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Kristofer Vernmark, psykolog/[email protected]
www.psykologpartners.sewww.kbtonline.se
Facebook: Internetbehandling med KBT
DEPRESSIONSHJÄLPEN®
Internet administered guided self-help versus individualized e-mail therapy:A randomized trial of two versions of CBT for major depression
Kristofer Vernmark a,b, Jan Lenndin a, Jonas Bjarehed a,c, Mattias Carlsson a, Johan Karlsson a,Jorgen Oberg a, Per Carlbring a, Thomas Eriksson d, Gerhard Andersson a,e, f,*
a Department of Behavioural Sciences and Learning, Linkoping University, SE-581 83 Linkoping, Swedenb Psykologpartners, Linkoping, Swedenc Deparment of Psychology, Lund University, Swedend Redakliniken, Linkoping, Swedene Swedish Institute for Disability Research, Linkoping University, Swedenf Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, Stockholm, Sweden
a r t i c l e i n f o
Article history:Received 20 October 2009Received in revised form19 January 2010Accepted 25 January 2010
Keywords:Internet treatmentMajor depressionE-mail therapyGuided self-help
a b s t r a c t
Internet-delivered psychological treatment of major depression has been investigated in several trials,but the role of personalized treatment is less investigated. Studies suggest that guidance is important andthat automated computerized programmes without therapist support are less effective. Individualizede-mail therapy for depression has not been studied in a controlled trial. Eighty-eight individuals withmajor depression were randomized to two different forms of Internet-delivered cognitive behaviourtherapy (CBT), or to a waiting-list control group. One form of Internet treatment consisted of guided self-help, with weekly modules and homework assignments. Standard CBT components were presented andbrief support was provided during the treatment. The other group received e-mail therapy, which wastailored and did not use the self-help texts i.e., all e-mails were written for the unique patient. Bothtreatments lasted for 8 weeks. In the guided self-help 93% completed (27/29) and in the e-mail therapy96% (29/30) completed the posttreatment assessment. Results showed significant symptom reductions inboth treatment groups with moderate to large effect sizes. At posttreatment 34.5% of the guided self-helpgroup and 30% of the e-mail therapy group reached the criteria of high-end-state functioning (BeckDepression Inventory score below 9). At six-month follow-up the corresponding figures were 47.4% and43.3%. Overall, the difference between guided self-help and e-mail therapy was small, but in favour of thelatter. These findings indicate that both guided self-help and individualized e-mail therapy can beeffective.
! 2010 Elsevier Ltd. All rights reserved.
Introduction
Major depression is widely acknowledged as a major healthproblem, with adverse consequences in terms of loss of produc-tivity and lowered quality of life (Ebmeier, Donaghey, & Steele,2006). Several psychological treatment options exist showingfairly equivalent outcomes (Cuijpers, van Straten, Andersson, & vanOppen, 2008), and evidence suggests that psychological treatmentsfor mild to moderate depression are about equally effective aspharmacological treatments (Cuijpers, van Straten, van Oppen,& Andersson, 2008). When equal effects are found other aspectsbecome relevant when making decisions about treatments for
depression. One issue concerns patient preferences, as patientsoften prefer psychological treatments (Leykin et al., 2007; vanSchaik et al., 2004), even if treatment preferences per se do notneed to have an impact on outcome (Leykin et al., 2007). Anotherissue concerns costs and cost-effectiveness of the treatments(Hargreaves, Shumway, & Hu, 1999). Yet another concern relates toaccess to the treatment. With increasing demand for psychologicaltreatments, guided self-help approaches have been developedshowing promising outcomes (den Boer, Wiersma, & Van denBosch, 2004). A recent promising and potentially cost-effectivetreatment format involves delivering cognitive behaviourtherapy (CBT) over the Internet (Andersson, 2009; Barak, Klein,& Proudfoot, 2009). Internet-delivered CBT for major depressionhas been tested in a number of trials, with varying outcomes frompromising (Andersson et al., 2005; Christensen, Griffiths, & Jorm,2004; Kessler et al., 2009; Meyer et al., 2009; Perini, Titov,
* Corresponding author. Tel.: þ46 13 28 58 40; fax: þ46 13 28 21 45.E-mail address: [email protected] (G. Andersson).
