| 1. |
- Ehlers, Anke, et al.
(författare)
-
Therapist-assisted online psychological therapies differing in trauma focus for post-traumatic stress disorder (STOP-PTSD) : a UK-based, single-blind, randomised controlled trial
- 2023
-
Ingår i: The lancet. Psychiatry. - : ELSEVIER SCI LTD. - 2215-0374 .- 2215-0366. ; 10:8, s. 608-622
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Many patients are currently unable to access psychological treatments for post-traumatic stress disorder (PTSD), and it is unclear which types of therapist-assisted internet-based treatments work best. We aimed to investigate whether a novel internet-delivered cognitive therapy for PTSD (iCT-PTSD), which implements all procedures of a first-line, trauma-focused intervention recommended by the UK National Institute for Health and Care Excellence (NICE) for PTSD, is superior to internet-delivered stress management therapy for PTSD (iStress-PTSD), a comprehensive cognitive behavioural treatment programme focusing on a wide range of coping skills.METHODS: We did a single-blind, randomised controlled trial in three locations in the UK. Participants (≥18 years) were recruited from UK National Health Service (NHS) Improving Access to Psychological Therapies (IAPT) services or by self-referral and met DSM-5 criteria for PTSD to single or multiple events. Participants were randomly allocated by a computer programme (3:3:1) to iCT-PTSD, iStress-PTSD, or a 3-month waiting list with usual NHS care, after which patients who still met PTSD criteria were randomly allocated (1:1) to iCT-PTSD or iStress-PTSD. Randomisation was stratified by location, duration of PTSD (<18 months or ≥18 months), and severity of PTSD symptoms (high vs low). iCT-PTSD and iStress-PTSD were delivered online with therapist support by messages and short weekly phone calls over the first 12 weeks (weekly treatment phase), and three phone calls over the next 3 months (booster phase). The primary outcome was the severity of PTSD symptoms at 13 weeks after random assignment, measured by self-report on the PTSD Checklist for DSM-5 (PCL-5), and analysed by intention-to-treat. Safety was assessed in all participants who started treatment. Process analyses investigated acceptability and compliance with treatment, and candidate moderators and mediators of outcome. The trial was prospectively registered with the ISRCTN registry, ISRCTN16806208.FINDINGS: Of the 217 participants, 158 (73%) self-reported as female, 57 (26%) as male, and two (1%) as other; 170 (78%) were White British, 20 (9%) were other White, six (3%) were Asian, ten (5%) were Black, eight (4%) had a mixed ethnic background, and three (1%) had other ethnic backgrounds. Mean age was 36·36 years (SD 12·11; range 18-71 years). 52 (24%) participants met self-reported criteria for ICD-11 complex PTSD. Fewer than 10% of participants dropped out of each treatment group. iCT-PTSD was superior to iStress-PTSD in reducing PTSD symptoms, showing an adjusted difference on the PCL-5 of -4·92 (95% CI -8·92 to -0·92; p=0·016; standardised effect size d=0·38 [0·07 to 0·69]) for immediate allocations and -5·82 (-9·59 to -2·04; p=0·0027; d=0·44 [0·15 to 0·72]) for all treatment allocations. Both treatments were superior to the waiting list for PCL-5 at 13 weeks (d=1·67 [1·23 to 2·10] for iCT-PTSD and 1·29 [0·85 to 1·72] for iStress-PTSD). The advantages in outcome for iCT-PTSD were greater for participants with high dissociation or complex PTSD symptoms, and mediation analyses showed both treatments worked by changing negative meanings of the trauma, unhelpful coping, and flashback memories. No serious adverse events were reported.INTERPRETATION: Trauma-focused iCT-PTSD is effective and acceptable to patients with PTSD, and superior to a non-trauma-focused cognitive behavioural stress management therapy, suggesting that iCT-PTSD is an effective way of delivering the contents of CT-PTSD, one of the NICE-recommended first-line treatments for PTSD, while reducing therapist time compared with face-to-face therapy.FUNDING: Wellcome Trust, UK National Institute for Health and Care Research Oxford Health Biomedical Research Centre.
|
|
| 2. |
- Forsström, David, 1981-, et al.
