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Alexander Miloff, porträtt. Foto: Niklas Björling.

Alexander Miloff

Doktorand

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Arbetar vid Psykologiska institutionen
Telefon 08-16 25 96
E-post alexander.miloff@psychology.su.se
Besöksadress Frescati hagväg 8
Rum B 215
Postadress Psykologiska institutionen 106 91 Stockholm

Publikationer

I urval från Stockholms universitets publikationsdatabas
  • 2016. George Vlaescu (et al.). Internet Interventions 6, 107-114

    The purpose of this article is to describe an internet-based platform for improving symptoms and quality of life for people with psychological and behavioural health problems such as depression, anxiety, phobia, psychological trauma, hearing loss and tinnitus. The online platform, called Iterapi, was developed at the Department of Behavioural Sciences and Learning at Linköping University, Sweden and has been running for nearly two decades and used in many randomized controlled trials and outpatient treatments.

    The intention of this article is to share our experience with developing such a treatment solution and the process flow and elements of running internet-based psychological interventions. This will likely be of use to developers building similar services, therapists considering integrating such approaches in their practices and institutions, as well as researchers curious about the functions included on the platform and methodology used for running studies.

    We describe the security aspects of the platform, central concepts underlying its development, how the platform can be used in a study or treatment and the main features and functions the platform offers. We comment on practical considerations regarding blending of methods within the platform, such as self-help treatments with asynchronous communication and real-time text chat and video conversations. We also point out the advantages of using Internet-assisted treatments, the challenges that we have faced and future planned upgrades.

    Due to continuous development of the platform, its user-friendliness, accessibility across devices and numerous features, many research colleagues from Sweden as well as other countries such as Germany, United Kingdom, Romania and Israel have chosen to implement their own studies on the platform.

  • 2016. Alexander Miloff (et al.). EABCT 2016 Abstract Book, 753-753

    This is the first large randomized-controlled trial to evaluate whether commercially available VR hardware and software can be used for exposure therapy. The aim of this study is to compare gold-standard One Session Treatment (OST) for reduction of spider phobia symptoms and avoidance behaviour using in vivo spiders and a human therapist, to a newly developed single-session gamified Virtual Reality Exposure Therapy (VRET) application with modern, consumer-available VR hardware, virtual spiders, and a virtual therapist. Subjects (N = 100) with spider phobia, diagnosed, and meeting inclusion criteria were recruited from the general population and randomized to 2 treatment arms. In 1-week intervals, pre-measurement, 3-hr treatment and post-measurement were completed with an in-vivo behavioral approach test (BAT) serving as the primary outcome measure for both groups. This study was powered to detect a non-inferiority margin of a 2-point between-group difference on the BAT, with a standard deviation of 4 (at 80% power). 98 patients commenced treatment and 97 patients completed post-measurement. Per protocol analysis indicated VR was not non-inferior to OST. Repeated-measures ANOVA identified a significant main effect of time (p < .001) and time x group effect (p < .05). Both OST and VR participants experienced large BAT within-group effect sizes (d = 2.28 and d = 1.45, respectively). OST is the superior treatment option for spider phobia. VRET is an effective alternative if OST cannot be provided, as pure self-help, as the initial intervention in a stepped-care model, or as a possible post-OST booster. Future studies will benefit from evaluating effectiveness of VRET when conducted at home.

  • 2016. Alexander Miloff (et al.).

    Introduction: Traditional one-session therapy (OST) in which a patient is gradually exposed to feared stimuli for up to 3hrs in a one-session format has been found effective for the treatment of specific phobias. However, many suffering from specific phobia are reluctant to seek help and access to care is lacking. Virtual reality (VR) exposure therapy using a smartphone may improve upon existing techniques by facilitating access, lowering cost, and increasing acceptability and effectiveness. The aim of this study was to compare traditional OST with in-vivo spiders and a human therapist to a newly developed single-session gamified VR exposure therapy application with modern VR headsets, virtual spiders and a virtual therapist.

    Method: Participants with specific phobia to spiders (N=100) were recruited from the general public, screened and randomized to either OST (N=50) or VR exposure therapy (N=50) using the smartphone-based Samsung Gear VR system. A behavioral approach test using in-vivo spiders served as the primary outcome measure. Secondary outcome measures included spider phobia questionnaires, and self-reported anxiety, depression and quality of life. Outcomes were assessed 1-week before and after treatment and at follow-up (12 and 52 weeks).

    Results: At the time of submitting this abstract all participants have been included and randomized and a large portion has also received the allotted treatment. However, since the study uses strict blinding, results will not be available until March 2016.

    Discussion: VR exposure therapy has previously been evaluated as a treatment for specific phobias but there has been a lack of high-quality randomized controlled trials. A new generation of modern VR devices are being released which advance upon existing technology and have the potential to improve clinical availability and treatment effectiveness.

    Conclusion: Preliminary clinical observations suggest that single-session gamified virtual reality exposure therapy using a smartphone is effective for the treatment of spider phobia.

