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Individually tailored internet-based cognitive behavioural therapy for adolescents, young adults and older adults with anxiety
Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Anxiety disorders share the feature of excessive fear, anxiety and related behavioural disturbances. Fear is defined as the emotional response to a real or a perceived imminent threat and anxiety is the anticipation of a future threat. The anxiety disorders covered in this thesis are panic disorder with or without agoraphobia, social phobia, post-traumatic stress disorder, generalized anxiety disorder and anxiety disorder not otherwise specified.

Cognitive behavioural treatment protocols are typically designed to target one specific disorder and falls under the definition of disorder-specific cognitive behavioural therapy. It is however unclear if this is the most optimal approach in regards to the high comorbidity between anxiety disorders and depressive disorders. Internet-based cognitive behavioural therapy has in the past generally been disorder-specific and from above mentioned predicament two alternative treatment approaches emerged, the tailored and the transdiagnostic approach that aims to simultaneously treat both principal and comorbid disorders. Previous trials on internet-based cognitive behavioural therapy have targeted adults in general and relatively few target adolescents, young adults and older adults.

The aims of this thesis were to further develop and test the effects of tailored internet-based cognitive behavioural therapy on the basis of age, for adolescents, young adults and older adults. Specifically by developing and testing the effects of individually tailored internet-based cognitive behavioural therapy for adolescents with anxiety and comorbid depressive symptoms and by adapting and testing the effects of individually tailored internet-based cognitive behavioural therapy for young adults and older adults with anxiety and comorbid depressive symptoms. These aims were tested in two pilot effectiveness studies (Paper I and III) and two efficacy randomised controlled trials (Paper II and IV). The results from these four trials showed significant results across all outcome measures with overall moderate to large effect sizes. The tentative conclusion based on these results is that tailoring internet-based cognitive behavioural therapy can be a feasible approach in the treatment of anxiety symptoms and comorbid depressive symptoms for adolescents, young adults and older adults. Despite the positive findings of the studies in this thesis, there is a need for more research examining the acceptability and effectiveness of internet-based cognitive behavioural therapy for adolescents, young adults and older adults with anxiety and depression before implementation on a larger scale.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2017. , p. 68
Series
Linköping Studies in Arts and Science, ISSN 0282-9800 ; 710
Series
Linköping Studies in Behavioural Science, ISSN 1654-2029 ; 198
Keywords [en]
internet-based treatment, cognitive behavioural therapy
National Category
Applied Psychology Psychiatry Behavioral Sciences Biology Gerontology, specialising in Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-135823DOI: 10.3384/diss.diva-135823ISBN: 9789176855669 (print)OAI: oai:DiVA.org:liu-135823DiVA, id: diva2:1084140
Public defence
2017-04-21, Sal I:101, Hus I, Campus Valla, Linköping, 10:00 (English)
Opponent
Supervisors
Available from: 2017-03-23 Created: 2017-03-23 Last updated: 2018-01-13Bibliographically approved
List of papers
1. Individually Tailored Internet-Based Treatment for Young Adults and Adults With Panic Attacks: Randomized Controlled Trial
Open this publication in new window or tab >>Individually Tailored Internet-Based Treatment for Young Adults and Adults With Panic Attacks: Randomized Controlled Trial
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2012 (English)In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 14, no 3, p. 32-44Article in journal (Refereed) Published
Abstract [en]

