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  • 201.
    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.

  • 202.
    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.

  • 203.
    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.

  • 204.
    Erlandsson, Arvid
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Lund Univ, Sweden.
    Moyner Hohle, Sigrid
    Simula Res Lab, Norway.
    Lohre, Erik
    Simula Res Lab, Norway.
    Västfjäll, Daniel
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Decis Res, OR USA.
    The rise and fall of scary numbers: The effect of perceived trends on future estimates, severity ratings, and help-allocations in a cancer context2018In: Journal of Applied Social Psychology, ISSN 0021-9029, E-ISSN 1559-1816, Vol. 48, no 11, p. 618-633Article in journal (Refereed)
    Abstract [en]

    Statistical information such as death risk estimates is frequently used for illustrating the magnitude of a problem. Such mortality statistics are however easier to evaluate if presented next to an earlier estimate, as the two data points together will illustrate an upward or downward change. How are people influenced by such changes? In seven experiments, participants read mortality statistics (e.g., number of yearly deaths or expert-estimated death risks) made at two points of time about various cancer types. Each cancer type was manipulated to have either a downward trajectory (e.g., the estimated death risk was 37% in 2012, and was adjusted downward to 22% in 2014), an upward trajectory (e.g., 7% -amp;gt; 22%), or a flat trajectory (e.g., 22% -amp;gt; 22%). For each cancer type, participants estimated future mortality statistics and rated the perceived severity. They also allocated real money between projects aimed at preventing the different cancer types. Participants responses indicated that they thought that a trend made out of two data points would continue in the future. People also perceived cancer types with similar present mortality statistics as more severe and allocated more money to them when they had an upward trajectory compared to a flat or downward trajectory. Although there are boundary conditions, we conclude that peoples severity ratings and helping behavior can be influenced by trend information even when such information is based on only two data points.

  • 205.
    Erlandsson, Arvid
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Nilsson, Arthur
    Lund University, Department of Psychology, Lund, Sweden.
    Tinghög, Gustav
    Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences.
    Västfjäll, Daniel
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Decision Research, Eugene, OR, United States of America.
    Bullshit-sensitivity predicts prosocial behavior2018In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 7, article id e0201474Article in journal (Refereed)
    Abstract [en]

    Bullshit-sensitivity is the ability to distinguish pseudo-profound bullshit sentences (e.g. “Your movement transforms universal observations”) from genuinely profound sentences (e.g. “The person who never made a mistake never tried something new”). Although bullshit-sensitivity has been linked to other individual difference measures, it has not yet been shown to predict any actual behavior. We therefore conducted a survey study with over a thousand participants from a general sample of the Swedish population and assessed participants’ bullshit-receptivity (i.e. their perceived meaningfulness of seven bullshit sentences) and profoundness-receptivity (i.e. their perceived meaningfulness of seven genuinely profound sentences), and used these variables to predict two types of prosocial behavior (self-reported donations and a decision to volunteer for charity). Despite bullshit-receptivity and profoundness-receptivity being positively correlated with each other, logistic regression analyses showed that profoundness-receptivity had a positive association whereas bullshit-receptivity had a negative association with both types of prosocial behavior. These relations held up for the most part when controlling for potentially intermediating factors such as cognitive ability, time spent completing the survey, sex, age, level of education, and religiosity. The results suggest that people who are better at distinguishing the pseudo-profound from the actually profound are more prosocial.

  • 206.
    Erlandsson, Arvid
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Nilsson, Artur
    Lund Univ, Sweden.
    Tinghög, Gustav
    Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences.
    Andersson, David
    Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences.
    Västfjäll, Daniel
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Donations to Outgroup Charities, but Not Ingroup Charities, Predict Helping Intentions Toward Street-Beggars in Sweden2019In: Nonprofit and Voluntary Sector Quarterly, ISSN 0899-7640, E-ISSN 1552-7395, Vol. 48, no 4, p. 814-838Article in journal (Refereed)
    Abstract [en]

    This article investigates how donation behavior to charitable organizations and helping intentions toward begging European Union (EU)-migrants are related. This question was tested by analyzing survey responses from 1,050 participants sampled from the general Swedish population. Although the overall results suggested that donations to charitable organizations were positively related to helping intentions toward beggars, the results differed substantially as a function of whether the organization was perceived to focus its efforts on outgroup victims or on ingroup victims. Specifically, whereas donation behavior toward outgroup-focused organizations clearly predicted more helping intentions toward beggars (also when controlling for demographics, education, income, religiosity, and political inclination), donation behavior toward ingroup-focused organizations predicted slightly less helping intentions toward beggars. We conclude that the type of charitable organization a person donates to might tell us more about his or her values and preferences than merely whether or not he or she donates at all.

  • 207.
    Erlandsson, Arvid
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Nilsson, Artur
    Lund University, Lund, Sweden.
    Västfjäll, Daniel
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Decision Research, Eugene, Oregon, USA.
    Attitudes and donation behavior when reading positive and negative charity appeals2018In: Journal of Nonprofit & Public Sector Marketing, ISSN 1049-5142, E-ISSN 1540-6997, Vol. 30, no 4, p. 444-474Article in journal (Refereed)
    Abstract [en]

    This article tries to clarify whether negative charity appeals (i.e., advertisements emphasizing the bad consequences of not helping) or positive charity appeals (i.e., advertisements emphasizing the good consequences of helping) are more effective. Previous literature does not provide a single answer to this question and we suggest that one contributing reason for this is that different studies have operationalized appeal effectiveness in different ways (e.g., actual behavior, self-rated helping intentions, or expressed attitudes about the ad or the organization). Results from four separate studies suggest that positive appeals are more effective in inducing favorable attitudes toward the ad and toward the organization but that negative appeals are more effective (in studies 1A and 1B) or at least equally effective (in studies 1C and 1D) in eliciting actual donations. Also, although people’s attitude toward the appeal (i.e., liking) was a good predictor for the expected effectiveness in increasing donation behavior (in Study 2), it was a poor predictor of actual donation behavior in all four main studies. These results cast doubt on marketing theories suggesting that attitudes toward an advertisement and toward the brand always lead to higher purchase behavior.

  • 208.
    Erlandsson, Arvid
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Lund University, Sweden.
    Västfjäll, Daniel
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. University of Oregon, OR 97403 USA.
    Sundfelt, Oskar
    Lund University, Sweden.
    Slovic, Paul
    University of Oregon, OR 97403 USA.
    Argument-inconsistency in charity appeals: Statistical information about the scope of the problem decrease helping toward a single identified victim but not helping toward many non-identified victims in a refugee crisis context2016In: Journal of Economic Psychology, ISSN 0167-4870, E-ISSN 1872-7719, Vol. 56, p. 126-140Article in journal (Refereed)
    Abstract [en]

    It is known that both the characteristics of the victims one can help and the existence of victims one cannot help influence economic helping decisions in suboptimal ways. The aim of this study was to systematically test if these two aspects interact with each other. In Studies 1 and 2, we created hypothetical charity appeals related to the Syrian refugee crisis and factorially manipulated characteristics of victims possible to help (one identified child/nine non-identified children) and presence of statistical information about the scope and nature of the problem (information-box absent/present). We found a significant interaction effect both when using self-rated helping intention (Study 1), and when using actual donation behavior as the dependent variable (Study 2). Statistical information decreased helping intentions toward a single identified child but had no, or even a small positive effect on helping nine non-identified children. In Study 3, non-student participants reading a charity appeal with both a story about one identified child and statistical information donated less often than participants reading appeals with either only a story about one identified child or only statistical information. We suggest that both emotional arguments (e.g., a story and picture of an identified child in need) and analytical arguments (e.g., detailed statistical information about the scope and nature of the problem) can make us more motivated to help refugees, but that mixing different argument-types can make charity appeals internally inconsistent and decrease donations. (C) 2016 Elsevier B.V. All rights reserved.

  • 209.
    Essery, Rosie
    et al.
    University of Southampton, England.
    Kirby, Sarah
    University of Southampton, England.
    Geraghty, Adam W. A.
    University of Southampton, England.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden.
    Carlbring, Per
    University of Stockholm, Sweden.
    Bronstein, Adolfo
    University of London Imperial Coll Science Technology and Med, England.
    Little, Paul
    University of Southampton, England.
    Yardley, Lucy
    University of Southampton, England.
    The Development of Balance Retraining: An Online Intervention for Dizziness in Adults Aged 50 Years and Older2015In: American Journal of Audiology, ISSN 1059-0889, E-ISSN 1558-9137, Vol. 24, no 3, p. 276-279Article in journal (Refereed)
    Abstract [en]

    Purpose: This article outlines the rationale and development process for an online intervention based on vestibular rehabilitation therapy (VRT). The intervention aims to assist adults aged 50 years and older to self-manage and reduce dizziness symptoms. Method: The intervention was developed according to the person-based approach to digital intervention design focused on accommodating perspectives of target users. A prototype version of the intervention was provided to 18 adults (11 women, 7 men) aged 50 years and older with dizziness. These adults were invited to use the intervention over a 6-week period and, during this time, took part in a think-aloud session. This session sought to understand users perceptions of how acceptable, engaging, and easy to use they found the online intervention. Results: Users were extremely positive regarding how easy to navigate, visually appealing, and informative they found the intervention. Think-aloud sessions provided valuable data for informing small amendments to further enhance acceptability of the intervention for target users. Conclusions: Informed by these development-phase data, a finalized version of the intervention is now being investigated in a primary care-based randomized controlled trial. Results should provide an understanding of whether VRT can be effectively-especially, cost-effectively-delivered via an online intervention to adults aged 50 years and older.

