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Yap DL, Mandell C, Behar E. The Role of Perceived Risk in the Relationship Between Disgust Sensitivity and COVID-19 Vaccine Hesitancy. COGNITIVE THERAPY AND RESEARCH 2023; 47:1-12. [PMID: 37363746 PMCID: PMC10206364 DOI: 10.1007/s10608-023-10391-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 06/28/2023]
Abstract
Background Despite widespread availability of COVID vaccines and evidence of their efficacy, vaccine hesitancy remains prevalent. Several studies have examined the relationship between disgust sensitivity and vaccine hesitancy. Although results from studies using data collected prior to the COVID pandemic indicate that higher disgust sensitivity is related to greater vaccine hesitancy, results from studies using data collected during the COVID pandemic are equivocal. The present study examined whether perceived risk of contracting COVID moderated the relationship between disgust sensitivity and vaccine hesitancy. Methods Participants (n = 152) completed self-report measures of disgust sensitivity, perceived risk of contracting COVID, and COVID vaccine hesitancy (defined as both vaccine confidence and vaccine complacency). Results Perceived risk of contracting COVID significantly moderated the relationship between disgust sensitivity and vaccine complacency, with the association strengthened at low levels of perceived risk. Perceived risk of contracting COVID also marginally moderated the relationship between disgust sensitivity and vaccine confidence, with the association strengthened at low and average levels of perceived risk. Conclusions Results suggest that individuals with elevated disgust sensitivity who also report low levels of perceived risk of contracting COVID are more likely to express vaccine hesitancy. Implications of these findings are discussed. Supplementary Information The online version contains supplementary material available at 10.1007/s10608-023-10391-8.
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Affiliation(s)
- David L. Yap
- Hunter College, City University of New York, New York, USA
- The Graduate Center, City University of New York, New York, USA
- Department of Psychology, Hunter College of The City University of New York, 695 Park Avenue, 611HN, New York, NY 10065 USA
| | | | - Evelyn Behar
- Hunter College, City University of New York, New York, USA
- The Graduate Center, City University of New York, New York, USA
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Inhibitory Learning-Based Exposure Therapy for Patients With Pathological Health Anxiety: Results From a Single Case Series Study. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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3
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An experimental investigation of intolerance of uncertainty and its impact on sub-clinical psychopathology. J Behav Ther Exp Psychiatry 2022; 75:101718. [PMID: 35081482 DOI: 10.1016/j.jbtep.2021.101718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 10/22/2021] [Accepted: 12/06/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Intolerance of Uncertainty (IU) is a transdiagnostic construct that is implicated in psychological difficulties, including Major Depressive Disorder (MDD), Generalised Anxiety Disorder (GAD), Obsessive-Compulsive Disorder (OCD), and eating disorders (ED). However, most studies exploring IU have been correlational in nature. This study examined (1) whether a linguistic manipulation of the Intolerance of Uncertainty Scale (IUS) would successfully manipulate IU in an undergraduate sample, (2) whether experimentally increased or decreased levels of IU affect symptoms of MDD, GAD, OCD and ED, and (3) whether increased baseline symptom severity influences the magnitude of change in symptom severity post-manipulation. METHODS A linguistic manipulation of the IUS was used to manipulate participants' beliefs about their ability to tolerate uncertainty. N = 106 undergraduate participants were randomised to one of two conditions: high IU (HIU; n = 54) or low IU (LIU; n = 52), and completed measures on symptom severity at baseline and one-week follow-up. RESULTS The manipulation successfully reduced IU in LIU. Participants in this group did not experience significant changes in symptom severity post-manipulation. However, individuals with higher baseline OCD in LIU demonstrated greater decreases in post-manipulation OCD symptoms, compared with individuals in HIU. LIMITATIONS Only the LIU manipulation was effective, limiting the findings from the HIU. The one-week follow-up and relatively small sample size of predominantly female undergraduate students may dilute and limit the generalisability of results. CONCLUSION Findings support the utility of this manipulation in reducing IU, and the significance of different levels of IU in OCD.
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Esfandiari N, Mazaheri MA, Akbari-Zardkhaneh S, Sadeghi-Firoozabadi V, Cheraghi M. Internet-Delivered Versus Face-to-Face Cognitive Behavior Therapy for Anxiety Disorders: Systematic Review and Meta-Analysis. Int J Prev Med 2022; 12:153. [PMID: 35070186 PMCID: PMC8724632 DOI: 10.4103/ijpvm.ijpvm_208_21] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 09/28/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Over the last 20 years, internet-delivered cognitive behavior therapy (ICBT) has been tested in a large number of randomized controlled trials, often with positive results. However, it is not widely known about the efficacy of ICBT as compared to face-to-face cognitive behavior therapy (CBT). Methods: In the present systematic review and meta-analysis, ICBT for treatment of anxiety disorders was directly compared to face- to-face CBT within the same trial. This study aimed to reinvestigate the effect of ICBT compared to face-to-face CBT for anxiety disorders. A total of 8 studies out of the 236 articles screened met all the inclusion criteria. The included studies targeting five different anxiety disorders, social anxiety disorder, adolescent anxiety, panic disorder, spider phobia, and fear of public speaking, had been carried out in Australia, Spain, and Sweden. The total number of participants was 348 in ICBT and 316 in face-to-face conditions. Results: The results of our meta-analysis are interesting both from theoretical and practical standpoints, which showed a pooled effect size posttreatment with Hedges' g = 0.01 (95% CI: −0.16 to 0.18), Conclusions: ICBT and face-to-face CBT created equivalent overall effects. in treatment of anxiety disorders. Since there have been similar systematic reviews about anxiety disorders so far, and in majority of them, ICBT has not been compared against face-to-face treatment. More research is needed to establish the general equivalence of the two treatment formats. Also, understanding what makes ICBT work is a challenge for future research.
