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Philips, Björn
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Publications (10 of 15) Show all publications
Gidhagen, Y., Holmqvist, R. & Philips, B. (2018). Attachment style among outpatients with substance use disorders in psychological treatment. Psychology and Psychotherapy: Theory, Research and Practice, 91(4), 490-508
Open this publication in new window or tab >>Attachment style among outpatients with substance use disorders in psychological treatment
2018 (English)In: Psychology and Psychotherapy: Theory, Research and Practice, ISSN 1476-0835, E-ISSN 2044-8341, Vol. 91, no 4, p. 490-508Article in journal (Refereed) Published
Abstract [en]

Objectives

To explore the associations between self-rated attachment style, psychological distress and substance use among substance use disorder (SUD) outpatients in psychological treatment.

Design and Methods

In this practice-based study, 108 outpatients were asked to fill in the Experiences in Close Relationships – Short form, the Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE-OM), the Alcohol Use Disorders Identification Test (AUDIT), and the Drug Use Disorders Identification Test (DUDIT) at treatment start and end. Patients were given psychological treatments with a directive, reflective or supportive orientation.

Results

An insecure attachment style was more common among the SUD outpatients, compared to non-clinical groups. Patients with a fearful attachment style scored higher on psychological distress than patients with a secure attachment style. The associations between the attachment dimensions and psychological distress were stronger than those between attachment and SUD. Significantly more patients had a secure attachment style at treatment end.

Conclusions

This study shows significant relations between patients’ attachment style and their initial psychological distress. The causal relationship between attachment style and psychological distress is, however, not clear and can likely go in both directions. The psychological treatment of patients with SUD contributed significantly to changes from insecure to secure attachment style.

Practitioner Points

We found among patients with SUD a strong relation between patients’ attachment style and their psychological distress. Knowledge of the patient’s attachment style may help the therapist to tailor the treatment to the patient’s needs. A change from insecure to secure attachment style can be an important goal for a SUD treatment, as it may prevent the patient from using defence strategies involving substance use for regulating emotions and interpersonal relationships.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
Keywords
attachment, CORE-OM, ECR-S, practice-based study, psychological distress, substance use disorder
National Category
Psychology
Identifiers
urn:nbn:se:liu:diva-152442 (URN)10.1111/papt.12172 (DOI)000451783900004 ()
Note

Funding agencies: Region Council in Ostergotland, Sweden [LIO-279451]; Department of Dependency Disorders, Vrinnevi Hospital, Norrkoping, Sweden

Available from: 2018-10-31 Created: 2018-10-31 Last updated: 2018-12-20Bibliographically approved
Holmqvist, R., Philips, B. & Mellor-Clark, J. (2016). Client and therapist agreement about the clients problemsAssociations with treatment alliance and outcome. Psychotherapy Research, 26(4), 399-409
Open this publication in new window or tab >>Client and therapist agreement about the clients problemsAssociations with treatment alliance and outcome
2016 (English)In: Psychotherapy Research, ISSN 1050-3307, E-ISSN 1468-4381, Vol. 26, no 4, p. 399-409Article in journal (Refereed) Published
Abstract [en]

Objective: A shared understanding of the patients symptoms and problems is seen by most theories as a crucial aspect of the collaboration in therapy, presumably influencing alliance and outcome. The empirical ground for this argument is not solid, however. Several studies have found weak associations between a common view of the patients problems and outcome. The purpose of the present study was to analyze whether agreement in the understanding of the patients depression and anxiety problems was important for alliance and outcome. Method: The study used data from a practice-based study using the CORE system with 846 patients who received psychological treatment in primary care. Results: The analyses indicated that although patients who were assessed by their therapists as having depression and anxiety problems scored higher on these subscales than other patients, about half of the patients reported such problems when the therapists did not, and vice versa. Agreement was not associated with better alliance or outcome. Conclusions: Productive collaboration in psychotherapy may be based on other factors than agreement about symptoms.

