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  • 51.
    Andersson, Gerhard
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institutet, Stockholm, Sweden.
    Waara, Johan
    Uppsala University, Sweden.
    Jonsson, Ulf
    Karolinska Institutet, Stockholm, Sweden.
    Malmaeus, Fredrik
    Uppsala University, Sweden.
    Carlbring, Per
    Stockholm University, Sweden.
    Öst, Lars-Göran
    Karolinska Institutet, Stockholm, Sweden.
    Internet-based exposure treatment versus one-session exposure treatment of snake phobia: a randomized controlled trial2013In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 42, no 4, p. 284-291Article in journal (Refereed)
    Abstract [en]

    In this study, the authors compared guided Internet-delivered self-help with one-session exposure treatment (OST) in a sample of snake phobic patients. A total of 30 patients were included following a screening on the Internet and a structured clinical interview. The Internet treatment consisted of four weekly text modules which were presented on a web page, a video in which exposure was modelled, and support provided via Internet. The OST was delivered in a three-hour session following a brief orientation session. The main outcome was the behavioural approach test (BAT), and as secondary measures questionnaires measuring anxiety symptoms and depression were used. Results showed that the groups did not differ at post-treatment or follow-up, with the exception of a significant interaction for the BAT in favour of the OST. At post-treatment, 61.5% of the Internet group and 84.6% of the OST group achieved a clinically significant improvement on the BAT. At follow-up, the corresponding figures were 90% for the Internet group and 100% for the OST group (completer sample). Within-group effect sizes for the Snake Phobia Questionnaire were large (d = 1.63 and d = 2.31 for the Internet and OST groups, respectively, at post-treatment). It is concluded that guided Internet-delivered exposure treatment is a potential treatment option in the treatment of snake phobia, but that OST probably is better.

  • 52.
    Andersson, Sandra
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology.
    Salomonsson, Julia
    Linköping University, Department of Behavioural Sciences and Learning, Psychology.
    Ungas perspektiv på föräldraskap och ursprung: Reflektioner från unga vuxna tillkomna genom könscellsdonation och/eller uppvuxna i regnbågsfamiljer2018Independent thesis Advanced level (degree of Master (Two Years)), 300 HE creditsStudent thesis
    Abstract [sv]

    Denna examensuppsats har ämnat undersöka ungdomars och unga vuxnas perspektiv på och upplevelser av föräldraskap och genetiskt ursprung samt aktuell föräldralagstiftning. Examensuppsatsen ämnar vidare utgöra underlag för en rapport som beaktas i en statlig utredning som handlar om att se över aktuella regler kring fastställande av rättsligt föräldraskap. Genom semistrukturerade intervjuer med tio unga vuxna i åldern 17 till 32 år har data samlats in och analyserats med tematisk analys.

    I resultaten fann vi att deltagarnas sätt definiera och tala om föräldraskap är i linje med tidigare forskning. Även internationell forskning kring synen på könscellsdonatorer och deras roll som föräldrar eller icke-föräldrar har kunnat appliceras på vårt intervjumaterial för att förstå donatorsrollen som infallande på ett kontinuum. Nya fynd som framkommit är att avsaknad av rättsliga band ej utgör ett oöverkomligt hinder för utövandet av socialt föräldraskap, både i avseende på att skaffa barn och sedermera uppfostra det. Deltagarna berättar dock att avsaknad av rättsligt föräldraskap har varit problematiskt vid dödsfall och separationer. Funderingar kring genetiskt ursprung och tillkomst beskrivs påbörjas i tidig ålder hos deltagarna och vara avslutat i tidig vuxen ålder, vilket är ett nytt fynd och går emot lagstiftad ålder för kännedom om donator och genetiskt ursprung. Möjlighet till kännedomen om genetiskt ursprung lyfts som barnets okränkbara rättighet.

    Utifrån dessa fynd drar vi slutsatsen att trots lagmässiga hinder kan ett fullständigt föräldraskap i många fall utövas av icke-juridiska föräldrar samt att avsaknad av genetiska band ej utgör en barriär för relationsskapande eller identitetsutveckling. Däremot anses lagstiftning och samhällsattityder fortfarande vara exkluderande och osynliggörande gentemot regnbågsfamiljer och könscellsdonation.

  • 53.
    Andersson, Ulf
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Skagerlund, Kenny
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Olsson, Linda
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Östergren, Rickard
    Linköping University, Department of Behavioural Sciences and Learning, Education, Teaching and Learning. Linköping University, Faculty of Educational Sciences.
    Pathways to arithmetic fact retrieval and percentage calculation in adolescents2017In: British Journal of Educational Psychology, ISSN 0007-0998, E-ISSN 2044-8279, Vol. 87, no 4, p. 647-663Article in journal (Refereed)
    Abstract [en]

    Background

    Developing sufficient mathematical skills is a prerequisite to function adequately in society today. Given this, an important task is to increase our understanding regarding the cognitive mechanisms underlying young people's acquisition of early number skills and formal mathematical knowledge.

    Aims

    The purpose was to examine whether the pathways to mathematics model provides a valid account of the cognitive mechanisms underlying symbolic-number processing and mathematics in adolescents. The pathways model states that the three pathways should provide independent support to symbolic-number skill. Each pathway's unique contribution to formal mathematics varies depending on the complexity and demand of the tasks.

    Sample

    The study used a sample of 114 adolescents (71 girls). Their mean age was 14.60 years (SD = 1.00).

    Methods

    The adolescents were assessed on tests tapping the three pathways and general cognitive abilities (e.g., working memory). A structural equation path analysis was computed.

    Results

    Symbolic-number comparison was predicted by the linguistic pathway, the quantitative pathway, and processing speed. The linguistic pathway, quantitative pathways, and symbolic-number comparison predicted arithmetic fact retrieval. The linguistic pathway, working memory, visual analogies, and symbolic-number comparison predicted percentage calculation.

    Conclusions

    There are both similarities and differences in the cognitive mechanisms underlying arithmetic fact retrieval and percentage calculation in adolescents. Adolescents’ symbolic-number processing, arithmetic fact retrieval, and percentage calculation continue to rely on the linguistic pathways, whereas the reliance upon the spatial pathway has ceased. The reliance upon the quantitative pathway varies depending on the task.

  • 54.
    Andersson, Ulf
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Östergren, Rickard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Number magnitude processing and basic cognitive functions in children with mathematical learning disabilities2012In: Learning and individual differences, ISSN 1041-6080, E-ISSN 1873-3425, Vol. 22, no 6, p. 701-714Article in journal (Refereed)
    Abstract [en]

    The study sought out to extend our knowledge regarding the origin ofmathematical learning disabilities (MLD) in children by testing different hypotheses in the same samples of children. Different aspects of cognitive functions and number processing were assessed in fifth- and sixth-graders (1113 years old) withMLD and compared to controls. The MLD group displayed weaknesses withmost aspects of number processing (e.g., subitizing, symbolic number comparison, number-line estimation) and two cognitive functions (e.g., visualspatial working memory). These findings favor the defective approximate number system (ANS) hypothesis, but do not fit well with the access deficit hypothesis. Support is also provided for the defective object-tracking system (OTS) hypothesis, the domain general cognitive deficit hypothesis and to some extent the defective numerosity-coding hypothesis. The study suggests that MLD might be caused by multiple deficits and not a single core deficit.

  • 55.
    Andersson, Yvonne
    et al.
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Holmqvist, Rolf
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Nilsson, Doris
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Child Evacuations During World War II: This ShouldNot Happen Again2019In: Journal of Loss and Trauma, ISSN 1532-5024Article in journal (Refereed)
    Abstract [en]

    There is little research about the long-term effects on childrenthat were separated from their parents and moved fromFinland to Sweden during World War II. The aim of this studywas to capture these now-lifelong reflections, and so questionnaireswere sent to 14 potential participants. Ten personsaged 7381 responded. The themes that emerged concernedpride over professional achievements, the pain of separation,and feelings of alienation and loneliness. The informantsemphasized the importance of sibling relationships. The conclusionwas that the participants, despite the hardships connectedwith the migration, had successfully lived a good lifein Sweden.ARTICLE HISTORYReceived 16 July 2018Accepted 11 May 2018KEYWORDSFinnish war children; childseparations; childevacuation; importance ofsibling relationsAt

  • 56.
    Andin, Josefine
    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.
    Fransson, Peter
    Karolinska Inst, Sweden.
    Dahlström, Örjan
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research.
    Rönnberg, Jerker
    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.
    Rudner, Mary
    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.
    The neural basis of arithmetic and phonology in deaf signing individuals2019In: Language, Cognition and Neuroscience, ISSN 2327-3798, E-ISSN 2327-3801, Vol. 34, no 7, p. 813-825Article in journal (Refereed)
    Abstract [en]

    Deafness is generally associated with poor mental arithmetic, possibly due to neuronal differences in arithmetic processing across language modalities. Here, we investigated for the first time the neuronal networks supporting arithmetic processing in adult deaf signers. Deaf signing adults and hearing non-signing peers performed arithmetic and phonological tasks during fMRI scanning. At whole brain level, activation patterns were similar across groups. Region of interest analyses showed that although both groups activated phonological processing regions in the left inferior frontal gyrus to a similar extent during both phonological and multiplication tasks, deaf signers showed significantly more activation in the right horizontal portion of the inferior parietal sulcus. This region is associated with magnitude manipulation along the mental number line. This pattern of results suggests that deaf signers rely more on magnitude manipulation than hearing non-signers during multiplication, but that phonological involvement does not differ significantly between groups.Abbreviations: AAL: Automated Anatomy Labelling; fMRI: functional magnetic resonance imaging; HIPS: horizontal portion of the intraparietal sulcus; lAG: left angular gyrus; lIFG: left inferior frontal gyrus; rHIPS: right horizontal portion of the intraparietal sulcus

  • 57.
    Angelhoff, Charlotte
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Department of Clinical and Experimental Medicine. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, H.K.H. Kronprinsessan Victorias barn- och ungdomssjukhus. Linköping University, Faculty of Medicine and Health Sciences.
    Thernström Blomqvist, Ylva
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Sahlén Helmer, Charlotte
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, H.K.H. Kronprinsessan Victorias barn- och ungdomssjukhus. Linköping University, Department of Clinical and Experimental Medicine.
    Olsson, Emma
    Department of Pediatrics and Centre for Health Care Sciences, Örebro University, Örebro, Sweden.
    Shorey, Shefaly
    Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore.
    Frostell, Anneli
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Mörelius, Evalotte
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, H.K.H. Kronprinsessan Victorias barn- och ungdomssjukhus.
    Effect of skin-to-skin contact on parents sleep quality, mood, parent-infant interaction and cortisol concentrations in neonatal care units: study protocol of a randomised controlled trial2018In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 7, article id e021606Article in journal (Refereed)
    Abstract [en]

    Introduction Separation after preterm birth is a major stressor for infants and parents. Skin-to-skin contact (SSC) is a method of care suitable to use in the neonatal intensive care unit (NICU) to minimise separation between parents and infants. Less separation leads to increased possibilities for parent-infant interaction, provided that the parents’ sleep quality is satisfactory. We aimed to evaluate the effect of continuous SSC on sleep quality and mood in parents of preterm infants born <33 weeks of gestation as well as the quality of parent-infant interaction and salivary cortisol concentrations at the time of discharge.

    Methods and analysis A randomised intervention study with two arms—intervention versus standard care. Data will be collected from 50 families. Eligible families will be randomly allocated to intervention or standard care when transferred from the intensive care room to the family-room in the NICU. The intervention consists of continuous SSC for four consecutive days and nights in the family-room. Data will be collected every day during the intervention and again at the time of discharge from the hospital. Outcome measures comprise activity tracker (Actigraph); validated self-rated questionnaires concerning sleep, mood and bonding; observed scorings of parental sensitivity and emotional availability and salivary cortisol. Data will be analysed with pairwise, repeated measures, Mann Whitney U-test will be used to compare groups and analysis of variance will be used to adjust for different hospitals and parents’ gender.

    Ethics and dissemination The study is approved by the Regional Research Ethics Board at an appropriate university (2016/89–31). The results will be published in scientific journals. We will also use conferences and social media to disseminate our findings.

