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  • 101.
    Johansson, Robert
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Linköping University, Sweden.
    Ramnerö, Jonas
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Jönsson, Arne
    Arbitrarily applicable relational responding as non-axiomatic logical reasoning2018Inngår i: Proceedings of the 14th SweCog Conference / [ed] Tom Ziemke, Mattias Arvola, Nils Dahlbäck, Erik Billing, Skövde: University of Skövde , 2018, s. 7-9Konferansepaper (Fagfellevurdert)
    Abstract [en]

    In the research tradition called “contextual behavioral science” (Zettle, Hayes, & Barnes-Holmes, 2016) it is argued that a large part of cognitive phenomena are made possible due to a type of operant behavior known as “arbitrarily applicable relational responding”. Relational Frame Theory (RFT; Hayes, Barnes-Holmes, & Roche, 2001; Roche & Dymond, 2013) is a contextual behavioral account of language and cognition. RFT aims to develop a unified account of language and cognition and have been showed to account for as diverse topics as language development, the emergence of a self, human suffering, intelligence, problem solving, etc. The fundamental thesis of RFT is that language and cognition are all instances of arbitrarily applicable relational responding (AARR). According to this perspective, relating means responding to one event in terms of another. While both non-humans and humans are able to respond relationally, only humans seem to able to do this arbitrarily. For example, a human being can be presented with three similar coins and being told that “coin A is worth less than coin B, which in turn is worth less than coin C”. The fact that a human being in some context would immediately pick coin A, is to RFT an example of AARR in which stimuli are arbitrarily related along a comparative dimension of worth.

    NARS (Non-Axiomatic Reasoning System; Wang, 2006, 2013) is a project aiming to building a general purpose intelligent system. An assumption in NARS is that the essence of intelligence is the principle of adapting to the environment while working with insufficient knowledge and resources. Accordingly, an intelligent system should rely on finite processing capacity, work in real time, be open to unexpected tasks, and learn from experience. NARS is built as a reasoning system, using a formal specification “non-axiomatic logic” (NAL) to define its functionality. NAL is designed incrementally with multiple layers. At each layer, NAL and its internal language Narsese are extended to have a higher expressive power, a richer semantics, and a larger set of inference rules, so as to increase the intelligence of the system. The reasoning process in NARS uniformly carries out many cognitive functions that are traditionally studied as separate processes with different mechanisms, such as learning, perceiving, planning, predicting, remembering, problem solving, decision making, etc.

    The primary aim of this work is to investigate if NARS can do AARR with gradually increasing complexity, and under which conditions this is made possible. Potential applications are for example describing and exploring mental health phenomena within an artificial general intelligence framework.

  • 102.
    Jonsson, Jakob
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Abbott, Max W.
    Sjöberg, Anders
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Arbets- och organisationspsykologi.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Measuring Gambling Reinforcers, Over Consumption and Fallacies: The Psychometric Properties and Predictive Validity of the Jonsson-Abbott Scale2017Inngår i: Frontiers in Psychology, ISSN 1664-1078, E-ISSN 1664-1078, Vol. 8, artikkel-id 1807Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Traditionally, gambling and problem gambling research relies on cross-sectional and retrospective designs. This has compromised identification of temporal relationships and causal inference. To overcome these problems a new questionnaire, the Jonsson-Abbott Scale (JAS), was developed and used in a large, prospective, general population study, The Swedish Longitudinal Gambling Study (Swelogs). The JAS has 11 items and seeks to identify early indicators, examine relationships between indicators and assess their capacity to predict future problem progression. The aims of the study were to examine psychometric properties of the JAS (internal consistency and dimensionality) and predictive validity with respect to increased gambling risk and problem gambling onset. The results are based on repeated interviews with 3818 participants. The response rate from the initial baseline wave was 74%. The original sample consisted of a random, stratified selection from the Swedish population register aged between 16 and 84. The results indicate an acceptable fit of a three-factor solution in a confirmatory factor analysis with ‘Over consumption,’ ‘Gambling fallacies,’ and ‘Reinforcers’ as factors. Reinforcers, Over consumption and Gambling fallacies were significant predictors of gambling risk potential and Gambling fallacies and Over consumption were significant predictors of problem gambling onset (incident cases) at 12 month follow up. When controlled for risk potential measured at baseline, the predictor Over consumption was not significant for gambling risk potential at follow up. For incident cases, Gambling fallacies and Over consumption remained significant when controlled for risk potential. Implications of the results for the development of problem gambling, early detection, prevention, and future research are discussed.

  • 103.
    Jonsson, Jakob
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Munck, Ingrid
    Volberg, Rachel
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    GamTest: Psychometric Evaluation and the Role of Emotions in an Online Self-Test for Gambling Behavior2017Inngår i: Journal of Gambling Studies, ISSN 1050-5350, E-ISSN 1573-3602, Vol. 33, nr 2, s. 505-523Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Recent increases in the number of online gambling sites have made gambling more available, which may contribute to an increase in gambling problems. At the same time, online gambling provides opportunities to introduce measures intended to prevent problem gambling. GamTest is an online test of gambling behavior that provides information that can be used to give players individualized feedback and recommendations for action. The aim of this study is to explore the dimensionality of GamTest and validate it against the Problem Gambling Severity Index (PGSI) and the gambler's own perceived problems. A recent psychometric approach, exploratory structural equation modeling (ESEM) is used. Well-defined constructs are identified in a two-step procedure fitting a traditional exploratory factor analysis model as well as a so-called bifactor model. Using data collected at four Nordic gambling sites in the autumn of 2009 (n = 10,402), the GamTest ESEM analyses indicate high correspondence with the players' own understanding of their problems and with the PGSI, a validated measure of problem gambling. We conclude that GamTest captures five dimensions of problematic gambling (i.e., overconsumption of money and time, and monetary, social and emotional negative consequences) with high reliability, and that the bifactor approach, composed of a general factor and specific residual factors, reproduces all these factors except one, the negative consequences emotional factor, which contributes to the dominant part of the general factor. The results underscore the importance of tailoring feedback and support to online gamblers with a particular focus on how to handle emotions in relation to their gambling behavior.

  • 104. Josephson, Henrik
    et al.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Forsberg, Lars
    Rosendahl, Ingvar
    People with gambling disorder and risky alcohol habits benefit more from motivational interviewing than from cognitive behavioral group therapy2016Inngår i: PeerJ, ISSN 2167-8359, E-ISSN 2167-8359, Vol. 4, artikkel-id 1899Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background. Effective psychological treatment, including cognitive behavioral therapy and motivational interviewing (MI), is available for people with problematic gambling behaviors. To advance the development of treatment for gambling disorder, it is critical to further investigate how comorbidity impacts different types of treatments. The purpose of this study was to investigate whether screening for risky alcohol habits can provide guidance on whether people with gambling disorder should be recommended cognitive behavioral group therapy (CBGT) or MI.

    Methods. The present study is a secondary analysis of a previous randomized controlled trial that compared the effects of CBGT, MI and a waitlist control group in the treatment of disordered gambling. Assessment and treatment was conducted at an outpatient dependency clinic in Stockholm, Sweden, where 53 trial participants with gambling disorder began treatment. A modified version of the National Opinion Research Centre DSM-IV Screen for gambling problems was used to assess gambling disorder. The Alcohol Use Disorders Identification Test (AUDIT) was used to screen for risky alcohol habits.

    Results. The interaction between treatment and alcohol habits was significant and suggests that patients with gambling disorder and risky alcohol habits were better helped by MI, while those without risky alcohol habits were better helped by CBGT.

    Conclusions. The results support a screening procedure including the AUDIT prior to starting treatment for gambling disorder because the result of the screening can provide guidance in the choice of treatment. Patients with gambling disorder and risky alcohol habits are likely to be best helped if they are referred to MI, while those without risky alcohol habits are likely to be best helped if they are referred to CBGT.

  • 105. Jović, Vladimir
    et al.
    Varvin, Sverre
    Rosenbaum, Bent
    Fischmann, Tamara
    Opačić, Goran
    Hau, Stephan
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Sleep Studies in Serbian Victims of Torture: Analysis of Traumatic Dreams2017Inngår i: Sleep and Combat-Related Post Traumatic Stress Disorder / [ed] Eric Vermetten, Anne Germain, Thomas C. Neylan, New York: Springer, 2017, s. 395-409Kapittel i bok, del av antologi (Fagfellevurdert)
    Abstract [en]

    One of prominent features related to the posttraumatic stress disorder (PTSD) is according to DSM-5 “recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s)”. The phenomenology and the underlying dynamics of traumatic dreams are areas of study that still need to be understood.

    The study presented in this chapter is a qualitative study of traumatic dreams of torture survivors of the last Balkan wars. Aims of the study were to demonstrate two different methods of qualitative analysis of dreams which could be used for the investigation of latent structures of reported narratives of dreams, and to demonstrate how these structures are reflected in posttraumatic states, as changes in affect regulation, symbolization and attachment to others. An additional aim of the study was to help clinicians to better understand their traumatized patients’ dreaming by identifying mechanisms related to posttraumatic processes within the dream and thus give a better understanding on how the traumatized dreamers attempt of healing fail in recurrent nightmares.

  • 106. Karyotaki, Eirini
    et al.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. University of Southern Denmark, Denmark.
    Cuijpers, Pim
    Do guided internet-based interventions result in clinically relevant changes for patients with depression?: An individual participant data meta-analysis2018Inngår i: Clinical Psychology Review, ISSN 0272-7358, E-ISSN 1873-7811, Vol. 63, s. 80-92Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Little is known about clinically relevant changes in guided Internet-based interventions for depression. Moreover, methodological and power limitations preclude the identification of patients' groups that may benefit more from these interventions. This study aimed to investigate response rates, remission rates, and their moderators in randomized controlled trials (RCTs) comparing the effect of guided Internet-based interventions for adult depression to control groups using an individual patient data meta-analysis approach. Literature searches in PubMed, Embase, PsycINFO and Cochrane Library resulted in 13,384 abstracts from database inception to January 1, 2016. Twenty-four RCTs (4889 participants) comparing a guided Internet-based intervention with a control group contributed data to the analysis. Missing data were multiply imputed. To examine treatment outcome on response and remission, mixed-effects models with participants nested within studies were used. Response and remission rates were calculated using the Reliable Change Index. The intervention group obtained significantly higher response rates (OR = 2.49, 95% CI 2.17–2.85) and remission rates compared to controls (OR = 2.41, 95% CI 2.07–2.79). The moderator analysis indicated that older participants (OR = 1.01) and native-born participants (1.66) were more likely to respond to treatment compared to younger participants and ethnic minorities respectively. Age (OR = 1.01) and ethnicity (1.73) also moderated the effects of treatment on remission.Moreover, adults with more severe depressive symptoms at baseline were more likely to remit after receiving internet-based treatment (OR = 1.19). Guided Internet-based interventions lead to substantial positive treatment effects on treatment response and remission at post-treatment. Thus, such interventions may complement existing services for depression and potentially reduce the gap between the need and provision of evidence-based treatments.

