| 1. |
- Abrahamsson, Niclas, 1976-, et al.
(författare)
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Video-based CBT-E improves eating patterns in obese patients with eating disorder : A single case multiple baseline study
- 2018
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Ingår i: Journal of Behavior Therapy and Experimental Psychiatry. - : Elsevier BV. - 0005-7916 .- 1873-7943. ; 61, s. 104-112
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND OBJECTIVES:Cognitive Behavioral Therapy (CBT) is effective for treating eating disorders but it may be difficult to reach patients living far from urban centers. Mobile video-based psychotherapy may potentially improve service reach but has not yet been evaluated. The purpose of this study was to investigate the effects of mobile video-based CBT for eating disorder and to explore the feasibility to use this technology in clinical care.METHODS:A controlled single case multiple baseline design was used which allowed for statistical analyses with randomization tests and non-overlap of all pairs (NAP). Five patients in the first stage of eating disorder treatment were included and the main outcome variable was daily meal frequency. Secondary outcome variables included eating disorder symptoms, psychological distress and treatment satisfaction.RESULTS:The treatment resulted in a significant (p < .01) increase in daily meal frequency with medium to large effect sizes (combined NAP = .89). Four participants reported reliable improvements in eating disorder symptoms and three reported improvements in mood. The participants reported high satisfaction with the treatment and with the mobile video-application despite some technical problems.LIMITATIONS:Self-reported data on eating behavior is prone to be biased and the results of single case studies may have limited generalizability.CONCLUSION:CBT can be delivered effectively via a mobile video application and, despite some technological issues, can be well received by patients. All participants in this study had previous low access to mental health services and reported high satisfaction with the treatment format.
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| 2. |
- Alfonsson, Sven, 1977-, et al.
(författare)
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Clinical supervision in cognitive behavior therapy improves therapists' competence : a single-case experimental pilot study
- 2020
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Ingår i: Cognitive Behaviour Therapy. - : Informa UK Limited. - 1650-6073 .- 1651-2316. ; 49:5, s. 425-438
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Tidskriftsartikel (refereegranskat)abstract
- Clinical supervision is a cornerstone in psychotherapists' training but there are few empirical evaluations on the effects of supervision on therapists' competencies. The aim of this study was therefore to evaluate the effects of standardized supervision on rater-assessed competency in Cognitive Behavior Therapy (CBT). Six therapists with basic training in CBT were provided with protocol-based clinical supervision in CBT in a single-case experimental multiple baseline design. The supervision focused on specific CBT competencies and used experiential learning methods such as role-play. Each therapist recorded weekly treatment sessions during phases without and with supervision. The therapists' CBT competence was assessed by third-party raters using the Revised Cognitive Therapy Scale (CTS-R). Statistical analyses showed that the therapists' CTS-R scores increased significantly during the phase with supervision with a mean item increase of M = 0.71 (range = 0.50-1.0) on the supervision focus areas. This is one of the first empirical studies that can confirm that supervision affect CBT competencies. The results also suggest that supervision can be manualized and that supervisees have a positive perception of more active training methods. Further studies are needed to replicate the results and to find ways to improve the impact of supervision.
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| 3. |
- Alfonsson, Sven, 1977-, et al.
(författare)
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Differences in motivation and adherence to a prescribed assignment after face-to-face and online psychoeducation : A randomized experiment
- 2017
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Ingår i: BMC Psychology. - : Springer Science and Business Media LLC. - 2050-7283. ; 5:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Adherence to treatment homework is associated with positive outcomes in behavioral psychotherapy but compliance to assignments is still often moderate. Whether adherence can be predicted by different types of motivation for the task and whether motivation plays different roles in face-to-face compared to online psychotherapy is unknown. If models of motivation, such as Self-determination theory, can be used to predict patients’ behavior, it may facilitate further research into homework promotion. The aims of this study were, therefore, to investigate whether motivation variables could predict adherence to a prescribed assignment in face-to-face and online interventions using a psychotherapy analog model. Methods: A total of 100 participants were included in this study and randomized to either a face-to-face or online intervention. Participants in both groups received a psychoeducation session and were given an assignment for the subsequent week. The main outcome measurements were self-reported motivation and adherence to the assignment. Results: Participant in the face-to-face condition reported significantly higher levels of motivation and showed higher levels of adherence compared to participants in the online condition. Adherence to the assignment was positively associated with intrinsic motivation and intervention credibility in the whole sample and especially in the online group. Conclusions: This study shows that intrinsic motivation and intervention credibility are strong predictors of adherence to assignments, especially in online interventions. The results indicate that intrinsic motivation may be partly substituted with face-to-face contact with a therapist. It may also be possible to identify patients with low motivation in online interventions who are at risk of dropping out. Methods for making online interventions more intrinsically motivating without increasing external pressure are needed.