  • 58.
    Areàn, Patricia A
    et al.
    University of Washington, Seattle, Washington, USA.
    Ly, Kien Hoa
    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. Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
    Mobile technology for mental health assessment.2016In: Dialogues in Clinical Neuroscience, ISSN 1294-8322, E-ISSN 1958-5969, Vol. 18, no 2, p. 163-169Article in journal (Refereed)
    Abstract [en]

    Assessment and outcome monitoring are critical for the effective detection and treatment of mental illness. Traditional methods of capturing social, functional, and behavioral data are limited to the information that patients report back to their health care provider at selected points in time. As a result, these data are not accurate accounts of day-to-day functioning, as they are often influenced by biases in self-report. Mobile technology (mobile applications on smartphones, activity bracelets) has the potential to overcome such problems with traditional assessment and provide information about patient symptoms, behavior, and functioning in real time. Although the use of sensors and apps are widespread, several questions remain in the field regarding the reliability of off-the-shelf apps and sensors, use of these tools by consumers, and provider use of these data in clinical decision-making.

  • 59.
    Arnison, Tor
    et al.
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Menon, JA
    Department of Psychology, University of Zambia, Lusaka, Zambia.
    Malambo, C
    Department of Psychology, University of Zambia, Lusaka, Zambia.
    Nilsson, Doris
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Posttraumatic Stress among women with HIV in Zambia2017In: The Medical Journal of Zambia, ISSN 0047-651X, Vol. 44, no 2, p. 100-105Article in journal (Refereed)
    Abstract [en]

    Objective: To examine whether HIV-positive women in Lusaka District, Zambia, displays a higher degree of PTSD-symptoms than a HIV-negative control group.

    Method: The study targeted 50 HIV-positive women from four ART-clinics and 42 HIV-negative women from corresponding VCT-units. All sites were located in Lusaka District, Zambia. The HIV-positive women were compared with the control group in regard for PTSD, PTSD-symptoms, dissociative symptoms and history of traumatic experiences. The instruments used were PCL-C, DES-T and LYLES-A. Prior to the main study, the validity of the instruments were assessed with a pilot-sample.

    Results: Three participants in the HIV-positive group fulfilled the criteria for clinical PTSD (10.7 %), as compared to none in the control group. The HIV-positive group also displayed a significantly higher degree of PTSD-symptoms and previous traumatic experiences, with strong effect sizes, but not for dissociative symptoms. The significant difference in PTSD-symptoms remained while trauma-history was controlled for.

    Conclusions: The results of this study clearly indicates that women with HIV are vulnerable to PTSD and that contracting HIV in itself can constitute a psychological trauma in itself. Since PTSD among persons with HIV has been associated with transmission risk behaviours, reduced treatment adherence and a faster disease progression, these findings are important to consider in actions against HIV and AIDS. 

  • 60.
    Asutay, E.
    et al.
    Division of Applied Acoustics, Chalmers University of Technology, Gothenburg, Sweden.
    Kleiner, M.
    Division of Applied Acoustics, Chalmers University of Technology, Gothenburg, Sweden.
    Västfjäll, Daniel
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Development of methodology for documentation of key action properties and haptie sensation of pipe organ playing2012In: Acoustics Bulletin, ISSN 0308-437X, Vol. 37, no 5, p. 42-44Article in journal (Refereed)
    Abstract [en]

    Musical instruments provide auditory, visual and tactile feedback to the performer. The organist hears the pipes sounding as well as the contribution of room acoustics, sees the console, smells the air of the room, and feels the key action properties through his or her fingers and feet. Thus just as perception of most objects and events is multisensory, the sensation and perception of instrument playing are also multisensory. Within the project, The Organ as Memory Bank, we investigate the underlying dimensions of haptics in pipe organ playing, focusing on the mechanical manual-key action. This research involves both objective and subjective characterisation of the key action. Objective characterisation focuses on mechanical construction of the key and trackers and how it shapes the tactile feedback. The dynamic behaviour of the keys is measured as a function of key-fall and velocity as keys are pressed using a controllable linear actuator and characterized by objective parameters. The subjective characterisation of the haptics of organ playing is initially surveyed online. Semantic differential scales, which are devised based on the results of the survey, will be used in subjective experiments to reveal the underlying dimensions. Finally the objective (physical) and subjective (perceptual) characteristics will be linked to reveal the salient sensorial key action properties.

  • 61.
    Asutay, Erkin
    et al.
    Chalmers, Sweden.
    Västfjäll, Daniel
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Decis Research, OR USA.
    Attentional and Emotional Prioritization of the Sounds Occurring Outside the Visual Field2015In: Emotion, ISSN 1528-3542, E-ISSN 1931-1516, Vol. 15, no 3, p. 281-286Article in journal (Refereed)
    Abstract [en]

    The ability to detect and localize sounds in an environment is critical for survival. Localizing sound sources is a computational challenge for the human brain because the auditory cortex seems to lack a topographical space representation. However, attention and task demands can modulate localization performance. Here, we investigated whether the localization performance for sounds occurring directly in front of or behind people could be modulated by emotional salience and sound-source location. We measured auditory-induced emotion by ecological sounds occurring in the frontal or rear perceptual fields, and employed a speeded localization task. The results showed that both localization speed and accuracy were higher, and that stronger negative emotions were induced when sound sources were behind the participants. Our results provide clear behavioral evidence that auditory attention can be influenced by sound-source location. Importantly, we also show that the effect of spatial location on attention is mediated by emotion, which is in line with the argument that emotional information is prioritized in processing. Auditory system functions as an alarm system and is in charge of detecting possible salient events, and alarming for an attention shift. Further, spatial processing in the auditory dorsal pathway has a function of guiding the visual system to a particular location of interest. Thus, an auditory bias toward the space outside the visual field can be useful, so that visual attention could be quickly shifted in case of emotionally significant information.

  • 62.
    Asutay, Erkin
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Chalmers, Sweden.
    Västfjäll, Daniel
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Decis Research, OR USA.
    Auditory attentional selection is biased by reward cues2016In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 6, article id 36989Article in journal (Refereed)
    Abstract [en]

    Auditory attention theories suggest that humans are able to decompose the complex acoustic input into separate auditory streams, which then compete for attentional resources. How this attentional competition is influenced by motivational salience of sounds is, however, not well-understood. Here, we investigated whether a positive motivational value associated with sounds could bias the attentional selection in an auditory detection task. Participants went through a reward-learning period, where correct attentional selection of one stimulus (CS+) lead to higher rewards compared to another stimulus (CS-). We assessed the impact of reward-learning by comparing perceptual sensitivity before and after the learning period, when CS+ and CS-were presented as distractors for a different target. Performance decreased after reward-learning when CS+ was a distractor, while it increased when CS- was a distractor. Thus, the findings show that sounds that were associated with high rewards captures attention involuntarily. Additionally, when successful inhibition of a particular sound (CS-) was associated with high rewards then it became easier to ignore it. The current findings have important implications for the understanding of the organizing principles of auditory perception and provide, for the first time, clear behavioral evidence for reward-dependent attentional learning in the auditory domain in humans.

  • 63.
    Asutay, Erkin
    et al.
    Chalmers, Sweden .
    Västfjäll, Daniel
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Emotional Bias in Change Deafness in Multisource Auditory Environments2014In: Journal of experimental psychology. General, ISSN 0096-3445, E-ISSN 1939-2222, Vol. 143, no 1, p. 27-32Article in journal (Refereed)
    Abstract [en]

    Theories of auditory attention suggest that humans decompose complex auditory input into individual auditory objects, which then compete for attention to dominate auditory perception. Since emotional significance of external stimuli has been argued to provide cues for sensory prioritization and allocation of attention, emotionally salient auditory objects can receive attention to dominate auditory perception. On the basis of the function of audition as an alarm system that informs the organism about its immediate surroundings, and on empirical evidence that emotion can modulate auditory perception, we argue that auditory stimuli with greater emotional saliency would dominate perception in multisource environments. To test our hypothesis, we employed a change detection task in which participants were asked to indicate whether multisource auditory scenes were identical or different. Participants were better at detecting changes at the presence of an emotionally negative environment compared to neutral environment. Further, we found that participants were better at detecting changes of emotionally negative targets compared to neutral targets. Our results demonstrate that detecting changes in auditory scenes is influenced by emotion. The findings are discussed in the light of the theories of auditory attention, emotional modulation of attention, and the adaptive function of emotion for perception.

  • 64.
    Asutay, Erkin
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Västfjäll, Daniel
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Decis Research, OR 97401 USA.
    Exposure to arousal-inducing sounds facilitates visual search2017In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 7, article id 10363Article in journal (Refereed)
    Abstract [en]

    Exposure to affective stimuli could enhance perception and facilitate attention via increasing alertness, vigilance, and by decreasing attentional thresholds. However, evidence on the impact of affective sounds on perception and attention is scant. Here, a novel aspect of affective facilitation of attention is studied: whether arousal induced by task-irrelevant auditory stimuli could modulate attention in a visual search. In two experiments, participants performed a visual search task with and without auditory-cues that preceded the search. Participants were faster in locating high-salient targets compared to low-salient targets. Critically, search times and search slopes decreased with increasing auditory-induced arousal while searching for low-salient targets. Taken together, these findings suggest that arousal induced by sounds can facilitate attention in a subsequent visual search. This novel finding provides support for the alerting function of the auditory system by showing an auditory-phasic alerting effect in visual attention. The results also indicate that stimulus arousal modulates the alerting effect. Attention and perception are our everyday tools to navigate our surrounding world and the current findings showing that affective sounds could influence visual attention provide evidence that we make use of affective information during perceptual processing.

  • 65.
    Asutay, Erkin
    et al.
    Chalmers, Sweden.
    Västfjäll, Daniel
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Decis Research, OR USA.
    Negative emotion provides cues for orienting auditory spatial attention2015In: Frontiers in Psychology, ISSN 1664-1078, E-ISSN 1664-1078, Vol. 6, no 618Article in journal (Refereed)
    Abstract [en]

    The auditory stimuli provide information about the objects and events around us. They can also carry biologically significant emotional information (such as unseen dangers and conspecific vocalizations), which provides cues for allocation of attention and mental resources. Here, we investigated whether task-irrelevant auditory emotional information can provide cues for orientation of auditory spatial attention. We employed a covert spatial orienting task: the dot-probe task. In each trial, two task-irrelevant auditory cues were simultaneously presented at two separate locations (lef-tright or front-back). Environmental sounds were selected to form emotional vs. neutral, emotional vs. emotional, and neutral vs. neutral cue pairs. The participants task was to detect the location of an acoustic target that was presented immediately after the task-irrelevant auditory cues. The target was presented at the same location as one of the auditory cues. The results indicated that participants were significantly faster to locate the target when it replaced the negative cue compared to when it replaced the neutral cue. The positive cues did not produce a clear attentional bias. Further, same valence pairs (emotionalemotional or neutralneutral) did not modulate reaction times due to a lack of spatial attention capture by one cue in the pair. Taken together, the results indicate that negative affect can provide cues for the orientation of spatial attention in the auditory domain.

  • 66.
    Asutay, Erkin
    et al.
    Chalmers, Sweden .
    Västfjäll, Daniel
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Perception of Loudness Is Influenced by Emotion2012In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 7, no 6Article in journal (Refereed)
    Abstract [en]

    Loudness perception is thought to be a modular system that is unaffected by other brain systems. We tested the hypothesis that loudness perception can be influenced by negative affect using a conditioning paradigm, where some auditory stimuli were paired with aversive experiences while others were not. We found that the same auditory stimulus was reported as being louder, more negative and fear-inducing when it was conditioned with an aversive experience, compared to when it was used as a control stimulus. This result provides support for an important role of emotion in auditory perception.

  • 67.
    Asutay, Erkin
    et al.
    Chalmers.
    Västfjäll, Daniel
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Tajadura-Jimenez, Ana
    Royal Holloway University of London.
    Genell, Anders
    VTI, Gothenburg.
    Bergman, Penny
    Chalmers.
    Kleiner, Mendel
    Chalmers.
    Emoacoustics: A Study of the Psychoacoustical and Psychological Dimensions of Emotional Sound Design2012In: JOURNAL OF THE AUDIO ENGINEERING SOCIETY, ISSN 1549-4950, Vol. 60, no 1-2, p. 21-28Article in journal (Refereed)
    Abstract [en]

    Even though traditional psychoacoustics has provided indispensable knowledge about auditory perception, it has, in its narrow focus on signal characteristics, neglected listener and contextual characteristics. To demonstrate the influence of the meaning the listener attaches to a sound in the resulting sensations we used a Fourier-time-transform processing to reduce the identifiability of 18 environmental sounds. In a listening experiment, 20 subjects listened to and rated their sensations in response to, first, all the processed stimuli and then, all original stimuli, without being aware of the relationship between the two groups. Another 20 subjects rated only the processed stimuli, which were primed by their original counterparts. This manipulation was used in order to see the difference in resulting sensation when the subject could tell what the sound source is. In both tests subjects rated their emotional experience for each stimulus on the orthogonal dimensions of valence and arousal, as well as perceived annoyance and perceived loudness for each stimulus. They were also asked to identify the sound source. It was found that processing caused correct identification to reduce substantially, while priming recovered most of the identification. While original stimuli induced a wide range of emotional experience, reactions to processed stimuli were emotionally neutral. Priming manipulation reversed the effects of processing to some extent. Moreover, even though the 5th percentile Zwickers-loudness (N5) value of most of the stimuli was reduced after processing, neither perceived loudness nor auditory-induced emotion changed accordingly. Thus indicating the importance of considering other factors apart from the physical sound characteristics in sound design.