  • 107.
    Kruijt, Anne-Wil
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Processing confusing procedures in the recent re-analysis of a cognitive bias modification (CBM) meta-analysis2017Inngår i: British Journal of Psychiatry, ISSN 0007-1250, E-ISSN 1472-1465, Vol. 211, nr 5, s. 266-271Artikkel i tidsskrift (Annet vitenskapelig)
  • 108.
    Kruijt, Anne-Wil
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Processing confusing procedures in the recent re-analysis of a cognitive bias modification meta-analysis2018Inngår i: British Journal of Psychiatry, ISSN 0007-1250, E-ISSN 1472-1465, Vol. 212, nr 4, s. 246-246Artikkel i tidsskrift (Annet vitenskapelig)
  • 109.
    Kruijt, Anne-Wil
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Parsons, Sam
    Fox, Elaine
    Treatment without target? No meta-analytical evidence for baseline bias towards threat in 860 clinically anxious individuals enrolled in Attention Bias Modification RCTs2017Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Background: Considerable effort and funding are spent on developing and assessing clinical efficacy of dot probe task (DPT) based Attention Bias Modification (ABM). ABM is regarded as a potential new (online) treatment for anxiety disorders especially. Anxiety disorders are commonly asserted to be characterised by ABM’s treatment target: preferential processing of threatening information. Yet the available meta-analytical evidence for this specific threat- bias in clinically anxious individuals is thin: the largest meta-analysis to date included DPT data for only n = 337 clinically anxious individuals. We reasoned that the baseline bias measures obtained in RCTs for ABM constitute a considerable, hitherto not assessed, body of data on the existence of DPT threat bias in clinically anxious samples.

    Method: Baseline ‘threat vs neutral’ DPT summary data for n=860 clinically anxious individuals enrolled in k=11 ABM RCTs were meta-analysed using REML. Additional Bayesian analysis was used to assess support for a series of 1 ms wide bias size intervals.

    Results: REML analysis indicated no evidence that mean observed Bias Index (BI) differs from point zero (k= 11, n= 860, mean BI = 1.8, SE = 1.53, p = .229, 95% CI [-1.2 - 4.8]). Bayesian analyses indicated moderate support for the traditional ‘point-zero’ over the ‘not point-zero’ hypothesis (BF01 = 6.7). Interval-based Bayesian analysis suggest that BI most likely falls in the 0-1 ms interval (BFinterval/notinterval = 231) and is almost certainly not larger than +2 ms (towards threat), or -1 ms (away from threat).

    Conclusion: Clinically anxious individuals enrolled in RCTs for Attention Bias Modification do not display attention bias towards threat at the start of their trials. This meta-analytical finding casts strong doubt on the common assumption that clinical anxiety is characterized by preferential attention allocation towards threatening information.

  • 110. Lenhard, Fabian
    et al.
    Sauer, Sebastian
    Andersson, Erik
    Månsson, Kristoffer N. T.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden.
    Mataix-Cols, David
    Rück, Christian
    Serlachius, Eva
    Prediction of outcome in internet-delivered cognitive behaviour therapy for paediatric obsessive-compulsive disorder: A machine learning approach2018Inngår i: International Journal of Methods in Psychiatric Research, ISSN 1049-8931, E-ISSN 1557-0657, Vol. 27, nr 1, artikkel-id e1576Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: There are no consistent predictors of treatment outcome in paediatric obsessive–compulsive disorder (OCD). One reason for this might be the use of suboptimal statistical methodology. Machine learning is an approach to efficiently analyse complex data. Machine learning has been widely used within other fields, but has rarely been tested in the prediction of paediatric mental health treatment outcomes.

    Objective: To test four different machine learning methods in the prediction of treatment response in a sample of paediatric OCD patients who had received Internet-delivered cognitive behaviour therapy (ICBT).

    Methods: Participants were 61 adolescents (12–17 years) who enrolled in a randomized controlled trial and received ICBT. All clinical baseline variables were used to predict strictly defined treatment response status three months after ICBT. Four machine learning algorithms were implemented. For comparison, we also employed a traditional logistic regression approach.

    Results: Multivariate logistic regression could not detect any significant predictors. In contrast, all four machine learning algorithms performed well in the prediction of treatment response, with 75 to 83% accuracy.

    Conclusions: The results suggest that machine learning algorithms can successfully be applied to predict paediatric OCD treatment outcome. Validation studies and studies in other disorders are warranted.

  • 111. Lesnierowska, Magdalena
    et al.
    Smoktunowicz, Ewelina
    Puchalska-Kaminska, Malwina
    Rzenca, Krzysztof
    Cieslak, Roman
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, Gerhard
    Resource-Oriented Internet Intervention for Occupational Stress among Medical Professionals (Med-Stress): Study Protocol for a Randomized Controlled Trial2018Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    Medical professionals are at high risk for job stress and burnout. Research show that the negative effects of stress can be reduced through strengthening personal resources such as self-efficacy and perceived social support. In line with cultivation and enabling hypotheses (Schwarzer & Knoll, 2007; Benight & Bandura, 2004) either self-efficacy cultivates perceived support, or rather perceived support enables self-efficacy. This study aims at testing both hypotheses in experimental design by applying them as a theoretical framework for the Med-Stress: evidence-based, CBI-framed internet intervention to foster resource accumulation among medical professionals.The effectiveness of intervention will be tested in a four-arm randomized controlled trial comparing the effects of: 1) self-efficacy and perceived support sequential enhancement (cultivation hypothesis), 2) perceived support and self-efficacy sequential enhancement (enabling hypothesis), 3) only self-efficacy, and 4) only social support enhancement (controls). Primary outcomes are job stress and burnout, secondary outcomes include work engagement, depression, and secondary traumatic stress. Self-efficacy and perceived support are expected to mediate the relationships between condition assignment and outcomes. Assessments include pre-test (Tl), three or six-weeks post-tests (depending on the condition, T2), as well as six- and twelve-months follow-ups (T3, T4). A total of N = 400 participants will be recruited. We will analyze intervention effect sizes and between-groups comparisons at post-intervention and follow-ups. This study will contribute to the findings on the role of personal resources in the development of job stress and burnout by demonstrating the cultivation vs enabling effects of self-efficacy and perceived social support.

  • 112.
    Letellier, Isabelle
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Du signifiant à l’inconscient comme béance: Lacan contre le structuralisme, vers Merleau-Ponty2016Inngår i: Revue roumaine de philosophie, ISSN 1220-5400, Vol. 60, nr 1, s. 39-53Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    When reading Lacan's text on Merleau-Ponty from 1961, commentators generally conclude that Lacan's critique makes clear the abyss that separates the two thinkers, which is fully supported by Lacan's absence of retractation. However, if one reads this text together with Merleau-Ponty's work, one can't but notice that Lacan's critique actually displays a qui pro quo on the notion of the signifier and its relation to the real. Lacan's reading of Le Visible et 1 'invisible in 1964 contrasts with this first critique in that it expresses a shift that affects his understanding of the relation between the signifier and the real. This results in a new elaboration of the concept of repetition that relies on the idea that the unconscious works as a gap (beance). Through this shift, Lacan steps away from structuralism and gets closer to Merleau-Ponty. This double move away from Levi-Strauss and towards Merleau-Ponty allows Lacan to get back to the investigation of the dynamic of structure, which goes along with a new reading of the Freudian notion of Spaltung.

  • 113. Leuzinger-Bohleber, Marianne
    et al.
    Bahrke, UlrichFischmann, TamaraArnold, Simon E.Hau, StephanStockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Flucht, Migration und Trauma: Die Folgen für die nächste Generation2017Collection/Antologi (Annet vitenskapelig)
    Abstract [de]

    Die Schicksale des ausgesetzten Königssohns Ödipus, von Odysseus, Persephone, Jason, Medea und vielen anderen Gestalten der Antike erinnern daran, dass Migration, Flucht und Trauma so alt sind wie die Menschheit selbst und sich in unbewussten Phantasien bei Individuen und Gruppen niedergeschlagen haben. Sie bilden oft unerkannte Quellen für Neugier und Interesse an Geflüchteten einerseits, aber auch von Fremdenhass, Antisemitismus und antimuslimischem Rassismus andererseits. Sie tragen zu den Spaltungsprozessen in vielen europäischen Gesellschaften im Zusammenhang mit der aktuellen Flüchtlingskrise bei. Zudem wecken Bilder von traumatisierten Geflüchteten Assoziationen zum Thema Trauma, das heißt zu extremen Erfahrungen, die das Selbst Todesangst, Hilflosigkeit und Ohnmacht aussetzen und derart überfluten, dass das Grundvertrauen in ein helfendes Objekt und ein aktives Selbst zusammenbricht. Dies mobilisiert den Impuls, wegzuschauen, zu verleugnen und die Augen vor dem Unerträglichen zu verschließen.

    In diesem Band möchten internationale Expertinnen und Experten aus unterschiedlichen Disziplinen, diesen Impulsen professionell begegnen, um sich traumatisierten Menschen mit Flucht oder Migrationserfahrung empathisch zuzuwenden und dadurch die transgenerative Weitergabe von Traumatisierungen abzumildern.

  • 114.
    Lilliengren, Peter
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Johansson, Robert
    Lindqvist, Karin
    Mechler, Jakob
    Andersson, Gerhard
    Efficacy of Experiential Dynamic Therapy for Psychiatric Conditions: a Meta-Analysis of Randomized Controlled Trials2016Inngår i: Psychotherapy, ISSN 0033-3204, E-ISSN 1939-1536, Vol. 53, nr 1, s. 90-104Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Experiential dynamic therapy (EDT) is a subgroup of short-term psychodynamic psychotherapy (STPP) that emphasizes patients’ in-session affective processing. To evaluate the efficacy of EDT for psychiatric conditions, we conducted a meta-analysis of randomized controlled trials. Twenty-eight studies published between 1978 and 2014 were included, encompassing 1,782 adult patients with mood, anxiety, personality, or mixed disorders. Across targeted outcome domains, medium-size between-groups effects (Cohen’s ds ranging from 0.39 to 0.65) favored EDT over inactive controls at posttreatment and in symptom measures at follow-up. We found no differences between EDT and active treatments (e.g., medication, cognitive–behavioral therapy, manualized supportive therapy) at posttreatment, but EDT outperformed supportive therapy at follow-up (d = 0.75). In terms of within-group effect sizes, EDT was associated with large improvements in general psychiatric symptoms (d = 1.11), depression (d = 1.33), and anxiety (d = 1.09) and with small to moderate gains in the areas of interpersonal problems (d = 0.55) and global functioning (d = 0.86). Small but significant effects suggested continued improvement between posttreatment and follow-up. Heterogeneity in pre–post effects was explored in subgroup analyses, which indicated that EDT might be most effective in depressive disorders and that individual EDT had larger effects compared with group treatment. In addition, EDT performed better in higher quality studies. We conclude that EDT is a promising treatment for psychiatric conditions in adults. Further high-quality studies evaluating contemporary versions of EDT in specific psychiatric conditions are warranted.

