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  • 1.
    Adnan, Ali
    et al.
    Univ Gothenburg, Sweden.
    Hogmo, Anders
    Karolinska Hosp, Sweden.
    Sjodin, Helena
    Karolinska Hosp, Sweden.
    Gebre-Medhin, Maria
    Lund Univ, Sweden.
    Laurell, Goran
    Uppsala Univ, Sweden.
    Reizenstein, Johan
    Orebro Univ Hosp, Sweden; Orebro Univ, Sweden.
    Farnebo, Lovisa
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för logopedi, otorhinolaryngologi och audiologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken.
    Norberg, Lena S.
    Umea Univ, Sweden.
    Notstam, Isak
    Umea Univ, Sweden.
    Holmberg, Erik
    Sahlgrens Univ Hosp, Sweden.
    Cange, Hedda H.
    Univ Gothenburg, Sweden.
    Hammerlid, Eva
    Univ Gothenburg, Sweden.
    Health-related quality of life among tonsillar carcinoma patients in Sweden in relation to treatment and comparison with quality of life among the population2020Ingår i: Head and Neck, ISSN 1043-3074, E-ISSN 1097-0347Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background The health-related quality of life (HRQOL) of tonsillar carcinoma survivors was explored to investigate any HRQOL differences associated with tumor stage and treatment. The survivors HRQOL was also compared to reference scores from the population. Methods In this exploratory cross-sectional study patients were invited 15 months after their diagnosis and asked to answer two quality of life questionnaires (EORTC QLQ- C30, EORTC QLQ- HN35), 405 participated. Results HRQOL was associated with gender, with males scoring better than females on a few scales. Patients HRQOL was more associated with treatment than tumor stage. Patients HRQOL was worse than that in an age- and sex-matched reference group from the normal population, the largest differences were found for problems with dry mouth followed by problems with sticky saliva, senses, swallowing and appetite loss. Conclusions The tonsillar carcinoma patients had a worse HRQOL compared to the general population one year after treatment.

  • 2.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken.
    Yrsel och balansproblem2019Ingår i: Somatisk sjukdom: ett biopsykosocialt perspektiv / [ed] Ali Sarkohi, Gerhard Andersson, Lund: Studentlitteratur AB, 2019, 1, Vol. Sidorna 245-259, s. 245-259Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 3.
    Andersson, Gerhard
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken. Karolinska Inst, Sweden.
    Carlbring, Per
    Stockholm Univ, Sweden; Univ Southern Denmark, Denmark.
    Rozental, Alexander
    Karolinska Inst, Sweden; UCL, England.
    Response and Remission Rates in Internet-Based Cognitive Behavior Therapy: An Individual Patient Data Meta-Analysis2019Ingår i: Frontiers in Psychiatry, ISSN 1664-0640, E-ISSN 1664-0640, Vol. 10, artikel-id 749Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Background: Internet-delivered cognitive behavior therapy (ICBT) was developed over 20 years ago and has since undergone a number of controlled trials, as well as several systematic reviews and meta-analyses. However, the crucial question of response rates remains to be systematically investigated. The aim of this individual patient meta-analysis (IPDMA) was to use a large dataset of trials conducted in Sweden to determine reliable change and recovery rates across trials for a range of conditions.

    Methods: We used previously collected and aggregated data from 2,866 patients in 29 Swedish clinical trials of ICBT for three categories of conditions: anxiety disorders, depression, and others. Raw scores at pre-treatment and post-treatment were used in an IPDMA to determine the rate of reliable change and recovery. Jacobson and Truax’s, (1991) reliable change index (RCI) was calculated for each primary outcome measure in the trials as well as the recovery rates for each patient, with the additional requirement of having improved substantially. We subsequently explored potential predictors using binomial logistic regression.

    Results: In applying an RCI of z = 1.96, 1,162 (65.6%) of the patients receiving treatment were classified as achieving recovery, and 620 (35.0%) were classified as reaching remission. In terms of predictors, patients with higher symptom severity on the primary outcome measure at baseline [odds ratio (OR) = 1.36] and being female (OR = 2.22) increased the odds of responding to treatment. Having an anxiety disorder was found to decrease the response to treatment (OR = 0.51). Remission was predicted by diagnosis in the same direction (OR = 0.28), whereas symptom severity was inversely predictive of worse outcome (OR = 0.81). Conclusions: Response seems to occur among approximately half of all clients administered ICBT, whereas about a third reach remission. This indicates that the efficacy of ICBT is in line with that of CBT based in prior trials, with a possible caveat being the lower remission rates. Having more symptoms and being female might increase the chances of improvement, and a small negative effect of having anxiety disorder versus depression and other conditions may also exist. A limitation of the IPDMA was that only studies conducted in Sweden were included.

  • 4.
    Andersson, Gerhard
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken. Karolinska Inst, Sweden.
    Carlbring, Per
    Stockholm Univ, Sweden; Univ Southern Denmark, Denmark.
    Titov, Nickolai
    Macquarie Univ, Australia.
    Lindefors, Nils
    Karolinska Inst, Sweden.
    Internet Interventions for Adults with Anxiety and Mood Disorders: A Narrative Umbrella Review of Recent Meta-Analyses2019Ingår i: Canadian journal of psychiatry, ISSN 0706-7437, Vol. 64, nr 7, s. 465-470Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Internet-delivered cognitive behaviour therapy (ICBT) has existed for 20 years and there are now several controlled trials for a range of problems. In this paper, we focused on recent meta-analytic reviews of the literature and found moderate to large effects reported for panic disorder, social anxiety disorder, generalized anxiety disorder, posttraumatic stress disorder, and major depression. In total, we reviewed 9 recent meta-analytic reviews out of a total of 618 meta-analytic reviews identified using our search terms. In these selected reviews, 166 studies were included, including overlap in reviews on similar conditions. We also covered a recent review on transdiagnostic treatments and 2 reviews on face-to-face v. internet treatment. The growing number of meta-analytic reviews of studies now suggests that ICBT works and can be as effective as face-to-face therapy.

  • 5.
    Axelsson, Erland
    et al.
    Karolinska Inst, Sweden.
    Hesser, Hugo
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken. Orebro Univ, Sweden.
    Andersson, Erik
    Karolinska Inst, Sweden.
    Ljotsson, Brjann
    Karolinska Inst, Sweden.
    Hedman-Lagerlof, Erik
    Karolinska Inst, Sweden.
    Mediators of treatment effect in minimal-contact cognitive behaviour therapy for severe health anxiety: A theory-driven analysis based on a randomised controlled trial2020Ingår i: Journal of Anxiety Disorders, ISSN 0887-6185, E-ISSN 1873-7897, Vol. 69, artikel-id 102172Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    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.

  • 6.
    Azharuddin, Mohammad
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för klinisk kemi. Linköpings universitet, Medicinska fakulteten.
    Roberg, Karin
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för cellbiologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken.
    Dhara, Ashis Kumar
    Natl Inst Technol Durgapur, India.
    Jain, Mayur Vilas
    Lund Univ, Sweden.
    Darcy, Padraig
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för läkemedelsforskning. Linköpings universitet, Medicinska fakulteten.
    Hinkula, Jorma
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för hematopoes och utvecklingsbiologi. Linköpings universitet, Medicinska fakulteten.
    Slater, Nigel K. H.
    Univ Cambridge, England.
    Patra, Hirak Kumar
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för cellbiologi. Linköpings universitet, Medicinska fakulteten. Univ Cambridge, England.
    Dissecting multi drug resistance in head and neck cancer cells using multicellular tumor spheroids2019Ingår i: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 9, artikel-id 20066Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    One of the hallmarks of cancers is their ability to develop resistance against therapeutic agents. Therefore, developing effective in vitro strategies to identify drug resistance remains of paramount importance for successful treatment. One of the ways cancer cells achieve drug resistance is through the expression of efflux pumps that actively pump drugs out of the cells. To date, several studies have investigated the potential of using 3-dimensional (3D) multicellular tumor spheroids (MCSs) to assess drug resistance; however, a unified system that uses MCSs to differentiate between multi drug resistance (MDR) and non-MDR cells does not yet exist. In the present report we describe MCSs obtained from post-diagnosed, pre-treated patient-derived (PTPD) cell lines from head and neck squamous cancer cells (HNSCC) that often develop resistance to therapy. We employed an integrated approach combining response to clinical drugs and screening cytotoxicity, monitoring real-time drug uptake, and assessing transporter activity using flow cytometry in the presence and absence of their respective specific inhibitors. The report shows a comparative response to MDR, drug efflux capability and reactive oxygen species (ROS) activity to assess the resistance profile of PTPD MCSs and two-imensional (2D) monolayer cultures of the same set of cell lines. We show that MCSs provide a robust and reliable in vitro model to evaluate clinical relevance. Our proposed strategy can also be clinically applicable for profiling drug resistance in cancers with unknown resistance profiles, which consequently can indicate benefit from downstream therapy.

  • 7.
    Berg, Matilda
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken. Karolinska Inst, Sweden.
    Rozental, Alexander
    Karolinska Inst, Sweden; UCL, England.
    Knowledge About Treatment, Anxiety, and Depression in Association With Internet-Based Cognitive Behavioral Therapy for Adolescents: Development and Initial Evaluation of a New Test2020Ingår i: SAGE Open, ISSN 2158-2440, E-ISSN 2158-2440, Vol. 10, nr 1, artikel-id 2158244019899095Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Evaluating knowledge and learning in psychotherapy is a growing field of research. Studies that develop and evaluate valid tests are lacking, however. Here, in the context of internet-based cognitive behavioral therapy (ICBT) for adolescents, a new test was developed using subject matter experts, consensus among researchers, self-reports by youths, and a literature review. An explorative factor analysis was performed on 93 adolescents between 15 and 19 years old, resulting in a three-factor solution with 20 items, accounting for 41% of the total variance. The factors were Act in aversive states, Using positive reinforcement, and Shifting attention. The internal consistency for the whole instrument was good (alpha = .84). Hopefully, the procedure presented here can contribute to the field by illustrating one way of evaluating knowledge in ICBT. The clinical use of the knowledge test needs further investigation.

  • 8.
    Beukes, Eldre W.
    et al.
    Lamar Univ, TX 77710 USA; Anglia Ruskin Univ, England.
    Manchaiah, Vinaya
    Lamar Univ, TX 77710 USA; Manipal Univ, India; Audiol India, India.
    Allen, Peter M.
    Lamar Univ, TX 77710 USA; Anglia Ruskin Univ, England.
    Baguley, David M.
    Nottingham Biomed Res Ctr, England; Univ Nottingham, England; Nottingham Univ Hosp, England.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken. Karolinska Inst, Sweden.
    Internet-Based Interventions for Adults With Hearing Loss, Tinnitus, and Vestibular Disorders: A Systematic Review and Meta-Analysis2019Ingår i: TRENDS IN HEARING, ISSN 2331-2165, Vol. 23, artikel-id 2331216519851749Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Internet-based interventions have been developed to improve access to audiovestibular health care. This review aimed to identify outcomes of Internet interventions for adults with hearing loss, tinnitus, and vestibular disorders. Electronic databases and manual searches were performed to identify studies meeting eligibility for inclusion. Fifteen studies (1,811 participants) met the inclusion criteria, with nine studies targeting tinnitus distress, five considering hearing loss, and one for vestibular difficulties. Only the tinnitus and hearing loss Internet intervention studies were eligible for data synthesis. Internet-based interventions for hearing loss were diverse. Overall, they showed no significant effects, although a statistically significant moderate effect (d = 0.59) was found after removing the study with the highest risk of bias (as a result of high attrition). Most Internet-based interventions for tinnitus provided cognitive behavioural therapy. They yielded statistically significant mean effect sizes for reducing tinnitus distress compared with both inactive (d = 0.59) and active controls (d = 0.32). Significant effects were also present for the secondary outcomes of anxiety, depression, insomnia, and quality of life (combined effect d = 0.28). Only Internet-based interventions for tinnitus evaluated the 1-year postintervention effects indicated that results were maintained long term (d = 0.45). Scientific study quality was appraised using the Grading of Recommendations Assessment, Development and Evaluation approach and found to vary from very low to moderate. This review indicates the potential of Internet interventions for tinnitus to provide evidence-based accessible care. There is a need for additional high-quality evidence before conclusive results can be established regarding the effects of audiovestibular Internet interventions.

