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  • 51.
    Löf, J
    et al.
    Stockholm County Council, Sweden.
    Clinton, D
    Karolinska Institutet, Sweden;Institute for Eating Disorders, Oslo, Norway.
    Kaldo, Viktor
    Stockholm County Council, Sweden;Karolinska Institutet, Sweden.
    Rydén, G
    Child and Adolescent Psychiatry Clinic, Stockholm, Sweden.
    Symptom, alexithymia and self-image outcomes of Mentalisation-based treatment for borderline personality disorder: a naturalistic study2018In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 18, no 1, p. 1-9, article id 185Article in journal (Refereed)
    Abstract [en]

    Background: Mentalisation-based treatment (MBT) in borderline personality disorder (BPD) has a growing evidence base, but there is a lack of effectiveness and moderator studies. The present study examined the effectiveness of MBT in a naturalistic setting and explored psychiatric and psychological moderators of outcome. 

    Method: Borderline and general psychiatric symptoms, suicidality, self-harm, alexithymia and self-image were measured in a group of BPD patients (n = 75) receiving MBT; assessments were made at baseline, and subsequently after 6, 12 and 18 months (when treatment ended). Borderline symptoms were the primary outcome variable. 

    Results: Borderline symptoms improved significantly (d = 0.79, p <.001), as did general psychiatric symptoms, suicidality, self-harm, self-rated alexithymiaand self-image. BPD severity or psychological moderators had no effect on outcome. Younger patients improved more on self-harm, although this could be explained by the fact that older patients had considerably lower baseline self-harm. 

    Conclusions: MBT seems to be an effective treatment in a naturalistic setting for BPD patients. This study is one of the first studies of MBT showing that outcomes related to mentalisation, self-image and self-rated alexithymia improved. Initial symptom severity did not influence results indicating that MBT treatment is well adapted to patients with severe BPD symptoms. 

    Trial registration: The study was retrospectively registered 25 September 2017 in the ClinicalTrials.gov PRS registry, no. NCT03295838.

  • 52.
    Moëll, Birger
    et al.
    Karolinska Institutet;Stockholm University.
    Kollberg, Linnea
    Karolinska Institutet.
    Nasri, Berkeh
    Karolinska Institutet.
    Lindefors, Nils
    Karolinska Institutet.
    Kaldo, Viktor
    Karolinska Institutet.
    Living SMART - A randomized controlled trial of a guided online course teaching adults with ADHD or sub-clinical ADHD to use smartphones to structure their everyday life2015In: Internet Interventions, ISSN 2214-7829, Vol. 2, no 1, p. 24-31Article in journal (Refereed)
    Abstract [en]

    Abstract

    Objective

    To evaluate an online intervention for adults with ADHD that aimed to improve organizational skills and attention with the help of smartphone applications.

    Method

    Participants (n = 57) were recruited and assessed through questionnaires and telephone interviews. Diagnoses of ADHD were confirmed for 83% of the participants, 5% most probably had the diagnoses, and 12% did not fulfill all diagnostic criteria despite high levels of symptoms. Participants were randomized between the intervention (n = 29) and a wait-list control group (n = 28). The 6-week intervention involved support from a coach in finding a routine for organizing everyday life with the help of smartphone applications. The primary outcome measure was ASRS Inattention. Secondary outcomes were ASRS sub-scale Hyperactivity and measures of depression, anxiety, stress, quality of life and general level of functioning. Blind evaluators also assessed improvement in organization and inattention at post treatment.

    Result

    The participants receiving the Living Smart course reduced their average scores on ASRS-Inattention from 28.1 (SD = 4.5) to 22.9 (SD = 4.3) which was a significantly larger reduction than found in the control group. 33% of participants were considered clinically significantly improved according to the blind evaluator, compared to 0% in the control group. The same results were found when only participants with a confirmed diagnose were included in the analyses.

    Conclusion

    Adults with ADHD seem to be able to use smartphone applications to organize their everyday life and can be taught how to do this via online interventions.

