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  • 1.
    Ahlström, Richard
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Social Sciences.
    Savemark, Mattias
    Mid Sweden University, Faculty of Human Sciences, Department of Social Sciences.
    Dödsfall under och efter skuldsanering2010Report (Other academic)
    Abstract [sv]

    Konsumentverket har enligt skuldsaneringslagen (SFS 2006:548) uppdrag att stödja och vägleda den budget- och skuldrådgivning som kommunerna skall svara för. Detta innefattar bland annat utbildning, metodutveckling, kunskapsbyggande och information samt utvärdering. Som ett led i detta har verket initierat en utvärdering av verksamheten från, såväl ett gäldenärsperspektiv som ur ett samhällsekonomiskt perspektiv. Föreliggande rapport är en del av en kommande större rapport rörande bl.a. ekonomi och hälsoaspekter i samband med överskuldsättning och skuldrådgivning i kommunerna. Författare är docent Richard Ahlstöm och forskningsassistent Mattias Savemark. De slutsatser och ståndpunkter som redovisas här är författarnas egna och de ansvarar för delrapportens riktighet och innehåll.

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    FULLTEXT02
  • 2.
    Almén, Niclas
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology and Social Work.
    A Cognitive Behavioral Model Proposing That Clinical Burnout May Maintain Itself2021In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 16, no 7, article id 3446Article, review/survey (Refereed)
    Abstract [en]

    Burnout is common in many countries and is associated with several other problems such as depression, anxiety, insomnia, and memory deficits, and prospectively it predicts long-term sick-leave, cardiovascular disease, and death. Clinical burnout or its residual symptoms often last several years and a common assumption is that recovery takes a long time by nature, despite full time sick-leave and the absence of work stress. The literature suggests models that hypothetically explain the development, but not maintenance, of the syndrome. Based on cognitive and behavioral principles, stress research, and stress theories, this paper describes a theoretical model explaining how clinical burnout can develop and be maintained. While the development of clinical burnout is mainly explained by prolonged stress reactions and disturbed recovery processes due to work related stressors, maintenance of the syndrome is particularly explained by prolonged stress reactions and disturbed recovery processes due to the new context of experiencing burnout and being on sick-leave. Worry about acquired memory deficits, passivity and excessive sleep, shame, fear of stress reactions, and the perception of not being safe are examples of responses that can contribute to the maintenance. The model has important implications for research and how to intervene in clinical burnout. For example, it can offer support to professional care providers and patients in terms of focusing on, identifying, and changing current contextual factors and behaviors that maintain the individual’s clinical burnout symptoms and by that facilitate burnout recovery. Regarding research, the model provides a highly important reason for researchers to study contextual factors and behaviors that contribute to the maintenance of clinical burnout, which has been neglected in research.

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  • 3.
    Almén, Niclas
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology and Social Work.
    A Functionalistic Stress Recovery Intervention Improves Perceived Recovery Opportunities and Relaxational Behaviors: A Secondary Analysis of a Randomized Controlled Trial2022In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, no 21, article id 14005Article in journal (Refereed)
    Abstract [en]

    The recovery perspective on stress management is new and few recovery intervention studies have been conducted. The aim of the study was to evaluate behavioral effects of a functionalistic stress recovery intervention, in which individuals perceiving high levels of stress were encouraged to pay attention to possibilities to perform potential recovery behaviors in everyday life and to choose behaviors that were predicted to lead to resource restoration. Seventy-three individuals were randomly allocated to either a 10-week intervention or a waiting-list control group. Three types of recovery behavior factors during leisure time were studied: perceived recovery opportunities (i.e., control), relaxational behaviors (i.e., relaxation), and positively challenging behaviors (i.e., mastery). In comparison with the control group, the intervention group significantly improved, showing high between-group effect sizes, regarding perceived recovery opportunities (p < 0.001; d = 0.75) and relaxational behaviors (p < 0.001; d = 0.80). Both groups normalized their levels of positively challenging behaviors between pre- and postassessment, and no statistically significant group difference was demonstrated. Analyses of reliable and clinically significant changes demonstrated results in favor of the intervention group regarding perceived recovery opportunities and relaxational behaviors but not positively challenging behaviors. The tested intervention warrants further research, for example, if a modified version of the intervention including components aiming at increasing postwork positively challenging behaviors would be beneficial for the improvement of the behavior and for health. 

