| 1. |
- Menkveld, Albert J., et al.
(författare)
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Nonstandard Errors
- 2024
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Ingår i: JOURNAL OF FINANCE. - : Wiley-Blackwell. - 0022-1082 .- 1540-6261. ; 79:3, s. 2339-2390
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Tidskriftsartikel (refereegranskat)abstract
- In statistics, samples are drawn from a population in a data-generating process (DGP). Standard errors measure the uncertainty in estimates of population parameters. In science, evidence is generated to test hypotheses in an evidence-generating process (EGP). We claim that EGP variation across researchers adds uncertainty-nonstandard errors (NSEs). We study NSEs by letting 164 teams test the same hypotheses on the same data. NSEs turn out to be sizable, but smaller for more reproducible or higher rated research. Adding peer-review stages reduces NSEs. We further find that this type of uncertainty is underestimated by participants.
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| 2. |
- Andersson, Claes, et al.
(författare)
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Academic self-efficacy : Associations with self-reported COVID-19 symptoms, mental health, and trust in universities' management of the pandemic-induced university lockdown
- 2022
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Ingår i: Journal of American College Health. - : Informa UK Limited. - 0744-8481 .- 1940-3208.
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate perceived changes in academic self-efficacy associated with self-reported symptoms of COVID-19, changes in mental health, and trust in universities’ management of the pandemic and transition to remote education during lockdown of Swedish universities in the spring of 2020. Methods: 4495 participated and 3638 responded to self-efficacy questions. Associations were investigated using multinomial regression. Results: Most students reported self-experienced effects on self-efficacy. Lowered self-efficacy was associated with symptoms of contagion, perceived worsening of mental health and low trust in universities’ capacity to successfully manage the lockdown and transition to emergency remote education. Increased self-efficacy was associated with better perceived mental health and high trust in universities. Conclusion: The initial phase of the pandemic was associated with a larger proportion of students reporting self-experienced negative effects on academic self-efficacy. Since self-efficacy is a predictor of academic performance, it is likely that students’ academic performance will be adversely affected.
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| 3. |
- Andersson, Claes, et al.
(författare)
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Does the management of personal integrity information lead to differing participation rates and response patterns in mental health surveys with young adults? A three-armed methodological experiment
- 2021
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Ingår i: International Journal of Methods in Psychiatric Research. - : John Wiley & Sons. - 1049-8931 .- 1557-0657. ; 30:4
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: This study evaluates whether initiation rates, completion rates, response patterns and prevalence of psychiatric conditions differ by level of personal integrity information given to prospective participants in an online mental health self-report survey.Methods: A three-arm, parallel-group, single-blind experiment was conducted among students from two Swedish universities. Consenting participants following e-mail invitation answered the World Health Organization (WHO) World Mental Health-International College Student (WMH-ICS) mental health self-report survey, screening for eight psychiatric conditions. Random allocation meant consenting to respond (1) anonymously; (2) confidentially, or (3) confidentially, where the respondent also gave consent for collection of register data.Results: No evidence was found for overall between-group differences with respect to (1) pressing a hyperlink to the survey in the invitation email; and (2) abandoning the questionnaire before completion. However, participation consent and self-reported depression were in the direction of higher levels for the anonymous group compared to the two confidential groups.Conclusions: Consent to participate is marginally affected by different levels of personal integrity information. Current standard participant information procedures may not engage participants to read the information thoroughly, and online self-report mental health surveys may reduce stigma and thus be less subject to social desirability bias.
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| 4. |
- Berman, Anne H., Professor, et al.
(författare)
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Compliance with recommendations limiting COVID-19 contagion among university students in Sweden : associations with self-reported symptoms, mental health and academic self-efficacy
- 2022
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Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 50:1, s. 70-84
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Tidskriftsartikel (refereegranskat)abstract
- Aims: The COVID-19 containment strategy in Sweden uses public health recommendations relying on personal responsibility for compliance. Universities were one of few public institutions subject to strict closure, meaning that students had to adapt overnight to online teaching. This study investigates the prevalence of self-reported recommendation compliance and associations with self-reported symptoms of contagion, self-experienced effects on mental health and academic self-efficacy among university students in Sweden in May–June 2020.Methods: This was a cross-sectional 23 question online survey in which data were analysed by multinomial regression, taking a Bayesian analysis approach complemented by null hypothesis testing.Results: A total of 4495 students consented to respond. Recommendation compliance ranged between 70% and 96%. Women and older students reported higher compliance than did men and younger students. Mild to moderate COVID-19 symptoms were reported by 30%, severe symptoms by fewer than 2%; 15% reported being uncertain and half of the participants reported no symptoms. Mental health effects were reported by over 80%, and changes in academic self-efficacy were reported by over 85%; in both these areas negative effects predominated. Self-reported symptoms and uncertainty about contagion were associated with non-compliance, negative mental health effects, and impaired academic self-efficacy.Conclusions: Students generally followed public health recommendations during strict closure of universities, but many reported considerable negative consequences related to mental health and academic self-efficacy. Digital interventions should be developed and evaluated to boost coping skills, build resilience and alleviate student suffering during the pandemic and future similar crises.
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| 5. |
- Berman, Anne H, et al.
(författare)
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National assessment and e-health interventions for mental health problems among university students : Swedish partnership in the WHO-World Mental Health International College Student (WHM- ICS) consortium
- 2021
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Ingår i: International journal of behavioral medicine : official journal of the International Society of Behavioral Medicine. - : Springer Nature. ; , s. S101-S101
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background: The life transition between late adolescence and emerg- ing adulthood is often troubled, with one in three university students showing symptoms of depression and anxiety. Help-seeking behavior is low due to emotional and practical barriers, generating a treatment gap. The purpose of this project is to map Swedish university stu- dents’ mental health problems and deliver e-health interventions to those at risk, thus reducing the treatment gap. The project is the first in a Swedish partnership with the WHO WMH-ICS 20-country international consortium.Methods: The project is organized in four work packages (WPs) over four years, beginning in 2020. An annual epidemiological survey targeting first-year students will map mental health problems and disor- ders, including suicidal thoughts and behaviors (WP1), and annual follow-up surveys will track participants’ developmental trajectories in terms of persisting problems and help-seeking behavior (WP2). Students identified as at-risk will be offered participation in a three-arm random- ized controlled trial (RCT), delivering guided or unguided transdiagnostic e-treatment, or treatment as usual in a control group (WP3). At 5-week follow-up, participants at higher risk of failing treatment according to a precision treatment algorithm will be randomized to personally adapted e- treatment or continued WP3 treatment in a secondary trial-within-trial (WP4). WP1 will begin in the spring of 2020 with a pilot survey at selected Swedish universitiesResults: We anticipate being able to present preliminary pilot survey results.Conclusions and implications: We envisage high potential for reducing mental health problems among Swedish university students, improving academic performance and reducing dropout.
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| 6. |
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| 7. |
- Berman, Anne H., Professor, et al.
