| 1. |
- Alfonsson, Sven, et al.
(författare)
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The effects of clinical supervision on supervisees and patients in cognitive-behavioral therapy : a study protocol for a systematic review
- 2017
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Ingår i: Systematic Reviews. - : Springer Science and Business Media LLC. - 2046-4053. ; 6:94, s. 1-6
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Forskningsöversikt (refereegranskat)abstract
- Background: Clinical supervision by a senior therapist is a very common practice in psychotherapist training and psychiatric care settings. Though clinical supervision is advocated by most educational and governing institutions, the effects of clinical supervision on the supervisees ’ competence, e.g., attitudes, behaviors, and skills, as well as on treatment outcomes and other patient variables are debated and largely unknown. Evidence-based practice is advocated in clinical settings but has not yet been fully implemented in educational or clinical training settings. The aim of this systematic review is to synthesize and present the empirical literature regarding effects of clinical supervision in cognitive-behavioral therapy. Methods: This study will include a systematic review of the literature to identify studies that have empirically investigated the effects of supervision on supervised psychotherapists and/or the supervisees ’ patients. A comprehensive search strategy will be conducted to identify published controlled studies indexed in the MEDLINE, EMBASE, PsycINFO, and Cochrane Library databases. Data on supervision outcomes in both psychotherapists and their patients will be extracted, synthesized, and reported. Risk of bias and quality of the included studies will be assessed systematically. Discussion: This systematic review will rigorously follow established guidelines for systematic reviews in order to summarize and present the evidence base for clinical supervision in cognitive-behavioral therapy and may aid further research and discussion in this area.
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| 2. |
- Fogelkvist, Maria, 1983-, et al.
(författare)
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A qualitative analysis of participants’ reflections on body image during participation in a randomized controlled trial of acceptance and commitment therapy
- 2016
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Ingår i: Journal of Eating Disorders. - : Springer Science and Business Media LLC. - 2050-2974. ; 4
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Tidskriftsartikel (refereegranskat)abstract
- Background: Negative body image is a risk factor for development and relapse in eating disorders (ED). Many patients continue to be dissatisfied with their body shape or weight after treatment. This study presents a qualitative analysis of written reflections on body image from patients with an ED and a negative body image before and after an Acceptance and Commitment Therapy group treatment at a specialized ED-unit. Method: Before and after the treatment participants (n = 47) answered a questionnaire with open ended questions on their thoughts on body image. Data were analyzed through conventional content analysis. Results: Body image meant different things for different participants. For some it had to do with how you evaluate your body, whereas others focused on whether their body image was realistic or not. Some emphasized their relationship with their body, while some described body image as strongly related to global self-esteem. These different views on the concept of body image affected the participants' descriptions of their own body image, and how they wanted it to change. Body image was considered a state that fluctuated from day to day. After treatment the participants described changes in their body image, for instance perceiving oneself as less judgmental towards one's body, and a shift in focus to the important things in life. Conclusions: The participants had different views on body image and how they wished it to change. Thus treatment interventions targeting negative body image needs to address various aspects of this complex construct.
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| 3. |
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| 4. |
- Lundgren, Tobias, et al.
(författare)
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Swedish Acceptance and Action Questionnaire (SAAQ) : A psychometric evaluation
- 2017
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Ingår i: Cognitive Behaviour Therapy. - : Informa UK Limited. - 1650-6073 .- 1651-2316. ; 46:4, s. 315-326
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Tidskriftsartikel (refereegranskat)abstract
- Psychological inflexibility and experiential avoidance are equivalent (with somewhat different connotations) concepts and refer to an unwillingness to remain in contact with particular private events. This concept is most often measured by the Acceptance and Action Questionnaire (AAQ-II) and is strongly related to psychopathology and behavioral effectiveness. In this study, the preliminary psychometric properties of the Swedish version of the AAQ-II (Swedish Acceptance and Action QuestionnaireSAAQ) are presented. The study is done in two steps. In the first step, the 10-item version of the AAQ-II is investigated through principal component analysis (n=147). Secondly, due to problems with the component structure, the instrument is reduced to a six-item version and its validity and internal consistency are investigated (n=154). The six-item version shows good concurrent and convergent validity as well as satisfying internal consistency (=.85). Furthermore, the Swedish six-item version of the AAQ-II showed one strong component. Test-retest reliability was satisfactory (r=.80; n=228). In future research, predictive and external validity would be important to investigate in order to further ensure that the SAAQ is a useful measure for clinical research. In conclusion, the SAAQ has satisfactory psychometric properties, but more data need to be gathered to further explore the possibilities for the instruments in Swedish contexts.
