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  • 151. Hansen, Bjarne
    et al.
    Kvale, Gerd
    Hagen, Kristen
    Havnen, Audun
    Öst, Lars-Göran
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Haukeland University Hospital, Norway.
    The Bergen 4-day treatment for OCD: four years follow-up of concentrated ERP in a clinical mental health setting2019Inngår i: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 48, nr 2, s. 89-105Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    There are few long-term follow-up studies on psychological treatment of anxiety disorders carried out in clinical mental health settings, so called effectiveness studies. The present paper presents a four year follow-up of patients with obsessive-compulsive disorder treated by the Bergen 4-day treatment (B4DT), a concentrated form of exposure and response prevention (ERP). A total of 77 obsessive–compulsive disorder (OCD) patients received treatment during four consecutive days and were assessed with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) pre, post, and at follow-ups after 3 and 6 months, and 4 years post-treatment. The Y-BOCS mean score changed from 25.9 at pre- to 10.0 post-treatment and 9.9 at long-term follow-up. The proportion fulfilling the strict international consensus criteria for remission was 73% at post-treatment and 69% at follow-up. When taking declining rate, attrition rate, remission, relapse, and further improvement during the follow-up period into account, 72% were recovered on a long-term basis. A comparison with previously published effectiveness studies of ERP indicated that the 4-day treatment yielded significantly higher proportions of remission at post-treatment and recovery at follow-up, as well as within-group effect size on the Y-BOCS. The implications of these results are discussed.

  • 152. Hansen, Bjarne
    et al.
    Kvale, Gerd
    Hagen, Kristen
    Hjelle, Kay M.
    Solem, Stian
    Bø, Beate
    Öst, Lars-Göran
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Haukeland University Hospital, Norway.
    The Bergen 4-Day Treatment for Panic Disorder: A Pilot Study2018Inngår i: Frontiers in Psychology, ISSN 1664-1078, E-ISSN 1664-1078, Vol. 9, artikkel-id 1044Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The current article reports on the findings from a pilot treatment study on panic disorder (PD) with or without agoraphobia. Consecutively referred patients were included and treated with the Bergen 4-day treatment format. Twenty-nine patients were included, primarily from unsuccessful treatment courses in the Norwegian specialist mental health care system, either ongoing or previously. Prior to treatment, only 34% were able to work but at 3-month follow-up 93% were able to do so. The proportion achieving reliable change on the panic severity measure was 76% post-treatment and 90% at follow-up. The remission rate was 72% at both assessments. These effects are significantly higher than those reported for six standard CBT studies in the literature using the same primary outcome measure (Panic Disorder Severity Scale). It is concluded that the Bergen 4-day treatment is a promising treatment approach for PD, and a randomized controlled trial is warranted.

  • 153. Hatcher, Robert L.
    et al.
    Lindqvist, Karin
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Falkenström, Fredrik
    Psychometric evaluation of the Working Alliance Inventory?Therapist version: Current and new short forms2019Inngår i: Psychotherapy Research, ISSN 1050-3307, E-ISSN 1468-4381Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The Working Alliance Inventory (WAI) and its short forms are widely used, although the properties of the therapists? versions have been little studied. Method: We examined the psychometric properties of two short forms (WAI-S-T, WAI-SR-T), and explored the creation of a psychometrically stronger short form using contemporary measure development techniques. Well-fitting items from the full 36-item WAI were identified in a development sample (131 therapists, 688 patients) using multi-level Bayesian Structural Equation Modeling, accounting for therapist rated effects. Multi-level Item Response Theory (IRT) methods aided creation of a revised short form (WAI-S-T-IRT). Factor structures of the three forms were assessed using multi-level ML estimation with robust standard errors. Results: Collinearity problems for the Goal and Task dimensions led to testing a two-factor model (Goal?Task, Bond). All three measures showed satisfactory fit; the WAI-S-T-IRT fit slightly better but differences were minor. Testing the structures in an independent sample (N?=?1117) yielded essentially the same results. No version showed strong measurement invariance. Discussion: Continued use of current therapist forms is supported; differentiation of theoretical dimensions is difficult with current measures, and may not be possible with self-report forms.

