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  • 1. Aafjes-van Doorn, Katie
    et al.
    Lilliengren, Peter
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Cooper, Angela
    McDonald, James
    Falkenström, Fredrik
    Patients’ Affective Processes Within Initial Experiential Dynamic Therapy Sessions2017Inngår i: Psychotherapy, ISSN 0033-3204, E-ISSN 1939-1536, Vol. 54, nr 2, s. 175-183Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Research has indicated that patients’ in-session experience of previously avoided affects may be important for effective psychotherapy. The aim of this study was to investigate patients’ in-session levels of affect experiencing in relation to their corresponding levels of insight, motivation, and inhibitory affects in initial Experiential Dynamic Therapy (EDT) sessions. Four hundred sixty-six 10-min video segments from 31 initial sessions were rated using the Achievement of Therapeutic Objectives Scale. A series of multilevel growth models, controlling for between-therapist variability, were estimated to predict patients’ adaptive affect experiencing (Activating Affects) across session segments. In line with our expectations, higher within-person levels of Insight and Motivation related to higher levels of Activating Affects per segment. Contrary to expectations, however, lower levels of Inhibition were not associated with higher levels of Activating Affects. Further, using a time-lagged model, we did not find that the levels of Insight, Motivation, or Inhibition during one session segment predicted Activating Affects in the next, possibly indicating that 10-min segments may be suboptimal for testing temporal relationships in affective processes. Our results suggest that, to intensify patients’ immediate affect experiencing in initial EDT sessions, therapists should focus on increasing insight into defensive patterns and, in particular, motivation to give them up. Future research should examine the impact of specific inhibitory affects more closely, as well as between-therapist variability in patients’ in-session adaptive affect experiencing.

  • 2. Abbass, Allan
    et al.
    Town, Joel
    Ogrodniczuk, John
    Joffres, Michel
    Lilliengren, Peter
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Intensive Short-Term Dynamic Psychotherapy Trial Therapy Effectiveness and Role of Unlocking the Unconscious2017Inngår i: Journal of Nervous and Mental Disease, ISSN 0022-3018, E-ISSN 1539-736X, Vol. 205, nr 6, s. 453-457Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This study examined the effects of trial therapy interviews using intensive short-term dynamic psychotherapy with 500 mixed sample, tertiary center patients. Furthermore, we investigated whether the effect of trial therapy was larger for patients who had a major unlocking of the unconscious during the interview compared with those who did not. Outcome measures were the Brief Symptom Inventory (BSI) and the Inventory of Interpersonal Problems (IIP), measured at baseline and at 1-month follow-up. Significant outcome effects were observed for both the BSI and the IIP with small to moderate preeffect/posteffect sizes, Cohen's d = 0.52 and 0.23, respectively. Treatment effects were greater in patientswho had a major unlocking of the unconscious comparedwith thosewho did not. The trial therapy interview appears to be beneficial, and its effects may relate to certain therapeutic processes. Further controlled research is warranted.

  • 3. Abdollahi, Abbas
    et al.
    Abu Talib, Mansor
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Harvey, Richard
    Yaacob, Siti Nor
    Ismail, Zanariah
    Problem-solving skills and perceived stress among undergraduate students: The moderating role of hardiness2018Inngår i: Journal of Health Psychology, ISSN 1359-1053, E-ISSN 1461-7277, Vol. 23, nr 10, s. 1321-1331Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This study was designed to examine the relationships between problem-solving skills, hardiness, and perceived stress and to test the moderating role of hardiness in the relationship between problem-solving skills and perceived stress among 500 undergraduates from Malaysian public universities. The analyses showed that undergraduates with poor problem-solving confidence, external personal control of emotion, and approach-avoidance style were more likely to report perceived stress. Hardiness moderated the relationships between problem-solving skills and perceived stress. These findings reinforce the importance of moderating role of hardiness as an influencing factor that explains how problem-solving skills affect perceived stress among undergraduates.

  • 4. Abdollahi, Abbas
    et al.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Coping Style as a Moderator of Perfectionism and Suicidal Ideation Among Undergraduate Students2017Inngår i: Journal of Rational-Emotive & Cognitive-Behavior Therapy, ISSN 0894-9085, E-ISSN 1573-6563, Vol. 35, nr 3, s. 223-239Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Suicide is a serious and growing public health problem and remains an unnecessary cause of death globally. In Iran, the highest prevalence of acute and chronic suicidal ideation is among young people aged 16-24. This study investigates the relationship between coping style, two types of perfectionism, and suicidal ideation among undergraduates, and examines coping style as a moderator of the relationship between perfectionism and suicidal ideation. Multi-stage cluster random sampling was employed to recruit 547 undergraduate students aged 19-24 years from the Islamic Azad University of Karaj. Structural Equation Modelling indicated that suicidal ideation was negatively associated with adaptive perfectionism and task-focused coping but positively associated with emotion-focused coping, avoidance coping, and maladaptive perfectionism. Coping style (including the three styles of task-focused, emotion-focused, and avoidance coping) was found to moderate the relationship between perfectionism and suicidal ideation. The study advances understanding of the importance of coping style in this context and explains how perfectionism affects suicidal ideation.

  • 5. Abdollahi, Abbas
    et al.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Khanbani, Mehdi
    Abdollahi Ghahfarokhi, Shahyar
    Emotional intelligence moderates perceived stress and suicidal ideation among depressed adolescent inpatients2016Inngår i: Personality and Individual Differences, ISSN 0191-8869, E-ISSN 1873-3549, Vol. 102, s. 223-228Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Because it remains one of the third leading causes of death among adolescents around the world, suicide is a major public health concern. This study was designed in response to this concern by examining the relationships among perceived stress, emotional intelligence, and suicidal ideation and to test the moderating role of emotional intelligence in the relationship between perceived stress and suicidal ideation. A sample of depressed adolescents (n = 202) was recruited from five hospitals in Tehran, Iran, and then asked to complete measures of patient health, suicidal ideation, perceived stress, and emotional intelligence. Structural Equation Modeling showed that depressed adolescent in-patients with high levels of perceived stress and low levels of emotional intelligence were more likely to report suicidal ideation. Multi-group analysis indicated that depressed in-patients high in both perceived stress and emotional intelligence had less suicidal ideation than others. The findings support the notion that perceived stress acts as a vulnerability factor that increase suicidal ideation among depressed inpatients. Suicidal history moderated the relationship between emotional intelligence and suicidal ideation. These findings also highlight the importance of emotional intelligence as a buffer in the relationship between perceived stress and suicidal ideation.

  • 6. Abdollahi, Abbas
    et al.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Vaez, Elham
    Abdollahi Ghahfarokhi, Shahyar
    Perfectionism and Test Anxiety among High-School Students: the Moderating Role of Academic Hardiness2018Inngår i: Current psychology (New Brunswick, N.J.), ISSN 1046-1310, E-ISSN 1936-4733, Vol. 37, nr 3, s. 632-639Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Recent evidence suggests that test anxiety is increasing among students; however, relatively little is known regarding the related factors of test anxiety. The purpose of this study was to (1) examine the relationships between two forms of perfectionism, academic hardiness, and test anxiety, and (2) examine the moderating role of academic hardiness on the association between two types of perfectionism and test anxiety. This study included 520 students ranging from 15 to 21 years of age from eight high schools in Tehran, Iran completed the self-administered questionnaires. The results of Structural Equation Modelling (SEM) revealed that students with high levels of personal standards perfectionism and high levels of academic hardiness were less likely to experience test anxiety, while students with high levels of evaluative concerns perfectionism were more likely to experience test anxiety. A multi-group analysis revealed that academic hardiness moderated the relationship between evaluative concerns perfectionism and test anxiety. These findings enhance existing literature by revealing moderating processes that explain how perfectionism effects test anxiety.

