| 1. |
- Andersson, Gerhard, et al.
(författare)
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Free choice of treatment content, support on demand and supervision in internet-delivered CBT for adults with depression : A randomized factorial design trial
- 2023
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Ingår i: Behaviour Research and Therapy. - : Elsevier. - 0005-7967 .- 1873-622X. ; 162
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Tidskriftsartikel (refereegranskat)abstract
- Even if much is known regarding the effects of internet-delivered cognitive behaviour therapy (ICBT) for depression there are several topics that have not been studied. In this factorial design trial with 197 participants we investigated if clients in ICBT could select treatment modules themselves based on a selection of 15 tailored treatment modules developed for use in ICBT for depression. We contrasted this against clinician-tailored module selection. We also investigated if support on demand (initiated by the client) could work as well as scheduled support. Finally, we tested if clients that were mentioned in supervision would improve more than clients not mentioned (with the exception of acute cases). The treatment period lasted for 10 weeks, and we measured effects at post-treatment and two-year follow-up. Measures of depression and secondary outcomes were collected at pre-treatment, post-treatment and two-year follow-up. Overall, within-group effects were large across con-ditions (e.g., d = 1.73 on the BDI-II). We also found a small but significant difference in favour of self-tailored treatment over clinician-tailored (d = 0.26). Within-group effects for the secondary measures were all moderate to large including a test of knowledge about CBT. The other two contrasts "support on demand" and "supervision" yielded mostly non-significant differences, with the exception of a larger dropout rate in the support on demand condition. There were few negative effects (2.2%). Effects were largely maintained at a two-year follow-up. We conclude that clients can choose treatment modules and that support on demand may work. The role of su-pervision is not yet clear as advice can be transferred across clients.
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| 2. |
- Bargoria, Victor, et al.
(författare)
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Running for your life : A qualitative study of champion long-distance runners strategies to sustain excellence in performance and health
- 2020
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Ingår i: Journal of Science and Medicine in Sport. - : Elsevier. - 1440-2440 .- 1878-1861. ; 23:8, s. 715-720
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Tidskriftsartikel (refereegranskat)abstract
- ObjectivesTo investigate champion long-distance runners’ strategies for managing injury and illness symptoms and staying well.DesignQualitative research study.MethodsTwelve long-distance runners were interviewed immediately after having competed in World Championships finals. Thematic analysis was used to categorise and structure the data. The results were presented as primary themes and overarching constructs representing connections between the primary themes.ResultsThe champion runners’ basic tactic to manage symptoms of ill health was characterized by rapid adjustment of sports load and a strong incentive to learn from experience and professional advice. This tactic was named here educated flexibility. A secondary exigency tactic was associated with reaching short-term goals and a consequential acceptance of health hazards. The runners used economic and other environmental strain to explain use of the exigency tactic. Most champion runners’ long-term strategy to stay well included both tactics successfully combined to maintain a performance level assuring a regular income. Avoidance of letting environmental strain and health problems create vicious circles was at the centre of these strategies.ConclusionsChampion runners’ main strategy to stay well and sustain their superiority in performance was characterized by constantly paying attention to symptoms of ill health, listening to medical advice, and not letting environmental strain interfere with adjustment of sports load. Many top-level runners originate from global regions where formal education programs and health insurance plans are poorly regulated and supported. Bio-psychosocial models including empowerment at individual and systems levels should be considered when health services are planned for professional runners.
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| 3. |
- Bendelin, Nina, et al.
(författare)
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Patients' experiences of internet-based Acceptance and commitment therapy for chronic pain : a qualitative study
- 2020
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Ingår i: BMC Musculoskeletal Disorders. - : BMC. - 1471-2474. ; 21
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Tidskriftsartikel (refereegranskat)abstract
- Background: Chronic pain is a globally widespread condition with complex clusters of symptoms within a heterogeneous patient group. Internet-delivered Acceptance and Commitment Therapy (IACT) has shown promising results in the treatment of chronic pain. How IACT is experienced by patients is less well known. Qualitative studies of patients' experiences are needed to further understand factors behind both engagement and negative effects. The aim of this study was to explore how IACT was experienced by chronic pain patients who had participated in a controlled trial.Methods: Through an open and exploratory approach this study aimed to investigate how IACT was experienced when delivered as a guided self-help program to persons with chronic pain. Eleven participants were interviewed over telephone after completing IACT.Results: Qualitative analysis based on grounded theory resulted in 2 core categories and 8 subcategories. In treatment: Physical and cognitive restraints, Time and deadline, Therapist contact, and Self-confrontation. After treatment: Attitude to pain, Image of pain, Control or Command, and Acting with pain. Individual differences as well as specific conditions of the treatment may explain variations in how the treatment was approached, experienced and what consequences it led to. Therapist guidance and deadlines for homework play complex roles in relation to autonomy and change.Conclusions: Adjusting treatment content and format based on participants' characteristics, such as expectations, motivation and restraints, might positively affect engagement, autonomy and change. Further research on attrition and negative effects of treatment might clarify what enables chronic pain patients to benefit from IACT.
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| 4. |
- Berg, Ida, et al.
(författare)
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“Good job!” : Therapists' encouragement, affirmation, and personal address in internet-based cognitive behavior therapy for adolescents with depression
- 2022
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Ingår i: Internet Interventions. - : Elsevier. - 2214-7829. ; 30
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Tidskriftsartikel (refereegranskat)abstract
- Internet-delivered interventions are generally effective for psychological problems. While the presence of a clinician guiding the client via text messages typically leads to better outcomes, the characteristics of what constitutes high-quality communication are less well investigated. This study aimed to identify how an internet therapist most effectively communicates with clients in internet-delivered cognitive behavioral therapy (ICBT). Using data from a treatment study of depressed adolescents with a focus on participants who had a positive outcome, messages from therapists were analyzed using thematic analysis. The study focused on the therapist's 1) encouragement and 2) affirmation, and how the therapists used 3) personal address. The analysis resulted in a total of twelve themes (Persistence Wins, You Are a Superhero, You Make Your Luck, You Understand, Hard Times, You Are Like Others, My View on the Matter, Time for a Change, Welcome In, Let Me Help You, You Affect Me, and I Am Human). Overall, the themes form patterns where treatment is described as hard work that requires a motivated client who is encouraged by the therapist. The findings are discussed based on the cognitive behavioral theoretical foundation of the treatment, prior research on therapist behaviors, and the fact that the treatment is provided over the internet.
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| 5. |
- 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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| 6. |
- Berman, Anne H., Professor, et al.
(författare)
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Transdiagnostic and tailored internet intervention to improve mental health among university students : Research protocol for a randomized controlled trial
- 2024
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Ingår i: Trials. - : Springer Nature. - 1745-6215. ; 25:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Emerging adulthood is often associated with mental health problems. About one in three university students report symptoms of depression and anxiety that can negatively affect their developmental trajectory concerning work, intimate relationships, and health. This can interfere with academic performance, as mood and anxiety disorders are key predictors of dropout from higher education. A treatment gap exists, where a considerable proportion of students do not seek help for mood and anxiety symptoms. Offering internet interventions to students with mental health problems could reduce the treatment gap, increase mental health, and improve academic performance. A meta-analysis on internet interventions for university students showed small effects for depression and none for anxiety. Larger trials are recommended to further explore effects of guidance, transdiagnostic approaches, and individual treatment components.Methods: This study will offer 1200 university students in Sweden participation in a three-armed randomized controlled trial (RCT) evaluating a guided or unguided transdiagnostic internet intervention for mild to moderate depression and anxiety, where the waitlist control group accesses the intervention at 6-month follow-up. Students reporting suicidal ideation/behaviors will be excluded and referred to treatment within the existing healthcare system. An embedded study within the trial (SWAT) will assess at week 3 of 8 whether participants in the guided and unguided groups are at higher risk of failing to benefit from treatment. Those at risk will be randomized to an adaptive treatment strategy, or to continue the treatment as originally randomized. Primary outcomes are symptoms of depression and anxiety. Follow-ups will occur at post-treatment and at 6-, 12-, and 24-month post-randomization. Between-group outcome analyses will be reported, and qualitative interviews about treatment experiences are planned.Discussion: This study investigates the effects of a transdiagnostic internet intervention among university students in Sweden, with an adaptive treatment strategy employed during the course of treatment to minimize the risk of treatment failure. The study will contribute knowledge about longitudinal trajectories of mental health and well-being following treatment, taking into account possible gender differences in responsiveness to treatment. With time, effective internet interventions could make treatment for mental health issues more widely accessible to the student group.
