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  • 1. Agdal, Maren Lillehaug
    et al.
    Raadal, Magne
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Skaret, Erik
    Quality-of-life before and after cognitive behavioral therapy (CBT) in patients with intra-oral injection phobia2012In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 70, no 6, p. 463-470Article in journal (Refereed)
    Abstract [en]

    Objective. To evaluate quality-of-life (QoL), before and after cognitive behavioral therapy (CBT) in patients diagnosed with intra-oral injection phobia according to DSM-IV and to compare with the general population. This study also aimed to evaluate if QoL was associated with self-reported injection anxiety, dental anxiety, time since last dental treatment and oral health. Materials and methods. Subjects were 55 patients (mean age 35.5 +/- 12.2, 78.2% women) who participated in a treatment study in which 89% managed an intra-oral injection at 1 year follow-up. The patients completed a set of questionnaires including Quality of Life Inventory (QOLI), Injection Phobia Scale-Anxiety, Dental Anxiety Scale and a single-item question assessing self-perceived oral health. Objective measures of oral health and treatment needs were based on clinical examination. QOLI-scores from a non-clinical sample were used for comparison. Results. Before treatment the general and health specific QoL were lower among intra-oral injection phobics than in the non-clinical sample. At 1 year follow-up the QoL in general had improved significantly and was similar to that of the non-clinical sample. Poor self-reported oral health and long-term avoidance of dental treatment were associated with lower general and health-specific QoL. Self-reported injection anxiety and dental anxiety were not associated with QoL. Conclusions. Patients with intra-oral injection phobia report lower QoL compared with a general population. Phobia treatment seems to increase QoL to normative levels. Self-perceived poor oral health is associated with reduced QoL in these patients.

  • 2. Andersson, Gerhard
    et al.
    Carlbring, Per
    Svanborg, Cecilia
    Bergström, Jan
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Lindefors, Nils
    Paniksyndrom - ond cirkel av feltolkade kroppsliga signaler2011In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 108, no 14, p. 795-797Article in journal (Refereed)
    Abstract [sv]

    Paniksyndrom kännetecknas av plötsliga, oväntade panikattacker med rädsla för nya attacker eller konsekvenser av dem. En andel patienter har även agorafobi. 

    Olika förklaringsmodeller har förts fram för att beskriva hur paniksyndrom uppstår och vidmakthålls. 

    Flera behandlingar för paniksyndrom finns, och bland dem är det psykologisk behandling i form av kognitiv beteendeterapi (KBT) eller läkemedelsbehandling (i förs­ta hand selektiva serotoninåterupptagshämmare) som rekommenderas och som har stöd i forskningen. 

    I Sverige har Internetbaserad KBT för paniksyndrom utvecklats och prövats med framgång. 

    I valet av behandling bör patientens preferenser vägas in.

  • 3. Andersson, Gerhard
    et al.
    Waara, Johan
    Jonsson, Ulf
    Malmaeus, Fredrik
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Karolinska Institute, Sweden.
    Internet-Based Exposure Treatment Versus One-Session Exposure Treatment of Snake Phobia: A Randomized Controlled Trial2013In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 42, no 4, p. 284-291Article in journal (Refereed)
    Abstract [en]

    In this study, the authors compared guided Internet-delivered self-help with one-session exposure treatment (OST) in a sample of snake phobic patients. A total of 30 patients were included following a screening on the Internet and a structured clinical interview. The Internet treatment consisted of four weekly text modules which were presented on a web page, a video in which exposure was modelled, and support provided via Internet. The OST was delivered in a three-hour session following a brief orientation session. The main outcome was the behavioural approach test (BAT), and as secondary measures questionnaires measuring anxiety symptoms and depression were used. Results showed that the groups did not differ at post-treatment or follow-up, with the exception of a significant interaction for the BAT in favour of the OST. At post-treatment, 61.5% of the Internet group and 84.6% of the OST group achieved a clinically significant improvement on the BAT. At follow-up, the corresponding figures were 90% for the Internet group and 100% for the OST group (completer sample). Within-group effect sizes for the Snake Phobia Questionnaire were large (d = 1.63 and d = 2.31 for the Internet and OST groups, respectively, at post-treatment). It is concluded that guided Internet-delivered exposure treatment is a potential treatment option in the treatment of snake phobia, but that OST probably is better.

  • 4.
    Andersson, Gerhard
    et al.
    Linköpings universitet.
    Waara, Johan
    Uppsala Universitet.
    Jonsson, Ulf
    Uppsala Universitet.
    Malmaeus, Fredrik
    Uppsala Universitet.
    Carlbring, Per
    Linköpings universitet.
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Internet-Based Self-Help Versus One-Session Exposure in the Treatment of Spider Phobia: A Randomized Controlled Trial2009In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 38, no 2, p. 114-120Article in journal (Refereed)
    Abstract [en]

    The authors compared guided Internet-delivered self-help with one session of live-exposure treatment in a sample of spider-phobic patients. A total of 30 patients were included following screening on the Internet and a structured clinical interview. The Internet treatment consisted of five weekly text modules, which were presented on a web page, a video in which exposure was modelled, and support provided via Internet. The live-exposure treatment was delivered in a 3-hr session following a brief orientation session. The main outcome measure was the behavioural approach test (BAT), and as secondary measures the authors used questionnaires measuring anxiety symptoms and depression. Results showed that the groups did not differ at posttreatment or follow-up, with the exception of the proportion showing clinically significant change on the BAT. At posttreatment 46.2% of the Internet group and 85.7% in the live-exposure group achieved this change. At follow-up the corresponding figures were 66.7% for the Internet group and 72.7% for the live treatment. Within-group effect sizes for the spider phobia questionnaire were large (d = 1.84 and 2.58 for the Internet and live-exposure groups, respectively, at posttreatment). The authors conclude that guided Internet-delivered exposure treatment is a promising new approach in the treatment of spider phobia.

  • 5.
    Arnberg, Alexandra
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Karolinska Institutet, Sweden.
    CBT for Children with Depressive Symptoms: A Meta-Analysis2014In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 43, no 4, p. 275-288Article in journal (Refereed)
    Abstract [en]

    Pediatric depression entails a higher risk for psychiatric disorders, somatic complaints, suicide, and functional impairment later in life. Cognitive behavior therapy (CBT) is recommended for the treatment of depression in children, yet research is based primarily on adolescents. The present meta-analysis investigated the efficacy of CBT in children aged 8-12 years with regard to depressive symptoms. We included randomized controlled trials of CBT with participants who had an average age of <= 12 years and were diagnosed with either depression or reported elevated depressive symptoms. The search resulted in 10 randomized controlled trials with 267 participants in intervention and 256 in comparison groups. The mean age of participants was 10.5 years. The weighted between-group effect size for CBT was moderate, Cohen's d=0.66. CBT outperformed both attention placebo and wait-list, although there was a significant heterogeneity among studies with regard to effect sizes. The weighted within-group effect size for CBT was large, d=1.02. Earlier publication year, older participants, and more treatment sessions were associated with a larger effect size. In conclusion, the efficacy of CBT in the treatment of pediatric depression symptoms was supported. Differences in efficacy, methodological shortcomings, and lack of follow-up data limit the present study and indicate areas in need of improvement.

  • 6. Bjaastad, Jon Fauskanger
    et al.
    Haugland, Bente Storm Mowatt
    Fjermestad, Krister W.
    Torsheim, Torbjorn
    Havik, Odd E.
    Heiervang, Einar R.
    Öst, Lars-Goran
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institutet, Sweden.
    Competence and Adherence Scale for Cognitive Behavioral Therapy (CAS-CBT) for Anxiety Disorders in Youth: Psychometric Properties2016In: Psychological Assessment, ISSN 1040-3590, E-ISSN 1939-134X, Vol. 28, no 8, p. 908-916Article in journal (Refereed)
    Abstract [en]

    The aim of the present study was to evaluate the psychometric properties of the Competence and Adherence Scale for Cognitive Behavioral Therapy (CAS-CBT). The CAS-CBT is an 11-item scale developed to measure adherence and competence in cognitive-behavioral therapy (CBT) for anxiety disorders in youth. A total of 181 videotapes from the treatment sessions in a randomized controlled effectiveness trial (Wergeland et al., 2014) comprising youth (N = 182, M age = 11.5 years, SD = 2.1, range 8-15 years, 53% girls, 90.7% Caucasian) with mixed anxiety disorders were assessed with the CAS-CBT to investigate interitem correlations, internal consistency, and factor structure. Internal consistency was good (Cronbach's alpha = .87). Factor analysis suggested a 2-factor solution with Factor 1 representing CBT structure and session goals (explaining 46.9% of the variance) and Factor 2 representing process and relational skills (explaining 19.7% of the variance). The sum-score for adherence and competence was strongly intercorrelated, r = .79, p < .001. Novice raters (graduate psychology students) obtained satisfactory accuracy (ICC > .40, n = 10 videotapes) and also good to excellent interrater reliability when compared to expert raters (ICC = .83 for adherence and .64 for competence, n = 26 videotapes). High rater stability was also found (n = 15 videotapes). The findings suggest that the CAS-CBT is a reliable measure of adherence and competence in manualized CBT for anxiety disorders in youth. Further research is needed to investigate the validity of the scale and psychometric properties when used with other treatment programs, disorders and treatment formats.