  • 7. Abdollahi, Abbas
    et al.
    Hosseinian, Simin
    Beh-Pajooh, Ahmad
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Self-Concealment Mediates the Relationship Between Perfectionism and Attitudes Toward Seeking Psychological Help Among Adolescents2017Inngår i: Psychological Reports, ISSN 0033-2941, E-ISSN 1558-691X, Vol. 120, nr 6, s. 1019-1036Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    One of the biggest barriers in treating adolescents with mental health problems is their refusing to seek psychological help. This study was designed to examine the relationships between two forms of perfectionism, self-concealment and attitudes toward seeking psychological help and to test the mediating role of self-concealment in the relationship between perfectionism and attitudes toward seeking psychological help among Malaysian high school students. The participants were 475 Malaysian high school students from four high schools in Kuala Lumpur, Malaysia. Structural equation modelling results indicated that high school students with high levels of socially prescribed perfectionism, high levels of self-concealment, and low levels of self-oriented perfectionism reported negative attitudes toward seeking psychological help. Bootstrapping analysis showed that self-concealment emerged as a significant, full mediator in the link between socially prescribed perfectionism and attitudes toward seeking psychological help. Moderated mediation analysis also examined whether the results generalized across men and women. The results revealed that male students with socially prescribed perfectionism are more likely to engage in self-concealment, which in turn, leads to negative attitudes toward seeking psychological help more than their female counterparts. The results suggested that students high in socially prescribed perfectionism were more likely to engage in self-concealment and be less inclined to seek psychological help.

  • 8. Abdollahi, Abbas
    et al.
    LeBouthillier, Daniel M.
    Najafi, Mahmoud
    Asmundson, Gordon J. G.
    Hosseinian, Simin
    Shahidi, Shahriar
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Kalhori, Atefeh
    Sadeghi, Hassan
    Jalili, Marzieh
    Effect of exercise augmentation of cognitive behavioural therapy for the treatment of suicidal ideation and depression2017Inngår i: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 219, s. 58-63Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Suicidal ideation and depression are prevalent and costly conditions that reduce quality of life. This study was designed to determine the efficacy of exercise as an adjunct to cognitive behavioural therapy (CBT) for suicidal ideation and depression among depressed individuals.

    Methods: In a randomized clinical trial, 54 mildly to moderately depressed patients (54% female, mean age=48.25) were assigned to a combined CBT and exercise group or to a CBT only group. Both groups received one weekly session of therapy for 12 weeks, while the combined group also completed exercise three times weekly over the same period. Self-reported suicidal ideation, depression, and activities of daily living were measured at the beginning and the end of treatment.

    Results: Multilevel modelling revealed greater improvements in suicidal ideation, depression, and activities of daily living in the combined CBT and exercise group, compared to the CBT only group.

    Limitations: No follow-up data were collected, so the long-term effects (i.e., maintenance of gains) is unclear.

    Conclusions: The findings revealed that exercise adjunct to CBT effectively decreases both depressive symptoms and suicidal ideation in mildly to moderately depressed individuals.

  • 9.
    Andersson, Gerhard
    et al.
    Linköpings universitet och Karolinska Instutet.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Behandling via internet2016Inngår i: Socialt arbete och internet: att förstå och hantera sociala problem på nya arenor / [ed] Kristian Daneback, Emma Sorbring, Stockholm: Liber, 2016, s. 215-225Kapittel i bok, del av antologi (Annet (populærvitenskap, debatt, mm))
    Abstract [sv]

    Inom det sociala arbetets praktik ser vi en ökad närvaro av internetrelaterade problem. Samtidigt föredrar allt fler människor webbaserad hjälp, samt råd och stöd i relation till mer traditionella behandlings- och preventionsprogram, vilket öppnar för nya möjligheter för det sociala arbetet.

  • 10. Andersson, Gerhard
    et al.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Enduring effects of ICBT2017Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Introduction: Numerous randomized controlled trials have been conducted on internet interventions. In addition to the effects observed in these trials immediately after treatment there are several long-term follow-ups. The aim of this talk is to review the long-term effects of internet-delivered CBT (ICBT) with a focus on results at 1-year or later following treatment termination.

    Methods: We were able to locate examples of enduring effects for a range of conditions including mood and anxiety disorders and somatic disorders. The longest follow-up period has been five years.

    Results: Large within-group effects have been documented in most trials, with effects sizes being moderate to large for anxiety and depression studies.

    Discussion: Studies have failed to document how much the treatment is used during the follow-up period and in the case of depression it is unclear if episodes of depression have occured during the period covered. We conclude that the effects of ICBT appear to be enduring but that more research is needed.

  • 11. Andersson, Gerhard
    et al.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Internet-Assisted Cognitive Behavioral Therapy2017Inngår i: Psychiatric Clinics of North America, ISSN 0193-953X, E-ISSN 1558-3147, Vol. 40, nr 4, s. 689-700Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The Internet, including modern information technology, has had a dramatic impact on many areas of life, including health care and psychological treatment. In particular, cognitive–behavioral therapy (CBT) has been found to be a form of psychological treatment that has been possible to transfer to other modes of delivery than regular face-to-face and group formats. The Internet is not only useful for providing CBT, but has a significant role in providing information about CBT and conditions that are treated using CBT. In addition, modern information technology also has a major role in assessment procedures, such as online administration of self-report mea- sures. In this article, we focus mainly on Internet-supported treatments, although another emerging format is to use video conferencing systems and conduct real- time face-to-face CBT, CBT training, or supervision.

  • 12. Andersson, Gerhard
    et al.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Internet-based brief therapies2018Inngår i: The art and science of brief psychotherapies: A Practioner's Guide / [ed] Mantosh J. Dewan, Brett N. Steenbarger, Roger P. Greenberg, Arlington: American Psychiatric Association , 2018, 3, s. 315-325Kapittel i bok, del av antologi (Fagfellevurdert)
  • 13. Andersson, Gerhard
    et al.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Hadjistavropoulos, Heather D.
    Internet-Based Cognitive Behavior Therapy2017Inngår i: The Science of Cognitive Behavioral Therapy / [ed] Stefan G. Hofmann, Gordon J. G. Asmundson, London: Elsevier, 2017, s. 531-549Kapittel i bok, del av antologi (Fagfellevurdert)
    Abstract [en]

    Internet-based cognitive behavior therapy (ICBT) is an evidence-based form of CBT. Most programs include text, video, and audio files and are similar to face-to-face CBT in terms of content and duration of treatment. Most often ICBT includes some guidance from a therapist, although automated self-guided ICBT programs also exist. Studies suggest that guided ICBT can be as effective as face-to-face CBT for anxiety and mood disorders as well as for distress associated with certain somatic disorders. Transdiagnostic programs, either relying on presentation of common strategies for, or tailoring of treatment to, disorders have generated strong outcomes in controlled trials. Interventions for problems like procrastination also show promise. Studies on predictors and mediators of outcome are emerging, but there is a need to develop intervention-specific theories in order to better understand change mechanisms. In the future, blending of face-to-face CBT and modern information technology are expected to be more common and attractive to therapists.

  • 14. Andersson, Gerhard
    et al.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Lindefors, Nils
    History and current status of ICBT2016Inngår i: Guided internet-based treatments in psychiatry / [ed] Nils Lindefors, Gerhard Andersson, Springer, 2016, s. 1-16Kapittel i bok, del av antologi (Fagfellevurdert)
    Abstract [en]

    We begin this chapter with a discussion of the history of ICBT and its roots in bibliotherapy and computerised CBT. We then provide a brief description of one way of administering guided ICBT, including the role of the therapist and data security issues. This description is followed by examples of conditions that are not covered later in the book, such as specific phobias and addictions. We end this chapter with a discussion of technical developments, cost-effectiveness and implementation.

  • 15. Andersson, Gerhard
    et al.
    Rozental, Alexander
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. University College London, England.
    Shafran, Roz
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. University College London, England.
    Long-term effects of internet-supported cognitive behaviour therapy2018Inngår i: Expert Review of Neurotherapeutics, ISSN 1473-7175, E-ISSN 1744-8360, Vol. 18, nr 1, s. 21-28Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Introduction: Internet-supported and therapist-guided cognitive behaviour therapy (ICBT) is effective for a range of problems in the short run, but less is known about the long-term effects with follow-ups of two years or longer.

