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  • 351.
    Werbart, Andrzej
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Die Kunst der Freiheit: Sieben psychoanalytische Thesen zu Kreativität und Grenzen2016Inngår i: Subjektivität und Verstehen: Psychoanalyse und Sozialwissenschaften im Dialog: Jörg Frommer zum 60. Geburtstag / [ed] Robert Müller-Herwig, Matthias Vogel, Giessen: Psychosozial-Verlag , 2016, s. 133-144Kapittel i bok, del av antologi (Annet (populærvitenskap, debatt, mm))
  • 352.
    Werbart, Andrzej
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    “The Skin is the Cradle of the Soul”: Didier Anzieu on the Skin-Ego, Boundaries, and Boundlessness2019Inngår i: Journal of the American Psychoanalytic Association, ISSN 0003-0651, E-ISSN 1941-2460, Vol. 67, nr 1, s. 37-58Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Didier Anzieu’s notion of the skin-ego builds on a long psychoanalytic tradition that began with Freud’s idea that the ego is first and foremost a body ego, a projection in the psyche of the surface of the body, or, in other words, the idea that psychic phenomena are always embodied. An interface, a container for the ego, but also its origin: thus did Anzieu conceptualize the skin’s psychic function. The baby’s fantasy of having a common skin with the mother is the concrete starting point for a development that, through the prohibition on touching, leads to the experience of being a separate and individual person. Psychoanalytic work with severe mental disorders makes it necessary to investigate deficiencies in the skin-ego’s containing function before the patient’s psychic contents can be explored. In the psychoanalytic situation, the analyst’s words replace tactile contact and thereby contribute to healing injuries to the skin-ego. The clinical implications of Anzieu’s theoretical model are illustrated by examples from psychoanalyses of children and adults. The close connection between touch, psychic envelopes, and thinking opens a wider perspective on the necessity of setting limits to violence, against both nature and human beings.

  • 353.
    Werbart, Andrzej
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Aldén, Siri
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Diedrichs, Anders
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Changes in the anaclitic-introjective personality configurations following psychoanalytic psychotherapy with young adults2017Inngår i: Research in Psychotherapy: Psychopathology, Process and Outcome, ISSN 2239-8031, Vol. 20, nr 1, s. 30-42Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Treatment goals in psychoanalytic psychotherapy often include changes in underlying psychological structures, rather than only symptom reduction. This study examines changes in the anaclitic-introjective personality configurations following psychoanalytic psychotherapy with young adults in relation to outcomes. Thirty-three patients were interviewed pretreatment and at termination using the Object Relations Inventory (ORI). Prototype Matching of Anaclitic-Introjective Personality Configuration (PMAI) was applied to the ORI material by two independent judges (intraclass correlation coefficient=0.73). The patients were classified pretreatment as predominately anaclitic (n=13) or introjective (n=20). Outcome measures included the Symptom Checklist-90-R (SCL-90) and Differentiation-Relatedness scale (D-R) pretreatment, at termination, at the 1.5-year and three-year follow-up. Both groups improved post-treatment in terms of symptoms and developmental levels of representations of self, mother, and father. No significant differences between the anaclitic and the introjective group were found in this respect, and could not be expected due to the low power (0.27). The anaclitic group showed better balance between relatedness and self-definition post-treatment, while this improvement was not significant in the introjective group. Further and larger studies are needed to draw more farreaching conclusions about the relations between changes in personality configurations over the course of treatment and the treatment efficacy. The clinical implications of this approach to underlying dynamic psychological structures are discussed.

