Guided Internet-Based Treatments in Psychiatry

244 Pages·2016·4.43 MB·English

by  Nils Lindefors

Guided Internet-
Based Treatments
in Psychiatry
Nils Lindefors
Gerhard Andersson
Editors
123
Guided Internet-Based Treatments
in Psychiatry

Nils Lindefors (cid:129) G erhard Andersson
Editors
Guided Internet-Based
Treatments in Psychiatry
Editors
Nils Lindefors Gerhard Andersson
Stockholm Linköping
Sweden Sweden
ISBN 978-3-319-06082-8 ISBN 978-3-319-06083-5 (eBook)
DOI 10.1007/978-3-319-06083-5
Library of Congress Control Number: 2015960761
Springer Cham Heidelberg New York Dordrecht London
© Springer International Publishing Switzerland 2016
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Pref ace
M any psychiatric disorders entail symptoms and problems treatable with cognitive
behaviour therapy (CBT). Research in this fi eld is extensive and expanding and
evidence for signifi cant reduction of burden of disease following CBT is ample.
Treatment guidelines in many countries recommend CBT as a fi rst-line treatment
for, for example, major depression and anxiety disorders. However, most if not all
countries suffer from a worldwide troublesome shortage in the number of trained
CBT therapists. Although we know from extensive evidence that CBT is cost-
effective and well received in clinical psychiatry, patients are often recommended
other means of treatment when asking for CBT due to this problematic shortage in
therapists. To assist the development of disseminated CBT with quality-assured
means, this book present methods and discuss related issues for Internet-based CBT
(ICBT). The focus is on therapist-guided ICBT.
ICBT is a novel contribution to modern health care in the domain of eHealth.
According to the World Health Organization (WHO), eHealth is the use of informa-
tion and communication technologies (ICT) for health. Possible domains for
eHealth development suggested by WHO include treating patients, conducting
research, educating the health workforce, tracking diseases and monitoring public
health. In line with this, we conclude that ICBT provides an important promising
relatively new contribution to global eHealth and ICBT should be tested further in
large-scale international trials.
I CBT may provide a direct safe electronic supply chain for information and com-
munication between therapist and patient. ICBT is less resource demanding than
conventional face-to-face interventions, without compromising treatment effective-
ness. Furthermore, ICBT add a sustainable treatment option as it reduces the patients’
need for transport to health centres or clinics for therapist interaction. This will most
probably reduce the carbon dioxide emission accompanying the treatment
W e suggest that the global burden of disease due to psychiatric disorders treat-
able with CBT imply such a movement. In addition and to support dissemination,
cost-effectiveness data are urgent to release funding for large-scale development for
IT platforms needed for further methods development and an opportunity for wide-
spread dissemination of ICBT.
Published scientifi c fi ndings and extensive clinical experiences presented and
discussed in this book suggest that ICBT provides means for fl exible dissemination
of CBT, where each therapist may guide more individuals through treatment
v
vi Preface
compared to in clinical live CBT. In addition, new hand-held devices and the devel-
opment of other means and gadgets that may assist the individual through the ICBT
will most probably further reduce dependence of professional therapists and to
allow real-life monitoring and thus enable the limited number of therapists to focus
on those not eligible for ICBT.
The health-care sector consists of a signifi cant part of the gross national products
(GNP) in most countries, and due to the development of new and often expensive
methods and materials, the cost of health care is increasing fast. The demand for
clinically effective, cost-effective and value-based methods in general is thus urgent.
Methods to systematically collect measures of patient outcome and other important
markers for delivered patient value by treatments are largely missing in clinical
practice. In psychiatry, this demand is displayed by lack of well-defi ned and stan-
dardised diagnostic procedures, value-based outcome measures and shortage of
reliable tools to monitor side effects and safety issues in disorders treatments.
