Introduction: Many people with type 1 diabetes struggle to manage their glucose levels and experience stress related to the behavioral demands of the disease. The aim of this study is to investigate whether treatment with a diabetes-educated psychologist can improve glucose levels and decrease diabetes distress. Materials and methods: Individuals with HbA1c >62 mmol/mol (7.8%) were randomized to either psychological treatment or control group. The study duration for each participant was 52 weeks. Patients who received treatment met with a diabetes-educated psychologist a minimum of seven times. In total 6 outpatient diabetes units and 10 psychologists participated. Cognitive behavioral therapy was primarily the treatment of choice. Both groups met with a diabetes nurse and/or physician at the start of the study and at 3, 6, and 12 months. HbA1c, blood pressure, and weight were measured at scheduled visits. Diabetes distress, quality of life, hypoglycemia confidence, and treatment satisfaction were evaluated using questionnaires. The primary endpoint is the difference in HbA1c from baseline to week 52. Secondary endpoints are changes in diabetes distress and quality of life from baseline to week 52, as well as treatment satisfaction at 52 weeks. Discussion: This study seeks to improve knowledge about how to support patients who struggle to manage their diabetes. If the results of this study show that psychological treatment has an effect on HbA1c or on diabetes distress, it could indicate that psychologists should become more involved in diabetes care teams. Clinical trial registration: ClinicalTrials.gov ID NCT03753997

Background Digital interventions offering behaviour change support are warranted to prevent and treat non-communicable diseases, and have been evaluated rigorously in controlled settings. Effectivenss, factors influencing the uptake of scaled-up interventions—such as reach, received dose, usability and acceptability— and predictors and mediators of efficiency are rarely explored in research. The study described herein aims to evaluate the effectiveness of a personally tailored digital intervention (the app EviBody®), intended to support healthy and sustained lifestyle behaviours among the adult population, on well-being and behaviour change. Further aims are to explore context and uptake factors, predictors and mediators for behaviour change over 24 months. Methods This is a real-world study, employing a quasi-experimental design and a process evaluation. EviBody® will be marketed and managed by its owner. A four-armed design will allow for comparison between three levels of intervention (basic, standard and premium) and a control group. Adults who sign up for the app will be invited to the research study including sharing app data and answering questionnaires at 0, 1, 3, 6, 12, 18, and 24 months. Study start is Autumn 2025. Controls (n = 200 to evaluate the primary endpoint well-being at 6 months) will be recruited through advertisements on social media and asked to answer the same questionnaires at 0 and 6 months provided by email. For predicting and mediating analyses the intention is to recruit 1500 app users. Well-being (measured with the WHO-5 Well-Being Index), goal achievement, physical activity, eating habits, mental health, mediators (motivation, self-efficacy, and perceived barriers), and demographics will be self-reported. Uptake will be collected using analytics and ratings of usability and acceptability, and described by demographics. Mixed models for repeated measures and structural equation modelling will be employed for data analysis. Discussion Besides evaluating the effectivenss of a digital intervention, this study also applies a theory-based evaluation to understand which mediators are effective, for whom they are effective, and the specific conditions under which they are most beneficial.

Personalized networks of psychological symptoms aim to advance therapy by identifying treatment targets for specific patients. Statistical relations in such networks can be estimated from intensive longitudinal data, but their causal interpretation is limited by strong statistical assumptions. An alternative is to create networks from patient perceptions, which comes with other limitations such as retrospective bias. We introduce the Longitudinal Perceived Causal Problem Networks (L-PECAN) approach to address both these concerns. 20 participants screening positive for depression completed 4 weeks day of brief daily assessments of perceived symptom interactions. Quality criteria of this new method are introduced, answering questions such as “Which symptoms should be included in networks?”, “How many datapoints need to be collected to achieve stable networks?”, and “Does the network change over time?”. Accordingly, about 40% of respondents achieved stable networks and only few respondents exhibited network structure that changed during the assessment period. The method was time-efficient (on average 7.4 min per day), and well received. Overall, L-PECAN addresses several of the prevailing issues found in statistical networks and therefore provides a clinically meaningful method for personalization.

Background: Alcohol-related issues are widespread worldwide and are fairly substantial. Numerous studies have identified and clarified the effects and prevalence of alcohol use across different contexts. However, when it comes to the prevalence of alcohol in psychiatry and its impact on treatment outcomes compared to other patient groups, studies are relatively scarce, and results often vary, sometimes with different outcomes. This study focuses on investigating the effectiveness of psychological treatment in psychiatric clinics for outpatients, considering those with and without hazardous alcohol use under naturalistic conditions.

