Research has indicated that patients in-session experience of previously avoided affects may be important for effective psychotherapy. The aim of this study was to investigate patients in-session levels of affect experiencing in relation to their corresponding levels of insight, motivation, and inhibitory affects in initial Experiential Dynamic Therapy (EDT) sessions. Four hundred sixty-six 10-min video segments from 31 initial sessions were rated using the Achievement of Therapeutic Objectives Scale. A series of multilevel growth models, controlling for between-therapist variability, were estimated to predict patients adaptive affect experiencing (Activating Affects) across session segments. In line with our expectations, higher within-person levels of Insight and Motivation related to higher levels of Activating Affects per segment. Contrary to expectations, however, lower levels of Inhibition were not associated with higher levels of Activating Affects. Further, using a time-lagged model, we did not find that the levels of Insight, Motivation, or Inhibition during one session segment predicted Activating Affects in the next, possibly indicating that 10-min segments may be suboptimal for testing temporal relationships in affective processes. Our results suggest that, to intensify patients immediate affect experiencing in initial EDT sessions, therapists should focus on increasing insight into defensive patterns and, in particular, motivation to give them up. Future research should examine the impact of specific inhibitory affects more closely, as well as between-therapist variability in patients in-session adaptive affect experiencing.

Kritiska mixed race-studier är ett forskningsområde som internationellt växer sig allt större, men i en svensk kontext saknas forskning på personer som klassificeras som mixed race. I denna studie har tretton personer intervjuats med syfte att se hur de talade om sitt identitetsskapande i förhållande till sin blandade identitet samt om omgivningens bemötande. För att analysera materialet användes Foucauldiansk diskursanalys som metod.

Resultatet visar att deltagarna på varierande sätt konceptualiserar vad den blandade identiteten innebär och om eller hur den har betydelse för dem. De diskurser som var tillgängliga för deltagarna när de talade om sin blandade identitet, var diskurser kring kultur, etnicitet, nationalitet, ras och svenskhet. Den blandade identiteten konceptualiserades som något en får genom tillgång till flera kulturer eller genom blodsband samt som kroppsliga markörer. Hur deltagarna förhållit sig till den beskrivs ha varierat under deras liv liksom i olika kontexter. Deltagarna förhåller sig till att benämnas halv: vissa använder själva detta som beskrivande benämning medan andra tar avstånd från den och beskriver sig som hela, dubbla och trippel.

Deltagarna beskriver hur deras svenskhet ifrågasätts och hur de på olika sätt förhandlar om sin tillgång till den. Det framställs hur de ofta ställs inför frågan ”var kommer du ifrån, egentligen?”. Vissa framställer praktiker som lättare ska låta dem klassas som svensk/vit, alternativt gör motstånd mot att klassas som detta. Ytterligare framförs hur deras utseende låter dem uppfattas som tillhörande gruppen invandrare, och att detta ibland kan ge fördelar. Slutligen beskrivs även rasifierande praktiker som sker i en skärningspunkt mellan ras och kön. Deltagare som identifierar sig som kvinnor beskriver hur de översexualiseras och hur deras utseende exotifieras medan de som kategoriseras som män talar om hur de misstänkliggörs. I vårt resultat blir det tydligt att ras som en socialt konstruerad kategori påverkar individers erfarenheter och villkor i dagens Sverige.

Eye tracking (ET) has been used extensively in driver attention research. Amongst other findings, ET data have increased our knowledge about what drivers look at in different traffic environments and how they distribute their glances when interacting with non-driving related tasks. Eye tracking is also the go-to method when determining driver distraction via glance target classification. At the same time, eye trackers are limited in the sense that they can only objectively measure the gaze direction. To learn more about why drivers look where they do, what information they acquire foveally and peripherally, how the road environment and traffic situation affect their behavior, and how their own expertise influences their actions, it is necessary to go beyond counting the targets that the driver foveates. In this perspective paper, we suggest a glance analysis approach that classifies glances based on their purpose. The main idea is to consider not only the intention behind each glance, but to also account for what is relevant in the surrounding scene, regardless of whether the driver has looked there or not. In essence, the old approaches, unaware as they are of the larger context or motivation behind eye movements, have taken us as far as they can. We propose this more integrative approach to gain a better understanding of the complexity of drivers' informational needs and how they satisfy them in the moment.

While the negative effects of alcohol on driving performance are undisputed, it is unclear how driver attention, eye movements and visual information sampling are affected by alcohol consumption. A simulator study with 35 participants was conducted to investigate whether and how a drivers level of attention is related to self-paced non-driving related task (NDRT)-engagement and tactical aspects of undesirable driver behaviour under increasing levels of breath alcohol concentration (BrAC) up to 1.0 %o. Increasing BrAC levels lead to more frequent speeding, short time headways and weaving, and higher NDRT engagement. Instantaneous distraction events become more frequent, with more and longer glances to the NDRT, and a general decline in visual attention to the forward roadway. With alcohol, the compensatory behaviour that is typically seen when drivers engage in NDRTs did not appear. These findings support the theory that alcohol reduces the ability to shift attention between multiple tasks. To conclude, the independent reduction in safety margins in combination with impaired attention and an increased willingness to engage in NDRTs is likely the reason behind increased crash risk when driving under the influence of alcohol.

The objective of this study was to compare the development of sleepiness during manual driving versus level 2 partially automated driving, when driving on a motorway in Sweden. The hypothesis was that partially auto-mated driving will lead to higher levels of fatigue due to underload. Eighty-nine drivers were included in the study using a 2 ? 2 design with the conditions manual versus partially automated driving and daytime (full sleep) versus night-time (sleep deprived). The results showed that night-time driving led to markedly increased levels of sleepiness in terms of subjective sleepiness ratings, blink durations, PERCLOS, pupil diameter and heart rate. Partially automated driving led to slightly higher subjective sleepiness ratings, longer blink durations, decreased pupil diameter, slower heart rate, and higher EEG alpha and theta activity. However, elevated levels of sleepiness mainly arose from the night-time drives when the sleep pressure was high. During daytime, when the drivers were alert, partially automated driving had little or no detrimental effects on driver fatigue. Whether the negative effects of increased sleepiness during partially automated driving can be compensated by the positive effects of lateral and longitudinal driving support needs to be investigated in further studies.

