| 1. |
- Vasiljevic, Sara, et al.
(författare)
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Brief internet-delivered skills training based on DBT for adults with borderline personality disorder : a feasibility study
- 2023
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Ingår i: Nordic Journal of Psychiatry. - : Taylor & Francis. - 0803-9488 .- 1502-4725. ; 77:1, s. 55-64
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Borderline personality disorder (BPD) is characterized by instability in emotions, relationships, and behaviors, such as self-injury and suicidal behavior. Dialectical Behavioral Therapy (DBT) is an established intervention for BPD, but there are long waiting times for treatment. This study aimed to explore if a brief internet-delivered DBT skills training program with minimal therapist support is acceptable, that it can be administered, useful, and does not do harm for patients with BPD.METHODS: Acceptability was measured through data on recruitment and attrition, utilization of the intervention, reported impulses to drop out, and through ratings on self-injury and suicidality. Participants were interviewed about their experiences of the intervention; analyzed with content analysis.RESULTS: Twenty patients on the waiting list for treatment at a DBT-clinic were invited and nine female patients (age 19-37 years) volunteered. The participants completed a large part of the intervention, which did not appear harmful since ratings of suicidal and self-harming behavior were similar before and after the intervention. In the interviews, participants stated that they had gained new knowledge and skills to manage situations, e.g. to stop and think before acting. Some even reported decreased levels of self-injury. The time spent on patient contact was short, and some patients reported difficulties to practice on their own and requested more support.CONCLUSIONS: The intervention seems to be acceptable. Future studies should investigate in what ways some BPD patients are more susceptible to internet-delivered skills training than others, and if this intervention could be delivered within a stepped-care model.
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| 2. |
- Alfonsson, Sven, et al.
(författare)
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The Self-Compassion Scale-Short Form : Psychometric evaluation in one non-clinical and two clinical Swedish samples
- 2023
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Ingår i: Clinical Psychology and Psychotherapy. - : John Wiley & Sons. - 1063-3995 .- 1099-0879. ; 30:3, s. 631-642
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Tidskriftsartikel (refereegranskat)abstract
- Background: Self-compassion has been defined as the ability to be with one's feelings of suffering in a warm and caring way. Research has shown a negative association between self-compassion and mental illness, and that low self-compassion can make psychotherapeutic effects less likely. The ability to measure a patient's self-compassion in a fast and reliable way is therefore important in investigating effects of psychotherapies. The aim of the present study was to evaluate the psychometric properties of the Swedish version of the Self-Compassion Scale-Short Form (SCS-SF) in both non-clinical (NC) and clinical samples.Methods: Cross-sectional data were gathered in a NC community sample (n = 1,089), an eating disorder (ED) sample (n = 253) and a borderline personality disorder (BPD) sample (n = 151). All participants were asked to complete a number of questionnaires, including the SCS-SF, and 121 participants in the NC sample repeated the assessment after 2 weeks for test-retest analysis.Results: Confirmatory factor analyses supported the first-order model suggested in previous research. Good internal consistency (Cronbach's alpha = 0.78-0.87) and test-retest reliability (intra-class correlation = 0.84) were demonstrated for the entire scale. Results also showed good convergent validity, demonstrating moderate negative associations between self-compassion and mental illnesses, as expected, and acceptable divergent validity, demonstrating weak positive associations between self-compassion and quality of life and mindfulness.Discussion: The correlations between the SCS-SF and the instruments used for validation were weaker in the clinical samples than the NC sample. This may be due to difficulties measuring these constructs or that the associations differ somewhat between different populations, which could warrant further research. The results added some support to the assumption that self-compassion may overlap with mindfulness yet still represents a distinct construct.Conclusions: Analyses of the SCS-SF provided evidence of adequate to good psychometric properties, supporting use of the scale's total sum score and a first-order factor structure. This is in accordance with previous evaluations of the SCS-SF, suggesting that it is a reliable and time-efficient instrument for measuring a general level of self-compassion. This may be important when evaluating psychotherapy and investigating self-compassion and its influence on psychiatric illness.
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| 3. |
- Alfonsson, Sven, et al.
