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Association between deliberate self-harm and violent criminality.

https://arctichealth.org/en/permalink/ahliterature283453
Source
JAMA Psychiatry. 2017 Jun 01;74(6):615-621
Publication Type
Article
Date
Jun-01-2017
Author
Hanna Sahlin
Ralf Kuja-Halkola
Johan Bjureberg
Paul Lichtenstein
Yasmina Molero
Mina Rydell
Erik Hedman
Bo Runeson
Jussi Jokinen
Brjánn Ljótsson
Clara Hellner
Source
JAMA Psychiatry. 2017 Jun 01;74(6):615-621
Date
Jun-01-2017
Language
English
Publication Type
Article
Keywords
Adolescent
Age of Onset
Child
Child, Preschool
Cohort Studies
Comorbidity
Crime - psychology - statistics & numerical data
Female
Humans
Incidence
Infant
Longitudinal Studies
Male
Mental Disorders - epidemiology - psychology
Proportional Hazards Models
Registries
Risk
Self-Injurious Behavior - epidemiology - psychology
Socioeconomic Factors
Statistics as Topic
Suicide - psychology - statistics & numerical data
Sweden
Violence - psychology - statistics & numerical data
Young Adult
Abstract
Individuals who self-harm may have an increased risk of aggression toward others, but this association has been insufficiently investigated. More conclusive evidence may affect assessment, treatment interventions, and clinical guidelines.
To investigate the association between nonfatal self-harm and violent crime.
This population-based longitudinal cohort study, conducted from January 1, 1997, through December 31, 2013, studied all Swedish citizens born between 1982 and 1998 who were 15 years and older (N?=?1?850?252). Individuals who emigrated from Sweden before the age of 15 years (n?=?104?051) or immigrated to Sweden after the age of 13 years (ie,
PubMed ID
28384711 View in PubMed
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Brief Online Cognitive Behavioural Intervention for Dysfunctional Worry Related to the COVID-19 Pandemic: A Randomised Controlled Trial.

https://arctichealth.org/en/permalink/ahliterature312204
Source
Psychother Psychosom. 2021; 90(3):191-199
Publication Type
Journal Article
Randomized Controlled Trial
Date
2021
Author
Tove Wahlund
David Mataix-Cols
Klara Olofsdotter Lauri
Elles de Schipper
Brjánn Ljótsson
Kristina Aspvall
Erik Andersson
Author Affiliation
Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden, tove.wahlund@ki.se.
Source
Psychother Psychosom. 2021; 90(3):191-199
Date
2021
Language
English
Publication Type
Journal Article
Randomized Controlled Trial
Keywords
Adult
Aged
Aged, 80 and over
Anxiety - therapy
COVID-19 - psychology
Cognitive Behavioral Therapy - methods
Female
Humans
Internet-Based Intervention
Male
Middle Aged
Patient Health Questionnaire
SARS-CoV-2
Sweden - epidemiology
Treatment Outcome
Young Adult
Abstract
Worries about the immediate and long-term consequences of the COVID-19 pandemic may for some individuals develop into pervasive worry that is disproportionate in its intensity or duration and significantly interferes with everyday life.
The aim of this study was to investigate if a brief self-guided, online psychological intervention can reduce the degree of dysfunctional worry related to the COVID-19 pandemic and associated symptoms.
670 adults from the Swedish general population reporting daily uncontrollable worry about CO-VID-19 and its possible consequences (e.g., illness, death, the economy, one's family) were randomised (1:1 ratio) to a 3-week self-guided, online cognitive behavioural intervention targeting dysfunctional COVID-19 worry and associated symptoms, or a waiting list of equal duration. The primary outcome measure was a COVID-19 adapted version of the Generalised Anxiety Disorder 7-item scale administered at baseline and weeks 1-3 (primary endpoint). Follow-up assessments were conducted 1 month after treatment completion. The trial was registered on ClinicalTrials.gov (NCT04341922) before inclusion of the first participant.
The main pre-specified intention-to-treat analysis indicated significant reductions in COVID-19-related worry for the intervention group compared to the waiting list (ß = 1.14, Z = 9.27, p
Notes
CommentIn: Psychother Psychosom. 2021;90(3):156-159 PMID 33517335
PubMed ID
33212440 View in PubMed
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Cost effectiveness of internet-based cognitive behaviour therapy and behavioural stress management for severe health anxiety.

