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Hallberg, J., Kaldo, V., Arver, S., Dhejne, C., Jokinen, J. & Oberg, K. G. (2019). A Randomized Controlled Study of Group-Administered Cognitive Behavioral Therapy for Hypersexual Disorder in Men. Journal of Sexual Medicine, 16(5), 733-745
Open this publication in new window or tab >>A Randomized Controlled Study of Group-Administered Cognitive Behavioral Therapy for Hypersexual Disorder in Men
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2019 (English)In: Journal of Sexual Medicine, ISSN 1743-6095, E-ISSN 1743-6109, Vol. 16, no 5, p. 733-745Article in journal (Refereed) Published
Abstract [en]

Background: Hypersexual disorder (HD) is defined as a condition in which the individual loses control over engagement in sexual behaviors, leading to distress and negative effects on key life areas. Cognitive behavioral therapy (CBT) has been proven to reduce symptoms of hypersexual behavior; however, no randomized controlled study of CBT interventions for HD has been reported previously. Aim: To investigate the efficacy of group-administered CBT for HD. Methods: Male participants (n = 137) diagnosed with HD, were randomized between 7 weeks of group-administered CBT (n = 70) and a waitlist control receiving the intervention after 8 weeks (n = 67). Measurements were administered at pre-, mid-, and posttreatment, with follow-up after 3 and 6 months. Outcomes: The primary outcome was the Hypersexual Disorder: Current Assessment Scale (HD: CAS), and secondary outcomes were the Sexual Compulsivity Scale (SCS) and measures of depression (Montgomery-Asberg Depression Rating Scale (MADRS-S), psychological distress (Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM), and treatment satisfaction (CSQ-8). Results: A significantly greater decrease in HD symptoms and sexual compulsivity, as well as significantly greater improvements in psychiatric well-being, were found for the treatment condition compared with the waitlist. These effects remained stable at 3 and 6 months after treatment. Clinical Implications: CBT can ameliorate HD symptoms and psychiatric distress, suggesting that the CBT program may serve as a first-line treatment in clinical settings. Strengths & Limitations: This is the first randomized controlled study evaluating the efficacy of a CBT programin a rather large sample of HD-specific diagnosed men. The long-termtreatment effects are vague due to the low response rate on follow-up measurements, and the efficacy of this program for hypersexual women remains unknown. Conclusion: This study supports the efficacy of a group-administered CBT program as a treatment option for HD; however, future studies should include women, comprise dismantling analysis of the constituting interventions, and evaluate other treatment formats, for example, administration via the Internet. Copyright (C) 2019, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Male Sexual Desire Disorders, Basic science male behavioral, Mental Health and Male Sexuality
National Category
Psychology
Research subject
Social Sciences, Psychology
Identifiers
urn:nbn:se:lnu:diva-85281 (URN)10.1016/j.jsxm.2019.03.005 (DOI)000469936400015 ()30956109 (PubMedID)
Available from: 2019-06-13 Created: 2019-06-13 Last updated: 2019-06-13Bibliographically approved
Rahman, M. S., Zhao, X., Liu, J. J., Torres, E. Q., Tibert, B., Kumar, P., . . . Lavebratt, C. (2019). Exercise Reduces Salivary Morning Cortisol Levels in Patients with Depression. Molecular Neuropsychiatry, 4(4), 196-203
Open this publication in new window or tab >>Exercise Reduces Salivary Morning Cortisol Levels in Patients with Depression
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2019 (English)In: Molecular Neuropsychiatry, ISSN 2296-9209, Vol. 4, no 4, p. 196-203Article in journal (Refereed) Published
Abstract [en]

Purpose of the Study: Cortisol hypersecretion plays a role in depression pathophysiology. Internet-based cognitive behavioural therapy (ICBT) and physical exercise (PE) are new treatment alternatives for depression, and their long-lasting effect on cortisol is unknown. We investigated cortisol level changes after 12 weeks of ICBT, PE or treatment as usual (TAU).