  • 9.
    Boersma, Katja
    et al.
    Orebro Univ, Sweden.
    Södermark, Martin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Hesser, Hugo
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken.
    Flink, Ida K.
    Orebro Univ, Sweden.
    Gerdle, Björn
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Linton, Steven J.
    Orebro Univ, Sweden.
    Efficacy of a transdiagnostic emotion-focused exposure treatment for chronic pain patients with comorbid anxiety and depression: a randomized controlled trial2019Ingår i: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 160, nr 8, s. 1708-1718Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The comorbidity between chronic pain and emotional problems has proven difficult to address with current treatment options. This study addresses the efficacy of a transdiagnostic emotion-focused exposure treatment ("hybrid") for chronic pain patients with comorbid emotional problems. Adults (n = 115) with chronic musculoskeletal pain and functional and emotional problems were included in a 2-centre, parallel randomized controlled, open-label trial comparing this treatment to an active control condition receiving a guided Internet-delivered pain management treatment based on CBT principles (iCBT). The hybrid treatment (n = 58, 10-16 sessions) integrates exposure in vivo for chronic pain based on the fear-avoidance model with an emotion-regulation approach informed by procedures in Dialectical Behavior Therapy. The iCBT (n = 57; 8 treatment modules) addresses topics such as pain education, coping strategies, relaxation, problem solving, stress, and sleep management using standard CBT techniques. Patient-reported outcomes were assessed before and after treatment as well as at a 9-month primary end point. Across conditions, 78% participants completed post-treatment and 81% follow-up assessment. Intent-to-treat analyses showed that the hybrid had a significantly better post-treatment outcome on pain catastrophizing (d = 0.39) and pain interference (d = 0.63) and significantly better follow-up outcomes on depression (d = 0.43) and pain interference (d = 0.51). There were no differences on anxiety and pain intensity. Observed proportions of clinically significant improvement favoured the hybrid on all but one comparison, but no statistically significant differences were observed. We conclude that the hybrid emotion-focused treatment may be considered an acceptable, credible, and efficacious treatment option for chronic pain patients with comorbid emotional problems.

  • 10.
    Flygare, Anna-Lena
    et al.
    Ctr Clin Res, Sweden.
    Engstrom, Ingemar
    Orebro Univ, Sweden.
    Hasselgren, Mikael
    Orebro Univ, Sweden.
    Jansson-Frojmark, Markus
    Karolinska Inst, Sweden.
    Frejgrim, Rikard
    Ctr Clin Res, Sweden.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken. Karolinska Inst, Sweden.
    Hollandare, Fredrik
    Orebro Univ, Sweden.
    Internet-based CBT for patients with depressive disorders in primary and psychiatric care: Is it effective and does comorbidity affect outcome?2020Ingår i: Internet Interventions, ISSN 2214-7829, INTERNET INTERVENTIONS-THE APPLICATION OF INFORMATION TECHNOLOGY IN MENTAL AND BEHAVIOURAL HEALTH, Vol. 19, artikel-id UNSP 100303Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Internet-based cognitive behavior therapy (ICBT) has proved effective in reducing mild to moderate depressive symptoms. However, only a few studies have been conducted in a regular healthcare setting which limits the generalizability of the results. The influence of psychiatric comorbidity on outcome is not well understood. In the current study, patients with mild to moderate depressive symptoms in primary and psychiatric care were interviewed using the SCID-I and SCID-II to assess psychiatric diagnoses. Those included were randomly allocated to ICBT (n = 48) or to an active control condition (n = 47). Both groups received therapist support. At post-treatment, ICBT had reduced depressive symptoms on the BDI-II more than the active control intervention (p = .021). However, the difference between groups was no longer significant at the 6-, 12- or 24-month followups. The within-group effect size after ICBT (BDI-II) was large (d = 1.4). A comorbid anxiety disorder didnt moderate the outcome, while the presence of a personality disorder predicted significantly less improvement in depressive symptoms. ICBT had a large effect on depressive symptoms in a sample from regular healthcare. It is possible to obtain a large effect from ICBT despite comorbid anxiety, however, including patients with a comorbid personality disorder in the current form of ICBT seems questionable.

  • 11.
    Hermansen, Anna
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Rörelse och Hälsa.
    Peolsson, Anneli
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Hedlund, Rune
    Department of Orthopaedics , Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg , Göteborg , Sweden.
    Kammerlind, Ann-Sofi
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken. Futurum , Region Jönköping County , Jönköping , Sweden.
    Balance problems and dizziness after neck surgery: associations with pain and health-related quality of life2019Ingår i: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, s. 1-8Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: Symptoms of dizziness or imbalance are often present in individuals with a variety of neck-disorders. The aims of this study were to determine the prevalence of patient-reported balance problems and dizziness 10-13 years after surgery for cervical degenerative disc disease; evaluate associations with neck pain and health-related quality of life; and investigate how these individuals described dizziness.

    MATERIAL AND METHODS: Sixty-eight individuals, 10 years or more after anterior cervical decompression and fusion surgery, who previously participated in a randomized controlled trial were included. Participants completed questionnaires including ratings of dizziness and balance problems, the Dizziness Handicap Inventory, and an open-ended question regarding their experience of dizziness. Secondary outcomes were neck pain and quality of life.

    RESULTS: Seventy-two percent experienced occasional or daily symptoms of unsteadiness and/or dizziness. Intensity ratings for dizziness during movement and for balance problems were similar and rather low, but had an impact on quality of life. Ratings of dizziness at rest were even lower. Dizziness ratings were associated with neck pain. Strenuous activities were related to dizziness and dizziness was primarily described as intermittent and non-rotatory.

    CONCLUSIONS: Dizziness or balance problems in the long-term after surgery for cervical degenerative disc disease are common and have an impact on daily life. Ratings of problem frequency and intensity were usually low. Dizziness and balance problems may affect quality of life. Patients' descriptions of these problems are in line with common symptoms of cervicogenic dizziness.

  • 12.
    Holmqvist Larsson, Kristina
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Centrum för social och affektiv neurovetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Barn- och ungdomspsykiatriska kliniken.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken. Karolinska Inst, Sweden.
    Stern, Helene
    Psykologhalsan, Linkoping, Sweden.
    Zetterqvist, Maria
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Centrum för social och affektiv neurovetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Barn- och ungdomspsykiatriska kliniken.
    Emotion regulation group skills training for adolescents and parents: A pilot study of an add-on treatment in a clinical setting2019Ingår i: Clinical Child Psychology and Psychiatry, ISSN 1359-1045, E-ISSN 1461-7021, artikel-id UNSP 1359104519869782Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Difficulties with emotion regulation have been identified as an underlying mechanism in mental health. This pilot study aimed at examining whether group skills training in emotion regulation for adolescents and parents as an add-on intervention was feasible in an outpatient child and adolescent psychiatric clinic. We also investigated if the treatment increased knowledge and awareness of emotions and their functions, increased emotion regulation skills and decreased self-reported symptoms of anxiety and depression. Six skills training groups were piloted with a total of 20 adolescents and 21 adults. The treatment consisted of five sessions dealing with psychoeducation about emotions and emotion regulation skills training. Paired-samples t test was used to compare differences between before-and-after measures for adolescents and parents separately. The primary outcome measure, Difficulties in Emotion Regulation Scale, showed significant improvement after treatment for both adolescents and parents. For adolescents, measures of alexithymia were significantly reduced. Also, emotional awareness was significantly increased. Measures of depression and anxiety did not change. In conclusion, group skills training as an add-on treatment can be feasible and effective but further studies are needed.

  • 13.
    Johansson, Olof
    et al.
    Lund University, Lund, Sweden.
    Bjärehed, Jonas
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Filosofiska fakulteten.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken. Karolinska Institute, Solna, Sweden.
    Carlbring, Per
    Stockholm University, Stockholm, Sweden; University of Southern Denmark, Odense, Denmark.
    Lundh, Lars-Gunnar
    Lund University, Lund, Sweden.
    Effectiveness of guided internet-delivered cognitive behavior therapy for depression in routine psychiatry: A randomized controlled trial2019Ingår i: Internet Interventions, ISSN 2214-7829, Internet interventions, ISSN 2214-7829, Vol. 17, artikel-id 100247Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Depression is one of the most common health problems worldwide but is often undertreated. Internet-delivered cognitive behavioral therapy (ICBT) appears to be an effective treatment option, with the potential to reach a larger proportion of individuals suffering from depression. While many studies have examined the efficacy of ICBT for depression in randomized controlled trials, fewer have focused on the effectiveness of ICBT when used as an integral part of routine health care. In this study the effectiveness of an 8-week ICBT program was examined when delivered in a routine psychiatric setting. A total of 108 patients were referred and 54 were then included and randomized to either ICBT or a waitlist control condition. The sample had a lower education level and a higher proportion of individuals were on sick leave than comparable previous efficacy trials of ICBT for depression conducted in Sweden. Measures assessing depression, anxiety and psychiatric symptoms were administered before and after treatment, follow up was performed at 6- and 12 months after treatment had ended. ICBT resulted in significant reductions of depressive symptoms in the treatment group when compared to a waitlist control group with a large effect size (Cohen's d = 1.6). Treatment gains were maintained at 6- and 12 months after the treatment had ended. In terms of clinical significance, 58% of the sample had improved or recovered after treatment. The study was small, and patients received general psychiatric care after the ICBT treatment had ended which limits the implications. We conclude that ICBT appears to be an effective treatment for depression when delivered as an integral part of routine psychiatric care.

