Internet CBT vs face-to-face CBT for OCD

New publication by research group members Lina Lundström and Oskar Flygare!

Cognitive-behavior therapy (CBT) for obsessive-compulsive disorder (OCD) is a highly specialized treatment that is in short supply worldwide. This study aimed to investigate whether therapist-guided internet-delivered CBT (ICBT) is non-inferior to face-to-face CBT for adults with OCD. Secondary objectives were to investigate if ICBT could be equally effective without therapist support (i.e. unguided), to conduct a health-economic evaluation, and to determine whether treatment effects were moderated by source of participant referral.

A consecutive sample of 120 adults with a primary diagnosis of OCD, either self-referred or referred by a clinician, were randomized to receive guided ICBT (n=42), unguided ICBT (n=40) or face-to-face CBT (n= 38) delivered over 14 weeks. The main outcome measure was change in OCD symptom severity according to the clinician rated Yale-Brown Obsessive Compulsive Scale (Y-BOCS) from baseline to 3-month follow-up (primary endpoint). The non-inferiority margin was set to 3 points on the Y-BOCS. 

Results: Of the 120 randomized participants, 80 (67%) were women with a mean age of 32 (SD = 9.64) years.The mean difference between therapist-guided ICBT and face-to-face CBT at the primary endpoint was 2.10 points on the Y-BOCS (90% CI -0.41 to 4.61), P = .17, favoring face-to-face CBT, meaning that the primary non-inferiority results were inconclusive. The difference between unguided ICBT and face-to-face CBT was 5.35 points (90% CI 2.76 to 7.94), P < .001), favoring face-to-face CBT. The health economic analysis showed that both guided and unguided ICBT were cost-effective compared to face-to-face CBT. Source of referral did not moderate treatment outcome. The most common adverse events were anxiety (25%), depressive symptoms (17%) and stress (9%).  

Conclusions and Relevance: In this randomized controlled trial of internet-based versus face-to-face cognitive behavioral therapy for adults with obsessive-compulsive disorder we could not conclusively demonstrate non-inferiority. Therapist-guided ICBT could be a cost-effective alternative to in-clinic CBT for adults with OCD in scenarios where traditional CBT is not readily available. Unguided ICBT is probably less efficacious but could be an alternative when providing remote clinician support is not feasible.

Read the article here.

Enkätstudie om problematiskt samlarbeteende under coronapandemin

Har du svårt att göra dig av med saker? Har det påverkats av coronapandemin?

Om du upplever att ditt samlande skapar problem för dig hoppas vi att du vill vara med i vår studie och hjälpa oss fylla i en anonym webbenkät:

Vi söker deltagare till en enkätstudie med syfte att undersöka coronapandemins påverkan på personer som har problem med samlande. Samlande kan bland annat bero på samlarsyndrom, vilket kännetecknas av att den drabbade har så stora svårigheter att slänga saker att hemmet blir belamrat och inte kan användas (helt eller delvis). Tillståndet kan leda till flera negativa konsekvenser både på individ- och samhällsnivå.

Eftersom vi inte kan diagnosticera deltagarna via internet använder vi formuleringen problematiskt samlarbeteende i stället för samlarsyndrom. 

Tryck här för att komma till enkäten.

English translation: We are looking for participants to a survey (in Swedish) about problematic hoarding behavior. Hoarding syndrome is characterized by difficulties discarding possessions which leads to cluttering in the home and ultimately to negative consequences on both the individual and the societal level.

Postdoctoral Researcher in Precision Psychiatry

We are now looking for a postdoctoral researcher for a two-year employment. You will be working with statistical modelling in two different studies. In both studies you will collaborate with colleagues at Oxford University (UK), University of North Carolina Chapel Hill (US) and collaborators in Sweden.

