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1.	Alfonsson, Sven, 1977- (author) Impulsivity, Negative Mood, and Disordered Eating in Obesity 2014 Doctoral thesis (other academic/artistic)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.	Alfonsson, Sven, et al. (author) Is age a better predictor of weight loss one year after Gastric bypass than symptoms of disordered eating, depression, adult ADHD, and alcohol consumption? 2014 In: Eating Behaviors. - : Elsevier BV. - 1471-0153 .- 1873-7358. ; 15:4, s. 644-647 Journal article (peer-reviewed)abstract INTRODUCTION:Findings regarding psychological risk factors for low weight loss after bariatric surgery have been inconsistent. The association between gender and weight outcome is unclear while younger age has been consistently shown to be associated with better weight outcome. The aim of this study was to analyze the interactions between gender and age on the one hand and symptoms of disordered eating, depression, adult ADHD and alcohol consumption on the other hand in regard to weight loss after gastric bypass.METHODS:Bariatric surgery patients were recruited and asked to fill out self-report questionnaires regarding behavioral risk factors before and twelve months after surgery. Data from one hundred and twenty-nine patients were analyzed.RESULTS:After controlling for age, no psychological variable measured prior to surgery could predict weight loss after twelve months. After surgery, there was an interaction effect between age, gender and specific eating disorder symptoms. Specifically, loss of control over eating was a risk factor for low weight loss among older, but not among younger, female participants. Symptoms of adult ADHD were associated with elevated alcohol consumption after surgery.DISCUSSION:These results indicate that age and gender may moderate the effects of potential risk factors for inferior weight outcome. This interaction could potentially be one of the reasons behind the mixed findings in this field. Thus, there are important gender differences in the bariatric population that should be considered. The present study is the first to show that symptoms of adult ADHD may not be a risk factor for inferior weight loss but for alcohol risk consumption after gastric bypass.
3.	Alfonsson, Sven, et al. (author) Screening of Adult ADHD Among Patients Presenting for Bariatric Surgery 2012 In: Obesity Surgery. - : Springer Science and Business Media LLC. - 0960-8923 .- 1708-0428. ; 22:6, s. 918-926 Journal article (peer-reviewed)abstract In the field of bariatric surgery, research on symptoms of adult attention deficit hyperactivity disorder (ADHD) and their interrelationships with other psychological risk factors such as depression and anxiety is scarce. The symptoms of adult ADHD seem to be common in the obese population, but they are rarely investigated before bariatric surgery. ADHD-related symptoms such as impulsivity have at the same time been identified as potential risk factors for less successful weight loss among bariatric surgery patients. The aims of the current study were to screen for symptoms of adult ADHD and to investigate their relationships with other psychological risk factors. Candidates for bariatric surgery ( = 187) were anonymously screened for symptoms of anxiety, depression, and adult ADHD, in addition to disordered eating patterns, by means of questionnaires. The relations between these symptoms were investigated. In the current sample, 10% of patients screened positively for adult ADHD, and the symptoms of adult ADHD were significantly correlated with those of anxiety, depression, and disordered eating. The results show that adult ADHD is more common in this clinical group than in the general population (4%) and that adult ADHD is associated with disordered eating patterns, depression, and anxiety. Further prospective research, using multivariate analysis, is needed to investigate whether the symptoms of adult ADHD, and their interaction with anxiety, depression, or disordered eating, may possibly constitute a risk factor in terms of difficulties in adhering to the post-surgery regime and its potential unfavorable outcome.
4.	Alfonsson, Sven, et al. (author) Self-€reported symptoms of adult attention deficit hyperactivity disorder among obese patients seeking bariatric surgery and its relation to alcohol consumption, disordered eating and gender 2013 In: Clinical Obesity. - : Wiley. - 1758-8103 .- 1758-8111. ; 3:5, s. 124-131 Journal article (peer-reviewed)abstract What is already known about this subjectSymptoms of adult attention deficit hyperactivity disorder (ADHD) are common among people with obesity.Symptoms of ADHD are associated with other impulsive behaviours.Impulsivity can manifest differently in women and men.What this study addsThe prevalence of ADHD symptoms was equal in both sexes in this patient group.ADHD symptoms were associated with hazardous alcohol consumption in men but not in women.It may be important to investigate several comorbid conditions simultaneously instead of a single diagnosis.Eating disorders and adult attention deficit hyperactivity disorder (ADHD), both characterized by deficits in impulse control, are common among bariatric surgery patients. Previous studies in other groups have found gender differences in how symptoms of ADHD and eating disorders manifest as women show more disordered eating and men show more risk consumption of alcohol. In the present study, the association between symptoms of adult ADHD, eating disorders and hazardous alcohol consumption was investigated, while considering gender differences. Self-report questionnaires were obtained from 276 bariatric surgery patients 3–6 months before surgery. The prevalence rates of adult ADHD and binge eating disorder (BED) were 8.6% and 6.3%, respectively, with no evidence of gender difference in the prevalence rates. Hazardous alcohol consumption was reported by a significantly larger portion of men (16.9%) than women (8.6%). There was an association between adult ADHD and both BED and hazardous alcohol consumption. However, symptoms of adult ADHD were associated with hazardous alcohol consumption in men but not in women. Our results suggest gender differences in hazardous alcohol consumption and self-reported symptoms of disordered eating despite similar prevalence rate of BED, but no gender difference in symptoms of adult ADHD. Finally, as the associations between these variables seem to be different in women and men, future
5.	Björnsdotter, Annika, 1970- (author) Evaluation of Family Check-Up and iComet : Effectiveness as well as Psychometrics and Norms for Parent Rating Scales 2014 Doctoral thesis (other academic/artistic)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.
