Cited by 8Digital Mental Health InterventionsTelemedicine and Telehealth ImplementationAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Internet-based treatments - Experiences from Sweden

Open access
Gerhard Andersson, Franz Caspar, Thomas Berger, Winfried Lotz-Rambaldi, Fritz Hohagen, Marion Jakob, Florian Weck, Martin Bohus +24 more·2013·Verhaltenstherapie

Abstract

Worldwide, Gerhard Andersson is one of the most influential researchers working on internet-based psychological treatments. Moreover, he is also one of the leading researchers in the field of psychologically oriented tinnitus research. He is full professor of clinical psychology at Linköping University and affiliated professor at the Karolinska Institute in Stockholm at the Department of Clinical Neuroscience, Section Psychiatry. Professor Andersson has been highly productive, having produced more the 300 scientific papers. During his whole career he has worked part-time with patients. Apart from his own research and clinical work, Professor Andersson has editorial responsibilities for several journals including Cognitive Behaviour Therapy, Plos One, BMC Psychiatry, and Scandinavian Journal of Psychology. The interview was conducted by Professor Thomas Berger.

AI snapshot

Written from the paper’s full text.

TL;DR

This interview-style article reviews Sweden’s early role in internet-delivered psychological treatments, especially therapist-supported text-based CBT, and discusses implementation, patient and therapist attitudes, and future directions. It argues that internet treatments are established for several conditions but remain unevenly integrated into routine care and need more research on predictors, blended care, and underserved groups.

Key findings

  • Sweden was an early adopter: internet treatment for severe tinnitus began in Uppsala in 1999, and a controlled trial of internet-delivered CBT for recurrent headache was conducted around 2000.
  • Implementation in regular Swedish healthcare is limited: tinnitus treatment has been implemented in one specialist setting, and anxiety/depression treatment operates through the Internet Psychiatry Unit at Karolinska Institute in Stockholm; other efforts are scattered local projects, and the interviewee could not provide figures on how many patients actually receive internet treatment.
  • Internet delivery has expanded beyond CBT: psychodynamic internet treatment has been studied for depression and anxiety, and ACT has been tested for pain, tinnitus, and depression; attention bias modification for social anxiety was disappointing.
  • Patient preferences are mixed: in a social anxiety trial patients preferred internet treatment over group treatment, while an earlier panic disorder study found the opposite; the interviewee notes patients may change preferences after experiencing benefit.

Methods

  • The piece is an interview with Professor Gerhard Andersson, conducted by Professor Thomas Berger, published in Verhaltenstherapie.
  • It presents Andersson’s clinical and research experiences, references selected trials and reviews, and discusses dissemination, implementation, attitudes, and open questions.
  • No formal sample, systematic search, or quantitative analysis is reported; the article is a narrative expert interview rather than an empirical study.

Limitations

  • The interviewee states that there are very few robust predictors of outcome, that he lacks good answers about who benefits or who has contraindications, and that he cannot give figures on patient access to internet treatment in Sweden.
  • He also notes few studies on older people, adolescents, and children, and says more research is needed on integrating internet interventions into practice.
  • Evident from the text: the article is an interview/opinion piece, so its claims rely on expert experience and selected citations rather than a systematic review or controlled comparison.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1159/000188079

Cites

28 of 28 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

6 of 19 cited sources checked · 4 supported · 1 flagged · accuracy not yet measured

  • Premisecitation
    § Internet-delivered treatments are mostly CBT-based. Are other approaches also suitable for internet delivery?

    In a recent comparative trial on social anxiety disorder, patients preferred internet treatment over group treatment.

    “In one of our more recent comparative trials on social anxiety disorder, we found that patients preferred internet treatment over group treatment [Hedman et al., 2011]”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Hedman et al., 2011 source

      The Discussion says internet treatment may be preferred over group treatment, but explicitly states that this had not yet been studied. The trial therefore did not find that patients preferred internet treatment. (LLM, conf=0.90)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
  • Premisecitation
    § Internet-delivered treatments are mostly CBT-based. Are other approaches also suitable for internet delivery?

    Attention bias modification for social anxiety disorder did not work as well as hoped.

    “Somehow disappointing was that attention bias modification for social anxiety disorder did not work as well as we had hoped [Carlbring et al., 2012], and other researchers found the same [Boettcher et al., 2012].”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites Carlbring et al., 2012 source
    • cites Boettcher et al., 2012 source
  • Premisecitation

    Results from Swedish internet treatments are often replicated in other countries, for example for social anxiety disorder.

    “While we were early to develop new internet treatments, it is often the case that the results we find are replicated in other countries, e.g., the work on social anxiety disorder [Berger et al., 2009].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Berger et al., 2009 source
  • Premisecitation
    § Professor Andersson, you and your team have conducted probably the highest number of studies worldwide on internetbased treatments. How did it all begin?