  • 68.
    Axelsson, Sandra
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Gustafsson, Tina
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Vem drar mest nytta av en internetadministrerad kognitiv beteendeterapi mot utövande av våld i nära relationer?: Moderatorer i en randomiserad kontrollerad studie2014Independent thesis Advanced level (professional degree), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Inom ramen för IVIN- projektet avsåg föreliggande studie att explorativt undersöka vilka variabler som kan moderera behandlingsutfallet i en internetadministrerad KBT-behandling för personer som upplever svårigheter att reglera ilska, aggressioner eller utagerande beteenden i nära relationer. Sextiofem personer inkluderades och randomiserades till de två betingelserna behandlingsgrupp (n=32) och kontrollgrupp (n=33). Aktuell studie baserades på resultaten för de deltagare som fyllt i för- och eftermätning (n = 59). Huvudutfallsmåtten beräknades utifrån individuella värden vid eftermätningen kontrollerat för förmätningen på Multidimensional Measure of Emotional Abuse och Aggression Questionnaire - Revised Swedish Version. För att undersöka valda variablers modererande effekt på respektive utfallsmått användes multipel regression. Resultaten visade att individer med initialt hög frekvens av emotionellt- och fysiskt våld, låg ilskeruminering och hög acceptans av sin partners negativa beteenden drog mest nytta av behandlingen. Resultaten visade även en tendens till att högre motivation, lägre ångest och högre ålder modererade ett bättre behandlingsutfall. Dessa tendenser bör dock utforskas vidare för att bringa ytterligare klarhet till dessa moderatorers påverkan på behandlingsutfallet. 

  • 69.
    Backlund, Lisa
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Luuk, Liisa
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    DAY: Allians, komorbiditet och kunskap i KBT-behandling bestående av fyra behandlingsträffar och tio veckors internetbehandling för depression2015Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    I studien utvärderades en KBT-behandling för depression bestående av fyra behandlingsträffar i kombination med ett internetprogram under tio veckor. Syftet var att undersöka om behandlingen ledde till ökad kunskap om behandlingsinnehållet samt om kunskap, allians och komorbiditet kunde predicera symptomförbättring. Kunskapsökning undersöktes med ett kunskapstest som analyserades med ANCOVA och resultatet visade på en trend mot att behandlingen ledde till ökad kunskap. När skattningar av deltagarnas säkerhet på svaren på frågorna i kunskapstestet inkluderades i analysen var resultatet signifikant bättre för behandlingsgruppen jämfört med kontrollgruppen. Huruvida kunskap, allians och komorbiditet kunde predicera förbättring i behandlingsgruppen undersöktes med Pearsons produktmomentkorrelationskoefficient. Allians och kunskap kunde inte predicera symptomförbättring. Däremot fanns ett negativt samband mellan antalet komorbida tillstånd och symptomförbättring på ett av utfallsmåtten, vilket kan indikera att formatet fungerar sämre för personer med en generellt hög symptombörda. Forskningsområdet är nytt, varför det behövs fler studier om faktorer som påverkar behandlingsresultatet när sedvanlig KBT-behandling kombineras med internetbehandling.

  • 70.
    Baguley, David
    et al.
    Cambridge University, UK.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    McFerran, Don
    Consultant Otolaryngologist, Colchester, Essex, UK.
    McKenna, Laurence
    Royal National Throat, Nose and Ear Hospital, London, UK.
    Tinnitus: a multidisciplinary approach2013 (ed. 2)Book (Other academic)
    Abstract [en]

    Tinnitus: A Multidisciplinary Approachprovides a broad account of tinnitus and hyperacusis, detailing the latest research and developments in clinical management, incorporating insights from audiology, otology, psychology, psychiatry and auditory neuroscience. It promotes a collaborative approach to treatment that will benefit patients and clinicians alike.

    The 2nd edition has been thoroughly updated and revised in line with the very latest developments in the field. The book contains 40% new material including two brand new chapters on neurophysiological models of tinnitus and emerging treatments; and the addition of a glossary as well as appendices detailing treatment protocols for use in an audiology and psychology context respectively.

  • 71.
    Baldwin, Scott A
    et al.
    Department of Psychology, Brigham Young University, Provo, Utah, USA.
    Murray, David M
    Division of Epidemiology, Ohio State University, Columbus, Ohio, USA.
    Shadish, William R
    School of Social Sciences, Humanities and Arts, University of California, Merced, Merced, California, USA.
    Pals, Sherri L
    Department of Psychology, University of Memphis, Memphis, Tennessee, USA.
    Holland, Jason M
    VA Palo Alto Health Care System, Stanford University School of Medicine, Stanford, California, USA.
    Abramowitz, Jonathan S
    Department of Psychology, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, USA.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Atkins, David C
    Center for the Study of Health and Risk Behaviors, Department of Psychiatry and Behavioral Science, University of Washington, Seattle, Washington, USA.
    Carlbring, Per
    Department of Psychology, Umeå University, Umeå, Sweden.
    Carroll, Kathleen M
    Division of Substance Abuse, Yale School of Medicine, New Haven, Connecticut, USA.
    Christensen, Andrew
    Department of Psychology, University of California, Los Angeles, Los Angeles, California, USA.
    Eddington, Kari M
    Department of Psychology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA.
    Ehlers, Anke
    Department of Psychology, Institute of Psychiatry, King's College London, London, United Kingdom.
    Feaster, Daniel J
    Department of Epidemiology and Public Health, Miller School of Medicine, University of Miami, Miami, Florida, USA.
    Keijsers, Ger P J
    Behaviour Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands.
    Koch, Ellen
    Department of Psychology, Eastern Michigan University, Ypsilanti, Michigan, USA.
    Kuyken, Willem
    Mood Disorders Centre, School of Psychology, University of Exeter, Exeter, United Kingdom.
    Lange, Alfred
    Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands.
    Lincoln, Tania
    Department of Psychology, University of Marburg, Marburg, Germany.
    Stephens, Robert S
    Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA.
    Taylor, Steven
    Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
    Trepka, Chris
    Bradford District NHS Care Trust, Bradford, United Kingdom.
    Watson, Jeanne
    Department of Adult Education, Community Development and Counselling Psychology, University of Toronto, Toronto, Ontario, Canada.
    Intraclass correlation associated with therapists: estimates and applications in planning psychotherapy research.2011In: Cognitive behaviour therapy, ISSN 1651-2316, Vol. 40, no 1, p. 15-33Article in journal (Refereed)
    Abstract [en]

    It is essential that outcome research permit clear conclusions to be drawn about the efficacy of interventions. The common practice of nesting therapists within conditions can pose important methodological challenges that affect interpretation, particularly if the study is not powered to account for the nested design. An obstacle to the optimal design of these studies is the lack of data about the intraclass correlation coefficient (ICC), which measures the statistical dependencies introduced by nesting. To begin the development of a public database of ICC estimates, the authors investigated ICCs for a variety outcomes reported in 20 psychotherapy outcome studies. The magnitude of the 495 ICC estimates varied widely across measures and studies. The authors provide recommendations regarding how to select and aggregate ICC estimates for power calculations and show how researchers can use ICC estimates to choose the number of patients and therapists that will optimize power. Attention to these recommendations will strengthen the validity of inferences drawn from psychotherapy studies that nest therapists within conditions.

  • 72.
    Barimani, M.
    et al.
    Karolinska Institute, Sweden.
    Forslund Frykedal, Karin
    Linköping University, Department of Behavioural Sciences and Learning, Education, Teaching and Learning. Linköping University, Faculty of Educational Sciences.
    Rosander, Michael
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Berlin, A.
    Karolinska Institute, Sweden.
    Childbirth and parenting preparation in antenatal classes2018In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 57Article in journal (Refereed)
    Abstract [en]

    Objectives: to describe topics (1) presented by midwives during antenatal classes and the amount of time spent on these topics and (2) raised and discussed by first-time parents and the amount of time spent on these topics. Design: qualitative; data were gathered using video or tape recordings and analysed using a three-pronged content analysis approach, i.e., conventional, summative, and directed analyses. Setting and participants: 3 antenatal courses in 2 antenatal units in a large Swedish city; 3 midwives; and 34 course participants. Findings: class content focused on childbirth preparation (67% of the entire antenatal course) and on parenting preparation (33%). Childbirth preparation facilitated parents understanding of the childbirth process, birthing milieu, the partners role, what could go wrong during delivery, and pain relief advantages and disadvantages. Parenting preparation enabled parents to (i) plan for those first moments with the newborn; (ii) care for/physically handle the infant; (iii) manage breastfeeding; (iv) manage the period at home immediately after childbirth; and (v) maintain their relationship. During the classes, parents expressed concerns about what could happened to newborns. Parents questions to midwives and discussion topics among parents were evenly distributed between childbirth preparation (52%) and parenting preparation (48%). Key conclusions: childbirth preparation and pain relief consumed 67% of course time. Parents particularly reflected on child issues, relationship, sex, and anxiety. Female and male participants actively listened to the midwives, appeared receptive to complex issues, and needed more time to ask questions. Parents appreciated the classes yet needed to more information for managing various post-childbirth situations. Implications for practice: while midwifery services vary among hospitals, regions, and countries, midwives might equalise content focus, offer classes in the second trimester, provide more time for parents to talk to each other, allow time in the course plan for parents to bring up new topics, and investigate: (i) ways in which antenatal course development and planning can improve; (ii) measures for evaluating courses; (iii) facilitator training; and (iv) parent satisfaction surveys.

  • 73.
    Barimani, Mia
    et al.
    Karolinska Institutet, Division for Reproductive Health, Women's and Children's Health, Sweden.
    Vikström, Anna
    Karolinska Institutet, Neurobiologi, Vårdvetenskap och Samhälle (NVS), Sektionen för omvårdnad, Sweden.
    Rosander, Michael
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Forslund Frykedal, Karin
    Linköping University, Department of Behavioural Sciences and Learning, Education, Teaching and Learning. Linköping University, Faculty of Educational Sciences.
    Berlin, Anita
    Karolinska Institutet, Neurobiologi, Vårdvetenskap och Samhälle (NVS), Sektionen för omvårdnad.
    Facilitating and inhibiting factors in transition to parenthood – ways in which health professionals can support parents2017In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 31, no 3, p. 537-546Article in journal (Refereed)
    Abstract [en]

    Background

    The transition to parenthood is an overwhelming life event. From a theoretical perspective, transition to parenthood is a developmental transition that contains certain phases and patterns.

    Aim

    This study aim was twofold (i) discover, describe and comprehend transitional conditions that parents perceive as facilitating and inhibiting during transition to parenthood and to (ii) use that knowledge to develop recommendations for professional interventions that support and facilitate transition to parenthood.

    Design

    Meleis transition theory framed the study's deductive qualitative approach – from planning to analysis.

    Methods

    In a secondary analysis, data were analysed (as per Meleis transition theory) from two studies that implemented interviews with 60 parents in Sweden between 2013 and 2014. Interview questions dealt with parents’ experiences of the transition to parenthood – in relation to experiences with parent-education groups, professional support and continuity after childbirth.

    Ethical issues

    A university research ethics board has approved the research.

    Results

    These factors facilitated transition to parenthood: perceiving parenthood as a normal part of life; enjoying the child's growth; being prepared and having knowledge; experiencing social support; receiving professional support, receiving information about resources within the health care; participating in well-functioning parent-education groups; and hearing professionals comment on gender differences as being complementary. These factors inhibited transition to parenthood: having unrealistic expectations; feeling stress and loss of control; experiencing breastfeeding demands and lack of sleep; facing a judgmental attitude about breastfeeding; being unprepared for reality; lacking information about reality; lacking professional support and information; lacking healthcare resources; participating in parent-education groups that did not function optimally; and hearing professionals accentuate gender differences in a problematic way.

