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2.
  • Andersson, Peter, et al. (författare)
  • Implementation and evaluation of Illness Management and Recovery (IMR) in mandated forensic psychiatric care-Study protocol for a multicenter cluster randomized trial
  • 2022
  • Ingår i: Contemporary Clinical Trials Communications. - : Elsevier. - 2451-8654. ; 27
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Forensic mental health care is hampered by lack of evidence-based treatments. The Swedish forensic mental health population consists of patients suffering from severe illnesses such as schizophrenia and bipolar disorders, similar to populations in international studies. Illness Management and Recovery (IMR) is an intervention for patients with serious mental illness, based on psychoeducational, cognitive-behavioral and motivational components. The purpose is to strengthen participants' illness management skills and recovery.Objective: To test effectiveness of IMR within forensic mental health by comparing it to treatment as usual.Method: This is a cluster-randomized controlled trial. Patients in forensic mental health inpatient units are randomized to an active (IMR) or a control condition (treatment as usual). Clustering of patients is based on ward-units where inpatients are admitted. Patients in the active condition receive two group and one individual IMR sessions per week. The treatment phase is estimated to last nine months. Outcomes include illness related disability, illness management skills, sense of recovery, hope, mental health and security related problems. Outcomes are measured at baseline, four months into treatment, at treatment completion and at three months follow-up. Staff experiences of implementing IMR will be explored by a self-report measure and semi-structured interview based on Normalization Process Theory.Ethics and dissemination: The study is approved by the Swedish Ethical Review Authority (Registration No. 2020-02046). Participation will be voluntary based on written informed consent. Results will be disseminated through peer-reviewed articles and conferences. The study is registered in the US registry of clinical trials (NCT04695132).
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3.
  • Björnsdotter, Annika, 1970- (författare)
  • Evaluation of Family Check-Up and iComet : Effectiveness as well as Psychometrics and Norms for Parent Rating Scales
  • 2014
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • This thesis compromise four studies, three regarding psychometrics and norms of parent rating scales, and one study regarding effectiveness of two different interventions. A normative sample consisting of 1443 parents with children aged 10 to 13 years old, was used in the Study I, II and III. In Study IV, 231 self-referred parents with children aged 10-13 years old with externalizing behavior problem (EBP) were randomized to either Family Check-Up (FCU) or iComet.The Strengths and Difficulties Questionnaire (SDQ) used in Study I proved to be a reliable and valid instrument with high internal consistency, clear factor structure and high correlation with other similar instruments. In addition, the results support the online use of SDQ as well as using norms obtained through traditional administration even when the SDQ has been administrated online. The Emotion Regulation Questionnaire (ERQ) investigated in Study II was shown to have adequate reliability and construct validity. The specific use of expressive suppression or cognitive reappraisal as a parental emotion regulation strategy was correlated as expected to the couple’s satisfaction, family warmth, and the employment of adequate discipline strategies. Swedish norms for self-rated ERQs are also presented. Study III investigated the Parental Knowledge and Monitoring Scale (PKMS), which was shown to be a useful instrument for assessing parental knowledge and its sources. Family climate appears to moderate important relationships between parental knowledge and conduct problems with implications for such things as family interventions. Finally, a person-oriented analysis was used in Study IV to subtype the children according to combinations of prosocial behavior and EBP, such as different levels of attention deficit hyperactivity disorder (ADHD) symptoms and/or oppositional defiant disorder (ODD) behaviors. Despite being a heterogeneous group of children with EBP, they were meaningfully grouped into significantly different profiles. Both FCU and iComet resulted in post-treatment measurement within non-clinical range for three of the five profiles. The two profiles that included high levels of ADHD behaviors at baseline assessment continued to have residual symptoms post intervention. 
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4.
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5.
  • Björnsdotter, Annika, 1970-, et al. (författare)
  • Psychometric properties of online administered parental Strengths and Difficulties Questionnarie (SDQ), and normative data based on combined online and paper-and-pencil administration
  • 2013
  • Ingår i: Child and Adolescent Psychiatry and Mental Health. - : Springer Science and Business Media LLC. - 1753-2000. ; 7
  • Tidskriftsartikel (refereegranskat)abstract
    • ObjectiveTo examine the psychometric properties of the online administered parental version of the Strength and Difficulties Questionnaire (SDQ), and to provide parental norms from a nationwide Swedish sample.MethodsA total of 1443 parents from of a national probability sample of 2800 children aged 10-13 years completed the SDQ online or as usual (i.e., using paper-and-pencil).ResultsThe SDQ subscales obtained from the online administration showed high internal consistency (polychoric ordinal alpha), and confirmatory factor analysis of the SDQ five factor model resulted in excellent fit. The Total Difficulties score of the SDQ and its other subscales were significantly related to the Disruptive Behavior Disorders (DBD) rating scale. Norms for the parent version of SDQ obtained from the Internet were identical to those collected using paper-and-pencil. They were thus combined and are presented sorted by child gender and age.ConclusionsThe SDQ seems to be a reliable and valid instrument given its high internal consistency, clear factor structure and high correlation with other instruments capturing the intended constructs. Findings in the present study support its use for online data collection, as well as using norms obtained through paper-and-pencil-administration even when SDQ has been administrated online.
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6.
  • Björnsdotter, Annika, 1970-, et al. (författare)
  • The Importance of Parental Knowledge
  • 2013
  • Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
    • Poor parenting is an important risk factor for development of conduct problems in children and adolescents. Inadequate parental monitoring is an example of a negative parenting behavior that has been shown to predict child conduct problems Findings from previous research on parental monitoring has been mixed due to the use of inconsistent and vague definitions. However, later research suggests that it is "parental knowledge" rather than "parental monitoring" that is associated with child and adolescent conduct problems. In the present study, we used an existing questionnaire that measures three possible sources of parental knowledge: child disclosure, parental solicitation and parental control. Our aims were to 1) examine the factor structure of a parenting monitoring/knowledge scale, 2) analyze if a high level of child disclosure and parental control as well as a low level of parental solicitation were associated to low conduct problems, 3) examine if a measure of family warmth correlates with child disclosure, and 4) whether parental knowledge mediates the relation between parental warmth and conduct problems. Parents of a national probability sample of 2800 children aged 10-13 years old were asked to complete a survey including these different scales. A total of 1446 parents completed the questionnaires. Brief description Analysis of the importance of parental knowledge regarding child disruptive behavior using an existing questionnaire that measures parental knowledge through three possible sources: child disclosure, parental solicitation and parental control.
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7.
  • Björnsdotter, Annika, 1970-, et al. (författare)
  • The Parental Knowledge and Monitoring Scale : Psychometrics and relations to conduct problems
  • Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
    • This study investigated psychometrics (internal consistency, factor structure) of the Parental Knowledge and Monitoring Scale (PKMS) when used for parents of children aged 10-13 years. We also evaluated PKMS associations to child conduct problems and potential moderators (family warmth, and conflict). Totally 1442 parents participated. The internal consistencies ranged from alpha .70 to .90. A confirmatory factor analysis of the sources of parental knowledge resulted in a fairly acceptable fit for a 4-factor model (Parental Solicitation, Parental Control, Child Disclosure, and Secrecy: RMSEA=.076, CFI=.99, GFI=.94). The subscales correlated positively (Secrecy negatively) with Parental Knowledge. Secrecy was associated with conduct problems in a hierarchical regression analysis. Family warmth and conflict significantly moderated the association of parental knowledge to conduct problems. 
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8.
  • Blom, Lisa, et al. (författare)
  • Little All Children in Focus (Little ACF), evaluation of a parental support program for parents of children aged 1–2 years : study protocol for a randomized controlled trial
  • 2023
  • Ingår i: Trials. - : BioMed Central (BMC). - 1745-6215. ; 24:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Child health and development can be promoted by strengthening and supporting parents. Research on parental support programs based on positive psychology and a health-promoting approach aimed at all parents, and in particular parents of infants is limited. All Children in Focus (ACF) is a parental support program that has been evaluated in a randomized trial in parents of children 3–12 years. The ACF is based on health promotion aiming to increase parents’ confidence and child’s well-being. In the current study, we will study the effects of a revised version of the ACF called Little ACF adapted to parents with children aged 1–2 years.Methods: The study includes a randomized controlled trial (RCT) taking place at several Child Health Centers (CHCs) in Sweden. The RCT will evaluate the efficacy of Little ACF (intervention) in comparison with four digital lectures about child development and parenting (active control). Parents are recruited at the 10-, 12-, or 18-month visits to CHC by CHC-nurses. Data to assess changes in parental competencies and child socio-emotional development are collected through online questionnaires completed by parents at five time points: baseline, post-intervention, after 6 and 12 months, and when the child is 3 years old.Discussion: The paper describes a study protocol of a randomized controlled trial evaluating the effects of a parental support program during infancy. Several issues related to the methodology and implementation are discussed.Trial registration: ClinicalTrials.gov NCT05445141. Registered on 6 July 2022.
