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  • 1. Aafjes-van Doorn, Katie
    et al.
    Lilliengren, Peter
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Cooper, Angela
    McDonald, James
    Falkenström, Fredrik
    Patients’ Affective Processes Within Initial Experiential Dynamic Therapy Sessions2017In: Psychotherapy, ISSN 0033-3204, E-ISSN 1939-1536, Vol. 54, no 2, p. 175-183Article in journal (Refereed)
    Abstract [en]

    Research has indicated that patients’ in-session experience of previously avoided affects may be important for effective psychotherapy. The aim of this study was to investigate patients’ in-session levels of affect experiencing in relation to their corresponding levels of insight, motivation, and inhibitory affects in initial Experiential Dynamic Therapy (EDT) sessions. Four hundred sixty-six 10-min video segments from 31 initial sessions were rated using the Achievement of Therapeutic Objectives Scale. A series of multilevel growth models, controlling for between-therapist variability, were estimated to predict patients’ adaptive affect experiencing (Activating Affects) across session segments. In line with our expectations, higher within-person levels of Insight and Motivation related to higher levels of Activating Affects per segment. Contrary to expectations, however, lower levels of Inhibition were not associated with higher levels of Activating Affects. Further, using a time-lagged model, we did not find that the levels of Insight, Motivation, or Inhibition during one session segment predicted Activating Affects in the next, possibly indicating that 10-min segments may be suboptimal for testing temporal relationships in affective processes. Our results suggest that, to intensify patients’ immediate affect experiencing in initial EDT sessions, therapists should focus on increasing insight into defensive patterns and, in particular, motivation to give them up. Future research should examine the impact of specific inhibitory affects more closely, as well as between-therapist variability in patients’ in-session adaptive affect experiencing.

  • 2. Abbass, Allan
    et al.
    Town, Joel
    Johansson, Robert
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Lahti, Melissa
    Kisely, Steve
    Sustained Reduction in Health Care Service Usage after Adjunctive Treatment of Intensive Short-Term Dynamic Psychotherapy in Patients with Bipolar Disorder2019In: Psychodynamic Psychiatry, ISSN 2162-2590, Vol. 47, no 1, p. 99-112Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to evaluate changes in long-term health care costs and symptom severity after adjunctive intensive short-term dynamic psychotherapy (ISTDP) individually tailored and administered to patients with bipolar disorder undergoing standard psychiatric care. Eleven therapists with different levels of expertise delivered an average of 4.6 one-hour sessions of ISTDP to 29 patients with bipolar disorders. Health care service costs were compiled for a one-year period prior to the start of ISTDP along with four one-year periods after termination. Two validated self-report scales, the Brief Symptom Inventory and the Inventory of Interpersonal Problems, were administered at intake and termination of ISTDP. Hospital cost reductions were significant for the one-year post-treatment period relative to baseline year, and all cost reductions were sustained for the follow-up period of four post-treatment years. Self-reported psychiatric symptoms and interpersonal problems were significantly reduced. These preliminary findings suggest that this brief adjunctive psychotherapy may be beneficial and cost-effective in select patients with bipolar disorders, and that gains may be sustained in long-term followup. Future research directions are discussed.

  • 3. Abbass, Allan
    et al.
    Town, Joel
    Ogrodniczuk, John
    Joffres, Michel
    Lilliengren, Peter
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Intensive Short-Term Dynamic Psychotherapy Trial Therapy Effectiveness and Role of Unlocking the Unconscious2017In: Journal of Nervous and Mental Disease, ISSN 0022-3018, E-ISSN 1539-736X, Vol. 205, no 6, p. 453-457Article in journal (Refereed)
    Abstract [en]

    This study examined the effects of trial therapy interviews using intensive short-term dynamic psychotherapy with 500 mixed sample, tertiary center patients. Furthermore, we investigated whether the effect of trial therapy was larger for patients who had a major unlocking of the unconscious during the interview compared with those who did not. Outcome measures were the Brief Symptom Inventory (BSI) and the Inventory of Interpersonal Problems (IIP), measured at baseline and at 1-month follow-up. Significant outcome effects were observed for both the BSI and the IIP with small to moderate preeffect/posteffect sizes, Cohen's d = 0.52 and 0.23, respectively. Treatment effects were greater in patientswho had a major unlocking of the unconscious comparedwith thosewho did not. The trial therapy interview appears to be beneficial, and its effects may relate to certain therapeutic processes. Further controlled research is warranted.

  • 4. Abdollahi, Abbas
    et al.
    Abu Talib, Mansor
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Harvey, Richard
    Yaacob, Siti Nor
    Ismail, Zanariah
    Problem-solving skills and perceived stress among undergraduate students: The moderating role of hardiness2018In: Journal of Health Psychology, ISSN 1359-1053, E-ISSN 1461-7277, Vol. 23, no 10, p. 1321-1331Article in journal (Refereed)
    Abstract [en]

    This study was designed to examine the relationships between problem-solving skills, hardiness, and perceived stress and to test the moderating role of hardiness in the relationship between problem-solving skills and perceived stress among 500 undergraduates from Malaysian public universities. The analyses showed that undergraduates with poor problem-solving confidence, external personal control of emotion, and approach-avoidance style were more likely to report perceived stress. Hardiness moderated the relationships between problem-solving skills and perceived stress. These findings reinforce the importance of moderating role of hardiness as an influencing factor that explains how problem-solving skills affect perceived stress among undergraduates.

  • 5. Abdollahi, Abbas
    et al.
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Coping Style as a Moderator of Perfectionism and Suicidal Ideation Among Undergraduate Students2017In: Journal of Rational-Emotive & Cognitive-Behavior Therapy, ISSN 0894-9085, E-ISSN 1573-6563, Vol. 35, no 3, p. 223-239Article in journal (Refereed)
    Abstract [en]

    Suicide is a serious and growing public health problem and remains an unnecessary cause of death globally. In Iran, the highest prevalence of acute and chronic suicidal ideation is among young people aged 16-24. This study investigates the relationship between coping style, two types of perfectionism, and suicidal ideation among undergraduates, and examines coping style as a moderator of the relationship between perfectionism and suicidal ideation. Multi-stage cluster random sampling was employed to recruit 547 undergraduate students aged 19-24 years from the Islamic Azad University of Karaj. Structural Equation Modelling indicated that suicidal ideation was negatively associated with adaptive perfectionism and task-focused coping but positively associated with emotion-focused coping, avoidance coping, and maladaptive perfectionism. Coping style (including the three styles of task-focused, emotion-focused, and avoidance coping) was found to moderate the relationship between perfectionism and suicidal ideation. The study advances understanding of the importance of coping style in this context and explains how perfectionism affects suicidal ideation.

  • 6. Abdollahi, Abbas
    et al.
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Khanbani, Mehdi
    Abdollahi Ghahfarokhi, Shahyar
    Emotional intelligence moderates perceived stress and suicidal ideation among depressed adolescent inpatients2016In: Personality and Individual Differences, ISSN 0191-8869, E-ISSN 1873-3549, Vol. 102, p. 223-228Article in journal (Refereed)
    Abstract [en]

    Because it remains one of the third leading causes of death among adolescents around the world, suicide is a major public health concern. This study was designed in response to this concern by examining the relationships among perceived stress, emotional intelligence, and suicidal ideation and to test the moderating role of emotional intelligence in the relationship between perceived stress and suicidal ideation. A sample of depressed adolescents (n = 202) was recruited from five hospitals in Tehran, Iran, and then asked to complete measures of patient health, suicidal ideation, perceived stress, and emotional intelligence. Structural Equation Modeling showed that depressed adolescent in-patients with high levels of perceived stress and low levels of emotional intelligence were more likely to report suicidal ideation. Multi-group analysis indicated that depressed in-patients high in both perceived stress and emotional intelligence had less suicidal ideation than others. The findings support the notion that perceived stress acts as a vulnerability factor that increase suicidal ideation among depressed inpatients. Suicidal history moderated the relationship between emotional intelligence and suicidal ideation. These findings also highlight the importance of emotional intelligence as a buffer in the relationship between perceived stress and suicidal ideation.

  • 7. Abdollahi, Abbas
    et al.
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Vaez, Elham
    Abdollahi Ghahfarokhi, Shahyar
    Perfectionism and Test Anxiety among High-School Students: the Moderating Role of Academic Hardiness2018In: Current psychology (New Brunswick, N.J.), ISSN 1046-1310, E-ISSN 1936-4733, Vol. 37, no 3, p. 632-639Article in journal (Refereed)
    Abstract [en]

    Recent evidence suggests that test anxiety is increasing among students; however, relatively little is known regarding the related factors of test anxiety. The purpose of this study was to (1) examine the relationships between two forms of perfectionism, academic hardiness, and test anxiety, and (2) examine the moderating role of academic hardiness on the association between two types of perfectionism and test anxiety. This study included 520 students ranging from 15 to 21 years of age from eight high schools in Tehran, Iran completed the self-administered questionnaires. The results of Structural Equation Modelling (SEM) revealed that students with high levels of personal standards perfectionism and high levels of academic hardiness were less likely to experience test anxiety, while students with high levels of evaluative concerns perfectionism were more likely to experience test anxiety. A multi-group analysis revealed that academic hardiness moderated the relationship between evaluative concerns perfectionism and test anxiety. These findings enhance existing literature by revealing moderating processes that explain how perfectionism effects test anxiety.