    Areas covered: This paper reviews studies in which the long-term effects of guided ICBT were investigated. Following literature searches in PubMed and other sources meta-analytic statistics were calculated for 14 studies involving a total of 902 participants, and an average follow-up period of three years. Studies were from Sweden (n = 11) or the Netherlands (n = 3). Long-term outcome studies were found for panic disorder, social anxiety disorder, generalized anxiety disorder, depression, mixed anxiety and depression, obsessive-compulsive disorder, pathological gambling, stress and chronic fatigue. The duration of the treatments was usually short (8–15 weeks). The pre-to follow-up effect size was Hedge’s g = 1.52, but with a significant heterogeneity. The average symptom improvement across studies was 50%. Treatment seeking in the follow-up period was not documented and few studies mentioned negative effects.

    Expert commentary: While effects may be overestimated, it is likely that therapist-supported ICBT can have enduring effects. Long-term follow-up data should be collected for more conditions and new technologies like smartphone-delivered treatments.

  • 16. Andersson, Gerhard
    et al.
    Rozental, Alexander
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Shafran, Roz
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Long-term effects of internet-supported cognitive behaviour therapy2018Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    Internet-supported and therapist-guided cognitive behaviour therapy (ICBT) is effective for a range of problems in the short run, but less is known about the long-term effects with follow-ups of two years or longer.This paper reviews studies in which the long-term effects of guided ICBT were investigated. Following literature searches in PubMed and other sources meta-analytic statistics were calculated for 14 studies involving a total of 902 participants, and an average follow-up period of three years. Studies were from Sweden (n = 11) or the Netherlands (n = 3). Long-term outcome studies were found for panic disorder, social anxiety disorder, generalized anxiety disorder, depression, mixed anxiety and depression, obsessive-compulsive disorder, pathological gambling, stress and chronic fatigue. The duration of the treatments was usually short (8–15 weeks). The pre-to follow-up effect size was Hedge’s g = 1.52, but with a significant heterogeneity. The average symptom improvement across studies was 50%. Treatment seeking in the follow-up period was not documented and few studies mentioned negative effects.While effects may be overestimated, it is likely that therapist-supported ICBT can have enduring effects. Long-term follow-up data should be collected for more conditions and new technologies like smartphone-delivered treatments.

  • 17. Ankarberg, Peter
    et al.
    Bergsten, Katja
    Bohman, Gunnar
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Bäck, Malin
    Falkenström, Fredrik
    Klingström, Anders
    Lilliengren, Peter
    Philips, Björn
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Werbart, Andrzej
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Socialstyrelsens riktlinjer är partiska och ovetenskapliga!2017Inngår i: Psykoterapi, ISSN 2001-5836, Vol. 26, nr 2, s. 30-34Artikkel i tidsskrift (Annet (populærvitenskap, debatt, mm))
    Abstract [sv]

    Denna artikel är ett remissvar med synpunkter på de nationella riktlinjerna för ångest och depression, som vi publicerar i sin helhet i tidskriften. Vi gör det på grund av den ingående kunskap om processerna i riktlinjearbetet som några av författarna har kunnat få genom egen medverkan och närvaro i det arbetet.

  • 18. Bas-Hoogendam, Janna Marie
    et al.
    van Steenbergen, Henk
    Pannekoek, J. Nienke
    Fouche, Jean-Paul
    Lochner, Christine
    Hattingh, Coenraad J.
    Cremers, Henk R.
    Furmark, Tomas
    Månsson, Kristoffer N.T.
    Frick, Andreas
    Engman, Jonas
    Boraxbekk, Carl-Johan
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Sample Size Matters: A Voxel-Based Morphometry Multi-Center Mega-Analysis of Gray Matter Volume in Social Anxiety Disorder2017Inngår i: Biological Psychiatry, ISSN 0006-3223, E-ISSN 1873-2402, Vol. 81, nr 10, s. S7-S8Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    Background: Social Anxiety Disorder (SAD) is a disabling psychiatric disorder, associated with high co-morbidity. Previous research on structural brain alterations associated with SAD has yielded inconsistent results concerning changes in gray matter (GM) in various brain regions, as well as on the relationship between GM and SAD-symptomatology. These heterogeneous findings are possibly due to limited sample sizes. Multi-site imaging offers new possibilities to investigate SAD-related GM changes in larger samples.

    Methods: An international multi-center mega-analysis on the largest database of SAD brain scans to date was performed to compare GM volumes of SAD-patients (n=174) and healthy participants (n=213) using voxel-based morphometry. A hypothesis-driven region of interest (ROI) approach was used, focusing on the basal ganglia, amygdala-hippocampal complex, prefrontal cortex and parietal cortex.

    Results: SAD-patients had larger GM volume in the dorsal striatum when compared to healthy participants. This increase correlated positively with the level of social anxiety symptoms. No SAD-related differences in GM volume were present in the other ROIs.

    Conclusions: The results suggest a role for the dorsal striatum in SAD, but previously reported SAD-related changes in GM in the amygdala, hippocampus, precuneus, prefrontal cortex and parietal regions were not replicated. Thereby, our findings indicate that sample size matters and stress the need for meta-analyses like those performed by the Enhancing NeuroImaging Genetics through Meta-Analysis (ENIGMA) Consortium and its working groups. Actually, the collaborative effort for this work has resulted in the start of the ENIGMA-Anxiety workgroup.

  • 19. Bas-Hoogendam, Janna Marie
    et al.
    van Steenbergen, Henk
    Pannekoek, J. Nienke
    Fouche, Jean-Paul
    Lochner, Christine
    Hattingh, Coenraad J.
    Cremers, Henk R.
    Furmark, Tomas
    Månsson, Kristoffer N.T.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Uppsala University, Sweden; Karolinska Institutet, Sweden.
    Frick, Andreas
    Engman, Jonas
    Boraxbekk, Carl-Johan
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, Gerhard
    Fredrikson, Mats
    Straube, Thomas
    Peterburs, Jutta
    Klumpp, Heide
    Phan, K. Luan
    Roelofs, Karin
    Veltman, Dick J.
    van Tol, Marie-José
    Stein, Dan J.
    van der Wee, Nic J. A.
    Voxel-based morphometry multi-center mega-analysis of brain structure in social anxiety disorder2017Inngår i: NeuroImage: Clinical, ISSN 0353-8842, E-ISSN 2213-1582, Vol. 16, s. 678-688Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Social anxiety disorder (SAD) is a prevalent and disabling mental disorder, associated with significant psychiatric co-morbidity. Previous research on structural brain alterations associated with SAD has yielded inconsistent results concerning the direction of the changes in gray matter (GM) in various brain regions, as well as on the relationship between brain structure and SAD-symptomatology. These heterogeneous findings are possibly due to limited sample sizes. Multi-site imaging offers new opportunities to investigate SAD-related alterations in brain structure in larger samples.

    An international multi-center mega-analysis on the largest database of SAD structural T1-weighted 3T MRI scans to date was performed to compare GM volume of SAD-patients (n = 174) and healthy control (HC)-participants (n = 213) using voxel-based morphometry. A hypothesis-driven region of interest (ROI) approach was used, focusing on the basal ganglia, the amygdala-hippocampal complex, the prefrontal cortex, and the parietal cortex. SAD-patients had larger GM volume in the dorsal striatum when compared to HC-participants. This increase correlated positively with the severity of self-reported social anxiety symptoms. No SAD-related differences in GM volume were present in the other ROIs. Thereby, the results of this mega-analysis suggest a role for the dorsal striatum in SAD, but previously reported SAD-related changes in GM in the amygdala, hippocampus, precuneus, prefrontal cortex and parietal regions were not replicated. Our findings emphasize the importance of large sample imaging studies and the need for meta-analyses like those performed by the Enhancing NeuroImaging Genetics through Meta-Analysis (ENIGMA) Consortium.

