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  • 101.
    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.

  • 102.
    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.

  • 103.
    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.

  • 104.
    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.

  • 105.
    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.

  • 106.
    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.

  • 107.
    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.

  • 108.
    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.

  • 109.
    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.

  • 110.
    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.

  • 111.
    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.

  • 112.
    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.

  • 113.
    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).

  • 114.
    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.

  • 115. 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.

  • 116.
    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

  • 117. 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.

  • 118. 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.

  • 119.
    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.

  • 120.
    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.

  • 121.
    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.

  • 122. 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.

  • 123. 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.

  • 124.
    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.

  • 125. 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.

  • 126. 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.

  • 127. Nordgreen, T.
    et al.
    Haug, T.
    Öst, Lars-Göran
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, Gerhard
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Kvale, G.
    Heiervang, E.
    Havik, O.
    Stepped care for social anxiety disorder or panic disorder: A randomised controlled trial2017Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Background: Stepped Care is considered a cost-effective way to deliver health care but few studies have investigated stepped care models for psychological treatments. Internet-based psychological treatment might be a highly suitable first step in a stepped care model. The aim of this study was to assess the effectiveness of a cognitive behavioral therapy (CBT) stepped care model (psychoeducation, guided Internet-based treatment, and face-to-face CBT) compared with direct face-to-face (FtF) CBT.

    Methods: Patients with panic disorder or social anxiety disorder were randomized to either stepped care (n = 85) or direct FtF CBT (n = 88). Recovery was defined as meeting two of the following three criteria: loss of diagnosis, below cut-off for self-reported symptoms, and functional improvement.

    Results: No significant differences in intention-to-treat recovery rates were identified between stepped care (40.0%) and direct FtF CBT (43.2%). The majority of the patients who recovered in the stepped care did so at the less therapist-demanding steps (26/34, 76.5%). Moderate to large within-groups effect sizes were identified at posttreatment and 1-year follow-up. The attrition rates were high: 41.2% in the stepped care condition and 27.3% in the direct FtF CBT condition.

    Discussion: These findings indicate that the outcome of a stepped care model for anxiety disorders is comparable to that of direct FtF CBT. The rates of improvement at the two less therapist- demanding steps indicate that stepped care models might be useful for increasing patients’ access to evidence-based psychological treatments for anxiety disorders. However, attrition in the stepped care condition was high. This may reflect inflexible stepping-up criteria. Limitations of this study will be discussed together with suggestions for more relevant and flexible stepping up criteria.

  • 128. Nordgreen, Tine
    et al.
    Gjestad, Rolf
    Andersson, Gerhard
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Havik, Odd E.
    The implementation of guided Internet-based cognitive behaviour therapy for panic disorder in a routine-care setting: effectiveness and implementation efforts2018Inngår i: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 47, nr 1, s. 62-75Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Panic disorder is a common mental disorder. Guided Internet-based cognitive behavioural therapy (Guided Internet-based cognitive behaviour therapy (ICBT)) is a promising approach to reach more people in need of help. In the present effectiveness study, we investigated the outcome of guided ICBT for panic disorder after implementation in routine care. A total of 124 patients were included in the study, of which 114 started the treatment. Large within-group effect sizes were observed on the primary panic disorder symptoms (post-treatment: d = 1.24; 6-month follow-up: d = 1.39) and moderate and large effects on secondary panic disorder symptoms and depressive symptoms at post-treatment and follow-up (d = .55–1.13). More than half (56.1%) of the patients who started treatment recovered or improved at post-treatment. Among treatment takers (completed at least five of the nine modules), 69.9% recovered or improved. The effectiveness reported in the present trial is in line with previous effectiveness and efficacy trials of guided ICBT for panic disorder. This provides additional support for guided ICBT as a treatment alternative in routine care.