  • 14.
    Johnson, Shevaugn
    et al.
    Flinders University, Adelaide, Australia.
    Egan, Sarah J
    Curtin University, Perth, Australia.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken. Karolinska Institutet, Stockholm, Sweden.
    Carlbring, Per
    Stockholm University, Stockholm, Sweden; University of Southern Denmark, Denmark.
    Shafran, Roz
    University College of London, London, England, United Kingdom.
    Wade, Tracey D
    Flinders University, Adelaide, Australia.
    Internet-delivered cognitive behavioural therapy for perfectionism: Targeting dysmorphic concern2019Ingår i: Body image, ISSN 1740-1445, E-ISSN 1873-6807, Vol. 30, s. 44-55, artikel-id S1740-1445(18)30489-3Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Perfectionism is an important transdiagnostic risk factor for several psychopathologies. As such, treatments targeting perfectionism have gained increased attention over recent years. While perfectionism is postulated to be an important underlying mechanism for dysmorphic concern, no research has explored the benefits of targeting perfectionism to reduce dysmorphic concern. The current study evaluated the use of Internet-delivered cognitive behavioural therapy for perfectionism (ICBT-P) with 31 participants (28 women) with high levels of dysmorphic concern to examine the impact on perfectionism, dysmorphic concern, body image disturbance, negative affect, and selective attention towards appearance-based stimuli. Using a case series design, observations were collected at baseline, at the end of a 4-week pre-treatment phase, after the 8-week ICBT-P, and 1-month post-treatment. Intent-to-treat analyses showed significant improvement from baseline to end-of-treatment and follow-up on most of the variables, with a large effect size decrease in dysmorphic concern, and decreased selective attention to BDD-body, BDD-positive, and BDD-negative words. The results of this study support the use of ICBT-P as an efficacious treatment worthy of further examination in populations who experience high levels of dysmorphic concern.

  • 15.
    Kothari, Radha
    et al.
    UCL, England.
    Barker, Chris
    UCL, England.
    Pistrang, Nancy
    UCL, England.
    Rozental, Alexander
    UCL, England; Karolinska Inst, Sweden.
    Egan, Sarah
    Curtin Univ, Australia.
    Wade, Tracey
    Flinders Univ S Australia, Australia.
    Allcott-Watson, Hannah
    UCL, England.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken. Karolinska Inst, Sweden.
    Shafran, Roz
    UCL, England.
    A randomised controlled trial of guided internet-based cognitive behavioural therapy for perfectionism: Effects on psychopathology and transdiagnostic processes2019Ingår i: Journal of Behavior Therapy and Experimental Psychiatry, ISSN 0005-7916, E-ISSN 1873-7943, Vol. 64, s. 113-122Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background and objectives

    Perfectionism is a transdiagnostic process that has been associated with a range of psychopathology and also with other transdiagnostic processes. We have previously shown that guided internet-based cognitive behavioural therapy (ICBT) can reduce symptoms of dysfunctional perfectionism, however, no impact was observed on symptoms of depression and anxiety. Here we explore the impact of guided ICBT for perfectionism on symptoms of other associated psychopathology, specifically obsessive-compulsive disorder (OCD) and eating disorders, and also on other associated transdiagnostic processes (self-esteem, intolerance of uncertainty, and self-compassion).

    Methods

    Participants who presented with clinical levels of perfectionism were randomised to an experimental group that received the intervention (n = 62), or a wait list control group (n = 58). Questionnaires assessing symptoms of OCD, eating disorders, self-esteem, intolerance of uncertainty, and fear of self-compassion were completed pre-intervention, post-intervention (12 weeks), and at follow-up (24 weeks). Between group effect sizes are reported.

    Results

    The intervention led to significant decreases in symptoms of OCD (d = −0.9; CI: -1.4, −0.4) and eating disorders (d = −0.6; CI: -1.0, −0.1), and had an impact on other transdiagnostic processes resulting in increased self-esteem (d = 0.7; CI: 0.2, 1.2), decreases in intolerance of uncertainty (d = −0.9; CI: -1.4, −0.4), and fear of self-compassion (d = −0.8; CI: -1.3, −0.3). At follow-up changes were maintained in symptoms of OCD (d = −1.3; CI: -1.8, −0.8), disordered eating (d = −0.7; CI: -1.2, −0.2), intolerance of uncertainty (d = −0.8; CI: -1.2, −0.3), and fear of self-compassion (d = −1.0; CI: -1.5, −0.5).

    Conclusions

    Guided ICBT for perfectionism improves associated psychopathology and transdiagnostic processes. ClinicalTrials.gov registration no. NCT02756871.

  • 16.
    Käll, Anton
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Backlund, Ulrika
    Uppsala Univ, Sweden.
    Shafran, Roz
    UCL Great Ormond St Inst Child Hlth, England.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken. Karolinska Inst, Sweden.
    Lonesome no more?: A two-year follow-up of internet-administered cognitive behavioral therapy for loneliness2020Ingår i: Internet Interventions, ISSN 2214-7829, INTERNET INTERVENTIONS-THE APPLICATION OF INFORMATION TECHNOLOGY IN MENTAL AND BEHAVIOURAL HEALTH, Vol. 19, artikel-id 100301Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The current study sought to investigate the long-term effects of an internet-administered programme based on CBT principles for which the initial efficacy has been reported in Kall, Jagholm, et al. (In press). Seventy-three participants who were recruited on the basis of experiencing frequent and prolonged loneliness were contacted to complete questionnaires measuring loneliness, quality of life, and symptoms of psychopathology two years after the conclusion of the initial treatment period. Additional items regarding use of the treatment techniques and strategies contained in the programme during the follow-up period was included. In total, 44 participants provided data for the loneliness measure at follow-up. The outcome data were analyzed with a piecewise mixed effects model to provide estimates of change for the continuous measures. Linear multiple regression analysis was used to investigate the relationship between use of treatment techniques and reliable change on the primary outcome measure. The results showed decreases in loneliness during the follow-up period for the sample as a whole. Additionally, an increase in quality of life and a decrease in social anxiety were noted, but no significant changes of depressive symptoms or generalized anxiety. Effect sizes for the observed changes from baseline to follow-up were in the moderate to large range for all measures. Reported use of the treatment techniques was not significantly related to reliable change in loneliness after the two-year period. In conclusion, the results of the study support the utility of internet-based CBT targeting loneliness and indicate that the benefits from the intervention can be enduring.

  • 17.
    Käll, Anton
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Jägholm, Sofia
    Linköpings universitet.
    Hesser, Hugo
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken.
    Andersson, Frida
    Linköpings universitet, Institutionen för ekonomisk och industriell utveckling, Industriell Produktion. Linköpings universitet, Tekniska fakulteten.
    Mathaldi, Aleksi
    Linköpings universitet.
    Tiger Norkvist, Beatrice
    Linköpings universitet.
    Shafran, Roz
    UCL, England.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken. Karolinska Inst, Sweden.
    Internet-Based Cognitive Behavior Therapy for Loneliness: A Pilot Randomized Controlled Trial2020Ingår i: Behavior Therapy, ISSN 0005-7894, E-ISSN 1878-1888, Vol. 51, nr 1, s. 54-68Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Loneliness has been described as a common source of discomfort based on a subjective discrepancy between the actual and desired social situation. For some people this feeling may become a sustained state that is associated with a wide range of psychiatric and psychosocial problems. While there are few existing treatment protocols, interventions based on cognitive behavioral therapy (CBT) have shown positive effects. The current study investigated the efficacy of an 8-week internet-based treatment containing CBT components aimed at reducing feelings of loneliness. Seventy-three participants were recruited from the general public and randomly allocated to treatment or a wait-list control condition. Participants were assessed with standardized self-report measures of loneliness, depression, social anxiety, worry, and quality of life at pretreatment and posttreatment. Robust linear regression analysis of all randomized participants showed significant treatment effects on the primary outcome measure of loneliness (between group Cohens d = 0.77), and on secondary outcomes measuring quality of life and social anxiety relative to control at postassessment. The results suggest the potential utility of internet-based CBT in alleviating loneliness but more research on the long-term effects and the mechanisms underlying the effects is needed.

  • 18.
    Käll, Anton
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Shafran, Roz
    UCL Great Ormond St Inst Child Hlth, England.
    Lindegaard, Tomas
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Bennett, Sophie
    UCL Great Ormond St Inst Child Hlth, England.
    Cooper, Zafra
    Univ Oxford, England; Yale Univ, CT 06520 USA.
    Coughtrey, Anna
    UCL Great Ormond St Inst Child Hlth, England.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken. Karolinska Inst, Sweden.
    A Common Elements Approach to the Development of a Modular Cognitive Behavioral Theory for Chronic Loneliness2020Ingår i: Journal of Consulting and Clinical Psychology, ISSN 0022-006X, E-ISSN 1939-2117, Vol. 88, nr 3, s. 269-282Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Loneliness is a transdiagnostic clinical phenomenon that can significantly impact mental health and well-being across the lifespan. Objective: The aim was to combine existing theory and evidence-based treatment approaches to propose a comprehensive transdiagnostic cognitive-behavioral analysis of the maintenance of chronic loneliness relevant across disorders, age groups, and populations. Method: A distillation and matching model-framework approach was taken to identify interventions designed to reduce loneliness. Eligible studies were coded for the presence of practice elements. The findings were combined with an analysis of the broader literature on loneliness and psychopathology to derive a comprehensive cognitive-behavioral analysis of the maintenance of loneliness over time across populations. Results: The search yielded 11 studies containing 14 practice elements with relative frequencies ranging from 7% to 64%. The identified practice elements target putative mechanisms such as negative interpersonal appraisals. anxiety, and social skills deficits. Counterproductive behavior and cognitive processes such as sell-focused attention were identified as maintenance factors based on the broader literature. A modular transdiagnostic model with multiple pathways is proposed to be consistent with the existing theoretical and treatment literature. Conclusions: Combining the distillation and matching model framework with existing theory from the literature is a novel approach for developing a model of factors that maintain loneliness over time. The model has varying treatment implications for different populations including children with autism spectrum disorders and bereaved older adults. Targeting transdiagnostic processes has the potential to transform interventions for loneliness across a range of formats and settings.

  • 19.
    Lindner, Philip
    et al.
    Stockholm Univ, Sweden; Karolinska Inst, Sweden; Stockholm Cty Council, Sweden.
    Miloff, Alexander
    Stockholm Univ, Sweden.
    Fagernas, Simon
    Uppsala Univ, Sweden.
    Andersen, Joel
    Stockholm Univ, Sweden.
    Sigeman, Martin
    Stockholm Univ, Sweden.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken. Karolinska Inst, Sweden; Stockholm Cty Council, Sweden.
    Furmark, Tomas
    Uppsala Univ, Sweden.
    Carlbring, Per
    Stockholm Univ, Sweden; Univ Southern Denmark, Denmark.
    Therapist-led and self-led one-session virtual reality exposure therapy for public speaking anxiety with consumer hardware and software: A randomized controlled trial (vol 61, pg 45, 2019)2019Ingår i: Journal of Anxiety Disorders, ISSN 0887-6185, E-ISSN 1873-7897, Vol. 64, s. 90-90Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    n/a

  • 20.
    Lundgren, Johan
    et al.
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten.
    Westas, Mats
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Avdelningen för omvårdnad.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken.
    Mourad, G
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten.
    Johansson, Peter
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i östra Östergötland, Medicinkliniken ViN. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad.
    The trajectory of depression and physical activity in patients with heart disease during nurse led internet based cognitive behavioural therapy2019Konferensbidrag (Refereegranskat)
    Abstract [en]

    Background

    Few studies have investigated the trajectory of depression and level of physical activity, in patients with heart disease during a psychosocial intervention such as internet based cognitive behavioural therapy (iCBT). For health care professionals in cardiac care it is important to know when an improvement in depression can be expected during iCBT and if this improvement can be associated with physical activity. The aim of this study therefore is, 1) to investigate the trajectory of depression and physical activity during participation in an iCBT program compared to a moderated online discussion forum (ODF). 2) to investigate the association between improvements in depression and physical activity.