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Affiliation(s)
- Narges Esfandiari
- Department of Psychology, Faculty of Education and Psychology, Shahid Beheshti University, Tehran, Iran
| | - Mohammad A Mazaheri
- Department of Psychology, Faculty of Education and Psychology, Shahid Beheshti University, Tehran, Iran
| | - Saeed Akbari-Zardkhaneh
- Department of Applied Psychology, Faculty of Education and Psychology, Shahid Beheshti University, Tehran, Iran
| | - Vahid Sadeghi-Firoozabadi
- Department of Psychology, Faculty of Education and Psychology, Shahid Beheshti University, Tehran, Iran
| | - Mona Cheraghi
- Department of Psychology, Faculty of Education and Psychology, Shahid Beheshti University, Tehran, Iran
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A qualitative exploration of adolescents’ experiences of digital Dialectical Behaviour Therapy during the COVID-19 pandemic. COGNITIVE BEHAVIOUR THERAPIST 2022. [DOI: 10.1017/s1754470x22000460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Abstract
The UK government implemented national social-distancing measures in response to the global COVID19 pandemic. As a result, many appointments in the National Health Service (NHS) took place virtually, including psychological interventions in out-patient settings. This study explored the experiences of adolescents participating in a dialectical behaviour therapy (DBT-A) programme via teletherapy (i.e. via video or telephone call) in a Children and Adolescent Mental Health Service (CAMHS). Thirteen adolescents with emotion dysregulation and related problems completed an online qualitative survey about their experience and acceptance of DBT-A delivered virtually. Thematic analysis was conducted on the survey data and generated three over-arching themes: (1) sense of loss; (2) feeling uncontained; and (3) benefits of virtual DBT. These over-arching themes were composed of eight subthemes (‘loss of connection with group and therapist’; ‘loss of skills-building opportunities’; ‘limited privacy’; ‘lack of safe therapy space’; ‘difficult endings’; ‘home comforts’; ‘convenience and accessibility’; and ‘easier to participate with others’). This study suggests that adolescents doing virtual DBT-A need approaches that acknowledge and address the additional relational, emotional and practical challenges of online therapy while maintaining fidelity to the evidence-based treatment model. Suggestions for further research and preliminary practice guidelines are discussed.
Key learning aims
(1)
To learn about the experiences of adolescents participating in a DBT programme for adolescents (DBT-A) conducted virtually, including the challenges and benefits they identified.
(2)
To learn about implications for clinical practice and future research directions.
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6
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Domhardt M, Nowak H, Engler S, Baumel A, Grund S, Mayer A, Terhorst Y, Baumeister H. Therapeutic processes in digital interventions for anxiety: A systematic review and meta-analytic structural equation modeling of randomized controlled trials. Clin Psychol Rev 2021; 90:102084. [PMID: 34610493 DOI: 10.1016/j.cpr.2021.102084] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 08/13/2021] [Accepted: 09/08/2021] [Indexed: 01/14/2023]
Abstract
While the efficacy of Internet- and mobile-based interventions (IMIs) for treating anxiety disorders is well established, there is no comprehensive overview about the underlying therapeutic processes so far. Thus, this systematic review and meta-analysis evaluated research on mediators and mechanisms of change in IMIs for adult anxiety disorders (PROSPERO: CRD42020185545). A systematic literature search was performed in five databases (i.e., CENTRAL, Embase, MEDLINE, PsycINFO and ClinicalTrials.gov). Two reviewers independently screened studies for inclusion, assessed the risk of bias and adherence to quality criteria for process research. Overall, 26 studies (N = 6042) investigating 64 mediators were included. Samples consisted predominantly of participants with clinically relevant symptoms of generalized anxiety disorder and severe health anxiety, as well as of participants with non-clinically relevant anxiety symptoms. The largest group of examined mediators (45%) were cognitive variables, evincing also the second highest proportion of significance (19/29); followed in numbers by skills (examined: 22%; significant: 10/14) and a wide range of other (19%; 7/12), emotional/affective (11%; 2/7) and behavioral mediators (3%; 1/2). Meta-analytical synthesis of mediators, limited by a small number of eligible studies, was conducted by deploying a two-stage structural equation modeling approach, resulting in a significant indirect effect for negative thinking (k = 3 studies) and non-significant indirect effects for combined cognitive variables, both in clinical (k = 5) and non-clinical samples (k = 3). The findings of this review might further the understanding on presumed change mechanisms in IMIs for anxiety, informing intervention development and the concurrent optimization of outcomes. Furthermore, by reviewing eligible mediation studies, we discuss methodological implications and recommendations for future process research, striving for causally robust findings. Future studies should investigate a broader range of variables as potential mediators, as well as to develop and apply original (digital) process and engagement measures to gather qualitative and high-resolution data on therapeutic processes.
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Affiliation(s)
- Matthias Domhardt
- Department of Clinical Psychology and Psychotherapy, Ulm University, Germany.
| | - Hannah Nowak
- Department of Clinical Psychology and Psychotherapy, Ulm University, Germany
| | - Sophie Engler
- Department of Clinical Psychology and Psychotherapy, Ulm University, Germany
| | - Amit Baumel
- Department of Community Mental Health, University of Haifa, Israel
| | - Simon Grund
- IPN - Leibniz Institute for Science and Mathematics Education, Kiel, Germany
| | - Axel Mayer
- Department of Psychological Methods and Evaluation, Bielefeld University, Germany
| | - Yannik Terhorst
- Department of Clinical Psychology and Psychotherapy, Ulm University, Germany; Department of Psychological Research Methods, Ulm University, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Ulm University, Germany
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7
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Regidor N, Ausín B. Tecnologías de información y comunicación (TIC) aplicadas al tratamiento de los problemas de ansiedad. CLÍNICA CONTEMPORÁNEA 2020. [DOI: 10.5093/cc2020a8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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8
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Axelsson E, Hesser H, Andersson E, Ljótsson B, Hedman-Lagerlöf E. Mediators of treatment effect in minimal-contact cognitive behaviour therapy for severe health anxiety: A theory-driven analysis based on a randomised controlled trial. J Anxiety Disord 2020; 69:102172. [PMID: 31864217 DOI: 10.1016/j.janxdis.2019.102172] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/25/2019] [Accepted: 12/05/2019] [Indexed: 02/03/2023]
Abstract
Cognitive behaviour therapy (CBT) is efficacious for severe health anxiety, but little is known about mechanisms. We analysed putative mediators of change based on 13 weekly assessments in a randomised controlled trial (N = 132) of exposure-based minimal-contact CBT (guided Internet-delivered CBT, unguided Internet-delivered CBT and bibliotherapy) vs. a waitlist control for severe health anxiety. We hypothesised that the effect of CBT on health anxiety would be mediated by non-reactivity to inner experiences, health anxiety behaviours and perceived competence. We also explored somatosensory amplification. In parallel process growth models, non-reactivity, health anxiety behaviours and perceived competence - but not somatosensory amplification - were influenced by CBT and associated with health anxiety. Random intercepts cross-lagged panel models were used to study within-individual ordering of change. None of the putative mediators systematically predicted subsequent changes in health anxiety. Rather, changes in health anxiety predicted subsequent changes in all putative mediators. In summary, CBT influenced health anxiety behaviours, non-reactivity to inner experiences and perceived competence, and these variables were associated with the outcome. However, their role as mediators was not corroborated because we found no evidence that changes in these variables predicted subsequent changes in health anxiety. We encourage further research into mediators of CBT for health anxiety.
