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  • 201. Josephson, Henrik
    et al.
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Forsberg, Lars
    Rosendahl, Ingvar
    People with gambling disorder and risky alcohol habits benefit more from motivational interviewing than from cognitive behavioral group therapy2016In: PeerJ, ISSN 2167-8359, E-ISSN 2167-8359, Vol. 4, article id 1899Article in journal (Refereed)
    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.

  • 202. Jović, Vladimir
    et al.
    Varvin, Sverre
    Rosenbaum, Bent
    Fischmann, Tamara
    Opačić, Goran
    Hau, Stephan
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Sleep Studies in Serbian Victims of Torture: Analysis of Traumatic Dreams2018In: Sleep and Combat-Related Post Traumatic Stress Disorder / [ed] Eric Vermetten, Anne Germain,Thomas C. Neylan, New York: Springer, 2018, p. 395-409Chapter in book (Refereed)
    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.

  • 203. Karyotaki, Eirini
    et al.
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. 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-analysis2018In: Clinical Psychology Review, ISSN 0272-7358, E-ISSN 1873-7811, Vol. 63, p. 80-92Article in journal (Refereed)
    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.

  • 204. Kodal, Arne
    et al.
    Fjermestad, Krister
    Bjelland, Ingvar
    Gjestad, Rolf
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. 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 disorders2018In: Journal of Anxiety Disorders, ISSN 0887-6185, E-ISSN 1873-7897, Vol. 53, p. 58-67Article in journal (Refereed)
    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.

  • 205. Kodal, Arne
    et al.
    Fjermestad, Krister W.
    Bjelland, Ingvar
    Gjestad, Rolf
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. 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 clinics2018In: Journal of Anxiety Disorders, ISSN 0887-6185, E-ISSN 1873-7897, Vol. 59, p. 53-63Article in journal (Refereed)
    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.

  • 206. Kraepelien, Martin
    et al.
    Blom, Kerstin
    Lindefors, Nils
    Johansson, Robert
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Kaldo, Viktor
    The effects of component-specific treatment compliance in individually tailored internet-based treatment2019In: Clinical Psychology and Psychotherapy, ISSN 1063-3995, E-ISSN 1099-0879, Vol. 26, no 3, p. 298-308Article in journal (Refereed)
    Abstract [en]

    The objective of this study was to explore the effects of treatment compliance in a guided individually tailored internet-based treatment (TAIL) in relation to depression and co-morbid symptoms. Compliance with the homework in the different treatment components in TAIL, each aimed at a specific condition, was rated for 207 participants by independent assessors. Six subgroups (n = 34-131) were constructed consisting of participants with co-occurring symptoms of worry, panic, social anxiety, stress, insomnia, or pain. For each group, hierarchical regression was used to investigate whether the total sum of compliance points, Overall Compliance, predicted reductions in depression and in condition-specific symptoms. Also, in each subgroup, it was tested whether working with specific treatment components, Specific Compliance, predicted reduction of the targeted symptoms. Overall Compliance predicted 15% of the reduction in depression symptoms. For participants with worry, panic, social anxiety, stress, or insomnia, Overall Compliance also predicted symptom reductions in that specific condition. Specific Compliance predicted reduction in the targeted symptoms for participants with social anxiety, stress, and insomnia. Specific Compliance with stress and insomnia components also predicted reductions in depression. Our results strengthen the importance of compliance in internet-based treatments. Because compliance with stress and insomnia components was particularly important for broad symptom reductions, these conditions should not be ignored when treating patients with co-morbid symptoms.

  • 207. Kraepelien, Martin
    et al.
    Forsell, Erik
    Karin, Eyal
    Johansson, Robert
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institutet, Sweden.
    Lindefors, Nils
    Kaldo, Viktor
    Comparing individually tailored to disorder-specific internet-based cognitive-behavioural therapy: benchmarking study2018In: BJPsych Open, E-ISSN 2056-4724, Vol. 4, no 4, p. 282-284Article in journal (Refereed)
    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.

  • 208.
    Kruijt, Anne-Wil
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Mechanics of contingency-based Cognitive Bias Modification: pre-existing bias affects potency of active training but not placebo conditionsManuscript (preprint) (Other academic)
    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.