  • 129. Nordgreen, Tine
    et al.
    Haug, Thomas
    Öst, Lars-Göran
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Haukeland University Hospital, Norway; University of Bergen, Norway; Karolinska Institutet, Sweden.
    Andersson, Gerhard
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Kvale, Gerd
    Tangen, Tone
    Haiervang, Einar
    Havik, Odd E.
    Stepped Care Versus Direct Face-to-Face Cognitive Behavior Therapy for Social Anxiety Disorder and Panic Disorder: A Randomized Effectiveness Trial2016Inngår i: Behavior Therapy, ISSN 0005-7894, E-ISSN 1878-1888, Vol. 47, nr 2, s. 166-183Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim of this study was to assess the effectiveness of a cognitive behavioral therapy(CBT) stepped care model (psychoeducation, guided Internet treatment, and face-to-face CBT) compared with direct face-to-face (FtF) CBT. Patients with panic disorder or social anxiety disorder were randomized to either stepped care (n = 85) or direct FtF CBT (n = 88). Recovery was defined as meeting two of the following three criteria: loss of diagnosis, below cut-off for self-reported symptoms, and functional improvement. No significant differences in intention-to-treat recovery rates were identified between stepped care (40.0%) and direct FtF CBT (43.2%). The majority of the patients who recovered in the stepped care did so at the less therapist-demanding steps (26/34, 76.5%). Moderate to large within-groups effect sizes were identified at posttreatment and 1-year follow-up. The attrition rates were high: 41.2% in the stepped care condition and 27.3% in the direct FtF CBT condition. These findings indicate that the outcome of a stepped care model for anxiety disorders is comparable to that of direct FtF CBT. The rates of improvement at the two less therapist-demanding steps indicate that stepped care models might be useful for increasing patients’ access to evidence-based psychological treatments for anxiety disorders. However, attrition in the stepped care condition was high, and research regarding the factors that can improve adherence should be prioritized.

  • 130. Nordh, Martina
    et al.
    Vigerland, Sarah
    Öst, Lars-Göran
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden.
    Ljótsson, Brjánn
    Mataix-Cols, David
    Serlachius, Eva
    Högström, Jens
    Therapist-guided internet-delivered cognitive–behavioural therapy supplemented with group exposure sessions for adolescents with social anxiety disorder: a feasibility trial2017Inngår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, nr 12, artikkel-id e018345Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: Social anxiety disorder (SAD) is one of the most common psychiatric disorders in youth, with a prevalence of about 3%–4% and increased risk of adverse long-term outcomes, such as depression. Cognitive–behavioural therapy (CBT) is considered the first-line treatment for youth with SAD, but many adolescents remain untreated due to limited accessibility to CBT. The aim of this study was to develop and evaluate the feasibility and preliminary efficacy of a therapist-guided internet-delivered CBT treatment, supplemented with clinic-based group exposure sessions (BIP SOFT). Design: A proof-of-concept, open clinical trial with 6-month follow-up. Participants: The trial was conducted at a child and adolescent psychiatric research clinic, and participants (n=30) were 13–17 years old (83% girls) with a principal diagnosis of SAD. Intervention: 12 weeks of intervention, consisting of nine remote therapist-guided internet-delivered CBT sessions and three group exposure sessions at the clinic for the adolescents and five internet-delivered sessions for the parents. Results: Adolescents were generally satisfied with the treatment, and the completion rate of internet modules, as well as attendance at group sessions, was high. Posttreatment assessment showed a significant decrease in clinician-rated, adolescent-rated and parent-rated social anxiety (d=1.17, 0.85 and 0.79, respectively), as well as in general self-rated and parent-rated anxiety and depression (d=0.76 and 0.51), compared with pretreatment levels. Furthermore, 47% of participants no longer met Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for SAD at posttreatment. At a 6-month follow-up, symptom reductions were maintained, or further improved, and 57% of participants no longer met criteria for SAD. Conclusion: Therapist-guided and parent-guided internetdelivered CBT, supplemented with a limited number of group exposure sessions, is a feasible and promising intervention for adolescents with SAD.

    Trial registration number: NCT02576171.

  • 131. Norell-Clarke, Annika
    et al.
    Tillfors, Maria
    Wilmenius, Lina
    Jansson Fröjmark, Markus
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Holländare, Fredrik
    Engström, Ingemar
    Insomnia severity mediates between cognitive behavioural therapy for insomnia and depression in a sample with insomnia and depression: New possibilities for treatments of comorbid patients2016Inngår i: EABCT 2016 Abstract Book: Total Awareness, 2016, s. 544-544Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Clinical trials have shown that cognitive behavioural therapy for insomnia (CBT-I) may have an effect on both insomnia and depression in comorbid samples, but there is a gap in the knowledge on why CBT-I has an impact on depression. Neuropsychological theories suggest that disturbed sleep may work as a transdiagnostic process that maintains psychopathology. The aim was to test whether CBT-I impacts depressive symptoms through improved sleep, in a sample with insomnia comorbid with major depression and subthreshold depressive symptoms. 64 participants were recruited through advertisements and randomised to receive either CBT-I or an active control (relaxation training: RT) in groups during four bi-weekly sessions. Insomnia (ISI) and depressive severity (BDI-II) were measured pre-, mid- and post-treatment. Mediational analyses were conducted. Insomnia and depressive severity lowered over the course of treatments. CBT-I was superior in reducing insomnia. The main treatment outcomes have been published elsewhere (Norell-Clarke et al, 2015). The relationship between CBT-I and post-treatment depressive severity was mediated by mid-treatment insomnia severity, which indicates that the effect of CBT-I on depression goes through improved sleep (b = -4.87, BCa CI = -9.21, -1.97). The results were maintained when pre-treatment insomnia and depressive severity were controlled for (b = -3.36, BCa CI = -8.86, -0.45). Testing for reciprocity, we found that mid-treatment depressive severity did not mediate between CBT-I and post-treatment insomnia severity. The results support the perpetuating role of insomnia in depression. This may have implications for other psychiatric patient groups with comorbid insomnia. Also, the results indicate that CBT for comorbid patient groups may need to target sleep specifically.