Place, publisher, year, edition, pages
ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD, 2016
Keywords
outcome research; alliance; agreement about problems; therapeutic collaboration
National Category
Applied Psychology
Identifiers
urn:nbn:se:liu:diva-130673 (URN)10.1080/10503307.2015.1013160 (DOI)000380056300003 ()25751451 (PubMedID)
Available from: 2016-08-20 Created: 2016-08-19 Last updated: 2017-11-28
Holmqvist, R., Philips, B. & Barkham, M. (2015). Developing practice-based evidence: Benefits, challenges, and tensions. Psychotherapy Research, 25(1), 20-31
Open this publication in new window or tab >>Developing practice-based evidence: Benefits, challenges, and tensions
2015 (English)In: Psychotherapy Research, ISSN 1050-3307, E-ISSN 1468-4381, Vol. 25, no 1, p. 20-31Article in journal (Refereed) Published
Abstract [en]

Attempts to regulate service delivery in line with results from randomized trials have been vigorously debated. In this paper, results from practice-based studies using the CORE System illustrate the potential to enrich knowledge about the actual outcome of psychological therapy in routine care. These studies also provide data for important questions in psychotherapy research, like orientation differences, the importance of the therapist factor, number of sessions needed for clinical effect, and the alliance-outcome question. Obstacles and challenges in making such studies are illustrated. In conclusion, arguments are put forward for introducing a common measurement system that strikes a balance between clinicians' questions and the need for comparable data, and that encompasses the complexities of patients' reasons for seeking psychological help.

Place, publisher, year, edition, pages
Routledge, 2015
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-104747 (URN)10.1080/10503307.2013.861093 (DOI)000345502700003 ()24283264 (PubMedID)
Available from: 2014-02-25 Created: 2014-02-25 Last updated: 2018-03-09Bibliographically approved
Holmqvist, R., Philips, B. & Barkham, M. (2015). Implementing routine outcome monitoring in clinical practice: Benefits, challenges, and solutions. Psychotherapy Research, 25(1), 20-31
Open this publication in new window or tab >>Implementing routine outcome monitoring in clinical practice: Benefits, challenges, and solutions
2015 (English)In: Psychotherapy Research, ISSN 1050-3307, E-ISSN 1468-4381, Vol. 25, no 1, p. 20-31Article in journal (Refereed) Published
Abstract [en]

This article reviews the benefits, obstacles, and challenges that can hinder (and have hindered) implementation of routine outcome monitoring in clinical practice. Recommendations for future routine outcome assessment efforts are also provided. Spanning three generations, as well as multiple developed tools and approaches, the four authors of this article have spent much of their careers working to address these issues and attempt to consolidate this learning and experience briefly here. Potential "elephants in the room" are brought into the discussion wherever relevant, rather than leaving them to obstruct silently the fields efforts. Some of these topics have been largely ignored, yet must be addressed if we are to fulfill our promise of integrating science and practice. This article is an attempt to identify these important issues and start an honest and open dialogue.

Place, publisher, year, edition, pages
Taylor andamp; Francis (Routledge): STM, Behavioural Science and Public Health Titles, 2015
Keywords
routine outcome monitoring; dissemination and implementation; feedback; science-practice integration
National Category
Basic Medicine
Identifiers
urn:nbn:se:liu:diva-113040 (URN)10.1080/10503307.2013.817696 (DOI)000345502700002 ()23885809 (PubMedID)
Available from: 2015-01-09 Created: 2015-01-08 Last updated: 2018-03-09
Konstenius, M., Jayaram-Lindström, N., Guterstam, J., Beck, O., Philips, B. & Franck, J. (2014). Methylphenidate for attention deficit hyperactivity disorder and drug relapse in criminal offenders with substance dependence: a 24-week randomized placebo-controlled trial.. Addiction, 109(3), 440-449
Open this publication in new window or tab >>Methylphenidate for attention deficit hyperactivity disorder and drug relapse in criminal offenders with substance dependence: a 24-week randomized placebo-controlled trial.
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2014 (English)In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 109, no 3, p. 440-449Article in journal (Refereed) Published
Abstract [en]

AIM: To test the efficacy and safety of osmotic release oral system (OROS) methylphenidate (MPH) in doses up to 180 mg/day to treat attention deficit hyperactivity disorder (ADHD) and prevent any drug relapse in individuals with a co-diagnosis of ADHD and amphetamine dependence.

DESIGN: Randomized placebo-controlled 24-week double-blind trial with parallel groups design.

SETTING: Participants were recruited from medium security prisons in Sweden. The medication started within 2 weeks before release from prison and continued in out-patient care with twice-weekly visits, including once-weekly cognitive behavioural therapy.

