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dc.contributor.advisorWaterloo, Knut
dc.contributor.authorHøifødt, Ragnhild Sørensen
dc.date.accessioned2015-10-08T13:43:15Z
dc.date.available2015-10-08T13:43:15Z
dc.date.issued2015-09-15
dc.description.abstractThe overall aim of this thesis was to explore the effectiveness and acceptability of a Web-based self-help program (MoodGYM) combined with brief face-to-face therapist support for adult primary care patients with mild to moderate depression. Depression is a highly prevalent disorder causing substantial suffering and impairment. Many depressed patients will receive all their treatment in primary health care. Structured psychological interventions are infrequently delivered in general practice, despite the development of several effective psychological therapies for depression, patients’ preferences for such treatments, and guideline recommendations. Studies indicate that guided internet-based treatments for depression are effective. A randomised controlled trial compared the guided internet-based intervention comprising MoodGYM and therapist support with a waitlist control group. Participants (n = 106) were primary care patients with mild to moderate depressive symptoms. Results indicated that the intervention was effective in reducing symptoms of depression and anxiety and in increasing life satisfaction. Treatment gains were largely maintained at 6-month follow-up. Moderate levels of non-adherence and positive ratings of treatment satisfaction indicated that the intervention was acceptable to patients. The intervention was introduced to general practitioners (GPs) through a 3-day educational course. Following the course most GPs recommended MoodGYM to their patients. However, follow-ups were not successfully implemented due to time constraints, competing tasks and inadequate module knowledge and practical training. Taken together these results indicate that the intervention may be effective and acceptable to primary care patients with mild to moderate depressive symptoms. A short educational course for GPs may promote recommendation of the program, but other approaches are needed to implement the full intervention including follow-ups. More comprehensive educational approaches may reach a selected group of GPs. However, multifaceted interventions including patient education, clinician education and organisational changes are necessary to implement such interventions more widely.en_US
dc.description.doctoraltypeph.d.en_US
dc.description.popularabstractDepresjon er et utbredt problem. Det finnes virksomme psykologiske behandlingsmetoder, men mange pasienter får ikke tilgang til slik behandling. Forskning viser at internettbaserte selvhjelpsprogrammer særlig med støtte fra en terapeut, kan være nyttige. Målet med avhandlingen “Internet-based cognitive behavioural therapy: A novel approach to treating depression in primary care patients” har vært å undersøke om bruk av et internettbasert selvhjelpsprogram kombinert med korte samtaler med psykolog er virksom behandling for depresjon. Vi undersøkte også om denne behandlingsmodellen kan egne seg for bruk i allmennpraksis (fastleger). Første fase av prosjektet var en utprøving av behandlingsmodellen der en gruppe deprimerte pasienter som fikk behandlingen ble sammenlignet med en gruppe som sto på venteliste til behandling. Totalt 106 pasienter deltok. Resultatene viste at behandlingen reduserte angst- og depresjonsplager, samt økte deltakernes livskvalitet. Oppfølging etter 6 måneder tydet på at de positive effektene i stor grad hadde vedvart. Frafallet fra behandlingen var moderat, og deltakerne var positive til behandlingsmodellen. I prosjektets neste fase ble en gruppe fastleger kurset i behandlingsmetoden. Etter kurset anbefalte de fleste legene selvhjelpsprogrammet til pasientene sine, men få leger tilbød oppfølgingssamtaler relatert til programmet, bl.a. på grunn av tidspress og for lite kunnskap om programmet. Dette tyder på at en mer omfattende innsats med opplæring av både leger eller andre helsearbeidere, og pasienter, samt organisatoriske endringer, trolig vil være nødvendig for å gjøre behandlingsmodellen tilgjengelig på en god måte i primærhelsetjenesten.en_US
dc.description.sponsorshipProsjektet var finansiert av Norges Forskningsråd (196423/V50).en_US
dc.descriptionThe papers of this thesis are not available in Munin.<br>Paper I. Effectiveness of cognitive behavioural therapy in primary health care: A review. Høifødt, R.S., Strøm, C., Kolstrup, N., Eisemann, M. & Waterloo, K. Available in <a href=http://dx.doi.org/10.1093/fampra/cmr017>Family Practice (2011) 28 (5)</a><br>Paper II. The clinical effectiveness of Web-based cognitive behavioral therapy with face-to-face therapist support for depressed primary care patients: Randomized controlled trial. Høifødt, R.S., Lillevoll, K.R., Griffiths, K.M., Wilsgaard, T., Eisemann, M., Waterloo, K., & Kolstrup, N. Available in <a href=http://dx.doi.org/10.2196/jmir.2714>Journal of Medical Internet Research, 2013 (Aug 05); 15(8)</a><br>Paper III. Predictors of response to Web-based cognitive behavioral therapy with face-to-face therapist support for depression: A Bayesian analysis. Høifødt, R.S., Mittner, M., Lillevoll, K.R., Katla, S.K., Kolstrup, N., Eisemann, M., Friborg, O., Waterloo, K. Available in <a href=http://dx.doi.org/doi:10.2196/jmir.4351>Journal of Medical Internet Research, 2015 (Sep 02); 17(9)</a><br>Paper IV. Norwegian general practitioners' perspectives on implementation of a guided Web-based cognitive behavioral therapy for depression: A qualitative study. Available in <a href=http://dx.doi.org/10.2196/jmir.3556>Journal of Medical Internet Research, 2014 (Sep 10); 16(9)</a>en_US
dc.identifier.urihttps://hdl.handle.net/10037/8202
dc.identifier.urnURN:NBN:no-uit_munin_7782
dc.language.isoengen_US
dc.publisherUiT The Arctic University of Norwayen_US
dc.publisherUiT Norges arktiske universiteten_US
dc.rights.accessRightsopenAccess
dc.rights.holderCopyright 2015 The Author(s)
dc.subject.courseIDDOKTOR-003en_US
dc.subjectVDP::Samfunnsvitenskap: 200::Psykologi: 260en_US
dc.subjectVDP::Social science: 200::Psychology: 260en_US
dc.titleInternet-based cognitive behavioural therapy: A novel approach to treating depression in primary care patientsen_US
dc.typeDoctoral thesisen_US
dc.typeDoktorgradsavhandlingen_US


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