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Affiliation(s)
- Erland Axelsson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Hugo Hesser
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden; Center for Health and Medical Psychology, Örebro University, Örebro, Sweden
| | - Erik Andersson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Brjánn Ljótsson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Erik Hedman-Lagerlöf
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Osher Center for Integrative Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Andersson G, Carlbring P, Titov N, Lindefors N. Internet Interventions for Adults with Anxiety and Mood Disorders: A Narrative Umbrella Review of Recent Meta-Analyses. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2019; 64:465-470. [PMID: 31096757 PMCID: PMC6610559 DOI: 10.1177/0706743719839381] [Citation(s) in RCA: 162] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Internet-delivered cognitive behaviour therapy (ICBT) has existed for 20 years and there are now several controlled trials for a range of problems. In this paper, we focused on recent meta-analytic reviews of the literature and found moderate to large effects reported for panic disorder, social anxiety disorder, generalized anxiety disorder, posttraumatic stress disorder, and major depression. In total, we reviewed 9 recent meta-analytic reviews out of a total of 618 meta-analytic reviews identified using our search terms. In these selected reviews, 166 studies were included, including overlap in reviews on similar conditions. We also covered a recent review on transdiagnostic treatments and 2 reviews on face-to-face v. internet treatment. The growing number of meta-analytic reviews of studies now suggests that ICBT works and can be as effective as face-to-face therapy.
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Affiliation(s)
- Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University,
Linköpin, Sweden
- Department of Clinical Neuroscience, Psychiatry Section, Karolinska
Institutet, Solna, Sweden
- Gerhard Andersson, PhD, Department of Behavioural
Sciences and Learning, Linköping University, Linköping SE-58183, Sweden.
| | - Per Carlbring
- Department of Clinical Psychology, Stockholm University, Stockholm,
Sweden
- Department of Psychology, University of Southern Denmark, Odense,
Denmark
| | - Nickolai Titov
- MindSpot Clinic, Macquarie University, Sydney, Australia
- eCentreClinic, Department of Psychology, Macquarie University, Sydney,
Australia
| | - Nils Lindefors
- Department of Clinical Neuroscience, Psychiatry Section, Karolinska
Institutet, Solna, Sweden
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10
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Andersson G, Carlbring P, Rozental A. Response and Remission Rates in Internet-Based Cognitive Behavior Therapy: An Individual Patient Data Meta-Analysis. Front Psychiatry 2019; 10:749. [PMID: 31708813 PMCID: PMC6823683 DOI: 10.3389/fpsyt.2019.00749] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 09/18/2019] [Indexed: 12/20/2022] Open
Abstract
Background: Internet-delivered cognitive behavior therapy (ICBT) was developed over 20 years ago and has since undergone a number of controlled trials, as well as several systematic reviews and meta-analyses. However, the crucial question of response rates remains to be systematically investigated. The aim of this individual patient meta-analysis (IPDMA) was to use a large dataset of trials conducted in Sweden to determine reliable change and recovery rates across trials for a range of conditions. Methods: We used previously collected and aggregated data from 2,866 patients in 29 Swedish clinical trials of ICBT for three categories of conditions: anxiety disorders, depression, and others. Raw scores at pre-treatment and post-treatment were used in an IPDMA to determine the rate of reliable change and recovery. Jacobson and Truax's, (1991) reliable change index (RCI) was calculated for each primary outcome measure in the trials as well as the recovery rates for each patient, with the additional requirement of having improved substantially. We subsequently explored potential predictors using binomial logistic regression. Results: In applying an RCI of z = 1.96, 1,162 (65.6%) of the patients receiving treatment were classified as achieving recovery, and 620 (35.0%) were classified as reaching remission. In terms of predictors, patients with higher symptom severity on the primary outcome measure at baseline [odds ratio (OR) = 1.36] and being female (OR = 2.22) increased the odds of responding to treatment. Having an anxiety disorder was found to decrease the response to treatment (OR = 0.51). Remission was predicted by diagnosis in the same direction (OR = 0.28), whereas symptom severity was inversely predictive of worse outcome (OR = 0.81). Conclusions: Response seems to occur among approximately half of all clients administered ICBT, whereas about a third reach remission. This indicates that the efficacy of ICBT is in line with that of CBT based in prior trials, with a possible caveat being the lower remission rates. Having more symptoms and being female might increase the chances of improvement, and a small negative effect of having anxiety disorder versus depression and other conditions may also exist. A limitation of the IPDMA was that only studies conducted in Sweden were included.
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Affiliation(s)
- Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden.,Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Alexander Rozental
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Institute of Child Health, University College London, London, United Kingdom
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Ebert DD, Harrer M, Apolinário-Hagen J, Baumeister H. Digital Interventions for Mental Disorders: Key Features, Efficacy, and Potential for Artificial Intelligence Applications. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1192:583-627. [PMID: 31705515 DOI: 10.1007/978-981-32-9721-0_29] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Mental disorders are highly prevalent and often remain untreated. Many limitations of conventional face-to-face psychological interventions could potentially be overcome through Internet-based and mobile-based interventions (IMIs). This chapter introduces core features of IMIs, describes areas of application, presents evidence on the efficacy of IMIs as well as potential effect mechanisms, and delineates how Artificial Intelligence combined with IMIs may improve current practices in the prevention and treatment of mental disorders in adults. Meta-analyses of randomized controlled trials clearly show that therapist-guided IMIs can be highly effective for a broad range of mental health problems. Whether the effects of unguided IMIs are also clinically relevant, particularly under routine care conditions, is less clear. First studies on IMIs for the prevention of mental disorders have shown promising results. Despite limitations and challenges, IMIs are increasingly implemented into routine care worldwide. IMIs are also well suited for applications of Artificial Intelligence and Machine Learning, which provides ample opportunities to improve the identification and treatment of mental disorders. Together with methodological innovations, these approaches may also deepen our understanding of how psychological interventions work, and why. Ethical and professional restraints as well as potential contraindications of IMIs, however, should also be considered. In sum, IMIs have a high potential for improving the prevention and treatment of mental health disorders across various indications, settings, and populations. Therefore, implementing IMIs into routine care as both adjunct and alternative to face-to-face treatment is highly desirable. Technological advancements may further enhance the variability and flexibility of IMIs, and thus even further increase their impact in people's lives in the future.