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| 7. |
- Carlbring, Per, et al.
(författare)
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Adverse effects in internet-based cognitive-behavior versus psychodynamic therapy
- 2022
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Ingår i: EABCT 2022: Re-Thinking CBT: providing startegies for a new way of living. ; , s. 66-66
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background: Internet-based psychological treatments provide many benefits for patients with psychiatric disorders, but research also suggests that negative effects might occur from the interventions involved.Methods: A total of 2400 participants presenting with anxiety and/or depression were randomized into 12 subgroups (n=200 each) based on treatment modality (Cognitive Behavior Therapy vs. Psychodynamic Therapy vs. Waitlist), duration (8 vs. 16 weeks), and moderated discussion forum (Yes vs. No). In addition to weekly measurements of the primary outcome measure (PHQ-9 & GAD-7), the Negative Effects Questionnaire was administered post-treatment. The Negative Effects Questionnaire has been proposed as a valuable instrument for investigating the negative effects of psychological treatments. An exploratory factor analysis suggested a six-factor solution: symptoms (“I felt more worried”), quality (“I did not always understand my treatment”), dependency (“I think that I have developed a dependency on my treatment”), stigma (“I became afraid that other people would find out about my treatment”), hopelessness (“I started thinking that the issue I was seeking help for could not be made any better”), and failure (“I lost faith in myself”).Results: All 2400 participants have been recruited. However, all post-assessment data is not yet collected at the time of writing (but will be by the time of the conference). This talk will focus on the occurrence and characteristics of the potential negative effects of internet-based treatment in the 12 subgroups.Discussion: Negative effects of psychotherapy are multifaceted, warranting careful considerations for them to be monitored and reported in research settings and routine care.
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| 8. |
- Carlbring, Per, et al.
(författare)
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Comparing Transdiagnostic Treatments: Unified Protocol vs. Affect Phobia Therapy and the Role of Negative Effects
- 2023
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Ingår i: Abstracts and Program Parallel Sessions. ; , s. 32-32
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Konferensbidrag (refereegranskat)abstract
- Aim: The aim of the TRAbee study was to compare the effectiveness of two transdiagnostic treatment modalities, Unified Protocol (Cognitive Behavior Therapy) and Affect Phobia Therapy (Psychodynamic Psychotherapy), in alleviating psychological distress and to examine the relative differences in the incidence of negative effects as assessed by the Negative Effects Questionnaire.Methods: This study is a randomized controlled trial with 2,400 participants divided into 12 subgroups based on treatment modality (CBT vs. PDT vs. waitlist), duration (8 or 16 weeks of treatment), and discussion forum access (yes/no). Participants were randomly assigned and measured weekly during treatment, and then at 6, 12, and 24 months. Inclusion criteria were: age 18 years or older, ability to read/write Swedish, access to a smartphone/computer, GAD-7 score ≥5, and/or PHQ-9 score ≥10. Exclusion criteria included: current psychological treatment, recent medication change, severe depression/suicidality. Outcome measures included the Generalized Anxiety Disorder 7-item scale (GAD-7), the Patient Health Questionnaire 9-item scale (PHQ-9), the Personality Inventory for DSM-5 (PID-5), the Reflective Functioning Questionnaire 8-item scale (RFQ- 8), the Negative Effects Questionnaire (NEQ), and the Brunnsviken Brief Quality of Life scale (BBQ).Results: Follow-up data is still being collected, but preliminary results, including 12-month follow-up, will be available at the ISRII conference. The results will report on the relative differences in the incidence of negative effects between the treatments as assessed by the NEQ scale.Conclusions: The study will provide insights into the comparative effectiveness of Unified Protocol and Affect Phobia Therapy in addressing psychological disorders in a transdiagnostic manner, as well as shedding light on the differences in negative effects experienced by patients undergoing these treatments. This information may inform future treatment approaches and help to optimize patient outcomes.
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| 9. |
- Carlbring, Per, et al.
(författare)
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Lessons learned from 'TRAbee' – a large full-factorial designed study (n=2400) targeting depression and/or anxiety
- 2022
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Ingår i: EABCT 2022: Re-Thinking CBT: providing startegies for a new way of living. ; , s. 117-117
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background: Typically, internet-based treatment programs are effective for various psychological problems. However, diagnosing, and matching treatments to an individual's need, is a challenge and potentially resource-intensive. In addition, it is unknown what the optimal treatment length is and whether access to an online forum is beneficial for treatment adherence and subsequent outcome. In this study, the Iterapi platform fully automated all decisions and communication with the participants, maximizing scalability.Methods: A total of 2400 participants presenting with anxiety and/or depression were randomized into 12 subgroups (n=200 each) based on treatment modality, duration, and moderated discussion forum (Yes vs. No). Weekly measurements using PHQ9 and GAD7 were the primary outcome measures.The treatments were based on Cognitive Behavior Therapy (Unified Protocol) or Psychodynamic models and treatment principles (Affect Phobia). Both Unified Protocol and the Affect Phobia treatment program are transdiagnostic methods targeting symptoms of anxiety and depression. The participants were also randomly assigned to either having (50%) or not having (50%) access to a discussion forum that a clinician moderated. Finally, all participants of the two treatment groups and the waitlist-control group were randomly assigned to either an 8- or 16-week intervention duration.Results: All 2400 participants have been recruited. However, all post-assessment data is not yet collected at the time of writing (but will be by the time of the conference). This talk will focus on design considerations and lessons learned from the 'TRAbee' study.Discussion: Since the weekly assessment of outcome has been collected, the statistical power is strong, especially since the total number of participants is 2400. The outcome will answer several dissemination questions, including treatment length, discussion boards' added value, and treatment type (CBT vs. PDT).
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| 10. |
- Carlbring, Per, et al.
(författare)
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TRAbee: Internet-delivered transdiagnostic self-help treatments for anxiety and/or depression : Preliminary results from a full-factorial designed randomized control trial
- 2022
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Ingår i: Abstracts from the 11th Swedish Congress on internet interventions (SWEsrii), Gothenburg, Sweden, 23-24 May 2022. - Linköping : Linköping University Electronic Press. ; , s. 14-15
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Konferensbidrag (refereegranskat)abstract
- Traditional evidence-based psychological treatments are often diagnosis-specific, with treatment manuals being developed for specific diagnoses. This methodology has been criticized by some for not corresponding with the clinical reality of individual variability of symptoms, comorbitity with other psychiatric diagnoses and subclinical symptoms of other conditions. A possible way of adapting treatments to clinical reality is through transdiagnostic modes of treatment.Transdiagnostic treatments have the great advantage of potentially being suitable to a larger, and likely more representative population. Within psychological treatment there are two main transdiagnostic modalities; Unified Protocol and Affect Phobia Therapy. Unified Protocol is based on Cognitive Behaviour Therapy and is directed at emotional regulation as an important maintaining, transdiagnostic factor. Affect phobia therapy has its theoretical roots in modern Psychodynamic Theory and is focused on breaking unconscious maladaptive patterns. Unified Protocol and Affect Phobia Therapy have to our knowledge never been compared with each other, which this study aims to accomplish.The current study is a randomized controlled trial with a full factorial design. A total of 2400 participants will be divided into 12 different subgroups (2 * treatment duration [8 vs 16 weeks], 2 * discussion forum access [yes vs. no], and 3 * treatment [Unified Protocol vs. Affect Phobia Therapy vs. Waitlist).Inclusion criteria for the study are the following: Ability to read and write Swedish, access to smartphone or computer, minimum age of 18 years, and total GAD-7 ≥ 5 points and/or PHQ-9 ≥ 10 points.Exclusion criteria for the study are the following: Concurrent psychological treatment, initiation of or change in medication for anxiety or depression within the previous month, or self-reported severe depression (PHQ-9 total score ≥ 20) or suicidality (PHQ-9, item 9 > 2). Participants who report severe depression or suicidality will be excluded and recommended to seek other treatment.GAD7 and PHQ9 are the main outcome measures. Secondary measures are: Personality Inventory for DSM Short Form, Reflective Functioning Questionnaire 8, Negative Effects Questionnaire, and Brunnsviken Brief Quality of Life Scale.The study is still recruiting, but preliminary results will be available at the time of the SWErii conference.