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9.
  • Bråthén Wijana, Moa, et al. (författare)
  • Preliminary evaluation of an intensive integrated individual and family therapy model for self-harming adolescents
  • 2018
  • Ingår i: BMC Psychiatry. - : Springer Science and Business Media LLC. - 1471-244X. ; 18:1
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: To investigate the outcome of an integrated individual and family therapy (Intensive Contextual Treatment: ICT) in terms of reducing suffering and increasing functional adjustment among self-harming and/or suicidal adolescents with high symptom loads and their families. METHODS: Forty-nine self-harming and/or suicidal adolescents, Mage = 14.6, of predominantly Swedish origin and female gender (85.7%) participated with their parents. The study had a within group design with repeated measures at pre- and post-treatment, as well as six- and twelve-months follow-ups. Self-reports were used for the main outcomes; self-harm rates, suicide attempts, parent-reported days of inpatient/institutional care, internalized and externalized symptoms, perceived stress, emotion regulation, school hours and adjustment. Secondary outcomes were levels of reported expressed emotions within family dyads, as well as parental anxiety, depression and stress. RESULTS: From pre- to post-assessment, the adolescents reported significant reductions of self-harm (p = .001, d = 0.54) and suicide attempts (p < .0001, d = 1.38). Parent-reported days of inpatient/institutional care were reduced, as well as parent- and adolescent-reported internalizing and externalizing symptoms. Furthermore, school attendance and adjustment were improved, and the adolescents reported experiencing less criticism while parents reported less emotional over-involvement. The results were maintained at follow-ups. CONCLUSIONS: The adolescents and the parents reported improvements for the main outcomes. This treatment appears promising in keeping the families in treatment and out of hospital, suggesting that an integrative approach may be beneficial and feasible for this group. TRIAL REGISTRATION: This study has been approved 19/12 2011, by the regional review board in Stockholm (Dnr 2011/1593-31/5).
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10.
  • Enebrink, Pia (författare)
  • Antisocial behaviour in clinically referred boys : early identification and assessment procedures in child psychiatry
  • 2005
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Background: Oppositional and aggressive behaviour in children below twelve years of age is a frequent cause of concern for parents and teachers, and a common reason for referral to child and adolescent psychiatry. Whereas most children outgrow these behaviours, a small subgroup is at risk for developing a persistent antisocial lifestyle. Successfully identifying children at risk could prevent potential human and economic suffering of the child, his/her family, potential victim(s) and society. However, predicting which children are at higher risk for future antisocial behaviours is intricate and associated with the perils of mislabelling. Recently, promising approaches for early identification of boys at risk for future antisocial behaviour have been formulated. These include assessments of risk factors (risk assessments) and evaluation of certain personality traits callous-unemotional (CU) traits. CU-traits are defined as patterns of emotional dysregulation, such as a pronounced lack of empathy, remorselessness and shallow affects. The main aim of this thesis was to investigate whether these structured approaches might improve early identification of clinic-referred boys at risk for future antisocial behaviour and to explore clinical child psychiatric work with these children and their families. Method: A combination of quantitative and qualitative methodologies was used. A prospective longitudinal multicentre project was initiated in mid-Sweden during 2001. Parents of clinic-referred boys (n = 76) completed questionnaires and participated in a semi-structured researcher-led interview at baseline, yielding information to evaluate the risk for future antisocial behaviour. Parents were then interviewed again after six and thirty months. At the thirty-month follow-up we also included teachers as informants. Child clinicians at each clinic were asked to fill in separate evaluations of the boys risk. Furthermore, a qualitative study was conducted in which narrative interviews with 16 clinicians from seven child psychiatric teams enabled exploration of clinical work with conduct-disordered boys. Results: Assessments of risk for future antisocial behaviour, based on the risk assessment tool Early Assessment Risk List for Boys (EARL-20B), demonstrated acceptable interrater reliability (Paper I). EARL-20B-based assessments were associated with concurrent and prospective estimates of antisocial behaviour (Paper I-II). Combinations of EARL-20B risk factors were tentatively identified through cluster analysis, distinguishing between boys with high and low levels of antisocial behaviour (Paper I). Comparing the EARL-20B-based baseline evaluations with unstructured clinical baseline evaluations of risk and baseline DSM-IV Conduct Disorder (CD) indicated incremental predictive validity of the EARL-20B. The AUC estimate of CD-diagnosis at the thirty-month follow-up was of good accuracy (.87) for the EARL-20B. Further, conduct problem boys (n = 41) high on CU-traits had significantly more pervasive, varied and aggressive disruptive behavioural problems than boys low on these traits. This finding was not explained by the presence of DSM-IV AD/HD and Oppositional Defiant Disorder (ODD)/CD symptoms. Boys with CU-traits experienced poorer household circumstances, lived in families under high stress and received less help in school from special teachers than boys low in CU-traits (Paper III). The qualitative study suggested that child psychiatry clinicians consider a multitude of case characteristics when working with antisocial boys (Paper IV). The behaviour of the boys sometimes evoked feelings of fear among caregivers, signalling the need for instant interventions. The teams described a lack of consent and collaboration with other agencies, with unclear responsibilities across organisations. Conclusions: The results suggest that structured assessments of risk and the evaluation of CU-traits can be valuable for identifying severe antisocial behaviour in boys. Early identification procedures touch upon the delicate balance between discerning children at risk to prevent them from repeated violent and norm-breaking behaviours, and the dangers of labelling. When addressing either risk for violence or CU-traits in boys, the purpose, due to ethical considerations, should therefore be to prevent serious antisocial behaviours from occurring through the provision of treatment and other interventions. Over the years, researchers and clinicians have pointed to a need for improved management of antisocial behaviour in child psychiatric services. Improved collaboration and clearer responsibilities among agencies still seem necessary to enable good care and management.
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11.
  • Enebrink, Pia, et al. (författare)
  • Clinical work with antisocial behaviour in boys : Narrative interviews with clinical teams in Swedish child- and adolescent psychiatry
  • 2006
  • Ingår i: Children and youth services review. - : Elsevier BV. - 0190-7409 .- 1873-7765. ; 28:6, s. 654-672
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: The aim with this study was to deepen the understanding of contextual aspects in child psychiatric clinical work with boys displaying antisocial behaviour. Method: An explorative, qualitative approach, based on team narrations of authentic cases, was used. Results: The results indicate that clinicians consider a multitude of case characteristics when working with this heterogeneous group of boys. The assessment and treatment planning procedure appeared to be intertwined. The teams were unspecific regarding how needs were translated into treatment plans. The behaviour of a boy was discussed to sometimes evoke feelings of fear among parents and clinicians, thus alerting the need for instant interventions. Furthermore, the teams described a lack of consent and collaboration with other agencies. Unclear responsibilities sometimes seemed to affect the possibility to intervene properly. Conclusions: The findings of this study are discussed in relation to evidence-based practices and illustrate how complicated the management of boys with antisocial behaviour can be. © 2005 Elsevier Ltd. All rights reserved.
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12.
  • Enebrink, Pia, et al. (författare)
  • Föräldrarstöd på selektiv och indikerad nivå : En sammanfattning av forskningsläget
  • 2020
  • Ingår i: Socialmedicinsk Tidskrift. - 0037-833X. ; 97:5/6, s. 910-932
  • Tidskriftsartikel (refereegranskat)abstract
    • I artikeln ges en översikt av effekterna av selektivt och indikerat föräldrastöd, med ett särskilt fokus på föräldrastöd som syftar till att minska barns beteendeproblem. Vi går igenom den internationella litteraturen och ger exempel på studier från Sverige. Ofta ses att föräldrastödsprogram baserat på social inlärningsteori, ibland kombinerat med anknytningsteori, ger en måttlig, medelstor effekt på barnens beteendeproblem. Artikeln beskriver olika föräldrastödsprogram, ger exempel på moderatorer och processer som utvärderats, och reflekterar kring strategier för ökad tillgång till föräldrastödsprogram.
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13.