6.	Björnsdotter, Annika, 1970-, et al. (author) Family Check-Up and iComet : a Randomized Controlled Trial in Sweden 2013 Conference paper (other academic/artistic)
7.	Björnsdotter, Annika, 1970-, et al. (author) Psychometric properties of online administered parental Strengths and Difficulties Questionnarie (SDQ), and normative data based on combined online and paper-and-pencil administration 2013 In: Child and Adolescent Psychiatry and Mental Health. - : Springer Science and Business Media LLC. - 1753-2000. ; 7 Journal article (peer-reviewed)abstract ObjectiveTo examine the psychometric properties of the online administered parental version of the Strength and Difficulties Questionnaire (SDQ), and to provide parental norms from a nationwide Swedish sample.MethodsA total of 1443 parents from of a national probability sample of 2800 children aged 10-13 years completed the SDQ online or as usual (i.e., using paper-and-pencil).ResultsThe SDQ subscales obtained from the online administration showed high internal consistency (polychoric ordinal alpha), and confirmatory factor analysis of the SDQ five factor model resulted in excellent fit. The Total Difficulties score of the SDQ and its other subscales were significantly related to the Disruptive Behavior Disorders (DBD) rating scale. Norms for the parent version of SDQ obtained from the Internet were identical to those collected using paper-and-pencil. They were thus combined and are presented sorted by child gender and age.ConclusionsThe SDQ seems to be a reliable and valid instrument given its high internal consistency, clear factor structure and high correlation with other instruments capturing the intended constructs. Findings in the present study support its use for online data collection, as well as using norms obtained through paper-and-pencil-administration even when SDQ has been administrated online.
8.	Björnsdotter, Annika, 1970-, et al. (author) The Importance of Parental Knowledge 2013 Conference paper (other academic/artistic)abstract Poor parenting is an important risk factor for development of conduct problems in children and adolescents. Inadequate parental monitoring is an example of a negative parenting behavior that has been shown to predict child conduct problems Findings from previous research on parental monitoring has been mixed due to the use of inconsistent and vague definitions. However, later research suggests that it is "parental knowledge" rather than "parental monitoring" that is associated with child and adolescent conduct problems. In the present study, we used an existing questionnaire that measures three possible sources of parental knowledge: child disclosure, parental solicitation and parental control. Our aims were to 1) examine the factor structure of a parenting monitoring/knowledge scale, 2) analyze if a high level of child disclosure and parental control as well as a low level of parental solicitation were associated to low conduct problems, 3) examine if a measure of family warmth correlates with child disclosure, and 4) whether parental knowledge mediates the relation between parental warmth and conduct problems. Parents of a national probability sample of 2800 children aged 10-13 years old were asked to complete a survey including these different scales. A total of 1446 parents completed the questionnaires. Brief description Analysis of the importance of parental knowledge regarding child disruptive behavior using an existing questionnaire that measures parental knowledge through three possible sources: child disclosure, parental solicitation and parental control.
9.	Bohman, Benjamin, et al. (author) Infrequent attention to dietary and physical activity behaviours in conversations in Swedish child health services 2013 In: Acta Paediatrica. - : Wiley-Blackwell. - 0803-5253 .- 1651-2227. ; 102:5, s. 520-524 Journal article (peer-reviewed)abstract Aim: To investigate conversations between nurses and parents in Swedish child health services and to assess to what extent attention is directed towards dietary and physical activity behaviours in children.Methods: Twenty-three nurses audio-recorded one session each. Recordings were assessed and topics were classified according to predetermined categories.Results: The three most frequent topics of conversation concerned physical examinations of the child (30% of session time), talking to the child to establish or maintain contact and interest (15%), and development of language skills (12%). Dietary habits came on fourth place (10%), and physical activity ranked 14 (4%).Conclusion: Attention to dietary and physical activity behaviours in children is infrequent in Swedish child health services. Concern is raised about the efficacy of prevention efforts against childhood obesity.