(författare)
-
A study protocol of a randomized controlled study of internet-based cognitive behavioral therapy for adult attention deficit hyperactivity disorder
- 2023
-
Ingår i: Internet Interventions. - : Elsevier. - 2214-7829. ; 33
-
Tidskriftsartikel (refereegranskat)abstract
- Attention deficit hyperactivity disorder (ADHD) is a disorder characterized by hyperactivity, impulsivity and lack of attention. It can have a major impact on everyday life and result in negative consequences for one's personal, academic, and work situation. For individuals with symptoms of ADHD, increased levels of anxiety and depression are common, and an overall reduction of quality of life is often present. This study protocol describes a clinical trial of internet-based cognitive behavioral therapy (iCBT), using a randomized controlled study design, with the primary aim to increase quality of life, as well as to reduce symptoms of ADHD, anxiety, depression, and stress. A second aim is to investigate, by qualitative means, what aspects of treatment were perceived as helpful and hindering when it comes to completing iCBT. Two hundred participants with symptoms of ADHD will be included and randomized to two conditions (treatment and wait-list control). The treatment period is comprised of a maximum of ten weeks, with two mandatory modules and ten modules from which the participants can choose freely. Self-report measures will be completed by the participants at baseline and end of treatment, as well as at a six-month follow-up. The treatment is guided by therapists and consists of weekly correspondence with the participants. The study will utilize an intention to treat design, with ANOVAs and Reliable Change Index to evaluate treatment effects. The qualitative part of the project will be interview-based and employ thematic analysis. Lastly, a psychometric evaluation of a common instrument for determining ADHD-symptoms will also be made. The results will hopefully contribute to the evidence base for iCBT for individuals with symptoms of ADHD and help disseminate potentially effective interventions.
|
|
| 3. |
- Forsström, David, et al.
(författare)
-
Alcohol Use and Gambling Associated with Impulsivity among a Swedish University Sample
- 2022
-
Ingår i: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1661-7827 .- 1660-4601. ; 19:4
-
Tidskriftsartikel (refereegranskat)abstract
- Excessive alcohol use and gambling can have negative consequences. Across countries, the risk of excessive alcohol use is more common in university populations than in the general population. However, few studies have investigated the prevalence of both alcohol use and gambling in this group. This study explores these behaviours in a Swedish university setting. In addition, this study investigates how impulsivity affects alcohol use and gambling. In total, 794 Swedish students answered an online survey. Data were analysed using descriptive statistics to determine prevalence, and multinomial logistic regression was used to determine the contribution of impulsivity, age, and sex to alcohol use and gambling. Compared to the Swedish national prevalence, the prevalence was higher for excessive alcohol use, but the prevalence of gambling was at the same level or lower. High levels of impulsivity and male sex increased the risk of excessive alcohol use, while older age lowered the risk of excessive alcohol use and gambling. The results indicate that primarily young men could benefit from primary prevention in a university setting. Also, screening for impulsivity in men might be one way to identify risk groups in a university population.
|
|
| 4. |
- Forsström, David, 1981-, et al.
(författare)
-
Isolation and worry in relation to gambling and onset of gambling among psychiatry patients during the COVID-19 pandemic : A mediation study
- 2022
-
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.
|
|
| 5. |
- Forsström, David, 1981-, et al.
(författare)
-
Psychometric properties of the Jonsson-Abbott Scale : Rasch and confirmatory factor analyses
- 2022
-
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.
|
|
| 6. |
- Johansson, Fred, et al.