  • Enebrink, Pia, et al. (författare)
  • Internet-based parent management training : A randomized controlled study
  • 2012
  • Ingår i: Behaviour Research and Therapy. - : Elsevier BV. - 0005-7967 .- 1873-622X. ; 50:4, s. 240-249
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: The current study evaluated the efficacy of an Internet-based parent-training program for children with conduct problems. Dose-response ratio and costs for the program were also considered. Method: Parents of 104 children (aged 3-12 years) were randomly allocated to either parent training or a waitlist control condition. Diagnostic assessment was conducted at baseline and parent ratings of child externalizing behaviors and parent strategies were completed before and after treatment and at 6-month follow-up. Results: At post-treatment assessment, children whose parent(s) had received the intervention showed a greater reduction in conduct problems compared to the waitlist children. Between group intent-to-treat effect sizes (Cohen's d) on the Eyberg Intensity and Problem scales were .42 and .72, respectively (study completers .66 and 1.08). In addition, parents in the intervention group reported less use of harsh and inconsistent discipline after the treatment, as well as more positive praise. Effects on behavior problems were maintained at 6-month follow-up. Conclusions: The results support the efficacy of parent training, administered through Internet, with outcomes comparable to many of the group-based parent training programs. The efficacy, low cost, and higher accessibility make this intervention a fitting part in a stepped-care model.
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14.
  • Enebrink, Pia, 1972-, et al. (författare)
  • The emotion regulation questionnaire : Psychometric properties and norms for Swedish parents of children aged 10-13 years
  • 2013
  • Ingår i: Europe's Journal of Psychology. - : Leibniz Institute for Psychology (ZPID). - 1841-0413. ; 9:2, s. 289-303
  • Tidskriftsartikel (refereegranskat)abstract
    • This study evaluated the internal consistency and factor structure of the Swedish version of the 10-item Emotion Regulation Questionnaire (ERQ), and its relation to family warmth and conflict, marital satisfaction, and parental discipline strategies, in addition to obtaining norms from the general population of parents of children aged 10-13 years. The ERQ has two subscales measuring an individual’s use of cognitive reappraisal and expressive suppression as emotion regulation strategies. A random non-referred sample of parents of 1433 children aged 10-13 years completed the ERQ and other questions targeting the family functioning and couple adjustment (Warmth/Conflict in the family; Dyadic Adjustment Scale-short form) and parental strategies (Parent Practices Interview). The results indicated adequate internal consistencies (Cronbach’s alpha) of the two subscales (cognitive reappraisal .81; expressive suppression .73). Confirmatory factor analysis resulted in close to acceptable fit (RMSEA = 0.089; CFI = 0.912; GFI = 0.93). Norms are presented as percentiles for mothers and fathers. The ERQ cognitive reappraisal scale correlated positively with marital adjustment (DAS), family warmth, appropriate discipline (PPI), and negatively with harsh discipline (PPI). The ERQ expressive suppression subscale was negatively correlated with marital satisfaction (DAS) and family warmth, and positively with harsh discipline (PPI). To conclude, this study showed the adequate reliability and construct validity of the ERQ in a large sample of Swedish parents. Specific use of suppression or reappraisal as a parental emotion regulation strategy was related to couple satisfaction, warmth in the family and employment of adequate discipline strategies in expected direction.
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15.
  • Finnes, Anna, et al. (författare)
  • Cost-Effectiveness of Acceptance and Commitment Therapy and a Workplace Intervention for Employees on Sickness Absence due to Mental Disorders.
  • 2017
  • Ingår i: Journal of Occupational and Environmental Medicine. - 1076-2752 .- 1536-5948. ; 59:12, s. 1211-1220
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: The aim of this study was to evaluate cost-effectiveness of Acceptance and Commitment Therapy (ACT) and workplace dialogue intervention (WDI), both as stand-alone interventions and in combination, compared with treatment as usual (TAU), for employees on sickness absence with mental disorders.METHODS: Employees (n = 352, 78.4% females) on sickness absence were randomized to one of four groups. Cost-utility analyses were conducted from a health care perspective and a limited societal perspective.RESULTS: All groups reported significant improvements in health-related quality-of-life (HRQoL) and there were no significant differences in HRQoL or costs between groups. The probability of cost-effectiveness for ACT+WDI was 50% compared with ACT, indicating that both treatment alternatives could be considered equally favorable for decision-makers. TAU and WDI were rejected due to less economic efficiency.CONCLUSION: Adding WDI to ACT cannot be recommended on the basis of our study results.
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16.
  • Finnes, Anna, et al. (författare)
  • Economic evaluation of return-to-work interventions for mental disorder-related sickness absence : two years follow-up of a randomized clinical trial
  • 2022
  • 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
  • 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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17.
  • Finnes, Anna, et al. (författare)
  • Psychological treatments for return to work in individuals on sickness absence due to common mental disorders or musculoskeletal disorders : a systematic review and meta-analysis of randomized-controlled trials
  • 2019
  • Ingår i: International Archives of Occupational and Environmental Health. - : Springer Science and Business Media LLC. - 0340-0131 .- 1432-1246. ; 92:3, s. 273-293
  • Forskningsöversikt (refereegranskat)abstract
    • Purpose: Common mental disorders (CMDs) and musculoskeletal disorders are highly prevalent in the population and cause significant distress and disability, and high costs to society. The main objective of this systematic review and meta-analysis was to examine the outcome and comparative effectiveness of psychological interventions in reducing sickness absence (SA) due to CMDs or musculoskeletal disorders, compared to a waitlist control group, usual care or another clinical intervention.Methods: We reviewed 3515 abstracts of randomized controlled trials published from 1998 to 2017. Of these, 30 studies were included in the analysis.Results: The psychological interventions were overall more effective than treatment as usual in reducing SA (small effect sizes), but not compared to other clinical interventions. Results were similar for studies on CMDs and musculoskeletal pain. A few significant moderating effects were found for treatment-specific variables. However, these were  difficult to interpret as they pointed in different directions.Conclusion: There was a small but significant effect of psychological treatments in reducing SA. We identified areas of improvement such as methodological problems among the included studies and failure to specifically address RTW in the interventions that were evaluated. Clinical implications of the findings, and ways of improving methodological rigour of future studies are discussed.
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18.
  • Finnes, Anna, et al. (författare)
  • Randomized Controlled Trial of Acceptance and Commitment Therapy and a Workplace Intervention for Sickness Absence Due to Mental Disorders.
  • 2019
  • Ingår i: Journal of Occupational Health Psychology. - : Educational Publishing Foundation. - 1076-8998 .- 1939-1307. ; 24:1, s. 198-212
  • Tidskriftsartikel (refereegranskat)abstract
    • Mental disorders contribute to high rates of sickness absence (SA) and impaired work functioning. The aim of the present study was to evaluate the efficacy of 3 interventions targeting SA of workers. Participants (n = 352; 78.4% females) of working age with current employment, and SA due to depression, anxiety disorders, or exhaustion disorder, were recruited to the study and randomized to (a) acceptance and commitment therapy (ACT), (b) a workplace dialogue intervention (WDI), (c) a combination of ACT and WDI, or (d) treatment as usual (TAU). For SA days, there was a significant interaction effect for the follow-up period, in which ACT + WDI generated more SA compared with TAU. When diagnostic group was included as a moderator, participants with exhaustion disorder had less SA days in the WDI group compared with TAU. For symptoms of depression, anxiety, and stress-related ill health, there were significant interaction effects for ACT and ACT + WDI, when compared with TAU, from pre- to postmeasurement (small to moderate between-groups effect sizes). Within-group effect sizes pre- to postmeasurement (Cohen’s d) ranged from .55 to 1.17 (ACT), .40 to .94 (WDI), .26 to 1.13 (ACT + WI), and −.06 to .70 (TAU). There were no differences between groups during follow-up for symptoms.
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19.
  • Giles, Clover, 1985-, et al. (författare)
  • The efficacy of psychological prevention, and health promotion interventions targeting psychological health, wellbeing or resilience among forced migrant children and youth : a systematic review and meta-analysis
  • 2024
  • Ingår i: European Child and Adolescent Psychiatry. - : Springer. - 1018-8827 .- 1435-165X.