10.	Bohman, Benjamin, et al. (author) Psychometric Properties of a New Measure of Parental Self-Efficacy for Promoting Healthy Physical Activity and Dietary Behaviors in Children 2013 In: European Journal of Psychological Assessment. - : Hogrefe Publishing Group. - 1015-5759 .- 2151-2426. ; 29:4, s. 291-298 Journal article (peer-reviewed)abstract There is a lack of validated measures of parental self-efficacy (PSE) covering both physical activity and dietary behaviors in children which can be used to prevent childhood obesity. This study developed a new measure of PSE for promoting healthy physical activity and dietary behaviors in children and assessed its psychometric properties. Participants were mothers (n = 2,232) with 3-year-old first-born children living in Stockholm, Sweden. The mothers responded to questionnaires measuring PSE, locus of control, and self-esteem. Exploratory factor analysis yielded a three-factor structure, interpreted as PSE for promoting healthy dietary behaviors in children (Factor 1), PSE for limit-setting of unhealthy dietary or physical activity behaviors in children (Factor 2), and PSE for promoting healthy physical activity behaviors in children (Factor 3). The factor model was supported by confirmatory factor analysis. The internal consistency and test-retest reliability of the new PSE measure were high; discriminant validity was adequate. The Parental Self-Efficacy for Promoting Healthy Physical Activity and Dietary Behaviors in Children Scale (PSEPAD) shows promise as a valuable instrument in childhood obesity prevention.
11.	de Man Lapidoth, Joakim, 1969-, et al. (author) Binge eating in surgical weight-loss treatments : long-term associations with weight loss, health related quality of life (HRQL), and psychopathology 2011 In: Eating and Weight Disorders. - : Editrice Kurtis S R L. - 1124-4909 .- 1590-1262. ; 16:4, s. E263-E269 Journal article (peer-reviewed)abstract BACKGROUND: Studies that have investigated the relationship between binge eating and the long-term outcome of bariatric surgery have shown mixed results. Does binge eating affect long-term BMI, health-related quality of life (HRQL), or psychopathology after surgery?METHODS: We assessed 173 bariatric patients before and three years after weight loss surgery with regard to weight, binge eating, HRQL, and psychopathology.RESULTS: Binge eating before and after weight loss surgery was unrelated to long-term BMI outcome. Binge eating after weight loss surgery was associated with more psychopathology and lower HRQL.CONCLUSIONS: Binge eating before or after weight loss surgery does not predict long-term BMI outcome. Therefore, exclusions from surgery for this reason alone are difficult to motivate. However, results show that binge eating after weight loss surgery is common and is associated with more psychopathology and lower HRQL, which might increase the vulnerability for future weight regain and complications beyond the follow-up period of the present study. The high rate of binge eating after surgery and its negative association with HRQL and psychopathology suggest that we need to be observant of the occurrence and potential effects of binge eating in the context of bariatric surgery.
12.	Doring, Nora, et al. (author) Primary prevention of childhood obesity through counselling sessions at Swedish child health centres : design, methods and baseline sample characteristics of the PRIMROSE cluster-randomised trial 2014 In: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 14:335 Journal article (peer-reviewed)abstract Background: Childhood obesity is a growing concern in Sweden. Children with overweight and obesity run a high risk of becoming obese as adults, and are likely to develop comorbidities. Despite the immense demand, there is still a lack of evidence-based comprehensive prevention programmes targeting pre-school children and their families in primary health care settings. The aims are to describe the design and methodology of the PRIMROSE cluster-randomised controlled trial, assess the relative validity of a food frequency questionnaire, and describe the baseline characteristics of the eligible young children and their mothers. Methods/Design: The PRIMROSE trial targets first-time parents and their children at Swedish child health centres (CHC) in eight counties in Sweden. Randomisation is conducted at the CHC unit level. CHC nurses employed at the participating CHC received training in carrying out the intervention alongside their provision of regular services. The intervention programme, starting when the child is 8-9 months of age and ending at age 4, is based on social cognitive theory and employs motivational interviewing. Primary outcomes are children's body mass index and waist circumference at four years. Secondary outcomes are children's and mothers' eating habits (assessed by a food frequency questionnaire), and children's and mothers' physical activity (measured by accelerometer and a validated questionnaire), and mothers' body mass index and waist circumference. Discussion: The on-going population-based PRIMROSE trial, which targets childhood obesity, is embedded in the regular national (routine) preventive child health services that are available free-of-charge to all young families in Sweden. Of the participants (n = 1369), 489 intervention and 550 control mothers (75.9%) responded to the validated physical activity and food frequency questionnaire at baseline (i.e., before the first intervention session, or, for children in the control group, before they reached 10 months of age). The food frequency questionnaire showed acceptable relative validity when compared with an 8-day food diary. We are not aware of any previous RCT, concerned with the primary prevention of childhood obesity through sessions at CHC that addresses healthy eating habits and physical activity in the context of a routine child health services programme.
