| 1. |
- Alfonsson, Sven, 1977-
(författare)
-
Impulsivity, Negative Mood, and Disordered Eating in Obesity
- 2014
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Bariatric surgery is a life-altering procedure that leads to substantial weight loss for most patients with obesity. Psychiatric conditions that may interfere with eating behavior and other behavioral prescriptions after surgery are common. Disordered eating is an established risk factor for inferior weight loss but the effects of negative mood and impulsivity are largely unknown. This thesis aims to investigate the prevalence of and associations between these potential risk factors and eating behavior in bariatric surgery patients.Study I assessed the prevalence of adult Attention Deficits/Hyperactivity Disorder (ADHD) symptoms in bariatric surgery patients. Symptoms of adult ADHD were elevated compared to the normal population and associated with symptoms of disordered eating, anxiety, and depression.Study II investigated whether treatment with Behavioral Activation (BA) could ameliorate binge eating and other symptoms of disordered eating in patients with obesity and Binge Eating Disorder. The results showed that BA was effective in increasing activity levels and improving mood but not in ameliorating binge eating in these patients.Study III was a prospective study on disordered eating, symptoms of depression and anxiety, symptoms of adult ADHD, and alcohol risk consumption before surgery and at follow-up after 12 months. After controlling for age, no variable measured before surgery could predict weight loss after surgery. Disordered eating after surgery was associated with inferior weight loss in men and a subgroup of older female participants.The present thesis concludes that symptoms of adult ADHD are common among bariatric surgery patients and associated with disordered eating. There is no indication that symptoms of adult ADHD are associated with short-term inferior weight loss after surgery. However, adult ADHD may be a risk factor for postsurgical alcohol abuse. The treatment study showed no direct association among activity, mood, and binge eating. BA, while effective in improving mood, was found not to be an effective treatment for BED, at least in the short group format investigated.
|
|
| 2. |
- Björnsdotter, Annika, 1970-
(författare)
-
Evaluation of Family Check-Up and iComet : Effectiveness as well as Psychometrics and Norms for Parent Rating Scales
- 2014
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis compromise four studies, three regarding psychometrics and norms of parent rating scales, and one study regarding effectiveness of two different interventions. A normative sample consisting of 1443 parents with children aged 10 to 13 years old, was used in the Study I, II and III. In Study IV, 231 self-referred parents with children aged 10-13 years old with externalizing behavior problem (EBP) were randomized to either Family Check-Up (FCU) or iComet.The Strengths and Difficulties Questionnaire (SDQ) used in Study I proved to be a reliable and valid instrument with high internal consistency, clear factor structure and high correlation with other similar instruments. In addition, the results support the online use of SDQ as well as using norms obtained through traditional administration even when the SDQ has been administrated online. The Emotion Regulation Questionnaire (ERQ) investigated in Study II was shown to have adequate reliability and construct validity. The specific use of expressive suppression or cognitive reappraisal as a parental emotion regulation strategy was correlated as expected to the couple’s satisfaction, family warmth, and the employment of adequate discipline strategies. Swedish norms for self-rated ERQs are also presented. Study III investigated the Parental Knowledge and Monitoring Scale (PKMS), which was shown to be a useful instrument for assessing parental knowledge and its sources. Family climate appears to moderate important relationships between parental knowledge and conduct problems with implications for such things as family interventions. Finally, a person-oriented analysis was used in Study IV to subtype the children according to combinations of prosocial behavior and EBP, such as different levels of attention deficit hyperactivity disorder (ADHD) symptoms and/or oppositional defiant disorder (ODD) behaviors. Despite being a heterogeneous group of children with EBP, they were meaningfully grouped into significantly different profiles. Both FCU and iComet resulted in post-treatment measurement within non-clinical range for three of the five profiles. The two profiles that included high levels of ADHD behaviors at baseline assessment continued to have residual symptoms post intervention.