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Affiliation(s)
- David Daniel Ebert
- Department of Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1881 BT, Amsterdam, The Netherlands.
| | - Mathias Harrer
- Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | | | - Harald Baumeister
- Clinical Psychology and Psychotherapy, University of Ulm, Ulm, Germany
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Rosser BA. Intolerance of Uncertainty as a Transdiagnostic Mechanism of Psychological Difficulties: A Systematic Review of Evidence Pertaining to Causality and Temporal Precedence. COGNITIVE THERAPY AND RESEARCH 2018. [DOI: 10.1007/s10608-018-9964-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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13
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Ebert DD, Van Daele T, Nordgreen T, Karekla M, Compare A, Zarbo C, Brugnera A, Øverland S, Trebbi G, Jensen KL, Kaehlke F, Baumeister H. Internet- and Mobile-Based Psychological Interventions: Applications, Efficacy, and Potential for Improving Mental Health. EUROPEAN PSYCHOLOGIST 2018. [DOI: 10.1027/1016-9040/a000318] [Citation(s) in RCA: 207] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Abstract. The majority of mental health disorders remain untreated. Many limitations of traditional psychological interventions such as limited availability of evidence-based interventions and clinicians could potentially be overcome by providing Internet- and mobile-based psychological interventions (IMIs). This paper is a report of the Taskforce E-Health of the European Federation of Psychologists’ Association and will provide an introduction to the subject, discusses areas of application, and reviews the current evidence regarding the efficacy of IMIs for the prevention and treatment of mental disorders. Meta-analyses based on randomized trials clearly indicate that therapist-guided stand-alone IMIs can result in meaningful benefits for a range of indications including, for example, depression, anxiety, insomnia, or posttraumatic stress disorders. The clinical significance of results of purely self-guided interventions is for many disorders less clear, especially with regard to effects under routine care conditions. Studies on the prevention of mental health disorders (MHD) are promising. Blended concepts, combining traditional face-to-face approaches with Internet- and mobile-based elements might have the potential of increasing the effects of psychological interventions on the one hand or to reduce costs of mental health treatments on the other hand. We also discuss mechanisms of change and the role of the therapist in such approaches, contraindications, potential limitations, and risk involved with IMIs, briefly review the status of the implementation into routine health care across Europe, and discuss confidentiality as well as ethical aspects that need to be taken into account, when implementing IMIs. Internet- and mobile-based psychological interventions have high potential for improving mental health and should be implemented more widely in routine care.
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Affiliation(s)
- David D. Ebert
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Tom Van Daele
- Department of Applied Psychology, Thomas More University of Applied Sciences, Antwerp, Belgium
| | - Tine Nordgreen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Maria Karekla
- Department of Psychology, University of Cyprus, Nicosia, Republic of Cyprus
| | - Angelo Compare
- Human Factors and Technology in Healthcare, University of Bergamo, Bergamo, BG, Italy
| | - Cristina Zarbo
- Department of Human and Social Science, University of Bergamo, Bergamo, Italy
| | - Agostino Brugnera
- Department of Human and Social Science, University of Bergamo, Bergamo, Italy
| | | | - Glauco Trebbi
- Trebbipsicologie, Luxembourg & Societé Luxembourgeoise de Psychologie SLP, Luxembourg
| | | | - Fanny Kaehlke
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, University of Ulm, Germany
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Optimizing Exposure Therapy for Pathological Health Anxiety: Considerations From the Inhibitory Learning Approach. COGNITIVE AND BEHAVIORAL PRACTICE 2018. [DOI: 10.1016/j.cbpra.2017.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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15
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Carlbring P, Andersson G, Cuijpers P, Riper H, Hedman-Lagerlöf E. Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: an updated systematic review and meta-analysis. Cogn Behav Ther 2017; 47:1-18. [PMID: 29215315 DOI: 10.1080/16506073.2017.1401115] [Citation(s) in RCA: 628] [Impact Index Per Article: 89.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
During the last two decades, Internet-delivered cognitive behavior therapy (ICBT) has been tested in hundreds of randomized controlled trials, often with promising results. However, the control groups were often waitlisted, care-as-usual or attention control. Hence, little is known about the relative efficacy of ICBT as compared to face-to-face cognitive behavior therapy (CBT). In the present systematic review and meta-analysis, which included 1418 participants, guided ICBT for psychiatric and somatic conditions were directly compared to face-to-face CBT within the same trial. Out of the 2078 articles screened, a total of 20 studies met all inclusion criteria. Results showed a pooled effect size at post-treatment of Hedges g = .05 (95% CI, -.09 to .20), indicating that ICBT and face-to-face treatment produced equivalent overall effects. Study quality did not affect outcomes. While the overall results indicate equivalence, there have been few studies of the individual psychiatric and somatic conditions so far, and for the majority, guided ICBT has not been compared against face-to-face treatment. Thus, more research, preferably with larger sample sizes, is needed to establish the general equivalence of the two treatment formats.