13.	Enebrink, Pia, et al. (author) Internet-based parent management training : A randomized controlled study 2012 In: Behaviour Research and Therapy. - : Elsevier BV. - 0005-7967 .- 1873-622X. ; 50:4, s. 240-249 Journal article (peer-reviewed)abstract Objective: The current study evaluated the efficacy of an Internet-based parent-training program for children with conduct problems. Dose-response ratio and costs for the program were also considered. Method: Parents of 104 children (aged 3-12 years) were randomly allocated to either parent training or a waitlist control condition. Diagnostic assessment was conducted at baseline and parent ratings of child externalizing behaviors and parent strategies were completed before and after treatment and at 6-month follow-up. Results: At post-treatment assessment, children whose parent(s) had received the intervention showed a greater reduction in conduct problems compared to the waitlist children. Between group intent-to-treat effect sizes (Cohen's d) on the Eyberg Intensity and Problem scales were .42 and .72, respectively (study completers .66 and 1.08). In addition, parents in the intervention group reported less use of harsh and inconsistent discipline after the treatment, as well as more positive praise. Effects on behavior problems were maintained at 6-month follow-up. Conclusions: The results support the efficacy of parent training, administered through Internet, with outcomes comparable to many of the group-based parent training programs. The efficacy, low cost, and higher accessibility make this intervention a fitting part in a stepped-care model.
14.	Enebrink, Pia, 1972-, et al. (author) The emotion regulation questionnaire : Psychometric properties and norms for Swedish parents of children aged 10-13 years 2013 In: Europe's Journal of Psychology. - : Leibniz Institute for Psychology (ZPID). - 1841-0413. ; 9:2, s. 289-303 Journal article (peer-reviewed)abstract This study evaluated the internal consistency and factor structure of the Swedish version of the 10-item Emotion Regulation Questionnaire (ERQ), and its relation to family warmth and conflict, marital satisfaction, and parental discipline strategies, in addition to obtaining norms from the general population of parents of children aged 10-13 years. The ERQ has two subscales measuring an individual’s use of cognitive reappraisal and expressive suppression as emotion regulation strategies. A random non-referred sample of parents of 1433 children aged 10-13 years completed the ERQ and other questions targeting the family functioning and couple adjustment (Warmth/Conflict in the family; Dyadic Adjustment Scale-short form) and parental strategies (Parent Practices Interview). The results indicated adequate internal consistencies (Cronbach’s alpha) of the two subscales (cognitive reappraisal .81; expressive suppression .73). Confirmatory factor analysis resulted in close to acceptable fit (RMSEA = 0.089; CFI = 0.912; GFI = 0.93). Norms are presented as percentiles for mothers and fathers. The ERQ cognitive reappraisal scale correlated positively with marital adjustment (DAS), family warmth, appropriate discipline (PPI), and negatively with harsh discipline (PPI). The ERQ expressive suppression subscale was negatively correlated with marital satisfaction (DAS) and family warmth, and positively with harsh discipline (PPI). To conclude, this study showed the adequate reliability and construct validity of the ERQ in a large sample of Swedish parents. Specific use of suppression or reappraisal as a parental emotion regulation strategy was related to couple satisfaction, warmth in the family and employment of adequate discipline strategies in expected direction.
15.	Hedman, Erik, et al. (author) Clinical effectiveness and cost-effectiveness of Internet- vs. group-based cognitive behavior therapy for social anxiety disorder : 4-Year follow-up of a randomized trial 2014 In: Behaviour Research and Therapy. - : Elsevier. - 0005-7967 .- 1873-622X. ; 59, s. 20-29 Journal article (peer-reviewed)abstract Social anxiety disorder (SAD) is common, debilitating and associated with high societal costs. The disorder can be effectively treated with Internet-based cognitive behavior therapy (ICBT), but no previous study has investigated the long-term clinical or health economic effects of ICBT for SAD in comparison to an evidence-based control treatment. The aim of the study was to investigate the clinical effectiveness and cost-effectiveness of ICBT compared to cognitive behavioral group therapy (CBGT) four years post-treatment. We conducted a 4-year follow-up study of participants who had received ICBT or CBGT for SAD within the context of a randomized controlled non-inferiority trial. The cost-effectiveness analyses were conducted taking a societal perspective. Participants in both treatment groups made large improvements from baseline to 4-year follow-up on the primary outcome measure (d = 1.34-1.48) and the 95% CI of the mean difference on the primary outcome was well within the non-inferiority margin. ICBT and CBGT were similarly cost-effective and both groups reduced their indirect costs. We conclude that ICBT for SAD yields large sustainable effects and is at least as long-term effective as CBGT. Intervention costs of both treatments are offset by net societal cost reductions in a short time. (C) 2014 Elsevier Ltd. All rights reserved.