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| 11. |
- Carlbring, Per, et al.
(författare)
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Transdiagnostic Internet interventions : A breakthrough in psychological disorders?
- 2023
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Ingår i: Abstracts from the 12th Swedish Congress on internet interventions (SWEsrii), Uppsala University, Sweden. ; , s. 4-4
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Traditional evidence-based treatments for psychological disorders are often specific to one diagnosis. Some criticize this approach for not accounting for individual variation in symptoms. Transdiagnostic treatments aim to address this issue by being applicable to a wider range of patients. This study, called TRAbee, compares two transdiagnostic modalities: Unified Protocol (=Cognitive Behavior Therapy) and Affect Phobia Therapy (= Psychodynamic Psychotherapy). The study design is a randomized controlled trial with n=2400 participants who are divided into 12 subgroups based on treatment modality (CBT vs. PDT vs. waitlist), duration (8 or 16 weeks of treatment), and discussion forum access (yes/no). Participants were randomly assigned and measured weekly during treatment and then at 6, 12 and 24 months. Inclusion criteria: 18 years or older, ability to read/write Swedish, access to smartphone/computer, GAD-7 score ≥5, and/or PHQ-9 score ≥10. Exclusion criteria: current psychological treatment, recent medication change, severe depression/suicidality. Outcome measures include GAD7, PHQ9, PID- 5, RFQ-8, NEQ, and quality of life. Follow-up data is still being collected, but preliminary results including 12 month follow-up will be available at the SWErii conference.
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| 12. |
- Carlbring, Per, et al.
(författare)
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Transdiagnostic self-help treatments for anxiety and/or depression : A full-factorial RCT investigating psychotherapeutic modalities, discussion boards and treatment length
- 2022
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Ingår i: International Society for Research onInternet Interventions 11th Scientific Meeting. ; , s. 19-19
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- ContextTypically, internet-based treatment programs are effective for a wide range of specific psychiatric diagnoses. However, diagnosing, and matching treatments to an individuals' need, is a challenge and potentially resource intensive. In this study, a computer automatically made the decision on inclusion and exclusion.Methods: A total of 2400 participants presenting with anxiety and/or depression were randomized into 12 subgroups (n=200 each) based on treatment modality (Cognitive Behavior Therapy vs. Psychodynamic Therapy vs. Waitlist), duration (8 vs. 16 weeks) and moderated discussion forum (Yes vs. No). Weekly measurements using PHQ9 and GAD7 were the primary outcome measures.Intervention (if relevant): Unified Protocol is a transdiagnostic Cognitive Behavior Therapy method for symptoms of anxiety and depression. The Affect Phobia treatment program was based on Psychodynamic models and treatment principles. The participants were also randomly assigned to either having (50%) or not having (50%) access to a discussion forum that was moderated by a clinician. Finally, all participants of the two treatment groups and the waitlist-control group were also randomly assigned to either an 8- or 16-week intervention duration.Results: All 2400 participants have been recruited. However, all post-assessment data is not yet collected at the time of writing (but will be by the time of the conference). The results will show if transdiagnostic treatment is better than a waitlist, if there is a relative difference between Cognitive Behavior Therapy and Psychodynamic treatment, if there is a relative difference between a 8 or 16 week long treatment, and if a discussion group has any added value.Conclusions: Since weekly assessment of outcome has been collected the statistical power is strong, especially since the total number of participants is 2400.Implications: The outcome will give a clear answer to several dissemination questions including treatment length, the added value of discussion boards and type of treatment (CBT vs. PDT).
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| 13. |
- Gao, YX, et al.
(författare)
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Mendelian randomization implies no direct causal association between leukocyte telomere length and amyotrophic lateral sclerosis
- 2020
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Ingår i: Scientific reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 10:1, s. 12184-
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Tidskriftsartikel (refereegranskat)abstract
- We employed Mendelian randomization (MR) to evaluate the causal relationship between leukocyte telomere length (LTL) and amyotrophic lateral sclerosis (ALS) with summary statistics from genome-wide association studies (n = ~ 38,000 for LTL and ~ 81,000 for ALS in the European population; n = ~ 23,000 for LTL and ~ 4,100 for ALS in the Asian population). We further evaluated mediation roles of lipids in the pathway from LTL to ALS. The odds ratio per standard deviation decrease of LTL on ALS was 1.10 (95% CI 0.93–1.31, p = 0.274) in the European population and 0.75 (95% CI 0.53–1.07, p = 0.116) in the Asian population. This null association was also detected between LTL and frontotemporal dementia in the European population. However, we found that an indirect effect of LTL on ALS might be mediated by low density lipoprotein (LDL) or total cholesterol (TC) in the European population. These results were robust against extensive sensitivity analyses. Overall, our MR study did not support the direct causal association between LTL and the ALS risk in neither population, but provided suggestive evidence for the mediation role of LDL or TC on the influence of LTL and ALS in the European population.
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| 14. |
- Gattinger, Pia, et al.
(författare)
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Neutralization of SARS-CoV-2 requires antibodies against conformational receptor-binding domain epitopes
- 2022
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Ingår i: Allergy. European Journal of Allergy and Clinical Immunology. - : Wiley. - 0105-4538 .- 1398-9995. ; 77:1, s. 230-242
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Tidskriftsartikel (refereegranskat)abstract
- Background: The determinants of successful humoral immune response to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are of critical importance for the design of effective vaccines and the evaluation of the degree of protective immunity conferred by exposure to the virus. As novel variants emerge, understanding their likelihood of suppression by population antibody repertoires has become increasingly important.Methods: In this study, we analyzed the SARS-CoV-2 polyclonal antibody response in a large population of clinically well-characterized patients after mild and severe COVID-19 using a panel of microarrayed structurally folded and unfolded SARS-CoV-2 proteins, as well as sequential peptides, spanning the surface spike protein (S) and the receptor-binding domain (RBD) of the virus.Results: S- and RBD-specific antibody responses were dominated by immunoglobulin G (IgG), mainly IgG1, and directed against structurally folded S and RBD and three distinct peptide epitopes in S2. The virus neutralization activity of patients´ sera was highly correlated with IgG antibodies specific for conformational but not sequential RBD epitopes and their ability to prevent RBD binding to its human receptor angiotensin-converting enzyme 2 (ACE2). Twenty percent of patients selectively lacked RBD-specific IgG. Only immunization with folded, but not with unfolded RBD, induced antibodies against conformational epitopes with high virus-neutralizing activity. Conformational RBD epitopes required for protection do not seem to be altered in the currently emerging virus variants.Conclusion: These results are fundamental for estimating the protective activity of antibody responses after natural infection or vaccination and for the design of vaccines, which can induce high levels of SARS-CoV-2–neutralizing antibodies conferring sterilizing immunity.
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| 15. |
- Gilmore, G., et al.
(författare)
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The Gaia-ESO Public Spectroscopic Survey : Motivation, implementation, GIRAFFE data processing, analysis, and final data products star
- 2022
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Ingår i: Astronomy and Astrophysics. - : EDP Sciences. - 0004-6361 .- 1432-0746. ; 666
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Tidskriftsartikel (refereegranskat)abstract
- Context. The Gaia-ESO Public Spectroscopic Survey is an ambitious project designed to obtain astrophysical parameters and elemental abundances for 100 000 stars, including large representative samples of the stellar populations in the Galaxy, and a well-defined sample of 60 (plus 20 archive) open clusters. We provide internally consistent results calibrated on benchmark stars and star clusters, extending across a very wide range of abundances and ages. This provides a legacy data set of intrinsic value, and equally a large wide-ranging dataset that is of value for the homogenisation of other and future stellar surveys and Gaia's astrophysical parameters. Aims. This article provides an overview of the survey methodology, the scientific aims, and the implementation, including a description of the data processing for the GIRAFFE spectra. A companion paper introduces the survey results. Methods. Gaia-ESO aspires to quantify both random and systematic contributions to measurement uncertainties. Thus, all available spectroscopic analysis techniques are utilised, each spectrum being analysed by up to several different analysis pipelines, with considerable effort being made to homogenise and calibrate the resulting parameters. We describe here the sequence of activities up to delivery of processed data products to the ESO Science Archive Facility for open use. Results. The Gaia-ESO Survey obtained 202 000 spectra of 115 000 stars using 340 allocated VLT nights between December 2011 and January 2018 from GIRAFFE and UVES. Conclusions. The full consistently reduced final data set of spectra was released through the ESO Science Archive Facility in late 2020, with the full astrophysical parameters sets following in 2022. A companion article reviews the survey implementation, scientific highlights, the open cluster survey, and data products.