  • 7.
    Cederlund, Rio
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Perception of Threat in Children With Social Phobia: Comparison to Nonsocially Anxious Children Before and After Treatment2011In: Journal of clinical child and adolescent psychology (Print), ISSN 1537-4416, E-ISSN 1537-4424, Vol. 40, no 6, p. 855-863Article in journal (Refereed)
    Abstract [en]

    The present study investigated interpretation bias and reduced evidence for danger (RED) bias in 49 children with social phobia and 49 nonsocially anxious children between the ages of 8 and 14 years, using an ambiguous stories task. A posttreatment and follow-up measure was included for 26 of the socially phobic children to examine whether there would be a change in interpretation and RED bias after a 12-week behavior therapy program. Ambiguous scenarios were presented sentence by sentence. Participants gave interpretations and fear ratings after each sentence, and they rated negative emotions after each complete scenario. Compared to the nonsocially anxious children, children with social phobia displayed both a RED bias and an interpretation bias. After the treatment program, the children with social phobia displayed a reduced tendency to make biased interpretations, but there were no significant posttreatment changes in the RED bias. At 1 year follow-up there was a significant reduction in both interpretation and RED bias and clinical children no longer differed from nonsocially anxious controls.

  • 8. Clefberg Liberman, Lisa
    et al.
    Larsson, Karolina
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Paz Altuzarra, Maria
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Ollendick, Thomas
    Self-reported Life Satisfaction and Response Style Differences Among Children in Chile and Sweden2015In: Journal of Child and Family Studies, ISSN 1062-1024, E-ISSN 1573-2843, Vol. 24, no 1, p. 66-75Article in journal (Refereed)
    Abstract [en]

    The purpose of the current study was to assess self-perceived life satisfaction in Chilean and Swedish children. The total sample consisted of a non-clinical sample of 1,352 school children between 8 and 14 years of age. Analyses were carried out to compare the children's subjective quality of life and life satisfaction. In addition, possible response style differences across the two countries were explored. Based on our findings, no difference was found between the two countries for the total life satisfaction score, and the only area on which the Swedish children had a significantly higher rating than the Chilean children was on their satisfaction with their friends. However, the Chilean children reported a higher satisfaction with their siblings, school and health than the Swedish children. Moreover, an interaction effect was found between country and age group on the school variable, with the three age groups in the Swedish sample being significantly different, whereas no significant difference was found between the age groups on this variable among the Chilean children. Overall, the satisfaction with the children's different life areas decreased, as they grew older, whereas gender differences were only found on three variables. Small significant response style differences were found between the Chilean and Swedish children. As the effect sizes of these differences were quite small, they should be viewed with caution, and are not likely to explain the few differences found between the children. How I Feel about Things seems fully adequate for use across normal non-clinical boys and girls belonging to different age groups and living in different countries in order to assess their self-reported life satisfaction.

  • 9. Clefberg Liberman, Lisa
    et al.
    Paz Altuzarra, Maria
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Ollendick, Thomas
    How I feel about things: Psychometric data from a sample of Spanish-speaking children2012In: International Journal of Clinical and Health Psychology, ISSN 1697-2600, E-ISSN 2174-0852, Vol. 12, no 3, p. 419-433Article in journal (Refereed)
    Abstract [en]

    This study investigated the psychometric properties of How I Feel about Things, a questionnaire that assesses perceived quality of life and life satisfaction, in a sample of 729 school children. Participants were a non-clinical sample of 8-14 year old children studying second to eighth grade at three different schools in three socio-economic areas in the Metropolitan area of Santiago de Chile. The internal consistency of the questionnaire was acceptable and its convergent validity was supported with a significant positive correlation with a self-report measure of self-esteem. The questionnaire's discriminant validity was also supported with significant negative correlations with well-known self-report measures that assess depressive symptomatology, general and social anxiety, and general fearfulness. The findings of this study provide initial support for the psychometric properties of How I Feel about Things with non-clinical children, although this questionnaire was originally adapted to assess quality of life in children receiving treatment for different anxiety disorders.

  • 10.
    Davis III, Thompson E.
    et al.
    Louisiana State University, Baton Rouge, LA..
    Ollendick, Thomas H.Child Study Center, Virginia Tech.Öst, Lars-GöranStockholm University, Faculty of Social Sciences, Department of Psychology.
    Intensive One-Session Treatment of Specific Phobias2012Collection (editor) (Other academic)
    Abstract [en]

    Whether it’s dogs, spiders, blood, heights or some other fear, specific phobias are one of the most prevalent mental health problems, affecting as many as one in eight people. In recent years, cognitive-behavioral therapy (CBT) has emerged as particularly effective in treating young people and adults with specific phobias. And of these methods, one-session treatment stands out as a long-lasting, cost-effective intervention of choice.

    Intensive One-Session Treatment of Specific Phobias not only provides a summary of the evidence base, it also serves as a practical reference and training guide. This concise volume examines the phenomenology, epidemiology, and etiology of phobias, laying the groundwork for subsequent discussion of assessment strategies, empirically sound one-session treatment methods, and special topics. In addition, expert contributors address challenges common to exposure therapy, offer age-appropriate guidelines for treating young clients, and describe innovative computer-assisted techniques.

    Organized to be read individually or in sequence, chapters delve into key areas, including:

    • Evidence-based assessment and treatment of specific phobias in children, adolescents, and adults.

    • One-session treatment theory and practice with children, adolescents, and adults.

    • Handling difficult cases of specific phobias in youth.

    • Interventions for specific phobias in special populations.

    • Training and assessing therapists in one-session treatment.

    • Ethical issues in considering exposure.

    Intensive One-Session Treatment of Specific Phobias is an essential resource for researchers, clinicians, and graduate students in child, school, clinical, and counseling psychology; social work; and general and special education.

  • 11.
    Davis III, Thompson E.
    et al.
    Louisiana State University.
    Ollendick, Thomas H.
    Virginia Tech.
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Intensive Treatment of Specific Phobias in Children and Adolescents2009In: Cognitive and Behavioral Practice, ISSN 1077-7229, E-ISSN 1878-187X, Vol. 16, no 3, p. 294-303Article in journal (Refereed)
    Abstract [en]

    One-session treatment (OST), a variant of cognitive-behavioral therapy, combines graduated in vivo exposure, participant modeling, reinforcement, psychoeducation, cognitive challenges, and skills training in an intensive treatment model. Treatment is maximized to one 3-hour session. In this paper, we review the application of OST for specific phobia in youth and highlight practical matters related to OST and its use in a clinical setting. We also briefly review results of treatment outcome studies and suggest future directions for clinical research and practice. We conclude that OST is an efficient and efficacious treatment.

  • 12. Ejeby, Kersti
    et al.
    Savitskij, Ruslan
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Ekbom, Anders
    Brandt, Lena
    Ramnerö, Jonas
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Åsberg, Marie
    Backlund, Lars G.
    Randomized controlled trial of transdiagnostic group treatments for primary care patients with common mental disorders2014In: Family Practice, ISSN 0263-2136, E-ISSN 1460-2229, Vol. 31, no 3, p. 273-280Article in journal (Refereed)
    Abstract [en]

    Background. The purpose was to test the effectiveness of two transdiagnostic group interventions compared to care as usual (CAU) for patients with anxiety, depressive or stress-related disorders within a primary health care context. Objectives. To compare the effects of cognitive-based-behavioural therapy (CBT) and multimodal intervention (MMI) on the quality of life and relief of psychological symptoms of patients with common mental disorders or problems attending primary health care centre. Methods. Patients (n = 278), aged 18-65 years, were referred to the study by the GPs and 245 were randomized to CAU or one of two group interventions in addition to CAU: (i) group CBT administered by psychologists and (ii) group MMI administered by assistant nurses. The primary outcome measure was the Mental Component Summary score of short form 36. Secondary outcome measures were Perceived Stress Scale and Self-Rating Scale for Affective Syndromes. The data were analysed using intention-to-treat with a linear mixed model. Results. On the primary outcome measure, the mean improvement based on mixed model analyses across post-and follow-up assessment was significantly larger for the MMI group than for the CBT (4.0; P = 0.020) and CAU (7.5; P = .001) groups. Participants receiving CBT were significantly more improved than those in the CAU group. On four of the secondary outcome measures, the MMI group was significantly more improved than the CBT and CAU groups. The course of improvement did not differ between the CBT group and the CAU group on these measures. Conclusions. Transdiagnostic group treatment can be effective for patients with common mental disorders when delivered in a primary care setting. The group format and transdiagnostic approach fit well with the requirements of primary care.

