A selection from Stockholm University publication database

• Seeing beyond the diagnostic and statistical manual: A function-centered review of obsessive-compulsive disorder and anxiety disorders

  2025. Jón Ingi Hlynsson, Jan Bergström, Per Carlbring. Journal of Obsessive-Compulsive and Related Disorders

  Article

  Obsessive-compulsive disorder (OCD) is classified within its own diagnostic category, separate from anxiety disorders, yet clinical practitioners still treat it as an anxiety disorder; both conceptually and therapeutically. This paper examines the rationale for seperating OCD from the anxiety disorders by contrasting cognitive models of anxiety disorders and OCD, and reviewing phenomenological and psychobiological evidence for OCD's distinctiveness. We compare OCD's behavioral functions with those of specific phobia, panic disorder, agoraphobia, social anxiety disorder, generalized anxiety disorder, and health anxiety disorder. Our review finds no compelling evidence that OCD differs sufficiently from anxiety disorders to warrant its own category. The same functional behaviors are evident in OCD and other anxiety disorders, with the foci of threat being the differentiating factor between disorders (e.g., fear of public speaking vs. fear of contamination in social anxiety and contamination-OCD, respectively). Consequently, we conclude by emphasizing that future research should focus on behavioral function when studying mental disorders, since descriptive similarities may not indicate clinical or functional equivalence. For diagnostic manuals to maintain validity and clinical utility, they must incorporate a functional analytic perspective. Failure to do so may result in inadequate diagnostic categories and stagnant treatment advances (cf. clinical guidelines for OCD have remained unchanged since 2005). While diagnostic manuals are meant to guide treatment selection, descriptive diagnoses need complementary theory-driven case conceptualizations to advance our understanding of maintaining factors and mechanisms of change during treatment. Without this approach, theoretical progress in OCD may stall, ultimately affecting patient outcomes.

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• Therapygenetic effects of 5-HTTLPR on cognitive-behavioral therapy in anxiety disorders

  2021. Miriam A. Schiele (et al.). European Neuropsychopharmacology 44, 105-120

  Article

  There is a recurring debate on the role of the serotonin transporter gene linked polymorphic region (5-HTTLPR) in the moderation of response to cognitive behavioral therapy (CBT) in anxiety disorders. Results, however, are still inconclusive. We here aim to perform a meta-analysis on the role of 5-HTTLPR in the moderation of CBT outcome in anxiety disorders. We investigated both categorical (symptom reduction of at least 50%) and dimensional outcomes from baseline to post-treatment and follow-up. Original data were obtained from ten independent samples (including three unpublished samples) with a total of 2,195 patients with primary anxiety disorder. No significant effects of 5-HTTLPR genotype on categorical or dimensional outcomes at post and follow-up were detected. We conclude that current evidence does not support the hypothesis of 5-HTTLPR as a moderator of treatment outcome for CBT in anxiety disorders. Future research should address whether other factors such as long-term changes or epigenetic processes may explain further variance in these complex gene-environment interactions and molecular-genetic pathways that may confer behavioral change following psychotherapy.

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• Smartphone-Supported versus Full Behavioural Activation for Depression

  2015. Kien Hoa Ly (et al.). PLoS ONE 10 (5)

  Article

  Background There is need for more cost and time effective treatments for depression. This is the first randomised controlled trial in which a blended treatment - including four face-to-face sessions and a smartphone application - was compared against a full behavioural treatment. Hence, the aim of the current paper was to examine whether a blended smartphone treatment was non-inferior to a full behavioural activation treatment for depression. Methods This was a randomised controlled non-inferiority trial (NCT01819025) comparing a blended treatment (n=46) against a full ten-session treatment (n=47) for people suffering from major depression. Primary outcome measure was the BDI-II, that was administered at pre- and post-treatment, as well as six months after the treatment. Results Results showed significant improvements in both groups across time on the primary outcome measure (within-group Cohen's d=1.35; CI [-0.82, 3.52] to d=1.47; CI [-0.41, 3.35]; between group d=-0.13 CI [-2.37, 2.09] and d=-0.10 CI [-2.53, 2.33]). At the same time, the blended treatment reduced the therapist time with an average of 47%. Conclusions We could not establish whether the blended treatment was non-inferior to a full BA treatment. Nevertheless, this study points to that the blended treatment approach could possibly treat nearly twice as many patients suffering from depression by using a smartphone application as add-on. More studies are needed before we can suggest that the blended treatment method is a promising cost-effective alternative to regular face-to-face treatment for depression.

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• Cognitive behavioural group therapy for emetophobia

  2015. Johan Åhlén (et al.). Clinical Psychologist 19 (2), 96-104

  Article

  Background: Emetophobia is a neglected area within clinical research. Only case studies have been performed examining treatment effectiveness. The present study aimed to examine the preliminary acceptability and effectiveness of a cognitive behavioural group therapy developed specifically for the treatment of emetophobia.

