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  • 351. Rozental, Alexander
    et al.
    Oscarsson, Martin
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Tio i tolv: en bok om att lyckas med nyårslöften, mål och beteendeförändringar2018Bok (Annet (populærvitenskap, debatt, mm))
    Abstract [sv]

    När det börjar dra ihop sig till tolvslag nyårsnatten är vi många lovar att ta tag i saker under det nya året enligt undersökningar avger var åttonde man och var femte kvinna i Sverige ett nyårslöfte. Ofta håller dock våra föresatser inte särskilt länge, framåt februari är det redan glesare på gymmen. Det är vanligt att gå ut för hårt i början samtidigt som det är lätt att falla tillbaka i gamla ovanor. Efter ett bakslag eller två är det lätt att ge upp.

    Trots detta visar psykologisk forskning att nyårslöften är förvånansvärt bra på att skapa varaktiga beteendeförändringar. Det gäller bara att komma lite mer förberedd till tolvslaget, ha realistiska förutsättningar och understryka att förändringsarbetet inte handlar om en kort sprint utan snarare utgör ett maratonlopp kombinerat med hinderbana.

    Tio i tolv förklarar varför nyårslöften är ett smart sätt att komma igång med nya vanor och överge gamla. Med hjälp av studier och undersökningar inom bland annat målsättning, rutiner och prokrastinering får läsaren kunskap om hur hen lättare kan lyckas med en förändring. Intressanta rön om svenskar egna nyårslöften presenteras, varvat med handfasta tips för att lättare uppnå våra mål vare sig det handlar om ett nyårslöfte eller en nystart efter semestern.

    Boken bygger på världens största vetenskapliga studie kring människors nyårslöften, utförd av Per Carlbring, Alexander Rozental och Martin Oscarsson vid Stockholms universitet.

  • 352.
    Rozental, Alexander
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. University College London, United Kingdom.
    Shafran, Roz
    Wade, Tracey D.
    Kothari, Radha
    Egan, Sarah J.
    Ekberg, Linda
    Wiss, Maria
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, Gerhard
    Guided web-based cognitive behavior therapy for perfectionism: Results from two different randomized controlled trials2018Inngår i: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 20, nr 4, artikkel-id e154Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Perfectionism can become a debilitating condition that may negatively affect functioning in multiple areas, including mental health. Prior research has indicated that internet-based cognitive behavioral therapy can be beneficial, but few studies have included follow-up data.

    Objective: The objective of this study was to explore the outcomes at follow-up of internet-based cognitive behavioral therapy with guided self-help, delivered as 2 separate randomized controlled trials conducted in Sweden and the United Kingdom.

    Methods: In total, 120 participants randomly assigned to internet-based cognitive behavioral therapy were included in both intention-to-treat and completer analyses: 78 in the Swedish trial and 62 in the UK trial. The primary outcome measure was the Frost Multidimensional Perfectionism Scale, Concern over Mistakes subscale (FMPS CM). Secondary outcome measures varied between the trials and consisted of the Clinical Perfectionism Questionnaire (CPQ; both trials), the 9-item Patient Health Questionnaire (PHQ-9; Swedish trial), the 7-item Generalized Anxiety Disorder scale (GAD-7; Swedish trial), and the 21-item Depression Anxiety Stress Scale (DASS-21; UK trial). Follow-up occurred after 6 months for the UK trial and after 12 months for the Swedish trial.

    Results: Analysis of covariance revealed a significant difference between pretreatment and follow-up in both studies. Intention-to-treat within-group Cohen d effect sizes were 1.21 (Swedish trial; 95% CI 0.86-1.54) and 1.24 (UK trial; 95% CI 0.85-1.62) for the FMPS CM. Furthermore, 29 (59%; Swedish trial) and 15 (43%; UK trial) of the participants met the criteria for recovery on the FMPS CM. Improvements were also significant for the CPQ, with effect sizes of 1.32 (Swedish trial; 95% CI 0.97-1.66) and 1.49 (UK trial; 95% CI 1.09-1.88); the PHQ-9, effect size 0.60 (95% CI 0.28-0.92); the GAD-7, effect size 0.67 (95% CI 0.34-0.99); and the DASS-21, effect size 0.50 (95% CI 0.13-0.85).

    Conclusions: The results are promising for the use of internet-based cognitive behavioral therapy as a way of targeting perfectionism, but the findings need to be replicated and include a comparison condition.

  • 353.
    Rozental, Alexander
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Shafran, Roz
    Wade, Tracey
    Egan, Sarah
    Bergman Nordgren, Lise
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Landström, Andreas
    Roos, Stina
    Skoglund, Malin
    Thelander, Elisabet
    Trosell, Linnéa
    Örtenholm, Alexander
    Andersson, Gerhard
    A randomized controlled trial of Internet-based cognitive behavior therapy for perfectionism including an investigation of outcome predictors2017Inngår i: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 95, s. 79-86Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Being highly attentive to details can be a positive feature. However, for some individuals, perfectionism can lead to distress and is associated with many psychiatric disorders. Cognitive behavior therapy has been shown to yield many benefits for those experiencing problems with perfectionism, but the access to evidence-based care is limited. The current study investigated the efficacy of guided Internet-based Cognitive Behavior Therapy (ICBT) and predictors of treatment outcome. In total, 156 individuals were included and randomized to an eight-week treatment or wait-list control. Self-report measures of perfectionism, depression, anxiety, self-criticism, self-compassion, and quality of life were distributed during screening and at post-treatment. Intention-to-treat were used for all statistical analyses. Moderate to large between-group effect sizes were obtained for the primary outcome measures, Frost Multidimensional Perfectionism Scale, subscales Concerns over Mistakes and Personal Standards, Cohen's d = 0.68–1.00, 95% Confidence Interval (CI) [0.36–1.33], with 35 (44.9%) of the patients in treatment being improved. Predictors were also explored, but none were related to treatment outcome. In sum, guided ICBT can be helpful for addressing problems with clinical perfectionism, but research of its long-term benefits is warranted.

  • 354.
    Rozental, Alexander
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Wade, Tracey
    Egan, Sarah
    Kothari, Radha
    Allcott-Watson, Hannah
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, Gerhard
    Is the devil in the detail? A randomized controlled trial of guided Internet-based CBT for perfectionism2017Inngår i: Applying CBT in Diverse Contexts: 51st Annual Convention: Program Book, 2017, s. 127-127Konferansepaper (Fagfellevurdert)
    Abstract [en]

    An internet guided self-help cognitive-behavioural treatment (ICBT) for perfectionism was recently found to be effective. Such studies stand in need of replication. The aim of this study was to report the outcomes and predictors of change when the treatment is delivered in a UK setting. A total of 120 people (Mean=28.9 years; 79% female) were randomised to receive ICBT or wait-list control over 12 weeks (trial registration: NCT02756871). While there were strong similarities between the current study and its Swedish counterpart, there were also important differences in procedural details. There was a significant impact of the intervention on the primary outcome measure (Frost Multidimensional Perfectionism Scale, Concern over Mistakes subscale) and also on the Clinical Perfectionism Questionnaire (between group effect sizes d =0.98 (95% CI: 0.60-1.36) and d =1.04 (95% CI: 0.66-1.43) respectively using intent-to-treat analyses). Unlike the Swedish study, there was significant non-engagement and non-completion of modules with 71% of participants completing fewer than half the modules. The number of modules completed moderated the rate of change in clinical perfectionism over time. In conclusion, the study indicates the intervention is effective in a UK setting but highlighted the importance of procedural details to optimise retention.

  • 355.
    Rozental, Alexander
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Wennersten, Lina
    Dansa på deadline: Uppskjutandets psykologi2014Bok (Annet vitenskapelig)
  • 356. Salomonsson, Sigrid
    et al.
    Hedman-Lagerlöf, Erik
    Öst, Lars-Göran
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Sickness absence: a systematic review and meta-analysis of psychological treatments for individuals on sick leave due to common mental disorders2018Inngår i: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 48, nr 12, s. 1954-1965Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Sick leave due to common mental disorders (CMDs) increase rapidly and present a major societal challenge. The overall effect of psychological interventions to reduce sick leave and symptoms has not been sufficiently investigated and there is a need for a systematic review and meta-analysis of the field. The aim of the present meta-analysis was to calculate the effect size of psychological interventions for CMDs on sick leave and psychiatric symptoms based on all published randomized controlled trials. Methodological quality, the risk of bias and publication bias were also assessed. The literature searches gave 2240 hits and 45 studies were included. The psychological interventions were more effective than care as usual on both reduced sick leave (g = 0.15) and symptoms (g = 0.21). There was no significant difference in effect between work focused interventions, problem-solving therapy, cognitive behavioural therapy or collaborative care. We conclude that psychological interventions are more effective than care as usual to reduce sick leave and symptoms but the effect sizes are small. More research is needed on psychological interventions that evaluate effects on sick leave. Consensual measures of sick leave should be established and quality of psychotherapy for patients on sick leave should be improved.

  • 357. Salomonsson, Sigrid
    et al.
    Santoft, Fredrik
    Lindsäter, Elin
    Ejeby, Kersti
    Ingvar, Martin
    Ljótsson, Brjánn
    Öst, Lars-Göran
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden.
    Lekander, Mats
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Stressforskningsinstitutet. Karolinska Institutet, Sweden.
    Hedman-Lagerlöf, Erik
    Effects of cognitive behavioural therapy and return-to-work intervention for patients on sick leave due to stress-related disorders: Results from a randomized trial2019Inngår i: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim of this study was to evaluate specific effects for patients with adjustment or exhaustion disorder, the Stress subgroup (n = 152), regarding symptom severity and sick leave after CBT, a return-to-work intervention (RTW-I), and a combination of them (COMBO), using data from a randomized trial. In the original study, primary care patients on sick leave (N = 211) were randomized to CBT (n = 64), RTW-I (n = 67), or COMBO (n = 80). Blinded Clinician Severity Rating (CSR) of symptoms and sick leave registry data were primary outcomes. Subgroup analyses showed that for the Stress subgroup, CBT led to greater reduction of symptoms than RTW-I posttreatment, but COMBO did not differ from CBT or RTW-I. Regarding sick leave, there was no difference between treatments in the Stress subgroup. An exploratory analysis of the treatment effects in a subgroup of patients with depression, anxiety or insomnia indicates that RTW-I reduced sick leave faster than CBT. We conclude that CBT may be promising as an effective treatment of stress and exhaustion disorder.

