The Effectiveness and Acceptability of Internet-Delivered Cognitive Behavioral Therapy for Depression and Anxiety in Routine Clinical Care
(2023)- Abstract
- Evidence-based psychological interventions delivered via the internet and mobile technologies (Digital Mental Health) hold the promise of reducing barriers to care, including difficulties accessing treatment because of distance, cost, work and family commitments, and limited provider capacity. Such barriers represent a particular challenge for individuals with depression and anxiety, that tend to co-occur and to recur following treatment cessation, and which are among the most common and burdensome illnesses worldwide. Numerous randomized controlled trials have shown that internet-delivered cognitive behavioral therapy (ICBT) for depression and anxiety is highly effective in reducing the severity and impact of symptoms and improving... (More)
- Evidence-based psychological interventions delivered via the internet and mobile technologies (Digital Mental Health) hold the promise of reducing barriers to care, including difficulties accessing treatment because of distance, cost, work and family commitments, and limited provider capacity. Such barriers represent a particular challenge for individuals with depression and anxiety, that tend to co-occur and to recur following treatment cessation, and which are among the most common and burdensome illnesses worldwide. Numerous randomized controlled trials have shown that internet-delivered cognitive behavioral therapy (ICBT) for depression and anxiety is highly effective in reducing the severity and impact of symptoms and improving overall functioning when compared to no-treatment in individuals recruited online. However, important knowledge gaps remain about the acceptability and effectiveness of ICBT when delivered in routine psychiatric care settings. Bridging these knowledge gaps is especially important now as ICBT is being disseminated at a rapid pace in Sweden. The current program of research was carried out with the purpose of investigating the usefulness, acceptability, and effectiveness of ICBT when delivered in a routine psychiatric care setting to adults. Study I was a naturalistic evaluation of the sustained effectiveness of treatment for depression in a psychiatric out-patient setting and examination of psychosocial and clinical predictors of symptom recurrence and relapse to a depression diagnosis. Study II was a randomized waitlist-controlled trial evaluating the acceptability and effectiveness of an 8-week ICBT program for depression delivered in a routine psychiatric setting. Study III was a qualitative study that sought to identify why patients with mixed symptoms of generalized anxiety disorder (GAD) and depression had non-adhered to an ICBT program for GAD. Overall, the findings indicate that ICBT for depression delivered in a routine outpatient psychiatric care setting is acceptable and effective in reducing depressive symptoms as well as mitigating anxiety. However, the study also highlights challenges related to treatment adherence and the need for more effective interventions to prevent relapse and recurrence in psychiatric depression treatment. Further research and improvements in ICBT delivery are warranted to address these issues and enhance mental health care outcomes in such settings. (Less)
- Abstract (Swedish)
- Psykologiska evidensbaserade interventioner som förmedlas via internet och mobila teknologier (Digital Mental Health) har potential att minska tröskeln för att få vård, samt minska svårigheter att få tillgång till behandling på grund av avstånd, kostnader, arbete och familjekonflikter eller begränsad kapacitet hos vårdgivare. Den här typen av hinder utgör en särskild utmaning för personer med depression och ångest, besvär som tenderar att förekomma samtidigt och dessutom återkomma efter behandlingsavslut, och som är bland de vanligaste och mest påfrestande sjukdomarna i ett globalt perspektiv. Ett stort antal randomiserade kontrollerade studier har visat att internetbaserad kognitiv beteendeterapi (IKBT) för depression och ångest är mycket... (More)
- Psykologiska evidensbaserade interventioner som förmedlas via internet och mobila teknologier (Digital Mental Health) har potential att minska tröskeln för att få vård, samt minska svårigheter att få tillgång till behandling på grund av avstånd, kostnader, arbete och familjekonflikter eller begränsad kapacitet hos vårdgivare. Den här typen av hinder utgör en särskild utmaning för personer med depression och ångest, besvär som tenderar att förekomma samtidigt och dessutom återkomma efter behandlingsavslut, och som är bland de vanligaste och mest påfrestande sjukdomarna i ett globalt perspektiv. Ett stort antal randomiserade kontrollerade studier har visat att internetbaserad kognitiv beteendeterapi (IKBT) för depression och ångest är mycket effektivt för att minska svårighetsgraden och påverkan av symtomen samt för att förbättra den övergripande funktionsförmågan jämfört med ingen behandling hos individer som rekryterats online. Det finns dock fortfarande viktiga kunskapsluckor kring metodens acceptabilitet och effektivitet när den förmedlas inom psykiatrisk rutinvård. Att överbrygga dessa kunskapsluckor är särskilt viktigt nu när IKBT