(författare)
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The self-efficacy in distress tolerance scale (SE-DT) : a psychometric evaluation
- 2022
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Ingår i: Borderline Personality Disorder and Emotion Dysregulation. - : BioMed Central (BMC). - 2051-6673. ; 9:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Skills training is believed to be essential in dialectical behavior therapy (DBT) and is also offered as a standalone intervention. There is a need to better understand each skills module's separate contribution to treatment outcomes. Several assessment instruments are available, but none of them provides specific information about patients' perceived ability to use skills promoting distress tolerance. The aim of the present study was to develop and evaluate the psychometric properties of a Swedish adaptation of the General Self-Efficacy scale (GSE) for skills use in distress tolerance - the Self-Efficacy in Distress Tolerance scale (SE-DT).Methods: Cross-sectional and longitudinal data were gathered in a non-clinical (NC) community sample (n = 407) and a clinical psychiatric (CP) sample (n = 46). Participants in the NC sample were asked to complete a set of 19 self-report instruments, including the SE-DT, and 45 participants repeated the assessment after 2 weeks. The patients in the CP sample filled out a subset of eight instruments; twenty patients repeated the assessment after completing a treatment intervention including mindfulness skills and distress tolerance skills or emotion regulation skills.Results: The analyses showed that the SE-DT is unidimensional with high internal consistency (Cronbach's alpha = .92) and good test-retest reliability (intraclass correlation = .74). The SE-DT also showed good convergent and divergent validity, demonstrating positive correlations with general self-efficacy and self-compassion, and negative correlations with difficulties in emotion regulation, psychiatric symptoms, and borderline symptoms. The SE-DT showed sensitivity to change, when pre- and post-treatment assessments were compared (Cohen's d = 0.82).Discussion: This is preliminary evidence that the SE-DT has adequate to good psychometric properties, supporting the use of a total sum score. The results indicate that the SE-DT can adequately measure the construct of self-efficacy with regard to dealing with distress and emotional crises. The instrument enables continued investigation of standalone skills training and the specific contribution of distress tolerance skills to treatment outcomes in DBT. Further studies are needed to investigate whether these results are valid in other populations. In addition, the field would benefit from a common definition of distress tolerance.
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| 4. |
- Eriksson, Emmi, et al.
(författare)
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The relationship between self-control and symptoms of anxiety and depression in patients with eating disorders : a cross-sectional study including exploratory longitudinal data
- 2023
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Ingår i: Journal of Eating Disorders. - : BioMed Central (BMC). - 2050-2974. ; 11
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Tidskriftsartikel (refereegranskat)abstract
- Background: Personality style can partly be described as the way an individual controls and regulates emotions and can be divided into over- and undercontrol. Studies have indicated that personality style may impact the onset, clinical presentation, and recovery from an eating disorder (ED). Furthermore, symptoms of anxiety and depression are common in patients with EDs. However, the association between self-control levels and anxiety/depression symptoms in patients with EDs remains unknown. The main aim of this study was to assess how levels of self-control relate to anxiety/depression symptoms in patients with EDs, with a secondary, exploratory aim to assess the stability of self-control during treatment.Methods: Patients were recruited from the outpatient ED clinic at the Uppsala University Hospital, between October 2014 and December 2019. In total, 227 patients (age: 25.4, SD: 7.1) were included at the start of their treatment, with 14 participants also completing post-treatment measurements. Self-control was assessed with the Ego Undercontrol scale (EUC-13), anxiety/depression symptoms with the Hopkins Symptoms Checklist (HSCL-25), and ED diagnosis and symptoms with the Eating Disorder Examination Interview (EDE-I) and Questionnaire (EDE-Q), respectively.Result: sA quadratic regression (n = 227) showed that levels of self-control accounted for about four percent of the variance in degree of global anxiety/depressive symptoms. Anxiety/depression symptoms were better explained by ED symptoms (R-2 = 0.24). Visualizations in boxplots revealed a tendency for extreme values of both over- and undercontrol to be associated with higher levels of depression, whereas symptoms of anxiety increased with increasing undercontrol. In the exploratory analyses (n = 14) levels of self-control remained more stable than symptoms of anxiety and depression, which decreased significantly during ED treatment.Conclusions: Our results indicated that anxiety/depression symptoms, in patients with EDs, were not strongly correlated with levels of self-control, but rather with ED symptoms. However, extreme values of both over- and undercontrol showed a tendency to be associated with higher levels of depression symptoms, whereas anxiety symptoms increased with increasing levels of undercontrol. Future studies could benefit from considering both over- and undercontrol as potentially dysfunctional.
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| 5. |
- Isaksson, Martina, 1985-, et al.
(författare)
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Longitudinal associations between community violence exposure, posttraumatic stress symptoms, and eating disorder symptoms
- 2024
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Ingår i: Journal of Eating Disorders. - : BioMed Central (BMC). - 2050-2974. ; 12:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Eating disorder (ED) symptoms have been associated with different types of traumatic events, such as exposure to sexual and physical violence, and emotional abuse. However, the relation between ED symptoms and community violence exposure (CVE) is underexplored, despite the latter's adverse effects on many aspects of adolescent functioning. The primary aim of this study was to evaluate the relation between CVE and ED symptoms in adolescents, while also investigating the potential mediating and moderating roles of posttraumatic stress (PTS) symptoms, gender, and ethnicity.METHODS: Data were collected longitudinally over two consecutive years in the city of New Haven, CT, in the United States. Participants were 2612 adolescent students from the public school system (1397 girls and 1215 boys) with an average age of 12.8 years (SD = 1.29). The students were comprised of several different ethnic groups, including Caucasians, African Americans and Hispanic Americans. Associations between CVE (no exposure, witnessing, and victimization) and PTS symptoms at year one, and ED symptoms (thoughts and compensatory behaviors) at year two, were assessed with self-rating instruments. Moderation and mediation analyses were conducted using a variant of linear regression (Hayes PROCESS macro).RESULTS: ED symptoms at year two were significantly associated with both witnessing and being a victim of community violence at year one, with most or all of the relations being explained by PTS symptoms. Overall, neither gender nor ethnicity had a meaningful moderating effect in the observed relations.CONCLUSIONS: The findings support the notion that assessing and addressing PTS symptoms might be beneficial when treating individuals with ED symptoms who have experienced community violence, irrespective of gender or ethnicity.