  • 154.
    Hau, Stephan
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Aktuelle tiefenpsychologische Traumforschung2018Inngår i: Schlaf, ISSN 2194-7880, Vol. 7, nr 1, s. 19-25Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [de]

    Experimentelle und klinische Traumforschung haben in den letzten Dekaden das Wissen über Traumprozesse wesentlich erweitert. Dabei ist die Bedeutung des manifesten Traums als Informationsquelle über das innere Erleben eines Menschen und über die bestehenden inneren Möglichkeiten, sich mit Konflikten, affektiv belastenden Situationen oder auch Beziehungskonflikten auseinanderzusetzen, hervorgehoben worden. In einer kurzen Zusammenstellung werden unterschiedliche Optionen psychoanalytischer beziehungsweise tiefenpsychologischer Traumforschung dargestellt.

  • 155.
    Hau, Stephan
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Day’s Residues2018Inngår 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]

    Day residues are defined as content from the last or recent days that reappears in a dream during the night.

  • 156.
    Hau, Stephan
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Die Bedeutung des Traums in der Psychotherapie2018Inngår i: Ärztliche Psychotherapie - Psychosomatische Medizin und Psychosomatische Grundversorgung, ISSN 1862-4715, Vol. 13, nr 3, s. 187-192Artikkel i tidsskrift (Fagfellevurdert)
  • 157.
    Hau, Stephan
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Dreamwork2018Inngår i: Encyclopedia of Personality and Individual Differences: Living Edition / [ed] Virgil Zeigler-Hill, Todd K. Shackelford, Springer, 2018, s. 1-4Kapittel i bok, del av antologi (Fagfellevurdert)
    Abstract [en]

    The term “dreamwork” was coined by Sigmund Freud in his seminal publication from 1900, The Interpretation of Dreams Freud (1900). In this book, Freud systematized the body of knowledge about dreams and developed a theory about dreaming as an unconscious mental process. He described how it is possible to find meaning in dream contents and introduced a method of analyzing individual patients’ dreams, conceptualizing dream activity as a process which includes both unconscious and conscious parts.

  • 158.
    Hau, Stephan
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Einleitung2017Inngår i: Flucht, Migration und Trauma: Die Folgen für die nächste Generation / [ed] Marianne Leuzinger-Bohleber, Ulrich Bahrke, Tamara Fischmann, Simon E. Arnold, Stephan Hau, Göttingen: Vandenhoeck & Ruprecht, 2017, s. 13-21Kapittel i bok, del av antologi (Annet vitenskapelig)
    Abstract [de]

    Die Tagung, welche die Grundlage für dieses Buch zum Thema »Mi- gration, Flucht und Trauma« war, wurde im Frühjahr 2015 geplant. Damals war es nicht absehbar, welche Aktualität und auch Brisanz das Thema ein Jahr später, im März 2016, haben würde. Angesichts der Ereignisse stand natürlich im Vordergrund, wie eine angemes- sene und gute Betreuung der hier eintreffenden Menschen gewähr- leistet werden kann. Aber es sind auch andere wichtige Aspekte hin- zugekommen, welche die öffentliche Diskussion prägen, wie etwa die immer deutlicher werdenden Ängste und Abgrenzungstendenzen in Teilen der Bevölkerung. Natürlich ist weiterhin die Hilfsbereit- schaft enorm, was sich an den vielen privaten Initiativen, Hilfen und Unterstützungen ablesen lässt. Es besteht die Gefahr, dass leicht übersehen wird, wie viele unermüdlich arbeitende Menschen ver- suchen, mit ihrem Engagement und unentgeltlichem Einsatz, es den Flüchtlingen zu erleichtern, sich in den ersten Tagen und Wochen nach der Ankunft zu orientieren und ein neues Leben zu beginnen. Eines kann man jedoch heute mit Sicherheit sagen: Der Umgang mit Flüchtlingen, Migrantinnen und Migranten sowie deren Integration in das Einwanderungsland Deutschland sind zur Herausforderung geworden. Ich möchte kurz darauf eingehen, welche verschiedenen Bedeutungen das Thema »Migration, Flucht und Trauma: Die Folgen für die nächste Generation« – haben kann, und damit auf einige Dinge hinweisen, die für die Tagung und dieses Buch relevant waren.

