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  • 151.
    Cope, Eva
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology.
    Jessica, Kaminski
    Linköping University, Department of Behavioural Sciences and Learning, Psychology.
    Kvinnors upplevelser av bemötande inom förlossningsvården efter en förlossningsskada: Psykologiska konsekvenser och önskade förändringar2017Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Women’s experiences of health care after sustaining an injury during labour have been covered frequently by the media during the last year, however, Swedish research on the topic is sparse. The purpose of this study was to explore how these women have experienced interactions with care staff and how they feel that these interactions have affected them psychologically. Data was collected through individual semi-structured interviews with 14 women who have sustained an injury during labour. The transcribed interviews were processed using thematic analysis and five themes were identified; There’s no place for us, Great that they focus on the baby - but what about me?, It is painful to give birth, I guess it was my fault then and finally I won’t put myself through this again. Care staff interactions showed to have a large impact on the women’s psychological well-being and also the women’s thought processes in regards to their potential future deliveries. 

  • 152.
    Cristea, Ioana A
    et al.
    University of Pisa, Pisa, Italy.
    Huibers, Marcus J H
    EMGO Institute for Health and Care Research, The Netherlands.
    David, Daniel
    Babeş-Bolyai University, Cluj-Napoca, Romania.
    Hollon, Steven D
    Vanderbilt University, Nashville, USA.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Cuijpers, Pim
    EMGO Institute for Health and Care Research, The Netherlands.
    The effects of cognitive behavior therapy for adult depression on dysfunctional thinking: A meta-analysis.2015In: Clinical Psychology Review, ISSN 0272-7358, E-ISSN 1873-7811, Vol. 42, p. 62-71Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: It is not clear whether cognitive behavior therapy (CBT) works through changing dysfunctional thinking. Although several primary studies have examined the effects of CBT on dysfunctional thinking, no meta-analysis has yet been conducted.

    METHOD: We searched for randomized trials comparing CBT for adult depression with control groups or with other therapies and reporting outcomes on dysfunctional thinking. We calculated effect sizes for CBT versus control groups, and separately for CBT versus other psychotherapies and respectively, pharmacotherapy.

    RESULTS: 26 studies totalizing 2002 patients met inclusion criteria. The quality of the studies was less than optimal. We found a moderate effect of CBT compared to control groups on dysfunctional thinking at post-test (g=0.50; 95% CI: 0.38-0.62), with no differences between the measures used. This result was maintained at follow-up (g=0.46; 95% CI: 0.15-0.78). There was a strong association between the effects on dysfunctional thinking and those on depression. We found no significant differences between CBT and other psychotherapies (g=0.17; p=0.31), except when restrict in outcomes to the Dysfunctional Attitudes Scale (g=0.29). There also was no difference between CBT and pharmacotherapy (g=0.04), though this result was based on only 4 studies.

    DISCUSSION: While CBT had a robust and stable effect on dysfunctional thoughts, this was not significantly different from what other psychotherapies or pharmacotherapy achieved. This result can be interpreted as confirming the primacy of cognitive change in symptom change, irrespective of how it is attained, as well as supporting the idea that dysfunctional thoughts are simply another symptom that changes subsequent to treatment.

  • 153.
    Cuijpers, P.
    et al.
    Vrije University of Amsterdam, Netherlands; EMGO Institute Health and Care Research, Netherlands.
    Karyotaki, E.
    Vrije University of Amsterdam, Netherlands; EMGO Institute Health and Care Research, Netherlands.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden.
    Li, J.
    Chinese Academic Science, Peoples R China.
    Mergl, R.
    University of Leipzig, Germany.
    Hegerl, U.
    University of Leipzig, Germany.
    The effects of blinding on the outcomes of psychotherapy and pharmacotherapy for adult depression: A meta-analysis2015In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 30, no 6, p. 685-693Article, review/survey (Refereed)
    Abstract [en]

    Background: Randomized trials with antidepressants are often run under double blind placebo-controlled conditions, whereas those with psychotherapies are mostly unblinded. This can introduce bias in favor of psychotherapy when the treatments are directly compared. In this meta-analysis, we examine this potential source of bias. Methods: We searched Pubmed, PsycInfo, Embase and the Cochrane database (1966 to January 2014) by combining terms indicative of psychological treatment and depression, and limited to randomized trials. We included 35 trials (with 3721 patients) in which psychotherapy and pharmacotherapy for adult depression were directly compared with each other. We calculated effect sizes for each study indicating the difference between psychotherapy and pharmacotherapy at post-test. Then, we examined the difference between studies with a placebo condition and those without in moderator analyses. Results: We did not find a significant difference between the studies with and those without a placebo condition. The studies in which a placebo condition was included indicated no significant difference between psychotherapy and pharmacotherapy (g = -0.07; NNT = 25). Studies in which no placebo condition was included (and patients and clinicians in both conditions were not blinded), resulted in a small, but significant difference between psychotherapy and pharmacotherapy in favor of pharmacotherapy (g = -0.13; NNT = 14). Conclusions: Studies comparing psychotherapy and pharmacotherapy in which both groups of patients (and therapists) are not blinded (no placebo condition is included) result in a very small, but significantly higher effect for pharmacotherapy. (C) 2015 Elsevier Masson SAS. All rights reserved.

  • 154.
    Cuijpers, P.
    et al.
    Vrije University of Amsterdam, Netherlands EMGO Institute Health and Care Research, Netherlands .
    Turner, E.H.
    Portland VA Medical Centre, OR USA Oregon Health and Science University, OR 97201 USA Oregon Health and Science University, OR 97201 USA .
    C. Mohr, D.
    Northwestern University, IL 60611 USA .
    Hofmann, S.G.
    Boston University, MA 02215 USA .
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Berking, M.
    University of Marburg, Germany .
    Coyne, J.
    University of Groningen, Netherlands .
    Comparison of psychotherapies for adult depression to pill placebo control groups: a meta-analysis2014In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 44, no 4, p. 685-695Article, review/survey (Refereed)
    Abstract [en]

    Background The effects of antidepressants for treating depressive disorders have been overestimated because of selective publication of positive trials. Reanalyses that include unpublished trials have yielded reduced effect sizes. This in turn has led to claims that antidepressants have clinically insignificant advantages over placebo and that psychotherapy is therefore a better alternative. To test this, we conducted a meta-analysis of studies comparing psychotherapy with pill placebo. Method Ten 10 studies comparing psychotherapies with pill placebo were identified. In total, 1240 patients were included in these studies. For each study, Hedges g was calculated. Characteristics of the studies were extracted for subgroup and meta-regression analyses. Results The effect of psychotherapy compared to pill placebo at post-test was g=0.25 [95% confidence interval (CI) 0.14-0.36, I (2)=0%, 95% CI 0-58]. This effect size corresponds to a number needed to treat (NNT) of 7.14 (95% CI 5.00-12.82). The psychotherapy conditions scored 2.66 points lower on the Hamilton Depression Rating Scale (HAMD) than the placebo conditions, and 3.20 points lower on the Beck Depression Inventory (BDI). Some indications for publication bias were found (two missing studies). We found no significant differences between subgroups of the studies and in meta-regression analyses we found no significant association between baseline severity and effect size. Conclusions Although there are differences between the role of placebo in psychotherapy and pharmacotherapy research, psychotherapy has an effect size that is comparable to that of antidepressant medications. Whether these effects should be deemed clinically relevant remains open to debate.

  • 155.
    Cuijpers, Pim
    et al.
    Vrije University of Amsterdam, Netherlands .
    Berking, Matthias
    Leuphana University, Germany .
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Quigley, Leanne
    University of Calgary, Canada .
    Kleiboer, Annet
    Vrije University of Amsterdam, Netherlands .
    Dobson, Keith S.
    University of Calgary, Canada .
    A Meta-Analysis of Cognitive-Behavioural Therapy for Adult Depression, Alone and in Comparison With Other Treatments2013In: Canadian journal of psychiatry, ISSN 0706-7437, Vol. 58, no 7, p. 376-385Article, review/survey (Refereed)
    Abstract [en]

    Objective: No recent meta-analysis has examined the effects of cognitive-behavioural therapy (CBT) for adult depression. We decided to conduct such an updated meta-analysis. less thanbrgreater than less thanbrgreater thanMethods: Studies were identified through systematic searches in bibliographical databases (PubMed, PsycINFO, Embase, and the Cochrane library). We included studies examining the effects of CBT, compared with control groups, other psychotherapies, and pharmacotherapy. less thanbrgreater than less thanbrgreater thanResults: A total of 115 studies met inclusion criteria. The mean effect size (ES) of 94 comparisons from 75 studies of CBT and control groups was Hedges g = 0.71 (95% CI 0.62 to 0.79), which corresponds with a number needed to treat of 2.6. However, this may be an overestimation of the true ES as we found strong indications for publication bias (ES after adjustment for bias was g = 0.53), and because the ES of higher-quality studies was significantly lower (g = 0.53) than for lower-quality studies (g = 0.90). The difference between high-and low-quality studies remained significant after adjustment for other study characteristics in a multivariate meta-regression analysis. We did not find any indication that CBT was more or less effective than other psychotherapies or pharmacotherapy. Combined treatment was significantly more effective than pharmacotherapy alone (g = 0.49). less thanbrgreater than less thanbrgreater thanConclusions: There is no doubt that CBT is an effective treatment for adult depression, although the effects may have been overestimated until now. CBT is also the most studied psychotherapy for depression, and thus has the greatest weight of evidence. However, other treatments approach its overall efficacy.

  • 156.
    Cuijpers, Pim
    et al.
    VU University Amsterdam, The Netherlands.
    de Beurs, Derek P.
    VU University Amsterdam, The Netherlands.
    van Spijker, Bregje A. J.
    VU University Amsterdam, The Netherlands.
    Berking, Matthias
    Philipps-University Marburg, Germany.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Kerkhof, Ad J. F. M.
    VU University Amsterdam, The Netherlands.
    The effects of psychotherapy for adult depression on suicidality and hopelessness: a systematic review and meta-analysis2013In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 144, no 3, p. 183-190Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Although treatment guidelines suggest that suicidal patients with depression should be treated for depression with psychotherapy, it is not clear whether these psychological treatments actually reduce suicidal ideation or suicide risk.

    METHODS: We conducted a systematic review and meta-analysis of studies on psychotherapy for depression in which outcomes on suicidality were reported. We also focused on outcomes on hopelessness because this is strongly associated with suicidal behavior in depression.

    RESULTS: Thirteen studies (with 616 patients) were included, three of which examined the effects of psychotherapy for depression on suicidal ideation and suicide risk, and eleven on hopelessness. No studies were found with suicide attempts or completed suicides as the outcome variables. The effects on suicidal ideation and suicide risk were small (g=0.12; 95% CI: -0.20-0.44) and not statistically significant. A power calculation showed that these studies only had sufficient power to find an effect size of g=0.47. The effects on hopelessness were large (g=1.10; 95% CI: 0.72-1.48) and significant, although heterogeneity was very high. Furthermore, significant publication bias was found. After adjustment of publication bias the effect size was reduced to g=0.60.

    DISCUSSION: At this point, there is insufficient evidence for the assumption that suicidality in depressed patients can be reduced with psychotherapy for depression. Although psychotherapy of depression may have small positive effects on suicidality, available data suggest that psychotherapy for depression cannot be considered to be a sufficient treatment. The effects on hopelessness are probably higher.

  • 157.
    Cuijpers, Pim
    et al.
    Linköping University, Faculty of Arts and Sciences. Vrije University of Amsterdam, Netherlands; EMGO Institute Health and Care Research, Netherlands; Karolinska Institute, Sweden.
    De Wit, Leonore
    Vrije University of Amsterdam, Netherlands; EMGO Institute Health and Care Research, Netherlands.
    Weitz, Erica
    Vrije University of Amsterdam, Netherlands; EMGO Institute Health and Care Research, Netherlands.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden.
    Huibers, Marcus J. H.
    Vrije University of Amsterdam, Netherlands; EMGO Institute Health and Care Research, Netherlands.
    THE COMBINATION OF PSYCHOTHERAPY AND PHARMACOTHERAPY IN THE TREATMENT OF ADULT DEPRESSION: A COMPREHENSIVE META-ANALYSIS2015In: JOURNAL OF EVIDENCE-BASED PSYCHOTHERAPIES, ISSN 2360-0853, Vol. 15, no 2, p. 147-168Article in journal (Refereed)
    Abstract [en]

    No meta-analysis in the field of depression has examined the effects of combined treatment compared with pill placebo, nor has any meta-analysis integrated the comparison of combined treatment against pharmacotherapy alone and psychotherapy alone (i.e., mono treatments). In this comprehensive meta-analysis, we found that combined treatment had a moderate effect on depression compared with pill placebo (g=0.46), and small to moderate effects compared against pharmacotherapy (g=0.38) alone, psychotherapy (g=0.34) alone, and psychotherapy plus placebo (g=0.23). There were some indications for publication bias when combined therapy was compared against placebo (adjusted effect size g=0.31). In multivariate metaregression analyses we found no significant differential predictors for the four comparisons. There were some indications that the use of interpersonal psychotherapy in the combined treatment was associated with a smaller effect size, but this has to be considered with caution, because of the correlational nature of this association. Despite limitations (small number of studies; suboptimal quality of studies) this meta-analysis suggests that combined treatment of depression may be the best treatment available for adult depression, and that it is significantly more effective than placebo, pharmacotherapy alone, psychotherapy alone and the combination of psychotherapy and placebo.