  • 210.
    Falkenström, Fredrik
    et al.
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences. Uppsala University, Sweden.
    Ekeblad, Annika
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences. Vasternorrland County Council, Sweden.
    Holmqvist, Rolf
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Improvement of the Working Alliance in One Treatment Session Predicts Improvement of Depressive Symptoms by the Next Session2016In: Journal of Consulting and Clinical Psychology, ISSN 0022-006X, E-ISSN 1939-2117, Vol. 84, no 8, p. 738-751Article in journal (Refereed)
    Abstract [en]

    Objective: Developments in working alliance theory posit that the therapists attention to fluctuations in the alliance throughout treatment is crucial. Accordingly, researchers have begun studying the alliance as a time-varying mechanism of change rather than as a static moderator. However, most studies to date suffer from bias owing to the nonindependence of error term and predictors (endogeneity). Method: Patients with major depressive disorder (N = 84) from a randomized trial comparing cognitive-behavioral therapy with interpersonal psychotherapy filled out the Beck Depression Inventory-II before each session. After each session, patients and therapists filled out the Working Alliance Inventory short forms. Data were analyzed using the generalized method of moments for dynamic panel data, a method commonly applied in econometrics to eliminate endogeneity bias. Results: Improvement of the alliance predicted significant reduction of depressive symptoms by the next session (patient rating: b = -4.35, SE = 1.96, p = .026, 95% confidence interval [CI] [-8.19, -0.51]; therapist rating: b = -4.92, SE = 1.84, p = .008, 95% CI [-8.53, -1.31]). In addition, there was a significant delayed effect on the session after the next (patient rating: b = -3.25, SE = 1.20, p = .007, 95% CI [-5.61, -0.89]; therapist rating: b = -5.44, SE = 1.92, p = .005, 95% CI [-9.20, -1.68]). Conclusion: If the quality of patient-therapist alliance is improved in a given treatment session, depressive symptoms will likely decrease by the next session. The most important limitation of this study is its relatively small sample size.

  • 211.
    Falkenström, Fredrik
    et al.
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Ekeblad, Annika
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Sandell, Rolf
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Holmqvist, Rolf
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Patient Reflective Functioning as Predictor of Early Psychotherapy Process in the Treatment of DepressionManuscript (preprint) (Other academic)
    Abstract [en]

    Aims: Despite considerable clinical attention to the concept of mentalization in psychotherapy, research on mentalization and the psychotherapy process is virtually absent. Using data from two ongoing randomized controlled trials of psychotherapy for depression, we studied mentalization in 45 patients diagnosed with DSM-IV Major Depressive Disorder. The initial psychotherapy process was hypothesized to be experienced as more difficult with patients showing lower capacity for mentalization because of their difficulty understanding behavior in terms of mental states.

    Methods: Mentalization was measured as Reflective Functioning (RF) on the Adult Attachment Interview, conducted before therapy start. Additionally, a measure of Depression-Specific Reflective Functioning (DSRF) measuring mentalization about depressive symptoms was tested. Psychotherapy process was measured by the Working Alliance Inventory – Short form (WAI-S) and the Feeling Checklist (FC), which were completed after each session by both therapist and patient.

    Results: Pre-treatment RF on the AAI was on average low (M = 3.1), but variation in RF did not predict any aspect of the initial (first four sessions) psychotherapy process. Higher DSRF predicted better working alliance and more positive feelings as rated by the patient. RF on the AAI did not predict any process measure significantly.

    Discussion: The low RF in depression replicates two previous studies, and may help explaining why maternal depression is a risk factor for infant developmental problems. If the results for DSRF are replicated, this measure might be used for identifying patients who are not easy candidates for psychotherapy.

  • 212.
    Falkenström, Fredrik
    et al.
    Karolinska Institute, Sweden; Stockholm County Council, Sweden.
    Finkel, Steven
    University of Pittsburgh, PA 15260 USA.
    Sandell, Rolf
    Lund University, Sweden.
    Rubel, Julian A.
    University of Trier, Germany.
    Holmqvist, Rolf
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Dynamic Models of Individual Change in Psychotherapy Process Research2017In: Journal of Consulting and Clinical Psychology, ISSN 0022-006X, E-ISSN 1939-2117, Vol. 85, no 6, p. 537-549Article in journal (Refereed)
    Abstract [en]

    Objective: There is a need for rigorous methods to study the mechanisms that lead to individual-level change (i.e., process-outcome research). We argue that panel data (i.e., longitudinal study of a number of individuals) methods have 3 major advantages for psychotherapy researchers: (1) enabling microanalytic study of psychotherapeutic processes in a clinically intuitive way, (2) modeling lagged associations over time to ensure direction of causality, and (3) isolating within-patient changes over time from between-patient differences, thereby protecting against confounding influences because of the effects of unobserved stable attributes of individuals. However, dynamic panel data methods present a complex set of analytical challenges. We focus on 2 particular issues: (1) how long-term trajectories in the variables of interest over the study period should be handled, and (2) how the use of a lagged dependent variable as a predictor in regression-based dynamic panel models induces endogeneity (i.e., violation of independence between predictor and model error term) that must be taken into account in order to appropriately isolate within-and between-person effects. Method: An example from a study of working alliance in psychotherapy in primary care in Sweden is used to illustrate some of these analytic decisions and their impact on parameter estimates. Results: Estimates were strongly influenced by the way linear trajectories were handled; that is, whether variables were "detrended" or not. Conclusions: The issue of when detrending should be done is discussed, and recommendations for research are provided. What is the public health significance of this article? This article provides recommendations on how to study psychotherapy processes using dynamic panel data models to strengthen causal inferences. Accurate estimates of what drives individual development in psychotherapy are needed to generate recommendations on what therapists should focus on in therapy. Using the alliance-outcome association as an example, we show that estimated effect sizes may vary greatly depending on which modeling approach is used, with the decision on whether to remove time-trends from the outcome variable making the largest difference.

  • 213.
    Falkenström, Fredrik
    et al.
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Granstrom, Fredrik
    Uppsala University, Sweden.
    Holmqvist, Rolf
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Therapeutic Alliance Predicts Symptomatic Improvement Session by Session2013In: Journal of counseling psychology, ISSN 0022-0167, E-ISSN 1939-2168, Vol. 60, no 3, p. 317-328Article in journal (Refereed)
    Abstract [en]

    The therapeutic alliance has been found to predict psychotherapy outcome in numerous studies. However, critics maintain that the therapeutic alliance is a by-product of prior symptomatic improvements. Moreover, almost all alliance research to date has used differences between patients in alliance as predictor of outcome, and results of such analyses do not necessarily mean that improving the alliance with a given patient will improve outcome (i.e., a within-patient effect). In a sample of 646 patients (76% women, 24% men) in primary care psychotherapy, the effect of working alliance on next session symptom level was analyzed using multilevel models. The Clinical Outcomes in Routine Evaluation–Outcome Measure was used to measure symptom level, and the patient version of the Working Alliance Inventory–Short form revised (Hatcher & Gillaspy, 2006) was used to measure alliance. There was evidence for a reciprocal causal model, in which the alliance predicted subsequent change in symptoms while prior symptom change also affected the alliance. The alliance effect varied considerably between patients. This variation was partially explained by patients with personality problems showing stronger alliance effect. These results indicate that the alliance is not just a by-product of prior symptomatic improvements, even though improvement in symptoms is likely to enhance the alliance. Results also point to the importance of therapists paying attention to ruptures and repair of the therapy alliance. Generalization of results may be limited to relatively brief primary care psychotherapy.

  • 214.
    Falkenström, Fredrik
    et al.
    Centre for Clinical Research Sörmland, Uppsala University, Sweden.
    Granström, Fredrik
    Centre for Clinical Research Sörmland, Uppsala University, Sweden.
    Holmqvist, Rolf
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Working alliance predicts psychotherapy outcome even while controlling for prior symptom improvement2014In: Psychotherapy Research, ISSN 1050-3307, E-ISSN 1468-4381, Vol. 24, no 2, p. 146-159Article in journal (Refereed)
    Abstract [en]

    Objective: Although the working alliance as been found to be a robust predictor of psychotherapy outcome, critics have questioned the causal status of this effect. Specifically, the effect of the alliance may be confounded with the effect of prior symptom improvement. The objective of the present study was to test this possibility. Method: A large dataset from primary care psychotherapy was used to study relationships between alliance and outcome using piecewise multilevel path analysis. Results: Initial symptom level and symptom change up to session three predicted the alliance at session three. Working alliance significantly predicted symptom change rate from session three to termination, even while controlling for several possible confounds. Conclusions: The alliance predicts outcome over and above the effect of prior symptom improvement, supporting a reciprocal influence model of the relationship between alliance and symptom change.

  • 215.
    Falkenström, Fredrik
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Uppsala University, Sweden.
    Grant, Johan
    Lund University, Sweden.
    Holmqvist, Rolf
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Review of organizational effects on the outcome of mental health treatments2018In: Psychotherapy Research, ISSN 1050-3307, E-ISSN 1468-4381, Vol. 28, no 1, p. 76-90Article, review/survey (Refereed)
    Abstract [en]

    Objective: As there are theoretical, clinical, and "common sense" reasons to expect a relationship between organizational factors and outcome in clinics providing psychotherapy and other mental health treatments, a review of empirical research in this area was undertaken with the aim of finding empirical evidence for organizational effects. Methods: A structured search for studies on organizational differences in patient mental health outcomes was performed using EBSCO host, Cochrane Library Database, and the Health Systems Evidence database at McMasters University. Finished studies published in English were included if they presented data from more than one mental health service and used change in symptom, level of functioning, or quality of life as outcome. Results: The search yielded not more than 19 studies fulfilling inclusion criteria. All studies showed some evidence for organization effects, and there was some evidence for organizational climate and culture explaining differences in outcome. Conclusion: Given that mental health treatments are likely to be especially susceptive to organizational effects, it is remarkable that not more research has been devoted to this. Clearly, more research is needed to study the consequences of work organization for the outcome of psychotherapy. Methodological issues in organizational studies are discussed.

