| 1. |
- González-Deleito, Carmen Muñoz, et al.
(författare)
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Ultra-brief acceptance & commitment therapy for inpatients with psychosis - a single-case experimental design investigating processes of change
- 2024
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Ingår i: Cognitive Behaviour Therapy. - : Routledge. - 1650-6073 .- 1651-2316. ; 53:3, s. 267-285
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Tidskriftsartikel (refereegranskat)abstract
- People with primary psychosis are among the most seen in inpatient psychiatry. Treatment guidelines recommend both pharmacological and psychological treatments. However, psychological treatments are not routinely offered in many settings. There is also a lack of research on psychological treatments for this vulnerable population in the inpatient setting. The first aim of the current study was to examine treatment effects of a brief form of Acceptance and Commitment Therapy on outcomes valued by the treatment recipients. The second aim was to explore hypothetical processes of change in relation to outcomes over time. Three people with primary psychosis were treated for two to four sessions. A replicated single-case experimental design with multiple baselines across subjects (Clinical Trials registration number ID NCT04704973) was employed to examine treatment effects. The Personal Questionnaire (PQ) was used as primary outcome, symptom believability and preoccupation as proposed processes of change. Data were analyzed using visual inspection, calculation of Tau-U values, and cross-lagged correlation. All participants improved significantly on PQ and the symptom preoccupation measure. Two improved significantly on the symptom believability measure. Cross-lagged correlation analyses showed no clear mediation. Change in proposed processes of change and primary outcome predominantly happened concomitantly, although patterns of results reflected individual differences.
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| 2. |
- Müssener, Ulrika, et al.
(författare)
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Promoting Healthy Behaviors Among Adolescents and Young Adults With Intellectual Disability : Protocol for Developing a Digital Intervention With Co-Design Workshops
- 2023
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Ingår i: JMIR Research Protocols. - : JMIR Publications Inc.. - 1929-0748. ; 12
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Tidskriftsartikel (refereegranskat)abstract
- Background: Intellectual disability (ID) is a neurodevelopmental disorder associated with a poorer health profile and higher mortality. Young people with ID have more sedentary lifestyles than their typically developing peers. Consequently, this group is at significant risk of developing lifestyle diseases (ie, noncommunicable diseases) later in life. Increasing physical activity and eating a healthier diet have been argued to be effective ways to improve the health of adolescents and young adults with ID. Digital interventions are a viable option for improving health behaviors. Objective: This research protocol describes a co-design approach using workshops to develop a digital intervention that promotes healthy behaviors, including increasing physical activity and eating a healthier diet, among adolescents and young adults with ID. Methods: A participatory design using a co-design approach will be applied as a strategy to include potential users of the digital intervention and other stakeholders in the research process, comprising research design, data collection, and data analysis. A total of 7 to 10 workshops will be conducted aimed at developing a digital intervention and will include procedures for assessing needs; facilitators and barriers to health promotion; physical, mental, and social well-being; participation; and relationships. The workshops will include 12 to 18 stakeholders with experience of clinical practice and research related to young people with ID, including relatives, as well as adolescents and young adults (aged 16-25 years) with mild to moderate ID. Participants will perform a mixture of individual and group work using whiteboards, sticky notes, felt-tip pens, cards, balls, stickers, and wireframe templates. Data analysis will take place concurrently with data collection as an iterative process. Transcribed data from the audio and video recordings of the groups’ discussions will be analyzed following a qualitative methodological procedure. Results: This study protocol provides a systematic record of the scientific methodologies used when developing the digital intervention and provides insights into the potential practical solutions and challenges when following a co-design approach in which relatives and professionals, as well as adolescents and young adults with ID, are included as research partners. Recruitment of participants started in April 2023. Data collection, analysis, and reporting will be completed in December 2023. Conclusions: This study will explore the effectiveness of workshops at gathering rich, reliable, and valid data in a co-design approach with participants. The results will provide increased knowledge in how to use technology to develop novel, evidence-based, and scalable interventions that adolescents and young adults with ID can and want to use to motivate physical activity and a healthier diet. The project will provide a simple and cognitively accessible digital solution for promoting lifestyle behaviors tailored to the needs of adolescents and young adults with ID.
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| 3. |
- Mälarstig, Ida, et al.