  • 4.
    Almén, Niclas
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology and Social Work.
    Intervening Stress Recovery Behaviors in Everyday Life2022Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background. High levels of perceived stress and stress-related ill health, such as burnout, are common in many countries. Several theories postulate that stress behaviors promote adaption to environmental changes and if sustained they are potentially harmful for the body. In accordance, impaired stress recovery behaviors, i.e., psychophysiological deactivation after periods of stress behaviors, have been suggested to be a critical factor in explaining stress-related ill health. Whereas research shows that interventions targeting stress reactivity can have beneficial effects on stress-related variables, studies on interventions targeting stress recovery are surprisingly few. Also, the number of validated instruments for measuring behaviors important for stress recovery are few, in particular easily used self-rating scales. 

    Aims. The primary aim of the thesis was to evaluate stress and health-related effects of an intervention targeting stress recovery behaviors in everyday life among people perceiving high levels of stress in life. A secondary aim was to validate a self-report scale measuring behaviors important for stress recovery in everyday life. 

    Method. Three empirical studies were conducted to evaluate effects of the behavioral stress recovery intervention “balance in everyday life”, which solely aims at strengthening stress recovery behaviors in everyday life. First, a brief version of the intervention was investigated through a small pilot study in which a single-subject experimental design was used (study 1). After that, the intervention was exploratively tested in a group format in which a quasi-experimental design was used (study 2). Due to the positive results of these two studies, a larger scale study using a randomized controlled design was conducted in order to further investigate the effects of the intervention when delivered in a group format (study 3). To fulfill the secondary aim of the thesis, the Recovery Experience Questionnaire was translated into Swedish and analyzed using exploratory factor analysis and confirmatory factor analysis (study 4). 

    Results. In study 1, data demonstrated immediate reduction of stress symptoms as a function of the intervention. The improvements were maintained at 1-year and 5-year follow-up assessments. In study 2, in comparison with a waiting-list-control group, the intervention yielded statistically significant improvements between pre- and postintervention assessment on eleven out of twelve stress and health-related variables. Medium to large between-groups effect sizes were demonstrated for the primary outcome measures covering (potential) recovery behaviors, perceived stress and rest and experiences of being recovered. In the third study, statistically significant improvements for all outcome measures at postintervention assessment and at the 3-month follow-up were demonstrated. The between-groups effect sizes for the primary measures - perceived stress, tension, and burnout - were medium-to-high at postintervention assessment and at follow-up. In addition, in all studies the intervention was associated with beneficial changes in levels of anxiety and depression. In the last study, support was found for the proposed four-factor structure of the Swedish version of the Recovery Experience Questionnaire. 

    Conclusions. The results clearly indicate that the intervention “balance in everyday life” improves stress and health-related factors in a relatively satisfactory way among people perceiving high levels of stress in life. The empirical support is strongest for the reduction in tension, perceived stress, burnout, anxiety and depression, and to deliver the intervention in a group format. The studies demonstrated results that warrant further investigation of the effects of “balance in everyday life”, for example in different contexts, and to study other behavioral recovery interventions. To test (potential) recovery facilitating behaviors as mediators of intervention effects, such as reduction in burnout, the Swedish version of the Recovery Experience Questionnaire could be used.

