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


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.


Available from: Gerhard Andersson
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    • "Guided Internet-delivered cognitive behavioural therapy (ICBT) has been shown to be an effective treatment for a variety of anxiety disorders (e.g. Haug et al., 2012; Hedman et al., 2012), including SAD (Andersson et al., 2006; Boettcher et al., 2013; Carlbring et al., 2007; Furmark et al., 2009; Hedman et al., 2014). Patients also consider guided ICBT to be a credible and suitable alternative to face-to-face treatment (Gun et al., 2011; Mohr et al., 2010; Spence et al., 2011; Wootton et al., 2011). "
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    ABSTRACT: Background: Guided Internet-delivered cognitive behavioural therapy (ICBT) is an effective treatment of social anxiety disorder (SAD). However, the treatment is not effective for all. The amount and type of therapist contact have been highlighted as a possible moderator of treatment outcome. Objective: The aim of this study was to examine whether treatment effects of ICBT are enhanced with an initial 90. min face-to-face psychoeducation (PE) session for university students with SAD. Method: University students with SAD (N=37) were randomized into one out of two conditions: 1) an initial therapist-led face-to-face PE session followed by guided ICBT, 2) guided ICBT without an initial PE session. Data was analysed with an intent-to-treat approach. Results: Eight participants (21.6%) dropped out of treatment. A statistically significant reduction in symptoms was found for all outcome measures for both groups. There were no significant additional effects of adding the initial face-to-face PE. Moderate to large within-group effect sizes on self-rated social anxiety symptoms were found at post-treatment (d=0.70-0.95) and at a six month follow-up (d=0.70-1.00). Nearly half of the participants were classified as recovered. Conclusions: Notwithstanding limitations due to the small sample size, the findings indicate that guided ICBT is an effective treatment for students with SAD. Adding an initial face-to-face PE session to the guided ICBT did not lead to enhanced outcomes in the present study.
    Internet Interventions 10/2015; 2(4). DOI:10.1016/j.invent.2015.10.003
    • "Modern technology has become a part of most people's life. Cognitive behavior therapy (CBT) via the Internet has shown successful results for anxiety disorders, depression , and other health problems such as chronic pain, insomnia , and tinnitus (Andersson, 2009). Results from CBT via the Internet are comparable to results from face-to-face CBT treatments (Andersson & Hedman, 2013). "
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    ABSTRACT: Purpose: Studies point to low help-seeking after a failed hearing screening. This research forum article presents the research protocol for a randomized controlled trial of motivational interviewing via the Internet to promote helpseeking in people who have failed an online hearing screening. Method: Adults who fail a Swedish online hearing screening, including a speech-in-noise recognition test, will be randomized to either an intervention group (participating in motivational interviewing) or an active control group (reading a book on history of hearing aids). Both of the conditions will be delivered via the Internet. The primary outcome is experience with seeking health care and using hearing aids 9 months after the intervention. Secondary outcomes are changes in before and after measures of self-reported hearing difficulties, anxiety, depression, and quality of life. Stages of change and self-efficacy in hearing help-seeking are measured immediately after intervention and at a 9-month follow-up for the purpose of mediation analysis. Results: The results of this randomized controlled trial may help bridge the gap between hearing screening and successful hearing rehabilitation. Conclusion: Although no large instantaneous benefits are expected, a slow change toward healthy behaviors— seeking health care and using hearing aids—would shed light on how to use the Internet to assist people with hearing impairment.
    American Journal of Audiology 07/2015; 24(3). DOI:10.1044/2015_AJA-15-0012 · 1.28 Impact Factor
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    • "Some form of personal contact with a CBT therapist is included for support. This contact is usually made via email, phone call or more rarely, during short personal meetings (Andersson, 2009, 2014). Research on therapist-guided ICBT for anxiety and depression in adolescents show promising results. "
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    ABSTRACT: This is the first study of adolescents suffering from anxiety disorder in Sweden to receive individually tailored internet-based treatment within a child and adolescent psychiatric clinic. The primary aim of this effectiveness study was to examine the effects of tailored internet-based cognitive behaviour therapy for adolescents.11 adolescents, aged 15-19. years, were allocated to treatment after assessment. Screening consisted of online questionnaires followed by a diagnostic face-to-face interview at the clinic. Treatment consisted of individually prescribed cognitive behaviour therapy (CBT) text modules adapted for the age group. Therapist guidance was via an online platform along with telephone support and face-to-face sessions if needed.Statistically significant improvements were found on all dependent measures immediately following treatment for the 8 adolescents who completed treatment. The within-group effect size on the Beck Anxiety Inventory, the primary outcome measure, was d. =. 2.51 at post-treatment and 80 percent (4/5) adolescents no longer met DSM-IV criteria for their primary anxiety disorder as measured by the Anxiety Disorders Interview Schedule for DSM- IV: Child and Parent Versions.Based on the results from this pilot study the tentative conclusion might be that tailored internet delivered CBT could be useful for adolescents with anxiety disorders along with standard treatment delivered in child and adolescent psychiatric clinics.
    Internet Interventions 07/2015; 47(3). DOI:10.1016/j.invent.2015.07.002
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