(författare)
-
Associations Between Procrastination and Subsequent Health Outcomes Among University Students in Sweden
- 2023
-
Ingår i: JAMA Network Open. - : American Medical Association (AMA). - 2574-3805. ; 6:1
-
Tidskriftsartikel (refereegranskat)abstract
- Importance Procrastination is prevalent among university students and is hypothesized to lead to adverse health outcomes. Previous cross-sectional research suggests that procrastination is associated with mental and physical health outcomes, but longitudinal evidence is currently scarce.Objective To evaluate the association between procrastination and subsequent health outcomes among university students in Sweden.Design, Setting, and Participants This cohort study was based on the Sustainable University Life study, conducted between August 19, 2019, and December 15, 2021, in which university students recruited from 8 universities in the greater Stockholm area and Örebro were followed up at 5 time points over 1 year. The present study used data on 3525 students from 3 time points to assess whether procrastination was associated with worse health outcomes 9 months later.Exposure Self-reported procrastination, measured using 5 items from the Swedish version of the Pure Procrastination Scale rated on a Likert scale from 1 (“very rarely or does not represent me”) to 5 (“very often or always represents me”) and summed to give a total procrastination score ranging from 5 to 25.Main Outcomes and Measures Sixteen self-reported health outcomes were assessed at the 9-month follow-up. These included mental health problems (symptoms of depression, anxiety, and stress), disabling pain (neck and/or upper back, lower back, upper extremities, and lower extremities), unhealthy lifestyle behaviors (poor sleep quality, physical inactivity, tobacco use, cannabis use, alcohol use, and breakfast skipping), psychosocial health factors (loneliness and economic difficulties), and general health.Results The study included 3525 participants (2229 women [63%]; mean [SD] age, 24.8 [6.2] years), with a follow-up rate of 73% (n = 2587) 9 months later. The mean (SD) procrastination score at baseline was 12.9 (5.4). An increase of 1 SD in procrastination was associated with higher mean symptom levels of depression (β, 0.13; 95% CI, 0.09-0.17), anxiety (β, 0.08; 95% CI, 0.04-0.12), and stress (β, 0.11; 95% CI, 0.08-0.15), and having disabling pain in the upper extremities (risk ratio [RR], 1.27; 95% CI, 1.14-1.42), poor sleep quality (RR, 1.09, 95% CI, 1.05-1.14), physical inactivity (RR, 1.07; 95% CI, 1.04-1.11), loneliness (RR, 1.07; 95% CI, 1.02-1.12), and economic difficulties (RR, 1.15, 95% CI, 1.02-1.30) at the 9-month follow-up, after controlling for a large set of potential confounders.Conclusions and Relevance This cohort study of Swedish university students suggests that procrastination is associated with subsequent mental health problems, disabling pain, unhealthy lifestyle behaviors, and worse psychosocial health factors. Considering that procrastination is prevalent among university students, these findings may be of importance to enhance the understanding of students’ health.
|
|
| 7. |
|
|
| 8. |
- Latth, Johanna, et al.
(författare)
-
Effects of internet-delivered cognitive behavioral therapy on use of child sexual abuse material : A randomized placebo-controlled trial on the Darknet
- 2022
-
Ingår i: Internet Interventions. - : Elsevier. - 2214-7829. ; 30
-
Tidskriftsartikel (refereegranskat)abstract
- Introduction: The use of child sexual abuse material (CSAM) is an international public health and child protection challenge.Objective: To investigate whether Prevent It, a therapist-supported, internet-delivered, eight-week, cognitive behavioral therapy, reduces CSAM viewing among users.Methods: We conducted a global online single-blind (participants), parallel-group, superiority, randomized, psychological placebo-controlled trial with a one-month follow-up, 2019-2021 (ISRCTN76841676). We recruited anonymous participants, mainly from Darknet forums. Inclusion criteria: age 18+ years, past week CSAM use, and sufficient English language skills; exclusion criteria: severe psychiatric illness or non-serious intent to participate. The main outcome was change in self-reported, weekly viewing time from pre-to post-treatment, according to the Sexual Child Molestation Risk Assessment+.Results: A total of 160 participants (157 male, 2 non-binary, and 1 not reporting gender) from all world regions (age intervals [%]: 18-29 [49]; 30-39 [30]; 40-49 [15]; 50-59 [6]) were randomized (1:1) to Prevent It (N = 80) or Placebo (N = 80). Between-group, intention-to-treat analyses suggested a significantly larger decrease in viewing time in Prevent It participants vs. controls pre-to post-treatment (Prevent It: N = 76, Placebo: N = 78, estimate-0.25, 95 % CI,-0.46 to-0.04, p = .017, Cohen's d 0.18). Negative side effects from treatment were fewer in Prevent It compared to control participants and neither group reported severe adverse events.Conclusion: We provide initial support for the feasibility, efficacy, and safety of Prevent It to reduce CSAM viewing among motivated users. Further research is needed to validate these findings.
|
|
| 9. |
- Lyle, Maria Smitmanis, et al.