  • 209.
    Kruijt, Anne-Wil
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Mechanics of Contingency-Based Cognitive Bias Modification: Pre-Existing Bias Affects Potency of Active Training but Not Placebo Conditions2019In: Proceedings of the 9th World Congress of Behavioural & Cognitive Therapies: Volume II. Posters / [ed] Thomas Heidenreich, Philip Tata, Tübingen: dgvt-Verlag , 2019, Vol. 2, p. 161-161Conference paper (Refereed)
    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.

  • 210.
    Kruijt, Anne-Wil
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Processing confusing procedures in the recent re-analysis of a cognitive bias modification (CBM) meta-analysis2017In: British Journal of Psychiatry, ISSN 0007-1250, E-ISSN 1472-1465, Vol. 211, no 5, p. 266-271Article in journal (Other academic)
  • 211.
    Kruijt, Anne-Wil
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Processing confusing procedures in the recent re-analysis of a cognitive bias modification meta-analysis2018In: British Journal of Psychiatry, ISSN 0007-1250, E-ISSN 1472-1465, Vol. 212, no 4, p. 246-246Article in journal (Other academic)
  • 212.
    Kruijt, Anne-Wil
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    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 PTSD2019In: Journal of Abnormal Psychology, ISSN 0021-843X, E-ISSN 1939-1846, Vol. 128, no 6, p. 563-573Article in journal (Refereed)
    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.

  • 213.
    Kruijt, Anne-Wil
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    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 RCTs2017Conference paper (Refereed)
    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.

  • 214. 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
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Haukeland University Hospital, Norway.
    Successfully treating 90 patients with obsessive compulsive disorder in eight days: the Bergen 4-day treatment2018In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 18, article id 323Article in journal (Refereed)
    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.

  • 215. Landström, Cajsa
    et al.
    Levander, Lisa
    Philips, Björn
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Dynamic interpersonal therapy as experienced by young adults2019In: Psychoanalytic Psychotherapy, ISSN 0266-8734, E-ISSN 1474-9734, Vol. 33, no 2, p. 99-116Article in journal (Refereed)
    Abstract [en]

    The purpose of the present study was to investigate young adults' experiences of brief dynamic interpersonal therapy (DIT). Six young adults (19-25years old) who had undergone DIT at the Psychology Clinic at Stockholm University and the Erica Foundation in Stockholm were interviewed about their experiences of therapy and the changes that therapy may have brought about. The results showed that after therapy the respondents had better understanding of their feelings and better capacity to set and manage boundaries in relationships. The changes described by the respondents mainly concerned relationships and were perceived as highly important for them. Regarding specific aspects of DIT, their views diverged. In future research, we suggest that DIT's interpersonal affective focus may be of particular interest, especially in relation to the therapeutic alliance.

  • 216.
    Laukka, Petri
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Perception and psychophysics.
    Månsson, Kristoffer N.T.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Cortes, Diana S.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Biological psychology.
    Manzouri, Amirhossein
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Biological psychology.
    Fischer, Håkan
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Biological psychology.
    Neural correlates of individual differences in emotion recognition ability: an fMRI study2019Conference paper (Other academic)
    Abstract [en]

    The ability to understand how others are feeling is important for social interaction. Studies have reported large inter-individual variability in emotion recognition ability (ERA) in the general population, but the causes for such differences are not well understood. This study investigated neural response during emotion recognition in individuals with high and low ERA. Forty-nine young adults were selected for inclusion based on their performance during previous testing of ERA (e.g., Hovey et al., 2018, Soc Cogn Affect Neurosci, 13, 173-181). Neural response was determined using the blood-oxygen level-dependent (BOLD) signal in a 3-Tesla functional magnetic resonance imaging (fMRI) experiment. The participants were asked to judge which emotions (anger, fear, disgust, happiness, interest, pride, relief, sadness, and neutral expression) were demonstrated in brief clips (i.e. audio-only, video-only, and multimodal audio- video) using a forced-choice response format. Stimuli were taken from the GEMEP emotion portrayal database (Bänziger et al., 2009, Emotion, 9, 691-704). In neural response to emotional stimuli, individuals with high ERA, relative to low ERA, showed higher activation bilaterally in the supplementary motor area, and in the left postcentral gyrus. Results provide initial evidence that the ability to effectively recognize the emotions of others is related to motor and somatosensory neural responses. We speculate that these neural responses in individuals with improved skills in emotion recognition could be related to increased embodiment of emotion expressions during emotion perception.

