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- Zetterqvist, Maria, 1970-
(författare)
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Non-Suicidal Self-Injury in Swedish Adolescents : Prevalence, Characteristics, Functions and Associations With Childhood Adversities
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Non-suicidal self-injury (NSSI), such as intentionally cutting, burning or hitting oneself, is a behavior with potentially detrimental consequences and empirical studies are necessary to gain knowledge of how to prevent NSSI in adolescents. The aims of this thesis were to investigate the prevalence, methods, characteristics and functions of NSSI in a large community sample of Swedish adolescents, and to examine the relationship between NSSI and adverse life events and trauma symptoms. All empirical studies had a cross-sectional design and were based on 3,097 adolescents in the county of Östergötland, aged 15-17 years, in their first year of high school. Participating school classes were selected through a randomization process and administered self-report questionnaires.In study I (n = 3,060) a single item NSSI question resulted in a prevalence rate of 17.2%, while 35.6% of adolescents reported having engaged in NSSI at least once during the past year when given a checklist. The most commonly reported type of NSSI in this sample was “bit yourself”, followed by “hit yourself on purpose”, “erased your skin” and “cut or carved on your skin”. Applying the proposed DSM-5 diagnostic criteria of NSSI resulted in a prevalence rate of 6.7%. Results in study II (n = 2,964) showed that after controlling for gender, parental occupation and living conditions, adolescents with no self-injurious behavior reported the lowest level of adversities and trauma symptoms, while adolescents with both NSSI and suicide attempts (5.7%) reported the highest levels compared to those with only NSSI or a suicide attempt. Adolescents reporting frequent NSSI reported more adversities and trauma symptoms than those with less frequent NSSI. Automatic functions, such as affect regulation, self-punishment and feeling-generation, were the most commonly reported functions of NSSI. Attempts in study I to confirm Nock and Prinstein’s (2004) four-factor model of underlying factors of NSSI functions resulted in a close to acceptable fit. An attempt to refine the factor analysis on this community sample of Swedish adolescents, using Mplus with cross-validation, was made in study III (n = 836). An exploratory factor analysis resulted in a three-factor model (social influence, automatic functions and non-conformist peer identification), which was validated in confirmatory analysis. In order to adhere more closely to learning theory and the concept of negative and positive reinforcement, the third factor was then split into two factors, resulting in a four-factor model (social influence, automatic functions, peer identification and avoiding demands), which showed excellent fit to the data in the confirmatory factor analysis. Study IV (n = 816) showed that NSSI frequency, gender (female), self-reported experience of emotional and physical abuse, having made a suicide attempt, prolonged illness or handicap and symptoms of depression and dissociation were significant predictors in the final model of the automatic functions, indicating that these variables are important in understanding the mechanisms underlying the need to engage in NSSI to regulate emotions, generate feelings, gain control or to self-punish. Symptoms of depression and dissociation mediated the relationship between sexual, physical and emotional abuse and the automatic functions. Furthermore, frequency of NSSI, gender, emotional abuse, prolonged illness or handicap and symptoms of depression uniquely predicted automatic functions but not social functions. Self-reported experience of physical abuse, having made a suicide attempt, symptoms of anxiety and dissociation were significant in the final model of social functions, i.e., performing NSSI to influence or communicate with others, to avoid demands or to identify with peers. Of these, symptoms of anxiety were uniquely associated with social functions. Symptoms of anxiety and dissociation mediated the relationship between physical abuse and social functions of NSSI.Taken together, this thesis has shown that NSSI is prevalent in Swedish adolescents and findings contribute to the discussion of a potential NSSI diagnosis. It is important to consider the effect of different types of negative life events and trauma symptoms in relation to NSSI in adolescents. Assessing the specific reinforcing functions of NSSI and the underlying factor structure can be helpful in developing functionally relevant individualized treatment.
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| 2. |
- Jansson, Markus, 1971-
(författare)
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Insomnia: psychological mechanisms and early intervention : a cognitive-behavioral perspective
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This dissertation focused on the role of psychological mechanisms in the development of insomnia and the effectiveness of an early cognitive-behavioral intervention for insomnia. The first aim was to examine whether distress, worry, and dysfunctional beliefs and attitudes about sleep were related to the development of insomnia. The findings from study I indicated that distress (anxiety and, to some extent, depression) was related to the development of insomnia. In study II, the relationship between sleep-related worry and subjective sleep perception was demonstrated to intensify over time, indicating that sleep-related worry was also linked to the development of insomnia. This indicates that both distress and sleep-related worry may be mechanisms that can be regarded as two of several pathways to insomnia. While distress was related to developing an onset of insomnia, worry was linked to the early development of insomnia. In study IV, dysfunctional beliefs and attitudes about sleep were not related to clinical improvement following cognitive behavior therapy for early insomnia. However, reductions in dysfunctional beliefs and attitudes about sleep were consistently linked to improvements in daytime symptoms, but not to sleep improvements. Instead of implying that such beliefs and attitudes are less important than distress and worry in the development of insomnia, it may rather suggest that dysfunctional beliefs and attitudes about sleep play a slightly different role in insomnia than previously envisioned. The second aim of this dissertation was to compare the effects of cognitive-behavioral therapy for insomnia with self-help information in patients with a short history of insomnia. In study III, the results showed that an early cognitive-behavioral intervention was effective for individuals with insomnia. To the benefit of the patients with insomnia and to society, cognitive behavior therapy may have a deserving and vital role as an early intervention for patients with insomnia. Taken together, the results in this dissertation indicate that psychological mechanisms play an important role in the development of insomnia. The findings might thus add to the elaboration of cognitive-behavioral models of insomnia. While most previous research has examined insomnia only in its persistent form, the focus of this dissertation was to study insomnia in its early phase. An approach where insomnia is studied in its early phase of development has not only heuristic value to the development of cognitive-behavioral models of the condition, but might also have implications for how cognitive-behavioral therapy for insomnia can be elaborated in future research and integrated in clinical settings.
