| 1. |
- Menkveld, Albert J., et al.
(författare)
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Nonstandard Errors
- 2024
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Ingår i: JOURNAL OF FINANCE. - : Wiley-Blackwell. - 0022-1082 .- 1540-6261. ; 79:3, s. 2339-2390
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Tidskriftsartikel (refereegranskat)abstract
- In statistics, samples are drawn from a population in a data-generating process (DGP). Standard errors measure the uncertainty in estimates of population parameters. In science, evidence is generated to test hypotheses in an evidence-generating process (EGP). We claim that EGP variation across researchers adds uncertainty-nonstandard errors (NSEs). We study NSEs by letting 164 teams test the same hypotheses on the same data. NSEs turn out to be sizable, but smaller for more reproducible or higher rated research. Adding peer-review stages reduces NSEs. We further find that this type of uncertainty is underestimated by participants.
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| 2. |
- Andersson, Claes, et al.
(författare)
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Academic self-efficacy : Associations with self-reported COVID-19 symptoms, mental health, and trust in universities' management of the pandemic-induced university lockdown
- 2022
-
Ingår i: Journal of American College Health. - : Informa UK Limited. - 0744-8481 .- 1940-3208.
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate perceived changes in academic self-efficacy associated with self-reported symptoms of COVID-19, changes in mental health, and trust in universities’ management of the pandemic and transition to remote education during lockdown of Swedish universities in the spring of 2020. Methods: 4495 participated and 3638 responded to self-efficacy questions. Associations were investigated using multinomial regression. Results: Most students reported self-experienced effects on self-efficacy. Lowered self-efficacy was associated with symptoms of contagion, perceived worsening of mental health and low trust in universities’ capacity to successfully manage the lockdown and transition to emergency remote education. Increased self-efficacy was associated with better perceived mental health and high trust in universities. Conclusion: The initial phase of the pandemic was associated with a larger proportion of students reporting self-experienced negative effects on academic self-efficacy. Since self-efficacy is a predictor of academic performance, it is likely that students’ academic performance will be adversely affected.
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| 3. |
- Andersson, Claes, et al.
(författare)
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Does the management of personal integrity information lead to differing participation rates and response patterns in mental health surveys with young adults? A three-armed methodological experiment
- 2021
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Ingår i: International Journal of Methods in Psychiatric Research. - : John Wiley & Sons. - 1049-8931 .- 1557-0657. ; 30:4
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: This study evaluates whether initiation rates, completion rates, response patterns and prevalence of psychiatric conditions differ by level of personal integrity information given to prospective participants in an online mental health self-report survey.Methods: A three-arm, parallel-group, single-blind experiment was conducted among students from two Swedish universities. Consenting participants following e-mail invitation answered the World Health Organization (WHO) World Mental Health-International College Student (WMH-ICS) mental health self-report survey, screening for eight psychiatric conditions. Random allocation meant consenting to respond (1) anonymously; (2) confidentially, or (3) confidentially, where the respondent also gave consent for collection of register data.Results: No evidence was found for overall between-group differences with respect to (1) pressing a hyperlink to the survey in the invitation email; and (2) abandoning the questionnaire before completion. However, participation consent and self-reported depression were in the direction of higher levels for the anonymous group compared to the two confidential groups.Conclusions: Consent to participate is marginally affected by different levels of personal integrity information. Current standard participant information procedures may not engage participants to read the information thoroughly, and online self-report mental health surveys may reduce stigma and thus be less subject to social desirability bias.
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| 4. |
- Berman, Anne H., Professor, et al.
(författare)
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Compliance with recommendations limiting COVID-19 contagion among university students in Sweden : associations with self-reported symptoms, mental health and academic self-efficacy
- 2022
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Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 50:1, s. 70-84
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Tidskriftsartikel (refereegranskat)abstract
- Aims: The COVID-19 containment strategy in Sweden uses public health recommendations relying on personal responsibility for compliance. Universities were one of few public institutions subject to strict closure, meaning that students had to adapt overnight to online teaching. This study investigates the prevalence of self-reported recommendation compliance and associations with self-reported symptoms of contagion, self-experienced effects on mental health and academic self-efficacy among university students in Sweden in May–June 2020.Methods: This was a cross-sectional 23 question online survey in which data were analysed by multinomial regression, taking a Bayesian analysis approach complemented by null hypothesis testing.Results: A total of 4495 students consented to respond. Recommendation compliance ranged between 70% and 96%. Women and older students reported higher compliance than did men and younger students. Mild to moderate COVID-19 symptoms were reported by 30%, severe symptoms by fewer than 2%; 15% reported being uncertain and half of the participants reported no symptoms. Mental health effects were reported by over 80%, and changes in academic self-efficacy were reported by over 85%; in both these areas negative effects predominated. Self-reported symptoms and uncertainty about contagion were associated with non-compliance, negative mental health effects, and impaired academic self-efficacy.Conclusions: Students generally followed public health recommendations during strict closure of universities, but many reported considerable negative consequences related to mental health and academic self-efficacy. Digital interventions should be developed and evaluated to boost coping skills, build resilience and alleviate student suffering during the pandemic and future similar crises.
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| 5. |
- Berman, Anne H, et al.
(författare)
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National assessment and e-health interventions for mental health problems among university students : Swedish partnership in the WHO-World Mental Health International College Student (WHM- ICS) consortium
- 2021
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Ingår i: International journal of behavioral medicine : official journal of the International Society of Behavioral Medicine. - : Springer Nature. ; , s. S101-S101
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background: The life transition between late adolescence and emerg- ing adulthood is often troubled, with one in three university students showing symptoms of depression and anxiety. Help-seeking behavior is low due to emotional and practical barriers, generating a treatment gap. The purpose of this project is to map Swedish university stu- dents’ mental health problems and deliver e-health interventions to those at risk, thus reducing the treatment gap. The project is the first in a Swedish partnership with the WHO WMH-ICS 20-country international consortium.Methods: The project is organized in four work packages (WPs) over four years, beginning in 2020. An annual epidemiological survey targeting first-year students will map mental health problems and disor- ders, including suicidal thoughts and behaviors (WP1), and annual follow-up surveys will track participants’ developmental trajectories in terms of persisting problems and help-seeking behavior (WP2). Students identified as at-risk will be offered participation in a three-arm random- ized controlled trial (RCT), delivering guided or unguided transdiagnostic e-treatment, or treatment as usual in a control group (WP3). At 5-week follow-up, participants at higher risk of failing treatment according to a precision treatment algorithm will be randomized to personally adapted e- treatment or continued WP3 treatment in a secondary trial-within-trial (WP4). WP1 will begin in the spring of 2020 with a pilot survey at selected Swedish universitiesResults: We anticipate being able to present preliminary pilot survey results.Conclusions and implications: We envisage high potential for reducing mental health problems among Swedish university students, improving academic performance and reducing dropout.
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| 6. |
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| 7. |
- Berman, Anne H., Professor, et al.
(författare)
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Transdiagnostic and tailored internet intervention to improve mental health among university students : Research protocol for a randomized controlled trial
- 2024
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Ingår i: Trials. - : Springer Nature. - 1745-6215. ; 25:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Emerging adulthood is often associated with mental health problems. About one in three university students report symptoms of depression and anxiety that can negatively affect their developmental trajectory concerning work, intimate relationships, and health. This can interfere with academic performance, as mood and anxiety disorders are key predictors of dropout from higher education. A treatment gap exists, where a considerable proportion of students do not seek help for mood and anxiety symptoms. Offering internet interventions to students with mental health problems could reduce the treatment gap, increase mental health, and improve academic performance. A meta-analysis on internet interventions for university students showed small effects for depression and none for anxiety. Larger trials are recommended to further explore effects of guidance, transdiagnostic approaches, and individual treatment components.Methods: This study will offer 1200 university students in Sweden participation in a three-armed randomized controlled trial (RCT) evaluating a guided or unguided transdiagnostic internet intervention for mild to moderate depression and anxiety, where the waitlist control group accesses the intervention at 6-month follow-up. Students reporting suicidal ideation/behaviors will be excluded and referred to treatment within the existing healthcare system. An embedded study within the trial (SWAT) will assess at week 3 of 8 whether participants in the guided and unguided groups are at higher risk of failing to benefit from treatment. Those at risk will be randomized to an adaptive treatment strategy, or to continue the treatment as originally randomized. Primary outcomes are symptoms of depression and anxiety. Follow-ups will occur at post-treatment and at 6-, 12-, and 24-month post-randomization. Between-group outcome analyses will be reported, and qualitative interviews about treatment experiences are planned.Discussion: This study investigates the effects of a transdiagnostic internet intervention among university students in Sweden, with an adaptive treatment strategy employed during the course of treatment to minimize the risk of treatment failure. The study will contribute knowledge about longitudinal trajectories of mental health and well-being following treatment, taking into account possible gender differences in responsiveness to treatment. With time, effective internet interventions could make treatment for mental health issues more widely accessible to the student group.
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| 8. |
- Boraxbekk, Carl-Johan, 1980-, et al.