Study 1 is a registry study led by John Wallert and focused on risk factors for suicide among psychiatric patients that have experienced compulsive mental careled. Temporal trends in the risk of suicide and also stratified risks by gender and age will be studied. Forty years of nationwide registry data with over 100,000 recorded compulsory care episodes defines the cohort to be studied. The work involves application of your expertise as epidemiologist/biostatistician to estimate absolute and relative risk of suicide. Your role also involves the production of scientific articles. There is also ample possibility to construct instruments that predict risk based on the risk factors that we will discover, and possibilities to apply more advanced modelling appropriate for large-scale observational data.

In Study 2 you will be working with multimodal data (including genetic data) in a nationwide suicide cohort with the purpose of improving present prediction of suicide aiming to derive and validate better risk models for suicide in the total population. Study 2 also provides the opportunity to apply both well-established statistical modelling and newer machine learning methodology.  

Read more and apply here.

Doctoral (PhD) student position in Precision Psychiatry

📣 We are looking for a PhD student interested in Precision Psychiatry to join our team! 📣

The overarching purpose of your PhD project is to improve routine-care predictions of post cognitive behaviour therapy (CBT) outcomes for common mental disorders. Our developed prediction models will be focused on avoiding unnecessary treatment failures, minimizing adverse long-term health and socioeconomic events, and promoting effective use of psychiatric resources. Today, there is a general lack of accurate prognostic risk tools implemented in routine psychiatric care, which directly hampers our possibilities for timely and cost-effective tailored intervention and care. The main objective of your PhD project is thus to construct and validate prediction models for both clinical CBT outcomes and long-term register outcomes using the world’s largest multimodal database in the field (clinical, register-linked, and genetic data) including 5,000 individuals treated with CBT.

You will be supervised by John Wallert and co-supervised by Christian Rück.

Click here to read more and apply.

Two grants to research program about suicide prevention

In the end of 2021, project Saving lives received two grants: 4.9 million kronor from Forte (Swedish Research Council for Health, Working Life and Welfare) and 2.4 million kronor from The Swedish Research Council. The research program involves several members from the research group, and the principal investigator of the project is Christian Rück.

Congratulations! 🎯

Saving lives: Constructing a nationwide cohort with multimodal data to improve precision in prediction and prevention of suicide

Project summary:

Suicide is a major public health issue, causing severe impact on individuals and families, as well as relevant societal costs. In Sweden alone, ~70,000 years of potential life are lost each year due to suicide. Despite dedicated research efforts and prevention strategies, suicide-related outcomes are still difficult to predict and prevent. The goal of this research program is to utilize unique resources in Sweden to improve prediction of suicide by integrating environmental factors captured by national registers and genetic information using multi-modal modelling. 

In aim 1, we will create the world’s largest suicide biobank by collecting neonatal blood spots stored at the Swedish PKU biobank from 4,000 individuals that died by suicide, i.e. total coverage of all suicides in Sweden from 1975 and onwards. DNA will be extracted from each of these blood spots. Data from the national registers will be added, covering major risk factors across the lifetime (socioeconomic, demographic and medical). Further, blood spots and register data from 8000 matched controls with no suicidal outcomes will be available through collaboration. 

In aim 2, we will identify register-based risk factors and genetic variants associated with suicide by genotyping all DNA samples from cases and matched controls and performing a case-control genome-wide association study meta-analysis. 

In aim 3, we will combine hundreds of candidate suicide predictors from the national registers (covering demographics, socioeconomic status, In aim 3, we will combine hundreds of candidate suicide predictors from the national registers (covering demographics, socioeconomic status, electronic medical records, criminality) with genetic predictors (polygenic risk scores for suicide, depression, impulsivity, and substance misuse) using both established quantitative modelling and newer machine learning approaches.