  • 217. Launes, Gunvor
    et al.
    Hagen, Kristen
    Sunde, Tor
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Haukeland University Hospital, Norway.
    Klovning, Ingrid
    Laukvik, Inger-Lill
    Himle, Joseph A.
    Solem, Stian
    Hystad, Sigurd W.
    Hansen, Bjarne
    Kvale, Gerd
    A Randomized Controlled Trial of Concentrated ERP, Self-Help and Waiting List for Obsessive- Compulsive Disorder: The Bergen 4-Day Treatment2019In: Frontiers in Psychology, ISSN 1664-1078, E-ISSN 1664-1078, Vol. 10, article id 2500Article in journal (Refereed)
    Abstract [en]

    Background: The Bergen 4-day treatment (B4DT) is a concentrated exposure-based treatment for patients with Obsessive-Compulsive Disorder (OCD) delivered during four consecutive days. The B4DT has in a number of effectiveness studies demonstrated promising results as approximately 90% of patients gain reliable clinical change post-treatment and nearly 70% are recovered on a long-term basis.

    Methods: The current study is the first randomized controlled trial evaluating the effects of the B4DT. Forty-eight patients diagnosed with OCD were randomized to B4DT, self-help (SH), or waiting list (WL) with 16 patients in each condition. All participants randomized to the B4DT underwent the treatment without any attrition.

    Results: The B4DT yielded significantly better effects than control conditions on measures of OCD, depression, and generalized anxiety. The response rate (≥35% reduction of the individual patient’s pre-treatment Y-BOCS score) was 93.8% in B4DT, 12.5% in SH and 0% in WL, while remission rate (response criterion is fulfilled and the post-treatment Y-BOCS score is ≤12 points) was 62.5%, 6.3%, and 0%, respectively. Furthermore, patients who had received the B4DT, showed improved work- and social functioning. None of the patients treated with B4DT showed signs of deterioration. In comparison, one patient in the SH condition was in remission, and one showed significant clinical improvement, whereas the remaining showed no change.

    Conclusion: The results indicate that the B4DT is an effective treatment for patients suffering from OCD.

    Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT02886780.

  • 218. Launes, Gunvor
    et al.
    Laukvik, Inger Lill
    Sunde, Tor
    Klovning, Ingrid
    Hagen, Kristen
    Solem, Stian
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Haukeland University Hospital, Norway.
    Hansen, Bjarne
    Kvale, Gerd
    The Bergen 4-Day Treatment for Obsessive-Compulsive Disorder: Does It Work in a New Clinical Setting?2019In: Frontiers in Psychology, ISSN 1664-1078, E-ISSN 1664-1078, Vol. 10, article id 1069Article in journal (Refereed)
    Abstract [en]

    Sorlandet Hospital in Norway has a history of offering patients with obsessive-compulsive disorder (OCD) cognitive behavior group therapy using 12 weekly sessions of 2.5 h each. A previous evaluation of this treatment has shown that 51.9% did not respond at post-treatment. Recently, a highly concentrated group-treatment format, the Bergen 4-day treatment (B4DT), has been shown to help more than 90% of patients with OCD post-treatment. Based on these positive results, it was decided to explore whether the B4DT could be a feasible format for delivering ERP at another clinic. Thirty-five consecutively recruited patients were included in the current pilot study, and assessed at pre-treatment, post-treatment, and 3-month follow-up. Treatment response rate (35% reduction in OCD-symptom score) was 94% at post-treatment, and 80% at follow-up. Seventy-four percent were in remission at post-treatment and 68% at followup. Only one patient dropped out of treatment. The patients were highly satisfied with the treatment content and format. The results indicate that the 4-day treatment could successfully be implemented at a new clinic.