https://arctichealth.org/en/permalink/ahliterature278928
Source
BMJ Open. 2016 Apr 25;6(4):e009327
Publication Type
Article
Date
Apr-25-2016
Author
Erik Hedman
Erik Andersson
Brjánn Ljótsson
Erland Axelsson
Mats Lekander
Source
BMJ Open. 2016 Apr 25;6(4):e009327
Date
Apr-25-2016
Language
English
Publication Type
Article
Keywords
Adult
Anxiety - therapy
Cognitive Therapy - economics
Cost-Benefit Analysis
Diagnostic and Statistical Manual of Mental Disorders
Female
Humans
Internet - utilization
Male
Middle Aged
Primary Health Care
Prospective Studies
Psychiatric Status Rating Scales
Quality-Adjusted Life Years
Self Report
Severity of Illness Index
Single-Blind Method
Sweden
Treatment Outcome
Abstract
Internet-delivered exposure-based cognitive behaviour therapy (ICBT) has been shown to be effective in the treatment of severe health anxiety. The health economic effects of the treatment have, however, been insufficiently studied and no prior study has investigated the effect of ICBT compared with an active psychological treatment. The aim of the present study was to investigate the cost effectiveness of ICBT compared with internet-delivered behavioural stress management (IBSM) for adults with severe health anxiety defined as Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) hypochondriasis. ICBT was hypothesised to be the more cost-effective treatment.
This was a cost-effectiveness study within the context of a randomised controlled trial conducted in a primary care/university setting. Participants from all of Sweden could apply to participate.
Self-referred adults (N=158) with a principal diagnosis of DSM-IV hypochondriasis, of whom 151 (96%) provided baseline and post-treatment data.
ICBT or IBSM for 12 weeks.
The primary outcome was the Health Anxiety Inventory. The secondary outcome was the EQ-5D. Other secondary measures were used in the main outcome study but were not relevant for the present health economic analysis.
Both treatments led to significant reductions in gross total costs, costs of healthcare visits, direct non-medical costs and costs of domestic work cutback (p=0.000-0.035). The incremental cost-effectiveness ratio (ICER) indicated that the cost of one additional case of clinically significant improvement in ICBT compared with IBSM was $2214. The cost-utility ICER, that is, the cost of one additional quality-adjusted life year, was estimated to be $10,000.
ICBT is a cost-effective treatment compared with IBSM and treatment costs are offset by societal net cost reductions in a short time. A cost-benefit analysis speaks for ICBT to play an important role in increasing access to effective treatment for severe health anxiety.
NCT01673035; Results.
Notes
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PubMed ID
27113231 View in PubMed
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Emotion regulation group therapy for deliberate self-harm: a multi-site evaluation in routine care using an uncontrolled open trial design.