  • 358. Salomonsson, Sigrid
    et al.
    Santoft, Fredrik
    Lindsäter, Elin
    Ejeby, Kersti
    Ingvar, Martin
    Öst, Lars-Göran
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden.
    Lekander, Mats
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Stressforskningsinstitutet. Karolinska Institutet, Sweden; Karolinska University Hospital, Sweden.
    Ljotsson, Brjann
    Hedman-Lagerlof, Erik
    Predictors of outcome in guided self-help cognitive behavioural therapy for common mental disorders in primary care2019Inngår i: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Cognitive behavioural therapy (CBT) can effectively treat common mental disorders (CMDs), but access to treatment is insufficient. Guided self-help (GSH) CBT has shown effects comparable to face-to-face CBT and may be a resource-efficient treatment alternative. However, not all patients respond to GSH. Learning more about predictors of outcome may increase knowledge regarding which patients respond to GSH. The aim of this study was to investigate predictors of outcome for GSH CBT for patients with CMDs in primary care. Consecutive patients (N = 396) with a principal disorder of depression, anxiety, insomnia or stress-related disorders were included. All patients received GSH CBT. Outcomes were remission status, reliable change and post-treatment depression ratings. Predictors investigated were clinical, demographic and therapy-related variables. Analyses were conducted using logistic and linear regression. Higher educational level predicted remission, higher quality of life ratings predicted remission and decreased depression, and higher age at onset predicted reliable change. Therapy-related variables, i.e. patient adherence to treatment and patients? and clinicians? estimation of treatment response, were all related to outcome. More large-scale studies are needed, but the present study points at the importance of therapy-related variables such as monitoring and supporting treatment adherence for an increased chance of remission.

  • 359. Salomonsson, Sigrid
    et al.
    Santoft, Fredrik
    Lindsäter, Elin
    Ejeby, Kersti
    Ljtosson, Brjann
    Öst, Lars-Göran
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden.
    Ingvar, Martin
    Lekander, Mats
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Stressforskningsinstitutet. Karolinska Institutet, Sweden; Karolinska University Hospital Stockholm, Sweden.
    Hedman-Lagerlöf, Erik
    Cognitive-behavioural therapy and return-to-work intervention for patients on sick leave due to common mental disorders: a randomised controlled trial2017Inngår i: Occupational and Environmental Medicine, ISSN 1351-0711, E-ISSN 1470-7926, Vol. 74, nr 12, s. 905-912Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives Common mental disorders (CMDs) cause great individual suffering and long-term sick leave. Cognitive–behavioural therapy (CBT) effectively treats CMDs, but sick leave is not reduced to the same extent as psychiatric symptoms. Research results regarding return-to-work interventions (RTW-Is) and their effect on sick leave are inconclusive. The aim of this study was to evaluate CBT, a RTW-I and combined CBT and RTW-I (COMBO) for primary care patients on sick leave due to CMDs.

    Methods Patients with CMDs (n=211) were randomised to CBT (n=64), RTW-I (n=67) or COMBO (n=80). Sick-leave registry data after 1 year and blinded Clinician’s Severity Rating (CSR) of symptoms post-treatment and at follow-ups after 6 and 12 months were primary outcomes.

    Results There was no significant difference between treatments in days on sick leave 1 year after treatment start (mean difference in sick-leave days range=9–27). CBT led to larger reduction of symptoms post-treatment (CSR; Cohen’s d=0.4 (95% CI 0.1 to 0.8)) than RTW-I, whereas COMBO did not differ from CBT or RTW-I. At follow-up, after 1 year, there was no difference between groups. All treatments were associated with large pre-treatment to post-treatment improvements, and results were maintained at 1-year follow-up.

    Conclusion No treatment was superior to the other regarding reducing sick leave. All treatments effectively reduced symptoms, CBT in a faster pace than RTW-I, but at 1-year follow-up, all groups had similar symptom levels. Further research is needed regarding how CBT and RTW-I can be combined more efficiently to produce a larger effect on sick leave while maintaining effective symptom reduction.

  • 360. Salomonsson, Sigrid
    et al.
    Santoft, Fredrik
    Lindsäter, Elin
    Ejeby, Kersti
    Ljótsson, Brjánn
    Öst, Lars-Göran
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden.
    Ingvar, Martin
    Lekander, Mats
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Stressforskningsinstitutet. Karolinska Institutet, Sweden.
    Hedman-Lagerlöf, Erik
    Stepped care in primary care - guided self-help and face-to-face cognitive behavioural therapy for common mental disorders: a randomized controlled trial2018Inngår i: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 48, nr 10, s. 1644-1654Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    Common mental disorders (CMD) cause large suffering and high societal costs. Cognitive behavioural therapy (CBT) can effectively treat CMD, but access to treatment is insufficient. Guided self-help (GSH) CBT, has shown effects comparable with face-to-face CBT. However, not all patients respond to GSH, and stepping up non-responders to face-to-face CBT, could yield larger response rates. The aim was to test a stepped care model for CMD in primary care by first evaluating the effects of GSH-CBT and secondly, for non-responders, evaluating the additional effect of face-to-face CBT.

    Methods

    Consecutive patients (N = 396) with a principal disorder of depression, anxiety, insomnia, adjustment or exhaustion disorder were included. In Step I, all patients received GSH-CBT. In Step II, non-responders were randomized to face-to-face CBT or continued GSH. The primary outcome was remission status, defined as a score below a pre-established cutoff on a validated disorder-specific scale.

    Results

    After GSH-CBT in Step I, 40% of patients were in remission. After Step II, 39% of patients following face-to-face CBT were in remission compared with 19% of patients after continued GSH (p = 0.004). Using this stepped care model required less than six therapy sessions per patient and led to an overall remission rate of 63%.

    Conclusions

    Stepped care can be effective and resource-efficient to treat CMD in primary care, leading to high remission rates with limited therapist resources. Face-to-face CBT speeded up recovery compared with continued GSH. At follow-ups after 6 and 12 months, remission rates were similar in the two groups.

  • 361. Santoft, Fredrik
    et al.
    Axelsson, Erland
    Öst, Lars-Göran
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden.
    Hedman-Lagerlöf, Maria
    Fust, Jens
    Hedman-Lagerlöf, Erik
    Cognitive behaviour therapy for depression in primary care: systematic review and meta-analysis2019Inngår i: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 49, nr 8, s. 1266-1274Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Depression is common in primary care, and most patients prefer psychological treatment over pharmacotherapy. Cognitive behaviour therapy (CBT) is an effective treatment, but there are gaps in current knowledge about CBT in the primary care context, especially with regard to long-term effects and the efficacy of specific delivery formats. This is an obstacle to the integration of primary care and specialist psychiatry. We conducted a systematic review and meta-analysis of randomised controlled trials of CBT for primary care patients with depression to investigate the effect of CBT for patients with depression in primary care. A total of 34 studies, with 2543 patients in CBT and 2815 patients in control conditions, were included. CBT was more effective than the control conditions [g = 0.22 (95% confidence interval (CI) 0.15-0.30)], and the effect was sustained at follow-up [g = 0.17 (95% CI 0.10-0.24)]. CBT also led to a higher response rate [odds ratio (OR) = 2.47 (95% CI 1.60-3.80)] and remission rate [OR = 1.56 (95% CI 1.15-2.14)] than the control conditions. Heterogeneity was moderate. The controlled effect of CBT was significant regardless of whether patients met diagnostic criteria for depression, scored above a validated cut-off for depression, or merely had depressive symptoms. CBT also had a controlled effect regardless of whether the treatment was delivered as individual therapy, group therapy or therapist-guided self-help. We conclude that CBT appears to be effective for patients with depression in primary care, and recommend that patients with mild to moderate depression be offered CBT in primary care.

  • 362. Santoft, Fredrik
    et al.
    Salomonsson, Sigrid
    Hesser, Hugo
    Lindsäter, Elin
    Ljótsson, Brjánn
    Lekander, Mats
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Stressforskningsinstitutet. Karolinska Institutet, Sweden.
    Kecklund, Göran
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Stressforskningsinstitutet. Radboud University, The Netherlands.
    Öst, Lars-Göran
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden.
    Hedman-Lagerlöf, Erik
    Mediators of Change in Cognitive Behavior Therapy for Clinical Burnout2019Inngår i: Behavior Therapy, ISSN 0005-7894, E-ISSN 1878-1888, Vol. 50, nr 3, s. 475-488Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Evidence supporting the effectiveness of cognitive behavior therapy (CBT) for stress-related illness is growing, but little is known about its mechanisms of change. The aim of this study was to investigate potential mediators of CBT for severe stress in form of clinical burnout, using an active psychological treatment as comparator. We used linear mixed models to analyze data from patients (N = 82) with clinical burnout who received either CBT or another psychological treatment in a randomized controlled trial. Potential mediators (i.e., sleep quality, behavioral activation, perceived competence, and therapeutic alliance) and outcome (i.e., symptoms of burnout) were assessed weekly during treatment. The results showed that the positive treatment effects on symptoms of burnout favoring CBT (estimated between-group d = 0.93) were mediated by improvements in sleep quality, ab = -0.017,95% CIasymmetric [-0.037, -0.002], and increase in perceived competence, ab = -0.037, 95% CIasymmetric [-0.070, -0.010]. Behavioral activation, ab = -0.004 [-0.016, 0.007], and therapeutic alliance, ab = 0.002 [-0.006, 0.011], did not significantly mediate the difference in effects between the treatments. Improving sleep quality and increasing perceived competence may thus constitute important process goals in order to attain symptom reduction in CBT for clinical burnout.