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Affiliation(s)
- Per Carlbring
- a Department of Psychology , Stockholm University , Stockholm , Sweden
| | - Gerhard Andersson
- b Department of Behavioural Sciences and Learning , Swedish Institute for Disability Research, Linköping University , Linköping , Sweden.,c Department of Clinical Neuroscience, Division of Psychiatry , Karolinska Institutet , Stockholm , Sweden
| | - Pim Cuijpers
- d Department of Clinical, Neuro and Developmental Psychology, Section of Clinical Psychology , Vrije Universiteit , Amsterdam , The Netherlands
| | - Heleen Riper
- d Department of Clinical, Neuro and Developmental Psychology, Section of Clinical Psychology , Vrije Universiteit , Amsterdam , The Netherlands.,e VU University Medical Centre/GGZ inGeest , Amsterdam , The Netherlands.,f Amsterdam Public Health Research Institute , Amsterdam , The Netherlands.,g Faculty of Health Science, Telepsychiatric Unit , University of Southern Denmark, University Hospital , Odense , Denmark
| | - Erik Hedman-Lagerlöf
- h Department of Clinical Neuroscience, Osher Center for Integrative Medicine and Division of Psychology , Karolinska Institutet , Stockholm , Sweden
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Hedman-Lagerlöf E, Axelsson E, Andersson E, Ljótsson B, Andreasson A, Lekander M. The impact of exposure-based cognitive behavior therapy for severe health anxiety on self-rated health: Results from a randomized trial. J Psychosom Res 2017; 103:9-14. [PMID: 29167052 DOI: 10.1016/j.jpsychores.2017.09.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 09/24/2017] [Accepted: 09/25/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Self-rated health (SRH) has been shown to be a stable predictor of illness and mortality. Improvement in SRH, even in the absence of change in objective health, predicts better health and reduced mortality. Severe health anxiety (SHA) is characterized by fear of illness and distorted health perception. The objective of the present study was to investigate if exposure-based cognitive behavior therapy (CBT) for SHA can lead to improvement in SRH and whether this improvement is mediated by reduced health anxiety. METHODS Data were collected from a randomized controlled trial where participants with SHA were allocated to 12weeks of exposure-based CBT (n=99) for SHA or to a no treatment control condition (n=33). The mediation analysis was based on SRH- and health anxiety data collected weekly during the treatment phase. RESULTS Linear mixed effects models analysis showed a significant interaction effect of group and time indicating superior improvements in SRH in exposure-based CBT compared to the control condition (Z=2.69, p=0.007). The controlled effect size was moderately large (d=0.64) and improvements were stable at 1-year follow-up. Reduced health anxiety was a significant mediator of improvement in SRH. CONCLUSIONS 12weeks of exposure-based CBT for SHA can lead to significant improvements in SRH. Considering the previously established importance of SRH as a predictor for disease and mortality, exposure-based CBT for severe health anxiety may lead to improvements on several important health parameters, possibly even increasing the likelihood of longevity.
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Affiliation(s)
- Erik Hedman-Lagerlöf
- Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.
| | - Erland Axelsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Erik Andersson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Anna Andreasson
- Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden; Stress Research Institute, Stockholm University, Stockholm, Sweden; Department of Psychology, Macquarie University, North Ryde, NSW, Australia
| | - Mats Lekander
- Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden; Stress Research Institute, Stockholm University, Stockholm, Sweden
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Hedman E, Hesser H, Andersson E, Axelsson E, Ljótsson B. The mediating effect of mindful non-reactivity in exposure-based cognitive behavior therapy for severe health anxiety. J Anxiety Disord 2017; 50:15-22. [PMID: 28528015 DOI: 10.1016/j.janxdis.2017.04.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 04/20/2017] [Accepted: 04/26/2017] [Indexed: 01/26/2023]
Abstract
Exposure-based cognitive behavior therapy (CBT) has been shown to be effective in the treatment of severe health anxiety, but little is known about mediators of treatment effect. The aim of the present study was to investigate mindful non-reactivity as a putative mediator of health anxiety outcome using data from a large scale randomized controlled trial. We assessed mindful non-reactivity using the Five Facets Mindfulness Questionnaire-Non-Reactivity scale (FFMQ-NR) and health anxiety with the Short Health Anxiety Inventory (SHAI). Participants with severe health anxiety (N=158) were randomized to internet-delivered exposure-based CBT or behavioral stress management (BSM) and throughout the treatment, both the mediator and outcome were measured weekly. As previously reported, exposure-based CBT was more effective than BSM in reducing health anxiety. In the present study, latent process growth modeling showed that treatment condition had a significant effect on the FFMQ-NR growth trajectory (α-path), estimate=0.18, 95% CI [0.04, 0.32], p=.015, indicating a larger increase in mindful non-reactivity among participants receiving exposure-based CBT compared to the BSM group. The FFMQ-NR growth trajectory was significantly correlated with the SHAI trajectory (β-path estimate=-1.82, 95% CI [-2.15, -1.48], p<.001. Test of the indirect effect, i.e. the estimated mediation effect (αβ) revealed a significant cross product of -0.32, which was statistically significant different from zero based on the asymmetric confidence interval method, 95% CI [-0.59, -0.06]. We conclude that increasing mindful non-reactivity may be of importance for achieving successful treatment outcomes in exposure-based CBT for severe health anxiety.
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Affiliation(s)
- Erik Hedman
- Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.
| | - Hugo Hesser
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Erik Andersson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Erland Axelsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
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Eilenberg T, Hoffmann D, Jensen JS, Frostholm L. Intervening variables in group-based acceptance & commitment therapy for severe health anxiety. Behav Res Ther 2017; 92:24-31. [PMID: 28196772 DOI: 10.1016/j.brat.2017.01.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 01/11/2017] [Accepted: 01/17/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The present study is based on a previously reported successful randomized controlled trial (RCT) on Acceptance and Commitment Group therapy (ACT-G) for severe health anxiety (HA) and investigates intervening variables of ACT for HA. The process primarily targeted by ACT is psychological flexibility (PF). No randomized study has yet examined the possible intervening variables of ACT for HA. METHODS 126 patients diagnosed with severe HA were enrolled in the RCT of which 107 were included in the analyses. The outcome measure was illness worry (Whiteley Index) and included process variables were PF and facets of mindfulness. RESULTS Statistically significant indirect effects (IE) of ACT-G on the outcome of illness worry 6 months after treatment were found for PF (IE = -5.5, BCa 99% CI -12.3;-1.2) and one mindfulness subscale, namely 'non-react' (IE = -6.5 BCa 99% CI -15.3: 1.0). CONCLUSION In line with the ACT model of change, PF may have a small to moderate IE on decrease in illness worry. Of the mindfulness scales, only 'non-react' showed a significant IE. Although tentative, due to no active comparison control condition, these results support that PF is a intervening variable in ACT treatment aimed at reducing illness worry in patients with severe HA.
