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  • 301.
    Hedman, Erik
    et al.
    Karolinska Institute, Sweden; Karolinska Institute, Sweden.
    Lekander, Mats
    Karolinska Institute, Sweden; Stockholm University, Sweden.
    Ljotsson, Brjann
    Karolinska Institute, Sweden.
    Lindefors, Nils
    Karolinska Institute, Sweden.
    Ruck, Christian
    Karolinska Institute, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden.
    Andersson, Erik
    Karolinska Institute, Sweden; Karolinska Institute, Sweden.
    Optimal Cut-Off Points on the Health Anxiety Inventory, Illness Attitude Scales and Whiteley Index to Identify Severe Health Anxiety2015In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 4, p. e0123412-Article in journal (Refereed)
    Abstract [en]

    Background Health anxiety can be viewed as a dimensional phenomenon where severe health anxiety in form of DSM-IV hypochondriasis represents a cut-off where the health anxiety becomes clinically significant. Three of the most reliable and used self-report measures of health anxiety are the Health Anxiety Inventory (HAI), the Illness Attitude Scales (IAS) and the Whiteley Index (WI). Identifying the optimal cut-offs for classification of presence of a diagnosis of severe health anxiety on these measures has several advantages in clinical and research settings. The aim of this study was therefore to investigate the HAI, IAS and WI as proximal diagnostic instruments for severe health anxiety defined as DSM-IV hypochondriasis. Methods We investigated sensitivity, specificity and predictive value on the HAI, IAS and WI using a total of 347 adult participants of whom 158 had a diagnosis of severe health anxiety, 97 had obsessive-compulsive disorder and 92 were healthy non-clinical controls. Diagnostic assessments were conducted using the Anxiety Disorder Interview Schedule. Results Optimal cut-offs for identifying a diagnosis of severe health anxiety was 67 on the HAI, 47 on the IAS, and 5 on the WI. Sensitivity and specificity were high, ranging from 92.6 to 99.4%. Positive and negative predictive values ranged from 91.6 to 99.4% using unadjusted prevalence rates. Conclusions The HAI, IAS and WI have very good properties as diagnostic indicators of severe health anxiety and can be used as cost-efficient proximal estimates of the diagnosis.

  • 302.
    Hedman, Erik
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Lekander, Mats
    Karolinska Institutet, Stockholm, Sweden.
    Ljótsson, Brjánn
    Karolinska Institutet, Stockholm, Sweden.
    Lindefors, Nils
    Karolinska Institutet, Stockholm, Sweden.
    Rück, Christian
    Karolinska Institutet, Stockholm, Sweden.
    Hofmann, Stefan G
    Boston University, MA, USA.
    Andersson, Erik
    Karolinska Institutet, Stockholm, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institutet, Stockholm, Sweden.
    Schulz, Stefan M
    University of Würzburg, Germany.
    Sudden gains in internet-based cognitive behaviour therapy for severe health anxiety2014In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 54, p. 22-29Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: A sudden gain is defined as a large and stable individual improvement occurring between two consecutive treatment sessions. Sudden gains have been shown to predict better long-term improvement in several treatment studies, including cognitive behavioural therapy for depression and anxiety disorders, but have not been studied in the treatment of health anxiety or any form of internet-based cognitive behavioural therapy. The aim of this study was to investigate the role of sudden gains in internet-based cognitive behavioural therapy for severe health anxiety.

    METHOD: We examined the occurrence and significance of sudden gains in measures of health anxiety in 81 participants receiving internet-based cognitive behavioural therapy. We compared patients with sudden gains, patients without sudden gains, and patients with gradual gains.

    RESULTS: Thirteen participants (16%) experienced one sudden gain in health anxiety with individual sudden gains distributed across the treatment. As expected, patients with a sudden gain showed larger improvements than patients without a sudden gain at post-treatment (d = 1.04) and at one-year follow-up (d = 0.91) on measures of health anxiety.

    CONCLUSIONS: Consistent with previous studies, sudden gains in internet-based cognitive behavioural therapy are associated with significantly larger and stable treatment effects up to one-year follow-up.

  • 303.
    Hedman, Erik
    et al.
    Karolinska Institute, Sweden .
    Lindefors, Nils
    Karolinska Institute, Sweden .
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden .
    Andersson, Erik
    Karolinska Institute, Sweden .
    Lekander, Mats
    Karolinska Institute, Sweden .
    Ruck, Christian
    Karolinska Institute, Sweden .
    Ljotsson, Brjann
    Karolinska Institute, Sweden .
    Predictors of outcome in Internet-based cognitive behavior therapy for severe health anxiety2013In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 51, no 10, p. 711-717Article in journal (Refereed)
    Abstract [en]

    Internet-based cognitive behavior therapy (CBT) for severe health anxiety can be effective, but not all patients achieve full remission. Under these circumstances, knowledge about predictors is essential for the clinician in order to make reliable treatment recommendations. The primary aim of this study was to investigate clinical, demographic, and therapy process-related predictors of Internet-based CBT for severe health anxiety. We performed three types of analyses on data from a sample comprising participants (N = 81) who had received Internet-based CBT in a randomized controlled trial. Outcomes were a) end state health anxiety, b) improvement in health anxiety (continuous change scores), and c) clinically significant improvement. Outcomes were assessed at six-month follow-up. The results showed that the most stable predictors of both end state health anxiety and improvement were baseline health anxiety and depressive symptoms. Treatment adherence, i.e. the number of completed treatment modules, also significantly predicted outcome. Notably, health anxiety at baseline was positively associated with symptom improvement while depressive symptoms was negatively related to improvement. Demographic factors were largely without significant impact on end state symptoms or improvement. We conclude that baseline symptom burden and adherence to treatment have strong predictive effects in Internet-based CBT for severe health anxiety.

  • 304.
    Hedman, Erik
    et al.
    Karolinska Institute, Sweden Karolinska Institute, Sweden Karolinska Institute, Sweden .
    Ljotsson, Brjann
    Karolinska Institute, Sweden Karolinska Institute, Sweden .
    Kaldo, Viktor
    Karolinska Institute, Sweden .
    Hesser, Hugo
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    El Alaoui, Samir
    Karolinska Institute, Sweden .
    Kraepelien, Martin
    Karolinska Institute, Sweden .
    Andersson, Evelyn
    Karolinska Institute, Sweden .
    Ruck, Christian
    Karolinska Institute, Sweden .
    Svanborg, Cecilia
    Karolinska Institute, Sweden .
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Lindefors, Nils
    Karolinska Institute, Sweden .
    Effectiveness of Internet-based cognitive behaviour therapy for depression in routine psychiatric care2014In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 155, p. 49-58Article in journal (Refereed)
    Abstract [en]

    Background: Efficacy of guided Internet-based cognitive behaviour therapy (ICBT) for depression has been demonstrated in several randomised controlled trials. Knowledge on the effectiveness of the treatment, i.e. how it works when delivered within routine care, is however scarce. The aim of this study was to investigate the effectiveness of ICBT for depression. Methods: We conducted a cohort study investigating all patients (N =1203) who had received guided ICBT for depression between 2007 and 2013 in a routine care setting at an outpatient psychiatric clinic providing Internet-based treatment The primary outcome measure was the Montgomery Asberg Depression Rating Scale-Self rated (MADRS-S). Results: Patients made large improvements from pre-treatment assessments to post-treatment on the primary outcome (effect size d on the MADRS-S = 1.27, 99% CI, 1.14-1.39). Participants were significantly improved in terms of suicidal ideation and sleep difficulties improvements were sustained at 6-month follow-up. Limitations: Attrition was rather large at 6-month follow-up. However, additional data was collected through telephone interviews with dropouts and advanced statistical models indicated that missing data did not bias the findings. Conclusions: ICBT for depression can be highly effective when delivered within the context of routine psychiatric care. This study suggests that the effect sizes are at least as high when the treatment is delivered in routine psychiatric care by qualified staff as when delivered in a controlled trial setting.

  • 305.
    Hedman, Erik
    et al.
    Division of Psychology, Karolinska Institutet, Stockholm, Sweden; Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden.
    Ljótsson, Brjánn
    Osher Center for Integrative Medicine, Stockholm, Sweden.
    Andersson, Erik
    Division of Psychology, Karolinska Institutet, Stockholm, Sweden; Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden; Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Lindefors, Nils
    Division of Psychiatry, Stockholm, Sweden.
    Rück, Christian
    Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
    Axelsson, Erland
    Division of Psychology, Karolinska Institutet, Stockholm, Sweden.
    Lekander, Mats
    Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden; Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Psychometric properties of Internet-administered measures of health anxiety: An investigation of the Health Anxiety Inventory, the Illness Attitude Scales, and the Whiteley Index.2015In: Journal of Anxiety Disorders, ISSN 0887-6185, E-ISSN 1873-7897, Vol. 31, p. 32-37Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The Health Anxiety Inventory (HAI), the Illness Attitude Scales (IAS), and the Whiteley Index (WI) are three of the most widely used health anxiety measures, but their psychometric properties have not been investigated when administered via the Internet.

    METHODS: We investigated the three instruments' test-retest reliability, internal consistency, convergent, and discriminant validity and sensitivity to change using one sample (n=111) of participants with severe health anxiety and one sample of healthy controls (n=92).

    RESULTS: The HAI, IAS, and WI showed high test-retest reliability (rs≥.80), good convergent, and discriminant validity and were sensitive to detect change. The HAI and IAS (αs≥.85), but not the WI (αs≤.60) demonstrated high internal consistency.

    CONCLUSIONS: The HAI, IAS, and WI have good psychometric properties, except for the low internal consistency of WI, when used as Internet-administered measures of health anxiety. Using these measures over the Internet offers highly important advantages such as increased ease of administration, reduced attrition, and cost-efficient treatment evaluation.