  • 158.
    Cuijpers, Pim
    et al.
    VU University Amsterdam, The Netherlands.
    Driessen, Ellen
    VU University Amsterdam, The Netherlands.
    Hollon, Steven D
    Vanderbilt University, Nashville, USA.
    van Oppen, Patricia
    EMGO Institute for Health and Care Research, The Netherlands.
    Barth, Jürgen
    University of Bern, Switzerland.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    The efficacy of non-directive supportive therapy for adult depression: A meta-analysis2012In: Clinical Psychology Review, ISSN 0272-7358, E-ISSN 1873-7811, Vol. 32, no 4, p. 280-291Article in journal (Refereed)
    Abstract [en]

    The effects of non-directive supportive therapy (NDST) for adult depression have been examined in a considerable number of studies, but no meta-analysis of these studies has been conducted. We selected 31 studies on NDST from a comprehensive database of trials, examining psychotherapies for adult depression, and conducted meta-analyses in which NDST was compared with control groups, other psychotherapies and pharmacotherapy. We found that NDST is effective in the treatment of depression in adults (g=0.58; 95% CI: 0.45-0.72). NDST was less effective than other psychological treatments (differential effect size g=-0.20; 95% CI: -0.32 to -0.08, p<0.01), but these differences were no longer present after controlling for researcher allegiance. We estimated that extra-therapeutic factors (those processes operating in waiting-list and care-as-usual controls) were responsible for 33.3% of the overall improvement, non-specific factors (the effects of NDST compared with control groups) for 49.6%, and specific factors (the effects of NDST compared with other therapies) for 17.1%. NDST has a considerable effect on symptoms of depression. Most of the effect of therapy for adult depression is realized by non-specific factors, and our results suggest that the contribution of specific effects is limited at best.

  • 159.
    Cuijpers, Pim
    et al.
    Vrije University of Amsterdam, Netherlands; Innovat Incubator, NY USA.
    Ebert, David D.
    Innovat Incubator, NY USA; Friedrich Alexander University of Erlangen Nuremberg, Germany.
    Acarturk, Ceren
    Istanbul Sehir University, Turkey.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden.
    Cristea, Ioana A.
    University of Babes Bolyai, Romania; University of Pisa, Italy.
    Personalized Psychotherapy for Adult Depression: A Meta-Analytic Review2016In: BEHAVIOR THERAPY, ISSN 0005-7894, Vol. 47, no 6, p. 966-980Article, review/survey (Refereed)
    Abstract [en]

    Personalized medicine is aimed at identifying which characteristics of an individual predict the outcome of a specific treatment, in order to get a better match between the individual and the treatment received. We conducted a systematic review and meta-analysis of randomized trials comparing two psychotherapies directly in a group of depressed patients with a specific characteristic. We focused on the six most examined types of psychotherapy for adult depression. Our searches resulted in 41 studies with 2,741 patients who met inclusion criteria. These 41 studies examined 27 specific characteristics of patients. Power calculations indicated that we would need 4 studies for each characteristic to find a clinically relevant effect size set at g = 0.50 and 16 studies for an effect size of 0.24. Only 3 patient characteristics were found to have sufficient power and to significantly moderate treatment outcomes. Cognitive-behavioral therapy was found to be more effective than other therapies in older adults (g= 0.29), in patients with comorbid addictive disorders (g = 0.31), and in university students (g = 0.46). Risk of bias was considerable in most of the included studies. It was estimated that it will take another 326 years to have sufficient statistical power for showing an effect size of g = 0.50 of the 27 characteristics, and 1,372 years to show an effect size of 0.24. Although several dozens of studies have compared the effects of psychotherapies in specific target groups, we will need to develop more powerful alternatives to comparative outcome studies in order to identify personalized treatments for depression.

  • 160.
    Cuijpers, Pim
    et al.
    Vrije University of Amsterdam, Netherlands EMGO Institute Health and Care Research, Netherlands .
    Hollon, Steven D.
    Vanderbilt University, TN 37235 USA .
    van Straten, Annemieke
    Vrije University of Amsterdam, Netherlands EMGO Institute Health and Care Research, Netherlands .
    Bockting, Claudi
    University of Groningen, Netherlands .
    Berking, Matthias
    University of Marburg, Germany .
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Does cognitive behaviour therapy have an enduring effect that is superior to keeping patients on continuation pharmacotherapy? A meta-analysis2013In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 3, no 4, p. 2542-Article in journal (Refereed)
    Abstract [en]

    Objectives Although cognitive behaviour therapy (CBT) and pharmacotherapy are equally effective in the acute treatment of adult depression, it is not known how they compare across the longer term. In this meta-analysis, we compared the effects of acute phase CBT without any subsequent treatment with the effects of pharmacotherapy that either were continued or discontinued across 6-18 months of follow-up. Design We conducted systematic searches in bibliographical databases to identify relevant studies, and conducted a meta-analysis of studies meeting inclusion criteria. Setting Mental healthcare. Participants Patients with depressive disorders. Interventions CBT and pharmacotherapy for depression. Outcome measures Relapse rates at long-term follow-up. Results 9 studies with 506 patients were included. The quality was relatively high. Short-term outcomes of CBT and pharmacotherapy were comparable, although drop out from treatment was significantly lower in CBT. Acute phase CBT was compared with pharmacotherapy discontinuation during follow-up in eight studies. Patients who received acute phase CBT were significantly less likely to relapse than patients who were withdrawn from pharmacotherapy (OR=2.61, 95% CI 1.58 to 4.31, pless than0.001; numbers-needed-to-be-treated, NNT=5). The acute phase CBT was compared with continued pharmacotherapy at follow-up in five studies. There was no significant difference between acute phase CBT and continued pharmacotherapy, although there was a trend (pless than0.1) indicating that patients who received acute phase CBT may be less likely to relapse following acute treatment termination than patients who were continued on pharmacotherapy (OR=1.62, 95% CI 0.97 to 2.72; NNT=10). Conclusions We found that CBT has an enduring effect following termination of the acute treatment. We found no significant difference in relapse after the acute phase CBT versus continuation of pharmacotherapy after remission. Given the small number of studies, this finding should be interpreted with caution pending replication.

  • 161.
    Cuijpers, Pim
    et al.
    Vrije University of Amsterdam, Netherlands .
    Huibers, Marcus
    Vrije University of Amsterdam, Netherlands .
    Daniel Ebert, David
    Leuphana University, Germany .
    Koole, Sander L.
    Vrije University of Amsterdam, Netherlands .
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    How much psychotherapy is needed to treat depression? A metaregression analysis2013In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 149, no 1-3, p. 1-13Article, review/survey (Refereed)
    Abstract [en]

    Background: Although psychotherapies are effective in the treatment of adult depression it is not clear how this treatment effect is related to amount, frequency and intensity of therapy. less thanbrgreater than less thanbrgreater thanMethods: To fill this gap in knowledge, the present metaregression analysis examined the association between the effects of psychotherapy for adult depression and several indicators of amount, frequency and intensity of therapy. The analysis included 70 studies (92 comparisons) with 5403 patients, in which individual psychotherapy was compared with a control group (e.g. waiting list, care-as-usual). less thanbrgreater than less thanbrgreater thanResults: There was only a small association between number of therapy sessions and effect size, and this association was no longer significant when the analysis adjusted for other characteristics of the studies. The multivariable analyses also found no significant association with the total contact time or duration of the therapy. However, there was a strong association between number of sessions per week and effect size. An increase from one to two sessions per week increased the effect size with g=0.45, while keeping the total number of treatment sessions constant. less thanbrgreater than less thanbrgreater thanDiscussion: More research is needed to establish the robustness of this finding. Based on these findings, it may be advisable to concentrate psychotherapy sessions within a brief time frame.

  • 162.
    Cuijpers, Pim
    et al.
    Vrije University of Amsterdam, Netherlands Vrije University of Amsterdam, Netherlands Vrije University of Amsterdam, Netherlands Leuphana University, Germany .
    Karyotaki, Eirini
    Vrije University of Amsterdam, Netherlands Vrije University of Amsterdam, Netherlands Vrije University of Amsterdam, Netherlands .
    Weitz, Erica
    Vrije University of Amsterdam, Netherlands Vrije University of Amsterdam, Netherlands Vrije University of Amsterdam, Netherlands .
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Hollon, Steven D.
    Vanderbilt University, TN 37235 USA .
    van Straten, Annemieke
    Vrije University of Amsterdam, Netherlands Vrije University of Amsterdam, Netherlands Vrije University of Amsterdam, Netherlands .
    The effects of psychotherapies for major depression in adults on remission, recovery and improvement: A meta-analysis2014In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 159, p. 118-126Article, review/survey (Refereed)
    Abstract [en]

    Background: Standardised effect sizes have been criticized because they are difficult to interpret and offer little clinical information. This meta-analyses examine the extent of actual improvement, the absolute numbers of patients no longer meeting criteria for major depression, and absolute rates of response and remission. Methods: We conducted a meta-analysis of 92 studies with 181 conditions (134 psychotherapy and 47 control conditions) with 6937 patients meeting criteria for major depressive disorder. Within these conditions, we calculated the absolute number of patients no longer meeting criteria for major depression, rates of response and remission, and the absolute reduction on the BDI, BDI-II and HAM-D. Results: After treatment, 62% of patients no longer met criteria for MDD in the psychotherapy conditions. However, 43% of participants in the control conditions and 48% of people in the care-as-usual conditions no longer met criteria for MDD, suggesting that the additional value of psychotherapy compared to care-as-usual would be 14%. For response and remission, comparable results were found, with less than half of the patients meeting criteria for response and remission after psychotherapy. Additionally, a considerable proportion of response and remission was also found in control conditions. In the psychotherapy conditions, scores on the BDl were reduced by 13.42 points, 15.12 points on the BDI-II, and 10.28 points on the HAM-D. In the control conditions, these reductions were 4.56, 4.68, and 5.29. Discussion: Psychotherapy contributes to improvement in depressed patients, but improvement in control conditions is also considerable.

  • 163.
    Cuijpers, Pim
    et al.
    Vrije University, Amsterdam, the Netherlands.
    Reynolds, Charles F.
    University of Pittsburgh School of Medicine, Pennsylvania, USA.
    Donker, Tara
    Vrije University, Amsterdam, the Netherlands.
    Li, Juan
    Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Beekman, Aartjan
    Vrije University Medical Center Amsterdam, The Netherlands.
    Personalized treatment of adult depression: medication, psychotherapy, or both? A systematic review2012In: Depression and anxiety (Print), ISSN 1091-4269, E-ISSN 1520-6394, Vol. 29, no 10, p. 855-864Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Personalized medicine aims to identify which characteristics of an individual predict the outcome of a specific treatment, in order to get a better match between the individual and the treatment received. We conducted a systematic review and meta-analysis of randomized trials comparing two treatments directly in a group of patients with a specific characteristic.

    METHODS: We searched relevant studies from bibliographical databases and included trials comparing (1) medication with psychotherapy, (2) medication with combined treatment, and (3) psychotherapy with combined treatment, in specific target groups (a) with a predefined sociodemographic characteristic, (b) a specific type of depression, (c) a comorbid mental or somatic disorder, or (d) from a specific setting (outpatients, primary care).

    RESULTS: We included 52 studies with 4,734 depressed patients. In these studies, 20 characteristics of the target groups were examined. The results showed that medication is probably the best treatment for dysthymia, and combined treatments are more effective in depressed outpatients, as well as in depressed older adults. However, in order to examine the 20 characteristics in the three categories of comparisons, 254 studies would be needed for having sufficient statistical power to show an effect size of g = 0.5. Currently, only 20.1% of these studies have been conducted.

