Hostname: page-component-8448b6f56d-m8qmq Total loading time: 0 Render date: 2024-04-23T19:50:52.625Z Has data issue: false hasContentIssue false
  • English
  • Français

Therapist Effects in Guided Internet-Delivered CBT for Anxiety Disorders

Published online by Cambridge University Press:  13 December 2010

Jonas Almlöv ,
Per Carlbring ,
Karin Källqvist ,
Björn Paxling ,
Pim Cuijpers  and
Gerhard Andersson
Jonas Almlöv
Affiliation:
Linköping University, Sweden
Per Carlbring
Affiliation:
Umeå University, Sweden
Karin Källqvist
Affiliation:
Linköping University, Sweden
Björn Paxling
Affiliation:
Linköping University, Sweden and Vrije Universiteit, Amsterdam, The Netherlands
Pim Cuijpers
Affiliation:
Vrije Universiteit, Amsterdam, The Netherlands
Gerhard Andersson*
Affiliation:
Linköping University, Sweden and Karolinska Institutet, Stockholm, Sweden
*
Reprint requests to Gerhard Andersson, Department of Behavioral Sciences and Learning, Linköping University, SE-581 83 Linköping, Sweden. E-mail: gerhard.andersson@liu.se
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: Guided internet-delivered CBT for anxiety disorders has received increasing empirical support, but little is known regarding the role of the therapist. Aims: This study addressed therapist factors in guided internet-delivered cognitive behavioural therapy for anxiety disorders. Method: Data from three controlled trials with a total N of 119 were analyzed with attention to differences between eight therapists. Results: No significant mean level differences between therapists appeared in the dataset. However, one significant intraclass correlation between participants was found, suggesting that the outcome on the Beck Anxiety Inventory might have been influenced by the impact of the individual therapists. Conclusion: The therapist can possibly have some influence on the outcome of guided internet-delivered CBT for anxiety disorders, but studies with more statistical power are needed to establish whether therapist effects are present in this modality of psychological treatment. The present study was underpowered to detect minor therapist effects.