  • 115.
    Lilliengren, Peter
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Johansson, Robert
    Town, Joel M.
    Kisely, Steve
    Abbass, Allan
    Intensive Short-Term Dynamic Psychotherapy for generalized anxiety disorder: A pilot effectiveness and process-outcome study2017Inngår i: Clinical Psychology and Psychotherapy, ISSN 1063-3995, E-ISSN 1099-0879, Vol. 24, nr 6, s. 1313-1321Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The objective of this study was to evaluate the clinical- and cost-effectiveness of Intensive Short-Term Dynamic Psychotherapy (ISTDP) for generalized anxiety disorder (GAD). We further aimed to examine if a key clinical process within the ISTDP framework, termed the level of mobilization of unprocessed complex emotions (MUCE), was related to outcome. The sample consisted of 215 adult patients (60.9% female) with GAD and comorbid conditions treated in a tertiary mental health outpatient setting. The patients were provided an average of 8.3 sessions of ISTDP delivered by 38 therapists. The level of MUCE in treatment was assessed from videotaped sessions by a rater blind to treatment outcome. Year-by-year healthcare costs were derived independently from government databases. Multilevel growth models indicated significant decreases in psychiatric symptoms and interpersonal problems during treatment. These gains were corroborated by reductions in healthcare costs that continued for 4years post-treatment reaching normal population means. Further, we found that the in-treatment level of MUCE was associated with larger treatment effects, underlining the significance of emotional experiencing and processing in the treatment of GAD. We conclude that ISTDP appears to reduce symptoms and costs associated with GAD and that the ISTDP framework may be useful for understanding key therapeutic processes in this challenging clinical population. Controlled studies of ISTDP for GAD are warranted.

  • 116.
    Lindau, Maria
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Kognitiv psykologi.
    Najström, Mats
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Predictive accuracy of Wechsler Adult Intelligence Scale, forth ed., (WAIS-IV) seven- and four- subtest short form models in estimating full scale IQ (FSIQ) and its indices in a Swedish non-clinical sample2016Inngår i: Proceedings of 4th Global Experts Meeting on Neuropharmacology, 2016Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Neurodegenerative disorders usually show characteristic cognitive profiles, determined by the anatomical dispersion of neuronal loss. Short-term/memory decline is a presenting symptom on Alzheimer’s disease, but atypical early signs also occur. The Wechlser Adult Intelligence Scale (WAIS) may be used to differentiate between normal and sub-normal cognitive performance levels, such as pre-dementia stages, AD and related disorders. According to Meyers et al., (2013), a brief measure consisting of a seven-subtest short form (SF) of the WAIS-IV including Block Design (BD), Similarities (SI), Digit Span (DS), Arithmetic (AR), Information (IN) Coding (CD) and Picture Completion (PC) provides a valid means of measuring cognitive level. In order to validate a short form of WAIS-IV on a Swedish non-clinical sample the aim of the present study was to assess the ability of the seven-subtest SF as well as a reduction of the number of subtests in the SF based on standardized β-values, to predict the full scale IQ (FSIQ) and its indices. WAIS-IV scaled score data from 98 healthy individuals (19-90 years M=46 years, SD=23 years, females=48, males=50) were analyzed with linear regression, which showed that the seven predictors explained 92.5% of the variance in FSIQ. When reducing the SF-set the four highest β-values were obtained from the following subtests: CD, β=0.34 (Processing Speed), SI, β=0.31 (Verbal Comprehension), BD, β=0.25 (Perceptual Reasoning), and AR, β=0.23 (Working memory), which showed to be one subtest from each of the four indices. FSIQ prediction rate of these four subtests was 88.1%. Each of the four subtests correlated significantly on p=<0.01 level with its index. To conclude, FSIQ prediction accuracy for the seven-subtest SF is very high, as well as for the four-subtest model. Since the four-subtest model strongly predicts FSIQ, as well as all its indices, it may be a valid, and timesaving, instrument to assess short-term memory (AR, partly CD) deficits typical for different stages of AD, signs on non-amnestic decline in AD, as well as typical clinical manifestations of frontotemporal degeneration, Parkinson’s disease, Lewy body disease, ischemic brain disorders and cognitive dysfunctions associated with depression. In unclear cases additional testing is necessary. Further analyses will reveal possible influences on the norms of age, genus and education.

  • 117.
    Lindbäck, Malin
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Tre fallstudier av kognitiv beteendeterapi vid smärtsam endometrios2017Independent thesis Advanced level (professional degree), 10 poäng / 15 hpOppgave
    Abstract [sv]

    Endometrios är en vanlig gynekologisk problematik som ofta är smärtsam. Trots att flera studier påpekar hög prevalens av psykiatrisk komorbiditet bland kvinnor med endometrios och att psykoterapeutiska och psykologiska insatser förordas så finns mycket lite forskning kring psykologisk behandling vid endometrios. Den här studien var explorativ och undersökte kvantitativa effekter och kvalitativa detaljer från tre fallstudier av kognitiv beteendeterapi vid smärtsam endometrios. Behandlingen innehöll fyra behandlingsmoment; psyko-edukation, fallformulering, beteendeförändring/exponering samt mindfulness och gavs i komprimerad form vid fem behandlingssessioner. Behandlingarna föll väl ut och fick positiva utvärderingar av samtliga patienter. Resultaten var blandade men vissa förbättringar kunde ses. En patient hade i slutet av studien ökad livskvalitet, sänkt nedstämdhet, minskad katastrofiering, ökad aktivitet och sänkt funktionsnedsättning. Den andra patienten beskrev behandlingen positivt men fick få utslag i mätningar utöver tendens till minskad katastrofiering. I slutet av studien färgades hennes mätningar av förändrat hälsotillstånd, som antagligen överskuggade eventuella positiva effekter av behandlingen. Den tredje patienten hade svårigheter med att följa behandlingsplanen och hade en varierande funktionsnivå. Problem uppstod kring hennes mätresultat men de visade tendens till ökad livskvalitet, minskad katastrofiering och minskad funktionsnedsättning. Resultaten ses som lovande och ytterligare utveckling av kognitiv beteendeterapeutisk behandling vid smärtsam endometrios föreslås.

  • 118.
    Lindner, Philip
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institute, Sweden.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Flodman, Erik
    Hebert, Amanda
    Poysti, Stephanie
    Hagkvist, Filip
    Johansson, Robert
    Zetterqvist Westin, Vendela
    Berger, Thomas
    Andersson, Gerhard
    Does cognitive flexibility predict treatment gains in Internet-delivered psychological treatment of social anxiety disorder, depression, or tinnitus?2016Inngår i: PeerJ, ISSN 2167-8359, E-ISSN 2167-8359, Vol. 4, artikkel-id E1934Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Little is known about the individual factors that predict outcomes in Internet-administered psychological treatments. We hypothesized that greater cognitive flexibility (i.e. the ability to simultaneously consider several concepts and tasks and switch effortlessly between them in response to changes in environmental contingencies) would provide a better foundation for learning and employing the cognitive restructuring techniques taught and exercised in therapy, leading to greater treatment gains. Participants in three trials featuring Internet-administered psychological treatments for depression (n = 36), social anxiety disorder (n = 115) and tinnitus (n = 53) completed the 64-card Wisconsin Card Sorting Test (WCST) prior to treatment. We found no significant associations between perseverative errors on the WCST and treatment gains in any group. We also found low accuracy in the classification of treatment responders. We conclude that lower cognitive flexibility, as captured by perseverative errors on the WCST, should not impede successful outcomes in Internet-delivered psychological treatments.

  • 119.
    Lindner, Philip
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden; Stockholm Center for Dependence Disorders, Stockholm County Council, Sweden.
    Flodin, Pär
    Larm, Peter
    Budhiraja, Meenal
    Savic-Berglund, Ivanka
    Jokinen, Jussi
    Tiihonen, Jari
    Hodgins, Sheilagh
    Amygdala-orbitofrontal structural and functional connectivity in females with anxiety disorders, with and without a history of conduct disorder2018Inngår i: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 8, artikkel-id 1101Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Conduct disorder (CD) and anxiety disorders (ADs) are often comorbid and both are characterized by hyper-sensitivity to threat, and reduced structural and functional connectivity between the amygdala and orbitofrontal cortex (OFC). Previous studies of CD have not taken account of ADs nor directly compared connectivity in the two disorders. We examined three groups of young women: 23 presenting CD and lifetime AD; 30 presenting lifetime AD and not CD; and 17 with neither disorder (ND). Participants completed clinical assessments and diffusion-weighted and resting-state functional MRI scans. The uncinate fasciculus was reconstructed using tractography and manual dissection, and structural measures extracted. Correlations of resting-state activity between amygdala and OFC seeds were computed. The CD + AD and AD groups showed similarly reduced structural integrity of the left uncinate compared to ND, even after adjusting for IQ, psychiatric comorbidity, and childhood maltreatment. Uncinate integrity was associated with harm avoidance traits among AD-only women, and with the interaction of poor anger control and anxiety symptoms among CD + AD women. Groups did not differ in functional connectivity. Reduced uncinate integrity observed in CD + AD and AD-only women may reflect deficient emotion regulation in response to threat, common to both disorders, while other neural mechanisms determine the behavioral response.

  • 120.
    Lindner, Philip
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden.
    Frykheden, Ola
    Forsström, David
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, Erik
    Ljótsson, Brjánn
    Hedman, Erik
    Andersson, Gerhard
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    The Brunnsviken Brief Quality of Life Scale (BBQ): Development and Psychometric Evaluation2016Inngår i: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 45, nr 3, s. 182-195Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Measurements of subjective quality of life (QoL) are an important complement to symptom ratings in clinical research and practice. Despite there being several established QoL self-rating scales, we identified a need for a freely accessible, easy-to-use inventory, validated for use with both clinical and non-clinical samples, based on the overall life satisfaction conceptualization of QoL. The Brunnsviken Brief Quality of life scale (BBQ) was designed to meet these requirements. Items were selected by performing a factor analysis on a large data-set of QoL ratings collected previously. Six life areas (Leisure time, View on life, Creativity, Learning, Friends and Friendship, and View of self) were identified as important for overall QoL and were included in the BBQ. A psychometric evaluation was performed using two independent samples: healthy undergraduate students (n = 163), and a sample seeking treatment for social anxiety disorder (n = 568). Results suggested a unifactorial structure, with good concurrent and convergent validity, high internal and test-retest reliability, and accurate classification ability. We conclude that the BBQ is a valid and reliable measure of subjective QoL for use in clinical and research settings. The BBQ is presently available in 31 languages and can be freely downloaded from www.bbqscale.com.