Background: Previous studies on Internet-based treatment with minimal therapist guidance have shown promising results for several specific diagnoses. Objective: To 91) investigate the effects of a tailored, therapist-guided, Internet-based treatment for individuals with reoccurring panic attacks, and 92) to examine whether people in different age groups 918-30 years and 31-45 years) would respond differently to the treatment. Methods: We recruited 149 participants from an online list of individuals having expressed an interest in Internet treatment. Screening consisted of online questionnaires followed by a telephone interview. A total of 57 participants were included after a semistructured diagnostic interview, and they were randomly assigned to an 8-week treatment program 9n = 29) or to a control condition 9n = 28). Treatment consisted of individually prescribed cognitive behavior therapy text modules in conjunction with online therapist guidance. The control group consisted of people on a waitlist who later received treatment. Results: All dependent measures improved significantly immediately following treatment and at the 12-month follow-up. The between-group effect size on the primary outcome measure, the Panic Disorder Severity Scale, was d = 1.41 995% confidence interval 0.81-1.95) at posttreatment. The within-group effect size from pretreatment to 12-month follow-up was d = 1.66 995% confidence interval 1.14-2.35). Age group had no effect, suggesting that age did not influence the outcome. Conclusions: Tailoring an Internet-based treatment can be a feasible approach in the treatment of panic symptoms and comorbid anxiety and depressive symptoms. Younger adults benefit as much as adults over 30 years and up to 45 years of age.

Place, publisher, year, edition, pages
Journal of Medical Internet Research, 2012
Keywords
Anxiety; depression; effectiveness; Internet-based treatment; cognitive behavior therapy
National Category
Social Sciences
Identifiers
urn:nbn:se:liu:diva-79782 (URN)10.2196/jmir.1853 (DOI)000305797300003 ()
Available from: 2012-08-17 Created: 2012-08-14 Last updated: 2017-12-07
2. Individually tailored internet-based cognitive behavior therapy for adolescents with anxiety disorders: A pilot effectiveness study
Open this publication in new window or tab >>Individually tailored internet-based cognitive behavior therapy for adolescents with anxiety disorders: A pilot effectiveness study
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2015 (English)In: Internet Interventions, ISSN 2214-7829, Vol. 2, no 3, p. 297-302Article in journal (Refereed) Published
Abstract [en]

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.

Keywords
Adolescent;Anxiety disorders;Cognitive behavior therapy;Internet-based treatment
National Category
Psychiatry
Identifiers
urn:nbn:se:liu:diva-125381 (URN)10.1016/j.invent.2015.07.002 (DOI)
Available from: 2016-02-22 Created: 2016-02-22 Last updated: 2017-11-30
3. Individually tailored internet-based cognitive behavioural therapy for young adults with anxiety disorders: A pilot effectiveness study
Open this publication in new window or tab >>Individually tailored internet-based cognitive behavioural therapy for young adults with anxiety disorders: A pilot effectiveness study
2017 (English)In: Internet Interventions, ISSN 2214-7829, Vol. 8, p. 5p. 48-52Article in journal (Refereed) Published
Abstract [en]

The mental health of young people is decreasing. It is therefore important to develop early interventions for young people with mental health problems. One previous randomized controlled trial on tailored Internet-based treatment for young adults with minimal therapist guidance has shown promising results for anxiety symptoms. The purpose of this study was to investigate the effects of tailored internet-administered CBT for young adults (16–25 years old) with anxiety, depression and possible comorbidity in regular care. Participants were recruited from a youth health care centre (n=15). Screening consisted of online questionnaires followed by a semi-structured interview. A total of 10 participants completed pre and post measurement. The treatment consisted of individually prescribed CBT text modules with online therapist guidance. All dependent measures improved significantly immediately following treatment and the within-group effect based on pre- to post measurement on the primary outcome measure, the Beck Anxiety Inventory, was d=1.50, the within-group effect on the secondary outcome measures, Montgomery Åsberg Depression Rating Scale-Self-Rated, Clinical Outcomes in Routine Evaluation and Quality of Life Inventory showed large improvement. Tailored internet-based treatment can be an approach in the treatment of anxiety symptoms and comorbid depressive symptoms in youth care.

Place, publisher, year, edition, pages
Amsterdam: Elsevier, 2017. p. 5
National Category
Psychiatry
Identifiers
urn:nbn:se:liu:diva-136525 (URN)10.1016/j.invent.2017.03.002 (DOI)
Available from: 2017-04-19 Created: 2017-04-19 Last updated: 2017-05-08Bibliographically approved

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