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| 16. |
- Lindqvist, Karin, et al.
(författare)
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Affect-Focused Psychodynamic Internet-Based Therapy for Adolescent Depression : Randomized Controlled Trial
- 2020
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Ingår i: Journal of Medical Internet Research. - Toronto, ON, Canada : JMIR Publications Inc.. - 1438-8871. ; 22:3
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Tidskriftsartikel (refereegranskat)abstract
- Background: Adolescent depression is one of the largest health issues in the world and there is a pressing need for effective and accessible treatments.Objective: This trial examines whether affect-focused internet-based psychodynamic therapy (IPDT) with therapist support is more effective than an internet-based supportive control condition on reducing depression in adolescents.Methods: The trial included 76 adolescents (61/76, 80% female; mean age 16.6 years), self-referred via an open access website and fulfilling criteria for major depressive disorder. Adolescents were randomized to 8 weeks of IPDT (38/76, 50%) or supportive control (38/76, 50%). The primary outcome was self-reported depressive symptoms, measured with the Quick Inventory of Depressive Symptomatology for Adolescents (QIDS-A17-SR). Secondary outcomes were anxiety severity, emotion regulation, self-compassion, and an additional depression measure. Assessments were made at baseline, postassessment, and at 6 months follow-up, in addition to weekly assessments of the primary outcome measure as well as emotion regulation during treatment.Results: IPDT was significantly more effective than the control condition in reducing depression (d=0.82, P=.01), the result of which was corroborated by the second depression measure (d=0.80, P<.001). IPDT was also significantly more effective in reducing anxiety (d=0.78, P<.001) and increasing emotion regulation (d=0.97, P<.001) and self-compassion (d=0.65, P=.003). Significantly more patients in the IPDT group compared to the control group met criteria for response (56% vs 21%, respectively) and remission (35% vs 8%, respectively). Results on depression and anxiety symptoms were stable at 6 months follow-up. On average, participants completed 5.8 (SD 2.4) of the 8 modules.Conclusions: IPDT may be an effective intervention to reduce adolescent depression. Further research is needed, including comparisons with other treatments.Trial Registration: International Standard Randomised Controlled Trial Number (ISRCTN) 16206254; http://www.isrctn.com/ISRCTN16206254
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| 17. |
- Lindqvist, Karin, et al.
(författare)
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Predictors of outcome in internet - delivered psychodynamic treatment for social anxiety
- 2024
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Ingår i: SweSRII 2024. - : Linköping University Electronic Press. ; , s. 13-14
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Konferensbidrag (refereegranskat)abstract
- INTRODUCTION: Guided self-help based on psychodynamic principles (IPDT) has shown efficacy for adolescent depression and non-inferiority to ICBT. Two randomized controlled trials have shown promising results for IPDT in Social Anxiety Disorder (SAD). There is little known regarding predictors of outcome in IPDT. This presentation focuses on predictors of outcome in IPDT for SAD. METHODS: In this randomized controlled trial (n = 181), participants were randomized to guided IPDT, unguided IPDT or waitlist. Participants were recruited nationwide in Sweden. Eligible participants were ≥ 18 years old, scoring ≥ 60 on the Liebowitz Social Anxiety Scale self-report (LSAS-SR) without meeting any exclusion criteria. The IPDT intervention comprised eight self-help modules based on affect-focused dynamic therapy, delivered over 8 weeks on a secure online platform. The primary outcome was SAD symptom severity measured weekly by the LSAS-SR. Baseline measures such as comorbid symptoms of depression, anxiety, self-compassion, emotion regulation and defensive functioning were all tested as potential predictors of outcome. RESULTS: Preliminary findings will be presented at the conference. DISCUSSION: This is the second predictor study on IPDT and the first on IPDT for SAD. Finding predictors of outcome could lead to improved outcomes in terms of matching patients to the most effective treatment given their baseline characteristics.
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| 18. |
- Lindqvist, Karin, et al.
(författare)
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Therapeutic alliance is calming and curing - The interplay between alliance and emotion regulation as predictors of outcome in Internet-based treatments for adolescent depression
- 2023
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Ingår i: Journal of Consulting and Clinical Psychology. - : American Psychological Association (APA). - 0022-006X .- 1939-2117. ; 91:7, s. 426-437
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Therapeutic alliance is one of the most stable predictors of outcome in psychotherapy, regardless of theoretical orientation. The alliance–outcome relationship in internet-based treatments has been investigated with mixed results. There is preliminary evidence that emotion regulation can work as a mediator for the alliance–outcome relationship. The present study aimed to investigate whether alliance predicted outcome session by session in two internet-based treatments for adolescent depression, and whether this relationship was mediated by emotion regulation.Method: Two hundred and seventy-two participants aged 15–19 years and diagnosed with depression were randomized to 10 weeks of internet-based psychodynamic or cognitive behavioral treatment. Both therapists and patients rated the alliance weekly. Patients also rated depressive symptoms and emotion regulation weekly. Analyses were made using cross-lagged panel modeling.Results: Alliance, as rated by both therapist and patient, predicted depression scores the following week. Emotion regulation rated by the patient also predicted depression scores the following week. Furthermore, alliance scores predicted emotion regulation scores the following week, which in turn predicted depression scores the week after, supporting the hypothesis that alliance influences outcome partly through emotion regulation. There were no group differences in any of these relationships.Conclusion: Alliance seems to play an important role in internet-based treatments, partly through emotion regulation. Clinicians working with text-based treatments should pay attention to the working alliance.
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| 19. |
- Loser, Dominik, et al.
(författare)
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Acute effects of the imidacloprid metabolite desnitro-imidacloprid on human nACh receptors relevant for neuronal signaling
- 2021
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Ingår i: Archives of Toxicology. - : Springer Science and Business Media LLC. - 0340-5761 .- 1432-0738. ; 95:12, s. 3695-3716
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Tidskriftsartikel (refereegranskat)abstract
- Several neonicotinoids have recently been shown to activate the nicotinic acetylcholine receptor (nAChR) on human neurons. Moreover, imidacloprid (IMI) and other members of this pesticide family form a set of diverse metabolites within crops. Among these, desnitro-imidacloprid (DN-IMI) is of special toxicological interest, as there is evidence (i) for human dietary exposure to this metabolite, (ii) and that DN-IMI is a strong trigger of mammalian nicotinic responses. We set out here to quantify responses of human nAChRs to DN-IMI and an alternative metabolite, IMI-olefin. To evaluate toxicological hazards, these data were then compared to those of IMI and nicotine. Ca2+-imaging experiments on human neurons showed that DN-IMI exhibits an agonistic effect on nAChRs at sub-micromolar concentrations (equipotent with nicotine) while IMI-olefin activated the receptors less potently (in a similar range as IMI). Direct experimental data on the interaction with defined receptor subtypes were obtained by heterologous expression of various human nAChR subtypes in Xenopus laevis oocytes and measurement of the transmembrane currents evoked by exposure to putative ligands. DN-IMI acted on the physiologically important human nAChR subtypes alpha 7, alpha 3 beta 4, and alpha 4 beta 2 (high-sensitivity variant) with similar potency as nicotine. IMI and IMI-olefin were confirmed as nAChR agonists, although with 2-3 orders of magnitude lower potency. Molecular docking studies, using receptor models for the alpha 7 and alpha 4 beta 2 nAChR subtypes supported an activity of DN-IMI similar to that of nicotine. In summary, these data suggest that DN-IMI functionally affects human neurons similar to the well-established neurotoxicant nicotine by triggering alpha 7 and several non-alpha 7 nAChRs.