(författare)
-
What are the effects of implementing patient-controlled admissions in inpatient care? : A study protocol of a large-scale implementation and naturalistic evaluation for adult and adolescent patients with severe psychiatric conditions throughout Region Stockholm
- 2022
-
Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 12:8
-
Tidskriftsartikel (refereegranskat)abstract
- Introduction Patient-controlled admissions (PCAs) represent a change in psychiatric inpatient care where patients are allowed to decide for themselves when hospitalisation might be required. Prior research has demonstrated that PCA increase the number of admissions, but decrease days in inpatient care, while both the admissions to and days in involuntary care decrease. However, investigations have been restricted to specific patient groups arid have not examined other possible benefits, such as effects on symptoms, quality of life and autonomy. Methods and analysis This study explores the implementation process and effects of PCA in Region Stockholm, who is currently introducing PCA for all patients with severe psychiatric conditions and extensive healthcare utilisation. In total, the study comprises approximately 45 inpatient wards, including child and adolescent psychiatry. In a naturalistic evaluation, patients assigned PCA will be followed up to 36 months, both with regard to hospitalisation rates and self-reported outcomes. In addition, qualitative studies will explore the experiences of patients, caregivers of adolescents and healthcare providers. Ethics and dissemination Approval has been granted by the Swedish Ethical Review Authority (Dnr: 2020-06498). The findings from this study will be disseminated via publications in international peer-reviewed journals, at scientific conferences, as part of two doctoral theses, and through the Swedish Partnership for Mental Health.
|
|
| 10. |
- Moell, Astrid, et al.
(författare)
-
Effects of stricter legislation on coercive measures in child and adolescent psychiatric care : a qualitative interview study with staff
- 2024
-
Ingår i: BMC Psychiatry. - : Springer Nature. - 1471-244X. ; 24:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Legislators often want to positively affect psychiatric inpatient care and reduce coercion by a stricter judicial regulation. However, staff experiences and comprehension of such legal changes are largely unknown, yet essential in obtaining the intended outcomes. We examined staff understanding and implementation of a July 1, 2020 legal change in Sweden regarding the use of coercive measures (e.g., restraint, seclusion, and forced medication) in child and adolescent psychiatric inpatient care.Methods: During 2021, semi-structured interviews were conducted with nine child and adolescent psychiatric inpatient staff (nurses, senior consultants, and head of units). Interviews were transcribed verbatim and analysed using reflexive thematic analysis. We used an implementation outcomes framework to relate data to a wider implementation science context.Results: The legislative change was viewed as both positive and negative by participating staff. They reported mixed levels of preparedness for the legislative change, with substantial challenges during the immediate introduction, including insufficient preparations and lack of clear guidelines. A knowledge hierarchy was evident, affecting various professional roles differently. While the law was positively viewed for its child-centred approach, we found notable distrust in legislators' understanding of the clinical reality, leading to practical difficulties in implementation. Care practices after the legal change varied, with some participants reporting little change in the use of coercive measures, while others noted a shift towards more seclusion and sedative medication usage. The work environment for consultants was described as more challenging due to increased bureaucratic procedures and a heightened pressure for accuracy.Conclusions: The study highlights the complexities and challenges in implementing legislative changes in psychiatric care, where stricter legislation does not necessarily entail reduced use of coercion.
|
|
| 11. |
|
|
| 12. |
- Oscarsson, Martin, et al.
(författare)
-
Stress and work-related mental illness among working adults with ADHD : a qualitative study
- 2022
-
Ingår i: BMC Psychiatry. - : Springer Science and Business Media LLC. - 1471-244X. ; 22:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Though many adults with ADHD underperform professionally, are more stressed, and have more days of sickness absence compared to adults without ADHD, few studies have explored the experience of working as an adult with ADHD. This study explores the general experience of working with ADHD, including stress and work-related mental illness.Methods: Semi-structured telephone interviews were conducted with 20 working adults with ADHD. Interview topics included how the ADHD diagnosis and/or symptoms of ADHD may have affected participants on the job, how work may have affected participants’ well-being, and the need for support and accommodation. Qualitative content analysis was used to explore verbatim transcripts from the interviews.Results: The analysis yielded three themes that describe some of the challenges of working with ADHD: Working and living with ADHD, Needs, and Special abilities, with a total of eight subcategories. Subcategories were Specific challenges; Relationships and cooperation; Negative consequences; Planning, prioritization, organization, and structure; Support, interventions, accommodations, and aids; Openness, understanding, and acceptance; Strategies; Strengths and qualities.Conclusion: Further knowledge about the challenges of working with ADHD is needed in workplaces; where organizational support is lacking, much in terms of accommodations and aids is up to the employee, and the disclosure of diagnoses may be associated with great dilemma.
|
|
| 13. |
- Rafi, Jonas, et al.