Background: Subjective Well-Being (SWB) is usually conceptiislind in terms of an affective (i.e., judgements of biological emotional reactions and experiences) and a cognitive component (i.e., judgements of life satisfaction in relation to a psychological self-imposed ideal). Recently, researchers have suggested that judgements of harmony in life can replace or at least complement the cognitive component of SWB. Here, however, we go beyond that suggestion and propose that harmony in life should be seen as SWBs social component since it is the sense of balance between the individual and the world around her-a process that comprises acceptance, adaptation, and balance. By adding judgements of ones social interactions (i.e., harmony in life) to judgments of ones life satisfaction (psycho) and judgements of ones emotional reactions (bio), we propose a tentatively biopsychosocial model of SWB. As a first step, we used different factorial models in order to determine if both a general factor and specific sub-factors contribute to the biopsychosocial model of SWB. Method: A total of 527 participants responded to the Positive Affect Negative Affect Schedule (PANAS; 20 items), the Satisfaction with Life Scale (SWLS; five items), and the Harmony in life Scale (HILS; five items). We conducted exploratory and confirmatory factor analyses to validate the biopsychosocial model of subjective well-being and a general factor (SWBS). Results: The 20 PANAS items reflected a mixture of general latent structure saturation and specific latent structure saturation, but contributed to their respective specific latent factor (PA: 48%; NA: 49%) more than to the general latent SWBS factor (positive affect: 25%; negative affect: 32%). The five SWLS items contributed to a larger degree to the general SWBS factor (72%) than to life satisfaction itself (22%), while the five HILS items contributed to even a larger degree to the general SWBS factor (98%) than to harmony in life (0%). The bifactor model was the best model compared with all other models we tested (chi(2) = 1,660.78, df = 375, p < 0.001); Satorra Bentler chi(2 )1,265.80, df = 375, p < 0.001; CFI = 0.92; Tucker-Lewis Index = 0.91; RMSEA = 0.067. This model of a general SWBS factor explained about 64% of the total variance in the model, while specific SWBS components together explained 15% of the total variance. Conclusion: Our study suggests SWB as a general factor in a multidimensional biopsychosocial model. Indeed, as much as 64% of the variance of SWB was explained by this general factor. The SWB components, however, contributed to a different degree to each corresponding factor in the model. For instance, while the affective and cognitive components seem to be their own constructs and also part of the general SWB factor, the social component tested here contributed 0% to its own variance but 98% to the general factor.

Objective: The objective of this study was to analyze the effect of adherence to both specific technique factors and facilitative condition variables (e.g., therapists involvement, understanding and support) in Cognitive Behavior Therapy (CBT) and Interpersonal Psychotherapy (IPT). In addition, we were interested in whether the effect of therapist adherence would depend on the level of the working alliance. Method: Three sessions each from 74 patients diagnosed with Major Depressive Disorder who were randomized to 14 sessions of IPT or CBT were rated for adherence using a modified version of The Collaborative Study Psychotherapy Rating Scale-6 (CSPRS-6). Data was analyzed using Multilevel Modeling. Results: No effects of adherence to specific factors on outcome were found in neither CBT nor IPT. Facilitative conditions were associated with better outcome in CBT but not in IPT, even after adjustment for the quality of the working alliance. No interaction effects were found. Conclusions: Our findings highlight the importance of relational factors in CBT, but do not support the need for specific adherence to any of the two treatments. Possible explanations of the findings and directions for future research are discussed.

Clinical supervision is a cornerstone in psychotherapists training but there are few empirical evaluations on the effects of supervision on therapists competencies. The aim of this study was therefore to evaluate the effects of standardized supervision on rater-assessed competency in Cognitive Behavior Therapy (CBT). Six therapists with basic training in CBT were provided with protocol-based clinical supervision in CBT in a single-case experimental multiple baseline design. The supervision focused on specific CBT competencies and used experiential learning methods such as role-play. Each therapist recorded weekly treatment sessions during phases without and with supervision. The therapists CBT competence was assessed by third-party raters using the Revised Cognitive Therapy Scale (CTS-R). Statistical analyses showed that the therapists CTS-R scores increased significantly during the phase with supervision with a mean item increase of M = 0.71 (range = 0.50-1.0) on the supervision focus areas. This is one of the first empirical studies that can confirm that supervision affect CBT competencies. The results also suggest that supervision can be manualized and that supervisees have a positive perception of more active training methods. Further studies are needed to replicate the results and to find ways to improve the impact of supervision.

Clinical supervision is a central part of psychotherapist training but the empirical support for specific supervision theories or features is unclear. The aims of this study were to systematically review the empirical research literature regarding the effects of clinical supervision on therapists competences and clinical outcomes within Cognitive Behavior Therapy (CBT). A comprehensive database search resulted in 4103 identified publications. Of these, 133 were scrutinized and in the end 5 studies were included in the review for data synthesis. The five studies were heterogeneous in scope and quality and only one provided firm empirical support for the positive effects of clinical supervision on therapists competence. The remaining four studies suffered from methodological weaknesses, but provided some preliminary support that clinical supervision may be beneficiary for novice therapists. No study could show benefits from supervision for patients. The research literature suggests that clinical supervision may have some potential effects on novice therapists competence compared to no supervision but the effects on clinical outcomes are still unclear. While bug-in-the-eye live supervision may be more effective than standard delayed supervision, the effects of specific supervision models or features are also unclear. There is a continued need for high-quality empirical studies on the effects of clinical supervision in psychotherapy.

Speech understanding is a fundamental human ability that enable flexible communication among individuals. Understanding natural speech in normal conditions is a fast and automatic process. It is facilitated through integration between prior knowledge about a speech signal and multimodal speech inputs. In situations where listening conditions are adverse, for example due to hearing impairment or environmental noise, speech understanding is challenged and reliance on prior knowledge increases. Prior knowledge about phonology and semantics are involved in predictive mechanisms that generates more successful speech understanding. Working memory processing seems to be involved in influencing the quality of such predictions. To evaluate the role of working memory in the quality of linguistic predictions, a cortical comparison using MEG was used. MEG data from a previous experiment, where participants performed an auditory sentence completion task with background noise was analyzed. Results from statistical analysis, time-domain analysis and time frequency analysis suggests that differences in working memory processing does not influence the quality of linguistic predictions. Further research is required to assess what factors are involved in the quality of linguistic predictions which could lead to unsuccessful speech understanding, in order to improve communication in everyday situations.  

The Team Resilience Assessment Method for Simulation (TRAMS) is an instrument that consist of several measurements, such as team-member exchange, workload, the TRAMS observation protocol etc. This thesis researches the observation protocol. The TRAMS protocol is an assessment method for resilience in simulation games. The aim of this protocol is to support the identification of resilience strategies used and developed by the participants in a simulation game. It is a challenge to assess resilience in teams and that is why the TRAMS protocol has been developed. The scenario of the simulation games is a disruption for 10 days in the card payment system. During the simulation games, the participants work in teams and have to try to cope with the disruption in the card payment system. During the course of this study, 14 simulation games have been conducted with seven different teams. Each of the simulation games has been executed during one whole day, and the participating teams have in total played two games each. During every simulation game there were three observers equipped with the TRAMS protocol. To interpret the data collected with the TRAMS protocol, two methods have been used: transcription and thematic analysis. As a result, guidelines and design changes was formed. In addition, results showed that the distribution and frequency of observations of resilience strategies made were similar, that the observations noted by the observers were similar, and lastly eight themes from the data collection could be extracted: Coordinate and collaborate, Payment options, Cash circulation, Safety, Fuel and transportation, Inform, communicate and the media, Hoarding and rationing, Vulnerable groups. In conclusion, the TRAMS protocol is still under development and 15 more simulation games are planned to be conducted within the ongoing CCRAAAFFTING project. However, the protocol has been applied in this study´s 14 simulation games so far, and the similarities in how the observers filled in the protocol and how similar the observations were, indicate that it hopefully can develop into a recognized research tool in the future. 

