| 1. |
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| 2. |
- Andersson, Erik, et al.
(author)
-
Internet-Based Extinction Therapy for Worry : A Randomized Controlled Trial
- 2017
-
In: Behavior Therapy. - : ASSOC ADV BEHAVIOR THERAPY. - 0005-7894 .- 1878-1888. ; 48:3, s. 391-402
-
Journal article (peer-reviewed)abstract
- Worry is a common phenotype in both psychiatric patients and the normal population. Worry can be seen as a covert behavior with primary function to avoid aversive emotional experiences. Our research group has developed a treatment protocol based on an operant model of worry, where we use exposure -based strategies to extinguish the catastrophic worry thoughts. The aim of this study was to test this treatment delivered via the Internet in a large-scale randomized controlled trial. We randomized 140 high-worriers [PSWQ]) to either Internet-based extinction therapy (IbET) or to a waiting-list condition (WL). Results showed that IbET was superior to WL with an overall large between-group effect size of d 1.39 (95% confidence interval [1.04,1.73]) on the PSWQ. In the IbET group, 58% were classified as responders. The corresponding figure for WL participants was 7%. IbET was also superior to the WL on secondary outcome measures of anxiety, depression, meta-cognitions, cognitive avoidance, and quality of life. Overall treatment results were maintained for the IbET group at 4- and 12-month follow-up. The results from this trial are encouraging as they indicate that worry can be targeted with an accessible and novel intervention for worry. Replication trials with active control group are needed.
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| 3. |
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| 4. |
- Boettcher, Johanna, et al.
(author)
-
Internet-Based Mindfulness Treatment for Anxiety Disorders : A Randomized Controlled Trial
- 2014
-
In: Behavior Therapy. - : Elsevier BV. - 0005-7894 .- 1878-1888. ; 45:2, s. 241-253
-
Journal article (peer-reviewed)abstract
- Mindfulness-based interventions have proven effective for the trans diagnostic treatment of heterogeneous anxiety disorders. So far, no study has investigated the potential of mindfulness-based treatments when delivered remotely via the Internet. The current trial aims at evaluating the efficacy of a stand-alone, unguided, Internet-based mindfulness treatment program for anxiety. Ninety-one participants diagnosed with social anxiety disorder, generalized anxiety disorder, panic disorder, or anxiety disorder not otherwise specified were randomly assigned to a mindfulness treatment group (MTG) or to an online discussion forum control group (CG). Mindfulness treatment consisted of 96 audio files with instructions for various mindfulness meditation exercises. Primary and secondary outcome measures were assessed at pre-, post-treatment, and at 6-months follow-up. Participants of the MTG showed a larger decrease of symptoms of anxiety, depression, and insomnia from pre- to postassessment than participants of the CG (Cohen's d(between) = 0.36-0.99). Within effect sizes were large in the MTG (d = 0.82-1.58) and small to moderate in the CG (d = 0.45-0.76). In contrast to participants of the CG, participants of the MTG also achieved a moderate improvement in their quality of life. The study provided encouraging results for an Internet-based mindfulness protocol in the treatment of primary anxiety disorders. Future replications of these results will show whether Web-based mindfulness meditation can constitute a valid alternative to existing, evidence-based cognitive-behavioural Internet treatments.
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| 5. |
- Boettcher, Johanna, et al.
(author)
-
Internet-Based Mindfulness Treatment for Anxiety Disorders : A Randomized Controlled Trial
- 2014
-
In: Behavior Therapy. - New York : Association for advanced behavior therapy. - 0005-7894 .- 1878-1888. ; 45:2, s. 241-253
-
Journal article (peer-reviewed)abstract
- Mindfulness-based interventions have proven effective for the trans diagnostic treatment of heterogeneous anxiety disorders. So far, no study has investigated the potential of mindfulness-based treatments when delivered remotely via the Internet. The current trial aims at evaluating the efficacy of a stand-alone, unguided, Internet-based mindfulness treatment program for anxiety. Ninety-one participants diagnosed with social anxiety disorder, generalized anxiety disorder, panic disorder, or anxiety disorder not otherwise specified were randomly assigned to a mindfulness treatment group (MTG) or to an online discussion forum control group (CG). Mindfulness treatment consisted of 96 audio files with instructions for various mindfulness meditation exercises. Primary and secondary outcome measures were assessed at pre-, post-treatment, and at 6-months follow-up. Participants of the MTG showed a larger decrease of symptoms of anxiety, depression, and insomnia from pre- to postassessment than participants of the CG (Cohen's d(between) = 0.36-0.99). Within effect sizes were large in the MTG (d = 0.82-1.58) and small to moderate in the CG (d = 0.45-0.76). In contrast to participants of the CG, participants of the MTG also achieved a moderate improvement in their quality of life. The study provided encouraging results for an Internet-based mindfulness protocol in the treatment of primary anxiety disorders. Future replications of these results will show whether Web-based mindfulness meditation can constitute a valid alternative to existing, evidence-based cognitive-behavioural Internet treatments.
