Stepped care in primary care – guided self-help and face-to-face cognitive behavioural therapy for common mental disorders: a randomized controlled trial

Salomonsson, Sigrid; Santoft, Fredrik; Lindsäter, Elin; Ejeby, Kersti; Ljótsson, Brjánn; Öst, Lars‐Göran; Ingvar, Martin; Lekander, Mats; Hedman‐Lagerlöf, Erik

doi:10.1017/s0033291717003129

Cited by 30 publications

(26 citation statements)

References 156 publications

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“…The ICBT protocol was a 12-week treatment based on a CBT protocol for AD and ED that was developed in clinical practice and evaluated in 2 randomized clinical trials conducted by our research group [22,23]. A key assumption of the treatment was that stress is a natural and necessary part of life, but that negative health consequences result, in part, from maladaptive behaviors adopted in response to stressors.…”

Section: Interventionsmentioning

confidence: 99%

Internet-Based Cognitive Behavioral Therapy for Chronic Stress: A Randomized Controlled Trial

Lindsäter

Axelsson

Salomonsson

et al. 2018

Psychother Psychosom

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Background: Prolonged exposure to stress can lead to substantial suffering, impairment and societal costs. However, access to psychological treatment is limited. Internet-based cognitive behavioral therapy (ICBT) can be effective in reducing symptoms of stress, but little is known of its effects in clinical samples. The aim of this study was to investigate the efficacy of ICBT for patients suffering from chronic stress, operationalized as adjustment disorder (AD) and exhaustion disorder (ED). Methods: A total of 100 adults diagnosed with AD or ED were randomly assigned to a 12-week ICBT (n = 50) or waitlist control condition (n = 50). Primary outcome was the level of perceived stress (PSS). Secondary outcomes included several mental health symptom domains as well as functional impairment and work ability. All outcomes were assessed at baseline, after treatment and at the 6-month follow-up. The study was preregistered at Clinicaltrials.gov: NCT02540317. Results: Compared to the control condition, patients in the ICBT group made large and significant improvements on the PSS (d = 1.09) and moderate to large improvements in secondary symptom domains. Effects were maintained at the 6-month follow-up. There was no significant between-group effect on functional impairment or work ability. Conclusions: A relatively short ICBT is indicated to be effective in reducing stress-related symptoms in a clinical sample of patients with AD and ED, and has the potential to substantially increase treatment accessibility. Results must be replicated, and further research is needed to understand the relationship between symptom reduction, functional impairment and work ability.

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Section: Interventionsmentioning

confidence: 99%

Internet-Based Cognitive Behavioral Therapy for Chronic Stress: A Randomized Controlled Trial

Lindsäter

Axelsson

Salomonsson

et al. 2018

Psychother Psychosom

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“…As no evidence‐based treatments exist for AD and ED, these disorders were treated with a CBT protocol that has been developed by our research group and tested in clinical practice since 2007. The treatment has been included in three randomized trials as face‐to‐face treatment (present study: Salomonsson et al ., ), stepped care with guided self‐help and face‐to‐face treatment (Salomonsson et al ., ), and as an Internet‐based treatment (Lindsäter et al ., ). The treatment is based on a model assuming that these disorders are maintained by a deficit of recuperation (Geurts & Sonnentag, ; Lisspers, Almén, & Sundin, ) that can be caused by for example difficulties to relax, extensive rumination, or aversive consequences of relaxing (e.g., a person may feel shame or guilt if taking a rest instead of working or helping friends or family).…”

Section: Methodsmentioning

confidence: 99%

Effects of cognitive behavioural therapy and return‐to‐work intervention for patients on sick leave due to stress‐related disorders: Results from a randomized trial

Salomonsson

Santoft

Lindsäter

et al. 2019

Scandinavian J Psychology

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The aim of this study was to evaluate specific effects for patients with adjustment or exhaustion disorder, the Stress subgroup (n = 152), regarding symptom severity and sick leave after CBT, a return‐to‐work intervention (RTW‐I), and a combination of them (COMBO), using data from a randomized trial. In the original study, primary care patients on sick leave (N = 211) were randomized to CBT (n = 64), RTW‐I (n = 67), or COMBO (n = 80). Blinded Clinician Severity Rating (CSR) of symptoms and sick leave registry data were primary outcomes. Subgroup analyses showed that for the Stress subgroup, CBT led to greater reduction of symptoms than RTW‐I posttreatment, but COMBO did not differ from CBT or RTW‐I. Regarding sick leave, there was no difference between treatments in the Stress subgroup. An exploratory analysis of the treatment effects in a subgroup of patients with depression, anxiety or insomnia indicates that RTW‐I reduced sick leave faster than CBT. We conclude that CBT may be promising as an effective treatment of stress and exhaustion disorder.