  • 53.
    Nasri, Berkeh
    et al.
    Karolinska Institutet, Sweden;Huddinge hospital, Sweden.
    Castenfors, Malin
    PRIMA Child and Adult Psychiatry, Sweden.
    Fredlund, Peggy
    Huddinge hospital, Sweden.
    Ginsberg, Ylva
    Karolinska Institutet, Sweden;Huddinge hospital, Sweden.
    Lindefors, Nils
    Karolinska Institutet, Sweden;Huddinge hospital, Sweden.
    Kaldo, Viktor
    Karolinska Institutet, Sweden;Huddinge hospital, Sweden.
    Group Treatment for Adults With ADHD Based on a Novel Combination of Cognitive and Dialectical Behavior Interventions: A Feasibility Study2020In: Journal of Attention Disorders, ISSN 1087-0547, E-ISSN 1557-1246, Vol. 24, no 6, p. 904-917Article in journal (Refereed)
    Abstract [en]

    Objectives: To evaluate feasibility and preliminary effects of a new group treatment manual for adults with ADHD and to explore adherence to treatment and its relation to outcome. Method:Eighteen adults with ADHD recruited from neuropsychiatric units in Stockholm underwent a 14-week program including combined cognitive and dialectical behavior therapy. Assessments were made at baseline, posttreatment, and follow-up, at one and six months after treatment end. Primary outcome measure was the Adult ADHD Self Report Scale version 1.1. Results/Conclusion: ADHD symptoms significantly decreased (d = 1.29) and remained stable for 6 months. Measures of depression, perceived stress, and anxiety were also significantly reduced. Attendance and patient satisfaction was high. Use, comprehension, and perceived benefit of treatment components varied from medium to high. Total use of treatment components was, in general, positively correlated with favorable outcome. The current combination of treatment components may be a valuable addition to available treatments in psychiatric care.

  • 54.
    Nissen, Eva Rames
    et al.
    Aarhus Univ, Denmark.
    O'Connor, Maja
    Aarhus Univ, Denmark.
    Kaldo, Viktor
    Linnaeus University, Faculty of Health and Life Sciences, Department of Psychology. Karolinska Institutet, Sweden;Stockholm Health Care Services, Sweden.
    Hojris, Inger
    Aarhus Univ Hosp, Denmark.
    Borre, Michael
    Aarhus Univ Hosp, Denmark.
    Zachariae, Robert
    Aarhus Univ, Denmark;Aarhus Univ Hosp, Denmark.
    Mehlsen, Mimi
    Aarhus Univ, Denmark.
    Internet-delivered mindfulness-based cognitive therapy for anxiety and depression in cancer survivors: A randomized controlled trial2020In: Psycho-Oncology, ISSN 1057-9249, E-ISSN 1099-1611, Vol. 29, no 1, p. 68-75Article in journal (Refereed)
    Abstract [en]

    Objective Internet-delivered interventions may alleviate distress in cancer survivors with limited access to psychological face-to-face treatment. In collaboration with a group of cancer survivors, we developed and tested the efficacy of a therapist-assisted internet-delivered mindfulness-based cognitive therapy (iMBCT) program for anxiety and depression in cancer survivors. Methods A total of 1282 cancer survivors were screened for anxiety and depression during their routine oncology follow-up; eligible breast (n = 137) and prostate cancer (n = 13) survivors were randomized to iMBCT or care-as-usual (CAU) wait-list. Primary outcomes of anxiety and depression were assessed at baseline, 5 weeks, 10 weeks (post intervention), and 6 months. Results Significant effects were found for both anxiety (Cohen's d = 0.45; P = .017) and depressive symptoms (d = 0.42; P = .024) post intervention. The effects were maintained at follow-up for anxiety (d = 0.40; P = .029), but not for depressive symptoms (d = 0.28; P = .131). Conclusions Our preliminary findings suggest iMBCT to be a helpful intervention for cancer survivors suffering from symptoms of anxiety. Further studies on the efficacy for symptoms of depression are needed.

  • 55.
    Rahman, M. S.
    et al.
    Karolinska Institutet, Sweden.
    Zhao, X.
    Karolinska Institutet, Sweden.
    Liu, J. J.
    Karolinska Institutet, Sweden;Karolinska University Hospital, Sweden.
    Torres, E. Q.
    Karolinska Institutet, Sweden.
    Tibert, B.
    Karolinska Institutet, Sweden;Karolinska University Hospital, Sweden.
    Kumar, P.
    Karolinska Institutet, Sweden;Karolinska University Hospital, Sweden.
    Kaldo, Viktor
    Linnaeus University, Faculty of Health and Life Sciences, Department of Psychology. Karolinska Institutet, Sweden.
    Lindefors, N.
    Karolinska Institutet, Sweden.
    Forsell, Y.
    Karolinska Institutet, Sweden.
    Lavebratt, C.
    Karolinska Institutet, Sweden;Karolinska University Hospital, Sweden.
    Exercise Reduces Salivary Morning Cortisol Levels in Patients with Depression2019In: Molecular Neuropsychiatry, ISSN 2296-9209, Vol. 4, no 4, p. 196-203Article in journal (Refereed)
    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.