    Method

    A sub-analysis of data collected in a randomised controlled trial (RCT) that evaluated the effect on depression of a nine-week iCBT program guided by nurse. In the RCT, 144 cardiac patients with at least mild depression were randomised to iCBT or ODF. The iCBT program consisted of seven modules where feedback was provided by nurses. The ODF consisted of nine discussion topics moderated by a nurse.

    Data for the present analysis was collected at baseline, once weekly during the intervention period, and the follow-up. Depression was measured by Montgomery Åsberg Depression Rating Scale – self rating (MADRS-S). Two modified items from the Physical Activity Questionnaire measured frequency and length of physical activity. Frequency was scored between “none of the days” (0) to “often, 5-7 days” (3). Length was scored from 0 (0 minutes) to 4 (more than 60 minutes). A combined physical activity factor was calculated by multiplying frequency and length scores.

    Results

    Figure 1a illustrates the trajectory of depression from baseline assessment until the follow up. There was a significant time and group interaction (F=9.98, p<.001, η2=.106) favouring iCBT. The significant difference in depression between iCBT and ODF started at week six and remained to the follow-up. Figures 1b to 1d illustrates the trajectories of physical activity. We found a significant interaction of time and group favouring iCBT for the combined physical factor (F=2.36, p=0.019, η2=.028). The interaction effects for time and group for frequency (F=1.95, p=0.056) and length in physical activity (F=1.26, p=0.272) was not statistically significant. Pearson correlational analyses showed a positive association between improvement in depression and increase of physical activity (r=.256, p=.004). For the iCBT-group this association was stronger (r= .312, p=.011), whereas there was no significant correlation in the ODF group (r= -.006, p= .965)

     

    Conclusion

    Both depression and physical activity improved during the course of the nine week iCBT program. However, improvement occur more clearly after half the duration of iCBT program. Early in the program, a temporary worsening of depression was seen. This indicates that patients need support and encouragement to complete the iCBT program, which gives them greater opportunities to improve in depression and physical activity.

  • 21.
    Magnusson, Kristoffer
    et al.
    Karolinska Inst, Sweden.
    Nilsson, Anders
    Karolinska Inst, Sweden.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken. Karolinska Inst, Sweden.
    Hellner, Clara
    Karolinska Inst, Sweden.
    Carlbring, Per
    Stockholm Univ, Sweden; Univ Southern Denmark, Denmark.
    Internet-Delivered Cognitive-Behavioral Therapy for Significant Others of Treatment-Refusing Problem Gamblers: A Randomized Wait-List Controlled Trial2019Ingår i: Journal of Consulting and Clinical Psychology, ISSN 0022-006X, E-ISSN 1939-2117, Vol. 87, nr 9, s. 802-814Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: Problem gambling can cause severe harm to concerned significant others (CSOs) in the form of, for example, relationship problems, financial difficulties, and mental and physical illness. CSOs are important for their ability to support problem gamblers and motivate them to change. This study investigated the effect of an Internet-based intervention for CSOs of treatment-refusing problem gamblers on (a) gambling-related harm, (b) the gamblers’ treatment-seeking rate, and (c) the relationship satisfaction and mental health of the CSOs. 

    Method: A total of 100 CSOs of problem gamblers were randomized into one of two conditions: Internet-delivered cognitive–behavioral therapy for CSOs or a wait-list control group. The intervention group was given Internet-based treatment consisting of nine modules with therapist support available via telephone and e-mail. Outcome measures were collected up 12 months posttreatment. 

    Results: The intervention improved the psychological well-being of the CSOs compared to the wait-list group at the posttest (CSO’s emotional consequences: d= −0.90, 95% CI [−1.47, −0.33]; relationship satisfaction: d = 0.41, 95% CI [0.05, 0.76]; anxiety: d = −0.45, 95% CI [−0.81, −0.09]; depression: d = −0.49, 95% CI [−0.82, −0.16]). However, the effects on the gambling outcomes were small and inconclusive (gambling losses: multiplicative effect = 0.73, 95% CI [0.29, 1.85]; treatment-seeking: hazard ratio = 0.86, 95% CI [0.31, 2.38]). 

    Conclusion: The results confirm earlier studies’ findings that affecting the gambler via a CSO is challenging, but it is possible to increase the CSO’s coping and well-being. The trial’s outcome data and scripts are available for download (https://osf.io/awtg7/).

  • 22.
    Magnusson, Kristoffer
    et al.
    Karolinska Inst, Sweden.
    Nilsson, Anders
    Karolinska Inst, Sweden.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken. Karolinska Inst, Sweden.
    Hellner, Clara
    Karolinska Inst, Sweden.
    Carlbring, Per
    Stockholm Univ, Sweden.
    Level of Agreement Between Problem Gamblers and Collaterals Reports: A Bayesian Random-Effects Two-Part Model2019Ingår i: Journal of Gambling Studies, ISSN 1050-5350, E-ISSN 1573-3602, Vol. 35, nr 4, s. 1127-1145Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This study investigates the level of agreement between problem gamblers and their concerned significant others (CSOs) regarding the amount of money lost when gambling. Reported losses were analyzed from 266 participants (133 dyads) seeking treatment, which included different types of CSO-gambler dyads. The intraclass correlation coefficients (ICCs) concerning the money lost when gambling during the last 30 days were calculated based on the timeline followback. In order to model reports that were highly skewed and included zeros, a two-part generalized linear mixed-effects model was used. The results were compared from models assuming either a Gaussian, two-part gamma, or two-part lognormal response distribution. Overall, the results indicated a fair level of agreement, ICC = .57, 95% CI (.48, .64), between the gamblers and their CSOs. The partner CSOs tended to exhibit better agreement than the parent CSOs with regard to the amount of money lost, ICCdiff = .20, 95% CI (.03, .39). The difference became smaller and inconclusive when reports of no losses (zeros) were included, ICCdiff = .16, 95% CI (- .05, .36). A small simulation investigation indicated that the two-part model worked well under assumptions related to this study, and further, that calculating the ICCs under normal assumptions led to incorrect conclusions regarding the level of agreement for skewed reports (such as gambling losses). For gambling losses, the normal assumption is unlikely to hold and ICCs based on this assumption are likely to be highly unreliable.

  • 23.
    Manchaiah, Vinaya
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutet för handikappvetenskap (IHV). Lamar Univ, TX 77710 USA; Audiol India, India; Manipal Univ, India.
    Abrams, Harvey
    Univ S Florida, FL USA.
    Bailey, Abram
    Hearing Tracker Inc, TX USA.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken. Karolinska Inst, Sweden.
    Negative Side Effects Associated with Hearing Aid Use in Adults with Hearing Loss2019Ingår i: Journal of american academy of audiology, ISSN 1050-0545, E-ISSN 2157-3107, Vol. 30, nr 6, s. 472-481Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background:

    The low uptake of hearing aids in the United States has been attributed to a number of reasons, including low perceived hearing disability, limited perceived benefit and cost. Another possible reason may be related to negative side effects associated with hearing aid use.

    Purpose:

    The present study was aimed at determining and classifying the negative side effects associated with hearing aid use in adults with hearing loss.

    Research Design:

    The study used a cross-sectional survey design.

    Study Sample:

    Five hundred and twelve participants completed an electronic survey.

    Data Collection and Analysis:

    The data was collected using the negative side effects of hearing aids (NSE-HAs) questionnaire. Data were analyzed using Chi square analysis, principal components analysis, and calculation of Cronbach’s alpha.

    Results:

    Some individuals reported negative side effects for all 32 items. However, careful examination of results suggests that, as a whole, reported negative side effects tend to be mild with mean scores falling close to the lower quartile of the total scores. Chi square test results suggest that the variables of age, gender, duration of hearing loss, self-reported hearing disability, and duration of hearing aid use seem to be significantly associated with the reported negative side effects. The NSE-HAs questionnaire was found to have a complex structure as indicated by the principal components analysis. However, good internal consistency was found in both the full scale and subscales.

    Conclusions:

    The present study suggests that, although a large number of adults with hearing loss who use hearing aids experience some degree of negative side effects, those effects tend to be mild.

  • 24.
    Manchaiah, Vinaya
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutet för handikappvetenskap (IHV). Lamar Univ, TX 77710 USA; Audiol India, India; Manipal Univ, India.
    Beukes, Eldre W.
    Anglia Ruskin Univ, England.
    Granberg, Sarah
    Orebro Univ, Sweden; Orebro Univ Hosp, Sweden.
    Durisala, Naresh
    GN Hearing Pte Ltd, Singapore.
    Baguley, David M.
    Anglia Ruskin Univ, England; Univ Nottingham, England; Univ Nottingham, England.
    Allen, Peter M.
    Anglia Ruskin Univ, England; Anglia Ruskin Univ, England.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken. Karolinska Inst, Sweden.
    Problems and Life Effects Experienced by Tinnitus Research Study Volunteers: An Exploratory Study Using the ICF Classification2018Ingår i: Journal of american academy of audiology, ISSN 1050-0545, E-ISSN 2157-3107, Vol. 29, nr 10, s. 936-947Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Tinnitus is one of the most distressing hearing-related symptoms. It is often associated with a range of physiological and psychological complications, such as depression, anxiety, and insomnia. Hence, approaching tinnitus from a biopsychological perspective may be more appropriate than from purely a biomedical model. Objective: The present study was aimed at determining the relationship between tinnitus and the problems and life effects experienced by UK-based tinnitus research study volunteers. Open-ended questions were used. Responses were classified using the International Classification of Functioning, Disability and Health (ICF) framework to understand the impact of tinnitus in a multidimensional manner using a biopsychosocial perspective. Research Design: A cross-sectional survey design was used. Study Sample: Study sample included a sample of 240 adults with tinnitus who were interested in undertaking an Internet-based intervention for tinnitus. Data Collection and Analysis: The data were collated using two open-ended questions. The first focused on problems related to having tinnitus and the second to life effects as a result of tinnitus. Responses were analyzed using a simplified content analysis approach to link concepts to ICF categories in accordance with established linking rules. A Wilcoxon signed-rank test was performed to compare the number of responses between the two questions. Results: There were 764 responses related to problems identified, 797 responses associated with life effects due to tinnitus, and 37 responses that did not fit into any ICF category. No significant differences were observed in the number of responses between the two questions. In addition, no significant association between the number of responses reported and demographic variables was found. Most of the problems and life effects experienced by tinnitus sufferers were related to body function, followed by activity limitations, and participation restrictions. Only a few responses were related to environmental and personal factors. The most frequent responses related to body function involved "emotional functions" (b152), "sleep functions" (b134), "hearing functions" (b230), "sustaining attention" (b1400), and "energy level" (b1300). For activity limitations and participation restrictions they were "communicating with-receiving-spoken messages" (d310), "socialization" (d9205), "handling stress and other psychological demands" (d240), and "recreation and leisure" (d920). The most frequently occurring responses related to environmental factors were "sound intensity" (e2500), "sound quality" (e2501), and "general products and technology for communication" (e1250). "Coping styles" was the most frequently occurring personal factor. Conclusions: The study highlights the use of open-ended questions in gathering useful information about the impact of tinnitus. The responses coded to ICF show that tinnitus impacts many domains, not only particularly body function, but also activity limitations and participation restrictions. The results demonstrate the heterogeneous nature of the impact of tinnitus on people affected.

