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Stepped care for social anxiety disorder or panic disorder: A randomised controlled trial
Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
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2017 (English)Conference paper, Oral presentation with published abstract (Refereed)
Abstract [en]

Background: Stepped Care is considered a cost-effective way to deliver health care but few studies have investigated stepped care models for psychological treatments. Internet-based psychological treatment might be a highly suitable first step in a stepped care model. The aim of this study was to assess the effectiveness of a cognitive behavioral therapy (CBT) stepped care model (psychoeducation, guided Internet-based treatment, and face-to-face CBT) compared with direct face-to-face (FtF) CBT.

Methods: 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.

Results: 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.

Discussion: 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. This may reflect inflexible stepping-up criteria. Limitations of this study will be discussed together with suggestions for more relevant and flexible stepping up criteria.

Place, publisher, year, edition, pages
2017.
Keywords [en]
artificial intelligence, machine learning, prediction, stepped care
National Category
Psychology
Research subject
Psychology
Identifiers
URN: urn:nbn:se:su:diva-148478OAI: oai:DiVA.org:su-148478DiVA, id: diva2:1152881
Conference
ISRII 9th Scientific Meeting: Making e/mHealth Impactful in People's Lives, Berlin, Germany, October 12-14, 2017
Note

Abstract available in the Conference App Elsevier Conferences (ISRII2017).

Available from: 2017-10-26 Created: 2017-10-26 Last updated: 2018-01-14Bibliographically approved

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CiteExportLink to record
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Citation style
  • apa
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