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  • 151.
    Hau, Stephan
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Wish Fulfillment2018Inngår i: Encyclopedia of Personality and Individual Differences: Living Edition / [ed] Virgil Zeigler-Hill, Todd K. Shackelford, Springer, 2018, s. 1-3Kapittel i bok, del av antologi (Fagfellevurdert)
    Abstract [en]

    Wish fulfillment can be understood as a psychological formation, e.g., as a result of imaginative processes like dream events, that are created in order to present the wish as fulfilled.

  • 152. Haug, Thomas
    et al.
    Nordgreen, Tine
    Öst, Lars-Göran
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Haukeland University Hospital, Norway; Karolinska Institutet, Sweden.
    Tangen, Tone
    Kvale, Gerd
    Hovland, Ole Johan
    Heiervang, Einar R.
    Havik, Odd E.
    Working alliance and competence as predictors of outcome in cognitive behavioral therapy for social anxiety and panic disorder in adults2016Inngår i: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 77, s. 40-51Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: The research on the association between the working alliance and therapist competence/adherence and outcome from cognitive behavioral therapy (CBT) is limited and characterized by inconclusive findings. This study investigates the working alliance and competence/adherence as predictors of outcome of CBT for social anxiety disorder(SAD) and panic disorder (PD).

    Method: Eighty-two clinically referred patients (58.5% female; age: M = 33.6 years, SD = 10.3) with PD (n = 31) or SAD (n = 51) were treated with 12 sessions of manualized CBT by 22 clinicians with limited CBT experience in a randomized controlled effectiveness trial. Independent assessors rated the CBT competence/adherence of the therapists using a revised version of the Cognitive Therapy Adherence and Competence Scale, and the patients rated the quality of the working alliance using the Working Alliance Inventory-short form in therapy sessions 3 and 8. The outcome was assessed by independent assessors as well as by patients self-report. A total of 20.7% of the patients (27.5% SAD, 9.7% PD) dropped out during treatment. The association between the alliance, competence/adherence, outcome and dropout was investigated using multiple regression analyses.

    Results: Higher therapist' competence/adherence early in the therapy was associated with a better outcome among PD patients, lower competence/adherence was associated with dropout among SAD patients. Higher rating of the alliance late in the therapy was associated with a better outcome, whereas lower alliance rating late in the therapy was associated with dropout.

    Conclusion: The findings indicate that the therapist competence/adherence and the working alliance have independent contributions to the outcome from CBT for anxiety disorders, but in different phases of the treatment.

  • 153. Havnen, Audun
    et al.
    Hansen, Bjarne
    Öst, Lars-Göran
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Haukeland University Hospital, Norway; Karolinska Institute, Sweden.
    Kvale, Gerd
    Concentrated ERP Delivered in a Group Setting: A Replication Study2017Inngår i: Behavioural and Cognitive Psychotherapy, ISSN 1352-4658, E-ISSN 1469-1833, Vol. 45, nr 5, s. 530-536Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: In a previous effectiveness study (Havnen et al., 2014), 35 obsessive compulsive disorder (OCD) patients underwent Concentrated Exposure Treatment (cET), which is a newly developed group treatment format delivered over four consecutive days. Aims: The primary aims of the present study were to evaluate the treatment results for a new sample of OCD patients receiving the cET treatment approach and to replicate the effectiveness study described in Havnen et al. (2014). Method: Forty-two OCD patients underwent cET treatment. Treatment was delivered by different therapists than in Havnen et al. (2014), except for two groups led by the developers of the treatment. Assessments of OCD symptom severity, treatment satisfaction, and occupational impairment were included. Results: The results showed a significant reduction in Yale-Brown Obsessive Compulsive Scale scores from pre-treatment to post-treatment, which was maintained at 6-month follow-up. At post-treatment, 74% of the sample was remitted; at 6-month follow-up, 60% were recovered. The sample showed a very high degree of overall treatment satisfaction. The results from the present study were statistically compared with those obtained in the previous study. The analyses showed that the study samples had comparable demographic data and equal application of treatment. The outcome of the present and original study did not differ significantly on primary and secondary outcome measures. Conclusions: This study shows that cET was successfully replicated in a new patient sample treated by different therapists than the original study. The results indicate that cET is well accepted by the patients, and the potential for dissemination is discussed.

  • 154. Hedman-Lagerlöf, Maria
    et al.
    Hedman-Lagerlöf, Erik
    Öst, Lars-Göran
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    The empirical support for mindfulness-based interventions for common psychiatric disorders: a systematic review and meta-analysis2018Inngår i: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 48, nr 13, s. 2116-2129Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Mindfulness-based interventions (MBIs) have become widely used for common mental disorders (CMDs) but the state of the evidence has not been sufficiently investigated. The aims for this study were: (1) to quantify the effect size of MBIs for CMDs in the acute phase; (2) to explore moderator variables; and (3) to evaluate the evidence status of MBIs for the CMDs it has been tried for. A comprehensive systematic review and meta-analysis of randomized controlled trials (RCTs) were conducted. RCTs that evaluated MBI and included patients with a primary manifest CMD was included. Methodological quality, the risk of bias, publication bias and evidence status were assessed. Literature searches gave 2448 hits and 19 studies were included. MBIs were more effective than no treatment (g = 1.07) and treatment-as-usual (g = 0.40) but not in comparison to placebo (g = 0.17) or other active treatments (g = -0.01). Methodological quality was negatively correlated with outcome. For all psychiatric disorders it has been tested, MBIs were judged to have weak or no empirical support. The conclusion of the study is that the evidence-base for MBIs for CMDs in the acute phase is weak.

  • 155.
    Heinrich, Sarah
    et al.
    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.
    Andersson, Gerhard
    Cotter, Katherine
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Weise, Cornelia
    Treating tinnitus distress via the Internet: A mixed methods approach of what makes patients seek help and stay motivated during Internet-based cognitive behavior therapy2016Inngår i: Internet Interventions, ISSN 2214-7829, Vol. 4, nr 2, s. 120-130Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Internet-based cognitive behavioral therapy (ICBT) has proven to be an effective treatment in improving patients' ability to cope with tinnitus. However, some patients prefer face-to-face therapy to ICBT, and a few studies have shown considerable dropout rates if the treatment is not guided. This renders it important to identify factors that contribute to the commencement and continuation of ICBT programs.

    Aims: Because treatment motivation and expectations are important factors in psychological treatment, the aim of our study was to investigate what leads tinnitus patients to seek out ICBT, what helps them to keep up with the treatment, and what (if any) impact these factors have on dropout rates and treatment outcomes.

    Method: 112 tinnitus patients taking part in ICBT for tinnitus responded to symptom-related questionnaires at three points in time (pre-treatment, post-treatment, and one-year-follow-up) and to a questionnaire consisting of open-ended questions about their treatment motivation and expectations before beginning treatment. Data were analyzed using qualitative content analysis, and the results were used to divide the participants into groups. The treatment outcomes of these groups were compared using t-tests, χ2-tests, and both one-factorial and mixed ANOVAs.

