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- Frankl, My, 1968-
(författare)
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Psychotherapy for Substance Use Disorders – the importance of affects
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Substance use disorder (SUD) is a serious disorder with severe consequences for the individual, the family and for society. Comorbidity is common in the SUD population and the diversity of the disorder calls for a multiplicity of treatment options.The overall aim of this thesis was to explore the role of affects in psychotherapy for SUD. Further aims were to investigate affect-focused therapeutic orientations, demonstrate the importance of common factors and evaluate a measure of affect phobia.In Study I a naturalistic design was employed to examine how the discrepancy between patients' expectations and experience of psychotherapy related to alliance in 41 patients: 24 in individual therapy and 17 in group. An additional analysis concerned whether different dimensions of role expectations predicted retention in psychotherapy. Study II was the first psychometric evaluation of the Affect phobia test – a test developed to screen the ability to experience, express and regulate emotions. Data were collected from two samples: A clinical sample of 82 patients with depression and/or anxiety participating in a randomized controlled trial of Internet-based affect-focused treatment, and a university student sample of 197 students. Data analysed included internal consistency, test-retest reliability, factor analysis and calculation of an empirical cut-off. Study III focused on the feasibility of individual 10 week Affect Phobia Therapy (APT) for patients diagnosed with mild to moderate alcohol use disorder (AUD) and problematic affective avoidance in a nonconcurrent multiple baseline design. Study IV comprised an evaluation of the feasibility and preliminary effectiveness of APT adapted to a structured group format for patients (n=22) with comorbid substance use disorder and ADHD with core features of affective avoidance/emotion dysregulation in an open design.In Study I an overall discrepancy between role expectations and experiences was significantly related to a lower level of therapeutic alliance in group therapy. This relationship was not found in individual therapy. Expectations prior to psychotherapy characterized by defensiveness correlated negatively with therapy retention, even when controlling for waiting time for therapy. In Study II the internal consistency for the total score on the Affect phobia test was satisfactory but it was not for the affective domains, Anger/Assertion, Sadness/Grief, and Attachment/Closeness. Test retest reliability was satisfactory. The exploratory factor analysis resulted in a six-factor solution and only moderately matched the test´s original affective domains. An empirical cut-off between the clinical and the university student sample were calculated and yielded a cut-off of 72 points. In Study III patients reported no adverse events due to the treatment and finished the whole study period. The patients had different trajectories of alcohol consumption and craving and the hypothesis that heavy episodic drinking would subside during the time in therapy did not hold true. In Study IV patients reported significant pre-to post changes in increased self-compassion and decreased affect phobia but no change in psychological distress or emotion dysregulation. Craving fluctuated throughout the study period and patients’ drinking pattern changed in the direction of more social drinking.Main conclusions are the following: The Affect Phobia Test is a useful screening instrument for detecting emotional difficulties related to psychological malfunction. APT in both group and individual format are feasible treatments for the SUD population and has the potential to broaden the treatment options for some patients with SUD. Investigating expectations and fears prior to therapy may be means to prevent attrition.
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| 2. |
- Gidhagen, Ylva, 1951-, et al.
(författare)
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Attachment style among outpatients with substance use disorders in psychological treatment
- 2018
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Ingår i: Psychology and Psychotherapy. - : Wiley. - 1476-0835 .- 2044-8341. ; 91:4, s. 490-508
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To explore the associations between self-rated attachment style, psychological distress and substance use among substance use disorder (SUD) outpatients in psychological treatment.Design and Methods In this practice-based study, 108 outpatients were asked to fill in the Experiences in Close Relationships - Short form, the Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM), the Alcohol Use Disorders Identification Test (AUDIT), and the Drug Use Disorders Identification Test (DUDIT) at treatment start and end. Patients were given psychological treatments with a directive, reflective or supportive orientation.Results An insecure attachment style was more common among the SUD outpatients, compared to non-clinical groups. Patients with a fearful attachment style scored higher on psychological distress than patients with a secure attachment style. The associations between the attachment dimensions and psychological distress were stronger than those between attachment and SUD. Significantly more patients had a secure attachment style at treatment end.Conclusions This study shows significant relations between patients' attachment style and their initial psychological distress. The causal relationship between attachment style and psychological distress is, however, not clear and can likely go in both directions. The psychological treatment of patients with SUD contributed significantly to changes from insecure to secure attachment style.
