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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.

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: 2019-01-17Bibliographically 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.

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: 2019-01-17Bibliographically 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
Titov, N., Dear, B., Nielssen, O., Staples, L., Hadjistavropoulos, H., Nugent, M., . . . Kaldo, V. (2018). ICBT in routine care: A descriptive analysis of successful clinics in five countries. Internet Interventions, 13, 108-115
Open this publication in new window or tab >>ICBT in routine care: A descriptive analysis of successful clinics in five countries
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2018 (English)In: Internet Interventions, ISSN 2214-7829, Vol. 13, p. 108-115Article, review/survey (Refereed) Published
Abstract [en]

Clinical trials have demonstrated the efficacy of internet delivered cognitive behaviour therapy (ICBT) for anxiety and depression. However, relatively little is known about the context, operations, and outcomes of ICBT when administered as part of routine care. This paper describes the setting, relationship to existing health services, procedures for referral, assessment, treatment, patients and outcomes of ICBT clinics in Sweden, Denmark, Norway, Canada and Australia. All five clinics provide services free or at low cost to patients. All have systems of governance to monitor quality of care, patient safety, therapist performance and data security. All five clinics include initial assessments by clinicians and between 10 and 20 min of therapist support during each week. Published reports of outcomes all demonstrate large clinical improvement, low rates of deterioration, and high levels of patient satisfaction. Services that require a face to face assessment treat smaller numbers of patients and have fewer patients from remote locations. The paper shows that therapist-guided ICBT can be a valuable part of mental health services for anxiety and depression. Important components of successful ICBT services are rigorous governance to maintain a high standard of clinical care, and the measurement and reporting of outcomes.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Delivery, Description, Implementation, Internet-delivered cognitive behaviour therapy, Psychological treatment, Routine care, Depression, Anxiety, Disorders
National Category
Psychology
Research subject
Social Sciences, Psychology; Health and Caring Sciences, Health Informatics
Identifiers
urn:nbn:se:lnu:diva-80572 (URN)10.1016/j.invent.2018.07.006 (DOI)000457135000014 ()30206525 (PubMedID)
Available from: 2019-02-19 Created: 2019-02-19 Last updated: 2019-02-19Bibliographically approved
Shahnavaz, S., Hedman-Lagerlöf, E., Hasselblad, T., Reuterskiöld, L., Kaldo, V. & Dahllöf, G. (2018). Internet-Based Cognitive Behavioral Therapy for Children and Adolescents With Dental Anxiety: Open Trial. Journal of Medical Internet Research, 20(1), e12
Open this publication in new window or tab >>Internet-Based Cognitive Behavioral Therapy for Children and Adolescents With Dental Anxiety: Open Trial
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2018 (English)In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 20, no 1, p. e12-Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Cognitive behavioral therapy (CBT) is an evidence-based method for treating specific phobias, but access to treatment is difficult, especially for children and adolescents with dental anxiety. Psychologist-guided Internet-based CBT (ICBT) may be an effective way of increasing accessibility while maintaining treatment effects.

OBJECTIVE:

The aim of this study was to test the hypothesis that psychologist-guided ICBT improves school-aged children's and adolescents' ability to manage dental anxiety by (1) decreasing avoidance and affecting the phobia diagnosis and (2) decreasing the dentalfear and increasing the target groups' self-efficacy. The study also aimed to examine the feasibility and acceptability of this novel treatment.

METHODS:

This was an open, uncontrolled trial with assessments at baseline, posttreatment, and the 1-year follow-up. The study enrolled and treated 18 participants. The primary outcome was level of avoidance behaviors, as measured by the picture-guided behavioral avoidance test (PG-BAT). The secondary outcome was a diagnostic evaluation with the parents conducted by a psychologist. The specific phobia section of the structured interview Kiddie-Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime (K-SADS-PL) was used. Other outcome measures included level of dental anxiety and self-efficacy. The ICBT, which employed exposure therapy, comprised 12 modules of texts, animations, dentistry-related video clips, and an exercise package (including dental instruments). Participants accessed the treatment through an Internet-based treatment platform and received Web-based guidance from a psychologist. Treatment also included training at dental clinics. Feasibility and acceptability were assessed by measures of engagement, adherence, compliance, completed measures, patient and parent satisfaction scale, and staff acceptability.

