| 1. |
- Berg, Matilda, et al.
(författare)
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The Role of Learning Support and Chat-Sessions in Guided Internet-Based Cognitive Behavioral Therapy for Adolescents With Anxiety: A Factorial Design Study
- 2020
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Ingår i: Frontiers in Psychiatry. - : Frontiers Media S.A.. - 1664-0640. ; 11
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Tidskriftsartikel (refereegranskat)abstract
- Background Increased awareness of anxiety in adolescents emphasises the need for effective interventions. Internet-based cognitive behavioural therapy (ICBT) could be a resource-effective and evidence-based treatment option, but little is known about how to optimize ICBT or which factors boost outcomes. Recently, the role of knowledge in psychotherapy has received increased focus. Further, chat-sessions are of interest when trying to optimize ICBT for youths. This study aimed to evaluate the role of learning support and chat-sessions during ICBT for adolescent anxiety, using a factorial design. Method A total of 120 adolescents were randomised to one of four treatment groups, in a 2x2 design with two factors: with or without learning support and/or chat-sessions. Results Anxiety and depressive symptoms were reduced (Beck Anxiety Inventory- BAI; Cohensd=0.72; Beck Depression Inventory- BDI;d=0.97). There was a main effect of learning support on BAI (d=0.38), and learning support increased knowledge gain (d =0.42). There were no main effects or interactions related to the chat-sessions. Treatment effects were maintained at 6-months, but the added effect of learning support had by then vanished. Conclusion ICBT can be an effective alternative when treating adolescents with anxiety. Learning support could be of importance to enhance short-term treatment effects, and should be investigated further.
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| 2. |
- Aspeqvist, Erik, 1983-, et al.
(författare)
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Measurement and stratification of nonsuicidal self-injury in adolescents
- 2024
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Ingår i: BMC Psychiatry. - : BMC. - 1471-244X. ; 24:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundNonsuicidal self-injury (NSSI) is highly prevalent in adolescents. In survey and interview studies assessing NSSI, methods of assessment have been shown to influence prevalence estimates. However, knowledge of which groups of adolescents that are identified with different measurement methods is lacking, and the characteristics of identified groups are yet to be investigated. Further, only a handful of studies have been carried out using exploratory methods to identify subgroups among adolescents with NSSI.MethodsThe performance of two prevalence measures (single-item vs. behavioral checklist) in the same cross-sectional community sample (n = 266, age M = 14.21, 58.3% female) of adolescents was compared regarding prevalence estimates and also characterization of the identified groups with lifetime NSSI prevalence. A cluster analysis was carried out in the same sample. Identified clusters were compared to the two groups defined using the prevalence measures.ResultsA total of 118 (44.4%) participants acknowledged having engaged in NSSI at least once. Of these, a group of 55 (20.7%) adolescents confirmed NSSI on a single item and 63 (23.7%) adolescents confirmed NSSI only on a behavioral checklist, while denying NSSI on the single item. Groups differed significantly, with the single-item group being more severely affected and having higher mean scores on difficulties in emotion regulation, self-criticism, number of methods, higher frequency of NSSI, higher rates of suicidal ideation and suicidal behavior and lower mean score on health-related quality of life. All cases with higher severity were not identified by the single-item question. Cluster analysis identified three clusters, two of which fit well with the groups identified by single-item and behavioral checklist measures.ConclusionsWhen investigating NSSI prevalence in adolescents, findings are influenced by the researchers' choice of measures. The present study provides some directions toward what kind of influence to expect given the type of measure used, both with regards to the size of the identified group and its composition. Implications for future research as well as clinical and preventive work are discussed.
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| 3. |
- Holmqvist Larsson, Kristina, et al.