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| 6. |
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| 7. |
- Carlbring, Per, et al.
(author)
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Treatment of panic disorder via the Internet : A randomized trial of a self-help program
- 2001
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In: Behavior Therapy. - 0005-7894 .- 1878-1888. ; 32:4, s. 751-764
-
Journal article (peer-reviewed)abstract
- This controlled study, evaluated an Internet-delivered self-help program plus minimal therapist contact via e-mail for people suffering front panic disorder. Out of the 500 individuals screened using the self-administered diagnostic instrument Composite International Diagnostic Interview in shortened form (World Health Organization, 1999), 41 fulfilled the inclusion criteria. These participants were randomized to either treatment via the Internet or to a waiting-list control. The main components of the treatment were psychoeducation. breathing retraining, cognitive restructuring, interoceptive exposure. in vivo exposure, and relapse prevention. From pre- to post- test self-help, participants improved significantly more on almost all dimensions. The results from this experiment generally provide evidence for the continued use and development of self-help programs for panic disorder distributed via the Internet.
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| 8. |
- Cuijpers, Pim, et al.
(author)
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Personalized Psychotherapy for Adult Depression: A Meta-Analytic Review
- 2016
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In: BEHAVIOR THERAPY. - : ASSOC ADV BEHAVIOR THERAPY. - 0005-7894 .- 1878-1888. ; 47:6, s. 966-980
-
Research review (peer-reviewed)abstract
- Personalized medicine is aimed at identifying which characteristics of an individual predict the outcome of a specific treatment, in order to get a better match between the individual and the treatment received. We conducted a systematic review and meta-analysis of randomized trials comparing two psychotherapies directly in a group of depressed patients with a specific characteristic. We focused on the six most examined types of psychotherapy for adult depression. Our searches resulted in 41 studies with 2,741 patients who met inclusion criteria. These 41 studies examined 27 specific characteristics of patients. Power calculations indicated that we would need 4 studies for each characteristic to find a clinically relevant effect size set at g = 0.50 and 16 studies for an effect size of 0.24. Only 3 patient characteristics were found to have sufficient power and to significantly moderate treatment outcomes. Cognitive-behavioral therapy was found to be more effective than other therapies in older adults (g= 0.29), in patients with comorbid addictive disorders (g = 0.31), and in university students (g = 0.46). Risk of bias was considerable in most of the included studies. It was estimated that it will take another 326 years to have sufficient statistical power for showing an effect size of g = 0.50 of the 27 characteristics, and 1,372 years to show an effect size of 0.24. Although several dozens of studies have compared the effects of psychotherapies in specific target groups, we will need to develop more powerful alternatives to comparative outcome studies in order to identify personalized treatments for depression.
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| 9. |
- Dahl, Joanne, et al.
(author)
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Acceptance and Commitment Therapy and the Treatment of Persons at Risk for Long-Term disability resulting from stress and pain symptoms : A Preliminary Randomizad trial
- 2004
-
In: Behavior Therapy. - 0005-7894 .- 1878-1888. ; 35:4, s. 785-801
-
Journal article (peer-reviewed)abstract
- Approximately 14% of the working-age Swedish population are either on long-term sick leave or early retirement due to disability. Substantial increase of sick listing,reports of work disabilities and early retirement due to stress and musculoskeletal chronic pain suggest a need for methods of preventing loss of function resulting from these conditions. The present preliminary investigation examined the effects of a brief Acceptance and Commitment Therapy (ACT) intervention for the treatment of public health sector workers who showed chronic stress/pain and were at risk for high sick leave utilization. ACT was compared in an additive treatment design with medical treatment as usual (MTAU). A group of 19 participants were randomly distributed into 2 groups. Both conditions received MTAU. The ACT condition receivedfour 1-hour weekly sessions of ACT in addition to MTAU. At post and 6-month followup, ACT participants showed fewer sick days and used fewer medical treatment resources than those in the MTAU condition. No significant differences were found inlevels of pain, stress, or quality of life. Improvements in sick leave and medical utilization could not be accounted for by remission of stress and pain in the ACT group as no between-group differences were found for stress or pain symptoms.
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| 10. |
- Feliu-Soler, Albert, et al.
