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Demetry Y, Wasteson E, Lindegaard T, Abuleil A, Geranmayeh A, Andersson G, Shahnavaz S. Individually Tailored and Culturally Adapted Internet-Based Cognitive Behavioral Therapy for Arabic-Speaking Youths With Mental Health Problems in Sweden: Qualitative Feasibility Study. JMIR Form Res 2023; 7:e46253. [PMID: 37999955 DOI: 10.2196/46253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 08/28/2023] [Accepted: 09/21/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Most forcibly displaced refugees in Sweden originate from the Arab Republic of Syria and Iraq. Approximately half of all refugees are aged between 15 and 26 years. This particular group of youths is at a higher risk for developing various mental disorders. However, low use of mental health services across Europe has been reported. Previous research indicates that culturally adapted psychological interventions may be suitable for refugee youths. However, little is known about the feasibility, acceptability, and efficacy of such psychological interventions. OBJECTIVE This study aimed to explore the feasibility, acceptability, and preliminary efficacy of an individually tailored and culturally adapted internet-based cognitive behavioral therapy for Arabic-speaking refugees and immigrant youths in Sweden. METHODS A total of 17 participants were included to participate in an open trial study of an individually tailored and culturally adapted internet-based cognitive behavioral therapy targeting common mental health problems. To assess the intervention outcome, the Hopkins Symptom Checklist was used. To explore the acceptability of the intervention, in-depth interviews were conducted with 12 participants using thematic analysis. Feasibility was assessed by measuring treatment adherence and by calculating recruitment and retention rates. RESULTS The intervention had a high dropout rate and low feasibility. Quantitative analyses of the treatment efficacy were not possible because of the high dropout rate. The qualitative analysis resulted in 3 overarching categories: experiences with SahaUng (the treatment), attitudes toward psychological interventions, and personal factors important for adherence. CONCLUSIONS The findings from this study indicate that the feasibility and acceptability of the current intervention were low and, based on the qualitative analysis, could be increased by a refinement of recruitment strategies, further simplification of the treatment content, and modifications to the cultural adaptation.
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Affiliation(s)
- Youstina Demetry
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Elisabet Wasteson
- Department of Psychology and Social Work, Mid Sweden University, Östersund, Sweden
| | - Tomas Lindegaard
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Amjad Abuleil
- Competence Team for migration health, Region Jämtland Härjedalen, Östersund, Sweden
| | - Anahita Geranmayeh
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Gerhard Andersson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Shervin Shahnavaz
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
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Berg M, Klemetz H, Lindegaard T, Andersson G. Self-esteem in new light: a qualitative study of experiences of internet-based cognitive behaviour therapy for low self-esteem in adolescents. BMC Psychiatry 2023; 23:810. [PMID: 37936134 PMCID: PMC10631070 DOI: 10.1186/s12888-023-05328-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/30/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Low self-esteem is common and can be impairing for adolescents. Treatments that primarily target low-esteem are lacking. Internet-delivered cognitive behaviour therapy (ICBT) is a treatment that can be used for adolescents but ICBT is yet to be evaluated for low self-esteem using qualitative methods. The aim of this study was to investigate experiences of participating in a novel ICBT treatment for adolescents suffering from low self-esteem. METHOD Fifteen adolescent girls who had received ICBT consented to participate in a semi-structured qualitative telephone interview at post-treatment. Data were analysed and categorised using inductive Thematic Analysis. RESULTS Four overarching themes were identified; (1) Increased awareness and agency in difficult situations, (2) Enhanced self-image, (3) Unique but not alone, and (4) Widened understanding and new perspectives. Participants reported positive changes in their thinking and behaviour, as well as helpful learning experiences in relation to themselves and their self-esteem. For instance, participants described a more self-accepting attitude, learned how to manage negative thoughts, and experienced an increased sense of connection to others. CONCLUSION The results suggest that ICBT is experienced as helpful and will inform further use and development of ICBT for low self-esteem. Future studies should validate and further evaluate experiences of ICBT for low self-esteem in other settings and in particular for boys as the study only include female participants.
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Affiliation(s)
- Matilda Berg
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, SE-58183, Sweden
| | | | - Tomas Lindegaard
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, SE-58183, Sweden.