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    DoctoralThesis_AlménNiclas_InterveningStressRecoveryBehaviors
  • 5.
    Almén, Niclas
    Mid Sweden University, Faculty of Human Sciences, Department of Social Sciences.
    KBT-rehabilitering för stress, ångest och depression: Preliminära resultat2012Conference paper (Other academic)
  • 6.
    Almén, Niclas
    Mid Sweden University, Faculty of Human Sciences, Department of Social Sciences.
    Rehabilitering enligt kognitiv beteendeterapeutisk modell2002In: Svensk Rehabilitering, ISSN 1403-4468, no 2, p. 38-41Article in journal (Other academic)
  • 7.
    Almén, Niclas
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology.
    Stress- och utmattningsproblem: Kognitiva och beteendeinriktade metoder2017 (ed. 2)Book (Other academic)
  • 8.
    Almén, Niclas
    Mid Sweden University, Faculty of Human Sciences, Department of Social Sciences.
    Stress- och utmattningsproblem: Kognitiva och beteendeterapeutiska metoder2007 (ed. 1)Book (Other academic)
  • 9.
    Almén, Niclas
    Mid Sweden University, Faculty of Human Sciences, Department of Social Sciences.
    Åreklinikens rehabiliteringsprogram för stressymtom och utbrändhet.: En utvärdering.2001In: Åreklinikens rehabiliteringsprogram för stressymtom och utbrändhet.: En utvärdering, 2001Conference paper (Refereed)
  • 10.
    Almén, Niclas
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology and Social Work.
    Återhämta dig i 7 steg: Minska stressen med forskarens bästa råd2021In: Modern psykologi, ISSN 2000-4087, no 4, p. 66-68Article in journal (Other (popular science, discussion, etc.))
  • 11.
    Almén, Niclas
    Mid Sweden University, Faculty of Human Sciences, Department of Social Sciences.
    Återhämtningsfokuserad stresshantering: Praktiskt och teoretisk bakgrund, samt två pilotstudier2012Conference paper (Other academic)
  • 12.
    Almén, Niclas
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology and Social Work.
    Jansson, Billy
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology and Social Work.
    The reliability and factorial validity of different versions of the Shirom-Melamed Burnout Measure/Questionnaire and normative data for a general Swedish sample2021In: International Journal of Stress Management, ISSN 1072-5245, E-ISSN 1573-3424, Vol. 28, no 4, p. 314-325Article in journal (Refereed)
    Abstract [en]

    Burnout is a common problem in many countries and is associated with psychological ill health, somatic diseases, mortality and long-term sick leave. Different versions of the Shirom-Melamed Burnout Questionnaire/Measure (SMBQ/SMBM) are widely used to measure burnout. Using confirmatory factor analysis, the main purpose of the present study was to empirically evaluate different Swedish versions of the SMBQ/SMBM. A questionnaire containing 23 SMBQ/SMBM-items was sent to 4,000 randomly selected individuals of which 765 with no missing data were included in the analyses. The well-used 4-factor SMBQ/SMBM-22 including the factors emotional and physiological exhaustion (EPE), cognitive weariness (CWE), listlessness (LIS), and tension (TES) and the 3-factor SMBQ/SMBM-18 (including the EPE, the CWE, and the LIS) reached good model fit after minor modifications. Two 2-factor models (based on 12 and 11 items, respectively), including the EPE and the CWE reached good model fit without any modifications. Even though there were some concerns regarding all models with respect to discriminant validity, the factors in all models showed evidence of good composite reliability (CR) and convergent validity. Lastly, a brief six-item version of the scale based on the 12-item version of the scale indicated an excellent model fit, and the composite score of the six-item scale correlated strongly with the composite scores from the others models, suggesting that the brief version could be used with advantage. In addition, based on the LIS, a new three-item scale that measures vitality is proposed. For all measures, normative data are reported.

  • 13.
    Almén, Niclas
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology and Social Work. Uppsala universitet, Institutionen för kvinnor och barns hälsa..
    Jansson, Billy
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology and Social Work.
    Validation of the new brief 6-item version of the Shirom-Melamed Burnout Measure2023In: Cogent Psychology, E-ISSN 2331-1908, Vol. 10, no 1, article id 2258476Article in journal (Refereed)
    Abstract [en]