  • 354.
    Werbart, Andrzej
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Annevall, Amanda
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Hillblom, Johan
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Successful and Less Successful Psychotherapies Compared: Three Therapists and Their Six Contrasting Cases2019Inngår i: Frontiers in Psychology, ISSN 1664-1078, E-ISSN 1664-1078, Vol. 10, artikkel-id 816Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Despite the general effectiveness of bona fide psychotherapies, the number of patients who deteriorate or fail to improve is still problematic. Furthermore, there is an increased awareness in the field that the therapists’ individual skills make a significant contribution to the variance in outcome. While some therapists are generally more successful than others, most therapists have experienced both therapeutic success and failure in different cases. The aim of this case-series study was to deepen our understanding of what matters for the therapists’ success in some cases, whereas other patients do not improve. How do the patients and their therapists make sense of and reflect on their therapy experiences in most successful and unsuccessful cases? Are there any distinctive features experienced by the participants at the outset of treatment? To explore these issues, we applied a mixed-method design. Trying to keep the therapist factor constant, we selected contrasting cases from the caseloads of three therapists, following the criterion of reliable and clinically significant symptom reduction or non-improvement at termination. Transcripts of 12 patient interviews and 12 therapist interviews (at baseline and at termination) were analyzed, applying inductive thematic analysis and the multiple-case comparison method. The comparisons within the three therapists’ caseloads revealed that in the successful cases the patient and the therapist shared a common understanding of the presenting problems and the goals of therapy and experienced the therapeutic relationship as both supportive and challenging. Furthermore, the therapists adjusted their way of working to their patients’ needs. In non-improved cases, the participants presented diverging views of the therapeutic process and outcome. The therapists described difficulties in the therapeutic collaboration but not how they dealt with obstacles. They tended to disregard their own role in the interactions and to explain difficulties as being caused by the nature of their patients’ problems. This could indicate that the therapists had difficulty in reflecting on their own contributions, accepting feedback from their patients, and adjusting their work accordingly. These within-therapist differences indicate that taking a “third position” is most needed and seems to be most difficult, when early signs of a lack of therapeutic progress appear.

  • 355.
    Werbart, Andrzej
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Swedish Psychoanalytical Society, Sweden.
    Brusell, Lars
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Iggedal, Rebecka
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Lavfors, Kristin
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Widholm, Alexander
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Changes in Self-Representations Following Psychoanalytic Psychotherapy for Young Adults: A Comparative Typology2016Inngår i: Journal of the American Psychoanalytic Association, ISSN 0003-0651, E-ISSN 1941-2460, Vol. 64, nr 5, s. 917-958Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Changes in dynamic psychological structures are often a treatment goal in psychotherapy. The present study aimed at creating a typology of self-representations among young women and men in psychoanalytic psychotherapy, to study longitudinal changes in self-representations, and to compare self-representations in the clinical sample with those of a nonclinical group. Twenty-five women and sixteen men were interviewed according to Blatt’s Object Relations Inventory pretreatment, at termination, and at a 1.5-year follow-up. In the comparison group, eleven women and nine men were interviewed at baseline, 1.5 years, and three years later. Typologies of the 123 self-descriptions in the clinical group and 60 in the nonclinical group were constructed by means of ideal-type analysis for men and women separately. Clusters of self-representations could be depicted on a two-dimensional matrix with the axes Relatedness-Self-definition and Integration-Nonintegration. In most cases, the self-descriptions changed over time in terms of belonging to different ideal-type clusters. In the clinical group, there was a movement toward increased integration in self-representations, but above all toward a better balance between relatedness and self-definition. The changes continued after termination, paralleled by reduced symptoms, improved functioning, and higher developmental levels of representations. No corresponding tendency could be observed in the nonclinical group.

  • 356.
    Werbart, Andrzej
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Engqvist, Karin
    Lind, Sofia
    Therapists of Nonimproved Patients Looking Back on Their Work2017Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    Aim: Despite clear evidence that about 5 to 10% of patients deteriorate and 35 to 40% does not improve in psychotherapy, nonimproved cases are seldom scrutinized. The therapists’ experiences of their work with nonimproved patients might be a rich source of clinically relevant knowledge. Our study explores therapists’ experiences of therapeutic process in unsuccessful cases of psychoanalytic psychotherapy with young adults. Method: A two-stage, mixed-method design was used. Nonimproved cases were identified according to the criterion of reliable and clinically significant change in self-rated symptoms. Transcripts of 16 therapist interviews (8 pretreatment and 8 at termination) were analyzed applying Grounded Theory methodology. Results: A tentative conceptual process model was constructed around the core category Having Half of the Patient in Therapy. Initially, the therapists experienced collaboration as stimulating, at the same time as the therapeutic relationship was marked by distance. At termination negative processes predominated: the patient reacted with aversion to closeness and the therapist experienced struggle and loss of control in therapy. The therapists described therapy outcome as favorable in form of increased insight and alleviated problems, while core problems remained. Discussion: This split picture was interpreted as a sign of a pseudo-process emerging when the therapist allies herself with the patient’s capable and seemingly well-functioning parts. The therapists’ experiences could be compared to the nonimproved patients’ descriptions of “spinning one’s wheels” in therapy. The therapists seem not to have succeeded in adjusting their technique to their patients’ problems, despite their attempts to meta-communicate.