  • 216.
    Falkenström, Fredrik
    et al.
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences. Uppsala University, Sweden.
    Hatcher, Robert L.
    CUNY, NY 10021 USA.
    Holmqvist, Rolf
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Confirmatory Factor Analysis of the Patient Version of the Working Alliance Inventory-Short Form Revised2015In: Assessment (Odessa, Fla.), ISSN 1073-1911, E-ISSN 1552-3489, Vol. 22, no 5, p. 581-593Article in journal (Refereed)
    Abstract [en]

    The working alliance concerns the quality of collaboration between patient and therapist in psychotherapy. One of the most widely used scales for measuring the working alliance is the Working Alliance Inventory (WAI). For the patient-rated version, the short form developed by Hatcher and Gillaspy (WAI-SR) has shown the best psychometric properties. In two confirmatory factor analyses of the WAI-SR, approximate fit indices were within commonly accepted norms, but the likelihood ratio chi-square test showed significant ill-fit. The present study used Bayesian structural equations modeling with zero mean and small variance priors to test the factor structure of the WAI-SR in three different samples (one American and two Swedish; N = 235, 634, and 234). Results indicated that maximum likelihood confirmatory factor analysis showed poor model fit because of the assumption of exactly zero residual correlations. When residual correlations were estimated using small variance priors, model fit was excellent. A two-factor model had the best psychometric properties. Strong measurement invariance was shown between the two Swedish samples and weak factorial invariance between the Swedish and American samples. The most important limitation concerns the limited knowledge on when the assumption of residual correlations being small enough to be considered trivial is violated.

  • 217.
    Falkenström, Fredrik
    et al.
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences. Uppsala University, Sweden.
    Hatcher, Robert L.
    CUNY, NY USA.
    Skjulsvik, Tommy
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Holmqvist Larsson, Mattias
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Holmqvist, Rolf
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Development and Validation of a 6-item Working Alliance Questionnaire for Repeated Administrations During Psychotherapy2015In: Psychological Assessment, ISSN 1040-3590, E-ISSN 1939-134X, Vol. 27, no 1, p. 169-183Article in journal (Refereed)
    Abstract [en]

    Recently, researchers have started to measure the working alliance repeatedly across sessions of psychotherapy, relating the working alliance to symptom change session by session. Responding to questionnaires after each session can become tedious, leading to careless responses and/or increasing levels of missing data. Therefore, assessment with the briefest possible instrument is desirable. Because previous research on the Working Alliance Inventory has found the separation of the Goal and Task factors problematic, the present study examined the psychometric properties of a 2-factor, 6-item working alliance measure, adapted from the Working Alliance Inventory, in 3 patient samples (ns = 1,095, 235, and 234). Results showed that a bifactor model fit the data well across the 3 samples, and the factor structure was stable across 10 sessions of primary care counseling/psychotherapy. Although the bifactor model with 1 general and 2 specific factors outperformed the 1-factor model in terms of model fit, dimensionality analyses based on the bifactor model results indicated that in practice the instrument is best treated as unidimensional. Results support the use of composite scores of all 6 items. The instrument was validated by replicating previous findings of session-by-session prediction of symptom reduction using the Autoregressive Latent Trajectory model. The 6-item working alliance scale, called the Session Alliance Inventory, is a promising alternative for researchers in search for a brief alliance measure to administer after every session.

  • 218.
    Falkenström, Fredrik
    et al.
    Karolinska Institute, Sweden; Stockholm County Council, Sweden.
    Holmqvist Larsson, Mattias
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Behavioural Sciences and Learning, Psychology.
    The Working Alliance: From Global Outcome Prediction to Micro-Analyses of Within-Session Fluctuations2017In: Psychoanalytic inquiry, ISSN 0735-1690, E-ISSN 1940-9133, Vol. 37, no 3, p. 167-178Article in journal (Refereed)
    Abstract [en]

    The working alliance, originally a psychoanalytic concept, is probably the most empirically studied psychotherapy process variable. There are many studies showing that a better alliance predicts better outcomes (e.g., Horvath et al., 2011), although the causal direction of this relationship is still debated (Barber et al., 2000; DeRubeis, Brotman, and Gibbons, 2005; Falkenstrom, Granstrom, and Holmqvist, 2013). Additionally, most of the empirical research on the working alliance is limited in clinical utility because of the relative simplicity of the research. Specifically, most empirical research on the working alliance has aimed to link patient-therapist dyads overall level of working alliance with global treatment outcomes. In actual clinical practice, therapists may be most interested in the fluctuations in the alliance from one session to the next, or even from one moment to the next within a session. There is a rich tradition in psychoanalysis of evaluating the results of therapeutic interventions by examining the patients responses. With the help of modern statistical methods, we believe the impact of a single intervention or series of interventions on factors such as working alliance, symptomatic improvement, or emotional experiences can be studied. Although this research is still in its infancy, we believe it is the future of scientific investigation of the talking cure.

  • 219.
    Falkenström, Fredrik
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Uppsala University, Sweden.
    Josefsson, Albin
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Berggren, Tore
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Holmqvist, Rolf
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    How Much Therapy Is Enough? Comparing Dose-Effect and Good-Enough Models in Two Different Settings2016In: Psychotherapy, ISSN 0033-3204, E-ISSN 1939-1536, Vol. 53, no 1, p. 130-139Article in journal (Refereed)
    Abstract [en]

    The Dose-Effect model holds that longer therapy leads to better outcome, although increasing treatment length will yield diminishing returns, as additional sessions lead to progressively less change in a negatively accelerating fashion. In contrast, the Good-Enough-Level (GEL) model proposes that patients, therapists, or patients-with-therapists decide on ending treatment when treatment outcome is satisfactory, meaning that patients who change faster will have shorter treatments. If true, this means that aggregating among patients with different treatment lengths would yield biased results. Most previous research has shown that symptom change rate depends on treatment length, but all of these studies used data from University counseling centers in the United States. There is a need to test if previous results hold in different settings. Two datasets from Swedish community-based primary care (n = 640) and psychiatric care (n = 284) were used. Patients made session-wise ratings on the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM). Multilevel models indicated better fit for a model in which treatment length moderated symptom change rate. In the primary care sample, patients in longer treatments achieved more symptom change from pre- to posttreatment, despite having slower rate of improvement. The most important aspect of the GEL model was supported, and no evidence was found for a negatively accelerating Dose-Effect curve. Results cannot be generalized beyond about 12 sessions, due to scarcity of data for longer treatments.

  • 220.
    Falkenström, Fredrik
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Kumar, Manasi
    Department of Psychiatry, University of Nairobi, Kenya; Honorary Research Fellow, Research Dept of Clinical Health and Educational Psychology, University College London, UK.
    Zahid, Aiysha
    Queen Marys College, Miles End, London, E1 4NS, UK.
    Kuria, Mary
    Department of Psychiatry, University of Nairobi, Nairobi, Kenya.
    Othieno, Caleb
    Department of Psychiatry, University of Nairobi, P.O. Box 19676, Nairobi, 00202, Kenya.
    Factor analysis of the Clinical Outcomes in Routine Evaluation - Outcome Measures (CORE-OM) in a Kenyan sample2018In: BMC Psychology, E-ISSN 2050-7283, Vol. 6, no 1, article id 48Article in journal (Refereed)
    Abstract [en]

    There is no generic psychotherapy outcome measure validated for Kenyan populations. The objective of this study was to test the acceptability and factor structure of the Clinical Outcomes in Routine Evaluation - Outcome Measure in patients attending psychiatric clinics at two state-owned hospitals in Nairobi.

  • 221.
    Falkenström, Fredrik
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Kuria, Mary
    Univ Nairobi, Kenya.
    Othieno, Caleb
    Univ Nairobi, Kenya.
    Kumar, Manasi
    Univ Nairobi, Kenya.
    Working Alliance Predicts Symptomatic Improvement in Public Hospital-Delivered Psychotherapy in Nairobi, Kenya2019In: Journal of Consulting and Clinical Psychology, ISSN 0022-006X, E-ISSN 1939-2117, Vol. 87, no 1, p. 46-55Article in journal (Refereed)
    Abstract [en]

    Objective: Although patient-therapist collaboration (working alliance) has been studied extensively in Europe and America, it is unknown to what extent the importance of working alliance for psychotherapy outcome generalizes to lower-and middle-income countries. Additionally, there is a need for more studies on the alliance using methods that are robust to confounders of its effect on outcome. Method: In this study, 345 outpatients seeking care at the 2 public psychiatric hospitals in Nairobi, Kenya, filled out the Session Alliance Inventory (SAI) and the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) during each session. The effect of alliance on next-session psychological distress was modeled using the random intercept cross-lagged panel model, which estimates a cross-lagged panel model on within- and between-subjects disaggregated data. Results: Changes in the working alliance from session to session significantly predicted change in psychological distress by the next session, with an increase of 1 point of the SAI in a given session resulting in a decrease of 1.27 points on the CORE-OM by the next session (SE = 60, 95% confidence interval [-2.44, -.10]). This finding represents a medium-sized standardized regression coefficient of between.16 and.21. Results were generally robust to sensitivity tests for stationarity, missing data assumptions, and measurement error. Conclusion: Results affirm cross-cultural stability of the session-by-session reciprocal effects model of alliance and psychological distress-symptoms as seen in a Kenyan psychiatric outpatient sample, using the latest developments in cross-lagged panel modeling. A limitation of the study is its naturalistic design and lack of control over several variables.

