Internet-based Cognitive Behaviour Therapy for Social Anxiety Disorder : From Efficacy to Effectiveness

Background: Cognitive behaviour therapy (CBT) is an effective, well-established, but not widely available treatment for social anxiety disorder (SAD). Internet-based cognitive behavior therapy (ICBT) has the potential to increase availability and facilitate dissemination of therapeutic services for SAD. However, research is needed to establish efficacy, effectiveness, long-term effects, cost-effectiveness and potential determinants of treatment outcome. Aims: The present thesis aimed at investigating the following: a) The efficacy of ICBT for SAD in a university setting (Study I), b) the effectiveness of ICBT for SAD in a psychiatric setting (Study II), c) The effects of ICBT for SAD over 5 years (Study III), d) The cost-effectiveness of ICBT for SAD compared to conventional CBT (Study IV), and e) Clinical and genetic determinants of ICBT for SAD in relation to conventional CBT (Study V). Methods: Two large scale randomised controlled trials (RCTs) were conducted. In the first RCT (Study I), ICBT (n=40) was compared to CBT bibliotherapy (n=40) and a waiting list control (n=40). The second RCT (Study II) was a non-inferiority trial comparing ICBT (n=64) to cognitive behavioural group therapy (CBGT; n=62) in a clinical setting. In Study III, a 5-year follow-up assessment was conducted of participants of Study I. In Study IV, a prospective cost-effectiveness and cost-utility analysis of ICBT compared to CBGT was conducted using a societal perspective. Based on clinical and genetic data collected in Study II, predictors and moderators of treatment outcome of ICBT in relation to CBGT were investigated in Study V. Results: Study I: ICBT for SAD yielded large effect sizes on measures of social anxiety and demonstrated superiority to waiting list controls and a trend towards superiority of CBT bibliotherapy. Study II: ICBT for SAD was well within the noninferiority margin compared to CBGT on the primary outcome measure. Study III: Participants receiving ICBT for SAD made further improvements from post-assessment to 1-year follow-up. These improvements were maintained at 5-year follow-up. Study IV: The incremental cost-effectiveness ratio was -7042 USD, suggesting that ICBT compared to CBGT leads to incremental gains to a lower cost. Study V: Demographic, clinical and therapy related factors predicted outcome of CBT. A few clinical factors moderated treatment outcome of ICBT in relation to CBGT. None of the investigated candidate genes had an impact on treatment outcome. Conclusions: ICBT for SAD is efficacious, effective in a clinical setting, long-term effective and, compared to conventional CBT, cost-effective regardless of willingness to pay. In addition, treatment outcome can be predicted. ICBT for SAD is ready for implementation and dissemination

Alien Registration- Hedman, Erik (Portland, Cumberland County)

https://digitalmaine.com/alien_docs/31277/thumbnail.jp

Corporate cash holdings: An empirical study of ownership identities on the Swedish market.

Purpose: The main purpose of this study is to investigate whether different ownership identities has any effect on the levels of cash amongst firms listed on the Stockholm Stock Exchange (SSE) main markets. The examined types of owners are family owners, insider owners and institutional owners. Methodology: A quantitative approach with the interpretation of the results from a panel data regression. Theoretical framework: Agency Theory, Stewardship Theory, Theories related to the determinants of cash holdings, Theory of Ownership Identity Empirical foundation: A sample of 209 firms during the time period 2008-2013 Conclusions: We come to the conclusion that different types of owners have an impact on the cash levels in firms listed on the SSE main markets. Through or regression models we found statistical significant evidence that family owners and insider owners affect corporate cash holdings. The observed relationship between family owners and cash holdings contradicts previous research; besides this the results were in line with previous findings. The relationship between institutionally owned firms and cash holdings are weaker, raising the question whether institutions are as active as they are supposed to be when it comes to monitoring and disciplining of management

International Contracts in European Courts: Jurisdiction Under Article 5(1) of the Brussels Convention