  • 159.
    Hau, Stephan
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Erinnerung und Gedächtnis in der Schlaf- und Traumforschung2018Inngår i: Traum und Schlaf: Ein interdisziplinäres Handbuch / [ed] Alfred Krovoza, Christine Walde, Stuttgart: Verlag J. B. Metzler, 2018, s. 293-298Kapittel i bok, del av antologi (Annet vitenskapelig)
    Abstract [de]

    Das Thema dieses kurzen Kapitels umfasst ein sehr weites Feld. Deshalb soll es eingegrenzt werden (1) auf die Darstellung verschiedener Gedächtniskonzepte. Ein zweiter Teil (2) wird sich der Frage zuwenden, wie Schlaf bzw. Traum Erinnerungen und Gedächtnisprozesse beeinflussen.

  • 160.
    Hau, Stephan
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Experimentelle Schlaf- und Traumforschung2018Inngår i: Traum und Schlaf: Ein interdisziplinäres Handbuch / [ed] Alfred Krovoza, Christine Walde, Stuttgart: Verlag J. B. Metzler, 2018, s. 275-286Kapittel i bok, del av antologi (Annet vitenskapelig)
    Abstract [de]

    Ungefähr ein Drittel seines Lebens verbringt der Mensch im Schlaf, und diese Zeit erscheint keineswegs verschwendet. Obwohl nicht alle Funktionen des Schlafes verstanden sind, ist dennoch unumstritten, dass Menschen schlafen müssen, um überleben zu können. Schlaf wird häufig als Ruhezustand interpretiert, in dem regenerative Prozesse stattfinden, die unter anderem das Immunsystem betreffen, das Nervensystem, den Knochenaufbau oder den Stoffwechsel.

  • 161.
    Hau, Stephan
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Forskning/PDT2018Inngår i: Socionomen, ISSN 0283-1929, nr 3, s. 28-30Artikkel i tidsskrift (Annet vitenskapelig)
  • 162.
    Hau, Stephan
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Kliniskt tänkande i en tid då själen ska mätas och testas2019Inngår i: Klinisk tenkning og psykoanalyse / [ed] Erik Stänicke, Hanne Strømme, Sølvi Kristiansen, Line Indrevoll Stänicke, Gyldendal Akademisk, 2019, s. 312-331Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 163.
    Hau, Stephan
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Overdetermination2018Inngår 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]

    The concept of overdetermination was introduced by Freud (1900) in a psychological theory. Conscious experiences are seen as potentially influenced by an unlimited number of experiences a human being has had, including events that cannot be remembered. Overdetermination describes multiple, independent, and concurrent causes of a psychological experience and is detectable not only in conscious thoughts and experiences but also in formations of unconscious processes such as dreams or neurotic symptoms (Laplanche and Pontalis 1973).

  • 164.
    Hau, Stephan
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Sigmund Freud – Briefe an Jeanne Lampl-de Groot 1921-1939. Herausgegeben von Gertie F. Bögels2018Inngår i: Psychosozial, ISSN 0171-3434, Vol. 41, nr 153, s. 133-134Artikkel, omtale (Annet vitenskapelig)
  • 165.
    Hau, Stephan
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Sigmund Freud letters to Jeanne Lampl-de Groot 1921–19392018Inngår i: Scandinavian Psychoanalytic Review, ISSN 0106-2301, E-ISSN 1600-0803, Vol. 41, nr 1, s. 59-60Artikkel, omtale (Annet vitenskapelig)
  • 166.
    Hau, Stephan
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Traum und Traumdeutung2019Inngår i: Analytische und tiefenpsychologisch fundierte Psychotherapie: Theorie und Praxis der psychoanalytisch begründeten Verfahren / [ed] Matthias Elzer, Alf Gerlach, Psychosozial-Verlag , 2019, s. 85-100Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 167.
    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.