    Results: Four main categories emerged as factors conducive to starting treatment: 1) Targets participants wanted to address, 2) circumstances that led to participation, 3) attitudes towards the treatment, and 4) training features. Participants identified six facilitators for continuing the treatment: success, training, individual attitude, hope, evidence, and support. Naming specific tinnitus-associated problems as targets was associated with greater improvement from pre-treatment to 1-year-follow-up. Describing an active involvement in the treatment was related to increased improvement from post-treatment to follow-up.

    Conclusion: There are several motivational factors that tinnitus patients consider relevant for beginning and continuing ICBT. Particularly, focusing on specific targets that do not involve the tinnitus itself, and encouraging participants to take an active role in treatment may increase treatment effectiveness. However, further hypothesis-guided research is necessary to confirm our explorative results.

  • 156. Holländare, Fredrik
    et al.
    Gustafsson, Sanna Aila
    Berglind, Maria
    Grape, Frida
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, Gerhard
    Hadjistavropoulos, Heather
    Tillfors, Maria
    Therapist behaviours in internet-based cognitive behaviour therapy (ICBT) for depressive symptoms2016Inngår i: Internet Interventions, ISSN 2214-7829, Vol. 3, nr 1, s. 1-7Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Internet-based cognitive behaviour therapy (ICBT) is efficacious for treating depression, with therapist guidance identified as important for favourable outcomes. We have limited knowledge, however, about the fundamental components of therapist guidance in ICBT. The purpose of this study was to systematically examine therapist messages sent to patients during the course of ICBT for depressive symptoms in order to identify common “therapist behaviours” and the extent to which these behaviours correlate with completion of modules and improvements in symptoms at post-treatment, one- and two-year follow-up. A total of 664 e-mails from 5 therapists to 42 patients were analysed using qualitative content analysis. The most frequent behaviour was encouraging that accounted for 31.5% of the total number of coded behaviours. This was followed by affirming (25.1%), guiding (22.2%) and urging (9.8%). Less frequently the therapists clarified the internet treatment frameworkinformed about module contentemphasised the importance of patient responsibilityconfronted the patient and made self-disclosures. Six of the nine identified therapist behaviours correlated with module completion. Three behaviours correlated with symptom improvement. Affirmingcorrelated significantly (r = .42, p = .005) with improvement in depressive symptoms at post-treatment and after two years (r = .39, p = .014). Encouraging was associated with outcome directly after treatment (r = .52, p = .001). Self-disclosure was correlated with improvement in depressive symptoms at post-treatment (r = .44, p = .003). The study contributes to a better understanding of therapist behaviours in ICBT for depressive symptoms. Future directions for research are discussed.

  • 157. Ivanov, Volen Z.
    et al.
    Enander, Jesper
    Mataix-Cols, David
    Serlachius, Eva
    Månsson, Kristoffer N. T.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden.
    Andersson, Gerhard
    Flygare, Oskar
    Tolin, David
    Rück, Christian
    Enhancing group cognitive-behavioral therapy for hoarding disorder with between-session Internet-based clinician support: A feasibility study2018Inngår i: Journal of Clinical Psychology, ISSN 0021-9762, E-ISSN 1097-4679, Vol. 74, nr 7, s. 1092-1105Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective Hoarding disorder (HD) is difficult to treat. In an effort to increase efficacy and engagement in cognitive-behavioral therapy (CBT), we developed and evaluated a novel intervention comprising group CBT combined with between-session Internet-based clinician support for people with HD.

    Method Twenty participants with HD received group CBT combined with an Internet-support system enabling therapist-participant communication between group sessions.

    Results The treatment was associated with a significant reduction on the Saving InventoryRevised (SI-R) and a large effect size (Cohen's d=1.57) was found at posttreatment. Treatment gains were maintained at the 3-month follow-up. Group attendance was high and no participants dropped out from treatment prematurely. Between-session motivational support from the therapist was most frequently mentioned as the main strength of the system.

    Conclusion The results of this study support adding Internet-based clinician support to group CBT for HD to increase treatment adherence and, potentially, improve the overall efficacy of CBT.

  • 158.
    Ivanova, Ekaterina
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Lindner, Philip
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Using the Random Forest Algorithm on Customer Gambling Data for Predicting Gambling Freezes in an Online Gambling PlatformManuskript (preprint) (Annet vitenskapelig)
    Abstract [en]

    Background. Data on gambling behaviors routinely collected on online gambling platforms can be used to detect individuals at risk of developing or having gambling problems. As only data on gambling activity is available on gambling platforms, it is important to find a proxy measure for gambling problems. Temporarily freezing one or several gambling categories has potential to serve this purpose. Aim. To predict gambling freeze in a sample of active users of an online gambling platform one week before the freeze, based on one week of behavioral data tracked on the platform. Method. N = 105 predictors were created, covering total values, frequencies, variations, and trajectories of monetary and time-related gambling involvement, number and type of games played, point in time when gambling occurred, age, and gender. The random forest algorithm was applied to a sample of N = 2618 gamblers (of which N = 1309 freezers), with the sample divided 70/30 into a training and testing data set. Results. The accuracy of random forest applied to the testing data set was 0.615, with sensitivity of 0.543 and specificity of 0.686. The five most predictive variables were current age, age on registration date, average session length, average sum of winnings per session, and total session length. Discussion. The predictive accuracy of the algorithm in the current study was relatively low, suggesting the need for a more suitable target variable. Also, analyzing data collected during a longer period might be needed to create a tool that could be used to identify at-risk gamblers.

  • 159.
    Ivanova, Ekaterina
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Lindner, Philip
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Dahlin, Mats
    Vernmark, Kristofer
    Ly, Kien Hoa
    Andersson, Gerhard
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Guided and unguided transdiagnostic Acceptance and Commitment Therapy for anxiety disorders provided via a computer and a smartphone application: A randomized controlled trial2016Inngår i: EABCT 2016 Abstract Book: Total Awareness, 2016, s. 530-530Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Technology-assisted psychological treatments are becoming well-known in the scientific networks throughout the world and are being implemented into routine health care in a number of countries. The interest in evaluating the potential of different devices is growing. The main objective of the current study was to evaluate the effects of guided and unguided computerand smartphone-based Acceptance and Commitment Therapy (ACT) for social anxiety disorder (SAD) and panic disorder (PD).

    A total of 152 participants were randomized into a guided treatment group, an unguided treatment group and a waiting list control group. Both treatment groups got access to a computer-based ACT-treatment and a smartphone application (app) with corresponding content. The eight modules treatment program covered a number of topics such as the nature of anxiety, functional analyses, acceptance, mindfulness and valued actions. The purpose of the app was to make it easier for the participants to access the key points of the program and to do homework assignments in their everyday life. Automatic messages in the app aimed to give feedback to the participants on their work as well as to prompt them to continue with the program. In addition to that, the participants in the guided group got therapist support via the app. The therapists were encouraged to work with each of their patient 15 min/week during the 10 weeks treatment period and focus on motivating, validating and correcting mistakes. On the whole group level GAD-7 was used as the primary outcome measure. LSAS and PDSS-SR were used for subgroup analyses in SAD and PD participants respectively. The measurements were collected at pre-, mid- and post-treatment and at 12-months follow-up.

