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Cited by 102Digital Mental Health InterventionsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesTelemedicine and Telehealth Implementation

Development and initial evaluation of an Internet-based support system for face-to-face cognitive behavior therapy: a proof of concept study

Open access
Månsson, Kristoffer NT, Skagius Ruiz, Erica, Gervind, Elisabet, Dahlin, Mats, Andersson, Gerhard·2013·Journal of Medical Internet Research
DOI 10.2196/jmir.3031PMC PMC3868964
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Abstract

BACKGROUND: Evidence-based psychological treatments, such as cognitive behavior therapy (CBT), have been found to be effective in treating several anxiety and mood disorders. Nevertheless, issues regarding adherence are common, such as poor patient compliance on homework assignments and therapists' drifting from strictly evidence-based CBT. The development of Internet-delivered CBT (ICBT) has been intensive in the past decade and results show that guided ICBT can be as effective as face-to-face CBT but also indicate a need to integrate the two forms of CBT delivery. OBJECTIVE: In this study, we developed and tested a new treatment format in which ICBT and face-to-face therapy were blended. We designed a support system accessible via the Internet (using a computer or an Apple iPad) for patients and therapists delivering CBT face-to-face. The support system included basic CBT components and a library of interventions gathered from existing ICBT manuals. METHODS: The study involved 15 patients with mild to moderate anxiety or depression (or both). Eight therapists conducted the treatments. All participants were interviewed after the nine-week intervention. Further, patients provided self-reports on clinical measures pre- and post-trial, as well as at a 12-month follow-up. RESULTS: A reduction was found in symptom scores across all measures. The reliable change index ranged from 60% to 87% for depression and anxiety. Large effect sizes (Cohen's d) ranging from 1.62 (CI 95% 0.59-2.66) to 2.43 (CI 95% 1.12-3.74) were found. There were no missing data and no treatment dropouts. In addition, the results had been maintained at the 12-month follow-up. Qualitative interviews revealed that the users perceived the support system as beneficial. CONCLUSIONS: The results suggest that modern information technology can effectively blend with face-to-face treatments and be used to facilitate communication and structure in therapy, thus reducing therapist drift.

AI snapshot

Written from the paper’s full text.

TL;DR

This proof-of-concept study developed an Internet-based support system blending ICBT components with face-to-face CBT and tested it in 15 patients with mild to moderate anxiety or depression and 8 therapists. Symptom scores improved significantly with large effect sizes and were maintained at 12-month follow-up, with no dropouts and positive user experiences.

Key findings

  • There were no missing data and no treatment dropouts. Statistically significant main effects were found on all clinical outcome measures pre- to post-treatment, t14=4.25 to 7.25, all P<.001, and pre-treatment to long-term follow-up, t14=3.53 to 6.20, all P<.05; post-treatment to follow-up comparisons were nonsignificant, t14=0.73 to 1.55, all P>.142.
  • Large within-group effect sizes were observed: pre- to post-treatment Cohen’s d ranged from 1.26 to 2.43, and pre-treatment to long-term follow-up from 1.08 to 1.94. Reliable change ranged from 60% to 87% on depression and anxiety measures at post-treatment and from 53% to 80% at long-term follow-up; reliable change on quality of life was 40% at post-treatment and 60% at 12-month follow-up.
  • Qualitative interviews found the support system was perceived as beneficial. Patients reported themes such as memory support, learning, positive implications for homework, overview of treatment, autonomy, and maintenance after therapy; therapists reported increased structure, positive between-session communication, and library support.
  • Therapists’ self-reported time spent per therapy and week ranged from 15 to 180 minutes (mean 77, SD 57), and 7 of 8 therapists (87.5%) estimated they spent less or as much time compared with treatments without the platform. Therapists accessed the platform on average seven times per patient per week.

Methods

  • Proof-of-concept case series with 15 patients with mild to moderate anxiety or depression (or both) and 8 therapists; treatment duration was eight to nine weeks, with post-treatment interviews and self-reports, plus a 12-month follow-up.
  • The Internet-based support system was accessible via computer or Apple iPad and included basic CBT components, a library of text/media resources drawn from prior ICBT manuals, questionnaires/forms, internal messaging, and therapist-controlled patient access.
  • Quantitative analyses used SPSS 21, intent-to-treat paired sample t tests, within-group Cohen’s d, and the Jacobson and Truax reliable change index; qualitative data were analyzed with content analysis of patient interviews, a therapist focus group, and one individual therapist interview.