(författare)
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Transdiagnostic and tailored internet intervention to improve mental health among university students : Research protocol for a randomized controlled trial
- 2024
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Ingår i: Trials. - : Springer Nature. - 1745-6215. ; 25:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Emerging adulthood is often associated with mental health problems. About one in three university students report symptoms of depression and anxiety that can negatively affect their developmental trajectory concerning work, intimate relationships, and health. This can interfere with academic performance, as mood and anxiety disorders are key predictors of dropout from higher education. A treatment gap exists, where a considerable proportion of students do not seek help for mood and anxiety symptoms. Offering internet interventions to students with mental health problems could reduce the treatment gap, increase mental health, and improve academic performance. A meta-analysis on internet interventions for university students showed small effects for depression and none for anxiety. Larger trials are recommended to further explore effects of guidance, transdiagnostic approaches, and individual treatment components.Methods: This study will offer 1200 university students in Sweden participation in a three-armed randomized controlled trial (RCT) evaluating a guided or unguided transdiagnostic internet intervention for mild to moderate depression and anxiety, where the waitlist control group accesses the intervention at 6-month follow-up. Students reporting suicidal ideation/behaviors will be excluded and referred to treatment within the existing healthcare system. An embedded study within the trial (SWAT) will assess at week 3 of 8 whether participants in the guided and unguided groups are at higher risk of failing to benefit from treatment. Those at risk will be randomized to an adaptive treatment strategy, or to continue the treatment as originally randomized. Primary outcomes are symptoms of depression and anxiety. Follow-ups will occur at post-treatment and at 6-, 12-, and 24-month post-randomization. Between-group outcome analyses will be reported, and qualitative interviews about treatment experiences are planned.Discussion: This study investigates the effects of a transdiagnostic internet intervention among university students in Sweden, with an adaptive treatment strategy employed during the course of treatment to minimize the risk of treatment failure. The study will contribute knowledge about longitudinal trajectories of mental health and well-being following treatment, taking into account possible gender differences in responsiveness to treatment. With time, effective internet interventions could make treatment for mental health issues more widely accessible to the student group.
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| 8. |
- Fagernäs, Simon, et al.
(författare)
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What do users think about Virtual Reality relaxation applications? A mixed methods study of online user reviews using natural language processing
- 2021
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Ingår i: Internet Interventions. - : Elsevier BV. - 2214-7829. ; 24
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Tidskriftsartikel (refereegranskat)abstract
- The advent of affordable Virtual Reality (VR) technology has spurred consumer and commercial interest in VR relaxation applications, which has quickly grown into a popular non-gaming genre on digital marketplaces. While laboratory studies have demonstrated efficacy of VR relaxation for mental health purposes, little is known about how users experience this type of intervention and no study has examined the reception of consumer versions among regular users in everyday life. Studying published user reviews offers a unique window into naturalistic user experiences that complements traditional qualitative methods by circumventing the sampling bias of interview studies, and allowing analyses on full samples, unconstrained by coding resources. Using an innovative, semi-automated Natural Language Processing technique, the current study analyzed 1379 published reviews (including star ratings) of 30 different VR relaxation applications available for the Oculus Go and Gear VR. The uncovered topic structure and sentiment analysis thereof suggests that users have an overall positive view of VR relaxation applications, describing them as successful in inducing immersion and relaxation, and having appreciated gamification elements. However, perceived quality varied substantially between applications that explained more variance in star ratings than specific features. Critical issues raised were both technical (e.g. “overheating”) in nature and related to specific design elements and use. Implications for the design of consumer VR applications and future research are discussed.
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| 9. |
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| 10. |
- Forsström, David, et al.
(författare)
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Further Exploration of the Psychometric Properties of GamTest : A Rasch Analysis
- 2021
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1661-7827 .- 1660-4601. ; 18:9
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Tidskriftsartikel (refereegranskat)abstract
- GamTest is a self-rating scale of negative consequences of gambling, included in the popular responsible gambling tool Playscan as part of an overall risk assessment and feedback feature. Two previous psychometric evaluations of this instrument yielded contradictory results: in an online high-gambling population, a five-factor model was supported and the instrument had overall good psychometric properties, but in a low-gambling population, the same factor structure was not supported. Because GamTest is used with both low- and high-gambling populations, more psychometric research is needed to fully understand how the instrument works. The current study examined, for the first time, psychometric performance among a sample of low-gambling respondents using a Rasch analysis. Results indicated that the instrument could be improved by decreasing the scale-steps and removing several problematic items demonstrating misfit. Furthermore, the findings indicated that some items functioned differently depending on gender, and that a shortened, improved nine-item version could not differentiate between different levels of risk. Our findings suggest that the instrument would arguably benefit from being adapted for use in a low-gambling population.
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| 11. |
- Forsström, David, et al.
(författare)
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Gamblers' Perception of the Playscan Risk Assessment : A Mixed-Methods Study
- 2022
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Ingår i: Journal of Gambling Studies. - : Springer Science and Business Media LLC. - 1050-5350 .- 1573-3602. ; 38:2, s. 591-606
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Tidskriftsartikel (refereegranskat)abstract
- Responsible gambling (RG) tools are globally widespread; they aim to prevent or decrease the harm caused by gambling. However, existing research suggests that several included features do not decrease gambling or significantly reduce the subsequent harm. Most of the previous studies have used gambling data to understand the changes in gambling behavior. However, the literature lacks research regarding gamblers' experience and perception of RG tools, which may provide insight into increasing the usage and effectiveness of RG tools. This mixed-methods study aimed to explore gamblers' perception of their risk assessment in the RG tool Playscan regarding developing harmful gambling problems. Overall, 757 participants rated the perceived accuracy of their risk assessment and their perception of the overall RG tool that conducted the assessment. Participants were also allowed to leave a comment providing feedback, which was analyzed using thematic analysis. Quantitative data was analyzed using logistic regression and structural equation modeling. Qualitative analyses revealed that most of the participants were pleased with the risk assessment and found it helpful. Moderated mediation analysis showed that participants' assessment agreement partially mediated the association between expressing a negative view and their general view of Playscan. These results highlight the need to decrease the level of disagreement for promoting a better general view of RG tools to potentially increase their usage and effectiveness.
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| 12. |
- Forsström, David, et al.
(författare)
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GamTest : Psychometric Evaluation in a Low-Gambling General Population
- 2020
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Ingår i: Journal of Gambling Issues. - Toronto : Concurrent Disorders Society Press. - 1910-7595. ; 44, s. 77-102
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Tidskriftsartikel (refereegranskat)abstract
- Instruments that investigate different aspects of gambling activities are needed to distinguish negative consequences. Because gambling is a complex activity that occurs both offline and online, different questionnaires are necessary for screening and risk classification. GamTest, an instrument used by several gambling companies, was designed to cover different aspects of gambling: money and time spent, as well as social, financial, and emotional consequences. This study explores GamTest’s psychometric properties in a general population. A total of 2,234 Swedish respondents completed an online survey containing demographic questions, the questionnaire (GamTest), and the Problem Gambling Severity Index (PGSI). A confirmatory factor analysis was performed and GamTest’s reliability and validity tested. The confirmatory factor analysis yielded an inclusive fit. The internal consistency (omega) for the five factors was high (.79–.91), indicating good reliability, and a high positive correlation with the PGSI supported the validity of the GamTest. The inclusive fit of the confirmatory factor analysis can be explained by the low endorsement of negative consequences of gambling in the sample. However, GamTest seems to have good reliability and validity. The utility of GamTest is discussed in relation to its psychometric properties and its use in the responsible gambling tool Playscan.
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| 13. |
- Forsström, David, 1981-, et al.
(författare)
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Isolation and worry in relation to gambling and onset of gambling among psychiatry patients during the COVID-19 pandemic : A mediation study
- 2022
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Ingår i: Frontiers in Psychology. - : Frontiers Media SA. - 1664-1078. ; 13
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Tidskriftsartikel (refereegranskat)abstract
- When the COVID-19 pandemic started spreading globally, there was a fear that addictive behaviors would increase due to changes in everyday life caused by restrictions due to COVID-19. Studies were carried out to explore if this was true for gambling, typically revealing no overall increase in gambling behavior, although individuals who had previous experience with gambling problems were more likely to increase gambling during the pandemic. However, these studies only included individuals with previous gambling problems. It remains unknown whether other vulnerable groups, such as individuals with common mental disorders increased their gambling. This study aimed to explore the level of gambling problems among individuals with a history of mental disorders, namely, (i) pre-pandemic gamblers and (ii) pandemic-onset gamblers. Furthermore, we explored if worry and isolation mediate gambling and problem gambling. The data were analyzed using descriptive statistics and a structural equation model to investigate mediation. The results showed a high prevalence of at-risk and problem gambling in both groups. The pre-pandemic gamblers had a high level of at-risk and problem gambling. Furthermore, the individuals that started to gamble during the pandemic had an even higher degree of at-risk and problem gambling. The mediation showed that the onset of gambling was linked with the worry of COVID-infection and that worry predicted the level of gambling problems. This study highlights that vulnerability factors, isolation, and worry can be triggers for individuals with common mental disorders to engage in gambling as well as the importance of screening this population for gambling problems.