  • 25.
    Manchaiah, Vinaya
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutet för handikappvetenskap (IHV). Lamar Univ, TX 77710 USA; Audiol India, India; Manipal Univ, India.
    Dockens, Ashley L.
    Lamar Univ, TX 77710 USA.
    Flagge, Ashley
    Lamar Univ, TX 77710 USA.
    Bellon-Harn, Monica
    Lamar Univ, TX 77710 USA.
    Azios, Jamie Hartwell
    Lamar Univ, TX 77710 USA.
    Kelly-Campbell, Rebecca J.
    Univ Canterbury, New Zealand.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken. Karolinska Inst, Sweden.
    Quality and Readability of English-Language Internet Information for Tinnitus2019Ingår i: Journal of american academy of audiology, ISSN 1050-0545, E-ISSN 2157-3107, Vol. 30, nr 1, s. 31-40Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background:

    Because of the wealth of information available on the internet and increasing numbers of individuals relying on websites as a primary source of information for health-related questions, it is important that the readability of their content is within the comprehension level of most readers.

    Objective:

    The study evaluated the quality and readability of English-language Internet information for tinnitus.

    Research Design:

    Analysis of Internet websites on tinnitus.

    Study Sample:

    A total of 134 websites with tinnitus information.

    Data Collection and Analysis:

    Three key words (i.e., tinnitus, ringing in the ear, and buzzing in the ear) were entered in five country-specific versions of the most commonly used internet search engine in August 2016. For each of the 15 searches, the first 20 relevant websites were examined. After removing duplicates, a total of 134 websites were assessed. Their origin (commercial, nonprofit organization, government, personal, or university), quality (Health On the Net [HON] certification and DISCERN scores), and readability (Flesch Reading Ease score, Flesch-Kincaid Reading Grade Level Formula, and Simple Measure of Gobbledygook) were assessed.

    Results:

    Most websites were of commercial (49.3%) or nonprofit organization (38.8%) origin. Their quality and readability was highly variable. Only 13.5% of websites had HON certification. χ2 analysis showed that there was significant association between website origin and HON certification [χ2(4) = 132.9, p < 0.0001]. The mean DISCERN scores were 2.39. No association between DISCERN scores and website origin was found. Readability measures showed that on average, only people with at least 10‐12 yr of education could read and understand the internet information for tinnitus in websites. Almost all the websites exceeded the most stringent reading level recommended for health information.

    Conclusions:

    The results highlight great variability in the quality and readability of health information, specifically for tinnitus in the internet. These findings underscores the need for stakeholders (e.g., web-developers, clinicians) to be aware of this and to develop more user-friendly health information on websites to make it more accessible for people with low literacy.

  • 26.
    Mansson, Kristoffer N. T.
    et al.
    Karolinska Inst, Sweden; Stockholm Univ, Sweden; Uppsala Univ, Sweden.
    Lindqvist, Daniel
    Lund Univ, Sweden.
    Yang, Liu L.
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Svanborg, Cecilia
    Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden.
    Isung, Josef
    Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden.
    Nilsonne, Gustav
    Karolinska Inst, Sweden; Stockholm Univ, Sweden.
    Bergman-Nordgren, Lise
    Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden.
    El Alaoui, Samir
    Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden.
    Hedman-Lagerlof, Erik
    Karolinska Inst, Sweden.
    Kraepelien, Martin
    Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden.
    Hogstrom, Jens
    Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken. Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden.
    Boraxbekk, Carl-Johan
    Umea Univ, Sweden; Copenhagen Univ Hosp, Denmark.
    Fischer, Hakan
    Stockholm Univ, Sweden.
    Lavebratt, Catharina
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Wolkowitz, Owen M.
    Univ Calif San Francisco, CA USA.
    Furmark, Tomas
    Uppsala Univ, Sweden.
    Improvement in indices of cellular protection after psychological treatment for social anxiety disorder2019Ingår i: Translational Psychiatry, ISSN 2158-3188, E-ISSN 2158-3188, Vol. 9, nr 1, artikel-id 340Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Telomere attrition is a hallmark of cellular aging and shorter telomeres have been reported in mood and anxiety disorders. Telomere shortening is counteracted by the enzyme telomerase and cellular protection is also provided by the antioxidant enzyme glutathione peroxidase (GPx). Here, telomerase, GPx, and telomeres were investigated in 46 social anxiety disorder (SAD) patients in a within-subject design with repeated measures before and after cognitive behavioral therapy. Treatment outcome was assessed by the Liebowitz Social Anxiety Scale ( self-report), administered three times before treatment to control for time and regression artifacts, and posttreatment. Venipunctures were performed twice before treatment, separated by 9 weeks, and once posttreatment. Telomerase activity and telomere length were measured in peripheral blood mononuclear cells and GPx activity in plasma. All patients contributed with complete data. Results showed that social anxiety symptom severity was significantly reduced from pretreatment to posttreatment (Cohens d = 1.46). There were no significant alterations in telomeres or cellular protection markers before treatment onset. Telomere length and telomerase activity did not change significantly after treatment, but an increase in telomerase over treatment was associated with reduced social anxiety. Also, lower pretreatment telomerase activity predicted subsequent symptom improvement. GPx activity increased significantly during treatment, and increases were significantly associated with symptom improvement. The relationships between symptom improvement and putative protective enzymes remained significant also after controlling for body mass index, sex, duration of SAD, smoking, concurrent psychotropic medication, and the proportion of lymphocytes to monocytes. Thus, indices of cellular protection may be involved in the therapeutic mechanisms of psychological treatment for anxiety.

  • 27.
    Matic, Natasa
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för cellbiologi. Linköpings universitet, Medicinska fakulteten.
    Ressner, Marcus
    Linköpings universitet, Institutionen för medicinsk teknik. Linköpings universitet, Tekniska fakulteten.
    Wiechec, Emilia
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för cellbiologi. Linköpings universitet, Medicinska fakulteten.
    Roberg, Karin
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för cellbiologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken.
    In vitro measurement of glucose uptake after radiation and cetuximab treatment in head and neck cancer cell lines using 18F-FDG, gamma spectrometry and PET/CT2019Ingår i: Oncology Letters, ISSN 1792-1074, E-ISSN 1792-1082, Vol. 18, nr 5, s. 5155-5162Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The standard treatment for head and neck squamous cell carcinoma (HNSCC) is radiotherapy, often in combination with chemotherapy or surgery. However, a novel monoclonal antibody, cetuximab (Erbitux (R)), has also been approved for patient therapy. The aim of present study was to develop an in vitro method for the measurement of 18F-fluoro-2deoxy-D-glucose (FDG) to determine if cellular 18F-FDG uptake is associated with response to radiotherapy or cetuximab treatment. In the current study, HNSCC cell lines were treated with radiation or with cetuximab. Next, the uptake of 18F-FDG was measured using a gamma spectrometer (GS). Thereafter, uptake after radiation was measured first with GS and then compared with positron emission tomography (PET)/computed tomography (CT) imaging. Furthermore, the mRNA expression of glucose transporter 1 (GLUT1) was measured following cetuximab treatment via reverse transcription-quantitative PCR. A study protocol was developed to measure the cellular uptake of 18F-FDG via gamma-ray spectrometry and comparable results were obtained with those of clinical PET/CT. The results revealed a decrease in 18F-FDG after radiation and cetuximab treatment. The uptake of 18F-FDG following cetuximab treatment was significantly lower in the cetuximab-sensitive cell line UT-SCC-14 compared with the cetuximab-resistant cell lines UT-SCC-2 and UT-SCC-45. Furthermore, after treatment with cetuximab for 24 and 48 h, a significant increase in GLUT1 expression was detected in the sensitive cell line compared with the two resistant cell lines. In conclusion, a novel yet reliable method for the measurement of intracellular 18F-FDG via GS has been developed, and our results indicate that 18F-FDG uptake is associated with radiation and cetuximab response in HNSCC.

  • 28.
    Mendes-Santos, Cristina
    et al.
    Linköpings universitet, Institutionen för kultur och kommunikation, Avdelningen för kultur och estetik. Linköpings universitet, Tekniska fakulteten. Universidade Nova de Lisboa, Lisboa, Portugal.
    Weiderpass, Elisabete
    Institute of Population-Based Cancer Research, Oslo, Norway; University of Tromsø, The Arctic University of Norway, Tromsø, Norway; Karolinska Institutet, Stockholm, Sweden; University of Helsinki, Helsinki, Finland.
    Santana, Rui
    Universidade Nova de Lisboa, Lisboa, Portugal.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken. Karolinska Institutet, Stockholm, Sweden.
    A guided internet-delivered individually-tailored ACT-influenced cognitive behavioural intervention to improve psychosocial outcomes in breast cancer survivors (iNNOVBC): Study protocol2019Ingår i: Internet Interventions, ISSN 2214-7829, Internet interventions, ISSN 2214-7829, Vol. 17, artikel-id 100236Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Internet-delivered interventions can provide remarkable opportunities in addressing breast cancer survivors' unmet support care needs, as they present an effective strategy to improve care coordination and provide access to efficacious, cost-efficient and convenient survivorship care. Nevertheless, research focusing on improving survivors' psychosocial needs using internet-based tools is scarce and its practical implementation is limited.

    Objectives: To study the acceptability, feasibility, efficacy and cost-effectiveness of iNNOVBC, a 10 weeks guided internet-delivered individually-tailored Acceptance and Commitment Therapy (ACT)-influenced cognitive behavioural (CBT) intervention developed to improve mild to moderate anxiety and depression in Breast cancer survivors when compared to treatment as usual (TAU) in a waiting list control group (WLC).

    Methods: A two-arm, parallel, open label, multicentre, waiting list randomized controlled trial will be conducted to investigate the efficacy and cost-effectiveness of INNOVBC. The primary outcomes in this research will be anxiety and depression. Secondary outcomes will include psychological flexibility, fatigue, insomnia, sexual dysfunction and Health Related Quality of Life (HRQoL).

    Ethical approval: This study has been reviewed and approved by Comissão Nacional de Proteção de Dados; Instituto Português de Oncologia do Porto Francisco Gentil; Unidade Local de Saúde de Matosinhos, EPE; Centro Hospitalar de São João and Ordem dos Psicólogos ethical committees.

    Expected results: It is anticipated that iNNOVBC will show to be an efficacious and cost-effective program in improving the outcomes of interest in this study, as opposed to a WLC under TAU. The results of this research will be published in accordance with CONSORT-EHEALTH guidelines.

    Conclusions: This study will inform on the acceptability, feasibility, efficacy and cost-effectiveness of iNNOVBC, in improving psychosocial outcomes in breast cancer survivors when compared to TAU in a WLC. Its conclusions will contribute to understand the idiosyncrasies of designing and implementing internet-delivered interventions in breast cancer survivors.Trial Registration code: INNOVBC (NCT03275727).