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| 20. |
- Loser, Dominik, et al.
(författare)
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Functional alterations by a subgroup of neonicotinoid pesticides in human dopaminergic neurons
- 2021
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Ingår i: Archives of Toxicology. - : Springer Science and Business Media LLC. - 0340-5761 .- 1432-0738. ; 95, s. 2081-2107
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Tidskriftsartikel (refereegranskat)abstract
- Neonicotinoid pesticides, originally developed to target the insect nervous system, have been reported to interact with human receptors and to activate rodent neurons. Therefore, we evaluated in how far these compounds may trigger signaling in human neurons, and thus, affect the human adult or developing nervous system. We used SH-SY5Y neuroblastoma cells as established model of nicotinic acetylcholine receptor (nAChR) signaling. In parallel, we profiled dopaminergic neurons, generated from LUHMES neuronal precursor cells, as novel system to study nAChR activation in human post-mitotic neurons. Changes of the free intracellular Ca2+ concentration ([Ca2+](i)) were used as readout, and key findings were confirmed by patch clamp recordings. Nicotine triggered typical neuronal signaling responses that were blocked by antagonists, such as tubocurarine and mecamylamine. Pharmacological approaches suggested a functional expression of alpha 7 and non-alpha 7 nAChRs on LUHMES cells. In this novel test system, the neonicotinoids acetamiprid, imidacloprid, clothianidin and thiacloprid, but not thiamethoxam and dinotefuran, triggered [Ca2+](i) signaling at 10-100 mu M. Strong synergy of the active neonicotinoids (at low micromolar concentrations) with the alpha 7 nAChR-positive allosteric modulator PNU-120596 was observed in LUHMES and SH-SY5Y cells, and specific antagonists fully inhibited such signaling. To provide a third line of evidence for neonicotinoid signaling via nAChR, we studied cross-desensitization: pretreatment of LUHMES and SH-SY5Y cells with active neonicotinoids (at 1-10 mu M) blunted the signaling response of nicotine. The pesticides (at 3-30 mu M) also blunted the response to the non-alpha 7 agonist ABT 594 in LUHMES cells. These data show that human neuronal cells are functionally affected by low micromolar concentrations of several neonicotinoids. An effect of such signals on nervous system development is a toxicological concern.
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| 21. |
- Ma, Lichen, et al.
(författare)
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Seeking neutral : A VR-based person-identity-matching task for attentional bias modification – A randomised controlled experiment
- 2020
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Ingår i: Internet Interventions. - : Elsevier BV. - 2214-7829. ; 21
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Tidskriftsartikel (refereegranskat)abstract
- Background: Attentional bias modification (ABM) aims to reduce anxiety by attenuating bias towards threatening information. The current study incorporated virtual reality (VR) technology and 3-dimensional stimuli with a person-identity-matching (PIM) task to evaluate the effects of a VR-based ABM training on attentional bias and anxiety symptoms.Methods: One hundred participants with elevated social anxiety were randomised to four training groups. Attentional bias was assessed at pre- and post-training, and anxiety symptoms were assessed at pre-training, post-training, 1-week follow-up, and 3-month follow-up.Results: Change in anxiety did not correlate with change in bias (r = −0.08). A repeated-measures ANOVA showed no significant difference in bias from pre- to post-ABM, or between groups. For anxiety symptoms, a linear mixed-effects model analysis revealed a significant effect of time. Participants showed reduction in anxiety score at each successive assessment (p < .001, Nagelkerke's pseudo r2 = 0.65). However, no other significant main effect or interactions were found. A clinically significant change analysis revealed that 4% of participants were classified as ‘recovered’ at 3-month follow-up.Conclusions: A single session of VR-based PIM task did not change attentional bias. The significant reduction in anxiety was not specific to active training, and the majority of participants remained clinically unchanged.
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| 22. |
- Mechler, Jakob, et al.
(författare)
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Emotion Regulation as a Time-Invariant and Time-Varying Covariate Predicts Outcome in an Internet-Based Psychodynamic Treatment Targeting Adolescent Depression
- 2020
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Ingår i: Frontiers in Psychiatry. - : Frontiers Media SA. - 1664-0640. ; 11
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Although psychodynamic psychotherapy is efficacious in the treatment of depression, research on mechanisms of change is still scarce. The aim of this study was to investigate if and how emotion regulation affects outcome both as a time-invariant and a lagged time-varying predictor.Method: The sample consisted of 67 adolescents diagnosed with major depressive disorder, attending affect-focused psychodynamic internet-based treatment (IPDT). Linear mixed models were used to analyze emotion regulation as a baseline predictor and to assess the effect of within-person changes in emotion regulation on depression.Results: Analyses suggested that emotion regulation at baseline was a significant predictor of outcome, where participants with relatively larger emotion regulation deficits gained more from IPDT. Further, the results showed a significant effect of improved emotion regulation on subsequent depressive symptomatology. When not controlling for time, increased emotion regulation explained 41.23% of the variance in subsequent symptoms of depression. When detrending the results were still significant, but the amount of explained variance was reduced to 8.7%.Conclusion: The findings suggest that patients with relatively larger deficits in emotion regulation gain more from IPDT. Decreased emotion regulation deficits seem to act as a mechanism of change in IPDT as it drives subsequent changes in depression.International Standard Randomised Controlled Trial Number (ISRCTN) 16206254, https://doi.org/10.1186/ISRCTN16206254.
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| 23. |
- Mechler, Jakob, et al.
(författare)
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Guided and unguided internet-delivered psychodynamic therapy for social anxiety disorder : A randomized controlled trial
- 2024
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Ingår i: npj Mental Health Research. - 2731-4251. ; 3:1
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Tidskriftsartikel (refereegranskat)abstract
- Social Anxiety Disorder (SAD) is highly prevalent and debilitating disorder. Treatments exist but are not accessible and/or helpful for all patients, indicating a need for accessible treatment alternatives. The aim of the present trial was to evaluate internet-delivered psychodynamic therapy (IPDT) with and without therapist guidance, compared to a waitlist control condition, in the treatment of adults with SAD.In this randomized, clinical trial, we tested whether IPDT was superior to a waitlist control, and whether IPDT with therapeutic guidance was superior to unguided IPDT. Participants were recruited nationwide in Sweden. Eligible participants were ≥ 18 years old and scoring ≥ 60 on the Liebowitz Social Anxiety Scale self-report (LSAS-SR) whilst not fulfilling any of the exclusion criteria. Included participants were randomly assigned to IPDT with guidance (n = 60), IPDT without guidance (n = 61), or waitlist (n = 60).The IPDT intervention comprised eight self-help modules based on affect-focused dynamic therapy, delivered over 8 weeks on a secure online platform. The primary outcome was SAD symptoms severity measured weekly by the LSAS-SR. Primary analyses were calculated on an intention-to-treat sample including all participants randomly assigned. Secondary outcomes were depressive symptoms, generalized anxiety, quality of life, emotion regulation and defensive functioning. At post-treatment, both active treatments were superior to the waitlist condition with guided treatment exhibiting larger between group effects than unguided treatment (d = 1.07 95% CI [0.72, 1.43], p < .001 and d = 0.61, 95% CI [0.25, 0.98], p = .0018) on the LSAS-SR respectively.Guided IPDT lead to larger improvements than unguided IPDT (d = 0.46, 95% CI [0.11, 0.80], p < .01). At post-treatment, guided IPDT was superior to waitlist on all secondary outcome measures. Unguided IPDT was superior to waitlist on depressive symptoms and general anxiety, but not on emotion regulation, self-compassion or quality of life. Guided IPDT was superior to unguided PDT on depressive symptoms, with a trend towards superiority on a measure of generalized anxiety. At six and twelve month follow-up there were no significant differences between guided and unguided IPDT.In conclusion, IPDT shows promising effects in the treatment of SAD, with larger benefits from guided IPDT compared to non-guided, at least at post-treatment. This finding increases the range of accessible and effective treatment alternatives for adults suffering from SAD.The study was prospectively registered at ClinicalTrials (NCT05015166).