    There were no significant differences in adherence between the treatment groups except for significantly higher rates of smartphone usage in the guided group. No significant differences in treatment outcome were found between the treatment groups with moderate within-group effects (Cohen’s d = 0.75 for the guided and Cohen’s d = 0.66 for the unguided group). The treated participants improved significantly in comparison to the control group both on the whole group level (between group Cohen’s d = 0.39) and for the participants suffering primarily from SAD (between group Cohen’s d = 0.70). Within group effect sizes were large for the PD-participants (Cohen’s d = 1.00) but the study was very underpowered in this part.

    Discussion. The treatment program as it was used in the present study appeared to be effective in treating social anxiety disorder and decreasing general anxiety symptoms, but the effects are smaller than seen in previous studies. The guided treatment was not clearly superior to the unguided one. The study contributes to the growing body of evidence on technology-assisted ACT.

    Conclusion. Computer- and smartphone-based ACT can be made into an effective treatment for anxiety disorders. A smartphone application seems to have a clear potential to partly compensate for the absence of therapist support which needs to be studied further.

  • 160.
    Ivanova, Ekaterina
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Lindner, Philip
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden.
    Ly, Kien Hoa
    Dahlin, Mats
    Vernmark, Kristofer
    Andersson, Gerhard
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Guided and unguided Acceptance and Commitment Therapy for social anxiety disorder and/or panic disorder provided via the Internet and a smartphone application: A randomized controlled trial2016Inngår i: Journal of Anxiety Disorders, ISSN 0887-6185, E-ISSN 1873-7897, Vol. 44, s. 27-35Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Acceptance and Commitment Therapy (ACT) can be effective in treating anxiety disorders, yet there has been no study on Internet-delivered ACT for social anxiety disorder (SAD) and panic disorder (PD), nor any study investigating whether therapist guidance is superior to unguided self-help when supplemented with a smartphone application. In the current trial, n = 152 participants diagnosed with SAD and/or PD were randomized to therapist-guided or unguided treatment, or a waiting-list control group. Both treatment groups used an Internet-delivered ACT-based treatment program and a smartphone application. Outcome measures were self-rated general and social anxiety and panic symptoms. Treatment groups saw reduced general (d = 0.39) and social anxiety (d = 0.70), but not panic symptoms (d = 0.05) compared to the waiting-list group, yet no differences in outcomes were observed between guided and unguided interventions. We conclude that Internet-delivered ACT is appropriate for treating SAD and potentially PD. Smartphone applications may partially compensate for lack of therapist support.

  • 161.
    Ivanova, Ekaterina
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Rafi, Jonas
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Lindner, Philip
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Stockholm County Council, Sweden.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. University of Southern Denmark, Denmark.
    Experiences of responsible gambling tools among non-problem gamblers: A survey of active customers of an online gambling platform2019Inngår i: Addictive Behaviors Reports, ISSN 2352-8532, E-ISSN 2076-3387, Vol. 9, artikkel-id 100161Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction: Responsible gambling (RG) tools, aiming at helping gamblers to avoid gambling-related harms, are common in online gambling platforms. Gambling industry, policy makers, and researchers have warned that RG tools can potentially disturb recreational gamblers, channeling them to less protective operators. No evidence exists to support these concerns, and they can hinder the development of effective RG tools. The current study aimed to investigate the recreational gamblers' experiences of RG tools.

    Methods: A total of 10,200 active customers of an online gambling service were invited to complete an online survey and rate their overall reactions, attitudes, disturbance and irritation towards RG tools, as well as their inclination to abandon a gambling service due to overexposure to RG tools. N = 1223 surveys were completed.

    Results: Non-problem gamblers had positive experiences of RG tools. Moderate-risk gamblers had more positive overall reaction and less irritation to previous experiences of RG tools compared to non-problem gamblers. Problem gamblers had least positive attitudes, most disturbance and most irritation towards RG pictures. Non-problem gamblers had lowest rates of having abandoned a service because of perceived overexposure to RG tools (5.2% compared to 25.9% of problem gamblers), with a significant between-group difference (OR [95%CI] = 7.17 [3.61–14.23], p < .001).

    Conclusions: Non-problem gamblers were not particularly disturbed by RG tools and were not at risk of abandoning online gambling services because of overexposure to RG tools. The study found no grounds for limiting the design and implementation of RG tools due to fears of disturbing recreational gamblers.

  • 162.
    Jansson-Fröjmark, Markus
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Örebro University, Sweden.
    Danielsson, Katarina
    Markström, Agneta
    Broman, Jan-Erik
    Developing a cognitive behavioral therapy manual for delayed sleep-wake phase disorder2016Inngår i: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 45, nr 6, s. 518-532Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This article reports the development of a treatment protocol, based on cognitive behavioral therapy (CBT) principles, for delayed sleep-wake phase disorder (DSWPD). The protocol consists of psychoeducation, presenting a CBT model for DSWPD, case formulation, motivational interviewing, registering sleep in a diary, strategies to improve the rhythm of sleep and wakefulness, relaxation training, cognitive restructuring, strategies to cope with daytime symptoms, constructing an individualized CBT program, and learning how to deal with relapses. Qualitative data, focusing on how the patients perceived the protocol, were collected within the realm of a trial exploring the efficacy of the protocol. These findings highlighted several advantages but also disadvantages of the therapy. It is our hope that this paper might act as a platform for further clinical work and future research efforts in patients with DSWPD.

  • 163.
    Jansson-Fröjmark, Markus
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Norell-Clarke, Annika
    Cognitive Behavioural Therapy for Insomnia in Psychiatric Disorders2016Inngår i: Current Sleep Medicine Reports, E-ISSN 2198-6401, Vol. 2, nr 4, s. 233-240Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Insomnia means difficulties in initiating or maintaining sleep and is commonly comorbid with psychiatric disorders. From being considered secondary to primary psychiatric disorders, comorbid insomnia is now considered an independent health issue that warrants treatment in its own right. Cognitive behavioural therapy for insomnia (CBT-I) is an evidence-based treatment for insomnia. The effects from CBT-I on comorbid psychiatric conditions have received increasing interest as insomnia comorbid with psychiatric disorders has been associated with more severe psychiatric symptomologies, and there are studies that indicate effects from CBT-I on both insomnia and psychiatric symptomology. During recent years, the literature on CBT-I for comorbid psychiatric groups has expanded and has advanced methodologically. This article reviews recent studies on the effects from CBT-I on sleep, daytime symptoms and function and psychiatric comorbidities for people with anxiety, depression, bipolar disorder, psychotic disorders and post-traumatic stress disorder. Future strategies for research are suggested.