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“…The efficacy of iCBT for depression in primary care so far has been investigated by only one study, wherein iCBT has been shown to be more effective than treatment-as-usual (Proudfoot et al, 2004). Salomonsson et al (2017) have argued that using a stepped-care model 2 is an effective and efficient way to achieve improvements for nearly two thirds of primary care patients with common mental disorders while using fewer therapist resources.…”

Section: Final)mentioning

confidence: 99%

“…A literature review of randomized controlled trials of iCBT in primary care in Europe, the USA and Australia proved that additional professional support is required to engage depressed patients with self-help internet-based psychotherapies. At present, computerized CBT is offered by many healthcare systems as a minimally supported low-intensity psychological intervention and as part of a stepped-care framework (Salomonsson et al, 2017;Høifødt et al, 2013). The level of support for each patient is different and it varies mainly in severity of depression and the patient's ability to perform tasks online.…”

Section: The Global Experience Of Icbt In Primary Carementioning

confidence: 99%

“…Even though the drop-out rate was related to improvement attributed to other concurrent treatments (Newby et al, 2013), a variety of adverse events was also reported during treatment. As a consequence of commencing iCBT, the patients experienced a negative impact on their general wellbeing and reported slightly worse mood and more anxiety (Salomonsson et al, 2017;Rollman et al, 2017;Simblett et al, 2017).…”

Section: Drop-out and Participants' Adherence To Icbt Throughout Selementioning

confidence: 99%

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A Review Article on Internet-based Psychological Interventions in Primary Care. What is the Global Experience? How Reliable are Results from RCTs? Lessons Learned from the European, US and Australian Case Studies

Sogomonjan

Kerikmäe

Ööpik

2018

Baltic Journal of European Studies

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In the context of the EU’s Digital Single Market (eHealth) Strategy, the deployment of digital tools for patients’ empowerment and person-centred care is of high demand and importance. Shifting from treatment to health promotion and disease prevention, a variety of internet-based cognitive behavioural therapy programmes have been proven to be effective for managing common mental health disorders in secondary care even hough the effectiveness and the clinical use of internet-based cognitive behavioural therapy programmes alone in primary care have not been approved yet. Additionally, such interventions are neither included in the international clinical guidelines for treating common mental health disorders nor regulated by Member States as a healthcare service. Despite that, the UK National Health Service and the Swedish National Board of Health and Welfare endorse the use of internet-based cognitive behavioural therapy as a first treatment option. The aim of this research is to investigate the global experience of internet-based cognitive behavioural therapy programmes in controlled and real-life conditions in general practice and to evaluate the reliability of the results and concomitantly their compliance with the European Commission’s eHealth Strategy. A systematic review of quantitative studies was conducted from January 2007 to December 2017. The results indicated that unsupported internet-based cognitive behavioural therapy programmes alone are less effective than combined therapy options for treatment purposes, if no additional therapy is prescribed. Guided internet-based cognitive behavioural therapy may supplement traditional treatment methods resulting in improving the control of mental disorders, but are unable to demonstrate consistent quality or replace face-to-face therapy.

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Stepped care in primary care – guided self-help and face-to-face cognitive behavioural therapy for common mental disorders: a randomized controlled trial

Cited by 30 publications

References 156 publications

Internet-Based Cognitive Behavioral Therapy for Chronic Stress: A Randomized Controlled Trial

Internet-Based Cognitive Behavioral Therapy for Chronic Stress: A Randomized Controlled Trial

Effects of cognitive behavioural therapy and return‐to‐work intervention for patients on sick leave due to stress‐related disorders: Results from a randomized trial

A Review Article on Internet-based Psychological Interventions in Primary Care. What is the Global Experience? How Reliable are Results from RCTs? Lessons Learned from the European, US and Australian Case Studies

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