  • 20.
    Bejnö, Hampus
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Specialpedagogiska institutionen.
    Johansson, Susanna
    Ramnerö, Jonas
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Grimaldi, Lauren
    Cepeda, Ray
    Emergent Language Responses Following Match-to-Sample Training among Children with Autism Spectrum Disorder2018Inngår i: International Journal of Psychology & Psychological Therapy / Revista Internacional de Psicologia y Terapia Psicologica, ISSN 1577-7057, E-ISSN 2340-2857, Vol. 18, nr 1, s. 1-14Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The present study explored the effects of match-to-sample training on emergent responses in the domains of receptive and expressive language among children with autism spectrum disorder (ASD) in an applied setting. A concurrent multiple probe design across six participants was applied, with a follow-up after 10 days. All six children participated in a match-to-sample training procedure. The participants were trained to match a picture card of an item with a word card corresponding to the name of the item, and a word card of an item with a picture card corresponding to the name of the item. After training, three participants developed the emergent responses of receptively identifying and expressively naming both picture cards and word cards. There was a correspondence between acquired matching skills and the development of emergent language responses. Follow-up measures showed that the acquired emergent responses remained somewhat stable over time. The results are discussed in relation to prior research and in terms of implications for teaching children with ASD language skills in applied settings such as preschools. The results are also discussed in relation to the participant’s prior verbal skills and to the retention of emergent language responses.

  • 21. Berg, M.
    et al.
    Johansson, S.
    Liljetörn, L.
    Rozental, Alexander
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Toopoco, N.
    Andersson, G.
    The role of knowledge in Internet-based cognitive behavioural therapy for adolescent depression: Results from a randomized controlled trial2017Konferansepaper (Fagfellevurdert)
  • 22. Bergman Nordgren, Lise
    et al.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, Gerhard
    Tailoring CBT-treatments delivered via the internet: Some examples from a Swedish context2017Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Introduction: In mental health comorbidity is common, both physical and psychiatric. Normally studies on cognitive behavior therapy (CBT) protocols do not exclude comorbid patients but leave the comorbidity to improve without being addressed, or remain unchanged without being identified. since most cognitive behavior treatment protocols are diagnosis-specific. Based on the idea that several problems can be targeted at once, individually tailored CBT protocols have developed. Including patients’ specific symptom profile and preferences, and the knowledge from established disorder-specific programs these protocols opens for individualization both before and during treatment based on individual progress. Tailoring can also be done to target different age groups and include for example the interface of the treatment program and the clinical examples used.

    Methods: Most programs have been tested in randomized controlled trials against active waitlist conditions. Specific symptom measures served as primary outcome measures and measures of life quality as secondary. Some studies also included economic evaluations of cost- effectiveness and ratings of therapeutic alliance. Our samples have been both self-recruited and referred by health care professionals. Most of the studies have measure-points not only directly at post treatment, but also at one- and two-year follow-up.

    Results: Taken together the tailored programs show, on average, a medium to large effect size (Cohen’s d) on primary outcome measures regarding both anxiety and depressive symptoms, and small effect sizes on life quality measures. Effects were sustained at follow-up. The tailored treatment proved to be cost-effective administered in regular care. We also found patient ratings of therapeutic alliance to correlate with outcome.

    Discussion: Individually tailored internet-administered CBT show promising results. Based on the available data, it might be a feasible approach in treating anxiety and depression. Acceptability, for whom it is most beneficial, and if some components are more powerful than others, are questions left to be answered.

  • 23.
    Bimont, Diane
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Werbart, Andrzej
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    "I've got you under my skin": Relational therapists' experiences of patients who occupy their inner world2018Inngår i: Counselling Psychology Quarterly, ISSN 0951-5070, E-ISSN 1469-3674, Vol. 31, nr 2, s. 243-268Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim of this study was to conduct an in-depth exploration of therapists' experiences of patients who affect them more than others and occupy their inner world beyond the context of therapy sessions. A phenomenological analysis was performed on semi-structured interviews with five relational therapists. All the therapists had a strong experience of a particular patient getting "under their skin". In all these cases, the patient was a traumatized woman. The distinctive characteristic of the phenomenon was a sense of blurred or too permeable boundaries between the therapist and the patient. This was associated with fear and anxiety, but also with feelings of love. The therapists' reactions to having a patient "under their skin" varied from resistance to symbiotic relatedness. The therapists' ideas of their professional role influenced how the experience of carrying the patient's suffering was interpreted. The phenomenon of the patient's presence in the therapist's representational world might be interpreted as a distinct countertransference phenomenon when working in a more "thin boundary" manner with particular cases. The therapists' ability to effectively manage their vulnerabilities, activated in the countertransference, seems to be crucial for therapeutic progress. Implications for research, clinical practice, and training are discussed.

  • 24. Bjaastad, Jon Fauskanger
    et al.
    Haugland, Bente Storm Mowatt
    Fjermestad, Krister W.
    Torsheim, Torbjorn
    Havik, Odd E.
    Heiervang, Einar R.
    Öst, Lars-Goran
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden.
    Competence and Adherence Scale for Cognitive Behavioral Therapy (CAS-CBT) for Anxiety Disorders in Youth: Psychometric Properties2016Inngår i: Psychological Assessment, ISSN 1040-3590, E-ISSN 1939-134X, Vol. 28, nr 8, s. 908-916Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 25. Blom, Kerstin
    et al.
    Gjestad, Rolf
    Andersson, Gerhard
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Havik, Odd
    Nordgreen, Tine
    Effectiveness of two guided Internet treatments in a routine care setting at the eMeistring clinic, Norwegian public health care: Panic disorder and major depression2018Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    We present data from two effectiveness studies of therapist-guided Internet-delivered cognitive behavioral therapy (ICBT) delivered as part of routine care within the public health care system in Norway. Treatments were ICBT for panic disorder (N=124, published in 2018) and for major depression (N=124, preliminary data).

  • 26. Boettcher, Johanna
    et al.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Linden, Michael
    Hollon, Steve
    Rozental, Alexander
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen. Karolinska Institutet, Sweden.
    Primun non nocere: Side effects in psychological treatments2018Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    Psychological treatments help patients overcome mental health problems. Thousands of studies document the positive effects of psychotherapeutic interventions. The potential of these same interventions to cause harm, on the other hand, has scarcely been subject to scientific investigation. The nature and frequency of side effects of psychological treatments are largely unknown. The present symposium aims at shedding light on some important questions concerning negative effects: How should side effects be defined? What are typical side effects? How frequent are side effects in different treatment formats? And how can side effects be effectively measured? 

    In the first presentation, Michael Linden will speak about side effects in group therapy and will report data from two different group therapy formats. Johanna Boettcher will focus on side effects of individual therapy for depression. She will present data from a large trial of Internet-based therapy and will summarize a qualitative analysis of the patients’ experience of negative effects. Steve Hollon will talk specifically about one particular side effect, the deterioration of targeted symptoms. He will report results of an individual patient data meta-analysis and compare rates of deterioration in cognitive-behaviour therapy and pharmacotherapy. Finally, Alexander Rozental will present a new questionnaire for the assessment of negative effects and will demonstrate its psychometric properties in a Rasch analysis.