  • 219. Lenhard, Fabian
    et al.
    Sauer, Sebastian
    Andersson, Erik
    Månsson, Kristoffer N. T.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. 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 approach2018In: International Journal of Methods in Psychiatric Research, ISSN 1049-8931, E-ISSN 1557-0657, Vol. 27, no 1, article id e1576Article in journal (Refereed)
    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.

  • 220. Lesnierowska, Magdalena
    et al.
    Smoktunowicz, Ewelina
    Puchalska-Kaminska, Malwina
    Rzenca, Krzysztof
    Cieslak, Roman
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Andersson, Gerhard
    Resource-Oriented Internet Intervention for Occupational Stress among Medical Professionals (Med-Stress): Study Protocol for a Randomized Controlled Trial2018Conference paper (Other academic)
    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.

  • 221.
    Letellier, Isabelle
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Du signifiant à l’inconscient comme béance: Lacan contre le structuralisme, vers Merleau-Ponty2016In: Revue roumaine de philosophie, ISSN 1220-5400, Vol. 60, no 1, p. 39-53Article in journal (Refereed)
    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.

  • 222. Leuzinger-Bohleber, Marianne
    et al.
    Bahrke, UlrichFischmann, TamaraArnold, Simon E.Hau, StephanStockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Flucht, Migration und Trauma: Die Folgen für die nächste Generation2017Collection (editor) (Other academic)
    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.

  • 223.
    Lilliengren, Peter
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Johansson, Robert
    Lindqvist, Karin
    Mechler, Jakob
    Andersson, Gerhard
    Efficacy of Experiential Dynamic Therapy for Psychiatric Conditions: a Meta-Analysis of Randomized Controlled Trials2016In: Psychotherapy, ISSN 0033-3204, E-ISSN 1939-1536, Vol. 53, no 1, p. 90-104Article in journal (Refereed)
    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.

  • 224.
    Lilliengren, Peter
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Johansson, Robert
    Town, Joel M.
    Kisely, Steve
    Abbass, Allan
    Intensive Short-Term Dynamic Psychotherapy for generalized anxiety disorder: A pilot effectiveness and process-outcome study2017In: Clinical Psychology and Psychotherapy, ISSN 1063-3995, E-ISSN 1099-0879, Vol. 24, no 6, p. 1313-1321Article in journal (Refereed)
    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.

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

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

  • 226. Linardon, Jake
    et al.
    Cuijpers, Pim
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Messer, Mariel
    Fuller-Tyszkiewicz, Matthew
    The efficacy of app‐supported smartphone interventions for mental health problems: a meta‐analysis of randomized controlled trials2019In: World Psychiatry, ISSN 1723-8617, E-ISSN 2051-5545, Vol. 18, no 3, p. 325-336Article in journal (Refereed)
    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.

  • 227.
    Lindau, Maria
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Cognitive psychology.
    Najström, Mats
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Cross-cultural applicability and reduction of the American seven-subtest short form of the WAIS on a Swedish non-clinical sample2019In: Nordic Psychology, ISSN 1901-2276, E-ISSN 1904-0016, Vol. 71, no 3, p. 148-163Article in journal (Refereed)
    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.

  • 228.
    Lindau, Maria
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Cognitive psychology.
    Najström, Mats
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    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 sample2016In: Proceedings of 4th Global Experts Meeting on Neuropharmacology, 2016Conference paper (Refereed)
    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.

  • 229.
    Lindbäck, Malin
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Tre fallstudier av kognitiv beteendeterapi vid smärtsam endometrios2017Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Endometriosis is a common gynecological disorder which is often painful. Dispite several studies remarking on the high prevelence of psychiatric comorbidity among women with endometriosis, and that psychological treatments are recommended, there is very little research of psychological treatment of endometriosis. This study was explorative and investigated quantitative effects and qualitative details from three case studies of cognitive behavioural therapy for painful endometriosis. The treatment contained four components: psychoeducation, case formulation, behavioural change/exposure, and mindfulness. The treatment was given in a short form of five sessions. The treatments went well and reseaved positive evalutations from all patients. The results were mixed, but some improvements were noticed. One patient had at the end of the study elevated life quality, reduced depression, reduced catastrophizing, increased activity and reduced disability. The second patient described the treatment positively, but showed few changes apart from tendency to reduced catastrophizing. At the end of the study her results were affected by changes in her physical condition, which probably overshadowed any positive results from the treatment. The third patient had difficulties with following the treatment plan, and had a variable level of functioning. Problems arose with her measures, but the measures showed tendency to improved life quality, reduced catastophizing and reduced disability. The results of the study are promising and further development of cognitive behavioural therapy for painful endometriosis are suggested. 