  • 306.
    Hedman, Erik
    et al.
    Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychology, Stockholm, Sweden.
    Ljótsson, Brjánn
    Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychology, Stockholm, Sweden.
    Axelsson, Erland
    Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychology, Stockholm, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychiatry, Stockholm, Sweden.
    Rück, Christian
    Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychiatry, Stockholm, Sweden.
    Andersson, Erik
    Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychology, Stockholm, Sweden.
    Health anxiety in obsessive compulsive disorder and obsessive compulsive symptoms in severe health anxiety: An investigation of symptom profiles.2017In: Journal of Anxiety Disorders, ISSN 0887-6185, E-ISSN 1873-7897, Vol. 45, p. 80-86Article in journal (Refereed)
    Abstract [en]

    Severe health anxiety (SHA) shares features with obsessive-compulsive disorder (OCD) and in recent years there has been a debate as to whether the two disorders may represent two facets of the same condition. Few studies have however investigated the overlap and differences in symptom profiles between the disorders. The primary aim of the present study was to investigate these aspects using one sample of participants with a principal diagnosis of SHA and one sample of participants with a principal OCD diagnosis. The second aim was to examine differences in improvement trajectories on measures of health anxiety and OCD symptoms in patients with SHA receiving treatment with exposure and response prevention. We compared persons participating in clinical trials with a principal diagnosis of SHA (N=290) to persons with a principal diagnosis of OCD (n=95) on measures of health anxiety, OCD symptoms, and depressive symptoms. A subsample of SHA participants (n=99) received exposure and response prevention (ERP) for SHA over 12 weeks and was assessed at baseline and post-treatment. The results showed large and significant differences between SHA and OCD patients on measures of health anxiety (ds=2.99-3.09) and OCD symptoms (ds=1.64-2.14), while they had equivalent levels of depressive symptoms (d=0.19, 95% CI [-0.04, 0.43]). In the SHA sample 7.6% had comorbid OCD, and in the OCD sample 9.5% had SHA. For participants with a principal diagnosis of SHA, ERP led to large reductions of health anxiety, but effects on OCD symptoms were small to moderate. Among participants with comorbid OCD, effect sizes were large on measures of health anxiety and moderate to large on OCD measures. We conclude that SHA and OCD are separate psychiatric disorders with limited overlap in symptom profiles.

  • 307.
    Hedman, Erik
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Ljótsson, Brjánn
    Karolinska Institutet, Stockholm, Sweden.
    Blom, Kerstin
    Karolinska Institutet, Stockholm, Sweden.
    El Alaoui, Samir
    Karolinska Institutet, Stockholm, Sweden.
    Kraepelien, Martin
    Karolinska Institutet, Stockholm, Sweden.
    Rück, Christian
    Karolinska Institutet, Stockholm, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institutet, Stockholm, Sweden.
    Svanborg, Cecilia
    Karolinska Institutet, Stockholm, Sweden.
    Lindefors, Nils
    Karolinska Institutet, Stockholm, Sweden.
    Kaldo, Viktor
    Karolinska Institutet, Stockholm, Sweden.
    Telephone versus internet administration of self-report measures of social anxiety, depressive symptoms, and insomnia: psychometric evaluation of a method to reduce the impact of missing data2013In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 15, no 10, p. e229-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Internet-administered self-report measures of social anxiety, depressive symptoms, and sleep difficulties are widely used in clinical trials and in clinical routine care, but data loss is a common problem that could render skewed estimates of symptom levels and treatment effects. One way of reducing the negative impact of missing data could be to use telephone administration of self-report measures as a means to complete the data missing from the online data collection.

    OBJECTIVE: The aim of the study was to compare the convergence of telephone and Internet administration of self-report measures of social anxiety, depressive symptoms, and sleep difficulties.

    METHODS: The Liebowitz Social Anxiety Scale-Self-Report (LSAS-SR), Montgomery-Åsberg Depression Rating Scale-Self-Rated (MADRS-S), and the Insomnia Severity Index (ISI) were administered over the telephone and via the Internet to a clinical sample (N=82) of psychiatric patients at a clinic specializing in Internet-delivered treatment. Shortened versions of the LSAS-SR and the ISI were used when administered via telephone.

    RESULTS: As predicted, the results showed that the estimates produced by the two administration formats were highly correlated (r=.82-.91; P<.001) and internal consistencies were high in both administration formats (telephone: Cronbach alpha=.76-.86 and Internet: Cronbach alpha=.79-.93). The correlation coefficients were similar across questionnaires and the shorter versions of the questionnaires used in the telephone administration of the LSAS-SR and ISI performed in general equally well compared to when the full scale was used, as was the case with the MADRS-S.

    CONCLUSIONS: Telephone administration of self-report questionnaires is a valid method that can be used to reduce data loss in routine psychiatric practice as well as in clinical trials, thereby contributing to more accurate symptom estimates.

  • 308.
    Hedman, Erik
    et al.
    Karolinska Institute, Sweden .
    Mortberg, Ewa
    Stockholm University, Sweden .
    Hesser, Hugo
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Clark, David M.
    University of Oxford, England .
    Lekander, Mats
    Karolinska Institute, Sweden .
    Andersson, Erik
    Karolinska Institute, Sweden .
    Ljotsson, Brjann
    Karolinska Institute, Sweden .
    Mediators in psychological treatment of social anxiety disorder: Individual cognitive therapy compared to cognitive behavioral group therapy2013In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 51, no 10, p. 696-705Article in journal (Refereed)
    Abstract [en]

    According to cognitive-behavioral models of social anxiety disorder (SAD), four of the important maintaining mechanisms are avoidance, self-focused attention, anticipatory processing and post-event cognitive processing. Individual cognitive therapy (ICT) and cognitive behavioral group therapy (CBGT) both have substantial empirical support. However, it is unclear whether they achieve their effects by similar or different mechanisms. The aim of this study was to investigate whether changes in the four maintenance processes mediate clinical improvement in la and CBGT for SAD. We analyzed data from participants (N = 94) who received either ICT or CBGT in two separate RCTs. The results showed that ICT had larger effects than CBGT on social anxiety and each of the four potential mediators. More pertinently, moderated mediation analyses revealed significant between-treatment differences. Whereas improvement in ICT was mainly mediated by reductions in avoidance and self-focused attention, improvement in CBGT was mediated by changes in self-focused attention and in anticipatory and post-event processing. These results support the importance of the putative mediators, but suggest that their relative weights are moderated by treatment type.

  • 309.
    Heimann, Mikael
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Att härma eller bli härmad – det är frågan: Kan imitation lära oss något om autism?2012Conference paper (Other academic)
    Abstract [sv]

    Förmågan att imitera har under lång tid setts som en av de förmågor som personer med autism har svårt med. Bl a har det diskuterats om bristande förmåga till imitation borde ses som ett grundläggande problem (”a core deficit”) som kan utgör ett tidigt tecken på avvikande utveckling redan under det första levnadsåret. Fortfarande råder emellertid ingen enighet, troligen beroende på att vi inte har tillräcklig kunskap, men också på det faktum att imitation är ett komplicerat fenomen med varierad betydelse inom olika områden. Imitation kan vara en förmåga man utövar, kan vara en aspekt av vår minnesförmåga, en sätt att etablera social kontakt eller en icke-språklig kommunikationskanal. Mer grundläggande kan förmågan att imitera eller upplevelsen av att bli härmad skapa en social närvaro, kanske t om en känsla av att jag är som andra – andra är nog som jag som är så viktig i den typiska utvecklingen.

     

    I föredraget presenteras och diskuteras imitationens olika ansikten i ljuset av aktuella forskningsresultat liksom hur imitation kan vara till hjälp i kliniskt och praktiskt pedagogiskt arbete med personer med autism.

  • 310.
    Heimann, Mikael
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Att växa och förändras av H Rijt & F Plooij: Förord och fackgranskning1999Other (Other (popular science, discussion, etc.))
  • 311.
    Heimann, Mikael
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Deferred imitation: Individual differences in early memory performance2012Conference paper (Other academic)
    Abstract [en]

    Infant memory researchers agree that deferred imitation is a robust, easily administered and reliable nonverbal method of capturing rudimentary declarative memory function prior to the onset of productive language. As of today there are two different ways of studying deferred imitation: An observation-only design in which no practice is allowed before a memory delay is imposed, and an elicited imitation procedure in which the child is allowed to spontaneously explore the objects before modeling in order to create a baseline.

    Although results from studies using these two methods are largely overlapping, crucial differences have also been noted. The elicited imitation procedure allows for both practice and verbal cues, which can affect the observed retention time. As a consequence, a stronger memory trace might be formed when the child can encode through several modalities: vision, auditory and motor. Thus we cannot ignore the distinction between these two methods when evaluating reported findings.

    Individual differences in behavioral memory performance have been reported by studies using both methods. As an example, a predictive correlation from deferred imitation at 9 months to gestural communication at 14 months has been reported. In addition, deferred imitation has also been found to predict cognition at 4 years of age. In order to achieve a better understanding of the individual differences reported in the literature researchers have become motivated to use different brain measures, foremost EEG (event-related-potentials). Findings from studies using the elicited imitation procedure report that electrophysiological indices of recognition correlate with memory observed behaviorally. In comparison, a recent study from our lab found that learning processes captured by an associative learning ERP-paradigm predicted the memory score for 14-month-old children. Change scores based on Nc, a middle latency component associated with attentional processes, predicted deferred imitation performance. Thus, better memory performance judged behaviorally was highly correlated with electrophysiological indices of successful learning of new associations.  The study used the observation-only design and is, to our knowledge, one of the first to directly compare how well children learn in two different but related situations, deferred imitation and in an ERP-design. The results suggest that associative learning is linked to memory performance observed in the deferred imitation procedure. This raises questions regarding our view on early memory development since deferred imitation is viewed as an early explicit memory. A speculative thought is that explicit and implicit systems are less separated early in development than later on. This will be further discussed in the presentation as will the pros and cons of the two methods currently used by deferred imitation researchers

  • 312.
    Heimann, Mikael
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Kan interaktiva dataprogram stimulera språk- och kommunikation hos barn med autism eller begåvningshandikapp1991In: Människa - Handikapp - Livsvillkor: Rapport nr 9 / [ed] E Petterson, 1991, p. 221-224Conference paper (Refereed)
  • 313.
    Heimann, Mikael
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Mentaliseringsförmåga hos barn med tidiga Cochleära implantat : Rapport till Hörselforskningsfonden (anslag B 2007/03)2010Report (Other academic)
    Abstract [sv]

    Rapporten sammanfattar resultaten från en studie kring mentaliseringsförmågan hos barn med cochleaimplantat (CI) som genomförts med stöd av Hörselforskningsfonden. Totalt deltog 16 barn (9 pojkar) där den yngsta deltagaren var 4:3 år och den äldsta 9:6 år. Hälften av barnen hade fått sitt första implantat innan 2:3 års ålder och hälften senare. Resultaten visar att de barn som fått implantatet i tidig ålder klarade 45 procent av de undersökta mentaliseringsuppgifterna medan barnen som fått implantat vid senare ålder klarade knappt 19 procent. Resultatet bör emellertid tolkas med försiktighet då gruppen är liten och dessutom heterogen. Fynden motiverar fortsatta studier på en större grupp barn.