  • 121.
    Lindner, Philip
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Miloff, Alexander
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Fagernäs, Simon
    Andersen, Joel
    Sigeman, Martin
    Andersson, Gerhard
    Furmark, Tomas
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Therapist-led and at-home one-session Virtual Reality exposure therapy for public speaking anxiety using consumer hardware and software, with online maintenance: A randomized controlled trial2017Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Introduction: Exposure therapy is an effective treatment of public speaking anxiety (PSA), yet inherent logistic challenges prevent widespread dissemination. Previous research has revealed that Virtual Reality (VR) may be effectively used for realistic stimuli presentation, but past generations of VR hardware have been inaccessible and expensive. We reasoned that VR stimuli, delivered using modern consumer hardware and software, would enable one-session treatment of PSA, both in the form of traditional therapist-led treatment and as an internet intervention.

    Methods: N=50 adult participants from the general public with clinically significant PSA were recruited and randomized to either therapist-led one-session treatment followed by online maintenance promoting in-vivo exposure, or waiting-list. The three-hour exposure session included psychoeducation and had participants conducting speech exercises, framed as behavioral experiments targeting idiosyncratic catastrophic beliefs, in front of virtual audiences, and listening to audio recording afterwards. Primary outcome measure was selfreported PSA, assessed using a validated instrument, measured before and after the treatment session, weekly during the four-week maintenance period, and at the end. After the first phase of the study, the waiting-list group received a simple VR headset by post and were given access to an online version of the same treatment (including the maintenance program), conducted their own one-session treatment followed by the same maintenance program, and reported PSA using the same intervals as before. Data were analyzed using mixed effects modeling.

    Results: A significant time*group effect was found such that the treatment group reported a 6.92-point larger decrease in PSA symptoms per treatment step than the waiting-list, corresponding to a between-group d=0.84 after the one-session treatment, growing to d=1.56 after the maintenance period. Piece-wise modeling of the waiting-list group’s PSA scores before and after they received their at-home equivalent treatment revealed a 6.39-point difference in decrease (per step) after receiving treatment compared to before, corresponding to a within-group d=1.22 after the at-home one-session treatment, growing to d=1.78 after the maintenance period.

    Conclusions: This trial demonstrates that simple, consumer VR hardware and software can be used to treat PSA using a one-session format, with large effect sizes. To our knowledge, this is the first study to evaluate the potential of internet-administered, at-home VR treatment, the results of which are promising.

  • 122.
    Lindner, Philip
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Miloff, Alexander
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Fagernäs, Simon
    Andersen, Joel
    Sigeman, Martin
    Andersson, Gerhard
    Furmark, Tomas
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Therapist-led and self-led one-session Virtual Reality exposure therapy for public speaking anxiety with consumer hardware and software: A randomized controlled trial2018Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    Public speaking anxiety (PSA) is a common condition which can be treated effectively with exposure therapy. However, inherent difficulties in stimuli presentation and control limits dissemination and the therapeutic potential. Virtual Reality (VR) technology has the potential to resolve these issues and provide a scalable platform for self-help interventions. No previous study has examined whether this can be achieved using the first generation of consumer VR hardware and software. In the current trial, n=25+25 participants were randomized to either one-session VR exposure therapy for PSA followed by a four-week internet-administered VR to in-vivo transition program, or a waiting-list. Linear mixed effects modeling revealed significant, large (within Cohen’s d=1.67) decreases in self-reported PSA. The waiting-list was then given access to an internet-administered, self-led version of the same VR exposure therapy to be conducted at home, followed by the same transition program. Dual-slope mixed effects modeling revealed significant, large (d=1.35) decreases in self-reported PSA. Results were maintained or improved at the six-month follow-up. We show for the first time that low-cost, off-the-shelf consumer VR hardware and software can be used to conduct exposure therapy for PSA, both in the traditional, previously unpractical one-session format, and in a novel self-led, at-home format.

  • 123.
    Lindner, Philip
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden.
    Miloff, Alexander
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Hamilton, William
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Mimerse, Sweden.
    Reuterskiöld, Lena
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, Gerhard
    Powers, Mark B.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Creating state of the art, next-generation Virtual Reality exposure therapies for anxiety disorders using consumer hardware platforms: Design considerations and future directions2017Inngår i: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 46, nr 5, s. 404-420Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Decades of research and more than 20 randomized controlled trials show that Virtual Reality exposure therapy (VRET) is effective in reducing fear and anxiety. Unfortunately, few providers or patients have had access to the costly and technical equipment previously required. Recent technological advances in the form of consumer Virtual Reality (VR) systems (e.g. Oculus Rift and Samsung Gear), however, now make widespread use of VRET in clinical settings and as self-help applications possible. In this literature review, we detail the current state of VR technology and discuss important therapeutic considerations in designing self-help and clinician-led VRETs, such as platform choice, exposure progression design, inhibitory learning strategies, stimuli tailoring, gamification, virtual social learning and more. We illustrate how these therapeutic components can be incorporated and utilized in VRET applications, taking full advantage of the unique capabilities of virtual environments, and showcase some of these features by describing the development of a consumer-ready, gamified self-help VRET application for low-cost commercially available VR hardware. We also raise and discuss challenges in the planning, development, evaluation, and dissemination of VRET applications, including the need for more high-quality research. We conclude by discussing how new technology (e.g. eye-tracking) can be incorporated into future VRETs and how widespread use of VRET self-help applications will enable collection of naturalistic “Big Data” that promises to inform learning theory and behavioral therapy in general.

  • 124.
    Lindner, Philip
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Miloff, Alexander
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Reuterskiöld, Lena
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, Gerhard
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Predicting treatment outcomes after Virtual Reality exposure therapy using gaze proxy data collected during exposure: Preliminary findings2018Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    BACKGROUND: Virtual Reality exposure therapy (VRET) is an efficacious treatment of phobias and allows for automatic data collection during standardized yet naturalistic exposure paradigms, yet next to no research has explored the clinical potential of such data. GOALS: To explore the predictive potential of using gaze proxy data collected during VRET to predict treatment outcomes. METHODS: Gaze focus proxy data from n=29 participants undergoing gamified, self-help VRET for spider phobia were extracted, compiled, and modeled. The VRET session featured eight levels with increasingly frightening spiders, each with an approach task requiring participants to keep looking at the phobic object for a specified time. Relative spider gaze focus was defined as time spent looking at each spider at each level (derived from head movement and overlap) divided by total time in level. High- versus low-improvement was defined using median-split on subsequent improvements on an in-vivo behavioral approach task. RESULTS: During the final three levels of the exposure session, relative spider focus time was initially lower among high-improvers (p=.039) and the decrease was lower over levels than among the low-improvers (p=.029). This suggests that non-improvers experienced a fear level mismatch during the final exposure phase. There were no differences in gaze patterns during other phases of the session. CONCLUSIONS: These preliminary results suggest that gaze proxy data automatically collected during VRET, even when rudimentary, can be used to predict treatment outcomes, and may thus be used to automatically personalize the exposure design of VRET self-help applications during actual use, to increase efficacy.

  • 125.
    Lindner, Philip
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Miloff, Alexander
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Zetterlund, Elin
    Reuterskiöld, Lena
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, Gerhard
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Attitudes towards and familiarity with Virtual Reality therapy among practicing cognitive behavior therapists: A first survey study in the era of consumer VR platforms2018Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    Objectives: To survey attitudes towards, knowledge of and familiarity with Virtual Reality (VR) technology and VR exposure therapy among practicing cognitive behavior therapists, after the recent release of consumer VR platforms, with the aim of identifying potential human barriers to implementing this technology and therapeutic method in regular care. Participants: 185 practicing cognitive behavior therapists attending a conference.Measures: Self-rated likelihood of future use of VR in a clinical setting, applicability of VR to treating specific mental disorders, as well as ratings of different positive and negative aspects of VR exposure therapy – all assessed using a standardized survey.Results: Very few respondents reported having used VR clinically. Therapists had an overall positive attitude toward VRET (pros rated higher than cons) and viewed VR as applicable to conditions other than anxiety. Unlike in earlier research, a high financial cost was no longer a top-rated negative aspects. Average negative attitude was a larger negative predictor of self-rated likelihood of future use than positive attitude was a positive predictor.Conclusions: We conclude that therapist’s attitudes towards VRET appear to have evolved in recent years, coinciding with the release of consumer VR platforms, and no longer appear to constitute a major barrier to implementing the next generation of VR technology in regular clinical practice.

  • 126.
    Lindner, Philip
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Nordby, Kent
    Rozental, Alexander
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Svartdal, Frode
    Domain-specific quality of life across five European countries: Cross-cultural validation of the Brunnsviken Brief Quality of life (BBQ) scale2016Inngår i: EABCT 2016 Abstract Book: Total Awareness, 2016, s. 590-590Konferansepaper (Fagfellevurdert)
    Abstract [en]

    The Brunnsviken Brief Quality of life (BBQ) scale is a valid, reliable and accessible self-report measure of subjective quality of life for use with both clinical and non-clinical populations. Although the BBQ has been professionally translated from original Swedish into over thirty languages, psychometric evaluations of other language versions are so far lacking. BBQ data was collected as part of an international study on procrastination in students and employees: n = 749 from Finland, n = 599 from Sweden, n = 542 from Norway, n = 411 from Germany, and n = 315 from Italy. Weighted satisfaction ratings (score range 0-16) for each of the BBQ’s six domains (Leisure, View on life, Creativity, Learning, Friends and friendships, and View on self), along with a total sum score and Cronbach’s alphas, were calculated and compared. Samples did not differ in BBQ total scores (F[4,2611] = 1.006, p = .403). Although there were some differences between samples on specific items, these were small (total difference M = 0.00, SD = 0.74) and confidence intervals overlapped, with the exception of the German sample that rated lower Learning than all other samples (p < .05, Bonferroni-adjusted). Cronbach’s alpha ranged from 0.752 (Finland) to 0.674 (Italy). Convergent validity (as assessed by correlations with scores on the Satisfaction With Life Scale) was high, ranging from r = .64 (Finland) to r = .42 (Italy). The BBQ is a valid measure of subjective quality of life in the examined languages. There are only minor cross-country differences in the quality of life domains measured by the BBQ.

