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Therapist Effects in Guided Internet-Delivered CBT for Anxiety Disorders

  • Jonas Almlöv (a1), Per Carlbring (a2), Karin Källqvist (a1), Björn Paxling (a3), Pim Cuijpers (a4) and Gerhard Andersson (a5)...


Background: Guided internet-delivered CBT for anxiety disorders has received increasing empirical support, but little is known regarding the role of the therapist. Aims: This study addressed therapist factors in guided internet-delivered cognitive behavioural therapy for anxiety disorders. Method: Data from three controlled trials with a total N of 119 were analyzed with attention to differences between eight therapists. Results: No significant mean level differences between therapists appeared in the dataset. However, one significant intraclass correlation between participants was found, suggesting that the outcome on the Beck Anxiety Inventory might have been influenced by the impact of the individual therapists. Conclusion: The therapist can possibly have some influence on the outcome of guided internet-delivered CBT for anxiety disorders, but studies with more statistical power are needed to establish whether therapist effects are present in this modality of psychological treatment. The present study was underpowered to detect minor therapist effects.


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Reprint requests to Gerhard Andersson, Department of Behavioral Sciences and Learning, Linköping University, SE-581 83 Linköping, Sweden. E-mail:


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Almlöv, J., Carlbring, P., Berger, T., Cuijpers, P. and Andersson, G. (2009). Therapist factors in internet-delivered CBT for major depressive disorder. Cognitive Behaviour Therapy, 38, 247254.
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders (rev. 4th ed.). Washington, DC: Author.
Andersson, G. (2009). Using the internet to provide cognitive behaviour therapy. Behaviour Research and Therapy, 47, 175180.
Andersson, G., Bergström, J., Buhrman, M., Carlbring, P., Holländare, F., Kaldo, V., et al. (2008). Development of a new approach to guided self-help via the internet. the Swedish experience. Journal of Technology in Human Services, 26, 161181.
Andersson, G., Bergström, J., Holländare, F., Ekselius, L. and Carlbring, P. (2004). Delivering CBT for mild to moderate depression via the internet: predicting outcome at 6-months follow-up. Verhaltenstherapie, 14, 185189.
Andersson, G., Carlbring, P. and Grimlund, A. (2008). Predicting treatment outcome in internet versus face to face treatment of panic disorder Computers in Human Behavior, 24, 17901801.
Beck, A. T., Epstein, N., Brown, G. and Steer, R. A. (1988). An inventory for measuring clinical anxiety: psychometric properties. Journal of Consulting and Clinical Psychology, 56, 893897.
Bergström, J., Andersson, G., Ljótsson, B., Rück, C., Andréewitch, S., Karlsson, A., et al. (2010). Internet- versus group-administered cognitive behaviour therapy for panic disorder in a psychiatric setting: a randomised trial. BMC Psychiatry, 10, 54.
Beutler, L. E., Mailk, M., Harwood, T. M., Talebi, H., Noble, S. and Wong, E. (2004). Therapist variables. In Lambert, M. J. (Ed.), Bergin and Garfield's Handbook of Psychotherapy and Behaviour Change (pp. 227306). New York: John Wiley and Sons.
Buchanan, T. (2003). Internet-based questionnaire assessment: appropriate use in clinical contexts. Cognitive Behaviour Therapy, 32, 100109.
Carlbring, P., Bohman, S., Brunt, S., Buhrman, M., Westling, B. E., Ekselius, L., et al. (2006). Remote treatment of panic disorder: a randomized trial of internet-based cognitive behavior therapy supplemented with telephone calls. American Journal of Psychiatry, 163, 21192125.
Carlbring, P., Brunt, S., Bohman, S., Austin, D., Richards, J. C., Öst, L.-G., et al. (2007). Internet vs. paper and pencil administration of questionnaires commonly used in panic/agoraphobia research. Computers in Human Behavior, 23, 14211434.