Background: The COVID-19 pandemic has been associated with various negative psychological consequences. This is a challenge for the society as regular psychological services cannot be offered to the same extent as before the pandemic. In addition to the requirement of social distancing, there is a need to adjust psychological treatment components like exposure to avoid increasing the spread of the infection. Internet-delivered cognitive behavior therapy (ICBT) has an established evidence base for a range of psychiatric problems and has been suggested as one possible approach to deal with the situation. This study aimed to conduct a randomized controlled pilot trial during the summer of 2020 with a broad focus on psychological distress and a treatment approach that tailors the intervention based on symptom profile and preferences.

Methods: Following the advertisement and interview, we included 52 participants with elevated levels of psychological distress. They were randomly allocated to either a 7-week-long individually tailored ICBT (n = 26) or a wait-list control condition (n = 26). Measures of depression and quality of life were used as primary outcomes. We also included secondary outcome measures of anxiety, insomnia, trauma, stress, anger, and alcohol use. For screening, we used the CoRonavIruS Health Impact Survey (CRISIS).

Results: Overall moderate to large between-group effects were found at post-treatment in favor of the treatment on measures of both depression [Beck Depression Inventory (BDI); Cohens d = 0.63; Patient Health Questionnaire (PHQ-9): d = 0.62] and anxiety [Generalized Anxiety Disorder-7-item scale (GAD-7); d = 0.82]. This was also observed for stress symptoms [Perceived Stress Scale (PSS-14); d = 1.04]. No effects were seen on measures of quality of life, insomnia, symptoms of post-traumatic stress, and anger. There was an effect on alcohol use [Alcohol Use Disorder Identification Test (AUDIT); d = 0.54], which was not of clinical relevance.

Conclusion: Individually tailored ICBT shows initial promise as a way to reduce psychological problems in association with the COVID-19 pandemic. A possible limitation was that the trial was conducted when the effects of the pandemic were decreasing and when fewer people were affected by the restrictions (e.g., the summer of 2020).

This paper gives a brief introduction to the starting points of an experimental project to study dolphin communicative behaviour using distributional semantics, with methods implemented for the large scale study of human language.

Objective: The aims of the present study was to investigate communication impairments in a Norwegian sample of children with ADHD and children with Asperger syndrome (AS) and to explore whether children with ADHD can be differentiated from children with AS in terms of their language profiles on the Norwegian adaptation of the Children’s Communication Checklist Second Edition (CCC-2). Method: The CCC-2 was completed by the parents, and altogether, 77 children aged between 6 and 15 years participated in the study. Results: Communication impairments were as common in a group of children with ADHD as in a group of children with AS. Although a similar pattern appeared on most CCC-2 scales, children with ADHD and children with AS could be distinguished from each other in terms of their language profiles on the subscales assessing stereotyped language and nonverbal communication. Conclusion: Language abilities should be taken into account when standard assessments of ADHD and AS are performed and before therapies are initiated

Objective: This study aimed to explore whether children with specific language impairment (SLI) and children with ADHDcan be differentiated from each other in terms of their language profiles, and also to investigate whether these two clinicalgroups differ regarding mental health problems. Method: A total of 59 children in the age range 6 to 12 years participatedin the study. The parents completed the Children’s Communication Checklist–Second Edition and the Strengths andDifficulties Questionnaire. Results: Communication impairments were as prominent in the ADHD group as in the SLIgroup; however, the groups were separable from each other in terms of their language profiles. Furthermore, the ADHDgroup experienced significantly more mental health problems compared with the SLI group. Conclusion: Language shouldbe assessed in children with ADHD and instruments sensitive to ADHD should be included when assessing children withSLI. Mental health should be an area of concern to be addressed in both groups. (J. of Att. Dis. 2012; XX(X) 1-XX)

Sammanfattningsvis handlar denna studie om relationen mellan metakognition och matematisk problemlösning.Metakognition betyder kortfattat förmågan att tänka över det egna tänkandet och har visat sig vara en central del avarbete med problemlösning. Syftet med studien var att undersöka vilka metakognitiva strategier som elever användervid arbete med rika matematiska problem samt hur dessa påverkar huruvida problemlösningsprocessen förs framåt.Studien bygger på fyra observationer av 13 elever i årskurs åtta som arbetade med rika matematiska problem. Resultatet kodades med hjälp av ett analysverktyg som skapades med stöd i tidigare forskning och studien kom framtill att de vanligaste strategierna som eleverna använde var att identifiera relevant information samt att hitta ”nyckeln”i problemet. Dessa strategier var också de som förde problemlösningsprocessen framåt. Avslutningsvis dras slutsatsenatt elever som lyckas i sin problemlösning använder många olika metakognitiva strategier och att de behärskar detvå vanligaste strategierna, vilket leder till att de kan komma vidare i problemlösningen.

BACKGROUND: As relapse after completed cognitive behavior therapy (CBT) for obsessive-compulsive disorder (OCD) is common, many treatment protocols include booster programs to improve the long-term effects. However, the effects of booster programs are not well studied. In this study, we investigated the long-term efficacy of Internet-based CBT (ICBT) with therapist support for OCD with or without an Internet-based booster program.

METHOD: A total of 101 participants were included in the long-term follow-up analysis of ICBT. Of these, 93 were randomized to a booster program or no booster program. Outcome assessments were collected at 4, 7, 12 and 24 months after receiving ICBT.

RESULTS: The entire sample had sustained long-term effects from pre-treatment to all follow-up assessments, with large within-group effect sizes (Cohen's d = 1.58-2.09). The booster group had a significant mean reduction in OCD symptoms compared to the control condition from booster baseline (4 months) to 7 months, but not at 12 or 24 months. Participants in the booster group improved significantly in terms of general functioning at 7, 12 and 24 months, and had fewer relapses. Kaplan-Meier analysis also indicated a significantly slower relapse rate in the booster group.

CONCLUSIONS: The results suggest that ICBT has sustained long-term effects and that adding an Internet-based booster program can further improve long-term outcome and prevent relapse for some OCD patients.

