Lonesome no more? A two-year follow-up of internet-administered cognitive behavioral therapy for loneliness

Anton Käll, Ulrika Backlund, Roz Shafran, Gerhard Andersson, Anton Käll, Ulrika Backlund, Roz Shafran, Gerhard Andersson

Abstract

The current study sought to investigate the long-term effects of an internet-administered programme based on CBT principles for which the initial efficacy has been reported in Käll, Jägholm, et al. (In press). Seventy-three participants who were recruited on the basis of experiencing frequent and prolonged loneliness were contacted to complete questionnaires measuring loneliness, quality of life, and symptoms of psychopathology two years after the conclusion of the initial treatment period. Additional items regarding use of the treatment techniques and strategies contained in the programme during the follow-up period was included. In total, 44 participants provided data for the loneliness measure at follow-up. The outcome data were analyzed with a piecewise mixed effects model to provide estimates of change for the continuous measures. Linear multiple regression analysis was used to investigate the relationship between use of treatment techniques and reliable change on the primary outcome measure. The results showed decreases in loneliness during the follow-up period for the sample as a whole. Additionally, an increase in quality of life and a decrease in social anxiety were noted, but no significant changes of depressive symptoms or generalized anxiety. Effect sizes for the observed changes from baseline to follow-up were in the moderate to large range for all measures. Reported use of the treatment techniques was not significantly related to reliable change in loneliness after the two-year period. In conclusion, the results of the study support the utility of internet-based CBT targeting loneliness and indicate that the benefits from the intervention can be enduring.

Keywords: CBT; Guided self-help; Internet-based cognitive behavior therapy; Loneliness.

Conflict of interest statement

We wish to confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome.

© 2019 Published by Elsevier B.V.

Figures

Fig. 1
Fig. 1
The flow of the participants through the study.
Fig. 2
Fig. 2
Timeline for the treatment and measurement points. Abbreviations. ULS-3 = UCLA Loneliness Scale Version 3; BBQ = Brunnsviken Brief Quality of Life Scale; SIAS = Social Interaction Anxiety Scale; PHQ-9 = Patient Health Questionnaire 9; GAD-7 = Generalized Anxiety Disorder 7-item scale.