    Conclusion

    Transition theory is appropriate for helping professionals understand and identify practices that might support parents during transition to parenthood. The study led to certain recommendations that are important for professionals to consider.

  • 74.
    Bas-Hoogendam, Janna Marie
    et al.
    Leiden University, Netherlands; Leiden Institute Brain and Cognit, Netherlands.
    van Steenbergen, Henk
    Leiden University, Netherlands; Leiden Institute Brain and Cognit, Netherlands.
    Nienke Pannekoek, J.
    Imperial Coll London, England.
    Fouche, Jean-Paul
    University of Cape Town, South Africa.
    Lochner, Christine
    UCT MRC Unit Anxiety and Stress Disorders, South Africa; University of Stellenbosch, South Africa.
    Hattingh, Coenraad J.
    University of Cape Town, South Africa.
    Cremers, Henk R.
    University of Amsterdam, Netherlands.
    Furmark, Tomas
    Uppsala University, Sweden.
    Mansson, Kristoffer N. T.
    Uppsala University, Sweden; Stockholm University, Sweden; Karolinska Institute, Sweden.
    Frick, Andreas
    Uppsala University, Sweden; Karolinska Institute, Sweden.
    Engman, Jonas
    Uppsala University, Sweden.
    Boraxbekk, Carl-Johan
    Umeå University, Sweden; Copenhagen University Hospital Hvidovre, Denmark.
    Carlbring, Per
    Stockholm University, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden.
    Fredrikson, Mats
    Uppsala University, Sweden; Karolinska Institute, Sweden.
    Straube, Thomas
    University of Munster, Germany.
    Peterburs, Jutta
    University of Munster, Germany.
    Klumpp, Heide
    University of Illinois, IL USA; University of Illinois, IL USA.
    Luan Phanp, K.
    University of Illinois, IL USA; University of Illinois, IL USA.
    Roelofs, Karin
    Radboud University of Nijmegen, Netherlands; Radboud University of Nijmegen, Netherlands.
    Veltman, Dick J.
    Vrije University of Amsterdam, Netherlands.
    van Tol, Marie-Jose
    University of Groningen, Netherlands.
    Stein, Dan J.
    University of Cape Town, South Africa; UCT MRC Unit Anxiety and Stress Disorders, South Africa.
    van der Wee, Nic J. A.
    Leiden University, Netherlands; Leiden Institute Brain and Cognit, Netherlands.
    Voxel-based morphometry multi-center mega-analysis of brain structure in social anxiety disorder2017In: NeuroImage: Clinical, ISSN 0353-8842, E-ISSN 2213-1582, Vol. 16, p. 678-688Article in journal (Refereed)
    Abstract [en]

    Social anxiety disorder (SAD) is a prevalent and disabling mental disorder, associated with significant psychiatric comorbidity. Previous research on structural brain alterations associated with SAD has yielded inconsistent results concerning the direction of the changes in graymatter (GM) in various brain regions, as well as on the relationship between brain structure and SAD-symptomatology. These heterogeneous findings are possibly due to limited sample sizes. Multisite imaging offers new opportunities to investigate SAD-related alterations in brain structure in larger samples. An international multi-center mega-analysis on the largest database of SAD structural T1-weighted 3T MRI scans to date was performed to compare GM volume of SAD-patients (n = 174) and healthy control (HC)-participants (n = 213) using voxel-based morphometry. A hypothesis-driven region of interest (ROI) approach was used, focusing on the basal ganglia, the amygdala-hippocampal complex, the prefrontal cortex, and the parietal cortex. SAD-patients had larger GM volume in the dorsal striatum when compared to HC-participants. This increase correlated positively with the severity of self-reported social anxiety symptoms. No SAD-related differences in GM volume were present in the other ROIs. Thereby, the results of this mega-analysis suggest a role for the dorsal striatum in SAD, but previously reported SAD-related changes in GM in the amygdala, hippocampus, precuneus, prefrontal cortex and parietal regions were not replicated. Our findings emphasize the importance of large sample imaging studies and the need for meta-analyses like those performed by the Enhancing NeuroImaging Genetics through Meta-Analysis (ENIGMA) Consortium.

  • 75.
    Becker, Jan
    et al.
    Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg-University, Untere Zahlbacher Str. 8, 55131 Mainz, Germany.
    Zwerenz, Rüdiger
    Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg-University, Untere Zahlbacher Str. 8, 55131 Mainz, Germany.
    Johansson, Robert
    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, SE-171 77 Stockholm, Sweden.
    Frederick, Ronald J.
    Center for Courageous Living, 9300 Wilshire Boulevard, Suite #520, Beverly Hills, CA 90212, USA.
    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.
    Beutel, Manfred E.
    Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg-University, Untere Zahlbacher Str. 8, 55131 Mainz, Germany.
    Using a transdiagnostic, psychodynamic online self-help intervention to maintain inpatient psychosomatic treatment effects: Study protocol of a feasibility study2016In: Internet Interventions, ISSN 2214-7829, Vol. 5, p. 30-35Article in journal (Refereed)
    Abstract [en]

    Background

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

    Methods

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

    Conclusion

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

  • 76.
    Bendelin, Nina
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Inst, Sweden.
    Internet-delivered aftercare following multimodal rehabilitation program for chronic pain: a qualitative feasibility study2018In: Journal of Pain Research, ISSN 1178-7090, E-ISSN 1178-7090, Vol. 11, p. 1715-1728Article in journal (Refereed)
    Abstract [en]

    Purpose: Methods for delivering aftercare to help chronic pain patients to continue practice self-management skills after rehabilitation are needed. Internet-delivered cognitive behavioral therapy (ICBT) has the potential to partly fill this gap given its accessibility and emphasis on self-care. Methods for engaging and motivating patients to persist throughout the full length of treatment are needed. The aim of this study was to describe how chronic pain patients work in an ICBT program, through their descriptions of what is important when they initiate behavior change in aftercare and their descriptions of what is important for ongoing practice of self-management skills in aftercare. Patients and methods: Following a multimodal rehabilitation program, 29 chronic pain patients participated in a 20-week-long Internet-delivered aftercare program (ACP) based on acceptance-based cognitive behavioral therapy. Latent content analysis was made on 138 chapters of diary-like texts written by participants in aftercare. Results: Attitudes regarding pain and body changed during ACP, as did attitudes toward self and the future for some participants. How participants practiced self-management skills was influenced by how they expressed motivation behind treatment goals. Whether they practiced acceptance strategies influenced their continuous self-management practice. Defusion techniques seemed to be helpful in the process of goal setting. Mindfulness strategies seemed to be helpful when setbacks occurred. Conclusion: Self-motivating goals are described as important both to initiate and in the ongoing practice of self-management skills. Experiencing a helpful effect of acceptance strategies seems to encourage participants to handle obstacles in new ways and to persist throughout treatment. Research on whether tailored therapist guidance might be helpful in stating self-motivating goals and contribute to ongoing practice of self-management skills is needed.

  • 77.
    Bendig, Eileen
    et al.
    Univ Ulm, Germany.
    Bauereiss, Natalie
    Univ Ulm, Germany.
    Ebert, David Daniel
    Friedrich Alexander Univ Erlangen Nuremberg, Germany.
    Snoek, Frank
    Vrije Univ Amsterdam, Netherlands; Acad Med Ctr, Netherlands.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Inst, Sweden.
    Baumeister, Harald
    Univ Ulm, Germany.
    Internet-Based Interventions in Chronic Somatic Disease2018In: Deutsches Ärzteblatt International, ISSN 1866-0452, E-ISSN 1866-0452, Vol. 115, no 38, p. 659-+Article, review/survey (Refereed)
    Abstract [en]

    Background: Clinical guidelines recommend psychosocial care as an integral part of medical treatment, but access is often limited. Technology-based approaches provide an attractive opportunity to optimize health outcomes and quality of life in people with chronic somatic diseases e.g. by means of Internet-and mobile-based interventions (IMIs). The present article provides an overview on the basics of IMIs, applications and their evidence base for people living with chronic somatic diseases. Methods: We conducted a selective literature search in the PubMed and Cochrane databases. Reviews which included randomized controlled trials investigating psychological IMIs were discussed pertaining to their relevance for the population described. Results: IMIs lead to a change in unfavorable behavior connected to chronic somatic diseases. IMIs can foster protective factors like balanced physical activity or risk factors like smoking or alcohol consumption. However, studies reveal small effect sizes of d=0.25 for physical activity and an averaged effect size of d=0.20 for smoking and alcohol consumption. Additionally, IMIs can be used for the (co-) treatment of chronic somatic diseases, for instance to increase disease-specific self-efficacy in patients with diabetes (d=0.23). Studies included in meta-analyses are often highly heterogenous and are investigated in research contexts with limited health care services relevance. Conclusion: IMIs are potentially effective when aiming at lifestyle changes and supporting medical treatment in people with chronic somatic diseases. However, results are still heterogenous and the evidence base is limited regarding specific settings, compounding the discussion of possible ways of implementing IMIs into our health-care systems.

  • 78.
    Berg, Johan
    et al.
    Lund Univ, Sweden.
    Lundh, Lars-Gunnar
    Lund Univ, Sweden.
    Falkenström, Fredrik
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Countertransference in Swedish psychotherapists: testing the factor structure of the Therapist Response Questionnaire2019In: RESEARCH IN PSYCHOTHERAPY-PSYCHOPATHOLOGY PROCESS AND OUTCOME, ISSN 2239-8031, Vol. 22, no 1, p. 99-112Article in journal (Refereed)
    Abstract [en]

    Questionnaires need testing of reliability and factor structure before clinical use or research in new languages or cultures. The aim of this study was to evaluate the Therapist Response Questionnaire (TRQ) in Sweden compared to corresponding factor analyses in USA and Italy. A national sample of psychotherapists (N=242) registered their countertransference with a single client using TRQ. The data were analyzed with confirmatory factor analysis (CFA) to test factor structures from previous studies, and exploratory factor analysis (EFA). The CFA did not verify the factor structure from the previous studies. The EFA extracted seven factors as the best solution: Helpless/Inadequate, Overwhelmed/Disorganized, Hostile/Angry, Parental/Protective, Disengaged, Special/Overinvolved, Sex-ualized. Analysis of convergent validity indicated that five of these could be considered equivalent to factors in the previous studies, and the remaining two were conceptually related to corresponding factors. Even though the factor structure was not confirmed by the CFA, the concordance was large, indicating a reliable self-report instrument with promising validity for measurement of complex aspects of countertransference. Common countertransference themes can inform psychotherapy supervision and education, give feedback to the therapist, and lay ground for a taxonomy for therapist reactions and feelings.

  • 79.
    Berg, Matilda
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Rozental, Alexander
    Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden; Institute of Child Health, University College London, London, United Kingdom of Great Britain and Northern Ireland.
    Johansson, Sofie
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Liljethorn, Lina
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Radvogin, Ella
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Topooco, Naira
    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. Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
    The role of knowledge in internet-based cognitive behavioural therapy for adolescent depression: Results from a randomised controlled study2019In: Internet Interventions, ISSN 2214-7829, Vol. 15, p. 10-17Article in journal (Refereed)
    Abstract [en]

    Background and objectives

    Clients' knowledge about their condition and treatment is considered crucial for general health improvement, and knowledge acquisition is an essential part in internet-based cognitive behavioural therapy (ICBT). Yet, little is known about the role of knowledge and how it influences treatment outcome. This study aimed to examine if explicit knowledgeincreased following ICBT for adolescent depression, if knowledge gainwould be associated with symptom reduction, and if pre-existing knowledge predicted changes in depressive symptoms.

    Methods

    Seventy-one adolescents were randomised to a therapist-supported ICBT or a attention control condition. A measure of depression (BDI-II) and a knowledge test dealing with depression, comorbid anxiety, and its CBT-treatment were administered before and after treatment.

    Results

    Significant improvements in knowledge were observed following ICBT compared to the attention control (between-group Cohen's d = 1.25, 95% CI [0.67–1.79]). On average, participants in the treatment group answered 1.4 more questions correctly at post treatment compared to the control group. No relation between change in knowledge and change in depressive symptoms could be observed. Knowledge scores at baseline were high for both groups, with participants answering approximately 75% of the questions correct. A higher level of initial knowledge level predicted poorer treatment response (Parson's r = −0.38, p = .048).