  • 8. Abdollahi, Abbas
    et al.
    Hosseinian, Simin
    Beh-Pajooh, Ahmad
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Self-Concealment Mediates the Relationship Between Perfectionism and Attitudes Toward Seeking Psychological Help Among Adolescents2017In: Psychological Reports, ISSN 0033-2941, E-ISSN 1558-691X, Vol. 120, no 6, p. 1019-1036Article in journal (Refereed)
    Abstract [en]

    One of the biggest barriers in treating adolescents with mental health problems is their refusing to seek psychological help. This study was designed to examine the relationships between two forms of perfectionism, self-concealment and attitudes toward seeking psychological help and to test the mediating role of self-concealment in the relationship between perfectionism and attitudes toward seeking psychological help among Malaysian high school students. The participants were 475 Malaysian high school students from four high schools in Kuala Lumpur, Malaysia. Structural equation modelling results indicated that high school students with high levels of socially prescribed perfectionism, high levels of self-concealment, and low levels of self-oriented perfectionism reported negative attitudes toward seeking psychological help. Bootstrapping analysis showed that self-concealment emerged as a significant, full mediator in the link between socially prescribed perfectionism and attitudes toward seeking psychological help. Moderated mediation analysis also examined whether the results generalized across men and women. The results revealed that male students with socially prescribed perfectionism are more likely to engage in self-concealment, which in turn, leads to negative attitudes toward seeking psychological help more than their female counterparts. The results suggested that students high in socially prescribed perfectionism were more likely to engage in self-concealment and be less inclined to seek psychological help.

  • 9. Abdollahi, Abbas
    et al.
    Hosseinian, Simin
    Zamanshoar, Elham
    Beh-Pajooh, Ahmad
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    The Moderating Effect of Hardiness on the Relationships between Problem-Solving Skills and Perceived Stress with Suicidal Ideation in Nursing Students2018In: Studia psychologica (Bratislava), ISSN 0039-3320, Vol. 60, no 1, p. 30-41Article in journal (Refereed)
    Abstract [en]

    Recent evidence indicates an elevated risk of suicidal ideation for undergraduate nursing students. This research was designed to enhance the understanding of suicidal ideation in nursing students by investigating the relationships between problem-solving skills, perceived stress, hardiness, and suicidal ideation, with the possibility of hardiness acting as a moderator in the relationships between problem-solving skills appraisal and perceived stress with suicidal ideation. A multi-stage cluster random sample of Malaysian nursing undergraduate students (N = 204) completed self-report questionnaires. The results of structural equation modeling revealed that poor problem-solving skills, greater levels of perceived stress, and low levels of hardiness predicted greater levels of suicidal ideation. Also, hardiness emerged as a moderator in the links between problem-solving skills appraisal and perceived stress with suicidal ideation. The findings incrementally improve our understanding about the importance of hardiness as a moderator in explaining how problem-solving skills and perceived stress affect suicidal ideation. The results of this study are obtained from Malaysian nursing students and possible generalization to other populations should be verified by further studies.

  • 10. Abdollahi, Abbas
    et al.
    LeBouthillier, Daniel M.
    Najafi, Mahmoud
    Asmundson, Gordon J. G.
    Hosseinian, Simin
    Shahidi, Shahriar
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Kalhori, Atefeh
    Sadeghi, Hassan
    Jalili, Marzieh
    Effect of exercise augmentation of cognitive behavioural therapy for the treatment of suicidal ideation and depression2017In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 219, p. 58-63Article in journal (Refereed)
    Abstract [en]

    Background: Suicidal ideation and depression are prevalent and costly conditions that reduce quality of life. This study was designed to determine the efficacy of exercise as an adjunct to cognitive behavioural therapy (CBT) for suicidal ideation and depression among depressed individuals.

    Methods: In a randomized clinical trial, 54 mildly to moderately depressed patients (54% female, mean age=48.25) were assigned to a combined CBT and exercise group or to a CBT only group. Both groups received one weekly session of therapy for 12 weeks, while the combined group also completed exercise three times weekly over the same period. Self-reported suicidal ideation, depression, and activities of daily living were measured at the beginning and the end of treatment.

    Results: Multilevel modelling revealed greater improvements in suicidal ideation, depression, and activities of daily living in the combined CBT and exercise group, compared to the CBT only group.

    Limitations: No follow-up data were collected, so the long-term effects (i.e., maintenance of gains) is unclear.

    Conclusions: The findings revealed that exercise adjunct to CBT effectively decreases both depressive symptoms and suicidal ideation in mildly to moderately depressed individuals.

  • 11.
    Ahlström, Katrin
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Von Below, Camilla
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Forsström, David
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden.
    Werbart, Andrzej
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Therapeutic encounters at the onset of the COVID-19 pandemic: psychodynamic therapists' experiences of transition to remote psychotherapy2022In: Psychoanalytic Psychotherapy, ISSN 0266-8734, E-ISSN 1474-9734, Vol. 36, no 3, p. 256-274Article in journal (Refereed)
    Abstract [en]

    The COVID-19 pandemic crippled many parts of society as it spread throughout the world beginning in early 2020. Overnight, whole societies were forced to change their way of life, because of social distancing and lockdowns. For therapists, the pandemic meant that in-person sessions were no longer possible and many switched to different forms of synchronous remote communication by telephone, online audio or video link. The aim of this study was to explore psychodynamic therapists’ experiences over time of forced transitions to telepsychotherapy. Five therapists were interviewed at the beginning of the pandemic and at a one-year follow-up. The data were analysed by applying thematic analysis with a phenomenological approach. Initially, the therapists struggled with technical and safety issues. The loss of the therapy room and of access to non-verbal nuances contributed to impaired contact with the patients and more superficial conversations. The therapists experienced that the very nature of psychodynamic psychotherapy was affected, even if telepsychotherapy could give some new opportunities. One year later many of the difficulties remained, but the therapists developed better coping strategies and were back to the therapy focus. One implication of this study is that telepsychotherapy needs to be integrated into psychotherapy training and supervision.

  • 12. Ahorsu, Daniel Kwasi
    et al.
    Lin, Chung-Ying
    Imani, Vida
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Nygårdh, Annette
    Broström, Anders
    Hamilton, Kyra
    Pakpour, Amir H.
    Testing an app-based intervention to improve insomnia in patients with epilepsy: A randomized controlled trial2020In: Epilepsy & Behavior, ISSN 1525-5050, E-ISSN 1525-5069, Vol. 112, article id 107371Article in journal (Refereed)
    Abstract [en]

    Purpose: Insomnia has adverse effects on people with epilepsy. We aimed to test a novel cognitive behavioral therapy for insomnia (CBT-I) app-based intervention on insomnia symptoms and social psychological factors in people with epilepsy and to examine the possible mechanisms among the factors.

    Methods: Participants were recruited from neurology clinics in Iran and comprised individuals diagnosed with epilepsy and having moderate to severe insomnia. A two-arm randomized controlled trial design was used, consisting of a treatment group (CBT-I; n = 160) and control group (patient education; n = 160). Primary outcomes were self-reported sleep quality, insomnia severity, and sleep hygiene behavior and objective sleep characteristics measured by actigraphy. Secondary outcomes were attitude, perceived behavioral control, intention, action planning, coping planning, behavioral automaticity, self-monitoring, anxiety, depression, and quality of life (QoL). All outcomes were measured at baseline, and at one, three, and six months postintervention, except objective sleep, which was assessed at baseline, and one and six months postintervention. Data were analyzed using linear mixed models.

    Results: Current findings showed that sleep quality, insomnia severity, sleep hygiene behavior, and sleep onset latency were significantly improved in the CBT-I group compared with the patient education group at all measurement points. Also, the CBT-I group had significantly improved anxiety, depression, and QoL compared with the patient education group. Mediation analyses showed that attitude, intention, coping planning, self-monitoring, and behavioral automaticity significantly mediated the effect of the intervention on sleep outcomes.

    Conclusion: Results support the use of the CBT-I app to improve sleep outcomes among people with epilepsy.