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| 3. |
- Claesson, Katja, 1967-
(författare)
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Shame: Mechanisms of Activation and Consequences for Social Perception and Self-image
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis was the exploration of shame. Four experiments are among the very first to empirically test the validity of Tomkins' shame concept. The relation between internalized shame and memories of early interactions was examined, as well as Tomkins' concept of shame as an innate, momentary emotion. The influence of internalized shame as a personality trait on momentary shame emotion was also explored. Thirdly, how momentarily activated shame influences perception of self and others was studied. Finally, consequences of conscious versus unconscious shame activation was compared. Data from two survey studies implied that memories of ignoring and abandoning behaviors from mother are those that correlate most strongly with internalized shame. In the four experimental studies, internalized shame did not seem to influence momentary shame emotion, although two experiments implied different reactions to the praise that constituted part of the shame activating sequence depending on degree of internalized shame. Two experiments in part supported Tomkins’ notion of shame as a consequence of impeded positive emotion. However, participants with a high degree of internalized shame reacted with shame emotion to the praise feedback intended to elicit positive emotion. Therefore Tomkins’ concept of shame was successfully tested only with participants with a low degree of internalized shame. With this group, Tomkins’ conceptualization, however, received support. In addition these two experiments implied different processes for consciously versus unconsciously activated shame, since consequences for social perception and self-image following shame were reversed depending on whether the activating circumstances were conscious or not. The two subsequent experiments did not support the conclusions from the previous two, but gave some implications that shame activation, its consequences, and the effects of conscious versus unconscious activation are highly dependent on personal characteristics and social context. Taken together, data give some support to the validity of Tomkins’ shame conceptualization, but implies that it might be far too general, and that shame emotion might be primarily socially dependent.
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| 4. |
- Söderquist, Johan, 1968-
(författare)
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Posttraumatic stress after childbirth
- 2002
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of the thesis was to study the occunence of posttraumatic stress after childbirth, as seen in Posttraumatic Stress Disorder (PTSD). Furthermore the studies explored potential risk factors, in pregnancy and during the delivery, for posttraumatic stress after childbirth and its longitudinal course, one to eleven months postpartum. Posttraumatic stress was also studied in comparison with the occunence of depression, in pregnancy and after childbirth.Study 1 and 2 had a cross-sectional design and comprised 1640 consecutively delivered women in Linköping, Sweden. The variables were assessed once, using questimmaires measuring posttraumatic stress and fear of childbirth. Obstetric data were collected from the medical records.Study 3, 4 and 5 were based on a cohort of 1224 women who were recruited in Linköping and Kalmar. Variables were assessed in early and late pregnancy. After the delivery the variables were assessed four times: 1, 4, 7, and 11 months postpartum. Measurements by means of questionnaires comprised demographic data, potential risk factors, posttraumatic stress, fear of childbirth, and depression.Within 1-11 months after the delivery, 1-2% of the women developed posttraumatic stress. Emergency cesarean section and vaginal instrumental delivery were associated with an increased risk for posttraumatic stress postpartum.Severe fear of childbirth, "pre"-traumatic stress (similar to posttraumatic stress but future oriented) and depression in pregnancy were associated with an increased tisk of suffedng from posttraumatic stress within 1-11 months postpartum. During that period, 24 of the 37 women with posttraumatic stress also had depression.
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| 5. |
- Willebrand, Mimmie, 1973-
(författare)
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Coping, Personality and Cognitive Processes in Burn Injured Patients
- 2003
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Being severely burned is a traumatic life event that affects the victim both physically and psychologically. Recovery can be a long process that is dependent in part upon psychological factors, but research in this area is still quite limited. The main aim of the thesis was to explore coping, personality and cognitive processes in long-term and short-term adaptation. The participants were recruited from three separate samples of former and consecutive adult burn patients. A questionnaire, the Coping with Burns Questionnaire (CBQ), was developed to retrospectively assess coping. It consisted of six coping factors related in different ways to self-reported health status. Regarding personality, the former patients displayed slightly more Neuroticism than people in general, suggesting an overrepresentation of premorbid neurotic personality traits. Avoidant coping was related to poorer perceived health status, more maladaptive personality traits, and was a strong predictor of psychological symptoms at three months post-burn. Regarding cognitive processes, a moderate attentional bias towards burn-related information was found in the former patients when using the emotional Stroop task. This indicates that the burn may still be an important issue years after the event. Finally, former patients’ reactions to participating in a trauma-related postal survey were investigated. A majority felt that participation was positive or even beneficial, while a small subgroup felt that participation was cumbersome or negative. To summarise, although many burn patients adapt well in the long run, the burn may still be a significant theme and the subgroup of Avoidant copers are especially vulnerable. The CBQ seems to be an adequate tool for discerning individuals at risk for poor adjustment. Trauma-related postal questionnaires are well accepted by a majority of former burn patients. Although long-term prospective follow-ups are needed to further validate the results, it is suggested that early screening of psychological factors could be of value in burn care.
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