  • 222.
    Falkenström, Fredrik
    et al.
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Markowitz, John C.
    New York State Psychiatric and Columbia University College of Physicians and Surgeons, New York, USA.
    Jonker, Hanske
    New York State Psychiatric and Columbia University College of Physicians and Surgeons, New York, USA and University of Utrecht, Netherlands .
    Philips, Björn
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Holmqvist, Rolf
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Can psychotherapists function as their own controls? Meta-analysis of the crossed therapist design in comparative psychotherapy trials2013In: Journal of Clinical Psychiatry, ISSN 0160-6689, E-ISSN 1555-2101, Vol. 74, no 5, p. 482-491Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

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

    DATA SOURCES:

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

    STUDY SELECTION:

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

    DATA EXTRACTION:

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

    RESULTS:

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

    CONCLUSIONS:

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

  • 223.
    Falkenström, Fredrik
    et al.
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Solbakken, Ole André
    Centre for Clinical Research Sörmland, Uppsala University, Sweden.
    Möller, Clara
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Lech, Börje
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Sandell, Rolf
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Holmqvist, Rolf
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Reflective Functioning, Affect Consciousness, and Mindfulness: Are These Different Functions?2014In: Psychoanalytic psychology, ISSN 0736-9735, E-ISSN 1939-1331, Vol. 31, no 1, p. 26-40Article in journal (Refereed)
    Abstract [en]

    Aims: Concepts of mentalization, affect consciousness, and mindfulness have been increasingly emphasized as crucial in psychotherapy of diverse orientations. Different measures have been developed that purportedly measure these concepts, but little is known about their interrelationships. We discuss conceptual overlaps and distinctions between these three concepts, and present results from a preliminary empirical study comparing their measures.

    Methods: To study the relationships between these concepts, data from a group of psychotherapy students (N = 46) was used. Mentalization operationalized as Reflective Functioning (RF) was rated on transcripts of a brief version of the Adult Attachment Interview, the Five Facet Mindfulness Questionnaire (FFMQ) was used to measure mindfulness, and the Affect Consciousness Interview-Self/Other version (ACI-S/O) to measure affect consciousness.

    Results: There was a small but statistically significant relationship between RF and FFMQ, but surprisingly no relationship between AC-S/O and RF or FFMQ. A post-hoc analysis showed a relationship between consciousness of others’ affects and a reduced version of the RF scale.

    Discussion: Results confirm that mentalization and mindfulness share some  common variance, but contrary to expectations affect consciousness seems to be more different from RF and mindfulness than expected. A possible explanation for the counterintuitive finding of no relationship between RF and affect consciousness is that affect consciousness measures a mature capacity for mentalized affectivity, while RF (especially at the high end) is largely a buffer against trauma and adversity. Low or absent findings for the FFMQ are explained more in terms of different methods variance.

  • 224.
    Faria, Vanda
    et al.
    Uppsala University, Sweden; Harvard Medical Sch, MA USA.
    Gingnell, Malin
    Uppsala University, Sweden.
    Hoppe, Johanna M.
    Uppsala University, Sweden.
    Hjorth, Olof
    Uppsala University, Sweden.
    Alaie, Iman
    Uppsala University, Sweden.
    Frick, Andreas
    Uppsala University, Sweden; Karolinska Institute, Sweden.
    Hultberg, Sara
    Uppsala University, Sweden.
    Wahlstedt, Kurt
    Uppsala University, Sweden.
    Engman, Jonas
    Uppsala University, Sweden.
    Mansson, Kristoffer N. T.
    Uppsala University, Sweden; Karolinska Institute, Sweden; Stockholm University, Sweden.
    Carlbring, Per
    Stockholm University, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Reis, Margareta
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences.
    Larsson, Elna-Marie
    Uppsala University, Sweden.
    Fredrikson, Mats
    Uppsala University, Sweden; Karolinska Institute, Sweden.
    Furmark, Tomas
    Uppsala University, Sweden.
    Do You Believe It? Verbal Suggestions Influence the Clinical and Neural Effects of Escitalopram in Social Anxiety Disorder: A Randomized Trial2017In: EBioMedicine, ISSN 0360-0637, E-ISSN 2352-3964, Vol. 24, p. 179-188Article in journal (Refereed)
    Abstract [en]

    Background: Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed for depression and anxiety, but their efficacy relative to placebo has been questioned. We aimed to test how manipulation of verbally induced expectancies, central for placebo, influences SSRI treatment outcome and brain activity in patients with social anxiety disorder (SAD). Methods: Wedid a randomized clinical trial, within an academicmedical center (Uppsala, Sweden), of individuals fulfilling the DSM-IV criteria for SAD, recruited through media advertising. Participants were 18 years or older and randomized in blocks, through a computer-generated sequence by an independent party, to nine weeks of overt or covert treatment with escitalopram(20mg daily). The overt group received correct treatment information whereas the covert group was treated deceptively with the SSRI described, by the psychiatrist, as active placebo. The treating psychiatrist was necessarily unmasked while the research staff was masked from intervention assignment. Treatment efficacy was assessed primarily with the self-rated Liebowitz Social Anxiety Scale (LSASSR), administered at week 0, 1, 3, 6 and 9, also yielding a dichotomous estimate of responder status (clinically significant improvement). Before and at the last week of treatment, brain activity during an emotional face matching task was assessed with functional magnetic resonance imaging (fMRI) and during fMRI sessions, anticipatory speech anxiety was also assessed with the Spielberger State-Trait Anxiety Inventory-State version (STAI-S). Analyses included all randomized patients with outcome data at posttreatment. This study is registered at ISRCTN, number 98890605. Findings: Between March 17th 2014 and May 22nd 2015, 47 patients were recruited. One patient in the covert group dropped out after a few days of treatment and did not provide fMRI data, leaving 46 patients with complete outcome data. After nine weeks of treatment, overt (n - 24) as compared to covert (n - 22) SSRI administration yielded significantly better outcome on the LSAS-SR (adjusted difference 21.17, 95% CI 10.69-31.65, p amp;lt; 0.0001) with more than three times higher response rate (50% vs. 14%;chi(2)(1)= 6.91, p= 0.009) and twice the effect size (d= 2.24 vs. d= 1.13) from pre-to posttreatment. There was no significant between-group difference on anticipatory speech anxiety (STAI-S), both groups improving with treatment. No serious adverse reactions were recorded. On fMRI outcomes, there was suggestive evidence for a differential neural response to treatment between groups in the posterior cingulate, superior temporal and inferior frontal gyri (all z thresholds exceeding 3.68, p amp;lt;= 0.001). Reduced social anxiety with treatment correlated significantly with enhanced posterior cingulate (z threshold 3.24, p - 0.0006) and attenuated amygdala (z threshold 2.70, p - 0.003) activity. Interpretation: The clinical and neural effects of escitalopram were markedly influenced by verbal suggestions. This points to a pronounced placebo component in SSRI-treatment of SAD and favors a biopsychosocial over a biomedical explanatory model for SSRI efficacy. (C) 2017 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license.

  • 225.
    Fontler, Sebastian
    Linköping University, Department of Behavioural Sciences and Learning, Psychology.
    #Icecrown Citadel #Ulduar: En kvalitativ studie om World of Warcraft utifrån spelarnas perspektiv2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The purpose of this study is to examine the player’s experiences and perspective of the massively multiplayer online role playing game World of Warcraft. This study wants to find out the effects on the players psychological and social well-being through interviewing 10 World of Warcraft players between the ages of 18-32. This has been done through a thematic analysis. The reason behind this study is because a lot of scientific studies and the media has portrayed World of Warcraft players in a negative light where they are described as lone wolfs. This study wants to find out how the players themselves talk about the game and how it has affected their lives. The findings of this study have shown that players describe World of Warcraft as a meaningful occupation where it has given them better confidence, self-awareness, language skills, social skills but also build a social network inside the game. The social interactions that the players have with their friends have given them a platform to be open about their lives but also problems that affect them in the real world. The conclusion of this study is that the picture that a lot of the scientific studies and the media are portraying is a dishonest one. They judge players as single group where they do not look at the bigger picture or through the perspective of the World of Warcraft player.

  • 226.
    Forsberg, Camilla
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Education, Teaching and Learning. Linköping University, Faculty of Educational Sciences.
    Thornberg, Robert
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Educational Sciences.
    The social ordering of belonging: children’s perspectives on bullying2016In: International Journal of Educational Research, ISSN 0883-0355, E-ISSN 1873-538X, Vol. 78, p. 13-23Article in journal (Refereed)
    Abstract [en]

    The aim with this study was to listen to how children themselves discuss, reason on and make sense of how and why bullying emerges to extend our knowledge of what social processes that are made important among the children. As stated by Green and Hill (2005), we value children’s perspectives and want to understand their lived experience, and are motivated to “find out more about how children understand and interpret, negotiate and feel about their daily lives” (p. 3). While most studies on bullying have used quant methods, Mishna, Saini, and Solomon (2009) argue that qualitative methodologies present an opportunity for developing a deeper understanding of the group processes of bullying and participants’ perspectives on peer harassment. They are “capable of discovering important discourses and nuances” (p. 1222) that might be less visible in large-scale studies. There is a small but growing body of research on children and adolescents’ perspectives on bullying. Previous qualitative studies have revealed that children report a range of explanations as to why bullying takes place but tend to address either the victim or the bully as the cause of bullying (for a review, see Thornberg, 2011b). The victim is commonly described as deviant, odd or different, and children explain such deviant or odd characteristics or behaviour as causing the bullying (e.g., Bibou-Nakou et al., 2012; Cheng et al., 2011; Frisén, Holmqvist, & Oscarsson, 2008; Teräsahjo & Salmivalli, 2003; Thornberg, 2010, 2015a; Varjas et al., 2008). Another common explanation used among children to describe why bullying occurs addresses the bully, the bully is viewed as striving for power and status (e.g., Frisén et al., 2008; Swart & Bredekamp, 2009; Thornberg, 2010; Thornberg & Knutsen, 2011; Varjas et al., 2008), suffering from psychosocial problems, insecurity or having problems at home (e.g., Frisén et al., 2008; Thornberg, 2010; Thornberg, & Knutsen, 2011; Varjas et al, 2008), or simply being a mean or bad person (e.g., Thornberg, 2010). Further bullying explanations address  peer pressure (e.g., Erling & Hwang, 2004) and having fun and  avoiding boredom (e.g., Hamarus & Kaikkonen, 2008; Owens et al., 2000). Thornberg (2011a) suggests labelling and stigma theory as a theoretical framework to gain a deeper understanding of children’s tendency to blame the victim, where bullying is viewed as a social process manifested as an interactional pattern of inhumanity and power abuse. Bullying could also be understood as a collective action where labelling the victim as the cause justifies the social act of bullying where the bullies are constructed as the “normal us” (Thornberg, 2015). Hence, inclusion and exclusions might be viewed as ongoing processes embedded in childrens’s way to organise their peer activities (e.g., Adler & Alder, 1995; Bliding, 2004; Svahn & Evaldsson, 2011), which means that some actions might not be defined as bullying from the perspectives of the children. In this study it is therefore of interest to explore how and in what ways children discuss bullying, to extend our knowledge of what processes that are made important among the children. In our theoretical and methodological framework we therefore came to adopt a symbolic interactionist perspective and constructivist grounded theory.