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| 3. |
- Söderberg Gidhagen, Ylva, 1951-
(författare)
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Psychological treatment of outpatients with substance use disorders in routine care : attachment style, alliance, and treatment outcome
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Substance use disorder is one of the most important threats to health and welfare in the world. More knowledge is needed about the outcomes of treatments in routine care for patients with substance use disorders (SUDs). These patients often suffer from psychological distress in addition to substance use disorders.Aims: To evaluate the effects of community-based psychological treatment on SUD outpatients’ psychological distress and substance use, and also to analyze the importance of their attachment style and the alliance with regard to treatment outcome.Methods: Patients who were referred or self-referred to a social worker or a psychotherapist at three outpatient treatment centers for SUD were invited to participate in the study. At each session the patients filled out an instrument measuring psychological distress, the Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE-OM) and to evaluate the alliance to the therapist the Working Alliance Inventory – short form revised (WAI-SR). At treatment start and end the patient filled out the Alcohol Use Disorders Identification Test (AUDIT), the Drug Use Disorders Identification Test including the extended version (DUDIT/DUDIT-E) and the Experiences in Close Relationships – short form (ECR-S) categorizing attachment style. Therapists filled out the CORE Therapy Assessment form at treatment start and the End of Therapy form at treatment termination. After each session, they also filled out the Working Alliance Inventory – short form for therapists (WAI-S).Results: Of the 119 patients who agreed to participate in the study, there were 100 patients who filled out two or more CORE-OM and WAI-SR forms. Outcome on substance use as measured with AUDIT-C and DUDIT-C was collected for 63 patients. The analyses showed that CORE-OM mean scores were significantly improved. In total 14% of the patients were recovered, 10% improved and 5% deteriorated. AUDIT-C and DUDIT-C mean scores were significantly improved for patients using alcohol and for patients using illicit drugs, respectively.An insecure attachment style was more common among the patients in this research project, compared to non-clinical groups. The patients with a fearful attachment style scored higher on psychological distress than the patients with a secure attachment style. The associations between the attachment dimensions and psychological distress were stronger than those between attachment and SUD. The causal relationship between attachment style and psychological distress is, however, not clear and can likely go in both directions. Significantly more patients had a secure attachment style at treatment end.Previous studies have found that the associations between alliance and outcome for SUD patients may be weaker than for other clinical groups, which was confirmed in this thesis. Three moderators of the alliance-outcome association – type of substance use, attachment style and treatment orientation – were assessed. None of the potential moderators tested showed any effect on the association between alliance and psychological distress. The variance among the therapies concerning the session-to-session alliance-outcome association was considerable, indicating that other moderating variables might be found.Conclusions: Routine psychological treatment had positive effects on psychological distress as well as on reduction of substance use. However, a substantial number of patients remained unchanged, particularly regarding psychological distress. Among patients with SUD there seems to be a strong relationship between attachment style and psychological distress. Knowledge of the patient’s attachment style may help the therapist to tailor the treatment to the patient’s needs. A change from an insecure to a secure attachment style can be an important goal for SUD treatment, as it may prevent the patient from using strategies involving substance use for regulating emotions and interpersonal relationships. This thesis confirms and strengthens the finding of a weaker association between alliance and outcome for SUD patients, compared to other clinical groups. A challenge for further research is to find factors that contribute to the alliance-outcome association among SUD patients.Studies with larger patient groups, additional instruments and methods are needed to develop treatments for SUD patients in routine care.
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| 4. |
- Uckelstam, Carl-Johan, 1983-
(författare)
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Looking into the Future : How to Use Advanced Statistical Methods for Predicting Psychotherapy Outcomes in Routine Care
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Psychotherapy research has shifted from mainly focusing on the average effects of different treatments to concentrating more on questions related to the individual patient. When research attention shifts, it can give rise to the implementation of new statistical methods that, in turn, can illuminate new challenges that must be addressed.The aim of the thesis was to study how traditional methods for predicting certain psychotherapy outcomes have been conducted in the past, and how more advanced statistical methods might be used to enhance knowledge of how to predict these outcomes today.Three studies were performed: Paper I focused on how Multi Level Modeling (MLM) can be used to study certain aspects of the relationship between working alliance and treatment outcome. In Paper II, Latent Profile Analysis (LPA) and item-level analysis were used to give nuance to the relationship between psychological distress at baseline and change rate during treatment. Finally, in Paper III, Machine Learning (ML) was used to detect dropout patients in the early phase of treatment by exploring complex patterns of symptom distress during the early phase of treatment.The thesis showed how different goals of scientific exploration can be studied in the context of routine care with the use of these statistical frameworks and discussed some of the challenges and opportunities worth noting when entering this line of research.
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| 5. |
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Vad är verksamt i psykoterapi?
- 2008
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Samlingsverk (redaktörskap) (övrigt vetenskapligt/konstnärligt)abstract
- Vad är det som gör att olika former av psykoterapi fungerar och är till hjälp för patienten? Vilka är de verksamma principerna eller mekanismerna som driver på den positiva förändringen? I denna bok diskuterar en grupp författare vad teori, forskning och klinisk erfarenhet säger om detta inom olika psykoterapeutiska inriktningar och deras respektive behandlingsmetodik. Boken tar också upp vad patienter själva tycker är till hjälp i deras terapier samt i vilken utsträckning faktorer hos patienten, terapeuten och behandlingsrelationen bidrar till psykoterapins utfall.
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