  • 363. Santoft, Fredrik
    et al.
    Salomonsson, Sigrid
    Hesser, Hugo
    Lindsäter, Elin
    Ljótsson, Brjánn
    Lekander, Mats
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Stressforskningsinstitutet. Karolinska Institutet, Sweden.
    Kecklund, Göran
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Stressforskningsinstitutet. Karolinska Institutet, Sweden.
    Öst, Lars-Göran
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden.
    Hedman-Lagerlöf, Erik
    Processes in cognitive behavior therapy for social anxiety disorder: Predicting subsequent symptom change2019Inngår i: Journal of Anxiety Disorders, ISSN 0887-6185, E-ISSN 1873-7897, Vol. 67, artikkel-id 102118Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Although cognitive behavior therapy (CBT) is an effective treatment for social anxiety disorder, little is known about the processes during treatment that bring about change. The aim of this study was to investigate whether the proposed processes of change according to the cognitive model of social anxiety disorder predicted subsequent symptom reduction in CBT delivered as therapist-guided bibliotherapy. We analyzed data from patients with social anxiety disorder (N = 61) who participated in an effectiveness trial of CBT in primary care. Seven putative processes and outcome (i.e., social anxiety) were assessed on a weekly basis throughout treatment. We used linear mixed models to analyze within-person relations between processes and outcome. The results showed a unidirectional effect of reduced avoidance on subsequent decrease in social anxiety. Further, we found support for reciprocal influences between four of the proposed processes (i.e., estimated probability and cost of adverse outcome, self-focused attention, and safety behaviors) and social anxiety. The remaining two processes, (i.e., anticipatory and post-event processing) did not predict subsequent social anxiety, but were predicted by prior symptom reduction. The findings support that several of the change processes according to the cognitive model of social anxiety disorder are involved in symptom improvement.

  • 364. Schuster, Raphael
    et al.
    Leitner, Isabella
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Laireiter, Anton-Rupert
    Exploring blended group interventions for depression: Randomised controlled feasibility study of a blended computer- and multimedia-supported psychoeducational group intervention for adults with depressive symptoms2017Inngår i: Internet Interventions, ISSN 2214-7829, Vol. 8, s. 63-71Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Blended interventions aim to capitalise on the strengths of both computer-based and face-to-face therapy. Studies on this innovative treatment format remain scare. This especially accounts for the group treatment of depression.

    Method: The present study applied eclectic psychotherapy methods to an adult sample exhibiting a variety of depressive symptoms (N = 46). Participants were recruited by a newspaper inlet and randomised either to a treatment or a waiting list condition. Computer supported components were multimedia group sessions, e-learning, online videos and worksheets, remote therapist-patient communication and online pre-post-assessment.

    Results: Large between-group effect sizes on primary outcome depressiveness (CES-D) (F(1,44) = 4.88, p = 0.032; d = 0.87) and secondary outcome personal resources (resource scales) (F(1,44) = 9.04, p = 0.004; d = 0.73 to F(1,44) = 8.82 p = 0.005, d = 1.15) were found in the intention to treat analysis (ANOVA). Subjective evaluation of the intervention revealed high treatment adherence (91%) and high perceived relevance of supportive computer and multimedia components. Participants rated computer and multimedia components comparable to treatment elements such as group interaction or specific cognitive behavioural exercises, and 25% associated the utilisation of those components with treatment success. Depressiveness and age did not predict the utilisation and the appraisal of computer and multimedia components.

    Discussion: Results provide preliminary support for the acceptability and feasibility of the investigated blended treatment in a group with non-specific depressive symptoms. However, small sample size and lack of diagnostics restrict generalizability. Additional research in clinical settings is needed.

  • 365. Shafran, Roz
    et al.
    Wade, Tracey D.
    Egan, Sarah J.
    Kothari, Radha
    Allcott-Watson, Hannah
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Rozental, Alexander
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, Gerhard
    Is the devil in the detail?: A randomised controlled trial of guided internet-based CBT for perfectionism2017Inngår i: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 95, s. 99-106Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    An internet guided self-help cognitive-behavioural treatment (ICBT) for perfectionism was recently found to be effective (see this issue). Such studies stand in need of replication. The aim of this study was to report the outcomes and predictors of change when the treatment is delivered in a UK setting. A total of 120 people (Mean = 28.9 years; 79% female) were randomised to receive ICBT or wait-list control over 12 weeks (trial registration: NCT02756871). While there were strong similarities between the current study and its Swedish counterpart, there were also important differences in procedural details. There was a significant impact of the intervention on the primary outcome measure (Frost Multidimensional Perfectionism Scale, Concern over Mistakes subscale) and also on the Clinical Perfectionism Questionnaire (between group effect sizes d = 0.98 (95% CI: 0.60–1.36) and d = 1.04 (95% CI: 0.66–1.43) respectively using intent-to-treat analyses). Unlike the Swedish study, there was significant non-engagement and non-completion of modules with 71% of participants completing fewer than half the modules. The number of modules completed moderated the rate of change in clinical perfectionism over time. In conclusion, the study indicates the intervention is effective in a UK setting but highlighted the importance of procedural details to optimise retention.

  • 366. Shahnavaz, S.
    et al.
    Hedman, E.
    Grindefjord, M.
    Reuterskiöld, Lena
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Dahllöf, G.
    Cognitive Behavioral Therapy for Children with Dental Anxiety: A Randomized Controlled Trial2016Inngår i: JDR Clinical & Translational Research, ISSN 2380-0844, Vol. 1, nr 3, s. 234-243Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Dental anxiety affects approximately 9% of children and is associated with poor oral health, pain, and psychosocial problems. The objective of this study was to investigate the efficacy of cognitive behavioral therapy (CBT) for children with dental anxiety in specialist pediatric dentistry. The study used a parallel-group superiority randomized controlled trial design. The primary outcome measure was the behavioral avoidance test; assessors were blind to treatment allocation. Participants were 8 boys and 22 girls 7 to 18 y old (mean ± SD, 10 ± 3.1). Children fulfilling the diagnostic criteria for dental anxiety were randomized to CBT (n = 13) or treatment as usual (n = 17), such as various sedation methods. Psychologists provided 10 h of CBT based on a treatment manual. Treatments were conducted in a naturalistic real-world clinical setting. Assessments were conducted before the treatment, 3 mo after the start of treatment, and at 1-y follow-up. The analyses of the primary outcome measure by repeated-measures analysis of variance and independent t test showed that children receiving CBT made superior, statistically significant improvements at follow-up (16.8 ± 2.4) compared with treatment as usual (11.4 ± 3.1, P < 0.01). A large between-group effect size (Cohen’s d = 1.9) was found. Following treatment, 73% of those in the CBT group managed all stages of the dental procedures included in the behavioral avoidance test compared with 13% in the treatment-as-usual group. Furthermore, 91% in the CBT group compared with 25% in the treatment-as-usual group no longer met the diagnostic criteria for dental anxiety at the 1-y follow-up according to the secondary outcome measure. Measures of dental anxiety and self-efficacy showed larger improvements in the CBT group compared with controls. We conclude that CBT is an efficacious treatment for children and adolescents with dental anxiety and should be made accessible in pediatric dentistry (ClinicalTrials.gov: NCT01798355).

  • 367. Shahnavaz, Shervin
    et al.
    Hedman-Lagerlöf, Erik
    Hasselblad, Tove
    Reuterskiöld, Lena
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Kaldo, Viktor
    Dahllöf, Göran
    Internet-Based Cognitive Behavioral Therapy for Children and Adolescents With Dental Anxiety: Open Trial2018Inngår i: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 20, nr 1, artikkel-id e12Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Cognitive behavioral therapy (CBT) is an evidence-based method for treating specific phobias, but access to treatment is difficult, especially for children and adolescents with dental anxiety. Psychologist-guided Internet-based CBT (ICBT) may be an effective way of increasing accessibility while maintaining treatment effects.

    Objective: The aim of this study was to test the hypothesis that psychologist-guided ICBT improves school-aged children’s and adolescents’ ability to manage dental anxiety by (1) decreasing avoidance and affecting the phobia diagnosis and (2) decreasing the dental fear and increasing the target groups’ self-efficacy. The study also aimed to examine the feasibility and acceptability of this novel treatment.

    Methods: This was an open, uncontrolled trial with assessments at baseline, posttreatment, and the 1-year follow-up. The study enrolled and treated 18 participants. The primary outcome was level of avoidance behaviors, as measured by the picture-guided behavioral avoidance test (PG-BAT). The secondary outcome was a diagnostic evaluation with the parents conducted by a psychologist. The specific phobia section of the structured interview Kiddie-Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime (K-SADS-PL) was used. Other outcome measures included level of dental anxiety and self-efficacy. The ICBT, which employed exposure therapy, comprised 12 modules of texts, animations, dentistry-related video clips, and an exercise package (including dental instruments). Participants accessed the treatment through an Internet-based treatment platform and received Web-based guidance from a psychologist. Treatment also included training at dental clinics. Feasibility and acceptability were assessed by measures of engagement, adherence, compliance, completed measures, patient and parent satisfaction scale, and staff acceptability.

    Results: The level of avoidance (according to the primary outcome measure PG-BAT) and dental anxiety decreased and self-efficacy increased significantly (P<.001), within-group effect sizes for both the primary outcome (Cohen d=1.5), and other outcomes were large in the range of 0.9 and 1.5. According to K-SADS-PL, 53% (8/15) of the participants were free from diagnosable dental anxiety at the 1-year follow-up. At the 1-year follow-up, improvements were maintained and clinically significant, with 60% (9/15) of participants who had been unable to manage intraoral injection of local anesthetics before ICBT reporting having accomplished this task at a dental clinic. The target group showed improvement in all the outcome measures. High levels of feasibility and acceptability were observed for the treatment.

    Conclusions: ICBT is a promising and feasible treatment for dental anxiety in children and adolescents. Integrating it into routine pediatric dental care would increase access to an effective psychological treatment. The results of this open trial must be replicated in controlled studies.

  • 368. Silfvernagel, Kristin
    et al.
    Westlinder, Anna
    Andersson, Stina
    Bergman, Kajsa
    Hernandez, Rosario Diaz
    Fallhagen, Line
    Lundqvist, Ida
    Masri, Nicole
    Viberg, Linda
    Forsberg, Marie-Louise
    Lind, Maria
    Berger, Thomas
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, Gerhard
    Individually tailored internet-based cognitive behaviour therapy for older adults with anxiety and depression: a randomised controlled trial2018Inngår i: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 47, nr 4, s. 286-300Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Mixed anxiety and depression is common among older adults. The aim of the study was to compare the effects of an eight-week-long tailored internet-supported cognitive behaviour therapy (ICBT) programme and to compare against the provision of weekly general support. A second aim was to investigate if pre-treatment cognitive flexibility and self-reported cognitive problems would predict outcome. We included 66 older adults (aged over 60 years) with mixed anxiety/depression following media recruitment and randomised them into treatment and control groups. We also included a one-year follow-up. As a measure of executive function, we used the Wisconsin Card Sorting Test (perseverative errors) and the Cognitive Failures Questionnaire during the pre-treatment phase. Results showed a moderate between-group effect on the main outcome measure, the Beck Anxiety Inventory (BAI) (d= .50), favouring the treatment group. Nearly half (45.5%) of that group were classified as responders. One person (3%) in the treatment group deteriorated. There were significant correlations between perseverative errors and outcome (on the BAI r = -.45), but not among self-reported cognitive function. We conclude that guided, tailored ICBT may be effective for some older adults and that the role of cognitive function needs to be investigated further.