OBJECTIVE: The role of genetics for predicting the response to cognitive behavior therapy (CBT) for social anxiety disorder (SAD) has only been studied in one previous investigation. The serotonin transporter (5-HTTLPR), the catechol-o-methyltransferase (COMT) val158met, and the tryptophan hydroxylase-2 (TPH2) G-703Tpolymorphisms are implicated in the regulation of amygdala reactivity and fear extinction and therefore might be of relevance for CBT outcome. The aim of the present study was to investigate if these three gene variants predicted response to CBT in a large sample of SAD patients.

METHOD: Participants were recruited from two separate randomized controlled CBT trials (trial 1: n = 112, trial 2: n = 202). Genotyping were performed on DNA extracted from blood or saliva samples. Effects were analyzed at follow-up (6 or 12 months after treatment) for both groups and for each group separately at post-treatment. The main outcome measure was the Liebowitz Social Anxiety Scale Self-Report.

RESULTS: At long-term follow-up, there was no effect of any genotype, or gene × gene interactions, on treatment response. In the subsamples, there was time by genotype interaction effects indicating an influence of the TPH2 G-703T-polymorphism on CBT short-term response, however the direction of the effect was not consistent across trials.

CONCLUSIONS: None of the three gene variants, 5-HTTLPR, COMTval158met and TPH2 G-703T, was associated with long-term response to CBT for SAD.

In recent years, there has been an increased interest in the cognitive foundations of religion and experimental methods have been used to explain religious behaviours. However, in the world, there are a substantial number of non-believers (atheists), and this has been a largely unknown field for experimental and more basic research informed by cognitive science. This has now changed and in this review, I cover three domains of study. First, studies in which belief in God has been manipulated in the direction of showing less belief are reviewed. For example, it is shown that analytical thinking reduces religious belief. Second, recent studies on cognitive bias against atheists are covered showing that atheists are distrusted, elicit disgust and are viewed as immoral both explicitly and implicitly. Third, I review studies in which prejudice against atheists has been experimentally manipulated showing that it is possible to reduce bias against atheists. I conclude the paper arguing that the bias against atheists need to be investigated in the Scan-dinavian countries.

Internet interventions have been around now for about 20 years. While the field still suffers from a scattered terminology a large number of programs and studies exist. In the present paper I present an overview of my experiences of studying internet-supported cognitive-behaviour therapy (ICBT), but also mention other approaches including the use of smartphones. The paper covers the history of ICBT, short-term effects in controlled trials for a range of conditions, long-term effects, comparisons against face-to-face therapy, effectiveness studies, prediction studies, how the treatment is perceived, critique, and finally future directions. I conclude that we have now reached a stage in which we have numerous evidence-based treatments and procedures, and increasingly internet interventions including ICBT are disseminated.

Internet-Delivered CBT: Distinctive Features offers a concise overview of how internet-delivered CBT and related methods (such as smartphones) can be used as single interventions as well as part of regular CBT in the form of “blended treatments”. The book also describes different applications and adaptions of internet treatments for different target groups (young persons, adults and older adults) and cultures/languages.

The book is in the style of A-Z, which means that all stages will be described from assessment/case formulation, treatment and how clinicians can/should support the treatments, evaluations and also new findings regarding the role of tailoring treatments based on client problem profile and preferences.

The book is written for clinical psychologists, psychotherapists and also students in these fields. It is also suitable for researchers in the field of digital treatments.

During the past 15 years, much progress has been made in developing and testing Internet-delivered psychological treatments. In particular, therapist-guided Internet treatments have been found to be effective for a wide range of psychiatric and somatic conditions in well over 100 controlled trials. These treatments require (a) a secure web platform, (b) robust assessment procedures, (c) treatment contents that can be text based or offered in other formats, and (d) a therapist role that differs from that in face-to-face therapy. Studies suggest that guided Internet treatments can be as effective as face-to-face treatments, lead to sustained improvements, work in clinically representative conditions, and probably are cost-effective. Despite these research findings, Internet treatment is not yet disseminated in most places, and clinical psychologists should consider using modern information technology and evidence-based treatment programs as a complement to their other services, even though there will always be clients for whom face-to-face treatment is the best option.

Objectives: Internet-delivered psychological treatments were developed more than 20 years ago, and tinnitus was among the first target conditions. The aim of this review article is to describe the history of Internet treatments for tinnitus and to comment on the evidence base. Challenges for future research and implementations will be mentioned. Method: A narrative historical review was conducted. Findings: There are now several studies including controlled trials on Internet interventions based on cognitive behavior therapy (ICBT) for tinnitus. Effects in controlled trials are moderate to large with regard to tinnitus annoyance. While the treatment format now exists in four languages, there is a large treatment versus demand gap as very few clients with tinnitus receive ICBT. There is a lack of research on related conditions with the exception of hearing loss. However, there is substantial support for Internet interventions for comorbid conditions such as insomnia and depression but not specifically in association with tinnitus. Conclusions: ICBT is a promising treatment approach for tinnitus and will hopefully increase access to evidence-based treatment to reduce tinnitus distress. More research is needed for related conditions such as hyperacusis and larger trials on tinnitus.

Comprehensive and practical, The Internet and CBT: A Clinical Guide describes how cognitive behavioural therapy can be delivered via the Internet, email, open access programmes, online communities and via smartphone. Detailing how these alternative methods of CBT support can be integrated within a busy practice, it is invaluable for all CBT clinicians and students wishing to find out more about assessing and supporting people in innovative ways. This book enables you to:

• Learn how to best give advice concerning online support communities and when to recommend guided self help online
• Understand how to integrate online and smartphone CBT delivery into your daily practice
• Explore the resources and treatment programmes available
• Perform online assessments
• Guide and supervise the people in your care
• Comprehend issues of patient confidentiality and what you need to do to ensure safe and ethical practice

With its no-nonsense and down-to-earth approach, this book covers the dos and don'ts of CBT delivery online and via smartphone and provides a highly accessible guide for students and practitioners wishing to incorporate online CBT into their work. It will be of great interest to CBT clinicians, psychologists, psychotherapists, counsellors and mental health nurses.