    The Shirom-Melamed Burnout Questionnaire/Measure (SMBQ/M) is one of the most commonly used measures of burnout. Using confirmatory factor analyses, the present study aimed to evaluate the model fit, composite reliability, and fac-torial (i.e. convergent and discriminant) validity of the new brief Swedish version of the scale-labeled SMBM-6. In addition, we used Cronbach’s α as an indicator of the internal consistency of the total scale. The SMBM-6 consists of two subscales: the emotional and physiological exhaustion subscale (three items) and the cognitive weariness subscale (three items). A total of 1251 teachers in Sweden were included in the study. The analyses showed that the Swedish version of the SMBM-6 has an excellent model fit and good convergent validity. The discriminant validity for the cognitive weariness subscale was good, but slightly inadequate for the physiological exhaustion subscale. Composite reliability and Cronbach’s α indicated high internal consistency for the subscales and the total scale, respectively. Multi-group invar-iance tests for age indicated no violation of invariance. These results are consistent with those of the study by Almén and Jansson (2021), in which the SMBM-6 was developed, and a subsequent psychometric study by Sundström et al. (2022). In conclusion, there is strong support for the Swedish version of the SMBM-6 as a reliable and valid scale for measuring burnout. Testing the scale in languages other than Swedish is warranted.

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  • 14.
    Almén, Niclas
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology.
    Lisspers, Jan
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology.
    Sundin, Örjan
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology.
    Effects of a Recovery-Focused Intervention for Stress Management: A Randomized Controlled Trial2015Conference paper (Refereed)
    Abstract [en]

    Abstract

    INTRODUCTION

    Stress symptoms, burnout, poor mental health and long-term sick leave related to these are major problems in Sweden and elsewhere. Evidence-based prevention and treatment efforts are lacking. Research indicates that stress related health problems primarily could be conceptualized as deficiencies in recovery responses between stress periods rather than high level of stress responses per se. Therefore it is relevant to examine whether it is effective to intervene the recovery behavior – instead of the stress behavior - of people with stress symptoms.

    OBJECTIVES

    The primary purpose of this study was to investigate if a behavioral oriented recovery management intervention could enhance “recovery behaviors” and experiences of recovery and reduce stress related ill health.

    METHODS A group based intervention program focusing exclusively on “recovery behavior” in everyday life (earlier developed and tested in two pilot studies) was evaluated in an experimental group study. The intervention consisted of seven group sessions of 2.5 hours over a period of approximately 10 weeks supplemented by an internet based treatment support system. Self- referred subjects with scores above 24.4 on the Perceived stress scale were randomized to the intervention (n=26) or a waiting-list (n=33).

    RESUL T

    Statistically significant and clinically relevant effects were achieved for the intervention group compare to the waiting-list group: recovery behaviors and experiences of recovery were increased, and levels of perceived stress, worry, anxiety, depression and exhaustion were decreased.

    DISCUSSION These results are in line with two previous pilot studies that we have done. A behavioral and recovery oriented intervention seems to be effective to increase the recovery of the individual and decrease stress related ill health. There are reasons to continue to explore the potential of recovery-oriented interventions for example for different populations (such as people with more extensive clinical health problems) and in different contexts. 

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  • 15.
    Arriaga, Patricia
    et al.
    Instituto Universitário de Lisboa (ISCTE-IUL), CIS-IUL.
    Zillmann, Dolf
    University of Alabama.
    Esteves, Francisco
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology.
    The Promotion of Violence by the Mainstream Media of Communication2016In: The Social Developmental Construction of Violence and Intergroup Conflict / [ed] J. Vala, S. Waldzus, M. Calheiros, Springer, 2016, p. 171-195Chapter in book (Refereed)
    Abstract [en]

    This chapter gives a comprehensive state-of-the-art review on the effects that exposure to or enactment of violence in mainstream media has on aggressive behavior, emotions, and empathy. In line with contemporary technological developments, the authors also cover the more and more widespread consumption of violent video games, which put the player in a more active role than traditional media (such as television) put their viewers. As the field is extremely controversial, the authors are careful in their analysis of the actually existing evidence as well as in their conclusions and recommendations for future research. Despite all controversy, and after reviewing existing literature, as well as a large number of own empirical work, the authors come to the conclusion that there is evidence for increased aggressive motivation and impulsivity as a result of exposure to media violence, but that it is not clear yet how much it affects people’s real-life behavior. Nevertheless, it is clear that there is no evidence for cathartic effects, a conclusion that is similar in research on the effects of filmed violence, and an idea that had been present in the controversy for decades but can now be abandoned.