    Conclusions

    The findings indicate that knowledge about basic concepts and principles about depression, anxiety, and CBT increases following ICBT. This increase in knowledge was not related to change in depressive symptoms, indicating that knowledge is a different construct. The results also suggest that clients who are more knowledgeable prior to treatment might benefit less from ICBT. In sum, the results highlight the need to further examine the role of knowledge in ICBT.

  • 80.
    Bergcrona, Linn
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Krantz, Maja
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    En familj är två eller en vuxna.. Och sen barn: en tematisk analys av hur barn till frivilligt ensamstående mammor och barn till olikkönade sammanboende föräldrapar pratar om familj2014Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Syftet var att undersöka hur barn i olika familjeformer ser på familjer, sin egen och andras. Intervjuer har genomförts med sammanlagt 22 barn varav elva kom från familjer med olikkönade och sammanboende föräldrar som fått barn på egen hand, nedan kallade relationsbarn, och övriga elva kom från familjer med en frivilligt ensamstående mamma som skaffat barn med hjälp av assisterad befruktning, nedan kallade femmisbarn. Barnens ålder varierade från tre år och tio månader till nio år och nio månader. Studien kan ses som en del av barndomsforskningen, där barns ses som kompetenta aktörer vars röster förtjänar att lyftas fram. En semistrukturerad intervjuguide låg till grund för intervjuerna där barnen ombads att måla sin egen och en annan familj. Barnens berättelser har analyserats med hjälp av tematisk analys.

    Resultatet visar att femmis- och relationsbarnens berättelser huvudsakligen liknar varandra samtidigt som vissa skillnader framkommer mellan grupperna. Det förkommer också stora individuella skillnader inom grupperna. En kärnfamiljsnorm är tydligt framträdande i både barnens prat och teckningar, samtidigt som barnen visar på en öppenhet kring olika familjeformer. I relationsbarnens berättelser omnämns far- och morföräldrar, föräldrars syskon och kusiner som släktingar medan femmisbarnen i större utsträckning inkluderar dessa samt husdjur som medlemmar i sina familjer. Gemensamt för alla barnen är att deras berättelser om familjelivet utgår från barnet och har barnet i fokus. I såväl femmis- som relationsbarnens prat om mammor och pappor framträder en bild av traditionella könsroller.

    Såväl relations- som femmisbarnens berättelser om familj är mestadels i linje med tidigare forskning kring barns syn på familj. Femmisbarnens inklusion av såväl husdjur som släktingar i familjen, kan vara ett resultat av att nätverket får en större betydelse hos de ensamstående föräldrarna vilket även setts i tidigare forskning. Den kärnfamiljsnorm som blev tydlig i barnens prat kan ses som en avspegling av de rådande normerna i samhället. Trots en ökad variation gällande familjeformer är kärnfamiljen fortfarande ett rådande ideal.

  • 81.
    Berger, Thomas
    et al.
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Educational Sciences. Linkoping Univ, Dept Behav Sci and Learning, S-58183 Linkoping, Sweden .
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Editorial Material: Internet-Based Treatments - Experiences from Sweden2013In: Verhaltenstherapie (Basel), ISSN 1016-6262, E-ISSN 1423-0402, Vol. 23, no 3, p. 211-214Article in journal (Other academic)
    Abstract [en]

    n/a

  • 82.
    Bergman Nordgren, Lise
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Individually tailored internet-based cognitive behavioural therapy for anxiety disorders2013Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Fear is an innate emotion and an adaptive response to provide protection from potential harm. When fear is excessive and out of proportion in relation to the confronted situation, it can lead to the development of an anxiety disorder. Many individuals feel anxious at some point, but not all experience clinical anxiety or meet the diagnostic criteria of an anxiety disorder. Still, anxiety disorders are the most prevalent form of psychiatric disorder in the general population. More often than not people suffering from one anxiety disorder also present other psychiatric conditions. As of today, cognitive and behavioural treatments have been tested and found to positively affect anxiety disorders, making them the treatment of choice. Nevertheless, many patients do not seek or receive adequate treatment.

    One common critique of the research trials from which the recommendations for treatments stem is the use of a single protocol targeting only one diagnosis. This is because many people suffer from comorbidities. Another problem connected to the recommendation that cognitive behavioural therapy (CBT) should be the treatment of choice for anxiety disorders is the lack of therapists with adequate training. One possible way of dealing both with the shortcoming of therapists and making CBT more accessible is the use of the Internet. Internet-based CBT (ICBT) has been tested in numerous trials during the last 15 years, showing positive outcomes for a large variety of disorders. Many ICBT trials also make use of a single protocol. Another way of dealing with comorbidities might be to tailor the treatment to let characteristics and preferences of the patient guide the design of the protocol. Little is known about possible effects of tailoring the ICBT, the effects of therapeutic relationships in ICBT, and the effectiveness and cost-effectiveness of these treatments. This thesis is based on three studies on two separate randomized controlled trials (RCTs) using the same set of modules accessible for the tailored protocol.

    Study I was an RCT investigating treatment effects up to two-year after completion, showing favourable outcomes of the treatment in a self-recruited sample at all measure points. Study II was a secondary analysis exploring possible relations between working alliance and treatment outcome for participants in the treatment group recruited for Study I indicating that working alliance predict outcome in this tailored treatment. The second RCT was an effectiveness trial (Study III) analysing treatment effects and cost-effectiveness of the treatment up to one year post treatment in a primary-care population. This study showed positive treatment effects both regarding symptom reduction and cost-effectiveness, and that effects were sustained at one year post treatment. Conclusions drawn from these studies are that individually tailored ICBT seems to be a feasible approach for patients with anxiety disorders regardless of comorbidities, and a responsible choice in terms of societal costs.

    List of papers
    1. Individually-tailored, Internet-based treatment for anxiety disorders: A randomized controlled trial
    Open this publication in new window or tab >>Individually-tailored, Internet-based treatment for anxiety disorders: A randomized controlled trial
    Show others...
    2011 (English)In: BEHAVIOUR RESEARCH AND THERAPY, ISSN 0005-7967, Vol. 49, no 1, p. 18-24Article in journal (Refereed) Published
    Abstract [en]

    Previous studies on Internet-based treatment with minimal to moderate therapist guidance have shown promising results for a number of specific diagnoses. The aim of this study was to test a new approach to Internet treatment that involves tailoring the treatment according to the patients unique characteristics and comorbidities. A total of 54 participants, regardless of specific anxiety diagnosis, were included after an in-person, semi-structured diagnostic interview and randomized to a 10 week treatment program or to a control group. Treatment consisted of a number of individually-prescribed modules in conjunction with online therapist guidance. Significant results were found for all dependent measures both immediately following treatment and at 1 and 2 year intervals. Mean between-group effect size including measures of anxiety, depression and quality of life was Cohens d = 0.69 at post-treatment, while the mean within-group effect size was d = 1.15 at post-treatment and d = 1.13 and d = 1.04 at 1 and 2 year follow-up respectively. The tentative conclusion drawn from these results is that tailoring the Internet-based therapy can be a feasible approach in the treatment of anxiety in a homogeneous population.

    Place, publisher, year, edition, pages
    Elsevier Science B.V., Amsterdam., 2011
    Keywords
    Anxiety, Depression, Effectiveness, Internet-based treatment
    National Category
    Social Sciences
    Identifiers
    urn:nbn:se:liu:diva-66957 (URN)10.1016/j.brat.2010.10.002 (DOI)000287061500003 ()
    Available from: 2011-03-23 Created: 2011-03-23 Last updated: 2014-11-28
    2. Role of the Working Alliance on Treatment Outcome in Tailored Internet-Based Cognitive Behavioural Therapy for Anxiety Disorders: Randomized Controlled Pilot Trial
    Open this publication in new window or tab >>Role of the Working Alliance on Treatment Outcome in Tailored Internet-Based Cognitive Behavioural Therapy for Anxiety Disorders: Randomized Controlled Pilot Trial
    2013 (English)In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 15, no 1Article in journal (Refereed) Published
    Abstract [en]

    Background: Internet-based cognitive behavioral therapy (ICBT) is a form of guided self-help that has been found to be effective for addressing several problems. The target for this type of therapy is usually restricted to one specific disorder. Tailoring the treatment widens the scope of ICBT in that it can address comorbid conditions directly.

    Objectives: The working, or therapeutic, alliance has been found to predict outcome in studies of face-to-face therapy. The extent to which these findings apply to ICBT is largely unknown. We therefore decided to find out whether the working alliance could predict outcome in tailored ICBT for anxiety disorders.

    Methods: Data were obtained from the treatment group (n=27) in a randomized controlled trial aiming to test the effects of tailored ICBT for anxiety disorders. The forthcoming study was designed to test the hypothesis that the working alliance measured both pre-treatment and early in treatment (week 3) can predict treatment outcome as measured by the Clinical Outcomes in Routine Evaluation–Outcome Measure (CORE-OM) in a heterogeneous group of patients with anxiety disorders (n=27).

    Results: Working alliance measured at week 3 into the treatment correlated significantly with the residual gain scores on the primary outcome measure (r=-.47, P=.019, n=25), while expected working alliance pre-treatment did not (r=-.17, P=.42, n=27).

    Conclusions: These results raise questions about the importance of working alliance in ICBT treatments, and suggest that the working alliance could be important in ICBT.

    Place, publisher, year, edition, pages
    Journal of Medical Internet Research / Gunther Eysenbach, 2013
    Keywords
    tailored Internet-based cognitive behavioural therapy, anxiety disorders, working alliance, prediction
    National Category
    Social Sciences
    Identifiers
    urn:nbn:se:liu:diva-90686 (URN)10.2196/resprot.2292 (DOI)000315113200008 ()
    Note

    Funding Agencies|Swedish Council for Working Life and Social Research|2008-1145|

    Available from: 2013-04-05 Created: 2013-04-03 Last updated: 2017-12-06Bibliographically approved
    3. Effectiveness and cost-effectiveness of individually tailored Internet-delivered cognitive behavior therapy for anxiety disorders in a primary care population: A randomized controlled rial
    Open this publication in new window or tab >>Effectiveness and cost-effectiveness of individually tailored Internet-delivered cognitive behavior therapy for anxiety disorders in a primary care population: A randomized controlled rial
    Show others...
    2014 (English)In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 59, p. 1-11Article in journal (Other academic) Published
    Abstract [en]

    A significant proportion of the general population suffers from anxiety disorders, often with comorbid psychiatric conditions. Internet-delivered cognitive behavior therapy (ICBT) has been found to be a potent treatment for patients with specific psychiatric conditions. The aim of this trial was to investigate the effectiveness and cost-effectiveness of ICBT when tailoring the treatment to address comorbidities and preferences for primary-care patients with a principal anxiety disorder. One hundred participants were recruited through their primary-care contact and randomized to either treatment or an active control group. The treatment consisted of 7–10 weekly individually assigned modules guided by online therapists. At post-treatment, 46% of the treatment group had achieved clinically significant improvement on the primary outcome measure (CORE-OM) and between-group effect sizes at ranged from d = 0.20 to 0.86, with a mean effect of d = 0.59. At one-year follow-up, within-group effect sizes varied between d = 0.53 to 1.00. Cost analysis showed significant reduction of total costs for the ICBT group, the results were maintained at one-year follow-up and the incremental  costeffectiveness ratio favored ICBT compared to control group. Individually tailored ICBT is an effective and cost-effective treatment for primary-care patients with anxiety disorders with or without comorbidities.

    Place, publisher, year, edition, pages
    Elsevier, 2014
    Keywords
    Primary care, anxiety, depression, comorbidity, Internet-administered cognitive behaviour therapy, cognitive behavior therapy, cost-effectiveness
    National Category
    Psychology
    Identifiers
    urn:nbn:se:liu:diva-100964 (URN)10.1016/j.brat.2014.05.007 (DOI)000340224000001 ()
    Available from: 2013-11-15 Created: 2013-11-15 Last updated: 2017-12-06Bibliographically approved
  • 83.
    Bergman Nordgren, Lise
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Carlbring, Per
    Stockholm University, Sweden .
    Linna, Emma
    Cereb, Sweden .
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Role of the Working Alliance on Treatment Outcome in Tailored Internet-Based Cognitive Behavioural Therapy for Anxiety Disorders: Randomized Controlled Pilot Trial2013In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 15, no 1Article in journal (Refereed)
    Abstract [en]

    Background: Internet-based cognitive behavioral therapy (ICBT) is a form of guided self-help that has been found to be effective for addressing several problems. The target for this type of therapy is usually restricted to one specific disorder. Tailoring the treatment widens the scope of ICBT in that it can address comorbid conditions directly.