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, SE-58183, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
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Lindegaard T. Do Psychedelics Facilitate Emergence of Unconscious Psychological Processes? Psychodyn Psychiatry 2023; 51:270-286. [PMID: 37712665 DOI: 10.1521/pdps.2023.51.3.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
Psychedelic substances have a long history of use in traditional healing and religious ceremonies worldwide and are increasingly being investigated for their possible therapeutic usage. However, there is still a lack of consensus regarding how best to characterize the psychological effects of psychedelics and how they bring about the positive therapeutic outcomes observed in clinical studies. The aim of this article is to review available evidence from quantitative and qualitative studies on psychedelic-assisted therapy, as well as neurobiological studies, in relation to the hypothesis that psychedelics facilitate the emergence of emotionally charged unconscious material, originally proposed by pioneering psychedelics researcher Stanislav Grof. The reviewed process studies of therapeutic mechanisms in psychedelic-assisted therapy and qualitative studies of treatment participants clearly indicate that the psychedelic experience is associated with the subjective experience of having increased access to and awareness of emotions, memories, and perceptions that are normally avoided or outside of conscious awareness. Brain-imaging studies point to several different neurobiological effects of psychedelics that might be related to these subjective psychological experiences. Available evidence also indicates that this process might constitute an important therapeutic mechanism in psychedelic-assisted therapy, worthy of further investigation.
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Affiliation(s)
- Tomas Lindegaard
- Assistant Professor, Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
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Berg M, Lindegaard T, Flygare A, Sjöbrink J, Hagvall L, Palmebäck S, Klemetz H, Ludvigsson M, Andersson G. Internet-based CBT for adolescents with low self-esteem: a pilot randomized controlled trial. Cogn Behav Ther 2022; 51:388-407. [PMID: 35503024 DOI: 10.1080/16506073.2022.2060856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Low self-esteem is a common problem among adolescents and is related to psychiatric problems such as depression and anxiety. However, effective and available interventions primarily targeting low self-esteem are scarce, in particular for youths. To address this gap, the aim of this pilot study was to evaluate a novel internet-based Cognitive Behavioral Therapy (ICBT) program for low self-esteem in adolescents using a randomized controlled design. Fifty-two participants (15-19 years) were recruited and randomly allocated to seven weeks of therapist-supported ICBT (n=26) or to a waitlist control condition (n=26). The primary outcome was the Rosenberg Self-Esteem Scale (RSES). Secondary outcomes measured domain-specific aspects of self-esteem, self-compassion, quality of life, depression and anxiety. The treatment group showed significantly higher levels of self-rated self-esteem compared to the control group at post-treatment, with a large between-group effect-size (RSES, d = 1.18). Further, the treatment had significant positive impact on secondary measures of self-esteem, self-compassion, quality of life, depression and anxiety. The results of this pilot-RCT suggest that ICBT can be effective for treating low self-esteem in adolescents, decrease depression and anxiety levels, and increasing quality of life. Replication of the results in larger samples is needed.
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Affiliation(s)
- Matilda Berg
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Tomas Lindegaard
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Anna Flygare
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Julia Sjöbrink
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Linn Hagvall
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Sofia Palmebäck
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | | | - Mikael Ludvigsson
- Department of Psychiatry in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Department of Acute Internal Medicine and Geriatrics in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
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Lindegaard T, Wasteson E, Demetry Y, Andersson G, Richards D, Shahnavaz S. Investigating the potential of a novel internet-based cognitive behavioural intervention for Dari and Farsi speaking refugee youth: A feasibility study. Internet Interv 2022; 28:100533. [PMID: 35433279 PMCID: PMC9006765 DOI: 10.1016/j.invent.2022.100533] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 03/28/2022] [Accepted: 03/30/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Over half of the world's forcibly displaced persons are under the age of 25, with many suffering from symptoms of psychological disorders. Many refugees from Afghanistan or Iran speak either Dari or Farsi, which are mutually intelligible dialects of the Persian language. Previous research on adult refugees and immigrants have shown that internet-based cognitive behavioural therapy (ICBT) can be a valuable complement to other forms of treatment. However, there is a lack of knowledge if ICBT is a feasible and acceptable treatment for adolescents and young adults with a refugee background. METHOD Fifteen Dari/Farsi-speaking adolescents and young adults between 15 and 26 years of age participated in a feasibility study of a novel individually tailored guided ICBT intervention targeting symptoms of common mental disorders such as anxiety and depression. Self-reported symptoms of anxiety and depression were assessed using the Hopkins Symptom Checklist-25 (HSCL-25) as the primary outcome measure. Four of the treatment participants and three additional non-treatment participants consented to be interviewed regarding the programme's acceptability. The interviews were analysed using Thematic Analysis. RESULTS The intervention suffered from low adherence, with only 3 participants completing the post-treatment assessment and with participants completing 0.9 modules on average, which meant that the intended quantitative analysis of the pre to post change was not possible. The thematic analysis resulted in two overarching categories, barriers and facilitators, that each contained four themes and related subthemes. Overall, the intervention was deemed culturally relevant and easy to understand. The most salient barriers to participation across interviews concerned interference of symptoms such as concentration difficulties, low energy, and a lack of human contact and support. CONCLUSION The current version of the ICBT program demonstrated low feasibility and acceptability in the target population, which mainly seemed to be related to the delivery format. Future studies should investigate if a blended treatment format with regular phone/video calls with a therapist can increase adherence to the intervention.
