| 1. |
- Eriksson, Maria Christina, 1981, et al.
(författare)
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Long-term effects of Internet-delivered cognitive behavioral therapy for depression in primary care - the PRIM-NET controlled trial.
- 2017
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Ingår i: Scandinavian journal of primary health care. - : Informa UK Limited. - 1502-7724 .- 0281-3432. ; 35:2, s. 126-136
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Tidskriftsartikel (refereegranskat)abstract
- Internet-delivered cognitive behavioral therapy (ICBT) is recommended as an efficient treatment alternative for depression in primary care. However, only few previous studies have been conducted at primary care centers (PCCs). We evaluated long-term effects of ICBT treatment for depression compared to treatment as usual (TAU) in primary care settings.Randomized controlled trial.Patients were enrolled at16 PCCs in south-west Sweden.Patients attending PCCs and diagnosed with depression (n = 90).Patients were assessed by a primary care psychologist/psychotherapist and randomized to ICBT or TAU. The ICBT included an ICBT program consisting of seven modules and weekly therapist e-mail or telephone support during the 3-month treatment period.Questionnaires on depressive symptoms (BDI-II), quality of life (EQ-5D) and psychological distress (GHQ-12) were administered at baseline, with follow-ups at 3, 6 and 12 months. Antidepressants and sedatives use, sick leave and PCC contacts were registered.Intra-individual change in depressive symptoms did not differ between the ICBT group and the TAU group during the treatment period or across the follow-up periods. At 3-month follow-up, significantly fewer patients in ICBT were on antidepressants. However, the difference leveled out at later follow-ups. There were no differences between the groups concerning psychological distress, sick leave or quality of life, except for a larger improvement in quality of life in the TAU group during the 0- to 6-month period.ICBT with weekly minimal therapist support in primary care can be equally effective as TAU among depressed patients also over a 12-month period.The trial was registered in the Swedish Registry, researchweb.org, ID number 30511.
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| 2. |
- Kivi, Marie, et al.
(författare)
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Experiences and attitudes of primary care therapists in the implementation and use of internet-based treatment in Swedish primary care settings
- 2015
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Ingår i: Internet Interventions. - : Elsevier BV. - 2214-7829. ; 2:3, s. 248-256
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Tidskriftsartikel (refereegranskat)abstract
- © 2015 The Authors. Published by Elsevier B.V. Background: The current knowledge of internet-based cognitive behavior therapy (ICBT) implemented in primary care settings is sparse. Our objective was to explore primary care therapists' experiences and attitudes of ICBT, the opportunities and conditions for research in primary care, and to identify potential barriers to the implementation of ICBT treatment in primary care. Methods: Eleven therapists (of 14) participating in the research and implementation project PRIM-NET completed a survey. Four of them were selected also for a detailed semi-structured interview. Data from the interviews were analyzed qualitatively and according to methods used in implementation science. Results: Six general themes were identified in which the therapists considered ICBT as a good treatment that ought to be introduced in primary care. To optimize procedure in primary care settings, several adaptations of ICBT were suggested. Integrating and blending ICBT and face-to-face therapies, for example, would render primary care psychology more efficient. The PRIM-NET study and research within primary care was seen as rewarding and necessary, but challenging. To a large extent primary care still revolves around the general practitioner, with a focus on production, finances, and a somatic aspect of the patients. Five possible barriers to implementation of ICBT were identified which perhaps explains why psychological procedures are not fully integrated into primary care. Conclusions: Although the implementation of new methods and routines is typically accompanied by challenges, the overall experience of the therapists supports the implementation of ICBT as an additional treatment in primary care.
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| 3. |
- Kivi, Marie, et al.