    Objectives: The working, or therapeutic, alliance has been found to predict outcome in studies of face-to-face therapy. The extent to which these findings apply to ICBT is largely unknown. We therefore decided to find out whether the working alliance could predict outcome in tailored ICBT for anxiety disorders.

    Methods: Data were obtained from the treatment group (n=27) in a randomized controlled trial aiming to test the effects of tailored ICBT for anxiety disorders. The forthcoming study was designed to test the hypothesis that the working alliance measured both pre-treatment and early in treatment (week 3) can predict treatment outcome as measured by the Clinical Outcomes in Routine Evaluation–Outcome Measure (CORE-OM) in a heterogeneous group of patients with anxiety disorders (n=27).

    Results: Working alliance measured at week 3 into the treatment correlated significantly with the residual gain scores on the primary outcome measure (r=-.47, P=.019, n=25), while expected working alliance pre-treatment did not (r=-.17, P=.42, n=27).

    Conclusions: These results raise questions about the importance of working alliance in ICBT treatments, and suggest that the working alliance could be important in ICBT.

  • 84.
    Bergman Nordgren, Lise
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Hedman, Erik
    Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, Stockholm, Sweden.
    Etienne, Julie
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Bodin, Jessica
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Kadowaki, Åsa
    Östergötlands Läns Landsting.
    Eriksson, Stina
    Department of Psychology, Umeå University, Umeå, Sweden.
    Lindkvist, Emelie
    Department of Psychology, Umeå University, Umeå, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, Stockholm, Sweden.
    Carlbring, Per
    Department of Psychology, Stockholm University, Stockholm, Sweden.
    Effectiveness and cost-effectiveness of individually tailored Internet-delivered cognitive behavior therapy for anxiety disorders in a primary care population: A randomized controlled rial2014In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 59, p. 1-11Article in journal (Other academic)
    Abstract [en]

    A significant proportion of the general population suffers from anxiety disorders, often with comorbid psychiatric conditions. Internet-delivered cognitive behavior therapy (ICBT) has been found to be a potent treatment for patients with specific psychiatric conditions. The aim of this trial was to investigate the effectiveness and cost-effectiveness of ICBT when tailoring the treatment to address comorbidities and preferences for primary-care patients with a principal anxiety disorder. One hundred participants were recruited through their primary-care contact and randomized to either treatment or an active control group. The treatment consisted of 7–10 weekly individually assigned modules guided by online therapists. At post-treatment, 46% of the treatment group had achieved clinically significant improvement on the primary outcome measure (CORE-OM) and between-group effect sizes at ranged from d = 0.20 to 0.86, with a mean effect of d = 0.59. At one-year follow-up, within-group effect sizes varied between d = 0.53 to 1.00. Cost analysis showed significant reduction of total costs for the ICBT group, the results were maintained at one-year follow-up and the incremental  costeffectiveness ratio favored ICBT compared to control group. Individually tailored ICBT is an effective and cost-effective treatment for primary-care patients with anxiety disorders with or without comorbidities.

  • 85.
    Bergman, Penny
    et al.
    SP Sveriges Tekniska Forskningsinst, Sweden.
    Västfjäll, Daniel
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Tajadura-Jimenez, Ana
    University of Loyola Andalucia, Spain.
    Asutay, Erkin
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Auditory-Induced Emotion Mediates Perceptual Categorization of Everyday Sounds2016In: Frontiers in Psychology, ISSN 1664-1078, E-ISSN 1664-1078, Vol. 7, no 1565Article in journal (Refereed)
    Abstract [en]

    Research has shown that emotion categorization plays an important role in perception and categorization in the visual domain. In the present paper, we investigated the role of auditory-induced emotions for auditory perception. We further investigated whether the emotional responses mediate other perceptual judgments of sounds. In an experiment, participants either rated general dissimilarities between sounds or dissimilarities of specific aspects of sounds. The results showed that the general perceptual salience map could be explained by both the emotional responses to, and perceptual aspects of, the sounds. Importantly, the perceptual aspects were mediated by emotional responses. Together these results show that emotions are an integral part of auditory perception that is used as the intuitive basis for categorizing everyday sounds.

  • 86.
    Bergwall, Kajsa
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Hansson-Malmlöf, Johan
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Förändringsprocesser i acceptance and commitment therapy för personer med hörselnedsättning: - en randomiserad kontrollerad studie2014Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    I Sverige beräknas 17 % av befolkningen ha en hörselnedsättning, vilket innebär att det är den vanligaste sensoriska funktionsnedsättningen. Idag finns det en mängd studier som visar att hörselnedsättning är relaterat till sämre psykisk hälsa. Acceptans av sin hörselnedsättning har visat sig vara positivt för hörselnedsatta och samvarierar med hjälpsökande. Acceptance and commitment therapy (ACT) är en transdiagnostisk behandling där psykopatologi antas bero på en hög grad av upplevelsemässigt undvikande och fusion med tankar. Målet i ACT är att öka psykologisk flexibilitet där acceptans är en betydande komponent. Denna explorativa studie undersökte förändringsprocesser i ACT för personer med hörselnedsättning där utfallet var känslomässig och social anpassning för hörselnedsättningen (HHIE-S). De förändringsprocesser som prövades var acceptans (HAQ), som tidigare visat på medierande effekt för ACT, samt två alternativa förändringsprocesser; self-efficacy (HSE-4) och upplevd stress (PSS-4). Behandlingen bestod av åtta internetadministrerade moduler givna med behandlarstöd där veckovisa mätningar av förändringsprocesser och utfall användes. Studiens resultat visar att behandlingsgruppen upplevde marginellt signifikant mindre problem med känslomässig och social anpassning för hörselnedsättningen (HHIE-S). Studiens resultat pekar på att hörselrelaterad acceptans (HAQ) och self- efficacy (HSE-4) medierar behandlingens effekt på deltagarnas känslomässiga och sociala anpassning för hörselnedsättning (HHIE-S). Således tillför denna studie ytterligare belägg för acceptans som förändringsprocess i ACT. Även self-efficacy kan vara en intressant mediator att beakta i fortsatt forskning. 

  • 87.
    Berlin, Anita
    et al.
    Karolinska Inst, Sweden.
    Rosander, Michael
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Forslund Frykedal, Karin
    Linköping University, Department of Behavioural Sciences and Learning, Education, Teaching and Learning. Linköping University, Faculty of Educational Sciences.
    Barimani, Mia
    Karolinska Inst, Sweden.
    Walk the talk: Leader behavior in parental education groups2018In: Nursing and Health Sciences, ISSN 1441-0745, E-ISSN 1442-2018, Vol. 20, no 2, p. 173-180Article in journal (Refereed)
    Abstract [en]

    Expectant and new parents are offered parental education groups as a way to support their transition to parenthood. Group leadership in these groups has been found to be challenging. Using a qualitative and summative design, the aim of the present study was to investigate how health professionals describe their role in parental education groups compared to their actual behavior. Thirteen health professional leaders in antenatal and child health services were interviewed. These descriptions were compared with the leaders actual behavior in video and audio-recordings of 16 different group sessions. The results revealed that regardless of how the leaders described their role, they acted as experts and left little time to parents for discussions and active participation. In particular, leaders who described themselves as discussion leaders did not walk the talk; that is, they did not do what they said they do when leading groups. That could be explained by lack of professional awareness, group leadership, and pedagogical skills. In order to provide high-quality parental support, leaders need training in group leadership and pedagogy combined with supervision and support on a regular basis.

  • 88.
    Beukes, E. W.
    et al.
    Department of Vision and Hearing Sciences, Anglia Ruskin University, Cambridge, UK.
    Manchaiah, Vinaya K. C.
    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 Speech and Hearing Sciences, Lamar University, Beaumont, TX, USA; Audiology India, Mysore, India; Department of Speech and Hearing, School of Allied Health Sciences, Manipal University, Karnataka, India.
    Valien, T. E.
    Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX, USA.
    Baguley, D. M.
    Department of Vision and Hearing Sciences, Anglia Ruskin University, Cambridge, UK; National Institute for Health Research, Nottingham Biomedical Research Centre, Ropewalk House, The Ropewalk, Nottingham, UK; Otology and Hearing Group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK.
    Allen, P. M.
    Department of Vision and Hearing Sciences, Anglia Ruskin University, Cambridge, UK; Vision and Eye Research Unit, Anglia Ruskin University, Cambridge, UK.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institute, Stockholm, Sweden.
    Positive experiences related to living with tinnitus: A cross-sectional survey2018In: Clinical Otolaryngology, ISSN 1749-4478, E-ISSN 1365-2273, Vol. 43, no 2, p. 489-495Article in journal (Refereed)
    Abstract [en]

    Objective

    The aim of this study was to gain insights related to positive experiences reported by adults with tinnitus living in the United Kingdom.

    Design

    A cross‐sectional survey design was used in a sample of adults with tinnitus who were interested in undertaking an Internet‐based intervention for tinnitus.

    Setting

    The study was UK wide and data collection was online.

    Participants

    Participants consisted of 240 adults (137 males, 103 females), with an average age of 48.16 years and average tinnitus duration of 11.52 years (SD: 11.88).

    Main outcome measures

    Tinnitus severity was measured by means of the Tinnitus Functional Index. To evaluate the secondary effects of tinnitus, the Insomnia Severity Index, the Hearing Handicap Inventory for Adults‐Screening Version and the Cognitive Failures Questionnaires were administered. Positive experiences related to tinnitus were explored using an open‐ended question format.

    Results

    Around a third of participants (32.5%) reported positive experiences associated with tinnitus. The number of positive responses ranged from one to eight responses per participant, although there were fewer participants with more than one positive response. The predominant themes concerned for (i) coping; (ii) personal development; (iii) support, and to a lesser extent (iv) outlook. Younger participants, those with a lower hearing disability and those with fewer cognitive failures were more likely to report positive experiences associated with having tinnitus.

    Conclusions

    This study has identified that personal development and a positive outlook are possible despite experiencing tinnitus. Ways to facilitate positive experiences related to tinnitus should be promoted, as these may reduce the negative consequences associated with tinnitus. The most prevalent positive theme was the ability to cope with tinnitus. Positive experiences were also drawn from having clinical and other support networks. This highlights the importance of providing tinnitus interventions that can assist people in coping with tinnitus, particularly to those less likely to relate tinnitus to any positive experiences. Those most likely to be helped include those who are older with greater cognitive difficulties and a greater hearing disability.

  • 89.
    Beukes, Eldre W.
    et al.
    Anglia Ruskin Univ, England; Lamar Univ, TX 77710 USA.
    Allen, Peter M.
    Anglia Ruskin Univ, England; Anglia Ruskin Univ, England; Lamar Univ, TX 77710 USA.
    Baguley, David M.
    Anglia Ruskin Univ, England; Nottingham Biomed Res Ctr, England; Univ Nottingham, England; Lamar Univ, TX 77710 USA.
    Manchaiah, Vinaya
    Lamar Univ, TX 77710 USA; Audiol India, India; Manipal Univ, India.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Inst, Sweden.
    Long-Term Efficacy of Audiologist-Guided Internet-Based Cognitive Behavior Therapy for Tinnitus2018In: American Journal of Audiology, ISSN 1059-0889, E-ISSN 1558-9137, Vol. 27, no 3, p. 431-447Article in journal (Refereed)
    Abstract [en]

    Purpose: The purpose of this study was to investigate the long-term outcomes 1 year after undertaking an audiologist-guided Internet-based cognitive behavioral therapy (iCBT) intervention for tinnitus. Secondary aims were to identify any predictors of outcome and whether there were any unwanted events related to undertaking iCBT for tinnitus. Method: Participants who had previously undertaken a randomized iCBT efficacy trial for tinnitus were invited to participate. Of the 146 who were initially randomized for the efficacy trial, 104 participants completed the 1-year post-intervention assessment measures. The primary outcome was a change in tinnitus distress as assessed by the Tinnitus Functional Index. Secondary assessment measures were included for insomnia, anxiety, depression, hearing handicap, hyperacusis, cognitive failures, and satisfaction with life. An intention-to-treat analysis using repeated-measures analysis of variance and hierarchical multiple regression was used for statistical analysis. Unwanted effects were categorized according to the unwanted events checklist. Results: Undertaking iCBT for tinnitus led to significant improvements 1 year post-intervention for tinnitus and related difficulties, for example, insomnia, anxiety, depression, hearing handicap, hyperacusis, and life satisfaction. The best predictors of improving tinnitus severity at 1-year post-intervention were greater baseline tinnitus severity scores, reading more of the modules, and higher satisfaction with the intervention. Unwanted events were reported by 11% of the participants and were more likely to be reported by women than men. These events were related to worsening of symptoms, the emergence of new symptoms, negative well-being, and prolongation of treatment. Conclusions: The clinical benefits of audiologist-guided iCBT for tinnitus and tinnitus-related difficulties were sustained 1 year post-intervention. Predictors of outcome indicated that the intervention is applicable to a wide range of participants regardless of their demographic backgrounds. Attempts should be made to minimize unwanted events in subsequent trials.