  • 230.
    Lindner, Philip
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    The Next Generation of Virtual Reality Interventions for Mental Health2019In: 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, p. 174-174Conference paper (Other academic)
    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.

  • 231.
    Lindner, Philip
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institute, Sweden.
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    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?2016In: PeerJ, ISSN 2167-8359, E-ISSN 2167-8359, Vol. 4, article id E1934Article in journal (Refereed)
    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.

  • 232.
    Lindner, Philip
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. 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 disorder2018In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 8, article id 1101Article in journal (Refereed)
    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.

  • 233.
    Lindner, Philip
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institutet, Sweden.
    Frykheden, Ola
    Forsström, David
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Andersson, Erik
    Ljótsson, Brjánn
    Hedman, Erik
    Andersson, Gerhard
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    The Brunnsviken Brief Quality of Life Scale (BBQ): Development and Psychometric Evaluation2016In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 45, no 3, p. 182-195Article in journal (Refereed)
    Abstract [en]

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

  • 234.
    Lindner, Philip
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institutet, Sweden; Stockholm Health Care Services, Sweden.
    Hamilton, William
    Miloff, Alexander
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. University of Southern Denmark, Denmark.
    How to Treat Depression With Low-Intensity Virtual Reality Interventions: Perspectives on Translating Cognitive Behavioral Techniques Into the Virtual Reality Modality and How to Make Anti-Depressive Use of Virtual Reality–Unique Experiences2019In: Frontiers in Psychiatry, ISSN 1664-0640, E-ISSN 1664-0640, Vol. 10, article id 792Article in journal (Refereed)
    Abstract [en]

    Depression is a common mental disorder with a large treatment gap. Low-intensity, automated virtual reality (VR) interventions (not requiring a therapist) is a scalable and promising solution now that VR is an accessible and mature, consumer technology. Yet unlike with phobias, there have been few attempts at translating evidence-based cognitive behavioral therapeutic (CBT) techniques for depression into the VR modality. In this paper, we discuss how specific CBT techniques can be made into VR experiences, including psychoeducation, behavioral activation, cognitive restructuring, and social skills training. We also discuss how VR-unique experiences, such as alternative embodiment and virtual pet interactions, can be made therapeutic. Creating a pre-clinical and clinical evidence base for these types of novel interventions should be considered a research priority, and high-quality development on par with other consumer VR applications will be essential to the success of any consumer-targeted intervention. If this is achieved, low-intensity VR interventions for depression have great potential to make an impact on public mental health.

  • 235.
    Lindner, Philip
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institutet, Sweden; Stockholm County Council, Sweden.
    Miloff, Alexander
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Bergman, Camilla
    Andersson, Gerhard
    Hamilton, William
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Gamified, Automated Virtual Reality Exposure Therapy for Fear of Spiders: A Single-Subject Trial Under Simulated Real-World Conditions2020In: Frontiers in Psychiatry, ISSN 1664-0640, E-ISSN 1664-0640, Vol. 11, article id 116Article in journal (Refereed)
    Abstract [en]

    Background: Virtual Reality exposure therapy (VRET) is an evidence-based treatment of phobias and recent research suggests that this applies also to self-contained, automated interventions requiring no therapist guidance. With the advent and growing adoption of consumer VR technology, automated VR intervention have the potential to close the considerable treatment gap for specific phobias through dissemination as consumer applications, self-help at clinics, or as blended treatment. There is however a lack of translational effectiveness studies on VRET treatment effects under real-world conditions.