PARTICIPANTS: Fifty-four men with a mean age of 42 years, currently incarcerated, meeting DSM-IV criteria for ADHD and amphetamine dependence.

MEASUREMENTS: Change in self-reported ADHD symptoms, relapse to any drug use (amphetamine and other drugs) measured by urine toxicology, retention to treatment, craving and time to relapse.

FINDINGS: The MPH-treated group reduced their ADHD symptoms during the trial (P = 0.011) and had a significantly higher proportion of drug-negative urines compared with the placebo group (P = 0.047), including more amphetamine-negative urines (P = 0.019) and better retention to treatment (P = 0.032).

CONCLUSIONS: Methylphenidate treatment reduces attention deficit hyperactivity disorder symptoms and the risk for relapse to substance use in criminal offenders with attention deficit hyperactivity disorder and substance dependence.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2014
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-104746 (URN)10.1111/add.12369 (DOI)000331098300001 ()24118269 (PubMedID)
Available from: 2014-02-25 Created: 2014-02-25 Last updated: 2017-12-05
Frankl, M., Philips, B. & Wennberg, P. (2014). Psychotherapy role expectations and experiences - Discrepancy and therapeutic alliance among patients with substance use disorders. Psychology and Psychotherapy: Theory, Research and Practice, 87(4), 411-424
Open this publication in new window or tab >>Psychotherapy role expectations and experiences - Discrepancy and therapeutic alliance among patients with substance use disorders
2014 (English)In: Psychology and Psychotherapy: Theory, Research and Practice, ISSN 1476-0835, E-ISSN 2044-8341, Vol. 87, no 4, p. 411-424Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: The main aim of the study was to examine how the discrepancy between role expectations prior to psychotherapy and experiences of ongoing psychotherapy related to therapeutic alliance. We hypothesized that a similarity between patient role expectations and experiences would be associated with a stronger alliance. The study also examined whether different dimensions of psychotherapy role expectations predicted retention in psychotherapy.

DESIGN: A naturalistic study design was used with data collected prior to therapy and during the first 6 months of therapy.

METHOD: Patients with substance use disorders completed the Psychotherapy Expectation Questionnaire-short version (PEX-S) at the time of therapy assessment. A subsample of these patients (n = 41; n = 24 in individual therapy and n = 17 in group therapy) provided data from therapy including psychotherapy experiences (also measured with PEX-S) and therapeutic alliance, measured with Working Alliance Questionnaire-short version.

RESULTS: For patients in group therapy, discrepancy between role expectations and experiences correlated negatively with alliance. Expectations prior to psychotherapy characterized by defensiveness correlated negatively with therapy retention.

CONCLUSION: The finding that disconfirmation of patients' role expectations in group therapy were associated with weaker therapeutic alliance highlights the importance of discussing psychotherapy expectations at an early stage in treatment. Expectations characterized by defensiveness predicted worse retention in psychotherapy, which indicates that the PEX-S can be helpful in detecting patients at risk for dropout.

PRACTITIONER POINTS: In targeting a patient's role expectancies prior to treatment, possible discrepancies between patient and therapist are made visible and possible to examine. Clarifying the patient's role expectations and the therapist's rationale might be a first step towards establishing a strong working alliance. Surveying the patient's defensiveness tendencies at the beginning of therapy offers a chance to discuss possible fears and other obstacles concerning therapy. Discrepancy between the patient's role expectations prior to treatment and their actual experiences of psychotherapy render valuable information that can be of use in the therapy process.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2014
Keywords
Psychotherapy; Treatment Expectations; Therapeutic alliance, Addiction; Dependence
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-104748 (URN)10.1111/papt.12021 (DOI)000344784300003 ()24415529 (PubMedID)
Available from: 2014-02-25 Created: 2014-02-25 Last updated: 2017-12-05
Philips, B. & Wennberg, P. (2014). The Importance of Therapy Motivation for Patients With Substance Use Disorders. Psychotherapy, 51(4), 555-562
Open this publication in new window or tab >>The Importance of Therapy Motivation for Patients With Substance Use Disorders
2014 (English)In: Psychotherapy, ISSN 0033-3204, E-ISSN 1939-1536, Vol. 51, no 4, p. 555-562Article in journal (Refereed) Published
Abstract [en]

