Youths´ and parents´ experiences and perceived effects of acceptance-based internet cognitive therapy in primary care: A mixed-methods study (Preprint)

BACKGROUND Anxiety is common among youths in primary care. Face-to-face treatment has been the first choice for clinicians, but during the Covid-19 pandemic digital psychological interventions have rapidly increased. Few studies have examined young people’s interest in Internet treatment or the attitudes they and their parents have towards it. OBJECTIVE This study aimed to investigate adolescents’ and parents’ attitudes towards and experiences of Internet-based anxiety treatment in primary care. METHODS The study used mixed methods, analysing qualitative data thematically and quantitative data with non-parametric analysis. Participants were 14 adolescents and 14 parents recruited in adolescent primary healthcare clinics. The adolescents and their parents filled out mental health questionnaires before and after treatment and were interviewed during ongoing treatment. RESULTS The quantitative data indicate (1) that the acceptance-based internet-delivered cognitive behavioural therapy programme used in this study was successful in reducing symptoms and (2) that adolescents’ motivation is essential to the treatment outcome. The qualitative results show that youths highly value their independence and freedom to organize treatment work on their own terms. The parents expressed uncertainty about their role and how to support their child in treatment. It was important for parents to respect the youths’ need for autonomy, while also engaging with them in the treatment work. CONCLUSIONS Internet treatment is accepted by both youths and their parents, who need clarification about the difference between their role and the therapist’s. Patient motivation should be considered before treatment and therapists need to continue to develop the virtual alliance. Finally, primary care should be clearer in informing adolescents and their parents about the possibility of Internet treatment.

Introduction

This chapter provides a brief introduction to and overview of the contents of the Handbook. Several issues are highlighted, including changes since the previous edition of this volume, namely, the revised Diagnostic and Statistical Manual (DSM-5); the research domain criteria (RDoC), and recent technological innovations such as Internet treatment and the use of virtual reality related to eating disorders. Chapters on selective eating, bariatric surgery, and cognitive remediation have also been added. Themes carried forward from the previous edition of the Handbook are presented in updated chapters reviewing etiological, maintenance, assessment, comorbidity, medical complications, and pharmacotherapy, as well as evidence-based prevention and treatment considerations.

Exposure-based cognitive–behavioural therapy via the internet and as bibliotherapy for somatic symptom disorder and illness anxiety disorder: randomised controlled trial

BackgroundIn DSM-5 two new diagnoses, somatic symptom disorder (SSD) and illness anxiety disorder (IAD), have replaced DSM-IV hypochondriasis. There are no previous treatment studies for these disorders. Cognitive–behavioural therapy (CBT) delivered as therapist-guided or unguided internet treatment or as unguided bibliotherapy could be used to increase treatment accessibility.AimsTo investigate the effect of CBT delivered as guided internet treatment (ICBT), unguided internet treatment (U-ICBT) and as unguided bibliotherapy.MethodA randomised controlled trial (RCT) where participants (n= 132) with a diagnosis of SSD or IAD were randomised to ICBT, U-ICBT, bibliotherapy or to a control condition on a waiting list (trial registration: Clinicaltrials.gov identifier NCT01966705).ResultsCompared with the control condition, all three treatment groups made large and significant improvements on the primary outcome Health Anxiety Inventory (between-groupdat post-treatment was 0.80–1.27).ConclusionsICBT, U-ICBT and bibliotherapy can be highly effective in the treatment of SSD and IAD. This is the first study showing that these new DSM-5 disorders can be effectively treated.