Procedures: The present pre-post repeated measure study analysed data derived from a randomised controlled trial evaluating the effects of 12 weeks’ interventions of ICBT, PE and TAU in depressed primary care patients (Sweden 2011–2013) and aimed at prospectively evaluating the within-group effects of ICBT, PE and TAU on diurnal salivary cortisol levels in a small representative subsample (n = 56, 38 and 27, respectively).

Results: We found a marked flattening of the diurnal cortisol slope (p = 0.004) and a reduced cortisol level at awakening (p = 0.017) after 12 weeks of PE treatment. No apparent effects of ICBT or TAU interventions were seen on diurnal cortisol levels.

Conclusions and Message: PE reduced the rate of cortisol level decline across the day in depressed adults. ICBT and TAU treatments had no detectable effects on diurnal cortisol levels. Larger samples are required for the detection and comparison of smaller effects of PE, ICBT and TAU on diurnal cortisol levels.

Place, publisher, year, edition, pages
S. Karger, 2019
National Category
Applied Psychology
Research subject
Social Sciences, Psychology
Identifiers
urn:nbn:se:lnu:diva-82208 (URN)10.1159/000494699 (DOI)30815455 (PubMedID)
Available from: 2019-04-30 Created: 2019-04-30 Last updated: 2019-05-03Bibliographically approved
Andersson, E., Crowley, J. J., Lindefors, N., Ljotsson, B., Hedman-Lagerlöf, E., Boberg, J., . . . Ruck, C. (2019). Genetics of response to cognitive behavior therapy in adults with major depression: a preliminary report. Molecular Psychiatry, 24(4), 484-490
Open this publication in new window or tab >>Genetics of response to cognitive behavior therapy in adults with major depression: a preliminary report
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2019 (English)In: Molecular Psychiatry, ISSN 1359-4184, E-ISSN 1476-5578, Vol. 24, no 4, p. 484-490Article in journal (Refereed) Published
Abstract [en]

Major depressive disorder is heritable and a leading cause of disability. Cognitive behavior therapy is an effective treatment for major depression. By quantifying genetic risk scores based on common genetic variants, the aim of this report was to explore the utility of psychiatric and cognitive trait genetic risk scores, for predicting the response of 894 adults with major depressive disorder to cognitive behavior therapy. The participants were recruited in a psychiatric setting, and the primary outcome score was measured using the Montgomery Asberg Depression Rating Scale-Self Rated. Single-nucleotide polymorphism genotyping arrays were used to calculate the genomic risk scores based on large genetic studies of six phenotypes: major depressive disorder, bipolar disorder, attention-deficit/hyperactivity disorder, autism spectrum disorder, intelligence, and educational attainment. Linear mixed-effect models were used to test the relationships between the six genetic risk scores and cognitive behavior therapy outcome. Our analyses yielded one significant interaction effect (B = 0.09, p < 0.001): the autism spectrum disorder genetic risk score correlated with Montgomery Asberg Depression Rating Scale-Self Rated changes during treatment, and the higher the autism spectrum disorder genetic load, the less the depressive symptoms decreased over time. The genetic risk scores for the other psychiatric and cognitive traits were not related to depressive symptom severity or change over time. Our preliminary results indicated, as expected, that the genomics of the response of patients with major depression to cognitive behavior therapy were complex and that future efforts should aim to maximize sample size and limit subject heterogeneity in order to gain a better understanding of the use of genetic risk factors to predict treatment outcome.