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Affiliation(s)
- Tomas Lindegaard
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Corresponding author at: Department of Behavioural Sciences and Learning, Linköping University, SE-581 83 Linköping, Sweden.
| | - Elisabet Wasteson
- Department of Psychology and Social Work, Mid Sweden University, Östersund, Sweden
| | - Youstina Demetry
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
- Stockholm Health Care Services, Region Stockholm, The Centre for Psychotherapy, Education & Research, Sweden
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Derek Richards
- E-mental Health Group, School of Psychology, University of Dublin, Trinity College Dublin, Dublin, Ireland
- Clinical Research & Innovation, SilverCloud Health, Dublin, Ireland
| | - Shervin Shahnavaz
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
- Stockholm Health Care Services, Region Stockholm, The Centre for Psychotherapy, Education & Research, Sweden
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Käll A, Bäck M, Welin C, Åman H, Bjerkander R, Wänman M, Lindegaard T, Berg M, Moche H, Shafran R, Andersson G. Therapist-Guided Internet-Based Treatments for Loneliness: A Randomized Controlled Three-Arm Trial Comparing Cognitive Behavioral Therapy and Interpersonal Psychotherapy. Psychother Psychosom 2021; 90:351-358. [PMID: 34182552 DOI: 10.1159/000516989] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/28/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Chronic loneliness has been linked to many adverse outcomes, including mental health problems. Psychological treatment of loneliness can be effective, but the evidence base is limited. OBJECTIVE To investigate the efficacy of 2 internet-based interventions based on cognitive behavioral therapy (ICBT) and interpersonal psychotherapy (IIPT) relative to a wait-list control group and each other. METHODS A total of 170 participants were recruited and randomized to either 9 weeks of ICBT (n = 68), IIPT (n = 68), or a wait-list condition (n = 34). The primary outcome was loneliness, measured using the UCLA Loneliness Scale before, during, and after treatment. Secondary measures of psychiatric disorders and quality of life were administered before and after treatment. Follow-up was conducted 4 months after the treatment had ended. Primary outcome data were analyzed using growth curve modeling. Secondary outcomes were analyzed using robust regression models. The trial was preregistered (ClinicalTrials.gov ID: NCT03807154). RESULTS The ICBT condition had a significantly greater impact on loneliness compared to the wait-list and IIPT conditions. Effect sizes were moderate to large (Cohen d = 0.71) compared to the wait-list and moderate (d = 0.53) compared to IIPT. The IIPT condition did not differ significantly from the wait-list. Both active treatments led to significant increases in quality of life. Only the ICBT group had significantly lower symptoms of depression and generalized anxiety compared to the wait-list group. Treatment gains were maintained but not improved at follow-up. CONCLUSIONS ICBT can be an efficacious option for alleviating loneliness. The IIPT intervention was not as effective.