  • 27. Boettcher, Johanna
    et al.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Warnock-Parkes, Emma
    Willutzki, Ulrike
    Innovations in the Treatment of Social Anxiety Disorder2017Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    Social anxiety disorder (SAD) is a very common and disabling mental disorder. Cognitive-behaviour therapy (CBT) is first-line treatment and has a strong empirical basis. However, not all patients benefit from CBT. About one third of the treated patients do not respond to a sufficient degree (Rodebaugh, Holaway, & Heimberg, 2004). Additionally, access to CBT is often limited. Only a small minority of patients with SAD receives adequate, evidence-based treatment (e.g. Issakidis & Andrews, 2002). Hence, there is a pressing need to optimize existing treatment approaches and to lower treatment barriers. The planned symposium will present different approaches on how to make CBT more efficient and more available for patients with SAD. Treatments that are facilitated via the Internet have the potential to reach patients who are otherwise unlikely to receive adequate treatment (e.g. patients in remote areas, patients fearing stigmatization, patients too shy to initiate face-to-face contact). At the same time, technology-based interventions also help to bring important therapeutic techniques into practice. The first two talks will therefore focus on innovations in the field of Internet-based CBT for SAD and will present strategies to facilitate exposure exercises. Johanna Boettcher will present two studies on a newly developed app for SAD. In a gamified approach, the app guides and motivates patients to conduct exposure exercises in their natural environment. The second presentation will introduce virtual reality (VR) exposure therapy for social fears. Per Carlbring will present data on a RCT, evaluating the impact of a three-hour VR exposure session on public speaking anxiety.  The third talk will present a different angle on how to improve treatment outcomes. Emma Warnock- Parks will outline how video-feedback can be optimized in the treatment of socially anxious patients  in order to increase its impact on patients’ symptomatology. She will present data on the beneficial effect of video feedback on patients’ distorted self-images and will show ways how to make this technique even more powerful. Optimizing intervention techniques and contexts is one way to improve treatment of SAD. It is also important to consider external factors that may influence treatment adherence or outcome. In the last talk, Ulrike Willutzki will present data on a long-time neglected topic in SAD. She will demonstrate how the well-meant support of patients’ spouses can contribute to the maintenance of the disorder. She will discuss how partners can be educated and become involved in treatment helping the patient to overcome anxiety in difficult social situations.  The planned symposium will offer four different strategies that can be implemented to improve cognitive-behavioural treatment techniques and to further the access to CBT. The symposium therefore contributes to a better understanding on how CBT for SAD can become more efficient in alleviating patients’ suffering.

  • 28. Boraxbekk, C. J.
    et al.
    Hagkvist, Filip
    Lindner, Philip
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Umeå University, Sweden; Karolinska Institutet, Sweden.
    Motor and mental training in older people: Transfer, interference, and associated functional neural responses2016Inngår i: Neuropsychologia, ISSN 0028-3932, E-ISSN 1873-3514, Vol. 89, s. 371-377Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Learning new motor skills may become more difficult with advanced age. In the present study, we randomized 56 older individuals, including 30 women (mean age 70.6 years), to 6 weeks of motor training, mental (motor imagery) training, or a combination of motor and mental training of a finger tapping sequence. Performance improvements and post-training functional magnetic resonance imaging (fMRI) were used to investigate performance gains and associated underlying neural processes. Motor only training and a combination of motor and mental training improved performance in the trained task more than mental-only training. The fMRI data showed that motor training was associated with a representation in the premotor cortex and mental training with a representation in the secondary visual cortex. Combining motor and mental training resulted in both premotor and visual cortex representations. During fMRI scanning, reduced performance was observed in the combined motor and mental training group, possibly indicating interference between the two training methods. We concluded that motor and motor imagery training in older individuals is associated with different functional brain responses. Furthermore, adding mental training to motor training did not result in additional performance gains compared to motor-only training and combining training methods may result in interference between representations, reducing performance.

  • 29. Bouchard, Stéphane
    et al.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Loranger, Claudie
    Botella, Cristina
    Mechanisms underlying the efficacy of exposure in virtual reality for anxiety disorders2016Inngår i: EABCT 2016 Abstract Book: Total Awareness, 2016, s. 139-139Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Many studies have documented the efficacy and effectiveness of using virtual reality to conduct exposure in the treatment of anxiety disorders (Wiederhold &amp; Bouchard, 2014). However, the factors related to treatment outcome remain unclear. In this symposium, four studies will be presented in order to document: (a) the role of presence in the potential of virtual reality (VR) to induce anxiety reactions in people suffering from an anxiety disorder (PTSD); (b) mechanisms of change, including treatment expectations, in the cognitive behavior treatment (CBT) of panic disorder where VR and in vivo techniques were used to conduct exposure; (c) the role of cognitive changes and self-efficacy compared to other predictors of change, such as presence and treatment alliance, in the CBT of social anxiety using VR and in vivo exposure; and (d) expanding these findings on predictors of change to augmented reality exposure for specific phobia. The first study is based on an experimental anxiety induction protocol while the other three use randomized control trials. The findings highlight to contribution of a few factors specific to technology-based exposure and those common to CBT of anxiety disorders. Attendees to the symposium will benefit from a clear understanding of what are the few key factors they need to take into account when conducting exposure with VR and augmented reality.

  • 30. Burman, Maria
    et al.
    Norlander, Anna-Karin
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, Gerhard
    Närmare varandra: Nio veckor till en starkare parrelation2018Bok (Annet vitenskapelig)
    Abstract [sv]

    Relationsproblem är vanliga och påverkar oss på många plan. Denna självhjälpsbok får par att se hur problemen inte ligger hos den ena eller andra partnern utan uppstår i samspelet mellan dem. Paren guidas till att hitta mönster och ömma punkter i sitt samspel och får hjälp att bygga vidare på styrkor de har som par.

  • 31. Böttcher, Johanna
    et al.
    Magnusson, Kristoffer
    Marklund, Arvid
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Challenger: eine, 'smarte' Erweiterung der internet-basierten Behandlung sozialer Ängste2017Konferansepaper (Fagfellevurdert)
    Abstract [de]

    Hintergrund: Online-Behandlungen für soziale Angststörungen (SAS) sind bereits gut untersucht. Ein nächster Schritt ist die Erprobung von Smartphone Anwendungen. Diese bieten zahlreiche Möglichkeiten, die Umsetzung einzelner Behandlungselemente im Alltag zu vereinfachen. „Challenger“ ist eine jüngst entwickelte App, die die Durchführung von Expositionsübungen unterstützt. Spielerisch bietet sie den Nutzer*innen Übungen an, die auf die individuellen Bedürfnisse der Betroffenen, sowie auf aktuelle räumliche und situationale Merkmale abgestimmt sind. Die vorliegende Studie untersucht, welchen zusätzlichen Nutzen Challenger zur internet-basierten Behandlung sozialer Ängste beiträgt.Methode: 209 Patient*innen mit SAS wurden zufällig drei Gruppen zugeteilt. Die erste Gruppe erhielt ein unbegleitetes Selbsthilfeprogramm mit zusätzlichem Zugang zur App, die zweite Gruppe erhielt ausschließlich das Selbsthilfeprogramm und die dritte Gruppe war eine Warteliste-Kontrollgruppe. Die Teilnehmer*innen füllten vor, nach und 12 Monate nach Ende der Behandlung Fragebögen zu sozialen Ängsten und sekundären Maßen aus.Ergebnisse: Beide aktive Gruppen zeigten bedeutsame Verbesserungen der sozialen Ängste. Patient*innen, die zusätzlich mit der App trainierten, waren der aktiven Vergleichsgruppe leicht überlegen (kontrolliertes d=0,25). Die Therapieerfolge waren über 12 Monate stabil. Diskussion: Die untersuchte Kombination der Challenger App mit internet-basierter Selbsthilfe war für Patient*innen mit SAS wirksam. Da die ungeleitete App keine personellen Ressourcen fordert und gleichzeitig einen neuartigen, spielerischen Zugang zu Expositionsübungen bietet, empfiehlt sich ihre weitere Erforschung in anderen Behandlungskontexten.

  • 32.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Internet-based CBT Interventions2017Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    Internet-delivered cognitive behavior therapy (ICBT) has a relatively short history, with the first trials being conducted in the late 1990s. Since then well above 150 randomized controlled trials suggest that ICBT can be effective. Effect sizes for ICBT have been well within the range of face-to-face CBT with the exception of unguided programs (e.g., not even minimal therapist contact), which usually, but not always, result in smaller effects.

    So, the evidence is there but how is it done? In this workshop two pioneers in the field will present some recent research findings, but primarily share their experiences of how to become a true expert internet therapist. It is clear that therapist guidance generally is important for good outcome – but how much, how often and when should you do it? And most importantly, what should you write in your feedback? Based on their own research from analyzing the written content of email messages, sent from both the client and the therapist, clear suggestions will be shared and also practiced during the workshop.

