Internet delivered treatments within regular care – Erik Forsell's team

We conduct research on internet-based psychotherapy and behavioral medicine within routine healthcare and are located at the Internet Psychiatry Clinic (internetpsykiatri.se) within Psychiatry Southwest in Region Stockholm.

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Internet Psychiatry, where team leader Erik Forsell is responsible for research and development, has for nearly 20 years treated tens of thousands of patients via the internet from across the country, and has successfully implemented around ten different treatments and support programs that have become permanent parts of the healthcare services offered nationally. As all assessment and treatment take place digitally, the unit has a nationwide reach.
 
Our research concerns, in part, developing, evaluating, and implementing new treatments based on the needs of psychiatry, quality assuring and maintaining implemented treatments, as well as investigating innovative new ways to improve the treatments themselves or the way we work with delivering treatments, so that more patients can receive care that is as good and effective as possible.
 
To achieve this, we conduct, among other things:
 
Mechanistic studies, which aim to understand how the treatments actually lead to improvements.

Assessment, matching, and prediction, in order to understand which patient will benefit from which treatment and how we can best match the patient to their most effective treatment.
 
Studies on how the patient and the psychologist understand and engage with the theoretical model on which a treatment is based, and on how important this is for the outcome.

Projects

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The ORIGAMI Project: Precision Psychiatry for Generalized Anxiety Disorder in Routine Care

Persistent and excessive worry, known as generalized anxiety disorder (GAD), is the most common anxiety diagnosis among adults. Many affected individuals have experienced symptoms for a long time and report reduced quality of life, difficulties working, and an increased risk of sick leave. Effective psychological treatments exist, but we still know too little about why a treatment works for some individuals but not for others.

This project investigates two of the most common treatment models for GAD. Both are used within healthcare, but it is unclear whether they are equally effective and whether they are better suited for different individuals. The project consists of two large, randomized, studies involving a total of nearly 900 patients. We aim to investigate whether the treatments are equally effective and whether they work in the way described by the theories underlying them.

The project also investigates whether it matters how well the patient understands and assimilates the core idea of the treatment. Perhaps a treatment works better if the way it describes and explains a patient’s problems “clicks” with the patient’s own understanding from the outset. The project also enables the development of personalized psychiatric treatment by understanding how we can most easily and effectively match patients to the right treatment.

The treatments are delivered through Internet Psychiatry in Stockholm, which has extensive experience with internet-based psychological treatment. The project is a collaboration between researchers and clinicians at Karolinska Institutet and Psychiatry Southwest.

The goal is to make treatment more precise and individualized without increasing the burden on healthcare services or patients.

Results so far

A pilot study has been completed and published. In this study, the program was tested at Internet Psychiatry after being adapted from a treatment originally aimed at adolescents. The treatment was delivered to 22 individuals with GAD. We found a significant reduction in GAD symptoms with an effect size similar to previous studies. Patients reported high treatment satisfaction and credibility. Only two patients discontinued treatment. The remaining patients completed a median of 7.5 out of 8 modules. The study demonstrated that the treatment protocol is preliminarily effective, acceptable to patients and clinicians, and feasible to implement within routine psychiatric care.

Huhn V, Andersson E, Wahlund T, Forsell E. Initial effectiveness of an ICBT-protocol for GAD in psychiatric care - A feasibility-pilot study. Internet Interventions. 2025 Jun;40:100817. DOI: 10.1016/j.invent.2025.100817. PMID: 40123820; PMCID: PMC11927722.

As we plan to conduct a benchmarking analysis in which we compare the within-group effects of the treatments against other treatments reported in the literature, a methodological question arose concerning effectiveness studies and how they report within-group effects. Specifically, it became apparent in the literature that it is often unclear exactly at what point in the care process the symptom measurement defined by researchers as “pre-treatment” is conducted, and what consequences this may have in uncontrolled studies. To highlight this issue, we conducted a methodological study based both on simulations and on routine care data from Internet Psychiatry (N=8744), in which we investigated the “effect” (i.e., the average magnitude of symptom reduction) between the symptom rating conducted when a patient registers/screens for ICBT and the rating conducted when treatment actually begins, and how much of that improvement is time-dependent. The study has now been accepted and published, and it showed that the, on average quite substantial, symptom reduction that clearly occurs between patient registration and treatment start is mostly entirely independent of the amount of time that passes in between. This means that it is extremely important for researchers to be transparent when reporting which measurement is used as the “pre-treatment” assessment, and that we need to be very careful when comparing the within-group effects of one study with those of another.

Huhn V, Hentati Isacsson N, Bendix M, Kraepelien M, Sahlin H, Kaldo V, Forsell E. Not just spontaneous remission: Time-dependent and independent effects in pre-intervention symptom reduction. Internet Interventions. 2026 Feb 27;44:100926. doi: 10.1016/j.invent.2026.100926.

Publications

Selected publications

All publications from group members

Funding

Grants

  • Development and testing of two treatments for excessive worry in routine psychiatric care: internet based treatment for adults with generalized anxiety disorder (GAD)
    CIMED junior grant
    1 January 2025 - 31 December 2027
  • Development and testing of two treatments for excessive worry in routine psychiatric care: internet based treatment for adults with generalized anxiety disorder (GAD)
    ALF-medicine project funding
    1 January 2024 - 31 December 2026
  • Development and testing of two treatments for excessive worry in routine psychiatric care: internet based treatment for adults with generalized anxiety disorder (GAD)
    ALF-medicine project funding
    1 January 2023 - 31 December 2023
  • Development and testing of two internet interventions for excessive worry in regular psychiatric care: internet based treatment for adults with generalized anxiety disorder (GAD)
    Region Stockholm stöd för klinisk postdoktor
    1 January 2022 - 31 December 2025
  • Development and testing of two treatments for excessive worry in routine psychiatric care: internet based treatment for adults with generalized anxiety disorder (GAD)
    CIMED junior grant
    1 January 2022 - 31 December 2024
  • Development and testing of two treatments for excessive worry in routine psychiatric care: internet based treatment for adults with generalized anxiety disorder (GAD)
    ALF-medicine projekt funding
    1 January 2022 - 31 December 2022

Staff and contact

Erik Forsell

  • Erik Forsell
    Postdoctoral Studies

    Erik Forsell studies internet-delivered CBT, precision psychiatry and adaptive digital treatments for common mental health disorders.

All members of the group

Visiting address

Psykiatri Sydväst, Internetpsykiatri, Röntgenvägen 3, Stockholm, 14152, Sverige

Postal address

Psykiatri Sydväst, Internetpsykiatri, Röntgenvägen 3, Stockholm, 14152, Sverige