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| 4. |
- Alfonsson, Sven, et al.
(författare)
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Factor structure and validity of the Depression Anxiety and Stress Scale-21 in Swedish translation
- 2017
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Ingår i: Journal of Psychiatric and Mental Health Nursing. - : Wiley. - 1351-0126 .- 1365-2850. ; 24:2-3, s. 154-162
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Tidskriftsartikel (refereegranskat)abstract
- Introduction There is a constant need for theoretically sound and valid self-report instruments for measuring psychological distress. Previous studies have shown that the Depression, Anxiety and Stress Scale-21 (DASS-21) is theoretically sound, but there have been some inconsistent results regarding its factor structure. Aims The aim of the present study was to investigate and elucidate the factor structure and convergent validity of the DASS-21. Methods A total of 624 participants recruited from student, primary care and psychotherapy populations. The factor structure of the DASS-21 was assessed by confirmatory factor analyses and the convergent validity by investigating its unique correlations with other psychiatric instruments. Results A bifactor structure with depression, anxiety, stress and a general factor provided the best fit indices for the DASS-21. The convergent validity was adequate for the Depression and Anxiety subscales but more ambiguous for the Stress subscale. Discussion The present study overall supports the validity and factor structure of the DASS-21. Implications for practice The DASS-21 can be used to measure symptoms of depression and anxiety as well as overall distress. It can be useful for mental health nurses, and other first-line psychiatric professionals, in need of a short, feasible and valid instrument in everyday care
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| 5. |
- Alfonsson, Sven, et al.
(författare)
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Group Behavioral activation for patients with severe obesity and Binge eating disorder : A randomized controlled trial
- 2015
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Ingår i: Behavior modification. - : SAGE Publications. - 0145-4455 .- 1552-4167. ; 39:2, s. 270-294
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the present study was to assess whether behavioral activation (BA) is an efficacious treatment for decreasing eating disorder symptoms in patients with obesity and binge eating disorder (BED). Ninety-six patients with severe obesity and BED were randomized to either 10 sessions of group BA or wait-list control. The study was conducted at an obesity clinic in a regular hospital setting. The treatment improved some aspects of disordered eating and had a positive effect on depressive symptoms but there was no significant difference between the groups regarding binge eating and most other symptoms. Improved mood but lack of effect on binge eating suggests that dysfunctional eating (including BED) is maintained by other mechanisms than low activation and negative mood. However, future studies need to investigate whether effects of BA on binge eating might emerge later than at post-assessment, as in interpersonal psychotherapy for bulimia nervosa.