  • 314.
    Heimann, Mikael
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Patterns of instability and change during the first year in typically developing infants2012In: Infant Mental Health Journal, 33 [Abstract Supplement 143-144] / [ed] K. Puura, M. Tomlinson. N.W. Boris & M. Sorsa, 2012Conference paper (Refereed)
    Abstract [en]

    A range of researchers in both Europe and the US (e.g.Brazelton, Plooij, and Trevarthen) have proposed that infant development proceeds through periods of regression atspecific points in time. Studies in several European countries have, independently confirmed this hypothesis, makingit possible to identify up to eight periods of regression (or periods of rapid change as suggested by Trevarthen andAitken, 2003) during the first year of life. These findings are still relatively unknown and have not rendered muchattention by the neither researchers nor clinicians. This presentation will summarize the European findings and tiethem to the current theoretical debate as well as to Brazelton’s concept of touchpoints (Sparrow & Brazelton, 2006).It will also be argued that the observed periods of rapid change in infancy, if taken seriously, will have a strongimpact on professional training, clinical service and future research.

  • 315.
    Heimann, Mikael
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Edorsson, Angelica
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Sundqvist, Anett (Annette)
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Koch, Felix-Sebastian
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Thirteen-to Sixteen-Months Old Infants Are Able to Imitate a Novel Act from Memory in Both Unfamiliar and Familiar Settings But Do Not Show Evidence of Rational Inferential Processes2017In: Frontiers in Psychology, ISSN 1664-1078, E-ISSN 1664-1078, Vol. 8, article id 2186Article in journal (Refereed)
    Abstract [en]

    Gergely et al. (2002) reported that children imitated a novel action - illuminating a light-box by using the forehead - after a delay significantly more often if the hands of the experimenter had been visible in comparison with if they had been covered. In an attempt to explore these findings we conducted two studies with a total N of 63 children. Both studies investigated deferred imitation of the action in two conditions, with the hands of the experimenter visible or covered, but the settings differed. Study 1 (n = 30; mean age = 16.6 months) was carried out in an unfamiliar environment (a laboratory setting) while Study 2 (n = 33; mean age = 13.3 months) was conducted in familiar surroundings (at home or at day care). The results showed that 50% of the children in Study 1 and 42.4% in Study 2 evidenced deferred imitation as compared to only 4.9% (n = 2) in the baseline condition. However, in none of the studies did the children use inferential processes when imitating, we detected no significant differences between the two conditions, hands visible or hands covered. The findings add to the validity of the head touch procedure as a measure of declarative-like memory processes in the pre-verbal child. At the same time the findings question the robustness of the concept rational imitation, it seems not as easy as expected to elicit a response based on rational inferential processes in this age group.

  • 316.
    Heimann, Mikael
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Herbert, Jane S
    Depart,emt of Psychology, University of Sheffield.
    Tjus, Tomas
    Psykologiska institutionen, Göteborgs universitet.
    Rönnberg, Jerker
    Recent advances in early memory development: Research on typical and atypical children2013In: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450, Vol. 54, no 1, p. 1-3Article in journal (Other academic)
  • 317.
    Heimann, Mikael
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Meltzoff, Andrew N
    University of Washingtong, Seattle, WA.
    Deferred imitation in 9- and 14- months old Infants: A longitudinal study of a Swedish sample1996In: British Journal of Developmental Psychology, ISSN 0261-510X, E-ISSN 2044-835X, Vol. 14, p. 55-64Article in journal (Refereed)
    Abstract [en]

    This study investigated deferred imitation using a longitudinal design. A total of 62Swedish children (32 girls) were tested at both 9 and 14 months of age. The memorydelay interval was 10 minutes at 9 months and five minutes at 14 months of age. Atboth ages children in the imitation group displayed significantly more target actionsafter modelling than the children in the control group, thus replicating earlierreports of imitation from memory. It was found that individual children with atendency to perform low deferred imitation at 9 months of age tended to remain lowon the test at 14 months, thus raising the possibility of stable individual differencesin imitation. This study provides a first investigation of deferred imitationlongitudinally among young children, and supports recent theoretical claims thatdeferred imitation arises earlier in ontogeny than was hypothesized by classicaltheory. It was observed that there are cultural differences in the way that Swedishversus American adult-infant pairs act in the test situation and ideas are offeredregarding the roots of such differences.

  • 318.
    Heimann, Mikael
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Nordqvist, Emelie
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Department of Behavioural Sciences and Learning, Developmental Psychology. Linköping University, Faculty of Arts and Sciences.
    Rudner, Mary
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    Johansson, Mikael
    Institutionen för psykologi, Lunds universitet.
    Lindgren, Magnus
    Institutionen för psykologi, Lunds universitet.
    Associative learning measured with ERP predicts deferred imitation using a strict observation only design in 14 to 15 month old children2013In: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450, Vol. 54, no 1, p. 33-40Article in journal (Refereed)
    Abstract [en]

    Deferred imitation is an established procedure for behavioural measurement of early declarative-like memories in infancy and previous work has indicated a link between this type of memory and brain potentials in infants. The present study compared infants’ memory performance in this paradigm with electrophysiological indices of associative learning. Thirty children (mean age: 14.5 months) participated, of which 15 (9 boys) had acceptable ERP recordings that could be included in the final analysis. Deferred imitation was measured with an observation-only procedure using three actions and a 30 min delay. ERP was recorded with a High Density Net (128 electrodes) during associative learning. Change scores based on Nc, a middle latency component associated with attentional processes, predicted deferred imitation performance. Thus, associative learning measured with ERP predicts deferred imitation using a strict observation only design in 14 to15 month old children.

  • 319.
    Heimann, Mikael
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Nordqvist, Emelie
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Strid, K.
    University of Gothenburg, Sweden.
    Connant Almrot, J.
    University of Gothenburg, Sweden; Regional Vastra Gotaland, Sweden.
    Tjus, T.
    University of Gothenburg, Sweden.
    Children with autism respond differently to spontaneous, elicited and deferred imitation2016In: Journal of Intellectual Disability Research, ISSN 0964-2633, E-ISSN 1365-2788, Vol. 60, no 5, p. 491-501Article in journal (Refereed)
    Abstract [en]

    BackgroundImitation, a key vehicle for both cognitive and social development, is often regarded as more difficult for children with autism spectrum disorders (ASD) than for children with Down syndrome (DS) or typically developing (TD) children. The current study investigates similarities and differences in observed elicited, spontaneous and deferred imitation using both actions with objects and gestures as imitation tasks in these groups. MethodsImitation among 19 children with autism was compared with 20 children with DS and 23 TD children matched for mental and language age. ResultsElicited imitation resulted in significantly lower scores for the ASD group compared with the other two groups, an effect mainly carried by a low level of gesture imitation among ASD children. We observed no differences among the groups for spontaneous imitation. However, children with ASD or DS displayed less deferred imitation than the TD group. Proneness to imitate also differed among groups: only 10 (53%) of the children with autism responded in the elicited imitation condition compared with all children with DS and almost all TD children (87%). ConclusionsThese findings add to our understanding of the kind of imitation difficulties children with ASD might have. They also point to the necessity of not equating various imitation measures because these may capture different processes and be differently motivating for children with autism.

  • 320.
    Heimann, Mikael
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Nordqvist, Emelie
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    Tjus, Tomas
    Psykologiska institutionen, Göteborgs universitet.
    Further exploration into the infant’s mind: Early memory, individual differences and electrophysiological correlates2011Conference paper (Other academic)
    Abstract [en]

    Deferred imitation is an established method used to study how several cognitive processes evolve during early infancy: Imitation, event-like memory and intentional understanding. In addition, deferred imitation has also been linked to early individual differences, which is the main aim of the current presentation: To further explore early individual differences as reflected by deferred imitation performance. Three strands of information that has come out of our Swedish research program will be presented. Firstly, published studies from our lab have demonstrated that deferred imitation observed between 9 and 14 months acts as an early marker of cognitive performance observed years later. Second, new observations show that electrophysiological (ERP) indices of associative learning is strongly related to memory as measured by deferred imitation at 14 months. The ERP procedure consisted of a learning phase  (several pairs of pictures were presented) and a test phase introducing two violations (a new association or a completely new picture). Larger Nc change scores (learning phase compared with the test phase) correlated strongly (rs = .57) with deferred imitation. Thirdly, some preliminary findings from an ongoing longitudinal study observing memory, imitation and intentional understanding in 9 to 16 months old children will be presented. It is our hypotheses that the cognitive processes captured by deferred imitation observed early will be linked to individual differences intentional understanding observed when the child is 16 months old. 

  • 321.
    Heimann, Mikael
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Tjus, Tomas
    Univ Gothenburg, Sweden.
    Neonatal imitation: Temporal characteristics in imitative response patterns2019In: Infancy, ISSN 1525-0008, E-ISSN 1532-7078, Vol. 24, no 5, p. 674-692Article in journal (Refereed)
    Abstract [en]

    Neonatal imitation has been an area that has attracted intense attention within developmental psychology. Reported here are data from 33 newborn infants (16 girls; mean age: 47 hr) assessed for imitation of tongue protrusion (TP) and mouth opening (MO). The stimuli were presented dynamically, in three 20-second-long gesture modeling intervals, interwoven with three 20-second-long intervals in which the presenter kept a passive face. Imitation of TP emerged among a majority of the infants during the first 60 s of the experiment. In contrast, MO showed a protracted response and a majority exhibited imitation after 60 s. The individual response pattern of the participating infants varied substantially over the course of the experiment. The study provides renewed support for neonatal imitation of MO and TP, and, in addition, suggests that the temporal organization of the responses observed is an important factor to consider, which in turn has methodological and theoretical implications.