Place, publisher, year, edition, pages
Nature Publishing Group, 2019
National Category
Psychology Medical Genetics
Research subject
Social Sciences, Psychology
Identifiers
urn:nbn:se:lnu:diva-81695 (URN)10.1038/s41380-018-0289-9 (DOI)000461902000003 ()30410065 (PubMedID)
Available from: 2019-04-05 Created: 2019-04-05 Last updated: 2019-04-05Bibliographically approved
Forsell, E., Jernelov, S., Blom, K., Kraepelien, M., Svanborg, C., Andersson, G., . . . Kaldo, V. (2019). Proof of Concept for an Adaptive Treatment Strategy to Prevent Failures in Internet-Delivered CBT: A Single-Blind Randomized Clinical Trial With Insomnia Patients. American Journal of Psychiatry, 176(4), 315-323
Open this publication in new window or tab >>Proof of Concept for an Adaptive Treatment Strategy to Prevent Failures in Internet-Delivered CBT: A Single-Blind Randomized Clinical Trial With Insomnia Patients
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2019 (English)In: American Journal of Psychiatry, ISSN 0002-953X, E-ISSN 1535-7228, Vol. 176, no 4, p. 315-323Article in journal (Refereed) Published
Abstract [en]

Objective: This study aimed to demonstrate proof of concept for an adaptive treatment strategy in Internet-delivered cognitive-behavioral therapy (ICBT), where risk of treatment failure is assessed early in treatment and treatment for at-risk patients is adapted to prevent treatment failure. Methods: A semiautomated algorithm assessed risk of treatment failure early in treatment in 251 patients undergoing ICBT for insomnia with therapist guidance. At-risk patients were randomly assigned to continue standard ICBT or to receive adapted ICBT. The primary outcome was self-rated insomnia symptoms using the Insomnia Severity Index in a linear mixed-effects model. The main secondary outcome was treatment failure (having neither responded nor remitted at the posttreatment assessment). Results: A total of 102 patients were classified as at risk and randomly assigned to receive adapted ICBT (N=51) or standard ICBT (N=51); 149 patients were classified as not at risk. Patients not at risk had significantly greater score reductions on the Insomnia Severity Index than at-risk patients given standard ICBT. Adapted ICBT for at-risk patients was significantly more successful in reducing symptoms compared with standard ICBT, and it decreased the risk of failing treatment (odds ratio= 0.33). At-risk patients receiving adapted ICBT were not more likely to experience treatment failure than those not at risk (odds ratio= 0.51), though they were less likely to experience remission. Adapted treatment required, on average, 14 more minutes of therapist-patient time per remaining week. Conclusions: An adaptive treatment strategy can increase treatment effects for at-risk patients and reduce the number of failed treatments. Future studies should improve accuracy in classification algorithms and identify key factors that boost the effect of adapted treatments.

Place, publisher, year, edition, pages
American Psychiatric Publishing, 2019
National Category
Psychiatry
Research subject
Social Sciences, Psychology
Identifiers
urn:nbn:se:lnu:diva-81839 (URN)10.1176/appi.ajp.2018.18060699 (DOI)000462848100011 ()30696270 (PubMedID)
Available from: 2019-04-12 Created: 2019-04-12 Last updated: 2019-04-12Bibliographically approved
Kraepelien, M., Blom, K., Lindefors, N., Johansson, R. & Kaldo, V. (2019). The effects of component-specific treatment compliance in individually tailored internet-based treatment. Clinical Psychology and Psychotherapy, 26(3), 298-308
Open this publication in new window or tab >>The effects of component-specific treatment compliance in individually tailored internet-based treatment
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2019 (English)In: Clinical Psychology and Psychotherapy, ISSN 1063-3995, E-ISSN 1099-0879, Vol. 26, no 3, p. 298-308Article in journal (Refereed) Published
Abstract [en]