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| 6. |
- Isaksson, Martina, 1985-
(författare)
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Overcontrol in anorexia nervosa : assessment, occurrence, and treatment
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Excessive overcontrol – characterized by high risk aversion, compulsiveness, emotion inhibition, and social deficits – has been suggested to be a core mechanism for developing and maintaining anorexia nervosa. However, such factors are rarely targeted as key elements in treatment of the disorder. The overall aim of this thesis was to evaluate the occurrence of over- and undercontrolled personality styles in patients with eating disorders, and to evaluate the treatment effects and patient experiences of Radically open dialectical behavior therapy (RO DBT) for outpatients with anorexia. In a cross-sectional study (Study I) with two non-clinical samples (n = 483 and n = 197), psychometric evaluations showed that a new shortened version of the Ego Undercontrol Scale (EUC-13), measuring over- and undercontrol, and the Ego Resilience Scale (ER) measuring adaptive control, seemed promising for assessing the constructs. In a cross-sectional study (Study II) assessing the occurrence of overcontrol in a clinical and non-clinical population, findings showed that overcontrol was more common in restricting anorexia (n = 34) and atypical anorexia (n = 29), than in bulimia (n = 76), borderline personality disorder (n = 108), and a non-clinical sample (n = 444). Anorexia with binge eating and purging (n = 31) showed similar, but somewhat lower, levels of overcontrol compared with atypical and restricting anorexia. However, differences from the other eating disorder groups were not significant. In a single-case experimental design study with 13 patients (Study III), the effect of RO DBT – a treatment developed for disorders related to excessive overcontrol – was evaluated for outpatients with mild to moderate anorexia. Findings were that all completers (62%) were in remission after treatment, and that the treatment clinically and reliably reduced eating disorder psychopathology and clinical impairment, and increased quality of life. In a qualitative interview study (Study IV), 11 participants from Study III reported that they appreciated the comprehensive approach, where both the eating disorder and the overcontrol were addressed, and that sharing with others was important. Findings indicated that the EUC-13 and the ER seemed promising for assessing overcontrol, undercontrol, and resilience. The occurence of overcontrol in different types of AN raised questions regarding if treatment of AN would be more effective if these difficulties were addressed. Lastly, preliminary evidence showed that outpatient RO DBT could be effective for patients with mild to moderate AN and overcontrol, and that the treatment was well received by the patients.
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| 7. |
- 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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| 8. |
- Isaksson, Martina, 1985-, et al.
(författare)
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Psychometric properties of the Eating Disorder Symptom List (EDSL), a brief questionnaire for weekly assessment of eating disorder symptoms
- 2021
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Ingår i: Scandinavian Journal of Psychology. - : John Wiley & Sons. - 0036-5564 .- 1467-9450. ; 62:5, s. 648-654
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Tidskriftsartikel (refereegranskat)abstract
- Frequent assessment of eating disorder (ED) symptoms (e.g., on a weekly basis) may guide treatment planning in clinical services, and be an invaluable tool for improving clinical research. The aim of the present study was to evaluate the psychometric properties of a brief eight-item scale designed to assess ED behaviors during the preceding week (Eating Disorder Symptom List: EDSL). Cross-sectional data were collected in a non-clinical community sample (n = 406) and cross-sectional and longitudinal data were gathered in a clinical ED sample before and after treatment with Enhanced Cognitive Behavior Therapy for eating disorders (n = 47) and weekly during treatment with Radically Open Dialectical Behavior Therapy (n = 13). The EDSL showed acceptable to good internal consistency (α = 0.72–0.82) and test-retest reliability (r = 0.88). Convergent and divergent validity was satisfactory. Also, the EDSL was sensitive to change and could detect changes between before and after treatment, as well as on a weekly basis. We conclude that the EDSL is a brief scale entailing little patient burden, and that initial analyses of the scale provide preliminary evidence of satisfactory psychometric properties. The scale can be used for repeated measures in ED treatment studies and clinics to assess change or absence of change during treatment.
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| 9. |
- 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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| 10. |
- 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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