Andersson G. Using the Internet to provide cognitive behaviour therapy

Department of Behavioural Sciences and Learning, Swedish Institute for Disability Research, Linköping University, Linköping, Sweden.
Behaviour Research and Therapy (Impact Factor: 3.85). 03/2009; 47(3):175-80. DOI: 10.1016/j.brat.2009.01.010
Source: PubMed

ABSTRACT A new treatment form has emerged that merges cognitive behaviour therapy with the Internet. By delivering treatment components, mainly in the form of texts presented via web pages, and provide ongoing support using e-mail promising outcomes can be achieved. The literature on this novel form of treatment has grown rapidly over recent years with several controlled trials in the field of anxiety disorders, mood disorders and behavioural medicine. For some of the conditions for which Internet-delivered CBT has been tested, independent replications have shown large effect sizes, for example in the treatment of social anxiety disorder. In some studies, Internet-delivered treatment can achieve similar outcomes as in face-to-face CBT, but the literature thus far is restricted mainly to efficacy trials. This article provides a brief summary of the evidence, comments on the role of the therapist and for which patient and therapist this is suitable. Areas of future research and exploration are identified.

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Available from: Gerhard Andersson, Sep 28, 2015
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    • "Several programs treating depression with different foci (for example cognitive or behavioral) and setups (for example number of modules, with or without support, and also mode of support) have been used (Andersson et al., 2005; Carlbring et al., 2013; Johansson et al., 2012; Meyer et al., 2009; Perini, Titov, & Andrews, 2009; Ruwaard et al., 2009; Titov et al., 2011; Warmerdam, van Straten, Twisk, Riper, & Cuijpers, 2008). However, so far most studies may be characterized as efficacy studies. "
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    ABSTRACT: Background: The current knowledge of internet-based cognitive behavior therapy (ICBT) implemented in primary care settings is sparse. Our objective was to explore primary care therapists' experiences and attitudes of ICBT, the opportunities and conditions for research in primary care, and to identify potential barriers to the implementation of ICBT treatment in primary care. Methods: Eleven therapists (of 14) participating in the research and implementation project PRIM-NET completed a survey. Four of them were selected also for a detailed semi-structured interview. Data from the interviews were analyzed qualitatively and according to methods used in implementation science. Results: Six general themes were identified in which the therapists considered ICBT as a good treatment that ought to be introduced in primary care. To optimize procedure in primary care settings, several adaptations of ICBT were suggested. Integrating and blending ICBT and face-to-face therapies, for example, would render primary care psychology more efficient. The PRIM-NET study and research within primary care was seen as rewarding and necessary, but challenging. To a large extent primary care still revolves around the general practitioner, with a focus on production, finances, and a somatic aspect of the patients. Five possible barriers to implementation of ICBT were identified which perhaps explains why psychological procedures are not fully integrated into primary care. Conclusions: Although the implementation of new methods and routines is typically accompanied by challenges, the overall experience of the therapists supports the implementation of ICBT as an additional treatment in primary care.
    Internet Interventions 06/2015; 47(3). DOI:10.1016/j.invent.2015.06.001
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    • "nitive behavior therapy (CBT) to promote mental health and wellbeing 55 (Andersson, 2009). It has been established that so-called 'e-therapies' "
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    ABSTRACT: Internet interventions for mental health concerns are known to be effective, but how can developing technology be utilised to improve engagement and augment the effectiveness of these programs? One option might be to incorporate feedback about the user's physiological state into the program, via wearable sensors.
    Internet Interventions 05/2015; 37. DOI:10.1016/j.invent.2015.04.005
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    • "One possible therapeutic deployment of such a brief treatment module would be to combine CBM with existing evidence-based computerized treatments such as Internet cognitive behavioral therapy (iCBT; Andersson, 2009). While both CBM and iCBT aim to change negative cognitive biases, they do so via different methods: iCBT via explicit 'top down' cognitive evaluation and behavioral experiments, and CBM via a potentially more direct 'bottom up' cognitive training approach. "
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    ABSTRACT: Accruing evidence suggests that positive imagery-based cognitive bias modification (CBM) could have potential as a standalone targeted intervention for depressive symptoms or as an adjunct to existing treatments. We sought to establish the benefit of this form of CBM when delivered prior to Internet cognitive behavioral therapy (iCBT) for depression METHODS: A randomized controlled trial (RCT) of a 1-week Internet-delivered positive CBM vs. an active control condition for participants (N=75, 69% female, mean age=42) meeting diagnostic criteria for major depression; followed by a 10-week iCBT program for both groups. Modified intent-to-treat marginal and mixed effect models demonstrated no significant difference between conditions following the CBM intervention or the iCBT program. In both conditions there were significant reductions (Cohen׳s d .57-1.58, 95% CI=.12-2.07) in primary measures of depression and interpretation bias (PHQ9, BDI-II, AST-D). Large effect size reductions (Cohen׳s d .81-1.32, 95% CI=.31-1.79) were observed for secondary measures of distress, disability, anxiety and repetitive negative thinking (K10, WHODAS, STAI, RTQ). Per protocol analyses conducted in the sample of participants who completed all seven sessions of CBM indicated between-group superiority of the positive over control group on depression symptoms (PHQ9, BDI-II) and psychological distress (K10) following CBM (Hedges g .55-.88, 95% CI=-.03-1.46) and following iCBT (PHQ9, K10). The majority (>70%) no longer met diagnostic criteria for depression at 3-month follow-up. The control condition contained many active components and therefore may have represented a smaller 'dose' of the positive condition. Results provide preliminary support for the successful integration of imagery-based CBM into an existing Internet-based treatment for depression. Copyright © 2015 The Authors. Published by Elsevier B.V. All rights reserved.
    Journal of Affective Disorders 03/2015; 59. DOI:10.1016/j.jad.2015.02.026 · 3.38 Impact Factor
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