- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04797273
Internet-based CBT vs. TAU for Stress-related Disorders
December 4, 2023 updated by: Erik Hedman, Karolinska Institutet
Internet-based Cognitive Behavior Therapy for Stress-related Disorders
Stress-related mental illness is common and one of the main causes of sick leave in Sweden.
Cognitive behavior therapy (CBT) is a promising treatment, but access to treatment is low.
In a previously conducted study, we found that internet-based CBT in comparison to a waitlist control group was effective in reducing symptoms of stress.
The aim of the present study is to take the next step and compare Internet-based CBT for stress-related disorders to an active control condition.
Study Overview
Status
Active, not recruiting
Conditions
Detailed Description
Non traumatic stress-related mental illness, in this study operationalized as adjustment disorder or exhaustion disorder, is highly prevalent in the general population and associated with high societal costs relating to productivity loss.
Cognitive behavior therapy (CBT) is the most well-studied psychological treatment and has demonstrated promising effects in terms of symptom reduction.
The overall evidence-base for CBT for these disorders is however fairly week and access to treatment is low.
In a previously published randomized controlled trial we found that internet-based CBT can yield large effects on core symptoms of stress for these disorders.
Delivering CBT via the internet has the large advantage of enabling increased accessibility as each therapist can have up to 80 patients in ongoing treatment.
In the previously conducted trial we compared the treatment to a waitlist control and between-group comparisons of treatment effects were only done at post-treatment as the waitlist condition was crossed over to treatment after this time point.
It is now therefore important to take the next step and investigate the effects of internet-based CBT in comparison to an active control condition.
The primary aim of this study was to compare two internet-based treatments, CBT vs. structured treatment-as-usual, for adjustment disorder and exhaustion disorder.
Study Type
Interventional
Enrollment (Actual)
300
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
-
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Stockholm
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Gustavsberg, Stockholm, Sweden, 13440
- Gustavsbergs Primary Care Center
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Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years to 65 years (Adult, Older Adult)
Accepts Healthy Volunteers
No
Description
Inclusion Criteria:
- primary adjustment disorder or exhaustion disorder
- regular access to a computer and to the internet
- ability to read and write in swedish
Exclusion Criteria:
- substance abuse in the past 6 months
- lifetime psychosis or bipolar disorder
- suicide risk
- initiated or changed psychopharmacological treatment for depression or anxiety in the past month
- concurrent psychological treatment
- cognitive behavior therapy for stress-related symptoms in the past year.
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Internet-based cognitive behavior therapy
|
12 week Internet-based cognitive behavior therapy, delivered via an online treatment platform.
The treatment includes components such as exercises in conducting recuperating activities, methods to improve sleep, exposure, and behavioral activation.
The treatment content is provided through written texts, images and audiofiles in the treatment platform.
The participant has access to a therapist who provides support throughout the treatment via asynchronous text messages.
|
Active Comparator: Internet-based structured treatment-as-usual
|
This is a 12-week treatment, delivered via an online treatment platform.
The treatment components in this treatment are designed to be similar to what is typically provided in primary care to these patients and includes information about stress and how different factors such as eating habits, physical exercise, and alcohol can contribute to stress problems.
The treatment content is provided through written texts, images and audiofiles in the treatment platform.
The participant has access to a therapist who provides support throughout the treatment via asynchronous text messages.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Perceived Stress Scale (PSS-10)
Time Frame: Baseline, weeks 3, 6, 9, 12 (post-treatment), 1-year follow-up, 2-year follow-up
|
Change in PSS at post-treatment and follow-ups compared to baseline (scale range 0-40, higher score means more symptoms)
|
Baseline, weeks 3, 6, 9, 12 (post-treatment), 1-year follow-up, 2-year follow-up
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Shirom-Melamed Burnout Questionnaire (SMBQ)
Time Frame: Baseline, weeks 3, 6, 9, 12 (post-treatment), 1-year follow-up, 2-year follow-up
|
Change in SMBQ at post-treatment and follow-ups compared to baseline (scale range 1-7, higher score means more symptoms)
|
Baseline, weeks 3, 6, 9, 12 (post-treatment), 1-year follow-up, 2-year follow-up
|
Montgomery-Åsberg Depression Rating Scale Self-report (MADRS-S)
Time Frame: Baseline, week 12 (post-treatment), 1-year follow-up, 2-year follow-up
|
Change in MADRS-S at post-treatment and follow-ups compared to baseline (scale range 0-54, higher score means more symptoms)
|
Baseline, week 12 (post-treatment), 1-year follow-up, 2-year follow-up
|
Insomnia Severity Index (ISI)
Time Frame: Baseline, weeks 3, 6, 9, 12 (post-treatment), 1-year follow-up, 2-year follow-up
|
Change in ISI at post-treatment and follow-ups compared to baseline (scale range 0-28, higher score means more symptoms)
|
Baseline, weeks 3, 6, 9, 12 (post-treatment), 1-year follow-up, 2-year follow-up
|
Generalized Anxiety Disorder-7 (GAD-7)
Time Frame: Baseline, week 12 (post-treatment), 1-year follow-up, 2-year follow-up
|
Change in GAD-7 at post-treatment and follow-ups compared to baseline (scale range 0-21, higher score means more symptoms)