16.	Hogstrom, Jens, et al. (author) The Moderating Role of Child Callous-Unemotional Traits in an Internet-Based Parent-Management Training Program 2013 In: Journal of family psychology. - : American Psychological Association (APA). - 0893-3200 .- 1939-1293. ; 27:2, s. 314-323 Journal article (peer-reviewed)abstract Although parent management training (PMT) is generally considered the treatment of choice for children with conduct problems, some specific adaptations might be essential for various subgroups of parents or children to benefit well from PMT. The aim of this study was to examine the influence of child callous-unemotional (CU) traits on the outcome of an Internet-based PMT program for parents of children with conduct problems (n = 57; mean age 6.65). Within a randomized controlled trial of PMT, children assigned to the intervention group were categorized and compared as either "high-CU" (n = 8) or "low-CU" (n = 49) based on a cut-off score on the CU subscale of the Antisocial Process Screening Device (APSD; Frick & Hare, 2001). CU traits in children were associated with more severe conduct problems at baseline, as well as more hyperactivity and peer-related problems. Treatment outcome, in terms of conduct-problem reduction, was poor in the high-CU group compared with the low-CU group, despite the fact that parents in both groups improved equally in parenting skills. The same pattern of results emerged after controlling for initial difficulties of conduct problems and other pretreatment differences between the groups. Elevated levels of CU traits in children seem to contribute to an inferior treatment response in PMT. These findings call for more attention on empathy and emotional patterns in the assessment of children with conduct problems.
17.	Josefin, Westerberg-Jacobson, 1970-, et al. (author) A 5-year longitudinal study of the relationship between the wish to be thinner, lifestyle behaviours and disturbed eating in 9–20-year old girls 2010 In: European eating disorders review. - : Wiley. - 1072-4133 .- 1099-0968. ; 18:3, s. 207-219 Journal article (peer-reviewed)abstract The aim of this 5-year longitudinal study of 593 girls (9-20-year-old) was to examine whether the internalization of the thinness ideal in terms of “a wish to be thinner” might be related to lifestyle factors and longitudinally increase the risk of disturbed eating over time. Results showed that a wish to be thinner was related to lifestyle factors, eating attitudes and BMI longitudinally. Girls who wished to be thinner dieted more often, thought that they would be more popular if they were thinner, skipped meals, were eating breakfast more often alone and had a higher BMI compared to the girls without such a wish. Girls who wished to be thinner were 4 times more likely to develop disturbed eating attitudes over a 5-year period. These findings point to the importance of helping adolescents to establish regular eating habits, to avoid unhealthy dieting practices and to prevent sedentary behaviours that might lead to overweight and or obesity in early childhood.
18.	Ljungman, Lisa, et al. (author) Development of a Psychological Treatment for Psychological Distress in Parents of Children Previously treated for with Cancer 2014 In: PSYCHO-ONCOLOGY. - 1057-9249. ; 23, s. 65-65 Conference paper (peer-reviewed)
19.	Olsson, Erik, et al. (author) Internet-based biofeedback-assisted relaxation training in the treatment of hypertension : a pilot study 2010 In: Applied Psychophysiology and Biofeedback. - : SpringerLink. - 1090-0586 .- 1573-3270. ; 35:2, s. 163-170 Journal article (peer-reviewed)abstract The effectiveness of biofeedback-assisted behavioral treatment with Internet-based client-therapist contact for hypertension was tested in outpatient settings. A pilot study with a randomized controlled design was adopted with two conditions (treatment versus passive controls), lasting for 8 weeks. There were two assessment time points (pre-treatment and post-treatment) measuring clinic systolic and diastolic blood pressure (SBP and DBP) and administration of a questionnaire collecting demographic and subjective data. Participants included 19 Swedish adults diagnosed with hypertension. The treatment group lowered their SBP 5.9 mm Hg and their DBP 7.6 mm Hg while the control group lowered their SBP 0.8 mm Hg and DBP 3.0 mm Hg. The effect of treatment was significant for DBP but not for SBP. There were no other significant effects of treatment. This pilot study shows encouraging results regarding Internet-based biofeedback treatment for hypertensive adults. However, further research using a larger sample is needed.
20.	Parling, Thomas, et al. (author) Alexithymia and emotional awareness in anorexia nervosa : time for a shift in the measurement of the concept? 2010 In: Eating Behaviors. - : Elsevier BV. - 1471-0153 .- 1873-7358. ; 11:4, s. 205-210 Journal article (peer-reviewed)abstract The present study compared 35 patients with anorexia nervosa (AN) with an age matched control group using the Toronto Alexithymia Scale (TAS-20; a self-report instrument) and the Levels of Emotional Awareness Scale (LEAS; a performance-based instrument). Depression and anxiety have been shown to account for elevated levels of alexithymia in AN, and an elevated level of perfectionism might affect self-reporting in general. The AN-group reported a higher level of alexithymia on the TAS-20 compared to the control group, a difference that disappeared after controlling for depression or anxiety (but not for perfectionism). The findings suggest that the AN-patients believe that they have difficulties in identifying and reporting emotions, but actually perform as well as the control group when confronted with the task of identifying and reporting their emotions according to LEAS. It might be time to rethink the measurement of alexithymia. Maybe, similar to assessment of personality disorders, it should not be assessed when patients are depressed, or it should be assessed through instruments and modalities that are not sensitive to the mood state of the patient.
21.	Parling, Thomas, 1968- (author) Anorexia Nervosa : Emotion, Cognition, and Treatment 2011 Doctoral thesis (other academic/artistic)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.