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Affiliation(s)
- Trine Eilenberg
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Barthsgade 5.1, Aarhus N, Denmark; Department of Occupational Medicine, Aarhus University Hospital, Norrebrogade 44, Aarhus C, Denmark.
| | - Ditte Hoffmann
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Barthsgade 5.1, Aarhus N, Denmark
| | - Jens S Jensen
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Barthsgade 5.1, Aarhus N, Denmark
| | - Lisbeth Frostholm
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Barthsgade 5.1, Aarhus N, Denmark
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Newby JM, Mahoney AE, Mason EC, Smith J, Uppal S, Andrews G. Pilot trial of a therapist-supported internet-delivered cognitive behavioural therapy program for health anxiety. Internet Interv 2016; 6:71-79. [PMID: 30135816 PMCID: PMC6096191 DOI: 10.1016/j.invent.2016.09.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 09/26/2016] [Accepted: 09/27/2016] [Indexed: 12/28/2022] Open
Abstract
Cognitive behavioural therapy (CBT) is an effective treatment for health anxiety, but more research is needed to evaluate accessible, low cost ways of delivering CBT. Internet CBT may be effective, but there are no iCBT programs available outside of Sweden. We developed the first English-language clinician-guided iCBT program for health anxiety and conducted an open pilot trial (n = 16) to examine its acceptability, and impact on health anxiety and comorbidity, disability, and the cognitive and behavioural factors thought to maintain the disorder (e.g., catastrophising, hypervigilance). 13/16 participants completed the program (81% adherence). We found large and significant reductions in health anxiety, depression, distress, anxiety and disability (g's > 1.0), dysfunctional cognitions, behaviours and body vigilance between pre- and post-treatment, which were maintained at 3-month follow-up. The results provide preliminary support for the use of iCBT for health anxiety. Randomised controlled efficacy trials are now needed to evaluate this program.
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Affiliation(s)
- Jill M. Newby
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent's Hospital, Darlinghurst, NSW, Australia
- School of Psychology, University of New South Wales, Australia
| | - Alison E.J. Mahoney
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Elizabeth C. Mason
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Jessica Smith
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Shivani Uppal
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Gavin Andrews
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent's Hospital, Darlinghurst, NSW, Australia
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Richtberg S, Jakob M, Höfling V, Weck F. Patient Characteristics and Patient Behavior as Predictors of Outcome in Cognitive Therapy and Exposure Therapy for Hypochondriasis. J Clin Psychol 2016; 73:612-625. [PMID: 27532367 DOI: 10.1002/jclp.22356] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 04/14/2016] [Accepted: 06/13/2016] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Psychotherapy for hypochondriasis has greatly improved over the last decades and cognitive-behavioral treatments are most promising. However, research on predictors of treatment outcome for hypochondriasis is rare. Possible predictors of treatment outcome in cognitive therapy (CT) and exposure therapy (ET) for hypochondriasis were investigated. METHOD Characteristics and behaviors of 75 patients were considered as possible predictors: sociodemographic variables (sex, age, and cohabitation); psychopathology (pretreatment hypochondriacal symptoms, comorbid mental disorders, and levels of depression, anxiety, and somatic symptoms); and patient in-session interpersonal behavior. RESULTS Severity of pretreatment hypochondriacal symptoms, comorbid mental disorders, and patient in-session interpersonal behavior were significant predictors in multiple hierarchical regression analyses. Interactions between the predictors and the treatment (CT or ET) were not found. CONCLUSIONS In-session interpersonal behavior is an important predictor of outcome. Furthermore, there are no specific contraindications to treating hypochondriasis with CT or ET.
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21
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Guided Internet-delivered cognitive behavioural therapy in patients with non-cardiac chest pain - a pilot randomized controlled study. Trials 2016; 17:352. [PMID: 27456689 PMCID: PMC4960843 DOI: 10.1186/s13063-016-1491-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 06/22/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Patients with recurrent episodes of non-cardiac chest pain may experience cardiac anxiety and avoidance behavior, leading to increased healthcare utilization. These patients might benefit from help and support to evaluate the perception and management of their chest pain. The purpose of this study was to test the feasibility of a short guided Internet-delivered cognitive behavioural therapy (CBT) program and explore the effects on cardiac anxiety, fear of body sensations, depressive symptoms, and chest pain in patients with non-cardiac chest pain, compared with usual care. METHODS A pilot randomized controlled study was conducted. Fifteen patients with non-cardiac chest pain with cardiac anxiety or fear of body sensations, aged 22-76 years, were randomized to intervention (n = 7) or control (n = 8) groups. The four-session CBT program contained psychoeducation, physical activity, and relaxation. The control group received usual care. Data were collected before and after intervention. RESULTS Five of seven patients in the intervention group completed the program, which was perceived as user-friendly with comprehensible language, adequate and varied content, and manageable homework assignments. Being guided and supported, patients were empowered and motivated to be active and complete the program. Patients in both intervention and control groups improved with regard to cardiac anxiety, fear of body sensations, and depressive symptoms, but no significant differences were found between the groups. CONCLUSIONS The Internet-delivered CBT program seems feasible for patients with non-cardiac chest pain, but needs to be evaluated in larger groups and with a longer follow-up period. TRIAL REGISTRATION Clinicaltrials.gov NCT02336880 . Registered on 8 January 2015.
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22
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Weck F, Neng JMB, Schwind J, Höfling V. Exposure therapy changes dysfunctional evaluations of somatic symptoms in patients with hypochondriasis (health anxiety). A randomized controlled trial. J Anxiety Disord 2015; 34:1-7. [PMID: 26093823 DOI: 10.1016/j.janxdis.2015.05.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 05/07/2015] [Accepted: 05/20/2015] [Indexed: 11/19/2022]
Abstract
Dysfunctional evaluations of somatic symptoms are considered a central factor in maintaining hypochondriasis. The aim of the current study was to investigate whether exposure therapy (ET) without cognitive restructuring is sufficient to change dysfunctional evaluations of somatic symptoms. The current study was based on a randomized controlled trial and compared patients with hypochondriasis (N=73) receiving ET or cognitive therapy (CT) to a wait list (WL) control group. In both the ET and CT groups, dysfunctional symptom evaluations changed significantly compared with the WL group. No differences between the ET and CT groups emerged. The relationship between the treatment condition (active treatment vs. WL) and reductions in health anxiety was mediated by changes in somatic symptom evaluations only in a specific card sorting procedure. We conclude that addressing dysfunctional symptom evaluations is a necessary precondition for the effective treatment of hypochondriasis. However, the results indicate that ET and CT appear to change those processes to a similar degree.
