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Long-term effectiveness and outcome predictors of therapist-guided internet-based cognitive–behavioural therapy for social anxiety disorder in routine psychiatric care
OBJECTIVES: Although the short-term outcome of therapist-guided internet-based cognitive–behavioural therapy (ICBT) for treating social anxiety disorder (SAD) has been well studied, little research has been undertaken on the sustainability of treatment gains, especially under clinically representati...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2015
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4479995/ https://www.ncbi.nlm.nih.gov/pubmed/26105031 http://dx.doi.org/10.1136/bmjopen-2015-007902 |
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author | El Alaoui, Samir Hedman, Erik Ljótsson, Brjánn Lindefors, Nils |
author_facet | El Alaoui, Samir Hedman, Erik Ljótsson, Brjánn Lindefors, Nils |
author_sort | El Alaoui, Samir |
collection | PubMed |
description | OBJECTIVES: Although the short-term outcome of therapist-guided internet-based cognitive–behavioural therapy (ICBT) for treating social anxiety disorder (SAD) has been well studied, little research has been undertaken on the sustainability of treatment gains, especially under clinically representative conditions. Further, there is some debate whether delivering psychological treatment via the internet may be suitable for more severely ill patients. DESIGN: Longitudinal multilevel growth-modelling of long-term (1–4 years) follow-up cohort data. SETTING: An outpatient psychiatric clinic specialised in internet interventions. PARTICIPANTS: 446 adults having been treated for SAD. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcomes were estimated improvement rate and Cohen's d effect size on the self-rated Liebowitz Social Anxiety Disorder Scale. Secondary outcome measures were change in comorbid depressive symptoms and health-related quality of life. RESULTS: A large treatment effect was observed on the primary outcome measure after treatment (d=0.8 (95% CI 0.7 to 0.9)), with continued long-term improvements (d=1.2 (95% CI 1.0 to 1.3)). However, the rate of change varied significantly between individuals over time. A faster rate of improvement was observed among patients with higher illness severity, whereas having a family history of social anxiety was related to worse response. Long-term improvements were also observed in comorbid depressive symptoms (d=0.7 (95% CI 0.5 to 0.8)) and health-related quality of life (d=−0.3 (95% CI −0.4 to −0.1)). CONCLUSIONS: These findings provide evidence for the long-term effectiveness of ICBT for SAD in routine clinical practice, even for more severe cases. |
format | Online Article Text |
id | pubmed-4479995 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-44799952015-07-02 Long-term effectiveness and outcome predictors of therapist-guided internet-based cognitive–behavioural therapy for social anxiety disorder in routine psychiatric care El Alaoui, Samir Hedman, Erik Ljótsson, Brjánn Lindefors, Nils BMJ Open Mental Health OBJECTIVES: Although the short-term outcome of therapist-guided internet-based cognitive–behavioural therapy (ICBT) for treating social anxiety disorder (SAD) has been well studied, little research has been undertaken on the sustainability of treatment gains, especially under clinically representative conditions. Further, there is some debate whether delivering psychological treatment via the internet may be suitable for more severely ill patients. DESIGN: Longitudinal multilevel growth-modelling of long-term (1–4 years) follow-up cohort data. SETTING: An outpatient psychiatric clinic specialised in internet interventions. PARTICIPANTS: 446 adults having been treated for SAD. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcomes were estimated improvement rate and Cohen's d effect size on the self-rated Liebowitz Social Anxiety Disorder Scale. Secondary outcome measures were change in comorbid depressive symptoms and health-related quality of life. RESULTS: A large treatment effect was observed on the primary outcome measure after treatment (d=0.8 (95% CI 0.7 to 0.9)), with continued long-term improvements (d=1.2 (95% CI 1.0 to 1.3)). However, the rate of change varied significantly between individuals over time. A faster rate of improvement was observed among patients with higher illness severity, whereas having a family history of social anxiety was related to worse response. Long-term improvements were also observed in comorbid depressive symptoms (d=0.7 (95% CI 0.5 to 0.8)) and health-related quality of life (d=−0.3 (95% CI −0.4 to −0.1)). CONCLUSIONS: These findings provide evidence for the long-term effectiveness of ICBT for SAD in routine clinical practice, even for more severe cases. BMJ Publishing Group 2015-06-23 /pmc/articles/PMC4479995/ /pubmed/26105031 http://dx.doi.org/10.1136/bmjopen-2015-007902 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ |
spellingShingle | Mental Health El Alaoui, Samir Hedman, Erik Ljótsson, Brjánn Lindefors, Nils Long-term effectiveness and outcome predictors of therapist-guided internet-based cognitive–behavioural therapy for social anxiety disorder in routine psychiatric care |
title | Long-term effectiveness and outcome predictors of therapist-guided internet-based cognitive–behavioural therapy for social anxiety disorder in routine psychiatric care |
title_full | Long-term effectiveness and outcome predictors of therapist-guided internet-based cognitive–behavioural therapy for social anxiety disorder in routine psychiatric care |
title_fullStr | Long-term effectiveness and outcome predictors of therapist-guided internet-based cognitive–behavioural therapy for social anxiety disorder in routine psychiatric care |
title_full_unstemmed | Long-term effectiveness and outcome predictors of therapist-guided internet-based cognitive–behavioural therapy for social anxiety disorder in routine psychiatric care |
title_short | Long-term effectiveness and outcome predictors of therapist-guided internet-based cognitive–behavioural therapy for social anxiety disorder in routine psychiatric care |
title_sort | long-term effectiveness and outcome predictors of therapist-guided internet-based cognitive–behavioural therapy for social anxiety disorder in routine psychiatric care |
topic | Mental Health |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4479995/ https://www.ncbi.nlm.nih.gov/pubmed/26105031 http://dx.doi.org/10.1136/bmjopen-2015-007902 |
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