T his book is compiled of chapters with world-leading ICBT researchers and cli-
nicians selected for their specifi c expertise. The scope to provide extensive evidence-
based ICBT programmes for psychiatry cannot be fulfi lled completely due to
limited evidence, but due to the relative novelty of ICBT, we think that the evidence
for effectiveness of this treatment format in clinical psychiatry is very promising
and demands further development.
We thank Springer for giving us the opportunity to edit this book and to our fami-
lies for their support during the process. Finally, we thank our co-workers in the
fi eld of ICBT and the many patients who have contributed to the research.
Stockholm, Sweden Nils Lindefors
September 2015 Gerhard Andersson
Contents
1 History and Current Status of ICBT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Gerhard Andersson , Per Carlbring , and N ils Lindefors
2 ICBT for Depression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Gerhard Andersson , Birgit Wagner , and Pim Cuijpers
3 ICBT for Panic Disorder and Agoraphobia: From the Computer
at Home to Real-Life ‘In Vivo’ Exposure . . . . . . . . . . . . . . . . . . . . . . . . 33
Wouter van Ballegooijen , Britt Klein , and Nils Lindefors
4 Internet-Based Cognitive Behavior Therapy for
Social Anxiety Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Erik Hedman , Cristina Botella , and Thomas Berger
5 ICBT in Psychiatry: Generalised Anxiety Disorder . . . . . . . . . . . . . . . 79
Nickolai Titov , Gerhard Andersson , and Björn Paxling
6 Internet-Delivered Cognitive Behavior Therapy (ICBT)
for Obsessive- Compulsive Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Bethany M. Wootton , Erik Andersson , and Christian Rück
7 Online Structured Writing Therapy for Post-traumatic
Stress Disorder and Complicated Grief . . . . . . . . . . . . . . . . . . . . . . . . 121
Jeroen Ruwaard and Alfred Lange
8 ICBT for Insomnia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
Annemieke van Straten , Kerstin Blom , Jaap Lancee , and Viktor Kaldo
9 ICBT for Severe Health Anxiety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Erik Hedman , Brjánn Ljótsson , and Nils Lindefors
10 ICBT for Eating Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
Alexandra Keyes and Ulrike Schmidt
11 Internet-Based Therapies for Child and Adolescent Emotional
and Behavioral Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
Susan H. Spence , Sonja March , Sarah Vigerland , and Eva Serlachius
vii
viii Contents
12 Internet-Delivered Cognitive Behaviour Therapy (ICBT) for Older
Adults with Anxiety and Depression . . . . . . . . . . . . . . . . . . . . . . . . . . . 219
Blake F. Dear , Kristin Silfvernagel , and Vincent J. Fogliati
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235
1
History and Current Status of ICBT
Gerhard Andersson , Per Carlbring , and Nils Lindefors
Abstract
We begin this chapter with a discussion of the history of ICBT and its roots in
bibliotherapy and computerised CBT. We then provide a brief description of one
way of administering guided ICBT, including the role of the therapist and data
security issues. This description is followed by examples of conditions that are
not covered later in the book, such as specifi c phobias and addictions. We end
this chapter with a discussion of technical developments, cost-effectiveness and
implementation.
Cognitive Behaviour Therapy (CBT)
In order to uncover the origin of Internet-based cognitive behaviour therapy (ICBT),
it is important to acknowledge the different strands in the literature. One source of
differentiation is choice of treatment format. There are two treatment formats of
particular importance. The fi rst is cognitive behaviour therapy (CBT), which is the
most well researched form of psychotherapy. CBT is also increasingly used in
G. Andersson , PhD (*)
Department of Behavioural Sciences and Learning , Linköping University ,
Linköping SE 581 83 , Sweden
Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden
e-mail: [email protected]
P. Carlbring , PhD
Department of Psychology , Stockholm University , Stockholm , Sweden
e-mail: [email protected]
N. Lindefors , MD, PhD
Division of Psychiatry, Department of Clinical Neuroscience , Karolinska Institutet ,
Stockholm , Sweden
e-mail: [email protected]
© Springer International Publishing Switzerland 2016 1
N. Lindefors, G. Andersson (eds.), Guided Internet-Based Treatments
in Psychiatry, DOI 10.1007/978-3-319-06083-5_1