(författare)
-
Effects of a workplace prevention program for problem gambling : A cluster-randomized controlled trial
- 2022
-
Ingår i: Journal of Gambling Issues. - : Concurrent Disorders Society Press. - 1910-7595. ; :50, s. 73-97
-
Tidskriftsartikel (refereegranskat)abstract
- Background and Aims: This study evaluated whether a preventive intervention program for problem gambling would increase managers' inclination to act when concerned about gambling in the workplace.Design: Cluster randomized controlled trial. Ten workplaces were randomized to either intervention or control condition.Participants: At the 12-month endpoint, there were n = 136 managers and n = 1594 subordinates in the intervention group, and n = 137 managers and n = 1150 subordinates in the waitlist group.Intervention: The intervention consisted of (1) six hours of skill-development training for managers regarding gambling, problem gambling, gaming, and harmful use of psychoactive drugs, and (2) six to eight hours of assistance in developing or improving workplace gambling policy.Measurements: The primary outcome was the managers' self-rated (on a 1 to 10 scale) inclination to act when concerned about an employee's problem gambling 12 months after baseline.Findings: The between -group difference in the managers' inclination for the full intervention group (M = 8) and the control group (M = 7.4) was not significant at the 12-month follow-up, but it was when only including managers who attended the skill development training (M = 8.2), d = 0.31, p = .04.Conclusion: A workplace prevention program aimed to increase managers' inclination to act when they are concerned regarding an employee's gambling resulted in statistically significant changes for those who attended training, but not for the whole intervention group when non-attendees were included.
|
|
| 14. |
- Reinebo, Gustaf, et al.
(författare)
-
Effects of Psychological Interventions to Enhance Athletic Performance : A Systematic Review and Meta-Analysis
- 2024
-
Ingår i: Sports Medicine. - : Springer. - 0112-1642 .- 1179-2035. ; 54:2, s. 347-373
-
Forskningsöversikt (refereegranskat)abstract
- BackgroundPsychological interventions are commonly applied in sports to help athletes enhance their performance, but the effect psychological interventions have on actual performance is unclear despite decades of research.ObjectiveWe conducted a systematic review with meta-analyses to investigate the effects of a wide range of psychological interventions on performance in competitive athletes.MethodsA study protocol was preregistered in PROSPERO, and a literary search was performed in the MEDLINE, PsycINFO, Web of Science, and SPORTDiscus databases. Psychological intervention studies were eligible by using a group design and a quantitative performance outcome with athletes competing at a regional or university level or higher. Included studies were assessed regarding intervention characteristics, research methodology, and risk of bias. A multi-level meta-analysis framework with cluster robust variance estimation was used to quantitatively synthesize the results.ResultsA total of 111 studies met the inclusion criteria, and 25 of these studies (37 effects) could be synthesized into five meta-analyses in which there were similarities in the type of psychological intervention, comparator, and experimental design. Meta-analyses I (multimodal psychological skills training vs control), II (mindfulness- and acceptance-based approaches vs control), and III (imagery vs control) consisted of parallel-group studies, and random-effects models were used to calculate the standardized mean difference. Meta-analyses IV (attentional focus strategies, external vs internal) and V (regulatory focus performance instructions, prevention vs promotion) consisted of counterbalanced crossover design studies, and random-effects models were used to calculate the standardized mean change using change score standardization. Significant results were found in three of the meta-analyses (I, II, and III). Psychological skills training (g = 0.83, 95% confidence interval 0.21–1.45), mindfulness- and acceptance-based approaches (g = 0.67, 95% confidence interval 0.01–1.32), and imagery (g = 0.75, 95% confidence interval 0.14–1.36) outperformed controls with moderate effects. However, when non-randomized trials and subjective performance outcomes were removed in sensitivity analyses, the overall estimates of the effect size were no longer significant in any of the syntheses.ConclusionsThe significant moderate effects for psychological skills training, mindfulness- and acceptance-based approaches, and imagery are not stable, and further trials with robust research methodology, such as randomized controlled trials, are requested for all types of psychological interventions aiming to enhance performance in athletes. Moreover, improved reporting standards and the provision of datasets in open science repositories are important to consider in future trials in sport psychology.
|
|
| 15. |
|
|
| 16. |
|
|
| 17. |
- Rozental, Alexander, 1985-, et al.