Om utmattningssyndrom i senaste Filter

I senaste numret av magasinet Filter granskas framtagningen av diagnosen utmattningssyndrom. Artikeln ”Brännmärkta  – Diagnosen utmattningssyndrom har främst gynnat en grupp i samhället: vårdbolagen.tar upp den för Sverige unika diagnosen utmattningssyndrom, dess historia och kontrovers. Artikeln kritiserar diagnosens tillblivelse, som skedde utan det vetenskapliga underlag som brukar krävas för nya diagnoser, och även hur den spretiga behandlingen av utmattningssyndrom har blivit en kostsam historia som dragit in stora pengar till vårdbolagen.

Intervjuade i artikeln är bland andra Elin Lindsäter, som pratar om sin forskning på behandling av utmattningssyndrom, och Christian Rück, som kommenterar kritiken mot diagnosen utifrån sin bok Olyckliga i Paradiset (2020). De berättar även om sitt nya forskningsnätverk relaterat till stress och utmattning, samt den nyligen genomförda systematiska litteraturöversikten av samtliga vetenskapliga artiklar om utmattningssyndrom. 

English translation: Elin Lindsäter and Christian Rück are interviewed in the latest edition of Swedish magazine Filter, commenting on the critics of the formation of the Swedish diagnosis “exhaustion disorder”, a Swedish diagnosis called “utmattningssyndrom” that corresponds to clinical burnout.

Rücklab 2021 summary

Today we had the last research group meeting of the year, the first one in a long while in person at Psykiatri Sydväst. We summarized the year that has gone by and looked ahead to 2022.

This year, new research tracks have been added to the group. In addition to OCD and related disorders, we now work with projects about “exhaustion disorder” (Swedish diagnosis utmattningssyndrom), trauma and suicide.

Apart from this, the research group’s members ongoing projects involve:

  • Trichotillomania and skin-picking disorder
  • Body dysphoric disorder, focused on dissatisfaction of genitals
  • Hoarding disorder
  • Tics and tourettes
  • Internet delivered psychological treatment
  • Statistical modelling
  • Genetics and microbiome in patients with OCD
  • Transcranial magnetic stimulation for major depression
  • Deep brain stimulation for OCD

The group is now extensive and well equipped for exciting new research!

Grant from the Swedish Research Council

A member of our Research Group, John Wallert, recently received a 4.5 million SEK grant from the Swedish Research Council (Vetenskapsrådet, VR) for his project about suicide among compulsory mental care

The project is a collaboration with Oxford University and involves studying risk factors for suicide in a cohort of more than 100 000 compulsory mental Care acts (Lagen om psykiatrisk tvångsvård, LPT, in Swedish), using 40 years of unique national register data.


Rücklab medverkar i UR Samtiden

Flera medlemmar ur forskargruppen deltog i Augusti i Utbildningsradions föreläsningsserie UR Samtiden. Åsa Anger berättade om projektet Braining, Elin Lindsäter diskuterade varför diagnosen utmattningssyndrom bara finns i Sverige, och Oskar Flygare pratade om tvångssyndrom.

Föreläsningarna kommer sändas senare i höst men finns redan nu att se online.

Här kan du se presentationerna om Braining

Här kan du se presentationen om utmattningssyndrom

Här kan du se presentationen om tvångssyndrom

Vi söker en post doc

Vill du bli post doc i vår grupp och vara med och leda en av de mest spännande studierna av psykologisk behandling? 4-dagars intensivbehandling med KBT utvecklad av Gerd Kvale och Bjarne Hansen från Bergen har fått stor uppmärksamhet och preliminära resultat ser mycket bra ut. De ser det som en helt ny sorts behandling, inte bara mer intensiv i tid. Om principen stämmer mer generellt skulle mycket ändras i hur KBT behandling ges. I Norge har det redan blivit standard för OCD. Men studien som jämför det med standardbehandling saknas. Vi vill göra den.En stor randomiserad prövning med fullt fokus på maximal kvalitet och reproducerbarhet (open science). Vill du vara med och leda den? Sök tjänsten! God finansiering, potentiell egen doktorand från start.

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