| 1. |
- Westerberg Jacobson, Josefin, 1970-
(författare)
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Wish to be thinner : Development and Prediction of Disturbed Eating: A Longitudinal Study of Swedish Girls and Young Women
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to examine the development and prediction of disturbed eating attitudes in girls aged 7–20 years. The four studies are part of a seven-year longitudinal project including 1279 girls in several age groups (7, 9, 11, 13, 15 years at inclusion) and their parents. Study I showed that among girls aged 11 and 13 years, in addition to a positive relation between disturbed eating attitudes and age, eating attitudes, higher BMI than peers, a less healthy relation to family, and fathers’ eating attitudes, predicted disturbed eating attitudes two years later. Study II demonstrated that girls aged 9–15 years, who wished to be thinner dieted more often, thought that they would be more popular if they were thinner, were skipping meals more often and had a higher BMI, over five years, compared with the girls without such a wish. Study III demonstrated an increasing trend in the wish to be thinner and dieting attempts between the ages of 9 and 18 years. Motives for wishing to be thinner were, e.g., “to feel better about yourself” and “to correspond to the societal ideal”. A majority of the girls adopted healthy weight control practices, but unhealthy and extreme methods were also used. In Study IV, among girls aged 9 and 13 years, a wish to be thinner, fathers’ eating attitudes and mothers’ perfectionism contributed most to the prediction of disturbed eating attitudes seven years later. Protective factors were low BMI and more healthy eating attitudes moderated by high self-esteem, and low-to-medium degree of perfectionism. In conclusion a wish to be thinner, higher BMI than peers, girls’ and fathers’ disturbed eating attitudes, mothers’ perfectionism and a less healthy relation to family predict the development of disturbed eating attitudes in girls. Low BMI and more healthy eating attitudes especially influenced by high self-esteem, and a low-to-medium degree of perfectionism protect against it. The “thin-ideal” is internalized early in girls and it is important to take a critical stand against the thinness ideal in our society, especially in families, and schools.
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| 2. |
- Welch, Elisabeth
(författare)
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Eating Disorders : Steps Towards an Increased Understanding
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Eating disorders and disordered eating attitudes and behaviors are characterized by an over-evaluation of weight and shape, under or over-controlled eating, as well as engagement in compensatory behaviors. The disorders are associated with psychological suffering, acute and long-term health impairments, a high rate of suicide attempts as well as an increased risk of mortality. Knowledge regarding the etiology of eating disorders is limited and based on current models it is not possible to adequately predict either who will get an eating disorder or who will recover. This lack of understanding has hindered the development of effective prevention and treatment interventions.The aim of the present thesis was to contribute towards an increased understanding of eating disorders and disordered eating attitudes and behavior through the collection of norms and psychometric data, investigation of risk factors and their roles, and focusing on the understudied group of males with eating disorders. Five studies were included. Specifically, Study I focused on collecting general population and clinical norms on the well-established Eating Disorder Examination Questionnaire (EDE-Q) and the Clinical Impairment Assessment Questionnaire (CIA). Study II both collected general population norms on, and investigated psychometric properties of, the Body Shape Questionnaire (BSQ-8C), an instrument intended to assess body dissatisfaction. Study III focused on the role of perfectionism (an established risk factor for eating disorders) as a possible mediator or moderator between body dissatisfaction and disordered eating behavior and attitudes. Finally, in Study IV and V attention was placed on males. In Study IV the specific aim was to compare the clinical characteristics between young males and females with eating disorders while in study V the specific aim was to explore variables associated with disordered eating among young males based on a compilation of factors known to play a role among females as well as factors thought to be uniquely associated with males, such as sexual orientation and drive for muscularity. A greater understanding of eating disorders will help reduce the stigma that is associated with eating disorders, easing the way for affected individuals to seek help and ultimately improve the development of effective prevention and intervention.