  • Forskningsöversikt (refereegranskat)abstract
    • There are over 40 million displaced children and youth worldwide and there is a need promote their mental wellbeing. This study aimed to synthesize evidence regarding promotion interventions to increase wellbeing, resilience, and quality of life (primary outcomes), and prevention interventions to reduce internalizing and externalizing symptoms (secondary outcomes) in this population. The review protocol was registered with PROSPERO (CRD42022329978). Medline, PsycINFO, and Web of Science were searched. Inclusion criteria were: ≥ 10 participants, sample ≤ 18 years of age, no parental participation, explicated forced migrant populations, implementation in non-clinical context, and validated measures. Fifteen studies (N interventions = 18, N participants = 5741) were eligible. Two studies included outcomes related to wellbeing and quality of life. The remaining studies reported depression, PTSD, anxiety, internalizing and externalizing behaviours, and behavioural and emotional problems. There was only sufficient data to perform random-effects meta-analysis of depression scores. No significant effects were observed in comparison to control condition in randomized trials (n = 4994, k = 5) but a small significant positive trend was observed in within-group analyses (n = 537, k = 12). Cochrane's risk of bias tools and the GRADE certainty of evidence tool were applied. No studies achieved low risk of bias and certainty of evidence was very low. In sum, there remains a dearth of rigorous intervention studies investigating the effects of promotive and preventative psychological interventions on the wellbeing, resilience, and quality of life of forcibly displaced minors. However, the few eligible studies in this review indicate promise.
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21.
  • González Moraga, Fernando Renee, et al. (författare)
  • VR-assisted aggression treatment in forensic psychiatry: a qualitative study in patients with severe mental disorders
  • 2024
  • Ingår i: FRONTIERS IN PSYCHIATRY. - 1664-0640. ; 15
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction Improvements in virtual reality (VR) have made it possible to create realistic, virtual settings for behavioral assessment and skills training that cannot otherwise be accessed in a safe way in forensic psychiatric settings. VR interventions are under development but little is known how forensic psychiatric patients with severe mental disorders experience VR-assisted assessments or treatments.Methods The present study aimed to help fill this knowledge gap via qualitative interviews with seven patients with severe mental disorders at a high-security forensic psychiatric clinic who had completed the newly revised Virtual Reality Aggression Prevention Training (VRAPT). All participants were interviewed 12 weeks after the VRAPT intervention, and interview data analyzed with manifest inductive content analysis.Results Six manifest content categories were identified: 1. Therapeutic process, 2. VRAPT method, 3. VR technology, 4. Previous treatment experiences, 5. Challenges to treatment of aggression, and 6. Unexpected experiences. The participants had diverse experiences related to both the VRAPT intervention and forensic psychiatric care. Participants described a mixture of positive experiences in relation to VR-assisted role-plays, and less positive in relation to motivation for aggression-focused treatment and technological limitations.Discussion The present findings suggest further studies are needed on how to best implement VR-assisted treatments for aggression in forensic settings, and potentially further modification of treatment content in interventions like VRAPT.
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22.
  • Helander, Maria, et al. (författare)
  • The Efficacy of Parent Management Training With or Without Involving the Child in the Treatment Among Children with Clinical Levels of Disruptive Behavior : A Meta-analysis
  • 2024
  • Ingår i: Child Psychiatry and Human Development. - : Springer Nature. - 0009-398X .- 1573-3327. ; 55, s. 164-181
  • Tidskriftsartikel (refereegranskat)abstract
    • A systematic review and meta-analysis was conducted where we evaluated the effects of Parent Management Training (PMT), Parent–Child Interaction Therapy (PCIT) and PMT combined with child cognitive behavioral therapy (CBT) using data from 25 RCTs on children with clinical levels of disruptive behavior (age range 2–13 years). Results showed that PMT (g = 0.64 [95% CI 0.42, 0.86]) and PCIT (g = 1.22 [95% CI 0.75, 1.69]) were more effective than waiting-list (WL) in reducing parent-rated disruptive behavior, and PMT also in improving parental skills (g = 0.83 [95% CI 0.67, 0.98]) and child social skills (g = 0.49 [95% CI 0.30, 0.68]). PCIT versus WL had larger effects in reducing disruptive behavior than PMT versus WL. In the few studies found, the addition of child CBT to PMT did not yield larger effects than PMT or WL. These results support offering PMT to children with clinical levels of disruptive behavior and highlight the additional benefits of PCIT for younger ages.  
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23.
  • Hogstrom, Jens, et al. (författare)
  • The Moderating Role of Child Callous-Unemotional Traits in an Internet-Based Parent-Management Training Program
  • 2013
  • Ingår i: Journal of family psychology. - : American Psychological Association (APA). - 0893-3200 .- 1939-1293. ; 27:2, s. 314-323
  • Tidskriftsartikel (refereegranskat)abstract
    • Although parent management training (PMT) is generally considered the treatment of choice for children with conduct problems, some specific adaptations might be essential for various subgroups of parents or children to benefit well from PMT. The aim of this study was to examine the influence of child callous-unemotional (CU) traits on the outcome of an Internet-based PMT program for parents of children with conduct problems (n = 57; mean age 6.65). Within a randomized controlled trial of PMT, children assigned to the intervention group were categorized and compared as either "high-CU" (n = 8) or "low-CU" (n = 49) based on a cut-off score on the CU subscale of the Antisocial Process Screening Device (APSD; Frick & Hare, 2001). CU traits in children were associated with more severe conduct problems at baseline, as well as more hyperactivity and peer-related problems. Treatment outcome, in terms of conduct-problem reduction, was poor in the high-CU group compared with the low-CU group, despite the fact that parents in both groups improved equally in parenting skills. The same pattern of results emerged after controlling for initial difficulties of conduct problems and other pretreatment differences between the groups. Elevated levels of CU traits in children seem to contribute to an inferior treatment response in PMT. These findings call for more attention on empathy and emotional patterns in the assessment of children with conduct problems.
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24.
  • Högström, Jens, et al. (författare)
  • Two-Year Findings from a National Effectiveness Trial : Effectiveness of Behavioral and Non-Behavioral Parenting Programs
  • 2017
  • Ingår i: Journal of Abnormal Child Psychology. - New York, USA : Springer. - 0091-0627 .- 1573-2835. ; 45:3, s. 527-542
  • Tidskriftsartikel (refereegranskat)abstract
    • Long-term follow-up studies of selective parent training (PT) programs are scarce, particularly in the case of effectiveness trials conducted within regular care settings. This study evaluated the 2-year effects of 4 programs: Comet, Incredible Years, Cope, and Connect and differences in the rate of change among programs were investigated using Latent Growth Modeling (LGM). Participants were parents who had sought help at 30 local service sector units (e.g., child psychiatric clinics and social services centers) for major problems in managing their children's externalizing behavior. Parents of 749 children (63 % boys) with moderate levels of externalizing behavior, aged 3-12, were randomized to one of the 4 PT programs. Assessments included parent-reported measures of child externalizing, hyperactivity and inattention, as well as parenting practices, sense of competence, and parents' stress and depressive symptoms. At 2-year follow-up, there were no differences in any of the child outcomes among the programs. All programs had reduced externalizing behaviors with large effect sizes (d = 1.21 to d = 1.32), and negative parenting practices with moderate to large effect sizes (d = 0.49 to d = 0.83). LGM analyses showed that the 2 behavioral programs, Comet and Incredible Years, produced more rapid reductions in externalizing behavior during the course of the intervention than the non-behavioral program, Connect. Connect, however, was the only program where children continued to improve after the intervention. Overall, the results indicate that the 4 programs were equally effective in a clinical setting, despite differences in their theoretical origin.
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25.
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26.
  • Ivarsson, David, et al. (författare)
  • Pinpointing change in virtual reality assisted treatment for violent offenders: a pilot study of Virtual Reality Aggression Prevention Training (VRAPT)
  • 2023
  • Ingår i: Frontiers in Psychiatry. - 1664-0640. ; 14
  • Tidskriftsartikel (refereegranskat)abstract
    • Preventing relapse into violence and its destructive consequences among persistent re-offenders is a primary concern in forensic settings. The Risk-Need-Responsivity framework models the best current practice for offender treatment, focused on building skills and changing pro-criminal cognitions. However, treatment effects are often modest, and the forensic context can obstruct the delivery of interventions. Developing treatments for offenders should focus on the best method of delivery to make “what works work.” Virtual reality (VR)-assisted treatments such as Virtual Reality Aggression Prevention Training (VRAPT) are a new and innovative approach to offender treatment. This pilot study followed 14 male violent offenders who participated in VRAPT in a Swedish prison context and measured changes from pre-treatment to post-treatment and 3-month follow-up in targeted aggression, emotion regulation, and anger. It also investigated potential impact factors (pro-criminal cognitions, externalizing behaviors, psychosocial background, and childhood adverse experiences). In Bayesian linear mixed effects models, participants showed a high probability of change from pre-treatment to post-treatment and to follow-up on all outcome measures. All outcome measures demonstrated a low probability of change from post-treatment to follow-up. Analysis of reliable change showed that participants’ results ranged from recovery to deterioration. We discuss the implications of the study for VRAPT’s impact on the target group, those who might benefit from the approach, and suggested foci for future studies in the field of VR-assisted offender treatment. The study was preregistered at the International Standard Randomized Controlled Trial Number registry (https://doi.org/10.1186/ISRCTN14916410).