    One of the first controlled trials in the world on internet-delivered cognitive behaviour therapy was for headache.

    “They had the idea that they wanted to use the internet to treat headache, and we agreed upon a design and conducted one of the first controlled trials in the world on internet-delivered cognitive behaviour therapy (CBT) [Ström et al., 2000].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Ström et al., 2000 source
  • Premisecitation
    § Professor Andersson, thank you very much for this interview.

    Internet-delivered treatment for irritable bowel syndrome is an example of a new treatment that did not exist before.

    “There are also examples of new treatments like treatment for irritable bowel syndrome, which did not exist before [Ljótsson et al., 2010].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Ljótsson et al., 2010 source
  • Classified as probably not a substantial claim. 8
  • May combine two claims. 5
  • The quote only partly states this claim. 1
  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation
    § Interview

    Australia and the Netherlands have more active research groups and a stronger push towards open access programs and prevention.

    “In Australia there are more active research groups and also in the Netherlands, but in these 2 places there has been a stronger push towards open access programs and prevention [Riper et al., 2008;Calear et al., 2009].”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites Riper et al., 2008 source

      The Interventions section describes a free-access web-based self-help program tested in the Netherlands, and the Conclusions call for making such programs widely available. The paper does not compare research activity or policy priorities across countries, or establish a stronger push toward open-access programs and prevention in Australia and the Netherlands. (LLM, conf=0.83)

      Experimental — accuracy not yet measured
    • cites Calear et al., 2009 source
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § of integrating internet-based interventions into practice? Do you have recommendations for practitioners on how to integrate internet-based interventions in their daily work?

    Trials in smartphone-delivered treatments have been started by Andersson's group and other research groups.

    “We have started to conduct trials in smartphone-delivered treatments and so did other research groups [Watts et al., 2013].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Watts et al., 2013 source
  • May combine two claims.

    Premisecitation
    § Internet-delivered treatments are mostly CBT-based. Are other approaches also suitable for internet delivery?

    Psychodynamic internet treatment works for depression and anxiety, with anxiety treated with affect phobia treatment.

    “We have found that psychodynamic internet treatment works for depression and anx-iety, the latter being treated with affect phobia treatment [Johansson et al., 2013]”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Johansson et al., 2013 source
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Interview

    Groundbreaking work has been done in Germany on internet-based aftercare by Hans Kordy's research group.

    “Here I think groundbreaking work has been done in Germany with Hans Kordy's research group providing internet-based aftercare [Bauer et al., 2011].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Bauer et al., 2011 source
  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning
    § Interview

    In Sweden, dissemination of internet-based treatments was rapid initially but has since been slower.

    “In Sweden the dissemination was rapid in the beginning but since then things have been slower.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: In Sweden, there is tax-funded healthcare but different IT systems in different regions.
  • May combine two claims.

    Premisecitation
    § Professor Andersson, you and your team have conducted probably the highest number of studies worldwide on internetbased treatments. How did it all begin?

    The Audiology Department in Uppsala was one of the first clinics in the world to provide internet treatment, starting in 1999.

    “That was already in 1999 [Andersson and Kaldo-Sandström, 2003], making the Audiology Department in Uppsala one of the first clinics in the world to provide internet treatment [Kaldo et al., 2013].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Andersson and Kaldo-Sandström, 2003

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Kaldo et al., 2013 source
  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The typical Swedish internet-based treatment approach involves therapist support and mainly text-based treatment, which does not require much programming to develop.

    “But of course we could say that the typical Swedish approach is characterised by involving therapist support and mainly text-based treatment, which does not require much programming to develop [Andersson et al., 2008].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Andersson et al., 2008 source
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationnone given
    § Interview

    An important barrier to dissemination is that internet treatment needs to be integrated in regular psychotherapy services.

    “There are many potential barriers and one important hurdle is that internet treatment needs to be integrated in regular psychotherapy services.”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given
    § Interview

    It is now established that especially therapist-guided internet-based treatments work for a range of clinical conditions.

    “As shown in the various contributions of this special issue, it is now established that especially therapist-guided internetbased treatments work for a range of clinical conditions.”
    Quote in the paperNot a substantial claim
  • The quote only partly states this claim.

    Premisecitation
    § Professor Andersson, thank you very much for this interview.

    Behavioural activation treatment for depression delivered via smartphone app and 4 live sessions was just as effective as face-to-face behavioural activation for 10 sessions.

    “we found that it was just as effective as face-to-face behavioural activation for 10 sessions (Ly et al., unpublished data).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Ly et al., unpublished data

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § of integrating internet-based interventions into practice? Do you have recommendations for practitioners on how to integrate internet-based interventions in their daily work?