|
|
| 3. |
- Dahlberg, Anton
(författare)
-
Capturing and addressing preschool children’s emotional and behavioural problems : Using parents’, teachers’ and children’s perspectives
- 2021
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Emotional and behavioural problems (EBP) are among the most common mental health problems in preschool children. EBP are also associated with poor parent mental health. Untreated, EBP can persist or worsen over time. In order to capture and address preschool children’s EBP, we need scientifically valid instruments that can access the perspectives of informants from different contexts of the child. We also need cut-off values for questionnaires assessing EBP that are representative of the population. Parenting support is a recommended intervention for addressing EBP in preschool children. Most parenting support programmes have a solid evidence-base and show positive effects on child EBP and parent wellbeing. However, we need a better understanding of the children’s emotional and relational experiences, especially in relation to their parents. Further, although the implementation of evidence-based interventions is a complex matter with substantial impact on intervention success, few studies assess the implementation process of parenting programmes. The studies constituting this thesis focused on preschool children. The Strengths and Difficulties Questionnaire (SDQ) was assessed for capturing EBP. Study I assessed the construct validity of the SDQ and its five subscales, when rated by fathers and preschool teachers. Confirmatory factor analysis was applied to evaluate construct validity. Results indicated that the SDQ can be used as an instrument to measure EBP in preschool children, rated by parents and preschool teachers. In study II, we established Swedish norms for the SDQ for preschool children. Results suggested lower SDQ cut-offs for Swedish preschool children compared with other countries, and higher cut-offs for boys compared with girls. In study III, preschool children whose parents participated in a parenting programme were interviewed regarding their emotional and relational experiences at home. Data were analysed using qualitative content analysis. The children provided accounts of negative and positive interactions with their parents, elaborately describing a coercive cycle with escalating conflicts and lack of problem resolution. In study IV, the implementation of the parenting programme Triple P in a preschool setting was assessed using the RE-AIM framework. Results indicated a successful implementation that relied on customisation of the programme; assessment of the process from parent, staff, and organisation levels; interdisciplinary collaboration; and continuous work on securing maintenance over time. This thesis provides pieces to a complex puzzle of understanding and addressing child mental health problems, particularly EBP. Assessing EBP from different perspectives and promoting children’s voices are essential, as well as actively working with the implementation of evidence-based programmes.
|
|
| 4. |
- Hassler Hallstedt, Martin, 1973-
(författare)
-
Closing the Gap : How an Adaptive Behavioral Based Program on a Tablet Can Help Low Performing Children Catch Up in Math: a Randomized Placebo Controlled Study
- 2018
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Early mathematic skills have a substantial impact on later school achievement. Children with poor school achievement are at risk for adverse consequences later in life. Math competencies also have consequences for the economy at large because societies are becoming increasingly dependent on skill sets including mathematics. Proficiency with basic arithmetic, also known as math fact (i.e., 3+8, 12-3), is considered to be a critical early math skill. Intervention research in mathematics have demonstrated that math fact deficits among students with low math performance can be improved with additional targeted, non- technological interventions (i.e., small-group tutoring).The aim of the present thesis was to investigate the effect, using a randomized placebo controlled design, of addititional adaptive, behavioral based, math training on a tablet on low performing second graders. The first study (study I), investigated if arithmetic skills could be assessed in a reliable and valid way on tablet. The examination showed that arithmetic scales could be transferred from paper-based tests to tablet with comparable psychometric properties, although not for a pictorial scale, and that separate norms are needed for tablet. Study II demonstrated that training on a tablet, for on average 19 hours across 20 weeks, improved basic arithmetic skills after training in the math conditions compared to control/ placebo conditions. The effects were medium sized at post assessment. There was a fadeout of effects at 6 months follow-up, where small effects were shown, and the effects decreased further at 12 months follow-up. Children with lower non-verbal IQ seemed to gain significantly more at follow- ups than children with higher non-verbal IQ. The study found no additional effects of combining working memory training and math training. Study III, using a machine learning analysis, found that children demonstrating a positive response at 6 months follow-up were characterized by having completed 90 % or more of the math program at the default level, in combination with having a fairly favorable socioeconomic background.In summation, this work demonstrates how an adaptive behavioral based program on a tablet can help low performing children improve critical early math skills.
|
|
| 5. |
- Isaksson, Martina, 1985-
(författare)
-
Overcontrol in anorexia nervosa : assessment, occurrence, and treatment
- 2021
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Excessive overcontrol – characterized by high risk aversion, compulsiveness, emotion inhibition, and social deficits – has been suggested to be a core mechanism for developing and maintaining anorexia nervosa. However, such factors are rarely targeted as key elements in treatment of the disorder. The overall aim of this thesis was to evaluate the occurrence of over- and undercontrolled personality styles in patients with eating disorders, and to evaluate the treatment effects and patient experiences of Radically open dialectical behavior therapy (RO DBT) for outpatients with anorexia. In a cross-sectional study (Study I) with two non-clinical samples (n = 483 and n = 197), psychometric evaluations showed that a new shortened version of the Ego Undercontrol Scale (EUC-13), measuring over- and undercontrol, and the Ego Resilience Scale (ER) measuring adaptive control, seemed promising for assessing the constructs. In a cross-sectional study (Study II) assessing the occurrence of overcontrol in a clinical and non-clinical population, findings showed that overcontrol was more common in restricting anorexia (n = 34) and atypical anorexia (n = 29), than in bulimia (n = 76), borderline personality disorder (n = 108), and a non-clinical sample (n = 444). Anorexia with binge eating and purging (n = 31) showed similar, but somewhat lower, levels of overcontrol compared with atypical and restricting anorexia. However, differences from the other eating disorder groups were not significant. In a single-case experimental design study with 13 patients (Study III), the effect of RO DBT – a treatment developed for disorders related to excessive overcontrol – was evaluated for outpatients with mild to moderate anorexia. Findings were that all completers (62%) were in remission after treatment, and that the treatment clinically and reliably reduced eating disorder psychopathology and clinical impairment, and increased quality of life. In a qualitative interview study (Study IV), 11 participants from Study III reported that they appreciated the comprehensive approach, where both the eating disorder and the overcontrol were addressed, and that sharing with others was important. Findings indicated that the EUC-13 and the ER seemed promising for assessing overcontrol, undercontrol, and resilience. The occurence of overcontrol in different types of AN raised questions regarding if treatment of AN would be more effective if these difficulties were addressed. Lastly, preliminary evidence showed that outpatient RO DBT could be effective for patients with mild to moderate AN and overcontrol, and that the treatment was well received by the patients.