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| 5. |
- Maathz, Pernilla
(författare)
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Application of the psychological flexibility model in the context of vulvar pain and sexual dysfunction
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Psychological processes are known to influence the development and impact of chronic pain. Moreover, psychological treatments have been shown to reduce the suffering that people with chronic pain experience. Still, limited work has considered the role of psychological processes in vulvar pain, and many aspects of vulvar pain remain largely unexplored. Given the relevance of psychological flexibility and ACT in chronic pain, the applicability of the psychological flexibility model to vulvar pain appears worth exploring. The overarching aim of this thesis was to explore the psychological flexibility model in the context of vulvar pain and develop an intervention based on this model, for women living with vulvodynia. Study I aimed specifically to examine the contribution of psychological inflexibility to sexual dysfunction over time, among women with vulvar pain. Findings demonstrated that psychological inflexibility predicted later sexual dysfunction. The aim of Study II was to examine the contribution of mindfulness during sexual activity to sexual wellbeing among women who experience pain with sexual activity as compared to women who do not. Study II found that higher levels of mindfulness during sexual activity was associated with better sexual functioning and less sexual distress. Additionally, the contribution of mindfulness to sexual function and distress was similar in the two groups. Study III aimed specifically to examine the feasibility of a larger trial investigating the efficacy of online ACT for vulvodynia and conduct a preliminary examination of the effects of the intervention. Findings largely suggest that a full scale randomized controlled trial is feasible and indicate that women with provoked vestibulodynia could potentially benefit from receiving ACT.This thesis contributes to the understanding of vulvar pain and sexual dysfunction by demonstrating that psychological flexibility is associated with the personal impact of pain. It provides initial evidence of the potential value of the psychological flexibility model in the context of vulvodynia, and encourage further studies entailing a contextual behavioural approach.
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| 6. |
- Maathz, Pernilla, et al.
(författare)
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Women, Painful Sex, and Mindfulness
- 2022
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Ingår i: Mindfulness. - : Springer Nature. - 1868-8527 .- 1868-8535. ; 13:4, s. 917-927
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Mindfulness-based approaches to treatment of sexual dysfunction associated with vulvar pain appear promising, but little is known about the specific processes of mindfulness in sexual interactions or if mindfulness may be of particular benefit to women who experience pain associated with sexual activity. This study aimed to examine the associations between sexual mindfulness and sexual function and distress among women who currently experience pain with sexual activity as compared to women who do not. Methods: Women over the age of 18 were invited to complete an online survey, including measures of mindfulness in sexual activity, pain associated with sexual activity, sexual function, and sexual distress. Of the participants, 134 (42.1%) were experiencing pain and 184 (57.9%) were pain free.Results: Higher levels of mindfulness during sexual activity were associated with greater sexual functioning and less sexual distress both among women with and without pain. However, the associations between Observing skills and sexual functioning among women with pain was weaker if the capacity for nonreactivity was low. Sexual mindfulness contributed significantly to the explanation of sexual function and distress in both groups. Of the mindfulness facets, Acting with awareness consistently contributed, beyond the other facets, to the explanation of sexual outcomes.Conclusions: The capacity to stay mindful in sexual interactions appear to be important to sexual functioning both among women who experience pain with sexual activity and among women who do not. These findings encourage further examination of the role of mindfulness and its facets in sexual outcomes.
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| 7. |
- Parling, Thomas, 1968-, et al.