    There are few studies on internet-based treatments for children.

    “There are also few studies on children [Spence et al., 2006].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Spence et al., 2006 source
11 of 11
  • The paper relies on this without support.

    Tinnitus internet treatment has been implemented in 1 specialist setting in Sweden.

    “When it comes to tinnitus the treatment has been implemented in 1 specialist setting”
  • The paper relies on this without support.

    Anxiety and depression internet treatment has been implemented within the Internet Psychiatry Unit at Karolinska Institute, Stockholm.

    “and the same is the case for anxiety and depression within the Internet Psychiatry Unit at Karolinska Institute, Stockholm.”
  • The paper relies on this without support.

    In addition to those 2 places, internet-based treatment in Sweden is scattered with local projects all over Sweden.

    “In addition to those 2 places the situation is more scattered with local projects all over Sweden.”
  • The paper relies on this without support.

    Companies provide internet treatment in Sweden.

    “There are also companies who provide treatment”
  • The paper relies on this without support.

    In Sweden, there is tax-funded healthcare but different IT systems in different regions.

    “One reason is technical, as we have tax-funded healthcare but different IT systems in different regions.”
  • The paper relies on this without support.

    There are not enough therapists.

    “Another thing is that there are not enough therapists”
  • The paper relies on this without support.

    Patients tend to forget what clinicians say.

    “We know that patients tend to forget what clinicians say”
  • The paper relies on this without support.

    In Sweden, there has been a lot of press about internet-based treatments, and people generally do not regard it as strange.

    “In Sweden we have had a lot of press, and in general people have heard about this and do not regard it as strange.”
  • The paper relies on this without support.

    Internet-based treatments are less well known in the USA.

    “It is less well known in the USA.”
  • The paper relies on this without support.

    Patients tend to change their preferences, appreciating the treatment they have been assigned to when they find that it helps.

    “Another observation is that patients tend to change their preferences, i.e. the patient appreciates the treatment he has been assigned to when he finds that it helps.”
  • The paper relies on this without support.

    Therapists notice that they can form a therapeutic alliance online and that patients reveal important information.

    “therapists notice that they can form a therapeutic alliance online and that patients reveal important information.”
  • The paper relies on this without support.

    In some places in the world, it is not allowed to communicate with patients via internet.

    “In some places in the world it is not even allowed to communicate with patients via internet.”
  • The paper relies on this without support.

    There are not many studies on internet-based treatments for older people and adolescents.

    “There are not many studies on, e.g., older people and adolescents.”
  • The paper relies on this without support.

    Knowledge acquisition has been widely neglected in CBT literature.

    “I also think knowledge acquisition has been widely neglected in CBT literature”
  • The paper relies on this without support.

    Few studies exist on what patients actually learn in CBT.

    “I was surprised to see that so few studies existed on what patients actually learn in CBT.”
  • The paper relies on this without support.

    More and more practitioners start to include internet-based interventions in their daily practice.

    “More and more practitioners start to include internet-based interventions in their daily practice”
16 of 16

Cites

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Authors
Andersson, G., Caspar, F., Berger, T., Lotz-Rambaldi, W., Hohagen, F., Jakob, M., Weck, F., Bohus, M., Klinitzke, G., Dölemeyer, R., Steinig, J., Wagner, B., Kersting, A., Hedman‐Lagerlöf, E., Klein, J. P., Berger, T., Boettcher, J., Carlbring, P., Renneberg, B., Berger, T., Brakemeier, E., Marchner, J., Gutgsell, S., Engel, V., Radtke, M., Tuschen‐Caffier, B., Normann, C., Berking, M., Bauer, S., Okon, E., Meermann, R., & Kordy, H.
Affiliations
Linköping University (SE)
Corresponding author
Gerhard Andersson
Venue
Verhaltenstherapie
Publisher
S. Karger AG
Published
2013
Volume
23
Issue
3
Pages
211-214
ISSN
  • 1016-6262 (ISSN-L)
  • 1423-0402
OpenAlex
W1524509026
Cited by
8
References
28
Citations by year
2020: 2 · 2018: 2 · 2016: 2 · 2014: 1 · 2013: 1
FWCI
2.02
Type
journal article
Language
en
Open access
Locations
  • Verhaltenstherapie (publishedVersion, other-oa)
  • Bern Open Repository and Information System (University of Bern) (submittedVersion, other-oa)
  • Open Access CRIS of the University of Bern
Topics
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
internet-based psychological treatment, tinnitus, cognitive behavioral therapy, online therapy

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

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Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-11.

Cited sources are checked by gpt-6-sol.

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