  • 369.
    Skogsberg, Jonatan
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Motstånd och utveckling: Att via video få återkoppling på sitt psykoterapeutiska arbete2019Independent thesis Advanced level (professional degree), 10 poäng / 15 hpOppgave
    Abstract [sv]

    Det finns tekniska möjligheter att spela in psykoterapi, för forskning, utveckling och kvalitetssäkring, men tekniken är underanvänd. Den aktuella studien vill undersöka vad som påverkar terapeuters benägenhet att använda video och hur man kan förstå terapeuters motstånd mot video. Terapeuter intervjuades och deras svar analyserades via tematisk analys. Resultatet visar att följande faktorer påverkar terapeuters användning av video: teknik, juridik, patientens motstånd, struktur, syfte, motstånd, självkritik och utveckling. Att använda video i den terapeutiska situationen förstås som något som kan ge stora möjligheter till utveckling men till en stor känslomässig ansträngning. Videons påverkan på det psykoterapeutiska samtalet är komplex och motiverar fortsatt forskning.    

  • 370. Smith, Dean P.
    et al.
    Hayward, Diane W.
    Gale, Catherine M.
    Eikeseth, Svein
    Klintwall, Lars
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Treatment Gains from Early and Intensive Behavioral Intervention (EIBI) are Maintained 10 Years Later2019Inngår i: Behavior modification, ISSN 0145-4455, E-ISSN 1552-4167Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This study reports outcome in adolescents with autism who in their childhood received Early and Intensive Behavioral Intervention (EIBI). Nineteen children (16 boys) who had received two years of EIBI starting at a mean age of 2-years-and-11-months were followed up, on average, 12 years later. Results showed the participants significantly increased their cognitive and adaptive standard scores during the two years of EIBI, and that these gains were maintained at follow-up, 10 years after the EIBI had ended. Participants also showed a significant reduction in autism symptoms between intake and follow-up. At follow-up, none of the participants had received any additional psychiatric diagnoses, and none were taking any psychotropic medication. Results indicate that treatment gains achieved in EIBI are maintained into adolescence.

  • 371. Smoktunowicz, Ewelina
    et al.
    Lesnierowska, Magdalena
    Cieslak, Roman
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. University of Southern Denmark, Denmark.
    Andersson, Gerhard
    Efficacy of an Internet-based intervention for job stress and burnout among medical professionals: study protocol for a randomized controlled trial2019Inngår i: Trials, ISSN 1745-6215, E-ISSN 1745-6215, Vol. 20, artikkel-id 338Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Medical professionals are at high risk of job stress and burnout. Research shows that work-related stress can be reduced through enhancing psychological resources, in particular, self-efficacy and perceived social support. These psychological resources can operate either individually or sequentially: in line with the cultivation hypothesis, self-efficacy precedes and cultivates perceived social support, whereas according to the enabling hypothesis it is perceived social support that comes first and enables self-efficacy. Based on this theoretical framework we developed an internet-based intervention, Med-Stress, dedicated to healthcare providers and aimed at reducing job stress and burnout. Med-Stress contains two modules that enhance self-efficacy and perceived social support, which are tested in four variants reflected in four study conditions. We expect that sequential enhancement of resources: self-efficacy and social support or social support and self-efficacy will yield larger posttest results than individual enhancement.

    Methods: In this four-arm randomized controlled trial we will test four variants of the Med-Stress intervention. The trial is open for professionally active medical providers aged at least 18 years (N = 1200) with access to an Internet-connected device. We will compare the effects of two experimental conditions reflecting cultivation and enabling effects of self-efficacy and perceived social support (sequential enhancement of resources), and two active controls strengthening self-efficacy or perceived social support. Job stress and job burnout will be the primary outcomes, whereas depression, job-related traumatic stress, and work engagement will be secondary ones. Additionally, we will measure perceived social support, self-efficacy to manage job stress and burnout, and the ability to obtain social support, exposure to traumatic events, and users’ expectancy and credibility of the intervention. All assessments will be applied before the intervention, at posttest (at 3 or 6 weeks depending on the study condition), and at 6-month and 12-month follow up. In the case of experimental groups, additional measurements will be taken after enhancing each resource.

    Discussion: Resource-based interventions are relatively context-free and could potentially benefit medical professionals across the field. If Med-Stress is successful, its most effective variant could be implemented in the healthcare system as a standalone, supportive tool for employees.

  • 372. Smoktunowicz, Ewelina
    et al.
    Lesnierowska, Magdalena
    Cieslak, Roman
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, Gerhard
    Med-Stress: Internet Intervention Aimed at Reducing Job Stress and Job Burnout Among Medical Professionals2018Inngår i: Book of Proceedings 13th Conference of the European Academy of Occupational Health Psychology: Adapting to rapid changes in today’s workplace / [ed] K. Teoh, N. Saade, V. Dediu, J. Hassard, L. Torres, Nottingham: European Academy of Occupational Health Psychology , 2018, s. 427-427, artikkel-id P110Konferansepaper (Fagfellevurdert)
    Abstract [en]

    The goal of the study is to design and test the efficacy of the online intervention dedicated to medical professionals and aimed at reducing their work–related stress and job burnout (primary outcomes) as well as decreasing depression, secondary traumatic stress, and increasing their work engagement (secondary outcomes). The content of the intervention is focused on enhancing personal resources: self–efficacy and perceived social support, and is based on the theoretical framework of cultivation and enabling hypotheses. According to the cultivation hypothesis, people with higher self–efficacy are more likely to reach out and obtain social support when needed, whereas enabling hypothesis suggests the reverse relationship: using members of social network as models—in particular those that are similar and/or face similar situations—or benefiting from their verbal assurance can increase the sense of efficacy. This study will allow for an experimental verification of these hypotheses through testing the efficacy of evidence- based, CBT-framed internet intervention.

    This is a randomised controlled trial with two experimental conditions and two active comparators: 1) self-efficacy and perceived support sequential enhancement (cultivation hypothesis), 2) perceived support and self-efficacy sequential enhancement (enabling hypothesis), 3) self-efficacy enhancement (active comparator), and 4) perceived social support enhancement (active comparator). The exercises comprising the intervention are designed based on evidence-supported strategies to strengthen self-efficacy and perceived social support, and additionally, users are able to benefit from optional content: relaxation, mindfulness, cognitive restructuring, and lifestyle modules; all designed within the framework of cognitive- behavioral therapy. We expect self-efficacy and perceived social support to mediate the relationships between condition assignment and given outcomes, and for these relationships tobe moderated by participants’ expectations about the intervention. The efficacy of theintervention will be assessed at baseline (T1), post-intervention (T2), and six and twelve months after baseline (T3 and T4 respectively). We plan to recruit a total of N = 400 participants.

    Verifying the efficacy of Med-Stress intervention will allow for the experimental test of the cultivation vs enabling effects of self-efficacy and perceived social support on work-related stress and its consequences.

  • 373. Sommer, Daniel
    et al.
    Marklund, Arvid
    Zagorscak, Pavle
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Knaevelsrud, Christine
    Böttcher, Johanna
    Challenger accepted?! Ergebnisse der Pilotierung einer App für Menschen mit sozialen Ängsten2016Inngår i: 34. Symposium der Fachgruppe Klinische Psychologie und Psychotherapie der Deutschen Gesellschaft für Psychologie, Bielefeld 2016: Baustelle Psychotherapie / [ed] Frank Neuner, Angelika A. Schlarb, 2016, s. 201-202, artikkel-id E40Konferansepaper (Annet vitenskapelig)
    Abstract [de]

    Hintergrund: Die Behandlung der sozialen Angststörung (SAS) durch internetbasierte kognitive Verhaltenstherapie (iKVT) verfügt bereits über breite Evidenz. Angesichts zunehmender Fokussierung auf internetfähige mobile Endgeräte für psychologische Interventionen überrascht es daher, dass bislang keine wissenschaftlich evaluierte Smartphone-Anwendung (App) für SAS in App-Stores erhältlich ist. Wir präsentieren Ergebnisse einer ersten randomisiert-kontrollierten Evaluierung der deutschen Version von „Challenger“ – einer speziell für Menschen mit sozialen Ängsten konzipierten, frei zugänglichen App. Ergänzend zu KVT- und Achtsamkeitselementen, generiert Challenger auf User zugeschnittene „Challenges“ - Expositionsübungen, Gedanken- und Verhaltensexperimente sowie Psychoedukation. Interaktive (peer-support) und innovative (Echtzeitanpassung an User-Umwelt mittels GPS) Elemente werden durch ein auf „Gamification“-Prinzipien beruhendes Konzept miteinander verknüpft. Methode: 77 sozial ängstliche Studierende wurden zwei Gruppen (6-wöchiger Zugang zur App oder Warteliste) randomisiert zugeteilt. Daten zu Nutzungsverhalten sowie Benutzerfreundlichkeit wurden erhoben. Soziale Ängstlichkeit wurde mit dem Social Phobia Inventory gemessen, sekundäre Maße umfassten allgemeine Ängstlichkeit, depressive und globale Symptombelastung. Ergebnisse: Die Auswertung der Nutzungsdaten ergab eine klare Präferenz für nicht-konfrontative Challenges, die ohne Beteiligung Dritter absolviert werden konnten. Zufriedenheits- und Benutzerfreundlichkeitsratings der App fielen gemischt aus. Analysen der Completer-Stichprobe zeigten eine signifikante Reduktion sozialer Ängste (Effektstärke PRÄ-POST innerhalb der Interventionsgruppe: d = - 0.94; zwischen Gruppen: d = 0.61), jedoch nicht-signifikante Verbesserungen auf sekundären Ergebnismaßen. Analysen nach Multipler Imputation fehlender Werte ergaben keine signifikanten Unterschiede. Diskussion: Zukünftige Herausforderungen in der Weiterentwicklung der App bestehen in einer Erhöhung der Nutzungsintensität wirksamer Elemente. Aufgrund des hohen Dropouts und Besonderheiten von Studiendesign und Stichprobe, erscheinen endgültige Schlüsse hinsichtlich der Wirksamkeit von Challenger verfrüht.