https://arctichealth.org/en/permalink/ahliterature292219
Source
BMJ Open. 2017 Oct 05; 7(10):e016220
Publication Type
Clinical Trial
Journal Article
Multicenter Study
Date
Oct-05-2017
Author
Hanna Sahlin
Johan Bjureberg
Kim L Gratz
Matthew T Tull
Erik Hedman
Jonas Bjärehed
Jussi Jokinen
Lars-Gunnar Lundh
Brjánn Ljótsson
Clara Hellner
Author Affiliation
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Source
BMJ Open. 2017 Oct 05; 7(10):e016220
Date
Oct-05-2017
Language
English
Publication Type
Clinical Trial
Journal Article
Multicenter Study
Keywords
Adolescent
Adult
Behavior Therapy - methods
Borderline Personality Disorder - complications
Emotions
Female
Humans
Middle Aged
Psychiatric Status Rating Scales
Psychotherapy, Group - methods
Regression Analysis
Self-Injurious Behavior - therapy
Sweden
Treatment Outcome
Young Adult
Abstract
Emotion regulation group therapy (ERGT) has shown promising results in several efficacy trials. However, it has not been evaluated outside a research setting. In order to increase the availability of empirically supported treatments for individuals with borderline personality disorder and deliberate self-harm, an evaluation of ERGT in routine clinical care was conducted with therapists of different professional backgrounds who had received brief intensive training in ERGT prior to trial onset.
Multi-site evaluation, using an uncontrolled open trial design with assessments at pretreatment, post-treatment and 6-month follow-up.
14 adult outpatient psychiatric clinics across Sweden.
Ninety-five women (mean age=25.1 years) with borderline personality disorder (both threshold and subthreshold) and repeated self-harm were enrolled in the study. Ninety-three per cent of participants completed the post-treatment assessment and 88% completed the follow-up assessment.
Primary outcome was self-harm frequency as measured with the Deliberate Self-Harm Inventory. Secondary outcomes included self-harm versatility, emotion dysregulation, other self-destructive behaviours, depression, anxiety, stress symptoms and interpersonal and vocational difficulties.
ERGT is an adjunctive, 14-week, acceptance-based behavioural group treatment that directly targets both self-harm and its proposed underlying mechanism of emotion dysregulation.
At post-treatment, intent-to-treat analyses revealed a significant improvement associated with a moderate effect size on the primary outcome of self-harm frequency (51%, reduction; Cohen's d=0.52, p
Notes
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ErratumIn: BMJ Open. 2017 Nov 3;7(11):e016220corr1 PMID 29101154
PubMed ID
28982814 View in PubMed
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Guided internet-administered self-help to reduce symptoms of anxiety and depression among adolescents and young adults diagnosed with cancer during adolescence (U-CARE: YoungCan): a study protocol for a feasibility trial.

https://arctichealth.org/en/permalink/ahliterature287664
Source
BMJ Open. 2017 Jan 27;7(1):e013906
Publication Type
Article
Date
Jan-27-2017
Author
Malin Ander
Anna Wikman
Brjánn Ljótsson
Helena Grönqvist
Gustaf Ljungman
Joanne Woodford
Annika Lindahl Norberg
Louise von Essen
Source
BMJ Open. 2017 Jan 27;7(1):e013906
Date
Jan-27-2017
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Anxiety - psychology - therapy
Body Image - psychology
Cancer Survivors - psychology
Cognitive Therapy - methods
Feasibility Studies
Female
Humans
Internet
Male
Patient Acceptance of Health Care
Qualitative Research
Self-Management - methods
Stress Disorders, Post-Traumatic - psychology - therapy
Sweden
Therapy, Computer-Assisted - methods
Treatment Outcome
Young Adult
Abstract
A subgroup of adolescents and young adults diagnosed with cancer during adolescence reports elevated levels of anxiety and depressive symptoms and unmet needs for psychological support. Evidence-based psychological treatments tailored for this population are lacking. This protocol describes a feasibility study of a guided-internet-administered self-help programme (YoungCan) primarily targeting symptoms of anxiety and depression among young persons diagnosed with cancer during adolescence and of the planned study procedures for a future controlled trial.
The study is an uncontrolled feasibility trial with a pre-post and 3-month follow-up design. Potential participants aged 15-25 years, diagnosed with cancer during adolescence, will be identified via the Swedish Childhood Cancer Registry. 30 participants will be included. Participants will receive YoungCan, a 12-week therapist-guided, internet-administered self-help programme consisting primarily of cognitive-behavioural therapy organised into individually assigned modules targeting depressive symptoms, worry and anxiety, body dissatisfaction and post-traumatic stress. Interactive peer support and psychoeducative functions are also available. Feasibility outcomes include: recruitment and eligibility criteria; data collection; attrition; resources needed to complete the study and programme; safety procedures; participants' and therapists' adherence to the programme; and participants' acceptability of the programme and study methodology. Additionally, mechanisms of impact will be explored and data regarding symptoms of anxiety, depression, post-traumatic stress, body dissatisfaction, reactions to social interactions, quality of life, axis I diagnoses according to the Mini International Neuropsychiatric Interview and healthcare service use will be collected. Exploratory analyses of changes in targeted outcomes will be conducted.
This feasibility protocol was approved by the Regional Ethical Review Board in Uppsala, Sweden (ref: 2016/210). Findings will be disseminated to relevant research, clinical, health service and patient communities through publications in peer-reviewed and popular science journals and presentations at scientific and clinical conferences.
ISRCTN97835363.
Notes
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PubMed ID
28132011 View in PubMed
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Long-term effectiveness and outcome predictors of therapist-guided internet-based cognitive-behavioural therapy for social anxiety disorder in routine psychiatric care.