  • 168. 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.

  • 169. 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.

  • 170. 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.

  • 171.
    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.

  • 172. Hertenstein, Elisabeth
    et al.
    Feige, Bernd
    Gmeiner, Tabea
    Kienzler, Christian
    Spiegelhalder, Kai
    Johann, Anna
    Jansson-Fröjmark, Markus
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Palagini, Laura
    Rücker, Gerta
    Riemann, Dieter
    Baglioni, Chiara
    Insomnia as a predictor of mental disorders: A systematic review and meta-analysis2019Inngår i: Sleep Medicine Reviews, ISSN 1087-0792, E-ISSN 1532-2955, Vol. 43, s. 96-105Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Previous research has identified insomnia as a predictor for the onset of depression. The aim of this meta-analysis is to investigate whether insomnia also predicts the onset of other mental disorders. Longitudinal studies were eligible for inclusion if they investigated insomnia at baseline (including nighttime- and daytime-symptoms) as a predictor of the later onset of psychopathology within a follow-up time-frame of at least 12 mo. Thirteen primary studies were included. The results suggest that insomnia is a significant predictor for the onset of depression (10 studies, OR 2.83, CI 1.55-5.17), anxiety (six studies, OR 3.23, CI 1.52-6.85), alcohol abuse (two studies, OR 1.35, CI 1.08-1.67, and psychosis (one study, OR 1.28, CI 1.03-1.59). The overall risk of bias in the primary studies was moderate. This meta-analysis provides evidence that insomnia increases the risk for psychopathology. A future research agenda should include more prospective studies using established diagnostic criteria, assessing insomnia at baseline and including long-term follow-up intervals evaluating a wider range of mental disorders. In addition, prospective long-term interventional studies investigating the efficacy of insomnia treatment for the prevention of mental disorders are called for.

  • 173. 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.

  • 174. Holmberg, Johan
    et al.
    Kemani, Mike K.
    Holmström, Linda
    Öst, Lars-Göran
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden.
    Wicksell, Rikard K.
    Evaluating the psychometric characteristics of the Work-related Acceptance and Action Questionnaire (WAAQ) in a sample of healthcare professionals2019Inngår i: Journal of Contextual Behavioral Science, ISSN 2212-1447, Vol. 14, s. 103-107Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The Work-related Acceptance and Action Questionnaire (WAAQ) has been developed to assess psychological flexibility in occupational settings. The aim of this study was to evaluate reliability and validity of the Swedish translation of WAAQ in a sample of 184 healthcare professionals. A principal component analysis supported a one-factor-solution, explaining 53.8% of the overall multivariate variability. WAAQ showed good internal consistency (Cronbach's alpha 0.85) and good test-retest reliability (ICC = 0.85). Validity was assessed by analysing the relationship between WAAQ and other work-related constructs. Spearman's rank correlations illustrated a significant negative relationship between WAAQ and perceived stress and a significant positive correlation with work engagement. Results from the study are consistent with previous studies on WAAQ, supporting the use of the Swedish translation of the instrument among healthcare professionals.

  • 175. 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.