Contents lists available at ScienceDirect
Behaviour Research and Therapy
journal homepage: www.elsevier .com/locate/brat
0005-7967/$ – see front matter ! 2010 Elsevier Ltd. All rights reserved.doi:10.1016/j.brat.2010.01.005
Behaviour Research and Therapy 48 (2010) 368–376
1
Internetbaserade stöd- och behandlingsprogram inom vård och omsorg
2014
VARFÖR DEPRESSIONSHJÄLPEN?
25% av alla kvinnor och 15% av alla män uppfyller kriterierna för depression under sin livstid
4-10% punktprevalens
DEPRESSION
Stark evidens för KBT-behandling vid depression (t ex Cuijpers et al 2013)
Vård av patienter med depression och ångest
– en nulägesrapport
SBU ALERT 2013
OM DEPRESSIONSHJÄLPEN
Skapare Kristofer Vernmark, leg.psykologElin Sjöberg, leg.psykolog
Ägare Psykologpartners
Depressionshjälpen är ett behandlingsprogram som är bevisat effektivt vid depression. Grunden i behandlingen är att använda beteendeaktivering som ett sätt att påverka livet i rätt riktning, mot ökad livskvalitet och mindre nedstämdhet. Dessutom finns strategier som medveten närvaro och acceptans integrerade i behandlingen.
DEPRESSIONSHJÄLPEN®
Depressionshjälpen! – ett KBT-baserat behandlingsprogram vid depression
www.depressionshjalpen.se
ARBETSBOK
BEHANDLARVY
TILLGÄNGLIGHET
‣ Depressionshjälpen har använts i reguljär vård sedan 2010.‣ Programmet har använts på mer än 20 olika hälso- och
sjukvårdsverksamheter, främst i primärvården via vårdcentraler.
‣ ca 300 patienter har hittills gått igenom Depressionshjälpen.‣ Programmet har även testats i gruppformat.
REKRYTERING
BEDÖMNING
UPPSTART
BEHANDLING
AVSLUT
UPPFÖLJNING
Kontakten tar ca 15 minper vecka för behandlaren
Bedömning i fyra steg
A review of technology-assisted self-help and minimal contact therapies for anxietyand depression: Is human contact necessary for therapeutic efficacy?
Michelle G. Newman ⁎, Lauren E. Szkodny, Sandra J. Llera, Amy PrzeworskiThe Pennsylvania State University, United States
a b s t r a c ta r t i c l e i n f o
Article history:Received 15 May 2010Received in revised form 29 September 2010Accepted 30 September 2010
Keywords:Anxiety disordersDepressionInternet therapyWeb-based therapyVirtual realityPalmtop computer assisted therapyComputer-assisted therapy
Technology-based self-help and minimal contact therapies have been proposed as effective and low-costinterventions for anxiety andmood disorders. The present article reviews the literature published before 2010on these treatments for anxiety and depression using self-help and decreased therapist-contact interventions.Treatment studies are examined by disorder as well as amount of therapist contact, ranging from self-administered therapy and predominantly self-help interventions to minimal contact therapy where thetherapist is actively involved in treatment but to a lesser degree than traditional therapy and predominantlytherapist-administered treatments involving regular contact with a therapist for a typical number of sessions.In the treatment of anxiety disorders, it is concluded that self-administered and predominantly self-helpinterventions are most effective for motivated clients. Conversely, minimal-contact therapies havedemonstrated efficacy for the greatest variety of anxiety diagnoses when accounting for both attrition andcompliance. Additionally, predominantly self-help computer-based cognitive and behavioral interventionsare efficacious in the treatment of subthreshold mood disorders. However, therapist-assisted treatmentsremain optimal in the treatment of clinical levels of depression. Although the most efficacious amount oftherapist contact varies by disorder, computerized treatments have been shown to be a less-intensive, cost-effective way to deliver empirically validated treatments for a variety of psychological problems.
© 2010 Elsevier Ltd. All rights reserved.