(författare)
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Internet-Based Therapy for Mild to Moderate Depression in Swedish Primary Care: Short Term Results from the PRIM-NET Randomized Controlled Trial
- 2014
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Ingår i: Cognitive Behaviour Therapy. - : Informa UK Limited. - 1650-6073 .- 1651-2316. ; 43:4
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Tidskriftsartikel (refereegranskat)abstract
- Depression presents a serious condition for the individual and a major challenge to health care and society. Internet-based cognitive behavior therapy (ICBT) is a treatment option supported in several trials, but there is as yet a lack of effective studies of ICBT in “real world” primary care settings. We examined whether ICBT differed from treatment-as-usual (TAU) in reducing depressive symptoms after 3 months. TAU comprised of visits to general practitioner, registered nurse, antidepressant drugs, waiting list for, or psychotherapy, or combinations of these alternatives. Patients, aged $18 years, who tentatively met criteria for mild to moderate depression at 16 primary care centers in the south-western region of Sweden were recruited and then assessed in a diagnostic interview. A total of 90 patients were randomized to either TAU or ICBT. The ICBT treatment included interactive elements online, a workbook, a CD with mindfulness and acceptance exercises, and minimal therapist contact. The treatment period lasted for 12 weeks after which both groups were assessed. The main outcome measure was Beck Depression Inventory-II (BDI-II). Additional measures were Montgomery A ° sberg Depression Rating Scale – self rating version (MADRS-S) and Beck Anxiety Inventory (BAI). The analyses revealed no significant difference between the two groups at post treatment, neither on BDI-II, MADRS-S, nor BAI. Twenty patients (56%) in the ICBT treatment completed all seven modules. Our findings suggest that ICBT may be successfully delivered in primary care and that the effectiveness, after 3 months, is at par with TAU.
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| 4. |
- Kivi, Marie, et al.
(författare)
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Internet therapy for Depression in Primary Care – a Randomized Controlled Trial
- 2013
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Ingår i: 13th European Congress of Psychology.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- This study aims to investigate whether Cognitive Behavior Internet therapy (iCBT) for depression is as effective as usual treatment in primary care (PC) settings. Previous research shows good efficacy for iCBT for depression. It might also be a way to cost-efficiently offer evidence based psychological treatment to more patients, given the substantial shortage of trained CBT-therapists in PC. So far, few studies are conducted with a focus on the effectiveness in PC-settings. We identified patients with mild to moderate depression at PC Centers in the Västra Götaland region. They were randomly assigned to either Internet therapy (iCBT) or to treatment as usual (TAU). Before inclusion a structured interview was performed by a psychologist/¬psychotherapist. At present, 75 patients are included. The iCBT encompasses a 12-week access to a Behavioral Activation treatment program on the internet, a workbook, support by the evaluating psychologist/psychotherapist via 3 telephone calls (week 1, 4-5 and 8-12), and weekly contact via secure e-mail. More intense telephone and e mail contacts are available when needed. The main outcome is measured by BDI-II. Preliminary findings show that iCBT is at least as effective as TAU also in PC-settings. Data from the 3- and 6-month follow-ups will be available in June 2013.
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| 5. |
- Kivi, Marie, et al.
(författare)
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Internet therapy for depression in primary care - a RCT
- 2013
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Ingår i: European Society for Research on Internet Internvention (ESRII) 2013.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- This study aims to investigate whether Cognitive Behavior Internet therapy (iCBT) for depression is as effective as usual treatment in primary care (PC) settings. Previous research shows good efficacy for iCBT for depression. It might also be a way to cost-efficiently offer evidence based psychological treatment to more patients, given the substantial shortage of trained CBT-therapists in PC. So far, few studies are conducted with a focus on the effectiveness in PC-settings. We identified patients with mild to moderate depression at 16 participating PC Centers in the Västra Götaland region. Before inclusion a structured interview was performed by a psychologist/¬psychotherapist to ascertain that the patients met the inclusion criteria. A total of 90 patients were included. The patients were then randomly assigned to either Internet therapy (iCBT) or to treatment as usual (TAU). The iCBT encompasses a 12-week access to a Behavioral Activation treatment program on the internet (Depressionshjälpen), a workbook, support by the evaluating psychologist/psychotherapist via 3 telephone calls (week 1, 4-5 and 8-12), and weekly contact via secure e-mail. More intense telephone and e mail contacts are available when needed. The primary outcome measure is BDI-II, secondarily MADRS-S is also used. Our findings at post-treatment is that iCBT is as effective as TAU also in PC-settings. Data from the 3- and 9-month follow-ups will be available in 2014.
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