Background: Internet-based cognitive behavior therapy (ICBT) has shown promising effects in the treatment of irritable bowel syndrome (IBS). However, to date no study has used a design where participants have been sampled solely from a clinical population. We aimed to investigate the acceptability, effectiveness, and cost-effectiveness of ICBT for IBS using a consecutively recruited sample from a gastroenterological clinic. less thanbrgreater than less thanbrgreater thanMethods: Sixty-one patients were randomized to 10 weeks of ICBT (n = 30) or a waiting list control (n = 31). The ICBT was guided by an online therapist and emphasized acceptance of symptoms through exposure and mindfulness training. Severity of IBS symptoms was measured with the Gastrointestinal symptom rating scale - IBS version (GSRS-IBS). Patients in both groups were assessed at pre- and post-treatment while only the ICBT group was assessed 12 months after treatment completion. Health economic data were also gathered at all assessment points and analyzed using bootstrap sampling. less thanbrgreater than less thanbrgreater thanResults: Fifty of 61 patients (82%) completed the post-treatment assessment and 20 of 30 patients (67%) in the ICBT group were assessed at 12-month follow-up. The ICBT group demonstrated significantly (p andlt; .001) larger improvements on the IBS-related outcome scales than the waiting list group. The between group effect size on GSRS-IBS was Cohens d = 0.77 (95% CI: 0.19-1.34). Similar effects were noted on measures of quality of life and IBS-related fear and avoidance behaviors. Improvements in the ICBT group were maintained at 12-month follow-up. The ICBT condition was found to be more cost-effective than the waiting list, with an 87% chance of leading to reduced societal costs combined with clinical effectiveness. The cost-effectiveness was sustained over the 12-month period. less thanbrgreater than less thanbrgreater thanConclusions: ICBT proved to be a cost-effective treatment when delivered to a sample recruited from a gastroenterological clinic. However, many of the included patients dropped out of the study and the overall treatment effects were smaller than previous studies with referred and self-referred samples. ICBT may therefore be acceptable and effective for only a subset of clinical patients. Study dropout seemed to be associated with severe symptoms and large impairment. Objective and empirically validated criteria to select which patients to offer ICBT should be developed.Funding Agencies|Stockholm City Council||Stockholm Centre for Psychiatry Research, Linkoping University||Soderstrom-Konigska Foundation||Bror Gadelius Foundation|

Profits du commerce intercontinental et croissance dans la France du XVIIIe siècle

Cet article étudie le rôle du commerce intercontinental dans l’accumulation de capital en France à la fin de l’Ancien Régime. J’utilise la méthode de O’Brien pour mesurer la quantité annuelle de profits dégagée par ce secteur. En prenant en compte les utilisations alternatives des moyens de production du secteur utilisait, je calcule le gain net qui peut lui être attribué. Finalement, je propose une méthode originale pour mesurer son effet qui s’appuie sur la notion de « coeur de croissance ». Cet article montre que les profits du commerce intercontinental ont pu avoir une bien plus grande importance que ne le suggère leur valeur agrégée.This paper studies the role of French intercontinental trade in the accumulation of domestic capital at the end of the Ancien Régime. It uses O’Brien’s method to measure the amount of annual profits generated by this sector. The marginal gain linked to the existence of the sector is then computed by estimating what would have been the return of the resources the sector was using if they had been invested domestically instead. Finally, the paper uses the notion of “hearth of growth” to argue that profits from intercontinental trade were more important for the French economy than what their size suggests.This version is the pre-print of the published article

Internet-Based Cognitive Behavior Therapy vs. Cognitive Behavioral Group Therapy for Social Anxiety Disorder: A Randomized Controlled Non-inferiority Trial

Background and Aims: Cognitive behavioral group therapy (CBGT) is an effective, well-established, but not widely available treatment for social anxiety disorder (SAD). Internet-based cognitive behavior therapy (ICBT) has the potential to increase availability and facilitate dissemination of therapeutic services for SAD. However, ICBT for SAD has not been directly compared with in-person treatments such as CBGT and few studies investigating ICBT have been conducted in clinical settings. Our aim was to investigate if ICBT is at least as effective as CBGT for SAD when treatments are delivered in a psychiatric setting. Methods: We conducted a randomized controlled non-inferiority trial with allocation to ICBT (n = 64) or CBGT (n = 62) with blinded assessment immediately following treatment and six months post-treatment. Participants were 126 individuals with SAD who received CBGT or ICBT for a duration of 15 weeks. The Liebowitz Social Anxiety Scale (LSAS) was the main outcome measure. The following non-inferiority margin was set: following treatment, the lower bound of the 95 % confidence interval (CI) of the mean difference between groups should be less than 10 LSAS-points. Results: Both groups made large improvements. At follow-up, 41 (64%) participants in the ICBT group were classified as responders (95% CI, 52%-76%). In the CBGT group, 28 participants (45%) responded to the treatment (95% CI, 33%-58%). At post-treatment and follow-up respectively, the 95 % CI of the LSAS mean difference was 0.68-17.66 (Cohens d between group = 0.41) and -22.51-15.69 (Cohens d between group = 0.36) favoring ICBT, which was well within the non-inferiority margin. Mixed effects models analyses showed no significant interaction effect for LSAS, indicating similar improvement across treatments (F = 1.58; df = 2, 219; p = .21). Conclusions: ICBT delivered in a psychiatric setting can be as effective as CBGT in the treatment of SAD and could be used to increase availability to CBT.Original Publication:Erik Hedman, Gerhard Andersson, Brjann Ljotsson, Erik Andersson, Christian Ruck, Ewa Mortberg and Nils Lindefors, Internet-Based Cognitive Behavior Therapy vs. Cognitive Behavioral Group Therapy for Social Anxiety Disorder: A Randomized Controlled Non-inferiority Trial, 2011, PLOS ONE, (6), 3, .http://dx.doi.org/10.1371/journal.pone.0018001Licensee: Public Library of Science (PLoS)http://www.plos.org