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| 14. |
- Forsström, David, 1981-, et al.
(författare)
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Psychometric properties of the Jonsson-Abbott Scale : Rasch and confirmatory factor analyses
- 2022
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Ingår i: Frontiers in Psychology. - : Frontiers Media SA. - 1664-1078. ; 13
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Tidskriftsartikel (refereegranskat)abstract
- Measuring and assessing the different aspects of gambling behavior and its consequences is crucial for planning prevention, treatment, and understanding the development of at-risk and problem gambling. Studies indicate that instruments measuring problem gambling produce different results based on the characteristics of the population assessed. To accurately measure at-risk and problem gambling behavior, especially in a low-risk population, measures must cover a wider set of dimensions than the negative consequences already manifest. The Jonsson-Abbott Scale (JAS) includes items that cover overconsumption, actions that reinforce gambling behavior, and belief in gambling fallacies, based on a three-factor structure and has previously demonstrated good psychometric properties. However, there is a need to investigate how the instrument also functions in low-risk populations. This study aims to do so using both confirmatory factor and Rasch analysis; this research included 1,413 Swedish participants who endorsed at least one JAS item. The results replicated the previous three-factor solution and indicated that the instrument had good reliability. In addition, the results demonstrated that the three factors are independent, and the overall score per factor needs to be analyzed. In summary, the JAS appears suitable for use in low-risk populations to measure various aspects of gambling behavior.
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| 15. |
- Hlynsson, Jón Ingi, et al.
(författare)
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Exploring cutoff points and measurement invariance of the Brunnsviken brief quality of life inventory
- 2024
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Ingår i: Frontiers in Psychology. - 1664-1078. ; 14
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Quality of life (QoL) can be defined as the goodness of life, beyond simply absence of disease or functional impairments, self-rating scales of which capture valuable information beyond change in primary outcomes. This study (n = 3,384) validated the Brunnsviken Brief Quality of Life Inventory (BBQ) across divergent groups by evaluating its measurement invariance (MI). We hypothesized measurement invariance for the BBQ across age groups, genders, depression, and anxiety severity. Potential cutoff points for the BBQ were also explored.Method: Confirmatory factor analysis (CFA) models were fit to sample data obtained from an ongoing study on transdiagnostic internet-based treatment modules. Parameters were successively constrained to assess configural, metric, scalar, and residual invariance factor structures across different groups.Results: The BBQ demonstrated MI at the metric level and partial MI at the scalar level across all these groups, which remained stable at the strict-residual level for all groups except for genders. These results remained stable after correcting for unbalanced group sizes for gender, clinical–subclinical levels of depression, and clinical–subclinical levels of anxiety. A cutoff point analysis revealed that a BBQ total scores below 39 was associated with notable psychopathology.Discussion: The BBQ is a reliable measure of QoL that is applicable for various divergent groups (e.g., vulnerable persons), and thus a viable instrument for use in healthcare and research with minimal aversive impact.Clinical trial registration: NCT05016843.
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| 16. |
- Hlynsson, Jón Ingi, et al.
(författare)
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Let's talk about digital mental health assessment : Utilizing PHQ-2 and GAD-2 for in-treatmentmonitoring & BBQ and QWB for outcome evaluation in internet interventions
- 2024
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Ingår i: SweSRII 2024. ; , s. 14-14
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Konferensbidrag (refereegranskat)abstract
- INTRODUCTION: In internet-based mental health research, the efficacy of assessment tools is pivotal. Extensive questionnaires often deter participant completion, undermining data integrity. This presentation focuses on the application of brief yet effective measures: The PHQ-2 and GAD-2 as ultra-brief measures for psychopathology, and Brunnsviken brief quality of life inventory (BBQ) and Questionnaire on Well-Being (QWB) as positively valanced measures for positive functioning. By prioritizing instruments with concise formats and positive framing, such as the BBQ and QWB, our research aims to enhance response rates and data quality. We explore psychometric findings from various internet-based trials, demonstrating the utility of these measures in capturing in-treatment fluctuations and informing treatment outcomes. METHOD: We outline findings from three studies at different stages of development. Primary statistics are obtained from ROC curve and factor analyses. RESULTS: Preliminary results suggest that brief measures like the PHQ-2 and GAD-2 can monitor in-treatment fluctuations in symptoms as effectively as their full-scale equivalents. The BBQ, indicating positive functioning, can validly assess divergent subgroups (e.g., vulnerable persons). Notably, BBQ total scores below 39 are linked with significant psychopathology. Preliminary results for the QWB indicate total scores are negatively associated with psychopathology and positively correlated with positive affect. CONCLUSIONS: Ultra-brief measures of psychopathology are too often used incorrectly; usage is recommended to be bound to in-treatment monitoring of treatment outcomes. Collecting data more frequently through concise surveys can provide insights into the mechanisms driving change. Treatment trials often overlook positive functioning. Thus, we encourage using the BBQ and QWB as they are psychometrically valid, freely available, and inform treatment outcomes beyond standard measures of psychopathology.
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| 17. |
- Ilioudi, Maria, 1993, et al.
(författare)
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Patient experience of a virtual reality calm room in a psychiatric inpatient care setting in Sweden: a qualitative study with inpatients
- 2023
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Ingår i: BMJ open. - 2044-6055. ; 13:12
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Calm rooms have been developed and implemented in psychiatric inpatient care settings to offer patients a dedicated space for relaxation in a convenient and safe environment. Recent technology developments have enabled virtual reality (VR) equivalents of calm rooms that can be feasibly deployed in psychiatric care settings. While research has shown VR environments to be efficacious in inducing relaxation, little is known how these virtual calm rooms are perceived by patients. The aim of this study was to elucidate patient experiences of using a VR calm room in a psychiatric inpatient setting. DESIGN: Qualitative interview study. Semi-structured interviews were analysed using qualitive inductive content analysis, which focuses on the interpretation of texts for making replicable and valid inferences. SETTING: Swedish hospital psychiatric inpatient care setting with a wireless, three degrees-of-freedom VR head-mounted display running a calm room application simulating nature environment. PARTICIPANTS: 20 adult patients (12women) with bipolar disorder (n=18) or unipolar depression (n=2). RESULTS: Participants experienced the use of the VR calm room as having a positive impact on them, inducing awareness, calmness and well-being. They were thankful to be offered a non-pharmacological alternative for anxiety relief. Participants also expressed that they had some concerns about how they would react emotionally before using the VR device. However, after use, they highlighted that their overall experience was positive. They also expressed that they could see potential for further development of VR technology in psychiatric care. CONCLUSIONS: VR technology has the potential to solve pressing logistic issues in offering calm rooms in psychiatric inpatient care. VR calm rooms appear to be appreciated by psychiatric inpatients, who value their accessibility, convenience and variety of modalities offered. Participants perceived an increase in their well-being after use.