  • 56.
    Rosen, A.
    et al.
    Karolinska Institutet.
    Jernelov, S.
    Karolinska Institutet.
    Kaldo, Viktor
    Linnaeus University, Faculty of Health and Life Sciences, Department of Psychology. Karolinska Institutet.
    Forsell, E.
    Karolinska Institutet.
    Akerstedt, T.
    Karolinska Institutet.
    D'onofrio, P.
    Stockholm University.
    Cognitive behavior therapy for insomnia - is sleep compression an equally effective and less difficult alternative compared to sleep restriction?2018In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 27Article in journal (Other academic)
  • 57.
    Rozental, Alexander
    et al.
    Stockholm University.
    Andersson, Gerhard
    Linköping University;Karolinska Institutet.
    Boettcher, Johanna
    Freie Universität Berlin, Germany.
    Ebert, David Daniel
    Philipps University Marburg, Germany.
    Cuijpers, Pim
    Vrije Universiteit Amsterdam, The Netherlands.
    Knaevelsrud, Christine
    Freie Universität Berlin, Germany.
    Ljotsson, Brjann
    Karolinska Institutet.
    Kaldo, Viktor
    Karolinska Institutet.
    Titov, Nickolai
    Macquarie University, Australia.
    Carlbring, Per
    Stockholm University.
    Consensus statement on defining and measuring negative effects of Internet interventions2014In: Internet Interventions, ISSN 2214-7829, Vol. 1, no 1, p. 12-19Article in journal (Refereed)
    Abstract [en]

    Abstract Internet interventions have great potential for alleviating emotional distress, promoting mental health, and enhancing well-being. Numerous clinical trials have demonstrated their efficacy for a number of psychiatric conditions, and interventions delivered via the Internet will likely become a common alternative to face-to-face treatment. Meanwhile, research has paid little attention to the negative effects associated with treatment, warranting further investigation of the possibility that some patients might deteriorate or encounter adverse events despite receiving best available care. Evidence from research of face-to-face treatment suggests that negative effects afflict 5–10% of all patients undergoing treatment in terms of deterioration. However, there is currently a lack of consensus on how to define and measure negative effects in psychotherapy research in general, leaving researchers without practical guidelines for monitoring and reporting negative effects in clinical trials. The current paper therefore seeks to provide recommendations that could promote the study of negative effects in Internet interventions with the aim of increasing the knowledge of its occurrence and characteristics. Ten leading experts in the field of Internet interventions were invited to participate and share their perspective on how to explore negative effects, using the Delphi technique to facilitate a dialog and reach an agreement. The authors discuss the importance of conducting research on negative effects in order to further the understanding of its incidence and different features. Suggestions on how to classify and measure negative effects in Internet interventions are proposed, involving methods from both quantitative and qualitative research. Potential mechanisms underlying negative effects are also discussed, differentiating common factors shared with face-to-face treatments from those unique to treatments delivered via the Internet. The authors conclude that negative effects are to be expected and need to be acknowledged to a greater extent, advising researchers to systematically probe for negative effects whenever conducting clinical trials involving Internet interventions, as well as to share their findings in scientific journals.

  • 58.
    Safinianaini, Negar
    et al.
    KTH Royal instute of technology, Sweden.
    Boström, Henrik
    KTH Royal instute of technology, Sweden.
    Kaldo, Viktor
    Linnaeus University, Faculty of Health and Life Sciences, Department of Psychology. Karolinska Institutet, Sweden;Stockholm County Council, Sweden.
    Gated Hidden Markov Models for Early Prediction of Outcome of Internet-Based Cognitive Behavioral Therapy2019In: Artificial Intelligence in Medicine, AIME 2019 / [ed] Riano, D Wilk, S TenTeije, A, Springer, 2019, p. 160-169Conference paper (Refereed)
    Abstract [en]