Företagsförvärv eller företagsfördärv? - En långsiktig studie på den skandinaviska förvärvsmarknaden

The purpose of this thesis is to, through statistical analysis, investigate whether the stock price of Scandinavian acquiring firms develops differently compared to benchmark. The thesis also researches if a set of variables can explain the eventual difference. This thesis is of quantitative nature and the authors have used a deductive approach. Through a regression analysis the thesis secondary data has been analyzed and compared to earlier research and theories. The theory of this thesis is mainly based on earlier research about the effect that different variables have on an acquiring companies stock prices. The majority of this research mainly comes from the American market and studies a different time period than this thesis. The thesis’ empirical evidence is based on data from 54 acquiring firms between 2003-2008. Nine independent variables has been tested on these companies. This thesis finds that acquiring firms significantly underperforms compared to benchmark on both a 24- and 36-month basis. The thesis also finds that the underperformance can be explained by one of the nine variables

Internet-delivered cognitive behavior therapy for adolescents with irritable bowel syndrome : a randomized controlled trial

OBJECTIVES: Few treatments have been able to effectively manage pediatric irritable bowel syndrome (IBS). Internet-delivered cognitive behavior therapy (Internet-CBT) based on exposure for abdominal symptoms is effective for adult IBS. The objective of this study was to evaluate the efficacy of Internet-CBT based on behavioral exposure for adolescents with IBS. METHODS: Adolescents with IBS fulfilling the Rome III criteria were randomized to either Internet-CBT or a wait-list control. The Internet-CBT was a 10-week intervention where the main component was exposure to IBS symptoms by reduction of avoidance of abdominal symptoms and instead stepwise provocation of symptoms. The primary outcome was total score on Gastrointestinal Symptoms Rating Scale for IBS (GSRS-IBS). Secondary outcomes included adolescent- and parent-rated quality of life and parent-rated gastrointestinal symptoms. Difference between groups was assessed from pretreatment to posttreatment and the Internet-CBT group was also evaluated at 6 months after treatment completion. RESULTS: A total of 101 adolescents with IBS (13-17 years of age) were included in this study. Dropout rates were low (6%) and all randomized patients were included in intent-to-treat analyses based on mixed effects models. Analyses showed a significant larger pretreatment to posttreatment change on the primary outcome GSRS-IBS (B=-6.42, P=0.006, effect size Cohen's d=0.45, 95% confidence interval (0.12, 0.77)) and on almost all secondary outcomes for the Internet-CBT group compared with the control group. After 6 months, the results were stable or significantly improved. CONCLUSIONS: Internet-CBT based on exposure exercises for adolescents with IBS can effectively improve gastrointestinal symptoms and quality of life.Jane and Dan Olsson foundation, 4-1559/2013Kempe-Carlgrenska foundationRuth and Richard Julin foundation, 2012Juli0048Ishizu Matsumurais DonationMajblomman foundationBengt Ihre research fellowshipBengt Ihre foundation, SLS-331861The Samariten foundationThe Swedish society of medicine, SLS-331681, SLS-410501VärkstadststiftelsenGadelius foundationSwedish Research Council, 521-2013-2846Regional agreement on medical training and clinical research between Stockholm County Council and Karolinska Institutet, 20130129Accepte

Internet-based cognitive behavior therapy for obsessive compulsive disorder: A pilot study

<p>Abstract</p> <p>Background</p> <p>Cognitive behavior therapy (CBT) is widely regarded as an effective treatment for obsessive compulsive disorder (OCD), but access to CBT therapists is limited. Internet-based CBT (ICBT) with therapist support is a way to increase access to CBT but has not been developed or tested for OCD. The aim of this study was to evaluate ICBT for OCD.</p> <p>Method</p> <p>An open trial where patients (N = 23) received a 15-week ICBT program with therapist support consisting of psychoeducation, cognitive restructuring and exposure with response prevention. The primary outcome was the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), which was assessed by a psychiatrist before and immediately after treatment. Secondary outcomes were self-rated measures of OCD symptoms, depressive symptoms, general functioning, anxiety and quality of life. All assessments were made at baseline and post-treatment.</p> <p>Results</p> <p>All participants completed the primary outcome measure at all assessment points. There were reductions in OCD symptoms with a large within-group effect size (Cohen's <it>d </it>= 1.56). At post-treatment, 61% of participants had a clinically significant improvement and 43% no longer fulfilled the diagnostic criteria of OCD. The treatment also resulted in statistically significant improvements in self-rated OCD symptoms, general functioning and depression.</p> <p>Conclusions</p> <p>ICBT with therapist support reduces OCD symptoms, depressive symptoms and improves general functioning. Randomized trials are needed to confirm the effectiveness of this new treatment format.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov: <a href="http://www.clinicaltrials.gov/ct2/show/NCT01348529">NCT01348529</a></p