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| 18. |
- Ivanova, Ekaterina, 1987-
(författare)
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Responsible provision of online gambling : Effects, usability and gamblers’ experiences of protective measures implemented in online gambling environments
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Problem gambling is considered a public health problem in many countries and is associated with serious financial and health-related harms for both problem gamblers and significant others. It is possible to create gambling environments that would promote sustainable gambling behaviors and prevent excessive gambling. However, research on the effectiveness of tools for responsible provision of gambling is scarce and the quality of the research is low. Also, there exists a conflict of interest between making a profit when providing gambling and protecting vulnerable customers. The general aim of the project was to study the effects, usability and gamblers’ experiences of tools for responsible provision of online gambling. Study I evaluated the effects of a prompt to set voluntary deposit-limit of optional size among 4,328 customers of an online gambling platform. During the data collection period, all customers from Finland registering an account on the gambling platform were randomized into being prompted to set a deposit-limit either 1) at-registration, 2) before their first deposit, 3) after their first deposit or 4) to an unprompted control group. Gambling intensity, measured with aggregated net loss, was tracked during 90 days after registration. No differences in gambling intensity between the intervention and control groups were found neither on the whole-group level (B (95% CI) =-0.080 (-0.229-0.069), p=.291), nor in the subgroup of the most involved gamblers (B (95% CI) =0.042(-0.359-0.442), p=.838). Study II aimed at predicting gaming freeze (as a proxy parameter for problem gambling) in online gamblers. For the sample of N=2,618 (N=1,309 freezers), a total of 105 predictors were created based on the data tracked by the gambling platform. The analysis was carried out using the machine learning method Random Forest. The predictive accuracy of the model applied to the dataset was 0.615, with a specificity of 0.686 and a sensitivity of 0.543. Study III aimed at investigating non-problem gamblers’ experiences of protective measures. A total of N=10,200 active customers of an online gambling platform were asked to rate their previous experiences of protective tools, their inclination to abandon a gambling service due to perceived overexposure to protective measures and answer questions on their symptoms of problem gambling. N=1,223 responded to the questionnaire, with the majority of the sample being moderate-risk gamblers (38.5%), followed by low-risk gamblers (26.8%), non-problem gamblers (18.9%) and problem gamblers (15.8%). In general, non-problem gamblers were not more disturbed by protective measures than other categories of gamblers. More problem gamblers have previously abandoned a gambling service due to perceived overexposure to protective measures compared to non-problem gamblers (OR(95% CI)= 7.17(3.61-14.23), p<.001). In conclusion, a prompt to set a voluntary deposit-limit of optional size did not appear to be effective in decreasing gambling intensity in online gamblers, indicating the need of evaluating alternative designs. Predicting gaming freezes in the current project resulted in a low accuracy, indicating that gaming freeze is not suitable as a proxy measurement for problem gambling and suggesting the need for collecting subjective data on symptoms of problem gambling. The results of Study III suggest that protective measures can be tested and implemented without the risk of disturbing recreational gamblers.
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| 19. |
- J. Erliksson, Olivia, et al.
(författare)
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Measuring associations between social anxiety and use of different types of social media using the Swedish Social Anxiety Scale for Social Media Users : A psychometric evaluation and cross-sectional study
- 2020
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Ingår i: Scandinavian Journal of Psychology. - : Wiley. - 0036-5564 .- 1467-9450. ; 61:6, s. 819-826
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Tidskriftsartikel (refereegranskat)abstract
- Research on the association between social anxiety and social media usage remains inconclusive: despite the preference for computer-mediated communication there is currently no clear empirical support for social anxiety being associated with longer duration of social media use. Self-report measures for social anxiety that are adapted for the context of social media could facilitate further research. The current study aimed to develop a Swedish version of the recently developed Social Anxiety Scale for Social Media Users (SAS-SMU), evaluate its psychometric properties, and explore associations between different uses of social media and social anxiety. Three factors were retained for SAS-SMU with excellent internal consistency. SAS-SMU evidenced convergent validity with measures of social anxiety, negative convergent validity with satisfaction with life, and divergent validity with measures of obsessive-compulsive disorder, depression and generalized anxiety disorder. Results indicated that higher levels of social anxiety were associated with passive and active use as well as longer duration of social media use in general, which is at odds with a previous study where passive use remained the only significant predictor for social anxiety.
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| 20. |
- Johansson, Magnus, et al.
(författare)
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Effects of Internet-Based Cognitive Behavioral Therapy for Harmful Alcohol Use and Alcohol Dependence as Self-help or With Therapist Guidance : Three-Armed Randomized Trial
- 2021
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Ingår i: Journal of Medical Internet Research. - : JMIR Publications. - 1438-8871. ; 23:11
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Alcohol use is a major contributor to health loss. Many persons with harmful use or alcohol dependence do not obtain treatment because of limited availability or stigma. They may use internet-based interventions as an alternative way of obtaining support. Internet-based interventions have previously been shown to be effective in reducing alcohol consumption in studies that included hazardous use; however, few studies have been conducted with a specific focus on harmful use or alcohol dependence. The importance of therapist guidance in internet-based cognitive behavioral therapy (ICBT) programs is still unclear.OBJECTIVE: This trial aims to investigate the effects of a web-based alcohol program with or without therapist guidance among anonymous adult help-seekers.METHODS: A three-armed randomized controlled trial was conducted to compare therapist-guided ICBT and self-help ICBT with an information-only control condition. Swedish-speaking adult internet users with alcohol dependence (3 or more International Classification of Diseases, Tenth Revision criteria) or harmful alcohol use (alcohol use disorder identification test>15) were included in the study. Participants in the therapist-guided ICBT and self-help ICBT groups had 12-week access to a program consisting of 5 main modules, as well as a drinking calendar with automatic feedback. Guidance was given by experienced therapists trained in motivational interviewing. The primary outcome measure was weekly alcohol consumption in standard drinks (12 g of ethanol). Secondary outcomes were alcohol-related problems measured using the total alcohol use disorder identification test-score, diagnostic criteria for alcohol dependence and alcohol use disorder, depression, anxiety, health, readiness to change, and access to other treatments or support. Follow-up was conducted 3 (posttreatment) and 6 months after recruitment.RESULTS: During the recruitment period, from March 2015 to March 2017, 1169 participants were included. Participants had a mean age of 45 (SD 13) years, and 56.72% (663/1169) were women. At the 3-month follow-up, the therapist-guided ICBT and control groups differed significantly in weekly alcohol consumption (-3.84, 95% Cl -6.53 to -1.16; t417=2.81; P=.005; Cohen d=0.27). No significant differences were found in weekly alcohol consumption between the self-help ICBT group and the therapist-guided ICBT at 3 months, between the self-help ICBT and the control group at 3 months, or between any of the groups at the 6-month follow-up. A limitation of the study was the large number of participants who were completely lost to follow-up (477/1169, 40.8%).CONCLUSIONS: In this study, a therapist-guided ICBT program was not found to be more effective than the same program in a self-help ICBT version for reducing alcohol consumption or other alcohol-related outcomes. In the short run, therapist-guided ICBT was more effective than information. Only some internet help-seekers may need a multisession program and therapist guidance to change their drinking when they use internet-based interventions.TRIAL REGISTRATION: ClinicalTrials.gov NCT02377726; https://clinicaltrials.gov/ct2/show/NCT02377726.
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| 21. |
- Johansson, Magnus, et al.