(författare)
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Emotion regulation group skills training: a pilot study of an add-on treatment for eating disorders in a clinical setting
- 2020
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Ingår i: Journal of Eating Disorders. - : BMC. - 2050-2974. ; 8:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Emotion regulation difficulties appear to play a role in the development and maintenance of several eating disorders. This pilot study aimed at examining whether a short add-on group skills training in emotion regulation for young adults with different eating disorders was feasible in a psychiatric clinical setting. We also investigated if the treatment increased knowledge of emotions, and decreased self-reported difficulties with emotion regulation, alexithymia, symptoms of eating disorder, anxiety and depression, as well as clinical impairment. Methods Six skills training groups were piloted with a total of 29 participants (M = 21.41 years, SD = 1.92). The treatment consisted of five sessions dealing with psychoeducation about emotions and emotion regulation skills training. Paired samples t-test was used to compare differences between before-and-after measures. Results The primary outcomes measures difficulties in emotion regulation (p < 0.001) and alexithymia (p < 0.001) showed significant improvement after treatment. The total eating disorder score (p = 0.009) was also significantly reduced, as was clinical impairment (p < 0.001). Acceptance/valued direction, identifying primary emotions and learning about secondary emotions was rated as especially helpful. Conclusions This preliminary pilot study showed that group training targeting emotion regulation skills was feasible and appreciated by participants, as well as being potentially promising as an adjunctive treatment for different eating disorders. Further controlled studies are needed.
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| 4. |
- Holmqvist Larsson, Kristina, et al.
(författare)
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Emotion regulation group skills training for adolescents and parents : A pilot study of an add-on treatment in a clinical setting
- 2020
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Ingår i: Clinical Child Psychology and Psychiatry. - : Sage Publications. - 1359-1045 .- 1461-7021. ; 25:1, s. 141-155
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Tidskriftsartikel (refereegranskat)abstract
- Difficulties with emotion regulation have been identified as an underlying mechanism in mental health. This pilot study aimed at examining whether group skills training in emotion regulation for adolescents and parents as an add-on intervention was feasible in an outpatient child and adolescent psychiatric clinic. We also investigated if the treatment increased knowledge and awareness of emotions and their functions, increased emotion regulation skills and decreased self-reported symptoms of anxiety and depression. Six skills training groups were piloted with a total of 20 adolescents and 21 adults. The treatment consisted of five sessions dealing with psychoeducation about emotions and emotion regulation skills training. Paired-samples t test was used to compare differences between before-and-after measures for adolescents and parents separately. The primary outcome measure, Difficulties in Emotion Regulation Scale, showed significant improvement after treatment for both adolescents and parents. For adolescents, measures of alexithymia were significantly reduced. Also, emotional awareness was significantly increased. Measures of depression and anxiety did not change. In conclusion, group skills training as an add-on treatment can be feasible and effective but further studies are needed.
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| 5. |
- Jonsson, Linda, 1975-, et al.
(författare)
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Similarities and Differences in the Functions of Nonsuicidal Self-Injury (NSSI) and Sex as Self-Injury (SASI)
- 2019
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Ingår i: Journal of Suicide and Life-threatening Behaviour. - : John Wiley & Sons. - 0363-0234 .- 1943-278X. ; 49:1, s. 120-136
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Tidskriftsartikel (refereegranskat)abstract
- Differences and similarities were studied in the functions of two different self-injurious behaviors (SIB): nonsuicidal self-injury (NSSI) and sex as self-injury (SASI). Based on type of SIB reported, adolescents were classified in one of three groups: NSSI only (n=910), SASI only (n=41), and both NSSI and SASI (n=76). There was support for functional equivalence in the two forms of SIB, with automatic functions being most commonly endorsed in all three groups. There were also functional differences, with adolescents in the SASI only group reporting more social influence functions than those with NSSI only. Adolescents reporting both NSSI and SASI endorsed the highest number of functions for both behaviors. Clinical implications are discussed, emphasizing the need for emotion regulation skills.
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| 6. |
- Perini, Irene, et al.
(författare)
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Brain-based Classification of Negative Social Bias in Adolescents With Nonsuicidal Self-injury : Findings From Simulated Online Social Interaction.