    In the workshop clinical case examples will be provided together with screenshots and demonstration of treatment systems including the Swedish web platform as well as a gamified virtual reality exposure therapy intervention. Furthermore, a recently tested smartphone application will also be briefly presented.

    Finally, you will learn about the risk of negative effects of Internet-based cognitive behavior therapy and how to measure the occurrence of symptom deterioration, adverse and unwanted events, and their relationship with long term treatment outcome.

  • 33.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Internet-based CBT interventions2018Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Internet-delivered cognitive behavior therapy (ICBT) has a relatively short history, with the first trials being conducted in the late 1990s. Since then well above 150 randomized controlled trials suggest that ICBT can be effective. Effect sizes for ICBT have been well within the range of face-to-face CBT with the exception of unguided programs (e.g., not even minimal therapist contact), which usually, but not always, result in smaller effects. So, the evidence is there but how is it done? In this workshop a pioneer in the field will present some recent research findings, but primarily share his experiences of how to become a true expert internet therapist. It is clear that therapist guidance generally is important for good outcome – but how much, how often and when should you do it? And most importantly, what should you write in your feedback? Based on their own research from analyzing the written content of email messages, sent from both the client and the therapist, clear suggestions will be shared and also practiced during the workshop. In the workshop clinical case examples will be provided together with screenshots and demonstration of treatment systems including the Swedish web platform as well as a gamified virtual reality exposure therapy intervention. Furthermore, a recently tested smartphone application will also be briefly presented. Finally, you will learn about the risk of negative effects of Internet-based cognitive behavior therapy and how to measure the occurrence of symptom deterioration, adverse and unwanted events, and their relationship with long term treatment outcome. Educational Learning Objectives:Understanding the varieties of Internet treatments and their differential effects and learn what is required to obtain good outcomes with guided Internet treatment. Knowing what is required in terms of therapist training and skills. Learning about the pros and cons of Internet treatment including tailoring treatment according to patient symptom profile. Workshop Outline:For the first part of the workshop an interactive lecture using PowerPoint will be used. The presentation will be interactive since the audience is encouraged to interrupt and ask questions at any time. Also, questions will be called out for the audience to reflect and comment on. In addition, group discussions will be used so that pairs can come up with examples of what an internet-therapist perhaps could reply to a case example. Finally, the last few minutes will be a question-and-answer session.

  • 34.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Internet-Based CBT Interventions in Practice2018Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    Internet-delivered cognitive behavior therapy (ICBT) has a relatively short history, with the first trials being conducted in the late 1990s. Since then well above 150 randomized controlled trials suggest that ICBT can be effective. Effect sizes for ICBT have been well within the range of face-to-face CBT with the exception of unguided programs (e.g., not even minimal therapist contact), which usually, but not always, result in smaller effects.

    So, the evidence is there but how is it done? In this workshop a pioneer in the field will present some recent research findings, but primarily share his experiences of how to become a true expert internet therapist. It is clear that therapist guidance generally is important for good outcome – but how much, how often and when should you do it? And most importantly, what should you write in your feedback? Based on their own research from analyzing the written content of email messages, sent from both the client and the therapist, clear suggestions will be shared and also practiced during the workshop.

    In the workshop clinical case examples will be provided together with screenshots and demonstration of treatment systems including the Swedish web platform as well as a gamified virtual reality exposure therapy intervention. Furthermore, a recently tested smartphone application will also be briefly presented.

    Finally, you will learn about the risk of negative effects of Internet-based cognitive behavior therapy and how to measure the occurrence of symptom deterioration, adverse and unwanted events, and their relationship with long term treatment outcome.

  • 35.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Internet-Delivered CBT: State of the Art and Future Directions2016Inngår i: EABCT 2016 Abstract Book: Total Awareness, 2016, s. 18-18Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Internet-delivered cognitive behavior therapy (ICBT) has a relatively short history, with the first trials being conducted in the late 1990s. Since then well above 120 randomized controlled trials suggest that ICBT can be effective. Effect sizes for ICBT have been well within the range of face-to-face CBT with the exception of unguided programs (e.g., not even minimal therapist contact), which usually, but not always, result in smaller effects. So, the evidence is there but how is it done? In this keynote Carlbring will present recent research findings from efficacy and effectiveness studies, but also share experiences of how to become a true expert internet therapist. It is clear that therapist guidance generally is important for good outcome – but how much, how often and when should you do it? And most importantly, what should you write in your feedback? Based on the Swedish research from analyzing the written content of email messages, sent from both the client and the therapist, suggestions will be shared.

    In the keynote short clinical case examples will be provided together with screenshots and demonstration of treatment systems including the Swedish web platform as well as a gamified virtual reality exposure therapy intervention. Furthermore, a recently tested smartphone application will also be briefly presented.

    Finally, you will learn about the risk of negative effects of Internet-based cognitive behavior therapy and how to measure the occurrence of symptom deterioration, adverse and unwanted events, and their relationship with long term treatment outcome.

  • 36.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Om att använda appar och virtual reality i och utanför terapirummet2018Konferansepaper (Annet vitenskapelig)
    Abstract [sv]

    Föreläsningen kommer innehålla en kort uppdatering kring evidensen för internetbehandlingar, hur det praktiskt går till och vad som är viktigt att få med i stödjande textmeddelanden. Per kommer dessutom att demonstrera två hjälpmedel som du redan nu kan använda både i och utanför terapirummet; dels en smartphone-applikation mot social fobi, dels en virtual reality-behandling mot spindelfobi. Mer information om dessa tekniker finns på www.carlbring.se.

  • 37.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Psychological interventions, App technology, Virtual context2018Konferansepaper (Annet vitenskapelig)
  • 38.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Single-session Gamified Virtual Reality Exposure Therapy for Spider Phobia vs. Traditional Exposure Therapy: A Randomized-controlled Non-inferiority Trial with 12-month Follow-up2017Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    Introduction: This is the first large randomized-controlled trial to evaluate whether commercially available VR hardware and software can be used for exposure therapy. The aim of this study was to compare gold-standard One Session Therapy (OST) for reduction of spider phobia symptoms and avoidance behavior using in vivo spiders and a human therapist, to a newly developed single-session gamified Virtual Reality Exposure Therapy (VRET) application with modern, consumer-available VR hardware, virtual spiders, and a virtual therapist. Method: Subjects (N=100) with spider phobia, diagnosed, and meeting inclusion criteria were recruited from the general population and randomized to 2 treatment arms. In 1-week intervals, pre-measurement, 3-hr treatment and post-measurement were completed with an in-vivo behavioral approach test (BAT) serving as the primary outcome measure for both groups. This study was powered to detect a non-inferiority margin of a 2-point between-group difference on the BAT, with a standard deviation of 4 (at 80% power). Results: 98 patients commenced treatment and 97 patients completed post-measurement. Per protocol analysis indicated VR was not non-inferior to OST. Repeated-measures ANOVA identified a significant main effect of time (p<.001) and time x group effect (p<.05). Both OST and VR participants experienced large BAT within-group effect sizes (d=2.28 and d=1.45, respectively). By the time of the conference there will be 12-month follow-up data including prediction analysis and the effect of treatment credibility, preference and working alliance. Conclusion: OST is the superior treatment option for spider phobia. VRET is an effective alternative if OST cannot be provided, as pure self-help, as the initial intervention in a stepped-care model, or as a possible post-OST booster.

  • 39.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Using the internet and virtual reality to treat psychological problems2017Konferansepaper (Annet vitenskapelig)
  • 40.
    Carlbring, Per
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, Gerhard
    Internet treatment for anxiety disorders2016Inngår i: EABCT 2016 Abstract Book: Total Awareness, 2016, s. 51-51Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Scientific background: Internet-delivered cognitive behavior therapy (ICBT) has a relatively short history, with the first trials being conducted in the late 1990s. Since then well above 120 randomized controlled trials suggest that ICBT can be effective. Effect sizes for ICBT have been well within the range of face-to-face CBT with the exception of unguided programs (e.g., not even minimal therapist contact), which usually, but not always, result in smaller effects.

