Individually tailored internet-based cognitive behavioural therapy for anxiety disorders

Abstract

All previously published articles were reproduced with permission from the publisher. It´s hard to remember that this day will never come again. That the time is nowand the place is here and that there are no second chances at a single moment. Jeanette Winterson, The Passion 1 ABSTRACTFear is an innate emotion and an adaptive response to provide protection from potential harm. When fear is excessive and out of proportion in relation to the confronted situation, it can lead to the development of an anxiety disorder. Many individuals feel anxious at some point, but not all experience clinical anxiety or meet the diagnostic criteria of an anxiety disorder. Still, anxiety disorders are the most prevalent form of psychiatric disorder in the general population. More often than not people suffering from one anxiety disorder also present other psychiatric conditions. As of today, cognitive and behavioural treatments have been tested and found to positively affect anxiety disorders, making them the treatment of choice. Nevertheless, many patients do not seek or receive adequate treatment.One common critique of the research trials from which the recommendations for treatments stem is the use of a single protocol targeting only one diagnosis. This is because many people suffer from comorbidities. Another problem connected to the recommendation that cognitive behavioural therapy (CBT) should be the treatment of choice for anxiety disorders is the lack of therapists with adequate training. One possible way of dealing both with the shortcoming of therapists and making CBT more accessible is the use of the Internet. Internet-based CBT (ICBT) has been tested in numerous trials during the last 15 years, showing positive outcomes for a large variety of disorders. Many ICBT trials also make use of a single protocol. Another way of dealing with comorbidities might be to tailor the treatment to let characteristics and preferences of the patient guide the design of the protocol. Little is known about possible effects of tailoring the ICBT, the effects of therapeutic relationships in ICBT, and the effectiveness and cost-effectiveness of these treatments. This thesis is based on three studies on two separate randomized controlled trials (RCTs) using the same set of modules accessible for the tailored protocol.Study I was an RCT investigating treatment effects up to two-year after completion, showing favourable outcomes of the treatment in a 2 self-recruited sample at all measure points. Study II was a secondary analysis exploring possible relations between working alliance and treatment outcome for participants in the treatment group recruited for Study I indicating that working alliance predict outcome in this tailored treatment.The second RCT was an effectiveness trial (Study III) analysing treatment effects and cost-effectiveness of the treatment up to one year post treatment in a primary-care population. This study showed positive treatment effects both regarding symptom reduction and cost-effectiveness, and that effects were susta...

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“…Ze względu na nowe zastosowanie konieczne są jednak dalsze badania w kierunku udoskonalenia i oceny interwencji poznawczo-behawioralnych w leczeniu bólu z zastosowaniem zdalnej pracy terapeutycznej. Badania wskazują, że terapia internetowa, jak również wszelkie programy internetowe czy aplikacje na telefon, mogą się przyczynić do wzrostu dostępności CBT oraz wpływają na zmniejszenie stygmatyzacji [28,38].…”

“…Jednym z elementów krytyki pod adresem standardowej CBT jest zastosowanie pojedynczego protokołu, który uwzględnia tylko jedną diagnozę. Należy podkreślić, że wiele osób cierpi z powodu chorób współistniejących, co powinno być wzięte pod uwagę w planowaniu terapii [38].…”

“…Dopasowanie terapii poznawczo-behawioralnej do unikalnych, indywidualnych cech pacjenta i jego sytuacji życiowej, jak również ewentualnych chorób współistniejących -to nowe podejście do leczenia. W terapii dopasowanej pacjent nie tylko odgrywa aktywną rolę w ustalaniu celów terapeutycznych, lecz ma także wpływ na zawartość terapii -wybór modułów leczenia [38,43]. Standardowe protokoły CBT oferują podobny program leczenia dla wszystkich pacjentów, podczas gdy w spersonalizowanym (dopasowanym) podejściu stosowane są interwencje uwzględniające specyfikę pacjenta.…”

Individually tailored internet-based cognitive behavioural therapy for adolescents, young adults and older adults with anxiety

“…The goal is to identify and target participant's specific psychosocial difficulties and psychological comorbidities with the aim of increasing the relevance, comprehensiveness and clinical outcomes of ICBT treatments. Importantly, the treatment package for older adults consists of modules derived from previous ICBT treatments Andersson et al, 2011;Johansson et al, 2012;Bergman Nordgren et al, 2013), which have been adapted to make them suitable for an older population. The first module (the introduction module) and the last module (a relapse prevention module) are fixed and the following are optional for the therapists to prescribe within an 8-week timeframe: cognitive restructuring (2 modules), panic disorder (2 modules), agoraphobia (1 module), generalised anxiety (3 modules), social anxiety (2 modules), behavioural activation (2 modules), applied relaxation (1 module), stress (1 module), mindfulness (1 module), problem-solving (1 module) and sleep habits (1 module).…”