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- 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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| 2. |
- Alfonsson, Sven
(författare)
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Treatment Adherence in Internet-Based CBT : The Effects of Presentation, Support and Motivation
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Homework assignments that patient work with between sessions is a key component in both face-to-face and Internet-based Cognitive Behavior Therapy (CBT). However, adherence to assignments is often low and it is largely unclear what factors predict or affect treatment adherence, and in the end, treatment outcomes. The overall aim of this thesis was to investigate if treatment presentation and therapist support can affect adherence and treatment outcome in internet-based CBT, whether adherence can be predicted by motivation variables and to compare differences in face-to-face and online conditions in this regard.A randomized controlled trial with a brief online relaxation program for people with stress and anxiety symptoms was conducted (n = 162). Participants in the enhanced support conditions completed a larger proportion of the online treatment but adherence was not affected by enhanced treatment presentation (Study I). Participants reported reduced symptoms of stress and anxiety after the relaxation program but there were no significant additional effects of enhanced presentation or support (Study II). Participants who adhered to the prescribed assignments reported lower symptom levels at study end, regardless of treatment conditions. Adherence to the online treatment was predicted by subject factors such as treatment credibility prior to the treatment and intrinsic motivation during the treatment (Study III). To further elucidate how motivation may affect adherence, an experiment with a one-session psychotherapy model was subsequently conducted (n = 100). Participants who were randomized to the face-to-face condition reported higher motivation for the assignment and completed significantly more of the homework compared to participants in the online condition (Study IV). Self-reported intrinsic motivation could predict adherence in both conditions while new motivational variables were identified specifically for the online condition.The results from these studies confirm that adherence to assignments in Internet-based CBT is difficult to affect with treatment features but can be predicted early in treatment by subject factors such as treatment credibility and motivation. How such motivational variables can be affected to improve treatments is still unclear.
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| 3. |
- Buhrman, Monica, 1974-
(författare)
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Guided Internet-Based Cognitive Behaviour Therapy for Chronic Pain
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Chronic pain is a one of the most common causes of disability and sick leave. Psychological factors play a central role in the experience of pain and are important in the management of pain. However, for many people with chronic pain CBT is not available. There is a need to develop alternative ways to deliver treatments that reach more individuals with chronic pain. Internet-based treatments have been shown to be effective for several disorders and recent research suggests that internet-based CBT for chronic pain can be effective. The present thesis included four randomized controlled studies with the aim of evaluating whether guided internet-based treatments based on CBT can help individuals with chronic pain regarding psychological variables.Study I investigated the effects of an internet-based CBT intervention with telephone support for chronic back pain. The study showed reductions in some variables assessed. Study II investigated the effects of an internet-based CBT intervention for chronic back pain without telephone support and with a live structured interview before inclusion. It was found that the treatment can reduce some of the distress associated with chronic pain.Study III investigated the effects of a guided internet-delivered CBT as a secondary intervention. Participants were patients who had previously completed multidisciplinary treatment at a pain management unit. Results showed that the internet-based treatment can be a feasible option for persons with residual problems after completed pain rehabilitation. Effects remained at six-month follow-up. Study IV focused on the effect of a guided internet-delivered acceptance and commitment therapy (ACT) for persons with chronic pain. Results suggest that an internet-delivered ACT treatment can help persons with chronic pain. Effects remained at six-month follow-up.In conclusion, guided internet-based CBT can decrease distress associated with chronic pain.
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