(author)
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Economic Impact of Third-Wave Cognitive Behavioral Therapies : A Systematic Review and Quality Assessment of Economic Evaluations in Randomized Controlled Trials
- 2018
-
In: Behavior Therapy. - : Elsevier BV. - 0005-7894 .- 1878-1888. ; 49:1, s. 124-147
-
Journal article (peer-reviewed)abstract
- The term third-wave cognitive behavioral therapy (CBT) encompasses new forms of CBT that both extend and innovate within CBT. Most third-wave therapies have been subject to randomized controlled trials (RCTs) focused on clinical effectiveness; however, the number and quality of economic evaluations in these RCTs has been unknown and may be few. Evidence about efficiency of these therapies may help support decisions on efficient allocation of resources in health policies. The main aim of this study was to systematically review the economic impact of third-wave therapies in the treatment of patients with physical or mental conditions. We conducted a systematic literature search in PubMed, PsycINFO, EMBASE, and CINALH to identify economic evaluations of third-wave therapies. Quality and Risk of Bias (RoB) assessment of economic evaluations was also made using the Drummond 35-item checklist and the Cochrane Collaboration's tool for assessing risk of bias, respectively. Eleven RCTs were included in this systematic review. Mindfulness-Based Cognitive Therapy (MBCT), Mindfulness-Based Stress Reduction (MBSR), Acceptance and Commitment Therapy (ACT), Dialectical Behavior Therapy (DBT), and extended Behaviour Activation (eBA) showed acceptable cost-effectiveness and cost-utility ratios. No study employed a time horizon of more than 3 years. Quality and RoB assessments highlight some limitations that temper the findings. There is some evidence that MBCT, MBSR, ACT, DBT, and eBA are efficient from a societal or a third-party payer perspective. No economic analysis was found for many third-wave therapies. Therefore, more economic evaluations with high methodological quality are needed.
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| 11. |
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| 12. |
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| 13. |
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| 14. |
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| 15. |
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| 16. |
- Hesser, Hugo, et al.
(author)
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Predicting Response to Therapist-Assisted Internet-Delivered Cognitive Behavior Therapy for Depression or Anxiety Within an Open Dissemination Trial
- 2016
-
In: Behavior Therapy. - : Elsevier. - 0005-7894 .- 1878-1888. ; 47:2, s. 155-165
-
Journal article (peer-reviewed)abstract
- Therapist-assisted Internet-delivered cognitive behavior therapy (ICBT) is efficacious for treating anxiety and depression, but predictors of response to treatment when delivered in clinical practice are not well understood. In this study, we explored demographic, clinical, and program variables that predicted modules started and symptom improvement (i.e., Generalized Anxiety Disorder-7 or Patient Health Questionnaire-9 total scores over pre-, mid-, and posttreatment) within a previously published open dissemination trial (Hadjistavropoulos et al., 2014). The sample consisted of 195 patients offered 12 modules of therapist-assisted ICBT for depression or generalized anxiety; ICBT was delivered by therapists working in six geographically dispersed clinics. Consistent across ICBT for depression or generalized anxiety, starting fewer modules was associated with more phone calls from therapists reflecting that therapists tended to call patients who did not start modules as scheduled. Also consistent for both ICBT programs, greater pretreatment condition severity and completion of more modules was associated with superior ICBT-derived benefit. Other predictors of response to treatment varied across the two programs. Younger age, lower education, taking psychotropic medication, being in receipt of psychiatric care and lower comfort with written communication were associated with either fewer program starts or lower symptom improvement in one of the two programs. It is concluded that monitoring response to ICBT may be particularly important in patients with these characteristics. Research directions for identifying patients who are less likely to benefit from ICBT are discussed.
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| 17. |
- Holmes, Emily A., et al.
(author)
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Positive interpretation training : Effects of mental imagery versus verbal training on positive mood
- 2006
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In: Behavior Therapy. - : ELSEVIER INC. - 0005-7894 .- 1878-1888. ; 37:3, s. 237-247
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Journal article (peer-reviewed)abstract
- Therapists often assume a special association between mental imagery and emotion, though empirical evidence has been lacking. Using an interpretation training paradigm, we previously found that imagery had a greater impact on anxiety than did verbal processing of the same material (Holmes & Mathews, 2005). Although the finding of a differential impact of imagery versus verbal processing of negative material was replicated, findings did not extend to benign material. Results therefore left open the question of whether there may be a special association between imagery and positive emotion. The current experiment examined positive interpretation training. Numerous scenarios were presented with initial ambiguity as to positive outcome or not, with final information then yielding consistently positive resolutions. Participants were asked to either imagine these positive events or to listen to the same descriptions while thinking about their verbal meaning. Those participants in the imagery condition reported greater increases in positive affect and rated new descriptions as being more positive than did those in the verbal condition. Results suggest that positive training can be enhanced through imagery as opposed to verbal processing. This study also provides the first test of a standardized intervention using an "interpretive bias training" paradigm to improve positive mood.
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| 18. |
- Ji, Julie L., et al.