|
|
| 6. |
- Ljungman, Lisa, 1981-
(författare)
-
Parents of Children with Cancer : Psychological Long-Term Consequences and Development of a Psychological Treatment for Parents of Survivors
- 2016
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aims of this thesis were to increase the knowledge about the long-term psychological consequences in parents of children diagnosed with cancer, including parents of childhood cancer survivors (CCSs) and bereaved parents, and to take the first steps towards developing a psychological treatment for parents of CCSs.Study I was a systematic review synthesizing the literature on psychological long-term consequences in parents of CCSs. Study II had a longitudinal design assessing posttraumatic stress symptoms (PTSS) from shortly after the child’s diagnosis (T1, N=259) up to five years after end of the child’s treatment or death (T7, n=169). Study I and II concluded that while most parents show resilience in the long-term, a subgroup report high levels of general distress and/or PTSS. In Study III, interview data from the last assessment in the longitudinal project (T7, n=168) was used. Participants described particularly negative and/or positive experiences in relation to their child’s cancer, and results pointed to the wide range of such experiences involved in parenting a child with cancer. In Study IV and V, parents of CCSs reporting cancer-related psychological distress were included (N=15). In Study IV, a conceptualization of this distress was generated by aggregation of individual behavioral case formulations. The conceptualization consisted of two separate but overlapping paths describing development and maintenance of symptoms of traumatic stress and depressive symptoms. In Study V, cognitive behavior therapy (CBT) based on the individual case formulations were preliminarily evaluated in an open trial. The CBT appeared feasible, and at post-assessment participants reported significant decreases in PTSS (p<.001), depression (p<.001), and anxiety (p<.01) with medium to large effect sizes (Cohen’s d=0.65-0.92).Findings indicate that psychological long-term consequences in parents of children with cancer consist of a broad range of negative as well as positive experiences, and that while most parents show resilience in the long-term, a subgroup report high levels of psychological distress. For parents of CCSs this distress is suggested to primarily consist of symptoms of traumatic stress and depression, and a preliminary evaluation of CBT targeting hypothesized maintaining mechanisms showed promise in terms of feasibility and treatment effect.
|
|
| 7. |
- Parling, Thomas, 1968-
(författare)
-
Anorexia Nervosa : Emotion, Cognition, and Treatment
- 2011
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Anorexia nervosa (AN) is a serious disorder with long-term consequences for those afflicted. No evidence-based care is available for adults with full or subthreshold AN. The thesis research investigated aspects of emotion and cognition relevant to the maintenance of AN that might inform psychological treatment. In addition, the effectiveness of a recent psychotherapy model of AN was investigated. Study I investigated alexithymia and emotional awareness and their associations with depression, anxiety, and perfectionism among patients with AN compared with a control group. The AN group exhibited the same level of emotional awareness as did the control group and the same level of alexithymia when controlling for depression and anxiety. Alexithymia and emotional awareness were not associated, despite representing an overlapping construct. The results of the present study indicate that those with AN can trust their emotional awareness. Study II explored implicit pro-thin and anti-fat attitudes (towards the self and others), striving for thinness (loosely corresponding to positive reinforcement), and avoidance of fatness (loosely corresponding to negative reinforcement). The AN and the control groups were found to have equally strong implicit pro-thin and striving for thinness attitudes. The AN group exhibited stronger implicit anti-fat and avoidance of fatness attitudes (loosely corresponding to negative reinforcement) than did the control group. There was no association between implicit and explicit measures. The results are in line with the over-evaluation of weight and shape as a core feature of eating disorders. Study III compared the effectiveness of Acceptance and Commitment Therapy (ACT) and treatment as usual (TAU) for adults with AN after day-care. Follow-up measures indicated no difference in improvement or deterioration between the two groups. The level of perfectionism was reduced in the ACT group relative to the TAU group. The study was compromised by a lower inflow of patients than anticipated and by a high drop-out rate, and thus fails to provide evidence of a difference between the two groups. The present thesis demonstrates that emotional awareness is intact in those with AN and that implicit attitudes concerning weight and shape reflect the explicit attitudes, although without association. The treatment study indicates that, when designing treatment, it is important to consider the ambivalence to treatment among those suffering from AN, which is reflected in the high drop-out rate in the present study.