  • 374. Strandhäll, Annika
    et al.
    Wieselgren, Ing-Marie
    Westerholm, Barbro
    Rück, Christian
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, Gerhard
    Vård av psykisk ohälsa i Sverige: aktuell situation och framtida utmaningar2016Inngår i: EABCT 2016 Abstract Book: Total Awareness, 2016, s. 98-98Konferansepaper (Fagfellevurdert)
    Abstract [sv]

    Psykisk ohälsa utgör ett växande samhällsproblem som kommer att kräva bättre samordning och nya sätt att möta behovet av effektiva behandlingsmetoder. Kognitiv beteendeterapi rekommenderas idag vid ett flertal psykiatriska diagnoser, men bristande tillgänglighet och problem med implementering innebär att inte alla får tillgång till rätt hjälp. Hur kan hälso- och sjukvården tillgodose en ökad efterfrågan på bästa möjliga vård? Bör en bredd av behandlingsmetoder erbjudas istället för de mest starkast forskningsstöd? Vilken roll kan kognitiv beteendeterapi spela, och vilka risker finns det med dagens oreglerade marknad vad gäller behandlare och utbildningsaktörer inom området psykologisk behandling? I paneldebatten diskuterar några av landets främsta forskare, politiker och myndighetsutövare dagens situation och kommande utmaningar.

  • 375. Ström, Lars
    et al.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Handbok för oglada: vetenskapligt förankrade metoder för ökad glädje och livskvalitet2016 (oppl. 2 uppl.)Bok (Annet vitenskapelig)
    Abstract [sv]

    Är du deprimerad, nedstämd eller bara oglad i största allmänhet? Då är du långt ifrån ensam! Idag räknar man med att uppemot 25 procent av kvinnorna och 10 procent av männen någon gång kommer att vara kliniskt deprimerade. Till det kommer ett mycket stort antal människor som “bara” är nedstämda eller oglada! Även om det är skrämmande siffror kan man samtidigt konstatera att det inte behöver vara på det viset! Idag finns nämligen en många verktyg som effektivt påverkar ens mående på ett postivt sätt. I denna bok får du tillgång till en lång rad av dessa metoder och strategier. De flesta har sin utgångspunkt i kognitiv beteendeterapi (KBT), och alla är sådana som i forskning har visat sig ge en tydlig effekt för att minska nedstämdhet och depression – och skapa ökad livsglädje! Boken är förhoppningsvis även användbar för dig som arbetar med vård av människor, och den innehåller både förklaringsmodeller och arbetsformulär som kan användas i den egna verksamheten. Alla bokens formulär kan också laddas ner från www.kbtakademin.se och användas fritt.

  • 376.
    Stålnacke, Johanna
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Lundequist, Aiko
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Personlighets-, social- och utvecklingspsykologi.
    Böhm, Birgitta
    Forssberg, Hans
    Smedler, Ann-Charlotte
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    A longitudinal model of executive function development from birth through adolescence in children born very or extremely preterm2019Inngår i: Child Neuropsychology, ISSN 0929-7049, E-ISSN 1744-4136, Vol. 25, nr 3, s. 318-335Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Executive function deficits are often reported as a specific weakness in preterm children. Yet, executive function development is still not fully understood. In a prospective longitudinal study, 115 preterm born children, <= 31 weeks of gestation, were recruited at birth and subject to neuropsychological assessments at ages 5.5 and 18 years. By applying Miyake and colleagues' integrative framework of executive function to our data, two core components of executive function, working memory and cognitive flexibility, were identified through confirmatory factor analysis. Developmental stability was investigated in a serial multiple mediator structural equation model. Biological, medical, and social factors as well as mental development at 10 months were entered as predictors. Both components of executive function were highly stable from 5.5 to 18 years. Gestational age, intrauterine growth, lack of perinatal medical complications, and female sex were positively related to mental development at 10 months, which together with parental education influenced both core executive functions at 5.5 years. Working memory at 5.5 years mediated outcome in working memory at 18 years. In addition to the mediation of cognitive flexibility at 5.5 years, perinatal medical complications and restricted intrauterine growth had a continued direct negative impact on cognitive flexibility at 18 years. The application of a theoretical framework added to our understanding of executive function development in preterm born children. The study supports early identification of executive deficits among children born preterm, as deficits are unlikely to diminish with maturation.

  • 377.
    Sundqvist, Kristina
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Beyond Recreational Gambling: a Psychological Perspective on Risk- and Problem Gambling2016Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    The general aim of this thesis was to examine risk gambling in the general population from a psychological perspective. This was done in three studies targeting personality, risky alcohol habits and gambling motives, respectively. Initially, 19 530 randomly assigned Swedish citizens were screened for problem gambling via telephone using the two questions in the Lie/Bet questionnaire. This sample constitutes the basis for one of the studies in the thesis. For the other studies, individuals answering yes to one of the questions in the Lie/Bet questionnaire and agreeing to participate further were sent a postal questionnaire. The questionnaire included questions about gambling, personality and gambling motives.

     

    Some of the main results showed that:

    • Negative consequences of gambling were associated with higher levels of impulsivity and negative affectivity.
    • Risk gamblers reported lower levels of negative affectivity compared to the general population.
    • Compared to non-risk gamblers, twice as many of the risk gamblers reported weekly binge drinking during the past 12 months. This association, however, seemed to be explained by shared demographic characteristics, rather than by the risk gambling causing binge drinking.
    • High risk gamblers more often reported that they gambled for the challenge and for coping reasons, compared to low risk gamblers.
    • High risk gamblers had overall stronger motives for gambling.
    • The results also indicated that the level of risk gambling was highly intertwined with gambling motives and could explain some differences in gambling motives between, for example, women/men and younger/older gamblers.

    One of the focal points in the discussion was that higher levels of negative affectivity may be a cause of elevated problems rather than a cause of risk gambling. Another issue discussed was that the level of risk- /problem gambling may be important to consider when comparing gambling motives across subgroups of gamblers.

  • 378.
    Sundqvist, Kristina
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för socialvetenskaplig alkohol- och drogforskning (SoRAD).
    Jonsson, Jakob
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Wennberg, Peter
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för socialvetenskaplig alkohol- och drogforskning (SoRAD).
    Gambling Motives in a Representative Swedish Sample of Risk Gamblers2016Inngår i: Journal of Gambling Studies, ISSN 1050-5350, E-ISSN 1573-3602, Vol. 32, nr 4, s. 1231-1241Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Motives for gambling have been shown to be associated with gambling involvement, and hence important in the understanding of the etiology of problem gambling. The aim of this study was to describe differences in gambling motives in different subgroups of lifetime risk gamblers, categorized by: age, gender, alcohol- and drug habits and type of game preferred, when considering the level of risk gambling. A random Swedish sample (n = 19,530) was screened for risk gambling, using the Lie/Bet questionnaire. The study sample (n = 257) consisted of the respondents screening positive on Lie/Bet and completing a postal questionnaire about gambling and motives for gambling (measured with the NODS-PERC and the RGQ respectively). When considering the level of risk gambling, motives for gambling were not associated with gender, whereas younger persons gambled for the challenge more often than did older participants. Card/Casino and Sport gamblers played to a greater extent for social and challenge reasons then did Lotto/Bingo-gamblers. EGM-gamblers played more for coping reasons than did Lotto/Bingo gamblers. However, this association turned non-significant when considering the level of risk gambling. Moderate risk gamblers played for the challenge and coping reasons to a greater extent than low risk gamblers motives for gambling differ across subgroups of preferred game and between gamblers with low and moderate risk. The level of risk gambling is intertwined with motives for gambling and should be considered when examining gambling reasons.

  • 379. Svartdal, Frode
    et al.
    Pfuhl, Gerit
    Nordby, Kent
    Foschi, Gioel
    Klingsieck, Katrin B.
    Rozental, Alexander
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Lindblom-Ylänne, Sari
    Rebkowska, Kaja
    On the measurement of procrastination: Comparing two scales in six European countries2016Inngår i: Frontiers in Psychology, ISSN 1664-1078, E-ISSN 1664-1078, Vol. 7, artikkel-id 1307Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Procrastination is a common problem, but defining and measuring it has been subject to some debate. This paper summarizes results from students and employees (N = 2893) in Finland, Germany, Italy, Norway, Poland, and Sweden using the Pure Procrastination Scale (PPS) and the Irrational Procrastination Scale (IPS; Steel, 7010), both assumed to measure unidimensional and closely related constructs. Confirmatory factor analyses indicated inadequate configural fit for the suggested one-factor model for PPS; however, acceptable fit was observed for a three-factor model corresponding to the three different scales the PPS is based on. Testing measurement invariance over countries and students employees revealed configural but not strong or strict invariance, indicating that both instruments are somewhat sensitive to cultural differences. We conclude that the PPS and IPS are valid measures of procrastination, and that the PPS may be particularly useful in assessing cultural differences in unnecessary delay.

  • 380. Tukel, S.
    et al.
    Eliasson, A. C.
    Bohm, B.
    Smedler, Ann-Charlotte
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Simple Categorization of Human Figure Drawings at 5 Years of Age as an Indicator of Developmental Delay2019Inngår i: Developmental Neurorehabilitation, ISSN 1751-8423, E-ISSN 1751-8431, Vol. 22, nr 7, s. 479-486Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: To elucidate the association between developmental stage of human figure drawing(HFD) and fine motor control, visual perception, and further investigate its potential to be used for screening developmental delay. Methods: Participants were 301 children at 51/2 years of age, 176 born preterm and 125 at term, whose HFDs were categorized into six developmental stages. Motor-Free-Visual-Perception Test, Movement-ABC, Performance Intelligence Quotient (PIQ: Wechsler Scale), and the Visual-Motor Integration test were used. Fine motor functions were explored using ImageJ. Results: Age-expected HFDs were drawn by 87% of the children, while 13%, mostly preterm boys, drew immature ones. Stages of HFD were related to both PIQ and Movement-ABC. Visuomotor control and visual perception significantly explained the HFD. The sensitivity and specificity of HFD as a screening tool was moderate to good. Conclusions: HFD is influenced by visual perception and visuomotor control and can be used for screening developmental delay at preschool age.