  • 357.
    Werbart, Andrzej
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Hägertz, Mikael
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Borg Ölander, Nadja
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Matching Patient and Therapist Anaclitic: Introjective Personality Configurations Matters for Psychotherapy Outcomes2018Inngår i: Journal of Contemporary Psychotherapy, ISSN 0022-0116, E-ISSN 1573-3564, Vol. 48, nr 4, s. 241-251Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Decades of psychotherapy research suggest that patient–therapist match accounts for outcome beyond single patient or therapist variables. This study examines the associations between different patterns of patient–therapist matching (in terms of orientation on relatedness or self-definition) and outcomes at termination of psychoanalytic psychotherapy with young adults. Thirty-three patients and their therapists were classified as predominately anaclitic or introjective at baseline. Patients in the convergent patient–therapist dyads (both anaclitic or both introjective) showed significantly greater symptom reduction and increased developmental levels of representations of mother than patients in the complementary dyads (opposite personality configurations). Moreover, convergent patient–therapist match was connected with larger effect sizes on all outcome measures and lower proportion of non-improved patients. These findings suggest the importance of the therapists’ early adjusting their orientation on relatedness or self-definition to their patients’ predominant personality configuration in order to enhance treatment outcomes.

  • 358.
    Werbart, Andrzej
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Hägertz, Mikael
    Borg Ölander, Nadja
    Matching Patient and Therapist Anaclitic-Introjective Personality Configurations Matters for Psychotherapy Outcomes2018Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    Aim: Decades of psychotherapy research suggest that patient-therapist match accounts for outcome beyond single patient or therapist variables. The therapist’s personality does influence the psychotherapeutic process. This study examines how the therapist’s personality configuration (orientation on relatedness and on self-definition) manifests itself early in the relationship to the patient. Furthermore, we examine the associations between different patterns of patient-therapist matching (convergent or complementary personality configurations) and outcomes at termination of psychotherapy with young adults. Method: Thirty-three patients and their therapists were interviewed at baseline. Prototype Matching of Anaclitic-Introjective Personality Configuration (PMAI) was applied to the interview material by two pairs of independent judges. Patients and their therapists were classified as predominately anaclitic or introjective at baseline (16 convergent and 17 complementary dyads). Outcome measures included Symptom Checklist-90-R and Differentiation-Relatedness scale at baseline and at termination. Results: Patients in the convergent patient-therapist dyads (both anaclitic or both introjective) showed significantly greater symptom reduction and increased developmental levels of representations of mother than patients in the complementary dyads (opposite personality configurations). Convergent patient-therapist match was connected with larger effect sizes on all outcome measures and lower proportion of non-improved patients. Different personality configurations could be actualized in the same therapist.Discussion: These findings suggest the importance of the therapists’ early adjusting their orientation on relatedness or on self-definition to their patients’ predominant personality configuration in order to enhance treatment outcome. Further and larger studies are needed to draw more far-reaching conclusions about the relations between patient-therapist personality match and the treatment efficacy.

  • 359.
    Werbart, Andrzej
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Levander, Sonja
    Fostering change in personality configurations: Anaclitic and introjective patients in psychoanalysis2016Inngår i: Psychoanalytic psychology, ISSN 0736-9735, E-ISSN 1939-1331, Vol. 33, nr 2, s. 217-242Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Treatment goals in psychoanalysis often include changes in underlying psychological structures. Different patterns of change have been demonstrated in anaclitic and introjective patients. In a series of 14 cases, we took a further step and examined changes in the anaclitic - introjective personality configurations following psychoanalysis, as well as patients' experiences of these changes. Clinical case formulations were based on repeated interviews and the application of prototype-matching methodology. Patients' experiences were explored by applying inductive thematic analysis. We found a development toward more mature levels of differentiation and individuation in the anaclitic group, whereas relatedness and intimacy remained problematic in some introjective cases. Patients described their experienced changes in terms of complementary personality configuration, but the introjective group described more benefits from psychoanalysis. Several patients expressed their ambivalence toward these changes and a feeling of loss of their former selves. Patients' view of their analysts and the analytic method were congruent with patients' primary personality configuration. To reactivate developmental processes, the psychoanalytic technique has to be adjusted to the anaclitic and introjective patients' different needs and defenses.