    CONCLUSIONS: Although a considerable number of studies have compared medication, psychotherapy, and combined treatments, and some preliminary results are useful for deciding which treatment is best for which patient, the development of personalized treatment of depression has only just begun.

  • 164.
    Cuijpers, Pim
    et al.
    VU University Amsterdam, The Netherlands.
    Sijbrandij, Marit
    VU University Amsterdam, The Netherlands.
    Koole, Sander
    VU University Amsterdam, The Netherlands.
    Huibers, Marcus
    VU University Amsterdam, The Netherlands.
    Berking, Matthias
    Leuphana University, Lueneburg, Germany.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institutet, Stockholm, Sweden.
    Psychological treatment of generalized anxiety disorder: A meta-analysis2014In: Clinical Psychology Review, ISSN 0272-7358, E-ISSN 1873-7811, Vol. 34, no 2, p. 130-140Article in journal (Refereed)
    Abstract [en]

    Recent years have seen a near-doubling of the number of studies examining the effects of psychotherapies for generalized anxiety disorder (GAD) in adults. The present article integrates this new evidence with the older literature through a quantitative meta-analysis. A total of 41 studies (with 2132 patients meeting diagnostic criteria for GAD) were identified through systematic searches in bibliographical databases, and were included in the meta-analysis. Most studies examined the effects of cognitive behavior therapy (CBT). The majority of studies used waiting lists as control condition. The pooled effect of the 38 comparisons (from 28 studies) of psychotherapy versus a control group was large (g=0.84; 95% CI: 0.71-0.97) with low to moderate heterogeneity. The effects based on self-report measures were somewhat lower than those based on clinician-rated instruments. The effects on depression were also large (g=0.71; 95% CI: 0.59-0.82). There were some indications for publication bias. The number of studies comparing CBT with other psychotherapies (e.g., applied relaxation) or pharmacotherapy was too small to draw conclusions about comparative effectiveness or the long-term effects. There were some indications that CBT was also effective at follow-up and that CBT was more effective than applied relaxation in the longer term.

  • 165.
    Cuijpers, Pim
    et al.
    VU University and VU University Medical Center Amsterdam, The Netherlands.
    Sijbrandij, Marit
    VU University and VU University Medical Center Amsterdam, The Netherlands.
    Koole, Sander L
    VU University and VU University Medical Center Amsterdam, The Netherlands.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institutet, Stockholm, Sweden.
    Beekman, Aartjan T
    VU University and VU University Medical Center Amsterdam, The Netherlands.
    Reynolds, Charles F
    University of Pittsburgh School of Medicine, PA, USA.
    Adding psychotherapy to antidepressant medication in depression and anxiety disorders: a meta-analysis2014In: World Psychiatry, ISSN 1723-8617, E-ISSN 2051-5545, Vol. 13, no 1, p. 56-67Article in journal (Refereed)
    Abstract [en]

    We conducted a meta-analysis of randomized trials in which the effects of treatment with antidepressant medication were compared to the effects of combined pharmacotherapy and psychotherapy in adults with a diagnosed depressive or anxiety disorder. A total of 52 studies (with 3,623 patients) met inclusion criteria, 32 on depressive disorders and 21 on anxiety disorders (one on both depressive and anxiety disorders). The overall difference between pharmacotherapy and combined treatment was Hedges' g = 0.43 (95% CI: 0.31-0.56), indicating a moderately large effect and clinically meaningful difference in favor of combined treatment, which corresponds to a number needed to treat (NNT) of 4.20. There was sufficient evidence that combined treatment is superior for major depression, panic disorder, and obsessive-compulsive disorder (OCD). The effects of combined treatment compared with placebo only were about twice as large as those of pharmacotherapy compared with placebo only, underscoring the clinical advantage of combined treatment. The results also suggest that the effects of pharmacotherapy and those of psychotherapy are largely independent from each other, with both contributing about equally to the effects of combined treatment. We conclude that combined treatment appears to be more effective than treatment with antidepressant medication alone in major depression, panic disorder, and OCD. These effects remain strong and significant up to two years after treatment. Monotherapy with psychotropic medication may not constitute optimal care for common mental disorders.

  • 166.
    Cuijpers, Pim
    et al.
    Vrije University of Amsterdam, Netherlands Vrije University of Amsterdam, Netherlands Vrije University of Amsterdam Medical Centre, Netherlands Leuphana University, Germany .
    Sijbrandij, Marit
    Vrije University of Amsterdam, Netherlands Vrije University of Amsterdam, Netherlands Vrije University of Amsterdam Medical Centre, Netherlands .
    Koole, Sander L.
    Vrije University of Amsterdam, Netherlands Vrije University of Amsterdam, Netherlands Vrije University of Amsterdam Medical Centre, Netherlands .
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Beekman, Aartjan T.
    Vrije University of Amsterdam, Netherlands Vrije University of Amsterdam Medical Centre, Netherlands Vrije University of Amsterdam Medical Centre, Netherlands .
    Reynolds, Charles F.
    University of Pittsburgh, PA USA .
    The efficacy of psychotherapy and pharmacotherapy in treating depressive and anxiety disorders: a meta-analysis of direct comparisons2013In: World Psychiatry, ISSN 1723-8617, E-ISSN 2051-5545, Vol. 12, no 2, p. 137-148Article in journal (Refereed)
    Abstract [en]

    Although psychotherapy and antidepressant medication are efficacious in the treatment of depressive and anxiety disorders, it is not known whether they are equally efficacious for all types of disorders, and whether all types of psychotherapy and antidepressants are equally efficacious for each disorder. We conducted a meta-analysis of studies in which psychotherapy and antidepressant medication were directly compared in the treatment of depressive and anxiety disorders. Systematic searches in bibliographical databases resulted in 67 randomized trials, including 5,993 patients that met inclusion criteria, 40 studies focusing on depressive disorders and 27 focusing on anxiety disorders. The overall effect size indicating the difference between psychotherapy and pharmacotherapy after treatment in all disorders was g=0.02 (95% CI: -0.07 to 0.10), which was not statistically significant. Pharmacotherapy was significantly more efficacious than psychotherapy in dysthymia (g=0.30), and psychotherapy was significantly more efficacious than pharmacotherapy in obsessive-compulsive disorder (g=0.64). Furthermore, pharmacotherapy was significantly more efficacious than non-directive counseling (g=0.33), and psychotherapy was significantly more efficacious than pharmacotherapy with tricyclic antidepressants (g=0.21). These results remained significant when we controlled for other characteristics of the studies in multivariate meta-regression analysis, except for the differential effects in dysthymia, which were no longer statistically significant.

  • 167.
    Cuijpers, Pim
    et al.
    Vrije Univ Amsterdam, NL-1081 BT Amsterdam, Netherlands Leuphana Univ, Luneburg, Germany.
    Weitz, Erica
    Vrije Univ Amsterdam, NL-1081 BT Amsterdam, Netherlands..
    Karyotaki, Eirini
    Vrije Univ Amsterdam, NL-1081 BT Amsterdam, Netherlands.
    Garber, Judy
    Vanderbilt Univ, Dept Psychol & Human Dev, Nashville, TN 37235 USA.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research. Karolinska Inst, Psychiat Sect, Dept Clin Neurosci, Stockholm, Sweden.
    The effects of psychological treatment of maternal depression on children and parental functioning: a meta-analysis.2015In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 24, no 2, p. 237-245Article in journal (Refereed)
    Abstract [en]

    Successful treatment of parental depression may have a positive effect on the functioning and psychopathology of their children. We conducted a meta-analysis to examine the effects of psychotherapy for depressed mothers on their children and parental functioning. We used a database of randomized controlled trials examining the effects of psychotherapy for adult depression and selected trials comparing psychotherapy and control conditions in depressed mothers and reporting outcomes in their children and parental functioning. Nine studies were included. The quality of these studies was not optimal and the outcome instruments differed considerably from each other. The therapies resulted in significantly decreased levels of depression (g = 0.66) in the mothers. In the seven studies that reported outcomes on the mental health of children, a significant effect size was also found (g = 0.40). The eight studies examining mother-child interactions resulted in a significant effect size of g = 0.35, and the five studies examining parenting/marital distress had a pooled effect size of g = 0.67. We found that psychotherapy leads to decreased levels of depression in depressed mothers and also found indications that psychotherapy may have a positive effect on the mental health of their children and parenting/marital distress. However, more high-quality research is needed before a definite answer can be given.

  • 168.
    Dagöö, Jesper
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Persson Asplund, Robert
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Andersson Bsenko, Helene
    Umeå University, Sweden .
    Hjerling, Sofia
    Uppsala University, Sweden .
    Holmberg, Anna
    Mid Sweden University, Sweden .
    Westh, Susanne
    Mid Sweden University, Sweden .
    Oberg, Louise
    Lund University, Sweden .
    Ljotsson, Brjann
    Karolinska Institute, Sweden .
    Carlbring, Per
    Stockholm University, Sweden .
    Furmark, Tomas
    Uppsala University, Sweden .
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Cognitive behavior therapy versus interpersonal psychotherapy for social anxiety disorder delivered via smartphone and computer: A randomized controlled trial2014In: Journal of Anxiety Disorders, ISSN 0887-6185, E-ISSN 1873-7897, Vol. 28, no 4, p. 410-417Article in journal (Refereed)
    Abstract [en]

    In this study, a previously evaluated guided Internet-based cognitive behavior therapy for social anxiety disorder (SAD) was adapted for mobile phone administration (mCBT). The treatment was compared with a guided self-help treatment based on interpersonal psychotherapy (mIPT). The treatment platform could be accessed through smartphones, tablet computers, and standard computers. A total of 52 participants were diagnosed with SAD and randomized to either mCBT (n = 27) or mIPT (n = 25). Measures were collected at pre-treatment, during the treatment, post-treatment and 3-month follow-up. On the primary outcome measure, the Liebowitz Social Anxiety Scale - self-rated, both groups showed statistically significant improvements. However, mCBT performed significantly better than mIPT (between group Cohens d = 0.64 in favor of mCBT). A larger proportion of the mCBT group was classified as responders at post-treatment (55.6% versus 8.0% in the mIPT group). We conclude that CBT for SAD can be delivered using modern information technology. IPT delivered as a guided self-help treatment may be less effective in this format.

  • 169.
    Dahlbäck, Nils
    et al.
    Linköping University, Department of Computer and Information Science, Human-Centered systems. Linköping University, Faculty of Arts and Sciences.
    Skagerlund, Kenny
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Culture, Cognitive Systems and Extended Mind – Embedding the Extended Mind within Activity Theory2011Conference paper (Other academic)
  • 170.
    Dahlin, Mats
    et al.
    Psykologpartners, Private Practice, Linköping, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden.
    Magnusson, Kristoffer
    Karolinska Institute, Sweden.
    Johansson, Tomas
    Umeå University, Sweden.
    Sjögren, Johan
    Umeå University, Sweden.
    Håkansson, Andreas
    Umeå University, Sweden.
    Pettersson, Magnus
    Umeå University, Sweden.
    Kadowaki, Åsa
    Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Psychiatry.
    Cuijpers, Pim
    Vrije University of Amsterdam, Netherlands; EMGO Institute Health and Care Research, Netherlands.
    Carlbring, Per
    Stockholm University, Sweden.
    Internet-delivered acceptance-based behaviour therapy for generalized anxiety disorder: A randomized controlled trial2016In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 77, p. 86-95Article in journal (Refereed)
    Abstract [en]

    Generalized anxiety disorder (GAD) is a disabling condition which can be treated with cognitive behaviour therapy (CBT). The present study tested the effects of therapist-guided internet-delivered acceptance-based behaviour therapy on symptoms of GAD and quality of life. An audio CD with acceptance and mindfulness exercises and a separate workbook were also included in the treatment. Participants diagnosed with GAD (N = 103) were randomly allocated to immediate therapist-guided internet-delivered acceptance-based behaviour therapy or to a waiting-list control condition. A six month follow-up was also included. Results using hierarchical linear modelling showed moderate to large effects on symptoms of GAD (Cohens d = 0.70 to 0.98), moderate effects on depressive symptoms (Cohens d = 0.51 to 0.56), and no effect on quality of life. Follow-up data showed maintained effects. While there was a 20% dropout rate, sensitivity analyses showed that dropouts did not differ in their degree of change during treatment. To conclude, our study suggests that internet-delivered acceptance based behaviour therapy can be effective in reducing the symptoms of GAD. (C) 2015 Elsevier Ltd. All rights reserved.