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| 6. |
- Alfonsson, Sven, 1977-
(författare)
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Impulsivity, Negative Mood, and Disordered Eating in Obesity
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Bariatric surgery is a life-altering procedure that leads to substantial weight loss for most patients with obesity. Psychiatric conditions that may interfere with eating behavior and other behavioral prescriptions after surgery are common. Disordered eating is an established risk factor for inferior weight loss but the effects of negative mood and impulsivity are largely unknown. This thesis aims to investigate the prevalence of and associations between these potential risk factors and eating behavior in bariatric surgery patients.Study I assessed the prevalence of adult Attention Deficits/Hyperactivity Disorder (ADHD) symptoms in bariatric surgery patients. Symptoms of adult ADHD were elevated compared to the normal population and associated with symptoms of disordered eating, anxiety, and depression.Study II investigated whether treatment with Behavioral Activation (BA) could ameliorate binge eating and other symptoms of disordered eating in patients with obesity and Binge Eating Disorder. The results showed that BA was effective in increasing activity levels and improving mood but not in ameliorating binge eating in these patients.Study III was a prospective study on disordered eating, symptoms of depression and anxiety, symptoms of adult ADHD, and alcohol risk consumption before surgery and at follow-up after 12 months. After controlling for age, no variable measured before surgery could predict weight loss after surgery. Disordered eating after surgery was associated with inferior weight loss in men and a subgroup of older female participants.The present thesis concludes that symptoms of adult ADHD are common among bariatric surgery patients and associated with disordered eating. There is no indication that symptoms of adult ADHD are associated with short-term inferior weight loss after surgery. However, adult ADHD may be a risk factor for postsurgical alcohol abuse. The treatment study showed no direct association among activity, mood, and binge eating. BA, while effective in improving mood, was found not to be an effective treatment for BED, at least in the short group format investigated.
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| 7. |
- Alfonsson, Sven, et al.
(författare)
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Interformat Reliability of Digital Psychiatric Self-Report Questionnaires : A Systematic Review
- 2014
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Ingår i: Journal of Medical Internet Research. - : JMIR Publications Inc.. - 1438-8871. ; 16:12, s. 86-97
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Research on Internet-based interventions typically use digital versions of pen and paper self-report symptom scales. However, adaptation into the digital format could affect the psychometric properties of established self-report scales. Several studies have investigated differences between digital and pen and paper versions of instruments, but no systematic review of the results has yet been done.OBJECTIVE: This review aims to assess the interformat reliability of self-report symptom scales used in digital or online psychotherapy research.METHODS: Three databases (MEDLINE, Embase, and PsycINFO) were systematically reviewed for studies investigating the reliability between digital and pen and paper versions of psychiatric symptom scales.RESULTS: From a total of 1504 publications, 33 were included in the review, and interformat reliability of 40 different symptom scales was assessed. Significant differences in mean total scores between formats were found in 10 of 62 analyses. These differences were found in just a few studies, which indicates that the results were due to study effects and sample effects rather than unreliable instruments. The interformat reliability ranged from r=.35 to r=.99; however, the majority of instruments showed a strong correlation between format scores. The quality of the included studies varied, and several studies had insufficient power to detect small differences between formats.CONCLUSIONS: When digital versions of self-report symptom scales are compared to pen and paper versions, most scales show high interformat reliability. This supports the reliability of results obtained in psychotherapy research on the Internet and the comparability of the results to traditional psychotherapy research. There are, however, some instruments that consistently show low interformat reliability, suggesting that these conclusions cannot be generalized to all questionnaires. Most studies had at least some methodological issues with insufficient statistical power being the most common issue. Future studies should preferably provide information about the transformation of the instrument into digital format and the procedure for data collection in more detail.
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| 8. |
- Alfonsson, Sven, et al.
(författare)
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Is age a better predictor of weight loss one year after Gastric bypass than symptoms of disordered eating, depression, adult ADHD, and alcohol consumption?
- 2014
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Ingår i: Eating Behaviors. - : Elsevier BV. - 1471-0153 .- 1873-7358. ; 15:4, s. 644-647
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION:Findings regarding psychological risk factors for low weight loss after bariatric surgery have been inconsistent. The association between gender and weight outcome is unclear while younger age has been consistently shown to be associated with better weight outcome. The aim of this study was to analyze the interactions between gender and age on the one hand and symptoms of disordered eating, depression, adult ADHD and alcohol consumption on the other hand in regard to weight loss after gastric bypass.METHODS:Bariatric surgery patients were recruited and asked to fill out self-report questionnaires regarding behavioral risk factors before and twelve months after surgery. Data from one hundred and twenty-nine patients were analyzed.RESULTS:After controlling for age, no psychological variable measured prior to surgery could predict weight loss after twelve months. After surgery, there was an interaction effect between age, gender and specific eating disorder symptoms. Specifically, loss of control over eating was a risk factor for low weight loss among older, but not among younger, female participants. Symptoms of adult ADHD were associated with elevated alcohol consumption after surgery.DISCUSSION:These results indicate that age and gender may moderate the effects of potential risk factors for inferior weight outcome. This interaction could potentially be one of the reasons behind the mixed findings in this field. Thus, there are important gender differences in the bariatric population that should be considered. The present study is the first to show that symptoms of adult ADHD may not be a risk factor for inferior weight loss but for alcohol risk consumption after gastric bypass.