Contents
1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 902. Critical review of the literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 903. Use of technology to treat anxiety disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90
3.1. Mixed anxiety disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 903.2. Obsessive-compulsive disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 953.3. Panic disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 963.4. Social phobia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 973.5. Generalized anxiety disorder and posttraumatic stress disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 973.6. Simple phobias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
3.6.1. Claustrophobia and driving phobia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 983.6.2. Acrophobia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 983.6.3. Flight phobia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 983.6.4. Spider phobia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 983.6.5. Summary and conclusions for simple phobia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
4. Technology-based depression treatments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 994.1. Subthreshold depression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 994.2. Major depression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 994.3. Summary and conclusions regarding computer-based depression treatments . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
5. Conclusions and future directions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Clinical Psychology Review 31 (2011) 89–103
⁎ Corresponding author. Department of Psychology, 310 Moore Building, The Pennsylvania State University, University Park, PA 16802-3103, United States. Tel.: +814 863 1148;fax: +814 863 7002.
E-mail address: [email protected] (M.G. Newman).
0272-7358/$ – see front matter © 2010 Elsevier Ltd. All rights reserved.doi:10.1016/j.cpr.2010.09.008
Contents lists available at ScienceDirect
Clinical Psychology Review
Artiklar, vetenskapliga arbeten och abstracts Lindner, P., Linderot Olsson, E., Johnsson, A., Dahlin, M., Andersson, G., & Carlbring, P. (2014). The impact of telephone versus e-mail therapist guidance on treatment outcomes, therapeutic alliance and treatment engagement in internet-delivered CBT for depression: A randomised pilot trial. Internet Interventions, 1, 182-187.Kivi, M., Eriksson, M., Hange, D., Petersson, E-L., Vernmark, K., Johansson, B. & Björkelund, C. (2014), Internet-based therapy for mild to moderate depression in Swedish primary care: Short term results from the PRIM-NET randomized controlled trial. Cognitive Behaviour Therapy, Jun 9:1-10 Kristofer Vernmark, Marie Kivi, Maria Eriksson, Dominique Hange, Eva-Lisa Petersson, Boo Johansson, Cecilia Björkelund, Marielle Ryberg, Fredrik Malmaeus, Celia Young. (2014). Effectiveness in Primary Care - Online Therapy Solutions for Depression, Insomnia and Worry. 7th scientific meeting International Society for Research on Internet Interventions (ISRII). Konferensbidrag- refereegranskat abstract.Carlbring, P., Hägglund, M., Luthström, A., Dahlin, M., Kadowaki, Å., Vernmark, K., & Andersson, G. (2013). Internet-based behavioral activation and acceptance-based treatment for depression: A randomized controlled trial. Journal of Affective Disorders. Volume 148, p331-337 Marie Kivi, Maria Christina Eriksson, Dominique Hange, Eva-Lisa Petersson, Boo Johansson, Cecilia Björkelund (2013) Internet therapy for Depression in Primary Care – a Randomized Controlled Trial, 13th European Congress of Psychology, Konferensbidrag - refereegranskat abstract.
Rapporter Kivi, M. (2012). Primärvårdspsykologi på distans: Psykoterapeuters och psykologers attityder till och erfarenheter av Internetbehandling i forskningsprojektet PRIM-NET [Primary Care Psychology at a distance: Psychotherapists and psychologists attitudes and experiences from Internet-delivered treatment within the research project PRIM-NET]. Unpublished Report. Department of psychology. Gothenburg.Utvärdering av iKBT – pilottest av internetstödd psykologisk behandling vid landstinget i Kalmar län. Clara Axelsson. Projektrapport Linnéuniversitetet 2014.Projektrapport – Pyskisk ohälsa hos unga, förbättra och förebygga (PUFF). Charlotte Barouma och Fredrik Malmaeus. 2012. Diarienr RSK 868-2010.
Carlbring, P., Hägglund, M., Luthström, A., Dahlin, M., Kadowaki, Å., Vernmark, K., & Andersson, G. (2013). Internet-based behavioral activation and acceptance-based treatment for depression: A randomized controlled trial. Journal of Affective Disorders. Volume 148, p331-337
Kivi, M., Eriksson, M., Hange, D., Petersson, E-L., Vernmark, K., Johansson, B. & Björkelund, C. (2014), Internet-based therapy for mild to moderate depression in Swedish primary care: Short term results from the PRIM-NET randomized controlled trial. Cognitive Behaviour Therapy, Jun 9:1-10
Internetbaserade behandlingsprogram FEBRUARI 2015
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