- 2019
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Ingår i: eClinicalMedicine. - : Elsevier. - 2589-5370. ; 13, s. 81-90
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Tidskriftsartikel (refereegranskat)abstract
- Background: Interpersonal stress and perceived rejection have been clinically observed as common triggers of nonsuicidal self-injury (NSSI), with self-injury behavior regulating both affective and social experiences. We investigated whether the subjective interpretation of social interaction in a simulated online environment might be biased in the NSSI group, and the brain mechanisms underlying the experience.Methods: Thirty female adolescent patients with NSSI and thirty female age-matched controls were investigated in this case-control study. In our novel task that simulates interaction on current social media platforms, participants indicated whether they liked or disliked pictures of other players during a functional magnetic resonance imaging (fMRI) scan. Participants also viewed positive and negative feedback directed toward them by others. The task also assessed the subjective effects of the social interaction. Finally, subjects underwent a separate facial electromyography session, which measured facial expressions processing.Outcomes: Behaviorally, the NSSI group showed a negative bias in processing social feedback from others. A multi-voxel pattern analysis (MVPA) identified brain regions that robustly classified NSSI subjects and controls. Regions in which mutual activity contributed to the classification included dorsomedial prefrontal cortex and subgenual anterior cingulate cortex, a region implicated in mood control. In the NSSI group, multi-voxel classification scores correlated with behavioral sensitivity to negative feedback from others. Results remained significant after controlling for medication, symptoms of depression, and symptoms of borderline personality disorder.Interpretation: This study identified behavioral and neural signatures of adolescents with NSSI during social interaction in a simulated social media environment. These findings highlight the importance of understanding social information processing in this clinical population and can potentially advance treatment approaches.
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| 7. |
- Perini, Irene, et al.
(författare)
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The salience of self, not social pain, is encoded by dorsal anterior cingulate and insula
- 2018
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Ingår i: Scientific Reports. - : NATURE PUBLISHING GROUP. - 2045-2322. ; 8
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Tidskriftsartikel (refereegranskat)abstract
- The human neural correlates of social rejection have attracted significant research interest, but remain subject to vigorous debate. Specifically, it has been proposed that a matrix of brain regions overlapping with the classical pain matrix, and including the dorsal anterior cingulate cortex (dACC) and the anterior insular cortex (AI) is critical for processing of social rejection. The present study expands on this conceptualization, by showing that these areas are involved in processing of self-relevant social evaluation, irrespective of valence. Forty healthy adolescents (N = 20 females) were tested in a magnetic resonance imaging (MRI) scanner. We used a novel paradigm that balanced participants experience of rejection and acceptance. In addition, the paradigm also controlled for whether the social judgment was towards the participants or towards other fictitious players. By creating a "self" and "other" distinction, we show that right AI and dACC are involved in processing the salience of being judged by others, irrespective of the quality of this judgment. This finding supports the idea that these regions are not specific to social rejection or even to pain or metaphorically painful experiences, but activate to self-relevant, highly salient information.
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| 8. |
- Topooco, Naira, 1980-, et al.
(författare)
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Chat- and internet-based cognitive-behavioural therapy in treatment of adolescent depression : randomised controlled trial
- 2018
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Ingår i: British Journal of Psychiatry. - : Royal College of Psychiatry. - 0007-1250 .- 1472-1465. ; 26:4, s. 199-207
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Tidskriftsartikel (refereegranskat)abstract
- Background: Depression is a major contributor to the burden of disease in the adolescent population. Internet-based interventions can increase access to treatment.Aims: To evaluate the efficacy of internet-based cognitive-behavioural therapy (iCBT), including therapist chat communication, in treatment of adolescent depression.Method: Seventy adolescents, 15-19 years of age and presenting with depressive symptoms, were randomised to iCBT or attention control. The primary outcome was the Beck Depression Inventory II (BDI-II).Results: Significant reductions in depressive symptoms were found, favouring iCBT over the control condition (F(1,67) = 6.18, P < 0.05). The between-group effect size was Cohen's d = 0.71 (95% CI 0.22-1.19). A significantly higher proportion of iCBT participants (42.4%) than controls (13.5%) showed a 50% decrease in BDI-II score post-treatment (P < 0.01). The improvement for the iCBT group was maintained at 6 months.Conclusions: The intervention appears to effectively reduce symptoms of depression in adolescents and may be helpful in overcoming barriers to care among young people.Declaration of interest: N.T. and G.A. designed the programme. N.T. authored the treatment material. The web platform used for treatment is owned by Linköping University and run on a non-for-profit basis. None of the authors receives any income from the programme.