  • 227.
    Forsberg, Camilla
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Education, Teaching and Learning. Linköping University, Faculty of Educational Sciences.
    Wood, Laura
    Georgia state university, USA.
    Smith, Jennifer
    Georgia state university, USA.
    Varjas, Kris
    Georgia state university, USA.
    Jungert, Tomas
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Thornberg, Robert
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Students’ views of factors affecting their bystander behaviors in response to school bullying: A cross-collaborative conceptual qualitative analysisManuscript (preprint) (Other academic)
    Abstract [en]

    The present study seeks to contribute to qualitative research on students’ perspectives on bystander behaviors to better understand their behaviors in bullying situations. Researchers have found that the prevalence of school bullying in Sweden is amongst the lowest in the world, whereas there is a much higher rate of bullying in the US (Craig et al. 2009). This in turn motivates the inclusion of a Swedish sub-sample and a US sub-sample of students in the current study, and to conduct a qualitative comparative analysis within as well as between these sub-samples. The aim of the present study was to focus on how students in Sweden and in the US articulate and discuss what factors influence their own and other students’ decisions to defend or not defend victims when witnessing bullying. We asked the following questions: How would students respond to bullying? What are students’ perceived reasons for responding in a particular way? What factors do students articulate as supporting defending or not defending in response to bullying? Across each of these questions, we aimed to identify similarities and differences between and within the students from the Swedish and US schools.

  • 228.
    Forsell, Erik
    et al.
    Karolinska Inst, Sweden; Huddinge Hosp, Sweden.
    Jernelov, Susanna
    Karolinska Inst, Sweden; Huddinge Hosp, Sweden; Karolinska Inst, Sweden.
    Blom, Kerstin
    Karolinska Inst, Sweden; Huddinge Hosp, Sweden.
    Kraepelien, Martin
    Karolinska Inst, Sweden; Huddinge Hosp, Sweden.
    Svanborg, Cecilia
    Karolinska Inst, Sweden; Huddinge Hosp, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Inst, Sweden; Huddinge Hosp, Sweden.
    Lindefors, Nils
    Karolinska Inst, Sweden; Huddinge Hosp, Sweden.
    Kaldo, Viktor
    Karolinska Inst, Sweden; Huddinge Hosp, Sweden; Linnaeus Univ, Sweden.
    Proof of Concept for an Adaptive Treatment Strategy to Prevent Failures in Internet-Delivered CBT: A Single-Blind Randomized Clinical Trial With Insomnia Patients2019In: American Journal of Psychiatry, ISSN 0002-953X, E-ISSN 1535-7228, Vol. 176, no 4, p. 315-323Article in journal (Refereed)
    Abstract [en]

    Objective: This study aimed to demonstrate proof of concept for an adaptive treatment strategy in Internet-delivered cognitive-behavioral therapy (ICBT), where risk of treatment failure is assessed early in treatment and treatment for at-risk patients is adapted to prevent treatment failure. Methods: A semiautomated algorithm assessed risk of treatment failure early in treatment in 251 patients undergoing ICBT for insomnia with therapist guidance. At-risk patients were randomly assigned to continue standard ICBT or to receive adapted ICBT. The primary outcome was self-rated insomnia symptoms using the Insomnia Severity Index in a linear mixed-effects model. The main secondary outcome was treatment failure (having neither responded nor remitted at the posttreatment assessment). Results: A total of 102 patients were classified as at risk and randomly assigned to receive adapted ICBT (N=51) or standard ICBT (N=51); 149 patients were classified as not at risk. Patients not at risk had significantly greater score reductions on the Insomnia Severity Index than at-risk patients given standard ICBT. Adapted ICBT for at-risk patients was significantly more successful in reducing symptoms compared with standard ICBT, and it decreased the risk of failing treatment (odds ratio= 0.33). At-risk patients receiving adapted ICBT were not more likely to experience treatment failure than those not at risk (odds ratio= 0.51), though they were less likely to experience remission. Adapted treatment required, on average, 14 more minutes of therapist-patient time per remaining week. Conclusions: An adaptive treatment strategy can increase treatment effects for at-risk patients and reduce the number of failed treatments. Future studies should improve accuracy in classification algorithms and identify key factors that boost the effect of adapted treatments.

  • 229.
    Forsell, Johan
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Education, Teaching and Learning. Linköping University, Faculty of Educational Sciences.
    Forslund Frykedal, Karin
    Linköping University, Department of Behavioural Sciences and Learning, Education, Teaching and Learning. Linköping University, Faculty of Educational Sciences.
    Hammar Chiriac, Eva
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Group Work Assessment: Assessing Social Skills at Group Level2019In: Small Group Research, ISSN 1046-4964, E-ISSN 1552-8278, article id UNSP 1046496419878269Article in journal (Refereed)
    Abstract [en]

    Group work assessment is often described by teachers as complex and challenging, with individual assessment and fair assessment emerging as dilemmas. The aim of this literature review is to explore and systematize research about group work assessment in educational settings. This is an integrated research area consisting of research combining group work and classroom assessment. A database search was conducted, inspired by the guidelines of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The analysis and categorization evolved into a typology consisting of five themes: (a) purpose of group work assessment, (b) what is assessed in group work, (c) methods for group work assessment, (d) effects and consequences of group work assessment, and (e) quality in group work assessment. The findings reveal that research in the field of group work assessment notably focuses on social skills and group processes. Peer assessment plays a prominent role and teachers as assessors are surprising absences in the reviewed research.

  • 230.
    Forslund Frykedal, Karin
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Education, Teaching and Learning. Linköping University, Faculty of Educational Sciences.
    Barimani, Mia
    Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Stockholm, Sweden.
    Rosander, Michael
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Berlin, Anita
    Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Huddinge, Sweden.
    ”I Didn’T Fit In” – Reasons For Not Attending Parental Education Groups In Antenatal And Child Health Care2019In: The 21st Congress of the Nordic Federation of Midwives - Midwifery Across Borders - in Reykjavik, Iceland, 2-4 May 2019, 2019Conference paper (Refereed)
    Abstract [en]

    Background – In Sweden expectant and new parents are offered parental education groups (PE) during pregnancy in Antenatal Care (AC) and after delivery in Child health Care (CHC) with the goal of preparing for childbirth and parenthood. Parents also seek information from  other sources such as the webb and magazines to gain information. Nevertheless, many parents feel unprepared for parenthood. During pregnancy and the time closest to childbirth is an important part of the transition to parenting and parents are very receptive to advice and information. To gain more knowledge about parents’ participation in PE the aim of this study was to explore expectant and new parents’ reasons to participate or not participate in PE.

     

    Method – A web questionnaire including open questions was answered by 915 parents with children aged 0 to 21 months. Open questions about (a) reasons to not participate, (b) anything that could change their mind and (c) parenting support instead of the PE was analyses using content analysis.

     

    Findings – The parents expressed reasons not to attend on an individual, group and organizational level. At an individual level they expressed personal reasons or that they had other forms of support. When it came to the group level the parents asked for more heterogeneity and openness regarding both the groups’ content and methods, not excluding parents and that parents’ different interests could be accommodated within the group. Reasons for not attending PE at organizational level were due to lack of information or invitation from AC or CHC, or that  PE was not available.

     

    Conclusion

    Parents ask for more nonconformity and diversity in PE. Despite of different approaches or attitudes all parents should be able to feel included in a way that would be relevant for them to participate in PE.

     

  • 231.
    Forslund Frykedal, Karin
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Education, Teaching and Learning. Linköping University, Faculty of Educational Sciences. Univ West, Sweden.
    Barimani, Mia
    Karolinska Inst, Sweden.
    Rosander, Michael
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Berlin, Anita
    Karolinska Inst, Sweden.
    Parents reasons for not attending parental education groups in antenatal and child health care: A qualitative study2019In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 28, no 17-18, p. 3330-3338Article in journal (Refereed)
    Abstract [en]

    Aims and objectives To explore expectant and new parents reasons not to participate in parental education (PE) groups in antenatal care or child health care. Background In Sweden, expectant and new parents are offered PE groups in antenatal care and in child health care. Although many parents feel unprepared for parenthood, an urgent task is to attract parents to attend the PE groups. Design A total of 915 parents with children aged 0 to 21 months answered a web questionnaire with open questions about (a) reasons not to participate; (b) anything that could change their mind; and (c) parenting support instead of PE groups. This was analysed using content analysis. The study follows the SRQR guidelines. Results Parents expressed private reasons for not attending PE groups. Some parents also asked for more heterogeneity regarding content and methods, as well as accommodation of parents different interests. Other parents asked for like-minded individuals who were in similar situation to themselves. Lack of information or invitations from antenatal care or child health care, or that PE groups were unavailable, were additional reasons for not participating in groups. Conclusions Reasons for not attending PE groups were multifaceted from personal, self-interested and norm-critical reasons, to that the groups were not available or that the parents were not aware of their existence. Relevance to clinical practice Parents of today are a diverse group with different interests and needs. Nevertheless, all parents need to feel included in a way that makes participation in PE groups relevant for them. Thus, it is important for leaders to be aware of structures and norms, and to be able to create a group climate and a pedagogy of acceptance where group members value each others differences. However, to attract parents to participate in PE groups, it is necessary for clinical practice to work on individual, group and organisational levels.

