https://doi.org/10.4081/ripppo.2023.681

Effectiveness of and processes related to internet-delivered acceptance and commitment therapy for adolescents with anxiety disorders: a randomized controlled trial

Vol. 26 No. 2 (2023)
Submitted: December 22, 2022
Accepted: June 2, 2023
Published: July 4, 2023
Acceptance and commitment therapy, internet-based intervention, adolescents, anxiety disorders
Abstract Views: 2623
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Authors

Linnea Nissling
linnea.nissling@psy.gu.se
https://orcid.org/0000-0001-6479-2973
Department of Psychology, Faculty of Social Sciences, University of Gothenburg; Research, Development, Education and Innovation, Primary Health Care, Västra Götaland Region; General Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.
Sandra Weineland
https://orcid.org/0000-0003-2428-4004
Department of Psychology, Faculty of Social Sciences, University of Gothenburg; Research, Development, Education and Innovation, Primary Health Care, Västra Götaland Region; General Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.
Kristofer Vernmark
https://orcid.org/0000-0003-4250-8868
Department of Behavioural Sciences and Learning (IBL), University of Linköping, Sweden.
Ella Radvogin
Department of Behavioural Sciences and Learning (IBL), University of Linköping, Sweden.
Anna-Karin Engström
https://orcid.org/0009-0007-6126-6258
Department of Psychology, Faculty of Social Sciences, University of Uppsala, Sweden.
Sara Schmidt
https://orcid.org/0000-0002-5576-904X
Department of Psychology, Faculty of Social Sciences, University of Uppsala, Sweden.
Eva Nieto Granberg
Department of Psychology, Faculty of Social Sciences, University of Uppsala, Sweden.
Elin Larsson
Department of Psychology, Faculty of Social Sciences, University of Uppsala, Sweden.
Timo Hursti
https://orcid.org/0000-0003-1990-5785
Department of Psychology, Faculty of Social Sciences, University of Uppsala, Sweden.

Early access to evidence-based help is crucial for adolescents with anxiety disorders. Internet-delivered acceptance and commitment therapy (iACT) may offer adolescents increased access to care and more flexibility in engaging with treatment when and how they prefer. Process-based therapies, such as ACT, focus on theoretically derived and empirically tested key mechanisms in treatment that enable change. This study aimed to investigate the effectiveness of iACT for adolescents with anxiety disorders. The study also assessed the relationship between psychological flexibility and treatment outcomes and the relationship between participating adolescents’ and therapists’ perceived alliance and treatment outcomes. This was a randomized controlled trial comparing a 10-week intervention group with a wait-list control group. The 52 participants, aged 15 to 19, were recruited from all over Sweden. The treatment was effective in increasing quality of life and psychological flexibility, with moderate between-group effect sizes based on observed values. Changes in psychological flexibility was associated with changes in anxiety symptoms. The results further showed a statistically significant between-group difference in post-treatment diagnoses. No significant time per group interaction was found for anxiety symptoms, as both groups improved. Working alliance was rated as high by both participating adolescents and therapists but showed no significant relationship with treatment outcomes. Participants found the treatment an acceptable intervention. This study shows promising results for iACT in treating adolescents with anxiety disorders. The results suggest the model of psychological flexibility as an important process of change in treatment outcomes. Future research should validate these findings in larger samples and clinical contexts.