    The full text will be freely available from 2021-06-19 11:09
  • 322.
    Heimann, Mikael
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Tjus, Tomas
    Psykologiska institutionen, Göteborgs universitet.
    Nordqvist, Emelie
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    Kognitiv utveckling2012In: Kognitionsvetenskap / [ed] Jens Allwood & Mikael Jensen, Lund: Studentlitteratur, 2012, 1, p. 349-367Chapter in book (Other academic)
    Abstract [sv]

    Kognitionsvetenskapär den första boken på svenska som beskriver kärnan i kognitionsvetenskap - att förstå hur människor tänker. Den spänner därmed över ett brett tvärvetenskapligt fält som inrymmer filosofi, lingvistik, psykologi, antropologi, datavetenskap och neurovetenskap. Författarna beskriver hur ämnet har vuxit fram och hur man kan studera kognition utifrån filosofiska, psykologiska och neurovetenskapliga aspekter. Även språkvetenskapliga och sociala aspekter på tänkande presenteras. Författarna tar dessutom upp relationen mellan mänskligt tänkande och djurs tänkande, samt utvecklingen av kognition från barndom till vuxen ålder. Avslutningsvis berörs flera aspekter av tänkande i förhållande till teknologi, både som stöd för tänkande och som simulering av tänkande. Boken vänder sig till studenter som läser introduktionskurs eller grundkurs i kognitionsvetenskap, men är även lämplig för beteendevetenskapliga eller språkinriktade utbildningar. Den kan även vara av intresse för alla som vill förstå mer om mänskligt tänkande

  • 323.
    Heimann, Mikael
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Ullsatdius, Eva
    Göteborgs universitet.
    Swerlander, Agneta
    Göteborgs universitet.
    Imitation in Eight Infants with Down Syndrome1998In: Pediatric Research, ISSN 0031-3998, E-ISSN 1530-0447, Vol. 44, no 5, p. 780-784Article in journal (Refereed)
    Abstract [en]

    Imitation of tongue protrusion and mouth opening was studied in eight infants with Down's syndrome. Five of the children were observed at approximately 1 mo, seven around 3 mo, and seven at 4 mo. The only significant group result revealed imitation of tongue protrusion at 1 mo. In addition, a descriptive analysis of each child's response pattern during the presentation period showed that all five children observed at 1 mo imitated tongue protrusion and that four of them also seemed to imitate mouth opening. The result for the 3-mo observation was somewhat inconsistent. All but one of the infants increased their response rates of both tongue protrusion and mouth opening when mouth opening was modeled. At 4 mo imitation seems to disappear. Overall, the findings are in agreement with what is known from typically developing children.

  • 324.
    Heinrich, Sarah
    et al.
    Department of Psychology, Stockholm University, Stockholm, Sweden.
    Rozental, Alexander
    Department of Psychology, Stockholm University, Sweden.
    Carlbring, Per
    Division of Clinical Psychology, Department of Psychology, Stockholm University, Stockholm, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institute, Stockholm, Sweden.
    Cotter, Katherine
    Department of Psychology, Stockholm University, Stockholm, Sweden.
    Weise, Cornelia
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research. Department of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Germany.
    Treating tinnitus distress via the Internet: A mixed methods approach of what makes patients seek help and stay motivated during Internet-based cognitive behavior therapy2016In: Internet Interventions, ISSN 2214-7829, Vol. 4, no 2, p. 120-130Article in journal (Refereed)
    Abstract [en]

    Background

    Internet-based cognitive behavioral therapy (ICBT) has proven to be an effective treatment in improving patients' ability to cope with tinnitus. However, some patients prefer face-to-face therapy to ICBT, and a few studies have shown considerable dropout rates if the treatment is not guided. This renders it important to identify factors that contribute to the commencement and continuation of ICBT programs.

    Aims

    Because treatment motivation and expectations are important factors in psychological treatment, the aim of our study was to investigate what leads tinnitus patients to seek out ICBT, what helps them to keep up with the treatment, and what (if any) impact these factors have on dropout rates and treatment outcomes.

    Method

    112 tinnitus patients taking part in ICBT for tinnitus responded to symptom-related questionnaires at three points in time (pre-treatment, post-treatment, and one-year-follow-up) and to a questionnaire consisting of open-ended questions about their treatment motivation and expectations before beginning treatment. Data were analyzed using qualitative content analysis, and the results were used to divide the participants into groups. The treatment outcomes of these groups were compared using t-tests, χ2-tests, and both one-factorial and mixed ANOVAs.

    Results

    Four main categories emerged as factors conducive to starting treatment: 1) Targets participants wanted to address, 2) circumstances that led to participation, 3) attitudes towards the treatment, and 4) training features. Participants identified six facilitators for continuing the treatment: success, training, individual attitude, hope, evidence, and support. Naming specific tinnitus-associated problems as targets was associated with greater improvement from pre-treatment to 1-year-follow-up. Describing an active involvement in the treatment was related to increased improvement from post-treatment to follow-up.

    Conclusion

    There are several motivational factors that tinnitus patients consider relevant for beginning and continuing ICBT. Particularly, focusing on specific targets that do not involve the tinnitus itself, and encouraging participants to take an active role in treatment may increase treatment effectiveness. However, further hypothesis-guided research is necessary to confirm our explorative results.

  • 325.
    Helland, Wenche Andersen
    et al.
    Helse Fonna HF, Div Psychiat, Sect Mental Hlth Res, Haugesund, Norway, Statped Vest, Norwegian Support Syst Special Educ, Bergen, Norway.
    Posserud, Maj-Britt
    Haukeland Hosp, Bergen, Norway, RKBU, Bergen, Norway.
    Helland, Turid
    Universitetet i Bergen, Norge.
    Heimann, Mikael
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research.
    Lundervold, Astri
    Language impairments in children with ADHD and in children with reading disorder2016In: Journal of Attention Disorders, ISSN 1087-0547, E-ISSN 1557-1246, Vol. 20, no 7, p. 581-589Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate language impairments (LI) in a non –clinical sample of children with symptoms of AD/HD,  RD,   AD/HD + RD and controls, and to explore whether these groups could be differentiated from each other regarding different aspects of language.

    Method: Out of a population-based sample  of 5672 children aged 7-9, four groups were derived.

    Results: LI was identified in the vast majority of the AD/HD+RD group and in more than 40 % of both the AD/HD group and the RD group.

    Conclusions: More phonological and expressive language problems were seen in RD compared to AD/HD, while receptive language problems were more prominent in AD/HD. As to pragmatics, more problems were identified in AD/HD, but the difference did not reach significance. These results support findings from clinical samples pointing to a considerable rate of LI both in children with symptoms of AD/HD and in children with symptoms of RD.

  • 326.
    Hendry, Gillian
    et al.
    University of Strathclyde, Glasgow, UK.
    Wiggins, Sally
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Anderson, Tony
    University of Strathclyde, Glasgow, UK.
    Are you still with us?: Managing group togetherness and mobile phone use in PBL tutorials2016In: Interdisciplinary Journal of Problem-based Learning, ISSN 1541-5015, Vol. 10, no 2Article in journal (Refereed)
    Abstract [en]

    As mobile phone technology becomes more advanced, so too does its presence in everyday life. Research has shown, for instance, that students are using their mobile phones in classroom settings, a practice that holds both potential advantages and disadvantages. In group work, these interactions may have consequences for group dynamics in that orienting to a mobile phone can display a shift in an individual’s attention to the group. The current essay details a research project conducted on problem-based learning (PBL) tutorials in the United Kingdom in which student groups were video-recorded as they worked. A discursive psychological analysis focused on instances of interaction in which a group member picked up his or her mobile phone in the middle of a working session and how the accountability for the phone use was managed by either the phone user or a fellow group member. In understanding more about the microprocesses that take place in such environments, we are better positioned to support students’ learning and socialization as they progress through college.

  • 327.
    Hendry, Gillian
    et al.
    School of Psychological Sciences and Health, University of Strathclyde, UK.
    Wiggins, Sally
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. School of Psychological Sciences and Health, University of Strathclyde, UK.
    Anderson, Tony
    School of Psychological Sciences and Health, University of Strathclyde, UK.
    The discursive construction of group cohesion in problem-based learning (PBL) tutorials2016In: Psychology Learning and Teaching, ISSN 1475-7257, Vol. 15, no 2, p. 180-194Article in journal (Refereed)
    Abstract [en]

    Research has shown that educators may be reluctant to implement group work in their teaching due to concerns about students partaking in off-task behaviours. However, such off-task interactions have been shown to promote motivation, trust, and rapport-building. This paper details a study in which student groups were video recorded as they engaged in problem-based learning tutorials, with the aim of examining the social interaction within such settings. Eighty-five hours of data were collected from nine groups, with discursive psychology being used to analyse how group cohesion is constructed through off-topic talk such as gossiping and teasing. Two case studies are detailed in which we demonstrate how cohesion is established through a process of collective action against the ‘other’: highlighting the differences between ‘us’ and ‘them’, and how this can impact on group dynamics. There is often a discrepancy between self-reported and observed behaviour in groups and so the more we know about what actually happens in such environments, the better placed we are to support student learning. The paper concludes with recommendations on how analyses of social interaction and the management of psychological issues in problem-based learning tutorials can inform the use of problem-based learning as a teaching and learning approach.

  • 328.
    Henricson, Cecilia
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research.
    Lidestam, Björn
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Lyxell, Björn
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping. Linköping University, The Swedish Institute for Disability Research.
    Moller, Claes
    Örebro University Hospital, Sweden.
    Cognitive skills and reading in adults with Usher syndrome type 22015In: Frontiers in Psychology, ISSN 1664-1078, E-ISSN 1664-1078, Vol. 6, no 326Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate working memory (WM), phonological skills, lexical skills, and reading comprehension in adults with Usher syndrome type 2 (USH2). Design: The participants performed tests of phonological processing, lexical access, WM, and reading comprehension. The design of the test situation and tests was specifically considered for use with persons with low vision in combination with hearing impairment. The performance of the group with USH2 on the different cognitive measures was compared to that of a matched control group with normal hearing and vision (NVH). Study Sample: Thirteen participants with USH2 aged 21-60 years and a control group of 10 individuals with NVH, matched on age and level of education. Results: The group with USH2 displayed significantly lower performance on tests of phonological processing, and on measures requiring both fast visual judgment and phonological processing. There was a larger variation in performance among the individuals with USH2 than in the matched control group. Conclusion: The performance of the group with USH2 indicated similar problems with phonological processing skills and phonological WM as in individuals with long-term hearing loss. The group with USH2 also had significantly longer reaction times, indicating that processing of visual stimuli is difficult due to the visual impairment. These findings point toward the difficulties in accessing information that persons with USH2 experience, and could be part of the explanation of why individuals with USH2 report high levels of fatigue and feelings of stress (Wahlqvist et al., 2013).