  • 171.
    Dahlin, Mats
    et al.
    Psykologpartners, Private practice, Linköping, Sweden.
    Ryberg, Marielle
    Psykologpartners, Private practice, Linköping, Sweden.
    Vernmark, Kristofer
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Psykologpartners, Private practice, Linköping, Sweden.
    Annas, Nina
    Psykiatripartners, Private practice, Linköping, Sweden.
    Carlbring, Per
    Division of Clinical Psychology, Department of Psychology, Stockholm University, Stockholm, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institute, Stockholm, Sweden.
    Internet-delivered acceptance-based behavior therapy for generalized anxiety disorder: A pilot study2016In: Internet Interventions, ISSN 2214-7829, Vol. 6, p. 16-21Article in journal (Refereed)
    Abstract [en]

    Objective

    Internet-delivered cognitive behavior therapy (ICBT) has been developed and tested for treating persons with generalized anxiety disorder (GAD). A new form of CBT focuses on acceptance (of internal experiences or difficult psychological content), mindfulness and valued actions. To date this form of CBT has not been delivered via the internet for persons with GAD. The aim of this study was to describe the functionality of a new internet-delivered acceptance-based behavior therapy for GAD, and to test the effect of the intervention in an open pilot trial.

    Methods

    Following exclusion of two patients we included 14 patients diagnosed with GAD from two primary care clinics. At 2–3 months follow-up after treatment 10 patients completed the outcome measures. The treatment lasted for an average of 15 weeks and consisted of acceptance-based techniques, behavior therapy components and homework assignments.

    Results

    A majority of participants completed all modules during the treatment. Findings on the Penn State Worry Questionnaire showed a within-group improvement of Cohen's d = 2.14 at posttreatment. At the follow-up results were maintained. Client satisfaction ratings were high.

    Conclusions

    We conclude that internet-delivered acceptance-based behavior therapy potentially can be a promising new treatment for GAD. A controlled trial of the program has already been completed.

  • 172.
    Dahlström, Örjan
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research.
    Sjöwall, Christopher
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Rheumatology.
    The diagnostic accuracies of the 2012 SLICC criteria and the proposed EULAR/ACR criteria for systemic lupus erythematosus classification are comparable2019In: Lupus, ISSN 0961-2033, E-ISSN 1477-0962, Vol. 28, no 6, p. 778-782Article in journal (Refereed)
    Abstract [en]

    In a joint effort, the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR) recently proposed new criteria for the classification of systemic lupus erythematosus (SLE) with the overarching goal to identify potential participants for clinical studies. Herein, we present the first independent evaluation of these criteria in comparison with older classification grounds using an adult Scandinavian study population of confirmed SLE cases and individuals with SLE-mimicking conditions. We included 56 confirmed SLE cases meeting the 1982 ACR criteria (ACR-82) and/or the Fries diagnostic principle (antinuclear antibodies on at least one occasion plus involvement of at least two defined organ systems) and 55 controls with possible systemic autoimmune disease, including the presence of any SLE-related autoantibody. The proposed EULAR/ACR criteria showed a diagnostic sensitivity of 93% (95% confidence interval (CI), 0.83-0.98) compared with 83% (95% CI, 0.72-0.91) for the updated ACR criteria from 1997. The diagnostic accuracy of all tested classification grounds was fairly similar, achieving approximately 85%. However, the disease specificity of the EULAR/ACR criteria reached only 73% (95% CI, 0.59-0.83), which was comparable with the 2012 Systemic Lupus International Collaborating Clinics (SLICC) criteria, 75% (95% CI, 0.61-0.85), but clearly lower than for ACR-82, 94% (95% CI, 0.83-0.99). In this first independent evaluation of a limited number of cases, we found comparable results with respect to diagnostic sensitivity, specificity and accuracy regarding the SLICC-12 and the proposed EULAR/ACR classification criteria. However, their specificity for SLE appeared to be lower compared with ACR-82.

  • 173.
    Davis, Paul
    et al.
    Univ Umea, Sweden.
    Halvarsson, Anton
    Univ Umea, Sweden.
    Lundstrom, Wictor
    Univ Umea, Sweden.
    Lundqvist, Carolina
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Alpine Ski Coaches and Athletes Perceptions of Factors Influencing Adaptation to Stress in the Classroom and on the Slopes2019In: Frontiers in Psychology, ISSN 1664-1078, E-ISSN 1664-1078, Vol. 10, article id 1641Article in journal (Refereed)
    Abstract [en]

    Research examining the student-athlete experience proposes a number of factors that can be both sources of stress and/or support. The dual career pathway offers a number of potential positive outcomes including psychological, social, and financial benefits; however, challenges including time management, fatigue, and restricted social activities are well documented. In consideration of the multidimensional student-athlete experience and the numerous factors that influence the complexity of potential stress, a mixed methods research study design was used in the study. First, data collected from surveys completed by 173 elite junior alpine skiers were analyzed to identify the degree to which athletes report experiencing stress associated with specific aspects pertaining to training, life, and organizational factors. These factors were then explored through semi-structured interviews with six coaches at the associated national elite sport schools. Taken collectively, athletes reports of psychophysiological training stress on the Multidimensional Training Distress Scale were low. Scores on the college studentathletes life stress scale revealed very low levels of general life stress; although the subscales associated with "performance demand" and "academic requirements" scored marginally higher. Scores on the Organizational Stressor Indicator for Sport Performers indicated low levels of organizational stress. The interviews with coaches elucidated the underlying factors potentially influencing athletes positive adaptations to stress as they reported programming a number of strategies to reduce negative outcomes. Coaches aimed to teach athletes self-awareness and regulation strategies through the use of the training diaries and ongoing communication to promote positive adaptation to stress. A number of coaches also worked with sport psychology consultants to optimize athletes training and study situations. Traditionally, research has noted high levels of stress in student-athletes due to co-occurring demands (school amp; sport); however, the data in the present study suggests that optimizing support mechanisms across domains can promote positive adaptations to potential sources of stress.

  • 174.
    Dear, Blake
    et al.
    Department of Psychology eCentreClinic, Macquarie University, Sydney, Australia.
    Silfvernagel, Kristin
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Fogliati, Vincent
    Department of Psychology eCentreClinic, Macquarie University, Sydney, Australia.
    Internet-delivered cognitive behaviour therapy (ICBT) for older adults with anxiety and depression2016In: Guided internet-based treatments in psychiatry / [ed] Lindefors, N. & Andersson, G., Cham: Springer International Publishing , 2016, p. 219-234Chapter in book (Other academic)
    Abstract [en]

    Anxiety and depression are prevalent among older adults and are associated increased disability, reduced quality of life and poorer physical health. Effective psychological treatments such as cognitive behaviour therapy (CBT) are known to be effective and acceptable for older adults. However, as with younger adults, research indicates relatively few older adults access these treatments in their traditional face-to-face format. However, highlighting the potential of newer internet-delivered CBT (ICBT) approaches for increasing access to treatment, a large proportion of older adults are online and the overall proportion online is only likely to grow over time. Several clinical trials have now been conducted examining ICBT for older adults and the nature and finding of these emerging studies are reviewed in this chapter. Future directions for research focused in this area are also discussed.

  • 175.
    Dedic, Helena
    et al.
    Concordia University, Montreal, Canada.
    Rosenfield, Steven
    Concordia University, Montreal, Canada.
    Jungert, Tomas
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    L’écart entre les sexes dans les études en sciences: Une question de style cognitif et non d’aptitude cognitive [The gender gap in science studies: A question of cognitive style, not cognitive ability]2011In: Pédagogie Collégial, ISSN 0835-8974, Vol. 25, no 1, p. 30-37Article in journal (Refereed)
    Abstract [fr]

    Selon une hypothèse controversée, le nombre inférieurde femmes par rapport à celui des hommes qui décidentde poursuivre des études en sciences, en technologie,en génie et en mathématiques (STGM) serait imputableà un écart entre les sexes dans l’aptitude cognitive(QI). Dans cet article, nous offrons des preuves quecet écart est plutôt lié aux différences dans les stylescognitifs qu’aux aptitudes cognitives. Nous démontronscomment les styles cognitifs influent sur le succès desétudiants et suggérons des méthodes pour que lesprofesseurs utilisent ces résultats afin d’améliorer laréussite des étudiants. Nos conclusions peuvent avoirdes répercussions non seulement sur l’enseignementdes STGM, mais également dans des domaines tels quela psychologie, la méthodologie quantitative (MQ),l’économie et l’éducation.Cet article fait état d’un sous-ensemble de résultatstirés d’une étude (Dedic et collab., 2010) subventionnéepar le Programme d’aide à la recherche sur l’enseignementet l’apprentissage (PAREA) qui examinait plusieursfacteurs (dont la culture, l’aptitude cognitive etle soutien du professeur) pouvant influer sur le choixd’une carrière en STGM. L’étude du PAREA portait surdes étudiants québécois et suédois âgés de 18 ans(n = 9801) qui se dirigeaient vers une carrière dans lesSTGM et qui avaient rempli deux questionnaires enclasse. Ayant suivi les cours de sciences et de mathématiquesappropriés du secondaire, tous les étudiantsquébécois étaient inscrits à un programme de sciencesdu collégial. Pour cette raison, nous affirmons qu’ils« se dirigeaient vers une carrière dans les STGM ». De lamême façon, tous les étudiants suédois étaient inscritsà des cours avancés en mathématiques et en sciences,en préparation d’études universitaires en STGM. L’étudePAREA n’a relevé aucune différence entre les Suédois etles Québécois ni de différences significatives sur le plande l’aptitude cognitive entre les sexes. Toutefois, elle amis en lumière d’importantes différences dans les stylescognitifs entre les sexes. Puisque l’étude n’a pu établiraucune corrélation entre l’aptitude cognitive et le stylecognitif, nous avons conclu que ces deux concepts sontindépendants l’un de l’autre.

  • 176.
    Delisle, Christine
    et al.
    Karolinska Institute, Sweden.
    Sandin, Sven
    Karolinska Institute, Sweden.
    Forsum, Elisabet
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Henriksson, Hanna
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Institute, Sweden.
    Trolle-Lagerros, Ylva
    Karolinska Institute, Sweden.
    Larsson, Christel
    University of Gothenburg, Sweden.
    Maddison, Ralph
    University of Auckland, New Zealand.
    Ortega, Francisco B.
    University of Granada, Spain.
    Ruiz, Jonatan R.
    University of Granada, Spain.
    Silfvernagel, Kristin
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Health and Developmental Care, Center for Public Health.
    Löf, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Karolinska Institute, Sweden.
    A web- and mobile phone-based intervention to prevent obesity in 4-year-olds (MINISTOP): a population-based randomized controlled trial2015In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 15, no 95Article in journal (Refereed)
    Abstract [en]

    Background: Childhood obesity is an increasing health problem globally. Overweight and obesity may be established as early as 2-5 years of age, highlighting the need for evidence-based effective prevention and treatment programs early in life. In adults, mobile phone based interventions for weight management (mHealth) have demonstrated positive effects on body mass, however, their use in child populations has yet to be examined. The aim of this paper is to report the study design and methodology of the MINSTOP (Mobile-based Intervention Intended to Stop Obesity in Preschoolers) trial. Methods/Design: A two-arm, parallel design randomized controlled trial in 300 healthy Swedish 4-year-olds is conducted. After baseline measures, parents are allocated to either an intervention-or control group. The 6-month mHealth intervention consists of a web-based application (the MINSTOP app) to help parents promote healthy eating and physical activity in children. MINISTOP is based on the Social Cognitive Theory and involves the delivery of a comprehensive, personalized program of information and text messages based on existing guidelines for a healthy diet and active lifestyle in pre-school children. Parents also register physical activity and intakes of candy, soft drinks, vegetables as well as fruits of their child and receive feedback through the application. Primary outcomes include body fatness and energy intake, while secondary outcomes are time spent in sedentary, moderate, and vigorous physical activity, physical fitness and intakes of fruits and vegetables, snacks, soft drinks and candy. Food and energy intake (Tool for Energy balance in Children, TECH), body fatness (pediatric option for BodPod), physical activity (Actigraph wGT3x-BT) and physical fitness (the PREFIT battery of five fitness tests) are measured at baseline, after the intervention (six months after baseline) and at follow-up (12 months after baseline). Discussion: This novel study will evaluate the effectiveness of a mHealth program for mitigating gain in body fatness among 4-year-old children. If the intervention proves effective it has great potential to be implemented in child-health care to counteract childhood overweight and obesity.