Carlbring, P., Gunnarsdóttir, M., Hedensjo, L., Andersson, G., Ekselius, L. and Furmark, T. (2007). Treatment of social phobia: randomised trial of internet-delivered cognitive-behavioural therapy with telephone support. British Journal of Psychiatry, 190, 123128.
Carlbring, P., Nilsson-Ihrfelt, E., Waara, J., Kollenstam, C., Buhrman, M., Kaldo, V., et al. (2005). Treatment of panic disorder: live therapy vs. self-help via internet. Behaviour Research and Therapy, 43, 13211333.
Chambless, D. L., Caputo, G. C., Bright, P. and Gallagher, R. (1984). Assessment of fear of fear in agoraphobics: the body sensations questionnaire and the agoraphobic cognitions questionnaire. Journal of Consulting and Clinical Psychology, 52, 10901097.
Chambless, D. L., Caputo, G. C., Jasin, S. E., Gracely, E. J. and Williams, C. (1985). The mobility inventory for agoraphobia. Behaviour Research and Therapy, 23, 3544.
Cook, J. E. and Doyle, C. (2002). Working alliance in online therapy as compared to face-to-face therapy: preliminary results. Cyberpsychology and Behavior, 5, 95105.
Crits-Christoph, P., Baranackie, K., Kurcias, J. S., Beck, A. T., Carroll, K., Perry, K., et al. (1991). Meta-analysis of therapist effects in psychotherapy outcome studies. Psychotherapy Research, 1, 8191.
Crits-Cristoph, P. and Mintz, J. (1991). Implications of therapist effects for the design and analysis of comparative studies of psychotherapies. Journal of Consulting and Clinical Psychology, 57, 414419.
D'Arcy, J., Reynolds, J. R., Stiles, W. B. and Grohol, J. M. (2006). An investigation of session impact and alliance in internet based psychotherapy: preliminary results. Counseling and Psychotherapy Research, 6, 164168.
Derogatis, L. R., Lippman, R. S. and Covi, L. (1973). SCL-90: an outpatient psychiatric rating scale – preliminary report. Psychopharmacology Bulletin, 9, 1328.
Fleiss, J. L., Levin, B. and Paik, M. C. (2003). Statistical Methods for Rates and Proportions (3rd ed.). Hoboken, NJ: John Wiley and Sons.
Frisch, M. B., Cornell, J., Villanueva, M. and Retzlaff, P. J. (1992). Clinical validation of the quality of life inventory: a measure of life satisfaction for use in treatment planning and outcome assessment. Psychological Assessment, 4, 92101.
Gellatly, J., Bower, P., Hennessy, S., Richards, D., Gilbody, S. and Lovell, K. (2007). What makes self-help interventions effective in the management of depressive symptoms? Meta-analysis and meta-regression. Psychological Medicine, 37, 12171228.
Horvath, A. O. and Greenberg, L. S. (1989). The development and validation of the Working Alliance Inventory. Journal of Counseling Psychology, 36, 223233.
Kenny, D. A., Mannetti, L., Pierro, A., Livi, S. and Kashy, D. A. (2002). The statistical analysis of data from small groups. Journal of Personality and Social Psychology, 83, 126137.
Kiropoulos, L. A., Klein, B., Austin, D. W., Gilson, K., Pier, C., Mitchell, J., et al. (2008). Is internet-based CBT for panic disorder and agoraphobia as effective as face-to-face CBT? Journal of Anxiety Disorders, 22, 12731284.
Klein, B., Richards, J. C. and Austin, D. W. (2006). Efficacy of internet therapy for panic disorder. Journal of Behavior Therapy and Experimental Psychiatry, 37, 213238.
Knaevelsrud, C. and Maercker, A. (2007). Internet-based treatment for PTSD reduces distress and facilitates the development of a strong therapeutic alliance: a randomized controlled clinical trial. BMC Psychiatry, 7, e13.
Lange, A., Van Den Ven, J.-P., Schrieken, B. and Emmelkamp, P. M. G. (2001). Interapy – treatment of posttraumatic stress through the internet: a controlled trial. Journal of Behavior Therapy and Experimental Psychiatry, 32, 7390.
Mattick, R. P. and Clarke, J. C. (1998). Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Behaviour Research and Therapy, 36, 455470.
Maxwell, S. E. and Delaney, H. D. (2004). Designing Experiments and Analyzing Data: a model comparison approach (2nd ed.). Mahwah, NJ: Lawrence Erlbaum Associates.
McGraw, K. O. and Wong, S. P. (1996). Forming inferences about some intraclass correlation coefficients. Psychological Methods, 1, 3046.