  • 381.
    Tyrberg, Mårten
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Bringing psychological treatment to the psychiatric ward: Affecting patients, staff, and the milieu2019Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    The psychiatric ward is a complex setting. This has to do partly with the severity of the patients’ suffering. Often, they present with such diagnoses as psychosis, self-harm, substance abuse, and suicidality. In fact, they often present with a combination of these. This renders the delivery of effective treatment a challenging task. Partly, the complexity of the ward has to do with aspects of the context itself. Admissions and discharges often happen fast and unexpectedly, staff members are expected to handle various challenging behaviors, they display quite high levels of burnout and work dissatisfaction, and the wards are often staffed by bank staff, leading to a lack of continuity of care. This adds to the challenge of delivering effective treatment. In the typical Swedish ward, treatment consists of medication, nursing, observation, and management of risk behaviors. Psychological treatment is seldom a routine part of inpatient care. However, there are sound arguments for adding psychological treatment in the form of cognitive behavior therapy (CBT) of various modalities. Further, there is promise in psychosocial interventions delivered by the nursing staff after appropriate training, and in providing supervision to the staff.

    The aim of the present thesis was to investigate the feasibility and potential efficacy of acceptance and commitment therapy (ACT), a CBT based psychotherapy model, as a broadly applied intervention in the context of psychiatric inpatient care. In three studies, ACT was evaluated as a brief individual psychotherapy intervention, and as a psychologically informed approach to dealing with patients performed by the nursing staff group in a psychiatric ward for psychosis patients.

    In study I, an average of two sessions of ACT was delivered to patients (n = 11) with a diagnosis of psychosis. Compared to a control group (n = 10), the risk for rehospitalization during a four-month follow-up period was significantly smaller for patients in the experimental group. There was also a trend toward increased values-based living scores in the experimental group, compared to controls.

    Study II evaluated the effects on staff members (n = 20) and patients (n = 9) of a brief ACT training intervention tailored to the staff group, the aim of which was to introduce ACT as a day-to-day approach to dealing with patients. After a total of 12 hours of ACT training, the staff group displayed a slight increase in work-related psychological flexibility, compared to before, while a non-randomized control group (n = 18) displayed a slight decrease. Patients being treated on the ward after the staff training displayed a slight increase in psychological flexibility during ward treatment, while patients being treated before displayed a slight decrease. In both cases, however, the differences were considered quite small (non-significant in statistical terms). Further, the study investigated ACT-consistent behavior changes among staff members following ACT training, using a multiple baseline single-subject design. Results revealed both expected and unexpected patterns of behavior.

    In study III, the usefulness of the ACT model was investigated using a qualitative content analysis. Staff members (n = 10) experienced ACT as useful in terms of dealing with patients’ struggles, enriching typical duties, and dealing with their own stress. Difficulties in using the model related to time restraints, complexities of the model itself, and the severity of patients’ illnesses.

    In summary, the present thesis adds to the research basis for ACT as a treatment for psychosis, delivered in an inpatient setting. It shows that the introduction of ACT as an add-on to traditional ward treatment in Sweden is for the most part feasible and acceptable. However, the thesis also discusses various challenges in the implementation of psychological treatment in such a complex context as the inpatient ward, both in terms of delivery of the treatment itself and the evaluation of its effectiveness.

  • 382.
    Tyrberg, Mårten
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Hospital of Västmanland, Sweden.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Lundgren, Tobias
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden.
    Affecting the psychiatric ward milieu using a combination of individual treatment and staff behavior change2018Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    Changing the context surrounding patients treated in psychiatric wards is a great challenge, with barriers in terms of the organization, work culture and clinical skill. We propose a model to influence the ward context by adding psychological treatment in both individual form and by teaching inpatient staff how to use a simplified ACT model to inform their daily interactions with patients. We further discuss difficulties in the implementation of psychological treatment in inpatient milieus. Results from three empirical studies in a naturalistic setting in Sweden form the basis of a model describing how access to evidence-based psychological treatment might be increased using limited extra resources. Data suggest that 1) an average of two individual ACT sessions might lessen the need for future inpatient care for psychosis patients, 2) inpatients as well as staff members themselves might benefit from staff learning and using a simplified ACT model, and 3) staff find the ACT model useful both in terms of helping patients handle psychiatric symptoms and in terms of handling their own work-related stress.

  • 383.
    Tyrberg, Mårten
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Västmanlands Hospital, Sweden.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Lundgren, Tobias
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden.
    Implementation of ACT training in a psychiatric ward: Clinical experiences and staff-patient outcomes2016Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Conducting research in clinical psychiatric settings presents significant challenges. Patients’ suffering is often severe, and organizational aspects might hinder the implementation of structured psychological treatment. In this symposium, empirical data are presented from three different projects concerning ACT for different diagnoses –psychosis, body dysmorphic disorder (BDD) and high functioning autism spectrum disorder (ASD). The first talk concerns training inpatient ward staff in using the ACT model with psychosis patients. Data suggest slight positive changes in psychological flexibility for patients and staff. The second talk describes the evaluation of an ACT group treatment intervention for BDD outpatients, with results showing significant reductions in BDD symptomatology. The third talk covers a researchproject on ACT adapted for students and psychiatric outpatients with ASD, where data indicate reduced levels of stress and autistic core symptoms. Presenters will share their data, as well as common clinical experiences of implementing ACT in clinical psychiatric contexts.

  • 384.
    Tyrberg, Mårten
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Hospital of Västmanland Västerås, Sweden.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Lundgren, Tobias
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden; Stockholm County Council, Sweden.
    Usefulness of the ACT model for nurses in psychiatric inpatient care: A qualitative content analysis2017Inngår i: Journal of Contextual Behavioral Science, ISSN 2212-1447, Vol. 6, nr 2, s. 208-214Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Alleviating the suffering of patients treated in psychiatric inpatient wards is a great challenge. Preliminary or multiple diagnoses, inherent complexities of the inpatient milieu and the lack of potentially effective psychological treatment form part of this challenge. The present study explored the usefulness of a transdiagnostic psychological treatment model (Acceptance & Commitment Therapy, ACT) as a means of improving inpatient care from the perspective of psychiatric nurses. Nurses (n = 10) participated in three ACT workshops, a total of 21 h, and were interviewed about the experienced usefulness and difficulties of the ACT model, as a tool for improving everyday ward work. Results, revealed by qualitative content analysis, suggest usefulness in the areas of alleviating patients symptoms, enriching typical ward duties, and handling one's own thoughts and feelings. Difficulties stemmed from lack of time, the model itself and patients' severe illness. Possible adjustments of the ward context are suggested.

  • 385.
    Tyrberg, Mårten J.
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Västmanland County Hospital, Sweden.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Lundgren, Tobias
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden.
    Brief acceptance and commitment therapy for psychotic inpatients: A randomized controlled feasibility trial in Sweden2017Inngår i: Nordic Psychology, ISSN 1901-2276, E-ISSN 1904-0016, Vol. 69, nr 2, s. 110-125Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Psychiatric inpatient care in Sweden is often described as lacking in content other than medication and mere containment. In an attempt to increase structured psychological content in the ward context, this study aims to investigate whether a brief form of acceptance and commitment therapy (ACT) is a feasible addition to standard care for psychotic inpatients. ACT has previously been administered to psychotic inpatients in the US, and the present study was an attempt at implementing this intervention in Sweden. In this feasibility study, 22 psychotic inpatients were randomized to one of two conditions: treatment as usual (TAU) or TAU plus an average of two ACT sessions. Measures of rehospitalization and values-based living were obtained before treatment, after treatment, and at four-month follow-up. Results indicate that participants in the TAU plus ACT group were rehospitalized at a lower rate than those who only received TAU (9% vs. 40%), though the difference was not statistically significant. Controlling for age, gender, and pretreatment values-based living scores, there was a significantly higher risk for TAU participants to be rehospitalized. There was a trend toward increased values-based living scores in the ACT group. These results suggest that it is feasible to add structured psychotherapeutic interventions to the existing care package at psychiatric inpatient wards in Sweden. However, the findings need to be explored in larger samples.

  • 386.
    Tyrberg, Mårten J.
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Uppsala University, Sweden .
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Lundgren, Tobias
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden .
    Implementation of acceptance and commitment therapy training in a psychiatric ward: feasibility, lessons learned and potential effectiveness2017Inngår i: Journal of Psychiatric Intensive Care, ISSN 1742-6464, E-ISSN 1744-2206, Vol. 13, nr 2, s. 73-82Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Psychiatric inpatient wards are inherently complex milieus. Staff in wards are expected to alleviate severe suffering in patients whilst handling an increasing administrative burden, resulting in less direct contact with patients. Reports from both patients and staff indicate institutional aimlessness and lack of care content beyond medication and containment. As a possible means of improving this situation, this pilot study investigated the feasibility, potential effectiveness and challenges of the implementation of a 12-hour training programme in acceptance and commitment therapy (ACT), a CBT-based psychotherapy model, on staff (n = 20) and patients (n = 9). The context was a psychiatric inpatient ward for psychosis patients. The staff members of a neighbouring unit acted as non-randomised controls. Feasibility of implementation, data collection and acceptance among staff of the intervention seemed acceptable, while data collection among patients was more challenging. Mean change scores suggest marginal positive changes in psychological flexibility for patients and staff post-intervention. Results are discussed in light of methodological and institutional limitations, and clinical experiences.

  • 387.
    Tyrberg, Mårten
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Lundgren, Tobias
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Fydrich, Thomas
    ACT for Psychotic Inpatients, Broad Implementation in a Swedish Context2015Konferansepaper (Fagfellevurdert)
    Abstract [en]

    In recent years, the research base supporting ACT for psychosis has grown (e.g. Bach & Hayes, 2002; Gaudiano & Herbert, 2006; White et al., 2011; Bach, Hayes & Gallop, 2012; Shawyer et al., 2012). In this symposium, pilot results from a small study on a clinical sample in Sweden will be presented. A total of 21 psychotic inpatients were randomized to either treatment as usual (TAU) or TAU plus a short ACT intervention, on average 2 sessions. Groups were measured for rehospitalization and values-based living at pretreatment, posttreatment and four month follow-up. Results indicate that the ACT group was rehospitalized to a lesser extent than the TAU group, although the difference was not significant. Also, the ACT group scored higher on the Bull’s-Eye Values Survey at follow-up, the difference being marginally significant. All in all, the results expand somewhat upon previous findings in the same population (Bach & Hayes, 2002; Gaudiano & Herbert, 2006), by indicating that ACT might affect values-based living in addition to decreasing need for rehospitalization. The next step in this research project in Sweden will be implementing ACT in the ward context in a broader way. This will be done in two ways: 1) By training all ward staff in the method. The effects of this training, and of regular supervision, will be investigated by administering measures of work related acceptance to staff. 2) By investigating ACT as an individual treatment in a larger sample, where therapists will be ward staff using a manual that was custom-made for this particular project.