  • 13. Ejeby, Kersti
    et al.
    Savitskij, Ruslan
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Ekbom, Anders
    Brandt, Lena
    Ramnerö, Jonas
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Åsberg, Marie
    Backlund, Lars G.
    Symptom reduction due to psychosocial interventions is not accompanied by a reduction in sick leave: Results from a randomized controlled trial in primary care2014In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 32, no 2, p. 67-72Article in journal (Refereed)
    Abstract [en]

    Objective. To investigate whether interventions that have positive effects on psychological symptoms and quality of life compared with usual care would also reduce days on sick leave. Design. A randomized controlled trial. Setting. A large primary health care centre in Stockholm, Sweden. Intervention. Patients with common mental disorders were recruited by their GPs and randomized into one of two group interventions that took place in addition to usual care. These group interventions were: (a) group cognitive behavioural therapy (CBT), and (b) group multimodal intervention (MMI). Both types of intervention had previously shown significant effects on quality of life, and MMI had also shown significant effects on psychological symptoms. Patients. Of the 245 randomized patients, 164 were employed and had taken sick leave periods of at least two weeks in length during the study period of two years. They comprised the study group. Main outcome measures. The odds, compared with usual care, for being sick-listed at different times relative to the date of randomization. Results. The mean number of days on sick leave increased steadily in the two years before randomization and decreased in the two years afterwards, showing the same pattern for all three groups. The CBT and MMI interventions did not show the expected lower odds for sick-listing compared with usual care during the two-year follow-up. Conclusion. Reduction in psychological symptoms and increased well-being did not seem to be enough to reduce sickness absence for patients with common mental problems in primary care. The possibility of adding workplace-oriented interventions is discussed.

  • 14. Fjermestad, K. W.
    et al.
    Lerner, M. D.
    McLeod, B. D.
    Wergeland, G. J. H.
    Haugland, B. S. M.
    Havik, O. E.
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Silverman, W. K.
    Motivation and treatment credibility predict alliance in cognitive behavioral treatment for youth with anxiety disorders in community clinics2018In: Journal of Clinical Psychology, ISSN 0021-9762, E-ISSN 1097-4679, Vol. 74, no 6, p. 793-805Article in journal (Refereed)
    Abstract [en]

    Objective We examined whether motivation and treatment credibility predicted alliance in a 10-session cognitive behavioral treatment delivered in community clinics for youth anxiety disorders.

    Method Ninety-one clinic-referred youths (mean(age)=11.4 years, standard deviation=2.1, range 8-15 years, 49.5% boys) with anxiety disorders-rated treatment motivation at pretreatment and perceived treatment credibility after session 1. Youths and therapists (YT) rated alliance after session 3 (early) and session 7 (late). Hierarchical linear models were applied to examine whether motivation and treatment credibility predicted YT early alliance, YT alliance change, and YT alliance agreement.

    Results Motivation predicted high early YT alliance, but not YT alliance change or alliance agreement. Youth-rated treatment credibility predicted high early youth alliance and high YT positive alliance change, but not early therapist alliance or alliance agreement.

    Conclusion Efforts to enhance youth motivation and treatment credibility early in treatment could facilitate the formation of a strong YT alliance.

  • 15.
    Fjermestad, Krister W.
    et al.
    University of Bergen, Norway.
    Haugland, Bente Storm Mowatt
    University of Bergen, Norway.
    Heiervang, Einar
    Haukeland University Hospital.
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Relationship Factors and Outcome in Child Anxiety Treatment Studies2009In: Clinical Child Psychology and Psychiatry, ISSN 1359-1045, E-ISSN 1461-7021, Vol. 14, no 2, p. 195-214Article, review/survey (Refereed)
    Abstract [en]

    This study reviews 19 randomized controlled trials examiningthe association between three relationship factors — participation,treatment involvement, and therapeutic relationship —and outcome of cognitive-behavioral anxiety treatments for childrenand adolescents. In 12 studies, parent participation was consideredas an independent variable compared to child-only participation.In three studies, parental involvement was measured. Child involvementwas measured in one study. The child's perception of the therapeuticrelationship was considered in three studies. Six studies founda significant positive effect of parent participation on diagnosticstatus, symptom level, or global functioning outcome measures.One study found a significant effect of parental involvementon global outcome measures. Another study found a significantpositive association between child involvement and symptom measuresand global functioning measures. No association was found betweenthe quality of the child's perception of the therapeutic relationshipand treatment outcome. Clinical implications are discussed.

  • 16. Fjermestad, Krister W.
    et al.
    Lerner, Matthew D.
    McLeod, Bryce D.
    Wergeland, Gro Janne H.
    Heiervang, Einar R.
    Silverman, Wendy K.
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    De Los Reyes, Andres
    Havik, Odd E.
    Haugland, Bente S. M.
    Therapist-youth agreement on alliance change predicts long-term outcome in CBT for anxiety disorders2016In: Journal of Child Psychology and Psychiatry and Allied Disciplines, ISSN 0021-9630, E-ISSN 1469-7610, Vol. 57, no 5, p. 625-632Article in journal (Refereed)
    Abstract [en]

    Background: In individual cognitive behavioral therapy (ICBT) for youth anxiety disorders, it is unclear whether, and from whose perspective, the alliance predicts outcome. We examined whether youth- and therapist-rated alliance, including level of youth-therapist alliance agreement, predicted outcome in a randomized controlled trial.

    Methods: Youth (N = 91, M age = 11.4 years (SD = 2.1), 49.5% boys, 86.8% Caucasian) diagnosed with separation anxiety disorder, social phobia, or generalized anxiety disorder drawn from the ICBT condition of an effectiveness trial were treated with an ICBT program. Youth- and therapist-rated alliance ratings, assessed with the Therapeutic Alliance Scale for Children (TASC-C/T), were collected following session 3 (early) and 7 (late). Early alliance, change in alliance from early to late, and level of youth-therapist agreement on early alliance and alliance change were examined, in relation to outcomes collected at posttreatment and 1-year follow-up. Outcome was defined as primary diagnosis loss and reduction in clinicians' severity ratings (CSR; Anxiety Disorders Interview Schedule; ADIS-C/P) based on youth- and parent-report at posttreatment and follow-up, and youth treatment satisfaction collected at posttreatment (Client Satisfaction Scale; CSS).

    Results: Early TASC-C scores positively predicted treatment satisfaction at posttreatment. Higher levels of agreement on change in TASC-C and TASC-T scores early to late in treatment predicted diagnosis loss and CSR reduction at follow-up.

    Conclusions: Only the level of agreement in alliance change predicted follow-up outcomes in ICBT for youth anxiety disorders. The findings support further examination of the role that youth-therapist alliance discrepancies may play in promoting positive outcomes in ICBT for youth anxiety disorders. Clinical trial number NCT00586586, clinicaltrials.gov.

  • 17. Fjermestad, Krister W.
    et al.
    McLeod, Bryce D.
    Heiervang, Einar R.
    Havik, Odd E.
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Haugland, Bente S. M.
    Factor Structure and Validity of the Therapy Process Observational Coding System for Child Psychotherapy-Alliance Scale2012In: Journal of clinical child and adolescent psychology (Print), ISSN 1537-4416, E-ISSN 1537-4424, Vol. 41, no 2, p. 246-254Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to examine the factor structure and psychometric properties of an observer-rated youth alliance measure, the Therapy Process Observational Coding System for Child Psychotherapy-Alliance scale (TPOCS-A). The sample was 52 youth diagnosed with anxiety disorders (M age = 12.43, SD = 2.23, range = 8-15; 56% boys; 98% Caucasian) drawn from a randomized controlled trial. Participants received a manualized individual cognitive behavioral treatment, the FRIENDS for life program, in public community clinics in Norway. Diagnostic status, treatment motivation, and perceived treatment credibility were assessed at pretreatment. Using the TPOCS-A, independent observers rated child-therapist alliance from the third therapy session. Child-and therapist-reported alliance measures were collected from the same session. An exploratory factor analysis supported a one-factor solution, which is consistent with previous studies of self-and observer-rated youth alliance scales. Psychometric analyses supported the interrater reliability, internal consistency, and convergent/divergent validity of the TPOCS-A. Accumulating psychometric evidence indicate that the TPOCS-A has the potential to fill a measurement gap in the youth psychotherapy field. In youth psychotherapy, alliance may be unidimensional, so establishing a strong bond and engaging the child in therapeutic activities may both be instrumental to establishing good alliance early in treatment. However, it is important to be cautious when interpreting the factor analytic findings, because the sample size may have been too small to identify additional factors. Future research can build upon these findings by examining the factor structure of youth alliance measures with larger, more diverse samples.

  • 18. Graham, Bronwyn M.
    et al.
    Li, Sophie H.
    Black, Melissa J.
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Karolinska Institutet, Sweden; Haukeland University Hospital, Norway.
    The association between estradiol levels, hormonal contraceptive use, an responsiveness to one-session-treatment for spider phobia in women2018In: Psychoneuroendocrinology, ISSN 0306-4530, E-ISSN 1873-3360, Vol. 90, p. 134-140Article in journal (Refereed)
    Abstract [en]

    Preclinical studies have demonstrated that conditioned fear extinction is impaired in females with low endogenous levels of the sex hormone estradiol, due to menstrual fluctuations or hormonal contraceptive use. As fear extinction is a laboratory model of exposure therapy for anxiety and trauma disorders, here we assessed the hypothesis that treatment outcomes may be diminished when exposure therapy occurs during periods of low estradiol. 90 women with spider phobia (60 cycling and 30 using hormonal contraceptives) underwent a one session exposure treatment for spider phobia, following which, serum estradiol levels were assessed. A median split in estradiol level was used to divide cycling participants into two groups; lower and higher estradiol. Behavioral avoidance and self-reported fear of spiders were measured pre-treatment, post-treatment, and at a 12 week follow-up assessment. Women using hormonal contraceptives exhibited a significantly slower rate of improvement across treatment, greater behavioral avoidance at post-treatment and follow-up, and fewer self initiated post-treatment exposure tasks, relative to both groups of cycling women, who did not differ. No group differences in self-reported fear were evident. Correlational analyses revealed that across the whole sample, lower estradiol levels were associated with slower rates of improvement across treatment, and greater self reported fear and behavioral avoidance at post-treatment, but not follow-up. These results provide the first evidence of an association between endogenous estradiol, hormonal contraceptive use, and exposure therapy outcomes in spider phobic women. Hormonal profile may partly account for variability in responsiveness to psychological treatments for anxiety and trauma disorders in women.