(author)
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Emotional Mental Imagery as Simulation of Reality : Fear and Beyond-A Tribute to Peter Lang
- 2016
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In: Behavior Therapy. - : ELSEVIER INC. - 0005-7894 .- 1878-1888. ; 47:5, s. 702-719
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Journal article (peer-reviewed)abstract
- This article pays tribute to the seminal paper by Peter J. Lang (1977; this journal), "Imagery in Therapy: Information Processing Analysis of Fear." We review research and clinical practice developments in the past five decades with reference to key insights from Lang's theory and experimental work on emotional mental imagery. First, we summarize and recontextualize Lang's bio-informational theory of emotional mental imagery (1977, 1979) within contemporary theoretical developments on the function of mental imagery. Second, Lang's proposal that mental imagery can evoke emotional responses is evaluated by reviewing empirical evidence that mental imagery has a powerful impact on negative as well as positive emotions at neurophysiological and subjective levels. Third, we review contemporary cognitive and behavioral therapeutic practices that use mental imagery, and consider points of extension and departure from Lang's original investigation of mental imagery in fear-extinction behavior change. Fourth, Lang's experimental work on emotional imagery is revisited in light of contemporary research on emotional psychopathology-linked individual differences in mental imagery. Finally, key insights from Lang's experiments on training emotional response during imagery are discussed in relation to how specific techniques may be harnessed to enhance adaptive emotional mental imagery training in future research.
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| 19. |
- Kaldo, Viktor, et al.
(author)
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Internet versus group cognitive-behavioral treatment of distress associated with tinnitus : A randomized controlled trial
- 2008
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In: Behavior Therapy. - : Elsevier BV. - 0005-7894 .- 1878-1888. ; 39:4, s. 348-359
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Journal article (peer-reviewed)abstract
- Tinnitus distress can be reduced by means of cognitive-behavior therapy (CBT), and the treatment can be delivered in different ways. The most recent format is Internet-based self-help. The aim of this study was to compare this treatment (n = 26) with standard group-based CBT (n = 25) in a randomized controlled trial. Outcomes on self-report inventories measuring tinnitus distress were evaluated immediately after and 1 year after treatment. Results showed that both groups had improved, and there were few differences between them. The effect size for the Internet treatment was d = 0.73 (95% CI = 0.16-1.30) and for the group treatment was d = 0.64 (95% CI = 0.07-1.21). The Internet treatment consumed less therapist time and was 1.7 times as cost-effective as the group treatment. At pretreatment patients rated the Internet treatment as less credible than the group treatment. In conclusion, Internet treatment for tinnitus distress merits further investigation, as the outcomes achieved are promising.
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| 20. |
- Kilic, Aysenur, et al.
(author)
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A Systematic Review of the Effectiveness of Self-Compassion-Related Interventions for Individuals With Chronic Physical Health Conditions
- 2021
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In: Behavior Therapy. - : Elsevier. - 0005-7894 .- 1878-1888. ; 52:3, s. 607-625
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Research review (peer-reviewed)abstract
- Self-compassion, defined as a mindful way of coping with pain and suffering by showing kindness, care, and concern towards the self, may improve psychological adjustment in people living with a chronic physical health condition (CPHC). Various studies illustrate that self-compassion is associated with positive outcomes in general. The aim of this systematic review is to establish the effect of compassion-related therapies on self-compassion specifically in people with CPHCs. Secondary aims are to (a) establish the effect on other psychological and physiological outcomes and (b) explore the relative effectiveness of different therapy types among those identified. Cochrane, Embase, Medline, Psy-cINFO, and CINAHL databases were searched using & ldquo;compassion & rdquo; AND & ldquo;chronic disease & rdquo; AND & ldquo;psychological outcomes & rdquo; and their synonyms, from 2004 to March 2019. Eligible studies had an experimental design using a self-compassion scale with an adult population. Risk of bias (RoB)& nbsp;was assessed using the Cochrane RoB tool. Effect sizes were calculated for study outcomes. Fifteen studies, including a total of 1,190 participants, 7 different CPHCs, and 11 types of therapies, were included in the review. Nearly all included therapies significantly increased self-compassion with medi-um to large effect sizes, and reported positive outcomes, such as decreased depression. None of the therapy types appeared clearly superior to the others. Findings from this review show that included therapies increased self-compassion and im -proved various outcomes, which may represent clinically significant benefits for patients. However, there is a need to further understand how self-compassion exerts its benefits and determine the best methods to increase self-compassion.
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| 21. |
- Kling, Åsa, et al.