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| 9. |
- Zetterqvist, Maria, 1970-
(författare)
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Non-Suicidal Self-Injury in Swedish Adolescents : Prevalence, Characteristics, Functions and Associations With Childhood Adversities
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Non-suicidal self-injury (NSSI), such as intentionally cutting, burning or hitting oneself, is a behavior with potentially detrimental consequences and empirical studies are necessary to gain knowledge of how to prevent NSSI in adolescents. The aims of this thesis were to investigate the prevalence, methods, characteristics and functions of NSSI in a large community sample of Swedish adolescents, and to examine the relationship between NSSI and adverse life events and trauma symptoms. All empirical studies had a cross-sectional design and were based on 3,097 adolescents in the county of Östergötland, aged 15-17 years, in their first year of high school. Participating school classes were selected through a randomization process and administered self-report questionnaires.In study I (n = 3,060) a single item NSSI question resulted in a prevalence rate of 17.2%, while 35.6% of adolescents reported having engaged in NSSI at least once during the past year when given a checklist. The most commonly reported type of NSSI in this sample was “bit yourself”, followed by “hit yourself on purpose”, “erased your skin” and “cut or carved on your skin”. Applying the proposed DSM-5 diagnostic criteria of NSSI resulted in a prevalence rate of 6.7%. Results in study II (n = 2,964) showed that after controlling for gender, parental occupation and living conditions, adolescents with no self-injurious behavior reported the lowest level of adversities and trauma symptoms, while adolescents with both NSSI and suicide attempts (5.7%) reported the highest levels compared to those with only NSSI or a suicide attempt. Adolescents reporting frequent NSSI reported more adversities and trauma symptoms than those with less frequent NSSI. Automatic functions, such as affect regulation, self-punishment and feeling-generation, were the most commonly reported functions of NSSI. Attempts in study I to confirm Nock and Prinstein’s (2004) four-factor model of underlying factors of NSSI functions resulted in a close to acceptable fit. An attempt to refine the factor analysis on this community sample of Swedish adolescents, using Mplus with cross-validation, was made in study III (n = 836). An exploratory factor analysis resulted in a three-factor model (social influence, automatic functions and non-conformist peer identification), which was validated in confirmatory analysis. In order to adhere more closely to learning theory and the concept of negative and positive reinforcement, the third factor was then split into two factors, resulting in a four-factor model (social influence, automatic functions, peer identification and avoiding demands), which showed excellent fit to the data in the confirmatory factor analysis. Study IV (n = 816) showed that NSSI frequency, gender (female), self-reported experience of emotional and physical abuse, having made a suicide attempt, prolonged illness or handicap and symptoms of depression and dissociation were significant predictors in the final model of the automatic functions, indicating that these variables are important in understanding the mechanisms underlying the need to engage in NSSI to regulate emotions, generate feelings, gain control or to self-punish. Symptoms of depression and dissociation mediated the relationship between sexual, physical and emotional abuse and the automatic functions. Furthermore, frequency of NSSI, gender, emotional abuse, prolonged illness or handicap and symptoms of depression uniquely predicted automatic functions but not social functions. Self-reported experience of physical abuse, having made a suicide attempt, symptoms of anxiety and dissociation were significant in the final model of social functions, i.e., performing NSSI to influence or communicate with others, to avoid demands or to identify with peers. Of these, symptoms of anxiety were uniquely associated with social functions. Symptoms of anxiety and dissociation mediated the relationship between physical abuse and social functions of NSSI.Taken together, this thesis has shown that NSSI is prevalent in Swedish adolescents and findings contribute to the discussion of a potential NSSI diagnosis. It is important to consider the effect of different types of negative life events and trauma symptoms in relation to NSSI in adolescents. Assessing the specific reinforcing functions of NSSI and the underlying factor structure can be helpful in developing functionally relevant individualized treatment.
