| 1. |
- Babiano-Espinosa, L., et al.
(författare)
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eCBT Versus Standard Individual CBT for Paediatric Obsessive-Compulsive Disorder
- 2023
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Ingår i: Child Psychiatry & Human Development. - : Springer Science and Business Media LLC. - 0009-398X .- 1573-3327. ; 54:6, s. 1567-1576
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Tidskriftsartikel (refereegranskat)abstract
- Obsessive-compulsive disorder (OCD) is characterized by recurring obsessions and compulsions often with severe impairment affecting 1-3% of children and adolescents. Cognitive behavioural therapy (CBT) is the therapeutic golden standard for paediatric OCD. However, face-to-face CBT is limited by accessibility, availability, and quality of delivery. Enhanced CBT (eCBT) a combination of face-to-face sessions at the clinic and treatment at home via webcam and a supportive app system aims to address some of these barriers. In this pilot study, we compared eCBT outcomes of 25 paediatric patients with OCD benchmarked against traditional face-to-face CBT (n = 269) from the Nordic Long-term OCD Treatment Study, the largest paediatric OCD CBT study to date. Pairwise comparisons showed no difference between eCBT and NordLOTS treatment outcomes. Mean estimate difference was 2.5 in favour of eCBT (95% CI - 0.3 to 5.3). eCBT compared to NordLOTS showed no significant differences between response and remission rates, suggesting similar effectiveness.
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| 2. |
- Broberg, Anders G, 1950, et al.
(författare)
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Anknytning i praktiken -- tillämpningar av anknytningsteorin
- 2008
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Bok (övrigt vetenskapligt/konstnärligt)abstract
- Denna fristående andra del om anknytning ger ett fylligt kunskapsunderlag till hur anknytningsteorin kan tillämpas från spädbarnsåren till vuxen ålder. Anknytningsteorin anses idag vara den viktigaste psykologiska teorin för att förklara hur människor förhåller sig till närhet, omsorg och självständighet i relationer. I boken beskrivs betydelsen av ett lyhört föräldraskap, tidiga insatser vid omsorgssviktklinisk späd- och småbarnspsykologi, hur olika anknytningsmönster påverkar psykisk hälsa och ohälsa i olika åldrar samt hur forskare och kliniker kan mäta anknytningstrygghet hos barn, ungdomar och vuxna. Ett andligt perspektiv beskriver hur relationen till Gud kan fungera som en trygg säker hamn vid oro, förvirring och sorg. Inom psykoterapi är anknytningsperspektivet bland annat värdefullt eftersom terapeuten kan ofta fungerar som en trygg bas för inre och yttre utforskande, och då de flesta terapier ofta berör relationella områden som separationer, trygghet och kärlek.
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| 3. |
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| 4. |
- Conzelmann, A., et al.
(författare)
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Internet-based psychotherapy in children with obsessive-compulsive disorder (OCD): protocol of a randomized controlled trial
- 2022
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Ingår i: Trials. - : Springer Science and Business Media LLC. - 1745-6215. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Obsessive-compulsive disorder (OCD) in children can lead to a huge burden on the concerned patients and their family members. While successful state-of-the art cognitive behavioral interventions exist, there is still a lack of available experts for treatment at home, where most symptoms manifest. Internet-based cognitive behavioral therapy (iCBT) could overcome these restrictions; however, studies about iCBT in children with OCD are rare and mostly target computerized self-help resources and only email contact with the therapist. Therefore, we intended to build up and to evaluate an iCBT approach for children with OCD, replacing successful elements of traditional in-office face-to-face CBT, with face-to-face teleconferences, online materials, and apps. Methods: With the help of a pilot feasibility study, we developed the iCBT consisting of 14 teleconference sessions with the child and parents. The sessions are supported by an app assessing daily and weekly symptoms and treatment course completed by children and parents. Additionally, we obtain heart rate and activity scores from the child via wristbands during several days and exposure sessions. Using a waiting list randomized control trial design, we aim to treat and analyze 20 children with OCD immediately after a diagnostic session whereas the control group of another set of 20 OCD patients will be treated after waiting period of 16 weeks. We will recruit 30 patients in each group to take account for potential dropouts. Outcomes for the treatment group are evaluated before randomization (baseline, t0), 16 weeks (end of treatment, t1), 32 weeks (follow-up 1, t2), and 48 weeks after randomization (follow-up 2, t3). For the waiting list group, outcomes are measured before the first randomization (baseline), at 16 weeks (waiting list period), 32 weeks (end of treatment), 48 weeks after the first randomization (follow-up I), and 64 weeks after the first randomization (follow-up II). Discussion: Based on our experience of feasibility during the pilot study, we were able to develop the iCBT approach and the current study will investigate treatment effectiveness. Building up an iCBT approach, resembling traditional in-office face-to-face therapy, may ensure the achievement of well-known therapy effect factors, the acceptance in both patients and clinicians, and the wide distribution within the health system.
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| 5. |
- Duholm, C. S., et al.
(författare)
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Specific Contamination Symptoms are Associated with Experiencing a Limited Response of Cognitive-Behavioral Therapy in Pediatric Patients with OCD
- 2022
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Ingår i: Child Psychiatry & Human Development. - : Springer Science and Business Media LLC. - 0009-398X .- 1573-3327.