(författare)
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A randomised trial of Acceptance and Commitment Therapy for Anorexia Nervosa after daycare treatment, including five-year follow-up
- 2016
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Ingår i: BMC Psychiatry. - : Springer Science and Business Media LLC. - 1471-244X. ; 16
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: No specific psychotherapy for adult anorexia nervosa (AN) has shown superior effect. Maintenance factors in AN (over-evaluation of control over eating, weight and shape) were addressed via Acceptance and Commitment Therapy (ACT). The study aimed to compare 19 sessions of ACT with treatment as usual (TAU), after 9 to 12weeks of daycare, regarding recovery and risk of relapse up to five years. METHODS: Patients with a full, sub-threshold or partial AN diagnosis from an adult eating disorder unit at a hospital were randomized to ACT (n=24) and TAU (n=19). The staff at the hospital, as well as the participants, were unaware of the allocation until the last week of daycare. Primary outcome measures were body mass index (BMI) and specific eating psychopathology. Analyses included mixed model repeated measures and odds ratios. RESULTS: Groups did not differ regarding recovery and relapse using a metric of BMI and the Eating Disorder Examination Questionnaire (EDE-Q). There were only significant time effects. However, odds ratio indicated that ACT participants were more likely to reach good outcome. The study was underpowered due to unexpected low inflow of patients and high attrition. CONCLUSION: Longer treatment, more focus on established perpetuating factors and weight restoration integrated with ACT might improve outcome. Potential pitfalls regarding future trials on AN are discussed. Trial registration number ISRCTN 12106530. Retrospectively registered 08/06/2016.
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| 8. |
- Parling, Thomas, 1968-
(författare)
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Anorexia Nervosa : Emotion, Cognition, and Treatment
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Anorexia nervosa (AN) is a serious disorder with long-term consequences for those afflicted. No evidence-based care is available for adults with full or subthreshold AN. The thesis research investigated aspects of emotion and cognition relevant to the maintenance of AN that might inform psychological treatment. In addition, the effectiveness of a recent psychotherapy model of AN was investigated. Study I investigated alexithymia and emotional awareness and their associations with depression, anxiety, and perfectionism among patients with AN compared with a control group. The AN group exhibited the same level of emotional awareness as did the control group and the same level of alexithymia when controlling for depression and anxiety. Alexithymia and emotional awareness were not associated, despite representing an overlapping construct. The results of the present study indicate that those with AN can trust their emotional awareness. Study II explored implicit pro-thin and anti-fat attitudes (towards the self and others), striving for thinness (loosely corresponding to positive reinforcement), and avoidance of fatness (loosely corresponding to negative reinforcement). The AN and the control groups were found to have equally strong implicit pro-thin and striving for thinness attitudes. The AN group exhibited stronger implicit anti-fat and avoidance of fatness attitudes (loosely corresponding to negative reinforcement) than did the control group. There was no association between implicit and explicit measures. The results are in line with the over-evaluation of weight and shape as a core feature of eating disorders. Study III compared the effectiveness of Acceptance and Commitment Therapy (ACT) and treatment as usual (TAU) for adults with AN after day-care. Follow-up measures indicated no difference in improvement or deterioration between the two groups. The level of perfectionism was reduced in the ACT group relative to the TAU group. The study was compromised by a lower inflow of patients than anticipated and by a high drop-out rate, and thus fails to provide evidence of a difference between the two groups. The present thesis demonstrates that emotional awareness is intact in those with AN and that implicit attitudes concerning weight and shape reflect the explicit attitudes, although without association. The treatment study indicates that, when designing treatment, it is important to consider the ambivalence to treatment among those suffering from AN, which is reflected in the high drop-out rate in the present study.
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| 9. |
- Parling, Thomas, 1968-
(författare)
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Att hantera stora förändringar i livet
- 2014. - 1
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Ingår i: Kirurgisk behandling av fetma. - Lund : Studentlitteratur AB. - 9789144069029 ; , s. 87-95
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 10. |
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| 11. |
- Parling, Thomas, 1968-, et al.
