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  • 1.
    Lundgren, Tobias
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Luoma, Jason B.
    Dahl, JoAnne
    Strosahl, Kirk
    Melin, Lennart
    The Bull's-Eye Values Survey: A Psychometric Evaluation2012In: Cognitive and Behavioral Practice, ISSN 1077-7229, E-ISSN 1878-187X, Vol. 19, no 4, p. 518-526Article in journal (Refereed)
    Abstract [en]

    Two studies were conducted to develop and evaluate an instrument intended to identify and measure personal values, values attainment, and persistence in the face of barriers. Study 1 describes a content validity approach to the construction and preliminary validation of the Bull's Eye Values Survey (BEVS), using a sample of institutionalized patients suffering from epilepsy. Study 2 investigated the psychometric properties of the BEVS with a sample of Swedish university students. Results suggest that the BEVS is sensitive to treatment effects and can differentiate between clients who receive values-based interventions and those who do not. The BEVS subscales and total score appear to measure an independent dimension of psychological functioning that is negatively correlated with measures of depression, anxiety, and stress, and positively correlated with a measure of psychological flexibility. The BEVS also exhibits acceptable temporal stability and internal consistency. The study provides preliminary support for the BEVS as both a research and clinical tool for measuring values, values-action discrepancies, and barriers to value-based living.

  • 2.
    Lundgren, Tobias
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institutet, Sweden.
    Parling, Thomas
    Swedish Acceptance and Action Questionnaire (SAAQ): A psychometric evaluation2017In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 46, no 4, p. 315-326Article in journal (Refereed)
    Abstract [en]

    Psychological inflexibility and experiential avoidance are equivalent (with somewhat different connotations) concepts and refer to an unwillingness to remain in contact with particular private events. This concept is most often measured by the Acceptance and Action Questionnaire (AAQ-II) and is strongly related to psychopathology and behavioral effectiveness. In this study, the preliminary psychometric properties of the Swedish version of the AAQ-II (Swedish Acceptance and Action QuestionnaireSAAQ) are presented. The study is done in two steps. In the first step, the 10-item version of the AAQ-II is investigated through principal component analysis (n=147). Secondly, due to problems with the component structure, the instrument is reduced to a six-item version and its validity and internal consistency are investigated (n=154). The six-item version shows good concurrent and convergent validity as well as satisfying internal consistency (=.85). Furthermore, the Swedish six-item version of the AAQ-II showed one strong component. Test-retest reliability was satisfactory (r=.80; n=228). In future research, predictive and external validity would be important to investigate in order to further ensure that the SAAQ is a useful measure for clinical research. In conclusion, the SAAQ has satisfactory psychometric properties, but more data need to be gathered to further explore the possibilities for the instruments in Swedish contexts.

  • 3.
    Lundgren, Tobias
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institutet, Sweden; Stockholm County Council, Sweden.
    Reinebo, Gustaf
    Löf, Per-Olov
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Näslund, Markus
    Svartvadet, Per
    Parling, Thomas
    The Values, Acceptance, and Mindfulness Scale for Ice Hockey: A Psychometric Evaluation2018In: Frontiers in Psychology, ISSN 1664-1078, E-ISSN 1664-1078, Vol. 9, article id 1794Article in journal (Refereed)
    Abstract [en]

    There is an increased interest in mindfulness, acceptance, and values based skills training interventions in sports but there is a lack of psychometrically evaluated instruments to investigate the processes adapted to sport populations. This paper describes the development and investigation of an instrument that measure acceptance, mindfulness, and values for ice hockey players. Ice hockey players at elite and sub elite level (n = 94) in Sweden participated in the study. The results reveal that the values, acceptance, and mindfulness (VAMS) shows acceptable internal consistency (alpha = 0.76) and satisfactory validity. Furthermore, scores on the VAMS predicts ice hockey performance as measured by assists and team points. Future research is suggested to evaluate the sensitivity of the instrument for longitudinal research design studies. In conclusion, VAMS is a useful instrument for practitioners and researchers to increase the knowledge in how psychological processes such as acceptance, mindfulness, and values influence performance among ice hockey players.

  • 4. Pahnke, Johan
    et al.
    Lundgren, Tobias
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Hursti, Timo
    Hirvikoski, Tatja
    Outcomes of an acceptance and commitment therapy-based skills training group for students with high-functioning autism spectrum disorder: A quasi-experimental pilot study2014In: Autism, ISSN 1362-3613, E-ISSN 1461-7005, Vol. 18, no 8, p. 953-964Article in journal (Refereed)
    Abstract [en]

    Autism spectrum disorder is characterized by social impairments and behavioural inflexibility. In this pilot study, the feasibility and outcomes of a 6-week acceptance and commitment therapy-based skills training group were evaluated in a special school setting using a quasi-experimental design (acceptance and commitment therapy/school classes as usual). A total of 28 high-functioning students with autism spectrum disorder (aged 13-21 years) were assessed using self- and teacher-ratings at pre- and post-assessment and 2-month follow-up. All participants completed the skills training, and treatment satisfaction was high. Levels of stress, hyperactivity and emotional distress were reduced in the treatment group. The acceptance and commitment therapy group also reported increased prosocial behaviour. These changes were stable or further improved at the 2-month follow-up. Larger studies are needed to further evaluate the benefits of acceptance and commitment therapy for autism spectrum disorder.

