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  • 1.
    El Alaoui, Samir
    et al.
    Karolinska Institutet.
    Hedman, Erik
    Karolinska Institutet.
    Kaldo, Viktor
    Karolinska Institutet.
    Hesser, Hugo
    Linköping University.
    Kraepelien, Martin
    Karolinska Institutet.
    Andersson, Evelyn
    Karolinska Institutet.
    Ruck, Christian
    Karolinska Institutet.
    Andersson, Gerhard
    Karolinska Institutet;Linköping University.
    Ljotsson, Brjann
    Karolinska Institutet.
    Lindefors, Nils
    Karolinska Institutet.
    Effectiveness of Internet-Based Cognitive-Behavior Therapy for Social Anxiety Disorder in Clinical Psychiatry2015In: Journal of Consulting and Clinical Psychology, ISSN 0022-006X, E-ISSN 1939-2117, Vol. 83, no 5, p. 902-914Article in journal (Refereed)
    Abstract [en]

    Objective: Internet-based cognitive-behavioral therapy (ICBT) has received increased attention as an innovative approach to improve access to evidence-based psychological treatments. Although the efficacy of ICBT for social anxiety disorder has been established in several studies, there is limited knowledge of its effectiveness and application in clinical psychiatric care. The purpose of this study was to evaluate the effectiveness of ICBT in the treatment of social anxiety disorder and to determine the significance of patient adherence and the clinic's years of experience in delivering ICBT. Method: A longitudinal cohort study was conducted using latent growth curve modeling of patients (N = 654) treated with ICBT at an outpatient psychiatric clinic between 2009 and 2013. The primary outcome measure was the Liebowitz Social Anxiety Scale-Self-Rated. Results: Significant reductions in symptoms of social anxiety were observed after treatment (effect size d = 0.86, 99% CI [0.74, 0.98]). Improvements were sustained at 6-month follow-up (d = 1.15, 99% CI [0.99, 1.32]). Patient adherence had a positive effect on the rate of improvement. A positive association between the clinic's years of experience with ICBT and treatment outcome was also observed. Conclusions: This study suggests that ICBT for social anxiety disorder is effective when delivered within the context of a unit specialized in Internet-based psychiatric care and may be considered as a treatment alternative for implementation within the mental health care system.

  • 2.
    Kaldo, Viktor
    et al.
    Karolinska Institutet.
    Ramnerö, Jonas
    Stockholm University.
    Jernelöv, Susanna
    Karolinska Institutet.
    Involving clients in treatment methods: A neglected interaction in the therapeutic relationship2015In: Journal of Consulting and Clinical Psychology, ISSN 0022-006X, E-ISSN 1939-2117, Vol. 83, no 6, p. 1136-1141, article id 2015-30577-001Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    The authors investigate a model on how clients' differential involvement in therapeutic methods mediates the effect of therapist support in psychological treatment-in this case, a cognitive behaviorally based bibliotherapy for insomnia, administered with or without supportive telephone calls.

    METHOD:

    Eighty-nine participants, who fulfilled diagnostic criteria for insomnia, had a mean age of 49.1 years (range, 18-73 years) and were predominantly female (77%), fairly well educated, and mainly Caucasian. Participants were randomized between a bibliotherapeutic self-help treatment and the same treatment with the addition of therapist support. Primary outcome measure was the Insomnia Severity Index. Data on involvement in different methods and aspects of the treatment were estimated by clients at posttreatment and validated against therapist ratings of client involvement during treatment. Structural equation modeling was used to test if the effect of therapeutic support on outcome was mediated by involvement in treatment.

    RESULTS:

    Carrying out the treatment with therapist support significantly boosted the therapeutic effects. A mediational analysis with involvement in the three key treatment methods (sleep restriction, sleep compression, and stimulus control) as the mediator fully mediated the differential effect between the two conditions (Sobel test; r = .31; z = 2.173; p < .05) and explained 68.4% of the total effect.

    CONCLUSIONS:

    Therapeutic support improved outcome via higher patient involvement rather than having a direct effect on outcome. Thus, relationship and methods could be regarded as interactional, and patient involvement should be considered. These factors could be further studied in treatments where specific ingredients within the therapeutic contact can be experimentally manipulated.

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