  • 90.
    Beukes, Eldre W.
    et al.
    Anglia Ruskin University, England.
    Allen, Peter M.
    Anglia Ruskin University, England; Anglia Ruskin University, England.
    Manchaiah, Vinaya
    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. Lamar University, TX 77710 USA; Audiol India, India.
    Baguley, David M.
    Anglia Ruskin University, England; University of Nottingham, England.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden.
    Internet-Based Intervention for Tinnitus: Outcome of a Single-Group Open Trial2017In: Journal of american academy of audiology, ISSN 1050-0545, E-ISSN 2157-3107, Vol. 28, no 4, p. 340-351Article in journal (Refereed)
    Abstract [en]

    Background: Managing chronic tinnitus is challenging, and innovative ways to address the resulting health-care burden are required. Internet-based cognitive behavioral therapy (iCBT) for tinnitus shows promise as a cost-effective treatment option. The feasibility and effectiveness of iCBT in the United Kingdom are yet to be explored. Furthermore, it is not known if iCBT can be supported by an audiologist rather than a psychologist. Purpose: This study aimed to determine the feasibility of guided iCBT using audiological support on tinnitus distress and tinnitus-related comorbidities. Furthermore, it aimed to establish the feasibility of iCBT for tinnitus distress in the United Kingdom, by determining recruitment, attrition, and compliance rates. Finally, it aimed to identify which aspects of the protocol require refinement for subsequent clinical trials. Research Design: A single-group open trial design was implemented. This study would serve as a prerequisite study, to identify barriers, before undertaking effectiveness trials. Study Sample: Participants consisted of 37 adults (18 males, 19 females), with an age range of between 50 and 59 yr. The mean preintervention tinnitus severity rating was 56.15 (standard deviation = 18.35), which is categorized as "severe tinnitus" as measured by the Tinnitus Functional Index (TFI). Five participants withdrew during the study, and 29 of the remaining participants completed the postintervention questionnaire. Intervention: The guided iCBT intervention ran over an eight-week period and consisted of 16 obligatory modules and five optional modules. The intervention was designed to be interactive, interesting, and stimulating. A key element was the provision of support from an audiologist throughout the program. Data Collection and Analysis: Online questionnaires were used throughout the study. These were administered at baseline and postintervention to determine attrition and compliance rates and to facilitate sample size estimates for further clinical trials. Outcome measures for tinnitus severity, hearing handicap, insomnia, cognitive functioning, hyperacusis, anxiety, depression, and life satisfaction were used to investigate the effects of iCBT with audiological support. In addition, a weekly questionnaire was incorporated to monitor change in tinnitus distress while undertaking the intervention. Results: Feasibility was established using an audiologist to support this guided iCBT intervention, as a significant change postintervention was found for tinnitus severity, as measured by the TFI and the Tinnitus Handicap Inventory, Screening version. The attrition rate was 22% and compliance was variable. Although these results were based on a small sample, they provide encouraging evidence for the feasibility of delivering iCBT treatment for tinnitus symptoms with audiology support in the United Kingdom. Conclusions: An Internet-based intervention of tinnitus appears to be feasible in the United Kingdom when using audiological support. Randomized controlled trials to further investigate the effectiveness of iCBT for tinnitus in the United Kingdom are required.

  • 91.
    Beukes, Eldre W.
    et al.
    Anglia Ruskin Univ, England; Lamar Univ, TX 77710 USA.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Inst, Sweden.
    Allen, Peter M.
    Anglia Ruskin Univ, England.
    Manchaiah, Vinaya
    Lamar Univ, TX 77710 USA; Audiol India, India; Manipal Univ, India.
    Baguley, David M.
    Nottingham Biomed Res Ctr, England; Univ Nottingham, England; Nottingham Univ Hosp, England.
    Effectiveness of Guided Internet-Based Cognitive Behavioral Therapy vs Face-to-Face Clinical Care for Treatment of Tinnitus A Randomized Clinical Trial2018In: JAMA Otolaryngology - Head and Neck Surgery, ISSN 2168-6181, E-ISSN 2168-619X, Vol. 144, no 12, p. 1126-1133Article in journal (Refereed)
    Abstract [en]

    IMPORTANCE Accessible clinical care is not always available to individuals with distressing tinnitus. Internet-based cognitive behavioral therapy has the potential to increase access to evidence-based services that manage tinnitus. Research comparing the effectiveness of this internet-based intervention with face-to-face care is required. OBJECTIVE To evaluate whether an internet-based cognitive behavioral therapy intervention is at least as effective as established individualized face-to-face clinical care in reducing tinnitus distress and tinnitus-related difficulties. DESIGN, SETTING. AND PARTICIPANTS A randomized, multicenter, 2-arm parallel group, non-inferiority trial with 2-month follow-up was performed between October 4, 2016, and July 14, 2017. Invited to participate were 374 adults based in the United Kingdom who had been referred to their local tinnitus clinics because of bothersome tinnitus. The experimental group received the internet-based intervention online, and the active control group underwent the usual face-to-face tinnitus care at 1 of 3 UK-based National Health Service hospitals. Participants were randomly assigned (1:1) to either intervention using variable permuted block sizes of 4 and 6. Of 92 participants who were randomized (46 each in the experimental and control groups), 88 participants completed the assessment immediately after intervention and 74 participants completed the follow-up assessment. INTERVENTIONS Participants were randomized to receive either 8 weeks of guided internet-based cognitive behavioral therapy or a mean of 2 to 3 individualized face-to-face appointments in a tinnitus clinic. MAIN OUTCOMES AND MEASURES The primary outcome was a change in tinnitus distress (assessed by the Tinnitus Functional Index). Secondary assessment measures were included for insomnia, anxiety, depression, hearing disability, hyperacusis, cognitive failures, and satisfaction with life. RESULTS Of 92 patients overall, 55 (60%) were men with a mean (SD) age of 52.96 (12.07) years and mean (SD) tinnitus duration of 6.54 (9.25) years. The between-group difference in the Tinnitus Functional Index scores after intervention were 5.18 (95% CI, -4.17 to 14.53) at the initial assessment and 5.52 (95% CI, -4.60 to 15.61) at follow-up; both differences were within the non-inferiority margin of 13 points for the lower 95% CI. For the secondary outcomes, only outcomes for insomnia fell outside the non-inferiority margin, both after intervention and at follow-up, favoring internet-based cognitive behavioral therapy. CONCLUSIONS AND RELEVANCE This is the first trial, to our knowledge, to compare an internet-based intervention with standard individualized face-to-face care for tinnitus. It revealed that both interventions are equally effective for reducing tinnitus distress and most tinnitus-related difficulties.

  • 92.
    Beukes, Eldre W.
    et al.
    Anglia Ruskin Univ, England.
    Baguley, David M.
    Anglia Ruskin Univ, England; Nottingham Biomed Res Ctr, England; Univ Nottingham, England.
    Allen, Peter M.
    Anglia Ruskin Univ, England.
    Manchaiah, Vinaya
    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. Lamar Univ, TX 77710 USA; Audiol India, India; Manipal Univ, India.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Inst, Sweden.
    Audiologist-Guided Internet-Based Cognitive Behavior Therapy for Adults With Tinnitus in the United Kingdom: A Randomized Controlled Trial2018In: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, Vol. 39, no 3, p. 423-433Article in journal (Refereed)
    Abstract [en]

    Objectives: Specialist tinnitus services are in high demand as a result of the negative effect tinnitus may have on quality of life. Additional clinically and cost-effective tinnitus management routes are needed. One potential route is providing Cognitive Behavioural Therapy for tinnitus via the Internet (iCBT). This study aimed to determine the efficacy of guided iCBT, using audiological support, on tinnitus distress and tinnitus-related comorbidities, in the United Kingdom. A further aim was to establish the stability of intervention effects 2-months postintervention. The hypothesis was that iCBT for tinnitus would be more effective at reducing tinnitus distress than weekly monitoring. Design: A randomized, delayed intervention efficacy trial, with a 2-month follow-up was implemented to evaluate the efficacy of iCBT in the United Kingdom. Participants were randomly assigned to the experimental (n = 73) or weekly monitoring control group (n = 73) after being stratified for tinnitus severity and age. After the experimental group completed the 8-week long iCBT intervention, the control group undertook the same intervention. Intervention effects were, therefore, evaluated in two independent groups at two time points. The primary outcome was a change in tinnitus distress between the groups as assessed by the Tinnitus Functional Index. Secondary assessment measures were included for insomnia, anxiety, depression, hearing disability, hyperacusis, cognitive failures, and satisfaction with life. These were completed at baseline, postintervention, and at a 2-month postintervention follow-up. Results: After undertaking the iCBT intervention, the experimental group had a greater reduction in tinnitus distress when compared with the control group. This reduction was statistically significant (Cohens d = 0.7) and was clinically significant for 51% of the experimental group and 5% of the control group. This reduction was evident 4 weeks after commencing the iCBT intervention. Furthermore, the experimental group had a greater reduction in insomnia, depression, hyperacusis, cognitive failures, and a greater improvement in quality of life, as evidenced by the significant differences in these assessment measures postintervention. Results were maintained 2 months postintervention. Conclusions: Guided (using audiological support) iCBT for tinnitus resulted in statistically significant reductions in tinnitus distress and comorbidities (insomnia, depression, hyperacusis, cognitive failures) and a significant increase in quality of life. These effects remained stable at 2-months postintervention. Further trials to determine the longer term efficacy of ICBT to investigate predictors of outcome and to compare iCBT with standard clinical care in the United Kingdom are required.

  • 93.
    Beukes, Eldre W.
    et al.
    Anglia Ruskin University, England.
    Baguley, David M.
    Anglia Ruskin University, England; Nottingham Biomed Research Centre, England; University of Nottingham, England.
    Allen, Peter M.
    Anglia Ruskin University, England; Anglia Ruskin University, England.
    Manchaiah, Vinaya
    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. Lamar University, TX 77710 USA; Audiol India, India; Manipal University, India.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden.
    Guided Internet-based versus face-to-face clinical care in the management of tinnitus: study protocol for a multi-centre randomised controlled trial2017In: Trials, ISSN 1745-6215, E-ISSN 1745-6215, Vol. 18, article id 186Article in journal (Refereed)
    Abstract [en]

    Background: Innovative strategies are required to improve access to evidence-based tinnitus interventions. A guided Internet-based cognitive behavioural therapy (iCBT) intervention for tinnitus was therefore developed for a U.K. population. Initial clinical trials indicated efficacy of iCBT at reducing tinnitus severity and associated comorbidities such as insomnia and depression. The aim of this phase III randomised controlled trial is to compare this new iCBT intervention with an established intervention, namely face-to-face clinical care for tinnitus. Methods/design: This will be a multi-centre study undertaken across three hospitals in the East of England. The design is a randomised, two-arm, parallel-group, non-inferiority trial with a 2-month follow-up. The experimental group will receive the guided iCBT intervention, whereas the active control group will receive the usual face-to-face clinical care. An independent researcher will randomly assign participants, using a computer-generated randomisation schedule, after stratification for tinnitus severity. There will be 46 participants in each group. The primary assessment measure will be the Tinnitus Functional Index. Data analysis will establish whether non-inferiority is achieved using a pre-defined non-inferiority margin. Discussion: This protocol outlines phase III of a clinical trial comparing a new iCBT with established face-to-face care for tinnitus. If guided iCBT for tinnitus proves to be as effective as the usual tinnitus care, it may be a viable additional management route for individuals with tinnitus. This could increase access to evidence-based effective tinnitus care and reduce the pressures on existing health care systems.