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| 3. |
- de Man Lapidoth, Joakim
(författare)
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Binge eating and obesity treatment : prevalence, measurement and long-term outcome
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Eating disorders and binge eating has repeatedly been shown to be common in surgical and behavioural weight loss treatments. Due to methodological variations and shortcomings in previous research, there is insufficient information about how eating disorders and binge eating are associated with outcome in weight loss treatments. There is therefore no consensus on how eating pathology should be adressed in weight loss treatments, which has led to large differences in the clinical practice. The main aim of this thesis was to address the issues of eating disorders and binge eating in weight loss treatments, and to investigate how binge eating is associated with long-term treatment outcome.
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| 4. |
- Finnes, Anna, et al.
(författare)
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Economic evaluation of return-to-work interventions for mental disorder-related sickness absence : two years follow-up of a randomized clinical trial
- 2022
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Ingår i: Scandinavian Journal of Work, Environment and Health. - : Scandinavian Journal of Work, Environment and Health. - 0355-3140 .- 1795-990X. ; 48:4, s. 264-272
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The objective was to (i) assess the long-term cost-effectiveness of acceptance and commitment therapy (ACT), a workplace dialog intervention (WDI), and ACT+WDI compared to treatment as usual (TAU) for common mental disorders and (ii) investigate any differences in cost-effectiveness between diagnostic groups.METHODS: An economic evaluation from the healthcare and limited welfare perspectives was conducted alongside a randomized clinical trial with a two-year follow-up period. Persons with common mental disorders receiving sickness benefits were invited to the trial. We used registry data for cost analysis alongside participant data collected during the trial and the reduction in sickness absence days as treatment effect. A total of 264 participants with a diagnosis of depression, anxiety, or stress-induced exhaustion disorder participated in a two-year follow-up of a four-arm trial: ACT (N=74), WDI (N=60), ACT+WDI (N=70), and TAU (N=60).RESULTS: For all patients in general, there were no statistically significant differences between interventions in terms of costs or effect. The subgroup analyses suggested that from a healthcare perspective, ACT was a cost-effective option for depression or anxiety disorders and ACT+WDI for stress-induced exhaustion disorder. With a two-year time horizon, the probability of WDI to be cost-saving in terms of sickness benefits costs was 80% compared with TAU.CONCLUSIONS: ACT had a high probability of cost-effectiveness from a healthcare perspective for employees on sick leave due to depression or anxiety disorders. For participants with stress-induced exhaustion disorder, adding WDI to ACT seems to reduce healthcare costs, while WDI as a stand-alone intervention seems to reduce welfare costs.
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| 5. |
- Isaksson, Martina, 1985-, et al.
(författare)
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Overcontrolled, undercontrolled, and resilient personality styles among patients with eating disorders
- 2021
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Ingår i: Journal of Eating Disorders. - : BioMed Central (BMC). - 2050-2974. ; 9:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Personality has been suggested to be an important factor in understanding onset, maintenance, and recovery from eating disorders (ED). The objective of the current study was to evaluate personality style in different ED diagnostic groups as classified in the Diagnostic and Statistical Manual of Mental Disorders, Fifth edition (DSM-5). Methods: The overcontrolled, undercontrolled, and resilient personality styles were compared in four groups of patients with EDs: anorexia nervosa restricting (ANr) (n = 34), anorexia nervosa binge eating/purging (ANbp) (n = 31), atypical anorexia nervosa (AAN) (n = 29), and bulimia nervosa (BN) (n = 76). These groups were compared with a group of patients with borderline personality disorder (BPD) (n = 108) and a non-clinical group (NC) (n = 444). Patient data were collected at two outpatient clinics in Uppsala, Sweden. NC control data were collected through convenience sampling. Participants filled out questionnaires assessing personality style. Results: The main findings were more pronounced overcontrol reported by the ANr and AAN groups compared with the BN, BPD, and NC groups, and no significant difference in resiliency between the ED and the NC groups. Considerable variability of over- and undercontrol was also found within each group. Conclusions: The results replicate previous findings when EDs are classified according to current diagnostic criteria (DSM-5). Results indicate that taking personality style into account may improve understanding of EDs. For example, it may facilitate understanding of characteristics like social deficits and rigidity that are attributed to poor treatment outcome in anorexia.
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| 6. |
- Isaksson, Martina, 1985-, et al.