Methods: Patients were recruited between 2012 and 2016 from psychiatric clinics in Sormland, Sweden, as part of the regular services. Patients completed symptom assessment instruments regarding depression, anxiety, quality-of-life, and alcohol consumption at the beginning of their psychological treatment, upon completion, and during a follow-up 1 year after completion. Completion of questionnaires was ongoing for some patients until 2021. A total of 324 patients were included in the study, distributed among 59 participating therapists.

Results: Among all patients in the study, 30.2% showed hazardous alcohol use at the start of their psychological treatment, with a higher proportion being men. There was a significant reduction in the proportion of patients with hazardous use and a notable decrease in the mean audit score upon completion of psychological treatment. At follow-up, there was no significant change compared to completion. There were 31.2% of the patients who achieved recovery or improvement in the audit score upon completion of treatment. Patients with hazardous alcohol use consistently scored higher mean values on the symptom assessment instruments and lower on the quality-of-life instrument at the beginning. More individuals with hazardous alcohol use typically achieved better results across all outcome instruments at both at completion and follow-up.

Conclusion: Patients with hazardous alcohol use demonstrate significant improvements in their alcohol consumption through standard psychological treatment in psychiatry, despite the treatment not specifically focusing on alcohol consumption. The progress/improvement appears to be largely maintained at follow-up. Moreover, patients with hazardous alcohol use tend to show greater progress across all outcome instruments. No significant gender differences were detected in this context.

Most research showing results of psychotherapy come from efficacy studies or effectiveness studies from university counselling centers, or therapy clinics at universities. This study is an effectiveness study that aims to investigate the results of psychological treatment in psychiatric clinics for outpatients under naturalistic conditions. The study contributes unique insights regarding the outcomes of psychological treatment for patients with severe psychiatric problems in the complex real environment where many influencing variables exist. Patients were recruited from 2012 to 2016 from psychiatric clinics in Sormland, Sweden in the regular service. They received psychological treatment lasting between 1 and 50 months. The entire period of assessment took place between 2012 and 2021. A total of 325 patients received treatment from 59 participating therapists. Patients completed symptom assessment instruments regarding anxiety, depression, and quality of life at the start of therapy, upon the completion of therapy and, at follow-up one year after completion. Analyses indicated a significant improvement in all outcome instruments between start and completion of therapy. The improvement was largely maintained until follow-up. The effect sizes were moderate. Between 49.1% and 62.9% of patients “improved” or “recovered” as measured by the symptom assessment instruments at completion of therapy. The proportion of improved/recovered on the quality-of-life instrument was 37.4%. In a naturalistic cohort with comparatively severe psychiatric problems, substantial and stable improvements were achieved. The outcomes were respectable considering the population. The study provides external validity to efficacy studies on how psychological treatment works in a real-life context.

Background and purpose: The Acceptance and Action Diabetes Questionnaire (AADQ) is a tool for assessing the acceptance of thoughts and emotions related to diabetes in people living with the disease. This study aimed to examine the psychometric properties of the Swedish version of AADQ (Swe-AADQ) in a sample of adults with type 1 diabetes. Methods: To examine the psychometric properties of the Swe-AADQ, the Rasch model was used. Data for 120 individuals were included. Results: The Swe-AADQ showed an acceptable fit to the Rasch model. A sufficiently high value of the separation index indicated a capacity to distinguish between different levels of acceptance in the sample. The seven-point Likert scale was reduced to three categories suggesting an improvement in the ordering of the item thresholds. Conclusions: The Swe-AADQ possesses reasonable quality in terms of reliability and validity. However, there are some deficiencies regarding the categorization of the response rating that should be addressed.

Aims: Psychological care is recognised as an integral part of quality diabetes care. We set out to describe the roles and competencies of the clinical psychologist as a member of the multidisciplinary adult diabetes care team, focused on secondary care.

Methods: The authors are clinically experienced psychologists involved in adult diabetes care, from Australia, Europe and North America, and active members of the international psychosocial aspects of diabetes study group. Consensus was reached as a group on the roles and competencies of the clinical psychologist working in adult diabetes secondary care, building both on expert opinion and a selective review and discussion of the literature on psychological care in diabetes, clinical guidelines and competency frameworks.

Results: The clinical psychologist fulfils multiple roles: (1) as a clinician (psychological assessment and therapy), (2) as advisor to the healthcare team (training, consulting), (3) as a communicator and promotor of person-centred care initiatives and (4) as a researcher. Four competencies that are key to successfully fulfilling the above-mentioned roles in a diabetes setting are as follows: (a) specialised knowledge, (b) teamwork and advice, (c) assessment, (d) psychotherapy (referred to as STAP framework).

Conclusions: The roles and competencies of clinical psychologists working in diabetes extend beyond the requirements of most university and post-graduate curricula. There is a need for a comprehensive, accredited specialist post-graduate training for clinical psychologists working in diabetes care, building on the proposed STAP framework. This calls for a collaborative effort involving diabetes organisations, clinical psychology societies and diabetes psychology interest groups.