The present study aimed to examine whether patients' pretherapy motivation was related to other patient characteristics and whether it predicted retention in psychotherapy. Data were collected within a naturalistic outcome study of various forms of psychotherapy for patients (N = 172) with substance use disorders (SUD). Therapy motivation was measured using the Client Motivation for Therapy Scale (CMOTS), including the variables autonomous motivation, controlled motivation, and amotivation. Female patients had higher levels of autonomous motivation (d = .53), lower levels of controlled motivation (d = -.32), and lower levels of amotivation (d = -.62). Level of symptoms and impairment was significantly positively correlated with controlled motivation (r = .31). Autonomous motivation was positively correlated with four expectation subscales associated with constructive therapeutic work, whereas amotivation was negatively correlated with three of these subscales. Controlled motivation was positively correlated with the subscales external orientation, defensiveness, and support. In a logistic regression, amotivation stood out as a negative predictor of retention, in terms of starting in psychotherapy after assessment or not. Quite surprisingly, autonomous motivation was not a significant predictor of retention. The present study indicates that amotivation is a risk factor for early dropout among SUD patients. More efforts should be directed at preparing patients for psychotherapy through strengthening motivation.

Place, publisher, year, edition, pages
American Psychological Association (APA), 2014
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-104745 (URN)10.1037/a0033360 (DOI)000345453500015 ()24059740 (PubMedID)
Available from: 2014-02-25 Created: 2014-02-25 Last updated: 2017-12-05
Falkenström, F., Markowitz, J. C., Jonker, H., Philips, B. & Holmqvist, R. (2013). Can psychotherapists function as their own controls? Meta-analysis of the crossed therapist design in comparative psychotherapy trials. Journal of Clinical Psychiatry, 74(5), 482-491
Open this publication in new window or tab >>Can psychotherapists function as their own controls? Meta-analysis of the crossed therapist design in comparative psychotherapy trials
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2013 (English)In: Journal of Clinical Psychiatry, ISSN 0160-6689, E-ISSN 1555-2101, Vol. 74, no 5, p. 482-491Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE:

Clinical trials sometimes have the same therapists deliver more than 1 psychotherapy, ostensibly to control for therapist effects. This "crossed therapist" design makes controlling for therapist allegiance imperative, as therapists may prefer one treatment they deliver to the other(s). Research has established a strong relationship between principal investigators' allegiances and treatment outcome. Study therapists' allegiances probably also influence outcome, yet this moderating factor on outcome has never been studied.

DATA SOURCES:

English language abstracts in PsycINFO and MEDLINE from January 1985 to December 2011 were searched for keywords psychotherapy and randomized trial.

STUDY SELECTION:

The search yielded 990 abstracts that were searched manually. Trials using the same therapists in more than 1 condition were included.

DATA EXTRACTION:

Thirty-nine studies fulfilled inclusion criteria. Meta-regression analyses assessed the influence of researchers' allegiance on treatment outcome, testing the hypothesis that studies poorly controlling for therapist allegiance would show stronger influence of researcher allegiance on outcome. A single-item measure assessed researchers' reported attempts to control for therapist allegiance.

RESULTS:

Only 1 of 39 studies (3%) measured therapist treatment allegiance. Another 5 (13%) mentioned controlling for, without formally assessing, therapist allegiance. Most publications (67%) did not even mention therapist allegiance. In studies not controlling for therapist allegiance, researcher allegiance strongly influenced outcome, whereas studies reporting control for therapist allegiance showed no differential researcher allegiance. Researchers with cognitive-behavioral therapy allegiance described controlling for therapist allegiance less frequently than other researchers.

CONCLUSIONS:

The crossed therapist design is subject to bias due to differential psychotherapist allegiance. Worrisome results suggest that researchers strongly allied to a treatment may ignore therapist allegiance, potentially skewing outcomes. All clinical trials, and especially crossed therapist designs, should measure psychotherapist allegiance to evaluate this possible bias.