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Affiliation(s)
- Florian Weck
- Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes Gutenberg University of Mainz, Wallstraße 3, D-55122 Mainz, Germany.
| | - Julia M B Neng
- Department of Clinical Psychology and Psychotherapy, Goethe University, Varrentrappstraße 40-42, D-60486 Frankfurt am Main, Germany.
| | - Julia Schwind
- Department of Clinical Psychology and Psychotherapy, Goethe University, Varrentrappstraße 40-42, D-60486 Frankfurt am Main, Germany.
| | - Volkmar Höfling
- Department of Clinical Psychology and Psychotherapy, Goethe University, Varrentrappstraße 40-42, D-60486 Frankfurt am Main, Germany.
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Hedman E, Axelsson E, Görling A, Ritzman C, Ronnheden M, El Alaoui S, Andersson E, Lekander M, Ljótsson B. Internet-delivered exposure-based cognitive-behavioural therapy and behavioural stress management for severe health anxiety: randomised controlled trial. Br J Psychiatry 2014; 205:307-14. [PMID: 25104835 DOI: 10.1192/bjp.bp.113.140913] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Exposure-based cognitive-behavioural therapy (CBT) delivered via the internet has been shown to be effective for severe health anxiety (hypochondriasis) but has not been compared with an active, effective and credible psychological treatment, such as behavioural stress management (BSM). AIMS To investigate two internet-delivered treatments - exposure-based CBT v. BSM - for severe health anxiety in a randomised controlled trial (trial registration: NCT01673035). METHOD Participants (n = 158) with a principal diagnosis of severe health anxiety were allocated to 12 weeks of exposure-based CBT (n = 79) or BSM (n = 79) delivered via the internet. The Health Anxiety Inventory (HAI) was the primary outcome. RESULTS Internet-delivered exposure-based CBT led to a significantly greater improvement on the HAI compared with BSM. However, both treatment groups made large improvements on the HAI (pre-to-post-treatment Cohen's d: exposure-based CBT, 1.78; BSM, 1.22). CONCLUSIONS Exposure-based CBT delivered via the internet is an efficacious treatment for severe health anxiety.
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Affiliation(s)
- Erik Hedman
- Erik Hedman, PhD, Department of Clinical Neuroscience, Osher Center for Integrative Medicine, and Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm; Erland Axelsson, MSc, Anders Görling, MSc, Carina Ritzman, MSc, Markus Ronnheden, MSc, Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm; Samir El Alaoui, MSc, Erik Andersson, MSc, Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm; Mats Lekander, PhD, Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, and Stress Research Institute, Stockholm University, Stockholm; Brjánn Ljótsson, PhD, Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Erland Axelsson
- Erik Hedman, PhD, Department of Clinical Neuroscience, Osher Center for Integrative Medicine, and Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm; Erland Axelsson, MSc, Anders Görling, MSc, Carina Ritzman, MSc, Markus Ronnheden, MSc, Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm; Samir El Alaoui, MSc, Erik Andersson, MSc, Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm; Mats Lekander, PhD, Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, and Stress Research Institute, Stockholm University, Stockholm; Brjánn Ljótsson, PhD, Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Anders Görling
- Erik Hedman, PhD, Department of Clinical Neuroscience, Osher Center for Integrative Medicine, and Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm; Erland Axelsson, MSc, Anders Görling, MSc, Carina Ritzman, MSc, Markus Ronnheden, MSc, Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm; Samir El Alaoui, MSc, Erik Andersson, MSc, Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm; Mats Lekander, PhD, Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, and Stress Research Institute, Stockholm University, Stockholm; Brjánn Ljótsson, PhD, Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Carina Ritzman
- Erik Hedman, PhD, Department of Clinical Neuroscience, Osher Center for Integrative Medicine, and Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm; Erland Axelsson, MSc, Anders Görling, MSc, Carina Ritzman, MSc, Markus Ronnheden, MSc, Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm; Samir El Alaoui, MSc, Erik Andersson, MSc, Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm; Mats Lekander, PhD, Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, and Stress Research Institute, Stockholm University, Stockholm; Brjánn Ljótsson, PhD, Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Markus Ronnheden
- Erik Hedman, PhD, Department of Clinical Neuroscience, Osher Center for Integrative Medicine, and Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm; Erland Axelsson, MSc, Anders Görling, MSc, Carina Ritzman, MSc, Markus Ronnheden, MSc, Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm; Samir El Alaoui, MSc, Erik Andersson, MSc, Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm; Mats Lekander, PhD, Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, and Stress Research Institute, Stockholm University, Stockholm; Brjánn Ljótsson, PhD, Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Samir El Alaoui
- Erik Hedman, PhD, Department of Clinical Neuroscience, Osher Center for Integrative Medicine, and Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm; Erland Axelsson, MSc, Anders Görling, MSc, Carina Ritzman, MSc, Markus Ronnheden, MSc, Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm; Samir El Alaoui, MSc, Erik Andersson, MSc, Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm; Mats Lekander, PhD, Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, and Stress Research Institute, Stockholm University, Stockholm; Brjánn Ljótsson, PhD, Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Erik Andersson
- Erik Hedman, PhD, Department of Clinical Neuroscience, Osher Center for Integrative Medicine, and Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm; Erland Axelsson, MSc, Anders Görling, MSc, Carina Ritzman, MSc, Markus Ronnheden, MSc, Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm; Samir El Alaoui, MSc, Erik Andersson, MSc, Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm; Mats Lekander, PhD, Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, and Stress Research Institute, Stockholm University, Stockholm; Brjánn Ljótsson, PhD, Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Mats Lekander
- Erik Hedman, PhD, Department of Clinical Neuroscience, Osher Center for Integrative Medicine, and Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm; Erland Axelsson, MSc, Anders Görling, MSc, Carina Ritzman, MSc, Markus Ronnheden, MSc, Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm; Samir El Alaoui, MSc, Erik Andersson, MSc, Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm; Mats Lekander, PhD, Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, and Stress Research Institute, Stockholm University, Stockholm; Brjánn Ljótsson, PhD, Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Brjánn Ljótsson