    Methods: We conducted a single-arm (n = 25), single-subject study of automated, gamified VRET for fear of spiders, under simulated real-world conditions. After setup and reading instructions, participants completed the automated, single-session treatment by themselves. Self-rated fear of spiders and quality of life served as outcome measures, measured twice before, and one and two weeks after treatment, and at a six-month follow-up. Session characteristics and user experience measures were collected at the end of the session.

    Results: Mixed-effects modeling revealed a significant and large (d = 1.26) effect of treatment-onset on phobia symptoms (p < .001), and a small (d = 0.49) effect on quality of life (p = .025). Results were maintained at a six-month follow-up (p > .053). The intervention was tolerable and practical. There were no significant correlations between any user experience measure and decrease in phobia symptoms (p > .209).

    Conclusions: An automated VRET intervention for fear of spiders showed equivalent effects on phobia symptoms under effectiveness conditions as previously reported under efficacy conditions. These results suggest that automated VRET applications are promising self-help treatments also when provided under real-world conditions.

  • 236.
    Lindner, Philip
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Miloff, Alexander
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Fagernäs, Simon
    Andersen, Joel
    Sigeman, Martin
    Andersson, Gerhard
    Furmark, Tomas
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Therapist-led and at-home one-session Virtual Reality exposure therapy for public speaking anxiety using consumer hardware and software, with online maintenance: A randomized controlled trial2017Conference paper (Refereed)
    Abstract [en]

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

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

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

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

  • 237.
    Lindner, Philip
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Miloff, Alexander
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Fagernäs, Simon
    Andersen, Joel
    Sigeman, Martin
    Andersson, Gerhard
    Furmark, Tomas
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Therapist-led and self-led one-session Virtual Reality exposure therapy for public speaking anxiety with consumer hardware and software: A randomized controlled trial2018Conference paper (Other academic)
    Abstract [en]

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

  • 238.
    Lindner, Philip
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institutet, Sweden; Stockholm County Council, Sweden.
    Miloff, Alexander
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Fagernäs, Simon
    Andersen, Joel
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Sigeman, Martin
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Andersson, Gerhard
    Furmark, Tomas
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. University of Southern Denmark, Denmark.
    Therapist-led and self-led one-session virtual reality exposure therapy for public speaking anxiety with consumer hardware and software: A randomized controlled trial2019In: Journal of Anxiety Disorders, ISSN 0887-6185, E-ISSN 1873-7897, Vol. 61, p. 45-54Article in journal (Refereed)
    Abstract [en]

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

  • 239.
    Lindner, Philip
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Miloff, Alexander
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Hamilton, William
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. University of Southern Denmark, Denmark.
    The Potential of Consumer-Targeted Virtual Reality Relaxation Applications: Descriptive Usage, Uptake and Application Performance Statistics for a First-Generation Application2019In: Frontiers in Psychology, ISSN 1664-1078, E-ISSN 1664-1078, Vol. 10, article id 132Article in journal (Refereed)
    Abstract [en]

    Virtual Reality (VR) technology can be used to create immersive environments that promote relaxation and distraction, yet it is only with the recent advent of consumer VR platforms that such applications have the potential for widespread dissemination, particularly in the form of consumer-targeted self-help applications available at regular digital marketplaces. If widely distributed and used as intended, such applications have the potential to make a much-needed impact on public mental health. In this study, we report real-world aggregated uptake, usage and application performance statistics from a first-generation consumer-targeted VR relaxation application which has been publicly available for almost 2 years. While a total of 40,000 unique users signals an impressive dissemination potential, average session duration was lower than expected, and the data suggests a low number of recurrent users. Usage of headphones and auxiliary input devices was relatively low, and some application performance issues were evident (e.g., lower than intended framerate and occurrence of overheating). These findings have important implications for the design of the future VR relaxation applications, revealing primarily that user engagement needs to be addressed in the early stage of development by including features that promote prolonged and recurrent use (e.g., gamification elements).