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| 24. |
- Mechler, Jakob, et al.
(författare)
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Guided and Unguided Internet - delivered Psychodynamic Therapy for Social Anxiety Disorder : A Randomized Controlled Trial
- 2024
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Ingår i: SweSRII 2024. - : Linköping University Electronic Press. ; , s. 13-13
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Konferensbidrag (refereegranskat)abstract
- INTRODUCTION: Social Anxiety Disorder (SAD) is a highly prevalent and debilitating disorder. While effective treatments exist, they are not always easily accessible or helpful for all patients. This highlights the need for accessible treatment alternatives. The aim of the STePS study was to evaluate internet-delivered psychodynamic therapy (IPDT) with and without therapist support, compared to a waitlist control condition, in the treatment of adults with SAD. METHODS: In this randomized clinical trial, we tested whether IPDT was superior to a waitlist control, and whether IPDT with therapeutic guidance was superior to unguided IPDT. Participants were recruited nationwide in Sweden. Eligible participants were ≥ 18 years old, scoring ≥ 60 on the Liebowitz Social Anxiety Scale self-report (LSAS-SR) without meeting any exclusion criteria. Included participants were randomly assigned to IPDT with guidance (n=60), IPDT without guidance (n=61), or waitlist (n=60). The IPDT intervention comprised eight self-help modules based on affect-focused dynamic therapy, delivered over 8 weeks on a secure online platform. The primary outcome was SAD symptom severity measured weekly by the LSAS-SR. Primary analyses were conducted on an intention-to-treat sample, including all randomly assigned participants. Secondary outcomes included depressive symptoms, generalized anxiety, quality of life, emotion regulation, and defensive functioning. RESULTS: During the conference, results obtained from the study at post-treatment, as well as at 6- and 12-month follow-ups will be presented. CONCLUSION: This is the second RCT to investigate the efficacy of IPDT in the treatment of SAD. If found efficacious, IPDT should be compared to existing evidence-based internet-delivered treatments.
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| 25. |
- Mechler, Jakob, et al.
(författare)
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Internet-based psychodynamic versus cognitive behaviour therapy for adolescents with depression : study protocol for a non-inferiority randomized controlled trial (the ERiCA study)
- 2020
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Ingår i: Trials. - : Springer Science and Business Media LLC. - 1745-6215. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Adolescent depression is a common mental health problem and there is an urgent need for effective and accessible treatments. Internet-based interventions solve many obstacles for seeking and receiving treatment, thus increasing access to effective treatments. Internet-based cognitive behavioural therapy (ICBT) for adolescent depression has demonstrated efficacy in previous trials. In order to broaden the range of evidence-based treatments for young people, we evaluated a newly developed affect-focused Internet-based psychodynamic treatment (IPDT) in a previous study with promising results. The purpose of the planned study is to evaluate the efficacy of IPDT for adolescent depression in a non-inferiority trial, comparing it to ICBT.Methods: The study will employ a parallel randomized non-inferiority design (ratio 1:1; n = 270). Eligible participants are adolescents 15–19 years suffering from depression. The primary hypothesis is that IPDT will be non-inferior to ICBT in reducing depressive symptoms from pre-treatment to end of treatment. Secondary research questions include comparing outcomes of IPDT and ICBT regarding anxiety symptoms, emotion regulation and self-compassion. Additional data will be collected to evaluate cost-effectiveness as well as investigating predictors, moderators and mediators of outcome. In addition, we will examine long-term outcome up to 1 year after end of treatment. Diagnostic interviews with MINI 7.0 will be used to establish primary diagnosis of depression as well as ruling out any exclusion criteria. Both treatments consist of eight modules over 10 weeks, complemented with therapist support through text messages and weekly chat sessions. Primary outcome measure is the Quick Inventory of Depressive Symptomatology in Adolescents Self-Rated (QIDS-A17-SR). Primary outcome will be analysed using data from all participants entering the study using a multilevel growth curve strategy based on the weekly measurements of QIDS-A17-SR. The non-inferiority margin is defined as d = 0.30.Discussion: This trial will demonstrate whether IPDT is non-inferior to ICBT in the treatment of adolescent depression. The study might therefore broaden the range of evidence-based treatment alternatives for young people struggling with depression. Further analyses of data from this trial may increase our knowledge about “what works for whom” and the pathways of change for two distinct types of interventions.Trial registration: ISRCTN12552584, Registered on 13 August 2019.
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| 26. |
- Mechler, Jakob, et al.
(författare)
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Sudden gains and large intersession improvements in internet-based psychodynamic treatment (IPDT) for depressed adolescents
- 2021
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Ingår i: Psychotherapy Research. - : Informa UK Limited. - 1050-3307 .- 1468-4381. ; 31:4, s. 455-467
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Sudden gains (SGs) have often been found associated with better treatment outcome across different psychiatric disorders. However, no studies have evaluated SGs in internet-based treatment targeting adolescent depression. Method: The sample consisted of 66 adolescents diagnosed with major depressive disorder, attending psychodynamic internet-based treatment. Effects of SGs were evaluated at posttreatment and 6-month follow-up. We also evaluated effects of large intersession improvements (LIIs; sudden and relatively large gains, between sessions, without the stability criterion). Effects of SGs and LIIs early in treatment were also investigated. Results: A total of 17 patients (25.75%) experienced an SG. The effect of having an SG or early SG was non-significant after treatment (d = 0.48) and at follow-up (d= 0.66). However, having an LII was related to better outcome after treatment (d = 0.97) and at follow-up (d = 0.76). Early LIIs were associated with significantly better results at end of treatment (d = 0.72).Conclusions: The original criteria of SGs might be overly conservative and thus miss important improvements in depression. Relatively large intersession gains, regardless of stability, seem to be predictive of outcome.
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| 27. |
- Mechler, Jakob, et al.
(författare)
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Therapist-guided internet-based psychodynamic therapy versus cognitive behavioural therapy for adolescent depression in Sweden : a randomised, clinical, non-inferiority trial
- 2022
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Ingår i: The Lancet Digital Health. - : Elsevier. - 2589-7500. ; 4:8, s. e594-e603
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Tidskriftsartikel (refereegranskat)abstract
- Background: Adolescent major depressive disorder (MDD) is highly prevalent and associated with lifelong adversity. Evidence-based treatments exist, but accessible treatment alternatives are needed. We aimed to compare internet-based psychodynamictherapy (IPDT) with an established evidence-based treatment (internet-based cognitive behavioural therapy [ICBT]) for the treatment of adolescents with depression.Methods: In this randomised, clinical trial, we tested whether IPDT was non-inferior to ICBT in the treatment of adolescent MDD. Eligible participants were 15–19 years old, presenting with a primary diagnosis of MDD according to DSM-5. Participants were recruited nationwide in Sweden through advertisements on social media, as well as contacts with junior and senior high schools, youth associations, social workers, and health-care providers. Adolescents who scored 9 or higher on the Quick Inventory of Depressive Symptomatology for Adolescents (QIDS-A17-SR) in an initial online screening were contacted by telephone for a diagnostic assessment using the Mini International Neuropsychiatric Interview. Participants were randomly assigned to ICBT or IPDT. Both interventions comprised eight self-help modules delivered over 10 weeks on a secure online platform. The primary outcome was change in depression severity measured weekly by the QIDS-A17-SR. Primary analyses were based on an intention-to-treat sample including all participants randomly assigned. A non-inferiority margin of Cohen's d=0·30 was predefined. The study is registered at ISRCTN, ISRCTN12552584.Findings: Between Aug 19, 2019, and Oct 7, 2020, 996 young people completed screening; 516 (52%) were contacted for a diagnostic interview. 272 participants were eligible and randomly assigned to ICBT (n=136) or IPDT (n=136). In the ICBT group, 51 (38%) of 136 participants were classified as remitted, and 54 (40%) of 136 participants were classified as remitted in the IPDT group. Within-group effects were large (ICBT: within-group d=1·75, 95% CI 1·49 to 2·01; IPDT: within-group d=1·93, 1·67 to 2·20; both p<0·0001). No statistically significant treatment difference was found in the intention-to-treat analysis. Non-inferiority for IPDT was shown for the estimated change in depression during treatment (d=–0·18, 90% CI –0·49 to 0·13; p=0·34). All secondary outcomes showed non-significant between-group differences.Interpretation: IPDT was non-inferior to ICBT in terms of change in depression for the treatment of adolescents with MDD. This finding increases the range of accessible and effective treatment alternatives for adolescents with depression.