  • 232.
    Forslund Frykedal, Karin
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Education, Teaching and Learning. Linköping University, Faculty of Educational Sciences.
    Hammar Chiriac, Eva
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Group work management in the classroom2014In: Scandinavian Journal of Educational Research, ISSN 0031-3831, E-ISSN 1470-1170, Vol. 58, no 2, p. 222-234Article in journal (Refereed)
    Abstract [en]

    This study aims to provide a better understanding of teachers’ managing roles when using group work in the classroom. Building on Granström’s (2007) two concepts of leadership and teachership, a more specific aim is to investigate teachers’ managing roles when using group work and how teachers’ presumptions affect the way in which they manage the pedagogical mode. The results show that teachers’ managing roles influence teachers’ willingness to use group work. Teachers may be unwilling to use group work based on their presumption that it teaches students only collaboration abilities and not subject knowledge. This may be a supplemental yet significant explanation as to why group work continues to decrease in classrooms.

     

  • 233.
    Forslund Frykedal, Karin
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Education, Teaching and Learning. Linköping University, Faculty of Educational Sciences.
    Hammar Chiriac, Eva
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Läraren som arbetsledare vid grupparbete i klassrummet2011In: The individual and the group - Future chalanges: Proceedings from the 7th GRASP conference, University of Gothenburg, May 2010 / [ed] Christian Jacobsson & Max Rapp Ricciardi, Göteborg: University of Gothenburg , 2011, p. 8-18Conference paper (Other academic)
    Abstract [en]

    The main purpose of this paper is to increase and deepen the knowledge about teacher’s management of group work in the classroom. A more specific aim is to create and present a model illustrating different possible ways for teachers’ management appropriate for group work. The result shows that it is beneficial, but not sufficient, to use the two concepts leadership and teachership, to create a complete model. To ascertain a complete model it is also necessary to pay attention to the teachers’ considerations, which play a decisive influence on teachers’ willingness to use group work. By combining leadership, teachership and considerations it was possible to create and present a model of four possible ways for teachers’ management pertaining group work.

  • 234.
    Forslund Frykedal, Karin
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Education, Teaching and Learning. Linköping University, Faculty of Arts and Sciences.
    Hammar Chiriac, Eva
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Student collaboration in group work - Inclusion as active participation2017Conference paper (Refereed)
    Abstract [en]

    Group work is an educational mode that promotes both learning and socialization among students, and students’ engagement and participation in the group work has proven to be important. Empirical research conducted on the implementation of inclusive and collaborative processes in group work is sparse. Based on social psychological perspective we will in this study focus on inclusive and collaborative processes when students are working in small groups.

     

    The aim of the study was to investigate and describe students’ inclusive and collaborative processes in group work and how the teacher supports or impedes these transactions.

     

    Social Interdependence Theory (Johnson & Johnson, 2002), one of the dominant influences on Cooperative learning, was utilized as the theoretical perspective overarching the study. Data were obtained through observations made from video-recording 500 minutes of group work undertaken in one Year 5 classroom at a municipal school in Sweden and were analysed using thematic analysis (Braun & Clark, 2006). Part of Black-Hawkins (2010, 2013) framework of participation was used to define inclusion and for the analysis of inclusive and collaborative processes.

     

    The results suggest that students’ active participation in the analytical discussions around the group task and discussions around group work structures, together with the teacher’s more defined feedback and avoidance of the traditional authoritative role are examples on prerequisites for group work to be enacted in an inclusive and collaborative manner. These prerequisites give the students opportunities to be accountable both for the individual and the group’s collective work. 

  • 235.
    Forslund Frykedal, Karin
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Education, Teaching and Learning. Linköping University, Faculty of Educational Sciences.
    Hammar Chiriac, Eva
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Student Collaboration in Group Work: Inclusion as Participation2018In: International journal of disability, development and education, ISSN 1034-912X, E-ISSN 1465-346X, no 2, p. 183-198Article in journal (Refereed)
    Abstract [en]

    Group work is an educational mode that promotes learning and socialisation among students. In this study, we focused on the inclusive processes when students work in small groups. The aim was to investigate and describe students’ inclusive and collaborative processes in group work and how the teacher supported or impeded these transactions. Social Interdependence Theory was utilised as the theoretical perspective overarching the study. The observational data employed were collected by video-recording group work. A part of Black-Hawkins framework of participation was used to define inclusion and for the analysis of inclusive and collaborative processes. The results suggest that students’ active participation in the discussions around the group work structures and analytical discussions, together with the teacher’s more defined feedback and avoidance of the traditional authoritative role, are examples of prerequisites for group work to be enacted in an inclusive manner.

  • 236.
    Forslund Frykedal, Karin
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Education, Teaching and Learning. Linköping University, Faculty of Educational Sciences.
    Hammar Chiriac, Eva
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    To make the unknown known: assessment in group work amongst students2016In: Student learning: assessment, perceptions and strategies / [ed] Dale Bowen, Nova Science Publishers, Inc., 2016, 1, p. 61-79Chapter in book (Other academic)
  • 237.
    Forslund Frykedal, Karin
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Education, Teaching and Learning. Linköping University, Faculty of Educational Sciences.
    Rosander, Michael
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    The role as moderator and mediator in parent education groups - a leadership and teaching approach model from a parent perspective2015In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 24, no 13-14, p. 1966-1974Article in journal (Refereed)
    Abstract [en]

    Aims and objectives. To investigate the didactic and social leadership in parent education groups based on a parent perspective, and to conceptualize parent experiences of the leader roles in these groups.

    Background.  Leadership in parent education groups has been associated with a lack of confidence in one's ability to function in that role. Research on how it can be delivered to produce a favourable outcome is scarce. It can be difficult to abandon the role of expert and let participants set their own learning agenda. To facilitate these processes requires leadership skills, knowledge of group dynamics, as well as pedagogical skills.

    Design.  Qualitative interview study.

    Methods. Semi-structured interviews with parents (25 participants, 21 interviews). Transcripts were analysed using, first, thematic analysis, then comparative analysis.

    Results.  The study resulted in a four-field model, The Leadership – Teaching Approach model. It consists of the dimensions "Teaching approaches" ("Knowledge is imparted" and "Knowledge is jointly constructed "), and "Leadership approaches" ("Instrumental approach" and "Investigative approach").

    Conclusions. Using an investigative approach is necessary in order to get a well-functioning group that can help the expectant and new parents in the transition to parenthood. Supervision can help develop an awareness of one's professional role as a nurse and leader of a parent education group.

    Relevance to clinical practice.  The actions and choices of nurses as leaders of parent groups have an impact on how the participants perceive and take in the content and purpose of the group, and whether they perceive it as meaningful. Getting support in reflecting about one’s role as a leader in this context can help create a learning environment in which the participants can become engaged in the activities and be strengthened by the experience. 

  • 238.
    Forslund Frykedal, Karin
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Education, Teaching and Learning. Linköping University, Faculty of Educational Sciences.
    Rosander, Michael
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Barimani, Mia
    Karolinska Institutet, Solna, Sweden.
    Berlin, Anita
    Karolinska Institutet, Solna, Sweden.
    Leaders limitations and approaches to creating conditions for interaction and communication in parental groups: A qualitative study2019In: Journal of Child Health Care, ISSN 1367-4935, E-ISSN 1741-2889, Vol. 23, no 1, p. 147-159Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to describe and understand parental group (PG) leaders experiences of creating conditions for interaction and communication. The data consisted of 10 interviews with 14 leaders. The transcribed interviews were analysed using thematic analysis. The results showed that the leaders ambition was to create a parent-centred learning environment by establishing conditions for interaction and communication between the parents in the PGs. However, the leaders experience was that their professional competencies were insufficient and that they lacked pedagogical tools to create constructive group discussions. Nevertheless, they found other ways to facilitate interactive processes. Based on their experience in the PG, the leaders constructed informal socio-emotional roles for themselves (e.g. caring role and personal role) and let their more formal task roles (e.g. professional role, group leader and consulting role) recede into the background, so as to remove the imbalance of power between the leaders and the parents. They believed this would make the parents feel more confident and make it easier for them to start communicating and interacting. This personal approach places them in a vulnerable position in the PG, in which it is easy for them to feel offended by parents criticism, questioning or silence.

  • 239.
    Forslund Frykedal, Karin
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Education, Teaching and Learning. Linköping University, Faculty of Educational Sciences.
    Rosander, Michael
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Berlin, Anita
    Karolinska Institutet, Neurobiologi, Vårdvetenskap och Samhälle (NVS), Sektionen för omvårdnad.
    Barimani, Mia
    Karolinska Institutet, Division for Reproductive Health, Women's and Children's Health.
    With or without the group: Swedish midwives' and child healthcare nurses' experiences in leading parent education groups2016In: Health Promotion International, ISSN 0957-4824, E-ISSN 1460-2245, Vol. 31, no 4, p. 899-907Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to describe and to understand midwives’ and child health care nurses’ experiences of working with parent education groups through their descriptions of the role and what they find rewarding and challenging in that work. Data were collected through three open-ended questions from a web survey: “How do you refer to your role when working in parent education?” “What is the biggest challenge or difficulty for you when working in parent education?” and “What is most rewarding when working in parent education?” The answers were analysed by using qualitative content analysis and correlation analysis. The results show that the midwives and child health care nurses either included or excluded the group when describing their role as leaders and their influence on parents. The same applies to what they found rewarding and what was difficult and challenging for them in working with the groups. Primarily, the leaders who excluded the group expressed a lack of competence on a professional level in managing groups and using the right teaching methods to process the knowledge content. One important question to deal with is how to best support midwives and nurses in child health care to be prepared for working with parent education groups. One obvious thing is to provide specialized training in an educational sense. An important aspect could also be providing supervision, individually or in groups.