  •  
27.
  • Lindqvist, Helena, et al. (författare)
  • Relational Skills and Client Language Predict Outcome in Smoking Cessation Treatment
  • 2017
  • Ingår i: Substance Use & Misuse. - : TAYLOR & FRANCIS INC. - 1082-6084 .- 1532-2491. ; 52:1, s. 33-42
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: We currently lack insight into the predictive processes of Motivational Interviewing (MI) in smoking cessation treatment. More knowledge is necessary to be able to further enhance the treatment effect in smoking cessation interventions. Objectives: To examine certain hypothesized active components of MI in smoking cessation treatment delivered in an ordinary clinical setting. Methods: Audio-recordings of 106 smoking cessation treatment sessions were analyzed using the Motivational Interviewing Sequential Code for Observing Process Exchanges (MI-SCOPE) Coders Manual and the Motivational Interviewing Treatment Integrity code (MITI) Manual, version 3.1. The outcome measure was self-reported 6-month continuous abstinence at 12-month follow-up. Results: Client Activation utterances in favor of change were positively associated with smoking cessation at follow-up. The combined category of client language expressing a Desire or a Need to continue to smoke was negatively predictive of smoking cessation. In addition, we found preliminary support for a negative interaction effect between counselors demonstration of the spirit of MI and clients Activation utterances in favor of change. Conclusions/Importance: Our data suggest that if smoking cessation counselors cultivate client Activation utterances in favor of abstinence and softening client utterances expressing desire or perceived need to smoke, this could contribute to higher rates of treatment success. In addition, counselors demonstration of the spirit of MI was a statistically significant predictor of outcome when the negative interaction effect between Activation utterances in favor of change and MI spirit was taken into account. These findings should be evaluated in larger studies in the future.
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28.
  • Lindqvist, Helena, et al. (författare)
  • The relationship between counselors technical skills, clients in-session verbal responses, and outcome in smoking cessation treatment
  • 2017
  • Ingår i: Journal of Substance Abuse Treatment. - : PERGAMON-ELSEVIER SCIENCE LTD. - 0740-5472 .- 1873-6483. ; 77, s. 141-149
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The technical component of Motivational Interviewing (MI) posits that client language mediates the relationship between counselor techniques and subsequent client behavioral outcomes. The purpose of this study was to examine this hypothesized technical component of MI in smoking cessation treatment in more depth. Method: Secondary analysis of 106 first treatment sessions, derived from the Swedish National Tobacco Quitline, and previously rated using the Motivational Interviewing Sequential Code for Observing Process Exchanges (MI SCOPE) Coders Manual and the Motivational Interviewing Treatment Integrity code (MITI) Manual, version 3.1. The outcome measure was self-reported 6-month continuous abstinence at 12-month follow-up. Results: Sequential analyses indicated that clients were significantly more likely than expected by chance to argue for change (change talk) following MI-consistent behaviors and questions and reflections favoring change. Conversely, clients were more likely to argue against change (sustain talk) following questions and reflections favoring status-quo. Parallel mediation analysis revealed that a counselor technique (reflections of client sustain talk) had an indirect effect on smoking outcome at follow-up through client language mediators. Conclusions: The study makes a significant contribution to our understanding of how MI works in smoking cessation treatment and adds further empirical support for the hypothesized technical component in MI. The results emphasize the importance of counselors avoiding unintentional reinforcement of sustain talk and underline the need for a greater emphasis on the direction of questions and reflections in MI trainings and fidelity measures. (C) 2017 Elsevier Inc. All rights reserved.
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29.
  • Maria, Cederblad, 1968-, et al. (författare)
  • No difference in relationship satisfaction between parents of children with enuresis and normative data
  • 2016
  • Ingår i: Journal of Child and Family Studies. - : Springer Science and Business Media LLC. - 1062-1024 .- 1573-2843. ; 25:4, s. 1345-1351
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim of this cross-sectional study was to evaluate relationship satisfaction in parents of children with nocturnal enuresis and put it in context by comparisons with normative data. The secondary aim was to investigate the potential differences in feelings of incompetence in the parenting role and parental conflict among parents of children with enuresis of varying severity. Parents (n = 52) of 41 children with enuresis aged between 6 and 12 years participated. The questionnaire consisted of five components: demographic background, The Dyadic Adjustment Scale, The Swedish Parent Stress Questionnaire, The Parent Problem Checklist, and The Depression, Anxiety, and Stress Scale. Normative data was used to provide an age- and gender-stratified sample, with adequate distribution and representation of both sexes and all ages. This sample consisted 1411 parents of 1411 children aged 6-9 years. Parents of children with enuresis reported similar relationship quality as a representative sample of parents with children of the same age. The parents' report of feeling of incompetence and parental conflict were similar among children with enuresis of varying frequency. Mothers reported more problematic areas related to child rearing than fathers. This study shows that to have a child with enuresis doesn't necessarily affect the parents' feeling of competence or the quality of the intra-parental relationship.
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30.
  • Norman, Åsa, et al. (författare)
  • Multi-level barriers and facilitators to implementing a parenting intervention in prison, perceptions from deliverers and responsible managers : a mixed-methods study
  • 2022
  • Ingår i: BMC Psychology. - : Springer Science and Business Media LLC. - 2050-7283. ; 10
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Children of incarcerated parents run a high risk of poor health and own delinquency and positive parenting is vital for their healthy development. Internationally, parenting interventions for incarcerated parents suggest impacts on parenting and child behaviour outcomes. The intervention For Our Children’s Sake (FOCS), was developed for incarcerated parents in Sweden and evaluated in a controlled trial with a parallel process evaluation during 2019–2021. This study constitutes part of the process evaluation and aims to describe barriers and facilitators for the implementation of FOCS, and how the intervention targets parents’ needs, as perceived by delivering group leaders and responsible correctional inspectors.Methods: In this mixed-methods study, group leaders (n = 23) and correctional inspectors (n = 12) in both intervention and control group of the FOCS trial responded to a quantitative questionnaire regarding factors of importance for intervention implementation. Group leaders (n = 12) and correctional inspectors (n = 6) in the intervention group also participated in qualitative interviews. Quantitative data were analysed using descriptive statistics and comparison of means. Qualitative data were analysed inductively using qualitative content analysis.Results: A synthesis of the quantitative and qualitative results showed that the topic of parenting and child issues in general was perceived as highly important to work with in prison, and FOCS to be an important programme in specific. At the same time, the implementation of FOCS was perceived as reliant on the individual engagement of group leaders and correctional inspectors and implementation was described as a struggle due to the scarce resources that were allowed for FOCS. Thus, additional resources and support from the Prison and Probation Service’s management were called for to facilitate implementation of FOCS, and to make it an automatic part of prison activities.Conclusion: This study showed that there was high engagement among deliverers and managers for working with parenting in prison, where the need among parents has been described as great. Additional resources and support within the overall Prison and Probation Service, is vital to facilitate implementation of FOCS and make it sustainable within the prisons. The findings can be used to refine an implementations structure for similar interventions in the prison or similar settings.
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31.
  • Nystrand, Camilla, et al. (författare)
  • Adding the Coping Power Programme to parent management training : the cost‑effectiveness of stacking interventions for children with disruptive behaviour disorders
  • 2020
  • Ingår i: European Child and Adolescent Psychiatry. - : Springer Nature. - 1018-8827 .- 1435-165X. ; 30, s. 1603-1614
  • Tidskriftsartikel (refereegranskat)abstract
    • Parent management training (PMT) programmes and child cognitive behavioural therapy are recommended approaches for treatment of oppositional defiant disorder in children, and combining these may be effective. However, little is known regarding the economic efficiency of this additive effect. A within-trial cost-effectiveness analysis was carried out in Sweden including 120 children aged 8–12 who screened positive for disruptive behaviour disorders, within a psychiatric care setting, and their parents. They were randomly assigned to either the Swedish group-based PMT Comet, or to an enhanced version, where an additional child component was provided, the Coping Power Programme (CPP). Child behaviour problems as well as healthcare and educational resource use were measured at baseline, post-test and at two-year follow-up. A net benefit regression framework was used to estimate differences in costs and health outcomes between the two intervention arms during the two-year period. Comet with CPP cost on average 820 EURO more per family than Comet only. At the 2-year follow-up, there were 37% recovered cases of ODD in Comet with CPP, in comparison to 26% in the Comet only arm. At a willingness-to-pay of approximately 62,300 EURO per recovered case of ODD, Comet with CPP yielded positive net benefits, in comparison to Comet only. Offering children the CPP simultaneously as their parents receive PMT, in comparison to only providing PMT, yields clinically relevant gains. Despite the relatively small cost for CPP, investment in combining PMT and CPP should be guided by resource prioritisation. Trial registration number: ISRCTN10834473, date of registration: 23/12/2015
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32.