  • 127.
    Lindner, Philip
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Rozental, Alexander
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Forsström, David
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, Gerhard
    Furmark, Tomas
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Differential impact of performance and interaction related types of social anxiety symptoms on different quality of life domains2016Inngår i: EABCT 2016 Abstract Book: Total Awareness, 2016, s. 748-748Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Social anxiety disorder (SAD) is a common disorder associated with impaired quality of life (QoL), that indexes anxious distress and avoidance related to social situations. The DSM-5 features a specifier to delineate those with only performance-related social anxiety, yet little is known whether performance- and interaction-related anxieties have a differential impact on total QoL and on different QoL domains. To investigate this, we pooled screening data from eight intervention studies for SAD (n = 2017). Total sample mean age was 35.28 (SD = 12.26) and 69% were female. SAD symptoms were measured using the self-rated Liebowitz Social Anxiety Scale with items classified as measuring either performance or interaction anxiety. QoL, both total and across four domains, was measured using the Quality of Life Inventory. Data was analyzed using multiple regression models featuring the two anxiety scores as predictors, and by simulating the Performance-only specifier through 2˙2 median-split subgrouping and standard ANOVAs. Both interaction and performance anxieties were independently associated with lower QoL in general and across domains. Interaction anxiety had a larger negative impact on Personal Growth- and Achievement-related QoL than performance anxiety. The High-Performance/Low-Interaction-group rated higher Achievement-related QoL compared to the Low-Performance/High-Interaction-group (p = .012), yet groups were matched on total QoL and on other domains. Other group differences were in the expected direction.

    QoL impairments in SAD is primarily driven by number of feared social situations, and only secondarily by types of fear social situations, with interaction anxiety having a larger, negative impact on some QoL domains.

  • 128.
    Lindner, Philip
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Silijehom, Ola
    Johansson, Magnus
    Forster, Martin
    Andreasson, Sven
    Hammberg, Anders
    Combining online community reinforcement and family training with a parent training program for parents with partners suffering from alcohol use disorder: Study protocol for a randomized controlled trial2018Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    Introduction: Partners and children of individuals with alcohol use disorder (AUD) present impaired quality of life and mental health, yet seldom seek or participate in traditional supportive interventions. Engaging the parent/partner without AUD in treatment is a promising way of supporting behavior change in both the child and the parent with AUD. Universal parent training (PT) programs are effective in increasing children´s well-being and decreasing problem behaviors, but have yet to be tailored for children with a parent with AUD. Community reinforcement approach and family training (CRAFT) programs are conceptually similar, and aim to promote behavior change in individuals with AUD by having a concerned significant other change environmental contingencies. There has been no study on whether these two interventions can be combined and tailored for partners of individuals with AUD with common children, and delivered as accessible, online self-help. Methods and analysis: N=300 participant who share a child showing mental health problems with a person with AUD, but do not present AUD themselves, will be recruited from the general public and randomized 1:1 to either a four-module, online combined PT and CRAFT program, or a psychoeducation-only comparison intervention. Primary outcome will be the child’s mental health. Additional outcomes will cover the partner’s drinking, the participants own mental health and drinking, the child’s social adjustment, treatment-seeking in all three parties, and parental self-efficacy. Measures will be collected pre-, mid- and post-intervention, and three times during a two-year follow-up period. Data will be analyzed using mixed effects modeling. Trial status: This trial is currently recruiting.

  • 129.
    Lindner, Philip
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden; Stockholm County Council, Sweden.
    Siljeholm, Ola
    Johansson, Magnus
    Forster, Martin
    Andreasson, Sven
    Hammarberg, Anders
    Combining online Community Reinforcement and Family Training (CRAFT) with a parent-training programme for parents with partners suffering from alcohol use disorder: study protocol for a randomised controlled trial2018Inngår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, nr 8, artikkel-id e020879Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction: Partners and children of individuals with alcohol use disorder (AUD) present with impaired quality of life and mental health, yet seldom seek or participate in traditional supportive interventions. Engaging the parent/partner without AUD in treatment is a promising way of supporting behavioural change in both the child and the parent with AUD. Universal parent-training (PT) programmes are effective in increasing children’s well-being and decreasing problem behaviours, but have yet to be tailored for children with a parent with AUD. Community Reinforcement Approach And Family Training (CRAFT) programmes are conceptually similar, and aim to promote behavioural change in individuals with AUD by having a concerned significant other change environmental contingencies. There has been no study on whether these two interventions can be combined and tailored for partners of individuals with AUD with common children, and delivered as accessible, online self-help.

    Methods and analysis: n=300 participants with a child showing mental health problems and partner (co-parent) with AUD, but who do not themselves present with AUD, will be recruited from the general public and randomised 1:1 to either a four-module, online combined PT and CRAFT programme or a psychoeducation-only comparison intervention. Primary outcome will be the child’s mental health. Additional outcomes will cover the partner’s drinking, the participants own mental health and drinking, the child’s social adjustment, treatment seeking in all three parties and parental self-efficacy. Measures will be collected preintervention, mid-intervention and postintervention, and three times during a 2-year follow-up period. Data will be analysed using mixed-effects modelling.

    Ethics and dissemination: This study has been approved by the Stockholm Regional Ethical Review Board (2016/2179-31). The results will be presented at conferences and published as peer-reviewed publications.

    Trial registration number: ISRCTN38702517; Pre-results.

  • 130.
    Ljunggren, Ingrid
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Samtalet som psykologisk metod2014Bok (Annet vitenskapelig)
    Abstract [sv]

    Samtalet som psykologisk metod presenterar konkreta beskrivningar och en systematisering av generiska professionella samtalsfärdigheter. De har ofta betecknats som s.k. tyst kunskap och som därför inte tidigare i nämnvärd utsträckning har systematiserats så att man kan beskriva vad och hur man gör när man leder ett professionellt samtal. Dessa generiska färdigheter är av sådan karaktär att de ligger till grund för alla professionella psykologuppdrag. Boken ger även förslag på hur undervisning och bedömning av samtalsfärdigheter kan läggas upp.

    Boken vänder sig i första hand till psykologstudenter men även till studenter vid övriga professionsutbildningar där samtalet är ett professionellt verktyg. Det kan till exempel vara socionomer, läkare och jurister. Förhoppningsvis kan även redan yrkesverksamma ha glädje av boken.

  • 131.
    Ljunggren, Ingrid
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Stödsamtal och stödterapi2017Bok (Annet vitenskapelig)
    Abstract [sv]

    Många olika yrkesgrupper använder stödjande samtal professionellt. Stödsamtal och stödterapi används inom till exempel sjukvård, social­­tjänst, skola och psykiatri när man av olika skäl inte kan erbjuda traditionell och evidensbaserad psykoterapi.Trots att dessa stödformer är så vanliga har de inte särskilt hög status och är inte heller väl utforskade. De bygger därmed till stor del på samtalsledarens egna erfarenheter och tysta kunskap om vad som är viktigt i stödjande samtal.


    Denna bok operationaliserar och konkretiserar begrepp som hjälper oss att förstå vad skickliga stödsamtalsledare och stödterapeuter gör, hur de gör det och varför. Därmed synliggörs professionella stödsamtal och stödterapi som det kvalificerade arbete det faktiskt är.


    I boken beskrivs den professionella samtalsledarens generiska samtals­färdigheter. Både stödsamtalet och stödterapin ges en teoretisk ram men presenteras också med konkreta exempel. Såväl det gemensamma som skillnaderna mellan de båda stödformerna tydliggörs.


    Stödsamtal och stödterapi riktar sig främst till professionella hjälpare inom psykiatri, vård, skola och omsorg samt till studenter inom dessa utbildningsområden. Den är en fristående fortsättning till Samtalet som psykologisk metod (2014).

  • 132.
    Lundgren, Tobias
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden.
    Parling, Thomas
    Swedish Acceptance and Action Questionnaire (SAAQ): A psychometric evaluation2017Inngår i: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 46, nr 4, s. 315-326Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 133. Lussier, Desiree
    et al.
    Hayes, Rita
    Horta, Marilyn
    Lin, Tian
    Frazier, Ian
    Weir, Devon
    Perez, Eliany
    Fischer, Håkan
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Biologisk psykologi.
    Månsson, Kristoffer
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden.
    Feifel, David
    Ebner, Natalie
    Four-week Intranasal Oxytocin vs Placebo Administration Modulation of Amygdala and Accumbens Volume2018Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    Introduction: Gray matter (GM) volumes of limbic and striatal structures, including the amygdala (AMY)1 and the nucleus accumbens (NAcc)2, are associated with socioemotional phenotypes. For instance, GM atrophy accompanies some dementias in which socioemotional processing is impaired2,3. Evidence suggests that intranasally administered oxytocin (OT) exerts a modulatory effect on socioemotional processing4, with the AMY5,6 and NAcc7 constituting strong potential targets for this in the brain modulatory process. There, further, is evidence that AMY volume is associated with endogenous OT levels in young adults8. However, the generalizability of this finding to older adults is currently unknown. Additionally, literature describing the effects of long-term OT administration on the aging brain is lacking.

    Methods: Twenty-four healthy male participants, aged 55 years and older, were randomly assigned in a double-blind design to self-administer intranasally either 24IUs of OT or placebo (P) twice daily for four weeks as part of an ongoing clinical trial conducted at the University of Florida. A structural T1-weighted magnetization prepared rapid gradient-echo (MPRAGE) (1 mm3 isotropic voxels) scan was acquired at baseline and again posttreatment using a 3T Phillips scanner with a 32-channel head coil. Freesurfer was used for whole-brain structural segmentation9. Subcortical segmentation statistics (aseg.stat) volumetrics were extracted and analyses were conducted with Rstudio. The Stats10 package for R was used to run paired t-tests within each of the two treatment conditions (OT vs. P) to determine volume changes in amygdala and nucleus accumbens pre- to post-treatment. All analyses were conducted blind to the experimental conditions. Unblinding will be undertaken prior to the presentation of the final results.

    Results: T-tests resulted in a significant increase in bilateral NAcc GM volume for one (t = -5.60, df = 12, p-value < 0.001 left; t = -4.2851, df = 12, p-value = 0.001 right) but not in the other (t = -1.58, df = 10, p-value = 0.149 left; t = t = -1.78, df = 10, p-value = 0.105 right) treatment condition. Additionally, there was a trend-wise decrease in total GM volume from pre- to post-treatment in the right AMY in one (t = 3.20, df = 12, p-value = 0.008) but not in the other (t = 0.89, df = 10, p-value = 0.396) treatment condition. However, this observation was reversed for the left AMY (t = 1.130, df = 12, p-value = 0.280 and t = 3.2065, df = 10, p-value = 0.009, respectively).

    Conclusions: The results of this project suggest that 4-week intranasal OT vs. P administration differentially modulates brain volume in AMY and NAcc in healthy older men, with these modulatory effects possibly lateralized for the AMY. These findings are in line with previous literature showing that there may be hemispheric differences in socioemotional task-related AMY activation. Future extensions of this work will include a larger sample size to confirm the robustness of the findings and investigation into associations with socioemotional functioning.