22.	Parling, Thomas, 1968-, et al. (author) Using the Implicit Relational Assessment Procedure to Compare Implicit Pro-Thin/Anti-Fat Attitudes of Patients with Anorexia Nervosa and Non-clinical Controls 2012 In: Eating Disorders. - : Informa UK Limited. - 1064-0266 .- 1532-530X. ; 20:2, s. 127-143 Journal article (peer-reviewed)abstract Implicit pro-thin/anti-fat attitudes was investigated among a mixed group of patients with full and sub-threshold Anorexia Nervosa (n = 17), and a matched-age control group (n = 17). The Implicit Relational Assessment Procedure (IRAP) was employed to measure implicit pro-thin and anti-fat attitudes towards Self and Others in addition to ‘striving for thinness’ and ‘avoidance of fatness’. The clinical group showed an implicit pro-fat attitude towards Others and stronger anti-fat attitudes towards Self and avoidance of fatness compared with controls. The findings are discussed in relation to the over-evaluation of weight and shape in the clinical group.
23.	Ramklint, Mia, et al. (author) Assessing personality disorders in eating disordered patients using the SCID-II : Influence of measures and timing on prevalence rate 2010 In: Personality and Individual Differences. - : Elsevier BV. - 0191-8869 .- 1873-3549. ; 48:2, s. 218-223 Journal article (peer-reviewed)abstract The SCID-II Personality Questionnaire is available as a screening tool to shorten the time it takes to perform the SCID-II interview. However, very little is known about combining the questionnaire with the interview in eating disordered individuals. The aim of this study was to examine the prevalence of personality disorder (PD) among patients with eating disorders (ED) by combining initial screening self-assessment with a later interview. not performed until axis I symptoms decreased. This was performed on 154 patients with ED. According to the initial self-assessment, the rate of any PD was 90%; however, according to the later SCID-II interview, the rate decreased to 37%. In a sub-sample of 15 patients, the questionnaire was filled out twice: at intake and at the time of the interview. In the subgroup performing the questionnaire twice, there was no decline in PD symptoms over time. However, the PD rate decreased significantly when the patient was assessed by the interview. These findings indicate that the influence of measures might be greater than the influence of timing. The findings support that prevalence rates of PD in eating disordered patients are high, but not as high as it has commonly been reported.
24.	Ramklint, Mia, et al. (author) Guided self-help as the first step for bulimic symptoms : Implementation of a stepped-care model within specialized psychiatry 2012 In: International Journal of Eating Disorders. - : Wiley. - 0276-3478 .- 1098-108X. ; 45:1, s. 70-78 Journal article (peer-reviewed)abstract Objective: This study describes the implementation and effectiveness of the first step, guided self-help (GSH), in a clinical setting, of a stepped-care model of cognitive behavior therapy for patients with bulimic symptoms. Method: Eighty-nine patients participated. Results: In the intent to-treat analyses, the effect sizes were small to moderate (0.25-0.66). However, the effect sizes were substantially larger (0.44-1.66) for the patients who completed all the GSH sessions (45%). The majority of non-completers stayed within psychiatric services. Supplementary treatments were mostly directed towards comorbid conditions, especially depression. Those discontinuing treatment in advance where characterized by more lifetime diagnoses and higher ratings on the restraint subscale of the EDE-Q. Discussion: GSH within specialized psychiatry might be effective for about 30% of the patients. There is no indication of patients losing their confidence in psychiatric services by being offered GSH as the first treatment.
25.	Schibbye, Peter, et al. (author) Using Early Change to Predict Outcome in Cognitive Behaviour Therapy : Exploring Timeframe, Calculation Method, and Differences of Disorder-Specific versus General Measures 2014 In: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 9:6 Journal article (peer-reviewed)abstract Early change can predict outcome of psychological treatment, especially in cognitive behavior therapy. However, the optimal operationalization of "early change'' for maximizing its predictive ability, and differences in predictive ability of disorder-specific versus general mental health measures has yet to be clarified. This study aimed to investigate how well early change predicted outcome depending on the week it was measured, the calculation method (regression slope or simple subtraction), the type of measures used, and the target disorder. During 10-15 weeks of internet-based cognitive behavior therapy for depression, social anxiety disorder, or panic disorder, weekly ratings were collected through both disorder-specific measures and general measures (Outcome Questionnaire-45 (OQ-45) and Clinical Outcomes in Routine Evaluation-10 (CORE-10)). With outcome defined as the disorder-specific measure, change at week four was the optimal predictor. Slope and subtraction methods performed equally well. The OQ-45 explained 18% of outcome for depression, 14% for social anxiety disorder, and 0% for panic disorder. Corresponding values for CORE-10 were 23%, 29%, and 25%. Specific measures explained 41%, 43%, and 34% respectively: this exceeded the ability of general measures also when they predicted themselves. We conclude that a simple calculation method with a disorder-specific measure at week four seems to provide a good choice for predicting outcome in time-limited cognitive behavior therapy.