  • 177.
    Delisle Nyström, Christine
    et al.
    Karolinska Institute, Sweden.
    Sandin, Sven
    Karolinska Institute, Sweden; Icahn School Medical Mt Sinai, NY 10029 USA; Icahn School Medical Mt Sinai, NY 10029 USA.
    Henriksson, Pontus
    University of Granada, Spain.
    Henriksson, Hanna
    University of Granada, Spain.
    Trolle-Lagerros, Ylva
    Karolinska Institute, Sweden; Karolinska University Hospital, Sweden.
    Larsson, Christel
    University of Gothenburg, Sweden.
    Maddison, Ralph
    Deakin University, Australia.
    Ortega, Francisco B.
    University of Granada, Spain.
    Pomeroy, Jeremy
    Marshfield Clin Research Fdn, WI USA.
    Ruiz, Jonatan R.
    University of Granada, Spain.
    Silfvernagel, Kristin
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Business support and Development, Department of Health and Care Development.
    Löf, Marie
    Karolinska Institute, Sweden.
    Mobile-based intervention intended to stop obesity in preschool-aged children: the MINISTOP randomized controlled trial2017In: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 105, no 6, p. 1327-1335Article in journal (Refereed)
    Abstract [en]

    Background: Traditional obesity prevention programs are time-and cost-intensive. Mobile phone technology has been successful in changing behaviors and managing weight; however, to our knowledge, its potential in young children has yet to be examined. Objective: We assessed the effectiveness of a mobile health (mHealth) obesity prevention program on body fat, dietary habits, and physical activity in healthy Swedish children aged 4.5 y. Design: From 2014 to 2015, 315 children were randomly assigned to an intervention or control group. Parents in the intervention group received a 6-mo mHealth program. The primary outcome was fat mass index (FMI), whereas the secondary outcomes were intakes of fruits, vegetables, candy, and sweetened beverages and time spent sedentary and in moderate-to-vigorous physical activity. Composite scores for the primary and secondary outcomes were computed. Results: No statistically significant intervention effect was observed for FMI between the intervention and control group (mean +/- SD: -0.23 +/- 0.56 compared with -0.20 +/- 0.49 kg/m(2)). However, the intervention group increased their mean composite score from baseline to follow-up, whereas the control group did not (+ 0.36 +/- 1.47 compared with -0.06 +/- 1.33 units; P = 0.021). This improvement was more pronounced among the children with an FMI above the median (4.11 kg/m(2)) (P = 0.019). The odds of increasing the composite score for the 6 dietary and physical activity behaviors were 99% higher for the intervention group than the control group (P = 0.008). Conclusions: This mHealth obesity prevention study in preschool-aged children found no difference between the intervention and control group for FMI. However, the intervention group showed a considerably higher postintervention composite score (a secondary outcome) than the control group, especially in children with a higher FMI. Further studies targeting specific obesity classes within preschool-aged children are warranted.

  • 178.
    Dettore, Davide
    et al.
    University of Florence, Italy; Miller Institute Behav and Cognit Psychotherapy, Italy.
    Pozza, Andrea
    Miller Institute Behav and Cognit Psychotherapy, Italy; University of Florence, Italy.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden.
    Efficacy of Technology-delivered Cognitive Behavioural Therapy for OCD Versus Control Conditions, and in Comparison with Therapist-Administered CBT: Meta-Analysis of Randomized Controlled Trials2015In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 44, no 3, p. 190-211Article, review/survey (Refereed)
    Abstract [en]

    Cognitive behavioural therapy (CBT) is a well-established treatment for obsessive-compulsive disorder (OCD). However, few patients receive CBT, due to factors such as geographic limitations, perceived stigmatization, and lack of CBT services. Technology-delivered cognitive behavioural therapy (T-CBT) could be an effective strategy to improve patients access to CBT. To date, a meta-analysis on the effectiveness of T-CBT for OCD has not been conducted. This study used meta-analytic techniques to summarize evidence on the efficacy of T-CBT for OCD versus control conditions and therapist-administered CBT. A meta-analysis according to Prisma guidelines was conducted on randomized controlled trials (RCTs) of T-CBT for OCD. Treatment was classified as T-CBT if evidence-based CBT active ingredients for OCD were included (psychoeducation, ERP, and cognitive restructuring), delivered through health technologies (e.g. self-help books, leaflets, and other forms of bibliotherapy) or remote communication technologies (e.g. the Internet, web-cameras, telephones, telephone-interactive voice response systems, and CD-ROMS). Studies using validated outcomes for OCD or depression were included. Eight trials were included (N=420). Two trials were classified as at high risk of bias. T-CBT seemed to be superior to control conditions on OCD symptom outcomes at post-treatment (d=0.82, 99% CI=0.55-1.08, p=0.001), but not on comorbid depression (d=0.33, 99% CI=-0.01-0.67, p=0.020). Difference in the efficacy on OCD symptoms between T-CBT and therapist-administered CBT was not significant, despite a trend favouring therapist-administered CBT emerged (d=0.45, 95% CI=0.03-0.87, p=0.033). Directions for research are discussed. Further RCTs are warranted to examine the efficacy of T-CBT for OCD.

  • 179.
    Dickert, Stephan
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. WU Vienna University of Econ and Business, Austria.
    Kleber, Janet
    WU Vienna University of Econ and Business, Austria; Alpen Adria University of Klagenfurt, Austria.
    Västfjäll, Daniel
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Decis Research, OR USA.
    Slovic, Paul
    Decis Research, OR USA; University of Oregon, OR 97403 USA.
    Mental Imagery, Impact, and Affect: A Mediation Model for Charitable Giving2016In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 2, p. e0148274-Article in journal (Refereed)
    Abstract [en]

    One of the puzzling phenomena in philanthropy is that people can show strong compassion for identified individual victims but remain unmoved by catastrophes that affect large numbers of victims. Two prominent findings in research on charitable giving reflect this idiosyncrasy: The (1) identified victim and (2) victim number effects. The first of these suggests that identifying victims increases donations and the second refers to the finding that peoples willingness to donate often decreases as the number of victims increases. While these effects have been documented in the literature, their underlying psychological processes need further study. We propose a model in which identified victim and victim number effects operate through different cognitive and affective mechanisms. In two experiments we present empirical evidence for such a model and show that different affective motivations (donor-focused vs. victim-focused feelings) are related to the cognitive processes of impact judgments and mental imagery. Moreover, we argue that different mediation pathways exist for identifiability and victim number effects.

  • 180.
    Dickert, Stephan
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. WU Vienna University of Econ and Business, Austria.
    Västfjäll, Daniel
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Decis Research, NY USA.
    Kleber, Janet
    University of Vienna, Austria.
    Slovic, Paul
    Decis Research, NY USA; University of Oregon, OR 97403 USA.
    Scope insensitivity: The limits of intuitive valuation of human lives in public policy2015In: Journal of Applied Research in Memory and Cognition, ISSN 2211-3681, E-ISSN 2211-369X, Vol. 4, no 3, p. 248-255Article in journal (Refereed)
    Abstract [en]

    A critical question for government officials, managers of NGOs, and politicians is how to respond to situations in which large numbers of lives are at risk. Theories in judgment and decision making as well as economics suggest diminishing marginal utility with increasing quantities of goods. In the domain of lifesaving, this form of non-linearity implies decreasing concern for individual lives as the number of affected people increases. In this paper, we show how intuitive valuations based on prosocial emotions can lead to scope insensitivity and suboptimal responses to lives at risk. We present both normative and descriptive models of valuations of lives and discuss the underlying psychological processes as they relate to judgments and decisions made in public policy and by NGO5. (C) 2015 Published by Elsevier Inc on behalf of Society for Applied Research in Memory and Cognition. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

  • 181.
    Dirkse, Dale
    et al.
    University of Regina, Canada.
    Hadjistavropoulos, Heather D.
    University of Regina, Canada.
    Hesser, Hugo
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Barak, Azy
    University of Haifa, Israel.
    Linguistic Analysis of Communication in Therapist-Assisted Internet-Delivered Cognitive Behavior Therapy for Generalized Anxiety Disorder2015In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 44, no 1, p. 21-32Article in journal (Refereed)
    Abstract [en]

    Therapist-assisted Internet-delivered cognitive behavior therapy (ICBT) involves elements of expressive writing through secure messaging with a therapist. Expressive writing has been associated with psychological and physical health benefits in past research; furthermore, certain linguistic dimensions in expressive writing have been identified as particularly beneficial to health, such as less frequent use of negative emotion words and greater use of positive emotion words. No research, to date, has analyzed linguistic dimensions in client communication over the course of therapist-assisted ICBT for individuals with symptoms of generalized anxiety. This naturalistic study examined messages sent to therapists during the course of ICBT using linguistic analysis, and explored covariation of word use with symptom improvement. Data were obtained from patients with symptoms of generalized anxiety (N=59) who completed 12 modules of therapist-assisted ICBT and rated symptoms of anxiety, depression, and panic at the beginning of each module. Linguistic analysis categorized text submitted to therapists into different word categories. Results found that patients use of negative emotion, anxiety, causation, and insight words reduced over the course of treatment, while past tense words increased. Furthermore, negative emotion words significantly covaried with symptom ratings over the course of treatment. While causal statements cannot be made, findings improve our understanding of patient communication in ICBT and suggest that the further study of linguistic dimensions as psychological indicators and the potential utility of expressive writing strategies in therapist-assisted ICBT may be worthwhile.

  • 182.
    Dävelid, Iza
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology.
    Ledin, Sara
    Linköping University, Department of Behavioural Sciences and Learning, Psychology.
    Child and Adolescent Trauma Screen (CATS): En psykometrisk studie i svensk normgrupp2019Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Syftet med föreliggande studie var att psykometriskt undersöka den svenska versionen av Child and Adolescent Trauma Screen (CATS) för att skapa tillgång till ett självsvarsinstrument för barn och ungdomar som screenar för både traumahistorik och traumasymtom utifrån aktuellt diagnossystem DSM-5. För detta syfte undersöktes reliabilitet och evidens för validitet med hjälp av två sample; en normgrupp med 591 svenska skolelever i åldrarna 10 till 17 år samt en test-retestgrupp med 90 svenska skolelever i åldrarna 13 till 17 år. En pilotstudie med 38 svenska skolelever i åldrarna 15 till 19 år användes för metodvägledning inför studiens genomförande.

     

    Reliabiliteten undersöktes med estimering av intern konsistens med Cronbachs α i normgrupp samt temporal stabilitet med ICC och Cohens k i test-retestgrupp. För att erhålla evidens för kriterievaliditet användes robust enkel regressionsanalys för att undersöka huruvida antalet traumahändelser kunde predicera symtomutfall.  För att erhålla evidens för konvergent och diskriminant validitet beräknades Pearsons r mellan CATS symtomskala och de sex subskalorna i Trauma Symtom Checklist for Children (TSCC). Cramérs V användes för evidensprövning av konvergent validitet mellan CATS skala för traumahistorik och LYLES.  Evidens för validitet undersöktes även med analys av formulärets interna struktur med konfirmatorisk faktoranalys (CFA) utifrån DSM-5s fyrfaktormodell för PTSD. CFA utfördes med estimeringsmetoden bootstrap Maximum-likelihood till följd av bristfällig uni- och multivariat normalitet. Oberoende t-test användes för att undersöka eventuella gruppskillnader avseende traumahistorik och traumasymtom uppmätt med CATS.

     

    CATS symtomskala uppvisade god intern konsistens på samtliga fyra subskalor (Cronbachs α = .73-.89) och moderat temporal stabilitet (ICC = .57-.68). Temporal stabilitet för CATS totalskala för traumahistorik var god (ICC = .84) och sett till varje item var överensstämmelsen mellan test- och retestmätningar varierande från liten till nästintill perfekt (k = .34-.87). Robust enkel regressionsanalys påvisade att antalet traumahändelser predicerar symtomutfall där 32% av variansen i symtomuttryck kunde härledas till antalet traumahändelser. Måttliga till starka korrelationer återfanns mellan CATS symtomskala och TSCC symtomskalor med starkast korrelation med subskalan posttraumatisk stress (r = .82) och svagast korrelation med subskalan för sexuella bekymmer (r = .44). CATS skala för traumahistorik korrelerade måttligt med LYLES (V = .45).  DSM-5s fyrfaktormodell för PTSD indikerade god passform, reliabilitet och konvergent validitet. Modellen uppvisade bristande intern diskriminant validitet vilket kunde förklaras med prövning av en second-ordermodell med PTSD som högre ordnad faktor.