(författare)
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Using the Implicit Relational Assessment Procedure to Compare Implicit Pro-Thin/Anti-Fat Attitudes of Patients with Anorexia Nervosa and Non-clinical Controls
- 2012
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Ingår i: Eating Disorders. - : Informa UK Limited. - 1064-0266 .- 1532-530X. ; 20:2, s. 127-143
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Tidskriftsartikel (refereegranskat)abstract
- Implicit pro-thin/anti-fat attitudes was investigated among a mixed group of patients with full and sub-threshold Anorexia Nervosa (n = 17), and a matched-age control group (n = 17). The Implicit Relational Assessment Procedure (IRAP) was employed to measure implicit pro-thin and anti-fat attitudes towards Self and Others in addition to ‘striving for thinness’ and ‘avoidance of fatness’. The clinical group showed an implicit pro-fat attitude towards Others and stronger anti-fat attitudes towards Self and avoidance of fatness compared with controls. The findings are discussed in relation to the over-evaluation of weight and shape in the clinical group.
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| 12. |
- Sjömark, Josefin, et al.
(författare)
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A longitudinal, multi-centre, superiority, randomized controlled trial of internet-based cognitive behavioural therapy (iCBT) versus treatment-as-usual (TAU) for negative experiences and posttraumatic stress following childbirth : the JUNO study protocol
- 2018
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Ingår i: BMC Pregnancy and Childbirth. - : BioMed Central. - 1471-2393 .- 1471-2393. ; 18
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Tidskriftsartikel (refereegranskat)abstract
- Background: About one-third of women report their childbirth as traumatic and up to 10% have severe traumatic stress responses to birth. The prevalence of Posttraumatic stress disorder following childbirth (PTSD FC) is estimated to 3%. Women with PTSD FC report the same symptoms as other patients with PTSD following other types of trauma. The effect of psychological treatment for women with PTSD FC has only been studied in a few trials. Similarly, studies on treatment needs for women not diagnosed as having PTSD FC but who nevertheless face psychological problems are lacking. Methods/design: Women who rate their overall birth experience as negative on a Likert scale, and/or had an immediate caesarean section and/or a major postpartum haemorrhage are randomized to either internet delivered cognitive behaviour therapy (iCBT) plus treatment as usual (TAU) or TAU. The iCBT is to be delivered in two steps. The first step consists of six weekly modules for both the woman and her partner (if they wish to participate) with minimal therapeutic support. Step 2 consists of eight weekly modules with extended therapeutic support and will be offered to participants whom after step 1 report PTSD FC. Assessments will be made at baseline, 6 weeks, 14 weeks, and at follow-ups at 1, 2, 3 and 4 years after baseline. The primary outcome measures are symptoms of posttraumatic stress and depression. Secondary outcomes are quality of life, parent-child bonding, marital satisfaction, coping strategies, experience regarding the quality of care received, health-related quality of life, number of re-visits to the clinic and number of appointments for counselling during the 4 years' period after the negative childbirth experience, time until the woman gets pregnant again, and the type of birth in the subsequent pregnancy. A health economic evaluation in the form of a cost utility analysis will be conducted. Discussion: This study protocol describes a randomized controlled trial that will provide information about the effectiveness of iCBT in women with negative experiences, posttraumatic stress, and PTSD FC.
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| 13. |
- Sjömark, Josefin, et al.