|
|
| 8. |
- Welch, Elisabeth
(författare)
-
Eating Disorders : Steps Towards an Increased Understanding
- 2014
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Eating disorders and disordered eating attitudes and behaviors are characterized by an over-evaluation of weight and shape, under or over-controlled eating, as well as engagement in compensatory behaviors. The disorders are associated with psychological suffering, acute and long-term health impairments, a high rate of suicide attempts as well as an increased risk of mortality. Knowledge regarding the etiology of eating disorders is limited and based on current models it is not possible to adequately predict either who will get an eating disorder or who will recover. This lack of understanding has hindered the development of effective prevention and treatment interventions.The aim of the present thesis was to contribute towards an increased understanding of eating disorders and disordered eating attitudes and behavior through the collection of norms and psychometric data, investigation of risk factors and their roles, and focusing on the understudied group of males with eating disorders. Five studies were included. Specifically, Study I focused on collecting general population and clinical norms on the well-established Eating Disorder Examination Questionnaire (EDE-Q) and the Clinical Impairment Assessment Questionnaire (CIA). Study II both collected general population norms on, and investigated psychometric properties of, the Body Shape Questionnaire (BSQ-8C), an instrument intended to assess body dissatisfaction. Study III focused on the role of perfectionism (an established risk factor for eating disorders) as a possible mediator or moderator between body dissatisfaction and disordered eating behavior and attitudes. Finally, in Study IV and V attention was placed on males. In Study IV the specific aim was to compare the clinical characteristics between young males and females with eating disorders while in study V the specific aim was to explore variables associated with disordered eating among young males based on a compilation of factors known to play a role among females as well as factors thought to be uniquely associated with males, such as sexual orientation and drive for muscularity. A greater understanding of eating disorders will help reduce the stigma that is associated with eating disorders, easing the way for affected individuals to seek help and ultimately improve the development of effective prevention and intervention.
|
|
| 9. |
- Åhlén, Johan
(författare)
-
Universal prevention of anxiety and depression in school children
- 2017
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Anxiety and depression are common in children and adolescents, and involve individual suffering, risk of future psychiatric problems, and high costs to society. However, only a limited number of children experiencing debilitating anxiety and depression are identified and receive professional help. One approach that could possibly reduce the prevalence of these conditions is universal school-based prevention aimed at reducing the impact of risk factors and strengthening protective factors involved in the development of anxiety and depression. The current thesis aimed to contribute to the literature on universal prevention of anxiety and depression in children. Study I involved a meta-analysis of earlier randomized, and cluster-randomized trials of universal prevention of anxiety and depression. Overall, the meta-analysis showed small but significant effects of universal preventive interventions, meaning that lower levels of anxiety and depression were evident after intervention completion and partially evident at follow-up assessments. No variables were found to significantly enhance the effects, however, there was a tendency for larger effects to be associated with mental health professionals delivering the interventions. In Study II, a widely adopted prevention program called Friends for Life was evaluated in a large school-based cluster-randomized effectiveness trial. The results showed no evidence of an intervention effect for the whole sample. However, children with elevated depressive symptoms at baseline and children with teachers who highly participated in supervision, seemed to benefit from the intervention in the short term. Study III involved a 3-year follow-up of Study II and an examination of the effects of sample attrition. The results showed no long-term effects for the whole sample and no maintenance of the short-term subgroup effects observed in Study II. Finally, to increase our understanding of the development of anxiety in children and to assist future improvements of universal prevention, Study IV evaluated different trajectories of overall anxiety together with related patterns of disorder-specific symptoms in a school-based sample over 39 months. Evidence favored a model of three different developmental trajectories across age. One trajectory was characterized by increasing levels of overall anxiety, but fluctuating disorder-specific symptoms arguably related to the normal challenges of children’s developmental level, which warrants an increased focus on age-relevant challenges in universal prevention. The four studies provide further understanding of the overall effectiveness of universal prevention of anxiety and depression in children, the short- and long-term effects of universal prevention in a Swedish context, and ideas for further development of preventive interventions.
|
|