  • 360.
    Werbart, Andrzej
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Missios, Peter
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Waldenström, Fredrik
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Lilliengren, Peter
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    “It was hard work every session”: Therapists’ view of successful psychoanalytic treatments2019Inngår i: Psychotherapy Research, ISSN 1050-3307, E-ISSN 1468-4381, Vol. 29, nr 3, s. 354-371Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To explore therapists’ experiences of the therapeutic process in successful cases of psychoanalytic psychotherapy.

    Method: A two-stage, mixed-method design was used. Sixteen successful cases were drawn from a sample of 92 young adults in psychoanalytic psychotherapy according to Jacobson’s criteria for reliable and clinically significant improvement. Therapist interviews at baseline and termination were analyzed applying Inductive Thematic Analysis.

    Results: Three core themes emerged: Being Particularly Motivated to be This Patient’s Therapist, Maintaining a Safe and Attentive Therapeutic Position, and Assiduous Work Every Session. The therapists experienced positive feelings towards the patient from the outset of treatment and described active, relational work that included paying attention to incongruities in the patient’s self-presentation and being mindful of patient’s avoidant behavior. The therapist’s motivation and attentive position made it possible to balance support and challenge in the therapeutic relationship.

    Conclusions: Successful therapeutic work presupposes positive expectations, an active therapeutic stance and assiduous work session-by-session. Therapist expertise may involve the ability to mobilize and work effectively with patient-specific resources and obstacles from the beginning of treatment. In addition to identifying the characteristics and actions of effective therapists, research should also focus on processes emerging within effective therapeutic dyads.

    Clinical or methodological significance of this article: Our study indicates several factors that seem to characterize therapist expertise and can inform psychotherapy training. Successful therapeutic work presupposes positive expectations, an active therapeutic stance, courage to challenge the patient, and assiduous work session-by-session. Therapist expertise may involve the ability to mobilize and work effectively with patient-specific resources and obstacles from the beginning of treatment. In addition to identifying the characteristics and actions of effective therapists, research should also focus on processes emerging within effective therapeutic dyads.

  • 361.
    Werbart, Andrzej
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    von Below, Camilla
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Engqvist, Karin
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Lind, Sofia
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    “It was like having half of the patient in therapy”: Therapists of nonimproved patients looking back on their work2019Inngår i: Psychotherapy Research, ISSN 1050-3307, E-ISSN 1468-4381, Vol. 29, nr 7, s. 894-907Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To explore therapists’ experiences of therapeutic process in psychoanalytic psychotherapy with nonimproved young adults. Method: Eight nonimproved cases were identified according to the criterion of reliable and clinically significant change in self-rated symptoms. Transcripts of therapist interviews (8 at baseline and 8 at termination) were analyzed applying grounded-theory methodology. Results: A tentative conceptual process model was constructed around the core category Having Half of the Patient in Therapy. Initially, the therapists experienced collaboration as stimulating, at the same time as the therapeutic relationship was marked by distance. At termination negative processes predominated: the patient reacted with aversion to closeness and the therapist experienced struggle and loss of control in therapy. The therapists described therapy outcome as favorable in form of increased insight and mitigated problems, while core problems remained. Conclusions: This split picture was interpreted as a sign of a pseudo-process emerging when the therapist one-sidedly allied herself with the patient’s capable and seemingly well-functioning parts. The therapists’ experiences could be compared to the nonimproved patients’ “spinning one’s wheels” in therapy. The therapists seem not to have succeeded in adjusting their technique to their patients’ core problems, despite attempts to meta-communicate.