    Depression is a major threat to public health and its mitigation is considered to be of utmost importance. Internet-based Cognitive Behavioral Therapy (ICBT) is one of the employed treatments for depression. However, for the approach to be effective, it is crucial that the outcome of the treatment is accurately predicted as early as possible, to allow for its adaptation to the individual patient. Hidden Markov models (HMMs) have been commonly applied to characterize systematic changes in multivariate time series within health care. However, they have limited capabilities in capturing long-range interactions between emitted symbols. For the task of analyzing ICBT data, one such long-range interaction concerns the dependence of state transition on fractional change of emitted symbols. Gated Hidden Markov Models (GHMMs) are proposed as a solution to this problem. They extend standard HMMs by modifying the Expectation Maximization algorithm; for each observation sequence, the new algorithm regulates the transition probability update based on the fractional change, as specified by domain knowledge. GHMMs are compared to standard HMMs and a recently proposed approach, Inertial Hidden Markov Models, on the task of early prediction of ICBT outcome for treating depression; the algorithms are evaluated on outcome prediction, up to 7 weeks before ICBT ends. GHMMs are shown to outperform both alternative models, with an improvement of AUC ranging from 12 to 23%. These promising results indicate that considering fractional change of the observation sequence when updating state transition probabilities may indeed have a positive effect on early prediction of ICBT outcome.

  • 59.
    Schibbye, Peter
    et al.
    Karolinska Institutet;Sundsvall Härnösand Cty Hosp.
    Ghaderi, Ata
    Karolinska Institutet.
    Ljotsson, Brjann
    Karolinska Institutet.
    Hedman, Erik
    Karolinska Institutet.
    Lindefors, Nils
    Karolinska Institutet.
    Ruck, Christian
    Karolinska Institutet.
    Kaldo, Viktor
    Karolinska Institutet.
    Using Early Change to Predict Outcome in Cognitive Behaviour Therapy: Exploring Timeframe, Calculation Method, and Differences of Disorder-Specific versus General Measures2014In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, no 6, article id e100614Article in journal (Refereed)
    Abstract [en]

    Early change can predict outcome of psychological treatment, especially in cognitive behavior therapy. However, the optimal operationalization of "early change'' for maximizing its predictive ability, and differences in predictive ability of disorder-specific versus general mental health measures has yet to be clarified. This study aimed to investigate how well early change predicted outcome depending on the week it was measured, the calculation method (regression slope or simple subtraction), the type of measures used, and the target disorder. During 10-15 weeks of internet-based cognitive behavior therapy for depression, social anxiety disorder, or panic disorder, weekly ratings were collected through both disorder-specific measures and general measures (Outcome Questionnaire-45 (OQ-45) and Clinical Outcomes in Routine Evaluation-10 (CORE-10)). With outcome defined as the disorder-specific measure, change at week four was the optimal predictor. Slope and subtraction methods performed equally well. The OQ-45 explained 18% of outcome for depression, 14% for social anxiety disorder, and 0% for panic disorder. Corresponding values for CORE-10 were 23%, 29%, and 25%. Specific measures explained 41%, 43%, and 34% respectively: this exceeded the ability of general measures also when they predicted themselves. We conclude that a simple calculation method with a disorder-specific measure at week four seems to provide a good choice for predicting outcome in time-limited cognitive behavior therapy.

  • 60.
    Shahnavaz, Shervin
    et al.
    Karolinska Institutet.
    Hedman-Lagerlöf, Erik
    Karolinska Institutet.
    Hasselblad, Tove
    Karolinska Institutet.
    Reuterskiöld, Lena
    Stockholm University.
    Kaldo, Viktor
    Karolinska Institutet.
    Dahllöf, Göran
    Karolinska Institutet.
    Internet-Based Cognitive Behavioral Therapy for Children and Adolescents With Dental Anxiety: Open Trial2018In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 20, no 1, p. e12-Article in journal (Refereed)
    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.

  • 61.
    Sundström, Christopher
    et al.
    Karolinska Institutet, Sweden;Univ Regina, Canada.
    Eek, Niels
    University of Gothenburg, Sweden.
    Kraepelien, Martin
    Karolinska Institutet, Sweden;Stockholm County Council, Sweden.
    Fahlke, Claudia
    University of Gothenburg, Sweden.
    Gajecki, Mikael
    Karolinska Institutet, Sweden;Stockholm County Council, Sweden.
    Jakobson, Miriam
    Stockholm County Council, Sweden.
    Beckman, Maria
    Karolinska Institutet, Sweden;Stockholm County Council, Sweden.
    Kaldo, Viktor
    Linnaeus University, Faculty of Health and Life Sciences, Department of Psychology. Karolinska Institutet, Sweden.
    Berman, Anne H.
    Karolinska Institutet, Sweden;Stockholm County Council, Sweden.
    High- versus low-intensity internet interventions for alcohol use disorders: results of a three-armed randomized controlled superiority trial2020In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 115, no 5, p. 863-874Article in journal (Refereed)
    Abstract [en]