  • 19. Hansen, Bjarne
    et al.
    Hagen, Kristen
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Haukeland University Hospital, Norway.
    Solem, Stian
    Kvale, Gerd
    The Bergen 4-Day OCD Treatment Delivered in a Group Setting: 12-Month Follow-Up2018In: Frontiers in Psychology, ISSN 1664-1078, E-ISSN 1664-1078, Vol. 9, article id 639Article in journal (Refereed)
    Abstract [en]

    The Bergen 4-day concentrated exposure treatment (cET) for obsessive-compulsive disorder (OCD) has proven highly acceptable; with practically no drop-out and a 6 month remission rate of nearly 70%. The aim of the present study was to evaluate long term gains of the approach, and to compare the results to findings from our recent meta-analysis. Sixty-nine of 95 patients consecutively referred to an outpatient clinic in the specialist health care, were offered the Bergen 4-day treatment. Among the 65 who initiated treatment, 60.0% were classified with severe to extreme OCD. None of the patients dropped-out during treatment. Independent Yale-Brown Obsessive-Compulsive Scale interviews were conducted post-treatment, and at 3- and 12-month follow-up. Using the international consensus criteria, 83.1% responded to treatment at 12-month follow-up, and 67.7% of patients were classified as recovered. Significant changes were also seen in depression, as measured by Patient Health Questionnaire-9, and in generalized anxiety, as measured by Generalized Anxiety Disorder-7 scale. A total of 89% of the patients rated the treatment as very good and 100% would recommend the treatment to a friend. Compared to results in a recent meta-analysis, the Bergen 4-day treatment is favorable in respect to attrition, response and 12-month recovery. In sum the Bergen 4-day treatment is a feasible way to deliver treatment for OCD, and the effects are stable at 12-month follow-up. Implications for dissemination are discussed.

  • 20. Hansen, Bjarne
    et al.
    Kvale, Gerd
    Hagen, Kristen
    Hjelle, Kay M.
    Solem, Stian
    Bø, Beate
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Haukeland University Hospital, Norway.
    The Bergen 4-Day Treatment for Panic Disorder: A Pilot Study2018In: Frontiers in Psychology, ISSN 1664-1078, E-ISSN 1664-1078, Vol. 9, article id 1044Article in journal (Refereed)
    Abstract [en]

    The current article reports on the findings from a pilot treatment study on panic disorder (PD) with or without agoraphobia. Consecutively referred patients were included and treated with the Bergen 4-day treatment format. Twenty-nine patients were included, primarily from unsuccessful treatment courses in the Norwegian specialist mental health care system, either ongoing or previously. Prior to treatment, only 34% were able to work but at 3-month follow-up 93% were able to do so. The proportion achieving reliable change on the panic severity measure was 76% post-treatment and 90% at follow-up. The remission rate was 72% at both assessments. These effects are significantly higher than those reported for six standard CBT studies in the literature using the same primary outcome measure (Panic Disorder Severity Scale). It is concluded that the Bergen 4-day treatment is a promising treatment approach for PD, and a randomized controlled trial is warranted.

  • 21. Haug, Thomas
    et al.
    Nordgreen, Tine
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Havik, Odd E.
    Self-help treatment of anxiety disorders: A meta-analysis and meta-regression of effects and potential moderators2012In: Clinical Psychology Review, ISSN 0272-7358, E-ISSN 1873-7811, Vol. 32, no 5, p. 425-445Article, review/survey (Refereed)
    Abstract [en]

    Self-help treatments have the potential to increase the availability and affordability of evidence-based treatments for anxiety disorders. Although promising, previous research results are heterogeneous, indicating a need to identify factors that moderate treatment outcome. The present article reviews the literature on self-help treatment for anxiety disorders among adults, with a total sample of 56 articles with 82 comparisons. When self-help treatment was compared to wait-list or placebo, a meta-analysis indicated a moderate to large effect size (g = 0.78). When self-help treatment was compared to face-to-face treatment, results indicated a small effect that favored the latter (g = -0.20). When self-help was compared to wait-list or placebo, subgroup analyses indicated that self-help treatment format, primary anxiety diagnosis and procedures for recruitment of subjects were related to treatment outcome in bivariate analyses, but only recruitment procedures remained significant in a multiple meta-regression analysis. When self-help was compared to face-to-face treatment, a multiple meta-regression indicated that the type of comparison group, treatment format and gender were significantly related to outcome. We conclude that self-help is effective in the treatment of anxiety disorders, and should be offered as part of stepped care treatment models in community services. Implications of the results and future directions are discussed.

  • 22.
    Haug, Thomas
    et al.
    Haukeland University Hospital and University of Bergen, Bergen, Norway.
    Nordgreen, Tine
    Haukeland University Hospital and University of Bergen, Bergen, Norway.
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Haukeland University Hospital, Bergen, Norway; Department of Clinical Neuroscience, Karolinska Institutet.
    Kvale, Gerd
    Haukeland University Hospital and University of Bergen, Bergen, Norway.
    Tangen, Tone
    Haukeland University Hospital and University of Bergen, Bergen, Norway.
    Andersson, Gerhard
    Linköping University; Karolinska Institutet.
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Heiervang, Einar R.
    Haukeland University Hospital and University of Oslo, Norway.
    Havik, Odd E.
    Haukeland University Hospital and University of Bergen, Bergen, Norway.
    Stepped care versus face-to–face cognitive behavior therapy for panic disorder and social anxiety disorder: Predictors and moderators of outcome2015In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 71, p. 76-89Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate predictors and moderators of treatment outcome by comparing immediate face-to-face cognitive behavioral therapy (FtF-CBT) to a Stepped Care treatment model comprising three steps: Psychoeducation, Internet-delivered CBT, and FtF-CBT for panic disorder (PD) and social anxiety disorder (SAD).

    Method: Patients (N = 173) were recruited from nine public mental health out-patient clinics and randomized to immediate FtF-CBT or Stepped Care treatment. Characteristics related to social functioning, impairment from the anxiety disorder, and comorbidity was investigated as predictors and moderators by treatment format and diagnosis in multiple regression analyses.

    Results: Lower social functioning, higher impairment from the anxiety disorder, and a comorbidcluster C personality disorder were associated with significantly less improvement, particularly among patients with PD. Furthermore, having a comorbid anxiety disorder was associated with a better treatment outcome among patients with PD but not patients with SAD. Patients with a comorbid depression had similar outcomes from the different treatments, but patients without comorbid depression had better outcomes from immediate FtF-CBT compared to guided self-help.

    Conclusions: In general, the same patient characteristics appear to be associated with the treatment outcome for CBT provided in low- and high-intensity formats when treated in public mental health care clinics. The findings suggest that patients with lower social functioning and higher impairment from their anxiety disorder benefit less from these treatments and may require more adapted and extensive treatment.

    ClinicalTrials.gov

    Identifier: NCT00619138.

  • 23. Haug, Thomas
    et al.
    Nordgreen, Tine
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Haukeland University Hospital, Norway; Karolinska Institutet, Sweden.
    Tangen, Tone
    Kvale, Gerd
    Hovland, Ole Johan
    Heiervang, Einar R.
    Havik, Odd E.
    Working alliance and competence as predictors of outcome in cognitive behavioral therapy for social anxiety and panic disorder in adults2016In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 77, p. 40-51Article in journal (Refereed)
    Abstract [en]

    Objective: The research on the association between the working alliance and therapist competence/adherence and outcome from cognitive behavioral therapy (CBT) is limited and characterized by inconclusive findings. This study investigates the working alliance and competence/adherence as predictors of outcome of CBT for social anxiety disorder(SAD) and panic disorder (PD).

    Method: Eighty-two clinically referred patients (58.5% female; age: M = 33.6 years, SD = 10.3) with PD (n = 31) or SAD (n = 51) were treated with 12 sessions of manualized CBT by 22 clinicians with limited CBT experience in a randomized controlled effectiveness trial. Independent assessors rated the CBT competence/adherence of the therapists using a revised version of the Cognitive Therapy Adherence and Competence Scale, and the patients rated the quality of the working alliance using the Working Alliance Inventory-short form in therapy sessions 3 and 8. The outcome was assessed by independent assessors as well as by patients self-report. A total of 20.7% of the patients (27.5% SAD, 9.7% PD) dropped out during treatment. The association between the alliance, competence/adherence, outcome and dropout was investigated using multiple regression analyses.

    Results: Higher therapist' competence/adherence early in the therapy was associated with a better outcome among PD patients, lower competence/adherence was associated with dropout among SAD patients. Higher rating of the alliance late in the therapy was associated with a better outcome, whereas lower alliance rating late in the therapy was associated with dropout.

    Conclusion: The findings indicate that the therapist competence/adherence and the working alliance have independent contributions to the outcome from CBT for anxiety disorders, but in different phases of the treatment.