  • 132. Nyström, M.
    et al.
    Stenling, A.
    Sjöström, E.
    Neely, G.
    Lindner, Philip
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Hassmén, P.
    Andersson, Gerhard
    Martell, C.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Behavioral activation versus physical activity via the internet: A randomized controlled trial2017Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Background: A major problem today is that only about fifty percent of those affected by depression seek help. One way to reach more sufferers would be by offering easily accessible internet based treatments. The purpose of this study was to compare/evaluate four therapist supported internet administered treatments.

    Method /Results: Two hundred eighty six participants were included. The treatment period lasted twelve weeks, consisting of the following treatments: 1) physical activity without treatment rational, 2) physical activity with treatment rational, 3) behavioral activation based on Lewinshon’s (1974) model and 4) behavioral activation based on Martell’s model (Martell et al., 2010). All groups (including a control-group) showed a significant decrease in depressive symptoms. When the treatment groups were pooled and compared to the control group, there were significant differences from pretest to posttest (Hedges gav treatment = 1.01, control group = 0.47). This held true also when each of the four treatment groups was compared to the control group, with one exception: Physical activity without treatment rationale.

    Limitations: The differences between how many modules the participants completed could indicate that there are other factors than the treatments that caused the symptom reduction, however, the dose-response analysis did not detect any significant differences on account of modules completed.

    Conclusions: The results support the positive effects of internet administered treatments for depression and highlights the importance of psychoeducation, which tends to affect both the treatment outcome and the probability of remaining in treatment. These aspects need to be considered when developing and conducting new treatments for depression since they would increase the likelihood of positive treatment outcomes.

  • 133. Nyström, Markus B. T.
    et al.
    Stenling, Andreas
    Sjöström, Emma
    Neely, Gregory
    Lindner, Philip
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Hassmén, Peter
    Andersson, Gerhard
    Martell, Christopher
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Behavioral activation versus physical activity via the internet: A randomized controlled trial2017Inngår i: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 215, s. 85-93Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: A major problem today is that only about fifty percent of those affected by depressionseeks help. One way to reach more sufferers would be by offering easily accessible internet based treatments. The purpose of this study was to compare/evaluate four therapist supported internet administered treatments.

    Method/results: Two hundred eighty six participants were included. The treatment period lasted twelve weeks, consisting of the following treatments: 1) physical activity without treatment rational, 2) physical activity with treatment rational, 3) behavioral activation without treatment rational and 4) behavioral activation with treatment rational. All groups (including a control-group) showed a significant decrease in depressive symptoms. When the treatment groups were pooled and compared to the control group, there were significant differences from pretest to posttest (Hedges gav treatment =1.01, control group =0.47). This held true also when each of the four treatment groups was compared to the control group, with one exception: Physical activity without treatment rationale.

    Limitations: The differences between how many modules the participants completed could indicate that there are other factors than the treatments that caused the symptom reduction, however, the dose-response analysis did not detect any significant differences on account of modules completed.

    Conclusions: The results support the positive effects of internet administered treatments for depression, and highlights the importance of psychoeducation, which tends to affect both the treatment outcome and the probability of remaining in treatment. These aspects need to be considered when developing and conducting new treatments for depression, since they would increase the likelihood of positive treatment outcomes.