Mental health problems are prevalent among therapists and may have a negative impact on therapist effectiveness. To counteract such problems, therapist self-care (for example, striking a balance between personal and professional demands and seeking personal therapy), has received increased attention. Conceptually, self-care can be considered as part of a personal practice model, focusing on techniques that therapists engage with self-experientially with a focus on their personal and/or professional development. However, studies of the self-application of specific treatment techniques are lacking. We aimed to explore the use, and perceived usefulness, of cognitive behavioural therapy (CBT) techniques for self-care to prevent or treat own mental health problems among practising therapists. Participants were therapists (n= 228) of various professional backgrounds in Sweden. Data were collected using a web-based survey. Descriptive statistics were calculated, and non-parametric analyses conducted to investigate associations of 13 CBT techniques with therapist characteristics. Use of CBT techniques for self-care was highly prevalent among participants, and they perceived the techniques as useful, irrespective of characteristics such as gender, age, profession, years since graduation, clinical experience, level of training in CBT, and previous experience of personal CBT. The high prevalence among therapists of the use of treatment techniques for self-care is very encouraging. Therapist self-care, including the self-application of treatment techniques, may be an important factor for therapist effectiveness, which calls for further development of personal practice models with respect to self-care, and future studies investigating associations between therapist mental health, self-care, effectiveness and patient outcome. Key learning aims Therapist self-care using cognitive behavioural therapy (CBT) techniques to prevent or treat own mental health problems may influence therapist effectiveness. However, studies of self-application of treatment techniques are lacking. In the present survey study, the use of CBT techniques for self-care was highly prevalent among practising therapists, and they perceived the techniques as useful, irrespective of characteristics such as gender, age, profession, years since graduation, clinical experience, level of training in CBT, and previous experience of personal CBT. Almost all therapists believed that it was a good idea to self-apply CBT techniques for their own sake and for the benefit of their patients.

Even if much is known regarding the effects of internet-delivered cognitive behaviour therapy (ICBT) for depression there are several topics that have not been studied. In this factorial design trial with 197 participants we investigated if clients in ICBT could select treatment modules themselves based on a selection of 15 tailored treatment modules developed for use in ICBT for depression. We contrasted this against clinician-tailored module selection. We also investigated if support on demand (initiated by the client) could work as well as scheduled support. Finally, we tested if clients that were mentioned in supervision would improve more than clients not mentioned (with the exception of acute cases). The treatment period lasted for 10 weeks, and we measured effects at post-treatment and two-year follow-up. Measures of depression and secondary outcomes were collected at pre-treatment, post-treatment and two-year follow-up. Overall, within-group effects were large across con-ditions (e.g., d = 1.73 on the BDI-II). We also found a small but significant difference in favour of self-tailored treatment over clinician-tailored (d = 0.26). Within-group effects for the secondary measures were all moderate to large including a test of knowledge about CBT. The other two contrasts "support on demand" and "supervision" yielded mostly non-significant differences, with the exception of a larger dropout rate in the support on demand condition. There were few negative effects (2.2%). Effects were largely maintained at a two-year follow-up. We conclude that clients can choose treatment modules and that support on demand may work. The role of su-pervision is not yet clear as advice can be transferred across clients.

Jobblabb är en ny utställning på Arbetets museum i Norrköping som tar emot skolklasser i årskurs 5 med syftet att hjälpa barnen att kunna fatta smarta framtida val kring jobb genom att hjälpa dem att förstå sina styrkor och hur de kan användas liksom att inspirera och visa bredden av de möjligheter som finns för dem. Den här studien utvärderar utställningens påverkan på jobbrelaterad kreativitet, specifikt att kunna komma på många och olika typer av jobb som man anser skulle kunna passa en själv i framtiden. Utvärderingen sker genom en variant av Guilfords Alternative Uses Test med mätningar av flöde, originalitet, flexibilitet, och utarbetning. Resultatet kunde inte visa några signifikanta skillnader på flöde, flexibilitet, eller utarbetning mellan de som hade respektive inte hade besökt museet, men däremot en signifikant lägre originalitet hos de som besökt museet.


There are many studies conducted on cognitive performance and of different aspects that can affect the performance. However, the literature review reveal that there is a knowledge gap in the area of measurements for bicycle stability and in how bicycle stability is affected during acute alcohol intoxication. The aim of this study is, therefore, to investigate if different group characteristics such as cycling experience, physical activity, sensation-seeking, or previous alcohol habits have an effect on bicycle performance or executive functions during acute alcohol intoxication. The method of the study was to measure stability while bicycling on a tread-mill and give participants doses of alcohol until a Breath alcohol concentration (BrAC) level of approximately 0.8‰ was reached. The results showed that cognitive performance was almost unaffected for the different groups studied. The results of bicycle stability were almost equal in effect of time among the four different group characteristics in both Roll and YAW measurements. Three of the group characteristics showed a main effect or a tendency for interaction effect of group by time. The conclusion is that the measure of Roll, the vertical orientation on a bicycle, maybe is the most effective stability measurement for bicycles.

Although the Flynn Effect has been studied widely across cultural, geographic, and intellectual domains, and many explanatory theories have been proposed, little past research attention has been paid to subgroup differences. Rodgers and Wänström (2007) identified an aggregate-level Flynn Effect (FE) at each age between 5 and 13 in the Children of the National Longitudinal Survey of Youth (NLSYC) PIAT-Math data. FE patterns were not obtained for Reading Recognition, Reading Comprehension, or Digit Span, consistent with past FE research suggesting a closer relationship to fluid intelligence measures of problem solving and analytic reasoning than to crystallized measures of verbal comprehension and memory. These prior findings suggest that the NLSYC data can be used as a natural laboratory to study more subtle FE patterns within various demographic subgroups. We test for subgroup Flynn Effect differences by gender, race/ethnicity, maternal education, household income, and urbanization. No subgroups differences emerged for three demographic categories. However, children with more educated (especially college educated) mothers and/or children born into higher income households had an accelerated Flynn Effect in their PIAT-M scores compared to cohort peers with lower educated mothers or lower income households. We interpret both the positive and the null findings in relation to previous theoretical explanations.

Objective: Primary care staff faces a complex work environment including a heavy administrative work load and perceive some work tasks as illegitimate. This study aimed to elucidate associations between the perceived legitimacy of work tasks, the psychosocial work environment, and the utilization of work time among Swedish primary care staff.

Design and setting: The study was designed as a multicenter study involving all staff categories, i.e. registered nurses, primary care physicians, care administrators, nurse assistants and allied professionals, at eleven primary care centers in Sweden.

Subjects: Participants completed the Bern Illegitimate Tasks Scale and the Copenhagen Psychosocial Questionnaire. They also recorded time spent on all work tasks, day by day during two separate weeks.

Main outcome measures and results: More than a quarter (27%) of primary care physicians perceived a high proportion of unnecessary work tasks. After adjusting for profession, age and gender, the perception of having to perform unreasonable work tasks was positively associated with experiencing role conflicts and with the proportion of organization-related administration and service work tasks.

