Internet-based therapy shows strong effects for stress-related disorders – but the diagnosis matters
A new study shows that both cognitive behavioral therapy (CBT) and an active online control treatment lead to significant improvements for individuals with stress-related disorders – but the effect varies depending on the diagnosis.
Researchers at Karolinska Institutet investigated the effects of a 12-week internet-based CBT program specifically designed to reduce symptoms of stress and exhaustion, compared to an equally long internet-based treatment focused on general health. Both treatments proved to be highly effective – participants reported reduced stress and improved mental health, and the effects persisted for a full year after the treatment began.
Surprisingly, there were no significant differences between the groups overall. However, when the researchers analyzed the results based on diagnosis, they found that individuals with adjustment disorder benefited more from CBT than from the control treatment. For those with exhaustion disorder, no such difference was observed.
Stress-related disorders have increased sharply in Sweden and are now the most common cause of long-term sick leave. Despite this, there is a lack of evidence-based psychological treatments. This study shows that structured, internet-based treatments can be both feasible and effective – which could have a major impact on both individuals and society.
“Stress-related ill health presents a major challenge for primary care. We need more knowledge about which treatments can be effective and how stress-related ill health can be understood and conceptualized,” says lead author Victoria Sennerstam at the Department of Clinical Neuroscience.
The results also raise important questions about how we define stress-related diagnoses and which treatment components actually drive improvement.
How was the study conducted, and what are the next steps in the research?
A total of 300 adults with either adjustment disorder or exhaustion disorder participated. Participants were randomly assigned to either CBT (n = 151) or an active control treatment focused on health behaviors (n = 149). Both treatments were internet-based and included therapist support. The effects were measured using self-reported assessments of perceived stress, mental health, and functional ability before, after, and one year after treatment.
One limitation was that the study did not include an untreated control group. However, a previous study showed that individuals who did not receive treatment exhibited very small improvements over time.
The research team is now working on a follow-up study investigating long-term effects on sick leave and cognitive function. All data have been collected, and a study protocol will be published openly in June 2025.
The study was funded by ALF Medicine and Region Stockholm in collaboration with Karolinska Institutet. Several research units contributed, including:
- Department of Clinical Neuroscience, Karolinska Institutet
- Gustavsberg Academic Primary Care Center
- Osher Center for Integrative Health
- Stress Research Institute, Stockholm University
- Center for Psychiatric Research
Publication
Internet-Delivered Treatment for Stress-Related Disorders: A Randomized Controlled Superiority Trial of Cognitive Behavioral Therapy versus General Health Promotion, Victoria Sennerstam, Ludwig Franke Föyen, Evelina Kontio, Frank Svärdman, Mats Lekander, Elin Lindsäter, Erik Hedman-Lagerlöf, Psychotherapy and Psychosomatics, online 27 june, doi: https://doi.org/10.1159/000546221