  • 329.
    Henricson, Cecilia
    et al.
    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.
    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.
    Lidestam, Björn
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Fonologiska och lexikala färdigheter samt arbetsminneskapacitet hos barn med ushers syndrom typ 1 och cochleaimplantat2012Conference paper (Other academic)
  • 330.
    Henricson, Cecilia
    et al.
    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.
    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.
    Möller, Claes
    Audiological Research Centre, Örebro University Hospital, Örebro University, Sweden.
    Lidestam, Björn
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Cognitive skills in children with Usher syndrome type 1 and cochlear implants2011Conference paper (Other academic)
  • 331.
    Henricson, Cecilia
    et al.
    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.
    Lyxell, Björn
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of ENT - Head and Neck Surgery UHL.
    Möller, Claes
    Örebro Universitetssjukhus, audiologiskt forskningscentrum, Örebro Universitet.
    Lidestam, Björn
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Ongoing project: Phonological and lexical skills, and working memory in children with Usher type 1 and CI2009Conference paper (Other academic)
  • 332.
    Henricson, Cecilia
    et al.
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Lyxell, Björn
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Möller, Claes
    Örebro Universitetssjukhus, audiologiskt forskningscentrum, Örebro Universitet.
    Lidestam, Björn
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Phonological skills and working memory in children with C1 and Usher typ 12012Conference paper (Refereed)
    Abstract [sv]

    Bakgrund: Ushers syndrom (USH) innebär hörselnedsättning/dövhet i kombination med Retinitis Pigmentosa och, i två av de tre kliniska typer som finns, ingen eller gradvis förlust av balansfunktion. Det är den vanligaste orsaken till dövblindhet och har varit i fokus i många studier med molekylära, fysiologiska och funktionella konsekvenser av de genetiska mutationerna. Det finns dock få studier med inriktning mot kognitiva aspekter. Föreliggande studie har undersökt kognition med tydlig koppling till hörsel och talspråk hos barn med Ushers syndrom typ 1 och cochleaimplantat.

    Metod: Sju barn i åldrarna 7.5-16 år, med bekräftad USH1-diagnos och CI, deltog i studien. Deltagarnas prestation på 10 test, riktade mot fonologiska och lexikala färdigheter samt arbetsminne, jämfördes mot tre kontrollgrupper: barn med normal hörsel, barn med hörselnedsättning och hörapparat, samt barn med icke-syndromal dövhet och cochleaimplantat.

    Resultat och slutsats: Liksom i tidigare studier av barn med CI når gruppen med USH1 och CI inte samma nivå avseende fonologiska och lexikala färdigheter, samt presterar signifikant lägre avseende fonologiskt arbetsminne än barn med normal hörsel. Resultaten från föreliggande studie visar dock att deltagarna med USH1 generellt har högre prestationsnivå än andra barn med CI, och presterar på en liknande nivå som barn med hörselnedsättning och hörapparat.

  • 333.
    Henricson, Cecilia
    et al.
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Lyxell, Björn
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping.
    Möller, Claes
    Örebro Universitetssjukhus, audiologiskt forskningscentrum, Örebro Universitet.
    Lidestam, Björn
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Phonological skills and working memory in children with CI and Usher type I2011Conference paper (Refereed)
    Abstract [en]

    Children with CI have a distinctive pattern of development of phonological skills (Wass, 2010). Previous research (Spencer & Tomblin, 2009; Wass et al., 2009) has shown that deaf children with CI perform on par with children with normal hearing on some cognitive tasks, whereas they have a significantly lower performance level than children with normal hearing on tasks with high demands on phonological processing. The present project aims to examine phonological skills and working memory capacity in children with Usher type 1 and compare their performance with deaf children with CI and nonsyndromal deafness, with children with normal hearing and children with hearing impairment. Few studies have focused on cognitive development in children with Usher syndrome type I and there is a lack of knowledge on whether the deafness and the co-existing visual condition have an impact on cognitive development and the spoken language development which is an outcome of the CI. Six children with Usher syndrome type I, in ages 6-14 years participated in the study. Preliminary results revealed that children with Usher syndrome type I have a similar pattern of results on the tests as the comparison group of children with CI.

  • 334.
    Henricson, Cecilia
    et al.
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    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.
    Möller, Claes
    Örebro Universitetssjukhus, audiologiskt forskningscentrum, Örebro Universitet.
    Lidestam, Björn
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Phonological skills and working memory in children with Usher type 1 and C12012Conference paper (Refereed)
  • 335.
    Henricson, Cecilia
    et al.
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Lyxell, Björn
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of ENT - Head and Neck Surgery UHL.
    Möller, Claes
    Örebro Universitetssjukhus, audiologiskt forskningscentrum, Örebro Universitet.
    Lidestam, Björn
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Wass, Malin
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Phonological skills and working memoryin children with CI and Usher type 12011Conference paper (Other academic)
  • 336.
    Hepburn, Alexa
    et al.
    Loughborough University, UK.
    Wiggins, Sally
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Developments in discursive psychology2014In: Qualitative research in psychology: Ten Volume Set / [ed] Brendan Gough, Jeremy Miles and Brian Stucky, London: Sage Publications, 2014Chapter in book (Refereed)
  • 337.
    Hesser, Hugo
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    Tinnitus in Context: A Contemporary Contextual Behavioral Approach2013Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Tinnitus is the experience of sounds in the ears without any external auditory source and is a common, debilitating, chronic symptom for which we have yet to develop sufficiently efficacious interventions. Cognitive behavioral therapy (CBT) has evolved over the last 20 years to become the most empirically supported treatment for treating the adverse effects of tinnitus. Nevertheless, a significant proportion of individuals do not benefit from CBT-based treatments. In addition, the theoretical underpinnings of the CBT-model are poorly developed, the relative efficacy of isolated procedures has not yet been demonstrated, and the mechanisms of therapeutic change are largely unknown. These significant limitations preclude scientific progression and, as a consequence, leave many individuals with tinnitus suffering.

    To address some of these issues, a contextual multi-method, principle-focused inductive scientific strategy, based on pragmatic philosophy, was employed in the present thesis project. The overarching aim of the thesis was to explore the utility of a functional dimensional process in tinnitus: Experiential avoidance—experiential openness/acceptance (EA). EA is defined as the inclination to avoid or alter the frequency, duration, or intensity of unwanted internal sensations, including thoughts, feelings or physical sensations. The thesis is based on experimental work (Study II, VI), process and mediation studies (Study I, III, V), and on randomized controlled trials (Study III, IV).

    Three main sets of findings supported the utility of EA in tinnitus. First, an acceptance-based treatment (i.e.,Acceptance and Commitment Therapy, ACT) was found to be effective in controlled trials. Study III demonstrated that face-to-face ACT was more effective than a wait-list control and a habituation-based sound therapy. Study IV showed that internet-delivered ACT was more effective than an active control condition (internet-discussion forum) and equally effective as an established internet-delivered CBT treatment. Second, processes research (Study I, III, V) showed that key postulated processes of change were linked to the specific technology of ACT and that these changes in processes were associated with therapeutic outcomes. Specifically, Study V found evidence to that decreases in suppression of thoughts and feelings over the course of treatment were uniquely associated with therapeutic gains in ACT as compared with CBT. Third, experimental manipulations of experiential avoidance and acceptance processes provided support to the underlying dimension (Study II, VI). That is, Study II, employing an experimental manipulation, found that controlling background sounds were associated with reduced cognitive efficiency and increased tinnitus interference over repeated experimental trials. In addition, in normal hearing participants, experimentally induced mindfulness counteracted reduced persistence in a mentally challenging task in the presence of a tinnitus-like sound stemming from initial effortful suppression of the same sound (Study VI). It is concluded that a principle-, contextual-focused approach to treatment development may represent an efficient strategy for scientific progression in the field of psychological treatments of tinnitus severity.

    List of papers
    1. Clients' in-session acceptance and cognitive defusion behaviors in acceptance-based treatment of tinnitus distress.
    Open this publication in new window or tab >>Clients' in-session acceptance and cognitive defusion behaviors in acceptance-based treatment of tinnitus distress.
    2009 (English)In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 47, no 6, p. 523-8Article in journal (Refereed) Published
    Abstract [en]

    Cognitive-behavioral treatment (CBT) is considered to be an effective treatment of distress associated with tinnitus (perception of internal noises without any outer auditory stimulation), but the processes by which the therapy works remain unclear. Mindfulness and acceptance is receiving increased attention in the treatment literature for chronic medical conditions. However, few studies have examined these and related processes with behavioral or observer measures. In the present study 57 videotapes (a total of 1710min) from 19 clients who participated in a controlled trial of an acceptance-based treatment for tinnitus distress, were coded for frequency and peak level of verbal behaviors expressing either acceptance or cognitive defusion. Frequency of cognitive defusion behaviors and peak level of cognitive defusion as well as peak level of acceptance rated in Session 2, predicted symptom reduction 6 month following treatment. These relationships were not accounted for by the improvement that had occurred prior to the measurement point of the process variables. Moreover, prior symptom changes could not predict process variables rated later in therapy (after most of the improvement in therapy had occurred). Thus, clients' in-session acceptance and cognitive defusion behaviors appear to play an important role in the reduction of negative impact of tinnitus.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-18989 (URN)10.1016/j.brat.2009.02.002 (DOI)19268281 (PubMedID)
    Available from: 2009-06-07 Created: 2009-06-07 Last updated: 2018-12-12Bibliographically approved
    2. Consequences of Controlling Background Sounds: The Effect of Experiential Avoidance on Tinnitus Interference
    Open this publication in new window or tab >>Consequences of Controlling Background Sounds: The Effect of Experiential Avoidance on Tinnitus Interference
    2009 (English)In: REHABILITATION PSYCHOLOGY, ISSN 0090-5550, Vol. 54, no 4, p. 381-389Article in journal (Refereed) Published
    Abstract [en]

    Objective: Masking by the use of sounds has been one of the most commonly applied means of coping with tinnitus. The ability to control auditory stimulation represents a potentially important process involved in tinnitus masking strategies. Little is, however, known about the consequences of control on tinnitus experience. The present study investigated the effects of control of background sounds (type and loudness) on perceived intrusiveness of tinnitus and cognitive performance. Design: Using an experimental design with a series of trials, participants with clinically significant tinnitus (N = 35) were randomly assigned to I of 2 experimental manipulation conditions (control of sounds vs. no control of sounds). Measures: Self-reported tinnitus interference and the Digit-Symbol subtest served as dependent measures. Results: Latent growth curve modeling showed that individuals assigned to the condition with control exhibited faster growth rates on tinnitus interference (increased interference) and demonstrated slower rates of improvement on cognitive performance measures over trials compared to individuals assigned to the condition with no control. Conclusion: These results suggest that efforts to control tinnitus through sounds can be associated with increased disability in individuals with tinnitus.