  • 13. Almén, Niclas
    et al.
    Lisspers, Jan
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Stress-Recovery Management: A Pilot Study Using a Single-Subject Experimental Design2020In: Behavior modification, ISSN 0145-4455, E-ISSN 1552-4167, Vol. 44, no 3, p. 449-466Article in journal (Refereed)
    Abstract [en]

    Work-related stress is considered one of the biggest health and safety challenges among the member states of the European Union. A critical factor is recovery between periods of stress. The primary purpose of this study was to investigate whether a brief behaviorally oriented stress-recovery management intervention delivered in an individual setting could reduce stress symptoms among individuals with high levels of perceived stress. A single-subject experimental design with multiple baselines across three individuals was used. The results indicate, with at least moderate experimental control, a temporal relation between the start of the intervention and beneficial changes from baseline in continuous self-recordings of stress symptoms. The changes were maintained at 1-year and 5-year follow-up assessments. Also, self-reporting inventories measuring perceived stress, worry, anxiety, depression, burnout, type A behavior, unwinding and recuperation from work stress, and insomnia showed overall changes in beneficial directions at post-assessment, as well as the two follow-up assessments. The results indicate that a behaviorally oriented stress-recovery management intervention delivered in an individual setting can reduce stress symptoms in individuals with high levels of perceived stress. However, for firm conclusions to be drawn, further research is needed.

  • 14. Almén, Niclas
    et al.
    Lisspers, Jan
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Sundin, Örjan
    Behavioral Stress Recovery Management Intervention for People With High Levels of Perceived Stress: A Randomized Controlled Trial2020In: International Journal of Stress Management, ISSN 1072-5245, E-ISSN 1573-3424, Vol. 27, no 2, p. 183-194Article in journal (Refereed)
    Abstract [en]

    Continuous and prolonged exposure to stressors or unsuccessfully dealing with such exposure has been suggested as precursors for burnout. Current research indicates that such stress problems could be conceptualized as deficiencies in recovery between periods of stress. The purpose of this study was to evaluate the efficacy of a behaviorally oriented stress recovery management intervention for people experiencing high levels of stress. A total of 73 individuals with experiences of stress symptoms and high levels of perceived stress (>= 25 on the Perceived Stress Scale) were randomly allocated to either a 10-week intervention group or a waiting-list control group. Participants were assessed at preintervention, postintervention, and 3-month follow-up. The Perceived Stress Scale, questions about tension, and the Shirom-Melamed Burnout Questionnaire were used as primary outcome measures. and the Hospital Anxiety and Depression Scale was used as a secondary outcome measure. Data were analyzed following the intention-to-treat principle. The analysis demonstrated statistically significant improvements for all measures at posttreatment and at follow-up. The between-groups effect sizes were high at posttreatment and moderate-to-high at follow-up. Intervention focused on stress recovery behavior seems to be an effective way of reducing perceived stress, tension, burnout symptoms, anxiety, and depression in people with stress symptoms and high levels of perceived stress in everyday life. The tested intervention warrants further research. Other stress recovery behavior interventions need to be tested to draw conclusions on the efficacy of stress recovery behavior interventions in general regarding stress and burnout.

  • 15. Amsberg, Susanne
    et al.
    Wijk, Ingrid
    Livheim, Fredrik
    Toft, Eva
    Johansson, Unn-Britt
    Anderbro, Therese
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institutet, Sweden.
    Acceptance and commitment therapy (ACT) for adult type 1 diabetes management: study protocol for a randomised controlled trial2018In: BMJ Open, E-ISSN 2044-6055, Vol. 8, no 11, article id e022234Article in journal (Refereed)
    Abstract [en]

    Introduction Integrating diabetes self-management into daily life involves a range of complex challenges for affected individuals. Environmental, social, behavioural and emotional psychological factors influence the lives of those with diabetes. The aim of this study is to evaluate the impact of a stress management group intervention based on acceptance and commitment therapy (ACT) among adults living with poorly controlled type 1 diabetes.

    Methods and analysis This study will use a randomised controlled trial design evaluating treatment as usual (TAU) and ACT versus TAU. The stress management group intervention will be based on ACT and comprises a programme divided into seven 2-hour sessions conducted over 14 weeks. A total of 70 patients who meet inclusion criteria will be recruited over a 2-year period with follow-up after 1, 2 and 5 years. The primary outcome measure will be HbA1c. The secondary outcome measures will be the Depression Anxiety Stress Scales, the Swedish version of the Hypoglycemia Fear Survey, the Swedish version of the Problem Areas in Diabetes Scale, The Summary of Self-Care Activities, Acceptance Action Diabetes Questionnaire, Swedish Acceptance and Action Questionnaire and the Manchester Short Assessment of Quality of Life. The questionnaires will be administered via the internet at baseline, after sessions 4 (study week 7) and 7 (study week 14), and 6, 12 and 24 months later, then finally after 5 years. HbA1c will be measured at the same time points. Assessment of intervention effect will be performed through the analysis of covariance. An intention-to-treat approach will be used. Mixed-model repeated measures will be applied to explore effect of intervention across all time points.

    Ethics and dissemination The study has received ethical approval (Dnr: 2016/14-31/1). The study findings will be disseminated through peer-reviewed publications, conferences and reports to key stakeholders.

    Trial registration number NCT02914496; Pre-results.

  • 16.
    Anderbro, Therese Carin
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Amsberg, Susanne
    Moberg, Erik
    Gonder-Frederick, Linda
    Adamson, Ulf
    Lins, Per-Eric
    Johansson, Unn-Britt
    A longitudinal study of fear of hypoglycaemia in adults with type 1 diabetes2018In: Endocrinology, Diabetes & Metabolism, E-ISSN 2398-9238, Vol. 1, no 2, article id e00013Article in journal (Refereed)
    Abstract [en]

    Aims: To investigate fear of hypoglycaemia (FoH) longitudinally in a cross‐sectional study of adult patients with type 1 diabetes. Specifically, we investigated two subgroups of patients who over 4 years either showed a substantial increase or decrease in level of FoH to identify factors associated with changes in FoH.

    Methods: The Swedish version of the Hypoglycaemia Fear Survey (HFS) along with a questionnaire to assess hypoglycaemia history was sent by mail to 764 patients in 2010. The responders in 2010 (n = 469) received another set of the same two questionnaires in 2014. HbA1c, insulin regimen, weight and creatinine from 2010 and 2014 were obtained from medical records. Those with an absolute difference in HFS scores ≥ 75th percentile were included in the subgroup analyses. Statistical analyses included one‐sample t tests, chi‐square and McNemar's test.

    Results: The absolute difference in the HFS total score (n = 347) between 2010 and 2014 was m = ±7.6, SD ± 6. In the increased FoH group, more patients reported a high level of moderate hypoglycaemic episodes as well as impaired awareness of hypoglycaemia in 2014 compared with the decreased FoH group. There were more subjects in the increased FoH group with insulin pumps in 2014 and in 2010. In the decreased FoH group, more patients had a high frequency of daily self‐monitoring of blood glucose (SMBG) in 2010 and in 2014.

    Conclusions: Fear of hypoglycaemia is stable across time for most patients. Changes in fear level are associated with changes in hypoglycaemia frequency. Thus, asking patients about changes in hypoglycaemia experiences is of great importance.

  • 17.
    Anderbro, Therese
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institutet, Sweden.
    Moberg, Erik
    Adamson, Ulf
    Lins, Per-Eric
    Johansson, Unn-Britt
    Beliefs and Experiences of Fear of Hypoglycemia and Use of Uncooked Cornstarch before Bedtime in Persons with Type 1-Diabetes2018In: Open Journal of Nursing, ISSN 2162-5336, E-ISSN 2162-5344, Vol. 8, no 11, article id 88624Article in journal (Refereed)
    Abstract [en]

    Among persons living with type 1-diabetes hypoglycemia and fear of hypoglycemia remain limiting barriers for achieving optimal glucose control and a good quality of life. Fear of hypoglycemia has been found stable over time if not treated. Uncooked cornstarch has been found to reduce the risk of hypoglycemia but has not been studied in relation to fear of hypoglycemia. The aims of this study were to through clinical data, self-reported measures and clinical interviews explore subjects’ experience of using uncooked cornstarch before bedtime and their beliefs and experiences of fear of hypoglycemia. Methods: Mixed methods with both quantitative and qualitative data were used. Self-reported measures of hypoglycemia and fear of hypoglycemia were compared to subjects’ responses during a clinical interview. The interviews were analyzed with a functional behavior analytical approach. Results: A total of five subjects took part in the study. One subject perceived the uncooked cornstarch helpful in reducing hypoglycemia. Several subjects could recall frightening hypoglycemic episodes triggering their fear. Three out of the five subjects reported avoidance behaviors such as excessive self-monitoring of blood glucose or overeating related to fear of hypoglycemia. Conclusions: The uncooked cornstarch was found appetizing but was not perceived as having an effect on BG or hypoglycemia frequency. The clinical interviews confirmed previous research regarding experience of hypoglycemia and fear of hypoglycemia.