RESULTS:

The level of avoidance (according to the primary outcome measure PG-BAT) and dental anxiety decreased and self-efficacy increased significantly (P<.001), within-group effect sizes for both the primary outcome (Cohen d=1.5), and other outcomes were large in the range of 0.9 and 1.5. According to K-SADS-PL, 53% (8/15) of the participants were free from diagnosable dental anxiety at the 1-year follow-up. At the 1-year follow-up, improvements were maintained and clinically significant, with 60% (9/15) of participants who had been unable to manage intraoral injection of local anesthetics before ICBT reporting having accomplished this task at a dental clinic. The target group showed improvement in all the outcome measures. High levels of feasibility and acceptability were observed for the treatment.

CONCLUSIONS:

ICBT is a promising and feasible treatment for dental anxiety in children and adolescents. Integrating it into routine pediatric dental care would increase access to an effective psychological treatment. The results of this open trial must be replicated in controlled studies.

National Category
Applied Psychology
Research subject
Social Sciences, Psychology
Identifiers
urn:nbn:se:lnu:diva-73910 (URN)10.2196/jmir.7803 (DOI)29358158 (PubMedID)
Available from: 2018-05-04 Created: 2018-05-04 Last updated: 2018-05-08Bibliographically approved
Heinonen, E., Szymanska-von Schultz, B., Kaldo, V., Nasiell, J., Andersson, E., Bergmark, M., . . . Gustafsson, L. L. (2018). MAGDALENA: study protocol of a randomised, placebo-controlled trial on cognitive development at 2 years of age in children exposed to SSRI in utero. BMJ Open, 8(8), Article ID e023281.
Open this publication in new window or tab >>MAGDALENA: study protocol of a randomised, placebo-controlled trial on cognitive development at 2 years of age in children exposed to SSRI in utero
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2018 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 8, article id e023281Article in journal (Refereed) Published
Abstract [en]

Introduction Ten per cent of all pregnant women are depressed. Standard therapy of pregnant women with moderate depression is selective serotonin reuptakeinhibitors (SSRI). Observational studies on neurodevelopment after fetal SSRI exposure show conflicting results. Our primary objective is to compare the cognitive development in children exposed to sertraline and maternal depression with those exposed to maternal depression and placebo in utero. We hypothesise that there is a significant neurodevelopmental difference between the groups. As a secondary objective, we study the add-on effect of sertraline to internet-based cognitive behavioural therapy (ICBT) to treat moderate depression during pregnancy. Methods and analysis MAGDALENA is a randomised, placebo-controlled, double-blinded trial in Stockholm Healthcare Region with 2.3 million inhabitants. The women are recruited in weeks 9-21 of pregnancy either through Antenatal Health Clinics or through social media. They are to be diagnosed with moderate depression without ongoing antidepressive therapy or any serious comorbidity. The women in the intervention arm receive sertraline combined with a 12-week period of ICBT; the control arm is treated with placebo and ICBT. We assess the cognitive development in the offspring at the age of 2 years using Bayley Scales of Infant and Toddler Development, third edition (BSID-III). We aim at recruiting 200 women, 100 women in each treatment arm, to ensure statistical power to detect a clinically relevant difference between the groups. Ethics and dissemination This randomised trial will provide long-sought evidence about the effects of SSRI and maternal depression during pregnancy on the neurodevelopment in the offspring. The study is approved by the Regional Ethical Review Board at Karolinska Institutet in Stockholm and the Swedish Medical Products Agency. It is registered with the European Clinical Trials Database (EudraCT), Number: 2013-004444-31. Results will be disseminated at scientific conferences, published in peer-reviewed journals and made available to the public.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2018
Keywords
antenatal depression, internet-based cognitive behaviour therapy, serotonin reuptake inhibitors, neurodevelopment, pregnancy, drug metabolism
National Category
Psychology
Research subject
Social Sciences, Psychology
Identifiers
urn:nbn:se:lnu:diva-78622 (URN)10.1136/bmjopen-2018-023281 (DOI)000446470200178 ()30082365 (PubMedID)
Available from: 2018-11-01 Created: 2018-11-01 Last updated: 2018-11-01Bibliographically approved
Jernelov, S., Lekander, M., Blom, K. & Kaldo, V. (2018). One and ten-year follow-up of insomnia severity after a randomized trial of behavioral self-help treatment for insomnia with or without therapist guidance. 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 >>One and ten-year follow-up of insomnia severity after a randomized trial of behavioral self-help treatment for insomnia with or without therapist guidance
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-78099 (URN)000444228300875 ()
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
Hallberg, J., Kaldo, V., Arver, S., Dhejne, C. & Görts Öberg, K. (2017). A Cognitive-Behavioral Therapy Group Intervention for Hypersexual Disorder: A Feasibility Study. Journal of Sexual Medicine, 14(7), 950-958
Open this publication in new window or tab >>A Cognitive-Behavioral Therapy Group Intervention for Hypersexual Disorder: A Feasibility Study
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2017 (English)In: Journal of Sexual Medicine, ISSN 1743-6095, E-ISSN 1743-6109, Vol. 14, no 7, p. 950-958Article in journal (Refereed) Published
Abstract [en]