  Method: The present study design was a one-group pretest, post-test, follow-up design with a double pretest. Twenty-three patients, in three treatment groups, participated in the study. Four assessment time points were conducted (1) five weeks prior to treatment, (2) before the first treatment session, (3) after the final session and (4) 3 months after the final session. Participants completed the emetophobia questionnaire, Beck Anxiety Inventory, and Montgomery-angstrom sberg Depression Rating Scaleself assessment at all assessments.

  Results: After treatment, patients showed a significantly lower degree of emetophobic symptoms. About half of the patients were clinically significantly improved or recovered after treatment, and two thirds were improved or recovered at follow-up. Participation at sessions was high, and patients were satisfied with treatment.

  Conclusions: The results from this study, the largest trial yet for emetophobia, indicate that cognitive behavioural therapy may be an efficacious treatment for emetophobia. The study design involves several limitations, and further studies should include independent control groups, randomisation, and longer follow-up assessments.

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• Smartphone-Supported Versus Full Behavioural Activation for Depression: a Randomised Controlled Non-Inferiority Trial

  2014. Kien Hoa Ly (et al.). Oral Abstracts from the 7th Scientific Meeting of the International Society for Research on Internet Interventions, 19-19

  Conference

  Purpose: In light of the research support for behavioral activation, and the promising findings of smartphone-delivered psychological interventions in the treatment of depression, we evaluated a smartphone depression application as an adjunct to four face-to-face sessions (blended treatment) for mild to moderate depression. The blended treatment was compared to a full 10-session treatment with no support from a smartphone. 

  Methods: This was a non-inferiority study with unrestricted randomization in a 1:1 ratio. The study was conducted at three clinics in Sweden. 45 participants diagnosed with major depressive disorder received the blended treatment, and 43 participants received the full 10-session treatment. Main outcome measures were the BDI-II and the PHQ-9. 

  Results: Results showed significant improvements in both groups across time on the primary outcome measures (within-group Cohen’s d range 1.51–1.80; between group d range −0.21– 0.01), indicating non-inferiority of the blended treatment, and at the same time with an average 44.6% reduction of therapist time. 

  Conclusions: The blended treatment was non-inferior to the full behavioural treatment, and at the same time reduced therapist time. This may have important implications for planning psychological services. Moreover, from a theoretical point of view, the trial could be important as it tests the possibility to integrate modern information technology with face-to-face therapy.

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• Clinical validation of a non-heteronormative version of the Social Interaction Anxiety Scale (SIAS)

  2013. Philip Lindner (et al.). Health and Quality of Life Outcomes 11, 209

  Article

  Introduction: Despite welcomed changes in societal attitudes and practices towards sexual minorities, instances of heteronormativity can still be found within healthcare and research. The Social Interaction Anxiety Scale (SIAS) is a valid and reliable self-rating scale of social anxiety, which includes one item (number 14) with an explicit heteronormative assumption about the respondent´s sexual orientation. This heteronormative phrasing may confuse, insult or alienate sexual minority respondents. A clinically validated version of the SIAS featuring a non-heteronormative phrasing of item 14 is thus needed. Methods: 129 participants with diagnosed social anxiety disorder, enrolled in an Internet-based intervention trial, were randomly assigned to responding to the SIAS featuring either the original or a novel non-heteronormative phrasing of item 14, and then answered the other item version. Within-subject, correlation between item versions was calculated and the two scores were statistically compared. The two items’ correlations with the other SIAS items and other psychiatric rating scales were also statistically compared. Results: Item versions were highly correlated and scores did not differ statistically. The two items’ correlations with other measures did not differ statistically either. Conclusions: The SIAS can be revised with a non-heteronormative formulation of item 14 with psychometric equivalence on item and scale level. Implications for other psychiatric instruments with heteronormative phrasings are discussed.

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• Effectiveness of Internet-based cognitive behaviour therapy for panic disorder in routine psychiatric care

  2013. E. Hedman (et al.). Acta Psychiatrica Scandinavica 128 (6), 457-467

  Article

  ObjectiveGuided Internet-based cognitive behaviour therapy (ICBT) for panic disorder has been shown to be efficacious in several randomized controlled trials. However, the effectiveness of the treatment when delivered within routine psychiatric care has not been studied. The aim of this study was to investigate the effectiveness of ICBT for panic disorder within the context of routine psychiatric care. MethodWe conducted a cohort study investigating all patients (n=570) who had received guided ICBT for panic disorder between 2007 and 2012 in a routine care setting at an out-patient psychiatric clinic providing Internet-based treatment. The primary outcome measure was the Panic Disorder Severity Scale-Self-report (PDSS-SR). ResultsParticipants made large improvements from screening and pretreatment assessments to posttreatment (Cohen's d range on the PDSS-SR=1.07-1.55). Improvements were sustained at 6-month follow-up. ConclusionThis study suggests that ICBT for panic disorder is as effective when delivered in a routine care context as in the previously published randomized controlled trials.