  • 164.
    Jansson-Fröjmark, Markus
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Örebro University, Sweden.
    Norell-Clarke, Annika
    Linton, Steven J.
    The role of emotion dysregulation in insomnia: Longitudinal findings from a large community sample2016Inngår i: British Journal of Health Psychology, ISSN 1359-107X, E-ISSN 2044-8287, Vol. 21, nr 1, s. 93-113Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    ObjectivesThe purpose of this longitudinal investigation was to examine the association between emotion regulation and future insomnia (incidence and persistence). DesignA longitudinal study in the general population. MethodsA survey was sent out to 5,000 individuals in the community. To those who returned the baseline questionnaire (n=2,333), two follow-up surveys, 6 and 18months later, were sent out and then completed by 1,887 and 1,795 individuals, respectively. The survey contained information about demographic factors, insomnia symptomatology, the Difficulties in Emotion Regulation Scale, anxiety, and depression. ResultsThe findings suggested that emotion regulation at baseline was not associated with the incidence or persistence of insomnia. Overall, the effect sizes were very small to medium. When examining changes in emotion regulation over time, a different pattern emerged. Partial support was established for the notion that decreases in emotion regulation were related to incident and persistent insomnia, as a decrease in emotion regulation was associated with a higher likelihood of future insomnia. Yet, the effect sizes were very small to small. ConclusionThis study does partly point towards a longitudinal association between emotion dysregulation and insomnia. This might have implications for the conceptualization and management of insomnia as well as for future research.

  • 165.
    Johansson, Magnus
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Jansson-Fröjmark, Markus
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Örebro University, Sweden.
    Norell-Clarke, Annika
    Linton, Steven J.
    The role of psychiatric and somatic conditions in incidence and persistence of insomnia: A longitudinal, community study2016Inngår i: Sleep Health, ISSN 2352-7218, E-ISSN 2352-7226, Vol. 2, nr 3, s. 229-238Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: The objective was to investigate the role of psychiatric and somatic conditions in incident and persistent insomnia. Design: This was a prospective study with 3 measurement points over 1.5 years. Setting: The participants were sent a survey to their home addresses. Participants: A survey was sent out to 5000 random individuals (18-70 years) in 2 Swedish counties. To those who returned the baseline questionnaire (n = 2333), 2 follow-up surveys (6 and 18 months later) were sent out and completed by 1887 and 1795 individuals, respectively. Measurements: The survey contained questions about sociodemographic factors and insomnia symptomatology, the Hospital Anxiety and Depression Scale, and items assessing 12 forms of somatic conditions (eg, heart disease and headache). Results: Baseline depression, headache, and number of psychiatric and somatic conditions were found to be independent risk factors for incident insomnia. Also, deterioration in depression and heart disease status and increased number of conditions over time increased the risk for insomnia incidence. Anxiety; depression; pain in neck, back, or shoulders; and headache at baseline were found to significantly discriminate between those with persistent insomnia and those with persistent normal sleep. Those with persistent insomnia also reported a higher number of conditions relative to those with persistent normal sleep. None of the psychiatric or somatic conditions were found to be associated with persistence of insomnia relative to remission of insomnia. Conclusion: The current study suggests that both psychiatric and somatic conditions are involved in the incidence but not in the persistence of insomnia. Clinical and theoretical implications of the results are discussed.

  • 166. Johansson, Olof
    et al.
    Bjärehed, Jonas
    Andersson, Gerhard
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. University of Southern Denmark, Denmark.
    Lundh, Lars-Gunnar
    Effectiveness of guided internet-delivered cognitive behavior therapy for depression in routine psychiatry: A randomized controlled trial2019Inngår i: Internet Interventions, ISSN 2214-7829, Vol. 17, artikkel-id 100247Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Depression is one of the most common health problems worldwide but is often undertreated. Internet-delivered cognitive behavioral therapy(ICBT) appears to be an effective treatment option, with the potential to reach a larger proportion of individuals suffering from depression. While many studies have examined the efficacy of ICBT for depression in randomized controlled trials, fewer have focused on the effectiveness of ICBT when used as an integral part of routine health care. In this study the effectiveness of an 8-week ICBT program was examined when delivered in a routine psychiatric setting. A total of 108 patients were referred and 54 were then included and randomized to either ICBT or a waitlist control condition. The sample had a lower education level and a higher proportion of individuals were on sick leave than comparable previous efficacy trials of ICBT for depression conducted in Sweden. Measures assessing depression, anxiety and psychiatric symptoms were administered before and after treatment, follow up was performed at 6- and 12 months after treatment had ended. ICBT resulted in significant reductions of depressive symptoms in the treatment group when compared to a waitlist control group with a large effect size (Cohen's d = 1.6). Treatment gains were maintained at 6- and 12 months after the treatment had ended. In terms of clinical significance, 58% of the sample had improved or recovered after treatment. The study was small, and patients received general psychiatric care after the ICBT treatment had ended which limits the implications. We conclude that ICBT appears to be an effective treatment for depression when delivered as an integral part of routine psychiatric care.

  • 167. Johansson, Robert
    et al.
    Hesslow, Thomas
    Ljótsson, Brjánn
    Jansson, Angelica
    Jonsson, Lina
    Färdig, Smilla
    Karlsson, Josefine
    Hesser, Hugo
    Frederick, Ronald J.
    Lilliengren, Peter
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, Gerhard
    Internet-based affect-focused psychodynamic therapy for social anxiety disorder: A randomized controlled trial with 2-year follow-up2017Inngår i: Psychotherapy, ISSN 0033-3204, E-ISSN 1939-1536, Vol. 54, nr 4, s. 351-360Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Social anxiety disorder (SAD) is associated with considerable individual suffering and societal costs. Although there is ample evidence for the efficacy of cognitive behavior therapy, recent studies suggest psychodynamic therapy may also be effective in treating SAD. Furthermore, Internet-based psychodynamic therapy (IPDT) has shown promising results for addressing mixed depression and anxiety disorders. However, no study has yet investigated the effects of IPDT specifically for SAD. This paper describes a randomized controlled trial testing the efficacy of a 10-week, affect-focused IPDT protocol for SAD, compared with a wait-list control group. Long-term effects were also estimated by collecting follow-up data, 6, 12, and 24 months after the end of therapy. A total of 72 individuals meeting diagnostic criteria for DSM–IV social anxiety disorder were included. The primary outcome was the self-report version of Liebowitz Social Anxiety Scale. Mixed model analyses using the full intention-to-treat sample revealed a significant interaction effect of group and time, suggesting a larger effect in the treatment group than in the wait-list control. A between-group effect size Cohen’s d = 1.05 (95% [CI]: [0.62, 1.53]) was observed at termination. Treatment gains were maintained at the 2-year follow-up, as symptom levels in the treated group continued to decrease significantly. The findings suggest that Internet-based affect-focused psychodynamic therapy is a promising treatment for social anxiety disorder.