(author)
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A Randomized Controlled Effectiveness Trial of Parent Management Training With Varying Degrees of Therapist Support
- 2010
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In: Behavior Therapy. - Elsevier : Elsevier BV. - 0005-7894 .- 1878-1888. ; 41:4, s. 530-542
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Journal article (peer-reviewed)abstract
- This study examined the effectiveness of a Swedish parent management training (PMT) intervention for parents of children aged 3 to 10 within the context of regular social service. Self-referred parents of 159 children (aged 3–10) with conduct problems were randomly assigned to either eleven practitioner-assisted group sessions (PMT-P), or a single instructional workshop followed by self-administration of the training material (PMT-S), or a waitlist control group. Intent-to-treat analyses showed that both PMT-P and PMT-S improved parent competence and reduced child conduct problems compared to the waitlist at posttest. Both training conditions showed further significant improvements at the 6-month follow-up. In direct comparison, PMT-P was superior to PMT-S on measures of child conduct problems at both posttest and follow-up. Improvement in child conduct was mediated by improvement in parent competencies and homework fidelity. The findings in this study have implications for large-scale dissemination of parent management training through different means of delivery.
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| 22. |
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| 23. |
- Käll, Anton, et al.
(author)
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Internet-Based Cognitive Behavior Therapy for Loneliness : A Pilot Randomized Controlled Trial
- 2020
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In: Behavior Therapy. - : Elsevier. - 0005-7894 .- 1878-1888. ; 51:1, s. 54-68
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Journal article (peer-reviewed)abstract
- Loneliness has been described as a common source of discomfort based on a subjective discrepancy between the actual and desired social situation. For some people this feeling may become a sustained state that is associated with a wide range of psychiatric and psychosocial problems. While there are few existing treatment protocols, interventions based on cognitive behavioral therapy (CBT) have shown positive effects. The current study investigated the efficacy of an 8-week internet-based treatment containing CBT components aimed at reducing feelings of loneliness. Seventy-three participants were recruited from the general public and randomly allocated to treatment or a wait-list control condition. Participants were assessed with standardized self-report measures of loneliness, depression, social anxiety, worry, and quality of life at pretreatment and posttreatment. Robust linear regression analysis of all randomized participants showed significant treatment effects on the primary outcome measure of loneliness (between group Cohen’s d = 0.77), and on secondary outcomes measuring quality of life and social anxiety relative to control at postassessment. The results suggest the potential utility of internet-based CBT in alleviating loneliness but more research on the long-term effects and the mechanisms underlying the effects is needed.
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| 24. |
- Linde, Johanna, et al.
(author)
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Acceptance-Based Exposure Therapy for Body Dysmorphic Disorder : a Pilot Study
- 2015
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In: Behavior Therapy. - : Elsevier BV. - 0005-7894 .- 1878-1888. ; 46:4, s. 423-431
-
Journal article (peer-reviewed)abstract
- Body dysmorphic disorder (BDD) is an often severe, chronic, and disabling disorder, and although some controlled trials of cognitive behavior therapy (CBT) have shown efficacy, the body of evidence is still limited. The condition is generally considered difficult to treat, and further research to determine the effectiveness of psychological treatments for BDD is needed. The present study is the first to evaluate an acceptance-based therapy for BDD. In total, 21 patients received a 12-week group treatment consisting of weekly sessions of psychoeducation, acceptance and defusion practice, and exposure exercises to foster acceptance of internal discomfort and to strengthen the patients’ committed purposeful actions. The primary outcome was BDD symptomatology (measured on the BDD-YBOCS) assessed by a psychiatrist before and after treatment and at 6 months follow-up. The secondary outcomes were self-rated BDD symptoms, psychological flexibility, depressive symptoms, quality of life, and disability. Reductions in BDD symptomatology from pre- to posttreatment were significant and showed a large effect size, d = 1.93 (95% CI 0.82–3.04). At posttreatment, 68% of the participants showed clinically significant improvement in the primary outcome variable. Treatment gains were maintained at 6 months follow-up. The treatment also resulted in significant improvements in all secondary outcomes. The dropout rate was low; 90.5% of the participants completed treatment. This study suggests that acceptance-based exposure therapy may be an efficacious and acceptable treatment for BDD that warrants further investigation in larger controlled trials.
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| 25. |
- Nordgreen, Tine, et al.
(author)
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Stepped Care Versus Direct Face-to-Face Cognitive Behavior Therapy for Social Anxiety Disorder and Panic Disorder : A Randomized Effectiveness Trial
- 2016
-
In: Behavior Therapy. - : Elsevier BV. - 0005-7894 .- 1878-1888. ; 47:2, s. 166-183
-
Journal article (peer-reviewed)abstract
- The aim of this study was to assess the effectiveness of a cognitive behavioral therapy(CBT) stepped care model (psychoeducation, guided Internet treatment, and face-to-face CBT) compared with direct face-to-face (FtF) CBT. Patients with panic disorder or social anxiety disorder were randomized to either stepped care (n = 85) or direct FtF CBT (n = 88). Recovery was defined as meeting two of the following three criteria: loss of diagnosis, below cut-off for self-reported symptoms, and functional improvement. No significant differences in intention-to-treat recovery rates were identified between stepped care (40.0%) and direct FtF CBT (43.2%). The majority of the patients who recovered in the stepped care did so at the less therapist-demanding steps (26/34, 76.5%). Moderate to large within-groups effect sizes were identified at posttreatment and 1-year follow-up. The attrition rates were high: 41.2% in the stepped care condition and 27.3% in the direct FtF CBT condition. These findings indicate that the outcome of a stepped care model for anxiety disorders is comparable to that of direct FtF CBT. The rates of improvement at the two less therapist-demanding steps indicate that stepped care models might be useful for increasing patients’ access to evidence-based psychological treatments for anxiety disorders. However, attrition in the stepped care condition was high, and research regarding the factors that can improve adherence should be prioritized.