The objective of this study was to explore the effects of treatment compliance in a guided individually tailored internet-based treatment (TAIL) in relation to depression and co-morbid symptoms. Compliance with the homework in the different treatment components in TAIL, each aimed at a specific condition, was rated for 207 participants by independent assessors. Six subgroups (n = 34-131) were constructed consisting of participants with co-occurring symptoms of worry, panic, social anxiety, stress, insomnia, or pain. For each group, hierarchical regression was used to investigate whether the total sum of compliance points, Overall Compliance, predicted reductions in depression and in condition-specific symptoms. Also, in each subgroup, it was tested whether working with specific treatment components, Specific Compliance, predicted reduction of the targeted symptoms. Overall Compliance predicted 15% of the reduction in depression symptoms. For participants with worry, panic, social anxiety, stress, or insomnia, Overall Compliance also predicted symptom reductions in that specific condition. Specific Compliance predicted reduction in the targeted symptoms for participants with social anxiety, stress, and insomnia. Specific Compliance with stress and insomnia components also predicted reductions in depression. Our results strengthen the importance of compliance in internet-based treatments. Because compliance with stress and insomnia components was particularly important for broad symptom reductions, these conditions should not be ignored when treating patients with co-morbid symptoms.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
adherence, co-morbidity, depression, internet-based treatment, tailoring, treatment compliance
National Category
Psychology
Research subject
Social Sciences, Psychology
Identifiers
urn:nbn:se:lnu:diva-86866 (URN)10.1002/cpp.2351 (DOI)000470782800003 ()30650232 (PubMedID)
Available from: 2019-07-16 Created: 2019-07-16 Last updated: 2019-07-16Bibliographically approved
Rosen, A., Jernelov, S., Kaldo, V., Forsell, E., Akerstedt, T. & D'onofrio, P. (2018). Cognitive behavior therapy for insomnia - is sleep compression an equally effective and less difficult alternative compared to sleep restriction?. Paper presented at 24th Congress of the European-Sleep-Research-Society (ESRS), SEP 25-28, 2018, Basel, SWITZERLAND. Journal of Sleep Research, 27
Open this publication in new window or tab >>Cognitive behavior therapy for insomnia - is sleep compression an equally effective and less difficult alternative compared to sleep restriction?
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2018 (English)In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 27Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
Wiley-Blackwell, 2018
National Category
Psychology
Research subject
Social Sciences, Psychology
Identifiers
urn:nbn:se:lnu:diva-78100 (URN)000444228300874 ()
Conference
24th Congress of the European-Sleep-Research-Society (ESRS), SEP 25-28, 2018, Basel, SWITZERLAND
Available from: 2018-10-01 Created: 2018-10-01 Last updated: 2018-10-01Bibliographically approved
Kraepelien, M., Forsell, E., Karin, E., Johansson, R., Lindefors, N. & Kaldo, V. (2018). Comparing individually tailored to disorder-specific internet-based cognitive-behavioural therapy: benchmarking study. BJPsych Open, 4(4), 282-284
Open this publication in new window or tab >>Comparing individually tailored to disorder-specific internet-based cognitive-behavioural therapy: benchmarking study
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2018 (English)In: BJPsych Open, E-ISSN 2056-4724, Vol. 4, no 4, p. 282-284Article in journal (Refereed) Published
Abstract [en]

Disorder-specific internet-based cognitive-behavioural therapy (ICBT) is effective for depression, panic disorder and social anxiety. In this benchmarking study, a new, individually tailored, ICBT programme (TAIL) showed effects on depression (n = 284, d = 1.33) that were non-inferior to disorder-specific ICBT for depression in routine care (n = 2358, d = 1.35). However, the hypotheses that TAIL for individuals with social anxiety or panic disorder is inferior to disorder-specific ICBT could not be rejected (social anxiety: TAIL d = 0.74 versus disorder-specific d = 0.81; panic: TAIL d = 1.11 versus disorder-specific d = 1.47). Our findings strengthen the empirical base for TAIL as an alternative to disorder-specific ICBT for depression. (c) The Royal College of Psychiatrists 2018.