  • 29.
    Miloff, Alexander
    et al.
    Stockholm Univ, Sweden.
    Lindner, Philip
    Stockholm Univ, Sweden; Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden.
    Dafgard, Peter
    Stockholm Univ, Sweden.
    Deak, Stefan
    Stockholm Univ, Sweden.
    Garke, Maria
    Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden.
    Hamilton, William
    Mimerse AB, Sweden.
    Heinsoo, Julia
    Stockholm Univ, Sweden.
    Kristoffersson, Glenn
    Stockholm Univ, Sweden.
    Rafi, Jonas
    Stockholm Univ, Sweden.
    Sindemark, Kerstin
    Stockholm Univ, Sweden.
    Sjolund, Jessica
    Stockholm Univ, Sweden.
    Zenger, Maria
    Stockholm Univ, Sweden.
    Reuterskiold, Lena
    Stockholm Univ, Sweden.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken. Karolinska Inst, Sweden; Stockholm Hlth Care Serv, Sweden.
    Carlbring, Per
    Stockholm Univ, Sweden; Univ Southern Denmark, Denmark.
    Automated virtual reality exposure therapy for spider phobia vs. in-vivo one-session treatment: A randomized non-inferiority trial2019Ingår i: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 118, s. 130-140Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective This study compared the efficacy of a technician-assisted single-session virtual reality exposure therapy (VRET) for the treatment of spider phobia featuring low-cost consumer-available hardware and novel automated software to gold-standard in-vivo one-session treatment (OST), using a parallel group randomized non-inferiority design.

    Method Participants (N = 100) were randomized to VRET and OST arms. Assessors blinded to treatment allocation evaluated participants at pre- and post-treatment as well follow-up (3 and 12 months) using a behavioral approach test (BAT) and self-rated fear of spider, anxiety, depression and quality-of-life scales. A maximum post-treatment difference of 2-points on the BAT qualified as non-inferiority margin.

    Results Linear mixed models noted large, significant reductions in behavioral avoidance and self-reported fear in both groups at post-treatment, with VRET approaching the strong treatment benefits of OST over time. Non-inferiority was identified at 3- and 12- months follow-up but was significantly worse until 12-months. There was no significant difference on a questionnaire measuring negative effects.

    Conclusions Automated VRET efficaciously reduced spider phobia symptoms in the short-term and was non-inferior to in-vivo exposure therapy in the long-term. VRET effectiveness trials are warranted to evaluate real-world benefits and non-specific therapeutic factors accruing from the presence of a technician during treatment.

  • 30.
    Nilsson, Anders
    et al.
    Karolinska Inst, Sweden.
    Magnusson, Kristoffer
    Karolinska Inst, Sweden.
    Carlbring, Per
    Stockholm Univ, Sweden.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken. Karolinska Inst, Sweden.
    Hellner, Clara
    Karolinska Inst, Sweden.
    Behavioral couples therapy versus cognitive behavioral therapy for problem gambling: a randomized controlled trial2020Ingår i: Addiction, ISSN 0965-2140, E-ISSN 1360-0443Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background and aims

    There is evidence that cognitive behavioral therapy (CBT) is effective for treating problem gambling (PG). Some research points to the possible benefits of involving concerned significant others (CSOs) in treatment. This study compared the efficacy of behavioral couples therapy (BCT) and CBT for both the gambler and the CSO.

    Design

    Two parallel‐group randomized controlled study comparing two different internet‐based treatments for PG. Follow‐up measures were conducted at treatment finish, and at 3‐, 6‐ and 12‐month post‐treatment.

    Setting

    Stockholm, Sweden.

    Participants

    A total of 136 problem gamblers and 136 CSOs were included in the study: 68 gamblers and 68 CSOs for each treatment condition. The gamblers were on average 35.6 years old and 18.4% were female. CSOs were on average 45.3 years old and 75.7% were women.

    Interventions

    A treatment based on BCT was compared with a CBT intervention. Both treatments were internet‐based, with 10 therapist‐guided self‐help modules accompanied by weekly telephone and e‐mail support from a therapist. CSOs were given treatment in the BCT condition, but not in the CBT condition.

    Measurements

    The primary outcome measures were time‐line follow‐back for gambling (TLFB‐G) and the NORC Diagnostic Screen for Gambling Problems (NODS) for problem gamblers, corresponding to DSM‐IV criteria for pathological gambling. Secondary outcomes measures were the Patient Health Questionnaire‐9 (PHQ‐9), the Generalized Anxiety Disorder seven‐item scale (GAD‐7), the Relation Assessment Scale Generic (RAS‐G), the Alcohol Use Disorders Identification Test (AUDIT), the Inventory of Consequences of Gambling for the Gambler and CSO (ICS) and adherence to treatment for both the problem gambler and the CSO.

    Findings

    The outcomes of both gambler groups improved, and differences between the groups were not statistically significant: TLFB‐G: multiplicative effect = 1.13, 95% confidence interval (CI) = 0.30;4.31); NODS: multiplicative effect = 0.80, 95%, 95% CI = 0.24;2.36. BCT gamblers began treatment to a higher proportion than CBT gamblers: P = 0.002.

    Conclusions

    Differences in the efficacy of internet‐based behavioral couples therapy and cognitive behavioral therapy for treatment of problem gambling were not significant, but more gamblers commenced treatment in the behavioral couples therapy group.

  • 31.
    Nordgreen, Tine
    et al.
    Haukeland Hosp, Norway; Univ Bergen, Norway.
    Blom, Kerstin
    Haukeland Hosp, Norway; Karolinska Inst, Sweden; Karolinska Univ Hosp Huddinge, Sweden.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken. Karolinska Inst, Sweden.
    Carlbring, Per
    Stockholm Univ, Sweden; Univ Southern Denmark, Denmark.
    Havik, Odd E.
    Univ Bergen, Norway.
    Effectiveness of guided Internet-delivered treatment for major depression in routine mental healthcare: An open study2019Ingår i: Internet Interventions, ISSN 2214-7829, INTERNET INTERVENTIONS-THE APPLICATION OF INFORMATION TECHNOLOGY IN MENTAL AND BEHAVIOURAL HEALTH, Vol. 18, artikel-id 100274Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Depression is one of the most prevalent mental health disorders and is estimated to become the leading cause of disability worldwide by 2030. Increasing access to effective treatment for depression is a major societal challenge. In this context, the increasing use of computers in the form of laptops or smartphones has made it feasible to increase access to mental healthcare through digital technology. In this study, we examined the effectiveness of a 14-week therapist-guided Internet-delivered program for patients with major depression undergoing routine care. From 2015 to 2018, 105 patients were included in the study. For depressive symptoms, we identified significant within-group effect sizes (post-treatment: d = 0.96; 6-month follow-up: d = 1.21). We also found significant effects on secondary anxiety and insomnia symptoms (d = 0.55-0.92). Clinically reliable improvement was reported by 48% of those undergoing the main parts of the treatment, whereas 5% of the participants reported a clinically significant deterioration. However, a large proportion of patients showed no clinically reliable change. In summary, the study identified large treatment effects, but also highlighted room for improvement in the usability of the treatment.

  • 32.
    Nordgren, Line
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Filosofiska fakulteten.
    Monell, Elin
    Karolinska Inst, Sweden.
    Birgegard, Andreas
    Karolinska Inst, Sweden.
    Bjureberg, Johan
    Karolinska Inst, Sweden; Stockholm Cty Council, Sweden.
    Hesser, Hugo
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken.
    Factor Structure of the Difficulties in Emotion Regulation Scale in Treatment Seeking Adults with Eating Disorders2020Ingår i: Journal of Psychopathology and Behavioral Assessment, ISSN 0882-2689, E-ISSN 1573-3505, Vol. 42, nr 1, s. 111-126Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The Difficulties in Emotion Regulation Scale (DERS) is extensively used as a measure of emotion (dys-)regulation ability in both clinical and nonclinical populations. This is the first study to examine the factor structure of both the original 36-item and short 16-item version of the DERS in adults with eating disorders and to test measurement invariance across diagnostic subgroups. The factor structure of the scale was examined using confirmatory factor analysis in a psychiatric sample of adults with eating disorders (N = 857). Four primary factor structures were fitted to the data: (1) a unidimensional model, (2) a six-factor correlated-traits model, (3) a higher-order factor solution, and (4) a bifactor model. Measurement invariance was tested for diagnostic subgroups of anorexia nervosa and bulimia nervosa and associations between factors and eating pathology were examined in each diagnostic group. Results indicated that a modified bifactor solution fitted the data adequately for both the 36-item and 16-item version of the DERS. A general factor explained most of the variance (86%) and reliability was high for the general factor of DERS (total) but lower for the subscales. Measurement invariance of the bifactor model was supported across diagnostic subgroups and test of factor means reveled that bulimia nervosa had a higher factor mean than anorexia nervosa on the general factor. The general factor accounted for a significant proportion of variance in eating pathology. Our results support the use of the total scale of both the 36-item and 16-item version among adults with eating disorders.

  • 33.
    Nygren, Tomas
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Brohede, David
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Filosofiska fakulteten. ing, SE-58183 Linkoping, Sweden.
    Koshnaw, Kocher
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Filosofiska fakulteten.
    Osman, Shevan Sherzad
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Filosofiska fakulteten.
    Johansson, Robert
    Stockholm Univ, Sweden.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken. Karolinska Inst, Sweden.
    Internet-based treatment of depressive symptoms in a Kurdish population: A randomized controlled trial2019Ingår i: Journal of Clinical Psychology, ISSN 0021-9762, E-ISSN 1097-4679, Vol. 75, nr 6, s. 985-998Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective Kurdish immigrants in Sweden have a doubled risk of mental health problems, and refugee and immigrant populations underutilize mental health services. The present study investigated the efficacy of culturally adapted guided internet-based cognitive behavior therapy (ICBT) for depressive symptoms in a Kurdish population. Method We included 50 individuals who were randomized to either an 8-week treatment or a wait-list. The Beck Depression Inventory-II was the primary outcome measure, and measures of anxiety and insomnia were secondary outcomes. Results Depressive symptoms were significantly reduced (intention-to-treat analysis) in the treatment group, with a between-group effect size at posttreatment of Cohens d = 1.27. Moderate to large between-group effects were also observed on all secondary outcome measures. Treatment effects were sustained at 11-month follow-up. Conclusion The results provide preliminary support for culturally adapted ICBT as a complement to other treatment formats for treating symptoms of depression in a Kurdish population.

  • 34.
    Nystrom, Markus B. T.
    et al.
    Umea Univ, Sweden.
    Hassmen, Peter
    Umea Univ, Sweden; Southern Cross Univ, Australia.
    Sorman, Daniel E.
    Umea Univ, Sweden.
    Wigforss, Thomas
    Umea Univ, Sweden.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken. Karolinska Inst, Sweden.
    Carlbring, Per
    Stockholm Univ, Sweden.
    Are physical activity and sedentary behavior related to depression?2019Ingår i: COGENT PSYCHOLOGY, ISSN 2331-1908, Vol. 6, nr 1, artikel-id 1633810Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Depression is an increasing public health concern with rising prevalence. Nevertheless, far from everyone seeks help or receives adequate treatment. Although psychotherapy and antidepressants still constitute the bulk of treatments offered, recent research suggests that physical activity (PA) can be a powerful adjunct therapy while sedentary behavior (SB) is a definite risk factor for developing depression. The aim of the present study was to investigate the relationship between PA, SB and depressive symptoms in a population (n = 962) of applicants for an online treatment study. This study hypothesised that there will be; (1) a positive relationship between SB and depressive symptoms, and (2) a negative relationship between PA and depressive symptoms. In addition we investigated whether the combination of a sedentary lifestyle and physical inactivity increased the risk for depressive symptoms. Finally, we also examined whether gender, age, marital status, educational level, or medication affected the relationship between PA, SB, and depressive symptoms. The results showed a positive correlation between SB and depression. There was, however, no statistically significant support for a negative relation between PA and depressive symptoms. Even though no conclusions about causality can be drawn, our results suggest that high SB, being a woman, being young, not being in a stable relationship, and current or previous medication are risk factors for depression. To be able to determine the causal direction, that is, whether high SB increases the risk for depressive symptoms, or if depressive symptoms increase the likelihood of high SB, further research is needed.