    Keywords
    tinnitus, control, tinnitus interference, cognitive functioning, experiential avoidance
    National Category
    Social Sciences
    Identifiers
    urn:nbn:se:liu:diva-52818 (URN)10.1037/a0017565 (DOI)
    Available from: 2010-01-12 Created: 2010-01-12 Last updated: 2018-12-12
    3. Acceptance and Commitment Therapy versus Tinnitus Retraining Therapy in the treatment of tinnitus: A randomised controlled trial
    Open this publication in new window or tab >>Acceptance and Commitment Therapy versus Tinnitus Retraining Therapy in the treatment of tinnitus: A randomised controlled trial
    Show others...
    2011 (English)In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 49, no 11, p. 737-747Article in journal (Refereed) Published
    Abstract [en]

    The study compared the effects of Acceptance and Commitment Therapy (ACT) with Tinnitus Retraining Therapy (TRT) on tinnitus impact in a randomised controlled trial. Sixty-four normal hearing subjects with tinnitus were randomised to one of the active treatments or a wait-list control (WLC). The ACT treatment consisted of 10 weekly 60min sessions. The TRT treatment consisted of one 150min session, one 30min follow-up and continued daily use of wearable sound generators for a recommended period of at least 8h/day for 18 months. Assessments were made at baseline, 10 weeks, 6 months and 18 months. At 10 weeks, results showed a superior effect of ACT in comparison with the WLC regarding tinnitus impact (Cohen's d=1.04), problems with sleep and anxiety. The results were mediated by tinnitus acceptance. A comparison between the active treatments, including all assessment points, revealed significant differences in favour of ACT regarding tinnitus impact (Cohen's d=0.75) and problems with sleep. At 6 months, reliable improvement on the main outcome measure was found for 54.5% in the ACT condition and 20% in the TRT condition. The results suggest that ACT can reduce tinnitus distress and impact in a group of normal hearing tinnitus patients.

    Place, publisher, year, edition, pages
    Elsevier, 2011
    Keywords
    Acceptance and commitment therapy; Stress; Social workers; Burnout; Randomized controlled trial; Stress management
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-71844 (URN)10.1016/j.brat.2011.08.001 (DOI)000296941700003 ()21864830 (PubMedID)
    Available from: 2011-11-07 Created: 2011-11-07 Last updated: 2018-12-12
    4. A Randomized Controlled Trial of Internet-Delivered Cognitive Behavior Therapy and Acceptance and Commitment Therapy in the Treatment of Tinnitus
    Open this publication in new window or tab >>A Randomized Controlled Trial of Internet-Delivered Cognitive Behavior Therapy and Acceptance and Commitment Therapy in the Treatment of Tinnitus
    Show others...
    2012 (English)In: Journal of Consulting and Clinical Psychology, ISSN 0022-006X, E-ISSN 1939-2117, Vol. 80, no 4, p. 649-661Article in journal (Refereed) Published
    Abstract [en]

    Objective: Our aim in this randomized controlled trial was to investigate the effects on global tinnitus severity of 2 Internet-delivered psychological treatments, acceptance and commitment therapy (ACT) and cognitive behavior therapy (CBT), in guided self-help format. Method: Ninety-nine participants (mean age = 48.5 years; 43% female) who were significantly distressed by tinnitus were recruited from the community. Participants were randomly assigned to CBT (n = 32), ACT (n = 35), or a control condition (monitored Internet discussion forum; n = 32), and they were assessed with standardized self-report measures (Tinnitus Handicap Inventory; Hospital Anxiety and Depression Scale; Quality of Life Inventory; Perceived Stress Scale; Tinnitus Acceptance Questionnaire) at pre-, posttreatment (8 weeks), and 1-year follow-up. Results: Mixed-effects linear regression analysis of all randomized participants showed significant effects on the primary outcome (Tinnitus Handicap Inventory) for CBT and for ACT compared with control at posttreatment (95% CI [-17.03, -2.94], d = 0.70, and 95% CI [-16.29, -2.53], d = 0.68, respectively). Within-group effects were substantial from pretreatment through 1-year-follow-up for both treatments (95% CI [-44.65, -20.45], d = 1.34), with no significant difference between treatments (95% CI [-14.87, 11.21], d = 0.16). Conclusions: Acceptance-based procedures may be a viable alternative to traditional CBT techniques in the management of tinnitus. The Internet can improve access to psychological interventions for tinnitus.

    Place, publisher, year, edition, pages
    Washington, DC, USA: American Psychological Association (APA), 2012
    National Category
    Applied Psychology
    Identifiers
    urn:nbn:se:liu:diva-76865 (URN)10.1037/a0027021 (DOI)000306861800011 ()22250855 (PubMedID)
    Available from: 2012-04-20 Created: 2012-04-20 Last updated: 2018-12-12Bibliographically approved
    5. Acceptance as a Mediator in Internet-delivered Acceptance and Commitment Therapy and Cognitive Behavior Therapy for Tinnitus
    Open this publication in new window or tab >>Acceptance as a Mediator in Internet-delivered Acceptance and Commitment Therapy and Cognitive Behavior Therapy for Tinnitus
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Despite demonstrated efficacy of behavioral and cognitive techniques in treating the impact of tinnitus (constant ringing in the ears), little is known about the mechanisms by which these techniques achieve their effect. The present study examined acceptance of tinnitus as a potential mediator of treatment changes on global tinnitus severity in internet-delivered acceptance and commitment therapy (iACT) and internet-delivered cognitive behavior therapy (iCBT). Data from 67 participants who were distressed by tinnitus and who were randomly assigned to 1 of the 2 treatments were analyzed using a multilevel moderated mediation model. We predicted that acceptance as measured with the two subscales of the tinnitus acceptance questionnaire (i.e., activity engagement and tinnitus suppression) would mediate the outcome in iACT, but not in iCBT. Results provided partial support to the notion that mediation was moderated by treatment: tinnitus suppression mediated changes in tinnitus severity in iACT, but not in iCBT. However, inconsistent with the view that the treatments worked through different processes of change, activity engagement mediated treatment changes across both iACT and iCBT. Acceptance is identified as a key source of therapeutic change in behavioral-based treatments for tinnitus.

    Keywords
    Tinnitus, acceptance, mechanisms of change, internet-delivered selfhelp, cognitive behavior therapy
    National Category
    Applied Psychology
    Identifiers
    urn:nbn:se:liu:diva-88336 (URN)
    Available from: 2013-02-03 Created: 2013-02-03 Last updated: 2014-11-28Bibliographically approved
    6. Costs of Suppressing Emotional Sound and Countereffects of a Mindfulness Induction: An Experimental Analog of Tinnitus Impact
    Open this publication in new window or tab >>Costs of Suppressing Emotional Sound and Countereffects of a Mindfulness Induction: An Experimental Analog of Tinnitus Impact
    2013 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 5, p. e64540-Article in journal (Other academic) Published
    Abstract [en]

    Tinnitus is the experience of sounds without an appropriate external auditory source. These auditory sensations are intertwined with emotional and attentional processing. Drawing on theories of mental control, we predicted that suppressing an affectively negative sound mimicking the psychoacoustic features of tinnitus would result in decreased persistence in a mentally challenging task (mental arithmetic) that required participants to ignore the same sound, but that receiving a mindfulness exercise would reduce this effect. Normal hearing participants (N = 119) were instructed to suppress an affectively negative sound under cognitive load or were given no such instructions. Next, participants received either a mindfulness induction or an attention control task. Finally, all participants worked with mental arithmetic while exposed to the same sound. The length of time participants could persist in the second task served as the dependent variable. As hypothesized, results indicated that an auditory suppression rationale reduced time of persistence relative to no such rationale, and that a mindfulness induction counteracted this detrimental effect. The study may offer new insights into the mechanisms involved in the development of tinnitus interference. Implications are also discussed in the broader context of attention control strategies and the effects of emotional sound on task performance. The ironic processes of mental control may have an analog in the experience of sounds.

    Keywords
    Mental control, tinnitus, emotional sound, mindfulness, suppression
    National Category
    Applied Psychology
    Identifiers
    urn:nbn:se:liu:diva-88337 (URN)10.1371/journal.pone.0064540 (DOI)000318852400071 ()
    Note

    On the day of the defence date the status of this article was Manuscript.

    Available from: 2013-02-03 Created: 2013-02-03 Last updated: 2018-12-12Bibliographically approved
  • 338.
    Hesser, Hugo
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Dimensional or Categorical Approach to Tinnitus Severity: an Item Response Mixture Modeling Analysis of Tinnitus Handicap2014In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 21, no 6, p. 982-988Article in journal (Refereed)
    Abstract [en]

    Background Whether handicap due to tinnitus-sound(s) in the ears and/or in the head in the absence of an external auditory source-is best conceived as dimensional or categorical remains an unanswered empirical question. Purpose The objective was to investigate whether tinnitus severity was best conceptualized as qualitatively distinct subtypes, quantitative differences varying along a single continuum, or as severity differences within subtypes. Methods Various forms of item response mixture models (latent class models, factor analysis models, and hybrid models) that corresponded to the competing hypotheses were fitted to item responses on the Tinnitus Handicap Inventory in a Swedish sample of individuals with tinnitus (N = 362). Results A latent class model could be fitted to the data with a high probability of correctly classifying individuals into three different classes: high-, moderate-, and low-severity classes. However, a comparison of models showed that a unidimensional factor analysis model with a single class provided the best fit to the data. Conclusions The analysis provided evidence that tinnitus severity varies along a single severity continuum from mild to moderate to severe tinnitus-related handicap. The result that tinnitus severity exists on a continuum rather than as discrete categories has important implications for clinical research.