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Ahlen, J., Vigerland, S., & Ghaderi, A. (2018). Development of the Spence children’s anxiety scale - short version (SCASS). Journal of Psychopathology and Behavioral Assessment, 40(2), 288-304. doi: 10.1007/s10862-017-9637-3. DOI: https://doi.org/10.1007/s10862-017-9637-3
Andersson, G., Paxling, B., Wiwe, M., Vernmark, K., Felix, C. B., Lundborg, L., Furmark, T., Cuijpers, P., & Carlbring, P. (2012). Therapeutic alliance in guided internet-delivered cognitive behavioural treatment of depression, generalized anxiety disorder and social anxiety disorder. Behaviour Research and Therapy, 50(9), 544-550. doi: 10.1016/j.brat.2012.05.003. DOI: https://doi.org/10.1016/j.brat.2012.05.003
Andersson, G., & Titov, N. (2014). Advantages and limitations of internet-based interventions for common mental disorders. World Psychiatry, 13(1), 4-11. doi: 10.1002/wps.20083. DOI: https://doi.org/10.1002/wps.20083
Andersson, G., Titov, N., Dear, B. F., Rozental, A., & Carlbring, P. (2019). Internet-delivered psychological treatments: from innovation to implementation. World Psychiatry, 18(1), 20-28. doi: 10.1002/wps.20610. DOI: https://doi.org/10.1002/wps.20610
Andrews, G., Basu, A., Cuijpers, P., Craske, M. G., McEvoy, P., English, C. L., & Newby, J. M. (2018). Computer therapy for the anxiety and depression disorders is effective, acceptable and practical health care: an updated meta-analysis. Journal of Anxiety Disorders, 55, 70-78. doi: 10.1016/j.janxdis.2018.01.001. DOI: https://doi.org/10.1016/j.janxdis.2018.01.001
Bailey, A., Ciarrochi, J., & Hayes, L. (2012). Get out of your mind and into your life for teens: a guide to living an extraordinary life. Oakland, New Harbinger Publications.
Bandelow, B., & Michaelis, S. (2015). Epidemiology of anxiety disorders in the 21st century. Dialogues in Clinical Neuroscience, 17(3), 327-335. doi: 10.31887/DCNS.2015.17.3/bbandelow. DOI: https://doi.org/10.31887/DCNS.2015.17.3/bbandelow
Bergman Nordgren, L., Carlbring, P., Linna, E., & Andersson, G. (2013). Role of the working alliance on treatment outcome in tailored internet-based cognitive behavioural therapy for anxiety disorders: randomized controlled pilot trial. JMIR Research Protocols, 2(1), e4. doi:10.2196/resprot.2292. DOI: https://doi.org/10.2196/resprot.2292
Bordin, E. S. (1983). A working alliance based model of supervision. The Counseling Psychologist, 11(1), 35-42. doi: 10.1177/0011000083111007. DOI: https://doi.org/10.1177/0011000083111007
Cervin, M., & Lundgren, T. (2022). Technology-delivered cognitive- behavioral therapy for pediatric anxiety disorders: a meta-analysis of remission, posttreatment anxiety, and functioning. Journal of Child Psychology and Psychiatry, 63(1), 7-18. doi: 10.1111/jcpp.13485. DOI: https://doi.org/10.1111/jcpp.13485
Cohen, J. (2013). Statistical power analysis for the behavioral sciences. London, Routledge. DOI: https://doi.org/10.4324/9780203771587
Cuijpers, P., Reijnders, M., & Huibers, M. J. H. (2019). The role of common factors in psychotherapy outcomes. Annual Review of Clinical Psychology, 15(1), 207-231. doi: 10.1146/annurev-clinpsy-050718-095424. DOI: https://doi.org/10.1146/annurev-clinpsy-050718-095424
Duncan, L., Georgiades, K., Wang, L., Van Lieshout, R. J., MacMillan, H. L., Ferro, M. A., Lipman, E. L., Szatmari, P., Bennett, K., & Kata, A. (2018). Psychometric evaluation of the mini international neuropsychiatric interview for children and adolescents (MINI-KID). Psychological Assessment, 30(7), 916-928. doi: 10.1037/pas0000541. DOI: https://doi.org/10.1037/pas0000541
Ebert, D. D., Zarski, A. C., Christensen, H., Stikkelbroek, Y., Cuijpers, P., Berking, M., & Riper, H. (2015). Internet and computer-based cognitive behavioral therapy for anxiety and depression in youth: a meta-analysis of randomized controlled outcome trials. PLoS One, 10(3), e0119895. doi: 10.1371/journal.pone.0119895. DOI: https://doi.org/10.1371/journal.pone.0119895
Eifert, G. H., & Forsyth, J. P. (2005). Acceptance and commitment therapy for anxiety disorders: A practitioner's treatment guide to using mindfulness, acceptance, and values-based behavior change. Oakland, New Harbinger Publications.