(författare)
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Motor and mental training in older people : Transfer, interference, and associated functional neural responses
- 2016
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Ingår i: Neuropsychologia. - : Elsevier BV. - 0028-3932 .- 1873-3514. ; 89, s. 371-377
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Tidskriftsartikel (refereegranskat)abstract
- Learning new motor skills may become more difficult with advanced age. In the present study, we randomized 56 older individuals, including 30 women (mean age 70.6 years), to 6 weeks of motor training, mental (motor imagery) training, or a combination of motor and mental training of a finger tapping sequence. Performance improvements and post-training functional magnetic resonance imaging (fMRI) were used to investigate performance gains and associated underlying neural processes. Motor only training and a combination of motor and mental training improved performance in the trained task more than mental-only training. The fMRI data showed that motor training was associated with a representation in the premotor cortex and mental training with a representation in the secondary visual cortex. Combining motor and mental training resulted in both premotor and visual cortex representations. During fMRI scanning, reduced performance was observed in the combined motor and mental training group, possibly indicating interference between the two training methods. We concluded that motor and motor imagery training in older individuals is associated with different functional brain responses. Furthermore, adding mental training to motor training did not result in additional performance gains compared to motor-only training and combining training methods may result in interference between representations, reducing performance.
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| 9. |
- Budhiraja, Meenal, et al.
(författare)
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Brain structure abnormalities in young women who presented conduct disorder in childhood/adolescence
- 2017
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Ingår i: Cognitive, Affective, & Behavioral Neuroscience. - : Springer-Verlag New York. - 1530-7026 .- 1531-135X. ; 17:4, s. 869-885
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Tidskriftsartikel (refereegranskat)abstract
- The phenotype and genotype of antisocial behavior among females are different from those among males. Previous studies have documented structural brain alterations in males with antisocial behavior, yet little is known about the neural correlates of female antisocial behavior. The present study examined young women who had presented conduct disorder (CDW) prior to age 15 to determine whether brain abnormalities are present in adulthood and whether the observed abnormalities are associated with comorbid disorders or maltreatment that typically characterize this population. Using magnetic resonance imaging and voxel-based morphometry, we compared gray matter volumes (GMV) of 31 women who presented CD by midadolescence and 25 healthy women (HW), age, on average, 23 years. Participants completed structured, validated interviews to diagnose mental disorders, and validated questionnaires to document physical and sexual abuse. Relative to HW, CDW presented increased GMV in the left superior temporal gyrus that was associated with past alcohol and drug dependence, current use of alcohol and drugs, and current anxiety and depression symptoms and maltreatment. Additionally, CDW displayed reduced GMV in lingual gyrus, hippocampus, and anterior cingulate cortex that was associated with past comorbid disorders, current alcohol and drugs use, current anxiety and depression symptoms, and maltreatment. The CDW also presented reduced total GMV that was associated with past comorbid disorders and current anxiety/depression symptoms. Alterations of brain structure were observed among young adult females with prior CD, relative to HW, all of which were associated with internalizing and externalizing disorders and maltreatment that typically accompany CD.
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| 10. |
- Budhiraja, Meenal, et al.
(författare)
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Cortical structure abnormalities in females with conduct disorder prior to age 15
- 2019
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Ingår i: Psychiatry Research. - : Elsevier. - 0925-4927 .- 1872-7506. ; 289, s. 37-44
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Tidskriftsartikel (refereegranskat)abstract
- Among females, conduct disorder (CD) before age 15 is associated with multiple adverse outcomes in adulthood. The few existing structural neuroimaging studies of females with CD report abnormalities of gray matter volumes. The present study compared cortical thickness and surface area of young women with childhood/adolescent CD and healthy women to determine whether cortical abnormalities were present in adulthood and whether they were related to prior CD. Structural brain images from 31 women with CD and 25 healthy women were analyzed using FreeSurfer. Group differences between cortical thickness and surface area were assessed using cluster-wise corrections with Monte Carlo simulations. Women with prior CD, relative to healthy women, showed: (1) reduced cortical thickness in left fusiform gyrus extending up to entorhinal cortex and lingual gyrus; (2) reduced surface area in right superior parietal cortex; (3) increased surface area in left superior temporal gyrus, and right precentral gyrus. These differences remained significant after adjusting for past comorbid disorders, current symptoms of anxiety and depression, current substance use as well as maltreatment. The study suggests that among females, CD prior to age 15 is associated with cortical structure abnormalities in brain regions involved in emotion processing and social interaction.
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| 11. |
- Carlbring, Per, et al.
(författare)
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Behavioral Activation vs. Physical Exercise in the Treatment of Mild to Moderate Depression
- 2015
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Despite their potential as low-threshold, low-cost and high-flexibility treatments of depression, behavioral activation and physical exercise have not yet been directly compared. This study has examined the effects of these interventions, administered via the Internet. In this randomized controlled trial a total of 312 participants meeting the diagnostic criteria for mild to moderate major depression, recruited in multiple cycles and randomized to either a waiting list control group with delayed treatment, or one of the four active treatment groups: (1) physical exercise without a clear psychological treatment rationale; (2) physical exercise with a psychological treatment rationale; (3) behavioral activation a la Lewinsohn; or (4) behavioral activation a la Martel. A total of 72% were women and the average age of the participants were M=42.3 years (SD=13,5). More than half (53,9%) had a history of previous psychological treatment. Primary outcome measure was the 9-item Patient Health Questionnaire. Assessments were made on a weekly basis for the full duration of the acute treatment which was 12 weeks. The preliminary results are in line with previous online studies showing that all active treatment groups were superior to the waitlist (large effect sizes) and that only minor differences could be identified between the four active groups (large within effect sizes). At the time of the conference 6-month follow-up data will be available in addition to the already collected post-assessment data (analyzed according to the intention-to-treat principle).
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| 12. |
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| 13. |
- Carlbring, Per, et al.
(författare)
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ITSY : A Gamified One-Session Virtual Reality App With 12-Month Follow-Up Data
- 2017
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Ingår i: Program Book. ; , s. 396-396
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Konferensbidrag (refereegranskat)abstract
- Introduction: This is the first large randomized-controlled trial to evaluate whether commercially available VR hardware and software can be used for exposure therapy. The aim of this study was to compare gold-standard One Session Therapy (OST) for reduction of spider phobia symptoms and avoidance behavior using in vivo spiders and a human therapist, to a newly developed single-session gamified Virtual Reality Exposure Therapy (VRET) application with modern, consumer-available VR hardware, virtual spiders, and a virtual therapist.Method: Subjects (N=100) with spider phobia, diagnosed, and meeting inclusion criteria were recruited from the general population and randomized to 2 treatment arms. In 1-week intervals, pre-measurement, 3-hr treatment and post-measurement were completed with an in-vivo behavioral approach test (BAT) serving as the primary outcome measure for both groups. This study was powered to detect a non-inferiority margin of a 2-point between-group difference on the BAT, with a standard deviation of 4 (at 80% power).Results: 98 patients commenced treatment and 97 patients completed post-measurement. Per protocol analysis indicated VR was not non-inferior to OST. Repeated-measures ANOVA identified a significant main effect of time (p < .001) and time x group effect (p < .05). Both OST and VR participants experienced large BAT within-group effect sizes (d=2.28 and d=1.45, respectively). By the time of the conference there will be 12-month follow-up data including prediction analysis and the effect of treatment credibility and working alliance (with the virtual therapist).Conclusion: OST is the superior treatment option for spider phobia. VRET is an effective alternative if OST cannot be provided, as pure self-help, as the initial intervention in a stepped-care model, or as a possible post-OST booster.
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| 14. |
- Carlbring, Per, et al.
(författare)
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The effects of a 12-week relapse prevention program following acute depression treatment : A randomised controlled trial
- 2019
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Konferensbidrag (refereegranskat)abstract
- Context: Depression can be effectively treated using internet interventions. However, the relapse rate is non-ignorable. Methods: 286 participants were randomized to an additional relapse prevention program or a control group. Monthly telephone calls using the MINI diagnostic interview as well as online assessments were carried out for 24 months. Intervention: Standard cognitive behaviour therapy via the internet without guidance. Results: Relapse rates of 27.1% and 22.0% were reported in the relapse prevention program group and the control group respectively. A log-rank test of the Kaplan-Meier model did not show any significant difference between the prevention program group and the control group (χ2(1) = 0.87; p = .352) in terms of relapse rates. At the one-year follow-up, 79.2% in the prevention program group and 82.9% of the participants in the control group had PHQ-9 scores indicating them to be in remission. By the second-year follow-up the rate of remission was 75.8% in the relapse prevention program group and 81.2% in the control group. No significant differences could be seen neither at the one-year follow-up (χ2(1) = 0.36; p = .552) nor the two-year follow-up (χ2(1) = 0.53; p = .467). Conclusions: Don’t do it!
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| 15. |
- Carlbring, Per, et al.
(författare)
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The effects on depression of Internet-administered behavioral activation vs. physical exercise
- 2015
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Despite their potential as low-threshold, low-cost and high-flexibility treatments of depression, behavioral activation and physical exercise have not yet been directly compared. This study has examined the effects of these interventions, administered via the Internet. In this randomized controlled trial a total of 312 participants meeting the diagnostic criteria for mild to moderate major depression, recruited in multiple cycles and randomized to either a waiting list control group with delayed treatment, or one of the four active treatment groups: (1) physical exercise without a clear psychological treatment rationale; (2) physical exercise with a psychological treatment rationale; (3)behavioral activation a la Lewinsohn; or (4) behavioral activation a la Martel. A total of 72% were women and the average age of the participants were M=42.3 years (SD=13,5). More than half (53,9%) had a history of previous psychological treatment. Primary outcome measure was the 9-item Patient Health Questionnaire. Assessments were made on a weekly basis for the full duration of the acute treatment which was 12 weeks. The preliminary results are in line with previous online studies showing that all active treatment groups were superior to the waitlist (large effect sizes) and that only minor differences could be identified between the four active groups (large within effect sizes). At the time of the conference 6-month follow-up data will be available in addition to the already collected post-assessment data (analyzed according to the intention-to-treat principle).