  • 134. Ollendick, Thomas H.
    et al.
    Ryan, Sarah M.
    Capriola-Hall, Nicole N.
    Reuterskiöld, Lena
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Öst, Lars-Göran
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    The mediating role of changes in harm beliefs and coping efficacy in youth with specific phobias2017Inngår i: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 99, s. 131-137Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Individuals with specific phobias (SPs) often experience catastrophic cognitions and compromised efficacy regarding their ability to cope when in the presence of the phobic object/situation. In the current study, 165 children (7-16 years; 62% male) received either One Session Treatment or Educational Support Therapy for their SP. The children identified their feared belief and rated how bad it was, how likely it was to occur, and their ability to cope if it did occur. All of these ratings were reduced from pre-treatment to 6-month follow-up, across both treatment conditions. However, ratings of how bad and how likely reduced to a significantly greater degree for children who received OST. Greater change in each of the three beliefs predicted lower clinician severity ratings (CSRs) at post-treatment and 6-month follow-up. Additionally, changes in how bad and how likely the children rated their beliefs, and their reported ability to cope, partially mediated the relationship between treatment and post-treatment and follow-up CSRs. Overall, these findings suggest that although both treatment conditions produced changes in harm beliefs and coping efficacy, OST elicited greater changes and these changes may be important mechanisms in reduction of SP clinical severity.

  • 135. Ollendick, Thomas H.
    et al.
    Öst, Lars-Göran
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Ryan, Sarah M.
    Capriola, Nicole N.
    Reuterskiöld, Lena
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Harm beliefs and coping expectancies in youth with specific phobias2017Inngår i: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 91, s. 51-57Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Catastrophic beliefs and lowered coping expectancies are often present in individuals with specific phobias (SPs). The current study examined these beliefs and expectancies in 251 youth who received One Session Treatment for one of the three most common types of SP in youth (animals, natural environment, and situational). We compared the children's subjective beliefs to objective ratings of the likelihood of occurrence and the dangerousness of the feared events. Results revealed pre-treatment differences in the youths' beliefs across phobia types and age. Specifically, children with animal phobias rated their beliefs as more likely to occur than did children with environmental and situational phobias. In addition, older children rated their beliefs as more dangerous than younger children. However, regardless of phobia type or child age, the beliefs improved following treatment. Changes in catastrophic beliefs and coping expectancies were related to changes in clinical severity following treatment but not 6-months following treatment. Moreover, at pre-treatment, children viewed their beliefs as significantly more catastrophic and likely to occur than did independent coders of these beliefs; however, these differences were no longer evident following treatment. Clinical implications are discussed, highlighting how changes in beliefs and expectancies might be associated with treatment outcomes.

  • 136. Oscarsson, Martin
    et al.
    Rozental, Alexander
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, Gerhard
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    New Year's resolutions - A large scale randomized controlled trial2017Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Introduction: At the start of every new year, millions of people around the world pledge to change some aspect of their lives. More often than not, New Year’s resolutions relate to positive behavior changes, such as quitting bad habits and forming new and more beneficial ones. Unfortunately, most people who try to lose weight, quit smoking or start exercising fail, most of them during the first three months. The aim of this ongoing study is to investigate the different categories of New Year’s resolutions among Swedes, to what degree they succeed in keeping their resolutions, and whether internet-administered support based on cognitive behavior therapy may increase the participants’ chances of keeping their resolutions.

    Methods: The study is a three-arm randomized control trial comparing two different levels of support and one control condition. During the year, participants rate their perceived success in keeping their resolutions. Data from online questionnaires regarding subjective well-being, quality of life, procrastination and self-efficacy is also collected at baseline as well as at follow-up three weeks into the following year.

    Results: A total of 1 066 participants were included in the study. Ten months in we have preliminary results regarding the categories of New Year’s resolutions. More than 70% of the participants report one or more resolutions falling into the “physical health” category. The second largest category is “self-improvement” (10%), followed by “psychological health” (5%). A majority of resolutions, 64%, are phrased as approach-oriented goals and 34% as avoidance-oriented goals.

    Discussion: We believe that this is the largest study of its kind to date. Smaller longitudinal studies of New Year’s resolvers have been published, but none in Sweden. Furthermore, very few studies on positive behavior change have evaluated active interventions to increase participants’ chances of success. Future analyses will provide insight into New Year’s resolutions among Swedes and whether short, non-personal information and exercises administered via email may increase their chances of success.

  • 137. Persson Asplund, Robert
    et al.
    Dagöö, Jesper
    Fjellström, Ida
    Niemi, Linnea
    Hansson, Katja
    Zeraati, Forough
    Ziuzina, Masha
    Geraedts, Anna
    Ljótsson, Brjánn
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, Gerhard
    Internet-based stress management for distressed managers: results from a randomised controlled trial2018Inngår i: Occupational and Environmental Medicine, ISSN 1351-0711, E-ISSN 1470-7926, Vol. 75, nr 2, s. 105-113Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective The aim of this randomised controlled trial (RCT) was to evaluate the efficacy of a guided internet-based stress management intervention (iSMI) among distressed managers compared with a attention control group (AC) with full access to treatment-as-usual.