  • 183.
    Ebert, D. D.
    et al.
    University of Erlangen Nurnberg, Germany.
    Donkin, L.
    University of Sydney, Australia; Vrije University of Amsterdam, Netherlands.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden.
    Andrews, G.
    University of New South Wales, Australia.
    Berger, T.
    University of Bern, Switzerland.
    Carlbring, P.
    Stockholm University, Sweden.
    Rozenthal, A.
    Stockholm University, Sweden.
    Choi, I.
    University of Sydney, Australia.
    Laferton, J. A. C.
    Psychol Hsch Berlin, Germany.
    Johansson, Robert
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden.
    Kleiboer, A.
    Vrije University of Amsterdam, Netherlands.
    Lange, A.
    University of Amsterdam, Netherlands.
    Lehr, D.
    Leuphana University of Luneburg, Germany.
    Reins, J. A.
    Leuphana University of Luneburg, Germany.
    Funk, B.
    Leuphana University of Luneburg, Germany.
    Newby, J.
    University of New South Wales, Australia.
    Perini, S.
    Macquarie University, Australia.
    Riper, H.
    Vrije University of Amsterdam, Netherlands.
    Ruwaard, J.
    Vrije University of Amsterdam, Netherlands.
    Sheeber, L.
    Oregon Research Institute, OR 97403 USA.
    Snoek, F. J.
    Vrije University of Amsterdam, Netherlands; University of Amsterdam, Netherlands.
    Titov, N.
    Macquarie University, Australia; Macquarie University, Australia.
    Unlu Ince, B.
    Vrije University of Amsterdam, Netherlands.
    van Bastelaar, K.
    Vrije University of Amsterdam, Netherlands.
    Vernmark, Kristofer
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    van Straten, A.
    Vrije University of Amsterdam, Netherlands.
    Warmerdam, L.
    Vrije University of Amsterdam, Netherlands.
    Salsman, N.
    Xavier University, OH 45207 USA.
    Cuijpers, P.
    Vrije University of Amsterdam, Netherlands.
    Does Internet-based guided-self-help for depression cause harm? An individual participant data meta-analysis on deterioration rates and its moderators in randomized controlled trials2016In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 46, no 13, p. 2679-2693Article, review/survey (Refereed)
    Abstract [en]

    Background: Almost nothing is known about the potential negative effects of Internet-based psychological treatments for depression. This study aims at investigating deterioration and its moderators within randomized trials on Internet-based guided self-help for adult depression, using an individual patient data meta-analyses (IPDMA) approach.

    Method: Studies were identified through systematic searches (PubMed, PsycINFO, EMBASE, Cochrane Library). Deterioration in participants was defined as a significant symptom increase according to the reliable change index (i.e. 7.68 points in the CES-D; 7.63 points in the BDI). Two-step IPDMA procedures, with a random-effects model were used to pool data.

    Results: A total of 18 studies (21 comparisons, 2079 participants) contributed data to the analysis. The risk for a reliable deterioration from baseline to post-treatment was significantly lower in the intervention v. control conditions (3.36 v. 7.60; relative risk 0.47, 95% confidence interval 0.29-0.75). Education moderated effects on deterioration, with patients with low education displaying a higher risk for deterioration than patients with higher education. Deterioration rates for patients with low education did not differ statistically significantly between intervention and control groups. The benefit-risk ratio for patients with low education indicated that 9.38 patients achieve a treatment response for each patient experiencing a symptom deterioration.

    Conclusions: Internet-based guided self-help is associated with a mean reduced risk for a symptom deterioration compared to controls. Treatment and symptom progress of patients with low education should be closely monitored, as some patients might face an increased risk for symptom deterioration. Future studies should examine predictors of deterioration in patients with low education.

  • 184.
    Ebert, David Daniel
    et al.
    University of Luneburg, Germany; University of Marburg, Germany; University of Erlangen Nurnberg, Germany.
    Lehr, Dirk
    University of Luneburg, Germany.
    Boss, Leif
    University of Luneburg, Germany.
    Riper, Heleen
    University of Luneburg, Germany; Vrije University of Amsterdam, Netherlands; Vrije University of Amsterdam, Netherlands.
    Cuijpers, Pim
    Vrije University of Amsterdam, Netherlands.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Thiart, Hanne
    University of Luneburg, Germany.
    Heber, Elena
    University of Luneburg, Germany.
    Berking, Matthias
    University of Luneburg, Germany; University of Erlangen Nurnberg, Germany.
    Efficacy of an internet-based problem-solving training for teachers: results of a randomized controlled trial2014In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 40, no 6, p. 582-596Article in journal (Refereed)
    Abstract [en]

    Objective The primary purpose of this randomized controlled trial (RCT) was to evaluate the efficacy of internet-based problem-solving training (iPST) for employees in the educational sector (teachers) with depressive symptoms. The results of training were compared to those of a waitlist control group (WLC). Methods One-hundred and fifty teachers with elevated depressive symptoms (Center for Epidemiologic Studies Depression Scale, CES-D greater than= 16) were assigned to either the iPST or WLC group. The iPST consisted of five lessons, including problem-solving and rumination techniques. Symptoms were assessed before the intervention began and in follow-up assessments after seven weeks, three months, and six months. The primary outcome was depressive symptom severity (CES-D). Secondary outcomes included general and work-specific self-efficacy, perceived stress, pathological worries, burnout symptoms, general physical and mental health, and absenteeism. Results iPST participants displayed a significantly greater reduction in depressive symptoms after the intervention (d=0.59, 95% CI 0.26-0.92), after three months (d=0.37, 95% CI 0.05-0.70) and after six months (d=0.38, 95% CI 0.05-0.70) compared to the control group. The iPST participants also displayed significantly higher improvements in secondary outcomes. However, workplace absenteeism was not significantly affected. Conclusion iPST is effective in reducing symptoms of depression among teachers. Disseminated on a large scale, iPST could contribute to reducing the burden of stress-related mental health problems among teachers. Future studies should evaluate iPST approaches for use in other working populations.

  • 185.
    Eckhardt, Anna
    et al.
    Institute of Tropical Medicine and International Health, Charité Universitätsmedizin, Berlin, Germany.
    Aguilar Zambrano, Enrique
    Universidad Central del Ecuador, Instituto de Investigación y Postgrado, Facultad de Sciencias Médicas, Quito, Ecuador.
    Nilsson, Doris
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Traumatic experiences and dissociation in a non-clinical group of university students in Ecuador: a cross-sectional study2018In: Journal of Child and Adolescent Mental Health, ISSN 1728-0583, E-ISSN 1728-0591, Vol. 30, no 3, p. 191-202Article in journal (Refereed)
    Abstract [en]

    Background: In Ecuador, as in most Latin American countries, scientific research on trauma and dissociation is scarce. The aim of this study was to examine the prevalence of potentially traumatic experiences and dissociative symptoms in adolescents and young adults who were students at the Central University in Quito, Ecuador.

    Methods: A cross-sectional study in which 144 students completed a self-administrated questionnaire consisting of Linköping Youth Life Experience Scale (LYLES), Adolescent-Dissociation Experience Scale (A-DES ) and background variables. Data collection was conducted in autumn 2012. Standard multiple regression analysis was used to analyse the data.

    Results: All students reported a history of a minimum of five potentially traumatic experiences with a mean of 14.8. Eight participants (5.6%) scored above 3.7 on the Adolescent-Dissociation Experience Scale, which is considered clinically significant dissociation. No correlation was found between high scores on LYLES and A-DES.

    Conclusions: The prevalence of potentially traumatic experiences in the study population is very high compared to studies conducted in high-income settings. The low prevalence of dissociation suggests high resilience in the study population but more research on morbidity is needed to draw conclusions about mental health outcomes. Further research should include study populations in less advantageous contexts.

  • 186.
    Ekeblad, Annika
    et al.
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences. Vasternorrland County Council, Sweden.
    Falkenström, Fredrik
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences. Uppsala University, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden.
    Vestberg, Robert
    Vasternorrland County Council, Sweden.
    Holmqvist, Rolf
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Randomized Trial of Interpersonal Psychotherapy and Cognitive Behavioral Therapy for Major Depressive Disorder in a Community-Based Psychiatric Outpatient Clinic2016In: Depression and anxiety (Print), ISSN 1091-4269, E-ISSN 1520-6394, Vol. 33, no 12, p. 1090-1098Article in journal (Refereed)
    Abstract [en]

    BackgroundInterpersonal psychotherapy (IPT) and cognitive behavioral therapy (CBT) are both evidence-based treatments for major depressive disorder (MDD). Several head-to-head comparisons have been made, mostly in the United States. In this trial, we compared the two treatments in a small-town outpatient psychiatric clinic in Sweden. The patients had failed previous primary care treatment and had extensive Axis-II comorbidity. Outcome measures were reduction of depressive symptoms and attrition rate. MethodsNinety-six psychiatric patients with MDD (DSM-IV) were randomized to 14 sessions of CBT (n = 48) or IPT (n = 48). A noninferiority design was used with the hypothesis that IPT would be noninferior to CBT. A three-point difference on the Beck Depression Inventory-II (BDI-II) was used as noninferiority margin. ResultsIPT passed the noninferiority test. In the ITT group, 53.5% (23/43) of the IPT patients and 51.0% (24/47) of the CBT patients were reliably improved, and 20.9% (9/43) and 19.1% (9/47), respectively, were recovered (last BDI score amp;lt;10). The dropout rate was significantly higher in CBT (40%; 19/47) compared to IPT (19%; 8/43). Statistically controlling for antidepressant medication use did not change the results. ConclusionsIPT was noninferior to CBT in a sample of depressed psychiatric patients in a community-based outpatient clinic. CBT had significantly more dropouts than IPT, indicating that CBT may be experienced as too demanding. Since about half the patients did not recover, there is a need for further treatment development for these patients. The study should be considered an effectiveness trial, with strong external validity but some limitations in internal validity.

  • 187.
    Ekeblad, Annika
    et al.
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences. Sundsvall Hospital, Sweden.
    Falkenström, Fredrik
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Uppsala University, Sweden.
    Holmqvist, Rolf
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Reflective Functioning as Predictor of Working Alliance and Outcome in the Treatment of Depression2016In: Journal of Consulting and Clinical Psychology, ISSN 0022-006X, E-ISSN 1939-2117, Vol. 84, no 1, p. 67-78Article in journal (Refereed)
    Abstract [en]

    Aims: Although considerable attention has been paid to the concept of mentalization in psychotherapy, there is little research on mentalization as predictor of psychotherapy process and outcome. Using data from a randomized controlled trial of cognitive-behavioral therapy and interpersonal psychotherapy for depression, we studied mentalization in 85 outpatients with major depressive disorder (MDD) according to the Diagnostic and Statistical Manual of Mental Disorders. It was hypothesized that patients showing lower capacity for mentalization would experience poorer quality of alliance and worse outcome. Method: Depressive symptoms were measured each session using the Beck Depression Inventory-II. Mentalization was measured as reflective functioning (RF) on a slightly shortened version of the Adult Attachment Interview. A measure of depression-specific reflective functioning (DSRF), measuring mentalization about depressive symptoms, was also used. The Working Alliance Inventory-Short Form Revised was completed after each session by both therapist and patient. Longitudinal multilevel modeling was used to analyze data. Results: The patients had on average very low RF (M = 2.62, SD = 1.22). Lower pretreatment RF/DSRF predicted significantly lower therapist-rated working alliance during treatment. RF did not affect patient-rated alliance, but lower DSRF predicted lower patient-rated alliance across treatment. Patients with higher RF/DSRF had better outcomes on self-rated depression. Conclusions: The findings showed lower than normal capacity for mentalization in patients with MDD. Lower RF/DSRF predicted worse treatment outcome. More research is needed to understand how RF affects psychotherapy response and how RF is affected after recovery from depression.

