Lars Ström

Internet-Based Treatment for Insomnia : A Controlled Evaluation

This study investigated the effects of an Internet-based intervention for insomnia. Participants who met criteria for insomnia (N = 109) were randomly assigned to either a cognitive-behavioral self-help treatment or a waiting list control condition. The 5-week intervention mainly consisted of sleep restriction, stimulus control, and cognitive restructuring. Sleep diary data were collected for 2 weeks at baseline and at posttreatment. The dropout rate was 24% (n = 28). Results showed statistically significant improvements in the treatment group on many outcome measures, including total sleep time, total wake time in bed, and sleep efficiency. However, improvements were also found in the control group. Overall, between-groups effect sizes were low, with the exception of the Beliefs and Attitudes About Sleep Scale (Cohens d =.81).

Controlled trial of Internet-based treatment with telephone support for chronic back pain

Abstract The purpose of this study was to investigate the effects of an Internet‐based cognitive‐behavioral intervention with telephone support for chronic back pain. Participants who met the criteria for chronic back pain (N=56) were randomly assigned to either an Internet‐based cognitive behavioral self‐help treatment or to a waiting‐list control condition. The study period lasted 8 weeks and consisted of 1 week of self‐monitoring prior to the intervention, 6 weeks of intervention, and 1 week of post‐intervention assessment. Treatment consisted of education, cognitive skill acquisition, behavioral rehearsal, generalization and maintenance. The dropout rate was 9% (N=5). Results showed statistically significant improvements in catastrophizing, control over pain and ability to decrease pain. Some improvement was found in both the control group and the treatment group. A follow‐up of 3 months after treatment termination was completed in 92% (N=47) of the participants who completed the treatment intervention. Follow‐up results showed that some improvement was maintained. Findings indicate that Internet‐based self‐help with telephone support, based on established psychological treatment methods, holds promise as an effective approach for treating disability in association with pain.

Internet administration of the Hospital Anxiety and Depression Scale in a sample of tinnitus patients.

OBJECTIVE To administer and validate the Hospital Anxiety and Depression Scale (HADS) via the Internet to a sample of persons with tinnitus. METHOD The HADS was converted into a Web page and administered via the Internet to a sample of 157 persons with tinnitus who were recruited for participation in a treatment trial. Also included were the Tinnitus Reaction Questionnaire (TRQ) and the Anxiety Sensitivity Index (ASI). A clinical comparison sample (n=86) was also recruited who completed the same tests in a paper-and-pencil format. RESULTS Both the Internet and the paper-and-pencil version yielded comparable results in terms of psychometric properties. When using the cut-off of 11 points suggested by Zigmond and Snaith [Acta Psychiatr. Scand. 67 (1983) 361] a 25% (n=40) prevalence of probable anxiety and a 17% (n=27) prevalence of probable depression were found in the Internet group. In the clinic sample, the prevalence was only 15% for both anxiety and depression, suggesting that Internet administration might result in higher percentages. The HADS correlated with both tinnitus distress and anxiety sensitivity. CONCLUSIONS Internet administration of the HADS results in meaningful and valid data. Consistent with previous research anxiety and depression are common comorbid conditions in individuals with tinnitus, but norms should be developed for Internet based screening.

Randomized Controlled Trial of Internet-Based Stress Management

This study investigated the effects of an internet-based self-help stress management program with a randomized controlled design. Of 85 participants, 26% dropped out, leaving a final sample of 63 participants with 23 in the treatment group and 40 in the waiting list control group. Treatment included applied relaxation, problem solving, time management and cognitive restructuring. All information and treatment interventions were provided via the internet. Results were evaluated with the Perceived Stress Scale and the Hospital Anxiety and Depression Scale. Improvements were seen in both groups, with greater improvements in the self-help treatment group. It is concluded that the internet can be used to provide stress management techniques and result in stress relief. However, spontaneous improvement, differential dropout rate and compliance need to be monitored in future studies.

Internet-based treatment of headache: Does telephone contact add anything?

Objective.—To study the contribution of therapist‐initiated telephone contact in the treatment of recurrent headache via the Internet.

Development of a New Approach to Guided Self-Help via the Internet: The Swedish Experience

ABSTRACT This article describes the development and empirical status of guided Internet-delivered self-help. The treatment approach combines the benefits of bibliotherapy with book-length text materials and the support given online via web pages and e-mail. Interactive features such as online registrations, tests, and online discussion forums are also included. Cognitive behavior therapy (CBT) guided the research and clinical implementations of this approach, as it lends itself more easily to the self-help format compared with other presently available psychotherapy approaches. We include an overview of the research, current issues and research in service delivery, lessons learned through a program of research, and directions for future investigations.