(författare)
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Psychometric properties of the Swedish version of the Ego Resilience scale (ER) and a new shortened version of the Ego Undercontrol scale (EUC)
- 2021
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Ingår i: Current Psychology. - : Springer Science and Business Media LLC. - 1046-1310 .- 1936-4733. ; 40:3, s. 1498-1506
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Tidskriftsartikel (refereegranskat)abstract
- The Ego Resilience scale (ER) and The Ego Undercontrol scale (EUC) are designed to assess personality types based on how people inhibit or express their emotional impulses. The study aim was to evaluate the psychometric properties of the Swedish version of both scales. Two community samples were recruited through convenience sampling and were informed about the study either while attending an undergraduate class at University or through advertisement on the Internet. For the two samples respectively, 483 and 197 individuals aged 18–70 completed the self-rating questionnaires via a website. In the first sample, factor structure, internal consistency, test-retest reliability and construct validity of the ER and the EUC were evaluated and a shorter version ofthe EUC (EUC-13) was developed based on the outcome. In the second sample, factor structure and psycho- metric properties ofthe EUC-13 were analyzed. Exploratory and confirmatory factor analysis supported both the original version of the ER and the EUC-13. Both instruments showed satisfactory levels of internal consistency for all subscales but Socially restrained behavior from the EUC-13, good test-retest reliability, as well as satisfactory preliminary evidence ofvalidity. Further validation studies are recommended, such as investigating the scales in clinical settings.
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| 7. |
- Isaksson, Martina, 1985-, et al.
(författare)
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Radically open dialectical behavior therapy for anorexia nervosa : A multiple baseline single-case experimental design study across 13 cases.
- 2021
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Ingår i: Journal of Behavior Therapy and Experimental Psychiatry. - : Elsevier. - 0005-7916 .- 1873-7943. ; 71
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND OBJECTIVES: No treatment for adult anorexia nervosa (AN) has shown sufficient effectiveness or superiority to other treatments. Overcontrol has been suggested as a viable mechanism to target in the treatment of patients with AN. Radically open dialectical behavior therapy (RO DBT) is developed for disorders related to maladaptive overcontrol. Our objective was to evaluate the outcome of RO DBT for AN in a clinical outpatient setting.METHODS: Thirteen adult female patients with mild to moderate AN provided written consent and entered a multiple baseline single-case experimental design study. Median age at eating disorder (ED) onset was 15 years and the median duration of the ED was 10 years. Individual changes were assessed weekly during a baseline phase (A) of four to six weeks, and during the subsequent 40-week RO DBT phase (B). Additional assessments were conducted before and after treatment, and at a six-month follow-up. Primary outcome was ED psychopathology. Secondary outcomes were psychosocial impairment, quality of life, social connectedness, and adaptive control strategies.RESULTS: Eight patients (62%) completed treatment. All completers were in full remission after treatment, with BMI ≥18.5 kg/m2 and ED psychopathology within one standard deviation of the community mean. Improvements occurred after introducing RO DBT, not during baseline.LIMITATIONS: Participants were female with mild to moderate AN, limiting generalizability to severe AN or males.CONCLUSIONS: The study provides preliminary support for using RO DBT in adult outpatients with AN and overcontrol. Further studies should replicate these findings.
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| 8. |
- Isaksson, Martina, 1985-, et al.
(författare)
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Sharing and connecting with others – patient experiences of radically open dialectical behavior therapy for anorexia nervosa and overcontrol : a qualitative study
- 2021
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Ingår i: Journal of Eating Disorders. - : BioMed Central (BMC). - 2050-2974. ; 9:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Recovery rates after psychological treatments for anorexia nervosa are low to moderate, and in adults, no treatment outperforms any other. The aim of this study was to evaluate patient experiences of radically open dialectical behavior therapy, a treatment developed for disorders related to maladaptive overcontrol. Methods: Eleven female patients with anorexia nervosa were interviewed after either treatment completion (eight patients) or drop-out (three patients). Interviews were transcribed ans analyzed with inductive thematic analysis. Results: The analysis yielded five main themes: 1) a comprehensive treatment, 2) the benefits of sharing and connecting with others, 3) growing trust, 4) moving toward valued goals – but some remain, and 5) doing well in treatment. Conclusion: Patients appreciated what they described as a comprehensive treatment and holistic view of their problems, which helped them reduce both maladaptive overcontrol and eating disorder symptoms. Gradually sharing personal experiences both in- and outside therapy was described as essential and led to enhanced social connectedness.