  • 18.
    Andersson, Gerhard
    et al.
    Linköpings universitet och Karolinska Instutet.
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Behandling via internet2016In: Socialt arbete och internet: att förstå och hantera sociala problem på nya arenor / [ed] Kristian Daneback, Emma Sorbring, Stockholm: Liber, 2016, p. 215-225Chapter in book (Other (popular science, discussion, etc.))
    Abstract [sv]

    Inom det sociala arbetets praktik ser vi en ökad närvaro av internetrelaterade problem. Samtidigt föredrar allt fler människor webbaserad hjälp, samt råd och stöd i relation till mer traditionella behandlings- och preventionsprogram, vilket öppnar för nya möjligheter för det sociala arbetet.

  • 19. Andersson, Gerhard
    et al.
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Cognitive behavioral therapy delivered using the internet2021In: Handbook of cognitive behavioral therapy, Volume 2: Applications / [ed] Amy Wenzel, American Psychological Association (APA), 2021, p. 607-631Chapter in book (Refereed)
    Abstract [en]

    The internet is no longer something new. It has existed now for a long time and has been part of many peoples' lives for at least 20 years. The internet increasingly informs many aspects of our lives, including the economy, health care, and delivery of psychological treatments. There are many areas in which the internet has had an impact on cognitive behavioral therapy (CBT). This chapter describes challenges when delivering CBT via the internet, comments on assumptions behind treatment programs, and describes the main approaches, outcomes, and potential mechanisms of change. Further, the authors comment on the dissemination of internet-delivered CBT (ICBT), as well as applications for diverse target groups, and possible future developments. Although ICBT may appear as something new, it is almost as old as the internet itself, and the research field is very large, with more than 200 controlled trials.

  • 20. Andersson, Gerhard
    et al.
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Enduring effects of ICBT2017Conference paper (Refereed)
    Abstract [en]

    Introduction: Numerous randomized controlled trials have been conducted on internet interventions. In addition to the effects observed in these trials immediately after treatment there are several long-term follow-ups. The aim of this talk is to review the long-term effects of internet-delivered CBT (ICBT) with a focus on results at 1-year or later following treatment termination.

    Methods: We were able to locate examples of enduring effects for a range of conditions including mood and anxiety disorders and somatic disorders. The longest follow-up period has been five years.

    Results: Large within-group effects have been documented in most trials, with effects sizes being moderate to large for anxiety and depression studies.

    Discussion: Studies have failed to document how much the treatment is used during the follow-up period and in the case of depression it is unclear if episodes of depression have occured during the period covered. We conclude that the effects of ICBT appear to be enduring but that more research is needed.

  • 21. Andersson, Gerhard
    et al.
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Factorial Trial Design in Internet Intervention Research2019In: Proceedings of the 9th World Congress of Behavioural & Cognitive Therapies: Volume I. Research, Applied Issues / [ed] Thomas Heidenreich, Philip Tata, Tübingen: dgvt-Verlag , 2019, Vol. 1, p. 155-156Conference paper (Other academic)
    Abstract [en]

    Numerous controlled trials have been published on the effects of internet-delivered psychological treatments for a range of problems and disorders. Generally, trials adhere to the CONSORT statement and include control groups. Often this is attention control, waitlist but also alternative treatments. In experimental psychology factorial designs is the common way to investigate research questions but in psychotherapy research this is rare given the need for large samples in order to have sufficient power to detect differntial effects of  independent variables (like for example different versions of a treatment). With the advent of internet-delivered CBT (ICBT) this has changes and it is now possible to run trials with larger samples. At the same time there is really no need for more studies showing that a treatment is better than just waiting (for some areas at least like depression). In this talk we will present result from three completed factorial design trials in which we have manipulated support form (on demand versus scheduled in one trial and chat-support versus just email in another), and also other aspects like learning support and choice of treatment. The talk will end with a discussion on future directions of ICBT research with regards to design of trials.

  • 22. Andersson, Gerhard
    et al.
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Internet Interventions in Clinical Psychology2022In: Comprehensive Clinical Psychology: Volume 6: Case Conceptualization and Treatment: Adults / [ed] Gordon J. G. Asmundson; volume editor Gerhard Andersson, Elsevier, 2022, 2, p. 194-205Chapter in book (Refereed)
    Abstract [en]

    The internet and modern information technology have influenced society and also the practice of clinical psychology. In this chapter, we describe how internet-delivered psychological assessment and treatment procedures work and provide an updated review of the evidence. Therapist-supported internet interventions, mainly derived from cognitive behavior therapy treatment protocols, have been developed and tested in a large number of controlled trials and also for a range of psychiatric and somatic problems and conditions. There are clear indications that internet interventions can be as effective as seeing a therapist face-to-face, that long-term effects can be obtained, and that it has been possible to transfer internet interventions to more regular service provision (e.g., effectiveness trials).

  • 23. Andersson, Gerhard
    et al.
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Internet-Assisted Cognitive Behavioral Therapy2017In: Psychiatric Clinics of North America, ISSN 0193-953X, E-ISSN 1558-3147, Vol. 40, no 4, p. 689-700Article in journal (Refereed)
    Abstract [en]

    The Internet, including modern information technology, has had a dramatic impact on many areas of life, including health care and psychological treatment. In particular, cognitive–behavioral therapy (CBT) has been found to be a form of psychological treatment that has been possible to transfer to other modes of delivery than regular face-to-face and group formats. The Internet is not only useful for providing CBT, but has a significant role in providing information about CBT and conditions that are treated using CBT. In addition, modern information technology also has a major role in assessment procedures, such as online administration of self-report mea- sures. In this article, we focus mainly on Internet-supported treatments, although another emerging format is to use video conferencing systems and conduct real- time face-to-face CBT, CBT training, or supervision.

  • 24. Andersson, Gerhard
    et al.
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Internet-based brief therapies2018In: The art and science of brief psychotherapies: A Practioner's Guide / [ed] Mantosh J. Dewan, Brett N. Steenbarger, Roger P. Greenberg, Arlington: American Psychiatric Association , 2018, 3, p. 315-325Chapter in book (Refereed)
  • 25. Andersson, Gerhard
    et al.
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Hadjistavropoulos, Heather D.
    Internet-Based Cognitive Behavior Therapy2017In: The Science of Cognitive Behavioral Therapy / [ed] Stefan G. Hofmann, Gordon J. G. Asmundson, London: Elsevier, 2017, p. 531-549Chapter in book (Refereed)
    Abstract [en]

    Internet-based cognitive behavior therapy (ICBT) is an evidence-based form of CBT. Most programs include text, video, and audio files and are similar to face-to-face CBT in terms of content and duration of treatment. Most often ICBT includes some guidance from a therapist, although automated self-guided ICBT programs also exist. Studies suggest that guided ICBT can be as effective as face-to-face CBT for anxiety and mood disorders as well as for distress associated with certain somatic disorders. Transdiagnostic programs, either relying on presentation of common strategies for, or tailoring of treatment to, disorders have generated strong outcomes in controlled trials. Interventions for problems like procrastination also show promise. Studies on predictors and mediators of outcome are emerging, but there is a need to develop intervention-specific theories in order to better understand change mechanisms. In the future, blending of face-to-face CBT and modern information technology are expected to be more common and attractive to therapists.

  • 26. Andersson, Gerhard
    et al.
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Huppert, Jonathan
    Round Table: What are the most pressing questions in clinical psychology today?2023In: Innovative Technologies For the Improvement of Mental Health: A Joint Research Workshop, The Hebrew University, Jerusalem, Israel, 2023Conference paper (Other academic)
  • 27. Andersson, Gerhard
    et al.
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Lindefors, Nils
    History and current status of ICBT2016In: Guided internet-based treatments in psychiatry / [ed] Nils Lindefors, Gerhard Andersson, Springer, 2016, p. 1-16Chapter in book (Refereed)
    Abstract [en]

    We begin this chapter with a discussion of the history of ICBT and its roots in bibliotherapy and computerised CBT. We then provide a brief description of one way of administering guided ICBT, including the role of the therapist and data security issues. This description is followed by examples of conditions that are not covered later in the book, such as specific phobias and addictions. We end this chapter with a discussion of technical developments, cost-effectiveness and implementation.

  • 28. Andersson, Gerhard
    et al.
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. University of Southern Denmark, Denmark.
    Rozental, Alexander
    Response and Remission Rates in Internet-Based Cognitive Behavior Therapy: An Individual Patient Data Meta-Analysis2019In: Frontiers in Psychiatry, E-ISSN 1664-0640, Vol. 10, article id 749Article, review/survey (Refereed)
    Abstract [en]

    Background: Internet-delivered cognitive behavior therapy (ICBT) was developed over 20 years ago and has since undergone a number of controlled trials, as well as several systematic reviews and meta-analyses. However, the crucial question of response rates remains to be systematically investigated. The aim of this individual patient meta-analysis (IPDMA) was to use a large dataset of trials conducted in Sweden to determine reliable change and recovery rates across trials for a range of conditions.