  • 362. Wergeland, Gro Janne H.
    et al.
    Fjermestad, Krister W.
    Marin, Carla E.
    Bjelland, Ingvar
    Storm Mowatt Haugland, Bente
    Silverman, Wendy K.
    Öst, Lars-Göran
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden; Haukeland University Hospital, Norway; University of Bergen, Norway.
    Fauskanger Bjaastad, Jon
    Oeding, Kristin
    Havik, Odd E.
    Heiervang, Einar R.
    Predictors of treatment outcome in an effectiveness trial of cognitive behavioral therapy for children with anxiety disorders2016Inngår i: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 76, s. 1-12Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    A substantial number of children with anxiety disorders do not improve following cognitive behavioral therapy (CBT). Recent effectiveness studies have found poorer outcome for CBT programs than what is typically found in efficacy studies. The present study examined predictors of treatment outcome among 181 children (aged 8–15 years), with separation anxiety, social phobia, or generalized anxiety disorder, who participated in a randomized, controlled effectiveness trial of a 10-session CBT program in community clinics. Potential predictors included baseline demographic, child, and parent factors. Outcomes were as follows: a) remission from all inclusion anxiety disorders; b) remission from the primary anxiety disorder; and c) child- and parent-rated reduction of anxiety symptoms at post-treatment and at 1-year follow-up. The most consistent findings across outcome measures and informants were that child-rated anxiety symptoms, functional impairment, a primary diagnosis of social phobia or separation anxiety disorder, and parent internalizing symptoms predicted poorer outcome at post-treatment. Child-rated anxiety symptoms, lower family social class, lower pretreatment child motivation, and parent internalizing symptoms predicted poorer outcome at 1-year follow-up. These results suggest that anxious children with more severe problems, and children of parents with elevated internalizing symptom levels, may be in need of modified, additional, or alternative interventions to achieve a positive treatment outcome.

  • 363. Westphal, Maren
    et al.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Frazier, Patricia
    Hadjistavropoulos, Heather
    Muench, Frederick
    Bridging the Gap Between Research and Practice in Clinical Applications of Digital Technology2018Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    Despite increasing evidence that cognitive-behavioral therapies (CBTs) involving digital technology are efficacious in the treatment of various psychological disorders and health problems, they are not yet widely disseminated. While the ubiquity of smartphones presents rich opportunities for leveraging technology to facilitate behavior change, there remain real and perceived barriers to implementation. This panel brings together researchers and clinicians to discuss promises and challenges in incorporating digital technology into mental health service delivery. Panelists will discuss key findings on the efficacy and effectiveness of internet-based and smartphone-delivered CBT to reduce stress, anxiety and depression in college students (Frazier); therapist-guided internet/smartphone-based CBT, acceptance and commitment therapy, and mindfulness-based interventions (MBIs) for mood and anxiety disorders (Carlbring); and therapist-guided internet-based CBT for mood and anxiety disorders and chronic medical conditions (Hadjistavropoulos). Panelist will also provide clinical case examples of incorporating text messaging, alert-based reminders, and commercially available apps to treat co-occurring psychological and health problems (Muench) and to promote acquisition and generalization of mindfulness and emotion regulation skills in dialectical behavior therapy for borderline personality disorder, depression, and anxiety disorders (Westphal). Collectively, panelists will address questions such as: Which components of CBTs and MBIs are particularly suited for internet-based/smartphone delivered self-help programs? In what form and how frequently should therapists be involved in guided internet- or smartphone-based treatments? Which therapist behaviors are predictive of worse outcome? What can be done to reduce attrition in self-guided interventions? For whom are technology-based interventions most appropriate?

  • 364. Wittmann, Lutz
    et al.
    Anstadt, Thomas
    Fischmann, Tamara
    Hau, Stephan
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Kempe, Simon
    Herot, Katrin
    Binswanger, Ralf
    Ein Traum, zwei Methoden: das Traumseminar nach Morgenthaler und das Zurich Dream Proces Coding System im Vergleich2017Inngår i: Journal für Psychoanalyse, ISSN 1613-4702, Vol. 58, s. 99-129Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [de]

    Die vorliegende Arbeit will zwei bezüglich Zielsetzung und Methodik unterschiedliche Herangehensweisen zum Thema Traum miteinander vergleichen. Nach einer Vorstellung von zugrundeliegenden Annahmen und technischem Vorgehen wird derselbe Traumbericht einer Patientin unabhängig voneinander von einem Traumseminar nach Morgenthaler sowie dem Zurich Dream Process Coding System nach Moser und von Zeppelin untersucht. Die Analyseschritte werden von einer Fallvignette ergänzt und von der behandelnden Therapeutin kommentiert. Eine kritische und vergleichende Reflexion der beiden Ansätze schliesst den Aufsatz ab.