(författare)
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Internet-based therapy versus face-to-face therapy for alcohol use disorder, a randomized controlled non-inferiority trial
- 2021
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Ingår i: Addiction. - : John Wiley & Sons. - 0965-2140 .- 1360-0443. ; 116:5, s. 1088-1100
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Tidskriftsartikel (refereegranskat)abstract
- Background and aimsMost people with alcohol use disorder (AUD) are never treated. Internet-based interventions are effective in reducing alcohol consumption and could help to overcome some of the barriers to people not seeking or receiving treatment. The aim of the current study was to compare internet-delivered and face-to-face treatment among adult users with AUD.DesignRandomized controlled non-inferiority trial with a parallel design, comparing internet-delivered cognitive–behavioural therapy (ICBT) (n = 150) with face-to-face CBT (n = 151), at 3- and 6-month follow-ups.SettingA specialized clinic for people with AUD in Stockholm, Sweden. Participants were recruited between 8 December 2015 and 5 January 2018.ParticipantsA total of 301 patients [mean age 50 years, standard deviation (SD) = 12.3] with AUD, of whom 115 (38%) were female and 186 (62%) were male.Intervention and comparatorParticipants were randomized in blocks of 20 at a ratio of 1 : 1 to five modules of therapist-guided ICBT or to five modules of face-to-face CBT, delivered over a 3-month period. The same treatment material and the same therapists were used in both groups.MeasurementsThe primary outcome was standard drinks of alcohol consumed during the previous week at 6-month follow-up, analysed according to intention-to-treat. The pre-specified non-inferiority limit was five standard drinks of alcohol and d = 0.32 for secondary outcomes.ResultsThe difference in alcohol consumption between the internet and the face-to-face group was non-inferior in the intention-to-treat analysis of data from the 6-month follow-up [internet = 12.33 and face-to-face = 11.43, difference = 0.89, 95% confidence interval (CI) = −1.10 to 2.88]. The secondary outcome, Alcohol Use Disorder Identification Test score, failed to show non-inferiority of internet compared with face-to-face in the intention-to-treat analysis at 6-month follow-up (internet = 12.26 and face-to-face = 11.57, d = 0.11, 95% CI = –0.11 to 0.34).ConclusionsInternet-delivered treatment was non-inferior to face-to-face treatment in reducing alcohol consumption among help-seeking patients with alcohol use disorder but failed to show non-inferiority on some secondary outcomes.
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| 22. |
- Jonsson, Jakob, et al.
(författare)
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Offering an auto-play feature likely increases total gambling activity at online slot-machines : preliminary evidence from an interrupted time series experiment at a real-life online casino
- 2024
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Ingår i: Frontiers in Psychiatry. - 1664-0640. ; 15
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Tidskriftsartikel (refereegranskat)abstract
- Auto-play is a ubiquitous feature in online casino gambling and virtual slot machines especially, allowing gamblers to initiate spin sequences of pre-set length and value. While theoretical accounts diverge on the hypothesized causal effect on gambling behavior of using the auto-play feature, observational findings show that this feature is used to a higher degree by problem and/or high-intensity gamblers, suggesting that banning this feature may constitute a global responsible gambling measure. Direct, experimental research on causal effects of offering auto-play at online casinos is however lacking. Here, we report the findings of an interrupted time series experiment, conducted at a real-life online casino in Sweden, in which the auto-play feature was made available during a pre-set duration on 40 online slot machines, with 40 matched slots serving as control. Aggregated time series on daily betted amount, spins and net losses were analyzed using a structural Bayesian framework that compared observed developments during the peri-intervention period to modeled counterfactual estimates. Results suggest that offering an auto-play feature on online casinos likely increases total gambling activity in terms of betted amount (approx.+ 7-9%) and (perhaps) number of spins (approx. +3%) but has no effect on net losses. Limitations of studying auto-play effects on a population-level, as well as the complexities of banning this feature within a complex ecosystem of non-perfect channelization to licensed providers, are discussed, including suggestions for future research.
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| 23. |
- Lindner, Philip, et al.
(författare)
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Experiences of Gamified and Automated Virtual Reality Exposure Therapy for Spider Phobia : Qualitative Study
- 2020
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Ingår i: JMIR Serious Games. - Toronto, ON, Canada : JMIR Publications Inc.. - 2291-9279. ; 8:2
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Tidskriftsartikel (refereegranskat)abstract
- Background: Virtual reality exposure therapy is an efficacious treatment of anxiety disorders, and recent research suggests that such treatments can be automated, relying on gamification elements instead of a real-life therapist directing treatment. Such automated, gamified treatments could be disseminated without restrictions, helping to close the treatment gap for anxiety disorders. Despite initial findings suggesting high efficacy, very is little is known about how users experience this type of intervention.Objective: The aim of this study was to examine user experiences of automated, gamified virtual reality exposure therapy using in-depth qualitative methods.Methods: Seven participants were recruited from a parallel clinical trial comparing automated, gamified virtual reality exposure therapy for spider phobia against an in vivo exposure equivalent. Participants received the same virtual reality treatment as in the trial and completed a semistructured interview afterward. The transcribed material was analyzed using thematic analysis.Results: Many of the uncovered themes pertained directly or indirectly to a sense of presence in the virtual environment, both positive and negative. The automated format was perceived as natural and the gamification elements appear to have been successful in framing the experience not as psychotherapy devoid of a therapist but rather as a serious game with a psychotherapeutic goal.Conclusions: Automated, gamified virtual reality exposure therapy appears to be an appealing treatment modality and to work by the intended mechanisms. Findings from the current study may guide the next generation of interventions and inform dissemination efforts and future qualitative research into user experiences.
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| 24. |
- Lindner, Philip, et al.
(författare)
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Gamified, Automated Virtual Reality Exposure Therapy for Fear of Spiders : A Single-Subject Trial Under Simulated Real-World Conditions
- 2020
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Ingår i: Frontiers in Psychiatry. - : Frontiers Media SA. - 1664-0640. ; 11
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Tidskriftsartikel (refereegranskat)abstract
- Background: Virtual Reality exposure therapy (VRET) is an evidence-based treatment of phobias and recent research suggests that this applies also to self-contained, automated interventions requiring no therapist guidance. With the advent and growing adoption of consumer VR technology, automated VR intervention have the potential to close the considerable treatment gap for specific phobias through dissemination as consumer applications, self-help at clinics, or as blended treatment. There is however a lack of translational effectiveness studies on VRET treatment effects under real-world conditions.Methods: We conducted a single-arm (n = 25), single-subject study of automated, gamified VRET for fear of spiders, under simulated real-world conditions. After setup and reading instructions, participants completed the automated, single-session treatment by themselves. Self-rated fear of spiders and quality of life served as outcome measures, measured twice before, and one and two weeks after treatment, and at a six-month follow-up. Session characteristics and user experience measures were collected at the end of the session.Results: Mixed-effects modeling revealed a significant and large (d = 1.26) effect of treatment-onset on phobia symptoms (p < .001), and a small (d = 0.49) effect on quality of life (p = .025). Results were maintained at a six-month follow-up (p > .053). The intervention was tolerable and practical. There were no significant correlations between any user experience measure and decrease in phobia symptoms (p > .209).Conclusions: An automated VRET intervention for fear of spiders showed equivalent effects on phobia symptoms under effectiveness conditions as previously reported under efficacy conditions. These results suggest that automated VRET applications are promising self-help treatments also when provided under real-world conditions.
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| 25. |
- Lindner, Philip, et al.
(författare)
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Is Continued Improvement After Automated Virtual Reality Exposure Therapy for Spider Phobia Explained by Subsequent in-vivo Exposure? : A First Test of the Lowered Threshold Hypothesis
- 2021
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Ingår i: Frontiers in Psychiatry. - : Frontiers Media SA. - 1664-0640. ; 12
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Tidskriftsartikel (refereegranskat)abstract
- Consumer Virtual Reality (VR) technology offers a powerful, immersive medium for scalable dissemination of mental health interventions. Decades of research has shown VR exposure therapy to be efficacious in the treatment of anxiety disorders and that the fear reduction generalizes to real-world stimuli. Many studies also report continued improvement over time, after discontinuing VR use. The lowered threshold hypothesis states that this continued improvement is moderated by lowering the threshold to conduct subsequent in-vivo exposure. The current study is the first to formally test this hypothesis, using data from a recent trial on automated VR exposure therapy for spider phobia, in which participants (n = 49) were followed for 1 year, completing assessments 1 week, 3 and 12 months post-treatment. The assessment included validated self-report of phobia symptoms, a standardized behavioral approach test featuring a real spider, and a questionnaire for self-reporting frequency of in-vivo exposures since last assessment. Number of in-vivo exposures was found to be independently associated with greater symptom decrease in longitudinal outcome models. In sequential structural equation models, immediate post-treatment symptom reduction was associated with subsequent in-vivo exposures, which in turn was associated with continued symptom reduction. However, this applied only to self-reported phobia symptoms (not behavioral avoidance) and no associations were found past 3 months. Our findings offer preliminary, partial support for the lowered threshold hypothesis, suggesting that VR exposure interventions may benefit from including explicit in-virtuo to in-vivotransitioning components.