References

    1. Andersson G. Internet-delivered psychological treatments. Annu. Rev. Clin. Psychol. 2016;12:157–179.
    1. Andersson G., Rozental A., Shafran R., Carlbring P. Long-term effects of internet-supported cognitive behaviour therapy. Expert. Rev. Neurother. 2018;18:21–28.
    1. Baumeister H., Reichler L., Munzinger M., Lin J. The impact of guidance on internet-based mental health interventions — a systematic review. Internet Interv. 2014;1:205–215.
    1. Beutel M.E., Klein E.M., Brähler E., Reiner I., Jünger C., Michal M.…Tibubos A.N. Loneliness in the general population: prevalence, determinants and relations to mental health. BMC Psychiatry. 2017;17:1–7.
    1. Cacioppo J.T., Hawkley L.C., Thisted R.A. Perceived social isolation makes me sad: 5-year cross-lagged analyses of loneliness and depressive symptomatology in the Chicago Health, Aging, and Social Relations Study. Psychol. Aging. 2010;25:453–463.
    1. Cohen J. 2. ed. L. Erlbaum Associates; 1988. Statistical Power Analysis for the Behavioral Sciences.
    1. Cohen-Mansfield J., Hazan H., Lerman Y., Shalom V., Birkenfeld S., Cohen R. Efficacy of the I-SOCIAL intervention for loneliness in old age: lessons from a randomized controlled trial. J. Psychiatr. Res. 2018;99:69–75.
    1. Cuijpers P., Hollon S.D., van Straten A., Bockting C., Berking M., Andersson G. Does cognitive behaviour therapy have an enduring effect that is superior to keeping patients on continuation pharmacotherapy? A meta-analysis. BMJ Open. 2013;3
    1. Dahlberg L., Agahi N., Lennartsson C. Lonelier than ever? Loneliness of older people over two decades. Arch. Gerontol. Geriatr. 2018;75:96–103.
    1. El Alaoui S., Hedman E., Kaldo V., Hesser H., Kraepelien M., Andersson E.…Lindefors N. Effectiveness of internet-based cognitive-behavior therapy for social anxiety disorder in clinical psychiatry. 2015;83:902–914.
    1. Enders C.K. Guilford Press; New York, NY, US: 2010. Applied Missing Data Analysis.
    1. Hadjistavropoulos H.D., Schneider L.H., Edmonds M., Karin E., Nugent M.N., Dirkse D.…Titov N. Randomized controlled trial of internet-delivered cognitive behaviour therapy comparing standard weekly versus optional weekly therapist support. Journal of Anxiety Disorders. 2017;52:15–24.
    1. Harvey L., Inglis S.J., Espie C.A. Insomniacs' reported use of CBT components and relationship to long-term clinical outcome. Behav. Res. Ther. 2002;40:75–83.
    1. Haslam C., Cruwys T., Chang M.X.L., Bentley S.V., Haslam S.A., Dingle G.A., Jetten J. GROUPS 4 HEALTH reduces loneliness and social anxiety in adults with psychological distress: findings from a randomized controlled trial. J. Consult. Clin. Psychol. 2019;87:787–801.
    1. Hollon S.D., Stewart M.O., Strunk D. Enduring effects for cognitive behavior therapy in the treatment of depression and anxiety. Annu. Rev. Psychol. 2006;57:285–315.
    1. Hopps S.L., Pépin M., Boisvert J.-M. The effectiveness of cognitive-behavioral group therapy for loneliness via inter relaychat among people with physical disabilities. Psychother. Theory Res. Pract. Train. 2003;40:136–147.
    1. Jacobson N.S., Truax P. Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J. Consult. Clin. Psychol. 1991;59:12–19.
    1. Johansson R., Andersson G. Internet-based psychological treatments for depression. Expert. Rev. Neurother. 2012;12:861–870.
    1. Käll, A., Jägholm, S., Hesser, H., Tiger Norkvist, B., Mathaldi, A., Andersson, F., … Andersson, G. (in press-a). Internet-administered cognitive-behavioral therapy against loneliness – a randomized controlled pilot trial. Behav. Ther.
    1. Käll, A., Shafran, R., Lindegaard, T., Bennett, S., Cooper, Z., Coughtrey, A., & Andersson, G. (in press-b). A common elements approach to the development of a modular cognitive behavioural theory for chronic loneliness. Journal of Clinical and Consulting Psychology.
    1. Kroenke K., Spitzer R.L., Williams J.B.W. The PHQ-9: validity of a brief depression severity measure. J. Gen. Intern. Med. 2001;16:606–613.
    1. Lecrubier, Y., Sheehan, D. V., Weiller, E., Amorim, P., Bonora, I., Harnett Sheehan, K., … Dunbar, G. C. (1997). The Mini International Neuropsychiatric Interview (MINI). A short diagnostic structured interview: reliability and validity according to the CIDI. European Psychiatry, 12, 224–231. doi:10.1016/S0924-9338(97)83296–8.
    1. Lim M.H., Rodebaugh T.L., Zyphur M.J., Gleeson J.F.M. Loneliness over time: the crucial role of social anxiety. J. Abnorm. Psychol. 2016;125:620–630.
    1. Lindner P., Frykheden O., Forsström D., Carlbring P., Andersson E., Ljótsson B.…Andersson G. The Brunnsviken brief quality of life scale (BBQ): development and psychometric evaluation. Cogn. Behav. Ther. 2016;45:182–195.