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| 9. |
- Alfonsson, Sven, et al.
(författare)
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Is online treatment adherence affected by presentation and therapist support? : A randomized controlled trial
- 2016
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Ingår i: Computers in human behavior. - : Elsevier BV. - 0747-5632 .- 1873-7692. ; 60, s. 550-558
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Tidskriftsartikel (refereegranskat)abstract
- In both face to face and Internet based Cognitive Behavior Therapy, patients' adherence can be improved by different means such as by using motivational techniques or automatic reminders. The main aim of this study was to investigate whether enriched treatment material presentation and/or increased frequency and quality of support would increase participants' adherence to an online relaxation program. One hundred and sixty-two participants with mild to moderate symptoms of stress or worry were included in this study. Participants were randomized to either Normal or Enhanced intervention presentation and Normal or Enhanced support in a full factorial design. Main outcome variables were progress through the online intervention and adherence to prescribed exercises. Participants in the Enhanced support group progressed further through the program than participants in the Normal support group (Z = 2.11, p = .035, r = .17) but there were no significant differences found between the Normal and Enhanced presentation groups. Participants registered a mean of 60% of the prescribed exercises with no significant differences between groups. This study shows that adherence to online interventions can be increased by increased frequency and quality of therapeutic contact. Future studies may investigate how to increase adherence to prescribed homework assignments and whether parts of the therapeutic support may be substituted with automatic systems with retained effects.
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| 10. |
- Alfonsson, Sven, et al.
(författare)
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Motivation and Treatment Credibility Predicts Dropout, Treatment Adherence, and Clinical Outcomes in an Internet-Based Cognitive Behavioral Relaxation Program : A Randomized Controlled Trial.
- 2016
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Ingår i: Journal of Medical Internet Research. - : JMIR Publications Inc.. - 1438-8871. ; 18:3
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Tidskriftsartikel (refereegranskat)abstract
- Background: In previous research, variables such as age, education, treatment credibility, and therapeutic alliance have shown to affect patients' treatment adherence and outcome in Internet-based psychotherapy. A more detailed understanding of how such variables are associated with different measures of adherence and clinical outcomes may help in designing more effective online therapy.Objective: The aims of this study were to investigate demographical, psychological, and treatment-specific variables that could predict dropout, treatment adherence, and treatment outcomes in a study of online relaxation for mild to moderate stress symptoms.Methods: Participant dropout and attrition as well as data from self-report instruments completed before, during, and after the online relaxation program were analyzed. Multiple linear and logistical regression analyses were conducted to predict early dropout, overall attrition, online treatment progress, number of registered relaxation exercises, posttreatment symptom levels, and reliable improvement.Results: Dropout was significantly predicted by treatment credibility, whereas overall attrition was associated with reporting a focus on immediate consequences and experiencing a low level of intrinsic motivation for the treatment. Treatment progress was predicted by education level and treatment credibility, whereas number of registered relaxation exercises was associated with experiencing intrinsic motivation for the treatment. Posttreatment stress symptoms were positively predicted by feeling external pressure to participate in the treatment and negatively predicted by treatment credibility. Reporting reliable symptom improvement after treatment was predicted by treatment credibility and therapeutic bond.Conclusions: This study confirmed that treatment credibility and a good working alliance are factors associated with successful Internet-based psychotherapy. Further, the study showed that measuring adherence in different ways provides somewhat different results, which underscore the importance of carefully defining treatment adherence in psychotherapy research. Lastly, the results suggest that finding the treatment interesting and engaging may help patients carry through with the intervention and complete prescribed assignments, a result that may help guide the design of future interventions.
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