  • 5.
    Ramnerö, Jonas
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Gustavsson, Thomas
    Lundgren, Tobias
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Må dåligt: Om psykopatologi i vardagslivet2017Book (Other academic)
    Abstract [sv]

    När vi ställs inför ångest, depression, självskadebeteende och psykos uppfattar vi det ofta som svårbegripligt och främmande. Med Må dåligt vill författarna öka förståelsen för psykisk ohälsa.  De visar både hur olika tillstånd yttrar sig i vardagslivet och hur allmänmänskliga psykologiska processer bidrar till dem. Bokens utgångspunkt är att psykisk ohälsa utvecklas i samspel mellan den omgivande miljön och vad vi lär oss av våra erfarenheter under livet. Ett huvudbudskap är att psykisk hälsa inte är detsamma som ett liv fritt från det som kan vara plågsamt, utan det avgörande är ett liv som är värt att leva.

  • 6.
    Tyrberg, Mårten
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Hospital of Västmanland, Sweden.
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Lundgren, Tobias
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institutet, Sweden.
    Affecting the psychiatric ward milieu using a combination of individual treatment and staff behavior change2018Conference paper (Other academic)
    Abstract [en]

    Changing the context surrounding patients treated in psychiatric wards is a great challenge, with barriers in terms of the organization, work culture and clinical skill. We propose a model to influence the ward context by adding psychological treatment in both individual form and by teaching inpatient staff how to use a simplified ACT model to inform their daily interactions with patients. We further discuss difficulties in the implementation of psychological treatment in inpatient milieus. Results from three empirical studies in a naturalistic setting in Sweden form the basis of a model describing how access to evidence-based psychological treatment might be increased using limited extra resources. Data suggest that 1) an average of two individual ACT sessions might lessen the need for future inpatient care for psychosis patients, 2) inpatients as well as staff members themselves might benefit from staff learning and using a simplified ACT model, and 3) staff find the ACT model useful both in terms of helping patients handle psychiatric symptoms and in terms of handling their own work-related stress.

  • 7.
    Tyrberg, Mårten
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Västmanlands Hospital, Sweden.
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Lundgren, Tobias
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institutet, Sweden.
    Implementation of ACT training in a psychiatric ward: Clinical experiences and staff-patient outcomes2016Conference paper (Refereed)
    Abstract [en]

    Conducting research in clinical psychiatric settings presents significant challenges. Patients’ suffering is often severe, and organizational aspects might hinder the implementation of structured psychological treatment. In this symposium, empirical data are presented from three different projects concerning ACT for different diagnoses –psychosis, body dysmorphic disorder (BDD) and high functioning autism spectrum disorder (ASD). The first talk concerns training inpatient ward staff in using the ACT model with psychosis patients. Data suggest slight positive changes in psychological flexibility for patients and staff. The second talk describes the evaluation of an ACT group treatment intervention for BDD outpatients, with results showing significant reductions in BDD symptomatology. The third talk covers a researchproject on ACT adapted for students and psychiatric outpatients with ASD, where data indicate reduced levels of stress and autistic core symptoms. Presenters will share their data, as well as common clinical experiences of implementing ACT in clinical psychiatric contexts.

  • 8.
    Tyrberg, Mårten
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Hospital of Västmanland Västerås, Sweden.
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Lundgren, Tobias
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institutet, Sweden; Stockholm County Council, Sweden.
    Usefulness of the ACT model for nurses in psychiatric inpatient care: A qualitative content analysis2017In: Journal of Contextual Behavioral Science, ISSN 2212-1447, Vol. 6, no 2, p. 208-214Article in journal (Refereed)
    Abstract [en]

    Alleviating the suffering of patients treated in psychiatric inpatient wards is a great challenge. Preliminary or multiple diagnoses, inherent complexities of the inpatient milieu and the lack of potentially effective psychological treatment form part of this challenge. The present study explored the usefulness of a transdiagnostic psychological treatment model (Acceptance & Commitment Therapy, ACT) as a means of improving inpatient care from the perspective of psychiatric nurses. Nurses (n = 10) participated in three ACT workshops, a total of 21 h, and were interviewed about the experienced usefulness and difficulties of the ACT model, as a tool for improving everyday ward work. Results, revealed by qualitative content analysis, suggest usefulness in the areas of alleviating patients symptoms, enriching typical ward duties, and handling one's own thoughts and feelings. Difficulties stemmed from lack of time, the model itself and patients' severe illness. Possible adjustments of the ward context are suggested.