    Method A total sample of 117 distressed managers, mainly employed in the healthcare, IT, communication and educational sector, were randomised to either iSMI (n=59) or an AC group (n=58). The iSMI consisted of eight modules including cognitive behavioural stress management and positive management techniques. Participants received a minimal and weekly guidance from a psychologist or master-level psychology student focusing on support, feedback and adherence to the intervention. Self-report data were assessed at pre, post and 6 months after the intervention. The primary outcome was perceived stress (Perceived Stress Scale-14). The secondary outcomes included mental and work-related health outcomes.

    Results Participants in the iSMI intervention reported significantly less symptoms of perceived stress (d=0.74, 95% CI 0.30 to 1.19) and burnout (d=0.95, 95% CI 0.53 to 1.37) compared with controls, at postassessment. Significant medium-to-large effect sizes were also found for depression, insomnia and job satisfaction. Long-term effects (6 months) were seen on the mental health outcomes.

    Conclusion This is one of the first studies showing that iSMIs can be an effective, accessible and potentially time-effective approach of reducing stress and other mental-related and work-related health symptoms among distressed managers. Future studies are needed addressing distressed managers and the potential of indirect effects on employee stress and satisfaction at work.

  • 138.
    Philips, Björn
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Stockholm City Council, Sweden; Karolinska Institutet, Sweden.
    Karlsson, Roger
    Nygren, Rebecca
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Rother-Schirren, Amelie
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Werbart, Andrzej
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Early therapeutic process related to dropout in mentalization-based treatment with dual diagnosis patients2018Inngår i: Psychoanalytic psychology, ISSN 0736-9735, E-ISSN 1939-1331, Vol. 35, nr 2, s. 205-216Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

  • 139. Powers, M. B.
    et al.
    Levin-Coon, A.
    Miller, W.
    Caven, A.
    MacClements, J.
    Oh, J.
    Bernhardt, J.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Smits, J. A. J.
    A Randomized Controlled Trial of Animated Versus Live Action Virtual Reality Therapy for Anxiety & Pain in a Level I Trauma Center2018Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    While virtual reality exposure therapy (VRET) shows promise as a treatment for anxiety and pain (Powers & Emmelkamp, 2008), many users complain that computer-generated virtual reality (VR) stimuli appear unrealistic, eccentric, and too much like a video game (Kwon, Powell, & Chalmers, 2013). Historically, programmers using video game assets and computer-generated imagery (CGI) created VR content. While CGI can be used to make intricate virtual environments, unless there is a team of expert digital artists, the virtual stimulus may look unrealistic and exhibit a number of graphical glitches that could prove distracting in therapy. Furthermore, CGI often suffers from the uncanny valley effect, where CGI representations of people are perceived as unsettling as the representations become more lifelike. Thus, the only method to overcome the uncanny valley effect is to present the VR as less realistic (CGI) or photorealistic. In addition, current CGI VR packages are expensive and difficult to implement in widespread medical settings. Recently, however, an exciting alternative to traditional computer-generated VR has emerged: 360-Degree 3-D HD Video VR (Live Action). The benefit of Live Action VR as opposed to CGI VR is that it is photorealistic and doesn’t cause the uncanny valley effect of CGI. In addition, the projected cost of the end product is approximately $500 and delivered using a portable VR headset. In this RCT, participants in a Level I Trauma Center reporting pain (N = 78) were randomized to waitlist, 10-minutes of CGI VR, or 10-minutes of Live Action VR. Consistent with prediction, both VR conditions showed greater reduction in anxiety relative to waitlist (p < .05). However, there was no difference between the conditions. The two VR conditions also showed significantly greater reductions in pain (p < .001) and pain interference (p < .001) relative to the waitlist with no differences between conditions. As expected, participants rated Live Action VR significantly more realistic than CGI VR (p < .001) and reported a greater sense of being in the virtual world (p < .05). Finally, 92% of participants in the waitlist preferred to view the Live Action VR.