  • 2016. Alexander Miloff (et al.). Trials 17

    Background: Traditional one-session exposure therapy (OST) in which a patient is gradually exposed to feared stimuli for up to 3 h in a one-session format has been found effective for the treatment of specific phobias. However, many individuals with specific phobia are reluctant to seek help, and access to care is lacking due to logistic challenges of accessing, collecting, storing, and/or maintaining stimuli. Virtual reality (VR) exposure therapy may improve upon existing techniques by facilitating access, decreasing cost, and increasing acceptability and effectiveness. The aim of this study is to compare traditional OST with in vivo spiders and a human therapist with a newly developed single-session gamified VR exposure therapy application with modern VR hardware, virtual spiders, and a virtual therapist. Methods/design: Participants with specific phobia to spiders (N = 100) will be recruited from the general public, screened, and randomized to either VR exposure therapy (n = 50) or traditional OST (n = 50). A behavioral approach test using in vivo spiders will serve as the primary outcome measure. Secondary outcome measures will include spider phobia questionnaires and self-reported anxiety, depression, and quality of life. Outcomes will be assessed using a non-inferiority design at baseline and at 1, 12, and 52 weeks after treatment. Discussion: VR exposure therapy has previously been evaluated as a treatment for specific phobias, but there has been a lack of high-quality randomized controlled trials. A new generation of modern, consumer-ready VR devices is being released that are advancing existing technology and have the potential to improve clinical availability and treatment effectiveness. The VR medium is also particularly suitable for taking advantage of recent phobia treatment research emphasizing engagement and new learning, as opposed to physiological habituation. This study compares a market-ready, gamified VR spider phobia exposure application, delivered using consumer VR hardware, with the current gold standard treatment. Implications are discussed.

  • 2016. Per Carlbring (et al.).

    Aim: Social anxiety disorder (SAD) is a common debilitating mental illness with large negative effects on quality of life and economic productivity. Modern psychotherapy treatments utilizing cognitive–behavioral theory are increasingly delivered over the Internet and more recently using smartphone applications. The Challenger App written natively for the Apple iPhone was developed at the Stockholm University Department of Psychology for the treatment of SAD and uses a number of advanced features not previously seen in past mental health applications; these include real-time location awareness, notifications, anonymous social interaction between users, a high-degree of personalization and use of gamification techniques.

    Method: A total of 209 participants with a primary diagnosis of SAD were randomized to one of three groups: 1) Self-help book, 2) Self-help book + the Challenger app, or 3) waitlist. The treatment period lasted 6 weeks. Primary outcome measure was Liebowitz Social Anxiety Scale self- report (LSAS-SR). Also included where the Quality of Life Inventory, Patient Health Questionnaire, and the Generalized Anxiety Disorder-7 (GAD-7). Outcome was analyzed according to the intention to treat principle.

    Results: Both treatment groups were superior to the waitlist. On the main outcome measure (LSAS-SR) the effect size for the waitlist was Cohens d=0.14. The group that received the self-help book with the addition of the Challenger app was significantly superior (d=1.0) to just reading the self- help book (d=0.61). Participants requited by way of Newspaper advertisement were more likely to reach high end-state functioning (OR=4.1) and the same was true for participants without prior psychological treatment history as compared with having a previous experience (OR=4.4).

    Conclusion: Adding the smartphone app is a cost effective way of improving the outcome when treating SAD with a self-help book.

  • 2015. Alexander Miloff, Andreas Savva, Per Carlbring. Internet Interventions 2 (3), 227-234

    Social anxiety disorder (SAD) and attentional bias are theoretically connected in cognitive behavioral therapeutic models. In fact, there is an emerging field focusing on modifying attentional bias as a stand-alone treatment. However, it is unclear to what degree these attentional biases are present before commencing treatment. The purpose of this study was to measure pre-treatment attentional bias in 153 participants diagnosed with SAD using a home-based Internet version of the dot-probe paradigm. Results showed no significant correlation for attentional bias (towards or away from negative words or faces) and the self-rated version of the Liebowitz Social Anxiety Scale (LSAS-SR). However, two positive correlations were found for the secondary measures Generalized Anxiety Disorder 7 (GAD-7) and Patient Health Questionnaire 9 (PHQ-9). These indicated that those with elevated levels of anxiety and depression had a higher bias towards negative faces in neutral–negative and positive–negative valence combinations, respectively. The unreliability of the dot-probe paradigm and home-based Internet delivery are discussed to explain the lack of correlations between LSAS-SR and attentional bias. Changes to the dot-probe task are suggested that could improve reliability.

  • 2015. Alexander Miloff, Arvid Marklund, Per Carlbring. Internet Interventions 2 (4), 382-391

    Social anxiety disorder (SAD) is a common debilitating mental illness with large negative effects on quality of life and economic productivity. Modern psychotherapy treatments utilizing cognitive–behavioral theory are increasingly delivered over the Internet and more recently using smartphone applications. The Challenger App written natively for the Apple iPhone was developed at the Stockholm University Department of Psychology for the treatment of SAD and uses a number of advanced features not previously seen in past mental health applications; these include real-time location awareness, notifications, anonymous social interaction between users, a high-degree of personalization and use of gamification techniques. This paper explores design considerations for the various components of the app, their theoretical and evidence base, and research opportunities that exist for apps making use of these novel features.

  • 2015. Alexander Miloff (et al.). SWEsrii 2015, 17-17

    VIMSE is a new spider phobia exposure application developed for use on next generation VR headsets. Developed by Mimerse AB for the Stockholm University Department of Psychology the application advances exposure technology along a number of important fronts. VIMSE uses gamification to increase user engagement and learning, is fully automated with a virtual therapist to allow at home-self care, contains multiple open-ended environments and lighting to ensure exposure in multiple contexts, as well as a range of spiders, spider behaviors and stimuli intensity levels to ensure gradually increasing exposure levels. Collaboration with a for-profit corporation ensures the application is market-ready and scalable rather than restricted to a research environment. VIMSE is currently completing clinical trials comparing it to gold-standard one session therapy phobia treatment in a group of 100 spider phobics.

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Senast uppdaterad: 1 december 2018

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