(författare)
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Antepartum and labour-related single predictors of non-participation, dropout and lost to follow up in a randomised controlled trial comparing internet-based cognitive-behaviour therapy with treatment as usual for women with negative birth experiences and/or post-traumatic stress following childbirth
- 2022
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 12:11
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Internet-based interventions are often hampered by high dropout rates. The number of individuals who decline to participate or dropout are reported, but reasons for dropout are not. Identification of barriers to participation and predictors of dropout may help improve the efficacy of internet-based clinical trials. The aim was to investigate a large number of possible predictors for non-participation and dropout in a randomised controlled trial for women with a negative birth experience and/or post-traumatic stress following childbirth.Setting: A childbirth clinic at a university hospital in Sweden.Participants: The sample included 1523 women who gave birth between September 2013 and February 2018. All women who rated an overall negative birth experience on a Likert scale, and/or had an immediate caesarean section (CS), and/or severe postpartum haemorrhage (& GE; 2000 mL) were eligible.Methods: Demographic, antepartum, and labour-related/postpartum predictors were investigated for non-participation (eligible but denied participation), pre-treatment dropout (prior to intervention start), treatment dropout, and loss to follow-up. Descriptive statistics and logistic regression were used in the data analysis.Results: A majority (80.3 %) were non-participants. Non-participation was predicted by lower level of education, being foreign-born, no experience of counselling for fear of childbirth, multiparity, vaginal delivery (vs CS and vacuum-assisted delivery) and absence of: preeclampsia, anal sphincter injury and intrapartum fetal distress. Pretreatment dropout was predicted by the absence of severe haemorrhage. Treatment dropout was predicted by vaginal delivery (vs immediate CS), vertex presentation and good overall birth experience. Loss to follow-up was predicted by vaginal delivery (vs immediate CS or vacuum-assisted delivery) and absence of intrapartum fetal distress.Conclusions: Mothers with no obstetric complications were more likely to not participate and dropout at different time points. Both demographic, antepartum and obstetrical variables are important to attend to while designing procedures to maximise participation in internet-delivered cognitive-behavioral therapy.
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| 14. |
- Sjömark, Josefin, et al.
(författare)
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Effect of internet-based cognitive behaviour therapy among women with negative birth experiences on mental health and quality of life : a randomized controlled trial
- 2022
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Ingår i: BMC Pregnancy and Childbirth. - : Springer Nature. - 1471-2393 .- 1471-2393. ; 22
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Tidskriftsartikel (refereegranskat)abstract
- Background: Giving birth is often a positive experience, but 7-44% have negative experiences and about 4% develop posttraumatic stress disorder following childbirth (PTSD FC). This randomized controlled trial (RCT) investigated the effect of internet-based cognitive behaviour therapy (iCBT) for women with negative birth experiences and/or at risk for PTSD FC.Methods: This was a superiority nonblinded multicentre RCT comparing iCBT combined with treatment as usual (TAU) with TAU only. Data were collected through questionnaires at baseline, at 6 weeks, 14 weeks and 1 year after randomization. The RCT was conducted at four delivery clinics in Sweden and participants were recruited from September 2013 until March 2018. Women who rated their childbirth experience as negative on a Likert scale, and/or had an immediate caesarean section or a haemorrhage of > 2000 ml were eligible. Primary outcomes were symptoms of posttraumatic stress (Traumatic Event Scale, TES) and symptoms of depression (Edinburgh Postnatal Depression Scale, EPDS). Secondary outcomes were satisfaction with life (Satisfaction With Life Scale, SWLS) and coping (Ways of Coping Questionnaire, WCQ).Results: Out of 1810 eligible women, 266 women were randomised to iCBT+TAU (n = 132) or to TAU (n = 134). In the iCBT+TAU group 59 (45%) completed the treatment. ICBT+TAU did not reduce PTSD FC at 6 weeks, at 14 weeks, or at 1 year follow-up compared with TAU, according to the TES. Both the ITT and completer analyses showed significant time and quadratic time effects due to reduction of symptoms in both groups on the TES (re-experience subscale) and on the EPDS, and significant time effect on the self-controlling subscale of the WCQ (which increased over time). There was also a significant main effect of group on the SWLS where the TAU group showed higher initial satisfaction with life. Exploratory subgroup analyses (negative birth experience, immediate caesarean section, or severe haemorrhage) showed significant time effects among participants with negative birth experience on re-experience, arousal symptoms and depressive symptoms.Conclusions: The ICBT intervention did not show superiority as both groups showed similar beneficial trajectories on several outcomes up to 1 year follow-up. This intervention for women with negative birth experiences and/or at risk for PTSD FC was feasible; however, the study suffered from significant drop out rate. Future studies with more narrow inclusion criteria and possibly a modified intervention are warranted.
