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Cited by 55Digital Mental Health InterventionsCOVID-19 and Mental HealthAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Internet-Based Cognitive Behavioral Therapy for Psychological Distress Associated With the COVID-19 Pandemic: A Pilot Randomized Controlled Trial

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Aminoff, Victoria, Sellén, Malin, Sörliden, Elise, Ludvigsson, Mikael, Berg, Matilda, Andersson, Gerhard·2021·Frontiers in Psychology
DOI 10.3389/fpsyg.2021.684540PMC PMC8236879
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Abstract

Background: The COVID-19 pandemic has been associated with various negative psychological consequences. This is a challenge for the society as regular psychological services cannot be offered to the same extent as before the pandemic. In addition to the requirement of social distancing, there is a need to adjust psychological treatment components like exposure to avoid increasing the spread of the infection. Internet-delivered cognitive behavior therapy (ICBT) has an established evidence base for a range of psychiatric problems and has been suggested as one possible approach to deal with the situation. This study aimed to conduct a randomized controlled pilot trial during the summer of 2020 with a broad focus on psychological distress and a treatment approach that tailors the intervention based on symptom profile and preferences. Methods: Following the advertisement and interview, we included 52 participants with elevated levels of psychological distress. They were randomly allocated to either a 7-week-long individually tailored ICBT (n = 26) or a wait-list control condition (n = 26). Measures of depression and quality of life were used as primary outcomes. We also included secondary outcome measures of anxiety, insomnia, trauma, stress, anger, and alcohol use. For screening, we used the CoRonavIruS Health Impact Survey (CRISIS). Results: Overall moderate to large between-group effects were found at post-treatment in favor of the treatment on measures of both depression [Beck Depression Inventory (BDI); Cohens d = 0.63; Patient Health Questionnaire (PHQ-9): d = 0.62] and anxiety [Generalized Anxiety Disorder-7-item scale (GAD-7); d = 0.82]. This was also observed for stress symptoms [Perceived Stress Scale (PSS-14); d = 1.04]. No effects were seen on measures of quality of life, insomnia, symptoms of post-traumatic stress, and anger. There was an effect on alcohol use [Alcohol Use Disorder Identification Test (AUDIT); d = 0.54], which was not of clinical relevance. Conclusion: Individually tailored ICBT shows initial promise as a way to reduce psychological problems in association with the COVID-19 pandemic. A possible limitation was that the trial was conducted when the effects of the pandemic were decreasing and when fewer people were affected by the restrictions (e.g., the summer of 2020).

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  • Across studies conducted in the United States, Sweden, Belgium, and Japan, researchers documented positive effects of behavioral activation.

    “Across studies conducted in the United States (e.g., England et al., 2022;Guzick et al., 2022;Kim et al., 2022b;Marquardt et al., 2023;Tigershtrom & Boyraz, 2022;Wasil et al., 2021), Sweden (e.g., Aminoff et al., 2021;Pellas et al., 2022), Belgium (e.g., Franck et al., 2021) and Japan (e.g., Takagaki & Yokoyama, 2023), researchers succeeded in documenting positive effects of behavioral activation.”

    From RESILIENCE, COPING, AND THE COVID-19 PANDEMIC ACROSS THE GLOBE – AN UPDATE: WHAT HAVE WE LEARNED? (2023) · cites this paper as Aminoff et al., 2021

    The Methods describe behavioral activation as one component of a tailored internet-based CBT treatment, and the Discussion reports reduced depressive symptoms in the Swedish trial. The authors suggest that behavioral activation and cognitive restructuring were useful, but the trial measured the combined treatment’s effects, not a separate effect of behavioral activation. (LLM, conf=0.84)

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2 of the 70 references couldn’t be matched to a known paper.

Research works printed but not linked: 3

  1. Andersson E. Ljótsson B. Hedman-Lagerlöf M. Nygren L. Persson M. Rosengren K.. (n.d.). Targeting excessive worry with internet-based extinction therapy: a randomized controlled trial with meditation analysis and economical evaluation. Psychol. Med. (in press). PMC8426147 32340638
  2. Beck A. T. Steer R. A. Brown G. K. (2005). BDI-II. Beck Depression Inventory Second Edition: Manual, Svensk Version (Swedish Version). Stockholm: Psykologiförlaget AB.
  3. Frykheden O. (2014). Effektiv mätning av livskvalitet – Brunnsviken brief quality of life inventory (BBQ): En psykometrisk utvärdering [Effective measurement of quality of life. Brunnsviken brief quality of life instrument (BBQ): a psychometric evaluation. [unpublished master of science thesis]. [Stockholm]: Stockholm university.

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Authors
Aminoff, V., Sellén, M., Sörliden, E., Ludvigsson, M., Berg, M., & Andersson, G.
Affiliations
Linköping University (SE)
Corresponding author
Andersson, Gerhard
ORCID
Venue
Frontiers in Psychology
Publisher
Frontiers Media SA
Published
2021-06-14
Volume
12
Pages
684540-684540
ISSN
1664-1078 (ISSN-L)
DOI
10.3389/fpsyg.2021.684540
PMC
PMC8236879
OpenAlex
W3172662147
Cited by
54
References
70
Citations by year
2026: 1 · 2025: 5 · 2024: 12 · 2023: 11 · 2022: 19 · 2021: 6
FWCI
10.78
Type
journal article
Language
en
Open access
Licence
Locations
  • Frontiers in Psychology (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DiVA (Linkoping University) (submittedVersion, other-oa)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Swedish research council
Topics
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
  • Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
internet-based cognitive behavioral therapy, COVID-19 pandemic, psychological distress, depression, anxiety, perceived stress, alcohol consumption, quality of life, insomnia, post-traumatic stress, personalized treatment

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