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| 26. |
- Nordin, Sara, et al.
(author)
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Expanding the limits of bibliotherapy for panic disorder : Randomized trial of self-help without support but with a clear deadline
- 2010
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In: Behavior Therapy. - : Elsevier. - 0005-7894 .- 1878-1888. ; 41:3, s. 267-276
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Journal article (peer-reviewed)abstract
- Cognitive behavioral bibliotherapy for panic disorder has been found to be less effective without therapist support. In this study, participants were randomized to either unassisted bibliotherapy (n = 20) with a scheduled follow-up telephone interview or to a waiting list control group (n = 19). Following a structured psychiatric interview, participants in the treatment group were sent a self-help book consisting of 10 chapters based on cognitive behavioral strategies for the treatment of panic disorder. No therapist contact of any kind was provided during the treatment phase, which lasted for 10 weeks. Results showed that the treatment group had, in comparison to the control group, improved on all outcome measures at posttreatment and at 3-month follow-up. The tentative conclusion drawn from these results is that pure bibliotherapy with a clear deadline can be effective for people suffering from panic disorder with or without agoraphobia.
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| 27. |
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| 28. |
- Rautio, Daniel, et al.
(author)
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Body-Focused Repetitive Behavior Disorders in Children and Adolescents : Clinical Characteristics and Treatment Outcomes in a Naturalistic Setting
- 2024
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In: Behavior Therapy. - 0005-7894 .- 1878-1888. ; 55:2, s. 376-390
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Journal article (peer-reviewed)abstract
- Body-focused repetitive behavior disorders, including trichotillomania (hair-pulling disorder) and excoriation (skin picking) disorder, typically emerge in early adolescence, but little is known about the clinical characteristics and treatment outcomes of these disorders in young people, particularly in real-world clinical settings. Participants were 63 children and adolescents (51 girls; age range 9–17) with a diagnosis of trichotillomania (n = 33) and/or skin-picking disorder (n = 33) attending a specialist outpatient clinic in Stockholm, Sweden. Demographic and clinical characteristics were gathered at the initial assessment. Of the 63 assessed youths, 56 received manual-based behavior therapy mainly focusing on habit reversal training, which was combined with medication when deemed appropriate. The mean clinician-reported trichotillomania and skin-picking disorder symptom severity at baseline (n = 63) was in the moderate range. We observed high rates of psychiatric comorbidity (63.5%) and use of psychiatric medication (54.8%). For the 56 individuals undertaking treatment at the clinic, mixed-effects regression models showed a significant decrease in symptom severity from baseline to posttreatment, with gains maintained up to the 12-month follow-up. Substantial and durable improvements were also seen on self-reported symptoms, self-reported depression, and global functioning. Specialist care should be made more widely available to improve the prognosis and quality of life of young people with trichotillomania and skin-picking disorder.
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| 29. |
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| 30. |
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| 31. |
- Rozental, Alexander, et al.
(author)
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Treating procrastination using cognitive behavior therapy : A pragmatic randomized controlled trial comparing treatment delivered via the Internet or in groups
- 2018
-
In: Behavior Therapy. - : Elsevier BV. - 0005-7894 .- 1878-1888. ; 49:2, s. 180-197
-
Journal article (peer-reviewed)abstract
- Procrastination is a common problem among university students, with at least half of the population reporting great difficulties initiating or completing tasks and assignments. Procrastination can have a negative impact on course grades and the ability to achieve a university degree, but can also lead to psychological distress. Cognitive behavior therapy (CBT) is believed to reduce procrastination, but few studies have investigated its effectiveness in a regular clinical setting. The current study explored its effects using a pragmatic randomized controlled trialcomparing treatment delivered during 8 weeks as self-guided CBT via the Internet (ICBT) or as group CBT. In total, 92 university students with severe procrastination were included in the study (registered as a clinical trial on Clinicaltrials.gov: NCT02112383). Outcome measures on procrastination, depression, anxiety, and well-being were distributed at pre- and posttreatment as well as 6-month follow-up. An outcome measure of procrastination was administered weekly. Linear mixed and fixed effects models were calculated, along with improvement and deterioration rates. The results showed large within-group effect sizes on procrastination, Cohen’s d of 1.29 for ICBT, 95% Confidence Interval (CI) [0.81, 1.74], and d of 1.24 for group CBT, 95% CI [0.76, 1.70], and small to moderate benefits for depression, anxiety, and well-being. In total, 33.7% were regarded as improved at posttreatment and 46.7% at follow-up. No differences between conditions were observed after the treatment period, however, participants in group CBT continued or maintained their improvement at follow-up, while participants in self-guided ICBT showed some signs of deterioration. The findings from the current study suggest that CBT might be an effective treatment for those struggling with severe procrastination, but that a group format may be better for some to sustain their benefits over time and that the clinical significance of the results need to be investigated further.