  • Nystrand, Camilla, et al. (författare)
  • Cost-effectiveness analysis of parenting interventions for the prevention of behaviour problems in children
  • 2019
  • Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 14:12
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Behavior problems are common among children and place a high disease and financial burden on individuals and society. Parenting interventions are commonly used to prevent such problems, but little is known about their possible longer-term economic benefits. This study modelled the longer-term cost-effectiveness of five parenting interventions delivered in a Swedish context: Comet, Connect, the Incredible Years (IY), COPE, bibliotherapy, and a waitlist control, for the prevention of persistent behavior problems.METHODS: A decision analytic model was developed and used to forecast the cost per averted disability-adjusted life-year (DALY) by each parenting intervention and the waitlist control, for children aged 5-12 years. Age-specific cohorts were modelled until the age of 18. Educational and health care sector costs related to behavior problems were included. Active interventions were compared to the waitlist control as well as to each other.RESULTS: Intervention costs ranged between US$ 14 (bibliotherapy) to US$ 1,300 (IY) per child, with effects of up to 0.23 averted DALYs per child (IY). All parenting interventions were cost-effective at a threshold of US$ 15,000 per DALY in relation to the waitlist control. COPE and bibliotherapy strongly dominated the other options, and an additional US$ 2,629 would have to be invested in COPE to avert one extra DALY, in comparison to bibliotherapy.CONCLUSIONS: Parenting interventions are cost-effective in the longer run in comparison to a waitlist control. Bibliotherapy or COPE are the most efficient options when comparing interventions to one another. Optimal decision for investment should to be based on budget considerations and priority settings.
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33.
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34.
  • Olsson, Tina M., et al. (författare)
  • Study protocol for a non-randomized controlled trial of the effects of internet-based parent training as a booster to the preschool edition of PATHS® : Universal edition of the Parent Web
  • 2023
  • Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 18:4, s. e0284926-e0284926
  • Tidskriftsartikel (refereegranskat)abstract
    • Well implemented, universal parental support is often effective in families with younger children, but research on their effects on families with adolescent children is scarce. In this study, a trial of the universal parent training intervention “Parent Web” in early adolescence is added to the social emotional learning intervention Promoting Alternative Thinking Strategies (PATHS®), completed in early childhood. The Parent Web is a universal online parenting intervention based on social learning theory. The intervention aims to promote positive parenting and family interaction through five weekly modules completed over 6–8 weeks.The main hypothesis is that participants in the intervention group will exhibit significant pre to post- intervention-related benefits relative participants in the comparison group.The aims of this study are: 1) provide Parent Web as a booster aimed at improving parenting support and practices at the transition into adolescence to a cohort of parents whose children have previously participated in preschool PATHS, and 2) examine the effects of the universal edition of Parent Web. The study has a quasi-experimental design with pre- and post-testing.The incremental effects of this internet-delivered parent training intervention are tested in parents of early adolescents (11–13 years) who participated in PATHS when 4–5 years old compared to a matched sample of adolescents with no prior experience of PATHS. The primary outcomes are parent reported child behavior and family relationships. Secondary outcomes include self-reported parent health and stress. The proposed study is one of the few trials to test the effects of universal parental support in families of early adolescents and will therefore contribute to the understanding of how mental health in children and young people can be promoted across developmental periods through a continuum of universal measures.Trial registration: Clinical trials.gov (NCT05172297), prospectively registered on December 29, 2021.
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35.
  • Romare Strandh, Maria, et al. (författare)
  • Psychosocial interventions targeting parenting distress among parents with cancer : A systematic review and narrative synthesis of available interventions
  • 2023
  • Ingår i: Critical reviews in oncology/hematology. - : Elsevier. - 1040-8428 .- 1879-0461. ; 191
  • Forskningsöversikt (refereegranskat)abstract
    • BackgroundBalancing having cancer and parenting a major stressor, and may result in parenting distress, negatively affecting the whole family. To provide adequate support, knowledge of existing psychosocial interventions are crucial to guide future interventions. This study aimed to describe available psychosocial interventions for parents with cancer and dependent children (<18 years).MethodWe conducted a systematic review, and four databases were searched from January 2000 to March 2023.ResultsThirty studies were included, reporting on 22 psychosocial interventions for parents with cancer. They aimed to improve different aspects of parenting distress, and included psychoeducation and communication strategies. Interventions were beneficial to and acceptable among parents, but only a few had been evaluated. The study quality was, overall, assessed as moderate.ConclusionsThe results of this review highlight the diversity of available psychosocial interventions for parents with cancer and the outcomes on parenting distress, as well as methodological challenges.
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36.
  • Romare Strandh, Maria, et al. (författare)
  • The Complexity of Being a Parent in the Hospital and a Patient at Home : A Qualitative Study on Parenting Concerns and Challenges Among Parents With Cancer
  • 2023
  • Ingår i: Cancer Nursing. - 0162-220X .- 1538-9804.
  • Tidskriftsartikel (refereegranskat)abstract
    • Background Parents given a diagnosis of cancer must balance the demands of their illness and caregiving responsibilities. This can result in parental stress and have a negative impact on the well-being of the whole family. A greater understanding of the experiences of parents with cancer is necessary to provide adequate support.Objective The aim of this study was to explore parenting concerns and challenges among parents with cancer who were caring for dependent children younger than 18 years.Methods Semistructured interviews were carried out with 22 parents with cancer. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis.Results Parental concerns and challenges affected parents in their parental role and their everyday family life. Three overarching themes described the struggles in balancing life as a parent and as a patient: navigating dual roles as a parent with cancer, impact of cancer on parenting, and impact on family life. Parents’ primary focus was on their children’s well-being, and they struggled to manage their own expectations of parenting and the demands on their role in the family.Conclusion The results highlight the complexity of being a parent with cancer while caring for dependent children. To support parents during the cancer journey, it is important to understand the consequences of their illness on their parental role and the family.Implications for Practice Supporting parents to feel secure in their parental role and providing support to them during their cancer journey should be integrated into routine cancer care, where parenting concerns and challenges are addressed.
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37.
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38.
  • Sampaio, Filipa, et al. (författare)
  • Cost-Effectiveness of Four Parenting Programs and Bibliotherapy for Parents of Children with Conduct Problems
  • 2016
  • Ingår i: Journal of Mental Health Policy and Economics. - 1091-4358 .- 1099-176X. ; 19:4, s. 201-212
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Parenting programs and self-help parenting interventions employing written materials are effective in reducing child conduct problems (CP) in the short-term compared to control groups, however evidence on the cost-effectiveness of such interventions is insufficient. Few studies have looked at the differences in effects between interventions in the same study design.AIM: This study aimed to determine the cost-effectiveness of four parenting programs: Comet, Incredible Years (IY), Cope and Connect, and bibliotherapy, compared to a waitlist control (WC), with a time horizon of 4 months, targeting CP in children aged 3-12 years.METHODS: This economic evaluation was conducted alongside an RCT of the four parenting interventions and bibliotherapy compared to a WC. The study sample consisted of 961 parents of 3-12 year-old children with CP. CP was measured by the Eyberg Child Behavior Inventory. Effectiveness was expressed as the proportion of "recovered" cases of CP. The time horizon of the study was four months with a limited health sector perspective, including parents' time costs. We performed an initial comparative cost analysis for interventions whose outcomes differed significantly from the WC, and later a cost-effectiveness analysis of interventions whose outcomes differed significantly from both the WC and each other. Secondary analyses were performed: (i) joint outcome "recovered and improved", (ii) intervention completers, (iii) exclusion of parents' time costs, (iv) exclusion of training costs.RESULTS: All interventions apart from Connect significantly reduced CP compared to the WC. Of the other interventions Comet resulted in a significantly higher proportion of recovered cases compared to bibliotherapy. A comparative cost analysis of the effective interventions rendered an average cost per recovered case for bibliotherapy of USD 483, Cope USD 1972, Comet USD 3741, and IY USD 6668. Furthermore, Comet had an ICER of USD 8375 compared to bibliotherapy. Secondary analyses of "recovered and improved" and of intervention completers held Cope as the cheapest alternative. Exclusion of parents' time and training costs did not change the cost-effectiveness results.DISCUSSION: The time horizon for this evaluation is very short. This study also had a limited costing perspective. Results may be interpreted with caution when considering decision-making about value for money. The inclusion of a multi-attribute utility instrument sensitive to domains of quality-of-life impacted by CP in children would be valuable so that pragmatic value for money estimations can be made.IMPLICATIONS FOR FUTURE RESEARCH: Further studies are needed with longer follow-up periods to ascertain on the sustainability of the effects, and fuller economic evaluations and economic modeling to provide insights on longer-term cost-effectiveness. These results also raise the need to investigate the cost-effectiveness of the provision of these interventions as a "stepped care" approach.CONCLUSIONS: The results suggest the delivery of different programs according to budget constraints and the outcome desired. In the absence of a WTP threshold, bibliotherapy could be a cheap and effective option to initially target CP within a limited budget, whereas Comet could be offered to achieve greater effects based on decision-makers' willingness to make larger investments. In its turn, Cope could be offered when targeting broader outcomes, such as symptom improvement, rather than clinical caseness.