Essau, C. A., Lewinsohn, P. M., Olaya, B., & Seeley, J. R. (2014). Anxiety disorders in adolescents and psychosocial outcomes at age 30. Journal of Affective Disorders, 163, 125-132. doi: 10.1016/j.jad.2013.12.033. DOI: https://doi.org/10.1016/j.jad.2013.12.033
Essau, C. A., Sasagawa, S., Anastassiou-Hadjicharalambous, X., Guzmán, B. O., & Ollendick, T. H. (2011). Psychometric properties of the Spence child anxiety scale with adolescents from five European countries. Journal of Anxiety Disorders, 25(1), 19-27. doi: 10.1016/j.janxdis.2010.07.001. DOI: https://doi.org/10.1016/j.janxdis.2010.07.001
Fang, S., & Ding, D. (2020). A meta-analysis of the efficacy of acceptance and commitment therapy for children. Journal of Contextual Behavioral Science, 15, 225-234. doi: 10.1016/j.jcbs.2020.01.007. DOI: https://doi.org/10.1016/j.jcbs.2020.01.007
Flückiger, C., Del Re, A. C., Wampold, B. E., & Horvath, A. O. (2018). The alliance in adult psychotherapy: a meta-analytic synthesis. Psychotherapy, 55(4), 316-340. doi: 10.1037/pst0000172. DOI: https://doi.org/10.1037/pst0000172
Gilbody, S., Richards, D., Brealey, S., & Hewitt, C. (2007). Screening for depression in medical settings with the patient health questionnaire (PHQ): a diagnostic meta-analysis. Journal of General Internal Medicine, 22(11), 1596-1602. doi: 10.1007/s11606-007-0333-y. DOI: https://doi.org/10.1007/s11606-007-0333-y
Gloster, A. T., Meyer, A. H., & Lieb, R. (2017). Psychological flexibility as a malleable public health target: evidence from a representative sample. Journal of Contextual Behavioral Science, 6(2), 166-171. doi: 10.1016/j.jcbs.2017.02.003. DOI: https://doi.org/10.1016/j.jcbs.2017.02.003
Gloster, A. T., Walder, N., Levin, M. E., Twohig, M. P., & Karekla, M. (2020). The empirical status of acceptance and commitment therapy: a review of meta-analyses. Journal of Contextual Behavioral Science, 18, 181-192. doi: 10.1016/j.jcbs.2020.09.009. DOI: https://doi.org/10.1016/j.jcbs.2020.09.009
Greco, L. A., Lambert, W., & Baer, R. A. (2008). Psychological inflexibility in childhood and adolescence: development and evaluation of the avoidance and fusion questionnaire for youth. Psychological Assessment, 20(2), 93-102. doi: 10.1037/1040-3590.20.2.93. DOI: https://doi.org/10.1037/1040-3590.20.2.93
Hadjistavropoulos, H. D., Pugh, N. E., Hesser, H., & Andersson, G. (2017). Therapeutic alliance in internet-delivered cognitive behaviour therapy for depression or generalized anxiety. Clinical Psychology & Psychotherapy, 24(2), 451-461. doi: 10.1002/cpp.2014. DOI: https://doi.org/10.1002/cpp.2014
Hatcher, R. L., & Gillaspy, J. A. (2006). Development and validation of a revised short version of the working alliance inventory. Psychotherapy Research, 16(1), 12-25. doi: 10.1080/10503300500352500. DOI: https://doi.org/10.1080/10503300500352500
Hayes, L. L., & Ciarrochi, J. V. (2015). The thriving adolescent: using acceptance and commitment therapy and positive psychology to help teens manage emotions, achieve goals, and build connection. Oakland, New Harbinger Publications.