sprids snabbt i Sverige. Den aktuella avhandlingen genomfördes med syfte att undersöka användbarheten, acceptabiliteten och effektiviteten av IKBT när det används inom psykiatrisk rutinvård för vuxna. Studie I var en naturalistisk utvärdering av den långsiktiga effekten av depressionsbehandling på en psykiatrisk öppenvårdsmottagning, dessutom undersöktes i vilken utsträckning psykosociala och kliniska faktorer predicerar återfall och tillbakagång till en depressionsdiagnos. Studie II var en randomiserad studie med väntliste-kontrollgrupp som utvärderade acceptabiliteten och effektiviteten av ett 8-veckors IKBT-program för depression, förmedlat inom psykiatrisk rutinvård. Studie III var en kvalitativ studie som syftade till att identifiera varför patienter med blandade symtom på generaliserat ångestsyndrom (GAD) och depression inte fullföljde ett IKBT-program för GAD. Sammanfattningsvis tyder resultaten på att IKBT för depression, förmedlat inom psykiatrisk öppenvård, är acceptabelt och effektivt för att minska depression- och ångestsymtom. Resultaten belyser dock även utmaningar såsom problem med följsamhet till behandling och behovet av mer effektiva interventioner för att förhindra återfall i depression inom psykiatrisk vård. Ytterligare forskning och förbättringar av IKBT behövs för att hantera dessa frågor och förbättra utfallet av psykiatrisk vård. (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/aac15ffb-62bf-4aa3-85f0-f877d79b70ea
- author
- Johansson, Olof LU
- supervisor
- opponent
-
- Professor Watkins, Edward Robert, University of Exeter
- organization
- alternative title
- Effektivitet och acceptans av internetbaserad kognitiv beteendeterapi för depression och ångest i reguljär vård.
- publishing date
- 2023-09
- type
- Thesis
- publication status
- published
- subject
- keywords
- effectiveness, internet-delivered CBT, Depression and Anxiety, acceptability, psychiatry
- pages
- 69 pages
- publisher
- Lund University
- defense location
- Kulturens auditorium, Teqnérplatsen, Lund
- defense date
- 2023-10-06 09:00:00
- ISBN
- 978-91-8039-785-8
- 978-91-8039-786-5
- language
- English
- LU publication?
- yes
- id
- aac15ffb-62bf-4aa3-85f0-f877d79b70ea
- date added to LUP
- 2023-09-06 17:11:52
- date last changed
- 2023-09-12 12:18:55
@phdthesis{aac15ffb-62bf-4aa3-85f0-f877d79b70ea,
abstract = {{Evidence-based psychological interventions delivered via the internet and mobile technologies (Digital Mental Health) hold the promise of reducing barriers to care, including difficulties accessing treatment because of distance, cost, work and family commitments, and limited provider capacity. Such barriers represent a particular challenge for individuals with depression and anxiety, that tend to co-occur and to recur following treatment cessation, and which are among the most common and burdensome illnesses worldwide. Numerous randomized controlled trials have shown that internet-delivered cognitive behavioral therapy (ICBT) for depression and anxiety is highly effective in reducing the severity and impact of symptoms and improving overall functioning when compared to no-treatment in individuals recruited online. However, important knowledge gaps remain about the acceptability and effectiveness of ICBT when delivered in routine psychiatric care settings. Bridging these knowledge gaps is especially important now as ICBT is being disseminated at a rapid pace in Sweden. The current program of research was carried out with the purpose of investigating the usefulness, acceptability, and effectiveness of ICBT when delivered in a routine psychiatric care setting to adults. Study I was a naturalistic evaluation of the sustained effectiveness of treatment for depression in a psychiatric out-patient setting and examination of psychosocial and clinical predictors of symptom recurrence and relapse to a depression diagnosis. Study II was a randomized waitlist-controlled trial evaluating the acceptability and effectiveness of an 8-week ICBT program for depression delivered in a routine psychiatric setting. Study III was a qualitative study that sought to identify why patients with mixed symptoms of generalized anxiety disorder (GAD) and depression had non-adhered to an ICBT program for GAD. Overall, the findings indicate that ICBT for depression delivered in a routine outpatient psychiatric care setting is acceptable and effective in reducing depressive symptoms as well as mitigating anxiety. However, the study also highlights challenges related to treatment adherence and the need for more effective interventions to prevent relapse and recurrence in psychiatric depression treatment. Further research and improvements in ICBT delivery are warranted to address these issues and enhance mental health care outcomes in such settings.}},
author = {{Johansson, Olof}},
isbn = {{978-91-8039-785-8}},
keywords = {{effectiveness; internet-delivered CBT; Depression and Anxiety; acceptability; psychiatry}},
language = {{eng}},
publisher = {{Lund University}},
school = {{Lund University}},
title = {{The Effectiveness and Acceptability of Internet-Delivered Cognitive Behavioral Therapy for Depression and Anxiety in Routine Clinical Care}},
url = {{https://lup.lub.lu.se/search/files/157566177/Olof_Johansson_Thesis.pdf}},
year = {{2023}},
}