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  • 1.
    Boettcher, Johanna
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Freie Universitaet Berlin, Germany.
    Åstrom, Viktor
    Påhlsson, Daniel
    Schenström, Ola
    Andersson, Gerhard
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Internet-Based Mindfulness Treatment for Anxiety Disorders: A Randomized Controlled Trial2014In: Behavior Therapy, ISSN 0005-7894, E-ISSN 1878-1888, Vol. 45, no 2, p. 241-253Article in journal (Refereed)
    Abstract [en]

    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.

  • 2.
    Linde, Johanna
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Karolinska Institutet, Sweden.
    Rück, Christian
    Bjureberg, Johan
    Ivanov, Volen Z.
    Djurfeldt, Diana Radu
    Ramnerö, Jonas
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Acceptance-Based Exposure Therapy for Body Dysmorphic Disorder: a Pilot Study2015In: Behavior Therapy, ISSN 0005-7894, E-ISSN 1878-1888, Vol. 46, no 4, p. 423-431Article in journal (Refereed)
    Abstract [en]

    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.

  • 3. Nordgreen, Tine
    et al.
    Haug, Thomas
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Haukeland University Hospital, Norway; University of Bergen, Norway; Karolinska Institutet, Sweden.
    Andersson, Gerhard
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Kvale, Gerd
    Tangen, Tone
    Haiervang, Einar
    Havik, Odd E.
    Stepped Care Versus Direct Face-to-Face Cognitive Behavior Therapy for Social Anxiety Disorder and Panic Disorder: A Randomized Effectiveness Trial2016In: Behavior Therapy, ISSN 0005-7894, E-ISSN 1878-1888, Vol. 47, no 2, p. 166-183Article in journal (Refereed)
    Abstract [en]

    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.

  • 4.
    Rozental, Alexander
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Forsström, David
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Lindner, Philip
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institutet, Sweden.
    Nilsson, Simon
    Mårtensson, Lina
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Rizzo, Angela
    Andersson, Gerhard
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Treating procrastination using cognitive behavior therapy: A pragmatic randomized controlled trial comparing treatment delivered via the Internet or in groups2018In: Behavior Therapy, ISSN 0005-7894, E-ISSN 1878-1888, Vol. 49, no 2, p. 180-197Article in journal (Refereed)
    Abstract [en]

    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.

  • 5. Santoft, Fredrik
    et al.
    Salomonsson, Sigrid
    Hesser, Hugo
    Lindsäter, Elin
    Ljótsson, Brjánn
    Lekander, Mats
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Radboud University, The Netherlands.
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Karolinska Institutet, Sweden.
    Hedman-Lagerlöf, Erik
    Mediators of Change in Cognitive Behavior Therapy for Clinical Burnout2019In: Behavior Therapy, ISSN 0005-7894, E-ISSN 1878-1888, Vol. 50, no 3, p. 475-488Article in journal (Refereed)
    Abstract [en]

    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.

  • 6.
    Öst, Lars-Göran
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Karlstedt, Anna
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Widén, Sara
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    The Effects of Cognitive Behavior Therapy Delivered by Students in a Psychologist Training Program: An Effectiveness Study2012In: Behavior Therapy, ISSN 0005-7894, E-ISSN 1878-1888, Vol. 43, no 1, p. 160-173Article in journal (Refereed)
    Abstract [en]

    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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