  • 388. Uckelstam, Carl-Johan
    et al.
    Philips, Björn
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Holmqvist, Rolf
    Falkenström, Fredrik
    Prediction of Treatment Outcome in Psychotherapy by Patient Initial Symptom Distress Profiles2019Inngår i: Journal of counseling psychology, ISSN 0022-0167, E-ISSN 1939-2168, Vol. 66, nr 6, s. 736-746Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Understanding how different groups of patients change at different rates is important for treatment selection, planning and evaluation. This study aimed to assess whether an approach to classifying patients on the basis of initial symptom distress profiles (ISDPs) derived from a self-rated questionnaire measuring psychological distress may be useful in predicting treatment response. The Clinical Outcome in Routine Evaluation-Outcome Measure were collected from 1,095 first line mental health service patients (M [SD] age = 37.3 [14.3] years; 74% female) prior to every session. Latent profile analysis was performed on the questionnaires from the first session to classify participants into subtypes, which were then used to predict change rates. The best-fitting model identified 4 ISDP subtypes with significantly different treatment responses. Profile 1 predicted very slow change rate and indicated low initial distress coupled with low deviations among problem areas. Profile 2 predicted slow change rate with average initial distress and low emphasis on questions relating to risk of harming oneself and/or others. Profile 3 predicted fast improvement rate and showed high initial distress combined with low emphasis on the risk area. Profile 4 predicted moderate change rate and displayed very high initial distress accompanied with more emphasis on the risk area. Findings support the potential utility of ISDP subtypes to predict treatment response, suggesting that intake data that is easily collected by the clinician contain reliable information about treatment prognosis. The study is exploratory and needs to be replicated before stable conclusions can be drawn.

  • 389. Vernmark, K.
    et al.
    Hesser, H.
    Topoco, T.
    Berger, T.
    Riper, H.
    Luuk, L.
    Backlund, L.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, Gerhard
    Working alliance predicts outcome in blended treatment (bCBT) for depression2017Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Introduction: Blended cognitive behavior therapy (bCBT) is a treatment format that mixes internet-based modules with face-to-face sessions. It has the potential of making internet-based interventions more easily accessible and saving therapist time when delivering treatment for depression. The role of working alliance in this treatment format has not yet been thoroughly investigated. There is therefore a need to explore patient- and therapist rated alliance and the ability to predict change in depression during treatment using measurements of working alliance.

    Methods: We used ratings of depression and alliance from 73 participants in a study on bCBT for depression (part of the E-COMPARED project). Data were analyzed using growth curve models.

    Results: Both patient- and therapist rated alliance was high. The main finding was that therapist-rated alliance predicted change in depression scores during treatment.

    Discussion: Working alliance can be established in bCBT, which is in line with previous research on face-to-face and internet-based treatment for depression. An interesting find was that therapist-rated alliance was of greater importance than patient-rated alliance when predicting change in depression during treatment. These results point towards therapist ratings of alliance being essential when delivering bCBT and conducting research on this method in the future.

  • 390. Vernmark, Kristofer
    et al.
    Hesser, Hugo
    Topooco, Naira
    Berger, Thomas
    Riper, Heleen
    Luuk, Liisa
    Backlund, Lisa
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, Gerhard
    The role of therapeutic alliance in blended treatment for depression2017Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Introduction: Blended Cognitive Behaviour Therapy (bCBT) uses a combination of face-to-face sessions and online material, such as self-help modules, and can be used in the treatment of depression. The blended format has the potential of integrating internet-based components into treatment without completely removing the traditional face-to-face setting. This way of delivery can lower the threshold when it comes to using digital components in CBT. The role of therapeutic alliance in this format is yet to be explored, specifically the role of therapist rated alliance, as most studies only include patient rated measurements of alliance. Methods: Working alliance and depression ratings from 73 participants in a study on bCBT for depression (part of the E-COMPARED project) was analysed using growth curve models. Results: High ratings for both patient-and therapist rated working alliance were found. Therapist rated alliance predicted a positive change (decreased PHQ-9 scores) in depression during treatment. Discussion: Ratings of therapeutic alliance was similar to what have been seen in face-to-face and internet-based treatment. Patient rated alliance could not predict change rate in depression, which is a common finding in ICBT-studies. However, therapist rated alliance had a significant correlation with change rate and predicted a decrease in depression during treatment. These results sheds more light on the concept and role of therapeutic alliance in internet-based and blended treatments.

  • 391. Vernmark, Kristofer
    et al.
    Hesser, Hugo
    Topooco, Naira
    Berger, Thomas
    Riper, Heleen
    Luuk, Liisa
    Backlund, Lisa
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. University of Southern Denmark, Denmark.
    Andersson, Gerhard
    Working alliance as a predictor of change in depression during blended cognitive behaviour therapy2019Inngår i: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 48, nr 4, s. 285-299Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Blended Cognitive Behaviour Therapy (bCBT) is a new form of treatment, mixing internet-based modules and face-to-face therapist sessions. How participants rate the therapeutic alliance in bCBT has not yet been thoroughly explored, and neither is it clear whether therapist- and patient-rated alliances are predictors of change in depression during treatment. Depression and alliance ratings from 73 participants in a treatment study on bCBT (part of the E-COMPARED project) were analysed using growth curve models. Alliance, as rated by both patients and therapists, was high. The therapist-rated working alliance was predictive of subsequent changes in depression scores during treatment, whereas the patient-rated alliance was not. A therapeutic alliance can be established in bCBT. The role of the therapist-rated alliance seems to be of particular importance and should be carefully considered when collecting data in future studies on bCBT.

  • 392. Vigerland, Sarah
    et al.
    Ljótsson, Brjánn
    Thulin, Ulrika
    Öst, Lars-Göran
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. Karolinska Institutet, Sweden.
    Andersson, Gerhard
    Serlachius, Eva
    Internet-delivered cognitive behavioural therapy for children with anxiety disorders: A randomised controlled trial2016Inngår i: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 76, s. 47-56Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Cognitive behaviour therapy (CBT) has been shown to be an effective treatment for anxiety disorders in children, but few affected seek or receive treatment. Internet-delivered CBT (ICBT) could be a way to increase the availability of empirically supported treatments.

    Aims: A randomised controlled trial was conducted to evaluate ICBT for children with anxiety disorders.

    Method: Families (N = 93) with a child aged 8–12 years with a principal diagnosis of generalised anxiety disorder, panic disorder, separation anxiety, social phobia or specific phobiawere recruited through media advertisement. Participants were randomised to 10 weeks of ICBT with therapist support, or to a waitlist control condition. The primary outcome measure was the Clinician Severity Rating (CSR) and secondary measures included child- and parent-reported anxiety. Assessments were made at pre-treatment, post-treatment and at three-month follow-up.

    Results: At post-treatment, there were significant reductions on CSR in the treatment group, with a large between-group effect size (Cohen's d = 1.66). Twenty per cent of children in the treatment group no longer met criteria for their principal diagnosis at post-treatment and at follow-up this number had increased to 50%. Parent-reported child anxiety was significantly lower in the treatment group than in the waitlist group at post-treatment, with a small between-group effect size (Cohen's d = 0.45). There were no significant differences between the groups regarding child-ratings of anxiety at post-treatment. Improvements were maintained at three-month follow-up, although this should be interpreted cautiously due to missing data.

    Conclusions: Within the limitations of this study, results suggest that ICBT with therapist support for children with anxiety disorders can reduce clinician- and parent-rated anxiety symptoms.

    Trial registration: Clinicaltrials.gov: NCT01533402.

  • 393. Vlaescu, G.
    et al.
    Alasjö, A.
    Miloff, Alexander
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, Gerhard
    Features and functionality of the Iterapi platform for internet-based psychological treatment2017Konferansepaper (Fagfellevurdert)
    Abstract [en]

    The purpose of this article is to describe an internet-based platform for improving symptoms and quality of life for people with psychological and behavioural health problems such as depression, anxiety, phobia, psychological trauma, hearing loss and tinnitus. The online platform, called Iterapi, was developed at the Department of Behavioural Sciences and Learning at Linköping University, Sweden and has been running for nearly two decades and used in many randomized controlled trials and outpatient treatments.

    The intention of this article is to share our experience with developing such a treatment solution and the process flow and elements of running internet-based psychological interventions. This will likely be of use to developers building similar services, therapists considering integrating such approaches in their practices and institutions, as well as researchers curious about the functions included on the platform and methodology used for running studies.

    We describe the security aspects of the platform, central concepts underlying its development, how the platform can be used in a study or treatment and the main features and functions the platform offers. We comment on practical considerations regarding blending of methods within the platform, such as self-help treatments with asynchronous communication and real-time text chat and video conversations. We also point out the advantages of using Internet-assisted treatments, the challenges that we have faced and future planned upgrades.

  • 394. Vlaescu, George
    et al.
    Alasjö, Alexander
    Miloff, Alexander
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, Gerhard
    Features and functionality of the Iterapi platform for internet-based psychological treatment2016Inngår i: Internet Interventions, ISSN 2214-7829, Vol. 6, s. 107-114Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The purpose of this article is to describe an internet-based platform for improving symptoms and quality of life for people with psychological and behavioural health problems such as depression, anxiety, phobia, psychological trauma, hearing loss and tinnitus. The online platform, called Iterapi, was developed at the Department of Behavioural Sciences and Learning at Linköping University, Sweden and has been running for nearly two decades and used in many randomized controlled trials and outpatient treatments.

    The intention of this article is to share our experience with developing such a treatment solution and the process flow and elements of running internet-based psychological interventions. This will likely be of use to developers building similar services, therapists considering integrating such approaches in their practices and institutions, as well as researchers curious about the functions included on the platform and methodology used for running studies.

    We describe the security aspects of the platform, central concepts underlying its development, how the platform can be used in a study or treatment and the main features and functions the platform offers. We comment on practical considerations regarding blending of methods within the platform, such as self-help treatments with asynchronous communication and real-time text chat and video conversations. We also point out the advantages of using Internet-assisted treatments, the challenges that we have faced and future planned upgrades.

    Due to continuous development of the platform, its user-friendliness, accessibility across devices and numerous features, many research colleagues from Sweden as well as other countries such as Germany, United Kingdom, Romania and Israel have chosen to implement their own studies on the platform.