  • 176.
    Ivanova, Ekaterina
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Responsible provision of online gambling: Effects, usability and gamblers’ experiences of protective measures implemented in online gambling environments2020Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Problem gambling is considered a public health problem in many countries and is associated with serious financial and health-related harms for both problem gamblers and significant others. It is possible to create gambling environments that would promote sustainable gambling behaviors and prevent excessive gambling. However, research on the effectiveness of tools for responsible provision of gambling is scarce and the quality of the research is low. Also, there exists a conflict of interest between making a profit when providing gambling and protecting vulnerable customers. The general aim of the project was to study the effects, usability and gamblers’ experiences of tools for responsible provision of online gambling. Study I evaluated the effects of a prompt to set voluntary deposit-limit of optional size among 4,328 customers of an online gambling platform. During the data collection period, all customers from Finland registering an account on the gambling platform were randomized into being prompted to set a deposit-limit either 1) at-registration, 2) before their first deposit, 3) after their first deposit or 4) to an unprompted control group. Gambling intensity, measured with aggregated net loss, was tracked during 90 days after registration. No differences in gambling intensity between the intervention and control groups were found neither on the whole-group level (B (95% CI) =-0.080 (-0.229-0.069), p=.291), nor in the subgroup of the most involved gamblers (B (95% CI) =0.042(-0.359-0.442), p=.838). Study II aimed at predicting gaming freeze (as a proxy parameter for problem gambling) in online gamblers. For the sample of N=2,618 (N=1,309 freezers), a total of 105 predictors were created based on the data tracked by the gambling platform. The analysis was carried out using the machine learning method Random Forest. The predictive accuracy of the model applied to the dataset was 0.615, with a specificity of 0.686 and a sensitivity of 0.543. Study III aimed at investigating non-problem gamblers’ experiences of protective measures. A total of N=10,200 active customers of an online gambling platform were asked to rate their previous experiences of protective tools, their inclination to abandon a gambling service due to perceived overexposure to protective measures and answer questions on their symptoms of problem gambling. N=1,223 responded to the questionnaire, with the majority of the sample being moderate-risk gamblers (38.5%), followed by low-risk gamblers (26.8%), non-problem gamblers (18.9%) and problem gamblers (15.8%). In general, non-problem gamblers were not more disturbed by protective measures than other categories of gamblers. More problem gamblers have previously abandoned a gambling service due to perceived overexposure to protective measures compared to non-problem gamblers (OR(95% CI)= 7.17(3.61-14.23), p<.001). In conclusion, a prompt to set a voluntary deposit-limit of optional size did not appear to be effective in decreasing gambling intensity in online gamblers, indicating the need of evaluating alternative designs. Predicting gaming freezes in the current project resulted in a low accuracy, indicating that gaming freeze is not suitable as a proxy measurement for problem gambling and suggesting the need for collecting subjective data on symptoms of problem gambling. The results of Study III suggest that protective measures can be tested and implemented without the risk of disturbing recreational gamblers.

  • 177.
    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.

  • 178.
    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.

  • 179.
    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.

  • 180.
    Ivanova, Ekaterina
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Magnusson, Kristoffer
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. University of Southern Denmark, Denmark.
    Deposit Limit Prompt in Online Gambling for Reducing Gambling Intensity: A Randomized Controlled Trial2019Inngår i: Frontiers in Psychology, ISSN 1664-1078, E-ISSN 1664-1078, Vol. 10, artikkel-id 639Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Pre-commitment tools – allowing users of gambling services to pre-set a limit for how much money they may spend – are relatively common. However, there exist no clear evidence of their effectiveness in preventing gamblers from spending more money than they otherwise planned. The aim of the study was to compare gambling intensity between users of an online gambling service prompted to set a deposit limit and non-prompted customers, both in the whole sample and among most active users based on the total number of gambling days. Prospective customers of a publicly governed gambling operator from Finland were randomized to receive a prompt to set a voluntary deposit limit of optional size either (1) at registration, (2) before or (3) after their first deposit, or (4) to an unprompted control condition. Data on customers from Finland with online slots as a preferred gambling category (N = 4328) were tracked in the platform for 90 days starting at account registration, gambling intensity being measured with aggregated net loss. The intervention groups did not differ from each other in either proportion of participants with positive net loss or size of positive net loss. The pooled intervention group did not differ from the control group regarding proportion of gamblers with positive net loss (OR = 1.0; p = 0.921) or size of net loss (B = -0.1; p = 0.291). The intervention groups had higher rates of limit-setters compared to the control condition (ORat-registration/pre-deposit/post-deposit = 11.9/9.2/4.1). Customers who have increased/removed a previously set deposit limit had higher net loss than the limit-setters who have not increased/removed their limit (Bat-registration/pre-deposit/post-deposit/control = 0.7/0.6/1.0/1.3), and unprompted limit-setters lost more than unprompted non-setters (B = 1.0). Prompting online gamblers to set a voluntary deposit limit of optional size did not affect subsequent net loss compared to unprompted customers, motivating design and evaluation of alternative pre-commitment tools. Setting a deposit limit without a prompt or increasing/removing a previously set limit may be a marker of gambling problems and may be used to identify customers in need of help.