  • 134. Långh, Ulrika
    et al.
    Hammar, Martin
    Klintwall, Lars
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Bölte, Sven
    Allegiance and knowledge levels of professionals working with early intensive behavioural intervention in autism2017Inngår i: Early Intervention in Psychiatry, ISSN 1751-7885, E-ISSN 1751-7893, Vol. 11, nr 5, s. 444-450Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim: Early intensive behavioural intervention (EIBI) for children with autism spectrum disorder (ASD) is often delivered using a community model. Behaviourmodification experts train and supervise non-experts (e.g. preschool personnel) to teach children according to applied behaviour analysis principles in their natural environment. Several factors predict EIBI outcomes in ASD, for example, knowledge of EIBI and EIBI allegiance among trainers. The aim of the present study was to survey levels of knowledge about and allegiance towards EIBI.

    Methods: Formal knowledge of EIBI and EIBI allegiance was surveyed in supervised preschool staff conducting EIBI (n = 33), preschool staff not involved in EIBI (n = 26), behaviour modification experts (n = 60), school staff (n = 25) and parents of children with ASD (n = 150) [N = 294]. A 27-item (15 knowledge and 12 allegiance questions) online questionnaire was collected.

    Results: Supervised preschool staff conducting EIBI had more knowledge than preschool staff not using EIBI, but they were not more allegiant. Compared with behaviour modification experts, the supervised EIBI preschool staff group showed markedly less knowledge and allegiance.

    Conclusions: Findings indicate potential for improvement regarding formal knowledge levels of preschool staff delivering EIBI to children with ASD in real-world settings. In addition, fostering EIBI allegiance might be prioritized when teaching EIBI among non-experts. Broadly increased EIBI knowledge levels among all preschool teachers should be achieved by adding behaviour modification techniques to common university curricula in preschool education. Allegiance of preschool personnel might be accomplished by EIBI supervisors meeting skepticism in practice with conveyance of evidence-based principles and discussions of ethical issues.

  • 135.
    Ma, Lichen
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Zetterlund, Elin
    Nöjd, Sofia
    Ek, Anna-Karin
    Åbyhammar, Gustaf
    Kruijt, Anne-Wil
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Furmark, Tomas
    Andersson, Gerhard
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Attentional bias modification in virtual reality2017Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Introduction: It has been theorised that attentional biases (sensitivity and hypervigilance towards threat-related information) may play a causal role in the aetiology and maintenance of dysfunctional anxiety. Attentional bias modification (ABM) aims to directly modify the underlying attentional biases implicated in anxiety disorders, and consequently reduce anxiety symptoms.

    We conducted two studies that examined the effectiveness of ABM training programs in reducing attentional bias and anxiety. Both programs were delivered via virtual reality (VR) technology. Study 1 utilised a traditional dot-probe ABM, and Study 2 utilised a Person Identity Match (PIM) ABM. In addition to the comparison of two different ABM programs, the studies also investigated whether the use of 3 dimensional stimuli has an impact on the outcome of the ABM training.

    Methods:

    Study 1

    One hundred participants with elevated anxiety scores (LSAS > 30) were randomly assigned to 4 groups:

    1. ABM with 2D stimuli (n = 25)2. Mock-ABM with 2D stimuli (n = 25)3. ABM with 3D stimuli (n = 25)4. Mock-ABM with 3D stimuli (n = 25)

    The participants first completed questionnaires that measured their anxiety and other factors of interest. After which the participants completed 100 trials of a dot-probe task to measure their pre-training attentional bias. The participants then completed 360 trials of ABM training. Following ABM, the participants carried out post-training bias measurement and anxiety measurement. Finally, the participants answered follow-up questionnaires 1 week and 3months after the ABM training.

    Study 2

    Study 2 shares the exact same design as Study 1, but utilised a different version of ABMtraining.

    Results: Data analysis is currently ongoing and results are pending. The change in attentional bias and anxiety are the primary outcome measures. Both within-group comparisons (pre-training vs. post-training) and between-group comparisons (ABM vs. mock; 2D vs 3D; Dot-probe vs. PIM) will be carried out. Some preliminary results will be presented at the conference.

    Conclusions: Pending

  • 136. Magnusson, Kristoffer
    et al.
    Rozental, Alexander
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Boettcher, Johanna
    Andersson, Gerhard
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    For better or worse: An individual patient data meta-analysis of deterioration among participants receiving Internet-based cognitive behavior therapy2016Inngår i: EABCT 2016 Abstract Book: Total Awareness, 2016, s. 285-285Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Objective: Psychological treatments can relieve mental distress and improve well-being, and the dissemination of evidencebased methods is believed to aid patients in gaining access to the right type of help. Meanwhile, Internet-based cognitive behavior therapy (ICBT) has shown promising results for many psychiatric disorders. However, research on the potential for negative effects of psychological treatments has been lacking. Method: An individual patient data meta-analysis of 29 clinical trials of ICBT (N = 2866) was performed using the Reliable Change Index for each of the primary outcome measures to distinguish deterioration rates among patients in treatment and control conditions. Statistical analyses of predictors were subsequently conducted using generalized linear mixed models. Missing data was handled by multiple imputation. Results: Deterioration rates were 122 (5.8%) in treatment and 130 (17.4%) in control conditions, yielding a total of 252 (8.8%). Patients in a control condition had higher odds of deteriorating, Odds Ratios (OR) 3.10, 95% Confidence Interval (CI) [2.21-4.34]. Clinical severity at pre treatment was related to lower odds, OR 0.62, 95% CI [0.50-0.77], and 0.51, 95% CI [0.51-0.80], for treatment and control conditions. In terms of sociodemographic variables, being in a relationship, 0.58, 95% CI [0.35-0.95], having at least a university degree, 0.54, 95% CI [0.33-0.88], and being older, 0.78, 95% CI, [0.62-0.98], were also associated with lower odds of deterioration, but only for patients assigned to treatment. Conclusion: Deterioration among patients receiving ICBT is not uncommon and should be monitored by researchers in order to reverse a negative treatment trend.

  • 137. Martin, Katherine Riley
    et al.
    Rothbaum, Barbara
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Botella, Cristina
    Peskin, Melissa
    Loucks, Laura
    Powers, Mark
    Real World Observations Using Virtual Reality Treatments for Anxiety and Related Disorders2018Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    This session will present recent advances in virtual reality therapy for depression, anxiety, and related disorders. Many of these advances are a result of a boom in personal consumer electronics. We will discuss both stationary (e.g. Virtually Better, Oculus Rift) and mobile (e.g. Samsung Gear) systems along with new stimuli and capture techniques. Together, these advances improve the efficacy and availability of high tech solutions to previous obstacles in the delivery of cognitive behavioral therapy. The first presentation is a randomized controlled trial of therapist and internet administered one-session virtual reality exposure therapy for public speaking anxiety. The second presentation is an Individual Patient Data Meta-Analysis (IPDMA) of 35 virtual reality studies with 846 patients. Outcome data include overall findings and deterioration rates along with moderators. The third presentation will describe the relationship between posttraumatic and depressive symptoms during virtual reality exposure therapy with a cognitive enhancer. The fourth presentation describes a study that examined the feasibility and efficacy of VRE in treating MST-related PTSD. The fifth presentation will discuss a randomized controlled trial of animated versus live action virtual reality therapy for anxiety & pain in a Level I Trauma Center. Finally, the discussant, who has decades of experience in the field of VRET, will cover implications and future directions in the field of VR in the treatment of mental disorders.

  • 138.
    Miloff, Alexander
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Lindner, Philip
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden.
    Hamilton, W.
    Reuterskiöld, Lena
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, Gerhard
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Single-session gamified virtual reality exposure therapy for spider phobia vs. traditional exposure therapy: A randomized-controlled trial2016Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Introduction: Traditional one-session therapy (OST) in which a patient is gradually exposed to feared stimuli for up to 3hrs in a one-session format has been found effective for the treatment of specific phobias. However, many suffering from specific phobia are reluctant to seek help and access to care is lacking. Virtual reality (VR) exposure therapy using a smartphone may improve upon existing techniques by facilitating access, lowering cost, and increasing acceptability and effectiveness. The aim of this study was to compare traditional OST with in-vivo spiders and a human therapist to a newly developed single-session gamified VR exposure therapy application with modern VR headsets, virtual spiders and a virtual therapist.

    Method: Participants with specific phobia to spiders (N=100) were recruited from the general public, screened and randomized to either OST (N=50) or VR exposure therapy (N=50) using the smartphone-based Samsung Gear VR system. A behavioral approach test using in-vivo spiders served as the primary outcome measure. Secondary outcome measures included spider phobia questionnaires, and self-reported anxiety, depression and quality of life. Outcomes were assessed 1-week before and after treatment and at follow-up (12 and 52 weeks).

    Results: At the time of submitting this abstract all participants have been included and randomized and a large portion has also received the allotted treatment. However, since the study uses strict blinding, results will not be available until March 2016.

    Discussion: VR exposure therapy has previously been evaluated as a treatment for specific phobias but there has been a lack of high-quality randomized controlled trials. A new generation of modern VR devices are being released which advance upon existing technology and have the potential to improve clinical availability and treatment effectiveness.

    Conclusion: Preliminary clinical observations suggest that single-session gamified virtual reality exposure therapy using a smartphone is effective for the treatment of spider phobia.

  • 139.
    Miloff, Alexander
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Lindner, Philip
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden.
    Hamilton, William
    Reuterskiöld, Lena
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, Gerhard
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Is virtual reality treatment for spider phobia noninferior to traditional one-session treatment? The results of a randomized-controlled trial2016Inngår i: EABCT 2016 Abstract Book: Total Awareness, 2016, s. 753-753Konferansepaper (Annet (populærvitenskap, debatt, mm))
    Abstract [en]

    This is the first large randomized-controlled trial to evaluate whether commercially available VR hardware and software can be used for exposure therapy. The aim of this study is to compare gold-standard One Session Treatment (OST) for reduction of spider phobia symptoms and avoidance behaviour using in vivo spiders and a human therapist, to a newly developed single-session gamified Virtual Reality Exposure Therapy (VRET) application with modern, consumer-available VR hardware, virtual spiders, and a virtual therapist. Subjects (N = 100) with spider phobia, diagnosed, and meeting inclusion criteria were recruited from the general population and randomized to 2 treatment arms. In 1-week intervals, pre-measurement, 3-hr treatment and post-measurement were completed with an in-vivo behavioral approach test (BAT) serving as the primary outcome measure for both groups. This study was powered to detect a non-inferiority margin of a 2-point between-group difference on the BAT, with a standard deviation of 4 (at 80% power). 98 patients commenced treatment and 97 patients completed post-measurement. Per protocol analysis indicated VR was not non-inferior to OST. Repeated-measures ANOVA identified a significant main effect of time (p < .001) and time x group effect (p < .05). Both OST and VR participants experienced large BAT within-group effect sizes (d = 2.28 and d = 1.45, respectively). OST is the superior treatment option for spider phobia. VRET is an effective alternative if OST cannot be provided, as pure self-help, as the initial intervention in a stepped-care model, or as a possible post-OST booster. Future studies will benefit from evaluating effectiveness of VRET when conducted at home.