    Methods: We used previously collected and aggregated data from 2,866 patients in 29 Swedish clinical trials of ICBT for three categories of conditions: anxiety disorders, depression, and others. Raw scores at pre-treatment and post-treatment were used in an IPDMA to determine the rate of reliable change and recovery. Jacobson and Truax’s, (1991) reliable change index (RCI) was calculated for each primary outcome measure in the trials as well as the recovery rates for each patient, with the additional requirement of having improved substantially. We subsequently explored potential predictors using binomial logistic regression.

    Results: In applying an RCI of z = 1.96, 1,162 (65.6%) of the patients receiving treatment were classified as achieving recovery, and 620 (35.0%) were classified as reaching remission. In terms of predictors, patients with higher symptom severity on the primary outcome measure at baseline [odds ratio (OR) = 1.36] and being female (OR = 2.22) increased the odds of responding to treatment. Having an anxiety disorder was found to decrease the response to treatment (OR = 0.51). Remission was predicted by diagnosis in the same direction (OR = 0.28), whereas symptom severity was inversely predictive of worse outcome (OR = 0.81). Conclusions: Response seems to occur among approximately half of all clients administered ICBT, whereas about a third reach remission. This indicates that the efficacy of ICBT is in line with that of CBT based in prior trials, with a possible caveat being the lower remission rates. Having more symptoms and being female might increase the chances of improvement, and a small negative effect of having anxiety disorder versus depression and other conditions may also exist. A limitation of the IPDMA was that only studies conducted in Sweden were included.

  • 29. Andersson, Gerhard
    et al.
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. University of Southern Denmark, Denmark.
    Titov, Nickolai
    Lindefors, Nils
    Internet Interventions for Adults with Anxiety and Mood Disorders: A Narrative Umbrella Review of Recent Meta-Analyses2019In: Canadian journal of psychiatry, ISSN 0706-7437, Vol. 64, no 7, p. 465-470Article, review/survey (Refereed)
    Abstract [en]

    Internet-delivered cognitive behaviour therapy (ICBT) has existed for 20 years and there are now several controlled trials for a range of problems. In this paper, we focused on recent meta-analytic reviews of the literature and found moderate to large effects reported for panic disorder, social anxiety disorder, generalized anxiety disorder, posttraumatic stress disorder, and major depression. In total, we reviewed 9 recent meta-analytic reviews out of a total of 618 meta-analytic reviews identified using our search terms. In these selected reviews, 166 studies were included, including overlap in reviews on similar conditions. We also covered a recent review on transdiagnostic treatments and 2 reviews on face-to-face v. internet treatment. The growing number of meta-analytic reviews of studies now suggests that ICBT works and can be as effective as face-to-face therapy.

  • 30. Andersson, Gerhard
    et al.
    Hildbrand, Martin
    Rozental, Alexander
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    How well does internet-based CBT work for depression in Sweden? A patient-level meta-analysis2023In: Abstracts and Program Parallel Sessions: European Society for Research on Internet Interventions, 7th Conference, Aug 30 – Sept 1, 2023, Amsterdam, the Netherlands, 2023, p. 50-51Conference paper (Refereed)
    Abstract [en]

    Background: Several studies and meta-analysis suggest that ICBT works for patients with mild to moderate depression/depressive symptoms. Given the quality of the data is is now possible to conduct IPMAs. Several IPMAs have been published with data from different countries. A problem with that approach is the some studies may be left out as data are not provided. The aim of this IPMA was to study the effects focusing on Swedish data only with less loss of data/studies.

    Methods: We were able to include data from 16 studies with a total of 2952 participants. Missing data were imputed. The overall effect-size for nine studies compared to wait-list was d = 0.63 95 % CI [0.48, 0.78] and within-group effect-size for 15 studies d = 1.17 95 % CI [1.11, 1.22]. The results were surprisingly similar across different subgroups. Women had on average more symptoms before treatment and also reported a larger symptom decrease after treatment.

    Conclusions: Results show a large effect of ICBT on depressive symptoms in a Swedish setting, including in routine care. This meta-analysis supports treatment of depressive symptoms with ICBT in Sweden.

  • 31. Andersson, Gerhard
    et al.
    Olsson, Elin
    Ringsgård, Emma
    Sandgren, Therese
    Viklund, Ida
    Andersson, Catja
    Hesselman, Ylva
    Johansson, Robert
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Nordgren, Lise Bergman
    Bohman, Benjamin
    Individually tailored Internet-delivered cognitive-behavioral therapy for survivors of intimate partner violence: A randomized controlled pilot trial2021In: Internet Interventions, ISSN 2214-7829, Vol. 26, article id 100453Article in journal (Refereed)
    Abstract [en]

    Intimate partner violence (IPV) is a serious public health concern worldwide and defined as behavior performed by spouses or other intimate partners that causes physical, sexual, or psychological harm. Internet-delivered cognitive-behavioral therapy (ICBT) may be particularly useful for survivors of IPV for several reasons, including barriers pertaining to limited community recourses and treatment availability, safety concerns, and issues of stigma, guilt and shame, which may prevent members of this population from seeking help via face-to-face interactions. However, Internet interventions are lacking. The primary aim of the present randomized controlled pilot trial was to explore the feasibility of ICBT as guided self-help individually tailored to the predominant symptomatology of PTSD or depression in survivors of IPV. A second aim was to conduct a preliminary evaluation exploring the short- and long-term effects of the treatment in comparison to a waitlist control condition. Results showed that the treatment was feasible. Attrition rate was low (9.4%), and participants were satisfied with treatment. However, treatment adherence was moderate in terms of completed modules (62.5%). Results of the preliminary evaluation of treatment effects showed large and statistically significant between-group effect sizes (Cohen's d = 0.86–1.08) on some measures of PTSD and depression at post assessment, favoring the treatment condition. However, there were no effects on other measures. At follow-up assessment, when the control condition had received delayed treatment, there were large and statistically significant within-group effect sizes (d = 0.96–1.48) on measures of PTSD, depression and anxiety, and small effects (d = 0.48) on a measure of quality of life. The results of the present pilot study are promising and warrant further research on ICBT for this population.

  • 32. Andersson, Gerhard
    et al.
    Rozental, Alexander
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Shafran, Roz
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Long-term effects of internet-supported cognitive behaviour therapy2018Conference paper (Other academic)
    Abstract [en]

    Internet-supported and therapist-guided cognitive behaviour therapy (ICBT) is effective for a range of problems in the short run, but less is known about the long-term effects with follow-ups of two years or longer.This paper reviews studies in which the long-term effects of guided ICBT were investigated. Following literature searches in PubMed and other sources meta-analytic statistics were calculated for 14 studies involving a total of 902 participants, and an average follow-up period of three years. Studies were from Sweden (n = 11) or the Netherlands (n = 3). Long-term outcome studies were found for panic disorder, social anxiety disorder, generalized anxiety disorder, depression, mixed anxiety and depression, obsessive-compulsive disorder, pathological gambling, stress and chronic fatigue. The duration of the treatments was usually short (8–15 weeks). The pre-to follow-up effect size was Hedge’s g = 1.52, but with a significant heterogeneity. The average symptom improvement across studies was 50%. Treatment seeking in the follow-up period was not documented and few studies mentioned negative effects.While effects may be overestimated, it is likely that therapist-supported ICBT can have enduring effects. Long-term follow-up data should be collected for more conditions and new technologies like smartphone-delivered treatments.

  • 33. Andersson, Gerhard
    et al.
    Rozental, Alexander
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. University College London, England.
    Shafran, Roz
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. University College London, England.
    Long-term effects of internet-supported cognitive behaviour therapy2018In: Expert Review of Neurotherapeutics, ISSN 1473-7175, E-ISSN 1744-8360, Vol. 18, no 1, p. 21-28Article, review/survey (Refereed)
    Abstract [en]

    Introduction: Internet-supported and therapist-guided cognitive behaviour therapy (ICBT) is effective for a range of problems in the short run, but less is known about the long-term effects with follow-ups of two years or longer.

    Areas covered: This paper reviews studies in which the long-term effects of guided ICBT were investigated. Following literature searches in PubMed and other sources meta-analytic statistics were calculated for 14 studies involving a total of 902 participants, and an average follow-up period of three years. Studies were from Sweden (n = 11) or the Netherlands (n = 3). Long-term outcome studies were found for panic disorder, social anxiety disorder, generalized anxiety disorder, depression, mixed anxiety and depression, obsessive-compulsive disorder, pathological gambling, stress and chronic fatigue. The duration of the treatments was usually short (8–15 weeks). The pre-to follow-up effect size was Hedge’s g = 1.52, but with a significant heterogeneity. The average symptom improvement across studies was 50%. Treatment seeking in the follow-up period was not documented and few studies mentioned negative effects.