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39.
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40.
  • Stattin, Håkan, 1951-, et al. (författare)
  • A National Evaluation of Parenting Programs in Sweden : The Short-Term Effects Using an RCT Effectiveness Design
  • 2015
  • Ingår i: Journal of Consulting and Clinical Psychology. - : American Psychological Association (APA). - 0022-006X .- 1939-2117. ; 83:6, s. 1069-1084
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: We evaluated the effectiveness of 4 parent-training programs for children with externalizing problems. We tested the effectiveness of 3 behavioral programs (Comet, Cope, and Incredible Years) and 1 nonbehavioral program (Connect) in reducing child behavior problems and attention-deficit/hyperactivity disorder (ADHD) symptoms, in improving positive parenting and parenting competence, and in decreasing negative parenting and parents’ stress and depressive symptoms.Method: This national study was designed as a randomized-controlled effectiveness trial (RCT). The treatments were carried out in 30 clinical and community-based practices. Parents of 908 children (ages 3–12 years) were randomly assigned to 1 of 2 parent training programs available at each practice, or to a wait-list condition, where parents had sought help from regular services. Before and after treatment, parents rated child behavior problems and parenting strategies.Results: At posttreatment, children whose parents had received interventions showed a strong decrease in child conduct problems and a moderate to strong decrease in ADHD symptoms. About half of parents whose children scored over the 95th percentile on the behavior measures (Eyberg Child Behavior Inventory, Swanson, Nolan, and Pelham Rating Scale), a clinically meaningful cutoff, reported that their children were no longer above the cutoff after the intervention. Parents showed considerably less negative behaviors toward their children at posttest compared with pretest; they increased in parental competence, and decreased in both stress and depressive symptoms. Overall, the behavioral programs were more effective than the nonbehavioral program.Conclusions: The results support the general efficacy of parent training in a short-term perspective.
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41.
  • Stattin, Håkan, et al. (författare)
  • Föräldrastöd på universell nivå : En forskningsöversikt
  • 2020
  • Ingår i: Socialmedicinsk Tidskrift. - 0037-833X. ; 97:5/6, s. 888-909
  • Tidskriftsartikel (refereegranskat)abstract
    •  I denna artikel summeras vad vi känner till om effekterna av universellt föräldrastöd. En separat redovisning ges av den internationella och den nordiska litteraturen. Artikeln ger en kort summering av de teoretiska baserna i gängse föräldrastödsprogram; erfarenheterna av de utvärderingar som gjorts och de förhållanden som utvärderats; rekrytering och bortfall, svagheter som man kan spåra i utvärderingar; skillnader mellan mammors och pappors erfarenheter, och differentieringen mellan preventiva och promotiva program. Artikeln avslutas med ett antal slutsatser. 
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42.
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43.
  • Västhagen, Maja, et al. (författare)
  • Refugee parents’ experiences of coming to Sweden : A qualitative study
  • 2022
  • Ingår i: International Journal of Intercultural Relations. - : Elsevier. - 0147-1767 .- 1873-7552. ; 91, s. 97-109
  • Tidskriftsartikel (refereegranskat)abstract
    • Each year, millions of people worldwide are forced to leave their homes. Many of those affected are families. There are already a considerable number of initiatives designed to support refugees who are resettling in new countries and cultures. However, few are promotive interventions aiming to support parents and thereby their children through the extraordinary challenges they face. To develop a culturally adaptive intervention, more knowledge about how refugee parents from different countries perceive and handle these challenges is needed. This study explores refugee parents’ own perspectives on the obstacles, challenges and opportunities they faced during their first years in Sweden to guide the future development of promotive interventions for refugee parents. Interviews were conducted with Arabic, Kurdish, and Somali-speaking refugee parents (n = 28; 19 mothers, 9 fathers). The interviews were examined using content analysis. One overarching theme emerged; “The new language is the key for entering social networks and society, and for helping your child in a new country”. The new language was viewed as a key to integration, and to mastering parenthood in the new context. This theme consisted of four categories; “parents’ motivation and hope as driving forces,” “navigating among past and present culture and values”, “loneliness as a risk factor” and “a new way of being a parent and relating to an acculturation gap”. These findings may help guide the development of parenting interventions for refugees, to promote integration and well-being among parents and their children.
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44.
  • Wetterborg, Dan, et al. (författare)
  • Borderline personality disorder: Prevalence and psychiatric comorbidity among male offenders on probation in Sweden
  • 2015
  • Ingår i: Comprehensive Psychiatry. - : W B SAUNDERS CO-ELSEVIER INC. - 0010-440X .- 1532-8384. ; 62, s. 63-70
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Borderline personality disorder (BPD) is a severely disabling condition, associated with substantially increased risk of deliberate self-harm and, particularly in men, also with interpersonal violence and other criminal behavior. Although BPD might be common among prison inmates, little is known about prevalence and psychiatric comorbidity in probationers and parolees. Method: In 2013, a consecutive sample of 109 newly admitted adult male offenders on probation or parole in all three probation offices of Stockholm, Sweden, completed self-report screening questionnaires for BPD and other psychiatric morbidity. Participants scoring over BPD cut-off participated in a psychiatric diagnostic interview. Results: We ascertained a final DSM-5 BPD prevalence rate of 19.8% (95% CI: 12.3-27.3%). The most common current comorbid disorders among subjects with BPD were antisocial personality disorder (91%), major depressive disorder (82%), substance dependence (73%), attention deficit hyperactivity disorder (ADHD) (70%), and alcohol dependence (64%). Individuals diagnosed with BPD had significantly more current psychiatric comorbidity (M = 6.2 disorders) than interviewed participants not fulfilling BPD criteria (M = 3.6). Participants with BPD also reported substantially more symptoms of ADHD, anxiety and depression compared to all subjects without BPD. Conclusions: BPD affected one fifth of probationers and was related to serious mental ill-health known to affect recidivism risk. The findings suggest further study of possible benefits of improved identification and treatment of BPD in offender populations. (C) 2015 Elsevier Inc. All rights reserved.
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45.
  • Wetterborg, Dan, et al. (författare)
  • Dialectical Behavior Therapy for Men With Borderline Personality Disorder and Antisocial Behavior : A Clinical Trial
  • 2020
  • Ingår i: Journal of Personality Disorders. - : GUILFORD PUBLICATIONS INC. - 0885-579X .- 1943-2763. ; 34:1, s. 22-39
  • Tidskriftsartikel (refereegranskat)abstract
    • In addition to suicidal behaviors, men with borderline personality disorder (BPD) often display antisocial behavior that could impair contacts with mental health services. While research has established effective treatments for women with BPD, this is not yet the case for men. The authors evaluated 12 months of dialectical behavior therapy (DBT) for 30 men with BPD and antisocial behavior, using a within-group design with repeated measurements. The authors found moderate to strong, statistically significant pre-to posttreatment reductions of several dysfunctional behaviors, including self-harm, verbal and physical aggression, and criminal offending (rate ratios 0.17-0.39). Symptoms of BPD and depression were also substantially decreased. The dropout rate was 30%, and completing participants reported high satisfaction with treatment and maintained their improvements at 1-year follow-up. The authors conclude that DBT could be an effective treatment alternative for men with BPD and antisocial behavior, and it merits future studies with more rigorous design.