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| 16. |
- Carlbring, Per, et al.
(författare)
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The effects on depression of Internet-administered behavioural activation and physical exercise with treatment rationale and relapse prevention : study protocol for a randomised controlled trial
- 2013
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Ingår i: Trials. - : Springer Science and Business Media LLC. - 1745-6215. ; 14, s. 35-
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Tidskriftsartikel (refereegranskat)abstract
- Background: Despite their potential as low-threshold, low-cost and high-flexibility treatments of depression, behavioural activation and physical exercise have not yet been directly compared. This study will examine the effects of these interventions, administered via the Internet. The added effect of providing a treatment rationale will also be studied, as well as a relapse prevention program featuring cognitive behavioural therapy components.Methods/Design: This randomised controlled trial will include 500 participants meeting the diagnostic criteria for major depression, recruited in multiple cycles and randomised to either a waiting list control group with delayed treatment, or one of the four treatment groups: (1) physical exercise without a clear treatment rationale; (2) physical exercise with treatment rationale; (3) behavioural activation with treatment rationale; or (4) behavioural activation without a clear treatment rationale. Post treatment, half of the participants will be offered a relapse prevention program. Primary outcome measure will be the Patient Health Questionnaire 9-item. Secondary measures include diagnostic criteria for depression, as well as self-reported anxiety, physical activity and quality of life. Measurements - done via telephone and the Internet - will be collected pre-treatment, weekly during treatment period, immediately post treatment and then monthly during a 24-month follow-up period.Discussion: The results of this study will constitute an important contribution to the body of knowledge of the respective interventions. Limitations are discussed.
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| 17. |
- Carlbring, Per, et al.
(författare)
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The efficacy of internet-based virtual reality exposure therapy for public speaking anxiety : A randomized controlled trial
- 2017
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Fear of public speaking is common and for some individuals this interferes significantly with the person's life and causes marked distress. We wanted to test a newly developed virtual reality assisted 1-session in-person treatment (3 hours). The therapist guided session consisted of a series of behavioral experiments based on the expectancy violation principle. This was followed by a 4-week booster intervention delivered via the internet. Following a diagnostic interview a total of 50 individuals with a score of ≥ 60 on the Personal Report of Public Speaking Anxiety questionnaire were randomized to a treatment or a control condition. A total of 78% also met criteria for social anxiety disorder. Considering only having had one treatment session in-person the preliminary results were promising with a between group effect size on the primary outcome (Public Speaking Anxiety Scale) of Cohen’s d=1.32 before commencing the internet-based booster program. Four weeks later the between-group effect size was d=1.90. However, on the secondary outcome measures the effect sizes were more often moderate than large. At the time of the conference 6-month follow-up data will be available in addition to the already collected post-assessment data (analyzed according to the intention-to-treat principle).
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| 18. |
- Carlbring, Per, et al.
(författare)
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The relative effects of behavioral activation vs. physical exercise in the treatment of mild to moderate depression
- 2016
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Konferensbidrag (refereegranskat)abstract
- Aim: Despite their potential as low-threshold, low-cost and high-flexibility treatments of depression, behavioral activation and physical exercise have not yet been directly compared. This study has examined the effects of these interventions, administered via the Internet.Method: In this randomized controlled trial a total of 312 participants meeting the diagnostic criteria for mild to moderate major depression, recruited in multiple cycles and randomized to either a waiting list control group with delayed treatment, or one of the four active treatment groups: (1) physical exercise without a clear psychological treatment rationale; (2) physical exercise with a psychological treatment rationale; (3) behavioral activation a la Lewinsohn; or (4) behavioral activation a la Martel.Results: A total of 72% were women and the average age of the participants were M=42.3 years (SD=13,5). More than half (53,9%) had a history of previous psychological treatment. Primary outcome measure was the 9-item Patient Health Questionnaire. Assessments were made on a weekly basis for the full duration of the acute treatment which was 12 weeks.Conclusion: The preliminary results are in line with previous online studies showing that all active treatment groups were superior to the waitlist (large effect sizes) and that only minor differences could be identified between the four active groups (large within effect sizes). At the time of the conference 6-month follow-up data will be available in addition to the already collected post- assessment data (analyzed according to the intention-to-treat principle).
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| 19. |
- Carlbring, Per, et al.
(författare)
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Therapist and Internet Administered One-Session Virtual Reality Exposure Therapy for Public Speaking Anxiety : A Randomized Controlled Trial
- 2018
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Fear of public speaking is common and for some individuals this interferes significantly with the person's life and causes marked distress. We wanted to test a newly developed virtual reality assisted 1-session in-person treatment (3 hours). The therapist guided session consisted of a series of behavioral experiments based on the expectancy violation principle. This was followed by a 4-week booster intervention delivered via the internet. Following a diagnostic interview a total of 50 individuals with a score of ≥ 60 on the Personal Report of Public Speaking Anxiety questionnaire were randomized to a treatment or a control condition. A total of 78% also met criteria for social anxiety disorder. Considering only having had one treatment session in-person the preliminary results were promising with a between group effect size on the primary outcome (Public Speaking Anxiety Scale) of Cohen’s d=1.32 before commencing the internet-based booster program. Four weeks later the between-group effect size was d=1.90. However, on the secondary outcome measures the effect sizes were more often moderate than large. At the time of the conference 6-month follow-up data will be available in addition to the already collected post-assessment data (analyzed according to the intention-to-treat principle).
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| 20. |
- Carlbring, Per, et al.
(författare)
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Unified protocol vs. diagnostic specific treatment of social anxiety : a randomized treatment study with a factorial design
- 2018
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Ingår i: Scientific Programme.
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Konferensbidrag (refereegranskat)abstract
- Traditionally, Cognitive Behavior Therapy researchers have developed and tested diagnostic specific treatment manuals. Most of which are efficacious. However, since comorbidity between anxiety and mood disorders is common and as the choice of the best suited treatment manual for each patient can be hard when delivering the treatment via the internet, transdiagnostic interventions have been put forward.The purpose of this study was to compare the effect of unified protocol vs. diagnostic specific treatment in a group of 147 individuals with social anxiety. The score on Liebowitz Social Anxiety Scale at pre-treatment was M=52.7.The interventions were both delivered via the internet during 9 weeks. In addition, the relative effect of no guidance vs. guidance on demand was investigated in a factorial design with 25 % of the patients randomized into each of the four groups. The preliminary results at week 9 show large within group effects (average Cohen’s d = 1,03), but no significant between-group differences as measured with the self-report MINI-SPIN-R and OASIS/ODSIS.At the time of the conference 6-month follow-up data will be available in addition to the already collected post-assessment data (analyzed according to the intention-to-treat principle).
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| 21. |
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| 22. |
- Chien, Yin-Hsiu, et al.
(författare)
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Mudd's disease (MAT I/III deficiency) : a survey of data for MAT1A homozygotes and compound heterozygotes
- 2015
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Ingår i: Orphanet Journal of Rare Diseases. - : Springer Science and Business Media LLC. - 1750-1172. ; 10
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Tidskriftsartikel (refereegranskat)abstract
- Background: This paper summarizes the results of a group effort to bring together the worldwide available data on patients who are either homozygotes or compound heterozygotes for mutations in MAT1A. MAT1A encodes the subunit that forms two methionine adenosyltransferase isoenzymes, tetrameric MAT I and dimeric MAT III, that catalyze the conversion of methionine and ATP to S-adenosylmethionine (AdoMet). Subnormal MAT I/III activity leads to hypermethioninemia. Individuals, with hypermethioninemia due to one of the MAT1A mutations that in heterozygotes cause relatively mild and clinically benign hypermethioninemia are currently often being flagged in screening programs measuring methionine elevation to identify newborns with defective cystathionine beta-synthase activity. Homozygotes or compound heterozygotes for MAT1A mutations are less frequent. Some but not all, such individuals have manifested demyelination or other CNS abnormalities. Purpose of the study: The goals of the present effort have been to determine the frequency of such abnormalities, to find how best to predict whether they will occur, and to evaluate the outcomes of the variety of treatment regimens that have been used. Data have been gathered for 64 patients, of whom 32 have some evidence of CNS abnormalities (based mainly on MRI findings), and 32 do not have such evidence. Results and Discussion: The results show that mean plasma methionine concentrations provide the best indication of the group into which a given patient will fall: those with means of 800 mu M or higher usually have evidence of CNS abnormalities, whereas those with lower means usually do not. Data are reported for individual patients for MAT1A genotypes, plasma methionine, total homocysteine (tHcy), and AdoMet concentrations, liver function studies, results of 15 pregnancies, and the outcomes of dietary methionine restriction and/or AdoMet supplementation. Possible pathophysiological mechanisms that might contribute to CNS damage are discussed, and tentative suggestions are put forth as to optimal management.
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| 23. |
- Edenbrandt, Lars, et al.