    Expert commentary: While effects may be overestimated, it is likely that therapist-supported ICBT can have enduring effects. Long-term follow-up data should be collected for more conditions and new technologies like smartphone-delivered treatments.

  • 34. Andersson, Gerhard
    et al.
    Titov, Nickolai
    Dear, Blake F.
    Rozental, Alexander
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. University of Southern Denmark, Denmark.
    Internet‐delivered psychological treatments: from innovation to implementation2019In: World Psychiatry, ISSN 1723-8617, E-ISSN 2051-5545, Vol. 18, no 1, p. 20-28Article in journal (Refereed)
    Abstract [en]

    Internet interventions, and in particular Internet‐delivered cognitive behaviour therapy (ICBT), have existed for at least 20 years. Here we review the treatment approach and the evidence base, arguing that ICBT can be viewed as a vehicle for innovation. ICBT has been developed and tested for several psychiatric and somatic conditions, and direct comparative studies suggest that therapist‐guided ICBT is more effective than a waiting list for anxiety disorders and depression, and tends to be as effective as face‐to‐face CBT. Studies on the possible harmful effects of ICBT are also reviewed: a significant minority of people do experience negative effects, although rates of deterioration appear similar to those reported for face‐to‐face treatments and lower than for control conditions. We further review studies on change mechanisms and conclude that few, if any, consistent moderators and mediators of change have been identified. A recent trend to focus on knowledge acquisition is considered, and a discussion on the possibilities and hurdles of implementing ICBT is presented. The latter includes findings suggesting that attitudes toward ICBT may not be as positive as when using modern information technology as an adjunct to face‐to‐face therapy (i.e., blended treatment). Finally, we discuss future directions, including the role played by technology and machine learning, blended treatment, adaptation of treatment for minorities and non‐Western settings, other therapeutic approaches than ICBT (including Internet‐delivered psychodynamic and interpersonal psychotherapy as well as acceptance and commitment therapy), emerging regulations, and the importance of reporting failed trials.

  • 35. Ankarberg, Peter
    et al.
    Bergsten, Katja
    Bohman, Gunnar
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Bäck, Malin
    Falkenström, Fredrik
    Klingström, Anders
    Lilliengren, Peter
    Philips, Björn
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Werbart, Andrzej
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Socialstyrelsens riktlinjer är partiska och ovetenskapliga!2017In: Psykoterapi, ISSN 2001-5836, Vol. 26, no 2, p. 30-34Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Denna artikel är ett remissvar med synpunkter på de nationella riktlinjerna för ångest och depression, som vi publicerar i sin helhet i tidskriften. Vi gör det på grund av den ingående kunskap om processerna i riktlinjearbetet som några av författarna har kunnat få genom egen medverkan och närvaro i det arbetet.

  • 36. Ask, Karl
    et al.
    Granhag, Pär Anders
    Christianson, Sven Å.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Falska minnen och falska erkännanden2008In: Handbok i rättspsykologi, Liber, Stockholm , 2008Chapter in book (Other academic)
    Abstract [sv]

    This chapter discusses cognitive and social aspects that may contribute to false memories in children and adults. The chapter also discusses different causes behind false confessions among suspects of crimes and that interrogation methods recommended in some police manuals can result in miscarriages of justice as a result of false confessions.

  • 37. Asperholm, Martin
    et al.
    Hogman, Nadja
    Rafi, Jonas
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institutet, Sweden.
    Herlitz, Agneta
    What Did You Do Yesterday? A Meta-Analysis of Sex Differences in Episodic Memory2019In: Psychological bulletin, ISSN 0033-2909, E-ISSN 1939-1455, Vol. 145, no 8Article in journal (Refereed)
    Abstract [en]

    To remember what one did yesterday is an example of an everyday episodic memory task, in which a female advantage has sometimes been reported. Here, we quantify the impact of sex on episodic memory performance and investigate whether the magnitude of the sex difference is modified by study-, task-, and sample-specific moderators. Analyses were based on 617 studies conducted between 1973 and 2013 with 1,233,921 participants. A 5-level random-effects meta-analysis showed an overall female advantage in episodic memory (g = 0.19, 95% CI [0.17, 0.21]). The material to be remembered affected the magnitude of this advantage, with a female advantage for more verbal tasks, such as words, sentences, and prose (g = 0.28, 95% CI [0.25, 0.30]), nameable images (g = 0.16, 95% CI [0.11, 0.22]), and locations (g = 0.16, 95% CI [0.11, 0.21]). and a male advantage in more spatial tasks, such as abstract images (g = -0.20, 95% CI [-0.35, -0.05]) and routes (g = -0.24, 95% CI (-0.35, -0.12]). Furthermore, there was a female advantage for materials that cannot easily be placed along the verbal-spatial continuum, such as faces (g = 0.26, 95% CI [0.20, 0.33]), and odor, taste, and color (g = 0.37, 95% CI [0.18, 0.55]). These differences have remained stable since 1973. For verbal episodic memory tasks, differences were larger in Europe, North America, Oceania. and South America than in Asia, and smaller in childhood and old age than for other ages. Taken together. results suggest that men may use their spatial advantage in spatially demanding episodic memory tasks, whereas women do well in episodic memory tasks that are verbalizable and tasks that are neither verbal nor spatial, such as remembering faces and odors/tastes/colors.

  • 38. Asplund, Robert Persson
    et al.
    Carvallo, Fernanda
    Christensson, Hanna
    Videsäter, Elin
    Häggman, Annakarin
    Ljótsson, Brjánn
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Andersson, Gerhard
    Learning how to recover from stress: Results from an internet-based randomized controlled pilot trial2023In: Internet Interventions, ISSN 2214-7829, Vol. 34, article id 100681Article in journal (Refereed)
    Abstract [en]

    Introduction: This randomized, controlled pilot trial evaluated the efficacy of a brief internet-based recovery training intervention targeting a clinical sample of distressed employees.

    Method: A sample of 69 employees with elevated symptoms of stress were assigned randomly to a five-week guided recovery training intervention (iRTP, n = 35) or a wait-list control (WLC, n = 34). The study was conducted in Sweden and participants enrolled via an open recruitment strategy. Self-report data were collected pre- and post-intervention, then six and 12 months after the intervention. The primary outcome measure was the Recovery Experience Questionnaire (REQ. The secondary outcome measures gauged other relevant mental and work-related health outcomes. Participants in the wait-list control group received access to iRTP after the six-month follow-up.

    Results: Compared with the controls, participants in the intervention group showed a significant and large overall improvement on the primary outcome REQ (d = 0.93), and small to moderate effects on the secondary outcomes including, perceived stress (d = 0.48), anxiety (d = 0.49), quality of life (d = 0.47), and work ability (d = 0.47) during post-assessment. No significant differences were found at any time point regarding burnout, exhaustion, depression, physical exercise, work experience, or sickness absences.

    Conclusion: This pilot trial is one of the first to examine a brief recovery training program's efficacy, suggesting that employees across a wide range of professions could learn how to recover from elevated stress symptoms. This type of accessible and brief recovery intervention could potentially prevent and reduce the negative effects of stress, as well as improve recovery and quality of life. However, more research is needed with larger samples before further conclusions can be drawn.

    Trial Registration: The study was registered at Clinical Trials (clinicaltrials.gov) number NCT05220592.

  • 39.
    Azad, Azade
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Christianson, Sven Å.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Barn och ungdomar minns och berättar detaljerat efter att ha bevittnat dödligt våld2012In: Svensk Juristtidning, ISSN 0039-6591, Vol. 97, p. 746-759Article in journal (Other academic)
    Abstract [sv]

    De flesta barn som kommer i kontakt med rättsväsendet har utsatts för stressfyllda eller traumatiska händelser. Följaktligen är effekten av starka negativa känslor på minnet och berättandet, av både juridiska och kliniska skäl, av stor vikt att undersöka. I ett pågående forskningsprojekt har vi kartlagt de mönster som präglar barns minnen och berättande när de bevittnat dödligt våld, samt olika bakgrundsfaktorer som kan tänkas påverka barnens vittnesmål. Totalt har vi analyserat polisförhör med över 100 barn och ungdomar i åldrarna 3–17 år. Huvudresultaten visar att barn berättar detaljerat om dessa upplevelser i polisförhör, oavsett ålder och relation till gärningsmannen och/eller offret. Därtill visar resultaten att upprepade förhör leder till ett än mer detaljerat berättande. Det finns således skäl till att reflektera över etablerade uppfattningar angående i vilken utsträckning barn är lojala mot sina föräldrar och av den anledningen tiger om det våld de upplevt i hemmet. Barnets vittnesmål är av stor vikt för att få ett bättre underlag i en brottsutredning och för att försäkra barnets rätt till brottsskadeersättning samt för att domstolarna vid straffvärdesbedömningen ska kunna beakta att ett barn bevittnat brottet.