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| 10. |
- Zetterqvist, Maria, 1970-, et al.
(författare)
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Nonsuicidal Self-Injury Disorder in Adolescents: Clinical Utility of the Diagnosis Using the Clinical Assessment of Nonsuicidal Self-Injury Disorder Index
- 2020
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Ingår i: Frontiers in Psychiatry. - : FRONTIERS MEDIA SA. - 1664-0640. ; 11
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Tidskriftsartikel (refereegranskat)abstract
- Nonsuicidal self-injury disorder (NSSID) is a condition in need of further study, especially in adolescent and clinical populations where it is particularly prevalent and studies are limited. Twenty-nine clinical self-injuring adolescents were included in the study. The Clinical Assessment of Nonsuicidal Self-Injury Disorder Index (CANDI) was used to assess prevalence of NSSID. The NSSID diagnosis criteria were met by 62.1% of adolescents. The impairment or distress criterion was least often met. Criteria B and C (assessing reasons for NSSI and cognitions/emotions prior to NSSI) were confirmed by 96-100% of all participants. Adolescents with NSSI in this clinical sample had several comorbidities and high levels of psychopathology. NSSID occurred both in combination with and independently of borderline personality disorder traits as well as suicide plans and attempts. Those with NSSID had a significantly higher cutting frequency than those not meeting full NSSID criteria. Other NSSI characteristics, comorbidity, psychopathology, and trauma experiences did not differ between groups. CANDI was a feasible tool to assess NSSID in adolescents. It is important to use structured measures to assess the validity of the NSSID diagnosis across development in both community and clinical samples. The clinical utility of the NSSID diagnosis is discussed.
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| 11. |
- Zetterqvist, Maria, 1970-
(författare)
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Nonsuicidal Self-Injury in Adolescents : Characterization of the Disorder and the Issue of Distress and Impairment.
- 2017
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Ingår i: Journal of Suicide and Life-threatening Behaviour. - : Wiley-Blackwell. - 0363-0234 .- 1943-278X. ; 47:3, s. 321-335
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Tidskriftsartikel (refereegranskat)abstract
- Nonsuicidal self-injury disorder (NSSID) is a condition in need of further study to assess the validity of the potential diagnosis and its suggested criteria. This study examined the NSSID diagnosis and investigated the distress/impairment criterion by comparing community adolescents who met all criteria for NSSID (n = 186) to adolescents with five or more nonsuicidal self-injury (NSSI) episodes (n = 314), and to a group of adolescents who met all criteria but negated that their NSSI caused them any distress or impairment, thus failing to meet criterion E (n = 29). The NSSID group delimited from the ≥ 5 NSSI group by reporting significantly more frequent and severe self-injurious thoughts and behaviors, as well as having more experiences of negative life events and higher levels of trauma symptoms. There were also some differences between the NSSID group and adolescents without distress/impairment, which together contribute valuable information on the potential NSSID diagnosis, as well as the discussion of criterion E.
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| 12. |
- Zetterqvist, Maria, 1970-, et al.