  • 240.
    Lindner, Philip
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institutet, Sweden.
    Miloff, Alexander
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Hamilton, William
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Mimerse, Sweden.
    Reuterskiöld, Lena
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Andersson, Gerhard
    Powers, Mark B.
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Creating state of the art, next-generation Virtual Reality exposure therapies for anxiety disorders using consumer hardware platforms: Design considerations and future directions2017In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 46, no 5, p. 404-420Article in journal (Refereed)
    Abstract [en]

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

  • 241.
    Lindner, Philip
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Miloff, Alexander
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Reuterskiöld, Lena
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Andersson, Gerhard
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Predicting treatment outcomes after Virtual Reality exposure therapy using gaze proxy data collected during exposure: Preliminary findings2018Conference paper (Other academic)
    Abstract [en]

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

  • 242.
    Lindner, Philip
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institutet, Sweden; Stockholm County Council, Sweden.
    Miloff, Alexander
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Reuterskiöld, Lena
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Andersson, Gerhard
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    What is so frightening about spiders? Self‐rated and self‐disclosed impact of different characteristics and associations with phobia symptoms2019In: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450, Vol. 60, no 1, p. 1-6Article in journal (Refereed)
    Abstract [en]

    Spider phobia is a common and impairing mental disorder, yet little is known about what characteristics of spiders that spider phobic individuals find frightening. Using screening data from a clinical trial, we explored which characteristics that spider‐fearful individuals (n = 194) rated as having the greatest impact on fear, used factor analysis to group specific characteristics, and explored linear associations with self‐reported phobia symptoms. Second, a guided text‐mining approach was used to extract the most common words in free‐text responses to the question: “What is it about spiders that you find frightening?” Both analysis types suggested that movement‐related characteristics of spiders were the most important, followed by appearance characteristics. There were, however, no linear associations with degree of phobia symptoms. Our findings reveal the importance of targeting movement‐related fears in in‐vivo exposure therapy for spider phobia and using realistically animated spider stimuli in computer‐based experimental paradigms and clinical interventions such as Virtual Reality exposure therapy.

  • 243.
    Lindner, Philip
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institutet, Sweden.
    Miloff, Alexander
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Zetterlund, Elin
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Reuterskiöld, Lena
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Andersson, Gerhard
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Attitudes Toward and Familiarity With Virtual Reality Therapy Among Practicing Cognitive Behavior Therapists: A Cross-Sectional Survey Study in the Era of Consumer VR Platforms2019In: Frontiers in Psychology, ISSN 1664-1078, E-ISSN 1664-1078, Vol. 10, article id 176Article in journal (Refereed)
    Abstract [en]

    Virtual reality exposure therapy (VRET) is an efficacious treatment for fear and anxiety and has the potential to solve both logistic issues for therapists and be used for scalable self-help interventions. However, VRET has yet to see large-scale implementation in clinical settings or as a consumer product, and past research suggests that while therapists may acknowledge the many advantages of VRET, they view the technology as technically inaccessible and expensive. We reasoned that after the 2016 release of several consumer virtual reality (VR) platforms and associated public acquaintance with VR, therapists' concerns about VRET may have evolved. The present study surveyed attitudes toward and familiarity with VR and VRET among practicing cognitive behavior therapists (n = 185) attending a conference. Results showed that therapists had an overall positive attitude toward VRET (pros rated higher than cons) and viewed VR as applicable to conditions other than anxiety. Unlike in earlier research, high financial costs and technical difficulties were no longer top-rated negative aspects. Average negative attitude was a larger negative predictor of self-rated likelihood of future use than positive attitude was a positive predictor and partially mediated the positive association between VRET knowledge and likelihood of future use, suggesting that promotional efforts should focus on addressing concerns. We conclude that therapist's attitudes toward VRET appear to have evolved in recent years, and no longer appear to constitute a major barrier to implementing the next generation of VR technology in regular clinical practice.

  • 244.
    Lindner, Philip
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Miloff, Alexander
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Zetterlund, Elin
    Reuterskiöld, Lena
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Andersson, Gerhard
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Attitudes towards and familiarity with Virtual Reality therapy among practicing cognitive behavior therapists: A first survey study in the era of consumer VR platforms2018Conference paper (Other academic)
    Abstract [en]

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

  • 245.
    Lindner, Philip
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Nordby, Kent
    Rozental, Alexander
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Svartdal, Frode
    Domain-specific quality of life across five European countries: Cross-cultural validation of the Brunnsviken Brief Quality of life (BBQ) scale2016In: EABCT 2016 Abstract Book: Total Awareness, 2016, p. 590-590Conference paper (Refereed)
    Abstract [en]