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| 32. |
- Santoft, Fredrik, et al.
(author)
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Mediators of Change in Cognitive Behavior Therapy for Clinical Burnout
- 2019
-
In: Behavior Therapy. - : Elsevier BV. - 0005-7894 .- 1878-1888. ; 50:3, s. 475-488
-
Journal article (peer-reviewed)abstract
- Evidence supporting the effectiveness of cognitive behavior therapy (CBT) for stress-related illness is growing, but little is known about its mechanisms of change. The aim of this study was to investigate potential mediators of CBT for severe stress in form of clinical burnout, using an active psychological treatment as comparator. We used linear mixed models to analyze data from patients (N = 82) with clinical burnout who received either CBT or another psychological treatment in a randomized controlled trial. Potential mediators (i.e., sleep quality, behavioral activation, perceived competence, and therapeutic alliance) and outcome (i.e., symptoms of burnout) were assessed weekly during treatment. The results showed that the positive treatment effects on symptoms of burnout favoring CBT (estimated between-group d = 0.93) were mediated by improvements in sleep quality, ab = -0.017,95% CIasymmetric [-0.037, -0.002], and increase in perceived competence, ab = -0.037, 95% CIasymmetric [-0.070, -0.010]. Behavioral activation, ab = -0.004 [-0.016, 0.007], and therapeutic alliance, ab = 0.002 [-0.006, 0.011], did not significantly mediate the difference in effects between the treatments. Improving sleep quality and increasing perceived competence may thus constitute important process goals in order to attain symptom reduction in CBT for clinical burnout.
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| 33. |
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| 34. |
- Storch, Eric A, et al.
(author)
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Family Accommodation in Children and Adolescents with Misophonia
-
In: Behavior Therapy. - 1878-1888.
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Journal article (peer-reviewed)abstract
- Family accommodation (e.g., reassurance, modifying routines, assisting avoidance) has not been explored among youth with misophonia but may have important clinical and intervention implications. We examined family accommodation in 102 children and adolescents with interview-confirmed misophonia and compared its frequency and content to family accommodation in 95 children and adolescents with anxiety disorders. Findings showed that family accommodation was ubiquitous in pediatric misophonia and may be even more frequent than in youth with anxiety disorders. Assisting the child, participating in misophonia-related behaviors, and modifying family routines were endorsed by more than 70% of parents of children with misophonia. Further, compared to parents of children with anxiety disorders, parents of children with misophonia more frequently reported child distress and anger when they did not accommodate. Family accommodation was a moderate to strong predictor of misophonia severity even when accounting for co-occurring internalizing and externalizing symptoms and sociodemographic factors. This first study of family accommodation in pediatric misophonia suggests accommodation may be an important clinical feature oand a potential candidate to target in interventions.
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| 35. |
- Weineland, Sandra, et al.
(author)
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Effects of Tailored and ACT-Influenced Internet-Based CBT for Eating Disorders and the Relation Between Knowledge Acquisition and Outcome: A Randomized Controlled Trial
- 2017
-
In: Behavior Therapy. - : Elsevier BV. - 0005-7894 .- 1878-1888. ; 48:5, s. 624-637
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Journal article (peer-reviewed)abstract
- © 2017 This is the first trial to investigate the outcome of tailored and ACT-influenced, cognitive behavioral Internet treatment for eating disorder psychopathology, and the relation between knowledge acquisition and outcome. This study utilized a randomized controlled design, with computer-based allocation to treatment or waiting list control group. Participants were recruited via advertisements in social media and newspapers in Sweden. Participants fulfilling the criteria for bulimia nervosa (BN), or Eating Disorder Not Otherwise Specified (EDNOS), with a BMI above 17.5, were enrolled in the study (N = 92). The treatment group received an Internet-based, ACT-influenced CBT intervention, developed by the authors, for eating disorders. The treatment lasted 8 weeks, and was adapted to the participant's individual needs. A clinician provided support. The main outcome measures were eating disorder symptoms and body shape dissatisfaction. Intent-to-treat analysis showed that the treatment group (n = 46) improved significantly on eating disorder symptoms and body dissatisfaction, compared with the waiting list control group (n = 46), with small to moderate effect sizes (between group effects, d = 0.35–0.64). More than a third of the participants in the treatment group (36.6%), compared to 7.1% in the waiting list control condition, made clinically significant improvements. Results showed a significant increase in knowledge in the treatment group compared to the waiting list control group (between group effect, d = 1.12), but we found no significant correlations between knowledge acquisition and outcome (r = -0.27 to -r = 0.23). The results provide preliminary support for Internet-based, tailored, and ACT-influenced treatment, based on CBT for participants with eating disorder psychopathology.