  • 181.
    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.

  • 182.
    Jacobsson, Gunnel
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Kollegial återkoppling: Ett pedagogiskt projekt vid Psykologiska institutionen2019Rapport (Annet vitenskapelig)
    Abstract [sv]

    Många universitetslärare har på egen hand har utvecklat en god pedagogisk förmåga genom år av undervisning. Det finns en gedigen pedagogisk kompetens i det tysta bland universitetslärare, men den är i allmänhet svår att kommunicera. Det finns en kulturskillnad mellan forsknings- och lärarsysslan i det att det inom forskningen är självklart med ett peer reviewförfarande. I lärarsysslan tenderar kritik att istället handla om läraren som person, den professionella och privata självuppfattningen är ett. Att undervisa är av tradition en ensam uppgift väsensskilt från forskningens teamanda. Mot den bakgrunden genomförde Psykologiska institutionen vid Stockholms universitet modellen Kollegial återkoppling för att öppna upp undervisningsrummet för reflektion kring lärarnas undervisning. En lärargrupp, 10 n, återkopplade på varandra under tre terminer efter given instruktion. Hypotesen i projektet är att det finns en tyst pedagogisk kunskap bland universitetslärare som inte kommuniceras. Genom att skapa strukturer för kollegial återkoppling, liknande dem som finns inom forskning, påverkas lärarens förhållningssätt från att uppleva kritik som en personlig egenskap till att handlar om en professionell, pedagogisk roll. Resultaten visar att tryggheten ökade mellan tillfällena och återkopplingen fördjupats med allt mer givande efterdiskussioner. En god struktur var till hjälp. Vid sista tillfället finns större beredskap att tala om självupplevda brister. Att få återkoppling på okända omständigheter upplevdes hjälpsamt. Efter första tillfället tänkte lärarna i hög grad att projektet skulle leda till manifesta förändringar av undervisningsbeteende. Vid det sista tillfället tänker ingen ändra sitt lärarbeteende, men nästan alla är inspirerade, det vill säga det har gjort något med tänkandet om lärarrollen. För de som återkopplat finns inte samma förändringspotential. Lärarna har genom egen aktivitet uppnått en begynnande förändring i förhållningssätt.

  • 183.
    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.

  • 184.
    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.

  • 185.
    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.

  • 186.
    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.

  • 187. 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.

  • 188.
    Johansson, Robert
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Linköping University, Sweden.
    Arbitrarily Applicable Relational Responding2019Inngår i: Artificial General Intelligence. AGI 2019. Lecture Notes in Computer Science / [ed] Patrick Hammer, Pulin Agrawal, Ben Goertzel, Matthew Iklé, Springer, 2019, s. 101-110Konferansepaper (Fagfellevurdert)
    Abstract [en]

    The purpose of this paper is to introduce how contemporary behavioral psychology approaches intelligence and higher-order cognitive tasks, as instances of so-called arbitrarily applicable relational responding (AARR). We introduce the contemporary theory Relational Frame Theory (RFT), that suggests that key properties of AARR are mutual entailmentcombinatorial entailment, and transformation of stimulus function. Furthermore, AARR are contextually controlled and developed through multiple-exemplar training. We explain these concepts and provide examples of how RFT uses this framework to explain complex cognitive tasks such as language, analogies, a sense of Self, and implicit cognition. Applications of RFT are surveyed. Finally, the relevance of RFT for the AGI audience is discussed.