Hayes, S. C., Ciarrochi, J., Hofmann, S. G., Chin, F., & Sahdra, B. (2022). Evolving an idionomic approach to processes of change: towards a unified personalized science of human improvement. Behaviour Research and Therapy, 156, 104155. doi: 10.1016/j.brat.2022.104155. DOI: https://doi.org/10.1016/j.brat.2022.104155
Hayes, S. C., Pistorello, J., & Levin, M. E. (2012). Acceptance and commitment therapy as a unified model of behavior change. The Counseling Psychologist, 40(7), 976-1002. doi: 10.1177/0011000012460836. DOI: https://doi.org/10.1177/0011000012460836
Holmes, E. A., Ghaderi, A., Harmer, C. J., Ramchandani, P. G., Cuijpers, P., Morrison, A. P., Roiser, J. P., Bockting, C. L. H., O'Connor, R. C., Shafran, R., Moulds, M. L., & Craske, M. G. (2018). The Lancet psychiatry commission on psychological treatments research in tomorrow's science. Lancet Psychiatry, 5(3), 237-286. doi: 10.1016/s2215-0366(17) 30513-8. DOI: https://doi.org/10.1016/S2215-0366(17)30513-8
Karver, M. S., De Nadai, A. S., Monahan, M. F., & Shirk, S. R. (2018). Meta-analysis of the prospective relation between alliance and outcome in child and adolescent psychotherapy. Psychotherapy, 55(4), 341–355. doi: 10.1037/pst0000176. DOI: https://doi.org/10.1037/pst0000176
Katharine, A. S., Charlotte, B., Maria, F. J., Joseph, F., Tom Van, D., Carmen, M., Per, C., Ulrich, W. E. P., Nikolaos, K., Heleen, R., Stephane, M., John, T., & Andrea, C. (2023). Digital mental health: challenges and next steps. BMJ Mental Health, 26(1), e300670. doi: 10.1136/bmjment-2023-300670. DOI: https://doi.org/10.1136/bmjment-2023-300670
Kazdin, A. E. (2008). Evidence-based treatment and practice: new opportunities to bridge clinical research and practice, enhance the knowledge base, and improve patient care. American Psychologist, 63(3), 146-159. doi: 10.1037/0003-066X.63.3.146. DOI: https://doi.org/10.1037/0003-066X.63.3.146
Kelson, J., Rollin, A., Ridout, B., & Campbell, A. (2019). Internet- delivered acceptance and commitment therapy for anxiety treatment: systematic review. Journal of Medical Internet Research, 21(1), e12530. doi: 10.2196/12530. DOI: https://doi.org/10.2196/12530
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-ofonset distributions of DSM-IV disorders in the national comorbidity survey replication. Archives of General Psychiatry, 62(6), 593-602. doi: 10.1001/archpsyc.62.6.593. DOI: https://doi.org/10.1001/archpsyc.62.6.593
Kroenke, K., & Spitzer, R. L. (2002). The PHQ-9: a new depression diagnostic and severity measure. Psychiatric Annals, 32(9), 509-515. doi: 10.3928/0048-5713-20020901-06. DOI: https://doi.org/10.3928/0048-5713-20020901-06
Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606-613. doi: 10.1046/j.1525-1497.2001.016009606.x. DOI: https://doi.org/10.1046/j.1525-1497.2001.016009606.x
Kumar, V., Sattar, Y., Bseiso, A., Khan, S., & Rutkofsky, I. H. (2017). The effectiveness of internet-based cognitive behavioral therapy in treatment of psychiatric disorders. Cureus, 9(8), e1626. doi: 10.7759/cureus.1626. DOI: https://doi.org/10.7759/cureus.1626
Lindner, P., Frykheden, O., Forsström, D., Andersson, E., Ljótsson, B., Hedman, E., Andersson, G., & Carlbring, P. (2016). The Brunnsviken brief quality of life scale (BBQ): development and psychometric evaluation. Cognitive Behaviour Therapy, 45(3), 182-195. doi: 10.1080/16506073.2016.1143526. DOI: https://doi.org/10.1080/16506073.2016.1143526
Livheim, F., Tengström, A., Bond, F. W., Andersson, G., Dahl, J., & Rosendahl, I. (2016). Psychometric properties of the avoidance and fusion questionnaire for youth: a psychological measure of psychological inflexibility in youth. Journal of Contextual Behavioral Science, 5(2), 103-110. doi: 10.1016/j.jcbs.2016.04.001. DOI: https://doi.org/10.1016/j.jcbs.2016.04.001