26.	Weineland, Sandra, et al. (author) Development and validation of a new questionnaire measuring eating disordered behaviours post bariatric surgery 2012 In: Clinical Obesity. - : International Association for the Study of Obesity. - 1758-8103 .- 1758-8111. ; 2:5-6, s. 160-167 Journal article (peer-reviewed)abstract Contextualization of post-surgery circumstances in terms of key behaviours and emotions related to eating is crucial for reliable screening. Disordered eating post surgery is characterized by frequent snacking and a sense of loss of control over food intake. The purpose of this study was to evaluate the psychometric properties of a short self-report questionnaire entitled Disordered Eating after Bariatric Surgery (DEBS). Results indicate that the DEBS possesses satisfactory psychometric properties in terms of reliability, validity, internal consistency and test–retest reliability. The DEBS may facilitate both systematic clinical evaluation and future research within the area of bariatric surgery.
27.	Weineland, Sandra, et al. (author) Development and validation of a new questionnaire measuring eating disordered behaviours post bariatric surgery. 2012 In: Clinical obesity. - : Wiley. - 1758-8103 .- 1758-8111. ; 2:5-6, s. 160-7 Journal article (peer-reviewed)abstract Contextualization of post-surgery circumstances in terms of key behaviours and emotions related to eating is crucial for reliable screening. Disordered eating post surgery is characterized by frequent snacking and a sense of loss of control over food intake. The purpose of this study was to evaluate the psychometric properties of a short self-report questionnaire entitled Disordered Eating after Bariatric Surgery (DEBS). Results indicate that the DEBS possesses satisfactory psychometric properties in terms of reliability, validity, internal consistency and test-retest reliability. The DEBS may facilitate both systematic clinical evaluation and future research within the area of bariatric surgery.
28.	Welch, Elisabeth, et al. (author) Body Shape Questionnaire : Psychometric properties of the short version (BSQ-8C) and norms from the general Swedish population. 2012 In: Body image. - : Elsevier BV. - 1740-1445 .- 1873-6807. ; 9:4, s. 547-50 Journal article (peer-reviewed)abstract There is a need for brief, sensitive, and reliable instruments for contextual assessment of body dissatisfaction. Suitable selection and optimal use of psychological assessment instruments requires appropriate psychometric as well as normative data. Two studies were conducted to investigate the psychometric properties and collect general population norms for a short, eight item version of the Body Shape Questionnaire (BSQ-8C). In the first study, a sample of undergraduate students (N=182) was recruited to investigate the psychometric properties of the BSQ-8C, while in the second study a sample from the general population of Swedish women aged 18-30 years (N=747) was used to collect norms. The test-retest reliability, internal consistency, and convergent validity for BSQ-8C were high. Given the questionnaire's briefness and good psychometric properties, particularly when used in conjunction with norms, the BSQ-8C is considered a valuable instrument for measuring body shape dissatisfaction among young adult women.
29.	Welch, Elisabeth, et al. (author) Eating Disorder Examination Questionnaire and Clinical Impairment Assessment Questionnaire : General population and clinical norms for young adult women in Sweden 2011 In: Behaviour Research and Therapy. - : Elsevier BV. - 0005-7967 .- 1873-622X. ; 49:2, s. 85-91 Journal article (peer-reviewed)abstract Optimal use of assessment instruments for the detection and diagnosis of eating disorders (ED) depends on the availability of normative data. The aim of this work was to, for the first time, collect norms for both the Eating Disorder Examination Questionnaire (EDE-Q) and the newly developed Clinical Impairment Assessment (CIA) Scale from a general population of young women in Sweden, as well as from a clinical population of ED patients in Sweden. Participants were composed of both a randomized sample from the general population of women aged 18-30 years (N = 760) as well as from a clinical population aged 18-66 years (N = 2383). Data for the clinical population was extracted from the Stepwise database. Mean scores, standard deviations and percentile ranks for the global for the EDE-Q (as well as its subscales) and the CIA are presented. Prevalence figures of key eating disorder behaviors are also reported. Comparisons are made between the results in the present study with other existing normative studies on the EDE-Q and the CIA. The present study contributes to improving the accuracy of the interpretation of scores of the widely used self-report measure of ED, the EDE-Q, and the CIA, both of which play important roles in for diagnosis, prevention and intervention of ED.
30.	Welch, Elisabeth (author) Eating Disorders : Steps Towards an Increased Understanding 2014 Doctoral thesis (other academic/artistic)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.