  • 94.
    Beukes, Eldre W.
    et al.
    Anglia Ruskin University, England.
    Manchaiah, Vinaya
    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. Lamar University, TX 77710 USA; Audiol India, India.
    Allen, Peter M.
    Anglia Ruskin University, England; Anglia Ruskin University, England.
    Baguley, David M.
    Anglia Ruskin University, England; Cambridge University Hospital NHS Fdn Trust, England.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden.
    Internet-based cognitive behavioural therapy for adults with tinnitus in the UK: study protocol for a randomised controlled trial2015In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 5, no 9, p. e008241-Article in journal (Refereed)
    Abstract [en]

    Introduction: Tinnitus is one of the most distressing hearing-related symptoms. Innovative ways of managing tinnitus distress and the related healthcare burden of treating tinnitus are required. An internet-based cognitive behavioural therapy (iCBT) intervention has been developed in Sweden to improve access to evidence-based tinnitus treatments. This study aims to determine the feasibility and effectiveness of iCBT in reducing the impact associated with tinnitus, in the UK. It, furthermore, aims to establish whether there are subgroups of tinnitus sufferers for whom this iCBT intervention may be more suitable. Methods and analysis: A two-armed randomised control trial-with a 1-year follow-up design-will be used to evaluate the effectiveness of iCBT on tinnitus distress. A delayed treatment design using a weekly check-in control group will be used. 70 participants will be randomly assigned to each group by an independent researcher by using a computer-generated randomisation schedule, and after being prestratified for age and tinnitus severity. They will undergo the iCBT e-health intervention online together with audiological therapeutic support. The main outcome measure is the Tinnitus Functional Index. Process evaluation of the intervention will also be conducted. Data analysis will be in accordance with Consolidated Standards of Reporting Trials guidelines. Ethics and dissemination: Ethical approval has been granted. If this intervention proves effective, it may be possible that at least some tinnitus sufferers can be managed though an iCBT e-learning treatment programme. This would be cost effective and potentially will free up services for those with more severe problems that need face-to-face treatment.

  • 95.
    Beukes, Eldre W.
    et al.
    Lamar Univ, TX 77710 USA; Anglia Ruskin Univ, England.
    Manchaiah, Vinaya
    Lamar Univ, TX 77710 USA; Manipal Univ, India; Audiol India, India.
    Allen, Peter M.
    Lamar Univ, TX 77710 USA; Anglia Ruskin Univ, England.
    Baguley, David M.
    Nottingham Biomed Res Ctr, England; Univ Nottingham, England; Nottingham Univ Hosp, England.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology. Karolinska Inst, Sweden.
    Internet-Based Interventions for Adults With Hearing Loss, Tinnitus, and Vestibular Disorders: A Systematic Review and Meta-Analysis2019In: TRENDS IN HEARING, ISSN 2331-2165, Vol. 23, article id 2331216519851749Article, review/survey (Refereed)
    Abstract [en]

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

  • 96.
    Beukes, Eldre W.
    et al.
    Anglia Ruskin Univ, England.
    Manchaiah, Vinaya
    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. Lamar Univ, TX 77710 USA; Audiol India, India; Manipal Univ, India.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Inst, Sweden.
    Allen, Peter M.
    Anglia Ruskin Univ, England; Anglia Ruskin Univ, England.
    Terlizzi, Paige M.
    Lamar Univ, TX 77710 USA.
    Baguley, David M.
    Anglia Ruskin Univ, England; Nottingham Biomed Res Ctr, England; Univ Nottingham, England.
    Situationally influenced tinnitus coping strategies: a mixed methods approach2018In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 40, no 24, p. 2884-2894Article in journal (Refereed)
    Abstract [en]

    Purpose: The primary aim of this study was to identify coping strategies used to manage problematic tinnitus situations. A secondary aim was to determine whether different approaches were related to the level of tinnitus distress, anxiety, depression, and insomnia experienced. Materials and methods: A cross-sectional survey design was implemented. The study sample was adults interested in undertaking an Internet-based intervention for tinnitus. Self-reported measures assessed the level of tinnitus distress, depression, anxiety, and insomnia. An open-ended question was used to obtain information about how problematic tinnitus situations were dealt with. Responses were investigated using qualitative content analysis to identify problematic situations. Further data analysis comprised of both qualitative and quantitative methods. Results: There were 240 participants (137 males, 103 females), with an average age of 48.16 years (SD: 22.70). Qualitative content analysis identified eight problematic tinnitus situations. Participants had either habituated to their tinnitus (7.9%), used active (63.3%), or passive (28.8%) coping styles to manage these situations. Those who had habituated to tinnitus or used active coping strategies had lower levels of tinnitus distress, anxiety, and depression. Conclusions: The main problematic tinnitus situations for this cohort were identified. Both active and passive coping styles were applied to approach these situations. The coping strategies used most frequently and utilised in the widest range of problematic situations were using sound enrichment and diverting attention.

  • 97.
    Beukes, Eldre W.
    et al.
    Anglia Ruskin Univ, England.
    Manchaiah, Vinaya
    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. Lamar Univ, TX 77710 USA; Audiol India, India; Manipal Univ, India.
    Baguley, David M.
    Anglia Ruskin Univ, England; NIHR, England; Univ Nottingham, England.
    Allen, Peter M.
    Anglia Ruskin Univ, England; Anglia Ruskin Univ, England.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Inst, Sweden.
    Process evaluation of Internet-based cognitive behavioural therapy for adults with tinnitus in the context of a randomised control trial2018In: International Journal of Audiology, ISSN 1499-2027, E-ISSN 1708-8186, Vol. 57, no 2, p. 98-109Article in journal (Refereed)
    Abstract [en]

    Objective: The research objective was to identify processes that could either facilitate or hinder clinical implementation of an Internet-based cognitive behavioural therapy intervention for tinnitus in the UK. This was done by exploring the research context, the intervention components and the factors that contributed to the outcomes obtained. Design: This study investigated eight processes including the recruitment strategies, reach, research context, treatment dose delivered and received, implementation fidelity, barriers to implementation and effectiveness of the intervention. Study sample: Of the 169 registered participants, 146 were randomly assigned to the experimental or control groups (23 were excluded). The mean age was 55.57 years with an average tinnitus duration of 11.63 years. Results: The intended sample of people with distressing tinnitus who were underserved with evidence-based tinnitus interventions was reached. The full guided intervention was delivered. The recommended modules were read more than the optional modules. Intervention components such as the easily readable format and the benefits of the applied relaxation programme facilitated significant positive post-intervention outcomes. Barriers hampering the intervention application included time pressures and low self-motivation. Conclusions: Results of this process evaluation together with the outcome data can be used to facilitate translating this research into clinical practice.

  • 98.
    Beukes, Eldre W.
    et al.
    Anglia Ruskin Univ, England; Lamar Univ, TX 77710 USA.
    Manchaiah, Vinaya
    Lamar Univ, TX 77710 USA; Manipal Univ, India; Audiol India, India.
    Davies, Alice S. A.
    Swansea Univ, Wales; Princess Wales Hosp, Wales.
    Allen, Peter M.
    Anglia Ruskin Univ, England; Anglia Ruskin Univ, England.
    Baguley, David M.
    Nottingham Biomed Res Ctr, England; Univ Nottingham, England; Nottingham Univ Hosp, England.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Inst, Sweden.
    Participants experiences of an Internet-based cognitive behavioural therapy intervention for tinnitus2018In: International Journal of Audiology, ISSN 1499-2027, E-ISSN 1708-8186, Vol. 57, no 12, p. 947-954Article in journal (Refereed)
    Abstract [en]

    Objective: This study aimed to explore participants experiences after undertaking an Internet-based cognitive behavioural therapy intervention (ICBT) for tinnitus. Design: Semi-structured telephone interviews were conducted 6-8 months after participants undertook the ICBT intervention. Qualitative thematic analysis was used to interpret the interview data. Study sample: A purposeful sampling strategy was used to identify a diverse range of participants. Semi-structured interviews were carried out with 15 participants. The mean age was 58.5 years, 7 men and 8 women participated. Results: The analysis generated the following main themes: (1) expectations and motivation for doing the intervention, (2) experiences of the intervention, (3) intervention engagement and (4) intervention effects. Most participants expectations were hopeful that the intervention would lessen the impact of their tinnitus. Aspects of the intervention that were beneficial, as well as difficult, were identified together with the impact they had on engagement. Intervention effects were evident on both tinnitus and activities of daily life. Conclusions: The benefits described by participants indicate the potential of ICBT as an alternate form of intervention delivery. The difficulties that hampered engagement need to be addressed to enhance the application and to optimise the clinical acceptability of ICBT for tinnitus.

  • 99.
    Beukes, Eldré W
    et al.
    Anglia Ruskin University, Cambridge, UK; Lamar University, Beaumont, TX, USA.
    Manchaiah, Vinaya
    Lamar University, Beaumont, TX, USA; Manipal University, Manipal, Karnataka, India; Audiology India, Mysore, Karnataka, India.
    Baguley, David M
    Ropewalk House, Nottingham, UK; University of Nottingham, Nottingham, UK.
    Allen, Peter M
    Anglia Ruskin University, Cambridge, UK.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Stockholm, Sweden.
    Internet-based interventions for adults with hearing loss, tinnitus and vestibular disorders: a protocol for a systematic review2018In: Systematic Reviews, E-ISSN 2046-4053, Vol. 7, no 1, article id 205Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Internet-based interventions are emerging as an alternative way of delivering accessible healthcare for various conditions including hearing and balance disorders. A comprehensive review regarding the evidence-base of Internet-based interventions for auditory-related conditions is required to determine the existing evidence of their efficacy and effectiveness. The objective of the current protocol is to provide the methodology for a systematic review regarding the effects of Internet-based interventions for adults with hearing loss, tinnitus and vestibular disorders.

    METHOD: This protocol was developed according to the Preferred Reporting Items for Systematic reviews and Meta-analyses for Protocols (PRISMA-P) 2015 guidelines. Electronic database searches will include EBSCOhost, PubMed and Cochrane Central Register performed by two researchers. This will be complemented by searching other resources such as the reference lists for included studies to identify studies meeting the eligibility for inclusion with regard to study designs, participants, interventions, comparators and outcomes. The Cochrane risk of bias tool (RoB 2) for randomised trials will be used for the bias assessments in the included studies. Criteria for conducting meta-analyses were defined.

    DISCUSSION: The result of this systematic review will be of value to establish the effects of Internet-based interventions for hearing loss, tinnitus and vestibular disorders. This will be of importance to guide future planning of auditory intervention research and clinical services by healthcare providers, researchers, consumers and stakeholders.

    SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018094801.

  • 100.
    Beukes, Eldré W.
    et al.
    Department of Vision and Hearing Sciences, Anglia Ruskin University, Cambridge CB1 1PT, United Kingdom.
    Vlaescu, George
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Manchaiah, Vinaya K. C.
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX 77710, USA.
    Baguley, David M.
    Department of Vision and Hearing Sciences, Anglia Ruskin University, Cambridge CB1 1PT, United Kingdom Audiology Department, Cambridge University Hospital NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom.
    Allen, Peter M.
    Department of Vision and Hearing Sciences, Anglia Ruskin University, Cambridge CB1 1PT, United Kingdom Vision and Eye Research Unit, Anglia Ruskin University, Cambridge CB1 1PT, United Kingdom.
    Kaldo, Viktor
    Division of Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet, 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.
    Development and technical functionality of an Internet-based intervention for tinnitus in the UK2016In: Internet Interventions, ISSN 2214-7829, Vol. 6, p. 6-15Article in journal (Refereed)
    Abstract [en]

    Purpose

    Creative approaches to improve access to evidence-based tinnitus treatments are required. The purpose of this study was to develop an Internet-based cognitive behavioural therapy (iCBT) intervention, for those experiencing tinnitus in the United Kingdom (UK). Furthermore, it aimed, through technical functionality testing, to identify specific aspects of the iCBT that require improving.

    Method

    An innovative iCBT intervention for treating tinnitus in the UK has been developed using a cognitive-behavioural theoretical framework. This iCBT was evaluated by two user groups during this developmental phase. Initially, five expert reviews evaluated the intervention, prior to evaluation by a group of 29 adults experiencing significant levels of tinnitus distress. Both groups evaluated iCBT in an independent measures design, using a specifically designed satisfaction outcome measure.

    Results

    Overall, similar ratings were given by the expert reviewers and adults with tinnitus, showing a high level of satisfaction regarding the content, suitability, presentation, usability and exercises provided in the intervention. The iCBT intervention has been refined following technical functionality testing.

    Conclusions

    Rigorous testing of the developed iCBT intervention has been undertaken. These evaluations provide confidence that further clinical trials can commence in the UK, to assess the feasibility and effectiveness of this iCBT intervention for tinnitus.

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