Meyer, T. J., Miller, M. L., Metzger, R. L. and Borkovec, T. D. (1990). Development and validation of the Penn State Worry Questionnaire. Behaviour Research and Therapy, 28, 487495.
Newman, M. O., Zuellig, A. R., Kachin, K. E., Constantino, M. J., Przeworski, A., Erickson, T., et al. (2002). Preliminary reliability and validity of the generalized anxiety disorder questionnaire-IV: a revised self-report diagnostic measure of generalized anxiety disorder. Behavior Therapy, 33, 215233.
Van Oakman, J., Ameringen, M., Mancini, C. and Farvolden, P. (2003). A confirmatory factor analysis of a self-report version of the Liebowitz Social Anxiety Scale. Journal of Clinical Psychology, 59, 149161.
Palmqvist, B., Carlbring, P. and Andersson, G. (2007). Internet-delivered treatments with or without therapist input: does the therapist factor have implications for efficacy and cost? Expert Review of Pharmacoeconomics and Outcomes Research, 7, 291297.
Paxling, B., Almlöv, J., Dahlin, M., Carlbring, P., Breitholtz, E., Eriksson, T. and Andersson, G. (unpublished manuscript). A randomized controlled study of the efficacy of an internet-delivered guided self-help treatment for generalized anxiety disorder. Linköping University, Sweden.
Richardson, R., Richards, D. A. and Barkham, M. (2010). Self-help books for people with depression: the role of the therapeutic relationship. Behavioural and Cognitive Psychotherapy, 38, 6781.
Robinson, E., Titov, N., Andrews, G., McIntyre, K., Schwencke, G. and Solley, K. (2010). Internet treatment for generalized anxiety disorder: a randomized controlled trial comparing clinician vs. technician assistance. PloS one, 5, e10942.
Rosenthal, R. and Rosnow, R. L. (1991). Essentials of Behavioral Research: methods and data analysis. New York: McGraw Hill.
Spek, V., Cuijpers, P., Nyklicek, I., Riper, H., Keyzer, J. and Pop, V. (2007). Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: a meta-analysis. Psychological Medicine, 37, 319328.
Spek, V., Nyklicek, I., Cuijpers, P. and Pop, V. (2008). Predictors of outcome of group and internet-based cognitive behavior therapy. Journal of Affective Disorders, 105, 137145.
Spek, V., Nyklicek, I., Smits, N., Cuijpers, P., Riper, H., Keyzer, J., et al. (2007). Internet-based cognitive behavioural therapy for sub threshold depression in people over 50 years old: a randomized controlled clinical trial. Psychological Medicine, 37, 17971806.
Svanborg, P. and Åsberg, M. (2001). A comparison between the Beck Depression Inventory (BDI) and the self-rating version of the Montgomery Asberg Depression Rating Scale (MADRS). Journal of Affective Disorders, 64, 203216.
Titov, N., Andrews, G., Davies, M., McIntyre, K., Robinson, E. and Solley, K. (2010). Internet treatment for depression: a randomized controlled trial comparing clinician vs. technician assistance. PloS one, 5, e10939.
Titov, N., Andrews, G., Schwencke, G., Solley, K., Johnston, L. and Robinson, E. (2009). An RCT comparing the effects of two types of support on severity of symptoms for people completing internet-based cognitive behaviour therapy for social phobia. Australian and New Zealand Journal of Psychiatry, 43, 920926.
Wampold, B. E. (2001). The Great Psychotherapy Debate: models, methods, and findings. Mahaw, New Jersey: Lawrence Erlbaum.
Wampold, B. E. and Brown, G. S. (2005). Estimating variability in outcomes attributable to therapists: a naturalistic study of outcomes in managed care. Journal of Consulting and Clinical Psychology, 73, 914923.


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Therapist Effects in Guided Internet-Delivered CBT for Anxiety Disorders

  • Jonas Almlöv (a1), Per Carlbring (a2), Karin Källqvist (a1), Björn Paxling (a3), Pim Cuijpers (a4) and Gerhard Andersson (a5)...


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Therapist Effects in Guided Internet-Delivered CBT for Anxiety Disorders

  • Jonas Almlöv (a1), Per Carlbring (a2), Karin Källqvist (a1), Björn Paxling (a3), Pim Cuijpers (a4) and Gerhard Andersson (a5)...
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