  • 140. Powers, M.
    et al.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Recent Advances in Virtual Reality Therapy2017Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    This session will present recent advances in virtual reality therapy for mental disorders. Many of these advances are a result of a boom in personal consumer electronics. We will discuss both stationary (Virtually Better, Oculus Rift) and mobile (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 will present data on the relative efficacy of enhanced (360 3D HD film) virtual reality exposure therapy (VRET) to standard VRET (animated stimuli). The second presentation will discuss the development and efficacy of gamified VRET for spider phobia compared to traditional exposure therapy along with 12-month follow-up data. The third presentation will describe combining in vivo behavioral observations to enhance in virtuo exposure. The fourth presentation will describe VR systems as a potential adjunct to treatment of stress-related disorders. The final presentation will show the relative efficacy of in vivo and in virtual exposure for social anxiety disorder. 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.

  • 141. Powers, Mark B.
    et al.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Technology: Bridging the Gap from Research to Practice2016Inngår i: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 45, nr 1, s. 1-4Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    Anxiety disorders are the most common mental disorders and they account for approximately one-third of all mental health care costs. Fortunately, meta-analyses show exposure-based therapy is effective for most patients with anxiety disorders. Based on such findings, international treatment guidelines recommend exposure therapy for anxiety disorders as the gold standard. For example, the Institute of Medicine stated “the evidence is sufficient to conclude the efficacy of exposure therapies in the treatment of PTSD” (p. 97) but they did not find sufficient evidence for any other psychotherapy or pharmacotherapy. Following these guidelines should be uncomplicated, but in general therapists seem to prefer to use their clinical experience rather than research findings to improve their practice.

    Although well supported for over 50 years, most people with anxiety disorders still do not receive exposure therapy. In fact, most people with emotional disorders do not receive any treatment. This gap in what is known and what is available to patients is frustrating. Examination of obstacles to dissemination reveals how recent advances in technology may help bridge the gap. Below we briefly review some of the proposed obstacles to successful dissemination and potential technological solutions for each.

  • 142. Price, Rebecca B.
    et al.
    Kuckertz, Jennie M.
    Amir, Nader
    Bar-Haim, Yair
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Wallace, Meredith L.
    Less is more: Patient-level meta-analysis reveals paradoxical dose-response effects of a computer-based social anxiety intervention targeting attentional bias2017Inngår i: Depression and anxiety (Print), ISSN 1091-4269, E-ISSN 1520-6394, Vol. 34, nr 12, s. 1106-1115Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The past decade of research has seen considerable interest in computer-based approaches designed to directly target cognitive mechanisms of anxiety, such as attention bias modification (ABM).

    Methods: By pooling patient-level datasets from randomized controlled trials of ABM that utilized a dot-probe training procedure, we assessed the impact of training "dose" on relevant outcomes among a pooled sample of 693 socially anxious adults.

    Results: A paradoxical effect of the number of training trials administered was observed for both posttraining social anxiety symptoms and behavioral attentional bias (AB) toward threat (the target mechanism of ABM). Studies administering a large (>1,280) number of training trials showed no benefit of ABM over control conditions, while those administering fewer training trials showed significant benefit for ABM in reducing social anxiety (P = .02). These moderating effects of dose were not better explained by other examined variables and previously identified moderators, including patient age, training setting (laboratory vs. home), or type of anxiety assessment (clinician vs. self-report).

    Conclusions: Findings inform the optimal dosing for future dot-probe style ABM applications in both research and clinical settings, and suggest several novel avenues for further research.

  • 143. Price, Rebecca B.
    et al.
    Wallace, Meredith
    Kuckertz, Jennie M.
    Amir, Nader
    Graur, Simona
    Cummings, Logan
    Popa, Paul
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Bar-Haim, Yair
    Pooled patient-level meta-analysis of children and adults completing a computer-based anxiety intervention targeting attentional bias2016Inngår i: Clinical Psychology Review, ISSN 0272-7358, E-ISSN 1873-7811, Vol. 50, s. 37-49Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Computer-based approaches, such as Attention Bias Modification (ABM), could help improve access to care for anxiety. Study-level meta-analyses of ABM have produced conflicting findings and leave critical questions unresolved regarding ABM's mechanisms of action and clinical potential. We pooled patient-level datasets from randomized controlled trials of children and adults with high-anxiety. Attentional bias (AB) towards threat, the target mechanism of ABM, was tested as an outcome and a mechanistic mediator and moderator of anxiety reduction. Diagnostic remission and Liebowitz Social Anxiety Scale (LSAS) were clinical outcomes available in enough studies to enable pooling. Per-patient data were obtained on at least one outcome from 13/16 eligible studies [86% of eligible participants; n = 778]. Significant main effects of ABM on diagnostic remission (ABM—22.6%, control—10.8%; OR = 2.57; p = 0.006) and AB (β* (95%CI) = − 0.63 (− 0.83, − 0.42); p < 0.00005) were observed. There was no main effect of ABM on LSAS. However, moderator analyses suggested ABM was effective for patients who were younger (≤ 37 y), trained in the lab, and/or assessed by clinicians. Under the same conditions where ABM was effective, mechanistic links between AB and anxiety reduction were supported. Under these specific circumstances, ABM reduces anxiety and acts through its target mechanism, supporting ABM's theoretical basis while simultaneously suggesting clinical indications and refinements to improve its currently limited clinical potential.