Keywords

Therapisttreatment outcomeinternetintraclass correlationsnested design
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 39 , Issue 3 , May 2011 , pp. 311 - 322
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Almlöv, J., Carlbring, P., Berger, T., Cuijpers, P. and Andersson, G. (2009). Therapist factors in internet-delivered CBT for major depressive disorder. Cognitive Behaviour Therapy, 38, 247–254.CrossRefGoogle ScholarPubMed
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders (rev. 4th ed.). Washington, DC: Author.Google Scholar
Andersson, G. (2009). Using the internet to provide cognitive behaviour therapy. Behaviour Research and Therapy, 47, 175–180.CrossRefGoogle ScholarPubMed
Andersson, G., Bergström, J., Buhrman, M., Carlbring, P., Holländare, F., Kaldo, V., et al. (2008). Development of a new approach to guided self-help via the internet. the Swedish experience. Journal of Technology in Human Services, 26, 161–181.CrossRefGoogle Scholar
Andersson, G., Bergström, J., Holländare, F., Ekselius, L. and Carlbring, P. (2004). Delivering CBT for mild to moderate depression via the internet: predicting outcome at 6-months follow-up. Verhaltenstherapie, 14, 185–189.CrossRefGoogle Scholar
Andersson, G., Carlbring, P. and Grimlund, A. (2008). Predicting treatment outcome in internet versus face to face treatment of panic disorder Computers in Human Behavior, 24, 1790–1801.CrossRefGoogle Scholar
Beck, A. T., Epstein, N., Brown, G. and Steer, R. A. (1988). An inventory for measuring clinical anxiety: psychometric properties. Journal of Consulting and Clinical Psychology, 56, 893–897.CrossRefGoogle ScholarPubMed
Bergström, J., Andersson, G., Ljótsson, B., Rück, C., Andréewitch, S., Karlsson, A., et al. (2010). Internet- versus group-administered cognitive behaviour therapy for panic disorder in a psychiatric setting: a randomised trial. BMC Psychiatry, 10, 54.CrossRefGoogle Scholar
Beutler, L. E., Mailk, M., Harwood, T. M., Talebi, H., Noble, S. and Wong, E. (2004). Therapist variables. In Lambert, M. J. (Ed.), Bergin and Garfield's Handbook of Psychotherapy and Behaviour Change (pp. 227–306). New York: John Wiley and Sons.Google Scholar
Buchanan, T. (2003). Internet-based questionnaire assessment: appropriate use in clinical contexts. Cognitive Behaviour Therapy, 32, 100–109.CrossRefGoogle ScholarPubMed
Carlbring, P., Bohman, S., Brunt, S., Buhrman, M., Westling, B. E., Ekselius, L., et al. (2006). Remote treatment of panic disorder: a randomized trial of internet-based cognitive behavior therapy supplemented with telephone calls. American Journal of Psychiatry, 163, 2119–2125.CrossRefGoogle ScholarPubMed
Carlbring, P., Brunt, S., Bohman, S., Austin, D., Richards, J. C., Öst, L.-G., et al. (2007). Internet vs. paper and pencil administration of questionnaires commonly used in panic/agoraphobia research. Computers in Human Behavior, 23, 1421–1434.CrossRefGoogle Scholar
Carlbring, P., Gunnarsdóttir, M., Hedensjo, L., Andersson, G., Ekselius, L. and Furmark, T. (2007). Treatment of social phobia: randomised trial of internet-delivered cognitive-behavioural therapy with telephone support. British Journal of Psychiatry, 190, 123–128.CrossRefGoogle ScholarPubMed
Carlbring, P., Nilsson-Ihrfelt, E., Waara, J., Kollenstam, C., Buhrman, M., Kaldo, V., et al. (2005). Treatment of panic disorder: live therapy vs. self-help via internet. Behaviour Research and Therapy, 43, 1321–1333.CrossRefGoogle ScholarPubMed
Chambless, D. L., Caputo, G. C., Bright, P. and Gallagher, R. (1984). Assessment of fear of fear in agoraphobics: the body sensations questionnaire and the agoraphobic cognitions questionnaire. Journal of Consulting and Clinical Psychology, 52, 1090–1097.CrossRefGoogle ScholarPubMed
Chambless, D. L., Caputo, G. C., Jasin, S. E., Gracely, E. J. and Williams, C. (1985). The mobility inventory for agoraphobia. Behaviour Research and Therapy, 23, 35–44.CrossRefGoogle ScholarPubMed
Cook, J. E. and Doyle, C. (2002). Working alliance in online therapy as compared to face-to-face therapy: preliminary results. Cyberpsychology and Behavior, 5, 95–105.CrossRefGoogle ScholarPubMed
Crits-Christoph, P., Baranackie, K., Kurcias, J. S., Beck, A. T., Carroll, K., Perry, K., et al. (1991). Meta-analysis of therapist effects in psychotherapy outcome studies. Psychotherapy Research, 1, 81–91.CrossRefGoogle Scholar
Crits-Cristoph, P. and Mintz, J. (1991). Implications of therapist effects for the design and analysis of comparative studies of psychotherapies. Journal of Consulting and Clinical Psychology, 57, 414–419.Google Scholar
D'Arcy, J., Reynolds, J. R., Stiles, W. B. and Grohol, J. M. (2006). An investigation of session impact and alliance in internet based psychotherapy: preliminary results. Counseling and Psychotherapy Research, 6, 164–168.Google Scholar
Derogatis, L. R., Lippman, R. S. and Covi, L. (1973). SCL-90: an outpatient psychiatric rating scale – preliminary report. Psychopharmacology Bulletin, 9, 13–28.Google ScholarPubMed
Fleiss, J. L., Levin, B. and Paik, M. C. (2003). Statistical Methods for Rates and Proportions (3rd ed.). Hoboken, NJ: John Wiley and Sons.CrossRefGoogle Scholar
Frisch, M. B., Cornell, J., Villanueva, M. and Retzlaff, P. J. (1992). Clinical validation of the quality of life inventory: a measure of life satisfaction for use in treatment planning and outcome assessment. Psychological Assessment, 4, 92–101.CrossRefGoogle Scholar
Gellatly, J., Bower, P., Hennessy, S., Richards, D., Gilbody, S. and Lovell, K. (2007). What makes self-help interventions effective in the management of depressive symptoms? Meta-analysis and meta-regression. Psychological Medicine, 37, 1217–1228.CrossRefGoogle ScholarPubMed