  • 240.
    Forsstrom, David
    et al.
    Stockholm University, Sweden.
    Hesser, Hugo
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Carlbring, Per
    Stockholm University, Sweden.
    Usage of a Responsible Gambling Tool: A Descriptive Analysis and Latent Class Analysis of User Behavior2016In: Journal of Gambling Studies, ISSN 1050-5350, E-ISSN 1573-3602, Vol. 32, no 3, p. 889-904Article in journal (Refereed)
    Abstract [en]

    Gambling is a common pastime around the world. Most gamblers can engage in gambling activities without negative consequences, but some run the risk of developing an excessive gambling pattern. Excessive gambling has severe negative economic and psychological consequences, which makes the development of responsible gambling strategies vital to protecting individuals from these risks. One such strategy is responsible gambling (RG) tools. These tools track an individuals gambling history and supplies personalized feedback and might be one way to decrease excessive gambling behavior. However, research is lacking in this area and little is known about the usage of these tools. The aim of this article is to describe user behavior and to investigate if there are different subclasses of users by conducting a latent class analysis. The user behaviour of 9528 online gamblers who voluntarily used a RG tool was analysed. Number of visits to the site, self-tests made, and advice used were the observed variables included in the latent class analysis. Descriptive statistics show that overall the functions of the tool had a high initial usage and a low repeated usage. Latent class analysis yielded five distinct classes of users: self-testers, multi-function users, advice users, site visitors, and non-users. Multinomial regression revealed that classes were associated with different risk levels of excessive gambling. The self-testers and multi-function users used the tool to a higher extent and were found to have a greater risk of excessive gambling than the other classes.

  • 241.
    Forsström, D.
    et al.
    Department of Psychology, Stockholm University, Stockholm, Sweden.
    Jansson-Fröjmark, M.
    Department of Psychology, Stockholm University, Stockholm, Sweden; Centre for Psychiatry Research, Department of Clinical Neuroscience, Stockholm, Sweden.
    Hesser, Hugo
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Carlbring, P.
    Department of Psychology, Stockholm University, Stockholm, Sweden.
    Experiences of Playscan: Interviews with users of a responsible gambling tool2017In: Internet Interventions, ISSN 2214-7829, Vol. 8, p. 53-62Article in journal (Refereed)
    Abstract [en]

    Online gambling, encompassing a wide variety of activities and around-the-clock access, can be a potential risk factor for gamblers who tend to gamble excessively. Yet, the advent of online gambling has enabled responsible gambling (RG) features that may help individuals to limit their gambling behaviour. One of these features is RG tools that track gamblers’ behaviour, performs risk assessments and provides advice to gamblers. This study investigated users’ views and experiences of the RG tool Playscan from a qualitative perspective using a semi-structured interview. The tool performs a risk assessment on a three-step scale (low, medium and high risk). Users from every risk category were included. Twenty interviews were carried out and analysed using thematic analysis. Two main themes with associated sub-themes were identified: “Usage of Playscan and the gambling site” and “Experiences of Playscan”. Important experiences in the sub-themes were lack of feedback from the tool and confusion when signing up to use Playscan. These experiences counteracted positive attitudes that should have promoted usage of the tool. Providing more feedback directly to users is a suggested solution to increase usage of the RG tool. © 2017 The Authors

  • 242.
    Frankl, My
    et al.
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences. Stockholm Centre Dependency Disorders, Sweden.
    Philips, Björn
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Stockholm Centre Dependency Disorders, Sweden; Karolinska Institute, Sweden.
    Berggraf, Lene
    Research Institute, Norway.
    Ulvenes, Pal
    Research Institute, Norway.
    Johansson, Robert
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Wennberg, Peter
    Stockholm University, Sweden; Karolinska Institute, Sweden.
    Psychometric properties of the Affect Phobia Test2016In: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450, Vol. 57, no 5, p. 482-488Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to make the first evaluation of the psychometric properties of the Affect Phobia Test, using the Swedish translation - a test developed to screen the ability to experience, express and regulate emotions. Data was collected from a clinical sample (N=82) of patients with depression and/or anxiety participating in randomized controlled trial of Internet-based affect-focused treatment, and a university student sample (N=197). The internal consistency for the total score was satisfactory (Clinical sample =0.88/Student sample =0.84) as well as for all the affective domains, except Anger/Assertion (=0.44/0.36), Sadness/Grief (=0.24/0.46) and Attachment/Closeness (=0.67/0.69). Test retest reliability was satisfactory (ICCamp;gt;0.77) for the total score and for all the affective domains except for Sadness/Grief (ICC=0.04). The exploratory factor analysis resulted in a six-factor solution and did only moderately match the tests original affective domains. An empirical cut-off between the clinical and the university student sample were calculated and yielded a cut-off of 72 points. As expected, the Affect Phobia test showed negative significant correlations in the clinical group with measures on depression (r(xy)=-0.229; pamp;lt;0.01) and anxiety (r(xy)=-0.315; pamp;lt;0.05). The conclusion is that the psychometric properties are satisfactory for the total score of the Affect Phobia Test but not for some of the tests affective domains. Consequently the domains should not be used as subscales. The test can discriminate between individuals who seek help for psychological problems and those who do not.

  • 243.
    Frankl, My
    et al.
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Philips, Björn
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institutet, Stockholm, Sweden.
    Wennberg, Peter
    Stockholm University, Stockholm, Sweden.
    Psychotherapy role expectations and experiences - Discrepancy and therapeutic alliance among patients with substance use disorders2014In: Psychology and Psychotherapy: Theory, Research and Practice, ISSN 1476-0835, E-ISSN 2044-8341, Vol. 87, no 4, p. 411-424Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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

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

  • 244.
    Frodlund, Martina
    et al.
    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.
    Reid, S.
    Uppsala Univ, Sweden.
    Wetterö, Jonas
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Dahlström, Örjan
    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.
    Leonard, D.
    Uppsala Univ, Sweden.
    The majority of Swedish systemic lupus erythematosus patients are still affected by irreversible organ impairment: factors related to damage accrual in two regional cohorts2019In: Lupus, ISSN 0961-2033, E-ISSN 1477-0962, article id UNSP 0961203319860198Article in journal (Refereed)
    Abstract [en]

    Background Although the survival of patients with systemic lupus erythematosus (SLE) has improved, irreversible organ damage remains a critical concern. We aimed to characterize damage accrual and its clinical associations and causes of death in Swedish patients. Methods Accumulation of damage was evaluated in 543 consecutively recruited and well-characterized cases during 1998-2017. The Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology damage index (SDI) was used to estimate damage. Results Organ damage (SDI amp;gt;= 1) was observed in 59%, and extensive damage (SDI amp;gt;= 3) in 25% of cases. SDI amp;gt;= 1 was significantly associated with higher age at onset, SLE duration, the number of fulfilled SLICC criteria, neurologic disorder, antiphospholipid antibody syndrome (APS), hypertension, hyperlipidemia, depression and secondary Sjogrens syndrome (SS). In addition, SDI amp;gt;= 3 was associated with serositis, renal and haematological disorders and interstitial lung disease. A multiple regression model identified not only well-known risk factors like APS, antihypertensives and corticosteroids, but pericarditis, haemolytic anaemia, lymphopenia and myositis as being linked to SDI. Malignancy, infection and cardiovascular disease were the leading causes of death. Conclusions After a mean SLE duration of 17 years, the majority of todays Swedish SLE patients have accrued damage. We confirm previous observations and report some novel findings regarding disease phenotypes and damage accrual.

  • 245.
    Frölander, Hans Erik
    et al.
    Linköping University, The Swedish Institute for Disability Research. Örebro University; Örebro University Hospital, Sweden.
    Möller, Claes
    Linköping University, The Swedish Institute for Disability Research. Örebro University; Örebro University Hospital, Sweden.
    Marshall, Jan D.
    Jackson laboratory, Bar Harbor, ME, USA.
    Sundqvist, Anett
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research.
    Rönnåsen, Berit
    Linköping University, The Swedish Institute for Disability Research. Örebro University; Örebro University Hospital, Sweden.
    Falkensson, Lil
    National Resource Centre, Lund, Sweden.
    Lyxell, Björn
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping.
    Theory-of-mind in adolescents and young adults with Alström syndrome2014In: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, E-ISSN 1872-8464, Vol. 78, no 3, p. 530-536Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    The study focuses on theory-of-mind in adolescents and young adults with Alström syndrome (ALMS). ALMS, an autosomal recessive syndrome causes juvenile blindness, sensorineural hearing loss, cardiomyopathy, endocrinological disorders and metabolic dysfunction. Theory-of-mind (ToM) refers to the ability to impute mental states to one self and to others. Clinical observations have revealed an increased occurrence of deviances in mental state understanding in ALMS. In the present study ToM will be examined and related to working memory (WM), verbal ability and sensory loss.

    METHODS:

    Twelve young individuals (16-37 years) with ALMS and 24 nondisabled individuals matched on age, gender and educational level participated. ToM was assessed by means of a multiple task that taxes the ability to understand thoughts and feelings of story characters'. WM was examined by means of a reading span task and verbal ability by means of a vocabulary test.

    RESULTS:

    The ALMS group performed at significantly lower levels in ToM tasks and displayed a higher variability in performance than the control group. Individuals with ALMS and a relatively poor level performance provided fewer correct mental state inferences in ToM tasks than ALMS individuals with relatively higher performance levels. ALMS individuals with relatively high performance levels made as many correct inferences in ToM tasks as the control group, but their inferences were more often incomplete. Vocabulary skills and educational level, but not WM-capacity predicted ToM performance. Degree of deafblindness did not have an impact on ToM. Age of onset of visual loss but not hearing loss related to ToM.