Place, publisher, year, edition, pages
Cambridge: Cambridge University Press, 2018
Keywords
cognitive-behavioural therapies, comorbidity, depressive disorders
National Category
Psychology
Research subject
Social Sciences, Psychology
Identifiers
urn:nbn:se:lnu:diva-79494 (URN)10.1192/bjo.2018.41 (DOI)000451387300009 ()30083380 (PubMedID)
Available from: 2019-01-17 Created: 2019-01-17 Last updated: 2019-07-08Bibliographically approved
Kraepelien, M., Mattsson, S., Hedman-Lagerlöf, E., Petersson, I. F., Forsell, Y., Lindefors, N. & Kaldo, V. (2018). Cost-effectiveness of internet-based cognitive-behavioural therapy and physical exercise for depression. BJPsych Open, 4(4), 265-273
Open this publication in new window or tab >>Cost-effectiveness of internet-based cognitive-behavioural therapy and physical exercise for depression
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2018 (English)In: BJPsych Open, E-ISSN 2056-4724, Vol. 4, no 4, p. 265-273Article in journal (Refereed) Published
Abstract [en]

Background Both internet-based cognitive-behavioural therapy (ICBT) and physical exercise are alternatives to treatment as usual (TAU) in managing mild to moderate depression in primary care. Aims To determine the cost-effectiveness of ICBT and physical exercise compared with TAU in primary care. Method Economic evaluation of a randomised controlled trial (N=945) in Sweden. Costs were estimated by a service use questionnaire and used together with the effects on quality-adjusted life-years (QALYs). The primary 3-month healthcare provider perspective in primary care was complemented by a 1-year societal perspective. Results The primary analysis showed that incremental cost per QALY gain was (sic)8817 for ICBT and (sic)14 571 for physical exercise compared with TAU. At the established willingness-to-pay threshold of (sic) 21 536 ( pound 20 000) per QALY, the probability of ICBT being cost-effective is 90%, and for physical exercise is 76%, compared with TAU. Conclusions From a primary care perspective, both ICBT and physical exercise for depression are likely to be cost-effective compared with TAU. (c) The Royal College of Psychiatrists 2018.

Place, publisher, year, edition, pages
Cambridge: , 2018
Keywords
Cognitive-behavioural therapies, cost-effectiveness, depressive disorders, randomised controlled trial, exercise
National Category
Psychology
Research subject
Social Sciences, Psychology
Identifiers
urn:nbn:se:lnu:diva-79493 (URN)10.1192/bjo.2018.38 (DOI)000451387300006 ()30057780 (PubMedID)
Available from: 2019-01-17 Created: 2019-01-17 Last updated: 2019-07-08Bibliographically approved
Karyotaki, E., Ebert, D. D., Donkin, L., Riper, H., Twisk, J., Burger, S., . . . Cuijpers, P. (2018). Do guided internet-based interventions result in clinically relevant changes for patients with depression?: An individual participant data meta-analysis. Clinical Psychology Review, 63, 80-92
Open this publication in new window or tab >>Do guided internet-based interventions result in clinically relevant changes for patients with depression?: An individual participant data meta-analysis
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2018 (English)In: Clinical Psychology Review, ISSN 0272-7358, E-ISSN 1873-7811, Vol. 63, p. 80-92Article, review/survey (Refereed) Published
Abstract [en]