  • 40.
    Azad, Azade
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Ginner Hau, Hanna
    Stockholm University, Faculty of Social Sciences, Department of Special Education.
    Adolescent females with limited delinquency – At risk of school failure2018In: Children and youth services review, ISSN 0190-7409, E-ISSN 1873-7765, Vol. 95, p. 384-396Article in journal (Refereed)
    Abstract [en]

    During adolescence, risk behaviors (e.g., running away from home, truancy, alcohol/drug use, and delinquency) increase, and most individuals who at some point commit crimes do so during their teenage years. Since the crime rate is so high during adolescence, juvenile delinquency can be regarded as a normal rather than a deviant behavior. Delinquent females have historically been under-researched. However, the little research that is available indicates that low-risk female offenders (females with limited delinquency receiving community-based measures), may be at risk of suboptimal development. The objective of the present study was to provide a basic description of this group of offenders by using their self-reports on delinquency, drug and alcohol use, school, peers, family and mental health. The self-reports of 138 females between 15 and 20 years of age sentenced to youth service in Stockholm, Sweden, were compared to young females in residential care and to a reference group of adolescent females without known adjustment problems. The results showed that the youth service females did not have a higher number of accumulated problems than the reference group with regard to criminal acts, drug and alcohol use, peers, mental health, and in some regards also for family. However, the youth service group reported various school-related problems and failures, more in line with the residential group. This suggests that interventions aimed at helping the young females develop strategies for becoming more academically successful are important.

  • 41.
    Azad, Azade
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Ginner Hau, Hanna
    Stockholm University, Faculty of Social Sciences, Department of Special Education.
    Adolescent Females with Limited Delinquency: A Follow-Up on Educational Attainment and Recidivism2020In: Child and Youth Care Forum, ISSN 1053-1890, E-ISSN 1573-3319, Vol. 49, no 2, p. 325-342Article in journal (Refereed)
    Abstract [en]

    Background: Research has established a strong relationship between education and later life outcomes, where the connection between different school problems and delinquency have been widely acknowledged. These studies have often sampled male juvenile offenders exhibiting extensive and/or persistent delinquency. Less is known about the educational attainment of female juvenile offenders, especially those who display limited delinquency. In a previous study (Azad and Ginner Hau in Child Youth Serv Rev 95:384–396, 2018), the characteristics of this particular group of offenders were explored where the results showed limited self-reported delinquency but elevated school problems.

    Objective: The present aim was to conduct a follow-up study of the same sample of female adolescents, in order to study their educational attainment during adolescence and the rate of recidivism within 24 months after being sentenced through registry data.

    Method: The sample consisted of adolescent females (N = 144) who were convicted of a crime and sentenced to youth service between 2007 and 2012 in Stockholm, Sweden.

    Results: The results showed that the majority of the females did not reoffend within 2 years after being sentenced. They did, however, display high educational deficits. Their grade point average at the end of both compulsory education and upper secondary school was much lower than that of young females in general, and the majority had either dropped out, never begun or received zero in all subjects at the end of upper secondary school.

    Conclusions: The low school results indicate a need to support young delinquent females’ educational attainment in order to improve their overall life chances.

  • 42.
    Azad, Azade
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Ginner Hau, Hanna
    Stockholm University, Faculty of Social Sciences, Department of Special Education.
    Karlsson, Markus
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Adolescent female offenders’ subjective experiences of how peers influence norm-breaking behavior2018In: Child and Adolescent Social Work Journal, ISSN 0738-0151, E-ISSN 1573-2797, Vol. 35, no 3, p. 257-270Article in journal (Refereed)
    Abstract [en]

    Delinquent peers have a strong influence on adolescent delinquent behavior. However, few studies have investigated adolescents’, and in particular young females’, own perspectives of the role of peers on their delinquent behavior. The purpose of the present study was to explore how young female offenders described their delinquent behavior and more specifically the role they assign to peer relations in committing or avoiding delinquent acts. Nine female adolescents, sentenced to youth service, were interviewed, and the data was analyzed using the Consensual Qualitative Research (CQR) method. The results showed that committing crimes and taking drugs with peers were portrayed as a way for the female delinquents to socialize. Delinquent and pro-social activities with peers appear to serve similar developmental functions in the sense that it is described to fulfill the same developmental needs. The young offenders also described collectively created pressures and norms in the peer group as the main contributing factor to their norm-breaking behavior, where they described being both recipients and producers of influence in the group. Another important finding was that the female offenders showed an awareness of the importance of pro-social peers and the need to eliminate delinquent friends from their peer network in order to help them refrain from deviant behavior. Implications for prevention and intervention are discussed.

  • 43.
    Azad, Azade
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institutet, Sweden.
    Svärd, Veronica
    Patients' with Multimorbidity and Psychosocial Difficulties and Their Views on Important Professional Competence for Rehabilitation Coordinators in the Return-to-Work Process2021In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 18, no 19, article id 10280Article in journal (Refereed)
    Abstract [en]

    Coordinators may play a key role during the return-to-work (RTW) process for people on sickness absence. There are still few studies on the newly implemented rehabilitation coordinators (RECO) within Swedish healthcare, and none focus on their competence. The aim of this study was to explore how persons with multimorbidity and psychosocial difficulties describe the professional competence of the RECO they encountered during their RTW process. The study takes a relational and practical approach in defining professional competence, including both what professionals do and what they possess. Interviews with 12 people with multimorbidity and psychosocial difficulties who had encountered a RECO during their RTW process were analysed using thematic analysis. Six different themes were found: communicative and coordinating skills; advisory and guidance skills; engagement and advocacy skills; being persistent and flexible; being empathic and therapeutic; being professional and trustworthy. Most of these are found in research on RTW coordinators, but being persistent, and having advisory, guidance, advocacy and therapeutic skills have not been recognised as important competences previously. This study adds patients' views on important professional competence that support the RTW process, which should be regarded in further developments of RECOs' functions and their competence descriptions.

  • 44.
    Azad, Azadé
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Characteristics of adolescent females with limited delinquency: Developmental challenges in relation to family, peers and education2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Adolescence is a developmental period marked with several changes in a young person’s life. Most adolescents who commit crimes desist over time. Despite this, research has mainly focused on those with extensive and long-term delinquency, including mostly males. Young females with limited delinquency are thus an under-researched group. The overall aim of the thesis was to explore the characteristics of young females with limited delinquency, and relate these features to developmental aspects of adolescence. Further, the objective was to study potential challenges they experience, in connection to family, peers and school. All four studies were based on data from young females sentenced to youth service. Studies 1 and 2 include all (N=144) females convicted in a major city in Sweden during 2007–2012. The data collected through self-reports based on ADAD interviews at the beginning of youth service in Study 1 was further complemented and followed up in Study 2 with registry data on education and recidivism 24 months after starting their sentence. Studies 3 and 4 were based on in-depth interviews with nine adolescent females who started their sentence between 2012–2013 in one of two major cities in Sweden. The results confirmed the assumption that this group of offenders displayed limited delinquency. Their self-reports in Study 1 showed low involvement in crimes during twelve months prior to youth service, which was similar to the reporting of a reference group of females in general. Displaying limited delinquency was supported by registry data in Study 2, showing that the majority of the females did not reoffend within two years after being sentenced, as measured by suspicion and conviction rates. However, they did show high educational deficits. This was evident both by high levels of self-reported school problems in Study 1 and final grade point in compulsory and upper secondary school in Study 2. Their educational attainment was lower than adolescent females in general, irrespective of whether they reoffended or not. These findings suggest that although the females were limited in their delinquency, their low levels of education could still put them at risk for suboptimal development. In the interviews, participants ascribed particular importance to peers and family when describing their delinquency. The narratives illustrated how the process of delinquency as it concerned interpersonal relations involved mutually influential exchanges, both contributing to as well as being affected by the delinquency. As such, delinquency was, in Study 3, portrayed as a way to socialize, where delinquent peers were considered important for committing crimes, and pro-social peers for desisting. Likewise, family relations in Study 4 were given a prominent role in the entire process. Accordingly, delinquency was described as a consequence of the relations to the family, where these were negatively as well as positively affected by the crimes. The collective results indicate that committing crimes for the females may be viewed as part of normative development, in which the quest for independence and establishing ones’ identity can contribute to these behaviors. Practical implications for work with young female offenders are also discussed.