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

  • 246.
    Lindner, Philip
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Rozental, Alexander
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Forsström, David
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Andersson, Gerhard
    Furmark, Tomas
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Differential impact of performance and interaction related types of social anxiety symptoms on different quality of life domains2016In: EABCT 2016 Abstract Book: Total Awareness, 2016, p. 748-748Conference paper (Refereed)
    Abstract [en]

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

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

  • 247.
    Lindner, Philip
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Silijehom, Ola
    Johansson, Magnus
    Forster, Martin
    Andreasson, Sven
    Hammberg, Anders
    Combining online community reinforcement and family training with a parent training program for parents with partners suffering from alcohol use disorder: Study protocol for a randomized controlled trial2018Conference paper (Other academic)
    Abstract [en]

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

  • 248.
    Lindner, Philip
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institutet, Sweden; Stockholm County Council, Sweden.
    Siljeholm, Ola
    Johansson, Magnus
    Forster, Martin
    Andreasson, Sven
    Hammarberg, Anders
    Combining online Community Reinforcement and Family Training (CRAFT) with a parent-training programme for parents with partners suffering from alcohol use disorder: study protocol for a randomised controlled trial2018In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 8, article id e020879Article in journal (Refereed)
    Abstract [en]

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

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

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

    Trial registration number: ISRCTN38702517; Pre-results.

  • 249.
    Lindqvist, Karin
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Mechler, Jakob
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Lilliengren, Peter
    Falkenström, Fredrik
    Andersson, Gerhard
    Johansson, Robert
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Edbrooke-Childs, Julian
    Dahl, Hanne-Sofie J
    Lindert Bergsten, Katja
    Midgley, Nick
    Sandell, Rolf
    Thorén, Agneta
    Topooco, Naira
    Ulberg, Randi
    Philips, Björn
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Affect-Focused Psychodynamic Internet-Based Therapy for Adolescent Depression: Randomized Controlled Trial2020In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 22, no 3, article id e18047Article in journal (Refereed)
    Abstract [en]

    Background: Adolescent depression is one of the largest health issues in the world and there is a pressing need for effective and accessible treatments.

    Objective: This trial examines whether affect-focused internet-based psychodynamic therapy (IPDT) with therapist support is more effective than an internet-based supportive control condition on reducing depression in adolescents.

    Methods: The trial included 76 adolescents (61/76, 80% female; mean age 16.6 years), self-referred via an open access website and fulfilling criteria for major depressive disorder. Adolescents were randomized to 8 weeks of IPDT (38/76, 50%) or supportive control (38/76, 50%). The primary outcome was self-reported depressive symptoms, measured with the Quick Inventory of Depressive Symptomatology for Adolescents (QIDS-A17-SR). Secondary outcomes were anxiety severity, emotion regulation, self-compassion, and an additional depression measure. Assessments were made at baseline, postassessment, and at 6 months follow-up, in addition to weekly assessments of the primary outcome measure as well as emotion regulation during treatment.

    Results: IPDT was significantly more effective than the control condition in reducing depression (d=0.82, P=.01), the result of which was corroborated by the second depression measure (d=0.80, P<.001). IPDT was also significantly more effective in reducing anxiety (d=0.78, P<.001) and increasing emotion regulation (d=0.97, P<.001) and self-compassion (d=0.65, P=.003). Significantly more patients in the IPDT group compared to the control group met criteria for response (56% vs 21%, respectively) and remission (35% vs 8%, respectively). Results on depression and anxiety symptoms were stable at 6 months follow-up. On average, participants completed 5.8 (SD 2.4) of the 8 modules.

    Conclusions: IPDT may be an effective intervention to reduce adolescent depression. Further research is needed, including comparisons with other treatments.

    Trial Registration: International Standard Randomised Controlled Trial Number (ISRCTN) 16206254; http://www.isrctn.com/ISRCTN16206254

  • 250.
    Ljunggren, Ingrid
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Samtalet som psykologisk metod2014Book (Other academic)
    Abstract [sv]

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

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

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