  • 339.
    Hesser, Hugo
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Axelsson, Sandra
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Backe, Victoria
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Engstrand, Jonna
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Gustafsson, Tina
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Holmgren, Elin
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Jeppsson, Ulrika
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Pollack, Maria
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Norden, Kjell
    Alternat Violence, Sweden.
    Rosenqvist, Dan
    Alternat Violence, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden.
    Preventing intimate partner violence via the Internet: A randomized controlled trial of emotion-regulation and conflict-management training for individuals with aggression problems2017In: Clinical Psychology and Psychotherapy, ISSN 1063-3995, E-ISSN 1099-0879, Vol. 24, no 5, p. 1163-1177Article in journal (Refereed)
    Abstract [en]

    Objective

    The aim of this randomized controlled trial was to investigate the effect of an Internet-delivered cognitive behaviour therapy (iCBT), which incorporated emotion-regulation and conflict-resolution techniques, on intimate partner violence (IPV). Another aim was to test the theoretical underpinnings of the treatment model using mediation analysis.

    Method

    Sixty-five participants with aggression problems in intimate adult relationships were recruited from the community and were randomly assigned to iCBT or to a monitored waitlist control. Participants were assessed with standardized self-report measures of IPV or aggression (Multidimensional Measure of Emotional Abuse, Revised Conflict Tactics Scale, and Aggression Questionnaire), relationship quality (Dyadic Adjustment Scale), anxiety or depression symptomatology (Patient Health Questionnaire; Generalized Anxiety Disorder Screener), at pretreatment, posttreatment (8 weeks), and 1-year follow-up. Process variables (subscales of Dysfunctional and Emotional Regulation Scale and Anger Rumination Scale) were assessed weekly over the active treatment phase.

    Results

    Robust linear regression analysis of all randomized participants showed significant treatment effects on emotional abuse relative to control at postassessment. Mediation analysis using growth curve modeling revealed that the treatment effect was partially mediated by changes in emotion-regulation ability. Controlled effects on secondary outcomes were also observed. Analyses of uncontrolled effects indicted that gains on IPV were maintained at 1-year follow-up.

    Conclusions

    iCBT focusing on enhancing conflict-resolution skills and emotion-regulation ability has the potential to reduce IPV among self-recruited individuals with mild forms of abusive behaviour in intimate relationships. Emotion-regulation ability is potentially a key therapeutic process of change.

    Key Practitioner Message

    • Internet-delivered clinician-guided cognitive behaviour therapy is a viable treatment option for reducing intimate partner violence among self-recruited individuals with mild forms of abusive behaviour.
    • For persons who display patterns of frequent and severe violence, other treatments are most likely needed.
    • Emotion-regulation training is potentially a key therapeutic component that ought to be incorporated in interventions targeting IPV.
  • 340.
    Hesser, Hugo
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Bånkestad, Ellinor
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden.
    Acceptance of Tinnitus As an Independent Correlate of Tinnitus Severity2015In: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, Vol. 36, no 4, p. e176-e182Article in journal (Refereed)
    Abstract [en]

    Objectives: Tinnitus is the experience of sounds without an identified external source, and for some the experience is associated with significant severity (i.e., perceived negative affect, activity limitation, and participation restriction due to tinnitus). Acceptance of tinnitus has recently been proposed to play an important role in explaining heterogeneity in tinnitus severity. The purpose of the present study was to extend previous investigations of acceptance in relation to tinnitus by examining the unique contribution of acceptance in accounting for tinnitus severity, beyond anxiety and depression symptoms. Design: In a cross-sectional study, 362 participants with tinnitus attending an ENT clinic in Sweden completed a standard set of psychometrically examined measures of acceptance of tinnitus, tinnitus severity, and anxiety and depression symptoms. Participants also completed a background form on which they provided information about the experience of tinnitus (loudness, localization, sound characteristics), other auditory-related problems (hearing problems and sound sensitivity), and personal characteristics. Results: Correlational analyses showed that acceptance was strongly and inversely related to tinnitus severity and anxiety and depression symptoms. Multivariate regression analysis, in which relevant patient characteristics were controlled, revealed that acceptance accounted for unique variance beyond anxiety and depression symptoms. Acceptance accounted for more of the variance than anxiety and depression symptoms combined. In addition, mediation analysis revealed that acceptance of tinnitus mediated the direct association between self-rated loudness and tinnitus severity, even after anxiety and depression symptoms were taken into account. Conclusions: Findings add to the growing body of work, supporting the unique and important role of acceptance in tinnitus severity. The utility of the concept is discussed in relation to the development of new psychological models and interventions for tinnitus severity.

  • 341.
    Hesser, Hugo
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Engstrand, Jonna
    Jeppsson, Ulrika
    Gustafsson, Tina
    Axelsson, Sandra
    Pollack, Maria
    Bäcke, Viktoria
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Internet-delivered acceptance-based skills training for the prevention of interpersonal violence2014Conference paper (Refereed)
  • 342.
    Hesser, Hugo
    et al.
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Gustafsson, Tore
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Lundén, Charlotte
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Henrikson, Oskar
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Fattahi, Kidjan
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Johnsson, Erik
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Westin Zetterqvist, Vendela
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Educational Sciences.
    Carlbring, Per
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Mäki-Torkko, Elina
    Linköping University, Department of Clinical and Experimental Medicine, Technical Audiology. Linköping University, Faculty of Health Sciences.
    Kaldo, Viktor
    Department of Clinical Neuroscience, Psychiatric Section, Karolinska Institutet, Stockholm, Sweden.
    Andersson, Gerhard
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    A Randomized Controlled Trial of Internet-Delivered Cognitive Behavior Therapy and Acceptance and Commitment Therapy in the Treatment of Tinnitus2012In: Journal of Consulting and Clinical Psychology, ISSN 0022-006X, E-ISSN 1939-2117, Vol. 80, no 4, p. 649-661Article in journal (Refereed)
    Abstract [en]

    Objective: Our aim in this randomized controlled trial was to investigate the effects on global tinnitus severity of 2 Internet-delivered psychological treatments, acceptance and commitment therapy (ACT) and cognitive behavior therapy (CBT), in guided self-help format. Method: Ninety-nine participants (mean age = 48.5 years; 43% female) who were significantly distressed by tinnitus were recruited from the community. Participants were randomly assigned to CBT (n = 32), ACT (n = 35), or a control condition (monitored Internet discussion forum; n = 32), and they were assessed with standardized self-report measures (Tinnitus Handicap Inventory; Hospital Anxiety and Depression Scale; Quality of Life Inventory; Perceived Stress Scale; Tinnitus Acceptance Questionnaire) at pre-, posttreatment (8 weeks), and 1-year follow-up. Results: Mixed-effects linear regression analysis of all randomized participants showed significant effects on the primary outcome (Tinnitus Handicap Inventory) for CBT and for ACT compared with control at posttreatment (95% CI [-17.03, -2.94], d = 0.70, and 95% CI [-16.29, -2.53], d = 0.68, respectively). Within-group effects were substantial from pretreatment through 1-year-follow-up for both treatments (95% CI [-44.65, -20.45], d = 1.34), with no significant difference between treatments (95% CI [-14.87, 11.21], d = 0.16). Conclusions: Acceptance-based procedures may be a viable alternative to traditional CBT techniques in the management of tinnitus. The Internet can improve access to psychological interventions for tinnitus.

  • 343.
    Hesser, Hugo
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Hedman, E.
    Karolinska Institute, Sweden.
    Lindfors, P.
    University of Gothenburg, Sweden; Karolinska Institute, Sweden.
    Andersson, E.
    Karolinska Institute, Sweden.
    Ljotsson, B.
    Karolinska Institute, Sweden.
    The specific effect of systematic exposure in irritable bowel syndrome: complier average causal effect analysis using growth mixture modeling2017In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 47, no 15, p. 2653-2662Article in journal (Refereed)
    Abstract [en]

    Background. We reanalyzed data from a previously published randomized component study that aimed to test the incremental effect of systematic exposure in an internet-delivered cognitive behavioral treatment (ICBT) for irritable bowel syndrome (IBS). Methods. Three hundred and nine individuals with IBS were randomly assigned to either the full treatment protocol (experimental condition) or the same treatment protocol without systematic exposure (control). Participants were assessed weekly for IBS symptoms over the active treatment phase. We used a complier average causal effect (CACE) analysis, in the growth mixture modeling framework, to (1) examine the specific effect of exposure among those who received the intervention (i.e. compliers), and (2) explore the associations of pre-treatment patient characteristics with compliance status and outcome changes. Results. Fifty-five per cent of those assigned to the experimental condition were classified as compliers. The CACE analysis that took into account compliance status demonstrated that the magnitude of the incremental effect of systematic exposure on IBS symptoms was larger than the effect observed in an intention-to-treat analysis that ignored compliance status (d = 0.81 v. d = 0.44). Patients with university education showed more improvement during the exposure phase of the treatment. Pre-treatment patient characteristics did not predict compliance status. Conclusions. The effect of systematic exposure on IBS symptoms is of substantial magnitude among those individuals who actually receive the intervention (CACE). Studying the subsample of individuals who discontinue treatment prematurely and tailoring interventions to improve compliance may increase overall improvement rates in ICBT for IBS.

  • 344.
    Hesser, Hugo
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Hedman-Lagerlöf, Erik
    Karolinska Inst, Sweden.
    Andersson, Erik
    Karolinska Inst, Sweden.
    Lindfors, Perjohan
    Karolinska Inst, Sweden; Univ Gothenburg, Sweden.
    Ljotsson, Brjann
    Karolinska Inst, Sweden.
    How Does Exposure Therapy Work? A Comparison Between Generic and Gastrointestinal Anxiety-Specific Mediators in a Dismantling Study of Exposure Therapy for Irritable Bowel Syndrome2018In: Journal of Consulting and Clinical Psychology, ISSN 0022-006X, E-ISSN 1939-2117, Vol. 86, no 3, p. 254-267Article in journal (Refereed)
    Abstract [en]

    Objective: Systematic exposure is potentially an effective treatment procedure for treating irritable bowel syndrome (IBS), but little is known about the processes by which it achieves its effect on outcome. The aim of this study was to identify mediators in a previously published randomized dismantling trial in which participants with IBS were randomized to Internet-delivered cognitive-behavioral treatment (ICBT) that incorporated systematic exposure or to the same treatment protocol without exposure (ICBT-WE). Method: Weekly measurements of gastrointestinal anxiety-specific process variables (behavioral avoidance, gastrointestinal-specific anxiety) based on the gastrointestinal symptom-specific anxiety model, generic process variables (self-efficacy and mindful nonreactivity), and treatment outcome (IBS symptoms) were obtained from 309 participants with IBS. Growth models and cross-lagged panel models, estimated within structural equation modeling, were employed to evaluate mediators of outcome. Results: Parallel process growth modeling showed that behavioral avoidance, gastrointestinal-specific anxiety, self-efficacy mediated the incremental effect of ICBT compared to ICBT-WE. The mediated effect of avoidance was stronger for individuals scoring high on the avoidance variable at 1st measurement point. Cross-lagged regression analyses with random effects revealed that behavioral avoidance and gastrointestinal-specific anxiety had a stronger effect on subsequent symptom change rather than vice versa, whereas mindful nonreactivity and self-efficacy displayed the opposite pattern. Conclusions: The evidence collectively provided support for the hypothesis that exposure for IBS achieves its positive results by virtue of changing gastrointestinal anxiety-specific processes rather than generic processes. IBS-specific behavioral avoidance emerged as the most clear-cut mediator of the specific effect of exposure on outcome.