(författare)
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Area of ischemia assessed by physicians and software packages from myocardial perfusion scintigrams
- 2014
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Ingår i: BMC Medical Imaging. - : BioMed Central. - 1471-2342 .- 1471-2342. ; 14:5
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Tidskriftsartikel (refereegranskat)abstract
- Background: The European Society of Cardiology recommends that patients with greater than 10% area of ischemia should receive revascularization. We investigated inter-observer variability for the extent of ischemic defects reported by different physicians and by different software tools, and if inter-observer variability was reduced when the physicians were provided with a computerized suggestion of the defects. Methods: Twenty-five myocardial perfusion single photon emission computed tomography (SPECT) patients who were regarded as ischemic according to the final report were included. Eleven physicians in nuclear medicine delineated the extent of the ischemic defects. After at least two weeks, they delineated the defects again, and were this time provided a suggestion of the defect delineation by EXINI Heart(TM) (EXINI). Summed difference scores and ischemic extent values were obtained from four software programs. Results: The median extent values obtained from the 11 physicians varied between 8% and 34%, and between 9% and 16% for the software programs. For all 25 patients, mean extent obtained from EXINI was 17.0% (+/- standard deviation (SD) 14.6%). Mean extent for physicians was 22.6% (+/- 15.6%) for the first delineation and 19.1% (+/- 14.9%) for the evaluation where they were provided computerized suggestion. Intra-class correlation (ICC) increased from 0.56 (95% confidence interval (CI) 0.41-0.72) to 0.81 (95% CI 0.71-0.90) between the first and the second delineation, and SD between physicians were 7.8 (first) and 5.9 (second delineation). Conclusions: There was large variability in the estimated ischemic defect size obtained both from different physicians and from different software packages. When the physicians were provided with a suggested delineation, the inter-observer variability decreased significantly.
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| 24. |
- Fagernäs, Simon, et al.
(författare)
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Moderating effects of presence and adherence in internetbased CBT with virtual reality exposure therapy for public speaking anxiety
- 2017
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Konferensbidrag (refereegranskat)abstract
- Introduction: Previous research has revealed that Virtual Reality Exposure Therapy (VRET) is an effective method for reducing symptoms of public speaking anxiety (PSA). Research about presence in the virtual environment indicates a moderating effect on physiological arousal, but more ambiguous effect on treatment effects where some research indicates a small effect while other indicate no effect. Furthermore, previous research has found adherence to home work assignments to moderate treatment outcome. In this treatment study which aimed for treating public speaking anxiety with VRET and a internetbased CBT-program, we investigated whether presence in the virtual environment and adherence to home work moderated treatment effects.Methods: N=25 adult participants from the general public with clinically significant PSA were recruited to a wait-list to another study. After five weeks on waitlist, they started the treatment with a self-guided in virtuo exposure session followed by a four week online maintenance promoting in-vivo exposure. Participants got a simple VR headset by post. The three-hour exposure session included psychoeducation in text, and the participants conducted speech exercises, framed as behavioral experiments targeting idiosyncratic catastrophic beliefs, in front of virtual audiences, and listening to audio recording afterwards. Primary outcome measure was self-reported PSA. To measure moderating effects of presence on the primary outcome measure a self-reported validated scale with subscales for presence (iGroup Presence Questionnaire, IPQ) were used, and for adherence a score were manually calculated based on the number of completed home-work assignments in both a linear model and a binary model dividing participants in two groups: one with at least one completed home work assignment and one with no completed home work assignment. The analysis on presence included both the effects of the VRET-session alone and in combination with the internetbased CBT-program. Data were analyzed using mixed effects modeling.Results: No significant results were found in moderating effects of presence with its subscales on the primary outcome measure for either the VRET-session (p = .375-.616) nor in combination with the internetbased CBT-program (p = .454 - .877). Moderating effects of adherence on primary outcome measure neither revealed no significant results in the linear model (p = .368) nor the binary model (p = .113).Conclusions: The findings of this study indicate, in line with some previous research, that presence in the virtual environment has no significant moderating effect on treatment outcome. Furthermore, in contrast to previous research, this study found no significant moderating effect on adherence to home work assignments on primary treatment outcome. Internal- and external validity and other potential explanations are discussed in detail in the poster.
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| 25. |
- Fagernäs, Simon, et al.
(författare)
-
What do users think about Virtual Reality relaxation applications? A mixed methods study of online user reviews using natural language processing
- 2021
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Ingår i: Internet Interventions. - : Elsevier BV. - 2214-7829. ; 24
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Tidskriftsartikel (refereegranskat)abstract
- The advent of affordable Virtual Reality (VR) technology has spurred consumer and commercial interest in VR relaxation applications, which has quickly grown into a popular non-gaming genre on digital marketplaces. While laboratory studies have demonstrated efficacy of VR relaxation for mental health purposes, little is known about how users experience this type of intervention and no study has examined the reception of consumer versions among regular users in everyday life. Studying published user reviews offers a unique window into naturalistic user experiences that complements traditional qualitative methods by circumventing the sampling bias of interview studies, and allowing analyses on full samples, unconstrained by coding resources. Using an innovative, semi-automated Natural Language Processing technique, the current study analyzed 1379 published reviews (including star ratings) of 30 different VR relaxation applications available for the Oculus Go and Gear VR. The uncovered topic structure and sentiment analysis thereof suggests that users have an overall positive view of VR relaxation applications, describing them as successful in inducing immersion and relaxation, and having appreciated gamification elements. However, perceived quality varied substantially between applications that explained more variance in star ratings than specific features. Critical issues raised were both technical (e.g. “overheating”) in nature and related to specific design elements and use. Implications for the design of consumer VR applications and future research are discussed.
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| 26. |
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| 27. |
- Forsström, David, et al.
(författare)
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Further Exploration of the Psychometric Properties of GamTest : A Rasch Analysis
- 2021
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1661-7827 .- 1660-4601. ; 18:9
-
Tidskriftsartikel (refereegranskat)abstract
- GamTest is a self-rating scale of negative consequences of gambling, included in the popular responsible gambling tool Playscan as part of an overall risk assessment and feedback feature. Two previous psychometric evaluations of this instrument yielded contradictory results: in an online high-gambling population, a five-factor model was supported and the instrument had overall good psychometric properties, but in a low-gambling population, the same factor structure was not supported. Because GamTest is used with both low- and high-gambling populations, more psychometric research is needed to fully understand how the instrument works. The current study examined, for the first time, psychometric performance among a sample of low-gambling respondents using a Rasch analysis. Results indicated that the instrument could be improved by decreasing the scale-steps and removing several problematic items demonstrating misfit. Furthermore, the findings indicated that some items functioned differently depending on gender, and that a shortened, improved nine-item version could not differentiate between different levels of risk. Our findings suggest that the instrument would arguably benefit from being adapted for use in a low-gambling population.
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| 28. |
- Forsström, David, et al.
(författare)
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Gamblers' Perception of the Playscan Risk Assessment : A Mixed-Methods Study
- 2022
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Ingår i: Journal of Gambling Studies. - : Springer Science and Business Media LLC. - 1050-5350 .- 1573-3602. ; 38:2, s. 591-606
-
Tidskriftsartikel (refereegranskat)abstract
- Responsible gambling (RG) tools are globally widespread; they aim to prevent or decrease the harm caused by gambling. However, existing research suggests that several included features do not decrease gambling or significantly reduce the subsequent harm. Most of the previous studies have used gambling data to understand the changes in gambling behavior. However, the literature lacks research regarding gamblers' experience and perception of RG tools, which may provide insight into increasing the usage and effectiveness of RG tools. This mixed-methods study aimed to explore gamblers' perception of their risk assessment in the RG tool Playscan regarding developing harmful gambling problems. Overall, 757 participants rated the perceived accuracy of their risk assessment and their perception of the overall RG tool that conducted the assessment. Participants were also allowed to leave a comment providing feedback, which was analyzed using thematic analysis. Quantitative data was analyzed using logistic regression and structural equation modeling. Qualitative analyses revealed that most of the participants were pleased with the risk assessment and found it helpful. Moderated mediation analysis showed that participants' assessment agreement partially mediated the association between expressing a negative view and their general view of Playscan. These results highlight the need to decrease the level of disagreement for promoting a better general view of RG tools to potentially increase their usage and effectiveness.
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| 29. |
- Forsström, David, et al.
(författare)
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GamTest : Psychometric Evaluation in a Low-Gambling General Population
- 2020
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Ingår i: Journal of Gambling Issues. - Toronto : Concurrent Disorders Society Press. - 1910-7595. ; 44, s. 77-102
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Tidskriftsartikel (refereegranskat)abstract
- Instruments that investigate different aspects of gambling activities are needed to distinguish negative consequences. Because gambling is a complex activity that occurs both offline and online, different questionnaires are necessary for screening and risk classification. GamTest, an instrument used by several gambling companies, was designed to cover different aspects of gambling: money and time spent, as well as social, financial, and emotional consequences. This study explores GamTest’s psychometric properties in a general population. A total of 2,234 Swedish respondents completed an online survey containing demographic questions, the questionnaire (GamTest), and the Problem Gambling Severity Index (PGSI). A confirmatory factor analysis was performed and GamTest’s reliability and validity tested. The confirmatory factor analysis yielded an inclusive fit. The internal consistency (omega) for the five factors was high (.79–.91), indicating good reliability, and a high positive correlation with the PGSI supported the validity of the GamTest. The inclusive fit of the confirmatory factor analysis can be explained by the low endorsement of negative consequences of gambling in the sample. However, GamTest seems to have good reliability and validity. The utility of GamTest is discussed in relation to its psychometric properties and its use in the responsible gambling tool Playscan.