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  • 45.
    Azad, Azadé
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Carlsson, Johanna
    Identity status and narrative identity processes in female adolescents' stories about committing crimes and being convicted2024In: Journal of Adolescence, ISSN 0140-1971, E-ISSN 1095-9254, Vol. 96, no 1, p. 124-135Article in journal (Refereed)
    Abstract [en]

    Introduction Adolescent delinquency has been suggested to evolve from a normative motivation to establish independence and identity. However, few studies have examined this in detail, especially in young women. The aim was, therefore, to investigate identity formation in adolescent females with limited delinquency by focusing on identity status and identity processes in narratives about committing crimes and being convicted. Methods Interviews with 10 females, 15-18 years old, sentenced to youth service in three Swedish cities were conducted on Zoom. Results The results showed an equal distribution of all identity statuses within the group. Thematic analysis of their stories about crime and conviction showed that delinquency was described in terms of exploration and commitment, although commitment appeared more clearly. Social relations, in particular peers, played an important role in both committing as well as desisting from delinquency. In terms of narrative processes, the stories contained elements of agency, although diminishing of one's own capability and/or responsibility was common, and meaning making, mostly lesson learning, usually pertained to behaviors, interactional rules, or norms. Conclusion These findings point to the importance of viewing delinquency among young women in a social and developmental context, where delinquency may be a part of the process of identity formation. Interventions focusing on expressing needs of belonging as well as finding oneself in more adaptive ways are warranted, where supporting pro-social relations and contexts is a suggested focus.

  • 46.
    Azad, Azadé
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Carlsson, Johanna
    ‘When you told us what had happened to you, I started to shiver’ – what children and teenagers immediately express and comprehend after listening to testimonies of Holocaust survivors2024In: Holocaust Studies, ISSN 1750-4902, Vol. 30, no 1, p. 66-83Article in journal (Refereed)
    Abstract [en]

    We investigated how young people comprehend stories of trauma through their immediate expressions after listening to personal testimonies of Holocaust survivors. The material included 747 drawings and 182 texts by 10–16-year-old Swedish pupils from 14 schools. Qualitative analyses and cross-tabulations showed that the testimonies elicited complex patterns of emotions and cognitive processing. Personal testimonies can thus be a powerful way of teaching about historical trauma, although complex cognitive meaning making might often require additional time and adult-facilitated conversation. Also, as the testimonies aroused strong emotions, they should be used in a well-informed way.

  • 47.
    Azad, Azadé
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Svärd, Veronica
    Competence and professionalisation among return-to-work coordinators in Sweden: comparisons by original profession: [Kompetens och professionalisering bland rehabiliteringskoordinatorer i Sverige: Jämförelser mellan grundprofessioner]2023In: European Journal of Social Work, ISSN 1369-1457, E-ISSN 1468-2664Article in journal (Refereed)
    Abstract [en]

    Return-to-work coordinators (RTWC) support people on sickness absence and is a new healthcare occupation in Sweden. Its practitioners represent a variety of professions, there is no common undergraduate training and vague role and competence descriptions. The aim was to explore differences in training and competence according to original professions (occupational therapists, physiotherapists, counselling, and other professions) and coordinators' views on which professions they believe provide the best competence for the role. All RTWCs (82) in one region were invited to answer a questionnaire (89% response rate). Mixed-methods analyses were applied. The results showed that counselling professions were more likely than other professional groups to have further training, particularly in conversation methods, and a lower proportion of them stated needing more knowledge about gender equality, social problems, insurance/benefit and conversation methods. The analysis of free-text answers identified three competence areas of importance: advice and guidance, a holistic view, and personality over profession. Occupational therapists and social workers were seen as having the best competence for the coordinating role. The results outline some common values, norms and important competences for RTWCs that could help develop the RTW coordination training and pave the way for RTWCs professionalisation process.

  • 48. Bandelow, Borwin
    et al.
    Hau, StephanStockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    S3-Leitlinie Behandlung von Angststörungen: Version 22021Collection (editor) (Other academic)
  • 49.
    Baraldi, Erika
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Special Education.
    Allodi, Mara
    Stockholm University, Faculty of Social Sciences, Department of Special Education.
    Löwing, Kristina
    Smedler, Ann-Charlotte
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Westrup, Björn
    Ådén, Ulrika
    Early intervention program of extreme preterm born infants, status report three years into the project2021Conference paper (Other academic)
    Abstract [en]

    Children born extremely preterm (e.g. before 28 gestational weeks, EPT) runs a greater risk of cognitive, motor and neurobehavioral impairment later in life, compared to children born at term. Moreover, being a parent of an EPT born child increases the probability of developing depression and posttraumatic stress disorder post-partum, as well as the premature birth may affect the parent-child interaction negatively. In an attempt to decrease the psychological and motoric negative impact of both the child and parents, our multi-professional team has developed an early intervention during the first year at home focusing om parent-child interaction of the EPT born children: Stockholm Preterm Interaction-Based Intervention, SPIBI (Baraldi et al., 2020a). The target of the RCT is 130 children and after 32 months 112 children has been included in the study, evenly distributed in the intervention group and control group. At children’s corrected age of one-year, parents from 14 of the first included families were interviewed about their experiences from the intervention program, resulting in a qualitative article. Three main themes of parental experiences of the first year at home emerged: child-related concerns (concerning child medical state, self-regulation and recovery), parental inner state (concerning loneliness, ambivalence and premature parental identity), and changed family dynamics (concerning the couple, siblings and intergenerational support). The parents from the  intervention group reported that the intervention had given them security, a sense that the interventionist has been knowledgeable and in some cases that the program was important but not necessary to them (Baraldi et al., 2020b). With 85% of the targeted subjects included it is clear that an extensive early home-visit intervention program is feasible in the Swedish context, even though the pandemic has slowed down the recruitment pace and has forced adjustments to be made such as the use of telemedicine, exclusion of toys in the follow-up process and intensified hygienic procedures.

  • 50.
    Baraldi, Erika
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Special Education.
    Allodi, Mara
    Stockholm University, Faculty of Social Sciences, Department of Special Education.
    Smedler, Ann-Charlotte
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Erfarenheter & utmaningar vid prövning av ett hembesöksprogram för extremt prematurfödda barn och deras familjer2023In: Abstracts CKVO Konferens 11-12 maj: Jämlik hälsa i en osäker värld, 2023, p. 20-21Conference paper (Other academic)
    Abstract [sv]

    Bakgrund: Stockholm Preterm Interaction-Based Intervention (SPIBI) är ett nytt styrkebaserat tidigt interventionsprogram för samspelsstöd till föräldrar och barn i familjer där barnet föddes mer än tre månader för tidigt. Forskning visar att dessa barn löper ökad risk att stöta på problem i sin utveckling vad avser kognition, koncentrationsförmåga, skolgång och social situation. Det finns också ökad risk för att föräldrarna ska drabbas av psykisk ohälsa. SPIBI består av 10 hembesök under första året hemma, där fokus ligger på att stärka ett lyhört föräldra-barn samspel, bejaka lekfullhet och stötta barnets nyfikna utforskande. 130 extremt prematurfödda barn från 122 familjer har rekryterats och randomiserats till interventionsgrupp (n=66) och kontrollgrupp (n=64). Studien är i linje med FNs globala hållbarhetsmål för god hälsa och välbefinnande samt minskad ojämlikhet då den riktar sig till en grupp som riskerar drabbas av ohälsa och utsatthet även i vår kontext, med tillgång till avancerad neonatalvård och utbyggd välfärd.

    Syftet med detta bidrag är att redovisa erfarenheter av interventionens genomförande i hemmiljö från oktober 2018 till december 2022. 

    Metod: Samtliga intervenerare (n=6) och 17 av de deltagande föräldrarna har intervjuats om sina erfarenheter från SPIBI. Föräldraintervjuerna är tidigare publicerade (Baraldi et al., 2020).

    Resultat: Deltagande familjer varierar mycket vad avser barnens medicinska behov, hur svår sjukhusvistelse familjen har bakom sig, familjens socioekonomiska situation och tidigare föräldraerfarenhet. Vissa familjer har dubbel belastning både i form av kvarstående behov av frekventa sjukhusbesök efter ett års ålder, och utsatt familjesituation med exempelvis trångboddhet, otrygg boendemiljö eller bristande socialt nätverk. Således varierar också behoven som familjerna önskar få tillfredsställda av interventionsprogrammet, från utökat behov av stöd i att läsa barnets signaler till behov av socialt stöd i föräldrarollen. De familjer vars barn har störst funktionsnedsättning är inte nödvändigtvis i störst behov av SPIBI, eftersom de ofta redan har extra vårdkontakter. Coronapandemin drabbade deltagande familjer hårt, då hygienfrågor alltid är viktiga i omsorgen om svårt sjuka barn. Detta påverkade i sin tur SPIBI både avseende hembesöksmodellen och rekrytering. Trots olika förutsättningar uppger samtliga behandlare att det varit lätt att hitta styrkor att fokusera på i familjerna och att hembesöksupplägget överlag fungerat väl.

    Slutsats: Implementeringen av SPIBI under studieperioden har fungerat väl, men delvis störts av pandemin. Framtida vidareutveckling av SPIBI skulle kunna inkludera en flernivåmodell, där stödets intensitet men även fokusområden anpassas till den enskilda familjen.

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