  • 395. Vlaescu, George
    et al.
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, Gerhard
    Security in services for internet treatment and changes coming with GDPR2018Inngår i: Abstracts book, 2018, s. 75-76, artikkel-id ID:16Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    The goal of the presentation is to have a quick walkthrough for security requirements when developing and running a solution for internet treatment, that could be of help to both developers and administrators of such services and secondarily, to summarize the most important changes that will arise with the General Data Protection Regulation (GDPR) from the European Parliament, the Council of the European Union and the European Commission that comes into effect from 25 May 2018. Methods: We will first list the general features related to security in an internet treatment platform, from both the physical and software aspect, with details for some of them and examples on how to implement these features. In the second part of the presentation we will tackle the changes that are coming with the enforcement of GDPR, including responsibility, sanctions, patient rights etc. and what is needed to adapt our current solutions to the new regulations. Conclusions: Security is an important aspect of all services for internet treatment, that usually requires a lot of allocated resources, both of technical and decisional nature and the involved actors must keep themselves updated with the latest requirements and laws. The introduction of GDPR brings some updates that find some of the internet actors well prepared and only needing little accommodation to the new regulations, whilst other actors will need to invest comprehensive resources to comply with the new requirements.

  • 396. Vollmer, Brigitte
    et al.
    Lundequist, Aiko
    Mårtensson, Gustaf
    Nagy, Zoltan
    Lagercrantz, Hugo
    Smedler, Ann-Charlotte
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Forssberg, Hans
    Correlation between white matter microstructure and executive functions suggests early developmental influence on long fibre tracts in preterm born adolescents2017Inngår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, nr 6, artikkel-id e0178893Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Main objectives: Executive functions are frequently a weakness in children born preterm. We examined associations of executive functions and general cognitive abilities with brain structure in preterm born adolescents who were born with appropriate weight for gestational age and who have no radiological signs of preterm brain injury on neuroimaging.

    Methods: The Stockholm Neonatal Project (SNP) is a longitudinal, population-based study of children born preterm (<36 weeks of gestation) with very low birth weight (<1501g) between 1988–1993. At age 18 years (mean 18 years, SD 2 weeks) 134 preterm born and 94 full term participants underwent psychological assessment (general intelligence, executive function measures). Of these, 71 preterm and 63 full term participants underwent Magnetic Resonance Imaging (MRI) at mean 15.2 years (range 12–18 years), including 3D T1-weighted images for volumetric analyses and Diffusion Tensor Imaging (DTI) for assessment of white matter microstructure. Group comparisons of regional grey and white matter volumes and fractional anisotropy (FA, as a measure of white matter microstructure) and, within each group, correlation analyses of cognitive measures with MRI metrics were carried out.

    Results: Significant differences in grey and white matter regional volumes and widespread differences in FA were seen between the two groups. No significant correlations were found between cognitive measures and brain volumes in any group after correction for multiple comparisons. However, there were significant correlations between FA in projection fibres and long association fibres, linking frontal, temporal, parietal, and occipital lobes, and measures of executive function and general cognitive abilities in the preterm born adolescents, but not in the term born adolescents.

    Overall significance of the study: In persons born preterm, in the absence of perinatal brain injury on visual inspection of MRI, widespread alterations in regional brain tissue volumes and microstructure are present in adolescence/young adulthood. Importantly, these alterations in WM tracts are correlated with measures of executive function and general cognitive abilities. Our findings suggest that disturbance of neural pathways, rather than changes in regional brain volumes, are involved in the impaired cognitive functions.

  • 397. Vollmer, Brigitte
    et al.
    Stålnacke, Johanna
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Young Adult Motor, Sensory, and Cognitive Outcomes and Longitudinal Development after Very and Extremely Preterm Birth2019Inngår i: Neuropediatrics, ISSN 0174-304X, E-ISSN 1439-1899, Vol. 50, nr 4, s. 219-227Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    In this narrative review, we report on adult outcomes after very (before 32 weeks of gestation [wGA]) and extremely (before 28 wGA) preterm birth, with a focus on neuromotor function, neurosensory impairment, general cognitive abilities, executive function, and attentional abilities, all of which are important for academic progress, peer relationships, and participation. Longitudinal development from childhood to adulthood is described. Preterm born individuals have a higher risk for impairment of general cognitive abilities, executive function, attention, and neuromotor abilities well into adulthood, with, however, considerable variability in outcomes. Differences between individuals born preterm and their term born peers persist. Long-term outcomes of general cognitive ability can be predicted with some degree of certainty from childhood assessments: those who perform poor on early childhood age assessments very likely will not catch up, whereas those who perform within the normal range on early assessments sometimes accelerate their development relative to term born peers. This appears similar for executive function and attention, although data on trajectories for these functions are somewhat inconsistent. In adulthood, some studies describe poorer educational outcomes, employment, independent living, and/or economic situation compared with term born individuals; however, large proportion of those born preterm report similar self-perceived quality of life.

  • 398. Wade, Tracey D.
    et al.
    Kay, Enola
    de Valle, Madelaine K.
    Egan, Sarah J.
    Andersson, Gerhard
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi. University of Southern Denmark, Denmark.
    Shafran, Roz
    Internet-based cognitive behaviour therapy for perfectionism: More is better but no need to be prescriptive2019Inngår i: Clinical Psychologist, ISSN 1328-4207, E-ISSN 1742-9552, Vol. 23, nr 3, s. 196-205Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The current study explored whether higher- (up to 8 modules) versus lower-dose (3 or less modules) unguided internet Cognitive Behaviour Therapy for perfectionism (ICBT-P) was more effective, and the best method to promote higher dosage.

    Methods: Two sequential randomised ICBT-P studies were conducted with participants who self-identified as having difficulties with perfectionism; in the first participants (N = 51) received 3-module ICBT-P or wait-list, and in the second participants (N = 55) received fixed (asked to complete all 8 modules two per week over 4-weeks) or flexible format (after completing the first psychoeducational module, participants decided how many/in what order they completed the modules). We examined impact on our primary variables, perfectionistic concerns and standards, and secondary outcomes of negative affect, body image flexibility, and self-efficacy.

    Results: More modules were completed in the higher- (M modules = 4.36, SD = 3.29) versus lower-dose (M = 1.96, SD = 1.23) ICBT-P, d = 0.86 (95% confidence interval: 0.39, 1.34). The latter impacted perfectionism but not secondary outcomes; the former impacted all outcomes (except for self-efficacy), and within-group effect size improvements were double in the high- compared to low-dose ICBT-P. There was no difference between the fixed and flexible formats in terms of the number of modules completed or impact.

    Conclusions: We can offer a patient-centred approach to ICBT-P that is effective, while suggesting completion of more modules can result in larger, more pervasive improvements.

    ANZCTR Trial Number: ACTRN12619000147189.

  • 399. Wade, Tracey
    et al.
    Kay, Enola
    de Valle, Madelaine
    Egan, Sarah
    Andersson, Gerhard
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Shafran, Roz
    Internet-Based Cognitive Behaviour Therapy for Perfectionism: More is Better but no Need to Be Prescriptive2019Inngår i: Proceedings of the 9th World Congress of Behavioural & Cognitive Therapies: Volume I. Research, Applied Issues / [ed] Thomas Heidenreich, Philip Tata, Tübingen: dgvt-Verlag , 2019, Vol. 1, s. 233-233Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    Two sequential randomized internet ICBT for perfectionism (ICBT-P) studies were conducted with participants who self-identified as having difficulties with perfectionism; in the first participants (N=51) received 3-module ICBT-P or wait-list, and in the second participants (N=55) received fixed (asked to complete all 8 modules two per week over 4-weeks) or flexible format (after completing the first psychoeducational module, participants decided how many/in what order they completed the modules). We examined impact on our primary variables, perfectionistic concerns and standards, and secondary outcomes of negative affect, body image flexibility, and self-efficacy. First, while use of a 3 to 8 module intervention reliably decreased perfectionism, it appears that more modules are required in order to impact secondary outcomes, such as negative affect and body image. Second, there is no difference in impact when a fixed or flexible approach to the intervention (i.e., order and number of modules to be completed) is adopted. This suggests we can offer a patient-centred approach to ICBTP that is effective, while suggesting completion of more modules can result in larger, more pervasive improvements.

  • 400. Wahlund, Tove
    et al.
    Jolstedt, Maral
    Andersson, Erik
    Vigerland, Sarah
    Perrin, Sean
    Öst, Lars-Göran
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Högström, Jens
    Serlachius, Eva
    Online cognitive behavior therapy for adolescents with excessive worry: a multiple baseline design feasibility study2020Inngår i: mHealth, ISSN 2306-9740, Vol. 6, artikkel-id 5Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: One in twenty adolescents experience excessive worry and evidence-based psychological therapies are not sufficiently widespread to reach most of those affected. In this multiple baseline evaluation, we assess the feasibility and preliminary efficacy of a scalable, online cognitive-behavioral intervention for adolescents with excessive worry (BIP worry).

    Methods: Thirteen adolescents (age 13–17) with excessive worry underwent the 10-week online BIP worry intervention. The treatment also included an online intervention for parents. Completion rates, treatment satisfaction, and adverse events were measures of feasibility. Clinical outcomes included worry severity, symptoms of other anxiety and depression, and general functioning. To control for time and spontaneous fluctuations in symptoms, adolescents were randomized to a 2-, 6-, or 10-week baseline phase prior to treatment. A short measure of worry severity was administered weekly during the baseline and treatment phases. Outcomes were assessed before the baseline-phase, at pre-treatment, post-treatment, and at 1- and 3-month follow-ups.

    Results: Twelve of 13 included adolescents, together with their parents, participated in BIP worry, with a mean completion rate of 9.8 of the 10 treatment modules. Adolescents reported an average of 4.4 exposures per week as homework during treatment. High levels of treatment adherence, credibility, and satisfaction, and no serious adverse events were reported. Therapists averaged 21 min per week communicating with each family. Linear mixed effects models indicated significant improvements in worry, anxiety, and general functioning from pre- to post-treatment, with these gains maintained at 1- and 3-months follow-up. Reductions in worry severity during treatment were significantly larger than during the baseline phase. The results from the multiple baseline evaluation suggested an association between the introduction of the BIP worry intervention and subsequent symptom change for some but not all adolescents.

    Conclusions: BIP worry is a feasible and potentially effective treatment. As the treatment is scalable and involves limited therapist contact, it represents a low-cost method for treating adolescents with excessive worry and anxiety. Further investigation under randomized controlled trial (RCT) conditions is warranted.

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