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| 30. |
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| 31. |
- Forsström, David, 1981-, et al.
(författare)
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Isolation and worry in relation to gambling and onset of gambling among psychiatry patients during the COVID-19 pandemic : A mediation study
- 2022
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Ingår i: Frontiers in Psychology. - : Frontiers Media SA. - 1664-1078. ; 13
-
Tidskriftsartikel (refereegranskat)abstract
- When the COVID-19 pandemic started spreading globally, there was a fear that addictive behaviors would increase due to changes in everyday life caused by restrictions due to COVID-19. Studies were carried out to explore if this was true for gambling, typically revealing no overall increase in gambling behavior, although individuals who had previous experience with gambling problems were more likely to increase gambling during the pandemic. However, these studies only included individuals with previous gambling problems. It remains unknown whether other vulnerable groups, such as individuals with common mental disorders increased their gambling. This study aimed to explore the level of gambling problems among individuals with a history of mental disorders, namely, (i) pre-pandemic gamblers and (ii) pandemic-onset gamblers. Furthermore, we explored if worry and isolation mediate gambling and problem gambling. The data were analyzed using descriptive statistics and a structural equation model to investigate mediation. The results showed a high prevalence of at-risk and problem gambling in both groups. The pre-pandemic gamblers had a high level of at-risk and problem gambling. Furthermore, the individuals that started to gamble during the pandemic had an even higher degree of at-risk and problem gambling. The mediation showed that the onset of gambling was linked with the worry of COVID-infection and that worry predicted the level of gambling problems. This study highlights that vulnerability factors, isolation, and worry can be triggers for individuals with common mental disorders to engage in gambling as well as the importance of screening this population for gambling problems.
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| 32. |
- Forsström, David, 1981-, et al.
(författare)
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Psychometric properties of the Jonsson-Abbott Scale : Rasch and confirmatory factor analyses
- 2022
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Ingår i: Frontiers in Psychology. - : Frontiers Media SA. - 1664-1078. ; 13
-
Tidskriftsartikel (refereegranskat)abstract
- Measuring and assessing the different aspects of gambling behavior and its consequences is crucial for planning prevention, treatment, and understanding the development of at-risk and problem gambling. Studies indicate that instruments measuring problem gambling produce different results based on the characteristics of the population assessed. To accurately measure at-risk and problem gambling behavior, especially in a low-risk population, measures must cover a wider set of dimensions than the negative consequences already manifest. The Jonsson-Abbott Scale (JAS) includes items that cover overconsumption, actions that reinforce gambling behavior, and belief in gambling fallacies, based on a three-factor structure and has previously demonstrated good psychometric properties. However, there is a need to investigate how the instrument also functions in low-risk populations. This study aims to do so using both confirmatory factor and Rasch analysis; this research included 1,413 Swedish participants who endorsed at least one JAS item. The results replicated the previous three-factor solution and indicated that the instrument had good reliability. In addition, the results demonstrated that the three factors are independent, and the overall score per factor needs to be analyzed. In summary, the JAS appears suitable for use in low-risk populations to measure various aspects of gambling behavior.
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| 33. |
- Hlynsson, Jón Ingi, et al.
(författare)
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Exploring cutoff points and measurement invariance of the Brunnsviken brief quality of life inventory
- 2024
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Ingår i: Frontiers in Psychology. - 1664-1078. ; 14
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Quality of life (QoL) can be defined as the goodness of life, beyond simply absence of disease or functional impairments, self-rating scales of which capture valuable information beyond change in primary outcomes. This study (n = 3,384) validated the Brunnsviken Brief Quality of Life Inventory (BBQ) across divergent groups by evaluating its measurement invariance (MI). We hypothesized measurement invariance for the BBQ across age groups, genders, depression, and anxiety severity. Potential cutoff points for the BBQ were also explored.Method: Confirmatory factor analysis (CFA) models were fit to sample data obtained from an ongoing study on transdiagnostic internet-based treatment modules. Parameters were successively constrained to assess configural, metric, scalar, and residual invariance factor structures across different groups.Results: The BBQ demonstrated MI at the metric level and partial MI at the scalar level across all these groups, which remained stable at the strict-residual level for all groups except for genders. These results remained stable after correcting for unbalanced group sizes for gender, clinical–subclinical levels of depression, and clinical–subclinical levels of anxiety. A cutoff point analysis revealed that a BBQ total scores below 39 was associated with notable psychopathology.Discussion: The BBQ is a reliable measure of QoL that is applicable for various divergent groups (e.g., vulnerable persons), and thus a viable instrument for use in healthcare and research with minimal aversive impact.Clinical trial registration: NCT05016843.
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| 34. |
- Hlynsson, Jón Ingi, et al.
(författare)
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Let's talk about digital mental health assessment : Utilizing PHQ-2 and GAD-2 for in-treatmentmonitoring & BBQ and QWB for outcome evaluation in internet interventions
- 2024
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Ingår i: SweSRII 2024. - : Linköping University Electronic Press. ; , s. 14-14
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Konferensbidrag (refereegranskat)abstract
- INTRODUCTION: In internet-based mental health research, the efficacy of assessment tools is pivotal. Extensive questionnaires often deter participant completion, undermining data integrity. This presentation focuses on the application of brief yet effective measures: The PHQ-2 and GAD-2 as ultra-brief measures for psychopathology, and Brunnsviken brief quality of life inventory (BBQ) and Questionnaire on Well-Being (QWB) as positively valanced measures for positive functioning. By prioritizing instruments with concise formats and positive framing, such as the BBQ and QWB, our research aims to enhance response rates and data quality. We explore psychometric findings from various internet-based trials, demonstrating the utility of these measures in capturing in-treatment fluctuations and informing treatment outcomes. METHOD: We outline findings from three studies at different stages of development. Primary statistics are obtained from ROC curve and factor analyses. RESULTS: Preliminary results suggest that brief measures like the PHQ-2 and GAD-2 can monitor in-treatment fluctuations in symptoms as effectively as their full-scale equivalents. The BBQ, indicating positive functioning, can validly assess divergent subgroups (e.g., vulnerable persons). Notably, BBQ total scores below 39 are linked with significant psychopathology. Preliminary results for the QWB indicate total scores are negatively associated with psychopathology and positively correlated with positive affect. CONCLUSIONS: Ultra-brief measures of psychopathology are too often used incorrectly; usage is recommended to be bound to in-treatment monitoring of treatment outcomes. Collecting data more frequently through concise surveys can provide insights into the mechanisms driving change. Treatment trials often overlook positive functioning. Thus, we encourage using the BBQ and QWB as they are psychometrically valid, freely available, and inform treatment outcomes beyond standard measures of psychopathology.
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| 35. |
- Ilioudi, Maria, 1993, et al.
(författare)
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Patient experience of a virtual reality calm room in a psychiatric inpatient care setting in Sweden: a qualitative study with inpatients
- 2023
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Ingår i: BMJ open. - 2044-6055. ; 13:12
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Calm rooms have been developed and implemented in psychiatric inpatient care settings to offer patients a dedicated space for relaxation in a convenient and safe environment. Recent technology developments have enabled virtual reality (VR) equivalents of calm rooms that can be feasibly deployed in psychiatric care settings. While research has shown VR environments to be efficacious in inducing relaxation, little is known how these virtual calm rooms are perceived by patients. The aim of this study was to elucidate patient experiences of using a VR calm room in a psychiatric inpatient setting. DESIGN: Qualitative interview study. Semi-structured interviews were analysed using qualitive inductive content analysis, which focuses on the interpretation of texts for making replicable and valid inferences. SETTING: Swedish hospital psychiatric inpatient care setting with a wireless, three degrees-of-freedom VR head-mounted display running a calm room application simulating nature environment. PARTICIPANTS: 20 adult patients (12women) with bipolar disorder (n=18) or unipolar depression (n=2). RESULTS: Participants experienced the use of the VR calm room as having a positive impact on them, inducing awareness, calmness and well-being. They were thankful to be offered a non-pharmacological alternative for anxiety relief. Participants also expressed that they had some concerns about how they would react emotionally before using the VR device. However, after use, they highlighted that their overall experience was positive. They also expressed that they could see potential for further development of VR technology in psychiatric care. CONCLUSIONS: VR technology has the potential to solve pressing logistic issues in offering calm rooms in psychiatric inpatient care. VR calm rooms appear to be appreciated by psychiatric inpatients, who value their accessibility, convenience and variety of modalities offered. Participants perceived an increase in their well-being after use.
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| 36. |
- Ivanova, Ekaterina, et al.
