Jan Bergström

Effectiveness of Internet-based cognitive behaviour therapy for panic disorder in routine psychiatric care

Guided Internet‐based cognitive behaviour therapy (ICBT) for panic disorder has been shown to be efficacious in several randomized controlled trials. However, the effectiveness of the treatment when delivered within routine psychiatric care has not been studied. The aim of this study was to investigate the effectiveness of ICBT for panic disorder within the context of routine psychiatric care.

The COMTval158met polymorphism is associated with symptom relief during exposure-based cognitive-behavioral treatment in panic disorder

BackgroundCognitive behavioral therapy (CBT) represents a learning process leading to symptom relief and resulting in long-term changes in behavior. CBT for panic disorder is based on exposure and exposure-based processes can be studied in the laboratory as extinction of experimentally acquired fear responses. We have recently demonstrated that the ability to extinguish learned fear responses is associated with a functional genetic polymorphism (COMTval158met) in the COMT gene and this study was aimed at transferring the experimental results on the COMTval158met polymorphism on extinction into a clinical setting.MethodsWe tested a possible effect of the COMTval158met polymorphism on the efficacy of CBT, in particular exposure-based treatment modules, in a sample of 69 panic disorder patients.ResultsWe present evidence that panic patients with the COMTval158met met/met genotype may profit less from (exposure-based) CBT treatment methods as compared to patients carrying at least one val-allele. No association was found with the 5-HTTLPR/rs25531 genotypes which is presented as additional material.ConclusionsWe were thus able to transfer findings on the effect of the COMTval158met polymorphism from an experimental extinction study obtained using healthy subjects to a clinical setting. Furthermore patients carrying a COMT val-allele tend to report more anxiety and more depression symptoms as compared to those with the met/met genotype. Limitations of the study as well as possible clinical implications are discussed.Trial registrationClinical Trial Registry name: Internet-Versus Group-Administered Cognitive Behavior Therapy for Panic Disorder (IP2). Registration Identification number: NCT00845260, http://www.clinicaltrials.gov/ct2/show/NCT00845260

Smartphone-Supported versus Full Behavioural Activation for Depression: A Randomised Controlled Trial

Background There is need for more cost and time effective treatments for depression. This is the first randomised controlled trial in which a blended treatment - including four face-to-face sessions and a smartphone application - was compared against a full behavioural treatment. Hence, the aim of the current paper was to examine whether a blended smartphone treatment was non-inferior to a full behavioural activation treatment for depression. Methods This was a randomised controlled non-inferiority trial (NCT01819025) comparing a blended treatment (n=46) against a full ten-session treatment (n=47) for people suffering from major depression. Primary outcome measure was the BDI-II, that was administered at pre- and post-treatment, as well as six months after the treatment. Results Results showed significant improvements in both groups across time on the primary outcome measure (within-group Cohen’s d=1.35; CI [−0.82, 3.52] to d=1.47; CI [−0.41, 3.35]; between group d=−0.13 CI [−2.37, 2.09] and d=−0.10 CI [−2.53, 2.33]). At the same time, the blended treatment reduced the therapist time with an average of 47%. Conclusions We could not establish whether the blended treatment was non-inferior to a full BA treatment. Nevertheless, this study points to that the blended treatment approach could possibly treat nearly twice as many patients suffering from depression by using a smartphone applica¬tion as add-on. More studies are needed before we can suggest that the blended treatment method is a promising cost-effective alternative to regular face-to-face treatment for depression. Trial Registration Cognitive Behavioral Therapy Treatment of Depression With Smartphone Support NCT01819025

Clinical validation of a non-heteronormative version of the Social Interaction Anxiety Scale (SIAS)

IntroductionDespite welcomed changes in societal attitudes and practices towards sexual minorities, instances of heteronormativity can still be found within healthcare and research. The Social Interaction Anxiety Scale (SIAS) is a valid and reliable self-rating scale of social anxiety, which includes one item (number 14) with an explicit heteronormative assumption about the respondent´s sexual orientation. This heteronormative phrasing may confuse, insult or alienate sexual minority respondents. A clinically validated version of the SIAS featuring a non-heteronormative phrasing of item 14 is thus needed.Methods129 participants with diagnosed social anxiety disorder, enrolled in an Internet-based intervention trial, were randomly assigned to responding to the SIAS featuring either the original or a novel non-heteronormative phrasing of item 14, and then answered the other item version. Within-subject, correlation between item versions was calculated and the two scores were statistically compared. The two items’ correlations with the other SIAS items and other psychiatric rating scales were also statistically compared.ResultsItem versions were highly correlated and scores did not differ statistically. The two items’ correlations with other measures did not differ statistically either.ConclusionsThe SIAS can be revised with a non-heteronormative formulation of item 14 with psychometric equivalence on item and scale level. Implications for other psychiatric instruments with heteronormative phrasings are discussed.

1153 – Effectiveness and health economic evaluation of internet-based cognitive behavioural therapy in regular psychiatric care

Introduction Anxiety disorders are highly prevalent and among the leading causes of the global disease burden. Cognitive behaviour therapy (CBT) is an effective treatment, but demand is high and resources to deliver CBT are scarce. Embracing new technologies to meet these growing needs, there is an emergent evidence base of the efficacy of internet-based CBT (ICBT). Objectives Evaluating (1) treatment effects, (2) cost-effectiveness and (3) cost-utility of ICBT for panic disorder. Aims To evaluate clinical effectiveness and health economics of ICBT for patients within regular psychiatric care. Methods Longitudinal analysis of 570 patients diagnosed with panic disorder that have been treated between 2007 and 2012 at an ICBT unit within regular psychiatric care. The ICBT was therapist-guided and lasted for three months. Clinical outcome measures were improvements in symptom severity and health related quality of life. Economic outcome measures were direct and indirect costs and incremental cost-effectiveness ratios (ICER). Results Analyses of treatment outcome suggest significant reductions in primary symptoms of panic disorder and that ICBT is an economically and clinically effective treatment for panic disorder leading to improvement of symptom severity and quality of life for these patients. Conclusions The findings of this study can aid decision makers when considering options of evidence-based treatment delivery formats within psychiatric care.