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.

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    • "Thus as a first step acceptance-based treatment for GAD needs to be developed and tested, with subsequent comparative studies investigating moderators and mediators of outcome in large samples. Therapist-guided internet-based cognitive behaviour therapy (ICBT) is a way to deliver treatments that has been found to be effective and accepted by patients (Andersson, 2009), with large effects for both anxiety and mood disorders (Andersson, 2014). There is a growing number of ICBT studies on GAD indicating that it can be effective. "
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    ABSTRACT: Generalized anxiety disorder (GAD) is a disabling condition which can be treated with cognitive behaviour therapy (CBT). The present study tested the effects of therapist-guided internet-delivered acceptance-based behaviour therapy on symptoms of GAD and quality of life. An audio CD with acceptance and mindfulness exercises and a separate workbook were also included in the treatment. Participants diagnosed with GAD (N = 103) were randomly allocated to immediate therapist-guided internet-delivered acceptance-based behaviour therapy or to a waiting-list control condition. A six month follow-up was also included. Results using hierarchical linear modelling showed moderate to large effects on symptoms of GAD (Cohen's d = 0.70 to 0.98), moderate effects on depressive symptoms (Cohen's d = 0.51 to 0.56), and no effect on quality of life. Follow-up data showed maintained effects. While there was a 20% dropout rate, sensitivity analyses showed that dropouts did not differ in their degree of change during treatment. To conclude, our study suggests that internet-delivered acceptance-based behaviour therapy can be effective in reducing the symptoms of GAD.
    Full-text · Article · Dec 2015 · Behaviour Research and Therapy
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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.
    Full-text · Article · Oct 2015 · Internet Interventions
    • "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 help-seeking 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.
    No preview · Article · Jul 2015 · American Journal of Audiology
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