https://arctichealth.org/en/permalink/ahliterature272978
Source
BMJ Open. 2015;5(6):e007902
Publication Type
Article
Date
2015
Author
Samir El Alaoui
Erik Hedman
Brjánn Ljótsson
Nils Lindefors
Source
BMJ Open. 2015;5(6):e007902
Date
2015
Language
English
Publication Type
Article
Keywords
Adult
Anxiety Disorders - epidemiology - psychology - therapy
Cognitive Therapy
Evidence-Based Practice
Female
Follow-Up Studies
Humans
Longitudinal Studies
Male
Middle Aged
Phobic Disorders - epidemiology - psychology - therapy
Prognosis
Psychotherapy
Quality of Life - psychology
Sweden - epidemiology
Treatment Outcome
Abstract
Although the short-term outcome of therapist-guided internet-based cognitive-behavioural therapy (ICBT) for treating social anxiety disorder (SAD) has been well studied, little research has been undertaken on the sustainability of treatment gains, especially under clinically representative conditions. Further, there is some debate whether delivering psychological treatment via the internet may be suitable for more severely ill patients.
Longitudinal multilevel growth-modelling of long-term (1-4 years) follow-up cohort data.
An outpatient psychiatric clinic specialised in internet interventions.
446 adults having been treated for SAD.
Primary outcomes were estimated improvement rate and Cohen's d effect size on the self-rated Liebowitz Social Anxiety Disorder Scale. Secondary outcome measures were change in comorbid depressive symptoms and health-related quality of life.
A large treatment effect was observed on the primary outcome measure after treatment (d=0.8 (95% CI 0.7 to 0.9)), with continued long-term improvements (d=1.2 (95% CI 1.0 to 1.3)). However, the rate of change varied significantly between individuals over time. A faster rate of improvement was observed among patients with higher illness severity, whereas having a family history of social anxiety was related to worse response. Long-term improvements were also observed in comorbid depressive symptoms (d=0.7 (95% CI 0.5 to 0.8)) and health-related quality of life (d=-0.3 (95% CI -0.4 to -0.1)).
These findings provide evidence for the long-term effectiveness of ICBT for SAD in routine clinical practice, even for more severe cases.
Notes
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PubMed ID
26105031 View in PubMed
Less detail

Predictors and moderators of internet- and group-based cognitive behaviour therapy for panic disorder.

https://arctichealth.org/en/permalink/ahliterature106108
Source
PLoS One. 2013;8(11):e79024
Publication Type
Article
Date
2013
Author
Samir El Alaoui
Erik Hedman
Brjánn Ljótsson
Jan Bergström
Erik Andersson
Christian Rück
Gerhard Andersson
Nils Lindefors
Author Affiliation
Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychiatry, Stockholm, Sweden.
Source
PLoS One. 2013;8(11):e79024
Date
2013
Language
English
Publication Type
Article
Keywords
Adult
Age of Onset
Cognitive Therapy
Female
Follow-Up Studies
Humans
Internet
Male
Panic Disorder - epidemiology - psychology - therapy
Sweden - epidemiology
Time Factors
Abstract
Internet-based cognitive behaviour therapy (ICBT) can be equally effective as traditional face-to-face cognitive behaviour therapy (CBT) for treating panic disorder (PD). However, little is known about the predictors and moderators of outcome of ICBT when delivered in psychiatric outpatient settings. This study investigated a selection of outcome predictors and moderators of ICBT for panic disorder based on data from a randomised controlled trial where therapist-guided ICBT was compared with group CBT (GCBT) for panic disorder. Participants (N?=?104) received 10 weeks of ICBT or GCBT and were assessed before and after treatment, and after six months. Multiple regression analyses were used to test for significant predictors of treatment outcome. Predictors of positive treatment response for both modalities were having low levels of symptom severity and work impairment. In addition, anxiety sensitivity was found to have a small negative relationship with treatment outcome, suggesting that anxiety sensitivity may slightly enhance treatment response. Treatment modality had a moderating effect on the relationship between domestic impairment and outcome and on the relationship between initial age of onset of panic symptoms and treatment outcome, favouring ICBT for patients having had an early onset of PD symptoms and for patients having a high domestic functional impairment. These results suggest that both ICBT and GCBT are effective treatment modalities for PD and that it is possible to predict a significant proportion of the long-term outcome variance based on clinical variables.
Notes
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PubMed ID
24244406 View in PubMed
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[Self-injurious behavior is common and stigmatizing. National self-injury project working for better treatment and care].