Lønfeldt, N. N., Silverman, W. K., & Esbjørn, B. H. (2017). A systematic review and meta-analysis of the association between third-wave cognitive constructs and youth anxiety. International Journal of Cognitive Therapy, 10(2), 115-137. doi: 10.1521/ijct.2017.10.2.115. DOI: https://doi.org/10.1521/ijct.2017.10.2.115
Munder, T., Wilmers, F., Leonhart, R., Linster, H. W., & Barth, J. (2010). Working alliance inventory short revised (WAI SR): psychometric properties in outpatients and inpatients. Clinical Psychology & Psychotherapy, 17(3), 231-239. doi: 10.1002/cpp.658. DOI: https://doi.org/10.1002/cpp.658
Nuñez, L., Fernández, S., Alamo, N., Midgley, N., Capella, C., & Krause, M. (2022). The therapeutic relationship and change processes in child psychotherapy: a qualitative, longitudinal study of the views of children, parents and therapists. Research in Psychotherapy, 25(1), 556. doi: 10.4081/ripppo.2022.556. DOI: https://doi.org/10.4081/ripppo.2022.556
Olofsdotter, S., Sonnby, K., Vadlin, S., Furmark, T., & Nilsson, K. W. (2015). Assessing adolescent anxiety in general psychiatric care: diagnostic accuracy of the Swedish self-report and parent versions of the Spence children’s anxiety scale. Assessment, 23(6), 744-757. doi: 10.1177/1073191115583858. DOI: https://doi.org/10.1177/1073191115583858
Olthuis, J. V., Watt, M. C., Bailey, K., Hayden, J. A., & Stewart, S. H. (2016). Therapist-supported internet cognitive behavioural therapy for anxiety disorders in adults. Cochrane Database of Systematic Reviews, 3(3), CD011565. doi: 10.1002/14651858.CD011565.pub2. DOI: https://doi.org/10.1002/14651858.CD011565.pub2
Petersen, J. M., Zurita Ona, P., & Twohig, M. P. (2022). A review of acceptance and commitment therapy for adolescents: developmental and contextual considerations. Cognitive and Behavioral Practice. doi: 10.1016/j.cbpra.2022.08.002. DOI: https://doi.org/10.1016/j.cbpra.2022.08.002
Racine, N., McArthur, B. A., Cooke, J. E., Eirich, R., Zhu, J., & Madigan, S. (2021). Global prevalence of depressive and anxiety symptoms in children and adolescents during COVID-19: a meta-analysis. JAMA Pediatrics, 175(11), 1142-1150. doi: 10.1001/jamapediatrics.2021.2482. DOI: https://doi.org/10.1001/jamapediatrics.2021.2482
Ralston, A. L., Andrews, A. R., & Hope, D. A. (2019). Fulfilling the promise of mental health technology to reduce public health disparities: review and research agenda. Clinical Psychology: Science and Practice, 26(1), e12277. doi: 10.1111/cpsp.12277. DOI: https://doi.org/10.1111/cpsp.12277
Reynolds, S., Wilson, C., Austin, J., & Hooper, L. (2012). Effects of psychotherapy for anxiety in children and adolescents: a meta-analytic review. Clinical Psychology Review, 32(4), 251-262. doi: 10.1016/j.cpr.2012.01.005. DOI: https://doi.org/10.1016/j.cpr.2012.01.005
Rutter, L. A., & Brown, T. A. (2017). Psychometric properties of the generalized anxiety disorder scale-7 (GAD-7) in outpatients with anxiety and mood disorders. Journal of Psychopathology and Behavioral Assessment, 39(1), 140-146. doi: 10.1007/s10862-016-9571-9. DOI: https://doi.org/10.1007/s10862-016-9571-9
Sheehan, D. V., Sheehan, K. H., Shytle, R. D., Janavs, J., Bannon, Y., Rogers, J. E., Milo, K. M., Stock, S. L., & Wilkinson, B. (2010). Reliability and validity of the mini international neuropsychiatric interview for children and adolescents (MINIKID). Journal of Clinical Psychiatry, 71(3), 313-326. doi: 10.4088/JCP.09m05305whi. DOI: https://doi.org/10.4088/JCP.09m05305whi
Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine, 166(10), 1092-1097. doi: 10.1001/archinte.166.10.1092. DOI: https://doi.org/10.1001/archinte.166.10.1092
