| 1. |
- Bjureberg, Johan, et al.
(författare)
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Effect of Internet-Delivered Emotion Regulation Individual Therapy for Adolescents With Nonsuicidal Self-Injury Disorder : A Randomized Clinical Trial
- 2023
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Ingår i: JAMA Network Open. - : American Medical Association (AMA). - 2574-3805. ; 6:7
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Tidskriftsartikel (refereegranskat)abstract
- IMPORTANCE: Nonsuicidal self-injury is prevalent in adolescence and associated with adverse clinical outcomes. Effective interventions that are brief, transportable, and scalable are lacking.OBJECTIVE: To test the hypotheses that an internet-delivered emotion regulation individual therapy for adolescents delivered adjunctive to treatment as usual is superior to treatment as usual only in reducing nonsuicidal self-injury and that improvements in emotion regulation mediate these treatment effects.DESIGN, SETTING, AND PARTICIPANTS: This 3-site, single-masked, randomized superiority trial enrolled participants from November 20, 2017, to April 9, 2020. Eligible participants were aged between 13 and 17 years and met diagnostic criteria for nonsuicidal self-injury disorder; they were enrolled as a mixed cohort of consecutive patients and volunteers. Parents participated in parallel to their children. The primary end point was at 1 month after treatment. Participants were followed up at 3 months posttreatment. Data collection ended in January 2021.INTERVENTIONS: Twelve weeks of therapist-guided, internet-delivered emotion regulation individual therapy delivered adjunctive to treatment as usual vs treatment as usual only.MAIN OUTCOMES AND MEASURES: Primary outcome was the youth version of the Deliberate Self-harm Inventory, both self-reported by participants prior to treatment, once every week during treatment, and for 4 weeks posttreatment, and clinician-rated by masked assessors prior to treatment and at 1 and 3 months posttreatment.RESULTS: A total of 166 adolescents (mean [SD] age, 15.0 [1.2] years; 154 [92.8%] female) were randomized to internet-delivered emotion regulation therapy plus treatment as usual (84 participants) or treatment as usual only (82 participants). The experimental intervention was superior to the control condition in reducing clinician-rated nonsuicidal self-injury (82% vs 47% reduction; incidence rate ratio, 0.34; 95% CI, 0.20-0.57) from pretreatment to 1-month posttreatment. These results were maintained at 3-month posttreatment. Improvements in emotion dysregulation mediated improvements in self-injury during treatment.CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, a 12-week, therapist-guided, internet-delivered emotion regulation therapy delivered adjunctive to treatment as usual was efficacious in reducing self-injury, and mediation analysis supported the theorized role of emotion regulation as the mechanism of change in this treatment. This treatment may increase availability of evidence-based psychological treatments for adolescents with nonsuicidal self-injury.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03353961.
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| 2. |
- Bjureberg, Johan, et al.
(författare)
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Targeting Maladaptive Anger With Brief Therapist-Supported Internet-Delivered Emotion Regulation Treatments : A Randomized Controlled Trial
- 2023
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Ingår i: Journal of Consulting and Clinical Psychology. - : American Psychological Association Press. - 0022-006X .- 1939-2117. ; 91:5, s. 254-266
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To evaluate the relative impact of three brief therapist-supported internet-delivered emotion regulation treatments for maladaptive anger (mindful emotion awareness [MEA], cognitive reappraisal [CR], and mindful emotion awareness + cognitive reappraisal [MEA + CR]) and to test whether baseline levels of anger pathology moderate treatment outcome.Method: Treatments were evaluated in a randomized controlled trial. In total, 234 participants (59% female; mean age = 41.1, SD = 11.6) with maladaptive anger were randomized to MEA (n = 78), CR (n = 77), or MEA + CR (n = 79). Self-reported primary and secondary outcomes were followed up at primary endpoint, 3 months after treatment termination (88% retention). Primary outcomes were also assessed weekly during a prolonged baseline phase (4 weeks) and an active treatment phase (4 weeks).Results: At the primary endpoint, the MEA + CR was superior in terms of anger expression (d = 0.27 95% confidence interval, CI [0.03, 0.51]), aggression (d = 0.43 [0.18, 0.68]), and anger rumination (d = 0.41 [0.18, 0.63]). MEA + CR was particularly effective in reducing anger expression (d = 0.66 [0.21, 1.11]), aggression (d = 0.90 [0.42, 1.39]), and anger rumination (d = 0.80 [0.40, 1.20]) for individuals who reported high values (+1SD) of the outcomes at baseline.Conclusions: Brief therapist-supported internet-delivered MEA and CR treatments are effective interventions for maladaptive anger. Combining MEA and CR is especially effective in reducing anger expression and aggression, particularly, in individuals who report higher levels of initial anger pathology. The present study highlights the importance of emotion regulation as an important treatment target for reducing maladaptive anger.