Limitations

  • The paper states the sample size was low, reducing statistical power; there was no waitlist or active control group, so there was no control for time and repeated testing, limiting generalizability.
  • The paper states the design cannot explore different factors explaining outcome, and it is possible that certain features such as stand-alone SMS communication between sessions could achieve similar results.
  • The paper states two therapists were involved in the research process and evaluation, therapists had relatively little CBT experience, patients were recruited via media advertisement, and limited computer experience may reduce efficiency; only two participants reported limited computer experience and no additional evaluative questions were included. Evident from the text, this was an uncontrolled proof-of-concept study with self-report outcomes and qualitative interviews conducted partly by researchers involved in developing the system.

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

Integrity signals

Registry

Crossref · 10.2196/jmir.3031

Cites

45 of 45 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 23 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Patients indicated that the availability of assignments on the Internet prevented avoidance of feared situations.

    “patients indicated that it prevented avoidance of feared situations (eg, in exposure therapy tasks).”
    Quote in the paperNot a substantial claim
  • Findingnone given

    Using the platform contributed to structure in therapy.

    “Using the platform also contributed to structure in therapy.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Post-treatment and long-term follow-up mean values did not differ significantly.

    “Moreover, comparing mean values post-treatment to long-term follow-up were nonsignificant: t 14=0.73 to 1.55, all P’s>.142.”
    Quote in the paperSubstantial claim
  • Findingown data

    Qualitative interviews revealed that users perceived the support system as beneficial.

    “Qualitative interviews revealed that the users perceived the support system as beneficial.”
    Quote in the paperNot a substantial claim
  • Findingown data

    The therapists accessed the platform on average seven times per patient per week.

    “The therapists accessed the platform on average seven times per patient per week.”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim. 27
  • May combine two claims. 27

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

    Findingown data

    The iPad was used to take notes, to draw, and to take pictures and videos during therapy sessions that could later be shared via the platform.

    “The iPad was used to take notes, to draw, and to take pictures and videos during therapy sessions that could later be shared via the platform.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Large within-group effect sizes were observed on all clinical outcome measures, with pre- to post-treatment effect sizes ranging from 1.26 to 2.43 and long-term follow-up effect sizes from 1.08 to 1.94.

    “Large within-group effect sizes (Cohen’s d) were observed on all clinical outcome measures, with pre- to post-effect sizes ranging from 1.26-2.43 and long-term follow-up between 1.08-1.94 (Table 4).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Clinical outcome data showed significant main effects and reliable changes on all measures and these results had been maintained at 12-month follow-up.

    “Clinical outcome data showed significant main effects and reliable changes on all measures and these results had been maintained at 12-month follow-up.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The library was considered a source of knowledge and therapy-skill enhancement; it supported therapists in choosing among interventions and was helpful when therapists presented the treatment rationale.

    “The library was considered a source of knowledge and therapy-skill enhancement; it supported therapists in choosing among interventions and was helpful when therapists presented the treatment rationale.”
    Quote in the paperNot a substantial claim

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

    Findingown data

    Several patients highlighted the use of the platform as a memory aid.

    “Several patients highlighted the use of the platform as a memory aid.”
    Quote in the paperNot a substantial claim

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

    Findingnone given

    Several patients stated that they gained more from the treatment than they had originally expected to during the nine-week period.

    “Several patients stated that they gained more from the treatment than they had originally expected to during the nine-week period.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Messages contained clarifications and reformulations of homework assignments, providing support, encouragement, and answers to patients' questions.

    “Messages contained clarifications and reformulations of homework assignments, providing support, encouragement, and answers to patients’ questions.”
    Quote in the paperNot a substantial claim

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

    Findingown data

    Two patients reported that they had carried out more than half their homework assignments.

    “two patients reported that they had carried out more than half their assignments.”
    Quote in the paperNot a substantial claim

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

    Findingown data

    Correspondence via the platform was used to remind patients about assignments.

    “Correspondence via the platform was also used to remind patients about assignments.”
    Quote in the paperNot a substantial claim

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

    Findingnone given

    One patient had more frequent contact with the therapist during a period of challenging homework assignments.

    “One patient had more frequent contact with the therapist during a period of challenging homework assignments.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Easy access to the library led therapists to rely more on the content of the library material and to seek fewer other sources for help and supervision.

    “However, this easy access also led therapists to rely more on the content of the library material and to seek fewer other sources for help and supervision.”
    Quote in the paperNot a substantial claim

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

    Findingnone given

    The therapists confirmed that they had used all the components of the platform.