(författare)
-
Cognitive Behaviour Therapy: 50th anniversary
- 2023
-
Ingår i: Cognitive behaviour therapy. - : Informa UK Limited. - 1651-2316 .- 1650-6073. ; 52:3, s. 163-175
-
Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
|
|
| 18. |
- Rozental, Alexander, 1985-, et al.
(författare)
-
Jonas Ramnerö : in memoriam
- 2024
-
Ingår i: Cognitive Behaviour Therapy. - : Taylor & Francis Group. - 1650-6073 .- 1651-2316. ; 53:1, s. 119-120
-
Tidskriftsartikel (populärvet., debatt m.m.)abstract
- On 18 October 2023, the Swedish researcher, clinician, and CBT instructor Jonas Ramnerö (1959–2023) suddenly passed away at the age of 64 years due to an acute heart failure. The Swedish Association of Behaviour Therapy and a large group of clinicians and researchers grieve one of its most important teachers, authors, and key figures in the advancement of CBT in the Nordic countries during the last three decades.
|
|
| 19. |
- Rozental, Alexander, 1985-, et al.
(författare)
-
Mental health in individuals with self-reported psychiatric symptoms during the COVID-19 pandemic : Baseline data from a swedish longitudinal cohort study
- 2022
-
Ingår i: Frontiers in Psychiatry. - : Frontiers Media SA. - 1664-0640. ; 13
-
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.
|
|
| 20. |
- Rozental, Alexander, 1985-
(författare)
-
Negative effects of Internet-based cognitive behavior therapy : Monitoring and reporting deterioration and adverse and unwanted events
- 2016
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Internet-based cognitive behavior therapy (ICBT) has the potential of providing many patients with an effective form of psychological treatment. However, despite helping to improve mental health and well-being, far from everyone seem to benefit. In some cases, negative effects may also emerge. The overall aim of the present thesis was to establish the occurrence and characteristics of such incidents in ICBT using a combination of quantitative and qualitative methods. Study I determined deterioration, non-response, and adverse and unwanted events in a sample of 133 patients undergoing ICBT for social anxiety disorder. The results indicated that up to 6.8% fared worse during the treatment period, depending on the self-report measure and time point, as determined using the Reliable Change Index (RCI), while the non-response rate was between 29.3 to 86.5% at post treatment assessment, and 12.9% experienced other negative effects. Study II investigated the responses to open-ended questions on adverse and unwanted events among 556 patients in four separate clinical trials of ICBT; social anxiety disorder, panic disorder, major depressive disorder, and procrastination. In total, 9.3% reported negative effects, with a qualitative content analysis revealing two categories and four subcategories; patient-related, i.e., gaining insight and experiencing new symptoms, and treatment-related, i.e., difficulties applying the treatment interventions and problems related to the treatment format. Study III explored the number of patients achieving reliable deterioration, as determined using the RCI on the individual raw scores of 2866 patients from 29 clinical trials of ICBT. The results showed that the deterioration rate was higher among patients in a control condition, 17.4%, in comparison to treatment, 5.8%. Predictors were related to decreased odds of deterioration for patients receiving treatment; clinical severity at pre treatment assessment, being in a relationship, having a university degree, and being older. As for the control condition, only clinical severity at pre treatment assessment was associated with decreased odds of deterioration. Study IV examined a newly developed self-report measure for monitoring and reporting adverse and unwanted events, the Negative Effects Questionnaire. The results suggested a six-factor solution with 32 items; symptoms, quality, dependency, stigma, hopelessness, and failure. One-third of the patients reported experiencing unpleasant memories, stress, and anxiety, with novel symptoms and a lack of quality in the treatment and therapeutic relationship having the greatest negative impact. The general finding of the present thesis is that negative effects do occur in ICBT and that they are characterized by deterioration, non-response, and adverse and unwanted events, similar to psychological treatments delivered face-to-face. Researchers and clinicians in ICBT are recommended to monitor and report negative effects to prevent a negative treatment trend and further the understanding of what might contribute to their incidents. Future research should investigate the relationship between negative effects and treatment outcome, especially at follow-up, to examine if they are transient or enduring. Also, interviews could be conducted with those achieving reliable deterioration to explore if and how it is experienced by the patients and to see if it is attributed to the treatment interventions or other circumstances.