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Tidskriftsartikel (refereegranskat)abstract
- A recent study identified three distinct treatment-response trajectories in pediatric OCD where higher levels of contamination symptoms predicted a limited response to cognitive-behavioral therapy (CBT). This study extends these findings by examining which specific symptoms characterize limited CBT response from baseline to 3-year follow-up, with an emphasis on contamination symptoms. The study sample comprised 269 pediatric patients with OCD, all receiving stepped-care treatment with manualized CBT. Differences in single item-reporting between the three trajectory groups were examined using linear mixed-effect modeling. Limited responders displayed a higher symptom load across all OCD symptom categories at 3-year follow-up, dominated by contamination symptoms. Five of these (obsessions about dirt and germs, about bodily fluids, about the feeling of contamination and compulsions regarding handwashing and showering) showed persistence from baseline to 3-year follow-up. The results indicate that presence of specific contamination symptoms may influence long-term symptom severity trajectories in young patients with OCD.
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| 6. |
- Granqvist, Pehr, et al.
(författare)
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Examining relations among attachment, religiosity, and new age spirituality using the adult attachment interview
- 2007
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Ingår i: Developmental Psychology. - : American Psychological Association (APA). - 0012-1649 .- 1939-0599. ; 43:3, s. 590-601
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Tidskriftsartikel (refereegranskat)abstract
- This study was the first to examine relations between attachment and religion-spirituality in adults using a developmentally validated attachment assessment, the Adult Attachment Interview. Security of attachment was expected to be linked to a religiosity-spirituality that is socially based on the parental relationships and reflects extrapolation of attachment experiences with sensitive parents to perceived relationships with a loving God. Insecurity of attachment was expected to be related to religiosity-spirituality via emotional compensation for states of insecurity. Participants (N=84; 40% men; mean age=29 years) were drawn from religious-spiritual groups. Religiousness-spirituality was assessed with questionnaires. Results generally supported the hypotheses (ps<.05). Estimates of parental loving were linked to socially based religiosity, loving God images, and gradual religious changes occurring at early ages and in life contexts indicating a positive influence of close relationships. Estimates of parental rejection and role reversal were related to New Age spirituality and sudden-intense religious changes occurring in life contexts of turmoil. Current attachment state of mind was generally unrelated to traditional religiosity, but current preoccupation, unresolved-disorganized, and cannot classify states were associated with New Age spirituality.
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| 9. |
- Gustafsson, Per E., 1981-, et al.
(författare)
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Diurnal cortisol levels and cortisol response in youths with obsessive-compulsive disorder
- 2008
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Ingår i: Neuropsychobiology. - : S. Karger AG. - 0302-282X .- 1423-0224. ; 57:1-2, s. 14-21
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Tidskriftsartikel (refereegranskat)abstract
- <i>Background/Aims:</i> Recent results indicate a role of the hypothalamic-pituitary-adrenal (HPA) axis in the pathophysiology of obsessive-compulsive disorder (OCD). Although childhood onset is common, the HPA axis has scarcely been studied in young OCD subjects. Therefore, the present study aimed at examining basal and response levels of salivary cortisol in a sample of young OCD subjects. <i>Methods:</i> Twenty-three children and adolescents with DSM-IV OCD were compared to a reference group of school children (n = 240–336). The basal cortisol rhythm was measured through saliva samples 3 times/day. The cortisol response to a psychological stressor (exposure therapy in the OCD group and a fire alarm in the reference group) was also examined. <i>Results:</i> Compared to the reference group, OCD subjects displayed higher early-morning cortisol values (p = 0.005) with no difference between the late-morning and evening values. The cortisol levels in the OCD group diminished in response to the psychological stressor, compared to a positive response in the reference group (p < 0.001). No relation was found between cortisol and clinical parameters. <i>Conclusion:</i> These results support the idea that HPA hyperactivity, commonly found in adult OCD patients, is also present at an earlier stage of development, with specificity for the early-morning peak.
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| 10. |
- Hollmann, K., et al.
(författare)
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Internet-based cognitive behavioral therapy in children and adolescents with obsessive compulsive disorder: a feasibility study
- 2021
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Ingår i: Journal of Neural Transmission. - : Springer Science and Business Media LLC. - 0300-9564 .- 1435-1463. ; 128, s. 1445-1459
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Tidskriftsartikel (refereegranskat)abstract
- Cognitive behavioral therapy (CBT) is the first choice of treatment of obsessive-compulsive disorder (OCD) in children and adolescents. However, there is often a lack of access to appropriate treatment close to the home of the patients. An internet-based CBT via videoconferencing could facilitate access to state-of-the-art treatment even in remote areas. The aim of this study was to investigate feasibility and acceptability of this telemedical approach. A total of nine children received 14 sessions of CBT. The first session took place face-to-face, the remaining 13 sessions via videoconference. OCD symptoms were recorded with a smartphone app and therapy materials were made accessible in a data cloud. We assessed diagnostic data before and after treatment and obtained measures to feasibility, treatment satisfaction and acceptability. Outcomes showed high acceptance and satisfaction on the part of patients with online treatment (89%) and that face-to-face therapy was not preferred over an internet-based approach (67%). The majority of patients and their parents classified the quality of treatment as high. They emphasized the usefulness of exposures with response prevention (E/RP) in triggering situations at home. The app itself was rated as easy to operate and useful. In addition to feasibility, a significant decrease in obsessive-compulsive symptoms was also achieved. Internet-based CBT for pediatric OCD is feasible and well received by the patients and their parents. Furthermore, obsessive-compulsive symptomatology decreased in all patients. The results of this study are encouraging and suggest the significance of further research regarding this technology-supported approach, with a specific focus on efficacy. Trial registration number: Clinical trials AZ53-5400.1-004/44.
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