31.	Westerberg-Jacobson, Josefin, 1970-, et al. (author) A longitudinal study of motives for wishing to be thinner and weight-control practices in 7-to 18-year-old Swedish girls 2012 In: European eating disorders review. - : Wiley. - 1072-4133 .- 1099-0968. ; 20:4, s. 294-302 Journal article (peer-reviewed)abstract The main aim of this seven-year longitudinal study, of 411 Swedish pre-adolescent girls, (aged 7–11 years, Year 1) was to examine a wish to be thinner, dieting attempts, described motives for wishing to be thinner, and weight-control practices. A further aim was to examine to what extent BMI accounted for motives for wishing to be thinner and weight control practices. A wish to be thinner and dieting attempts increased significantly with increasing age between the ages of 9 and18. The most frequently reported motive for wishing to be thinner was to “feel better about yourself”. Categories that emerged from the qualitative analysis of self-described motives for the wish to be thinner were for example to “correspond to the societal ideal” and to “wear particular clothes”. A majority of the girls adopted weight control practices that would be considered as healthy, but extreme weight control practices increased with age. Girls with BMIs over the 75th percentile reported a greater number of motives for wishing to be thinner and used extreme weight control practices significantly more often than the other girls. However, of the girls who changed BMI from above the 75th percentile to under the 75th percentile, 34.1% reported that they had not used any weight control practices at all. Our results show that girls at a very early age are aware of the ‘thin’ ideal in our society, wish to be thinner, and try to lose weight. The results point to the importance of detecting girls who wish to be thinner as early as possible. If we can employ preventive action in time it is possible that dieting behavior will never develop. By considering the motives for wishing to be thinner, preventive efforts might be perceived as more meaningful and relevant to the girls at risk of developing eating disorders.
32.	Westerberg-Jacobson, Josefin, 1970-, et al. (author) Risk and Protective Factors for Disturbed Eating : A 7-Year Longitudinal Study of Eating Attitudes and Psychological Factors in Adolescent Girls and their Parents 2010 In: Eating and Weight Disorders. - 1124-4909 .- 1590-1262. ; 15:4, s. e208-e218 Journal article (peer-reviewed)abstract The aims of this seven-year longitudinal study of 228 girls (9 and 13 year olds) were 1) to examine the predictive value of eating attitudes, a wish to be thinner, dieting, perfectionism, self-esteem and Body Mass Index; 2) to examine the girls’ parents’ eating attitudes and perfectionism in relation to the development of disturbed eating attitudes, seven years later; and 3) to examine whether normal body weight, healthy eating attitudes and low perfectionism together with high self-esteem might operate as protective factors for the later development of disturbed eating attitudes. The pre-adolescent girls (9-year olds) “wish to be thinner” and fathers’ EAT scores contributed most to the prediction of disturbed eating attitudes seven years later. Corresponding analysis for the adolescent girls (13-year olds) showed that a “wish to be thinner” and mothers’ rating on perfectionism contributed most to the prediction of disturbed eating attitudes seven years later. Protective factors were low BMI and more healthy eating attitudes - especially moderated by high self-esteem, and a low-to-medium degree of perfectionism. High self-esteem appeared to be a protective factor when the girls had a high degree of perfectionism. These results suggest that it is important to focus on healthy eating attitudes at home to prevent overweight in early childhood, enhance self-esteem and to take a critical stand toward the thinness ideal in our society.
33.	Westerberg Jacobson, Josefin, 1970- (author) Wish to be thinner : Development and Prediction of Disturbed Eating: A Longitudinal Study of Swedish Girls and Young Women 2010 Doctoral thesis (other academic/artistic)abstract The overall aim of this thesis was to examine the development and prediction of disturbed eating attitudes in girls aged 7–20 years. The four studies are part of a seven-year longitudinal project including 1279 girls in several age groups (7, 9, 11, 13, 15 years at inclusion) and their parents. Study I showed that among girls aged 11 and 13 years, in addition to a positive relation between disturbed eating attitudes and age, eating attitudes, higher BMI than peers, a less healthy relation to family, and fathers’ eating attitudes, predicted disturbed eating attitudes two years later. Study II demonstrated that girls aged 9–15 years, who wished to be thinner dieted more often, thought that they would be more popular if they were thinner, were skipping meals more often and had a higher BMI, over five years, compared with the girls without such a wish. Study III demonstrated an increasing trend in the wish to be thinner and dieting attempts between the ages of 9 and 18 years. Motives for wishing to be thinner were, e.g., “to feel better about yourself” and “to correspond to the societal ideal”. A majority of the girls adopted healthy weight control practices, but unhealthy and extreme methods were also used. In Study IV, among girls aged 9 and 13 years, a wish to be thinner, fathers’ eating attitudes and mothers’ perfectionism contributed most to the prediction of disturbed eating attitudes seven years later. Protective factors were low BMI and more healthy eating attitudes moderated by high self-esteem, and low-to-medium degree of perfectionism. In conclusion a wish to be thinner, higher BMI than peers, girls’ and fathers’ disturbed eating attitudes, mothers’ perfectionism and a less healthy relation to family predict the development of disturbed eating attitudes in girls. Low BMI and more healthy eating attitudes especially influenced by high self-esteem, and a low-to-medium degree of perfectionism protect against it. The “thin-ideal” is internalized early in girls and it is important to take a critical stand against the thinness ideal in our society, especially in families, and schools.

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