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| 3. |
- 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
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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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| 4. |
- Ojala, Olivia
(författare)
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Nonsuicidal self-injury in adolescence : attempts to improve and develop treatment
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Nonsuicidal self-injury (NSSI) and NSSI disorder are common in adolescence and associated with adverse outcomes, including suicide attempts. Detecting vulnerable children and adolescents is essential to decrease the risk of initiation as well as repetition of self-injury. Most individuals engage in NSSI to regulate difficult emotions; to effectively treat NSSI, targeting emotion regulation can thus be of importance. Accessibility to effective treatment is a challenge for adolescents engaging in NSSI. Internet-delivered treatment can increase access to treatment, but little is known about how such treatment is experienced and if it is efficacious for adolescents with NSSI or NSSI disorder. This thesis aimed to develop and evaluate the efficacy of Internetdelivered Emotion Regulation Therapy for Adolescents (IERITA), as well as to improve our understanding of early correlates of self-injurious behaviors. Study I was a qualitative study where eleven adolescents with NSSI disorder and nine parents were interviewed regarding their experience of IERITA. The results showed that receiving support from an online therapist was essential to the treatment. Parents appreciated having their separate intervention, and adolescents accepted this form of parental involvement. Self-responsibility and the flexibility of the treatment were appreciated but could be distressing. Implementing new emotion regulation skills was relevant but perceived as challenging for some. Nevertheless, improved emotion regulation ability was a mentioned effect of IERITA that improved functioning and could hinder NSSI. It was concluded that IERITA is acceptable and can be developed to facilitate learning and address potential distress inherent to the treatment format. Based on the findings from Study I and feedback from clinicians and patient organizations, we revised IERITA before conducting Study II. Study II was a randomized clinical trial comparing IERTA adjunctive to Treatment as Usual (TAU) to TAU only. Adolescents (N = 166) between 13 to 17 years old with NSSI disorder and past month NSSI were included. The IERITA plus TAU group reduced the NSSI frequency by 82% on average from pre- to posttreatment, significantly larger than the 47% reduction in the TAU-only group (blinded clinician-rated). Statistically significant improvements favoring ERITA plus TAU were also observed on most secondary outcomes, including other destructive behavior, emotion regulation difficulties, and functional impairment. In addition, the advantages of IERITA were maintained at the three-month follow-up. In line with theory, improvements in emotion regulation difficulties mediated reductions in NSSI. In addition, adolescents reported few adverse events concerning IERITA. It was concluded that IERITA can potentially improve access to evidence-based treatment for adolescents engaging in NSSI. In Study III, as a secondary analysis of Study II, we investigated for whom IERITA was more or less helpful. Age, emotion regulation difficulties, depressive symptoms, function level, parental invalidation, prior NSSI frequency, sleep difficulties, and suicidality were measured before randomization and investigated as moderators and predictors of treatment effect (i.e., change in NSSI frequency). No significant moderation effects were found. High parental invalidation was predictive of a less favorable outcome regardless of treatment condition. It was concluded that there is preliminary support for the efficacy of IERITA for adolescents with NSSI disorder with varying patient characteristics. In addition, detecting and reducing parental invalidation is of importance in NSSI treatments for adolescents. In Study IV, the focus shifted to childhood. We investigated the associations between Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms and NSSI as well as suicidal behaviors in children at risk of neurodevelopmental disorders (N = 391). The data came from an ongoing longitudinal cohort study of twins. At age 9 or 12, parents reported degree of ADHD symptoms and at age 15 clinicians assessed self-injury. Significant