Conclusion: Across all staff groups, the perception of unreasonable work tasks was more pronounced among staff with a high proportion of non-patient related administration. Also, the perception of having to perform a large amount of illegitimate work tasks affected the psychosocial work environment negatively, which might influence staffs perception of their professional roles. These results illuminate the importance of decision makers to thoroughly consider the distribution and allocation of non-patient related work tasks among staff in primary care.Key pointsWe observed an interaction between perception of having a large proportion of illegitimate work tasks and impaired psychosocial work environment. • More than a quarter of the primary care physicians perceived a high proportion of unnecessary work tasks.• Across all staff groups, performing unreasonable work tasks was associated with an experience of having role conflicts.• Across all staff groups, a perception of performing unreasonable work tasks was associated with the proportion of non-patient related administrative work tasks.

Introduction The overall aim of this study is to compare daytime driving with night-time driving looking at line crossings during self-reported sleepiness and long blinks. The hypothesis is that high levels of self-reported sleepiness (KSS 9) and long blink duration (amp;gt;0.15 s) will be less associated with critical events during the day-time compared to night-time. Method The study is based on data from a driving simulator experiment with 16 participants driving 150 km on a typical Swedish motorway scenario twice: once during daytime and once during night time. In total data from 6 segments of 4 km each equally distributed along the drive was averaged and included in the analysis. A Mixed Model Anova was used to test the effects on KSS, Blink Duration and Line Crossings with factors for Session (Day/Night) and Road segment (1-6), and participant as random. In addition, a logistic regression was used to identify when there is a risk for line crossings. Finally, the proportion of line crossings in relation to high KSS values and long blink durations was tested with Fishers exact test. Results The results show no differences in the percentage of Line Crossings to the left during high levels of Karolinska Sleepiness Scale during daytime (33%) compare to night-time (40%). However, there was a significant difference between day and night time line crossings while the driver had long duration blinks (4% during daytime and 35% during night-time). Despite these results the most promising predictor of line crossings in each segment of 4 km/h was KSS with an Odds Ratio of 5.4 with a reference value at Karolinska Sleepiness Scale level 5. Conclusion In conclusion, the results do not support the hypothesis that high levels of KSS will result in more frequent line crossings at night time compared to day time. However, the result supports the hypothesis that long blink durations are associated with more line crossings when they appear during night time than during daytime.

Bus drivers often work irregular hours or split shifts and their work involves high levels of stress. These factors can lead to severe sleepiness and dangerous driving. This study examined how split shift working affects sleepiness and performance during afternoon driving. An experiment was conducted on a real road with a specially equipped regular bus driven by professional bus drivers. The study had a within-subject design and involved 18 professional bus drivers (9 males and 9 females) who drove on two afternoons; one on a day in which they had driven early in the morning (split shift situation) and one on a day when they had been off duty until the test (afternoon shift situation). The hypothesis tested was that split shifts contribute to sleepiness during afternoon, which can increase the safety risks. The overall results supported this hypothesis. In total, five of the 18 drivers reached levels of severe sleepiness (Karolinska Sleepiness Scale 8) with an average increase in KSS of 1.94 when driving in the afternoon after working a morning shift compared with being off duty in the morning. This increase corresponded to differences observed between shift workers starting and ending a night shift. The Psychomotor Vigilance Task showed significantly increased response time with split shift working (afternoon: 0.337 s; split shift 0.347 s), as did the EEG-based Karolinska Drowsiness Score mean/max. Blink duration also increased, although the difference was not significant. One driver fell asleep during the drive. In addition, 12 of the 18 bus drivers reported that in their daily work they have to fight to stay awake while driving at least 2-4 times per month. While there were strong individual differences, the study clearly showed that shift working bus drivers struggle to stay awake and thus countermeasures are needed in order to guarantee safe driving with split shift schedules.

BackgroundThere is mixed evidence regarding the impact of interactive digital devices on child development. Tentatively some studies suggested that the use of digital devices may correlate negatively with language, executive function, and motor skills. However, attempts to amalgamate this evidence has been limited related to the available number of experimental and cohort studies that have evaluated the impact of digital technology use on child development. We conducted this review to determine the impact of interactive digital devices on child development among children aged 7 years or younger. Interactive technology has been defined as methods, tools, or devices that users interact with in order to achieve specific tasks. Data sourceTo carry out this systematic review, databases CINAHL, MEDLINE, Embase, PsychINFO, Scopus and Google Scholar were searched for relevant studies. Study selectionWe used the Joanna Briggs Institute methodology for systematic reviews. Data extractionData extraction and synthesis was carried out by two reviewers and checked by a third reviewer. Studies were stratified into tiers depending on the level of evidence provided and the domain of development assessed. ResultsFifty-three studies were eligible for inclusion in the review, 39 Tier 1 (randomized controlled trials and quasi-experimental studies) and 16 Tier 2 (descriptive studies). Childrens use of interactive digital technology was positively associated with receptive language and executive function and negatively associated or unrelated to motor proficiency. Other critical aspects informing the evidence, such as dose of exposure, intensity, or duration, were inconsistently reported, making estimates of exposure tentative and imprecise. ConclusionThe studies included in this review were predominantly correlational or comparative in nature and focuses on cognitive domains of learning rather than a specific developmental outcome. It is difficult to generalize our findings beyond the digital devices or applications that have been evaluated by earlier studies. The contextual factors that may moderate the relationship require elaboration in future studies.

The aim of this study is to explore whether a participatory, organizational intervention can reduce work-related risk factors, and thereby prevent stress-related ill health. We build on the job demand-control and effort-reward imbalance models of stress. It is a two-armed randomized trial, with one primary health care unit receiving the intervention and a two-unit control group. Validated questionnaires for the assessment of psychosocial work environment and health were administered, at the baseline and at 6 and 12-month follow up. The primary outcome was job strain. Secondary outcomes were effort-reward imbalance, exhaustion, sleep, and recovery. Group-level objective data on workload and data about relevant processes during the study were continuously collected. The changes in the intervention group with regard to job strain, effort-reward imbalance, exhaustion, sleep and recovery were not statistically different from changes in the control group. For the non-exhausted employees though, reward was significantly higher at follow up compared to baseline, but only in the intervention group. An important piece of information is that the objective workload was statistically significantly higher in the intervention group throughout the study. Not all the components of the intervention were implemented as intended. Context and process information, such as objective data and implementation fidelity are necessary for a valid interpretation of the results.

Self-driving buses will be part of the public transportation system of the future, and they must therefore be accessible to all. The study reported in this paper examines the user experiences of 16 children with mild intellectual disability riding a self-driving bus. The qualitative analysis, performed by iterative affinity diagramming, of interviews, observations, and a co-design session with five of the children, suggests that familiar situations were characterized by contemplation and curiosity, while unfamiliar ones were characterized by surprise or confusion. The temporal structure of past, present, and future situations in the field of attention played a significant role in the children’s experiences. This leads to design considerations for an explainable interior of self-driving buses.