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| 15. |
- Sjömark, Josefin, 1976-
(författare)
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Internet-based cognitive behaviour therapy for women with negative birth experiences following childbirth
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Childbirth can be associated with both positive and negative psychological reactions. The experience of labour and birth is subjective, multidimensional and complex including physiological and psychological factors. Distress from a negative birth experience can lead to various psychiatric disorders, such as postpartum depression and post-traumatic stress disorder following childbirth (PTSD FC) which both can have extensive consequences for the woman and her family members. The overall aim of this thesis was to develop and evaluate internet-based cognitive behaviour therapy (iCBT) compared to Treatment as usual (TAU) for women with negative birth experiences at risk for PTSD FC. The work is summarized in four papers originating from one randomised controlled trial (RCT). Paper I presents the study protocol of the RCT. Paper II investigated predictors for non-participation, pre-treatment dropout, treatment dropout and loss to follow-up in the RCT. Paper III and IV evaluated the effect of iCBT on mental health and quality of life (paper III) and partner relationship and mother-infant bonding (paper IV). Results from paper II showed that a majority of the eligible women never participated and those with no obstetric complications were more likely to not participate and/or dropout at different time points. Nonparticipation was predicted by several variables, both demographic, antepartum and obstetrical. Results from paper III showed that ICBT did not reduce PTSD FC or depressive symptoms and in paper IV we found that iCBT had no effect on different aspects of partner relationship or mother-infant bonding. However, both groups (ICBT and TAU) reported reductions of re-experiences of traumatic memories and depressive symptoms over time. Both groups also reported fewer positive feelings and attitudes toward their partner over time and mother-infant bonding showed initial improvement, but this later changed into decline over time. In summary, we could not demonstrate any clear effect of iCBT as compared to TAU, but changes over time in both groups indicate some level of natural recovery from birth related trauma, decreased quality of partner relationship and initial improvement in mother-infant bonding. The challenge in future research will be to develop interventions that are both well accepted and effective in supporting women with negative birth experiences at risk for PTSD FC. The next step should be to apply more narrow inclusion criteria in order to capture a more motivated population in need of psychological support.
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| 16. |
- Swenne, Ingemar, 1953-, et al.
(författare)
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Family-based intervention in adolescent restrictive eating disorders : early treatment response and low weight suppression is associated with favourable one-year outcome
- 2017
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Ingår i: BMC Psychiatry. - : Springer Science and Business Media LLC. - 1471-244X. ; 17
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Tidskriftsartikel (refereegranskat)abstract
- Background: Family-based treatments are first-line treatments for adolescents with restrictive eating disorders (ED) but have to be improved since outcome is poor for some. We have investigated the one-year outcome of a family-based intervention programme with defined and decisive interventions at the start of treatment.Method: Data pertaining 201 adolescents with restrictive ED with features of anorexia nervosa but not fulfilling the weight criterion starting treatment 2010-2015, had a wide range of body mass index (BMI) and of weight loss at presentation, and completed a one-year follow-up was analysed. Recovery from the ED was defined as an Eating Disorder Examination-questionnaire (EDE-Q) score < 2.0 or as not fulfilling criteria for an ED at a clinical interview.Results: By EDE-Q 130 (65%) had recovered at 1 year and by clinical interview 106 (53%). According to the EDE-Q criterion recovery was independently associated with lower EDE-Q score at presentation, higher weight gain after 3 months of treatment and lower weight suppression at follow-up, weight suppression being defined as the difference between premorbid and current BMI. Not fulfilling criteria for an ED was associated with the same factors and also by higher BMI at presentation.Conclusion: The observations that low weight and high ED cognitions confer a poor prognosis but that rapid weight gain at the start of treatment predicts a better prognosis are presently extended to adolescents with restrictive ED with a wide range of BMI at presentation. High weight suppression at follow-up is associated with a poor prognosis and indicates the importance of taking premorbid BMI into account when setting weight targets for treatment.
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