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| 36. |
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| 37. |
- Wolgast, Martin
(author)
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What Does the Acceptance and Action Questionnaire (AAQ-II) Really Measure?
- 2014
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In: Behavior Therapy. - : Elsevier BV. - 1878-1888 .- 0005-7894. ; 45:6, s. 831-839
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Journal article (peer-reviewed)abstract
- The present study seeks to investigate the extent to which the Acceptance and Action Questionnaire (AAQ-II) is successful in discriminating between experiential avoidance/psychological flexibility on the one hand and the supposed outcomes in terms of psychological well-being of having this trait on the other. This was done using exploratory factor analysis on an item pool containing the AAQ-II items, and items designed for the present study to measure distress and acceptance/non-acceptance, to see what factors are identified and on which factor(s) the AAQ-II items had the highest factor loadings. Interestingly, the analysis found the items of the AAQ-II to be more strongly related to items designed to measure distress than items designed to measure acceptance/nonacceptance with minimal references to functional outcomes. The results of the study are interpreted and discussed in relation to the widespread use of the AAQ in both clinical and scientific contexts and given the centrality of the measure in empirically validating the ACT model of psychopathology and treatment.
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| 38. |
- Åhlén, Johan, et al.
(author)
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Long-term Outcome of a Cluster-Randomized Universal Preventive Intervention targeting Anxiety and Depression in School Children
- 2019
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In: Behavior Therapy. - : Elsevier BV. - 0005-7894 .- 1878-1888. ; 50:1, s. 203-213
-
Journal article (peer-reviewed)abstract
- The present study concerns a 3-year follow-up of a universal prevention trial targeting anxiety and depressive symptoms in school children. In addition to evaluating the long-term effect of the prevention program, we also examined attrition and its effect on the outcome. High rates of attrition have commonly been observed in studies in the field. However, the role of attrition is not sufficiently understood regarding internal and external validity biases. The current study comprised 695 children (aged 8–11 at baseline) from 17 schools in Sweden. Schools were cluster-randomized to either the intervention or control condition. Children completed measures of anxiety and depressive symptoms and parents completed measures of their child’s anxiety and general mental health. We found no evidence of long-term effects of the prevention program, except for a small effect regarding parent reports of child anxiety. However, that effect was not found to be of clinical significance. Regarding attrition, children with missing data at the 3-year follow-up displayed higher levels of psychiatric symptoms at baseline and increasing symptoms across time. Furthermore, children in the control condition with missing follow-up data were found to be significantly deteriorated across time compared to the corresponding children in the intervention condition regarding depressive symptoms and total difficulties. In other words, attrition served as a moderator of the effect, which suggests that the overall result was biased toward a null-result. Our study highlights that large and nonrandom attrition severely limits the validity of the results. Further, given the common problem of retaining participants in long-term evaluations of school-based prevention trials, previous studies may suffer from the same limitations as the current study.
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| 39. |
- Öst, Lars-Göran, et al.
(author)
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The Effects of Cognitive Behavior Therapy Delivered by Students in a Psychologist Training Program : An Effectiveness Study
- 2012
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In: Behavior Therapy. - : Elsevier BV. - 0005-7894 .- 1878-1888. ; 43:1, s. 160-173
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Journal article (peer-reviewed)abstract
- Relatively little is known about the efficacy of clinically inexperienced student therapists carrying out cognitive behavior therapy (CBT) under supervision during a professional, psychologist training program. The current study evaluated this by collecting pre- and posttreatment data on 591 consecutive patients receiving treatment at the Psychotherapy Clinic of the Department of Psychology, Stockholm University, Sweden, over an 8-year period. The patients had mainly anxiety disorders or depression with a mean duration of 15 years, and received individual CBT for a mean of 18 sessions. They improved significantly on both general measures (Beck Anxiety Inventory [BAI], Beck Depression Inventory [BDI], and Quality of Life Inventory [QOLI]) and disorder-specific self-report scales. The proportions of recovered patients on the BAI (63%) and the BDI (60%) were higher than those of a comparison effectiveness study. On the specific self-report scales the current sample improved as much as the samples in extant efficacy trials. We conclude that clinically inexperienced student therapists who receive supervision from experienced supervisors can achieve treatment effects that are on a par with those of experienced licensed psychotherapists.
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