  • 24. Haukebø, Kristin
    et al.
    Skaret, Erik
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Raadal, Magne
    Berg, Einar
    Sundberg, Håkan
    Kvale, Gerd
    One- vs. five-session treatment of dental phobia: A randomized controlled study2008In: Journal of Behavior Therapy and Experimental Psychiatry, ISSN 0005-7916, Vol. 39, no 3, p. 381-390Article in journal (Refereed)
    Abstract [en]

    Forty participants fulfilling the DSM-IV criteria for dental phobia were randomly assigned to a waitlist group, one-session or five-session exposure treatment. Assessment occurred pre-, post-waitlist/treatment, and after 1 year. Mean avoidance of dental care before treatment was 11.4 years. A total of 77% sought dental care in the follow-up year. Both treatments were equally effective at reducing avoidance behavior and changing cognitions during the feared situation. Post-treatment, the five-session group scored lower on the dental anxiety scales, but at follow-up, both groups reported the same level of dental anxiety. Conclusion: Both treatment conditions enable a return to ordinary dental treatment.

  • 25. Havnen, Audun
    et al.
    Hansen, Bjarne
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Haukeland University Hospital, Norway; Karolinska Institute, Sweden.
    Kvale, Gerd
    Concentrated ERP Delivered in a Group Setting: A Replication Study2017In: Behavioural and Cognitive Psychotherapy, ISSN 1352-4658, E-ISSN 1469-1833, Vol. 45, no 5, p. 530-536Article in journal (Refereed)
    Abstract [en]

    Background: In a previous effectiveness study (Havnen et al., 2014), 35 obsessive compulsive disorder (OCD) patients underwent Concentrated Exposure Treatment (cET), which is a newly developed group treatment format delivered over four consecutive days. Aims: The primary aims of the present study were to evaluate the treatment results for a new sample of OCD patients receiving the cET treatment approach and to replicate the effectiveness study described in Havnen et al. (2014). Method: Forty-two OCD patients underwent cET treatment. Treatment was delivered by different therapists than in Havnen et al. (2014), except for two groups led by the developers of the treatment. Assessments of OCD symptom severity, treatment satisfaction, and occupational impairment were included. Results: The results showed a significant reduction in Yale-Brown Obsessive Compulsive Scale scores from pre-treatment to post-treatment, which was maintained at 6-month follow-up. At post-treatment, 74% of the sample was remitted; at 6-month follow-up, 60% were recovered. The sample showed a very high degree of overall treatment satisfaction. The results from the present study were statistically compared with those obtained in the previous study. The analyses showed that the study samples had comparable demographic data and equal application of treatment. The outcome of the present and original study did not differ significantly on primary and secondary outcome measures. Conclusions: This study shows that cET was successfully replicated in a new patient sample treated by different therapists than the original study. The results indicate that cET is well accepted by the patients, and the potential for dissemination is discussed.

  • 26. Havnen, Audun
    et al.
    Hansen, Bjarne
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology. University of Bergen, Norway; Karolinska Institutet, Sweden.
    Kvale, Gerd
    Concentrated ERP delivered in a group setting: An effectiveness study2014In: Journal of Obsessive-Compulsive and Related Disorders, ISSN 2211-3649, E-ISSN 2211-3657, Vol. 3, no 4, p. 319-324Article in journal (Refereed)
    Abstract [en]

    The aims of the present study were to evaluate the acceptability and long term gains of a highly concentrated exposure and response prevention (ERP) for obsessive compulsive disorder (OCD). Treatment was individually tailored and delivered in a group format over four consecutive days in an outpatient OCD treatment unit, part of the ordinary specialist health care. A total of 35 patients accepted the offer of treatment; 23 of the patients were classified with severe to extreme OCD, and 74% of the sample had previously received treatment for their OCD (20% of these with ERP). The results showed that more than 90% of the patients expressed a high degree of satisfaction with the concentrated ERP. At six months follow-up 27 (77%) were classified as recovered and a significant improvement was seen in depressive symptoms as well. The majority of the sample also showed improvement with regard to employment status 12 months after treatment. The results indicate that this highly concentrated treatment may be a feasible format of delivering ERP.

  • 27. Hedman-Lagerlöf, Maria
    et al.
    Hedman-Lagerlöf, Erik
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    The empirical support for mindfulness-based interventions for common psychiatric disorders: a systematic review and meta-analysis2018In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 48, no 13, p. 2116-2129Article, review/survey (Refereed)
    Abstract [en]

    Mindfulness-based interventions (MBIs) have become widely used for common mental disorders (CMDs) but the state of the evidence has not been sufficiently investigated. The aims for this study were: (1) to quantify the effect size of MBIs for CMDs in the acute phase; (2) to explore moderator variables; and (3) to evaluate the evidence status of MBIs for the CMDs it has been tried for. A comprehensive systematic review and meta-analysis of randomized controlled trials (RCTs) were conducted. RCTs that evaluated MBI and included patients with a primary manifest CMD was included. Methodological quality, the risk of bias, publication bias and evidence status were assessed. Literature searches gave 2448 hits and 19 studies were included. MBIs were more effective than no treatment (g = 1.07) and treatment-as-usual (g = 0.40) but not in comparison to placebo (g = 0.17) or other active treatments (g = -0.01). Methodological quality was negatively correlated with outcome. For all psychiatric disorders it has been tested, MBIs were judged to have weak or no empirical support. The conclusion of the study is that the evidence-base for MBIs for CMDs in the acute phase is weak.

  • 28. Kodal, Arne
    et al.
    Fjermestad, Krister
    Bjelland, Ingvar
    Gjestad, Rolf
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Haukeland University Hospital, Norway.
    Bjaastad, Jon F.
    Haugland, Bente S. M.
    Havik, Odd E.
    Heiervang, Einar
    Wergeland, Gro Janne
    Long-term effectiveness of cognitive behavioral therapy for youth with anxiety disorders2018In: Journal of Anxiety Disorders, ISSN 0887-6185, E-ISSN 1873-7897, Vol. 53, p. 58-67Article in journal (Refereed)
    Abstract [en]

    Cognitive behavioral therapy (CBT) has demonstrated favorable long-term outcomes in youth with anxiety disorders in efficacy trials. However, long-term outcomes of CBT delivered in a community setting are uncertain. This study examined the long-term outcomes of individual (ICBT) and group CBT (GCBT) in youth with anxiety disorders treated in community mental health clinics. A total of 139 youth (mean age at assessment 15.5 years, range 11-21 years) with a principal diagnosis of separation anxiety disorder (SAD), social anxiety disorder (SOP), and/or generalized anxiety disorder (GAD) were evaluated, on average, 3.9 years post-treatment (range 2.2-5.9 years). Outcomes included loss of all inclusion anxiety diagnoses, loss of the principal anxiety diagnosis and changes in youth- and parent-rated youth anxiety symptoms. At long-term follow-up, there was loss of all inclusion anxiety diagnoses in 53%, loss of the principal anxiety diagnosis in 63% of participants as well as significant reductions in all anxiety symptom measures. No statistical significant differences in outcome were obtained between ICBT and GCBT. Participants with a principal diagnosis of SOP had lower odds for recovery, compared to those with a principal diagnosis of SAD or GAD. In conclusion, outcomes of CBT for youth anxiety disorders delivered in community mental health clinics were improved at nearly 4 years post-treatment, and recovery rates at long-term follow-up were similar to efficacy trials.

  • 29. Kvale, Gerd
    et al.
    Hansen, Bjarne
    Bjorgvinsson, Throstur
    Bortveit, Tore
    Hagen, Kristen
    Haseth, Svein
    Kristensen, Unn Beate
    Launes, Gunvor
    Ressler, Kerry J.
    Solem, Stian
    Strand, Arne
    van den Heuvel, Odile A.
    Öst, Lars-Goran
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Haukeland University Hospital, Norway.
    Successfully treating 90 patients with obsessive compulsive disorder in eight days: the Bergen 4-day treatment2018In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 18, article id 323Article in journal (Refereed)
    Abstract [en]

    Background: Oslo University Hospital, Norway, had by autumn 2016, accumulated a waiting list of 101 patients with obsessive-compulsive disorder (OCD) who had a legal right to receive treatment by a specialized OCD team. In this challenging situation, the Bergen OCD-team suggested to solve the problem by offering all patients an option for the rapid Bergen 4-day treatment (B4DT). The B4DT is an individual treatment delivered during four consecutive days in a group of six patients with the same number of therapists. The approach has previously shown a post-treatment response rate of 90% and a 3-month remission rate of 70%. Methods: Ninety-seven of the wait-list patients were available for the scheduled time slots, and 90 received the 4-day format during 8 days (45 patients each week). The therapists were recruited from 22 different specialized OCD-teams from all over Norway, and 44 (68%) had not previously delivered the 4-day format. Results: Post-treatment; 91.1% of the patients were classified as responders, and 72.2% were in remission. At 3-month follow-up; 84.4 were classified as responders and the remission rate was 67.7%. Oslo University Hospital now offers the 4-day treatment as standard treatment for OCD. Conclusions: We conclude that the B4DT is an acceptable and potentially effective OCD-treatment.