|
|
| 21. |
- Rozental, Alexander, 1985-, et al.
(författare)
-
Procrastination Among University Students : Differentiating Severe Cases in Need of Support From Less Severe Cases
- 2022
-
Ingår i: Frontiers in Psychology. - : Frontiers Media SA. - 1664-1078. ; 13
-
Tidskriftsartikel (refereegranskat)abstract
- Procrastination refers to voluntarily postponing an intended course of action despite expecting to be worse off for this delay, and students are considered to be especially negatively affected. According to estimates in the literature, at least half of the students believe procrastination impacts their academic achievements and well-being. As of yet, evidence-based ideas on how to differentiate severe from less severe cases of procrastination in this population do not exist, but are important in order to identify those students in need of support. The current study recruited participants from different universities in Sweden to participate in an anonymous online survey investigating self-rated levels of procrastination, impulsivity, perfectionism, anxiety, depression, stress, and quality of life. Furthermore, diagnostic criteria for pathological delay (PDC) as well as self-report items and open-ended questions were used to determine the severity of their procrastination and its associated physical and psychological issues. In total, 732 participants completed the survey. A median-split on the Pure Procrastination Scale (PPS) and the responses to the PDC were used to differentiate two groups; “less severe procrastination” (PPS ≤ 2.99; n = 344; 67.7% female; M age = 30.03; SD age = 9.35), and “severe procrastination” (PPS ≥ 3.00; n = 388; 66.2% female; M age = 27.76; SD age = 7.08). For participants in the severe group, 96–97% considered procrastination to a problem, compared to 42–48% in the less severe group. The two groups also differed with regard to considering seeking help for procrastination, 35–38% compared to 5–7%. Participants in the severe group also reported more problems of procrastination in different life domains, greater symptoms of psychological issues, and lower quality of life. A thematic analysis of the responses on what physical issues were related to procrastination revealed that these were characterized by stress and anxiety, e.g., tension, pain, and sleep and rest, while the psychological issues were related to stress and anxiety, but also depression, e.g., self-criticism, remorse, and self-esteem. The current study recommends the PPS to be used as an initial screening tool, while the PDC can more accurately determine the severity level of procrastination for a specific individual.
|
|
| 22. |
- Thew, Graham R., et al.
(författare)
-
Advances in digital CBT : where are we now, and where next?
- 2022
-
Ingår i: The Cognitive Behaviour Therapist. - : Cambridge University Press. - 1754-470X. ; 15
-
Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Digital CBT refers to the use of digital tools, platforms or devices to deliver or enhance cognitive behavioural therapy assessment, formulation, treatment, training and supervision. The 'Advances in Digital CBT' special issue aimed to document examples of innovative digital CBT practice in this rapidly developing field. In this paper, we have briefly summarised and synthesised the advances demonstrated in this group of articles. These include developments in our understanding of mental health apps, the use of digital tools as an adjunct to therapy, the effectiveness of remotely delivered CBT in routine clinical practice, our understanding of user experiences and involvement, and in digital CBT research methods. We consider the extent of current knowledge in these areas and identify where gaps in evidence lie and how the field could be taken forward to address these. Lastly, we reflect on the broader digital CBT picture and offer our suggestions of six key directions for future research: using robust study designs to evaluate and optimise digital tools; translating and culturally adapting digital tools and practices; understanding and addressing digital exclusion; exploring, reporting and addressing possible negative effects; improving user involvement in design and evaluation; and addressing the implementation gap for digital tools. We suggest that further advances in these areas would be of particular benefit to the digital CBT field.
|
|