    “The therapists confirmed that they had used all the components of the platform.”
    Quote in the paperNot a substantial claim

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

    Findingown data

    One therapist highlighted that the platform made it possible to focus more on the relational aspects of treatment during sessions.

    “One therapist also highlighted that the platform made it possible to focus more on the relational aspects of treatment during sessions.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Reliable change on quality of life was 40% at post-treatment and 60% at 12-month follow-up.

    “Reliable change on quality of life was 40% at post-treatment and 60% at 12-month follow-up.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The patients' user experiences show that the platform and the iPad were regarded as beneficial.

    “The patients’ user experiences show that the platform and the iPad were regarded as beneficial.”
    Quote in the paperSubstantial claim

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

    Findingown data

    The patients' level of computer experience was mentioned as important by the therapists, even if technology was not seen as a problem for a particular patient.

    “The patients’ level of computer experience was mentioned as important by the therapists, even if technology was not seen as a problem for a particular patient.”
    Quote in the paperNot a substantial claim

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

    Findingown data

    One-third of patients reported spending additional time reading other information on the Internet related to the therapy.

    “One-third of the patients also reported that they spent additional time reading other information on the Internet related to the therapy.”
    Quote in the paperNot a substantial claim

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

    Findingown data

    One patient described the educational advantages of obtaining information through several media, such as speech, writing, and images.

    “One patient described the educational advantages of obtaining information through several media, such as speech, writing, and images.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The content in the library was perceived as a supplement to the treatment, promoting theoretical understanding and enhanced knowledge.

    “The content in the library was perceived as a supplement to the treatment, promoting theoretical understanding and enhanced knowledge.”
    Quote in the paperNot a substantial claim

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

    Findingnone given

    The treatment was said to facilitate the generalization of treatment to the patients' everyday lives.

    “The treatment was said to facilitate the generalization of treatment to the patients’ everyday lives.”
    Quote in the paperNot a substantial claim

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

    Findingown data

    Using the iPad to take pictures of drawings on the wallboard was highlighted as beneficial.

    “But using the iPad to take pictures of drawings on the wallboard was highlighted as beneficial.”
    Quote in the paperNot a substantial claim

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

    Findingown data

    The availability of assignments on the Internet was described as easy, convenient, and modern.

    “The availability of assignments on the Internet was described as easy, convenient, and modern”
    Quote in the paperNot a substantial claim

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

    Findingown data

    Two patients with less computer experience had used the platform only sporadically.

    “two patients with less computer experience had used the platform only sporadically.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    Therapists found several major benefits to delivering treatment in this format-for instance, improved between-session communication and ease of sharing treatment-related information.

    “Therapists found several major benefits to delivering treatment in this format—for instance, improved between-session communication and ease of sharing treatment-related information.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Findingnone given

    The included patients were recruited via media advertisement.

    “the included patients were recruited via media advertisement.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Dropout from treatment, poor engagement, and incomplete adherence to homework assignments can reduce treatment effectiveness.

    “Dropout from treatment, poor engagement, and incomplete adherence to homework assignments are all issues that can reduce the treatment’s effectiveness [8].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [8] Burns, DD, 1991, J Consult Clin Psychol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Access to CBT is limited, leaving a gap between demand for treatment and actual provision.

    “However, access to CBT, often the preferred treatment option [5], is limited; thus, a gap remains between demand for treatment and actual provision [6].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [5] source

      Not checked in the free run.

    • cites [6] Kohn, R, 2004, Bull World Health Organ

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Evidence-based psychological treatments, mainly cognitive behavior therapy (CBT), have established evidence bases for treating several anxiety and mood disorders.

    “Evidence-based treatments exist and both pharmacotherapy and psychological treatments (mainly cognitive behavior therapy; CBT) have established evidence bases [4].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [4] source

      Not checked in the free run.

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

    Study design and conductown data

    Fifteen participants fulfilling all inclusion criteria gave written informed consent prior to treatment.

    “Fifteen participants fulfilling all inclusion criteria were notified via email of their acceptance and gave written informed consent prior to treatment.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductnone given

    There were no missing data and no treatment dropouts.

    “There were no missing data and no treatment dropouts.”
    • Also stated in: § Clinical Outcome Measures · plain
      “This study had no missing data and no treatment dropouts.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The platform may have contributed to the therapy's continuity, allowing therapists to prepare the face-to-face sessions based on the results of a patient's weekly assignments.