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Affiliation(s)
- Anton Käll
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
| | - Malin Bäck
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
| | - Camilla Welin
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
| | - Hanna Åman
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
| | - Rasmus Bjerkander
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
| | - Matilda Wänman
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
| | - Tomas Lindegaard
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
| | - Matilda Berg
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
| | - Hajdi Moche
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
| | - Roz Shafran
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Gerhard Andersson
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
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Lindegaard T, Kashoush F, Holm S, Halaj A, Berg M, Andersson G. Experiences of internet-based cognitive behavioural therapy for depression and anxiety among Arabic-speaking individuals in Sweden: a qualitative study. BMC Psychiatry 2021; 21:288. [PMID: 34082745 PMCID: PMC8173836 DOI: 10.1186/s12888-021-03297-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 05/19/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Internet-delivered cognitive behavioural therapy (ICBT) is a promising treatment for refugee and immigrant populations suffering from common mental disorders. The aim of the present study was to investigate experiences of participating in a guided ICBT program among resettled Arabic-speaking individuals suffering from symptoms of anxiety and depression. METHODS Ten individuals who had previously received ICBT consented to participate and were interviewed using semi-structured telephone interviews. The interviews were conducted 10 months after treatment termination. Data were transcribed and analysed using a Thematic Analysis framework. RESULTS The Thematic Analysis resulted in five overarching themes 1) The importance of being seen, 2) New ways of knowing and doing, 3) Treatment format not for everyone, 4) Changing attitudes towards mental health and help-seeking and 5) The healthcare system as a complex puzzle. Participants described varying levels of success in applying the new information learned from the treatment in their everyday lives. The results also indicate that participation in the ICBT program to some extent mitigated mental health stigma and acted as a precursor to other forms of treatment seeking. CONCLUSIONS The findings in the present study are largely in line with previous qualitative research studies on ICBT participants. Future research should investigate whether a more explicit focus on refugee-specific stressors and barriers to treatment engagement and implementation can increase adherence to ICBT programs in this population.
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Affiliation(s)
- Tomas Lindegaard
- Department of Behavioural Sciences and Learning, Linköping University, SE-581 83, Linköping, Sweden.
| | - Fatima Kashoush
- grid.5640.70000 0001 2162 9922Department of Behavioural Sciences and Learning, Linköping University, SE-581 83 Linköping, Sweden
| | - Sara Holm
- grid.5640.70000 0001 2162 9922Department of Behavioural Sciences and Learning, Linköping University, SE-581 83 Linköping, Sweden
| | - Asala Halaj
- grid.9619.70000 0004 1937 0538Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Matilda Berg
- grid.5640.70000 0001 2162 9922Department of Behavioural Sciences and Learning, Linköping University, SE-581 83 Linköping, Sweden
| | - Gerhard Andersson
- grid.5640.70000 0001 2162 9922Department of Behavioural Sciences and Learning, Linköping University, SE-581 83 Linköping, Sweden ,grid.4714.60000 0004 1937 0626Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden ,grid.5640.70000 0001 2162 9922Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Käll A, Shafran R, Lindegaard T, Bennett S, Cooper Z, Coughtrey A, Andersson G. A common elements approach to the development of a modular cognitive behavioral theory for chronic loneliness. J Consult Clin Psychol 2020; 88:269-282. [PMID: 32068427 DOI: 10.1037/ccp0000454] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Loneliness is a transdiagnostic clinical phenomenon that can significantly impact mental health and well-being across the lifespan. OBJECTIVE The aim was to combine existing theory and evidence-based treatment approaches to propose a comprehensive transdiagnostic cognitive-behavioral analysis of the maintenance of chronic loneliness relevant across disorders, age groups, and populations. METHOD A distillation and matching model-framework approach was taken to identify interventions designed to reduce loneliness. Eligible studies were coded for the presence of practice elements. The findings were combined with an analysis of the broader literature on loneliness and psychopathology to derive a comprehensive cognitive-behavioral analysis of the maintenance of loneliness over time across populations. RESULTS The search yielded 11 studies containing 14 practice elements with relative frequencies ranging from 7% to 64%. The identified practice elements target putative mechanisms such as negative interpersonal appraisals, anxiety, and social skills deficits. Counterproductive behavior and cognitive processes such as self-focused attention were identified as maintenance factors based on the broader literature. A modular transdiagnostic model with multiple pathways is proposed to be consistent with the existing theoretical and treatment literature. CONCLUSIONS Combining the distillation and matching model framework with existing theory from the literature is a novel approach for developing a model of factors that maintain loneliness over time. The model has varying treatment implications for different populations including children with autism spectrum disorders and bereaved older adults. Targeting transdiagnostic processes has the potential to transform interventions for loneliness across a range of formats and settings. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Anton Käll