  • 140.
    Miloff, Alexander
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Lindner, Philip
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden.
    Hamilton, William
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Mimerse, Stockholm, Sweden.
    Reuterskiöld, Lena
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, Gerhard
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Single-session gamified virtual reality exposure therapy for spider phobia vs. traditional exposure therapy: study protocol for a randomized controlled non-inferiority trial2016Inngår i: Trials, ISSN 1745-6215, E-ISSN 1745-6215, Vol. 17, artikkel-id 60Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Traditional one-session exposure therapy (OST) in which a patient is gradually exposed to feared stimuli for up to 3 h in a one-session format has been found effective for the treatment of specific phobias. However, many individuals with specific phobia are reluctant to seek help, and access to care is lacking due to logistic challenges of accessing, collecting, storing, and/or maintaining stimuli. Virtual reality (VR) exposure therapy may improve upon existing techniques by facilitating access, decreasing cost, and increasing acceptability and effectiveness. The aim of this study is to compare traditional OST with in vivo spiders and a human therapist with a newly developed single-session gamified VR exposure therapy application with modern VR hardware, virtual spiders, and a virtual therapist. Methods/design: Participants with specific phobia to spiders (N = 100) will be recruited from the general public, screened, and randomized to either VR exposure therapy (n = 50) or traditional OST (n = 50). A behavioral approach test using in vivo spiders will serve as the primary outcome measure. Secondary outcome measures will include spider phobia questionnaires and self-reported anxiety, depression, and quality of life. Outcomes will be assessed using a non-inferiority design at baseline and at 1, 12, and 52 weeks after treatment. Discussion: VR exposure therapy has previously been evaluated as a treatment for specific phobias, but there has been a lack of high-quality randomized controlled trials. A new generation of modern, consumer-ready VR devices is being released that are advancing existing technology and have the potential to improve clinical availability and treatment effectiveness. The VR medium is also particularly suitable for taking advantage of recent phobia treatment research emphasizing engagement and new learning, as opposed to physiological habituation. This study compares a market-ready, gamified VR spider phobia exposure application, delivered using consumer VR hardware, with the current gold standard treatment. Implications are discussed.

  • 141. Minns, Sean
    et al.
    Levihn-Coon, Andrew
    Carl, Emily
    Smits, Jasper A. J.
    Miller, Wayne
    Howard, Don
    Papini, Santiago
    Quiroz, Simon
    Lee-Furman, Eunjung
    Telch, Michael
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Xanthopoulos, Drew
    Powers, Mark B.
    Immersive 3D exposure-based treatment for spider fear: A randomized controlled trial2018Inngår i: Journal of Anxiety Disorders, ISSN 0887-6185, E-ISSN 1873-7897, Vol. 58, s. 1-7Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Stereoscopic 3D gives the viewer the same shape, size, perspective and depth they would experience viewing the real world and could mimic the perceptual threat cues present in real life. This is the first study to investigate whether an immersive stereoscopic 3D video exposure-based treatment would be effective in reducing fear of spiders. Participants with a fear of spiders (N = 77) watched two psychoeducational videos with facts about spiders and phobias. They were then randomized to a treatment condition that watched a single session of a stereoscopic 3D immersive video exposure-based treatment (six 5-min exposures) delivered through a virtual reality headset or a psychoeducation only control condition that watched a 30-min neutral video (2D documentary) presented on a computer monitor. Assessments of spider fear (Fear of Spiders Questionnaire [FSQ], Behavioral Approach Task [BAT], & subjective ratings of fear) were completed pre- and post-treatment. Consistent with prediction, the stereoscopic 3D video condition outperformed the control condition in reducing fear of spiders showing a large between-group effect size on the FSQ (Cohen's d = 0.85) and a medium between group effect size on the BAT (Cohen's d = 0.47). This provides initial support for stereoscopic 3D video in treating phobias.

  • 142. Månsson, K. N. T.
    et al.
    Salami, A.
    Frick, A.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, G.
    Furmark, T.
    Boraxbekk, C.-J.
    Neuroplasticity in response to cognitive behavior therapy for social anxiety disorder2016Inngår i: Translational Psychiatry, ISSN 2158-3188, E-ISSN 2158-3188, Vol. 6, artikkel-id e727Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Patients with anxiety disorders exhibit excessive neural reactivity in the amygdala, which can be normalized by effective treatment like cognitive behavior therapy (CBT). Mechanisms underlying the brain’s adaptation to anxiolytic treatments are likely related both to structural plasticity and functional response alterations, but multimodal neuroimaging studies addressing structure–function interactions are currently missing. Here, we examined treatment-related changes in brain structure (gray matter (GM) volume) and function (blood–oxygen level dependent, BOLD response to self-referential criticism) in 26 participants with social anxiety disorder randomly assigned either to CBT or an attention bias modification control treatment. Also, 26 matched healthy controls were included. Significant time × treatment interactions were found in the amygdala with decreases both in GM volume (family-wise error (FWE) corrected PFWE=0.02) and BOLD responsivity (PFWE=0.01) after successful CBT. Before treatment, amygdala GM volume correlated positively with anticipatory speech anxiety (PFWE=0.04), and CBT-induced reduction of amygdala GM volume (pre–post) correlated positively with reduced anticipatory anxiety after treatment (PFWE0.05). In addition, we observed greater amygdala neural responsivity to self-referential criticism in socially anxious participants, as compared with controls (PFWE=0.029), before but not after CBT. Further analysis indicated that diminished amygdala GM volume mediated the relationship between decreased neural responsivity and reduced social anxiety after treatment (P=0.007). Thus, our results suggest that improvement-related structural plasticity impacts neural responsiveness within the amygdala, which could be essential for achieving anxiety reduction with CBT.

  • 143.
    Månsson, Kristoffer
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden; Uppsala University, Sweden.
    Cortes, Diana
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Biologisk psykologi.
    Lin, Tian
    Horta, Marilyn
    Frazier, Ian
    Lussier, Desiree
    Feifel, David
    Fischer, Håkan
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Biologisk psykologi.
    Ebner, Natalie
    Neuroplasticity after acute and repeated exposure to oxytocin: a multi-site MRI analysis2018Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    Introduction: The hormone and neuropeptide oxytocin (OT) is suggested to be a crucial chemical modulator of social behavior, and exogenous intranasal oxytocin administration has been proposed as a potential treatment for affective and social deficits. Animal studies have found that repeated administration of OT induced cellular changes in the brain, particularly in the hippocampus complex (Sanchez-Vidana et al., 2016). To test this modulatory role of OT on brain structure in humans, we pooled data from three independent double-blind placebo-controlled OT studies that included structural magnetic resonance imaging (MRI), one study with repeated doses over time (repeated) and two studies with single dose (acute) oxytocin administration.

    Methods: The first analytic step included data from 25 older individuals (61-84y) who were exposed to four weeks of intranasal (24 IUs twice a day) administration of OT or placebo (P) and who underwent 3T-MRI before and after this intervention. The second analytic step included data from a total of 191 younger (18-31y) and older (63-81y) individuals from two similar studies administering a single-dose of OT (24 and 40 IUs respectively) and a single 3T-MRI session (scanning was performed about 40 minutes after the OT or P administration). Grey matter (GM) volume was assessed on T1-weighted anatomical images using automated tools (i.e., CAT12/SPM12). We applied total intracranial volume, sex, and education as covariates of no interest and hippocampus voxel-wise analyses were small volume corrected with a family-wise error (FWE) to determine statistical significance. A portion of the analyses were performed blindly, i.e., the researchers were not aware of the assigned group labels (OT vs. P).

    Results: First, a group x time interaction (xyz[–16,–10,–22], Z=4.40, pFWE=.005) suggested that repeated administration of OT in older adults showed no significant change in left hippocampal GM volume (trend toward increase), whereas the P group showed significant reduction in left hippocampal GM volume over time. Second, the acute effect of a single dose of OT showed reduction in left hippocampal GM volume after OT relative to P administration (xyz[–22,–12,–22], Z=2.96, pFWE=.023), i.e. the acute findings were reversed within the same hippocampal region compared to the findings after repeated administration.

    Conclusions: These results provide first evidence of an opposite effect in hippocampus GM volume after acute and repeated administration of OT. This points towards a potential mechanism wherein hippocampal GM volume shows rapid reduction after a single dose, but stable (and potentially greater) GM volume after repeated exposure to OT. Thus, hippocampus may be a key target of OT's modulatory potential on the human brain. Future studies should assess both acute and long-lasting effects of OT administration on brain structures and links to behavior, affect, and quality of life. This approach could advance our understanding of the neurobiological mechanisms of OT as a potential treatment for affective and social deficits.

  • 144.
    Månsson, Kristoffer
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Garrett, Douglas
    Manzouri, Amirhossain
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Wiegert, Steffen
    Furmark, Tomas
    Fischer, Håkan
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Biologisk psykologi.
    Affective Brain Signal Variability Separates Social Anxiety Disorder Patients From Healthy Individuals2018Inngår i: Biological Psychiatry, ISSN 0006-3223, E-ISSN 1873-2402, Vol. 83, nr 9, s. S249-S250Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    Background: Amygdala hyper-responsiveness to negative socio-affective stimuli have typically been demonstrated in patients with social anxiety disorder (SAD). Relative to conventional methods, there is emerging evidence that brain signal variability could be a better predictor of behavior than mean neural response.

    Methods: We recruited 46 patients with SAD (mean age 31, 63% females) and 40 matched healthy controls (HC) to undergo 3 Tesla functional magnetic resonance imaging (fMRI) at 2 time-points, totaling 172 MRIsessions. Blood-oxygen level-dependent (BOLD-fMRI) was performed while viewing happy and fearful faces in blocks of 80 seconds. BOLD-fMRI data was reviewed by manually classifying signal from noise. Variability was calculated as each voxel’s standard deviation on signal across scanning-time. Multivariate partial least squares (PLS) estimated patterns of variability that separates patient from controls.

    Results: PLS found one significant latent variable with cross-block covariance on 64%, permutated (x 1000) P<0.001, bootstrapped 95% confidence intervals on each condition, demonstrating less signal variability to happy faces in patients, relative to controls. This pattern of response was spatially located in several regions across the whole-brain, with large clusters appearing in bilateral amygdala, medial prefrontal cortex and posterior cingulate cortex/precuneus.

    Conclusions: We found that neural response variability to positive socio-affective stimuli accurately separated patients from controls. It is likely that less signal variability highlights a deficit in effective emotion processing. We add to the growing literature on healthy individuals suggesting that task-specific brain signal variability contains useful information. The brain signal variability approach opens new avenues to evaluate and better understand brain function in common psychopathology.