  • 168.
    Johansson, Robert
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Linköping University, Sweden.
    Ramnerö, Jonas
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Jönsson, Arne
    Arbitrarily applicable relational responding as non-axiomatic logical reasoning2018Inngår i: Proceedings of the 14th SweCog Conference / [ed] Tom Ziemke, Mattias Arvola, Nils Dahlbäck, Erik Billing, Skövde: University of Skövde , 2018, s. 7-9Konferansepaper (Fagfellevurdert)
    Abstract [en]

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

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

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

  • 169. Johnson, Shevaugn
    et al.
    Egan, Sarah J.
    Andersson, Gerhard
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. University of Southern Denmark, Denmark.
    Shafran, Roz
    Wade, Tracey D.
    Internet-delivered cognitive behavioural therapy for perfectionism: Targeting dysmorphic concern2019Inngår i: Body image, ISSN 1740-1445, E-ISSN 1873-6807, Vol. 30, s. 44-55Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Perfectionism is an important transdiagnostic risk factor for several psychopathologies. As such, treatments targeting perfectionism have gained increased attention over recent years. While perfectionism is postulated to be an important underlying mechanism for dysmorphic concern, no research has explored the benefits of targeting perfectionism to reduce dysmorphic concern. The current study evaluated the use of Internet-delivered cognitive behavioural therapy for perfectionism (ICBT-P) with 31 participants (28 women) with high levels of dysmorphic concern to examine the impact on perfectionism, dysmorphic concern, body image disturbance, negative affect, and selective attention towards appearance-based stimuli. Using a case series design, observations were collected at baseline, at the end of a 4-week pre-treatment phase, after the 8-week ICBT-P, and 1-month post-treatment. Intent-to-treat analyses showed significant improvement from baseline to end-of-treatment and follow-up on most of the variables, with a large effect size decrease in dysmorphic concern, and decreased selective attention to BDD-bodyBDD-positive, and BDD-negative words. The results of this study support the use of ICBT-P as an efficacious treatment worthy of further examination in populations who experience high levels of dysmorphic concern.

  • 170. Jolstedt, Maral
    et al.
    Wahlund, Tove
    Lenhard, Fabian
    Ljótsson, Brjánn
    Mataix-Cols, David
    Nord, Martina
    Öst, Lars-Göran
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Högström, Jens
    Seriachius, Eva
    Vigerland, Sarah
    Efficacy and cost-effectiveness of therapist-guided internet cognitive behavioural therapy for paediatric anxiety disorders: a single-centre, single-blind, randomised controlled trial2018Inngår i: Lancet child and adolescent health, ISSN 2352-4642, Vol. 2, nr 11, s. 792-801Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Paediatric anxiety disorders are associated with substantial disability and long-term adverse consequences, but only a small proportion of affected children have access to evidence-based treatment. Internet-delivered cognitive behavioural therapy (ICBT) could help increase accessibility but needs further rigorous assessment. We aimed to assess the efficacy and cost-effectiveness of ICBT in the treatment of paediatric anxiety disorders. Methods: We did a single-blind randomised controlled trial in a clinical research unit within the Child and Adolescent Mental Health Services in Stockholm (Sweden). Eligible participants were children aged 8-12 years with a diagnosis of a principal anxiety disorder (seperation anxiety disorder, generalised anxiety disorder, specific phobia, social anxiety disorder, or panic disorder) of at least moderate severity. We randomly allocated participants (1:1) to ICBT or internet-delivered child-directed play, an active comparator aimed to improve parent child relationships and increase a child's self-esteem without directly targeting anxiety. Block sizes for the randomisation varied between four and six and were generated using a computer random-number generator, and the allocation was concealed from the researchers by opaque sealed envelopes. Both treatment programmes comprised 12 modules presented over 12 weeks with weekly asynchronous online therapist support, and consisted of texts, films, illustrations, and exercises. The primary outcome was severity rating of the principal anxiety disorder 12-weeks post-treatment, via the Anxiety Disorder Interview Schedule for Diagnostic and Statistical Manual of Mental Disorders-IV (a rating of at least 4 corresponds to meeting the criteria for the principal diagnosis), assessed by clinicians masked to treatment allocation. All participants were included in the primary analysis (intention-to-treat). This trial is registered at ClinicalTrials.gov, number NCTO 2350257. Findings: Between March 11, 2015, and Oct 21, 2016, 131 participants were recruited and allocated to either ICBT (n=66) or internet-delivered child-directed play (n=65). The clinician-assessed severity rating of the principal anxiety disorder improved significantly after the 12-weeks treatment period for participants in both ICBT (within-group effect size 1.22, 95% CI 0 78-1.65) and the active control (0.72, 0.44-1.00) groups. However, greater improvement was seen with ICBT than with the active control (estimated mean difference 0.79, 95% CI 0.42-1.16, p=0.002; between-group effect size 0.77, 95% CI 0.40-1.15). 29 (48%) participants in the ICBT group no longer had their principal diagnosis, compared to nine (15%) in the active control group (odds ratio 5.41, 95% CI 2.26 to 12.90, p<0.0001); the number needed to treat for ICBT to gain one additional participant in remission was three (95% CI 2.85 to 3.15). ICBT resulted in an average societal-cost saving of 493 05 (95% CI 477.17 to 508.92) per participant. No severe adverse events were reported. Interpretation ICBT is an efficacious and cost-effective treatment for paediatric anxiety disorders that should be considered for implementation in routine clinical care.

  • 171.
    Jonsson, Jakob
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Abbott, Max W.
    Sjöberg, Anders
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Arbets- och organisationspsykologi.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Measuring Gambling Reinforcers, Over Consumption and Fallacies: The Psychometric Properties and Predictive Validity of the Jonsson-Abbott Scale2017Inngår i: Frontiers in Psychology, ISSN 1664-1078, E-ISSN 1664-1078, Vol. 8, artikkel-id 1807Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

  • 172.
    Jonsson, Jakob
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Hodgins, David C.
    Munck, Ingrid
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. University of Southern Denmark, Denmark.
    Reaching Out to Big Losers: A Randomized Controlled Trial of Brief Motivational Contact Providing Gambling Expenditure Feedback2019Inngår i: Psychology of Addictive Behaviors, ISSN 0893-164X, E-ISSN 1939-1501, Vol. 33, nr 3, s. 179-189Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Gambling disorder is a public health issue in many countries, and expectations that the gambling industry protects individuals from harm are increasing. The primary objective of this study was to investigate the effects of providing personalized feedback on gambling intensity among high consumers of venue-based and online gambling in Norway. A randomized controlled trial design was used to evaluate how behavioral feedback by telephone or letters sent via surface mail affects subsequent gambling expenditure and use of responsible gambling tools and whether a follow-up contact increases the effect. Gambling expenditure, the primary outcome, was measured using theoretical loss, which is the actual cost to the player, adjusted for the house advantage. From the top .5% of customers based upon annual expenditure, a sample of 1,003 statistical triplets, matched on sex, age, and net losses, were randomly assigned to the feedback intervention by telephone, letter, or a no-contact control condition. Participants assigned to the phone call or letter were also randomly assigned to receive or not receive a subsequent follow-up contact. The results showed that over 12 weeks, theoretical loss decreased 29% for the phone and 15% for the letter conditions, compared with 3% for the control group. A positive effect of the follow-up contact was limited to participants who at the initial call indicated an interest in receiving a follow-up call. Contacting high consumers about their gambling expenditure appears to be an effective method for gambling companies to meet their duty to care for customers.