  • 188.
    El Alaoui, Samir
    et al.
    Karolinska Institute, Sweden.
    Hedman, Erik
    Karolinska Institute, Sweden; Karolinska Institute, Sweden.
    Kaldo, Viktor
    Karolinska Institute, Sweden.
    Hesser, Hugo
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Kraepelien, Martin
    Karolinska Institute, Sweden.
    Andersson, Evelyn
    Karolinska Institute, Sweden.
    Ruck, Christian
    Karolinska Institute, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden.
    Ljotsson, Brjann
    Karolinska Institute, Sweden.
    Lindefors, Nils
    Karolinska Institute, Sweden.
    Effectiveness of Internet-Based Cognitive-Behavior Therapy for Social Anxiety Disorder in Clinical Psychiatry2015In: Journal of Consulting and Clinical Psychology, ISSN 0022-006X, E-ISSN 1939-2117, Vol. 83, no 5, p. 902-914Article in journal (Refereed)
    Abstract [en]

    Objective: Internet-based cognitive-behavioral therapy (ICBT) has received increased attention as an innovative approach to improve access to evidence-based psychological treatments. Although the efficacy of ICBT for social anxiety disorder has been established in several studies, there is limited knowledge of its effectiveness and application in clinical psychiatric care. The purpose of this study was to evaluate the effectiveness of ICBT in the treatment of social anxiety disorder and to determine the significance of patient adherence and the clinics years of experience in delivering ICBT. Method: A longitudinal cohort study was conducted using latent growth curve modeling of patients (N = 654) treated with ICBT at an outpatient psychiatric clinic between 2009 and 2013. The primary outcome measure was the Liebowitz Social Anxiety Scale-Self-Rated. Results: Significant reductions in symptoms of social anxiety were observed after treatment (effect size d = 0.86, 99% CI [0.74, 0.98]). Improvements were sustained at 6-month follow-up (d = 1.15, 99% CI [0.99, 1.32]). Patient adherence had a positive effect on the rate of improvement. A positive association between the clinics years of experience with ICBT and treatment outcome was also observed. Conclusions: This study suggests that ICBT for social anxiety disorder is effective when delivered within the context of a unit specialized in Internet-based psychiatric care and may be considered as a treatment alternative for implementation within the mental health care system.

  • 189.
    El Alaoui, Samir
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Hedman, Erik
    Karolinska Institutet, Stockholm, Sweden.
    Ljótsson, Brjánn
    Karolinska Institutet, Stockholm, Sweden.
    Bergström, Jan
    Karolinska Institutet, Stockholm, Sweden.
    Andersson, Erik
    Karolinska Institutet, Stockholm, Sweden.
    Rück, Christian
    Karolinska Institutet, Stockholm, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institutet, Stockholm, Sweden.
    Lindefors, Nils
    Karolinska Institutet, Stockholm, Sweden.
    Predictors and moderators of internet- and group-based cognitive behaviour therapy for panic disorder2013In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 11, p. e79024-Article in journal (Refereed)
    Abstract [en]

    Internet-based cognitive behaviour therapy (ICBT) can be equally effective as traditional face-to-face cognitive behaviour therapy (CBT) for treating panic disorder (PD). However, little is known about the predictors and moderators of outcome of ICBT when delivered in psychiatric outpatient settings. This study investigated a selection of outcome predictors and moderators of ICBT for panic disorder based on data from a randomised controlled trial where therapist-guided ICBT was compared with group CBT (GCBT) for panic disorder. Participants (N = 104) received 10 weeks of ICBT or GCBT and were assessed before and after treatment, and after six months. Multiple regression analyses were used to test for significant predictors of treatment outcome. Predictors of positive treatment response for both modalities were having low levels of symptom severity and work impairment. In addition, anxiety sensitivity was found to have a small negative relationship with treatment outcome, suggesting that anxiety sensitivity may slightly enhance treatment response. Treatment modality had a moderating effect on the relationship between domestic impairment and outcome and on the relationship between initial age of onset of panic symptoms and treatment outcome, favouring ICBT for patients having had an early onset of PD symptoms and for patients having a high domestic functional impairment. These results suggest that both ICBT and GCBT are effective treatment modalities for PD and that it is possible to predict a significant proportion of the long-term outcome variance based on clinical variables.

  • 190.
    El Alaoui, Samir
    et al.
    Karolinska Institute, Sweden.
    Ljotsson, Brjann
    Karolinska Institute, Sweden; Karolinska Institute, Sweden.
    Hedman, Erik
    Karolinska Institute, Sweden; Karolinska Institute, Sweden; Karolinska Institute, Sweden.
    Kaldo, Viktor
    Karolinska Institute, Sweden.
    Andersson, Evelyn
    Karolinska Institute, Sweden.
    Ruck, Christian
    Karolinska Institute, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden.
    Lindefors, Nils
    Karolinska Institute, Sweden.
    Predictors of Symptomatic Change and Adherence in Internet-Based Cognitive Behaviour Therapy for Social Anxiety Disorder in Routine Psychiatric Care2015In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 4, p. e0124258-Article in journal (Refereed)
    Abstract [en]

    Objective A central goal of health care is to improve patient outcomes. Although several studies have demonstrated the effectiveness of therapist guided internet-based cognitive behaviour therapy (ICBT) for social anxiety disorder (SAD), a significant proportion of patients do not respond to treatment. Consequently, the aim of this study was to identify individual characteristics and treatment program related factors that could help clinicians predict treatment outcomes and adherence for individuals with SAD. Method The sample comprised longitudinal data collected during a 4-year period of adult individuals (N = 764) treated for SAD at a public service psychiatric clinic. Weekly self-rated Liebowitz Social Anxiety Scale (LSAS-SR) scores were provided. Rates of symptomatic change during treatment and adherence levels were analysed using multilevel modelling. The following domains of prognostic variables were examined: (a) socio-demographic variables; (b) clinical characteristics; (c) family history of mental illness; and (d) treatment-related factors. Results Higher treatment credibility and adherence predicted a faster rate of improvement during treatment, whereas higher overall functioning level evidenced a slower rate of improvement. Treatment credibility was the strongest predictor of greater adherence. Having a family history of SAD-like symptoms was also associated with greater adherence, whereas Attention-Deficit/Hyperactivity Disorder (ADHD)-like symptoms, male gender, and family history of minor depression predicted lower adherence. Also, the amount of therapist time spent per treatment module was negatively associated with adherence. Conclusions Results from a large clinical sample indicate that the credibility of ICBT is the strongest prognostic factor explaining individual differences in both adherence level and symptomatic improvement. Early screening of ADHD-like symptoms may help clinicians identify patients who might need extra support or an adjusted treatment. Therapist behaviours that promote adherence may be important for treatment response, although more research is needed in order to determine what type of support would be most beneficial.

  • 191.
    Elisabet, Sundewall Thorén
    et al.
    Eriksholm Reserach Centre, Denmark.
    Öberg, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Technical Audiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping.
    Wänström, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Lunner, Thomas
    Eriksholm Research Centre, Denmark.
    Rehabiliteringsprogram för vuxna hörapparatanvändare2012Conference paper (Other academic)
  • 192.
    Ellis, Rachel
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    Molander, Peter
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    Rönnberg, Jerker
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    Lyxell, Björn
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institutet, Department of Clinical Neuroscience.
    Lunner, Thomas
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Snekkersten, Oticon A/S, Eriksholm Research Centre.
    Predicting speech-in-noise perception using the trail making task: Results from a large-scale internet study2015Conference paper (Refereed)
    Abstract [en]

    The purpose of this study was to investigate the utility of an internet-based version of the trail making test (TMT) to predict performance on a speech-in-noise perception task. Computerised versions of the tests were completed, via the internet, by a large (1500+) sample of listeners aged between 18 and 91 years old, both with and without hearing loss. The results show that better performance on both the simple and complex versions of the TMT are associated with better speech-in-noise recognition scores. The findings suggest that the relation between performance in the TMT and speech recognition test may be due to the capacity of the TMT to index perceptual speed, as opposed to the more complex cognitive abilities also implicated in TMT performance.

  • 193.
    Elofsson, Jessica
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Education, Teaching and Learning. Linköping University, Faculty of Educational Sciences.
    Gustafson, Stefan
    Linköping University, Department of Behavioural Sciences and Learning, Education, Teaching and Learning. Linköping University, Faculty of Educational Sciences.
    Samuelsson, Joakim
    Linköping University, Department of Behavioural Sciences and Learning, Education, Teaching and Learning. Linköping University, Faculty of Educational Sciences.
    Träff, Ulf
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Playing number board games supports 5-year-old children's early mathematical development2016In: Journal of Mathematical Behavior, ISSN 0732-3123, E-ISSN 1873-8028, Vol. 43, p. 134-147Article in journal (Refereed)
    Abstract [en]

    The study examined effects of playing number games (linear number board game, circular number board game, and nonlinear numerical activities) on the development of number knowledge and early arithmetic. A passive control group was also included in the design. 114 5-year-old preschool children participated. Four tasks (number line estimation, counting, naming Arabic numbers, and arithmetic calculation) were used as dependent measures. Children assigned to an intervention participated in six 10-min sessions during a period of three weeks. Children playing the linear number board game improved their performance on the number line estimation task, while children playing the other games did not. Furthermore, children playing the linear number board game showed a substantial enhancement of their calculation performance. The positive effects of playing linear number board games support the representational mapping hypothesis. The finding concerning calculation provides support to the assumption that a linear representation is important for early arithmetical learning.

  • 194.
    Emmelkamp, Paul M. G.
    et al.
    University of Amsterdam, Netherlands King Abdulaziz University, Saudi Arabia .
    David, Daniel
    University of Babes Bolyai, Romania Mt Sinai School Med, NY USA .
    Beckers, Tom
    Katholieke University of Leuven, Belgium University of Amsterdam, Netherlands .
    Muris, Peter
    Maastricht University, Netherlands .
    Cuijpers, Pim
    Vrije University of Amsterdam, Netherlands Vrije University of Amsterdam, Netherlands Vrije University of Amsterdam Medical Centre, Netherlands Leuphana University, Germany .
    Lutz, Wolfgang
    University of Trier, Germany .
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Araya, Ricardo
    University of Bristol, England .
    Banos Rivera, Rosa M.
    University of Valencia, Spain .
    Barkham, Michael
    University of Sheffield, England .
    Berking, Matthias
    Leuphana University, Germany University of Marburg, Germany University of Marburg, Germany .
    Berger, Thomas
    University of Bern, Switzerland .
    Botella, Christina
    Jaume I University, Spain .
    Carlbring, Per
    Stockholm University, Sweden .
    Colom, Francesc
    Hospital Clin Barcelona, Spain .
    Essau, Cecilia
    Roehampton University, England .
    Hermans, Dirk
    Katholieke University of Leuven, Belgium .
    Hofmann, Stefan G.
    Boston University, MA 02215 USA .
    Knappe, Susanne
    Technical University of Dresden, Germany .
    Ollendick, Thomas H.
    Virginia Technical University, VA USA .
    Raes, Filip
    Katholieke University of Leuven, Belgium .
    Rief, Winfried
    University of Marburg, Germany University of Marburg, Germany .
    Riper, Heleen
    Vrije University of Amsterdam, Netherlands Vrije University of Amsterdam, Netherlands Vrije University of Amsterdam Medical Centre, Netherlands Vrije University of Amsterdam Medical Centre, Netherlands .
    Van der Oord, Saskia
    Katholieke University of Leuven, Belgium University of Amsterdam, Netherlands .
    Vervliet, Bram
    Katholieke University of Leuven, Belgium .
    Advancing psychotherapy and evidence-based psychological interventions2014In: International Journal of Methods in Psychiatric Research, ISSN 1049-8931, E-ISSN 1557-0657, Vol. 23, no S1, p. 58-91Article in journal (Refereed)
    Abstract [en]

    Psychological models of mental disorders guide research into psychological and environmental factors that elicit and maintain mental disorders as well as interventions to reduce them. This paper addresses four areas. (1) Psychological models of mental disorders have become increasingly transdiagnostic, focusing on core cognitive endophenotypes of psychopathology from an integrative cognitive psychology perspective rather than offering explanations for unitary mental disorders. It is argued that psychological interventions for mental disorders will increasingly target specific cognitive dysfunctions rather than symptom-based mental disorders as a result. (2) Psychotherapy research still lacks a comprehensive conceptual framework that brings together the wide variety of findings, models and perspectives. Analysing the state-of-the-art in psychotherapy treatment research, component analyses aiming at an optimal identification of core ingredients and the mechanisms of change is highlighted as the core need towards improved efficacy and effectiveness of psychotherapy, and improved translation to routine care. (3) In order to provide more effective psychological interventions to children and adolescents, there is a need to develop new and/or improved psychotherapeutic interventions on the basis of developmental psychopathology research taking into account knowledge of mediators and moderators. Developmental neuroscience research might be instrumental to uncover associated aberrant brain processes in children and adolescents with mental health problems and to better examine mechanisms of their correction by means of psychotherapy and psychological interventions. (4) Psychotherapy research needs to broaden in terms of adoption of large-scale public health strategies and treatments that can be applied to more patients in a simpler and cost-effective way. Increased research on efficacy and moderators of Internet-based treatments and e-mental health tools (e.g. to support real time clinical decision-making to prevent treatment failure or relapse) might be one promising way forward.