  • 30. Lindner, Philip
    et al.
    Andersson, Gerhard
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Validation of the Internet-Administered Quality of Life Inventory (QOLI) in Different Psychiatric Conditions2013In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 42, no 4, p. 315-327Article in journal (Refereed)
    Abstract [en]

    The Quality of Life Inventory (QOLI) is an established rating scale of self-perceived quality of life across 16 domains. Norms for different psychiatric conditions when rated via the Internet, responsiveness to change following treatment, and the clinical impact of importance-weighting items have yet to be examined. To investigate these unanswered questions, important for the continued and expanded use of the QOLI, we compiled archival screening and post-treatment data from 20 studies featuring Internet-delivered psychological interventions for seven different psychiatric conditions and an undergraduate sample, totalling over 4000 participants. Disorder-specific norms were indicated by between-group analyses and are reported here, item-by-item. The QOLI showed adequate responsiveness to change and construct validity. Discrepancies were found when conducting between-group analyses with and without weighted items (more significant differences when items were not weighted) on both the screening and post-treatment data, suggesting that weighting is a procedure that is likely to have an impact when analysing QOLI results. Limitations and the needs for future research are discussed.

  • 31.
    Mörtberg, Ewa
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institutet, Sweden.
    Reuterskiöld, Lena
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Tillfors, Maria
    Furmark, Tomas
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institutet, Sweden.
    Factor solutions of the Social Phobia Scale (SPS) and the Social Interaction Anxiety Scale (SIAS) in a Swedish population2017In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 46, no 4, p. 300-314Article in journal (Refereed)
    Abstract [en]

    Culturally validated rating scales for social anxiety disorder (SAD) are of significant importance when screening for the disorder, as well as for evaluating treatment efficacy. This study examined construct validity and additional psychometric properties of two commonly used scales, the Social Phobia Scale and the Social Interaction Anxiety Scale, in a clinical SAD population (n = 180) and in a normal population (n = 614) in Sweden. Confirmatory factor analyses of previously reported factor solutions were tested but did not reveal acceptable fit. Exploratory factor analyses (EFA) of the joint structure of the scales in the total population yielded a two-factor model (performance anxiety and social interaction anxiety), whereas EFA in the clinical sample revealed a three-factor solution, a social interaction anxiety factor and two performance anxiety factors. The SPS and SIAS showed good to excellent internal consistency, and discriminated well between patients with SAD and a normal population sample. Both scales showed good convergent validity with an established measure of SAD, whereas the discriminant validity of symptoms of social anxiety and depression could not be confirmed. The optimal cut-off score for SPS and SIAS were 18 and 22 points, respectively. It is concluded that the factor structure and the additional psychometric properties of SPS and SIAS support the use of the scales for assessment in a Swedish population.

  • 32. Nordahl, Håkon
    et al.
    Havnen, Audun
    Hansen, Bjarne
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Haukeland University Hospital, Norway.
    Kvale, Gerd
    Sleep disturbances in treatment-seeking OCD-patients: Changes after concentrated exposure treatment2018In: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450, Vol. 59, no 2, p. 186-191Article in journal (Refereed)
    Abstract [en]

    Research indicates that patients with Obsessive Compulsive Disorder (OCD) frequently suffer from comorbid sleep difficulties, and that these difficulties often are not clinically recognized and diagnosed. There has been limited research investigating if comorbid sleep difficulties impair treatment outcome for OCD and if the sleep difficulties change following OCD-treatment. Thirty-six patients with obsessive compulsive disorder underwent concentrated exposure treatment delivered in a group over four consecutive days and were assessed with measures of OCD, depressive symptoms and sleep disturbance at three different time points (pre, post and 6 months follow-up). The sample was characterized by a high degree of comorbidity with other psychiatric disorders. At pre-treatment nearly 70% of the patients reported sleep difficulties indicative of primary insomnia. The results showed that patients had large reductions of OCD-symptoms as well as significant improvements in sleep disturbance assessed after treatment, and that these improvements were maintained at follow-up. Sleep disturbance did not impair treatment outcome, on the contrary patients with higher degree of sleep disturbance at pre-treatment had better outcome on OCD-symptoms after treatment. The results indicated that the majority of the OCD sample suffered from sleep disturbances and that these sleep disturbances were significantly reduced following adequate treatment of OCD without specific sleep interventions. However, a proportion of the patients suffered from residual symptoms of insomnia after treatment.

  • 33. Nordgreen, T.
    et al.
    Haug, T.
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Andersson, Gerhard
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Kvale, G.
    Heiervang, E.
    Havik, O.
    Stepped care for social anxiety disorder or panic disorder: A randomised controlled trial2017Conference paper (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.

  • 34. 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.

  • 35. Nordh, Martina
    et al.
    Vigerland, Sarah
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institutet, Sweden.
    Ljótsson, Brjánn
    Mataix-Cols, David
    Serlachius, Eva
    Högström, Jens
    Therapist-guided internet-delivered cognitive–behavioural therapy supplemented with group exposure sessions for adolescents with social anxiety disorder: a feasibility trial2017In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 12, article id e018345Article in journal (Refereed)
    Abstract [en]

    Objectives: Social anxiety disorder (SAD) is one of the most common psychiatric disorders in youth, with a prevalence of about 3%–4% and increased risk of adverse long-term outcomes, such as depression. Cognitive–behavioural therapy (CBT) is considered the first-line treatment for youth with SAD, but many adolescents remain untreated due to limited accessibility to CBT. The aim of this study was to develop and evaluate the feasibility and preliminary efficacy of a therapist-guided internet-delivered CBT treatment, supplemented with clinic-based group exposure sessions (BIP SOFT). Design: A proof-of-concept, open clinical trial with 6-month follow-up. Participants: The trial was conducted at a child and adolescent psychiatric research clinic, and participants (n=30) were 13–17 years old (83% girls) with a principal diagnosis of SAD. Intervention: 12 weeks of intervention, consisting of nine remote therapist-guided internet-delivered CBT sessions and three group exposure sessions at the clinic for the adolescents and five internet-delivered sessions for the parents. Results: Adolescents were generally satisfied with the treatment, and the completion rate of internet modules, as well as attendance at group sessions, was high. Posttreatment assessment showed a significant decrease in clinician-rated, adolescent-rated and parent-rated social anxiety (d=1.17, 0.85 and 0.79, respectively), as well as in general self-rated and parent-rated anxiety and depression (d=0.76 and 0.51), compared with pretreatment levels. Furthermore, 47% of participants no longer met Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for SAD at posttreatment. At a 6-month follow-up, symptom reductions were maintained, or further improved, and 57% of participants no longer met criteria for SAD. Conclusion: Therapist-guided and parent-guided internetdelivered CBT, supplemented with a limited number of group exposure sessions, is a feasible and promising intervention for adolescents with SAD.

    Trial registration number: NCT02576171.

  • 36. Ollendick, Thomas H.
    et al.
    Ryan, Sarah M.
    Capriola-Hall, Nicole N.
    Reuterskiöld, Lena
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    The mediating role of changes in harm beliefs and coping efficacy in youth with specific phobias2017In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 99, p. 131-137Article in journal (Refereed)
    Abstract [en]

    Individuals with specific phobias (SPs) often experience catastrophic cognitions and compromised efficacy regarding their ability to cope when in the presence of the phobic object/situation. In the current study, 165 children (7-16 years; 62% male) received either One Session Treatment or Educational Support Therapy for their SP. The children identified their feared belief and rated how bad it was, how likely it was to occur, and their ability to cope if it did occur. All of these ratings were reduced from pre-treatment to 6-month follow-up, across both treatment conditions. However, ratings of how bad and how likely reduced to a significantly greater degree for children who received OST. Greater change in each of the three beliefs predicted lower clinician severity ratings (CSRs) at post-treatment and 6-month follow-up. Additionally, changes in how bad and how likely the children rated their beliefs, and their reported ability to cope, partially mediated the relationship between treatment and post-treatment and follow-up CSRs. Overall, these findings suggest that although both treatment conditions produced changes in harm beliefs and coping efficacy, OST elicited greater changes and these changes may be important mechanisms in reduction of SP clinical severity.

  • 37. Ollendick, Thomas H.
    et al.
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Farrell, Lara J.
    Innovations in the psychosocial treatment of youth with anxiety disorders: implications for a stepped care approach2018In: Evidence-Based Mental Health, ISSN 1362-0347, E-ISSN 1468-960X, Vol. 21, no 3, p. 112-115Article, review/survey (Refereed)
    Abstract [en]

    Anxiety disorders are highly prevalent among children and adolescents and frequently result in impairments across multiple domains of life. While psychosocial interventions, namely cognitive-behavioural therapy (CBT), have been found to be highly effective in treating these conditions, significant numbers of youth simply do not have access to these evidence-based interventions, and of those who do, a substantial proportion (up to 40%) fail to achieve remission. Thus, there is a pressing need for innovation in both the delivery of evidence-based treatments and efforts to enhance treatment outcomes for those who do not respond to standard care. This paper reviews current innovations attempting to address these issues, including evidence for brief, low-intensity approaches to treatment; internet delivered CBT and brief, high-intensity CBT. Moreover, we propose a model of stepped care delivery of evidence-based mental health interventions for children and youth with anxiety. In general, a stepped care approach begins with a lower intensity, evidence-based treatment that entails minimal therapist involvement (ie, brief, low-intensity self-help or internet delivered CBT) and then proceeds to more intensive treatments with greater therapist involvement (ie, brief high-intensity CBT), but only for those individuals who show a poor response at each step along the way. Future research is needed in order to evaluate such a model, and importantly, to identify predictors and moderators of response at each step, in order to inform an evidence-based, fully-integrated stepped care approach to service delivery.