  • 9.
    Tyrberg, Mårten J.
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Västmanland County Hospital, Sweden.
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Lundgren, Tobias
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institutet, Sweden.
    Brief acceptance and commitment therapy for psychotic inpatients: A randomized controlled feasibility trial in Sweden2017In: Nordic Psychology, ISSN 1901-2276, E-ISSN 1904-0016, Vol. 69, no 2, p. 110-125Article in journal (Refereed)
    Abstract [en]

    Psychiatric inpatient care in Sweden is often described as lacking in content other than medication and mere containment. In an attempt to increase structured psychological content in the ward context, this study aims to investigate whether a brief form of acceptance and commitment therapy (ACT) is a feasible addition to standard care for psychotic inpatients. ACT has previously been administered to psychotic inpatients in the US, and the present study was an attempt at implementing this intervention in Sweden. In this feasibility study, 22 psychotic inpatients were randomized to one of two conditions: treatment as usual (TAU) or TAU plus an average of two ACT sessions. Measures of rehospitalization and values-based living were obtained before treatment, after treatment, and at four-month follow-up. Results indicate that participants in the TAU plus ACT group were rehospitalized at a lower rate than those who only received TAU (9% vs. 40%), though the difference was not statistically significant. Controlling for age, gender, and pretreatment values-based living scores, there was a significantly higher risk for TAU participants to be rehospitalized. There was a trend toward increased values-based living scores in the ACT group. These results suggest that it is feasible to add structured psychotherapeutic interventions to the existing care package at psychiatric inpatient wards in Sweden. However, the findings need to be explored in larger samples.

  • 10.
    Tyrberg, Mårten J.
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Uppsala University, Sweden .
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Lundgren, Tobias
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institutet, Sweden .
    Implementation of acceptance and commitment therapy training in a psychiatric ward: feasibility, lessons learned and potential effectiveness2017In: Journal of Psychiatric Intensive Care, ISSN 1742-6464, E-ISSN 1744-2206, Vol. 13, no 2, p. 73-82Article in journal (Refereed)
    Abstract [en]

    Psychiatric inpatient wards are inherently complex milieus. Staff in wards are expected to alleviate severe suffering in patients whilst handling an increasing administrative burden, resulting in less direct contact with patients. Reports from both patients and staff indicate institutional aimlessness and lack of care content beyond medication and containment. As a possible means of improving this situation, this pilot study investigated the feasibility, potential effectiveness and challenges of the implementation of a 12-hour training programme in acceptance and commitment therapy (ACT), a CBT-based psychotherapy model, on staff (n = 20) and patients (n = 9). The context was a psychiatric inpatient ward for psychosis patients. The staff members of a neighbouring unit acted as non-randomised controls. Feasibility of implementation, data collection and acceptance among staff of the intervention seemed acceptable, while data collection among patients was more challenging. Mean change scores suggest marginal positive changes in psychological flexibility for patients and staff post-intervention. Results are discussed in light of methodological and institutional limitations, and clinical experiences.

  • 11.
    Tyrberg, Mårten
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Lundgren, Tobias
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Fydrich, Thomas
    ACT for Psychotic Inpatients, Broad Implementation in a Swedish Context2015Conference paper (Refereed)
    Abstract [en]

    In recent years, the research base supporting ACT for psychosis has grown (e.g. Bach & Hayes, 2002; Gaudiano & Herbert, 2006; White et al., 2011; Bach, Hayes & Gallop, 2012; Shawyer et al., 2012). In this symposium, pilot results from a small study on a clinical sample in Sweden will be presented. A total of 21 psychotic inpatients were randomized to either treatment as usual (TAU) or TAU plus a short ACT intervention, on average 2 sessions. Groups were measured for rehospitalization and values-based living at pretreatment, posttreatment and four month follow-up. Results indicate that the ACT group was rehospitalized to a lesser extent than the TAU group, although the difference was not significant. Also, the ACT group scored higher on the Bull’s-Eye Values Survey at follow-up, the difference being marginally significant. All in all, the results expand somewhat upon previous findings in the same population (Bach & Hayes, 2002; Gaudiano & Herbert, 2006), by indicating that ACT might affect values-based living in addition to decreasing need for rehospitalization. The next step in this research project in Sweden will be implementing ACT in the ward context in a broader way. This will be done in two ways: 1) By training all ward staff in the method. The effects of this training, and of regular supervision, will be investigated by administering measures of work related acceptance to staff. 2) By investigating ACT as an individual treatment in a larger sample, where therapists will be ward staff using a manual that was custom-made for this particular project.

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