  • 35.
    Persson Asplund, Robert
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Jaderlind, Anna
    Karolinska Inst, Sweden.
    Hoijer Bjork, Isabel
    Karolinska Inst, Sweden.
    Ljotsson, Brjann
    Karolinska Inst, Sweden.
    Carlbring, Per
    Stockholm Univ, Sweden.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken. Karolinska Inst, Sweden.
    Experiences of internet-delivered and work-focused cognitive behavioral therapy for stress: A qualitative study2019Ingår i: Internet Interventions, ISSN 2214-7829, INTERNET INTERVENTIONS-THE APPLICATION OF INFORMATION TECHNOLOGY IN MENTAL AND BEHAVIOURAL HEALTH, Vol. 18, artikel-id 100282Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction

    Stress is one of the major challenges of modern society, causing significant costs and personal problems. In the recent decade a growing body of research has provided support for the efficacy of internet interventions for stress. However, few studies have focused on how participants experience internet interventions for stress.

    Method

    The current study was a qualitative follow-up study of an internet-delivered and work-focused cognitive behavioral treatment for stress. The aim was to capture participants' experiences of the treatment and their views on effects on health and well-being. Participants were selected from a controlled study (n = 27), using a criterion-based sampling approach selecting those participants who had completed all treatment modules. Nine semi-structured interviews were held, and the material was analyzed using Thematic Analysis.

    Results

    The results indicated that most of the participants experienced positive effects on their mental health and well-being in both life and at work. All participants emphasized the importance of having access to therapist support. In line with previous research, participants found the intervention to be extensive and demanding and expressed the need for extended treatment time and therapist support.

    Conclusions

    Considering the limitations of the present study, future research could examine the feasibility of reducing the length of each session, extending deadlines and increasing therapist support. This could improve treatment efficacy and further enhance utilization in the target population.

  • 36.
    Rozental, Alexander
    et al.
    Karolinska Inst, Sweden; UCL, England.
    Kottorp, Anders
    Malmo Univ, Sweden.
    Forsstrom, David
    Stockholm Univ, Sweden.
    Mansson, Kristoffer
    Karolinska Inst, Sweden; Stockholm Univ, Sweden; Uppsala Univ, Sweden.
    Boettcher, Johanna
    Free Univ Berlin, Germany.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken. Karolinska Inst, Sweden.
    Furmark, Tomas
    Uppsala Univ, Sweden.
    Carlbring, Per
    Stockholm Univ, Sweden; Univ Southern Denmark, Denmark.
    The Negative Effects Questionnaire: psychometric properties of an instrument for assessing negative effects in psychological treatments2019Ingår i: Behavioural and Cognitive Psychotherapy, ISSN 1352-4658, E-ISSN 1469-1833, Vol. 47, nr 5, s. 559-572, artikel-id PII S1352465819000018Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background:

    Psychological treatments provide many benefits for patients with psychiatric disorders, but research also suggests that negative effects might occur from the interventions involved. The Negative Effects Questionnaire (NEQ) has previously been developed as a way of determining the occurrence and characteristics of such incidents, consisting of 32 items and six factors. However, the NEQ has yet to be examined using modern test theory, which could help to improve the understanding of how well the instrument works psychometrically.

    Aims:

    The current study investigated the reliability and validity of the NEQ from both a person and item perspective, establishing goodness-of-fit, item bias, and scale precision.

    Method:

    The NEQ was distributed to 564 patients in five clinical trials at post-treatment. Data were analysed using Rasch analysis, i.e. a modern test theory application.

    Results:

    (1) the NEQ exhibits fairness in testing across sociodemographics, (2) shows comparable validity for a final and condensed scale of 20 instead of 32 items, (3) uses a rating scale that advances monotonically in steps of 0 to 4, and (4) is suitable for monitoring negative effects on an item-level.

    Conclusions:

    The NEQ is proposed as a useful instrument for investigating negative effects in psychological treatments, and its newer shorter format could facilitate its use in clinical and research settings. However, further research is needed to explore the relationship between negative effects and treatment outcome, as well as to test it in more diverse patient populations.

  • 37.
    Santoft, Fredrik
    et al.
    Karolinska Inst, Sweden.
    Salomonsson, Sigrid
    Karolinska Inst, Sweden.
    Hesser, Hugo
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken.
    Lindsater, Elin
    Karolinska Inst, Sweden.
    Ljotsson, Brjann
    Karolinska Inst, Sweden.
    Lekander, Mats
    Karolinska Inst, Sweden; Stockholm Univ, Sweden.
    Kecklund, Goran
    Stockholm Univ, Sweden; Radboud Univ Nijmegen, Netherlands.
    Ost, Lars-Goran
    Karolinska Inst, Sweden; Stockholm Univ, Sweden.
    Hedman-Lagerlof, Erik
    Karolinska Inst, Sweden.
    Mediators of Change in Cognitive Behavior Therapy for Clinical Burnout2019Ingår i: Behavior Therapy, ISSN 0005-7894, E-ISSN 1878-1888, Vol. 50, nr 3, s. 475-488Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Evidence supporting the effectiveness of cognitive behavior therapy (CBT) for stress-related illness is growing, but little is known about its mechanisms of change. The aim of this study was to investigate potential mediators of CBT for severe stress in form of clinical burnout, using an active psychological treatment as comparator. We used linear mixed models to analyze data from patients (N = 82) with clinical burnout who received either CBT or another psychological treatment in a randomized controlled trial. Potential mediators (i.e., sleep quality, behavioral activation, perceived competence, and therapeutic alliance) and outcome (i.e., symptoms of burnout) were assessed weekly during treatment. The results showed that the positive treatment effects on symptoms of burnout favoring CBT (estimated between-group d = 0.93) were mediated by improvements in sleep quality, ab = -0.017,95% CIasymmetric [-0.037, -0.002], and increase in perceived competence, ab = -0.037, 95% CIasymmetric [-0.070, -0.010]. Behavioral activation, ab = -0.004 [-0.016, 0.007], and therapeutic alliance, ab = 0.002 [-0.006, 0.011], did not significantly mediate the difference in effects between the treatments. Improving sleep quality and increasing perceived competence may thus constitute important process goals in order to attain symptom reduction in CBT for clinical burnout.

  • 38.
    Santoft, Fredrik
    et al.
    Karolinska Inst, Sweden.
    Salomonsson, Sigrid
    Karolinska Inst, Sweden; Karolinska Inst, Sweden.
    Hesser, Hugo
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken.
    Lindsater, Elin
    Karolinska Inst, Sweden.
    Ljotsson, Brjann
    Karolinska Inst, Sweden; Karolinska Inst, Sweden.
    Lekander, Mats
    Karolinska Inst, Sweden; Karolinska Inst, Sweden; Stockholm Univ, Sweden.
    Kecklund, Goran
    Karolinska Inst, Sweden; Stockholm Univ, Sweden.
    Osta, Lars-Goran
    Karolinska Inst, Sweden; Stockholm Univ, Sweden.
    Hedman-Lagerlof, Erik
    Karolinska Inst, Sweden; Karolinska Inst, Sweden.
    Processes in cognitive behavior therapy for social anxiety disorder: Predicting subsequent symptom change2019Ingår i: Journal of Anxiety Disorders, ISSN 0887-6185, E-ISSN 1873-7897, Vol. 67, artikel-id 102118Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Although cognitive behavior therapy (CBT) is an effective treatment for social anxiety disorder, little is known about the processes during treatment that bring about change. The aim of this study was to investigate whether the proposed processes of change according to the cognitive model of social anxiety disorder predicted subsequent symptom reduction in CBT delivered as therapist-guided bibliotherapy. We analyzed data from patients with social anxiety disorder (N = 61) who participated in an effectiveness trial of CBT in primary care. Seven putative processes and outcome (i.e., social anxiety) were assessed on a weekly basis throughout treatment. We used linear mixed models to analyze within-person relations between processes and outcome. The results showed a unidirectional effect of reduced avoidance on subsequent decrease in social anxiety. Further, we found support for reciprocal influences between four of the proposed processes (i.e., estimated probability and cost of adverse outcome, self-focused attention, and safety behaviors) and social anxiety. The remaining two processes, (i.e., anticipatory and post-event processing) did not predict subsequent social anxiety, but were predicted by prior symptom reduction. The findings support that several of the change processes according to the cognitive model of social anxiety disorder are involved in symptom improvement.

  • 39.
    Sarkohi, Ali
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Andersson, GerhardLinköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken.
    Somatisk sjukdom: ett biopsykosocialt perspektiv2019Samlingsverk (redaktörskap) (Övrigt vetenskapligt)
    Abstract [sv]

    Människans nyfikenhet och kreativitet har banat väg för att bättre förstå och förklara olika fenomen, bland annat vad som påverkar och vidmakthåller vår hälsa och ohälsa. Tydligt är att synen på hälsa och ohälsa har förändrats över tid. I dag finns en insikt i att kropp och själ hänger samman och att psykologiska faktorer har stor betydelse även för vår somatiska hälsa.

    I det biopsykosociala perspektivet, som presenteras i denna bok, vidgas förståelsen av den komplexa människan och av begreppen hälsa och ohälsa. Hälsa och ohälsa måste förstås inte bara som biologiska fenomen, utan också som psykologiska och sociala. I boken integreras således evidensbaserad psykologisk kunskap med etablerad kunskap om medicinska och sociala faktorers betydelse för somatisk ohälsa. På så sätt ger den stöd till främst personal inom hälso- och sjukvården i att inhämta och tillämpa kunskap från olika ämnesområden vid bedömning, förklaring och behandling av somatisk ohälsa, men också i arbetet att förebygga ohälsa.

    Bokens främsta målgrupper är yrkesverksamma inom hälso- och sjukvård samt studenter inom vård och psykologi, särskilt med inriktningen hälsopsykologi.

