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  • 1. 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.

  • 2. Gidhagen, Ylva
    et al.
    Holmqvist, Rolf
    Philips, Björn
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Linköping University, Sweden.
    Attachment style among outpatients with substance use disorders in psychological treatment2018In: Psychology and Psychotherapy: Theory, Research and Practice, ISSN 1476-0835, E-ISSN 2044-8341, Vol. 91, no 4, p. 490-508Article in journal (Refereed)
    Abstract [en]

    Objectives To explore the associations between self-rated attachment style, psychological distress and substance use among substance use disorder (SUD) outpatients in psychological treatment.

    Design and Methods In this practice-based study, 108 outpatients were asked to fill in the Experiences in Close Relationships - Short form, the Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM), the Alcohol Use Disorders Identification Test (AUDIT), and the Drug Use Disorders Identification Test (DUDIT) at treatment start and end. Patients were given psychological treatments with a directive, reflective or supportive orientation.

    Results An insecure attachment style was more common among the SUD outpatients, compared to non-clinical groups. Patients with a fearful attachment style scored higher on psychological distress than patients with a secure attachment style. The associations between the attachment dimensions and psychological distress were stronger than those between attachment and SUD. Significantly more patients had a secure attachment style at treatment end.

    Conclusions This study shows significant relations between patients' attachment style and their initial psychological distress. The causal relationship between attachment style and psychological distress is, however, not clear and can likely go in both directions. The psychological treatment of patients with SUD contributed significantly to changes from insecure to secure attachment style.

  • 3. Lilliengren, Peter
    et al.
    Philips, Björn
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Falkenström, Fredrik
    Bergquist, Mia
    Ulvenes, Pål
    Wampold, Bruce
    Comparing the Treatment Process in Successful and Unsuccessful Cases in Two Forms of Psychotherapy for Cluster C Personality Disorders2019In: Psychotherapy, ISSN 0033-3204, E-ISSN 1939-1536, Vol. 56, no 2, p. 285-296Article in journal (Refereed)
    Abstract [en]

    Different forms of psychotherapy are effective for cluster C personality disorders, but we know less about what in-session processes promote change. Contrasting successful and unsuccessful cases may elucidate processes that facilitate or impede outcome and offer suggestions for clinical practice and future research. In this exploratory outcome-process study, 10 successful and 10 unsuccessful cases were selected from a randomized trial comparing cognitive therapy and short-term psychodynamic psychotherapy for cluster C personality disorders. Videotaped sessions were rated with the Psychotherapy Process Q-Set (PQS). The treatments were compared in terms of which PQS items differentiated successful and unsuccessful cases, as well as their resemblance with PQS prototypes of ideal treatments. Therapists' behavior in early sessions was also explored. Results indicate that successful cases in our sample were characterized by a more active and engaged patient. In contrast, unsuccessful cases were characterized by a more directive or controlling therapist stance. Correlations with PQS prototypes were moderate to strong in both successful and unsuccessful cases, suggesting that optimal and suboptimal interpersonal processes may be independent of adherence to particular treatments. Exploration of therapist behaviors in early sessions indicated that therapists were more likely to adjust their way of working in the successful cases. Our result suggests that patient engagement and therapists' early efforts to improve the therapy relationship may be pivotal for successful outcome, whereas therapist controlling behavior may obstruct the treatment process, regardless of therapy model used. The impact of these in-session processes should be examined more closely in larger samples in future studies.

  • 4.
    Philips, Björn
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Stockholm City Council, Sweden; Karolinska Institutet, Sweden.
    Karlsson, Roger
    Nygren, Rebecca
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Rother-Schirren, Amelie
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Werbart, Andrzej
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Early therapeutic process related to dropout in mentalization-based treatment with dual diagnosis patients2018In: Psychoanalytic psychology, ISSN 0736-9735, E-ISSN 1939-1331, Vol. 35, no 2, p. 205-216Article in journal (Refereed)
    Abstract [en]

    Negative therapeutic reaction was first described by Freud, and theories about this phenomenon have focused on various patient factors, for example, unconscious guilt, narcissistic pride, and overwhelming feelings of shame, as well as devaluation of the therapist as a defense against envy. Different strategies to counteract negative therapeutic reactions in patients with severe personality disorder have been proposed. Bateman and Fonagy suggested that some psychoanalytic techniques are iatrogenic for patients with borderline personality disorder and, thus, the therapeutic method must be modified. One manifestation of negative therapeutic reaction is that patients discontinue therapy prematurely. The aim of this study was to explore the differences in the early therapeutic process between therapy dropouts and therapy completers in mentalization-based treatment (MBT) for patients with concurrent borderline personality disorder (BPD) and substance use disorder (SUD). The first 2 videotaped therapy sessions from 6 MBT therapies were selected—3 therapies that were completed and 3 therapies that were prematurely discontinued by the patient. The therapy process was analyzed using the Psychotherapy Process Q set (PQS). Lists of the most frequent and least frequent PQS items among therapy completers versus dropouts are presented. In comparing the sessions from therapy completers and dropouts, significant differences in frequencies were detected for 13 PQS items. These items included therapist and patient activities, as well as features of the therapeutic interaction. Continuation in therapy seems to be related to therapists’ general skills and adherence to MBT, as well as patients bringing up significant material and not being distant.

  • 5.
    Philips, Björn
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Stockholm County Council, Sweden; Karolinska Institutet, Sweden.
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden.
    Konradsson, Per
    Franck, Johan
    Mentalization-Based Treatment for Concurrent Borderline Personality Disorder and Substance Use Disorder: A Randomized Controlled Feasibility Study2018In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 24, no 1, p. 1-8Article in journal (Refereed)
    Abstract [en]

    Aims: There is a scarcity of clinical trials on psychological treatments for concurrent borderline personality disorder (BPD) and substance use disorder (SUD). Mentalization-based treatment (MBT) have shown efficacy in several trials on BPD. The aim of the present study was to examine the feasibility and effectiveness of MBT for concurrent BPD and SUD. Methods: Patients (n = 46) with concurrent BPD and SUD were randomized either to MBT in combination with SUD treatment (n = 24) or to SUD treatment alone (n = 22). Outcome was measured after 18 months using objective data, as well as interview and self-report measures. Results: There was no significant difference between the groups on any outcome variable. No suicide attempts occurred in the MBT group in contrast to 4 suicide attempts that occurred in the control group - a difference that did not reach statistical significance (p = 0.06). A majority of the therapists did not show sufficient MBT adherence and quality. Conclusion: MBT for patients with concurrent BPD and SD does not appear to be harmful; on the other hand, it is possibly helpful in reducing the risk involved in suicide attempts.

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