Little is known about clinically relevant changes in guided Internet-based interventions for depression. Moreover, methodological and power limitations preclude the identification of patients' groups that may benefit more from these interventions. This study aimed to investigate response rates, remission rates, and their moderators in randomized controlled trials (RCTs) comparing the effect of guided Internet-based interventions for adult depression to control groups using an individual patient data meta-analysis approach. Literature searches in PubMed, Embase, PsycINFO and Cochrane Library resulted in 13,384 abstracts from database inception to January 1, 2016. Twenty-four RCTs (4889 participants) comparing a guided Internet-based intervention with a control group contributed data to the analysis. Missing data were multiply imputed. To examine treatment outcome on response and remission, mixed-effects models with participants nested within studies were used. Response and remission rates were calculated using the Reliable Change Index. The intervention group obtained significantly higher response rates (OR = 2.49, 95% CI 2.17-2.85) and remission rates compared to controls (OR = 2.41, 95% CI 2.07-2.79). The moderator analysis indicated that older participants (OR = 1.01) and native-born participants (1.66) were more likely to respond to treatment compared to younger participants and ethnic minorities respectively. Age (OR = 1.01) and ethnicity (1.73) also moderated the effects of treatment on remission.Moreover, adults with more severe depressive symptoms at baseline were more likely to remit after receiving intemet-based treatment (OR = 1.19). Guided Internet-based interventions lead to substantial positive treatment effects on treatment response and remission at post-treatment. Thus, such interventions may complement existing services for depression and potentially reduce the gap between the need and provision of evidence-based treatments.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Internet-based guided self-help, Psychotherapy, Depression, Meta-analysis
National Category
Psychology
Research subject
Health and Caring Sciences, Health Informatics; Social Sciences, Psychology
Identifiers
urn:nbn:se:lnu:diva-77405 (URN)10.1016/j.cpr.2018.06.007 (DOI)000439086800007 ()29940401 (PubMedID)
Available from: 2018-08-29 Created: 2018-08-29 Last updated: 2018-08-29Bibliographically approved
Kaldo, V., Lundin, A., Hallgren, M., Kraepelien, M., Strid, C., Ekblom, Ö., . . . Forsell, Y. (2018). Effects of internet-based cognitive behavioural therapy and physical exercise on sick leave and employment in primary care patients with depression: two subgroup analyses. Occupational and Environmental Medicine, 75(1), 52-58
Open this publication in new window or tab >>Effects of internet-based cognitive behavioural therapy and physical exercise on sick leave and employment in primary care patients with depression: two subgroup analyses
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2018 (English)In: Occupational and Environmental Medicine, ISSN 1351-0711, E-ISSN 1470-7926, Vol. 75, no 1, p. 52-58Article in journal (Refereed) Published
Abstract [en]

Objectives Depression can negatively impact work capacity, but treatment effects on sick leave and employment are unclear. This study evaluates if internet-based cognitive behavioural therapy (ICBT) or physical exercise (PE), with already reported positive effects on clinical outcome and short-term work ability, has better effects on employment, sick leave and long-term work ability compared with treatment as usual (TAU) for depressed primary care patients (German clinical trials: DRKS00008745). Methods After randomisation and exclusion of patients not relevant for work-related analysis, patients were divided into two subgroups: initially unemployed (total n=118) evaluated on employment, and employed (total n=703) evaluated on long-term sick leave. Secondary outcomes were self-rated work ability and average number of sick days per month evaluated for both subgroups. Assessments (self-reports) were made at baseline and follow-up at 3 and 12 months. Results For the initially unemployed subgroup, 52.6% were employed after 1 year (response rate 82%). Both PE (risk ratio (RR)=0.44; 95% CI 0.23 to 0.87) and ICBT (RR=0.37; 95% CI 0.16 to 0.84) showed lower rates compared with TAU after 3 months, but no difference was found after 1 year (PE: RR=0.97; 95% CI 0.69 to 1.57; ICBT: RR=1.23; 95% CI 0.72 to 2,13), For those with initial employment, long-term sick leave (response rate 75%) decreased from 7.8% to 6.5%, but neither PE (RR=1.4; 95% CI 0.52 to 3.74) nor ICBT (RR=0.99; 95% CI 0.39 to 2,46) decreased more than TAU, although a temporary positive effect for PE was found. All groups increased self-rated work ability with no differences found. Conclusions No long-term effects were found for the initially unemployed on employment status or for the initially employed on sick leave. New types of interventions need to be explored.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2018
National Category
Applied Psychology
Research subject
Social Sciences, Psychology
Identifiers
urn:nbn:se:lnu:diva-74018 (URN)10.1136/oemed-2017-104326 (DOI)000419396600009 ()28951431 (PubMedID)
Available from: 2018-05-08 Created: 2018-05-08 Last updated: 2018-05-08Bibliographically approved
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Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-6443-5279

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