  • 38.
    Ollendick, Thomas H.
    et al.
    Virginia Tech University, Department of Psychology, Child Study Center, 460 Turner St., Suite 207, Blacksburg, VA 24060, USA.
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Reuterskiöld, Lena
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Costa, Natalie
    Virginia Tech University, Department of Psychology, Child Study Center, 460 Turner St., Suite 207, Blacksburg, VA 24060, USA.
    Comorbidity in youth with specific phobias: Impact of comorbidity on treatment outcome and the impact of treatment on comorbid disorders2010In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 48, no 9, p. 827-831Article in journal (Refereed)
    Abstract [en]

    The purpose of the present study was twofold. In an analysis of data from an existing randomized control trial of brief cognitive behavioral treatment onspecific phobias (One-Session Treatment, OST; Ollendick et al., 2009), we examined 1) the effect of comorbid specific phobias and other anxiety disorderson treatment outcomes, and 2) the effect of treatment of the specific phobia on these co-occurring disorders. These relations were explored in 100 youth presenting with animal, natural environment, situational, and “other” types of phobia. Youth were reliably diagnosed with the Anxiety Disorders Interview Schedule for DSM-IV: Child and Parent versions (Silverman & Albano, 1996). Clinician severity ratings at post-treatment and 6-month follow-up were examined as were parent and child treatment outcome satisfaction measures. Results indicated that the presence of comorbid phobias or anxiety disordersdid not affect treatment outcomes; moreover, treatment of the targeted specific phobias led to significant reductions in the clinical severity of other co-occurring specific phobias and related anxiety disorders. These findings speak to the generalization of the effects of this time-limited treatment approach. Implications for treatment of principal and comorbid disorders are discussed, and possible mechanisms for these effects are commented upon.

  • 39. Ollendick, Thomas, H.
    et al.
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Reuterskiöld, Lena
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Costa, Natalie
    Cederlund, Rio
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Sirbu, Cristian
    Davis, Thompson E., III
    Jarrett, Mathew, A.
    One-Session Treatment of Specific Phobias in Youth: A Randomized Clinical Trial in the United States and Sweden2009In: Journal of Consulting and Clinical Psychology, ISSN 0022-006X, E-ISSN 1939-2117, Vol. 77, no 3, p. 504-509Article in journal (Refereed)
    Abstract [en]

    One hundred and ninety-six youth, ages 7–16, who fulfilled Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria for various specific phobias were randomized to a one-session exposure treatment, education support treatment, or a wait list control group. After the waiting period, the wait list participants were offered treatment and, if interested, rerandomized to 1 of the 2 active treatments. The phobias were assessed with semistructured diagnostic interviews, clinician severity ratings, and behavioral avoidance tests, whereas fears, general anxiety, depression, and behavior problems were assessed with self- and parent report measures. Assessments were completed pretreatment, posttreatment, and at 6 months following treatment. Results showed that both treatment conditions were superior to the wait list control condition and that 1-session exposure treatment was superior to education support treatment on clinician ratings of phobic severity, percentage of participants who were diagnosis free, child ratings of anxiety during the behavioral avoidance test, and treatment satisfaction as reported by the youth and their parents. There were no differences on self-report measures. Treatment effects were maintained at follow-up. Implications of these findings are discussed.

  • 40. Ollendick, Thomas H.
    et al.
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Ryan, Sarah M.
    Capriola, Nicole N.
    Reuterskiöld, Lena
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Harm beliefs and coping expectancies in youth with specific phobias2017In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 91, p. 51-57Article in journal (Refereed)
    Abstract [en]

    Catastrophic beliefs and lowered coping expectancies are often present in individuals with specific phobias (SPs). The current study examined these beliefs and expectancies in 251 youth who received One Session Treatment for one of the three most common types of SP in youth (animals, natural environment, and situational). We compared the children's subjective beliefs to objective ratings of the likelihood of occurrence and the dangerousness of the feared events. Results revealed pre-treatment differences in the youths' beliefs across phobia types and age. Specifically, children with animal phobias rated their beliefs as more likely to occur than did children with environmental and situational phobias. In addition, older children rated their beliefs as more dangerous than younger children. However, regardless of phobia type or child age, the beliefs improved following treatment. Changes in catastrophic beliefs and coping expectancies were related to changes in clinical severity following treatment but not 6-months following treatment. Moreover, at pre-treatment, children viewed their beliefs as significantly more catastrophic and likely to occur than did independent coders of these beliefs; however, these differences were no longer evident following treatment. Clinical implications are discussed, highlighting how changes in beliefs and expectancies might be associated with treatment outcomes.

  • 41.
    Ramnerö, Jonas
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Panic and avoidance in panic disorder with agoraphobia: Clinical relevance of change in different aspects of the disorder2007In: Journal of Behavior Therapy and Experimental Psychiatry, ISSN 0005-7916, E-ISSN 1873-7943, Vol. 38, no 1, p. 29-39Article in journal (Refereed)
    Abstract [en]

    Different aspects of change were examined in 62 patients who fulfilled the DSM-IV criteria for a primary diagnosis of panic disorder with agoraphobia of moderate to severe magnitude, and who were treated with 16 sessions of behavioral therapy. The treatment resulted in substantial effects on panic attacks and agoraphobic avoidance. Panic-free status only differentiated the patients regarding mood at pre- and post-treatment. Changes in panic and avoidance were related to each other, but change in avoidance was more related to change in negative affect. Change in quality of life (QOL) was also more associated with change in avoidance at post-treatment. At follow-up change in QOL was more related to change in panic than change in avoidance.

  • 42.
    Reuterskiöld, Lena
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Real World Applications of One-Session Treatment2012In: Intensive One-Session Treatment of Specific Phobias / [ed] Thompson E. Davis III, Thomas H. Ollendick, Lars-Göran Öst, New York: Springer , 2012, 1, p. 127-141Chapter in book (Other academic)
    Abstract [en]

    Randomized Clinical Trials (RCTs) using cognitive-behavioral therapy (CBT) and specifically one-session treatment (OST) for the treatment of a broad spectrum of specific phobias have been conducted in both adult and child samples, and across countries. Furthermore, in clinical practice, OST has been extended to include even more unusual phobias such as fish, mushrooms, knees, and ET (the Extra-Terrestrial movie character) with equally good treatment effects overall. Despite these positive outcomes the dissemination of OST in the real world has not been as evident. There are several explanations for why clinicians might not choose OST for patients presenting with various specific phobias.

  • 43.
    Reuterskiöld, Lena
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Ollendick, Thomas
    Exploring Child and Parent Factors in the Diagnostic Agreement on the Anxiety Disorders Interview Schedule2008In: Journal of Psychopathology and Behavioral Assessment, ISSN 0882-2689, Vol. 30, no 4, p. 279-290Article in journal (Refereed)
    Abstract [en]

    Worryingly low levels of parent–child agreement on child psychiatric diagnosis are reported. This study examined parent–child agreement on diagnostic categories and severity ratings with the Anxiety Disorders Interview Schedule, Child and Parents versions (ADIS-C/P). Children’s age, gender, motivation and self-concept and parent’s general psychopathology and diagnoses were examined. Participants were 110 children (aged 8–14 years) with a principal specific phobia diagnosis, and their parents. Findings revealed excellent parent–child agreement on principal specific phobia diagnosis (97.3%), and fair levels of concordance on most co-occurring secondary diagnoses. As expected, children with high motivation had generally stronger parent–child agreement on diagnoses and severity ratings (for ADHD p < .001). Parents reported overall more diagnoses for their children (for GAD p < .03; SOCP p < .02) and parents with diagnoses seemed more tuned in to their children’s problematic behavior. It is suggested that clinicians screen for motivation status early in the assessment phase and use both parts of the ADIS-C/P.

  • 44. Riise, Eili N.
    et al.
    Kvale, Gerd
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Haukeland University Hospital, Norway; Karolinska Institutet, Sweden.
    Skjold, Solvei Harila
    Hansen, Hans
    Hansen, Bjarne
    Concentrated exposure and response prevention for adolescents with obsessive-compulsive disorder: An effectiveness study2016In: Journal of Obsessive-Compulsive and Related Disorders, ISSN 2211-3649, E-ISSN 2211-3657, Vol. 11, p. 13-21Article in journal (Refereed)
    Abstract [en]

    This study evaluated the effectiveness of a concentrated exposure and response prevention (ERP) treatment for adolescents with obsessive-compulsive disorder (OCD). Twenty-two adolescents with OCD (range 11–17 years) received therapist-assisted ERP during four consecutive days, followed by a three week period of self-administered ERP. Treatment was delivered to 2–3 patients and their parents simultaneously at an outpatient clinic for child and adolescent psychiatry as part of standard health care. OCD-symptoms were assessed at pre-treatment, post-treatment, 3- and 6-month follow-up. The results demonstrated that patients had significant reduction in OCD-symptoms from pre- to post-treatment and the gains were maintained at follow-up. 91% (n=20) were classified as responders at post-treatment, and 77% (n=17) at six-month follow-up. Remission rates were 73% (n=16) at post-treatment and 68% (n=15) at six-month follow-up. OCD-related impairment and symptoms of anxiety and depression were significantly reduced at post-treatment and follow-up. The results suggest that concentrated ERP is a promising treatment for adolescents with OCD.