  • 173.
    Jonsson, Jakob
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Hodgins, David
    Munck, Ingrid
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Reaching out to big losers: Brief motivational contact leads to sustained reductions in gambling over one yearInngår i: Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background and aims: We previously demonstrated that phone and letter-based motivational interventions with high expenditure gamblers had significant short term positive effects on gambling and use of responsible gambling tools. This report examines outcomes over twelve months.

    Design: A randomized controlled trial design with three conditions: feedback intervention by telephone, letter, or a no-contact control condition.

    Setting: Customers of Norsk Tipping gambling platforms.

    Participants: 1,003 statistical triplets from the top .5% of customers based upon annual expenditure, matched on sex, age, and net losses.

    Measurements: Primary outcome measure was gambling theoretical loss, derived from the Norsk Tipping customer database. Secondary outcomes were responsible gambling customer actions and whether the participant was retained as a NT customer.

    Findings: The results showed a positive and sustained effect of the phone and letter interventions over 12 months - the telephone group showed a 30% reduction in theoretic loss (d =0.44) and the letter group 13% (d =0.18), both outperforming the control group with a 7% reduction (d =0.11). The phone condition was superior to both the letter and control conditions in per protocol (p<0.001) and intention to treat analyses (ITT) (p< 0.018 and 0.001). Individuals in the phone condition took more responsible gambling actions. The letter condition had better outcomes than the control in the ITT only (p<0.001). Over 99% in the intervention groups were still customers during the follow-up year.

    Conclusions: A targeted telephone intervention with high expenditure customers effectively reduced theoretical losses over a 12 month period. Gambling companies can utilize this type of intervention as a response to their duty to care for customers.

  • 174.
    Jonsson, Jakob
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Munck, Ingrid
    Volberg, Rachel
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    GamTest: Psychometric Evaluation and the Role of Emotions in an Online Self-Test for Gambling Behavior2017Inngår i: Journal of Gambling Studies, ISSN 1050-5350, E-ISSN 1573-3602, Vol. 33, nr 2, s. 505-523Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

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

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

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

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

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

  • 176. Jović, Vladimir
    et al.
    Varvin, Sverre
    Rosenbaum, Bent
    Fischmann, Tamara
    Opačić, Goran
    Hau, Stephan
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Sleep Studies in Serbian Victims of Torture: Analysis of Traumatic Dreams2018Inngår i: Sleep and Combat-Related Post Traumatic Stress Disorder / [ed] Eric Vermetten, Anne Germain,Thomas C. Neylan, New York: Springer, 2018, s. 395-409Kapittel i bok, del av antologi (Fagfellevurdert)
    Abstract [en]

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

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

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

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

  • 178. Kodal, Arne
    et al.
    Fjermestad, Krister
    Bjelland, Ingvar
    Gjestad, Rolf
    Öst, Lars-Göran
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Haukeland University Hospital, Norway.
    Bjaastad, Jon F.
    Haugland, Bente S. M.
    Havik, Odd E.
    Heiervang, Einar
    Wergeland, Gro Janne
    Long-term effectiveness of cognitive behavioral therapy for youth with anxiety disorders2018Inngår i: Journal of Anxiety Disorders, ISSN 0887-6185, E-ISSN 1873-7897, Vol. 53, s. 58-67Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Cognitive behavioral therapy (CBT) has demonstrated favorable long-term outcomes in youth with anxiety disorders in efficacy trials. However, long-term outcomes of CBT delivered in a community setting are uncertain. This study examined the long-term outcomes of individual (ICBT) and group CBT (GCBT) in youth with anxiety disorders treated in community mental health clinics. A total of 139 youth (mean age at assessment 15.5 years, range 11-21 years) with a principal diagnosis of separation anxiety disorder (SAD), social anxiety disorder (SOP), and/or generalized anxiety disorder (GAD) were evaluated, on average, 3.9 years post-treatment (range 2.2-5.9 years). Outcomes included loss of all inclusion anxiety diagnoses, loss of the principal anxiety diagnosis and changes in youth- and parent-rated youth anxiety symptoms. At long-term follow-up, there was loss of all inclusion anxiety diagnoses in 53%, loss of the principal anxiety diagnosis in 63% of participants as well as significant reductions in all anxiety symptom measures. No statistical significant differences in outcome were obtained between ICBT and GCBT. Participants with a principal diagnosis of SOP had lower odds for recovery, compared to those with a principal diagnosis of SAD or GAD. In conclusion, outcomes of CBT for youth anxiety disorders delivered in community mental health clinics were improved at nearly 4 years post-treatment, and recovery rates at long-term follow-up were similar to efficacy trials.

  • 179. Kodal, Arne
    et al.
    Fjermestad, Krister W.
    Bjelland, Ingvar
    Gjestad, Rolf
    Öst, Lars-Göran
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Haukeland University Hospital, Norway.
    Bjaastad, Jon F.
    Haugland, Bente S. M.
    Havik, Odd E.
    Heiervang, Einar R.
    Wergeland, Gro Janne H.
    Predictors of long-term outcome of CBT for youth with anxiety disorders treated in community clinics2018Inngår i: Journal of Anxiety Disorders, ISSN 0887-6185, E-ISSN 1873-7897, Vol. 59, s. 53-63Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Cognitive behavioral therapy (CBT) has proven long-term effects in youth with anxiety disorders. However, only a few studies have examined predictors of long-term outcomes of CBT treatment. The present study investigated possible predictors of long-term treatment outcomes in youth with mixed anxiety disorders treated in community mental health clinics. A total of 139 youth (mean age at assessment 15.5 years, range 11–21 years) with a principal diagnosis of separation anxiety disorder, social anxiety disorder, and/or generalized anxiety disorder were evaluated a mean of 3.9 years post-treatment (range 2.2–5.9 years). Outcomes were loss of all inclusion anxiety diagnoses, loss of the principal inclusion anxiety diagnosis, and changes in youth- and parent-rated youth anxiety symptoms. Predictors encompassed youth, parent and demographic factors, and post-treatment recovery. The most consistent finding was that low family social class predicted poorer outcomes. Higher treatment motivation was associated with better outcome whereas a diagnosis of social anxiety was associated with poorer outcome. Identified predictors extend on previous findings from efficacy trials, and the results indicate a need for more specific treatment protocols.