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| 26. |
- Lindner, Philip, et al.
(författare)
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Studying Gambling Behaviors and Responsible Gambling Tools in a Simulated Online Casino Integrated With Amazon Mechanical Turk : Development and Initial Validation of Survey Data and Platform Mechanics of the Frescati Online Research Casino
- 2021
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Ingår i: Frontiers in Psychology. - : Frontiers Media SA. - 1664-1078 .- 1664-0640. ; 11
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Online gambling, popular among both problem and recreational gamblers, simultaneously entails both heightened addiction risks as well as unique opportunities for prevention and intervention. There is a need to bridge the growing literature on learning and extinction mechanisms of gambling behavior, with account tracking studies using real-life gambling data. In this study, we describe the development and validation of the Frescati Online Research Casino (FORC): a simulated online casino where games, visual themes, outcome sizes, probabilities, and other variables of interest can be experimentally manipulated to conduct behavioral analytic studies and evaluate the efficacy of responsible gambling tools.Methods: FORC features an initial survey for self-reporting of gambling and gambling problems, along with several games resembling regular real-life casino games, designed to allow Pavlovian and instrumental learning. FORC was developed with maximum flexibility in mind, allowing detailed experiment specification by setting parameters using an online interface, including the display of messages. To allow convenient and rapid data collection from diverse samples, FORC is independently hosted yet integrated with the popular crowdsourcing platform Amazon Mechanical Turk through a reimbursement key mechanism. To validate the survey data quality and game mechanics of FORC, n = 101 participants were recruited, who answered an questionnaire on gambling habits and problems, then played both slot machine and card-draw type games. Questionnaire and trial-by-trial behavioral data were analyzed using standard psychometric tests, and outcome distribution modeling.Results: The expected associations among variables in the introductory questionnaire were found along with good psychometric properties, suggestive of good quality data. Only 6% of participants provided seemingly poor behavioral data. Game mechanics worked as intended: gambling outcomes showed the expected pattern of random sampling with replacement and were normally distributed around the set percentages, while balances developed according to the set return to player rate.Conclusions: FORC appears to be a valid paradigm for simulating online gambling and for collecting survey and behavioral data, offering a valuable compromise between stringent experimental paradigms with lower external validity, and real-world gambling account tracking data with lower internal validity.
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| 27. |
- Lindner, Philip, et al.
(författare)
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Transitioning Between Online Gambling Modalities and Decrease in Total Gambling Activity, but No Indication of Increase in Problematic Online Gambling Intensity During the First Phase of the COVID-19 Outbreak in Sweden : A Time Series Forecast Study
- 2020
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Ingår i: Frontiers In Public Health. - : Frontiers Media SA. - 2296-2565. ; 8
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The COVID-19 outbreak will likely have a public health impact beyond immediate disease transmission. Little is known about whether social distancing and other societal changes has provoked an increase in gambling, whether decreased betting opportunities due to paused sports events spurred gamblers to transition to online casino gambling, or whether any of these factors have had an impact on problem gambling.Methods: Data on lookup queries against the Swedish Gambling Paus registry, logging all initiated gambling sessions by all licensed gambling providers, from 2019-01-01 (start of registry) to 2020-04-08 (well into the first phase of the outbreak) were analyzed using TBATS time series forecasting to estimate trends after the first domestic COVID-19 death. Obfuscated data on daily total wagered and deposited amounts, split by modality (casino or betting, and low and high intensity, respectively) for the equivalent period were supplied by a licensed online gambling provider.Results: Total gambling activity decreased by 13.29% during the first phase of the outbreak compared to forecast. Analyses of online gambling data revealed that although betting decreased substantially in synchrony with a slight increase in online casino gambling, there was no increase in likely problematic, high-intensity gambling and neither did total online gambling increase.Conclusions: This first, preliminary study revealed no increase in Swedish gambling activity, total or specifically online, in the first phase of the COVID-19 outbreak. Future research should examine whether pandemic-induced transitioning between gambling modalities and/or increased participation in gambling, leads to long-term effects on prevalence of problem gambling.
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| 28. |
- Lindner, Philip, et al.
(författare)
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Using alcohol consumption diary data from an internet intervention for outcome and predictive modeling : a validation and machine learning study
- 2020
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Ingår i: BMC Medical Research Methodology. - : Springer Science and Business Media LLC. - 1471-2288. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Alcohol use disorder (AUD) is highly prevalent and presents a large treatment gap. Self-help internet interventions are an attractive approach to lowering thresholds for seeking help and disseminating evidence-based programs at scale. Internet interventions for AUD however suffer from high attrition and since continuous outcome measurements are uncommon, little is known about trajectories and processes. The current study investigates whether data from a non-mandatory alcohol consumption diary, common in internet interventions for AUD, approximates drinks reported at follow-up, and whether data from the first half of the intervention predict treatment success.Methods: N = 607 participants enrolled in a trial of online self-help for AUD, made an entry in the non-mandatory consumption diary (total of 9117 entries), and completed the follow-up assessment. Using multiple regression and a subset of calendar data overlapping with the follow-up, scaling factors were derived to account for missing entries per participant and week. Generalized estimating equations with an inverse time predictor were then used to calculate point-estimates of drinks per week at follow-up, the confidence intervals of which were compared to that from the measurement at follow-up. Next, calendar data form the first half of the intervention were retained and summary functions used to create 18 predictors for random forest machine learning models, the classification accuracies of which were ultimately estimated using nested cross-validation.Results: While the raw calendar data substantially underestimated drinks reported at follow-up, the confidence interval of the trajectory-derived point-estimate from the adjusted data overlapped with the confidence interval of drinks reported at follow-up. Machine learning models achieved prediction accuracies of 64% (predicting non-hazardous drinking) and 48% (predicting AUD severity decrease), in both cases with higher sensitivity than specificity.Conclusions: Data from a non-mandatory alcohol consumption diary, adjusted for missing entries, approximates follow-up data at a group level, suggesting that such data can be used to reveal trajectories and processes during treatment and possibly be used to impute missing follow-up data. At an individual level, however, calendar data from the first half of the intervention did not have high predictive accuracy, presumable due to a high rate of missing data and unclear missing mechanisms.
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| 29. |
- Lindner, Philip, et al.
(författare)
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Virtual Reality exposure therapy for public speaking anxiety in routine care : a single-subject effectiveness trial
- 2021
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Ingår i: Cognitive Behaviour Therapy. - : Informa UK Limited. - 1650-6073 .- 1651-2316. ; 50:1, s. 67-87
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Tidskriftsartikel (refereegranskat)abstract
- Virtual Reality (VR) can be used as a therapeutic tool to conduct efficacious in-session exposure therapy by presenting virtual equivalents of phobic stimuli, yet past hardware restrictions hindered implementation in routine care and effectiveness studies. The current study examines the effectiveness of a VR-assisted treatment protocol for public speaking anxiety with demonstrated efficacy, this time in routine care, using affordable VR hardware. Participants (n = 23) were recruited via a private clinic and treated by one of four psychologists with only minimal VR-training. Using a single-subject design and dual-slope modeling (adjusting the treatment-onset slope for treatment effects), we found a significant, large decrease in self-rated public speaking anxiety following the primary three-hour session, similar in magnitude to the previous efficacy trial. Multilevel modeling of in-session process measures suggests that the protocol works as intended, by decreasing catastrophic belief expectancy and distress, and increasing perceived performance quality. Adherence to the online transition program that followed-encouraging in-vivo exposure-was relatively poor, yet symptoms decrease continued. No change was observed over the three-month follow-up period. We conclude that VR exposure therapy can be effective under routine care conditions and is an attractive approach for future, large-scale implementation and effectiveness trials.