associations were found between childhood impulsivity and suicidal behavior, and inattention and NSSI. However, childhood hyperactivity was not significantly or meaningfully associated with either outcome. It was concluded that screening for and treating childhood impulsivity and inattention can be valuable to prevent self-injurious behaviors. In sum, IERITA can be an efficacious, acceptable, and flexible treatment for adolescents engaging in NSSI. Nevertheless, additional support can be needed for those experiencing distress inherent to the online format. IERITA can increase access to evidence-based treatments for NSSI among a wide range of adolescents with NSSI disorder. Addressing difficulties in emotion regulation by adding IERITA to TAU can contribute to meaningful change for many with few adverse effects. Additional sufficiently powered trials are needed to understand the utility of IERITA across studies and samples. Inattention and impulsivity during childhood can, at least partly, help us understand self-injurious behaviors’ development. Further studies are needed to establish the temporal order and understand the pathways of these associations. The contributions from the included studies can, by extension, innovate how we treat NSSI among adolescents and generate new hypotheses on preventing self-injury.
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| 5. |
- Rozental, Alexander, 1985-, et al.
(författare)
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Mental health in individuals with self-reported psychiatric symptoms during the COVID-19 pandemic : Baseline data from a swedish longitudinal cohort study
- 2022
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Ingår i: Frontiers in Psychiatry. - : Frontiers Media SA. - 1664-0640. ; 13
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Individuals with psychiatric disorders may be both vulnerable and sensitive to rapid societal changes that have occurred during the COVID-19 pandemic. To fully understand these impacts, repeated measurements of these individuals are warranted. The current longitudinal study set out to perform monthly assessment of individuals with common psychiatric disorders using established questionnaires with a possibility for them to self- rate their symptoms, over time.Methods: Recruitment of individuals who identified themselves as struggling with mental health problems, living in Sweden between July 2020 and June 2021 using an online survey. The individuals answered questions on demographics, psychiatric history, current psychiatric symptoms (e.g., Patient Health Questionnaire, PHQ-9; General Anxiety Disorder, GAD-7), somatic health, health-care contacts and any changes therein during the pandemic. Monthly, longitudinal assessments are still ongoing (consenting participants provide data for 1 year), and here we present descriptive statistics from the baseline measurement. All measurements from baseline (>400 items), and follow-ups are presented in detail.Results: A total of 6.095 participants (average age 35 years) submitted complete baseline data. Marital status (43% single) and number of years of education (48% highest degree being high school) were evenly distributed in this population. The most common lifetime psychiatric disorder in the sample was depressive disorder (80.5%) and generalized anxiety disorder (45.9%), with a substantial proportion having severe symptoms of depression. (30.5%) and anxiety (37.1%). Lifetime suicidal ideation (75.0%) and non-suicidal self-harm (57.7%) were prevalent in the group and 14.5% reported drug use during the pandemic. Allergies (36.8%) were the most common somatic condition, followed by irritable bowel syndrome (18.7%). For those having experienced a traumatic event, 39% showed symptoms during the pandemic indicating PTSD. Regarding contact with mental health services during the pandemic, 22% had established a new contact, and 20% reported to have increased their psychiatric medication compared to before the pandemic.Conclusion: Baseline data collected during the pandemic from individuals in Sweden with pre-existing psychiatric disorders demonstrate that this sample represents a population suitable for an investigation on the long-term impact of the pandemic, as intended by the longitudinal investigation that is ongoing. Follow-up questionnaires over a 12-month period are being collected and will indicate how the health and well-being of this population was impacted during the changes and uncertainties that have been characteristic of the past 2 years.
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