    CONCLUSIONS:

    The individuals with ALMS display a high degree of heterogeneity in terms of ToM, where some individuals reached performance levels comparable to nondisabled individuals. The results are discussed with respect to how cognitive and verbal abilities and factors related to the disability affect ToM.

  • 246.
    Furukawa, Toshi A.
    et al.
    Kyoto University, Japan.
    Weitz, Erica S.
    Vrije University of Amsterdam, Netherlands.
    Tanaka, Shiro
    Kyoto University, Japan.
    Hollon, Steven D.
    Vanderbilt University, TN USA.
    Hofmann, Stefan G.
    Boston University, MA USA.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden.
    Twisk, Jos
    Vrije University of Amsterdam, Netherlands.
    DeRubeis, Robert J.
    University of Penn, PA USA; University of Leipzig, Germany.
    Dimidjian, Sona
    University of Colorado Boulder, CO USA.
    Hegerl, Ulrich
    Mergl, Roland
    University of Texas Southwest Medical Centre, TX USA.
    Jarrett, Robin B.
    The University of Texas Southwestern Medical Center, Dallas, Texas, USA.
    Vittengl, Jeffrey R.
    Truman State University, Kirksville, Missouri, USA.
    Watanabe, Norio
    Truman State University, MO USA; Kyoto University, Japan.
    Cuijpers, Pim
    Vrije University of Amsterdam, Netherlands.
    Initial severity of depression and efficacy of cognitive-behavioural therapy: individual-participant data meta-analysis of pill-placebo-controlled trials2017In: British Journal of Psychiatry, ISSN 0007-1250, E-ISSN 1472-1465, Vol. 210, no 3, p. 190-196Article, review/survey (Refereed)
    Abstract [en]

    Background The influence of baseline severity has been examined for antidepressant medications but has not been studied properly for cognitive behavioural therapy (CBT) in comparison with pill placebo. Aims To synthesise evidence regarding the influence of initial severity on efficacy of CBT from all randomised controlled trials (RCTs) in which CBT, in face-to-face individual or group format, was compared with pill-placebo control in adults with major depression. Method A systematic review and an individual-participant data meta-analysis using mixed models that included trial effects as random effects. We used multiple imputation to handle missing data. Results We identified five RCTs, and we were given access to individual-level data (n=509) for all five. The analyses revealed that the difference in changes in Hamilton Rating Scale for Depression between CBT and pill placebo was not influenced by baseline severity (interaction P=0.43). Removing the non-significant interaction term from the model, the difference between CBT and pill placebo was a standardised mean difference of 0.22 (95% CI 0.42 to 0.02, P=0.03, l(2)=0%). Conclusions Patients suffering from major depression can expect as much benefit from CBT across the wide range of baseline severity. This finding can help inform individualised treatment decisions by patients and their clinicians.

  • 247.
    Fälth, Linda
    et al.
    Linnaeus University, Växjö, Sweden.
    Gustafson, Stefan
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Educational Sciences.
    Tjus, Tomas
    University of Gothenburg, Sweden.
    Heimann, Mikael
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Svensson, Idor
    Linnaeus University, Växjö, Sweden.
    Computer-assisted Interventions Targeting Reading Skills of Children with Reading Disabilities - A Longitudinal Study2013In: Dyslexia, ISSN 1076-9242, E-ISSN 1099-0909, Vol. 19, no 1, p. 37-53Article in journal (Refereed)
    Abstract [en]

    The purpose of the present study was to examine the effects of three computerized interventionson the reading skills of children with reading disabilities in Grade 2. This longitudinalintervention study included five test sessions over 1 year. Two test points occur before theintervention, and three afterwards. The last follow-up was conducted 1 year after the firstmeasurement. One hundred thirty children in Grade 2 participated in the study. Threegroups of children with reading difficulties received computerized training programmes: oneaimed at improving word decoding skills and phonological abilities, the second focused on wordand sentence levels and the third was a combination of these two training programmes. A fourthgroup received ordinary special instruction. In addition, there was one comparison group withage-matched typical readers. All groups improved their reading skills. The group that receivedcombined training showed greater improvement than the one with ordinary special instructionand the group of typical readers at two follow-ups. The longitudinal results indicate additionalpositive results for the group that received the combined training, themajority of students fromthat group being no longer judged to be needing special education 1 year after the intervention.

  • 248.
    Gavin, Jacob
    et al.
    Linköping University.
    Hammarbäck, Jimmy
    Linköping University.
    Hammarbäck, Madeleine
    Linköping University.
    Helmersson, Benjamin
    Linköping University.
    Nyberg, Martina
    Linköping University.
    Svensson, Cassandra
    Linköping University.
    Foo, Jody
    Linköping University, Department of Computer and Information Science, Human-Centered systems. Linköping University, Faculty of Science & Engineering.
    Koch, Felix-Sebastian
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    An eye-tracking study on the importance of consistent terminology2014In: Proceedings of the Fifth Swedish Language Technology Conference (SLTC-14), 2014Conference paper (Refereed)
    Abstract [en]

    Using inconsistent terminology, e.g. having different terms in documentation and e.g. labels and menu items in a user interface is believed to be confusing to users. However, few empirical studies exist on this particular topic. In this paper we show how users' interaction with an interface is affected by inconsistent terminology. An experimental eye-tracking study with 30 participants was conducted where the participants were shown a user interface and a task description. The terminology in the interface and task description was manipulated to be either consistent or inconsistent. The results show that terminological inconsistencies led to a significantly higher number of visual fixations, more time needed to perform the task, and more returns to the task description. The conclusion is that inconsistent use of terms create unnecessary cognitive workload for the user that can be avoided by ensuring terminological consistency within a system.

  • 249.
    Genevsky, Alexander
    et al.
    Stanford University, CA USA .
    Västfjäll, Daniel
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Slovic, Paul
    Decis Research, OR USA .
    Knutson, Brian
    Stanford University, CA USA .
    Neural Underpinnings of the Identifiable Victim Effect: Affect Shifts Preferences for Giving2013In: Journal of Neuroscience, ISSN 0270-6474, E-ISSN 1529-2401, Vol. 33, no 43, p. 17188-17196Article in journal (Refereed)
    Abstract [en]

    The "identifiable victim effect" refers to peoples tendency to preferentially give to identified versus anonymous victims of misfortune, and has been proposed to partly depend on affect. By soliciting charitable donations from human subjects during behavioral and neural (i.e., functional magnetic resonance imaging) experiments, we sought to determine whether and how affect might promote the identifiable victim effect. Behaviorally, subjects gave more to orphans depicted by photographs versus silhouettes, and their shift in preferences was mediated by photograph-induced feelings of positive arousal, but not negative arousal. Neurally, while photographs versus silhouettes elicited activity in widespread circuits associated with facial and affective processing, only nucleus accumbens activity predicted and could statistically account for increased donations. Together, these findings suggest that presenting evaluable identifiable information can recruit positive arousal, which then promotes giving. We propose that affect elicited by identifiable stimuli can compel people to give more to strangers, even despite costs to the self.

  • 250.
    Geraghty, Adam W. A.
    et al.
    University of Southampton, England.
    Essery, Rosie
    University of Southampton, England.
    Kirby, Sarah
    University of Southampton, England.
    Stuart, Beth
    University of Southampton, England.
    Turner, David
    University of East Anglia, England.
    Little, Paul
    University of Southampton, England.
    Bronstein, Adolfo
    Imperial Coll London, England.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden.
    Carlbring, Per
    Stockholm University, Sweden.
    Yardley, Lucy
    University of Southampton, England; University of Oxford, England.
    Internet-Based Vestibular Rehabilitation for Older Adults With Chronic Dizziness: A Randomized Controlled Trial in Primary Care2017In: Annals of family medicine (online), ISSN 1544-1709, E-ISSN 1544-1717, Vol. 15, no 3, p. 209-216Article in journal (Refereed)
    Abstract [en]

    PURPOSE Vestibular rehabilitation is an effective intervention for dizziness due to vestibular dysfunction, but is seldom provided. We aimed to determine the effectiveness of an Internet-based vestibular rehabilitation program for older adults experiencing dizziness in primary care. METHODS We undertook a single-center, single-blind randomized controlled trial comparing an Internet-based vestibular rehabilitation intervention (Balance Retraining, freely available from https://balance. lifeguidehealth. org) with usual primary care in patients from 54 primary care practices in southern England. Patients aged 50 years and older with current dizziness exacerbated by head movements were enrolled. Those in the intervention group accessed an automated Internet-based program that taught vestibular rehabilitation exercises and suggested cognitive behavioral management strategies. Dizziness was measured by the Vertigo Symptom Scale-Short Form (VSS-SF) at baseline, 3 months, and 6 months. The primary outcome was VSS-SF score at 6 months. RESULTS A total of 296 patients were randomized in the trial; 66% were female, and the median age was 67 years. The VSS-SF was completed by 250 patients (84%) at 3 months and 230 patients (78%) at 6 months. Compared with the usual care group, the Internet-based vestibular rehabilitation group had less dizziness on the VSS-SF at 3 months (difference, 2.75 points; 95% CI, 1.39-4.12; P amp;lt; . 001) and at 6 months (difference, 2.26 points; 95% CI, 0.39-4.12; P =.02, respectively). Dizziness-related disability was also lower in the Internet-based vestibular rehabilitation group at 3 months (difference, 6.15 points; 95% CI, 2.81-9.49; P amp;lt;. 001) and 6 months (difference, 5.58 points; 95% CI, 1.19-10.0; P =.01). CONCLUSIONS Internet-based vestibular rehabilitation reduces dizziness and dizziness-related disability in older primary care patients without requiring clinical support. This intervention has potential for wide application in community settings.

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