BACKGROUND: The COVID-19 pandemic has affected people globally both physically and psychologically. The increased demands for mental health interventions provided by clinical psychologists, psychotherapists and mental health care professionals, as well as the rapid change in work setting (e.g., from face-to-face to video therapy) has proven challenging. The current study investigates European clinical psychologists and psychotherapists' views on the changes and impact on mental health care that occurred due to the COVID-19 pandemic. It further aims to explore individual and organizational processes that assist clinical psychologists' and psychotherapists' in their new working conditions, and understand their needs and priorities.

METHOD: Members of the European Association of Clinical Psychology and Psychological Treatment (EACLIPT) were invited (N = 698) to participate in a survey with closed and open questions covering their experiences during the first wave of the pandemic from June to September 2020. Participants (n = 92) from 19 European countries, mostly employed in universities or hospitals, completed the online survey.

RESULTS: Results of qualitative and quantitative analyses showed that clinical psychologists and psychotherapists throughout the first wave of the COVID-19 pandemic managed to continue to provide treatments for patients who were experiencing emotional distress. The challenges (e.g., maintaining a working relationship through video treatment) and opportunities (e.g., more flexible working hours) of working through this time were identified.

CONCLUSIONS: Recommendations for mental health policies and professional organizations are identified, such as clear guidelines regarding data security and workshops on conducting video therapy.

Cognitive behaviour therapy (CDT) is efficacious for severe health anxiety, but little is known about mechanisms. We analysed putative mediators of change based on 13 weekly assessments in a randomised controlled trial (N = 132) of exposure-based minimal-contact CBT (guided Internet-delivered CBT, unguided Internet-delivered CBT and bibliotherapy) vs. a waitlist control for severe health anxiety. We hypothesised that the effect of CBT on health anxiety would be mediated by non-reactivity to inner experiences, health anxiety behaviours and perceived competence. We also explored somatosensory amplification. In parallel process growth models, nonreactivity, health anxiety behaviours and perceived competence - but not somatosensory amplification - were influenced by CBT and associated with health anxiety. Random intercepts cross-lagged panel models were used to study within-individual ordering of change. None of the putative mediators systematically predicted subsequent changes in health anxiety. Rather, changes in health anxiety predicted subsequent changes in all putative mediators. In summary, CBT influenced health anxiety behaviours, non-reactivity to inner experiences and perceived competence, and these variables were associated with the outcome. However, their role as mediators was not corroborated because we found no evidence that changes in these variables predicted subsequent changes in health anxiety. We encourage further research into mediators of CBT for health anxiety.

A wide range of psychological treatments have been found to reduce the symptoms of irritable bowel syndrome (IBS) but their relative effects are unclear. In this systematic review and meta-analysis, we determined the effects of psychological treatments for IBS, including subtypes of cognitive behavior therapy, versus attention controls. We searched 11 databases (March 2022) for studies of psychological treatments for IBS, reported in journal articles, books, dissertations, and conference abstracts. The resulting database comprised 9 outcome domains from 118 studies published in 1983-2022. Using data from 62 studies and 6496 participants, we estimated the effect of treatment type on improvement in composite IBS severity using random-effects meta-regression. In comparison with the attention controls, there was a significant added effect of exposure therapy (g = 0.52, 95% CI = 0.17-0.88) and hypnotherapy (g = 0.36, 95% CI = 0.06-0.67) when controlling for the pre- to post-assessment duration. When additional potential confounders were included, exposure therapy but not hypnotherapy retained a significant added effect. Effects were also larger with a longer duration, individual treatment, questionnaire (non-diary) outcomes, and recruitment outside of routine care. Heterogeneity was substantial. Tentatively, exposure therapy appears to be a particularly promising treatment for IBS. More direct comparisons in randomized controlled trials are needed. OSF.io identifier: 5yh9a.

En ambient display är menad att fungera för användaren enbart genom att hen snabbt överblickar produkten. Denna form av display är perfekt att nyttja i dagligvaruhandeln där utbuden ständigt växer samtidigt som konsumenten snabbt vill hitta det den söker. I denna studie utforskas fördelarna med att använda färg och symbolkombinationer, som skapar en ambient display, istället för text när det kommer till att kategorisera i tidningssektionen. Feature- integrationsteorin beskriver hur den ambienta displayen ger stöd för användarens kognitiva processer, den är mer effektiv genom att den låter konsumenten använda det perifera seendet i sitt sökande.

Tidningssektionen är en produkt användaren inte nyttjar frekvent och denna design fungerar genom att kunden redan ska veta hur den önskade kategorin är representerad, det är därför väldigt viktigt att inlärningen sker snabbt. I studien framkommer vikten av att skapa bra associationer mellan färg och kategori, vilket har en extremt signifikant påverkan på inlärningsförmågan hos användaren.

Studien utvärderar även vilka färg- och kategorikombinationer som är lämpliga för Tidsam, distributör av tidningar. 17 kategorier associeras med 17 olika färger där multipla källor används för att styrka resultatet. Resultatet presenteras i form av virtuella prototyper av kategoriskyltar för samtliga 17 kategorier.

Background

Online self-help interventions have proven to be effective in treating various specific mental disorders, mainly depression and anxiety. Knowledge regarding their acceptance, efficacy, and usefulness in addition to inpatient or outpatient psychotherapy is limited. Therefore, we plan to evaluate an affect-focused, transdiagnostic, psychodynamic online self-help intervention following inpatient psychotherapy for mixed diagnoses in a feasibility study to determine acceptance, satisfaction, and preliminary estimates of efficacy.

Methods

The intervention is based on the book “Living Like You Mean It” by Ronald J. Frederick (2009) and the Swedish adaption by Johansson and colleagues (2013). The book was translated into German and thoroughly revised using parts of the Swedish adaption and additional tasks from their intervention. In a pilot phase, corrections concerning comprehensibility of the content and exercises were made based on patient's feedback. In the second step, we developed a website presenting the German adaption in eight units. In the third step, at least N = 66 patients from the Department of Psychosomatic Medicine and Psychotherapy will be recruited for a feasibility study. Patients are randomized into two groups. The intervention group (IG) will receive ten weeks of access to the online self-help intervention together with weekly therapeutic feedback on their progress. The wait-list control group (WLC) will receive access to the intervention for ten weeks as well, but without therapeutic feedback and with a ten-week delay. We will conduct assessments at the beginning of the intervention of the IG (T0), the end of the intervention of the IG (T1), two months later (only IG, T2), and at the end of the intervention of the WLC (T3). The primary outcome is satisfaction with the treatment as measured by the ZUF-8 at T1 and T3 respectively. Secondary outcome measures include emotional competence, depression, anxiety, and quality of life.

Conclusion

We expect insight into the usefulness and acceptance of an online self-help intervention used to maintain inpatient treatment effects. Furthermore, we await both groups to benefit from the participation in the intervention. Pre- post and between subject differences will be used as estimate effect sizes to calculate the necessary sample size for a larger efficacy trial.