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Baseline, week 12 (post-treatment), 1-year follow-up, 2-year follow-up
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Sickness Questionnaire (SQ)
Time Frame: Baseline, week 12 (post-treatment), 1-year follow-up, 2-year follow-up
|
Change in SQ at post-treatment and follow-ups compared to baseline (scale range 0-30, higher score means more symptoms)
|
Baseline, week 12 (post-treatment), 1-year follow-up, 2-year follow-up
|
Self-rated Health (SRH)
Time Frame: Baseline, week 12 (post-treatment), 1-year follow-up, 2-year follow-up
|
Change in SRH at post-treatment and follow-ups compared to baseline (scale range 1-5, higher score means better self-rated health)
|
Baseline, week 12 (post-treatment), 1-year follow-up, 2-year follow-up
|
World Health Organization's Disability Assessment Scale (WHODAS 2.0)
Time Frame: Baseline, week 12 (post-treatment), 1-year follow-up, 2-year follow-up
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Change in WHODAS at post-treatment and follow-ups compared to baseline (scale range 0-100, higher score means more functional disability)
|
Baseline, week 12 (post-treatment), 1-year follow-up, 2-year follow-up
|
EuroQol 5D (EQ5D 5L)
Time Frame: Baseline, week 12 (post-treatment), 1-year follow-up, 2-year follow-up
|
Change in EQ5D at post-treatment and follow-ups compared to baseline (The answers given in EQ-5D were combined to generate a utility score of health states ranging from 0 to 1, with 0 representing death and 1 representing full health) death and 1 representing full health
|
Baseline, week 12 (post-treatment), 1-year follow-up, 2-year follow-up
|
Trimbos and Institute Medical Technology Assessment of Costs Questionnaire for Psychiatry (TIC-P)
Time Frame: Baseline, week 12 (post-treatment), 1-year follow-up, 2-year follow-up
|
The TIC-P enables estimation of costs by collecting information about participant resource utilization and costs related to production loss.
Change in costs will be analysed at post-treatment and follow-ups compared to baseline.
|
Baseline, week 12 (post-treatment), 1-year follow-up, 2-year follow-up
|
Physical Health Questionnaire (PHQ-15)
Time Frame: Baseline, week 12 (post-treatment), 1-year follow-up, 2-year follow-up
|
Change in PHQ-15 at post-treatment and follow-ups compared to baseline (scale range 0-30, higher score means more symptoms)
|
Baseline, week 12 (post-treatment), 1-year follow-up, 2-year follow-up
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Cognitive impairment
Time Frame: Baseline, week 12 (post-treatment), 1-year follow-up, 2-year follow-up
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Test-battery of cognitive tests measuring executive functions at post-treatment and follow-ups compared to baseline
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Baseline, week 12 (post-treatment), 1-year follow-up, 2-year follow-up
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Sick leave
Time Frame: 1 year prior to baseline up to 2 years after baseline.
|
Sick leave data from the Microdata for Analysis of Social Security (MiDAS) registry.
Analyzed as full-day equivalents.
|
1 year prior to baseline up to 2 years after baseline.
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Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Karolinska Exhaustion Disorder Scale (KEDS)
Time Frame: Baseline, week 12 (post-treatment), 1-year follow-up, 2-year follow-up
|
Exploratory assessment of change at post-treatment and follow-ups compared to baseline (scale range 0-54, higher score means more symptoms)
|
Baseline, week 12 (post-treatment), 1-year follow-up, 2-year follow-up
|
Negative Events Questionnaire, 20-items (NEQ-20)
Time Frame: week 12 (Post-treatment)
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Post-treatment only report of negative events from treatment (scale range 0-80, higher score indicates more negative events)
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week 12 (Post-treatment)
|
Credibility scale (C-scale)
Time Frame: week 3
|
week 3 only report of treatment credibility (scale range 0-50, higher score means higher credibility)
|
week 3
|
The Corona Virus Health Impact Survey -Short (CRISIS short)
Time Frame: Baseline, week 12 (post-treatment), 1-year follow-up, 2-year follow-up
|
Exploratory analysis of the impact of the Corona virus on worry and life style.
Change in sum score of items 1,2,3,4,5,8 and 9 will be analyzed.
Scale range 0-24.
Higher scores mean higher impact of Corona.
|
Baseline, week 12 (post-treatment), 1-year follow-up, 2-year follow-up
|
Subjective memory
Time Frame: Baseline, week 12 (post-treatment), 1-year follow-up, 2-year follow-up
|
Exploratory analysis of change in subjective memory at post-treatment and follow-ups compared to baseline (scale range 0-26, higher score means more subjective problems with memory)
|
Baseline, week 12 (post-treatment), 1-year follow-up, 2-year follow-up
|
Recovery Experience Questionnaire short version
Time Frame: Baseline, weeks 3, 6, 9, 12 (post-treatment), 1-year follow-up, 2-year follow-up
|
Will be analyzed as potential mediator of treatment change.
7 items, scored 0-4.
Scale-range 0-28.
Higher scores indicate more recovery.
|
Baseline, weeks 3, 6, 9, 12 (post-treatment), 1-year follow-up, 2-year follow-up
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Collaborators
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
March 25, 2021
Primary Completion (Estimated)
September 1, 2024
Study Completion (Estimated)
September 1, 2024
Study Registration Dates
First Submitted
March 11, 2021
First Submitted That Met QC Criteria
March 11, 2021
First Posted (Actual)
March 15, 2021
Study Record Updates
Last Update Posted (Actual)
December 5, 2023
Last Update Submitted That Met QC Criteria
December 4, 2023
Last Verified
December 1, 2023
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- ICBT vs TAU for Stress
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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