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| 30. |
- Ma, Lichen, et al.
(författare)
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Integrating virtual realities and psychotherapy : SWOT analysis on VR and MR based treatments of anxiety and stress-related disorders
- 2021
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Ingår i: Cognitive Behaviour Therapy. - : Informa UK Limited. - 1650-6073 .- 1651-2316. ; 50:6, s. 509-526
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Tidskriftsartikel (refereegranskat)abstract
- The use of virtual reality (VR) and mixed reality (MR) technology in clinical psychology is growing. Efficacious VR-based treatments for a variety of disorders have been developed. However, the field of technology-assisted psychotherapy is constantly changing with the advancement in technology. Factors such as interdisciplinary collaboration, consumer familiarity and adoption of VR products, and progress in clinical science all need to be taken into consideration when integrating virtual technologies into psychotherapies. We aim to present an overview of current expert opinions on the use of virtual technologies in the treatment of anxiety and stress-related disorders. An anonymous survey was distributed to a select group of researchers and clinicians, using an analytic framework known as Strengths, Weaknesses, Opportunities, and Threats (SWOT). Overall, the respondents had an optimistic outlook regarding the current use as well as future development and implementation of technology-assisted interventions. VR and MR psychotherapies offer distinct advantages that can overcome shortcomings associated with traditional therapy. The respondents acknowledged and discussed current limitations of VR and MR psychotherapies. They recommended consolidation of existing knowledge and encouraged standardisation in both theory and practice. Continued research is needed to leverage the strengths of VR and MR to develop better treatments.
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| 31. |
- Miloff, Alexander, et al.
(författare)
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Measuring Alliance Toward Embodied Virtual Therapists in the Era of Automated Treatments With the Virtual Therapist Alliance Scale (VTAS) : Development and Psychometric Evaluation
- 2020
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Ingår i: Journal of Medical Internet Research. - Toronto, ON, Canada : JMIR Publications Inc.. - 1438-8871. ; 22:3
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Tidskriftsartikel (refereegranskat)abstract
- Background: Automated virtual reality exposure therapies (VRETs) are self-help treatments conducted by oneself and supported by a virtual therapist embodied visually and/or with audio feedback. This simulates many of the nonspecific relational elements and common factors present in face-to-face therapy and may be a means of improving adherence to and efficacy of self-guided treatments. However, little is known about alliance toward the virtual therapist, despite alliance being an important predictor of treatment outcome.Objective: In this study, we aimed to evaluate the first alliance instrument developed for use with embodied virtual therapists in an automated treatment format—the Virtual Therapist Alliance Scale (VTAS)—by (1) assessing its psychometric properties, (2) verifying the dimensionality of the scale, and (3) determining the predictive ability of the scale with treatment outcome.Methods: A psychometric evaluation and exploratory factor analysis of the VTAS was conducted using data from two samples of spider-fearful patients treated with VRET and the help of an embodied, voice-based virtual therapist (n=70). Multiple regression models and bivariate correlations were used to assess the VTAS relationship with treatment outcome, according to self-reported fear and convergence with presence and user-friendliness process measures.Results: The VTAS showed a sound two-factor solution composed of a primary factor covering task, goal, and copresence; adequate internal consistency; and good convergent validity, including moderate correlation (r=.310, P=.01) with outcomes over follow-up.Conclusions: These preliminary results suggest that alliance toward a virtual therapist is a significant predictor of treatment outcome, favors the importance of a task-goal over bond-factor, and should be explored in studies with larger sample sizes and in additional forms of embodiment.
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| 32. |
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| 33. |
- Molander, Olof, et al.
(författare)
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Internet-based cognitive behavior therapy for problem gambling in routine care : protocol for a non-randomized pilot and feasibility trial
- 2020
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Ingår i: Pilot and Feasibility Studies. - : Springer Science and Business Media LLC. - 2055-5784. ; 6
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Tidskriftsartikel (refereegranskat)abstract
- Background: Problem gambling and gambling disorder are major public health concerns worldwide, and awareness of associated negative consequences is rising. In parallel, treatment demand has increased, and Internet interventions offer a promising alternative for providing evidence-based treatment at scale to a low cost.Method: We developed a novel Internet-delivered cognitive behavioral treatment for gambling, based on qualitative interviews with treatment-seeking gamblers, behavioral research on gambling behavior, and the pathway model for problem gambling. This research protocol describes a non-randomized pilot and feasibility trial conducted in routine addiction care with adult treatment-seeking patients (max N = 25) with problem gambling. The primary aim is to ensure acceptability and safety, measured by satisfaction, credibility, working alliance, and possible negative effects. Secondary aims are feasibility of study procedures in terms of recruitment and measurement procedures as well as potential effectiveness measured weekly by gambling symptoms as primary outcome and gambling behavior, quality of life, symptoms of depression and anxiety, alcohol, and drug use as secondary outcomes. Potential mediators measured weekly are loss of control, verbal rules, and well-being.Discussion: This study is innovative in several respects, regarding both treatment development and implementation. The results of the study will guide a future randomized controlled trial, as well as the development of the intervention and intervention implementation within ordinary addiction care.Trial registration: Clinical trials.gov, NCT ID: NCT03946098. Registered 10 May 2019
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| 34. |
- Ribeiro, Barbara, et al.
(författare)
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Considering the dilemma of societal alignment: A response
- 2020
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- The publication of our article “Introducing the dilemma of societal alignment for inclusive and responsible research and innovation” (Ribeiro et al., 2018) was accompanied by three commentaries (Guston, 2018; Nordmann, 2018; and Kuzma and Roberts, 2018). In the original article, we invoked Collingridge’s dilemma of the social control of technology to introduce a complementary dilemma of “societal alignment” in the governance of science, technology and innovation. Thoughtful and challenging critiques were presented in the three commentaries. In this paper, as completed in June 2019, we respond to those critiques and, in so doing, seek to further clarify and extend our arguments.
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| 35. |
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| 36. |
- Romero, Danilo, et al.
(författare)
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Self-guided digital intervention to increase post-detoxification treatment-seeking among individuals with substance use disorders : Research protocol with preliminary findings
- 2023
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Ingår i: Abstracts from the 12th Swedish Congress on internet interventions (SWEsrii), Uppsala University, Sweden. ; , s. 1-2
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Inpatient detoxification provides a safe environment for withdrawal from alcohol and/or other drugs, as a possibly vital step towards behavior change. However, many patients relapse soon after discharge from detoxification treatment and readmission is common. Estimates from the US indicate that only every sixth patient seeks and accesses post-detoxification treatment of substance use disorders (SUD). In this two-phase project, we aim to (1) investigate the post-detoxification treatment gap and related patient-reported factors, and (2) develop and evaluate a self-guided digital intervention delivered after discharge, with the aim of increasing post-detoxification treatment.Methods: We have collected data for a registry-based mapping of patient flow from inpatient detoxification to outpatient treatment (N = 9,771) and conducted qualitative interviews (n = 23) on patients’ perceptions of barriers to treatment. These preparatory studies inform the ongoing development of a digital intervention, to be evaluated using a quasi-experimental interrupted time series design. We have conducted a simulation-based power analysis to estimate the minimum detectable effect size.Preliminary results: In addition to general person-related (e.g. stigma) and treatment-related (e.g. low accessibility) barriers to SUD treatment, interviewees reported context-specific barriers, most notably psychological vulnerability following discharge, which for some triggered a reluctance to experience in-person contact. Digital support may thus respond to their needs. In the simulation-based power analysis, we ran 10,000 simulations for each of a total of 128 scenarios, varying intervention length, effect size and change curve. Results suggested that the study, given a 1-year intervention period, an alpha level of .05 and power level of .8, will be powered to detect an absolute increase of at least 2% or 3%.Discussion: To our knowledge, this is the first project to evaluate a digital intervention for promoting post-detoxification treatment seeking. By offering a cost-effective, scalable intervention with minimal exclusion criteria, the study will, in case of successful outcomes, provide a novel and sustainable approach to increase post-detoxification treatment- seeking in real-world settings.