    1. Lindsay E.K., Young S., Brown K.W., Smyth J.M., Creswell J.D. Mindfulness training reduces loneliness and increases social contact in a randomized controlled trial. Proc. Natl. Acad. Sci. 2019;116:3488–3493.
    1. Luo Y., Hawkley L.C., Waite L.J., Cacioppo J.T. Loneliness, health, and mortality in old age: a national longitudinal study. Soc. Sci. Med. 2012;74:907–914.
    1. Masi C.M., Chen H.-Y., Hawkley L.C., Cacioppo J.T. A meta-analysis of interventions to reduce loneliness. Personal. Soc. Psychol. Rev. 2011;15:219–266.
    1. Mattick, R. P., & Clarke, J. C. (1998). Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Behav. Res. Ther., 36, 455–470. doi:10.1016/S0005-7967(97)10031–6.
    1. Nordin S., Carlbring P., Cuijpers P., Andersson G. Expanding the limits of Bibliotherapy for panic disorder: randomized trial of self-help without support but with a clear deadline. Behav. Ther. 2010;41:267–276.
    1. Peplau L.A., Perlman D. Wiley; New York: 1982. Loneliness: A Sourcebook of Current Theory, Research and Therapy.
    1. Pinheiro, J., Bates, D., DebRoy, S., Sarkar, D., & R Core Team. (2018). Nlme: linear and nonlinear mixed effects models. Retrieved from .
    1. Powers D.V., Thompson L.W., Gallagher-Thompson D. The benefits of using psychotherapy skills following treatment for depression: an examination of “Afterwork” and a test of the skills hypothesis in older adults. Cogn. Behav. Pract. 2008;15:194–202.
    1. R Core Team R: a language and environment for statistical computing. Vienna, Austria: R foundation for statistical computing. 2019. Retrieved from.
    1. Raudenbush S.W., Bryk A.S. Sage Publications; Thousand Oaks, CA: 2002. Hierarchical Linear Models: Applications and Data Analysis Methods. (2002)
    1. Rheker J., Andersson G., Weise C. The role of “on demand” therapist guidance vs. no support in the treatment of tinnitus via the internet: a randomized controlled trial. Internet Interv. 2015;2:189–199.
    1. Rozental A., Forsell E., Svensson A., Andersson G., Carlbring P. Overcoming procrastination: one-year follow-up and predictors of change in a randomized controlled trial of internet-based cognitive behavior therapy. Cogn. Behav. Ther. 2017;46:177–195.
    1. Russell D.W. UCLA loneliness scale (version 3): reliability, validity, and factor structure. J. Pers. Assess. 1996;66:20–40.
    1. Spitzer R.L., Williams J.B.W., Kroenke K., Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch. Intern. Med. 2006;166:1092–1097.
    1. Stickley A., Koyanagi A. Loneliness, common mental disorders and suicidal behavior: findings from a general population survey. J. Affect. Disord. 2016;197:81–87.
    1. Strunk D.R., DeRubeis R.J., Chiu A.W., Alvarez J. Patients' competence in and performance of cognitive therapy skills: relation to the reduction of relapse risk following treatment for depression. J. Consult. Clin. Psychol. 2007;75:523–530.
    1. Theeke L.A., Mallow J.A., Moore J., McBurney A., Rellick S., VanGilder R. Effectiveness of LISTEN on loneliness, neuroimmunological stress response, psychosocial functioning, quality of life, and physical health measures of chronic illness. International Journal of Nursing Sciences. 2016;3:242–251.
    1. Titov N., Andrews G., Kemp A., Robinson E. Characteristics of adults with anxiety or depression treated at an internet clinic: comparison with a national survey and an outpatient clinic. PLoS One. 2010;5
    1. Valtorta N.K., Kanaan M., Gilbody S., Ronzi S., Hanratty B. Loneliness and social isolation as risk factors for coronary heart disease and stroke: systematic review and meta-analysis of longitudinal observational studies. Heart. 2016;102:1009–1016.
    1. Vlaescu G., Alasjö A., Miloff A., Carlbring P., Andersson G. Features and functionality of the Iterapi platform for internet-based psychological treatment. Internet Interv. 2016;6:107–114.
    1. Wang J., Lloyd-Evans B., Giacco D., Forsyth R., Nebo C., Mann F., Johnson S. Social isolation in mental health: a conceptual and methodological review. Soc. Psychiatry Psychiatr. Epidemiol. 2017;52:1451–1461.
    1. Witkietvitz K., Kirouac M. Relapse prevention. In: Nezu C.M., Nezu A.M., editors. The Oxford Handbook of Cognitive and Behavioral Therapies. Oxford University Press; New York, NY: 2016. pp. 215–228.
    1. Yang K., Victor C. Age and loneliness in 25 European nations. Ageing & Society. 2011;31:1368–1388.
    1. Zetterberg M., Carlbring P., Andersson G., Berg M., Shafran R., Rozental A. Internet-based cognitive behavioral therapy of perfectionism: comparing regular therapist support and support upon request. Internet Interv. 2019;17:100237.

Source: PubMed

3
Abonnere