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| 28. |
- Mechler, Jakob, et al.
(författare)
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Therapist-guided internet-based psychodynamic therapy versus cognitive behavioural therapy for adolescent depression in Sweden : a randomised, clinical, non-inferiority trial
- 2022
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Ingår i: The Lancet Digital Health. - : Elsevier. - 2589-7500. ; 4:8, s. E594-E603
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Tidskriftsartikel (refereegranskat)abstract
- Background Adolescent major depressive disorder (MDD) is highly prevalent and associated with lifelong adversity. Evidence-based treatments exist, but accessible treatment alternatives are needed. We aimed to compare internet-based psychodynamic therapy (IPDT) with an established evidence-based treatment (internet-based cognitive behavioural therapy [ICBT]) for the treatment of adolescents with depression. Methods In this randomised, clinical trial, we tested whether IPDT was non-inferior to ICBT in the treatment of adolescent MDD. Eligible participants were 15-19 years old, presenting with a primary diagnosis of MDD according to DSM-5. Participants were recruited nationwide in Sweden through advertisements on social media, as well as contacts with junior and senior high schools, youth associations, social workers, and health-care providers. Adolescents who scored 9 or higher on the Quick Inventory of Depressive Symptomatology for Adolescents (QIDS-A17-SR) in an initial online screening were contacted by telephone for a diagnostic assessment using the Mini International Neuropsychiatric Interview. Participants were randomly assigned to ICBT or IPDT. Both interventions comprised eight self-help modules delivered over 10 weeks on a secure online platform. The primary outcome was change in depression severity measured weekly by the QIDS-A17-SR. Primary analyses were based on an intention -to-treat sample including all participants randomly assigned. A non-inferiority margin of Cohen's d=0.30 was predefined. The study is registered at ISRCTN, ISRCTN12552584. Findings Between Aug 19, 2019, and Oct 7, 2020, 996 young people completed screening; 516 (52%) were contacted for a diagnostic interview. 272 participants were eligible and randomly assigned to ICBT (n=136) or IPDT (n=136). In the ICBT group, 51 (38%) of 136 participants were classified as remitted, and 54 (40%) of 136 participants were classified as remitted in the IPDT group. Within-group effects were large (ICBT: within-group d=1.75, 95% CI 1.49 to 2.01; IPDT: within-group d=1.93, 1.67 to 2.20; both p<0.0001). No statistically significant treatment difference was found in the intention-to-treat analysis. Non-inferiority for IPDT was shown for the estimated change in depression during treatment (d=-0.18, 90% CI -0.49 to 0.13; p=0.34). All secondary outcomes showed non-significant between-group differences. Interpretation IPDT was non-inferior to ICBT in terms of change in depression for the treatment of adolescents with MDD. This finding increases the range of accessible and effective treatment alternatives for adolescents with depression. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.
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| 29. |
- Midgley, Nick, et al.
(författare)
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The Depression : Online Therapy Study (D:OTS) - A Pilot Study of an Internet-Based Psychodynamic Treatment for Adolescents with Low Mood in the UK, in the Context of the COVID-19 Pandemic
- 2021
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1661-7827 .- 1660-4601. ; 18:24
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Face-to-face therapy is unavailable to many young people with mental health difficulties in the UK. Internet-based treatments are a low-cost, flexible, and accessible option that may be acceptable to young people. This pilot study examined the feasibility, acceptability and effectiveness of an English-language adaptation of internet-based psychodynamic treatment (iPDT) for depressed adolescents, undertaken during the COVID-19 pandemic in the UK. Methods: A single-group, uncontrolled design was used. A total of 23 adolescents, 16–18 years old and experiencing depression, were recruited to this study. Assessments were made at baseline and end of treatment, with additional weekly assessments of depression and anxiety symptoms. Results: Findings showed that it was feasible to recruit to this study during the pandemic, and to deliver the iPDT model with a good level of treatment acceptability. A statistically significant reduction in depressive symptoms and emotion dysregulation was found, with large effect size, by the end of treatment. Whilst anxiety symptoms decreased, this did not reach statistical significance. Conclusions: The findings suggest that this English-language adaptation of iPDT, with some further revisions, is feasible to deliver and acceptable for adolescents with depression. Preliminary data indicate that iPDT appears to be effective in reducing depressive symptoms in adolescents.
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| 30. |
- Persson Asplund, Robert, 1977-, et al.
(författare)
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Work-Focused Versus Generic Internet-Based Interventions for Employees With Stress-Related Disorders : Randomized Controlled Trial
- 2023
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Ingår i: Journal of Medical Internet Research. - : JMIR Publications. - 1438-8871. ; 25
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Tidskriftsartikel (refereegranskat)abstract
- Background: In recent decades, stress-related disorders have received more attention, with an increasing prevalence, especially within the working population. The internet provides new options for broad dissemination, and a growing body of evidence suggests that web-based interventions for stress might be effective. However, few studies have examined the efficacy of interventions in clinical samples and work-related outcomes.Objective: The aim of this study was to evaluate the efficacy of an internet-based cognitive behavioral intervention for stress-related disorders integrating work-related aspects (work-focused and internet-based cognitive behavioral therapy [W-iCBT]), compared with a generic internet-based cognitive behavioral therapy (iCBT) group and a waitlist control (WLC) group.Methods: In this trial, 182 employees, mainly employed in the health care, IT, or educational sector, who fulfilled the criteria for a stress-related disorder, were randomized to a 10-week W-iCBT (n=61, 33.5%), generic iCBT (n=61, 33.5%), or WLC (n=60, 33%). Self-rated questionnaires on perceived stress, burnout, exhaustion, and other mental health– and work-related outcomes were administered before and after the treatment and at 6- and 12-month follow-ups.Results: Compared with the WLC group, participants of the W-iCBT and iCBT groups showed an equal and significant reduction in the primary outcome (Shirom-Melamed Burnout Questionnaire [SMBQ]) from pretreatment to posttreatment assessment (Cohen d=1.00 and 0.83, respectively) and at the 6-month follow-up (Cohen d=0.74 and 0.74, respectively). Significant moderate-to-large effect sizes were also found in the secondary health- and work-related outcomes. The W-iCBT was the only group that exhibited significant effects on work ability and short-term sickness absence. Short-term sickness absence was 445 days lower than the WLC group and 324 days lower than the iCBT intervention group. However, no significant differences were found in terms of work experience or long-term sick leave.Conclusions: The work-focused and generic iCBT interventions proved to be superior compared with the control condition in reducing chronic stress and several other mental health–related symptoms. Interestingly, effects on work ability and short-term sickness absence were only seen between the W-iCBT intervention and the WLC groups. These preliminary results are promising, indicating that treatments that include work aspects may have the potential to accelerate recovery and reduce short-term sickness absence because of stress-related disorders.Trial Registration: ClinicalTrials.gov NCT05240495
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| 31. |
- Ponten, Moa, et al.
(författare)
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Association between expectations and clinical outcomes in online v. face-to-face therapy - an individual participant data meta-analysis
- 2024
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Ingår i: Psychological Medicine. - : Cambridge University Press. - 0033-2917 .- 1469-8978. ; 54:6, s. 1207-1214
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Tidskriftsartikel (refereegranskat)abstract
- Background. Online treatments are increasing in number and are currently available for a wide range of clinical problems. To date little is known about the role of treatment expectations and other placebo-like mechanisms in online settings compared to traditional face-to-face treatment. To address this knowledge gap, we analyzed individual participant data from randomized clinical trials that compared online and face-to-face psychological interventions.Methods. MEDLINE (Ovid) and PsycINFO (Ovid) were last searched on 2 February 2021. Randomized clinical trials of therapist guided online v. face-to-face psychological interventions for psychiatric or somatic conditions using a randomized controlled design were included. Titles, abstracts, and full texts of studies were independently screened by multiple observers. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline was followed. Authors of the matching trials were contacted for individual participant data. Ratings from the Credibility and Expectancy Questionnaire and the primary outcome measure from each trial were used to estimate the association between expectation ratings and treatment outcomes in online v. face-to-face interventions, using a mixed-effects model.Results. Of 7045 screened studies, 62 full-text articles were retrieved whereof six studies fulfilled the criteria and provided individual participant data (n = 491). Overall, CEQ ratings predicted clinical outcomes (beta = 0.27) at end of treatment with no moderating effect of treatment modality (online v. face-to-face).Conclusions. Online treatment appears to be equally susceptible to expectancy effects as face-to-face therapy. This furthers our understanding of the importance of placebo-like factors in online treatment and may aid the improvement of healthcare in online settings.