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| 9. |
- Johansson, Linda, 1975-
(författare)
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The Role of Cognitive Processes in Eating Pathology
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Researchers have recently combined clinical and cognitive areas of research in order to investigate the role of cognitive factors in explaining how emotional disorders are developed and maintained. It is believed that biased cognitive processing of emotionally relevant information can greatly affect emotional responses and behaviour where insights into such cognitive processes can have invaluable clinical implications.The present thesis investigates the role of cognitive biases for information related to food and body appearance in individuals with eating disorders (ED) and those with non-clinically eating disorder-related concerns (NED). Are ED characterised by cognitive biases toward such information related to their specific concerns? Are such cognitive biases specific to clinical ED or present also in NED samples? Are cognitive biases operating at both conscious and unconscious levels of cognitive processing?The tasks used to pursue these questions were: the emotional Stroop task, an Internet version of the emotional Stroop, Jacoby’s white noise paradigm and a recognition task. The influence of priming on the emotional Stroop task was also investigated in order to test whether the use of this task could be extended to more complex investigations than selective attention.Results provide support for that cognitive processing of information related to eating and body appearance is biased in individuals with ED. It is, however, unclear whether such biased processing is specific to clinical ED. Findings further suggest that cognitive biases occur primarily at unconscious levels of cognitive processing. Support was also obtained for that the emotional Stroop task is sensitive to priming where initial body perception may be one factor influencing cognitive responses toward negative self referent words following exposure to thin ideal images. Results further suggest that the emotional Stroop task successfully can be administered via the Internet where manipulating task delivery and response mode may increase the sensitivity of this task. Some of the advantages of administering the emotional Stroop task via Internet over traditional methods are access to more heterogeneous samples, more ecologically valid situations, reduced costs and minimisation of demand characteristics.
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| 10. |
- Ljungman, Lisa, 1981-
(författare)
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Parents of Children with Cancer : Psychological Long-Term Consequences and Development of a Psychological Treatment for Parents of Survivors
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aims of this thesis were to increase the knowledge about the long-term psychological consequences in parents of children diagnosed with cancer, including parents of childhood cancer survivors (CCSs) and bereaved parents, and to take the first steps towards developing a psychological treatment for parents of CCSs.Study I was a systematic review synthesizing the literature on psychological long-term consequences in parents of CCSs. Study II had a longitudinal design assessing posttraumatic stress symptoms (PTSS) from shortly after the child’s diagnosis (T1, N=259) up to five years after end of the child’s treatment or death (T7, n=169). Study I and II concluded that while most parents show resilience in the long-term, a subgroup report high levels of general distress and/or PTSS. In Study III, interview data from the last assessment in the longitudinal project (T7, n=168) was used. Participants described particularly negative and/or positive experiences in relation to their child’s cancer, and results pointed to the wide range of such experiences involved in parenting a child with cancer. In Study IV and V, parents of CCSs reporting cancer-related psychological distress were included (N=15). In Study IV, a conceptualization of this distress was generated by aggregation of individual behavioral case formulations. The conceptualization consisted of two separate but overlapping paths describing development and maintenance of symptoms of traumatic stress and depressive symptoms. In Study V, cognitive behavior therapy (CBT) based on the individual case formulations were preliminarily evaluated in an open trial. The CBT appeared feasible, and at post-assessment participants reported significant decreases in PTSS (p<.001), depression (p<.001), and anxiety (p<.01) with medium to large effect sizes (Cohen’s d=0.65-0.92).Findings indicate that psychological long-term consequences in parents of children with cancer consist of a broad range of negative as well as positive experiences, and that while most parents show resilience in the long-term, a subgroup report high levels of psychological distress. For parents of CCSs this distress is suggested to primarily consist of symptoms of traumatic stress and depression, and a preliminary evaluation of CBT targeting hypothesized maintaining mechanisms showed promise in terms of feasibility and treatment effect.
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