Internet interventions: Past, present and future

Andersson, Gerhard

doi:10.1016/j.invent.2018.03.008

Cited by 250 publications

(211 citation statements)

References 133 publications

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“…ICBT and Internet interventions at large have been around for about 20 years, but implementation efforts have had mixed success. Moreover, these efforts have rarely been well documented from an implementation science perspective.…”

Section: Methodsmentioning

confidence: 99%

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Internet‐delivered psychological treatments: from innovation to implementation

et al. 2019

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Internet interventions, and in particular Internet-delivered cognitive behaviour therapy (ICBT), have existed for at least 20 years. Here we review the treatment approach and the evidence base, arguing that ICBT can be viewed as a vehicle for innovation. ICBT has been developed and tested for several psychiatric and somatic conditions, and direct comparative studies suggest that therapist-guided ICBT is more effective than a waiting list for anxiety disorders and depression, and tends to be as effective as face-to-face CBT. Studies on the possible harmful effects of ICBT are also reviewed: a significant minority of people do experience negative effects, although rates of deterioration appear similar to those reported for face-to-face treatments and lower than for control conditions. We further review studies on change mechanisms and conclude that few, if any, consistent moderators and mediators of change have been identified. A recent trend to focus on knowledge acquisition is considered, and a discussion on the possibilities and hurdles of implementing ICBT is presented. The latter includes findings suggesting that attitudes toward ICBT may not be as positive as when using modern information technology as an adjunct to face-to-face therapy (i.e., blended treatment). Finally, we discuss future directions, including the role played by technology and machine learning, blended treatment, adaptation of treatment for minorities and non-Western settings, other therapeutic approaches than ICBT (including Internet-delivered psychodynamic and interpersonal psychotherapy as well as acceptance and commitment therapy), emerging regulations, and the importance of reporting failed trials.

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Section: Methodsmentioning

confidence: 99%

“…Modern information technology has changed the world and the way we interact with one another. Computers were utilized early in psychotherapy research and, with the advent of the Internet, use of computers in research and practice increased rapidly.…”

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confidence: 99%

Internet‐delivered psychological treatments: from innovation to implementation

et al. 2019

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“…age, gender, income) and almost exclusively at baseline. While often theoretically reasonable, such predictors often turn out to be irrelevant in ICBT when examined (Andersson, 2018). For instance, the idea that ICBT is for non-complex or mild psychiatric cases does not seem to hold up.…”

Section: Predictors At Baselinementioning

confidence: 99%

Predicting treatment failure in regular care Internet-Delivered Cognitive Behavior Therapy for depression and anxiety using only weekly symptom measures.

Forsell

Isacsson

Blom

et al. 2020

Journal of Consulting and Clinical Psychology

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To my family Josefin, Selma and Oskar. Not only did they put up with me during the entire PhD journey, but they also spent the last two weeks of it in quarantine with me because of the coronavirus pandemic of 2020.ABSTRACT Background: Internet-delivered Cognitive Behavior Therapy (ICBT) is efficacious for a number of psychiatric disorders and can be successfully implemented in routine psychiatric care. Still, only about half of patients experience a good enough treatment outcome. Using data from the early part of treatment to identify patients with high risk of not benefitting from it, and target them with additional resources to prevent the predicted failure is a potential way forward. We call this an Adaptive Treatment Strategy, and a very important part of it is the ability to predict the outcome for a specific patient. Aims:To establish a proof of concept for an Adaptive Treatment Strategy in ICBT, and explore outcome prediction further by evaluating the accuracy of an empirically supported classification algorithm, the time point in treatment when acceptable accuracy can be reached, and the accuracy of ICBT-therapists' own predictions. Preliminary benchmarks regarding the clinical usefulness of prediction will be established. Studies:Four studies were performed: Study I was a randomized controlled trial (RCT; n=251) where patients' risk of treatment Failure (Red=high risk of failure, Green=low risk) was predicted during week 4 out of 9 in ICBT for Insomnia. Red patients (n=102) were then randomized to either continuing with standard treatment (n=51) or having their treatment individually adapted (n=51). In Study II, the classification algorithm from Study I was evaluated in terms of classification accuracy and the contribution of the different predictors used. In Study III, data from 4310 regular care ICBT-patients having received treatment for either Depression, Social anxiety disorder or Panic disorder were analyzed in a series of multiple regression models using weekly observations of the primary symptom measure as predictors to classify risk of Failure. As a contrast, Study IV examines ICBT therapists' own predictions on both categorical and continuous treatment outcomes, as they made predictions for each of their patients (n=897) during week 4 in the same three treatments as in Study III. Results:The RCT was successful in that Red patients receiving Adapted treatment improved significantly more than Red patients receiving standard treatment, and their odds of failure were nearly cut in half. Green patients did better than Red patients, indicating that the accuracy of the classification algorithm was clinically useful. Study II showed that the balanced accuracy of the classifier was 67% and that only 11 of 21 predictors correlated significantly with Failure. Notable predictors were symptom levels as well as different markers of treatment engagement. Study III and IV showed that acceptable predictions could be made halfway through treatment using only symptom scores and basic statistics, and that ICBT-...

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“…One of the world's foremost authorities on internet health care interventions, including computer‐assisted psychological assessment and psychotherapy, Gerhard Andersson, recently published an article that identified four future directions for the field overall (Andersson, ). These directions are not aimed exclusively at collegians, but are, nonetheless, instructive about computer‐assisted psychotherapy for collegians.…”

Section: Future Directionsmentioning

confidence: 99%