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| 32. |
- Randich, S., et al.
(författare)
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The Gaia-ESO Public Spectroscopic Survey : Implementation, data products, open cluster survey, science, and legacy
- 2022
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Ingår i: Astronomy and Astrophysics. - : EDP SCIENCES S A. - 0004-6361 .- 1432-0746. ; 666
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Tidskriftsartikel (refereegranskat)abstract
- Context. In the last 15 years different ground-based spectroscopic surveys have been started (and completed) with the general aim of delivering stellar parameters and elemental abundances for large samples of Galactic stars, complementing Gaia astrometry. Among those surveys, the Gaia-ESO Public Spectroscopic Survey, the only one performed on a 8m class telescope, was designed to target 100 000 stars using FLAMES on the ESO VLT (both Giraffe and UVES spectrographs), covering all the Milky Way populations, with a special focus on open star clusters. Aims. This article provides an overview of the survey implementation (observations, data quality, analysis and its success, data products, and releases), of the open cluster survey, of the science results and potential, and of the survey legacy. A companion article reviews the overall survey motivation, strategy, Giraffe pipeline data reduction, organisation, and workflow. Methods. We made use of the information recorded and archived in the observing blocks; during the observing runs; in a number of relevant documents; in the spectra and master catalogue of spectra; in the parameters delivered by the analysis nodes and the working groups; in the final catalogue; and in the science papers. Based on these sources, we critically analyse and discuss the output and products of the Survey, including science highlights. We also determined the average metallicities of the open clusters observed as science targets and of a sample of clusters whose spectra were retrieved from the ESO archive. Results. The Gaia-ESO Survey has determined homogeneous good-quality radial velocities and stellar parameters for a large fraction of its more than 110 000 unique target stars. Elemental abundances were derived for up to 31 elements for targets observed with UVES. Lithium abundances are delivered for about 1/3 of the sample. The analysis and homogenisation strategies have proven to be successful; several science topics have been addressed by the Gaia-ESO consortium and the community, with many highlight results achieved. Conclusions. The final catalogue will be released through the ESO archive in the first half of 2022, including the complete set of advanced data products. In addition to these results, the Gaia-ESO Survey will leave a very important legacy, for several aspects and for many years to come.
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| 33. |
- Titov, Nickolai, et al.
(författare)
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User characteristics and outcomes from a national digital mental health service : an observational study of registrants of the Australian MindSpot Clinic.
- 2020
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Ingår i: The Lancet Digital Health. - London, United Kingdom : The Lancet Publishing Group. - 2589-7500. ; 2:11, s. e582-e593
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Tidskriftsartikel (refereegranskat)abstract
- Background: Interest is growing in digital and telehealth delivery of mental health services, but data are scarce on outcomes in routine care. The federally funded Australian MindSpot Clinic provides online and telephone psychological assessment and treatment services to Australian adults. We aimed to summarise demographic characteristics and treatment outcomes of patients registered with MindSpot over the first 7 years of clinic operation.Methods: We used an observational design to review all patients who registered for assessment with the MindSpot Clinic between Jan 1, 2013, and Dec 31, 2019. We descriptively analysed the demographics, service preferences, and baseline symptoms of patients. Among patients enrolled in a digital treatment course, we evaluated scales of depression (Patient Health Questionnaire-9 [PHQ-9]) and anxiety (Generalized Anxiety Disorder 7-Item Scale [GAD-7]), as primary measures of treatment outcome, from the screening assessment to post-treatment and a 3 month follow-up. The Kessler Psychological Distress 10-Item Plus Scale was also used to assess changes in general distress and disability, and course satisfaction was measured post-treatment.Outcomes: A total of 121 652 screening assessments were started, of which 96 018 (78·9%) were completed. The mean age of patients was 35·7 years (SD 13·8) and 88 702 (72·9%) were women. Based on available assessment data, 36 866 (34·5%) of 106 811 participants had never previously spoken to a health professional about their symptoms, and most people self-reported symptoms of anxiety (88 879 [81·9%] of 108 494) or depression (78 803 [72·6%] of 108 494), either alone or in combination, at baseline. 21 745 patients started treatment in a therapist-guided online course, of whom 14 503 (66·7%) completed treatment (≥four of five lessons). Key trends in service use included an increase in the proportion of people using MindSpot primarily for assessment and information, from 52·6% in 2013 to 66·7% in 2019, while the proportion primarily seeking online treatment decreased, from 42·6% in 2013 to 26·7% in 2019. Effect sizes and percentage changes were large for estimated mean scores on the PHQ-9 and GAD-7 from assessment to post-treatment (PHQ-9, Cohen's d effect size 1·40 [95% CI 1·37-1·43]; and GAD-7, 1·45 [1·42-1·47]) and the 3 month follow-up (PHQ-9, 1·36 [1·34-1·38]; and GAD-7, 1·42 [1·40-1·44]); proportions of patients with reliable symptom deterioration (score increase of ≥6 points [PHQ-9] or ≥5 points [GAD-7]) were low post-treatment (of 13 058 respondents, 184 [1·4%] had symptom deterioration on the PHQ-9 and 282 [2·2%] on the GAD-7); and patient satisfaction rates were high (12 452 [96·6%] of 12 895 respondents would recommend the course and 12 433 [96·7%] of 12 860 reported the course worthwhile). We also observed small improvements in disability following treatment as measured by days out of role.Interpretation: Our findings indicate improvement in psychological symptoms and positive reception among patients receiving online mental health treatment. These results support the addition of digital services such as MindSpot as a component in contemporary national mental health systems.Funding: None.
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| 34. |
- Urbancsok, János, et al.
(författare)
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Flexure wood formation via growth reprogramming in hybrid aspen involves jasmonates and polyamines and transcriptional changes resembling tension wood development
- 2023
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Ingår i: New Phytologist. - : John Wiley & Sons. - 0028-646X .- 1469-8137. ; 240:6, s. 2312-2334
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Tidskriftsartikel (refereegranskat)abstract
- Stem bending in trees induces flexure wood but its properties and development are poorly understood. Here, we investigated the effects of low-intensity multidirectional stem flexing on growth and wood properties of hybrid aspen, and on its transcriptomic and hormonal responses.Glasshouse-grown trees were either kept stationary or subjected to several daily shakes for 5 wk, after which the transcriptomes and hormones were analyzed in the cambial region and developing wood tissues, and the wood properties were analyzed by physical, chemical and microscopy techniques.Shaking increased primary and secondary growth and altered wood differentiation by stimulating gelatinous-fiber formation, reducing secondary wall thickness, changing matrix polysaccharides and increasing cellulose, G- and H-lignin contents, cell wall porosity and saccharification yields. Wood-forming tissues exhibited elevated jasmonate, polyamine, ethylene and brassinosteroids and reduced abscisic acid and gibberellin signaling. Transcriptional responses resembled those during tension wood formation but not opposite wood formation and revealed several thigmomorphogenesis-related genes as well as novel gene networks including FLA and XTH genes encoding plasma membrane-bound proteins.Low-intensity stem flexing stimulates growth and induces wood having improved biorefinery properties through molecular and hormonal pathways similar to thigmomorphogenesis in herbaceous plants and largely overlapping with the tension wood program of hardwoods.
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| 35. |
- Abbafati, Cristiana, et al.
(författare)
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- 2020
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Tidskriftsartikel (refereegranskat)
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