Background: The proposed criteria of the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition for hypersexual disorder (HD) included symptoms reported by patients seeking help for excessive and out-of-control non-paraphilic sexual behavior, including sexual behaviors in response to dysphoric mood states, impulsivity, and risk taking. Although no prior studies of cognitive-behavioral therapy (CBT) for the treatment of HD have been performed, CBT has been found effective for dysphoric mood states and impulsivity. Aim: To investigate the feasibility of a CBT manual developed for HD explored through symptom decrease, treatment attendance, and clients' treatment satisfaction. Methods: Ten men with a diagnosis of HD took part in the CBT group program. Measurements were taken before, during, and at the end of treatment and 3 and 6 months after treatment. Outcomes: The primary outcome was the Hypersexual Disorder: Current Assessment Scale (HD: CAS) score that measured the severity of problematic hypersexual symptoms and secondary outcomes were the Hypersexual Disorder Screening Inventory (HDSI) score, the proportion of attended sessions, and the Client Satisfaction Questionnaire (CSQ-8) score. Results: Main results were significant decreases of HD symptoms from before to after treatment on HD: CAS and HDSI scores and a decrease in the number of problematic sexual behaviors during the course of therapy. A high attendance rate of 93% and a high treatment satisfaction score on CSQ-8 also were found. Clinical Implications: The CBT program seemed to ameliorate the symptoms of HD and therefore might be a feasible treatment option. Strengths and Limitations: This study provides data from a CBT program for the treatment of the specific proposed criteria of HD. Because of the small sample and lack of a control group, the results can be considered only preliminary. Conclusion: Although participants reported decreased HD symptoms after attending the CBT program, future studies should evaluate the treatment program with a larger sample and a randomized controlled procedure to ensure treatment effectiveness. Copyright (C) 2017, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

Place, publisher, year, edition, pages
Elsevier, 2017
Keywords
Hypersexual Disorder, Sexual Addiction, Cognitive-Behavioral Therapy, Hypersexual Disorder Screening Inventory, Hypersexual Disorder: Current Assessment Scale, Client Satisfaction Questionnaire, Treatment Satisfaction
National Category
Applied Psychology
Research subject
Social Sciences, Psychology
Identifiers
urn:nbn:se:lnu:diva-74020 (URN)10.1016/j.jsxm.2017.05.004 (DOI)000405224800012 ()28602666 (PubMedID)
Available from: 2018-05-08 Created: 2018-05-08 Last updated: 2018-05-08Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-6443-5279

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