Objective: To evaluate the impact of an Acceptance and Commitment Therapy (ACT) programme, tailored for people living with type 1 diabetes, on glycated haemoglobin (HbA1c), self-management and psychosocial factors among individuals with HbA1c>60 mmol/mol compared with treatment as usual (TAU). Setting: An endocrinologic clinic in Sweden. Participants: In this randomised controlled trial, 81 individuals with type 1 diabetes, aged 18–70 years with HbA1c>60 mmol/mol, were randomly assigned to either an ACT group intervention or TAU. Exclusion criteria were: unable to speak Swedish, untreated or severe psychiatric disease, cortisone treatment, untreated thyroid disease and newly started insulin pump therapy. At the 2-year follow-up, HbA1c was measured in 26 individuals. Intervention: The ACT programme comprised seven 2-hour sessions held over 14 weeks and focused on acceptance of stressful thoughts and emotions, and to promote value-based committed action. Outcomes: The primary outcome was HbA1c, and the secondary outcomes were measures of depression, anxiety, general stress, fear of hypoglycaemia, diabetes distress, self-care activities, psychological flexibility (general and related to diabetes) and quality of life. The primary endpoint was HbA1c 2 years after the intervention programme. Linear mixed models were used to test for an interaction effect between measurement time and group. Results: Likelihood ratio test of nested models demonstrated no statistically significant interaction effect (χ2=0.49, p=0.485) between measurement time and group regarding HbA1c. However, a statistically significant interaction effect (likelihood ratio test χ2=12.63, p<0.001) was observed with improved scores on The Acceptance and Action Questionnaire in the intervention group after 1 and 2 years. Conclusions: No statistically significant difference was found between the groups regarding the primary outcome measure, HbA1c. However, the ACT programme showed a persistent beneficial impact on psychological flexibility in the intervention group. The dropout rate was higher than expected, which may indicate a challenge in this type of study. Trial registration number NCT02914496.

Introduction: High HbA1c levels in type 1 diabetes (T1D) are associated with increased risk of micro- and macrovascular complications and severe diabetes distress. A more comprehensive understanding of the adult perspective of living with T1D can improve the quality of care. We aimed to describe experiences of living with T1D as an adult with prolonged elevated HbA1c.

Methods: Thirteen adults with T1D and HbA1c > 60 mmol/mol (7.6%) for at least 1 year were individually interviewed via a digital platform. The interviews were transcribed verbatim and analyzed using qualitative content analysis.

Results: The analysis identified an overarching theme, “a lifelong follower”, and generated two main categories describing study participants’ experience: constraining and manageable. Constraining experiences were explained in obligated control, loss of control, environmental impact, and consequences of diabetes. Manageable experiences were described in everyday life, approach to diabetes, and support in life. Diabetes knowledge in health care and in the general public, and individualized care were important factors in feeling understood, safe, and supported.

Conclusions: The findings revealed the diverse experiences of adults with prolonged elevated HbA1c. Living with T1D, a lifelong non-chosen follower, could be perceived as constraining but manageable in different degrees. A person-centered care approach addressing both dimensions may be beneficial. Experiences of living with and managing diabetes are multifaceted and intertwined with life context and medical prerequisites.

Rape is the most common trauma leading to post-traumatic stress disorder (PTSD) among women, with a conditioned prevalence of up to 50%. PTSD is considered to be a lethal condition associated with increased risk of suicide, drug- and alcohol dependence, neurological- and vascular problems, as well as sick leave. Given the scope of this problem, novel and swiftly delivered interventions for this large vulnerable population are clearly warranted. One previous trial conducted in the United States (N= 137) showed that an adapted brief version of prolonged exposure (PE) to the fearful memory of the event and situations, provided in the immediate aftermath after trauma (<72 h after a traumatic event), was effective in reducing early PTSD symptoms in rape victims. The aims of the present study were to adapt the brief PE protocol to a Swedish context and investigate its feasibility and delivery in 10 executive patients recruited at the Emergency Clinic for Rape Victims in Stockholm. Ten participants were provided with three sessions of early PE with overall successful results in terms of session attendance, home-work compliance, and also symptom reduction of PTSD and depressive symptoms. However, only a fraction of the screened patients at the Emergency Clinic (5.2%) were eligible to be included in the study, where the majority (40%) were excluded due to the time criteria of 72 h. In this article, we will present detailed results of the intervention and elaborate on how to increase feasibility of preventive interventions for rape victims. In the current form, providing PE with the strict time criteria was not feasible in the clinical setting that constitutes the Emergency Department for rape.