(författare)
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Self-reported nonsuicidal self-injury (NSSI) and sex as self-injury (SASI) : Relationship to abuse, risk behaviors, trauma symptoms, self-esteem and attachment
- 2018
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Ingår i: Psychiatry Research. - : Elsevier. - 0165-1781 .- 1872-7123. ; 265, s. 309-316
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Tidskriftsartikel (refereegranskat)abstract
- This study focuses on a conceptually unexplored behavior among adolescents who report deliberately using sex as a means of self-injury. In a large high school-based sample (n = 5743), adolescents who engaged in sex as self injury (SASI, n = 43) were compared to adolescents who reported direct nonsuicidal self-injury (NSSI, n = 933) and those who reported both NSSI and SASI (n = 82). Re.sults showed that significantly more adolescents with SASI had experience of penetrating sexual abuse, as well as more sexual partners compared to those with NSSI. The SASI group also had higher levels of self-reported trauma symptoms, such as dissociation, posttraumatic stress and sexual concerns compared to those with NSSI, suggesting a distinct relationship between sexual abuse, trauma symptoms and engaging in sex as self-injury. There was no difference between the SASI and NSSI groups regarding experiences of emotional and physical abuse, self-esteem, parental care or overprotection or symptoms of depression, anxiety and anger. Adolescents who engaged in both NSSI + SASI stood out as a more severe and burdened group, with more experience of abuse, risk behaviors and impaired psychosocial health. Adolescents with traumatic experiences such as sexual abuse need to be assessed for SASI and vice versa.
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| 13. |
- Zetterqvist, Maria, 1970-, et al.
(författare)
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Social Processes in Nonsuicidal Self-Injury
- 2023
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Ingår i: The Oxford Handbook of Nonsuicidal Self-Injury. - : Oxford University Press. - 9780197611302 - 9780197611272
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Social interactions are critical for the health and well-being of all group-living primates, including humans, across the lifespan. Social stressors, such as perceived criticism and rejection, are common triggers of nonsuicidal self-injury (NSSI). Social processes may thus have a central role in the etiology and maintenance of NSSI. Using the Research Domain Criteria (RDoC) framework for systems for social processes, the chapter presents recent findings on NSSI, mapping them onto the four constructs: affiliation and attachment, social communication, perception and understanding of self, and perception and understanding of others. The chapter also discusses available research related to NSSI for the respective units of analysis (genes and molecules, physiology, neurocircuitry, behavior, and self-report), focusing on the effects of social exclusion, rejection sensitivity, and negative social bias. The chapter also includes an overview of overlapping features related to social exclusion and rejection sensitivity between NSSI and borderline personality disorder, a condition characterized by interpersonal difficulties. This chapter provides an account of evidence-based assessment and intervention areas of social processes in NSSI together with recommendations and future directions. The chapter concludes that social processes are relevant to NSSI across the RDoC constructs and units of analyses. Social difficulties, social problem-solving, and experiences and interpretations of social situations need to be included in the conceptualization of how NSSI is developed and maintained and ultimately assessed and treated. In an effort to bring such conceptualization to life, a case example illustrates how an understanding of social processes may guide assessment and treatment of NSSI.
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| 14. |
- Zetterqvist, Maria, 1970-, et al.
(författare)
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Validation of the Systemic Clinical Outcome and Routine Evaluation (SCORE-15) self-report questionnaire: index of family functioning and change in Swedish families
- 2020
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Ingår i: Journal of Family Therapy. - : WILEY. - 0163-4445 .- 1467-6427. ; 42:1, s. 129-148
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Tidskriftsartikel (refereegranskat)abstract
- Instruments for evaluating the progress and outcome of systemic therapeutic treatments in clinical practice need to be easily administered and have sound psychometric properties. The Systemic Clinical Outcome and Routine Evaluation, 15-item version (SCORE-15), is a self-report instrument that measures aspects of family functioning. This study investigates the psychometric qualities of a Swedish version of SCORE-15. Seventy Swedish families with healthy children and 159 families with children with psychiatric or behavioural problems were included in the study, resulting in a total of 397 individuals. Results showed that SCORE-15 differentiated clinical from non-clinical families with acceptable psychometric properties for test-retest, internal consistency, convergent and construct validity, as well as sensitivity to change for the clinical sample. The three-factor solution of strengths, difficulties and communication was tested. Results imply preliminary psychometric support for the use of the Swedish version of SCORE-15 to evaluate progress and outcome in clinical practice. Practitioner points SCORE-15 is an easily administered questionnaire suitable for use in clinical practice to evaluate systemic therapeutic progress and outcome The Swedish version of SCORE-15 has acceptable psychometric properties
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