  • 195.
    Enander, J
    et al.
    Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
    Andersson, E
    Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
    Kaldo, V
    Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
    Lindefors, N
    Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Ruck, C
    Rück, C., Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
    Internet administration of the Dimensional Obsessive-Compulsive Scale: A psychometric evaluation2012In: Journal of Obsessive-Compulsive and Related Disorders, ISSN 2211-3649, Vol. 1, no 4, p. 325-330Article in journal (Refereed)
    Abstract [en]

    The Dimensional Obsessive-Compulsive Scale (DOCS) was designed to address the current limitations of existing obsessive-compulsive (OC) symptom measures and is a self-report questionnaire that assesses the severity of the four most empirically supported OC symptom dimensions. The aim of this study was to examine the psychometric properties of a Swedish version of the DOCS when administered via the Internet. Internal consistency, factor structure, and convergent and discriminant validity were examined in a sample consisting of 101 patients diagnosed with obsessive-compulsive disorder. The DOCS sensitivity to treatment effects were examined in a sample consisting of 48 patients treated with Internet-delivered cognitive behavioral therapy were the main intervention was exposure with response prevention. Results showed that the internal consistency was high. The DOCS also showed adequate convergent and discriminant validity, as well as fair sensitivity to treatment effects. The factor analysis supported the DOCS four-factor solution. In summary, the results from the present study give initial support that the DOCS can be administered via the Internet with adequate psychometric properties. © 2012 Elsevier Ltd.

  • 196.
    Enander, Jesper
    et al.
    Karolinska Institute, Sweden.
    Andersson, Erik
    Karolinska Institute, Sweden.
    Mataix-Cols, David
    Karolinska Institute, Sweden; Kings Coll London, England.
    Lichtenstein, Linn
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Alstroem, Katarina
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Ljotsson, Brjann
    Karolinska Institute, Sweden.
    Rueck, Christian
    Karolinska Institute, Sweden.
    Therapist guided internet based cognitive behavioural therapy for body dysmorphic disorder: single blind randomised controlled trial2016In: BMJ-BRITISH MEDICAL JOURNAL, ISSN 1756-1833, Vol. 352, no i241Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES To evaluate the efficacy of therapist guided internet based cognitive behavioural therapy (CBT) programme for body dysmorphic disorder (BDD-NET) compared with online supportive therapy. DESIGN A 12 week single blind parallel group randomised controlled trial. SETTING Academic medical centre. PARTICIPANTS 94 self referred adult outpatients with a diagnosis of body dysmorphic disorder and a modified Yale-Brown obsessive compulsive scale (BDD-YBOCS) score of &gt;= 20. Concurrent psychotropic drug treatment was permitted if the dose had been stable for at least two months before enrolment and remained unchanged during the trial. INTERVENTIONS Participants received either BDD-NET (n=47) or supportive therapy (n=47) delivered via the internet for 12 weeks. MAIN OUTCOME MEASURES The primary outcome was the BDD-YBOCS score after treatment and follow-up (three and six months from baseline) as evaluated by a masked assessor. Responder status was defined as a &gt;= 30% reduction in symptoms on the scale. Secondary outcomes were measures of depression (MADRS-S), global functioning (GAF), clinical global improvement (CGI-I), and quality of life (EQ5D). The six month follow-up time and all outcomes other than BDD-YBOCS and MADRS-S at 3 months were not pre-specified in the registration at clinicaltrials.gov because of an administrative error but were included in the original trial protocol approved by the regional ethics committee before the start of the trial. RESULTS BDD-NET was superior to supportive therapy and was associated with significant improvements in severity of symptoms of body dysmorphic disorder (BDD-YBOCS group difference -7.1 points, 95% confidence interval -9.8 to -4.4), depression (MADRS-S group difference -4.5 points, -7.5 to -1.4), and other secondary measures. At follow-up, 56% of those receiving BDD-NET were classed as responders, compared with 13% receiving supportive therapy. The number needed to treat was 2.34 (1.71 to 4.35). Self reported satisfaction was high. CONCLUSIONS CBT can be delivered safely via the internet to patients with body dysmorphic disorder. BDD-NET has the potential to increase access to evidence based psychiatric care for this mental disorder, in line with NICE priority recommendations. It could be particularly useful in a stepped care approach, in which general practitioner or other mental health professionals can offer treatment to people with mild to moderate symptoms at low risk of suicide.

  • 197.
    Eriksson, Kimmo
    et al.
    Stockholm University, Sweden; Mälardalen University, Sweden.
    Strimling, Pontus
    Stockholm University, Sweden; Institute Futures Studies, Sweden.
    Andersson, Per A
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Aveyard, Mark
    Amer University of Sharjah, U Arab Emirates.
    Brauer, Markus
    University of Wisconsin Madison, WI USA.
    Gritskov, Vladimir
    St Petersburg State University, Russia.
    Kiyonari, Toko
    Aoyama Gakuin University, Japan.
    Kuhlman, David M.
    University of Delaware, DE 19716 USA.
    Maitner, Angela T.
    Amer University of Sharjah, U Arab Emirates.
    Manesi, Zoi
    Vrije University of Amsterdam, Netherlands.
    Molho, Catherine
    Vrije University of Amsterdam, Netherlands.
    Peperkoorn, Leonard S.
    Vrije University of Amsterdam, Netherlands.
    Rizwan, Muhammad
    Delve Pvt Ltd, Pakistan.
    Stivers, Adam W.
    Gonzaga University, WA 99258 USA.
    Tian, Qirui
    Shandong Normal University, Peoples R China.
    Van Lange, Paul A. M.
    Vrije University of Amsterdam, Netherlands.
    Vartanova, Irina
    Institute Futures Studies, Sweden; National Research University of Higher School Econ, Russia.
    Wu, Junhui
    Beijing Normal University, Peoples R China.
    Yamagishi, Toshio
    Hitotsubashi University, Japan.
    Cultural Universals and Cultural Differences in Meta-Norms about Peer Punishment2017In: Management and Organization Review, ISSN 1740-8776, E-ISSN 1740-8784, Vol. 13, no 4, p. 851-870Article in journal (Refereed)
    Abstract [en]

    Violators of cooperation norms may be informally punished by their peers. How such norm enforcement is judged by others can be regarded as a meta-norm (i.e., a second-order norm). We examined whether meta-norms about peer punishment vary across cultures by having students in eight countries judge animations in which an agent who over-harvested a common resource was punished either by a single peer or by the entire peer group. Whether the punishment was retributive or restorative varied between two studies, and findings were largely consistent across these two types of punishment. Across all countries, punishment was judged as more appropriate when implemented by the entire peer group than by an individual. Differences between countries were revealed in judgments of punishers vs. non-punishers. Specifically, appraisals of punishers were relatively negative in three Western countries and Japan, and more neutral in Pakistan, UAE, Russia, and China, consistent with the influence of individualism, power distance, and/or indulgence. Our studies constitute a first step in mapping how meta-norms vary around the globe, demonstrating both cultural universals and cultural differences.

  • 198.
    Eriksson, Kimmo
    et al.
    Malardalen University, Sweden; Stockholm University, Sweden.
    Strimling, Pontus
    Linköping University, Department of Management and Engineering, The Institute for Analytical Sociology, IAS. Linköping University, Faculty of Arts and Sciences. Stockholm University, Sweden; Institute Futures Studies, Sweden.
    Andersson, Per A
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Stockholm University, Sweden.
    Lindholm, Torun
    Stockholm University, Sweden.
    Costly punishment in the ultimatum game evokes moral concern, in particular when framed as payoff reduction2017In: Journal of Experimental Social Psychology, ISSN 0022-1031, E-ISSN 1096-0465, Vol. 69, p. 59-64Article in journal (Refereed)
    Abstract [en]

    The ultimatum game is a common economic experiment in which some participants reject anothers unfair offer of how to split some money, even though it leaves them both worse off. This costly behavior can be seen as enforcement of a fairness norm and has been labeled "altruistic punishment", suggesting that it is a Moral thing to do. But is this behavior viewed as moral by participants? Is it viewed as punishment? And are the payoff consequences of the behavior sufficient to determine the answers to these questions? To investigate this we framed costly punishment in two different ways: either as rejection of an offer (the standard ultimatum game framing) or as reduction of payoff. In a series of paid and hypothetical experiments we found that moral concerns about costly punishment depended on the framing. Specifically, the reduction frame elicited more moral concern about, and less use of, costly punishment than did the rejection frame. Several implications are discussed. (C) 2016 Elsevier Inc. All rights reserved.

  • 199.
    Erlandsson, Arvid
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Björklund, Fredrik
    Lund University, Sweden.
    Bäckström, Martin
    Lund University, Sweden.
    Choice-justifications after allocating resources in helping dilemmas2017In: Judgment and decision making, ISSN 1930-2975, E-ISSN 1930-2975, Vol. 12, no 1, p. 60-80Article in journal (Refereed)
    Abstract [en]

    How do donors reason and justify their choices when faced with dilemmas in a charitable context? In two studies, Swedish students were confronted with helping dilemmas based on the identifiable victim effect, the proportion dominance effect and the ingroup effect. Each dilemma consisted of two comparable charity projects and participants were asked to choose one project over the other. They were then asked to provide justifications of their choice by stating the relative importance of different types of reasons. When faced with an identified victim dilemma, participants did not choose the project including an identified victim more often than the project framed statistically, but those who did emphasized emotional reasons (e.g., "Because I had more empathic feelings"), but not any other reasons, more than those choosing the statistical project. When faced with a Proportion dominance dilemma, participants more often chose the project with a high rescue proportion (e.g., you can save 100% out of 30) than the project with a low rescue proportion (e.g., you can save 4% out of 800), and those who did emphasized efficacy reasons (e.g., "Because my money can make a greater difference there"), but no other reasons, more than those favoring the low recue proportion project. Finally, when faced with an Ingroup dilemma, participants more often chose the project that could help ingroup-victims over the project that could help outgroup victims, and those who did emphasized responsibility reasons (e.g., "Because I have a greater obligation"), but no other reasons, more than those favoring outgroup projects. These results are consistent with and extend previous findings about how different helping effects are related to different psychological processes.

  • 200.
    Erlandsson, Arvid
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Lund University, Sweden.
    Jungstrand, Amand A.
    Lund University, Sweden.
    Västfjäll, Daniel
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Decis Research, OR USA.
    Anticipated Guilt for Not Helping and Anticipated Warm Glow for Helping Are Differently Impacted by Personal Responsibility to Help2016In: Frontiers in Psychology, ISSN 1664-1078, E-ISSN 1664-1078, Vol. 7, no 1475Article in journal (Refereed)
    Abstract [en]

    One important motivation for people behaving prosocially is that they want to avoid negative and obtain positive emotions. In the prosocial behavior literature however, the motivations to avoid negative emotions (e.g., guilt) and to approach positive emotions (e.g., warm glow) are rarely separated, and sometimes even aggregated into a single mood-management construct. The aim of this study was to investigate whether anticipated guilt if not helping and anticipated warm glow if helping are influenced similarly or differently when varying situational factors related to personal responsibility to help. Helping scenarios were created and pilot tests established that each helping scenario could be formulated both in a high-responsibility version and in a low-responsibility version. In Study 1 participants read high-responsibility and low-responsibility helping scenarios, and rated either their anticipated guilt if not helping or their anticipated warm glow if helping (i.e., separate evaluation). Study 2 was similar but here participants rated both their anticipated guilt if not helping and their anticipated warm glow if helping (i.e., joint evaluation). Anticipated guilt was clearly higher in the high-responsibility versions, but anticipated warm glow was unaffected (in Studies 1a and 1b), or even higher in the low-responsibility versions (Study 2). In Studies 3 (where anticipated guilt and warm glow were evaluated separately) and 4 (where they were evaluated jointly), personal responsibility to help was manipulated within-subjects. Anticipated guilt was again constantly higher in the high-responsibility versions but for many types of responsibility-manipulations, anticipated warm glow was higher in the low-responsibility versions. The results suggest that we anticipate guilt if not fulfilling our responsibility but that we anticipate warm glow primarily when doing over and beyond our responsibility. We argue that future studies investigating motivations for helping should measure both anticipated negative consequences for oneself if not helping, and anticipated positive consequences for oneself if helping.

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