Stabbe, O. K., Rolffs, J. L., & Rogge, R. D. (2019). Flexibly and/or inflexibly embracing life: identifying fundamental approaches to life with latent profile analyses on the dimensions of the Hexaflex model. Journal of Contextual Behavioral Science, 12, 106-118. doi: 10.1016/j.jcbs.2019.03.003. DOI: https://doi.org/10.1016/j.jcbs.2019.03.003
Stockton, D., Kellett, S., Berrios, R., Sirois, F., Wilkinson, N., & Miles, G. (2019). Identifying the underlying mechanisms of change during acceptance and commitment therapy (ACT): a systematic review of contemporary mediation studies. Behavioural and Cognitive Psychotherapy, 47(3), 332-362. doi: 10.1017/S1352465818000553. DOI: https://doi.org/10.1017/S1352465818000553
Swain, J., Hancock, K., Hainsworth, C., & Bowman, J. (2015). Mechanisms of change: exploratory outcomes from a randomised controlled trial of acceptance and commitment therapy for anxious adolescents. Journal of Contextual Behavioral Science, 4(1), 56-67. doi: 10.1016/j.jcbs.2014.09.001. DOI: https://doi.org/10.1016/j.jcbs.2014.09.001
Tiirikainen, K., Haravuori, H., Ranta, K., Kaltiala-Heino, R., & Marttunen, M. (2019). Psychometric properties of the 7-item generalized anxiety disorder scale (GAD-7) in a large representative sample of Finnish adolescents. Psychiatry Research, 272, 30-35. doi: doi: 10.1016/j.psychres.2018.12.004. DOI: https://doi.org/10.1016/j.psychres.2018.12.004
Tracey, T. J., & Kokotovic, A. M. (1989). Factor structure of the working alliance inventory. Psychological Assessment, 1(3), 207-210. doi: 10.1037/1040-3590.1.3.207 DOI: https://doi.org/10.1037/1040-3590.1.3.207
Vernmark, K., Hesser, H., Topooco, N., Berger, T., Riper, H., Luuk, L., Backlund, L., Carlbring, P., & Andersson, G. (2019). Working alliance as a predictor of change in depression during blended cognitive behaviour therapy. Cognitive Behaviour Therapy, 48(4), 285-299. doi: 10.1080/16506073. DOI: https://doi.org/10.1080/16506073.2018.1533577
1533577.
Vigerland, S., Lenhard, F., Bonnert, M., Lalouni, M., Hedman, E., Ahlen, J., Olén, O., Serlachius, E., & Ljótsson, B. (2016). Internet-delivered cognitive behavior therapy for children and adolescents: a systematic review and meta-analysis. Clinical Psychology Review, 50, 1-10. doi: 10.1016/j.cpr.2016. 09.005. DOI: https://doi.org/10.1016/j.cpr.2016.09.005
Wallin, E., Parling, T., Weineland, S., & Dahl, J. (2018). Acceptance and commitment therapy to promote value attainment among individuals with overweight: A multiple baseline evaluation. Journal of Contextual Behavioral Science, 10, 41-49. doi:10.1016/j.jcbs.2018.08.007. DOI: https://doi.org/10.1016/j.jcbs.2018.08.007
Weineland, S., Ribbegårdh, R., Kivi, M., Bygdell, A., Larsson, A., Vernmark, K., & Lilja, J. L. (2020). Transitioning from face-to-face treatment to iCBT for youths in primary care–therapists' attitudes and experiences. Internet Interventions, 22, 100356. doi: 10.1016/j.invent.2020.100356. DOI: https://doi.org/10.1016/j.invent.2020.100356
Windle, E., Tee, H., Sabitova, A., Jovanovic, N., Priebe, S., & Carr, C. (2020). Association of patient treatment preference with dropout and clinical outcomes in adult psychosocial mental health interventions: a systematic review and metaanalysis. JAMA Psychiatry, 77(3), 294-302. doi: 10.1001/jamapsychiatry.2019.3750. DOI: https://doi.org/10.1001/jamapsychiatry.2019.3750

How to Cite

Nissling, L., Weineland, S., Vernmark, K., Radvogin, E., Engström, A.-K., Schmidt, S., … Hursti, T. (2023). Effectiveness of and processes related to internet-delivered acceptance and commitment therapy for adolescents with anxiety disorders: a randomized controlled trial. Research in Psychotherapy: Psychopathology, Process and Outcome, 26(2). https://doi.org/10.4081/ripppo.2023.681
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