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• Les nouvelles thérapies par Internet

  2013. Jan Bergström. RESET – Recherches en Sciences Sociales sur Internet 1 (2), 130-149

  Article

  Cet article propose une synthèse du développement scientifique du traitement psychologique par Internet, en explicitant et discutant ses traits caractéristiques. L’auteur y compare ce type de soin avec la psychothérapie traditionnelle et dessine les enjeux que revêtent les traitements sur Internet dans le champ de la psychothérapie; avant tout au niveau théorique mais aussi au niveau pratique. Plus précisément, il met en évidence les nombreux facteurs indiquant que les thérapies utilisant Internet constituent, cent ans après la naissance de la discipline, un défi profond et durable pour la psychothérapie.

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• Predictors and Moderators of Internet- and Group-Based Cognitive Behaviour Therapy for Panic Disorder

  2013. Samir El Alaoui (et al.). PLoS ONE 8 (11), e79024

  Article

  Internet-based cognitive behaviour therapy (ICBT) can be equally effective as traditional face-to-face cognitive behaviour therapy (CBT) for treating panic disorder (PD). However, little is known about the predictors and moderators of outcome of ICBT when delivered in psychiatric outpatient settings. This study investigated a selection of outcome predictors and moderators of ICBT for panic disorder based on data from a randomised controlled trial where therapist-guided ICBT was compared with group CBT (GCBT) for panic disorder. Participants (N = 104) received 10 weeks of ICBT or GCBT and were assessed before and after treatment, and after six months. Multiple regression analyses were used to test for significant predictors of treatment outcome. Predictors of positive treatment response for both modalities were having low levels of symptom severity and work impairment. In addition, anxiety sensitivity was found to have a small negative relationship with treatment outcome, suggesting that anxiety sensitivity may slightly enhance treatment response. Treatment modality had a moderating effect on the relationship between domestic impairment and outcome and on the relationship between initial age of onset of panic symptoms and treatment outcome, favouring ICBT for patients having had an early onset of PD symptoms and for patients having a high domestic functional impairment. These results suggest that both ICBT and GCBT are effective treatment modalities for PD and that it is possible to predict a significant proportion of the long-term outcome variance based on clinical variables.

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• Internet-based cognitive behaviour therapy for obsessive-compulsive disorder

  2012. Erik Andersson (et al.). Psychological Medicine 42 (10), 2193-2203

  Article

  Background

  Cognitive behaviour therapy (CBT) is an effective treatment for obsessive–compulsive disorder (OCD) but access to CBT is limited. Internet-based CBT (ICBT) with therapist support is potentially a more accessible treatment. There are no randomized controlled trials testing ICBT for OCD. The aim of this study was to investigate the efficacy of ICBT for OCD in a randomized controlled trial.

  Method

  Participants (n=101) diagnosed with OCD were randomized to either 10 weeks of ICBT or to an attention control condition, consisting of online supportive therapy. The primary outcome measure was the Yale–Brown Obsessive Compulsive Scale (YBOCS) administered by blinded assessors.

  Results

  Both treatments lead to significant improvements in OCD symptoms, but ICBT resulted in larger improvements than the control condition on the YBOCS, with a significant between-group effect size (Cohen's d) of 1.12 (95% CI 0.69–1.53) at post-treatment. The proportion of participants showing clinically significant improvement was 60% (95% CI 46–72) in the ICBT group compared to 6% (95% CI 1–17) in the control condition. The results were sustained at follow-up.

  Conclusions

  ICBT is an efficacious treatment for OCD that could substantially increase access to CBT for OCD patients. Replication studies are warranted.

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• Paniksyndrom - ond cirkel av feltolkade kroppsliga signaler

  2011. Gerhard Andersson (et al.). Läkartidningen 108 (14), 795-797

  Article

  Paniksyndrom kännetecknas av plötsliga, oväntade panikattacker med rädsla för nya attacker eller konsekvenser av dem. En andel patienter har även agorafobi. 

  Olika förklaringsmodeller har förts fram för att beskriva hur paniksyndrom uppstår och vidmakthålls. 

  Flera behandlingar för paniksyndrom finns, och bland dem är det psykologisk behandling i form av kognitiv beteendeterapi (KBT) eller läkemedelsbehandling (i förs­ta hand selektiva serotoninåterupptagshämmare) som rekommenderas och som har stöd i forskningen. 

  I Sverige har Internetbaserad KBT för paniksyndrom utvecklats och prövats med framgång. 

  I valet av behandling bör patientens preferenser vägas in.

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• Internet-versus group-administered cognitive behaviour therapy for panic disorder in a psychiatric setting

  2010. Jan Bergström (et al.). BMC Psychiatry 10, 54-63

  Article

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• An open study of the effectiveness of Internet treatment for panic disorder delivered in a psychiatric setting

  2009. Jan Bergström (et al.). Nordic Journal of Psychiatry 63 (1), 44-50

  Article

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• Internet-based self-help for depression

  2005. Gerhard Andersson (et al.). British Journal of Psychiatry 187 (5), 456-461

  Article

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• The use of the Internet in the treatment of anxiety disorders

  2005. Gerhard Andersson (et al.). Current Opinion in Psychiatry 18 (1), 73-73

  Article

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Show all publications by Jan Bergström at Stockholm University