- Erik Hedman, PhD, Department of Clinical Neuroscience, Osher Center for Integrative Medicine, and Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm; Erland Axelsson, MSc, Anders Görling, MSc, Carina Ritzman, MSc, Markus Ronnheden, MSc, Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm; Samir El Alaoui, MSc, Erik Andersson, MSc, Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm; Mats Lekander, PhD, Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, and Stress Research Institute, Stockholm University, Stockholm; Brjánn Ljótsson, PhD, Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
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Andersson G, Cuijpers P, Carlbring P, Riper H, Hedman E. Guided Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: a systematic review and meta-analysis. World Psychiatry 2014; 13:288-95. [PMID: 25273302 PMCID: PMC4219070 DOI: 10.1002/wps.20151] [Citation(s) in RCA: 657] [Impact Index Per Article: 65.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Internet-delivered cognitive behavior therapy (ICBT) has been tested in many research trials, but to a lesser extent directly compared to face-to-face delivered cognitive behavior therapy (CBT). We conducted a systematic review and meta-analysis of trials in which guided ICBT was directly compared to face-to-face CBT. Studies on psychiatric and somatic conditions were included. Systematic searches resulted in 13 studies (total N=1053) that met all criteria and were included in the review. There were three studies on social anxiety disorder, three on panic disorder, two on depressive symptoms, two on body dissatisfaction, one on tinnitus, one on male sexual dysfunction, and one on spider phobia. Face-to-face CBT was either in the individual format (n=6) or in the group format (n=7). We also assessed quality and risk of bias. Results showed a pooled effect size (Hedges' g) at post-treatment of -0.01 (95% CI: -0.13 to 0.12), indicating that guided ICBT and face-to-face treatment produce equivalent overall effects. Study quality did not affect outcomes. While the overall results indicate equivalence, there are still few studies for each psychiatric and somatic condition and many conditions for which guided ICBT has not been compared to face-to-face treatment. Thus, more research is needed to establish equivalence of the two treatment formats.
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Affiliation(s)
- Gerhard Andersson
- Department of Behavioural Sciences and Learning, Swedish Institute for Disability Research, University of LinköpingLinköping, Sweden,Department of Clinical Neuroscience, Division of Psychiatry, Karolinska InstitutetStockholm, Sweden
| | - Pim Cuijpers
- Department of Clinical Psychology, VU University AmsterdamAmsterdam, The Netherlands
| | - Per Carlbring
- Department of Psychology, University of StockholmStockholm, Sweden
| | - Heleen Riper
- Department of Clinical Psychology, VU University AmsterdamAmsterdam, The Netherlands,Leuphana UniversityLünebrug, Germany
| | - Erik Hedman
- Department of Clinical Neuroscience, Osher Center for Integrative Medicine and Division of Psychology, Karolinska InstitutetStockholm, Sweden
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Fetzner MG, Asmundson GJG, Carey C, Thibodeau MA, Brandt C, Zvolensky MJ, Carleton RN. How do elements of a reduced capacity to withstand uncertainty relate to the severity of health anxiety? Cogn Behav Ther 2014; 43:262-74. [PMID: 24961385 DOI: 10.1080/16506073.2014.929170] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Intolerance of uncertainty (IU)--a multidimensional cognitive vulnerability factor--is associated with a variety of anxiety disorders and health anxiety (HA). To date, few studies have assessed whether IU dimensions (prospective and inhibitory IU) are differentially associated with HA and whether their contributions are independent of anxiety sensitivity (AS). This study addressed these issues using independent community (n = 155; 81% women) and undergraduate (n = 560; 86% women) samples. Results indicated that prospective IU, but not inhibitory IU, had significant positive associations with HA in community dwellers and undergraduate students. AS somatic and cognitive concerns were also significant predictors among both samples. In addition, severity of IU dimensions among individuals reporting elevated HA were compared against individuals diagnosed with generalized anxiety disorder, social anxiety disorder, panic disorder, and obsessive-compulsive disorder. Results indicated minimal differences between those with elevated HA and each of the anxiety disorder diagnoses. Findings lend support to the unique transdiagnostic nature of IU and support commonalities between HA and anxiety disorders.
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Olatunji BO, Kauffman BY, Meltzer S, Davis ML, Smits JAJ, Powers MB. Cognitive-behavioral therapy for hypochondriasis/health anxiety: a meta-analysis of treatment outcome and moderators. Behav Res Ther 2014; 58:65-74. [PMID: 24954212 DOI: 10.1016/j.brat.2014.05.002] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 05/12/2014] [Accepted: 05/16/2014] [Indexed: 10/25/2022]
Abstract
The present investigation employed meta-analysis to examine the efficacy of cognitive-behavioral therapy (CBT) for hypochondriasis/health anxiety as well as potential moderators that may be associated with outcome. A literature search revealed 15 comparisons among 13 randomized-controlled trials (RCTs) with a total sample size of 1081 participants that met inclusion criteria. Results indicated that CBT outperformed control conditions on primary outcome measures at post-treatment (Hedges's g = 0.95) and at follow-up (Hedges's g = 0.34). CBT also outperformed control conditions on measures of depression at post-treatment (Hedges's g = 0.64) and at follow-up (Hedges's g = 0.35). Moderator analyses revealed that higher pre-treatment severity of hypochondriasis/health anxiety was associated with greater effect sizes at follow-up visits and depression symptom severity was significantly associated with a lower in effect sizes at post-treatment. Although effect size did not vary as a function of blind assessment, smaller effect sizes were observed for CBT vs. treatment as usual control conditions than for CBT vs. waitlist control. A dose response relationship was also observed, such that a greater number of CBT sessions was associated with larger effect sizes at post-treatment. This review indicates that CBT is efficacious in the treatment of hypochondriasis/health anxiety and identifies potential moderators that are associated with outcome. The implications of these findings for further delineating prognostic and prescriptive indicators of CBT for hypochondriasis/health anxiety are discussed.
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Affiliation(s)
| | | | - Sari Meltzer
- Department of Psychology, Vanderbilt University, United States
| | - Michelle L Davis
- Department of Psychology, University of Texas-Austin, United States
| | - Jasper A J Smits
- Department of Psychology, University of Texas-Austin, United States
| | - Mark B Powers
- Department of Psychology, University of Texas-Austin, United States
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