Horvath, A. O. and Greenberg, L. S. (1989). The development and validation of the Working Alliance Inventory. Journal of Counseling Psychology, 36, 223–233.CrossRefGoogle Scholar
Kenny, D. A., Mannetti, L., Pierro, A., Livi, S. and Kashy, D. A. (2002). The statistical analysis of data from small groups. Journal of Personality and Social Psychology, 83, 126–137.CrossRefGoogle Scholar
Kiropoulos, L. A., Klein, B., Austin, D. W., Gilson, K., Pier, C., Mitchell, J., et al. (2008). Is internet-based CBT for panic disorder and agoraphobia as effective as face-to-face CBT? Journal of Anxiety Disorders, 22, 1273–1284.CrossRefGoogle ScholarPubMed
Klein, B., Richards, J. C. and Austin, D. W. (2006). Efficacy of internet therapy for panic disorder. Journal of Behavior Therapy and Experimental Psychiatry, 37, 213–238.CrossRefGoogle ScholarPubMed
Knaevelsrud, C. and Maercker, A. (2007). Internet-based treatment for PTSD reduces distress and facilitates the development of a strong therapeutic alliance: a randomized controlled clinical trial. BMC Psychiatry, 7, e13.CrossRefGoogle Scholar
Lange, A., Van Den Ven, J.-P., Schrieken, B. and Emmelkamp, P. M. G. (2001). Interapy – treatment of posttraumatic stress through the internet: a controlled trial. Journal of Behavior Therapy and Experimental Psychiatry, 32, 73–90.CrossRefGoogle ScholarPubMed
Mattick, R. P. and Clarke, J. C. (1998). Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Behaviour Research and Therapy, 36, 455–470.CrossRefGoogle ScholarPubMed
Maxwell, S. E. and Delaney, H. D. (2004). Designing Experiments and Analyzing Data: a model comparison approach (2nd ed.). Mahwah, NJ: Lawrence Erlbaum Associates.Google Scholar
McGraw, K. O. and Wong, S. P. (1996). Forming inferences about some intraclass correlation coefficients. Psychological Methods, 1, 30–46.CrossRefGoogle Scholar
Meyer, T. J., Miller, M. L., Metzger, R. L. and Borkovec, T. D. (1990). Development and validation of the Penn State Worry Questionnaire. Behaviour Research and Therapy, 28, 487–495.CrossRefGoogle ScholarPubMed
Newman, M. O., Zuellig, A. R., Kachin, K. E., Constantino, M. J., Przeworski, A., Erickson, T., et al. (2002). Preliminary reliability and validity of the generalized anxiety disorder questionnaire-IV: a revised self-report diagnostic measure of generalized anxiety disorder. Behavior Therapy, 33, 215–233.CrossRefGoogle Scholar
Van Oakman, J., Ameringen, M., Mancini, C. and Farvolden, P. (2003). A confirmatory factor analysis of a self-report version of the Liebowitz Social Anxiety Scale. Journal of Clinical Psychology, 59, 149–161.CrossRefGoogle ScholarPubMed
Palmqvist, B., Carlbring, P. and Andersson, G. (2007). Internet-delivered treatments with or without therapist input: does the therapist factor have implications for efficacy and cost? Expert Review of Pharmacoeconomics and Outcomes Research, 7, 291–297.CrossRefGoogle ScholarPubMed
Paxling, B., Almlöv, J., Dahlin, M., Carlbring, P., Breitholtz, E., Eriksson, T. and Andersson, G. (unpublished manuscript). A randomized controlled study of the efficacy of an internet-delivered guided self-help treatment for generalized anxiety disorder. Linköping University, Sweden.Google Scholar
Richardson, R., Richards, D. A. and Barkham, M. (2010). Self-help books for people with depression: the role of the therapeutic relationship. Behavioural and Cognitive Psychotherapy, 38, 67–81.CrossRefGoogle ScholarPubMed
Robinson, E., Titov, N., Andrews, G., McIntyre, K., Schwencke, G. and Solley, K. (2010). Internet treatment for generalized anxiety disorder: a randomized controlled trial comparing clinician vs. technician assistance. PloS one, 5, e10942.CrossRefGoogle ScholarPubMed
Rosenthal, R. and Rosnow, R. L. (1991). Essentials of Behavioral Research: methods and data analysis. New York: McGraw Hill.Google Scholar
Spek, V., Cuijpers, P., Nyklicek, I., Riper, H., Keyzer, J. and Pop, V. (2007). Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: a meta-analysis. Psychological Medicine, 37, 319–328.CrossRefGoogle ScholarPubMed
Spek, V., Nyklicek, I., Cuijpers, P. and Pop, V. (2008). Predictors of outcome of group and internet-based cognitive behavior therapy. Journal of Affective Disorders, 105, 137–145.CrossRefGoogle ScholarPubMed
Spek, V., Nyklicek, I., Smits, N., Cuijpers, P., Riper, H., Keyzer, J., et al. (2007). Internet-based cognitive behavioural therapy for sub threshold depression in people over 50 years old: a randomized controlled clinical trial. Psychological Medicine, 37, 1797–1806.CrossRefGoogle Scholar
Svanborg, P. and Åsberg, M. (2001). A comparison between the Beck Depression Inventory (BDI) and the self-rating version of the Montgomery Asberg Depression Rating Scale (MADRS). Journal of Affective Disorders, 64, 203–216.CrossRefGoogle ScholarPubMed
Titov, N., Andrews, G., Davies, M., McIntyre, K., Robinson, E. and Solley, K. (2010). Internet treatment for depression: a randomized controlled trial comparing clinician vs. technician assistance. PloS one, 5, e10939.CrossRefGoogle ScholarPubMed
Titov, N., Andrews, G., Schwencke, G., Solley, K., Johnston, L. and Robinson, E. (2009). An RCT comparing the effects of two types of support on severity of symptoms for people completing internet-based cognitive behaviour therapy for social phobia. Australian and New Zealand Journal of Psychiatry, 43, 920–926.CrossRefGoogle Scholar
Wampold, B. E. (2001). The Great Psychotherapy Debate: models, methods, and findings. Mahaw, New Jersey: Lawrence Erlbaum.Google Scholar
Wampold, B. E. and Brown, G. S. (2005). Estimating variability in outcomes attributable to therapists: a naturalistic study of outcomes in managed care. Journal of Consulting and Clinical Psychology, 73, 914–923.CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.