(författare)
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Experiences of conducting a substance use disorder treatment, A-CRA, in compulsory institutional care for youth-The challenge of promoting openness in a closed, temporary setting
- 2023
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Ingår i: Children and youth services review. - : Elsevier. - 0190-7409 .- 1873-7765. ; 148
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Tidskriftsartikel (refereegranskat)abstract
- Effective help for youths in compulsory institutional care in Sweden is of utter importance, but available sub-stance use disorder treatments have been designed for outpatient care and are not readily implemented in the specific lockable setting. The main objective of this study was to explore the experiences of seven therapists who were trained and supervised in conducting the evidence-based method Adolescent Community Reinforcement Approach (A-CRA), with youth 16-21 years old. The youths suffered from substance use disorder and socially disruptive or criminal behaviour and were placed in compulsory institutional care run by the Swedish National Board of Institutional Care. Using content analysis with an inductive approach, results show that therapists perceive A-CRA as a helpful treatment but also describe challenges with the flexible and goal-oriented approach and the temporary context. For future studies, it would be valuable to further explore the youths' experiences of psychological treatment in institutional care and how therapists can help youth identify and work towards desired change.
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| 4. |
- Tyrberg, Mårten, 1981-, et al.
(författare)
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ACT for Psychotic Inpatients, Broad Implementation in a Swedish Context
- 2015
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Konferensbidrag (refereegranskat)abstract
- In recent years, the research base supporting ACT for psychosis has grown (e.g. Bach & Hayes, 2002; Gaudiano & Herbert, 2006; White et al., 2011; Bach, Hayes & Gallop, 2012; Shawyer et al., 2012). In this symposium, pilot results from a small study on a clinical sample in Sweden will be presented. A total of 21 psychotic inpatients were randomized to either treatment as usual (TAU) or TAU plus a short ACT intervention, on average 2 sessions. Groups were measured for rehospitalization and values-based living at pretreatment, posttreatment and four month follow-up. Results indicate that the ACT group was rehospitalized to a lesser extent than the TAU group, although the difference was not significant. Also, the ACT group scored higher on the Bull’s-Eye Values Survey at follow-up, the difference being marginally significant. All in all, the results expand somewhat upon previous findings in the same population (Bach & Hayes, 2002; Gaudiano & Herbert, 2006), by indicating that ACT might affect values-based living in addition to decreasing need for rehospitalization. The next step in this research project in Sweden will be implementing ACT in the ward context in a broader way. This will be done in two ways: 1) By training all ward staff in the method. The effects of this training, and of regular supervision, will be investigated by administering measures of work related acceptance to staff. 2) By investigating ACT as an individual treatment in a larger sample, where therapists will be ward staff using a manual that was custom-made for this particular project.
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| 5. |
- Tyrberg, Mårten, 1981-
(författare)
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Bringing psychological treatment to the psychiatric ward : Affecting patients, staff, and the milieu
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The psychiatric ward is a complex setting. This has to do partly with the severity of the patients’ suffering. Often, they present with such diagnoses as psychosis, self-harm, substance abuse, and suicidality. In fact, they often present with a combination of these. This renders the delivery of effective treatment a challenging task. Partly, the complexity of the ward has to do with aspects of the context itself. Admissions and discharges often happen fast and unexpectedly, staff members are expected to handle various challenging behaviors, they display quite high levels of burnout and work dissatisfaction, and the wards are often staffed by bank staff, leading to a lack of continuity of care. This adds to the challenge of delivering effective treatment. In the typical Swedish ward, treatment consists of medication, nursing, observation, and management of risk behaviors. Psychological treatment is seldom a routine part of inpatient care. However, there are sound arguments for adding psychological treatment in the form of cognitive behavior therapy (CBT) of various modalities. Further, there is promise in psychosocial interventions delivered by the nursing staff after appropriate training, and in providing supervision to the staff.The aim of the present thesis was to investigate the feasibility and potential efficacy of acceptance and commitment therapy (ACT), a CBT based psychotherapy model, as a broadly applied intervention in the context of psychiatric inpatient care. In three studies, ACT was evaluated as a brief individual psychotherapy intervention, and as a psychologically informed approach to dealing with patients performed by the nursing staff group in a psychiatric ward for psychosis patients.In study I, an average of two sessions of ACT was delivered to patients (n = 11) with a diagnosis of psychosis. Compared to a control group (n = 10), the risk for rehospitalization during a four-month follow-up period was significantly smaller for patients in the experimental group. There