  • 45. Salomonsson, Sigrid
    et al.
    Hedman-Lagerlöf, Erik
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Sickness absence: a systematic review and meta-analysis of psychological treatments for individuals on sick leave due to common mental disorders2018In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 48, no 12, p. 1954-1965Article, review/survey (Refereed)
    Abstract [en]

    Sick leave due to common mental disorders (CMDs) increase rapidly and present a major societal challenge. The overall effect of psychological interventions to reduce sick leave and symptoms has not been sufficiently investigated and there is a need for a systematic review and meta-analysis of the field. The aim of the present meta-analysis was to calculate the effect size of psychological interventions for CMDs on sick leave and psychiatric symptoms based on all published randomized controlled trials. Methodological quality, the risk of bias and publication bias were also assessed. The literature searches gave 2240 hits and 45 studies were included. The psychological interventions were more effective than care as usual on both reduced sick leave (g = 0.15) and symptoms (g = 0.21). There was no significant difference in effect between work focused interventions, problem-solving therapy, cognitive behavioural therapy or collaborative care. We conclude that psychological interventions are more effective than care as usual to reduce sick leave and symptoms but the effect sizes are small. More research is needed on psychological interventions that evaluate effects on sick leave. Consensual measures of sick leave should be established and quality of psychotherapy for patients on sick leave should be improved.

  • 46. Salomonsson, Sigrid
    et al.
    Santoft, Fredrik
    Lindsäter, Elin
    Ejeby, Kersti
    Ljtosson, Brjann
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institutet, Sweden.
    Ingvar, Martin
    Lekander, Mats
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden; Karolinska University Hospital Stockholm, Sweden.
    Hedman-Lagerlöf, Erik
    Cognitive-behavioural therapy and return-to-work intervention for patients on sick leave due to common mental disorders: a randomised controlled trial2017In: Occupational and Environmental Medicine, ISSN 1351-0711, E-ISSN 1470-7926, Vol. 74, no 12, p. 905-912Article in journal (Refereed)
    Abstract [en]

    Objectives Common mental disorders (CMDs) cause great individual suffering and long-term sick leave. Cognitive–behavioural therapy (CBT) effectively treats CMDs, but sick leave is not reduced to the same extent as psychiatric symptoms. Research results regarding return-to-work interventions (RTW-Is) and their effect on sick leave are inconclusive. The aim of this study was to evaluate CBT, a RTW-I and combined CBT and RTW-I (COMBO) for primary care patients on sick leave due to CMDs.

    Methods Patients with CMDs (n=211) were randomised to CBT (n=64), RTW-I (n=67) or COMBO (n=80). Sick-leave registry data after 1 year and blinded Clinician’s Severity Rating (CSR) of symptoms post-treatment and at follow-ups after 6 and 12 months were primary outcomes.

    Results There was no significant difference between treatments in days on sick leave 1 year after treatment start (mean difference in sick-leave days range=9–27). CBT led to larger reduction of symptoms post-treatment (CSR; Cohen’s d=0.4 (95% CI 0.1 to 0.8)) than RTW-I, whereas COMBO did not differ from CBT or RTW-I. At follow-up, after 1 year, there was no difference between groups. All treatments were associated with large pre-treatment to post-treatment improvements, and results were maintained at 1-year follow-up.

    Conclusion No treatment was superior to the other regarding reducing sick leave. All treatments effectively reduced symptoms, CBT in a faster pace than RTW-I, but at 1-year follow-up, all groups had similar symptom levels. Further research is needed regarding how CBT and RTW-I can be combined more efficiently to produce a larger effect on sick leave while maintaining effective symptom reduction.

  • 47. Salomonsson, Sigrid
    et al.
    Santoft, Fredrik
    Lindsäter, Elin
    Ejeby, Kersti
    Ljótsson, Brjánn
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Karolinska Institutet, Sweden.
    Ingvar, Martin
    Lekander, Mats
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Hedman-Lagerlöf, Erik
    Stepped care in primary care - guided self-help and face-to-face cognitive behavioural therapy for common mental disorders: a randomized controlled trial2018In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 48, no 10, p. 1644-1654Article in journal (Refereed)
    Abstract [en]

    Background

    Common mental disorders (CMD) cause large suffering and high societal costs. Cognitive behavioural therapy (CBT) can effectively treat CMD, but access to treatment is insufficient. Guided self-help (GSH) CBT, has shown effects comparable with face-to-face CBT. However, not all patients respond to GSH, and stepping up non-responders to face-to-face CBT, could yield larger response rates. The aim was to test a stepped care model for CMD in primary care by first evaluating the effects of GSH-CBT and secondly, for non-responders, evaluating the additional effect of face-to-face CBT.

    Methods

    Consecutive patients (N = 396) with a principal disorder of depression, anxiety, insomnia, adjustment or exhaustion disorder were included. In Step I, all patients received GSH-CBT. In Step II, non-responders were randomized to face-to-face CBT or continued GSH. The primary outcome was remission status, defined as a score below a pre-established cutoff on a validated disorder-specific scale.

    Results

    After GSH-CBT in Step I, 40% of patients were in remission. After Step II, 39% of patients following face-to-face CBT were in remission compared with 19% of patients after continued GSH (p = 0.004). Using this stepped care model required less than six therapy sessions per patient and led to an overall remission rate of 63%.

    Conclusions

    Stepped care can be effective and resource-efficient to treat CMD in primary care, leading to high remission rates with limited therapist resources. Face-to-face CBT speeded up recovery compared with continued GSH. At follow-ups after 6 and 12 months, remission rates were similar in the two groups.

  • 48.
    Shafran, R.
    et al.
    University of Reading, UK.
    Clark, D.M.
    University of London, UK.
    Fairburn, C.G.
    University of Oxford, UK.
    Arntz, A.
    Maastricht University, the Netherlands.
    Barlow, D.H.
    Boston University, USA.
    Ehlers, A.
    University of London, UK.
    Freeston, M.
    University of Newcastle, UK.
    Garety, P.A.
    University of London, UK.
    Hollon, S.D.
    Vanderbilt University, USA.
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Salkovskis, P.M.
    University of London, UK.
    Williams, J.M.G.
    University of Oxford.
    Wilson, G.T.
    Rutgers University, USA.
    Mind the gap: Improving the dissemination of CBT2009In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 47, no 11, p. 902-909Article in journal (Refereed)
    Abstract [en]

    Empirically supported psychological treatments have been developed for a range of psychiatric disorders but there is evidence that patients are not receiving them in routine clinical care. Furthermore, even when patients do receive these treatments there is evidence that they are often not well delivered. The aim of this paper is to identify the barriers to the dissemination of evidence-based psychological treatments and then propose ways of overcoming them, hence potentially bridging the gap between research findings and clinical practice.

  • 49.
    Thorndike, Frances P.
    et al.
    University of Virginia Health System, USA.
    Carlbring, Per
    Linköpings universitet.
    Smyth, Frederick L.
    University of Virginia, USA.
    Magee, Joshua C.
    University of Virginia Health System, USA.
    Gonder-Frederick, Linda
    University of Virginia Health System, USA.
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Ritterband, Lee M.
    University of Virginia Health System, USA.
    Web-based measurement: Effect of completing single or multiple items per webpage2009In: Computers in human behavior, ISSN 0747-5632, E-ISSN 1873-7692, Vol. 25, no 2, p. 393-401Article in journal (Refereed)
    Abstract [en]

    The current study was conducted to determine whether participants respond differently to online questionnaires presenting all items on a single webpage versus questionnaires presenting only one item per page, and whether participants prefer one format over the other. Of participants seeking self-help treatment on the Internet (for depression, social phobia, or panic disorder), 710 completed four questionnaires (Beck Depression Inventory, Beck Anxiety Inventory, Quality of Life Index, Montgomery-Åsberg Depression Rating Scale) on the Internet on two occasions. The questionnaires were either presented with one questionnaire on one webpage (e.g., BDI on one webpage) or on multiple webpages (e.g., BDI on 21 webpages with one item each). Results suggest that the four web questionnaires measure the same construct across diagnostic group (depression, social phobia, panic), presentation type (single versus multiple items per page), and order of presentation (which format first). Within each diagnostic group, factor means for all questionnaires were equivalent across presentation method and time. Furthermore, factor means varied as expected across samples (e.g., depressed group scored higher on BDI), providing evidence of construct validity. The majority of participants in each diagnostic group preferred the single item per page format, even though this format required more time.

  • 50. Thulin, Ulrika
    et al.
    Svirsky, Liv
    Serlachius, Eva
    Andersson, Gerhard
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology. Karolinska Institutet, Sweden.
    The Effect of Parent Involvement in the Treatment of Anxiety Disorders in Children: A Meta-Analysis2014In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 43, no 3, p. 185-200Article in journal (Refereed)
    Abstract [en]

    Among clinicians, it is common practice to include parents in treatment, and it has been taken for granted that parents' involvement in their children's treatment is beneficial for therapy outcome, although research on this issue is far from clear. A meta-analysis was carried out in order to investigate whether parent involvement potentiates the outcome for children with anxiety disorders when treated with cognitive-behavior therapy. Sixteen studies, which directly compared parent-involved treatments with child-only treatments, were included in the meta-analysis. The results showed a small, nonsignificant effect size of -0.10 in favor of the child-only treatments. There was no indication of publication bias in the analysis. Implications of the results are discussed.

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