  • 365.
    Zetterberg, Molly
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. University of Southern Denmark, Denmark.
    Andersson, Gerhard
    Berg, Matilda
    Shafran, Roz
    Rozental, Alexander
    Internet-based cognitive behavioral therapy of perfectionism: Comparing regular therapist support and support upon request2019Inngår i: Internet Interventions, ISSN 2214-7829, Vol. 17, artikkel-id 100237Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Perfectionism may be a clinically relevant problem on its own or as part of the etiology and maintenance of psychiatric disorders, e.g., anxiety disorders, depression, and eating disorders. Cognitive behavior therapyhas been shown to be a promising treatment for managing perfectionism and its associated problems, including when being administered via the Internet, i.e., Internet-based cognitive behavioral therapy (ICBT). In the current study, seventy-eight self-referred participants underwent ICBT after an initial eight-week wait-list period, i.e., second wave of treatment. These were randomized to receive regular support from a therapist (ICBT-support) or ICBT with support on request (ICBT-request), in an eight-week treatment of perfectionism. Assessments of perfectionism were made at pre-, mid-, and post-treatment, as well as six-month follow-up, using the Frost Multidimensional Perfectionism Scale, subscale Concern over Mistakes. Mixed effects models revealed large symptom reductions for both conditions; Concern over Mistakes, Cohen's d = 1.40, 95% Confidence Interval (CI) [0.85, 1.95] for ICBT-support, and d = 1.00, 95% CI [0.51, 1.47] for ICBT-request. The effects were maintained at six-month follow-up and there were no differences between the conditions in terms of the results, opened modules, or completed exercises. A total of 28 out of 70 participants (42.4%; ICBT-support, 37.8%; ICBT-request) were classified as improved at post-treatment. Both types of ICBT may thus be beneficial in treating perfectionism, suggesting that just having the opportunity to ask for support from a therapist, when regular support is not provided, could be sufficient for many participants undergoing ICBT. However, the study was underpowered to detect differences between the conditions. The lack of a cutoff also makes it difficult to differentiate a dysfunctional from a functional population in terms of perfectionism. In addition, the study design could have affected the participants' motivational level from start, given their initial eight-week wait-list period. Recommendations for future studies include recruiting a larger sample size, a clearer cutoff for perfectionism, and the use of a non-inferiority test with a predetermined margin of change.

  • 366. Zetterberg, Molly
    et al.
    Rozental, Alexander
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, Gerhard
    Internet-based treatment of perfectionism: A randomized controlled trial comparing two types of self-help2017Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Introduction: Perfectionism may be a clinically relevant problem on its own or as a part of other conditions. Internet-based cognitive behavioral therapy (ICBT) is a promising method for treating perfectionism. ICBT with guidance is recommended over unguided versions; still there remain questions concerning the importance of guidance in ICBT.

    Methods: In this study, seventy-eight self-referred participants were randomized to either ICBT with support or ICBT with support on request in an eight-week treatment of perfectionism. Primary outcome measures included two subscales from Frost Multidimensional Perfectionism Scale, and the Clinical Perfectionism Questionnaire. In addition to this depression, anxiety and quality of life were assessed.

    Results: A mixed effects model revealed significant pre-post reductions on all measures for both groups. Neither significant differences nor considerable effects were detected between groups (Cohen’s d = 0.01-0.33).

    Conclusion: This trial demonstrates that ICBT with or without regular therapist support may be helpful in treating perfectionism.

  • 367.
    Åkerstedt, Torbjörn
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Stressforskningsinstitutet. Karolinska Institutet, Sweden.
    Lekander, Mats
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Stressforskningsinstitutet. Karolinska Institutet, Sweden.
    Nilsonne, Gustav
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Stressforskningsinstitutet. Karolinska Institutet, Sweden.
    Tamm, S.
    d'Onofrio, Paolo
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Stressforskningsinstitutet.
    Kecklund, Göran
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Stressforskningsinstitutet.
    Fischer, Håkan
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Biologisk psykologi.
    Petrovic, P.
    Månsson, Kristoffer N.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden.
    Gray Matter Volume Correlates Of Sleepiness: A Voxel-based Morphometry Study In Younger And Older Adults2018Inngår i: Sleep, ISSN 0161-8105, E-ISSN 1550-9109, Vol. 41, s. A58-A58, artikkel-id 0149Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    Introduction: Sleepiness is prevalent in society, often linked to disturbed sleep, shift work, stress, or diseases. It is also associated with an increased risk of accidents. Sleepiness may be related to brain metabolism and, we hypothesize that it is associated with brain gray matter (GM) volume. The present study investigated the association between sleepiness and GM volume in thalamus and insula, with a special focus on age, since both sleepiness and GM volume change with age.