    “This may have contributed to the therapy’s continuity, allowing therapists to prepare the face-to-face sessions based on the results of a patient’s weekly assignments.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Less time is needed when treatment is delivered via the Internet, so more patients can be reached at a lower cost.

    “Obviously, less time is needed when the treatment is delivered via the Internet [16]; hence, more patients can be reached at a lower cost.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [16] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Previous studies have combined computerized manuals with face-to-face treatment, used technological adjuncts in therapy, or used the Internet after treatment completion to help prevent relapse.

    “Previous studies have combined computerized manuals with face-to-face treatment [20,21], used technological adjuncts in therapy [22], or used the Internet after treatment completion to help prevent relapse [23,24].”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [20] source

      Not checked in the free run.

    • cites [21] source

      Not checked in the free run.

    • cites [22] source

      Not checked in the free run.

    • cites [23] source

      Not checked in the free run.

    • cites [24] source

      Not checked in the free run.

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

    Interpretationreasoning

    The patients gaining more from treatment than expected might also be explained by the therapists' level of involvement and may not directly relate to the availability of the platform.

    “However, this might also be explained by the therapists’ level of involvement and may not directly relate to the availability of the platform.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    All statistical analyses were intent-to-treat.

    “All the statistical analyses were intent-to-treat and statistical significance was set at P<.05.”
    Quote in the paperSubstantial claim

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

    Study design and conductown data

    The local ethics committee approved the study.

    “The local ethics committee approved the study (ID: 2011/456-31).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductnone given

    The sample size was low, thus reducing statistical power.

    “Among the limitations of the present study is that the sample size was low, thus reducing statistical power.”
    Quote in the paperNot a substantial claim

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

    Study design and conductreasoning

    The procedure is more biased than if independent researchers had conducted the interviews.

    “Even if our procedure is more biased than if independent researchers had conducted the interviews”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductnone given

    This study had no missing data, nor any dropouts from treatment.

    “This study had no missing data, nor any dropouts from treatment.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductreasoning

    The study did not include a wait list or an active control group and therefore had no control for time and repeated testing, which limits the generalizability of the findings.

    “We did not include a wait list or an active control group and therefore had no control for time and repeated testing, which limits the generalizability of the findings.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Replacing missed sessions with Internet-delivered interventions adds continuity and the treatment thus becomes less vulnerable to factors such as physical health and logistical problems, such as travel distance.

    “Replacing missed sessions with Internet-delivered interventions adds continuity and the treatment thus becomes less vulnerable to factors such as physical health and logistical problems, such as travel distance.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    Only two participants reported having limited computer experience and we did not include any additional evaluative questions.

    “However, only two participants reported having limited computer experience and we did not include any additional evaluative questions.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationnone given

    This may be important for new therapists in training.

    “This may be important for new therapists in training”
    Quote in the paperNot a substantial claim

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

    Study design and conductnone given

    Two therapists in the study were also involved in the research process and evaluation of the system.

    “It is noteworthy that two therapists in the study were also involved in the research process and evaluation of the system.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    This may have implications for structuring treatment, for it demonstrates the importance of the therapists being keen to set the agenda and it shows that homework assignments must be formulated clearly to provide clear, educative information.

    “Further, this may have implications for structuring treatment, for it demonstrates the importance of the therapists being keen to set the agenda and it shows that homework assignments must be formulated clearly to provide clear, educative information.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    Our results suggest that Internet-based treatment delivery might decrease tendencies toward therapist drift and might increase adherence to CBT treatment manuals.

    “Further, our results suggest that Internet-based treatment delivery might decrease tendencies toward therapist drift [9] and might increase adherence to CBT treatment manuals.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [9] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    It is also potentially valuable to experienced therapists, who can have a tendency to drift away from the treatment manuals.

    “but it is also potentially valuable to experienced therapists, who can have a tendency to drift away from the treatment manuals.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Internet-based support provides a vehicle for communication and for the structure of the therapy.

    “and that it in fact provides a vehicle for communication and for the structure of the therapy.”
    Quote in the paperSubstantial claim

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

    Study design and conductnone given

    The qualitative method, content analysis, provided the possibility of reviewing the comments and views of the participants.

    “the qualitative method, content analysis, provided us with the possibility of reviewing the comments and views of the participants.”
    Quote in the paperNot a substantial claim
49 of 49

  • The paper relies on this without support.

    The observed symptom improvements and user-reported benefits are attributable to the blended Internet-based support system rather than to face-to-face CBT alone or other factors.

