzed with qualitative manifest content analysis.RESULTS:Treatment activity was low with regard to number of completed modules (mean 0.76, SD 0.93, range 0-5) and completed assignments (mean 3.09, SD 4.05, range 0-29). Most of the participants initiated the introduction module (113/117, 96.6%), and about half (63/117, 53.9%) of all participants completed the introductory module, but only 18 (15.4%, 18/117) continued to work with any of the remaining 10 modules, and each of the remaining modules was completed by 7 or less of the participants. On average, patients sent less than 2 internal messages to their therapist during the intervention (mean 1.42, SD 2.56, range 0-16). Interviews revealed different preferences with regard to the internet-based portal, the content of the treatment program, and the therapist communication. Aspects related to the personal situation and required skills included unpleasant emotions evoked by the intervention, lack of time, and technical difficulties.CONCLUSIONS:Patients with a recent myocardial infarction and symptoms of depression and anxiety showed low treatment activity in this guided iCBT intervention with regard to completed modules, completed assignments, and internal messages sent to their therapist. The findings call attention to the need for researchers to carefully consider the preferences, personal situation, and technical skills of the end users during the development of these interventions. The study indicates several challenges that need to be addressed to improve treatment activity, user satisfaction, and usability in internet-based interventions in this population.
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