The aim of this randomized controlled trial was to investigate the effects of guided internet-based cognitive behavior therapy (ICBT) for posttraumatic stress disorder (PTSD). Sixty-two participants with chronic PTSD, as assessed by the Clinician-administered PTSD Scale, were recruited via nationwide advertising and randomized to either treatment (n= 31) or delayed treatment attention control (n= 31). The ICBT treatment consisted of 8 weekly text-based modules containing psychoeducation, breathing retraining, imaginal and in vivo exposure, cognitive restructuring, and relapse prevention. Therapist support and feedback on homework assignment were given weekly via an online contact handling system. Assessments were made at baseline, post-treatment, and at 1-year follow-up. Main outcome measures were the Impact of Events Scale - Revised (IES-R) and the Posttraumatic Stress Diagnostic Scale (PDS). Results showed significant reductions of PTSD symptoms (between group effect on the IES-R Cohens d= 1.25, and d= 1.24 for the PDS) compared to the control group. There were also effects on depression symptoms, anxiety symptoms, and quality of life. The results at one-year follow-up showed that treatment gains were maintained. In sum, these results suggest that ICBT with therapist support can reduce PTSD symptoms significantly. © 2014 The Authors

Internet-delivered interventions hold the possibility to make pain rehabilitation more accessible and adaptable by providing qualified individualized psychological care to chronic pain patients in their homes. Acceptance and commitment therapy (ACT) has shown promising results on psychological functioning and pain acceptance. Internet-delivered ACT (IACT) added to multimodal pain rehabilitation program (MMRP) in primary care has, so far, not shown better results than MMRP alone. The aim of this cluster randomized controlled study was to investigate the effects of adding IACT during and after MMRP in specialist care on psychological outcomes. In total, 122 patients who enrolled in a specialist pain clinic were cluster randomized groupwise to either MMRP (n = 12 groups) or to MMRP with added IACT (n = 12 groups). The IACT addition included 6 weeks of treatment during MMRP and 11 weeks of aftercare following MMRP. Online and paper-and-pencil self-report measures of pain acceptance, psychological inflexibility, self-efficacy, and psychosocial consequences of pain, were collected at four occasions: prior to and post MMRP, post aftercare intervention and at 1 year follow-up. Dropout was extensive with 25% dropping out at post treatment, an additional 35% at post aftercare, and 29% at 1 year follow-up. Medium treatment between-group effects were found on pain acceptance in favor of the group who received IACT added to MMRP, at post treatment and at post aftercare. Large effects were seen on psychological inflexibility and self-efficacy at post aftercare. A medium effect size was seen on affective distress at post aftercare. Moreover, a medium effect on self-efficacy was found at 1 year follow-up. The results indicate that IACT added during MMRP may enhance the treatment effects on pain-related psychological outcomes. Results also suggest that IACT as aftercare may strengthen the long-term effect of MMRP. However, adding a second pain treatment, IACT, to an already extensive pain treatment, MMRP, could be perceived as too comprehensive and might hence influence completion negatively. Further research on adverse events and negative effects could be helpful to improve adherence. Next step of implementation trials could focus on adding IACT before MMRP to improve psychological functioning and after MMRP to prolong its effect.

Book Reviews RecensionsAging and male sexuality. Schiavi RC. Cambridge (UK): Cambridge University Press; 1999. 253 pp with index. ISBN 0-521-65391-6 (paper). US$45.95. Aging and Male Sexuality is an impressive book written by an impressive man. Dr. Schiavi is Emeritus professor, Department of Psychiatry, Mount Sinai School of Medicine, New York. He is former president of both the International Academy for Sex Research and the Society for Sex Therapy and Research. He is a consummate clinician and a meticulous researcher. He is an authority on sexuality and the aging male. The book contains 14 chapters: Aging and sexuality: concepts, issues and research methods; Sexuality in the aged male; Research evidence; Neurobiology of aging male's sexuality; Aging and marital sexuality; Aging and homosexual relationships; The social context; Nature and prevalence of sexual disorders in the aged; Impact of medical illness on sexuality; Psychopathology and sexuality in aging; Effects of drugs and medications; Role of psychosocial factors; Assessment of sexual problems and Management of sexual problems.The material in these chapters is comprehensive, well digested and readable, and there are case histories to enrich the texts and to bring stark scientific facts to life.The author presents an array of theory and methods ranging from biomedical to psychosocial ones to address changes in male sexuality, as well as recent developments in psychotherapy for sexual problems.Schiavi starts by defining the aged. We learn that, at present, there