  • 180. Kraepelien, Martin
    et al.
    Forsell, Erik
    Karin, Eyal
    Johansson, Robert
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden.
    Lindefors, Nils
    Kaldo, Viktor
    Comparing individually tailored to disorder-specific internet-based cognitive-behavioural therapy: benchmarking study2018Inngår i: BJPsych Open, E-ISSN 2056-4724, Vol. 4, nr 4, s. 282-284Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Disorder-specific internet-based cognitive-behavioural therapy (ICBT) is effective for depression, panic disorder and social anxiety. In this benchmarking study, a new, individually tailored, ICBT programme (TAIL) showed effects on depression (n = 284, d = 1.33) that were non-inferior to disorder-specific ICBT for depression in routine care (n = 2358, d = 1.35). However, the hypotheses that TAIL for individuals with social anxiety or panic disorder is inferior to disorder-specific ICBT could not be rejected (social anxiety: TAIL d = 0.74 versus disorder-specific d = 0.81; panic: TAIL d = 1.11 versus disorder-specific d = 1.47). Our findings strengthen the empirical base for TAIL as an alternative to disorder-specific ICBT for depression.

  • 181.
    Kruijt, Anne-Wil
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Mechanics of contingency-based Cognitive Bias Modification: pre-existing bias affects potency of active training but not placebo conditionsManuskript (preprint) (Annet vitenskapelig)
    Abstract [en]

    Cognitive Bias Modification (CBM) is an overarching term for various computerized training protocols developed to change automatic information processing patterns (cognitive biases). CBM tasks are designed to reward response tendencies associated with more desired information processing patterns trough repeated practice. Target cognitive biases include those believed to be involved in anxiety, depression, addiction, and eating disorders, and CBM protocols are commonly regarded as potential new treatments. Most CBM forms rely on a (hidden) contingency between stimulus valence and response rewards. In CBM studies, active training conditions are typically contrasted with control conditions lacking the contingency, often called 50/50 placebo. This report focusses on the wide-spread, and intuitive, notion that pre-existing bias may affect the contingency experienced by an individual engaging in a 50/50 placebo control condition, and that this may inadvertently render the intended placebo condition more potent. Employing probabilistic reasoning, we conclude that, contrary to the often-forwarded notion, pre-existing bias cannot increase the potency of a 50/50 placebo condition. In contrast, we arrived at the unforeseen conclusion that lack of pre-existing bias may render an active training condition functionally similar to a placebo condition. In this paper we develop these arguments, review literature with respect to our assumptions, and discuss implications.

  • 182.
    Kruijt, Anne-Wil
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Mechanics of Contingency-Based Cognitive Bias Modification: Pre-Existing Bias Affects Potency of Active Training but Not Placebo Conditions2019Inngår i: Proceedings of the 9th World Congress of Behavioural & Cognitive Therapies: Volume II. Posters / [ed] Thomas Heidenreich, Philip Tata, Tübingen: dgvt-Verlag , 2019, Vol. 2, s. 161-161Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Introduction: Cognitive Bias Modification (CBM) refers various computerized training protocols aimed at modifying individuals’ automatic information processing patterns (cognitive biases). CBM protocols are commonly regarded as potential new treatments, targeting cognitive biases believed to be involved in anxiety, depression, substance abuse, disordered eating, pain perception, insomnia, etc. Designed to reward response tendencies associated with more desired information processing patterns trough repeated practice, CBM tasks tend to rely on a (hidden) contingency between stimulus valence and response rewards. In CBM studies, active training conditions are typically contrasted with control conditions lacking the contingency, often called 50/50 placebo. This report focusses on the wide-spread, and intuitive, notion that pre-existing bias may affect the contingency experienced by an individual engaging in a 50/50 placebo control condition thereby inadvertently rendering the intended placebo condition more potent.

    Method: We employed probabilistic reasoning, presenting formulae to compute the probability for each type of trial to modify or consolidate an individuals initial response tendency. In addition, an interactive online visualization app has been made available.

    Results: Contrary to the often-forwarded notion, pre-existing bias cannot increase the potency of a 50/50 placebo condition. In contrast, we arrived at the unforeseen conclusion that lack of pre-existing bias may render an active training condition functionally similar to a placebo condition.

    Discussion: Our probabilistic arguments invite discussion of CBM’s implicitness assumption, as well as the ever more clearly emerging problem of information processing biases not being reliably observed in clinical populations whereas our arguments suggest that pre-existing bias is necessary for CBM to function in the manner that it is devised to function.

  • 183.
    Kruijt, Anne-Wil
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Processing confusing procedures in the recent re-analysis of a cognitive bias modification (CBM) meta-analysis2017Inngår i: British Journal of Psychiatry, ISSN 0007-1250, E-ISSN 1472-1465, Vol. 211, nr 5, s. 266-271Artikkel i tidsskrift (Annet vitenskapelig)
  • 184.
    Kruijt, Anne-Wil
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Processing confusing procedures in the recent re-analysis of a cognitive bias modification meta-analysis2018Inngår i: British Journal of Psychiatry, ISSN 0007-1250, E-ISSN 1472-1465, Vol. 212, nr 4, s. 246-246Artikkel i tidsskrift (Annet vitenskapelig)
  • 185.
    Kruijt, Anne-Wil
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Parsons, Sam
    Fox, Elaine
    A Meta-Analysis of Bias at Baseline in RCTs of Attention Bias Modification: No Evidence for Dot-Probe Bias Towards Threat in Clinical Anxiety and PTSD2019Inngår i: Journal of Abnormal Psychology, ISSN 0021-843X, E-ISSN 1939-1846, Vol. 128, nr 6, s. 563-573Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Considerable effort and funding have been spent on developing Attention Bias Modification (ABM) as a treatment for anxiety disorders, theorized to exert therapeutic effects through reduction of a tendency to orient attention towards threat. However, meta-analytical evidence that clinical anxiety is characterized by threat-related attention bias is thin. The largest meta-analysis to date included dot-probe data for n=337 clinically anxious individuals. Baseline measures of biased attention obtained in ABM RCTs form an additional body of data that has not previously been meta-analyzed.

    Method: This paper presents a meta-analysis of threat-related dot-probe bias measured at baseline for 1005 clinically anxious individuals enrolled in 13 ABM RCTs.

    Results: Random-effects meta-analysis indicated no evidence that the mean bias index (BI) differed from zero (k= 13, n= 1005, mean BI = 1.8 ms, SE = 1.26 ms, p = .144, 95% CI [-0.6 - 4.3]. Additional Bayes factor analyses also supported the point-zero hypothesis (BF10 = .23), whereas interval-based analysis indicated that mean bias in clinical anxiety is unlikely to extend beyond the 0 to 5 ms interval. 

    Discussion: Findings are discussed with respect to strengths (relatively large samples, possible bypassing of publication bias), limitations (lack of control comparison, repurposing data, specificity to dot-probe data), and theoretical and practical context. We suggest that it should no longer be assumed that clinically anxious individuals are characterized by selective attention towards threat.

    Conclusion: Clinically anxious individuals enrolled in RCTs for Attention Bias Modification are not characterized by threat-related attention bias at baseline.