    Aims To test the efficacy of a therapist-guided high-intensity internet intervention compared with an unguided low-intensity internet intervention among individuals with alcohol use disorder. Design A three-group randomized controlled trial with follow-up assessments post-treatment (12 weeks) and 6 months post-randomization (primary end-point). Settings General population sample in Sweden. Participants A total of 166 on-line self-referred adults (49% males) with a score of 14 (females)/16 (males) or more on the Alcohol Use Disorders Identification Test, a preceding week alcohol consumption of 11 (females)/14 (males) or more standard drinks and an alcohol use disorder according to a diagnostic interview. Interventions and comparators Both the high- (n = 72) and low-intensity internet interventions (n = 71) consisted of modules based on relapse prevention. Controls were on a waiting-list (n = 23), and were only followed until the post-treatment follow-up. Participants were randomized at a 7 : 7 : 2 ratio. Measurements Primary outcome was self-reported alcohol consumption in the preceding week measured as (1) number of standard drinks and (2) number of heavy drinking days at the 6-month follow-up. Findings Alcohol use disorders were largely in the severe category (74.7%), with the majority of participants having had alcohol problems for more than 5 years. Attrition was 13 and 22% at the post-treatment and 6-month follow-up, respectively. At the 6-month follow-up, an intent-to-treat analysis showed no significant differences in alcohol consumption between the high- and low-intensity interventions [standard drinks d = -0.17, 95% confidence interval (CI) = -0.50 to 0.16; heavy drinking days: d = -0.07, 95% CI = -0.40 to 0.26]. Prevalence of negative effects was somewhat low (8-14%) in both intervention groups, as was deterioration (3-5%). Conclusions At 6-month follow-up, there were no significant differences between a therapist-guided high-intensity internet intervention and an unguided low-intensity internet intervention in reducing alcohol consumption among individuals with an alcohol use disorder.

  • 62.
    Sundström, Christopher
    et al.
    Karolinska Institutet;Stockholm Cty Council.
    Kraepelien, Martin
    Karolinska Institutet;Stockholm Cty Council.
    Eek, Niels
    University of Gothenburg.
    Fahlke, Claudia
    University of Gothenburg.
    Kaldo, Viktor
    Karolinska Institutet;Stockholm Cty Council.
    Berman, Anne H.
    Karolinska Institutet;Stockholm Cty Council;Stockholm Center for Dependency Disorders.
    High-intensity therapist-guided internet-based cognitive behavior therapy for alcohol use disorder: a pilot study2017In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 17, article id 197Article in journal (Refereed)
    Abstract [en]

    Background: A large proportion of individuals with alcohol problems do not seek psychological treatment, but access to such treatment could potentially be increased by delivering it over the Internet. Cognitive behavior therapy (CBT) is widely recognized as one of the psychological treatments for alcohol problems for which evidence is most robust. This study evaluated a new, therapist-guided internet-based CBT program (entitled ePlus) for individuals with alcohol use disorders. Methods: Participants in the study (n = 13) were recruited through an alcohol self-help web site (www.alkoholhjalpen.se) and, after initial internet screening, were diagnostically assessed by telephone. Eligible participants were offered access to the therapist-guided 12-week program. The main outcomes were treatment usage data (module completion, treatment satisfaction) as well as glasses of alcohol consumed the preceding week, measured with the self-rated Timeline Followback (TLFB). Participant data were collected at screening (T0), immediately pre-treatment (T1), post-treatment (T2) and 3 months post-treatment (T3). Results: Most participants were active throughout the treatment and found it highly acceptable. Significant reductions in alcohol consumption with a large within-group effect size were found at the three-month follow-up. Secondary outcome measures of craving and self-efficacy, as well as depression and quality of life, also showed significant improvements with moderate to large within-group effect sizes. Conclusions: Therapist-guided internet-based CBT may be a feasible and effective alternative for people with alcohol use disorders. In view of the high acceptability and the large within-group effect sizes found in this small pilot, a randomized controlled trial investigating treatment efficacy is warranted.