https://arctichealth.org/en/permalink/ahliterature104642
Source
Lakartidningen. 2014 Feb 5-11;111(6):204-5
Publication Type
Article

Testing the Mediating Effects of Obsessive Beliefs in Internet-Based Cognitive Behaviour Therapy for Obsessive-Compulsive Disorder: Results from a Randomized Controlled Trial.

https://arctichealth.org/en/permalink/ahliterature277570
Source
Clin Psychol Psychother. 2015 Nov-Dec;22(6):722-32
Publication Type
Article
Author
Erik Andersson
Brjánn Ljótsson
Erik Hedman
Hugo Hesser
Jesper Enander
Viktor Kaldo
Gerhard Andersson
Nils Lindefors
Christian Rück
Source
Clin Psychol Psychother. 2015 Nov-Dec;22(6):722-32
Language
English
Publication Type
Article
Keywords
Adult
Cognitive Therapy - methods
Female
Humans
Internet
Male
Obsessive Behavior - psychology - therapy
Obsessive-Compulsive Disorder - psychology - therapy
Sweden
Telemedicine - methods
Treatment Outcome
Abstract
Although cognitive interventions for obsessive-compulsive disorder (OCD) have been tested in randomized trials, there are few trials that have tested the specific mechanisms of cognitive interventions, i.e. how they achieve their effects. In this study, we aimed to investigate the mediating effects of a short cognitive intervention in the treatment of OCD and used data from a recently conducted randomized controlled trial where 101 participants were allocated to either Internet-based CBT (ICBT) or to a control condition. Obsessive beliefs were measured at pre-treatment, at the time they had received the cognitive intervention, and also at post-treatment. Weekly OCD symptoms were measured throughout the 10?weeks of treatment. We hypothesized that (1) the ICBT group would have greater reductions in obsessive beliefs (controlling for change in OCD symptoms) after completing the cognitive intervention, and that (2) this reduction would, in turn, predict greater OCD symptom reduction throughout the rest of the treatment period. Contrary to our expectations, the longitudinal mediation analysis indicated that (1) being randomized to ICBT actually increased the degree of obsessive beliefs after receiving the cognitive intervention at weeks 1-3, and (2) increase in obsessive beliefs predicted better outcome later in treatment. However, when repeating the analysis using cross-sectional data at post-treatment, the results were in line with the initial hypotheses. Results were replicated when the control condition received ICBT. We conclude that, although obsessive beliefs were significantly reduced at post-treatment for the ICBT group, early increase rather than decrease in obsessive beliefs predicted favourable outcome.
This study investigated the impact of cognitive interventions on obsessive beliefs for patients with obsessive-compulsive disorder. Results showed that a sudden increase in obsessive beliefs is not an indicator of worse treatment response. On the contrary, it is more likely that the patient is better off when having this sudden increase. Clinicians should not be alarmed if the patient has a sudden increase in obsessive beliefs, but we do recommend the clinician to investigate the reasons for this further.
PubMed ID
25418575 View in PubMed
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