Place, publisher, year, edition, pages
Physicians Postgraduate Press, 2013
National Category
Social Sciences
Identifiers
urn:nbn:se:liu:diva-96142 (URN)10.4088/JCP.12r07848 (DOI)000319890800004 ()23146326 (PubMedID)
Available from: 2013-08-14 Created: 2013-08-14 Last updated: 2017-12-06Bibliographically approved
Konstenius, M., Larsson, H., Lundholm, L., Philips, B., Glind, G. v., Jayaram-Lindström, N. & Franck, J. (2012). An Epidemiological Study of ADHD, Substance Use, and Comorbid Problems in Incarcerated Women in Sweden. Journal of Attention Disorders
Open this publication in new window or tab >>An Epidemiological Study of ADHD, Substance Use, and Comorbid Problems in Incarcerated Women in Sweden
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2012 (English)In: Journal of Attention Disorders, ISSN 1087-0547, E-ISSN 1557-1246Article in journal (Refereed) Published
Abstract [en]

Objective: The aim of this study was to examine the prevalence of ADHD and psychiatric comorbidity, including substance use in incarcerated women. Method: This was a cross-sectional study, consisting of two parts: (a) screening using the ADHD Self-Rating Scale (ASRS) and (b) diagnostic assessment using a structured interview. Results: A sample of 96 incarcerated women was screened and 56 underwent the diagnostic assessment. Twenty-nine percent of the women met the Diagnostic and Statistical Manual of Mental Disorders (4th ed.) diagnostic criteria for adult ADHD in the diagnostic assessment. Forty-four of the women had misuse of alcohol, and 83% had misuse of narcotics the year prior to the incarceration. The ASRS showed sensitivity of 1.0 and specificity of 0.66. Conclusion: The prevalence rate of ADHD in incarcerated women was high and comparable to that in male offenders. Illicit stimulant use and antisocial personality disorder were significantly more common in women with ADHD. ASRS is useful as a screener in this population. (J. of Att. Dis. 2012; XX(X) 1-XX).

Place, publisher, year, edition, pages
Sage Publications, 2012
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-104744 (URN)10.1177/1087054712451126 (DOI)000346654500006 ()22797213 (PubMedID)
Available from: 2014-02-25 Created: 2014-02-25 Last updated: 2017-12-05
Lindgren, A., Werbart, A. & Philips, B. (2010). Long-term outcome and post-treatment effects of psychoanalytic psychotherapy with young adults. Psychology and Psychotherapy: Theory, Research and Practice, 83(Pt 1), 27-43
Open this publication in new window or tab >>Long-term outcome and post-treatment effects of psychoanalytic psychotherapy with young adults
2010 (English)In: Psychology and Psychotherapy: Theory, Research and Practice, ISSN 1476-0835, E-ISSN 2044-8341, Vol. 83, no Pt 1, p. 27-43Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: The short- and long-term effects of open-ended, long-term psychoanalytic psychotherapy for young adults were investigated. Possible changes during the year and a half follow-up, as well as predictors of change, were explored.

DESIGN: Patients aged 18-25 years who accepted the offered psychoanalytic individual or group psychotherapy were included. Patients filled out questionnaires and were interviewed at intake, termination, and follow-up. Alliance data were collected after the second session of psychotherapy proper.

METHODS: The primary outcome measures were the Symptom Checklist-90 and the Inventory of Interpersonal Problems. The Helping Alliance Questionnaire-II was used to measure alliance. Mixed model ANOVAs were used to analyse changeover time and prediction of change in relation to gender, treatment format, treatment duration, and in individual psychotherapy, therapist- and patient-rated alliance.

RESULTS: All outcome measures changed significantly from intake to follow-up. None changed significantly during the follow-up period, but there was a tendency towards recurring symptoms and an improvement in one of the object relational measures during the follow-up. The latter was the only outcome measure that did not change significantly during treatment. Lower therapist-rated alliance was predictive of greater change in psychiatric symptoms for patients with high levels of symptoms at intake.

CONCLUSIONS: The long-term effectiveness of psychoanalytic psychotherapy for young adults was supported. Low therapist-rated alliance implies that the therapists have identified problematic interactions, which might have mobilized their effort to solve the problems. Further research on cases reporting no gain or even deterioration is needed.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2010
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-104739 (URN)10.1348/147608309X464422 (DOI)19646335 (PubMedID)
Available from: 2014-02-25 Created: 2014-02-25 Last updated: 2017-12-05Bibliographically approved
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