  • 40.
    Smoktunowicz, Ewelina
    et al.
    SWPS Univ Social Sci and Humanities, Poland.
    Lesnierowska, Magdalena
    SWPS Univ Social Sci and Humanities, Poland.
    Cieslak, Roman
    SWPS Univ Social Sci and Humanities, Poland; Univ Colorado, CO 80907 USA.
    Carlbring, Per
    Stockholm Univ, Sweden; Univ Southern Denmark, Denmark.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken. Karolinska Inst, Sweden.
    Efficacy of an Internet-based intervention for job stress and burnout among medical professionals: study protocol for a randomized controlled trial2019Ingår i: Trials, ISSN 1745-6215, E-ISSN 1745-6215, Vol. 20, artikel-id 338Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BackgroundMedical professionals are at high risk of job stress and burnout. Research shows that work-related stress can be reduced through enhancing psychological resources, in particular, self-efficacy and perceived social support. These psychological resources can operate either individually or sequentially: in line with the cultivation hypothesis, self-efficacy precedes and cultivates perceived social support, whereas according to the enabling hypothesis it is perceived social support that comes first and enables self-efficacy. Based on this theoretical framework we developed an internet-based intervention, Med-Stress, dedicated to healthcare providers and aimed at reducing job stress and burnout. Med-Stress contains two modules that enhance self-efficacy and perceived social support, which are tested in four variants reflected in four study conditions. We expect that sequential enhancement of resources: self-efficacy and social support or social support and self-efficacy will yield larger posttest results than individual enhancement.MethodsIn this four-arm randomized controlled trial we will test four variants of the Med-Stress intervention. The trial is open for professionally active medical providers aged at least 18 years (N=1200) with access to an Internet-connected device. We will compare the effects of two experimental conditions reflecting cultivation and enabling effects of self-efficacy and perceived social support (sequential enhancement of resources), and two active controls strengthening self-efficacy or perceived social support. Job stress and job burnout will be the primary outcomes, whereas depression, job-related traumatic stress, and work engagement will be secondary ones. Additionally, we will measure perceived social support, self-efficacy to manage job stress and burnout, and the ability to obtain social support, exposure to traumatic events, and users expectancy and credibility of the intervention. All assessments will be applied before the intervention, atposttest (at 3 or 6weeks depending on the study condition), and at 6-month and 12-month follow up. In the case of experimental groups, additional measurements will be taken after enhancing each resource.DiscussionResource-based interventions are relatively context-free and could potentially benefit medical professionals across the field. If Med-Stress is successful, its most effective variant could be implemented in the healthcare system as a standalone, supportive tool for employees.Trial registrationClinicalTrials.gov, NCT03475290 Registered on 23 March 2018.

  • 41.
    Talani, Charbél
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Logopedi, Audiologi och Otorhinolaryngologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken.
    Mäkitie, Antti
    Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland; Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska Hospital, Stockholm, Sweden; Research Programme in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
    Beran, Martin
    Department of ENT and Maxillofacial Surgery, NAL Medical Center Hospital, Trollhattan, Sweden.
    Holmberg, Erik
    Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Laurell, Göran
    Department of Clinical Sciences, ENT, Uppsala University, Uppsala, Sweden.
    Farnebo, Lovisa
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för logopedi, otorhinolaryngologi och audiologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken.
    Early mortality after diagnosis of cancer of the head and neck - A population-based nationwide study2019Ingår i: PLoS ONE, E-ISSN 1932-6203, Vol. 14, nr 10, artikel-id e0223154Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Cancers of the head and neck have a high mortality rate, and roughly 10% of the patients die within six months of diagnosis. To our knowledge little has been written about this group. We wished to identify risk factors for early death, to predict and monitor patients at risk better and, if possible, avoid unjustified major treatment.

  • 42.
    Titov, Nickolai
    et al.
    Macquarie Univ, Australia.
    Hadjistavropoulos, Heather D.
    Univ Regina, Canada.
    Nielssen, Olav
    Macquarie Univ, Australia.
    Mohr, David C.
    Northwestern Univ, IL 60611 USA.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken. Karolinska Inst, Sweden.
    Dear, Blake F.
    Macquarie Univ, Australia.
    From Research to Practice: Ten Lessons in Delivering Digital Mental Health Services2019Ingår i: JOURNAL OF CLINICAL MEDICINE, ISSN 2077-0383, Vol. 8, nr 8, artikel-id 1239Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    There is a large body of research showing that psychological treatment can be effectively delivered via the internet, and Digital Mental Health Services (DMHS) are now delivering those interventions in routine care. However, not all attempts to translate these research outcomes into routine care have been successful. This paper draws on the experience of successful DMHS in Australia and Canada to describe ten lessons learned while establishing and delivering internet-delivered cognitive behavioural therapy (ICBT) and other mental health services as part of routine care. These lessons include learnings at four levels of analysis, including lessons learned working with (1) consumers, (2) therapists, (3) when operating DMHS, and (4) working within healthcare systems. Key themes include recognising that DMHS should provide not only treatment but also information and assessment services, that DMHS require robust systems for training and supervising therapists, that specialist skills are required to operate DMHS, and that the outcome data from DMHS can inform future mental health policy. We also confirm that operating such clinics is particularly challenging in the evolving funding, policy, and regulatory context, as well as increasing expectations from consumers about DMHS. Notwithstanding the difficulties of delivering DMHS, we conclude that the benefits of such services for the broader community significantly outweigh the challenges.

  • 43.
    Wade, Tracey D.
    et al.
    Flinders Univ S Australia, Australia.
    Kay, Enola
    Flinders Univ S Australia, Australia.
    de Valle, Madelaine K.
    Flinders Univ S Australia, Australia.
    Egan, Sarah J.
    Curtin Univ, Australia.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken. Karolinska Inst, Sweden.
    Carlbring, Per
    Stockholm Univ, Sweden; Univ Southern Denmark, Denmark.
    Shafran, Roz
    UCL, England.
    Internet-based cognitive behaviour therapy for perfectionism: More is better but no need to be prescriptive2019Ingår i: Clinical Psychologist, ISSN 1328-4207, E-ISSN 1742-9552Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    The current study explored whether higher‐ (up to 8 modules) versus lower‐dose (3 or less modules) unguided internet Cognitive Behaviour Therapy for perfectionism (ICBT‐P) was more effective, and the best method to promote higher dosage.

    Methods

    Two sequential randomised ICBT‐P studies were conducted with participants who self‐identified as having difficulties with perfectionism; in the first participants (N = 51) received 3‐module ICBT‐P or wait‐list, and in the second participants (N = 55) received fixed (asked to complete all 8 modules two per week over 4‐weeks) or flexible format (after completing the first psychoeducational module, participants decided how many/in what order they completed the modules). We examined impact on our primary variables, perfectionistic concerns and standards, and secondary outcomes of negative affect, body image flexibility, and self‐efficacy.

    Results

    More modules were completed in the higher‐ (M modules = 4.36, SD = 3.29) versus lower‐dose (M = 1.96, SD = 1.23) ICBT‐P, d = 0.86 (95% confidence interval: 0.39, 1.34). The latter impacted perfectionism but not secondary outcomes; the former impacted all outcomes (except for self‐efficacy), and within‐group effect size improvements were double in the high‐ compared to low‐dose ICBT‐P. There was no difference between the fixed and flexible formats in terms of the number of modules completed or impact.

    Conclusions

    We can offer a patient‐centred approach to ICBT‐P that is effective, while suggesting completion of more modules can result in larger, more pervasive improvements.

  • 44.
    Westerberg, Johanna
    et al.
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för logopedi, otorhinolaryngologi och audiologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken.
    Mäki-Torkko, Elina
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för logopedi, otorhinolaryngologi och audiologi. Linköpings universitet, Medicinska fakulteten. Orebro Univ, Sweden.
    Harder, Henrik
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken.
    The evaluation of canal wall up cholesteatoma surgery with the Glasgow Benefit Inventory2020Ingår i: European Archives of Oto-Rhino-Laryngology, ISSN 0937-4477, E-ISSN 1434-4726, Vol. 277, nr 1, s. 61-68Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose The aim of the study was to investigate the change in health-related quality of life ( HRQoL) after canal wall up cholesteatoma surgery, using the Glasgow Benefit Inventory (GBI). Methods Data from a consecutive group of 47 adults scheduled for primary cholesteatoma surgery using canal wall up (CWU) with obliteration, from January 2005 to December 2009, were analysed. Information was extracted from a medical database, and complementary data from patient files and audiograms were collected and recorded retrospectively. The GBI questionnaire was used for the assessment of HRQoL after surgery. Results There was no finding of residual or recurrent cholesteatomas in the study group. Hearing was improved at 1 and 3 years postoperatively. No patient suffered a total hearing loss. The overall GBI scores showed an improved HRQoL after surgery. Twenty-nine (85%) patients benefitted from surgery, 1 (3%) had no change, and 4 (12%) expressed deterioration. Conclusions Cholesteatoma surgery using CWU with obliteration gives an improved HRQoL for the majority of patients. The GBI questionnaire provides complementary information to hearing and healing results after cholesteatoma surgery.

  • 45.
    Zetterberg, Molly
    et al.
    Stockholm Univ, Sweden.
    Carlbring, Per
    Stockholm Univ, Sweden; Univ Southern Denmark, Denmark.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken. Karolinska Inst, Sweden.
    Berg, Matilda
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Shafran, Roz
    UCL, England.
    Rozental, Alexander
    Karolinska Inst, Sweden; UCL, England.
    Internet-based cognitive behavioral therapy of perfectionism: Comparing regular therapist support and support upon request2019Ingår i: Internet Interventions, ISSN 2214-7829, INTERNET INTERVENTIONS-THE APPLICATION OF INFORMATION TECHNOLOGY IN MENTAL AND BEHAVIOURAL HEALTH, Vol. 17, artikel-id 100237Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Perfectionism may be a clinically relevant problem on its own or as part of the etiology and maintenance of psychiatric disorders, e.g., anxiety disorders, depression, and eating disorders. Cognitive behavior therapy has been shown to be a promising treatment for managing perfectionism and its associated problems, including when being administered via the Internet, i.e., Internet-based cognitive behavioral therapy (ICBT). In the current study, seventy-eight self-referred participants underwent ICBT after an initial eight-week wait-list period, i.e., second wave of treatment. These were randomized to receive regular support from a therapist (ICBT-support) or ICBT with support on request (ICBT-request), in an eight-week treatment of perfectionism. Assessments of perfectionism were made at pre-, mid-, and post-treatment, as well as six-month follow-up, using the Frost Multidimensional Perfectionism Scale, subscale Concern over Mistakes. Mixed effects models revealed large symptom reductions for both conditions; Concern over Mistakes, Cohens d = 1.40, 95% Confidence Interval (CI) [0.85, 1.95] for ICBT-support, and d = 1.00, 95% CI [0.51, 1.47] for ICBT-request. The effects were maintained at six-month follow-up and there were no differences between the conditions in terms of the results, opened modules, or completed exercises. A total of 28 out of 70 participants (42.4%; ICBT-support, 37.8%; ICBT-request) were classified as improved at post-treatment. Both types of ICBT may thus be beneficial in treating perfectionism, suggesting that just having the opportunity to ask for support from a therapist, when regular support is not provided, could be sufficient for many participants undergoing ICBT. However, the study was underpowered to detect differences between the conditions. The lack of a cutoff also makes it difficult to differentiate a dysfunctional from a functional population in terms of perfectionism. In addition, the study design could have affected the participants motivational level from start, given their initial eight-week wait-list period. Recommendations for future studies include recruiting a larger sample size, a clearer cutoff for perfectionism, and the use of a non-inferiority test with a predetermined margin of change.

  • 46.
    Öberg, Marie
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken.
    A multicenter study evaluating the effect of the Swedish ACE-programme.2018Konferensbidrag (Refereegranskat)
  • 47.
    Öberg, Marie
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken.
    Effekterna av interaktiv hörselrehabilitering2018Konferensbidrag (Refereegranskat)
  • 48.
    Öberg, Marie
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken.
    Konsekvenser av hörselnedsättning2019Konferensbidrag (Övrigt vetenskapligt)
  • 49.
    Öberg, Marie
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Logopedi, Audiologi och Otorhinolaryngologi. Linköpings universitet, Medicinska fakulteten.
    Validering av HHIE-S2018Konferensbidrag (Refereegranskat)
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