was also a trend toward increased values-based living scores in the experimental group, compared to controls.Study II evaluated the effects on staff members (n = 20) and patients (n = 9) of a brief ACT training intervention tailored to the staff group, the aim of which was to introduce ACT as a day-to-day approach to dealing with patients. After a total of 12 hours of ACT training, the staff group displayed a slight increase in work-related psychological flexibility, compared to before, while a non-randomized control group (n = 18) displayed a slight decrease. Patients being treated on the ward after the staff training displayed a slight increase in psychological flexibility during ward treatment, while patients being treated before displayed a slight decrease. In both cases, however, the differences were considered quite small (non-significant in statistical terms). Further, the study investigated ACT-consistent behavior changes among staff members following ACT training, using a multiple baseline single-subject design. Results revealed both expected and unexpected patterns of behavior.In study III, the usefulness of the ACT model was investigated using a qualitative content analysis. Staff members (n = 10) experienced ACT as useful in terms of dealing with patients’ struggles, enriching typical duties, and dealing with their own stress. Difficulties in using the model related to time restraints, complexities of the model itself, and the severity of patients’ illnesses.In summary, the present thesis adds to the research basis for ACT as a treatment for psychosis, delivered in an inpatient setting. It shows that the introduction of ACT as an add-on to traditional ward treatment in Sweden is for the most part feasible and acceptable. However, the thesis also discusses various challenges in the implementation of psychological treatment in such a complex context as the inpatient ward, both in terms of delivery of the treatment itself and the evaluation of its effectiveness.
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| 6. |
- Tyrberg, Mårten, 1981-, et al.
(författare)
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Implementation of ACT training in a psychiatric ward : Clinical experiences and staff-patient outcomes
- 2016
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Konferensbidrag (refereegranskat)abstract
- Conducting research in clinical psychiatric settings presents significant challenges. Patients’ suffering is often severe, and organizational aspects might hinder the implementation of structured psychological treatment. In this symposium, empirical data are presented from three different projects concerning ACT for different diagnoses –psychosis, body dysmorphic disorder (BDD) and high functioning autism spectrum disorder (ASD). The first talk concerns training inpatient ward staff in using the ACT model with psychosis patients. Data suggest slight positive changes in psychological flexibility for patients and staff. The second talk describes the evaluation of an ACT group treatment intervention for BDD outpatients, with results showing significant reductions in BDD symptomatology. The third talk covers a researchproject on ACT adapted for students and psychiatric outpatients with ASD, where data indicate reduced levels of stress and autistic core symptoms. Presenters will share their data, as well as common clinical experiences of implementing ACT in clinical psychiatric contexts.
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| 7. |
- Yekkalam, Negin, 1981-, et al.
(författare)
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Risk factors associated with symptoms of temporomandibular disorders among women with hypermobile Ehlers–Danlos syndrome : Questionnaire‐based study in Finland and Sweden
- 2024
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Ingår i: Journal of Oral Rehabilitation. - : John Wiley & Sons. - 1365-2842.
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Tidskriftsartikel (refereegranskat)abstract
- Background: Generalized joint hypermobility as a characteristic feature of Ehlers–Danlos syndromes (EDS) is among the factors contributing to temporomandibular disorders (TMD).Objective: To evaluate the prevalence of TMD symptoms and their risk factors among women born in Sweden or Finland who were 27- to 78-year-olds with diagnosed hypermobile EDS (hEDS).Methods: A cohort of women with confirmed hEDS (n = 185) was constructed from the members of the National EDS Associations in both countries. Based on questionnaire data, frequency of independent variables in terms of socio-demographic, general health and oral health-related factors, comorbid symptoms and psychological distress for self-reported TMD symptoms as the dependent variables, were calculated first. Prevalence ratios (PR) and their 95% confidence interval (95% CI) were estimated for the association between independent and dependent variables.Results: Nearly all participants reported TMD symptoms (98%) with TMD pain (95%), TMJ clicking (90%) and jaw fatigue (80%) as the most common symptoms and TMJ crepitation (63%) and luxation (44%) as the least common symptoms. Risk factors for TMD among 27- to 50-year-olds participants were Finland as a country of birth, living alone and self-reported worst pain in the body (not the joints). The respective risk factors among the 51- to 78-year-olds were Finland as a country of birth, family history of EDS, tinnitus and regularly taking contraceptives.Conclusions: Among adult women with confirmed hEDS, socio-demographic and health-related factors and comorbid symptoms were significantly associated with TMD but with differences regarding age group. Therefore, management of TMD requires a multidisciplinary approach among the affected.
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