    Methods: In all, 84 healthy individuals participated in the experiment, of which 46 were in the age range 20–30 years and 38 ranging between 65–75 years. Data was collected in a 3 T scanner during a 5 minute anatomical scan (first in a several sessions in the scanner) in the evening after a full night of sleep. Momentary sleepiness (Karolinska Sleepiness Scale) was rated 7 times during the time in the scanner.

    Results: Results showed that, in older, relative to younger adults, areas within bilateral insular cortex and thalamus GM regions of interest were negatively associated (FWE-corrected) with sleepiness (Z=4.02, p=.015 left insula and Z=4.42, p=.009 for right insula; Z=3.75, p=.020 for left thalamus and Z=4.60, p=.001 for right thalamus). Larger volume was associated with low sleepiness in the older group, but not in the older group. The effect in the insula was mainly present in the mid-anterior parts of the structure.. In addition, after applying a conservative small volume correction including all ROIs simultaneously, age-interaction effects remained significant.

    Conclusion: It was concluded that self-rated momentary sleepiness in a monotonous situation is negatively associated with GM volume in areas within both thalamus and insula in older individuals. The results are in line with notions of thalamus as a driver of arousal and of anterior insula as a structure evaluating the state of the organism. Possibly, a larger GM volume in these structures may be protective against sleepiness in older individuals, a hypothesis that needs confirmation in further studies.

  • 368.
    Öst, Lars-Göran
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Att utvärdera psykoterapi och kritiskt granska psykoterapistudier2016Bok (Annet vitenskapelig)
    Abstract [sv]

    Hur avgör du som terapeut på ett tillförlitligt sätt att dina patienter blir bättre? Vad menas egentligen med begreppet evidens? Hur kan du bedöma om en studie är välgjord?

    Denna bok hjälper dig som kliniker att utvärdera den behandling du bedriver på ett systematiskt och evidensbaserat sätt. Paradoxalt nog har forskning visat att psykoterapeuter har svårt att bedöma om deras patienter förbättras eller försämras under behandlingens gång. Därför har Lars-Göran Öst här samlat beprövade utvärderingsskalor som är lämpliga att använda session för session, samt före, efter och vid uppföljning av behandling. 

    I boken finns även en mall för att granska och förstå den metodologiska kvaliteten hos psykoterapistudier i vetenskapliga tidskrifter. Med hjälp av denna kan du på ett säkrare sätt bedöma vilka slutsatser som kan dras och vilken användbarhet en studie har för ditt eget kliniska arbete. I grunden handlar detta om att dina patienter ska få bästa möjliga vård.

    Boken vänder sig till både blivande och yrkesverksamma psykologer, psykoterapeuter samt till alla andra som vill veta mer om evidensbaserad psykoterapi.

  • 369.
    Öst, Lars-Göran
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    KBT inom barn- och ungdomspsykiatrin2017Collection/Antologi (Annet vitenskapelig)
    Abstract [sv]

    Här beskrivs hur KBT kan tillämpas vid de vanligaste psykiatriska tillstånden hos barn och unga. Boken inleds med en beskrivning av vad som är utmärkande för arbete med barn, ungdomar, och deras familjer och nätverk. De diagnoser som tas upp är bland annat social ångest, generaliserat ångestsyndrom, tvångssyndrom, PTSD, stresstörning, depression, ADHD och autism. Författarna visar hur KBT-modellen och beteendeanalysen kan se ut, beskriver olika behandlingsvägar och ger belysande fallvinjetter. Boken avslutas med en genomgång av det ökande empiriska stödet för KBT vid de olika tillstånden.