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46.
  • Wijana, Moa Bråthén, et al. (författare)
  • A pilot study of the impact of an integrated individual- and family therapy model for self-harming adolescents on overall healthcare consumption
  • 2021
  • Ingår i: BMC Psychiatry. - : BioMed Central. - 1471-244X. ; 21:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Self-harming behaviors in adolescents cause great suffering and can lead to considerable costs to the healthcare system. The aim of the current study was to investigate the cost of an integrated individual and family therapy (Intensive Contextual Treatment: ICT) and to compare the adolescent’s healthcare consumption 1 year before and 1 year after treatment.Method: The study had a within group design with repeated measures. The clinical outcomes and the cost of ICT treatment are based on a sample of 49 participants who were previously enrolled in an intervention trial. Participants with significantly improved clinical outcomes (self-harm behavior, or general mental health symptoms) were defined as treatment responders. Calculation of changes in healthcare consumption is based on 25 participants who gave their consent to participate in a retrospective collection of healthcare data from medical records, including inpatient and outpatient care, and prescribed medication.Results: The average estimated cost of ICT per person was €5293. There were no significant differences between the cost of healthcare consumption 1 year before and after ICT, but the results suggested that the adolescents consumed less inpatient and specialized care after treatment. There was a significantly higher cost of psychotropic medication after treatment explained by a higher consumption of central stimulants. Treatment responders (general mental health problems) reduced their consumption of healthcare resources significantly more than non-responders, especially regarding hospital visits and total health care costs.Conclusions: Good response to the ICT in terms of improved general mental health symptoms seems to be associated with reduced healthcare consumption during the post-treatment period. However, controlled studies with larger sample sizes are needed to draw causal conclusions. The results of this study should be interpreted with caution as it is based on a small sample and attrition rate was high. Trial registration: This study has been registered with the ISRCTN: 15885573.
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47.
  • Woodford, Joanne, et al. (författare)
  • Help-seeking behaviour and attitudes towards internet-administered psychological support among adolescent and young adults previously treated for cancer during childhood : Protocol for a survey and embedded qualitative interview study in Sweden
  • 2021
  • Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 11
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: A subgroup of adolescent and young adult childhood cancer survivors (AYACCS) are at increased risk of psychological distress. Despite this, AYACCS experience difficulties accessing psychological support.E-mentalhealth (e-MH) may offer a solution to reducethis treatment gap. However, research examining e-MHfor AYACCS has experienced difficulties with recruitment, retention and adherence. Such difficulties may relate to:(1) help-seeking behaviour and/or (2) e-MH acceptability.The overall study aims are to: (1) examine potential associations between health service use factors, informed by Andersen’s behavioural model of health services use, and help-seeking behaviour; (2) examine attitudes towards e-MHinterventions; and (3) explore perceived need for mental health support; past experience of receiving mental health support; preferences for support; and barriers and facilitators to help-seeking.Methods and analysis: An online and paper-based cross-sectional self-report survey (98 items) and embedded qualitative interview study across Sweden, with a target sample size of n=365. Participants are aged 16–39 years, diagnosed with cancer when 0–18 years and have completed successful cancer treatment. The survey examines sociodemographic and clinical characteristics, actual help-seeking behaviour, attitudes towards e-MH, stigma of mental illness, mental health literacy, social support and current symptoms of depression, anxiety, and stress. Survey respondents with past and/or current experience of mental health difficulties are invited into the qualitative interview study to explore: (1) perceived need for mental health support; (2) past experience of receiving mental health support; (3) preferences for support; and (4) barriers and facilitators to help-seeking. Potential associations between health service use factors and help-seeking behaviour are examined using univariable and multivariable logistic regressions. Qualitative interviews are analysed using content analysis.
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48.
  • Öst, Lars-Göran, 1945-, et al. (författare)
  • Cognitive Behavior Therapy for Adult Anxiety Disorders in Routine Clinical Care : A Systematic Review and Meta-Analysis
  • 2023
  • Ingår i: Clinical psychology. - 0969-5893 .- 1468-2850. ; 30:3, s. 272-290
  • Forskningsöversikt (refereegranskat)abstract
    • Cognitive-behavioral therapy (CBT) has received strong research support for anxiety disorders such as panic disorder, agoraphobia, social anxiety disorder, and generalized anxiety disorder. However, less is known about how CBT performs when delivered in routine clinical care. A systematic review and meta-analysis were conducted of CBT for these anxiety disorders in adults treated in routine clinical care. Ovid MEDLINE, Embase OVID, and PsycINFO were systematically searched for articles published until May 2022. The effectiveness of CBT, methodological quality, and moderators of treatment outcome were examined, and benchmarked by meta-analytically comparing with efficacy studies for the same disorders. Sixty-six studies were included, comprising 6,113 participants. Large within-group effect sizes (ESs; Hedges’s g) were detected for anxiety measures at posttreatment (1.09) and follow-up (1.39), as well as for the secondary outcome of depression measures (0.80 at both assessment points). Attrition rate across the disorders was 15.9%. The benchmarking analysis showed that effectiveness studies had very similar ES (1.09) as efficacy studies (1.07) at posttreatment and at follow-up (1.39 vs. 1.30), and there were no significant differences in remission rates. Thus, the outcomes of effectiveness studies for these anxiety disorders are comparable with the results obtained in efficacy studies.
  •  
49.
  • Öst, Lars-Göran, et al. (författare)
  • Cognitive behavior therapy for adult depressive disorders in routine clinical care : A systematic review and meta-analysis
  • 2023
  • Ingår i: Journal of Affective Disorders. - : Elsevier. - 0165-0327 .- 1573-2517. ; 331, s. 322-333
  • Forskningsöversikt (refereegranskat)abstract
    • Background: Different cognitive behavioral therapies (CBT) have strong research support for treatment of adult depressive disorders (DD). Given the scarcity of knowledge about the performance of CBT in routine clinical care, a systematic review and meta-analysis of CBT for adults with DD treated in this context was conducted.Methods: Published studies until the end of September 2022, were systematically searched in Ovid MEDLINE, Embase OVID, and PsycINFO. The effectiveness of CBT, methodological quality, and moderators of treatment outcome were examined, and benchmarked by meta-analytically comparing with efficacy studies for DD.Results: Twenty-eight studies, comprising 3734 participants, were included. Large within-group effect sizes (ES) were obtained for DD-severity at post-treatment, and follow-up, on average 8 months post-treatment. Benchmarking analysis showed that effectiveness studies had very similar ESs as efficacy studies at post-treatment (1.51 vs. 1.71) and follow-up (1.71 vs. 1.85). Remission rates were also very similar; effectiveness studies 44 % and 46 %, efficacy studies 45 % and 46 %, at post-treatment and follow-up, respectively.Limitations: Only studies published in English-language peer-reviewed journals were included and the use of pre-post ES in the meta-analyses could contribute to biased outcomes.Conclusions: CBT for DD is an effective treatment when delivered in routine clinical care and the outcomes of effectiveness studies for DD are comparable to the effects obtained in efficacy studies.
  •  
50.
  • Öst, Lars-Göran, 1945-, et al. (författare)
  • Cognitive behavior therapy for adult post-traumatic stress disorder in routine clinical care : A systematic review and meta-analysis
  • 2023
  • Ingår i: Behaviour Research and Therapy. - 0005-7967 .- 1873-622X. ; 166
  • Forskningsöversikt (refereegranskat)abstract
    • Although different cognitive behavioral therapies (CBT) have strong research support for treatment of adult post-traumatic stress disorder (PTSD) more knowledge is needed about the performance of CBT in routine clinical care. The present study is a systematic review and meta-analysis of CBT for PTSD in adults treated in routine clinical care. Ovid MEDLINE, Embase OVID, and PsycINFO were systematically searched for studies published until the end of May 2022. The effectiveness of CBT, methodological quality, and moderators of treatment outcome were examined, and benchmarked by meta-analytically comparing with efficacy studies for PTSD. Thirty-three studies, comprising 6482 participants, were included. The within-group effect sizes (ES) for PTSD-severity at post-treatment (1.75), and follow-up (1.70), on average 6 months post-treatment, were large. The effectiveness studies had very similar ESs as efficacy studies at post-treatment (1.75 vs. 1.72) and follow-up (1.70 vs. 2.02), based on the benchmarking analysis. As the heterogeneity was large, we can only cautiously consider CBT for PTSD an effective treatment when delivered in routine clinical care. The outcomes of effectiveness studies for PTSD seem to be comparable to the results obtained in efficacy studies.
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