  • 345.
    Hesser, Hugo
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, The Swedish Institute for Disability Research. Linköping University, Faculty of Arts and Sciences.
    Molander, Peter
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Jungermann, Mikael
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, The Swedish Institute for Disability Research. Linköping University, Faculty of Arts and Sciences.
    Costs of Suppressing Emotional Sound and Countereffects of a Mindfulness Induction: An Experimental Analog of Tinnitus Impact2013In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 5, p. e64540-Article in journal (Other academic)
    Abstract [en]

    Tinnitus is the experience of sounds without an appropriate external auditory source. These auditory sensations are intertwined with emotional and attentional processing. Drawing on theories of mental control, we predicted that suppressing an affectively negative sound mimicking the psychoacoustic features of tinnitus would result in decreased persistence in a mentally challenging task (mental arithmetic) that required participants to ignore the same sound, but that receiving a mindfulness exercise would reduce this effect. Normal hearing participants (N = 119) were instructed to suppress an affectively negative sound under cognitive load or were given no such instructions. Next, participants received either a mindfulness induction or an attention control task. Finally, all participants worked with mental arithmetic while exposed to the same sound. The length of time participants could persist in the second task served as the dependent variable. As hypothesized, results indicated that an auditory suppression rationale reduced time of persistence relative to no such rationale, and that a mindfulness induction counteracted this detrimental effect. The study may offer new insights into the mechanisms involved in the development of tinnitus interference. Implications are also discussed in the broader context of attention control strategies and the effects of emotional sound on task performance. The ironic processes of mental control may have an analog in the experience of sounds.

  • 346.
    Hesser, Hugo
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, The Swedish Institute for Disability Research. Linköping University, Faculty of Arts and Sciences.
    Zetterqvist Westin, Vendela
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Faculty of Arts and Sciences.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, The Swedish Institute for Disability Research. Linköping University, Faculty of Arts and Sciences.
    Acceptance as a Mediator in Internet-delivered Acceptance and Commitment Therapy and Cognitive Behavior Therapy for TinnitusManuscript (preprint) (Other academic)
    Abstract [en]

    Despite demonstrated efficacy of behavioral and cognitive techniques in treating the impact of tinnitus (constant ringing in the ears), little is known about the mechanisms by which these techniques achieve their effect. The present study examined acceptance of tinnitus as a potential mediator of treatment changes on global tinnitus severity in internet-delivered acceptance and commitment therapy (iACT) and internet-delivered cognitive behavior therapy (iCBT). Data from 67 participants who were distressed by tinnitus and who were randomly assigned to 1 of the 2 treatments were analyzed using a multilevel moderated mediation model. We predicted that acceptance as measured with the two subscales of the tinnitus acceptance questionnaire (i.e., activity engagement and tinnitus suppression) would mediate the outcome in iACT, but not in iCBT. Results provided partial support to the notion that mediation was moderated by treatment: tinnitus suppression mediated changes in tinnitus severity in iACT, but not in iCBT. However, inconsistent with the view that the treatments worked through different processes of change, activity engagement mediated treatment changes across both iACT and iCBT. Acceptance is identified as a key source of therapeutic change in behavioral-based treatments for tinnitus.

  • 347.
    Hesser, Hugo
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Zetterqvist Westin, Vendela
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Educational Sciences.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institutet, Stockholm, Sweden .
    Acceptance as a mediator in internet-delivered acceptance and commitment therapy and cognitive behavior therapy for tinnitus2014In: Journal of behavioral medicine, ISSN 0160-7715, E-ISSN 1573-3521, Vol. 37, no 4, p. 756-767Article in journal (Refereed)
    Abstract [en]

    Despite demonstrated efficacy of behavioral and cognitive techniques in treating the impact of tinnitus (constant ringing in the ears), little is known about the mechanisms by which these techniques achieve their effect. The present study examined acceptance of tinnitus as a potential mediator of treatment changes on global tinnitus severity in internet-delivered acceptance and commitment therapy (iACT) and internet-delivered cognitive behavior therapy (iCBT). Data from 67 participants who were distressed by tinnitus and who were randomly assigned to 1 of the 2 treatments were analyzed using a multilevel moderated mediation model. We predicted that acceptance as measured with the two subscales of the tinnitus acceptance questionnaire (i.e., activity engagement and tinnitus suppression) would mediate the outcome in iACT, but not in iCBT. Results provided partial support to the notion that mediation was moderated by treatment: tinnitus suppression mediated changes in tinnitus severity in iACT, but not in iCBT. However, inconsistent with the view that the treatments worked through different processes of change, activity engagement mediated treatment changes across both iACT and iCBT. Acceptance is identified as a key source of therapeutic change in behavioral-based treatments for tinnitus.

  • 348.
    Hollandare, F
    et al.
    University Orebro.
    Johnsson, S
    University Orebro.
    Randestad, M
    University Orebro.
    Tillfors, M
    University Orebro.
    Carlbring, P
    Umea University.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Clinical and Social Psychology. Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Behavioural Sciences and Learning, Psychology.
    Engstrom, I
    University Orebro.
    Randomized trial of Internet-based relapse prevention for partially remitted depression2011In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 124, no 4, p. 285-294Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate whether Internet-based cognitive behaviour therapy (CBT) can prevent relapse in persons with partially remitted major depression after previous treatment. less thanbrgreater than less thanbrgreater thanMethod: Seventy-one women and 13 men (N = 84) with partially remitted major depression after treatment were randomly assigned to either 10 weeks of Internet-based CBT or to a control group. Self-help material was used in combination with e-mail contact with a personal therapist. Monthly self-ratings of depressive symptoms were made, and diagnostic interviews were conducted before and after the treatment period, as well as 6 months later. less thanbrgreater than less thanbrgreater thanResults: Significantly fewer participants in the CBT group experienced relapse (4/38 or 10.5%) compared with those in the control group (14/37 or 37.8%). The difference in relapse rates between groups occurred early in the study period and was still apparent after 6 months. A trend towards a larger reduction in depressive symptoms was observed at post-treatment in the participants who received CBT compared with controls. Reduction in depressive symptoms reduced the risk of relapse. A trend towards a higher remission rate was found in the CBT group at the 6 month follow-up. less thanbrgreater than less thanbrgreater thanConclusion: Internet-based CBT seems promising in preventing relapse in persons with partially remitted major depression after previous treatment.

  • 349. Holländare, Fredrik
    et al.
    Anthony, Susanne A
    Randestad, Mia
    Tillfors, Maria
    Carlbring, Per
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institutet, Stockholm, Sweden.
    Engström, Ingemar
    Two-year outcome of internet-based relapse prevention for partially remitted depression2013In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 51, no 11, p. 719-722Article in journal (Refereed)
    Abstract [en]

    The objective of the study was to investigate the long-term effects of internet-based relapse prevention for sufferers of partially remitted depression. Eighty-four individuals with partially remitted unipolar depression were randomized to either internet-based CBT (iCBT) or to a control group. After the ten week intervention period the participants were followed for 24 months and diagnostic interviews conducted to detect relapse. The intervention and monthly self-ratings of depressive symptoms were administered via an internet-based platform that ensured secure communication with all participants. Significantly fewer participants in the iCBT group had experienced a relapse compared with those in the control group two years after the internet-based intervention. The relapse rate in the iCBT group was 13.7% (CI 95%=2.5-24.9) and in the control group it was 60.9% (CI 95%=44.8-77). Furthermore, a significantly larger proportion of the iCBT group experienced remission two years after the intervention compared with the control group. Internet-based CBT seems promising for preventing relapse in sufferers of partially remitted depression.

  • 350.
    Holländare, Fredrik
    et al.
    Psychiatric Research Centre, School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Gustafsson, Sanna Aila
    Psychiatric Research Centre, School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Berglind, Maria
    School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden.
    Grape, Frida
    School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden.
    Carlbring, Per
    Division of Clinical Psychology, Department of Psychology, Stockholm University, Stockholm, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institute, Stockholm, Sweden.
    Hadjistavropoulos, Heather
    Department of Psychology, University of Regina, Regina, Canada.
    Tillfors, Maria
    School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden.
    Therapist behaviours in internet-based cognitive behaviour therapy (ICBT) for depressive symptoms2016In: Internet Interventions, ISSN 2214-7829, Vol. 3, p. 1-7Article in journal (Refereed)
    Abstract [en]

    Internet-based cognitive behaviour therapy (ICBT) is efficacious for treating depression, with therapist guidance identified as important for favourable outcomes. We have limited knowledge, however, about the fundamental components of therapist guidance in ICBT. The purpose of this study was to systematically examine therapist messages sent to patients during the course of ICBT for depressive symptoms in order to identify common “therapist behaviours” and the extent to which these behaviours correlate with completion of modules and improvements in symptoms at post-treatment, one- and two-year follow-up. A total of 664 e-mails from 5 therapists to 42 patients were analysed using qualitative content analysis. The most frequent behaviour was encouraging that accounted for 31.5% of the total number of coded behaviours. This was followed by affirming (25.1%), guiding (22.2%) and urging (9.8%). Less frequently the therapists clarified the internet treatment frameworkinformed about module contentemphasised the importance of patient responsibilityconfronted the patient and made self-disclosures. Six of the nine identified therapist behaviours correlated with module completion. Three behaviours correlated with symptom improvement. Affirmingcorrelated significantly (r = .42, p = .005) with improvement in depressive symptoms at post-treatment and after two years (r = .39, p = .014). Encouraging was associated with outcome directly after treatment (r = .52, p = .001). Self-disclosure was correlated with improvement in depressive symptoms at post-treatment (r = .44, p = .003). The study contributes to a better understanding of therapist behaviours in ICBT for depressive symptoms. Future directions for research are discussed.

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