Relapse prevention after pain management is a neglected area and Internet-based interventions have the potential to partly fill this gap. A challenge in designing effective relapse prevention program is how to motivate patients to persist throughout the full length of treatment. Following a regular pain management program, 29 participants underwent a 20 week long Internet–based relapse prevention program based on acceptance-oriented CBT. Qualitative analyses showed changes in attitudes towards their pain and body during the course of treatment. Degree of personal commitment in treatment goals seemed to affect gains relating to new perspective on self and future. Therapeutic strategies of defusion and mindfulness seemed to ease perspective changes and persistence to comply. Values interventions are hypothesized to be a plausible therapeutic strategy to engage participants in continuous behavior change. Further studies on non-compliers and drop-outs could enhance understanding of interventions necessary to maintaining motivation. When and how to give therapist support during Internet-based treatment for chronic pain is another area in need of further studies.

The role of explicit, declarative knowledge in general health care and in psychotherapy is a growing field of research. In many areas of healthcare, knowledge is regarded as an important factor for successful interventions. Participants within mental-health interventions should ideally gain knowledge about their specific conditions and strategies to improve, in order to manage their problems in more helpful ways. In Cognitive Behaviour Therapy (CBT), explicit knowledge is a core feature when treating clients and educating them about their symptoms, problems and potential solutions. Still, the role of knowledge and its relation to treatment outcome within CBT treatments is unclear. CBT administered over the internet (ICBT), is mainly based on psychoeducative texts and thus provides a suitable format for an initial evaluation of explicit knowledge within a clinical research context. The role of explicit knowledge could be of particular importance in the study of younger target groups, who probably have their first treatment experience. Their knowledge gain and its use could be of importance both as separate constructs but also in relation to symptom reduction following treatment.

The overarching aim of this thesis was to explore the role of explicit knowledge in internet-delivered CBT for adolescents with depression and anxiety.

Study I explored the role of explicit knowledge in a randomised controlled trial with adolescents suffering from primary depression. A knowledge test was constructed and administered at pre- and post-treatment. Results showed that explicit knowledge and certainty of knowledge about depression, anxiety and CBT increased during treatment, but that these variables were unrelated to treatment outcome. Lower pre-treatment knowledge levels (certainty) however predicted greater improvement in depressive symptoms.

Study II describes the procedure of developing a new knowledge test in the context of ICBT for adolescents with depression and anxiety. An explorative factor analysis was performed and resulted in a three-factor solution with the following factors: Act in aversive states, Using positive reinforcement, and Shifting attention. The procedure presented could illustrate one way of creating a test for knowledge evaluation in ICBT, but its clinical use needs to be evaluated further.

In Study III, participants from a randomised controlled trial of ICBT for adolescent depression were asked about their acquired knowledge and knowledge use six months later. Qualitative methodology (thematic analysis) was used. The results showed two overarching ways that clients can remember and relate to CBT-principles after treatment; one more explicit way related to the active application of CBT principles, and another vague way of recalling treatment content and the passive usage of CBT. Both ways of recalling CBT principles were related to experiencing the treatment as helpful.

Study IV evaluated the role of learning strategies and chat-sessions in ICBT for adolescents with anxiety and depression. A total of 120 adolescents were randomised to one of four treatment groups, in a 2x2 factorial design with the two factors: with or without learning support and/or chat-sessions. Overall, the results showed general reductions of anxiety and depressive symptoms, and increased knowledge levels. Participants receiving learning strategies during treatment obtained more immediate benefits in treatment outcome and knowledge levels, but at six months follow-up participants without learning support had reached equal amounts of knowledge and symptom reduction. Chat-sessions did not add any effect on treatment outcome or knowledge levels.

In conclusion, this thesis suggests that explicit knowledge is a construct that is independent of symptom reduction and increases during ICBT treatments for adolescents with depression and anxiety. Increased knowledge, and increased certainty of knowledge, are valuable outcomes since CBT emphasises educating clients about symptoms, therapeutic principles, and strategies that they can remember and use later on. The lack of association between explicit knowledge gain and symptom reduction could indicate that explicit knowledge is a necessary but insufficient factor for symptom reduction. Adding learning strategies within a treatment programme could be of importance for enhancing short-term treatment effects.

There is a continued need for more research on the role of knowledge in ICBT, both as an outcome and as a way to improve treatment effects. The findings in this thesis however suggest that research on explicit knowledge is important to understand what makes ICBT work.

Background Low self-esteem is common and can be impairing for adolescents. Treatments that primarily target low-esteem are lacking. Internet-delivered cognitive behaviour therapy (ICBT) is a treatment that can be used for adolescents but ICBT is yet to be evaluated for low self-esteem using qualitative methods. The aim of this study was to investigate experiences of participating in a novel ICBT treatment for adolescents suffering from low self-esteem.

Method Fifteen adolescent girls who had received ICBT consented to participate in a semi-structured qualitative telephone interview at post-treatment. Data were analysed and categorised using inductive Thematic Analysis.

Results Four overarching themes were identified; (1) Increased awareness and agency in difficult situations, (2) Enhanced self-image, (3) Unique but not alone, and (4) Widened understanding and new perspectives. Participants reported positive changes in their thinking and behaviour, as well as helpful learning experiences in relation to themselves and their self-esteem. For instance, participants described a more self-accepting attitude, learned how to manage negative thoughts, and experienced an increased sense of connection to others.

Conclusion The results suggest that ICBT is experienced as helpful and will inform further use and development of ICBT for low self-esteem. Future studies should validate and further evaluate experiences of ICBT for low self-esteem in other settings and in particular for boys as the study only include female participants.

Low self-esteem is a common problem among adolescents and is related to psychiatric problems such as depression and anxiety. However, effective and available interventions primarily targeting low self-esteem are scarce, in particular for youths. To address this gap, the aim of this pilot study was to evaluate a novel internet-based Cognitive Behavioral Therapy (ICBT) program for low self-esteem in adolescents using a randomized controlled design. Fifty-two participants (15-19 years) were recruited and randomly allocated to seven weeks of therapist-supported ICBT (n=26) or to a waitlist control condition (n=26). The primary outcome was the Rosenberg Self-Esteem Scale (RSES). Secondary outcomes measured domain-specific aspects of self-esteem, self-compassion, quality of life, depression and anxiety. The treatment group showed significantly higher levels of self-rated self-esteem compared to the control group at post-treatment, with a large between-group effect-size (RSES, d = 1.18). Further, the treatment had significant positive impact on secondary measures of self-esteem, self-compassion, quality of life, depression and anxiety. The results of this pilot-RCT suggest that ICBT can be effective for treating low self-esteem in adolescents, decrease depression and anxiety levels, and increasing quality of life. Replication of the results in larger samples is needed.