  • 145.
    Månsson, Kristoffer
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Lindqvist, Daniel
    Yang, Liu
    Wolkowitz, Owen
    Nilsonne, Gustav
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Stressforskningsinstitutet.
    Isung, Josef
    Svanborg, Cecilia
    Boraxbekk, C-J.
    Fischer, Håkan
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Biologisk psykologi.
    Lavebratt, Catharina
    Furmark, Tomas
    Can Psychological Treatment Slow Down Cellular Aging in Social Anxiety Disorder?: An Intervention Study Evaluating Changes in Telomere Length and Telomerase Activity2018Inngår i: Biological Psychiatry, ISSN 0006-3223, E-ISSN 1873-2402, Vol. 83, nr 9, s. S351-S352Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    Background: Mental illness, including anxiety disorders, is linked to accelerated cell aging. This is evidenced by shorter leukocyte telomere length. Cells with critically short telomeres may undergo apoptosis. In dividing cells, telomere shortening is counteracted by the telomeraseenzyme. Telomerase is reportedly low following chronic psychological stress. We hypothesized that a psychological treatment may increase telomerase activity, less telomere attritionand greater symptom improvement.

    Methods: Forty-six patients (91% SSRI naïve) with social anxiety disorder(SAD; mean age 31, 63% females) underwent a 9-week waiting period, and 9 weeks of Internet-delivered cognitive behavior therapy(CBT). During treatment, symptoms were assessed weekly using the Liebowitz Social Anxiety Scale (LSAS-SR). Fasting blood samples were collected twice before treatment, and at post-treatment. Genomic DNA was extracted using DNeasy® Blood & Tissue Kit (Qiagene) to assess leukocyte telomere length. Telomerase activity was detected by real-time telomeric repeat amplification protocol (RT-TRAP).

    Results: Patients improved significantly on the LSAS-SR (p<.001; Cohen’s d=1.5). Pre-post changes in telomerase and telomere length correlated positively (Pearson’s r=.31, p=.05). Reduced telomerase activity (<33th percentile) was associated with less improvement and increased activity (>66th percentile) with more improvement on the LSAS-SR (Z=-2.4, p=.02).

    Conclusions: We demonstrate, to our knowledge for the first time, that altered telomerase activity is associated with clinical response to a psychological treatment in a psychiatric population. The observed CBT effect on telomerase in patients with SAD is consistent with results from animal trials and a small previous study of antidepressants in humans. Thus, telomerase activation may play an important role in clinical recovery.

  • 146. Månsson, Kristoffer N. T.
    et al.
    Salami, Alireza
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI). Umeå University, Sweden.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Boraxbekk, C.-J.
    Andersson, Gerhard
    Furmark, Tomas
    Structural but not functional neuroplasticity one year after effective cognitive behaviour therapy for social anxiety disorder2017Inngår i: Behavioural Brain Research, ISSN 0166-4328, E-ISSN 1872-7549, Vol. 318, s. 45-51Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Effective psychiatric treatments ameliorate excessive anxiety and induce neuroplasticity immediately after the intervention, indicating that emotional components in the human brain are rapidly adapTable Still, the interplay between structural and functional neuroplasticity is poorly understood, and studies of treatment-induced long-term neuroplasticity are rare. Functional and structural magnetic resonance imaging (using 3 T MRI) was performed in 13 subjects with social anxiety disorder on 3 occasions over 1 year. All subjects underwent 9 weeks of Internet-delivered cognitive behaviour therapy in a randomized cross-over design and independent assessors used the Clinically Global Impression-Improvement (CGI-I) scale to determine treatment response. Gray matter (GM) volume, assessed with voxel-based morphometry, and functional blood-oxygen level-dependent (BOLD) responsivity to self-referential criticism were compared between treatment responders and non-responders using 2 × 2 (group × time; pretreatment to follow-up) ANOVA. At 1-year follow-up, 7 (54%) subjects were classified as CGI-I responders. Left amygdala GM volume was more reduced in responders relative to non-responders from pretreatment to 1-year follow-up (Z = 3.67, Family-Wise Error corrected p = 0.02). In contrast to previous short-term effects, altered BOLD activations to self-referential criticism did not separate responder groups at follow-up. The structure and function of the amygdala changes immediately after effective psychological treatment of social anxiety disorder, but only reduced amygdala GM volume, and not functional activity, is associated with a clinical response 1 year after CBT.

  • 147.
    Månsson, Kristoffer
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Wager, Tor D.
    Isacsson, Nils
    Kolbeinsson, Örn
    Andersson, Gerhard
    Fischer, Håkan
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Biologisk psykologi.
    Furmark, Tomas
    Brain Before Behavior: Temporal Dynamics in the Treatment of Social Anxiety - Neural Changes Occur Early and Precede Clinical Improvement2018Inngår i: Biological Psychiatry, ISSN 0006-3223, E-ISSN 1873-2402, Vol. 83, nr 9, s. S130-S131Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    Background: The brain rapidly responds to affective processing and neural responsivity can separate anxiety disorder patients from healthy individuals. Psychiatric treatment also alters brain responsiveness however, the brain’s temporal dynamics during treatment remain unknown. Here, patients with social anxiety disorder (SAD) were treated with cognitive-behavioral therapy (CBT) and functional magnetic resonance imaging (fMRI) assessments were performed before, during and after intervention.

    Methods: Forty-six SAD patients received a 9-week Internet-delivered CBTand symptoms were assessed weekly using the Liebowitz social anxiety scale (LSAS-SR). MRI was acquired at 4 time-points (2 baselines, mid- and post-treatment). Blood-oxygen level-dependent(BOLD-fMRI) was performed while patients viewed negative facial expressions. BOLD-fMRI data was reviewed manually by classifying signal from noise, all subjects contributing with complete data.

    Results: Patients improved slightly from baseline to mid-treatment (P<.001, Cohen’s d=0.34) on the LSAS-SR, but more so from mid- to post-treatment (P<.001, d=1.46). Whole-brain neural responsivity decreased from baseline to post-treatment (False Discovery Rate, FDR P<.005) in the medial prefrontal cortex, precuneus and amygdala/parahippocampus. However, no changes (FDR P>.05) from mid- to post-treatment were found, suggesting that the early alterations accounted for the effect. Furthermore, early response reductions were positively associated with symptom improvement from pre-post treatment (Pearson’s r=.50, P<.001).

    Conclusions: This is, to our knowledge, the first study assessing early and late psychiatric treatment changes in the brain. Interestingly, altered neural responsivity in limbic and default-mode network regions preceded self-reported alleviation of social anxiety. Understanding the brain’s temporal dynamics and subsequent modification of behavior may be highly important for future clinical neuroimaging research.

  • 148.
    Mörtberg, Ewa
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden.
    Reuterskiöld, Lena
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Tillfors, Maria
    Furmark, Tomas
    Öst, Lars-Göran
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden.
    Factor solutions of the Social Phobia Scale (SPS) and the Social Interaction Anxiety Scale (SIAS) in a Swedish population2017Inngår i: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 46, nr 4, s. 300-314Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Culturally validated rating scales for social anxiety disorder (SAD) are of significant importance when screening for the disorder, as well as for evaluating treatment efficacy. This study examined construct validity and additional psychometric properties of two commonly used scales, the Social Phobia Scale and the Social Interaction Anxiety Scale, in a clinical SAD population (n = 180) and in a normal population (n = 614) in Sweden. Confirmatory factor analyses of previously reported factor solutions were tested but did not reveal acceptable fit. Exploratory factor analyses (EFA) of the joint structure of the scales in the total population yielded a two-factor model (performance anxiety and social interaction anxiety), whereas EFA in the clinical sample revealed a three-factor solution, a social interaction anxiety factor and two performance anxiety factors. The SPS and SIAS showed good to excellent internal consistency, and discriminated well between patients with SAD and a normal population sample. Both scales showed good convergent validity with an established measure of SAD, whereas the discriminant validity of symptoms of social anxiety and depression could not be confirmed. The optimal cut-off score for SPS and SIAS were 18 and 22 points, respectively. It is concluded that the factor structure and the additional psychometric properties of SPS and SIAS support the use of the scales for assessment in a Swedish population.

  • 149. Nilsson, Anders
    et al.
    Magnusson, Kristoffer
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, Gerhard
    Hellner Gumpert, Clara
    Effects of added involvement from concerned significant others in internet-delivered CBT treatments for problem gambling: Study protocol for a randomised controlled trial2016Inngår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, nr 9, artikkel-id e011974Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction: Problem gambling is a public health concern affecting ∼2.3% of the Swedish population. Problem gambling also severely affects concerned significant others (CSOs). Several studies have investigated the effect of individual treatments based on cognitive–behavioural therapy (CBT), but less is known of the effect of involving CSOs in treatment. This study aims to compare an intervention based on behavioural couples therapy (BCT), involving a CSO, with an individual CBT treatment to determine their relative efficacy. BCT has shown promising results in working with substance abuse, but this is the first time it is used as an intervention for problem gambling. Both interventions will be internet-delivered, and participants will receive written support and telephone support.

    Methods and analysis: A sample of 120 couples will be randomised to either the BCT condition, involving the gambler and the CSO, or the CBT condition, involving the gambler alone. Measures will be conducted weekly and at 3, 6 and 12 months follow-up. The primary outcome measure is gambling behaviour, as measured by Timeline Followback for Gambling. This article describes the outline of the research methods, interventions and outcome measures used to evaluate gambling behaviour, mechanisms of change and relationship satisfaction. This study will be the first study on BCT for problem gambling.

    Ethics and dissemination: This study has been given ethical approval from the regional ethics board of Stockholm, Sweden. It will add to the body of knowledge as to how to treat problem gambling and how to involve CSOs in treatment. The findings of this study will be published in peer-reviewed journals and published at international and national conferences.

  • 150. Nilsson, Anders
    et al.
    Magnusson, Kristoffer
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, Gerhard
    Hellner Gumpert, Clara
    The Development of an Internet-Based Treatment for Problem Gamblers and Concerned Significant Others: A Pilot Randomized Controlled Trial2018Inngår i: Journal of Gambling Studies, ISSN 1050-5350, E-ISSN 1573-3602, Vol. 34, nr 2, s. 539-559Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Problem gambling creates significant harm for the gambler and for concerned significant others (CSOs). While several studies have investigated the effects of individual cognitive behavioral therapy (CBT) for problem gambling, less is known about the effects of involving CSOs in treatment. Behavioral couples therapy (BCT) has shown promising results when working with substance use disorders by involving both the user and a CSO. This pilot study investigated BCT for problem gambling, as well as the feasibility of performing a larger scale randomized controlled trial. 36 participants, 18 gamblers and 18 CSOs, were randomized to either BCT or individual CBT for the gambler. Both interventions were Internet-delivered self-help interventions with therapist support. Both groups of gamblers improved on all outcome measures, but there were no differences between the groups. The CSOs in the BCT group lowered their scores on anxiety and depression more than the CSOs of those randomized to the individual CBT group did. The implications of the results and the feasibility of the trial are discussed.

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