  • 186.
    Kruijt, Anne-Wil
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Parsons, Sam
    Fox, Elaine
    Treatment without target? No meta-analytical evidence for baseline bias towards threat in 860 clinically anxious individuals enrolled in Attention Bias Modification RCTs2017Konferansepaper (Fagfellevurdert)
    Abstract [en]

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

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

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

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

  • 187. Kvale, Gerd
    et al.
    Hansen, Bjarne
    Bjorgvinsson, Throstur
    Bortveit, Tore
    Hagen, Kristen
    Haseth, Svein
    Kristensen, Unn Beate
    Launes, Gunvor
    Ressler, Kerry J.
    Solem, Stian
    Strand, Arne
    van den Heuvel, Odile A.
    Öst, Lars-Göran
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Haukeland University Hospital, Norway.
    Successfully treating 90 patients with obsessive compulsive disorder in eight days: the Bergen 4-day treatment2018Inngår i: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 18, artikkel-id 323Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Oslo University Hospital, Norway, had by autumn 2016, accumulated a waiting list of 101 patients with obsessive-compulsive disorder (OCD) who had a legal right to receive treatment by a specialized OCD team. In this challenging situation, the Bergen OCD-team suggested to solve the problem by offering all patients an option for the rapid Bergen 4-day treatment (B4DT). The B4DT is an individual treatment delivered during four consecutive days in a group of six patients with the same number of therapists. The approach has previously shown a post-treatment response rate of 90% and a 3-month remission rate of 70%. Methods: Ninety-seven of the wait-list patients were available for the scheduled time slots, and 90 received the 4-day format during 8 days (45 patients each week). The therapists were recruited from 22 different specialized OCD-teams from all over Norway, and 44 (68%) had not previously delivered the 4-day format. Results: Post-treatment; 91.1% of the patients were classified as responders, and 72.2% were in remission. At 3-month follow-up; 84.4 were classified as responders and the remission rate was 67.7%. Oslo University Hospital now offers the 4-day treatment as standard treatment for OCD. Conclusions: We conclude that the B4DT is an acceptable and potentially effective OCD-treatment.

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

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

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

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

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

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

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

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

  • 190.
    Letellier, Isabelle
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Du signifiant à l’inconscient comme béance: Lacan contre le structuralisme, vers Merleau-Ponty2016Inngår i: Revue roumaine de philosophie, ISSN 1220-5400, Vol. 60, nr 1, s. 39-53Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

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

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

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

  • 192.
    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.

  • 193.
    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.

  • 194. Linardon, Jake
    et al.
    Cuijpers, Pim
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Messer, Mariel
    Fuller-Tyszkiewicz, Matthew
    The efficacy of app‐supported smartphone interventions for mental health problems: a meta‐analysis of randomized controlled trials2019Inngår i: World Psychiatry, ISSN 1723-8617, E-ISSN 2051-5545, Vol. 18, nr 3, s. 325-336Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Although impressive progress has been made toward developing empirically‐supported psychological treatments, the reality remains that a significant proportion of people with mental health problems do not receive these treatments. Finding ways to reduce this treatment gap is crucial. Since app‐supported smartphone interventions are touted as a possible solution, access to up‐to‐date guidance around the evidence base and clinical utility of these interventions is needed. We conducted a meta‐analysis of 66 randomized controlled trials of app‐supported smartphone interventions for mental health problems. Smartphone interventions significantly outperformed control conditions in improving depressive (g=0.28, n=54) and generalized anxiety (g=0.30, n=39) symptoms, stress levels (g=0.35, n=27), quality of life (g=0.35, n=43), general psychiatric distress (g=0.40, n=12), social anxiety symptoms (g=0.58, n=6), and positive affect (g=0.44, n=6), with most effects being robust even after adjusting for various possible biasing factors (type of control condition, risk of bias rating). Smartphone interventions conferred no significant benefit over control conditions on panic symptoms (g=–0.05, n=3), post‐traumatic stress symptoms (g=0.18, n=4), and negative affect (g=–0.08, n=5). Studies that delivered a cognitive behavior therapy (CBT)‐based app and offered professional guidance and reminders to engage produced larger effects on multiple outcomes. Smartphone interventions did not differ significantly from active interventions (face‐to‐face, computerized treatment), although the number of studies was low (n≤13). The efficacy of app‐supported smartphone interventions for common mental health problems was thus confirmed. Although mental health apps are not intended to replace professional clinical services, the present findings highlight the potential of apps to serve as a cost‐effective, easily accessible, and low intensity intervention for those who cannot receive standard psychological treatment.

  • 195.
    Lindau, Maria
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Kognitiv psykologi.
    Najström, Mats
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Cross-cultural applicability and reduction of the American seven-subtest short form of the WAIS on a Swedish non-clinical sample2019Inngår i: Nordic Psychology, ISSN 1901-2276, E-ISSN 1904-0016, Vol. 71, nr 3, s. 148-163Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The study aimed at investigating whether the seven-subtest short form based on WAIS-R (Ward 1990) was statistically valid to use on the Swedish version of Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV), if this abbreviation was fit to catch the heterogeneity in test performance across age and if this brief measure was possible to abbreviate even more. WAIS-IV data from a non-clinical sample consisting of 261 participants ranging between 18 and 74 in age was analyzed with bivariate and multiple regression analyses, a prorating method for calculation of Full Scale IQ (FSIQ) and its indices as well as paired-samples t-test. The results were contradictory. When the original WAIS-IV was compared to the seven-subtest short form the results showed a good congruence on FSIQ-level between the two sets, but on index level there were several cases of mismatches. In the younger and middle aged sample (<55 years) results on FSIQ as well as index level were in accordance, whereas in the elderly group (∼55 years) they were incongruent. The best reduction of the seven-subtest short form was a four-subtest model, encompassing Block Design, Similarities, Arithmetic and Coding, one subtest from each index, but the t-tests indicated several cases of mismatches between the full WAIS-IV measures and the prorated scores. Applied on the Swedish version of the WAIS-IV the seven-subtest formula appears to be applicable on an FSIQ level, to be suitable for a younger sample, but not for an elderly. Otherwise, this model and the four-subtest model are recommended to be used with caution.

  • 196.
    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.

  • 197.
    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.

  • 198.
    Lindner, Philip
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    The Next Generation of Virtual Reality Interventions for Mental Health2019Inngår i: Proceedings of the 9th World Congress of Behavioural & Cognitive Therapies: Volume I. Research, Applied Issues / [ed] Thomas Heidenreich, Philip Tata, Tübingen: dgvt-Verlag , 2019, Vol. 1, s. 174-174Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    Decades of research have shown that Virtual Reality (VR) technology can be used efficaciously to treat anxiety disorders, and for pain management, stress reduction, and other mental health purposes. Yet it is only with the recently advent of consumer VR platforms that widespread clinical implementation and scalable dissemination of self-help application have become possible. The time is thus ripe to move VR interventions out from university labs and into clinics and the hands of regular patients. This talk will present recent research on the efficacy, effectiveness and real-world usage of automated, gamified VR self-help applications, as well as three on-going effectiveness studies in regular healthcare: VR pain-distraction at a post-operative ward, VR relaxation at a psychiatric inpatient clinic, and VR exposure therapy for public speaking anxiety at a general mental health clinic. The unique and inherent clinical capabilities of VR technology will be discussed, as will lessons learned from implementation and dissemination efforts.

  • 199.
    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.

  • 200.
    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.

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