  • 144.
    Rafi, Jonas
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Ivanova, Ekaterina
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Rozental, Alexander
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Effects of a workplace prevention programme for problem gambling: Study protocol for a cluster randomised controlled trial2017Inngår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, nr 9, artikkel-id e015963Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction: Despite being considered a public health problem, no prevention programme for problem gambling in workplace settings has been scientifically evaluated. This study aims to fill a critical gap in the field of problem gambling by implementing and evaluating a large-scale prevention programme in organisations.

    Methods and analysis: Ten organisations, with a total of n=549 managers and n=8572 employees, will be randomised to either receiving a prevention programme or to a waitlist control condition. Measurements will be collected at the baseline and 3, 12 and 24 months after intervention. The primary outcome of interest is the managers’ inclination to act when worried or suspicious about an employee’s problem gambling or other harmful use. Additional outcomes of interest include the Problem Gambling Severity Index and gambling habits in both managers and employees. Furthermore, qualitative analyses of the responses from semistructured interviews with managers will be performed.

    Ethics and dissemination: This study has been approved by the regional ethics board of Stockholm, Sweden, and it will contribute to the body of knowledge concerning prevention of problem gambling. The findings will be published in peer-reviewed, open-access journals.

    Trial registration number: NCT02925286; Pre-results.

  • 145.
    Ramnerö, Jonas
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Folke, Fredrik
    Kanter, Jonathan W.
    A learning theory account of depression2016Inngår i: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450, Vol. 57, nr 1, s. 73-82Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Learning theory provides a foundation for understanding and deriving treatment principles for impacting a spectrum of functional processes relevant to the construct of depression. While behavioral interventions have been commonplace in the cognitive behavioral tradition, most often conceptualized within a cognitive theoretical framework, recent years have seen renewed interest in more purely behavioral models. These modern learning theory accounts of depression focus on the interchange between behavior and the environment, mainly in terms of lack of reinforcement, extinction of instrumental behavior, and excesses of aversive control, and include a conceptualization of relevant cognitive and emotional variables. These positions, drawn from extensive basic and applied research, cohere with biological theories on reduced reward learning and reward responsiveness and views of depression as a heterogeneous, complex set of disorders. Treatment techniques based on learning theory, often labeled Behavioral Activation (BA) focus on activating the individual in directions that increase contact with potential reinforcers, as defined ideographically with the client. BA is considered an empirically well-established treatment that generalizes well across diverse contexts and populations. The learning theory account is discussed in terms of being a parsimonious model and ground for treatments highly suitable for large scale dissemination.

  • 146.
    Ramnerö, Jonas
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Gustavsson, Thomas
    Lundgren, Tobias
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Må dåligt: Om psykopatologi i vardagslivet2017Bok (Annet vitenskapelig)
    Abstract [sv]

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

  • 147.
    Ramnerö, Jonas
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Jansson, Billy
    The stability of treatment goals, as assessed by a Swedish version of the Bern Inventory of Treatment Goals2016Inngår i: Nordic Psychology, ISSN 1901-2276, E-ISSN 1904-0016, Vol. 68, nr 1, s. 30-39Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Formulating treatment goals has been shown to be an area of vital concern for both outcome and treatment processes. However, it is not as yet an area of structured routine assessment, either in clinical practice or in research. One possible explanation for this is the lack of validated and readily available goal assessment procedures. The present study investigated the test–retest stability of a Swedish translation of the checklist version of the Bern Inventory of Treatment Goals (BIT-C) among 30 patients in primary care. We calculated the consistency of the endorsement of the different therapeutic goal categories over a 2-week period prior to treatment. There were no changes in symptoms or quality-of-life-related measures between the two assessment points. Overall, the goal category items in BIT-C were found to demonstrate moderate to substantial reliability. In conclusion, even though our study was small, it provided initial psychometric support for the Swedish version of BIT-C as a clinically useful tool for the assessment of treatment goals.