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| 37. |
- Sinadinovic, Kristina, et al.
(författare)
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Guided web-based treatment program for reducing cannabis use : a randomized controlled trial
- 2020
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Ingår i: Addiction science & clinical practice. - : Springer Science and Business Media LLC. - 1940-0632 .- 1940-0640. ; 15:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: The aim of this study was to investigate the effects of a web-based treatment program with therapist guidance for adults and adolescents with regular cannabis use from the general population.Methods: A double blinded randomized controlled trial with a parallel group design was conducted (intervention group n = 151, wait-list control group n = 152). Follow-up 12 weeks from treatment commencement of a 13-module intervention. The primary outcome was frequency of cannabis use. Time by group interaction effects were modeled using generalized estimated equations and the instrumental variable approach was used to estimate the effect of intervention adherence.Results: At follow-up, the intention to treat (ITT) analyses did not show any significant time by group effects. A significant association between intervention adherence and scores on the cannabis abuse screening test (CAST) was found. Secondary analysis excluding participants who had received other professional help revealed time by group effects for secondary outcomes gram cannabis consumed past week, number of dependency criteria and CAST score. Due to methodological limitations, these latter results should be interpreted with caution.Conclusions: In this study we did not find a web-based treatment program with therapist guidance to be more effective than a waiting-list in reducing frequency of cannabis use.Trial registration: The trial was pre-registered at ClinicalTrials.gov (NCT02408640) April 3, 2015
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| 38. |
- Sundström, Christopher, et al.
(författare)
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Investigating the added effects of guidance in digital psychological self-care for alcohol problems (ALVA)-protocol for a randomized factorial optimization trial
- 2024
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Ingår i: Trials. - : Springer Nature. - 1745-6215. ; 25:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: The continual development and implementation of effective digital interventions is one important strategy that may serve to bridge the well-known treatment gap related to problematic alcohol use. Research suggests that clinician guidance, provided in different ways during the digital intervention (i.e., written weekly messages, phone calls etc.), can boost intervention engagement and effects. Digital psychological self-care (DPSC) is a new delivery format wherein an unguided digital intervention is provided within the framework of a structured care process that includes initial clinical assessment and follow-up interviews. In a recent feasibility study, a DPSC intervention for problematic alcohol use, ALVA, provided without any extra guidance, was found safe and credible and to have promising within-group effects on alcohol consumption. The aim of the current study is to gather information on the effects and efficiency of different forms of guidance added to ALVA, in order to optimize the intervention.Methods: This protocol describes a randomized factorial trial where the effects of two different ways of providing guidance (mid-treatment interview, weekly written messages, respectively) in DPSC for problematic alcohol use are investigated. Optimization criteria will be applied to the results regarding how effective the intervention is at reducing alcohol consumption measured by the number of standard drinks per week together with the clinician time spent on guidance.Discussion: This study will investigate the added benefit of different forms of guidance to DPSC for problematic alcohol use. These added effects will be compared to the added cost of guidance, according to pre-defined optimization criteria.Trial registration: Clinicaltrials.gov: NCT05649982. Registered on 06 December 2022. Prospectively registered.
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| 39. |
- Sunnhed, Rikard, 1979-, et al.
(författare)
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Mediators of Cognitive Therapy and Behavior Therapy for Insomnia Disorder : A Test of the Processes in the Cognitive Model
- 2022
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Ingår i: Journal of Consulting and Clinical Psychology. - : American Psychological Association (APA). - 0022-006X .- 1939-2117. ; 90:9, s. 696-708
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To examine if the processes in the cognitive model mediate cognitive therapy (CT) and behavior therapy (BT) for insomnia. Method: Individuals diagnosed with insomnia disorder (n = 219) were randomized to telephone-supported internet-delivered CT (n = 72), BT (n = 73), or a wait-list (WL; n = 74). Cognitive processes (worry, dysfunctional beliefs, monitoring, and safety behaviors) proposed to maintain insomnia and treatment outcome (insomnia severity index) were assessed biweekly. Criteria for evaluating mediators were assessed via parallel process growth modeling and cross-lagged panel models. Results: Parallel process growth modeling showed that dysfunctional beliefs, monitoring, and safety behaviors significantly mediated the effects of both CT and BT. Cross-lagged panel models confirmed that dysfunctional beliefs and monitoring (approaching significance) influenced subsequent within-individual change in insomnia severity in CT. In BT, however, prior changes in insomnia severity predicted subsequent changes in worry and monitoring, and reciprocal influences among processes and outcomes were observed for dysfunctional beliefs and safety behaviors. Furthermore, the effect of safety behaviors on outcome was significantly larger for BT compared to CT. Conclusion: Together, the findings support the role of dysfunctional beliefs and monitoring as processes of change in CT and safety behaviors as a specific mediator in BT. Limited evidence was provided for worry as a mediator. The findings could improve clinical management and increase our conceptual understanding of insomnia and its maintaining factors by underscoring the relevance of these three processes for insomnia, as well as indicate important routes for future research, such as investigating how baseline presentations might moderate these mediations, for example moderated mediation.
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| 40. |
- Wiklund, Tobias, et al.
(författare)
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Internet-Delivered Cognitive Behavioral Therapy for Insomnia Comorbid With Chronic Pain : Randomized Controlled Trial
- 2022
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Ingår i: Journal of Medical Internet Research. - : JMIR Publications Inc. - 1438-8871. ; 24:4
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Tidskriftsartikel (refereegranskat)abstract
- Background: Patients with chronic pain often experience insomnia symptoms. Pain initiates, maintains, and exacerbates insomnia symptoms, and vice versa, indicating a complex situation with an additional burden for these patients. Hence, the evaluation of insomnia-related interventions for patients with chronic pain is important. Objective: This randomized controlled trial examined the effectiveness of internet-based cognitive behavioral therapy for insomnia (ICBT-i) for reducing insomnia severity and other sleep- and pain-related parameters in patients with chronic pain. Participants were recruited from the Swedish Quality Registry for Pain Rehabilitation. Methods: We included 54 patients (mean age 49.3, SD 12.3 years) who were randomly assigned to the ICBT-i condition and 24 to an active control condition (applied relaxation). Both treatment conditions were delivered via the internet. The Insomnia Severity Index (ISI), a sleep diary, and a battery of anxiety, depression, and pain-related parameter measurements were assessed at baseline, after treatment, and at a 6-month follow-up (only ISI, anxiety, depression, and pain-related parameters). For the ISI and sleep diary, we also recorded weekly measurements during the 5-week treatment. Negative effects were also monitored and reported. Results: Results showed a significant immediate interaction effect (time by treatment) on the ISI and other sleep parameters, namely, sleep efficiency, sleep onset latency, early morning awakenings, and wake time after sleep onset. Participants in the applied relaxation group reported no significant immediate improvements, but both groups exhibited a time effect for anxiety and depression at the 6-month follow-up. No significant improvements on pain-related parameters were found. At the 6-month follow-up, both the ICBT-i and applied relaxation groups had similar sleep parameters. For both treatment arms, increased stress was the most frequently reported negative effect. Conclusions: In patients with chronic pain, brief ICBT-i leads to a more rapid decline in insomnia symptoms than does applied relaxation. As these results are unique, further research is needed to investigate the effect of ICBT-i on a larger sample size of people with chronic pain. Using both treatments might lead to an even better outcome in patients with comorbid insomnia and chronic pain.
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