  • 370.
    Öst, Lars-Göran
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Rebuttal of Atkins et al. (2017) critique of the Öst (2014) meta-analysis of ACT2017Inngår i: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 97, s. 273-281Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    Atkins et al. strongly criticize my (Öst, 2014) systematic review and meta-analysis of ACT. The bulk of their re-examination of my article is divided into four parts: a) Selection of studies, b) Ratings of methodological quality, c) Meta-analysis, and d) Judgments of quality of evidence. It is evident from my paper that I have refuted their claims regarding each of these parts. Regarding a) Selection of studies I showed that only four studies had a cell size of less than 10 and their inclusion did not change the mean effect size or increased variability. Concerning b) Ratings of methodological quality I have showed that my ratings were reliable and had accuracy. As for c) Meta-analysis, I have demonstrated that I got very similar results to those of A-Tjak et al. (2015) that Atkins et al. describes as a much better meta-analysis. Regarding d) Judgments of quality of evidence, Atkins et al. brought up 23 studies for which they argued that I have done an incorrect evaluation but for every single study I have disproved their arguments and maintain my 2014 evaluation of the evidence base of ACT. Thus, there is no reason to follow Atkins et al. suggestion that my review “should now be set aside in making decisions regarding the treatment efficacy of ACT.”

  • 371.
    Öst, Lars-Göran
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden .
    Ollendick, Thomas H.
    Brief, intensive and concentrated cognitive behavioral treatments for anxiety disorders in children: A systematic review and meta-analysis2017Inngår i: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 97, s. 134-145Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Anxiety disorders are among the most common disorders affecting youths in the general population, with up to 10% of children and 20% of adolescents meeting criteria for an anxiety disorder at any one point in time. Cognitive-behavior therapies (CBT), varying between 9 and 18 weeks of treatment, are considered evidence-based for the treatment of anxiety disorders in youth. During the last two decades treatments that are brief, intensive, or concentrated (BIC) have been developed and this meta-analysis includes 23 RCTs of these new approaches across the anxiety disorders. BIC yielded a lower attrition (2.3%) than standard CBT (6.5%). The effect sizes (ES) for comparison of BIC with waiting-list (1.47) and placebo (0.91) were significant, whereas that with standard CBT (0.01) was not. Regarding remission at post/recovery at follow-up BIC (54%/64%) and standard CBT (57%/63%) were comparable and both were significantly higher than placebo (26%/35%), which was higher than WLC (7%/9%). Within-group ES at post and follow-up were 1.50 and 1.53 for BIC, and 0.98 and 1.05 for standard CBT, indicating maintenance of the effects up to 12 months after therapy. Advantages and disadvantages of BIC are discussed and we suggest that BIC-interventions represent a paradigm shift in the delivery of services for youth with anxiety disorders.

  • 372.
    Öst, Lars-Göran
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden; University of Bergen, Norway.
    Riise, Eili N.
    Wergeland, Gro Janne
    Hansen, Bjarne
    Kvale, Gerd
    Cognitive behavioral and pharmacological treatments of OCD in children: A systematic review and meta-analysis2016Inngår i: Journal of Anxiety Disorders, ISSN 0887-6185, E-ISSN 1873-7897, Vol. 43, s. 58-69Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Obsessive-compulsive disorder (OCD) is ranked by the World Health Organization (WHO) among the 10 most debilitating disorders. The treatments which have been found effective are cognitive behavior therapy (CBT) and serotonin reuptake inhibitors (SRI). This meta-analysis includes all RCTs of CBT (25) and SRI (9) for OCD in youth using the Children’s Yale-Brown Obsessive Compulsive Scale (C-YBOCS). CBT yielded significantly lower attrition (12.7%) than SRI (23.5%) and placebo (24.7%). The effect sizes for comparisons of CBT with waiting-list (1.53), placebo (0.93), and SRI with placebo (0.51) were significant, whereas CBT vs. SRI (0.22) and Combo (CBT + SRI) vs. CBT (0.14) were not. Regarding response rate CBT (70%) and Combo (66%) were significantly higher than SRI (49%), which was higher than placebo (29%) and WLC (13%). As for remission CBT (53%) and Combo (49%) were significantly higher than SRI (24%), placebo (15%), and WLC (10%), which did not differ from each other. Combo was not more effective than CBT alone irrespective of initial severity of the samples. The randomized controlled trials (RCTs) have a number of methodological problems and recommendations for improving research methodology are discussed as well as clinical implications of the findings.

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