    So, the evidence is there but how is it done? In this workshop two pioneers in the field will present some recent research findings, but primarily share their experiences of how to become a true expert internet therapist. It is clear that therapist guidance generally is important for good outcome – but how much, how often and when should you do it? And most importantly, what should you write in your feedback? Based on their own research from analyzing the written content of email messages, sent from both the client and the therapist, clear suggestions will be shared and also practiced during the workshop.

    In the workshop clinical case examples will be provided together with screenshots and demonstration of treatment systems including the Swedish web platform as well as a gamified virtual reality exposure therapy intervention. Furthermore, a recently tested smartphone application will also be briefly presented.

    Finally, you will learn about the risk of negative effects of Internet-based cognitive behavior therapy and how to measure the occurrence of symptom deterioration, adverse and unwanted events, and their relationship with long term treatment outcome.

    Key learning objectives

    • Understanding the varieties of Internet treatments and their differential effects
    • Getting to know what is needed to set up a service using the Internet (the basics)
    • Learning what is required to obtain good outcomes with guided Internet treatment
    • Knowing what is required in terms of therapist training and skills.
    • Learning about the pros and cons of Internet treatment including tailoring treatment according to patient symptom profile.

  • 41.
    Carlbring, Per
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, Gerhard
    Cuijpers, Pim
    Riper, Heleen
    Hedman, Erik
    Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: An updated systematic review and meta-analysis2017Konferansepaper (Fagfellevurdert)
    Abstract [en]

    During the last two decades, Internet-delivered cognitive behavior therapy (ICBT) has been tested in hundreds of randomized controlled trials, often with promising results. However, the control groups were often waitlist, care-as-usual or attention control. Hence, little is known about the relative efficacy of ICBT as compared to face-to-face cognitive behavior therapy (CBT). In the present systematic review and meta-analysis, which included 1418 participants, guided ICBT for psychiatric and somatic conditions were directly compared to face-to-face CBT within the same trial. Out of the 2078 articles screened, a total of 20 studies met all inclusion criteria. These included three studies on social anxiety disorder, three on panic disorder, four on depression, two on body dissatisfaction, two on insomnia, two on tinnitus, one on male sexual dysfunction, one on spider phobia, one on snake phobia, and one on fibromyalgia. Half of the face-to-face CBT treatments were administered in an individual format, and the other half were administered in a group format. Results showed a pooled effect size at post-treatment of Hedges g = 0.05 (95% CI, -0.09 to 0.20), indicating that ICBT and face-to-face treatment produced equivalent overall effects. Study quality did not affect outcomes. While the overall results indicate equivalence, there have been few studies of the individual psychiatric and somatic conditions so far, and for the majority, guided ICBT has not been compared against face-to-face treatment. Thus, more research, preferably with larger sample sizes, is needed to establish the general equivalence of the two treatment formats.

  • 42.
    Carlbring, Per
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, Gerhard
    Cuijpers, Pim
    Riper, Heleen
    Hedman-Lagerlöf, Erik
    Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: an updated systematic review and meta-analysis2018Inngår i: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 47, nr 1, s. 1-18Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    During the last two decades, Internet-delivered cognitive behavior therapy (ICBT) has been tested in hundreds of randomized controlled trials, often with promising results. However, the control groups were often waitlisted, care-as-usual or attention control. Hence, little is known about the relative efficacy of ICBT as compared to face-to-face cognitive behavior therapy (CBT). In the present systematic review and meta-analysis, which included 1418 participants, guided ICBT for psychiatric and somatic conditions were directly compared to face-to-face CBT within the same trial. Out of the 2078 articles screened, a total of 20 studies met all inclusion criteria. Results showed a pooled effect size at post-treatment of Hedges g = .05 (95% CI, −.09 to .20), indicating that ICBT and face-to-face treatment produced equivalent overall effects. Study quality did not affect outcomes. While the overall results indicate equivalence, there have been few studies of the individual psychiatric and somatic conditions so far, and for the majority, guided ICBT has not been compared against face-to-face treatment. Thus, more research, preferably with larger sample sizes, is needed to establish the general equivalence of the two treatment formats.

  • 43.
    Carlbring, Per
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Böttcher, Johanna
    Magnusson, Kristoffer
    Marklund, Arvid
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Andersson, Gerhard
    Adding a Smartphone App to Bibliotherapy for Social Anxiety: A Randomized Controlled Comparison2017Inngår i: Applying CBT in Diverse Contexts: 51st Annual Convention: Program Book, 2017, s. 394-394Konferansepaper (Fagfellevurdert)
    Abstract [en]

    The efficacy of Internet-based treatments and bibliotherapy for Social Anxiety Disorder is well established. The next step is to evaluate smartphone supported interventions. ‘Challenger’ is a recently developed facilitating the implementation of exposure exercises in daily life. The present study evaluates the efficacy of the combination of Challenger and bibliotherapy for Social Anxiety Disorder. A total of 209 patients with Social Anxiety Disorder were randomly allocated to three groups. The first group received app and bibliotherapy for six weeks (parallel design) and the second group received first bibliotherapy for six weeks and then the app for another six weeks (sequential design). The third group was a wait-list control group. Participants filled in questionnaires on primary and secondary outcomes post treatment as well as at 4 and 12 months follow-up. Participants using both app and bibliotherapy showed somewhat larger reductions in social fears after six weeks of treatment compared to participants using only bibliotherapy (d=0.25). Decreases in social anxiety were large for both groups after 12 weeks of treatment (d= 1.11-1.20) and were maintained throughout the follow-up period. Results of the current study support the notion of adding a smartphone app to bibliotherapy for Social Anxiety Disorder. Future study should investigate the potential of the app in different treatment settings.

  • 44.
    Carlbring, Per
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Enoh, Matilda
    Lindner, Philip
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Andersson, Gerhard
    Unified protocol vs. diagnostic specific treatment of social anxiety: a randomized treatment study with a factorial design2018Inngår i: Scientific Programme: Nurturing processes of change in iCBTs, 2018Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Traditionally, Cognitive Behavior Therapy researchers have developed and tested diagnostic specific treatment manuals. Most of which are efficacious. However, since comorbidity between anxiety and mood disorders is common and as the choice of the best suited treatment manual for each patient can be hard when delivering the treatment via the internet, transdiagnostic interventions have been put forward.

    The purpose of this study was to compare the effect of unified protocol vs. diagnostic specific treatment in a group of 147 individuals with social anxiety. The score on Liebowitz Social Anxiety Scale at pre-treatment was M=52.7.

    The interventions were both delivered via the internet during 9 weeks. In addition, the relative effect of no guidance vs. guidance on demand was investigated in a factorial design with 25 % of the patients randomized into each of the four groups. The preliminary results at week 9 show large within group effects (average Cohen’s d = 1,03), but no significant between-group differences as measured with the self-report MINI-SPIN-R and OASIS/ODSIS.

    At the time of the conference 6-month follow-up data will be available in addition to the already collected post-assessment data (analyzed according to the intention-to-treat principle).

  • 45.
    Carlbring, Per
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Hassmén, Peter
    Nyström, Markus
    Lindner, Philip
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, Gerhard
    The relative effects of behavioral activation vs. physical exercise in the treatment of mild to moderate depression2016Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Aim: Despite their potential as low-threshold, low-cost and high-flexibility treatments of depression, behavioral activation and physical exercise have not yet been directly compared. This study has examined the effects of these interventions, administered via the Internet.

    Method: In this randomized controlled trial a total of 312 participants meeting the diagnostic criteria for mild to moderate major depression, recruited in multiple cycles and randomized to either a waiting list control group with delayed treatment, or one of the four active treatment groups: (1) physical exercise without a clear psychological treatment rationale; (2) physical exercise with a psychological treatment rationale; (3) behavioral activation a la Lewinsohn; or (4) behavioral activation a la Martel.