  • 189.
    Johansson, Robert
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Linköping University, Sweden.
    Internet-based psychodynamic psychotherapy2019Inngår i: Contemporary Psychodynamic Psychotherapy: Evolving Clinical Practice / [ed] David Kealy, John S. Ogrodniczuk, London: Academic Press, 2019, s. 337-347Kapittel i bok, del av antologi (Annet vitenskapelig)
    Abstract [en]

    One recent advance in the field of psychodynamic therapy is the development of internet-based models in the form of guided self-help. Typically, these treatments are in the form of self-help material that is provided to a client over the internet with additional therapist contact by e-mail. This chapter aims to introduce two distinct models of internet-based psychodynamic therapy in detail, give an overview of the current evidence base, and provide clinical illustrations of the process of working with this form of psychodynamic therapy.

  • 190. 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.

  • 191.
    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.

  • 192. 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.

  • 193. 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.

  • 194.
    Jonsson, Jakob
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Preventing problem gambling: Focus on overconsumption2019Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    A proportion of gamblers experience problems. The role of overconsumption in developing gambling problems is sparsely described in the literature and there is little scientific knowledge about the prevention of gambling problems. There are some promising results regarding personalized feedback on gambling habits, and there is a need for more research. The overall aim of this thesis was to explore the role of overconsumption in problem gambling and target it in a preventive intervention. The preventive intervention was to give gambling consumption feedback to high consumers in order to make them reflect upon their gambling habits and enhance their motivation for change. Study I aimed to explore the dimensionality of GamTest, an online test of gambling behaviour, and validate it against PGSI and the gambler’s own perceived problems. Data came from four Nordic gambling sites, n = 10,402. In an ESEM analyses, GamTest had a high degree of correspondence with the players’ own perceived problems and with the PGSI. In an EFA, GamTest captured five dimensions of problematic gambling (i.e. overconsumption of money and time, and negative financial, social and emotional consequences). A bifactor approach showed a general factor and four specific residual factors, negative emotional consequences contribute to the dominant part of the general factor. Study II aimed to examine both the psychometric properties of the Jonsson-Abbot Scale (JAS) and its predictive validity with respect to increased gambling risk and problem gambling onset. The results are based on repeated interviews with 3,818 participants within the Swedish longitudinal gambling study. The results indicate an acceptable fit of a three-factor solution in a CFA, with ‘Overconsumption (OC),’ ‘Gambling fallacies (GF),’ and ‘Reinforcers (RI)’ as factors. When controlled for risk potential measured at baseline, GF and RI were significant predictors of gambling risk potential, and GF and OC were significant predictors of problem gambling onset at 12-month follow up. Study III’s primary objective was to investigate the effects of providing personalized feedback on gambling intensity among high consumers in Norway. An RCT design was used to evaluate how behavioural feedback by telephone or letters affects subsequent gambling expenditure. A sample of 1,003 statistical matched triplets, from the top 0.5 % of customers, were randomly assigned to telephone, letter, or a no-contact control condition. Over 12 weeks, theoretical loss decreased 29 % for the telephone, and 15 % for the letter, conditions, compared with 3 % for the control group. Study IV was a 12-month follow-up of Study III, aimed to investigate the relative effects over twelve months. The telephone group showed a 30 % reduction in theoretical loss, the letter group 13 %, both outperforming the control group with a 7 % reduction. Less than 1% in all groups stopped playing at Norsk Tipping. These four studies indicate that overconsumption of gambling plays different roles in problem gambling. The role of overconsumption in preventing gambling problems is discussed. Contacting high consumers about their gambling expenditure appears to be an effective method for gambling companies to meet their duty of care for customers. Technical evolution has made it possible for gambling companies to fulfil their duty of care, but this has to be regulated and mandatory if it is to be effective.

  • 195.
    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.

  • 196.
    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.

  • 197.
    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.

  • 198.
    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.

  • 199. 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.

  • 200. 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.

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