    “The results suggest that modern information technology can effectively blend with face-to-face treatments and be used to facilitate communication and structure in therapy, thus reducing therapist drift.”

  • The paper relies on this without support.

    The support system was used consistently enough by therapists and patients during and between sessions to influence therapy.

    “Each therapist and patient pair individually decided how to use the platform during the treatment—for instance, during therapy sessions and in additional contact between sessions.”

  • The paper relies on this without support.

    Therapists' qualitative reports accurately reflect the degree of therapist drift in the face-to-face therapy.

    “The same procedure of qualitative analysis was applied in analyzing both the focus group discussions and the individual therapists’ comments.”

  • The authors state this as an assumption.

    The support system benefitted the delivery of the therapy.

    “it is reasonable to assume that the support system benefitted the delivery of the therapy.”
4 of 4

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • By providing CBT in a web-based format, therapist adherence to evidence-based treatment protocols can potentially be improved.

    “By providing CBT in a web-based format, therapist adherence to evidence-based treatment protocols can potentially be improved (Andersson, 2010, Månsson et al., 2013), because the online treatment environment provides all core treatment constructs (Andrews and Williams, 2014).”

    From Development and initial evaluation of blended cognitive behavioural treatment for major depression in routine specialized mental health care (2016) · cites this paper as Månsson et al., 2013

  • Preliminary evidence that a blended treatment format can offer CBT effectively was provided by the uncontrolled study of Månsson and colleagues, focussing on a community-based sample of patients with moderate anxiety or depression (n = 15).

    “Although high intensity blended treatment has not yet been studied, preliminary evidence that a blended treatment format can offer CBT effectively was provided by the uncontrolled study of Månsson and colleagues (Månsson et al., 2013), focussing on a community-based sample of patients with moderate anxiety or depression (n = 15).”

    From Development and initial evaluation of blended cognitive behavioural treatment for major depression in routine specialized mental health care (2016) · cites this paper as Månsson et al., 2013

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Table 4 footnotes misidentify three outcome measures

    Minor

    The Table 4 labels for MADRS-S, PHQ-9, and QOLI point to footnotes identifying GAD-7, MADRS-S, and PHQ-9, respectively. The QOLI definition is instead assigned to footnote f, which is not used in the table.

  • Conflicting reference numbers for the reliable change method

    Minor

    The results attribute the Jacobson and Truax reliable change method to reference 34, while the Methods section attributes it to reference 37.

2 of 2

Cites

Flagged first, then by citations

Research works printed but not linked: 4

  1. Kohn, R, 2004, Bull World Health Organ, 82, 858
  2. Andersson, G, 2012, Stud Health Technol Inform, 181, 3
  3. Furmark, T, 2006, Social fobi - Effektiv hjälp med kognitiv beteendeterapi Social Anxiety - Effective treatment using cognitive behavioural therapy. 1st edition
  4. Sheehan, DV, 1998, J Clin Psychiatry, 59 Suppl 20, 22

Cited by

Sorted by citations

Related

Authors
Månsson, K. N., Skagius Ruiz, E., Gervind, E., Dahlin, M., & Andersson, G.
Affiliations
Linköping University (SE)
Corresponding author
Månsson, Kristoffer NT
ORCID
Venue
Journal of Medical Internet Research
Publisher
JMIR Publications Inc.
Published
2013-12-10
Volume
15
Issue
12
Pages
e280
ISSN
1438-8871 (ISSN-L)
DOI
10.2196/jmir.3031
PMC
PMC3868964
OpenAlex
W2065807977
Semantic Scholar
eac63e2c5fcd626396d28bde6d3d02d6624373bc
Cited by
102
References
45
Citations by year
2026: 2 · 2025: 10 · 2024: 5 · 2023: 3 · 2022: 6 · 2021: 3 · 2020: 10 · 2019: 6 · 2018: 14 · 2017: 13 · 2016: 11 · 2015: 14 · 2014: 4 · 2012: 1
FWCI
14.77
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Journal of Medical Internet Research (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
Keywords
face-to-face therapy, homework adherence, anxiety disorders, depression, medication adherence, maintenance of treatment effects
MeSH terms
Adult, Aged, Anxiety Disorders, Depression, Female, Humans, Male, Middle Aged, Pilot Projects, Cognitive Behavioral Therapy, Treatment Outcome, Telemedicine, Internet, Young Adult, Self Report

About these checks

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.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-06.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-06.

Statistics and arithmetic are recomputed, not judged.

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