  • 63.
    Titov, Nickolai
    et al.
    Macquarie Univ, Australia.
    Dear, Blake
    Macquarie Univ, Australia.
    Nielssen, Olav
    Macquarie Univ, Australia.
    Staples, Lauren
    Macquarie Univ, Australia.
    Hadjistavropoulos, Heather
    Univ Regina, Canada.
    Nugent, Marcie
    Univ Regina, Canada.
    Adlam, Kelly
    Univ Regina, Canada.
    Nordgreen, Tine
    Haukeland Hosp, Norway;Univ Bergen, Norway.
    Bruvik, Kristin Hogstad
    Haukeland Hosp, Norway.
    Hovland, Anders
    Solli Dist Psychiat Ctr, Norway;Univ Bergen, Norway.
    Repal, Arne
    Vestfold Hosp, Norway.
    Mathiasen, Kim
    Univ Southern Denmark, Denmark;Mental Hlth Serv Southern Denmark, Denmark.
    Kraepelien, Martin
    Karolinska Institutet;Stockholm County Council.
    Blom, Kerstin
    Haukeland Hosp, Norway;Karolinska Institutet;Stockholm County Council.
    Svanborg, Cecilia
    Karolinska Institutet;Stockholm County Council.
    Lindefors, Nils
    Karolinska Institutet;Stockholm County Council.
    Kaldo, Viktor
    Linnaeus University, Faculty of Health and Life Sciences, Department of Psychology. Karolinska Institutet;Stockholm County Council.
    ICBT in routine care: A descriptive analysis of successful clinics in five countries2018In: Internet Interventions, ISSN 2214-7829, Vol. 13, p. 108-115Article, review/survey (Refereed)
    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.

  • 64.
    van Straten, Annemieke
    et al.
    Vrije University Amsterdam, The Netherlands.
    Blom, Kerstin
    Karolinska institutet.
    Lancee, Jaap
    University of Amsterdam, The Netherlands.
    Kaldo, Viktor
    Karolinska Institutet.
    ICBT for Insomnia2016In: Guided Internet-Based Treatments in Psychiatry / [ed] Nils Lindefors & Gerhard Andersson, Springer, 2016, p. 143-162Chapter in book (Refereed)
  • 65.
    Weise, Cornelia
    et al.
    Philipps-Universität Marburg, Germany.
    Kleinstäuber, Maria
    Philipps-Universität Marburg, Germany.
    Kaldo, Viktor
    Karolinska Institutet.
    Andersson, Gerhard
    Liköping university.
    Mit Tinnitus leben lernen: Ein Manual für Therapeuten und Betroffene2016Book (Refereed)
  • 66.
    Yogarajah, Aravinthan
    et al.
    Western Norway University of Applied Sciences, Norway.
    Kenter, Robin
    University of Bergen, Norway.
    Lamo, Yngve
    Western Norway University of Applied Sciences, Norway.
    Kaldo, Viktor
    Linnaeus University, Faculty of Health and Life Sciences, Department of Psychology. Karolinska Institutet, Sweden;Region Stockholm, Sweden.
    Nordgreen, Tine
    University of Bergen, Norway;Haukeland University Hospital, Norway.
    Internet-delivered mental health treatment systems in Scandinavia – A usability evaluation2020In: Internet Interventions, ISSN 2214-7829Article in journal (Refereed)
    Abstract [en]

    Mental health problems are a major public health concern worldwide. Approximately 50% of the population will experience mental problems during their life. Traditional treatment is based on psychopharmacotherapy or psychotherapy, with face-to-face interaction between the patient and the therapist. New technologies such as Internet-delivered treatments are seen as an opportunity to offer more scalable and cost-efficient treatments in the field of mental health. Despite the growing interest and new evidence supporting the effect of Internet-delivered treatments is it remarkably little research on how the technology and the usability of Internet-delivered treatment programs affects the treatment. In this paper, we propose a set of evaluation criteria for evaluating the usability and the responsive design of Internet-delivered treatment systems. By our knowledge we are the first to include usability and universal design principles in the evaluation of Internet-delivered treatment systems. Our findings indicate that despite the good treatment results and proven clinical effects, the systems in general have several issues regarding usability, universal design and outdated technology. Based on our findings we propose that there should be established guidelines for testing the usability and technology of Internet-delivered treatment systems.

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