    Results: A total of 72% were women and the average age of the participants were M=42.3 years (SD=13,5). More than half (53,9%) had a history of previous psychological treatment. Primary outcome measure was the 9-item Patient Health Questionnaire. Assessments were made on a weekly basis for the full duration of the acute treatment which was 12 weeks.

    Conclusion: The preliminary results are in line with previous online studies showing that all active treatment groups were superior to the waitlist (large effect sizes) and that only minor differences could be identified between the four active groups (large within effect sizes). At the time of the conference 6-month follow-up data will be available in addition to the already collected post- assessment data (analyzed according to the intention-to-treat principle).

  • 46.
    Carlbring, Per
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Huppert, Jonathan
    Koster, Ernst
    Watkins, Ed
    Boettcher, Johanna
    Blackwell, Simon
    What can bias modification training add to CBT?2016Inngår i: EABCT 2016 Abstract Book: Total Awareness, 2016, s. 100-100Konferansepaper (Annet (populærvitenskap, debatt, mm))
    Abstract [en]

    Bias modification training is a broad but very different form of CBT that is heavily inspired by experimental psychopathology research. Basically this treatment targets mechanisms maintaining psychopathology such as selective attention and memory biases. Some studies have found large effects of bias modification training but there are also negative findings. The panel will discuss the pros and cons of this treatment format including the prospect of combining traditional CBT delivery with bias modification training.

  • 47.
    Carlbring, Per
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Ivanova, Ekaterina
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Magnusson, K.
    Voluntary deposit-limit as a tool for reducing gambling intensity among customers of an online gambling platform: A randomized controlled trial2018Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    Aims: To compare gambling intensity between users of an online gambling service prompted to set a deposit limit and non-prompted customers, in the whole sample and among most active users based on total number of gambling days. Design: A randomized controlled trial with three prompted (N=1098/1110/1055) and one unprompted control condition (N=1065) and gambling activity of each participant followed for 90 days starting at account registration. Setting. A publicly governed online gambling operator from Finland. Interventions: The prompted participants received a one-time prompt to set a voluntary deposit limit of optional size either 1) at-registration, 2) before or 3) after they made their first deposit. Participants in the control condition were not prompted. Participants: All Finnish customers of the gambling service having registered an account during the study recruitment period with online slots as preferred gambling category during the 90 days following the registration. Measures: Gambling intensity was measured with aggregated net loss (NL), with proportions of limit-setters, sum of deposits and number of gambling days used as secondary outcomes. Findings: In the whole sample, the three intervention groups did not differ in either proportion of participants with positive NL (BF10prop=0.007) or size of positive net loss (BF10size=0.016), the results being similar for the most involved gamblers (BF10prop=0.030; BF10size=0.082). The pooled intervention group did not differ from the control group regarding proportion of gamblers with positive NL (OR(95%CI)=0.991(0.836–1.176); p=.921) or size of NL (B(95%CI) =-0.080(-0.229-0.069); p=.291), the results applying to the most involved gamblers (proportion positive NL: OR(95%CI)=0.834(0.492-1.412), p =.498; NL size: B(95%CI)=0.042(-0.359-0.442), p =.838). The three intervention groups had higher rates of limit-setters and NL was highest among participants who have increased/removed a deposit-limit. Conclusion: Prompting users of an online gambling service to set a voluntary deposit limit of optional size did not affect subsequent NL compared to unprompted participants.

  • 48.
    Carlbring, Per
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Lindner, P.
    Miloff, Alexander
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Fagernäs, S.
    Andersen, J.
    Sigeman, M.
    Furmark, T.
    Andersson, Gerhard
    In session virtual reality use for public speaking anxiety: A randomized controlled trial2017Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Fear of public speaking is common and for some individuals this interferes significantly with the person's life and causes marked distress. We wanted to test a newly developed virtual reality assisted 1-session in-person treatment (3 hours). The therapist guided session consisted of a series of behavioral experiments based on the expectancy violation principle. This was followed by a 4-week booster intervention delivered via the internet. Following a diagnostic interview a total of 50 individuals with a score of ≥ 60 on the Personal Report of Public Speaking Anxiety questionnaire were randomized to a treatment or a control condition. A total of 78% also met criteria for social anxiety disorder. Considering only having had one treatment session in-person the preliminary results were promising with a between group effect size on the primary outcome (Public Speaking Anxiety Scale) of Cohen’s d=1.32 before commencing the internet-based booster program. Four weeks later the between-group effect size was d=1.90. However, on the secondary outcome measures the effect sizes were more often moderate than large. At the time of the conference 6-month follow-up data will be available in addition to the already collected post-assessment data (analyzed according to the intention-to-treat principle).

  • 49.
    Carlbring, Per
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Lindner, Philip
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Miloff, Alexander
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Fagernäs, S.
    Andersen, J.
    Sigeman, M.
    Furmark, T.
    Andersson, Gerhard
    The efficacy of internet-based virtual reality exposure therapy for public speaking anxiety: A randomized controlled trial2017Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    Fear of public speaking is common and for some individuals this interferes significantly with the person's life and causes marked distress. We wanted to test a newly developed virtual reality assisted 1-session in-person treatment (3 hours). The therapist guided session consisted of a series of behavioral experiments based on the expectancy violation principle. This was followed by a 4-week booster intervention delivered via the internet. Following a diagnostic interview a total of 50 individuals with a score of ≥ 60 on the Personal Report of Public Speaking Anxiety questionnaire were randomized to a treatment or a control condition. A total of 78% also met criteria for social anxiety disorder. Considering only having had one treatment session in-person the preliminary results were promising with a between group effect size on the primary outcome (Public Speaking Anxiety Scale) of Cohen’s d=1.32 before commencing the internet-based booster program. Four weeks later the between-group effect size was d=1.90. However, on the secondary outcome measures the effect sizes were more often moderate than large. At the time of the conference 6-month follow-up data will be available in addition to the already collected post-assessment data (analyzed according to the intention-to-treat principle).

  • 50.
    Carlbring, Per
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Marklund, A.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Miloff, Alexander
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Sjöblom, K.
    Delin, L.
    Lundén, C.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Blomdahl, R.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Braun, U.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Cotter, K.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Magnusson, K.
    Andersson, G.
    Treat your social anxiety disorder with this gamified smartphone app2016Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Aim: Social anxiety disorder (SAD) is a common debilitating mental illness with large negative effects on quality of life and economic productivity. Modern psychotherapy treatments utilizing cognitive–behavioral theory are increasingly delivered over the Internet and more recently using smartphone applications. The Challenger App written natively for the Apple iPhone was developed at the Stockholm University Department of Psychology for the treatment of SAD and uses a number of advanced features not previously seen in past mental health applications; these include real-time location awareness, notifications, anonymous social interaction between users, a high-degree of personalization and use of gamification techniques.

    Method: A total of 209 participants with a primary diagnosis of SAD were randomized to one of three groups: 1) Self-help book, 2) Self-help book + the Challenger app, or 3) waitlist. The treatment period lasted 6 weeks. Primary outcome measure was Liebowitz Social Anxiety Scale self- report (LSAS-SR). Also included where the Quality of Life Inventory, Patient Health Questionnaire, and the Generalized Anxiety Disorder-7 (GAD-7). Outcome was analyzed according to the intention to treat principle.

    Results: Both treatment groups were superior to the waitlist. On the main outcome measure (LSAS-SR) the effect size for the waitlist was Cohens d=0.14. The group that received the self-help book with the addition of the Challenger app was significantly superior (d=1.0) to just reading the self- help book (d=0.61). Participants requited by way of Newspaper advertisement were more likely to reach high end-state functioning (OR=4.1) and the same was true for participants without prior psychological treatment history as compared with having a previous experience (OR=4.4).

    Conclusion: Adding the smartphone app is a cost effective way of improving the outcome when treating SAD with a self-help book.

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