(författare)
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Experiences of responsible gambling tools among non-problem gamblers : A survey of active customers of an online gambling platform
- 2019
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Ingår i: Addictive Behaviors Reports. - : Elsevier BV. - 2352-8532. ; 9
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Responsible gambling (RG) tools, aiming at helping gamblers to avoid gambling-related harms, are common in online gambling platforms. Gambling industry, policy makers, and researchers have warned that RG tools can potentially disturb recreational gamblers, channeling them to less protective operators. No evidence exists to support these concerns, and they can hinder the development of effective RG tools. The current study aimed to investigate the recreational gamblers' experiences of RG tools.Methods: A total of 10,200 active customers of an online gambling service were invited to complete an online survey and rate their overall reactions, attitudes, disturbance and irritation towards RG tools, as well as their inclination to abandon a gambling service due to overexposure to RG tools. N = 1223 surveys were completed.Results: Non-problem gamblers had positive experiences of RG tools. Moderate-risk gamblers had more positive overall reaction and less irritation to previous experiences of RG tools compared to non-problem gamblers. Problem gamblers had least positive attitudes, most disturbance and most irritation towards RG pictures. Non-problem gamblers had lowest rates of having abandoned a service because of perceived overexposure to RG tools (5.2% compared to 25.9% of problem gamblers), with a significant between-group difference (OR [95%CI] = 7.17 [3.61–14.23], p < .001).Conclusions: Non-problem gamblers were not particularly disturbed by RG tools and were not at risk of abandoning online gambling services because of overexposure to RG tools. The study found no grounds for limiting the design and implementation of RG tools due to fears of disturbing recreational gamblers.
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| 37. |
- Ivanova, Ekaterina, et al.
(författare)
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Guided and unguided Acceptance and Commitment Therapy for social anxiety disorder and/or panic disorder provided via the Internet and a smartphone application : A randomized controlled trial
- 2016
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Ingår i: Journal of Anxiety Disorders. - : Elsevier BV. - 0887-6185 .- 1873-7897. ; 44, s. 27-35
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Tidskriftsartikel (refereegranskat)abstract
- Acceptance and Commitment Therapy (ACT) can be effective in treating anxiety disorders, yet there has been no study on Internet-delivered ACT for social anxiety disorder (SAD) and panic disorder (PD), nor any study investigating whether therapist guidance is superior to unguided self-help when supplemented with a smartphone application. In the current trial, n = 152 participants diagnosed with SAD and/or PD were randomized to therapist-guided or unguided treatment, or a waiting-list control group. Both treatment groups used an Internet-delivered ACT-based treatment program and a smartphone application. Outcome measures were self-rated general and social anxiety and panic symptoms. Treatment groups saw reduced general (d = 0.39) and social anxiety (d = 0.70), but not panic symptoms (d = 0.05) compared to the waiting-list group, yet no differences in outcomes were observed between guided and unguided interventions. We conclude that Internet-delivered ACT is appropriate for treating SAD and potentially PD. Smartphone applications may partially compensate for lack of therapist support.
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| 38. |
- Ivanova, Ekaterina, et al.
(författare)
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Guided and unguided CBT for social anxiety disorder and/or panic disorder via the Internet and a smartphone application
- 2015
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Ingår i: Abstracts from the 7th Swedish Congress on internet interventions (SWEsrii). - Linköping : Linköping University Press. ; , s. 9-9
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background: As Acceptance and Commitment Therapy (ACT) becomes a part of the clinical practice, the interest for alternative ways of providing it continue to grow. Internet-based CBT, both guided and unguided, has proved to be effective for the treatment of a wide range of psychiatric disorders, including anxiety disorders. Moreover, the tremendous accessibility of smartphones makes them a potentially powerful instrument for providing psychological treatment. The purpose of this study was to investigate the effects of an Internet-based ACT-program for social anxiety disorder and panic disorder using both computers and smartphones, and with and without therapist support. Method: The participants were recruited from the general public by filling out an online screening form, which consisted of LSAS, PDSS-SR, GAD-7, PHQ-9, QOLI (the scales later served as outcome measures) and demographic questions. The individuals who met the inclusion criteria were contacted for a diagnostic telephone interview. The 152 people chosen for participation were then randomized into two treatment groups (guided and unguided) and a waiting list control group. The participants in the treatment groups were given access to an Internet-provided ACT-based treatment program consisting of 8 modules, as well as a smartphone application with content that corresponded to the Internet treatment program. Additionally, the participants in the guided group received minimum therapist support (15 min/week) through the smartphone application from psychology students undergoing their clinical training. The participants worked with the program for 10 weeks. They were evaluated twice during treatment, once after completing treatment, and once again 12-months later as a follow-up measure. A mixed effect model was used to analyze the data. Results: Regardless of diagnosis, as a whole the treated groups showed significant decreases in anxiety, with a moderate within-group effect size. This improvement appeared to be maintained when the groups were evaluated again during the follow-up. The participants suffering primarily from social anxiety disorder showed significant improvements, with moderate within-group effect sizes in both the guided (Cohen's d = 0.79) and unguided group (Cohen's d = 0.71). This improvement also appeared to be maintained when these participants were evaluated during the follow-up. No significant changes were observed in the symptoms of the participants suffering primarily from panic disorder. Discussion: Internet-delivered ACT-based treatment provided via both computer and smartphone can be effective for reducing general anxiety symptoms, as well as social anxiety symptoms. The guided treatment was not clearly superior to the unguided treatment. Some of the study’s uncertainties are likely due to the presence of a large number of different components, which made it difficult to isolate the effects of each individual component.
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| 39. |
- Ivanova, Ekaterina, et al.
(författare)
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Guided and unguided transdiagnostic Acceptance and Commitment Therapy for anxiety disorders provided via a computer and a smartphone application : A randomized controlled trial
- 2016
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Ingår i: EABCT 2016 Abstract Book. ; , s. 530-530
-
Konferensbidrag (refereegranskat)abstract
- Technology-assisted psychological treatments are becoming well-known in the scientific networks throughout the world and are being implemented into routine health care in a number of countries. The interest in evaluating the potential of different devices is growing. The main objective of the current study was to evaluate the effects of guided and unguided computerand smartphone-based Acceptance and Commitment Therapy (ACT) for social anxiety disorder (SAD) and panic disorder (PD).A total of 152 participants were randomized into a guided treatment group, an unguided treatment group and a waiting list control group. Both treatment groups got access to a computer-based ACT-treatment and a smartphone application (app) with corresponding content. The eight modules treatment program covered a number of topics such as the nature of anxiety, functional analyses, acceptance, mindfulness and valued actions. The purpose of the app was to make it easier for the participants to access the key points of the program and to do homework assignments in their everyday life. Automatic messages in the app aimed to give feedback to the participants on their work as well as to prompt them to continue with the program. In addition to that, the participants in the guided group got therapist support via the app. The therapists were encouraged to work with each of their patient 15 min/week during the 10 weeks treatment period and focus on motivating, validating and correcting mistakes. On the whole group level GAD-7 was used as the primary outcome measure. LSAS and PDSS-SR were used for subgroup analyses in SAD and PD participants respectively. The measurements were collected at pre-, mid- and post-treatment and at 12-months follow-up.There were no significant differences in adherence between the treatment groups except for significantly higher rates of smartphone usage in the guided group. No significant differences in treatment outcome were found between the treatment groups with moderate within-group effects (Cohen’s d = 0.75 for the guided and Cohen’s d = 0.66 for the unguided group). The treated participants improved significantly in comparison to the control group both on the whole group level (between group Cohen’s d = 0.39) and for the participants suffering primarily from SAD (between group Cohen’s d = 0.70). Within group effect sizes were large for the PD-participants (Cohen’s d = 1.00) but the study was very underpowered in this part.Discussion. The treatment program as it was used in the present study appeared to be effective in treating social anxiety disorder and decreasing general anxiety symptoms, but the effects are smaller than seen in previous studies. The guided treatment was not clearly superior to the unguided one. The study contributes to the growing body of evidence on technology-assisted ACT.Conclusion. Computer- and smartphone-based ACT can be made into an effective treatment for anxiety disorders. A smartphone application seems to have a clear potential to partly compensate for the absence of therapist support which needs to be studied further.
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| 40. |
- Ivanova, Ekaterina, 1987-
(författare)
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Responsible provision of online gambling : Effects, usability and gamblers’ experiences of protective measures implemented in online gambling environments
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Problem gambling is considered a public health problem in many countries and is associated with serious financial and health-related harms for both problem gamblers and significant others. It is possible to create gambling environments that would promote sustainable gambling behaviors and prevent excessive gambling. However, research on the effectiveness of tools for responsible provision of gambling is scarce and the quality of the research is low. Also, there exists a conflict of interest between making a profit when providing gambling and protecting vulnerable customers. The general aim of the project was to study the effects, usability and gamblers’ experiences of tools for responsible provision of online gambling. Study I evaluated the effects of a prompt to set voluntary deposit-limit of optional size among 4,328 customers of an online gambling platform. During the data collection period, all customers from Finland registering an account on the gambling platform were randomized into being prompted to set a deposit-limit either 1) at-registration, 2) before their first deposit, 3) after their first deposit or 4) to an unprompted control group. Gambling intensity, measured with aggregated net loss, was tracked during 90 days after registration. No differences in gambling intensity between the intervention and control groups were found neither on the whole-group level (B (95% CI) =-0.080 (-0.229-0.069), p=.291), nor in the subgroup of the most involved gamblers (B (95% CI) =0.042(-0.359-0.442), p=.838). Study II aimed at predicting gaming freeze (as a proxy parameter for problem gambling) in online gamblers. For the sample of N=2,618 (N=1,309 freezers), a total of 105 predictors were created based on the data tracked by the gambling platform. The analysis was carried out using the machine learning method Random Forest. The predictive accuracy of the model applied to the dataset was 0.615, with a specificity of 0.686 and a sensitivity of 0.543. Study III aimed at investigating non-problem gamblers’ experiences of protective measures. A total of N=10,200 active customers of an online gambling platform were asked to rate their previous experiences of protective tools, their inclination to abandon a gambling service due to perceived overexposure to protective measures and answer questions on their symptoms of problem gambling. N=1,223 responded to the questionnaire, with the majority of the sample being moderate-risk gamblers (38.5%), followed by low-risk gamblers (26.8%), non-problem gamblers (18.9%) and problem gamblers (15.8%). In general, non-problem gamblers were not more disturbed by protective measures than other categories of gamblers. More problem gamblers have previously abandoned a gambling service due to perceived overexposure to protective measures compared to non-problem gamblers (OR(95% CI)= 7.17(3.61-14.23), p<.001). In conclusion, a prompt to set a voluntary deposit-limit of optional size did not appear to be effective in decreasing gambling intensity in online gamblers, indicating the need of evaluating alternative designs. Predicting gaming freezes in the current project resulted in a low accuracy, indicating that gaming freeze is not suitable as a proxy measurement for problem gambling and suggesting the need for collecting subjective data on symptoms of problem gambling. The results of Study III suggest that protective measures can be tested and implemented without the risk of disturbing recreational gamblers.