  • 148.
    Ramnerö, Jonas
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Jansson, Billy
    Treatment goals and their attainment: A structured approach to assessment and evaluation2016Inngår i: The Cognitive Behaviour Therapist, ISSN 0965-5794, E-ISSN 1754-470X, Vol. 9, artikkel-id e2Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Treatment goals are considered a vital part of therapeutic work, and their role is often emphasized in cognitive behavioural therapy (CBT). However, the attainment of goals is rarely accounted for in terms of treatment outcome. In this study, we set out to investigate a structured format for goal assessment and goal attainment in CBT delivered as routine care. We were especially interested in the sensitivity to change in perceived goal attainment. Patients completed a self-administered version of the Bern Inventory of Treatment Goals (BIT-C) and rated their perceived attainment on a maximum of five prioritized goals before and after 12 weeks of treatment, along with measures on anxiety, depression and health-related quality of life. The results indicated that the prioritized goals only partially correspond to disorder-specific concerns, and that perceived proximity to treatment goals is clearly associated with improvements following treatment. The results are discussed in terms of the BIT-C being a promising tool for use in clinical settings in assessing treatment goals as well as in evaluating the attainment of these goals.

  • 149. Riise, Eili N.
    et al.
    Kvale, Gerd
    Öst, Lars-Göran
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Haukeland University Hospital, Norway; Karolinska Institutet, Sweden.
    Skjold, Solvei Harila
    Hansen, Hans
    Hansen, Bjarne
    Concentrated exposure and response prevention for adolescents with obsessive-compulsive disorder: An effectiveness study2016Inngår i: Journal of Obsessive-Compulsive and Related Disorders, ISSN 2211-3649, E-ISSN 2211-3657, Vol. 11, s. 13-21Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This study evaluated the effectiveness of a concentrated exposure and response prevention (ERP) treatment for adolescents with obsessive-compulsive disorder (OCD). Twenty-two adolescents with OCD (range 11–17 years) received therapist-assisted ERP during four consecutive days, followed by a three week period of self-administered ERP. Treatment was delivered to 2–3 patients and their parents simultaneously at an outpatient clinic for child and adolescent psychiatry as part of standard health care. OCD-symptoms were assessed at pre-treatment, post-treatment, 3- and 6-month follow-up. The results demonstrated that patients had significant reduction in OCD-symptoms from pre- to post-treatment and the gains were maintained at follow-up. 91% (n=20) were classified as responders at post-treatment, and 77% (n=17) at six-month follow-up. Remission rates were 73% (n=16) at post-treatment and 68% (n=15) at six-month follow-up. OCD-related impairment and symptoms of anxiety and depression were significantly reduced at post-treatment and follow-up. The results suggest that concentrated ERP is a promising treatment for adolescents with OCD.

  • 150. Ritterband, L.
    et al.
    Riper, H.
    Mohr, D.
    Palermo, T.
    Kay-Lambkin, F.
    Christensen, H.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Munoz, R.
    Van de ven, P.
    Challenges, controversies, and the future of developing, evaluating, and implementing Internet interventions2016Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Internet intervention research has been well established in the literature over the past two decades. The hundreds, if not thousands, of high quality research trials that have been conducted and published have convincingly demonstrated feasibility, efficacy and even effectiveness. The next decade will be a critical one for the field with numerous obstacles, barriers, disputes and debates to overcome. This talk will highlight many of the known challenges and controversies as well as key areas that will need to be part of future research. Furthermore, each of these areas overlap, resulting in additional topics of needed focus. Challenges include funding, recruitment, and conflict of interests to manage; controversies include best practices for iterative development, the relationship between usage and outcome, and public concerns of technology replacing jobs; issues that intersect with both challenges and controversies include how best to address the digital divide, the use of social networking, and how to determine the best control and comparison groups in ehealth research; future issues include a need to focus on deconstruction and dissemination trials, internationalization of interventions, and a greater emphasis on cost effectiveness; issues that traverse challenges and the future include a need for greater scientific underpinnings to interventions, improving the taxonomy and overall definitions used to define applications, and how best to maintain and sustain programs; controversies/future issues include the problem of so many programs continuing to be developed and made available with little to no scientific validity; and finally, issues that cross challenges, controversies and the future include the ongoing discussions of support, meta-analyses, and stepped care. Although not comprehensive, this list will provide a useful start for discussion and help guide research for the coming years.

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