Guided internet-based cognitive behavioural treatment for chronic back pain reduces pain catastrophizing : a randomized controlled trial

OBJECTIVE The aim of this study was to investigate whether an Internet-based cognitive behavioural intervention would have an effect on the symptoms of chronic back pain. DESIGN Experimental design with a treatment group and a control group measured before and after a treatment period. SUBJECTS Participants who met the criteria for chronic back pain (n = 54). METHODS All participants were screened in a live, structured interview before inclusion. The study period was 12 weeks and the treatment consisted of education, cognitive skills acquisition, behavioural rehearsal, generalization and maintenance. The main outcome of interest was the catastrophizing subscale of the Coping Strategies Questionnaire. RESULTS There were statistically significant reductions from pre- to post-treatment in catastrophizing in the treatment group, and an improvement in quality of life for the treatment group. However, most outcome measures did not indicate a positive treatment outcome. On a scale measuring pain catastrophizing, 58% (15/26) of the treated participants showed reliable improvement, compared with 18% (5/28) of the control group. CONCLUSION Internet-based cognitive behavioural therapy can serve as a complement for individuals with chronic pain who prefer this treatment and have difficulties accessing specialist treatment facilities.

Screening of psychiatric disorders via the Internet. A pilot study with tinnitus patients

Tinnitus has been associated with psychiatric disorders and more recently diagnostic tools have been used in a systematic manner. In the present study, we administered the World Health Organisations Composite International Diagnostic Interview – Short form (CIDI-SF) in a computerized Internet-based version to a self-selected sample of tinnitus patients (n=48). Using the cut-off for ‘probable case’ (12-month prevalence), 69% of the tinnitus patients fulfilled the criteria for depression, 60% for generalized anxiety disorder, 83% for specific phobia, 67% for social phobia, 58% for agoraphobia, 21% panic attack, 83% obsessive–compulsive disorder, 2% alcohol dependence and 0% drug dependence. Decreased percentages were found for depression (4%), specific phobia (62%) and social phobia (27%) when applying a more conservative criteria (maximum case criteria). In conclusion, the findings suggest that the Internet version of CIDI-SF can be used as a screening tool for psychiatric disturbance in somatic patients, but that diagnostic criteria need to be adjusted for Internet use.

Are coping strategies really useful for the tinnitus patient? An investigation conducted via the internet

This questionnaire study investigated the role of coping strategies in tinnitus. The Tinnitus Coping Strategy Questionnaire (12) was administered via the internet to a sample of 157 persons with tinnitus who were recruited for participation in a treatment trial. Also included were the Tinnitus Reaction Questionnaire, the Anxiety Sensitivity Index, and the Hospital Anxiety and Depression Scale. Results showed a significant positive correlation between use of coping strategies and tinnitus distress, even when controlling for anxiety sensitivity, and anxiety and depression levels in a multiple regression analysis. In line with previous studies, the role of coping strategies is not uniformly positive for tinnitus patients, and might even be associated with increased distress. Treatment implications are discussed and a possible role of acceptance strategies is put forward.

The effects on depression of Internet- administered behavioural activation and physical exercise with treatment rationale and relapse prevention: study protocol for a randomised controlled trial

BackgroundDespite their potential as low-threshold, low-cost and high-flexibility treatments of depression, behavioural activation and physical exercise have not yet been directly compared. This study will examine the effects of these interventions, administered via the Internet. The added effect of providing a treatment rationale will also be studied, as well as a relapse prevention program featuring cognitive behavioural therapy components.Methods/DesignThis randomised controlled trial will include 500 participants meeting the diagnostic criteria for major depression, recruited in multiple cycles and randomised to either a waiting list control group with delayed treatment, or one of the four treatment groups: (1) physical exercise without a clear treatment rationale; (2) physical exercise with treatment rationale; (3) behavioural activation with treatment rationale; or (4) behavioural activation without a clear treatment rationale. Post treatment, half of the participants will be offered a relapse prevention program. Primary outcome measure will be the Patient Health Questionnaire 9-item. Secondary measures include diagnostic criteria for depression, as well as self-reported anxiety, physical activity and quality of life. Measurements - done via telephone and the Internet - will be collected pre-treatment, weekly during treatment period, immediately post treatment and then monthly during a 24-month follow-up period.DiscussionThe results of this study will constitute an important contribution to the body of knowledge of the respective interventions. Limitations are discussed.Trial registrationClinicalTrials.gov: NCT01619930