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| 41. |
- Ivanova, Ekaterina, et al.
(författare)
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Using the Random Forest Algorithm on Customer Gambling Data for Predicting Gambling Freezes in an Online Gambling Platform
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background. Data on gambling behaviors routinely collected on online gambling platforms can be used to detect individuals at risk of developing or having gambling problems. As only data on gambling activity is available on gambling platforms, it is important to find a proxy measure for gambling problems. Temporarily freezing one or several gambling categories has potential to serve this purpose. Aim. To predict gambling freeze in a sample of active users of an online gambling platform one week before the freeze, based on one week of behavioral data tracked on the platform. Method. N = 105 predictors were created, covering total values, frequencies, variations, and trajectories of monetary and time-related gambling involvement, number and type of games played, point in time when gambling occurred, age, and gender. The random forest algorithm was applied to a sample of N = 2618 gamblers (of which N = 1309 freezers), with the sample divided 70/30 into a training and testing data set. Results. The accuracy of random forest applied to the testing data set was 0.615, with sensitivity of 0.543 and specificity of 0.686. The five most predictive variables were current age, age on registration date, average session length, average sum of winnings per session, and total session length. Discussion. The predictive accuracy of the algorithm in the current study was relatively low, suggesting the need for a more suitable target variable. Also, analyzing data collected during a longer period might be needed to create a tool that could be used to identify at-risk gamblers.
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| 42. |
- J. Erliksson, Olivia, et al.
(författare)
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Measuring associations between social anxiety and use of different types of social media using the Swedish Social Anxiety Scale for Social Media Users : A psychometric evaluation and cross-sectional study
- 2020
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Ingår i: Scandinavian Journal of Psychology. - : Wiley. - 0036-5564 .- 1467-9450. ; 61:6, s. 819-826
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Tidskriftsartikel (refereegranskat)abstract
- Research on the association between social anxiety and social media usage remains inconclusive: despite the preference for computer-mediated communication there is currently no clear empirical support for social anxiety being associated with longer duration of social media use. Self-report measures for social anxiety that are adapted for the context of social media could facilitate further research. The current study aimed to develop a Swedish version of the recently developed Social Anxiety Scale for Social Media Users (SAS-SMU), evaluate its psychometric properties, and explore associations between different uses of social media and social anxiety. Three factors were retained for SAS-SMU with excellent internal consistency. SAS-SMU evidenced convergent validity with measures of social anxiety, negative convergent validity with satisfaction with life, and divergent validity with measures of obsessive-compulsive disorder, depression and generalized anxiety disorder. Results indicated that higher levels of social anxiety were associated with passive and active use as well as longer duration of social media use in general, which is at odds with a previous study where passive use remained the only significant predictor for social anxiety.
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| 43. |
- Johansson, Magnus, et al.
(författare)
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Effects of Internet-Based Cognitive Behavioral Therapy for Harmful Alcohol Use and Alcohol Dependence as Self-help or With Therapist Guidance : Three-Armed Randomized Trial
- 2021
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Ingår i: Journal of Medical Internet Research. - : JMIR Publications. - 1438-8871. ; 23:11
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Alcohol use is a major contributor to health loss. Many persons with harmful use or alcohol dependence do not obtain treatment because of limited availability or stigma. They may use internet-based interventions as an alternative way of obtaining support. Internet-based interventions have previously been shown to be effective in reducing alcohol consumption in studies that included hazardous use; however, few studies have been conducted with a specific focus on harmful use or alcohol dependence. The importance of therapist guidance in internet-based cognitive behavioral therapy (ICBT) programs is still unclear.OBJECTIVE: This trial aims to investigate the effects of a web-based alcohol program with or without therapist guidance among anonymous adult help-seekers.METHODS: A three-armed randomized controlled trial was conducted to compare therapist-guided ICBT and self-help ICBT with an information-only control condition. Swedish-speaking adult internet users with alcohol dependence (3 or more International Classification of Diseases, Tenth Revision criteria) or harmful alcohol use (alcohol use disorder identification test>15) were included in the study. Participants in the therapist-guided ICBT and self-help ICBT groups had 12-week access to a program consisting of 5 main modules, as well as a drinking calendar with automatic feedback. Guidance was given by experienced therapists trained in motivational interviewing. The primary outcome measure was weekly alcohol consumption in standard drinks (12 g of ethanol). Secondary outcomes were alcohol-related problems measured using the total alcohol use disorder identification test-score, diagnostic criteria for alcohol dependence and alcohol use disorder, depression, anxiety, health, readiness to change, and access to other treatments or support. Follow-up was conducted 3 (posttreatment) and 6 months after recruitment.RESULTS: During the recruitment period, from March 2015 to March 2017, 1169 participants were included. Participants had a mean age of 45 (SD 13) years, and 56.72% (663/1169) were women. At the 3-month follow-up, the therapist-guided ICBT and control groups differed significantly in weekly alcohol consumption (-3.84, 95% Cl -6.53 to -1.16; t417=2.81; P=.005; Cohen d=0.27). No significant differences were found in weekly alcohol consumption between the self-help ICBT group and the therapist-guided ICBT at 3 months, between the self-help ICBT and the control group at 3 months, or between any of the groups at the 6-month follow-up. A limitation of the study was the large number of participants who were completely lost to follow-up (477/1169, 40.8%).CONCLUSIONS: In this study, a therapist-guided ICBT program was not found to be more effective than the same program in a self-help ICBT version for reducing alcohol consumption or other alcohol-related outcomes. In the short run, therapist-guided ICBT was more effective than information. Only some internet help-seekers may need a multisession program and therapist guidance to change their drinking when they use internet-based interventions.TRIAL REGISTRATION: ClinicalTrials.gov NCT02377726; https://clinicaltrials.gov/ct2/show/NCT02377726.
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| 44. |
- Johansson, Magnus, et al.
(författare)
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Internet-based therapy versus face-to-face therapy for alcohol use disorder, a randomized controlled non-inferiority trial
- 2021
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Ingår i: Addiction. - : John Wiley & Sons. - 0965-2140 .- 1360-0443. ; 116:5, s. 1088-1100
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Tidskriftsartikel (refereegranskat)abstract
- Background and aimsMost people with alcohol use disorder (AUD) are never treated. Internet-based interventions are effective in reducing alcohol consumption and could help to overcome some of the barriers to people not seeking or receiving treatment. The aim of the current study was to compare internet-delivered and face-to-face treatment among adult users with AUD.DesignRandomized controlled non-inferiority trial with a parallel design, comparing internet-delivered cognitive–behavioural therapy (ICBT) (n = 150) with face-to-face CBT (n = 151), at 3- and 6-month follow-ups.SettingA specialized clinic for people with AUD in Stockholm, Sweden. Participants were recruited between 8 December 2015 and 5 January 2018.ParticipantsA total of 301 patients [mean age 50 years, standard deviation (SD) = 12.3] with AUD, of whom 115 (38%) were female and 186 (62%) were male.Intervention and comparatorParticipants were randomized in blocks of 20 at a ratio of 1 : 1 to five modules of therapist-guided ICBT or to five modules of face-to-face CBT, delivered over a 3-month period. The same treatment material and the same therapists were used in both groups.MeasurementsThe primary outcome was standard drinks of alcohol consumed during the previous week at 6-month follow-up, analysed according to intention-to-treat. The pre-specified non-inferiority limit was five standard drinks of alcohol and d = 0.32 for secondary outcomes.ResultsThe difference in alcohol consumption between the internet and the face-to-face group was non-inferior in the intention-to-treat analysis of data from the 6-month follow-up [internet = 12.33 and face-to-face = 11.43, difference = 0.89, 95% confidence interval (CI) = −1.10 to 2.88]. The secondary outcome, Alcohol Use Disorder Identification Test score, failed to show non-inferiority of internet compared with face-to-face in the intention-to-treat analysis at 6-month follow-up (internet = 12.26 and face-to-face = 11.57, d = 0.11, 95% CI = –0.11 to 0.34).ConclusionsInternet-delivered treatment was non-inferior to face-to-face treatment in reducing alcohol consumption among help-seeking patients with alcohol use disorder but failed to show non-inferiority on some secondary outcomes.
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| 45. |
- Jonsson, Jakob, et al.