- Department of Behavioural Sciences and Learning, Linkoping University
| | - Roz Shafran
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health
| | - Tomas Lindegaard
- Department of Behavioural Sciences and Learning, Linkoping University
| | - Sophie Bennett
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health
| | | | - Anna Coughtrey
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linkoping University
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Lindegaard T, Seaton F, Halaj A, Berg M, Kashoush F, Barchini R, Ludvigsson M, Sarkohi A, Andersson G. Internet-based cognitive behavioural therapy for depression and anxiety among Arabic-speaking individuals in Sweden: a pilot randomized controlled trial. Cogn Behav Ther 2020; 50:47-66. [DOI: 10.1080/16506073.2020.1771414] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Tomas Lindegaard
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Felicia Seaton
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Asala Halaj
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Matilda Berg
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Fatima Kashoush
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | | | - Mikael Ludvigsson
- Department of Psychiatry in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Acute Internal Medicine and Geriatrics in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Ali Sarkohi
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
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Lindegaard T, Hesslow T, Nilsson M, Johansson R, Carlbring P, Lilliengren P, Andersson G. Internet-based psychodynamic therapy vs cognitive behavioural therapy for social anxiety disorder: A preference study. Internet Interv 2020; 20:100316. [PMID: 32257826 PMCID: PMC7118309 DOI: 10.1016/j.invent.2020.100316] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 03/16/2020] [Accepted: 03/17/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Both Internet-delivered cognitive behavioural therapy (ICBT) and Internet-delivered psychodynamic psychotherapy (IPDT) have shown promise in the treatment of social anxiety disorder (SAD). However, little is known about client preferences and what predicts treatment outcome. The objective of the present pilot study was to examine preference for ICBT versus IPDT in the treatment of SAD and whether participants' preference strength and therapeutic alliance predicted treatment response. Further, we also investigated the effect of the two treatments, including 6-months follow-up. METHOD Thirty-six participants were instructed to choose between either IPDT or ICBT based on a brief description. Both treatments were 10 weeks long. Liebowitz Social Anxiety Scale - Self Report was used as the primary outcome measure. RESULTS IPDT (N = 23; 63.9%) was preferred more often than ICBT (N = 13; 36.1%), but the difference did not reach statistical significance (p = .10). Preference strength did not predict the treatment effect but therapeutic alliance did. The observed within-group effects for the treatment period were d = 0.40 [-0.21, 0.99] for the IPDT group and d = 0.53 [-0.29, 1.31] for the ICBT group. An intention-to-treat (ITT) analysis revealed no significant difference between the two treatments on any outcome measure at either post-treatment or at six months follow-up. CONCLUSION The present pilot study did not find a difference in preference for IPDT or ICBT in the treatment of SAD and both treatments resulted in small to moderate improvements in symptoms of SAD. Preference strength might not predict treatment effect, but this needs to be tested in larger studies.
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Affiliation(s)
- Tomas Lindegaard
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden,Corresponding author at: Department of Behavioural Sciences and Learning, Linköping University, SE-581 83 Linköping, Sweden.
| | - Thomas Hesslow
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Maja Nilsson
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Robert Johansson
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | | | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Abstract
Recent years have seen an increase of internet-delivered interventions based on psychodynamic treatment models. To test the efficacy of internet-delivered psychodynamic therapy (IPDT), we conducted a systematic review and meta-analysis of randomized controlled trials. Following literature searches, we identified seven studies meeting inclusion criteria. The total number of participants was 528 in the treatment group and 552 in the control conditions. We found small effects favoring IPDT compared to inactive control conditions for main outcomes (g = 0.44), depression (g = 0.46), anxiety (g = 0.20), and quality of life (g = 0.40). There was significant heterogeneity between studies for main outcomes and depression. Within-group effects ranged from Hedges's g = 0.32-0.99. The effects of IPDT were maintained or increased at follow-up. Study quality varied but was generally high. No indications of publication bias were found. In conclusion, IPDT is a promising treatment alternative, especially for depression, although the small number of studies limits the generalizability of the findings.
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Affiliation(s)
- Tomas Lindegaard
- Clinical Psychology, Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Matilda Berg
- Clinical Psychology, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Gerhard Andersson
- Professor in Clinical Psychology, Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden, and Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
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