(författare)
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Offering an auto-play feature likely increases total gambling activity at online slot-machines : preliminary evidence from an interrupted time series experiment at a real-life online casino
- 2024
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Ingår i: Frontiers in Psychiatry. - 1664-0640. ; 15
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Tidskriftsartikel (refereegranskat)abstract
- Auto-play is a ubiquitous feature in online casino gambling and virtual slot machines especially, allowing gamblers to initiate spin sequences of pre-set length and value. While theoretical accounts diverge on the hypothesized causal effect on gambling behavior of using the auto-play feature, observational findings show that this feature is used to a higher degree by problem and/or high-intensity gamblers, suggesting that banning this feature may constitute a global responsible gambling measure. Direct, experimental research on causal effects of offering auto-play at online casinos is however lacking. Here, we report the findings of an interrupted time series experiment, conducted at a real-life online casino in Sweden, in which the auto-play feature was made available during a pre-set duration on 40 online slot machines, with 40 matched slots serving as control. Aggregated time series on daily betted amount, spins and net losses were analyzed using a structural Bayesian framework that compared observed developments during the peri-intervention period to modeled counterfactual estimates. Results suggest that offering an auto-play feature on online casinos likely increases total gambling activity in terms of betted amount (approx.+ 7-9%) and (perhaps) number of spins (approx. +3%) but has no effect on net losses. Limitations of studying auto-play effects on a population-level, as well as the complexities of banning this feature within a complex ecosystem of non-perfect channelization to licensed providers, are discussed, including suggestions for future research.
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| 46. |
- Kahlon, Smiti, et al.
(författare)
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Virtual reality exposure therapy for adolescents with fear of public speaking : a non-randomized feasibility and pilot study
- 2019
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Ingår i: Child and Adolescent Psychiatry and Mental Health. - : Springer Science and Business Media LLC. - 1753-2000. ; 13:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Public Speaking Anxiety (PSA) is a common anxiety with onset in adolescence and early adulthood. With the advent of consumer virtual reality (VR) technology, VR-delivered exposure therapy is now a scalable and practical treatment option and has previously been shown to be efficacious with adults. In this non-randomized feasibility and pilot trial, we explore the effect of one-session (90 min) VR-delivered exposure therapy for adolescents (aged 13-16) with PSA. Methods A total of 27 adolescents were recruited from Norwegian high schools and completed self-report measures of PSA twice prior to treatment, 1 week after treatment, and at 1 and 3 month follow-up. Heart rate was recorded during the treatment session. A low-cost head-mounted VR display with a custom-built VR stimuli material depicting a cultural and age appropriate classroom and audience were used when a series of speech (exposure exercises) were performed. Results Linear mixed effects model revealed a significant decrease in PSA symptoms (Cohen's d = 1.53) pre-post treatment, and improvements were maintained at follow-ups. Physiological data revealed a small increase in heart rate during exposure tasks. Based on feedback from the adolescents, the feasibility of the intervention was increased during the trial. Conclusions The results show that low-cost, consumer VR hardware can be used to deliver efficacious treatment for PSA in adolescents, in a feasible one-session format.
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| 47. |
- Lindner, Philip, et al.
(författare)
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Amygdala-orbitofrontal structural and functional connectivity in females with anxiety disorders, with and without a history of conduct disorder
- 2018
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Ingår i: Scientific Reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 8
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Tidskriftsartikel (refereegranskat)abstract
- Conduct disorder (CD) and anxiety disorders (ADs) are often comorbid and both are characterized by hyper-sensitivity to threat, and reduced structural and functional connectivity between the amygdala and orbitofrontal cortex (OFC). Previous studies of CD have not taken account of ADs nor directly compared connectivity in the two disorders. We examined three groups of young women: 23 presenting CD and lifetime AD; 30 presenting lifetime AD and not CD; and 17 with neither disorder (ND). Participants completed clinical assessments and diffusion-weighted and resting-state functional MRI scans. The uncinate fasciculus was reconstructed using tractography and manual dissection, and structural measures extracted. Correlations of resting-state activity between amygdala and OFC seeds were computed. The CD + AD and AD groups showed similarly reduced structural integrity of the left uncinate compared to ND, even after adjusting for IQ, psychiatric comorbidity, and childhood maltreatment. Uncinate integrity was associated with harm avoidance traits among AD-only women, and with the interaction of poor anger control and anxiety symptoms among CD + AD women. Groups did not differ in functional connectivity. Reduced uncinate integrity observed in CD + AD and AD-only women may reflect deficient emotion regulation in response to threat, common to both disorders, while other neural mechanisms determine the behavioral response.
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| 48. |
- Lindner, Philip, et al.
(författare)
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Associations of Psychopathic Traits With Local and Global Brain Network Topology in Young Adult Women
- 2018
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Ingår i: Biological Psychiatry. - : Elsevier BV. - 2451-9022 .- 2451-9030. ; 3:12, s. 1003-1012
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Tidskriftsartikel (refereegranskat)abstract
- Background: Psychopathic traits vary dimensionally in the population and are associated with multiple negative outcomes. The impaired integration theory (IIT) proposes that psychopathic traits are associated with abnormal neural network topology, such that disturbed integration of neural networks results in a self-perpetuating impairment in rapid integration and learning from multiple components of information. The IIT is based on findings from male offenders presenting high scores on all psychopathic traits. The present study investigated whether IIT predictions of topology abnormalities were associated with psychopathic traits, measured dimensionally, in young adult women with subsyndromal scores.Methods: Seventy-three women, with an average age of 25 years, were assessed using the Psychopathy Checklist–Revised and completed resting-state magnetic resonance imaging. Preprocessed time series from 90 anatomical regions were extracted to form connectivity matrices and used to calculate network topology based on graph theory. Correlations between total psychopathy and factor scores with both the raw connectivity matrix and global and local graph theory measures were computed.Results: Total psychopathy scores and behavioral factor scores were related to connectivity between several pairs of regions, primarily limbic/paralimbic. Psychopathic traits were not associated with global topology measures. Topology abnormalities, robust across network formation thresholds, were found in nodes of the default mode network and in hubs connecting several resting-state networks.Conclusions: IIT predictions of abnormal topology of hubs and default mode network nodes with dimensionally measured psychopathic traits were confirmed in a sample of young women. Regional abnormalities, accompanied by preserved global topology, may underlie context-specific abnormal information processing and integration.
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| 49. |
- Lindner, Philip, et al.
(författare)
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Attitudes Toward and Familiarity With Virtual Reality Therapy Among Practicing Cognitive Behavior Therapists : A Cross-Sectional Survey Study in the Era of Consumer VR Platforms
- 2019
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Ingår i: Frontiers in Psychology. - : Frontiers Media S.A.. - 1664-1078. ; 10
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Tidskriftsartikel (refereegranskat)abstract
- Virtual reality exposure therapy (VRET) is an efficacious treatment for fear and anxiety and has the potential to solve both logistic issues for therapists and be used for scalable self-help interventions. However, VRET has yet to see large-scale implementation in clinical settings or as a consumer product, and past research suggests that while therapists may acknowledge the many advantages of VRET, they view the technology as technically inaccessible and expensive. We reasoned that after the 2016 release of several consumer virtual reality (VR) platforms and associated public acquaintance with VR, therapists' concerns about VRET may have evolved. The present study surveyed attitudes toward and familiarity with VR and VRET among practicing cognitive behavior therapists (n = 185) attending a conference. Results showed that therapists had an overall positive attitude toward VRET (pros rated higher than cons) and viewed VR as applicable to conditions other than anxiety. Unlike in earlier research, high financial costs and technical difficulties were no longer top-rated negative aspects. Average negative attitude was a larger negative predictor of self-rated likelihood of future use than positive attitude was a positive predictor and partially mediated the positive association between VRET knowledge and likelihood of future use, suggesting that promotional efforts should focus on addressing concerns. We conclude that therapist's attitudes toward VRET appear to have evolved in recent years, and no longer appear to constitute a major barrier to implementing the next generation of VR technology in regular clinical practice.
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| 50. |
- Lindner, Philip, et al.
(författare)
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Attitudes towards and familiarity with Virtual Reality therapy among practicing cognitive behavior therapists : A first survey study in the era of consumer VR platforms
- 2018
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Objectives: To survey attitudes towards, knowledge of and familiarity with Virtual Reality (VR) technology and VR exposure therapy among practicing cognitive behavior therapists, after the recent release of consumer VR platforms, with the aim of identifying potential human barriers to implementing this technology and therapeutic method in regular care. Participants: 185 practicing cognitive behavior therapists attending a conference.Measures: Self-rated likelihood of future use of VR in a clinical setting, applicability of VR to treating specific mental disorders, as well as ratings of different positive and negative aspects of VR exposure therapy – all assessed using a standardized survey.Results: Very few respondents reported having used VR clinically. Therapists had an overall positive attitude toward VRET (pros rated higher than cons) and viewed VR as applicable to conditions other than anxiety. Unlike in earlier research, a high financial cost was no longer a top-rated negative aspects. Average negative attitude was a larger negative predictor of self-rated likelihood of future use than positive attitude was a positive predictor.Conclusions: We conclude that therapist’s attitudes towards VRET appear to have evolved in recent years, coinciding with the release of consumer VR platforms, and no longer appear to constitute a major barrier to implementing the next generation of VR technology in regular clinical practice.
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