  • 16.
    Christiansson, Reine
    Mid Sweden University, Faculty of Human Sciences, Department of Social Sciences.
    Ignatiansk retreat som kriminalvård: En kvalitativ studie om fångars personliga utveckling2012Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syftet med undersökningen har varit att undersöka om positiva förändringar och inre resurser utvecklas för intagna under en 30 dagars Ignatiansk klosterretreat på en av Sveriges högsäkerhetsanstalter. Deltagarna var dömda män i åldrarna 23 – 55 år med straff på fyra år till livstid.

    Studien har tillämpat en kvalitativ ansats med semistrukturerade intervjuer av deltagare och personal, observationer och dokumentanalyser. För ytterligare djuplodande kunskaper och information har studien också använt sig av ett autoetnografiskt perspektiv för att undersöka upplevelser och förändringsprocesser från retreaten.

    Resultaten påvisade att deltagarna utvecklat och förstärkt inre resurser, som emotionell kompetens, inre styrka och en positiv andlig utveckling. Resurserna har vidare legat till grund för den positiva posttraumatiska personlighetsutveckling deltagarna uppvisade.

    Slutsatserna i studien är att deltagarna erhåller en ökad positiv framtidstro och ökad reflektion över värderingar och vad som är viktigt i deras liv. Upplevelsen av retreaten resulterade i viktiga livsstilsförändringar och resurser för fortsatt främjande av personlighetsutveckling för framtiden.

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  • 17. Clason van de Leur, Jakob
    et al.
    Johansson, Fred
    McCracken, Lance M
    Åhs, Fredrik
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology and Social Work.
    Brodda Jansen, Gunilla
    Buhrman, Monica
    Predictors and sub-groups in the treatment of stress-induced exhaustion disorder2023In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 52, no 4, p. 397-418Article in journal (Refereed)
    Abstract [en]

    Little is known about psychological interventions for stress-induced Exhaustion disorder (ED), and there is a need for more research to improve the outcomes obtained in treatments. The present study examines predictors of improvement, including sub-group responses, in a large sample of ED patients receiving a Multimodal intervention (MMI) based on Cognitive Behavior Therapy (N = 915). In step one, available variables were explored separately as predictors of improvement in ED symptoms. In step two, sub-groups were explored through Latent Class Analysis to reduce the heterogeneity observed in the larger group and to investigate whether combining the variables from step one predicted symptom improvement. Younger age, no previous sick leave due to ED, and scoring high on anxiety, depression, insomnia, perfectionism, and treatment credibility emerged as separate predictors of improvement. In the sub-group analyses, a sub-group including participants who were single and had a lower income showed less improvement. Overall, people with ED participating in MMI report symptom improvement regardless of characteristics before treatment. However, the present findings do have the potential to inform future treatments for ED, as they highlight perfectionism as a predictor of improvement and the importance of assessing treatment credibility during treatment.

  • 18.
    Demetry, Youstina
    et al.
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden.;Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Norra Stationsgatan 69, Stockholm, Sweden..
    Wasteson, Elisabet
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology and Social Work.
    Lindegaard, Tomas
    Linköping Univ, Dept Behav Sci & Learning, Linköping, Sweden..
    Abuleil, Amjad
    Competence Team migrat Hlth, Reg Jamtland Harjedalen, Östersund, Sweden..
    Geranmayeh, Anahita
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden..
    Andersson, Gerhard
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden.;Linköping Univ, Dept Behav Sci & Learning, Linköping, Sweden.;Linköping Univ, Dept Biomed & Clin Sci, Linköping, Sweden..
    Shahnavaz, Shervin
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden..
    Individually Tailored and Culturally Adapted Internet-Based Cognitive Behavioral Therapy for Arabic-Speaking Youths With Mental Health Problems in Sweden: Qualitative Feasibility Study2023In: JMIR Formative Research, E-ISSN 2561-326X, Vol. 7, article id e46253Article in journal (Refereed)
    Abstract [en]

    Background: Most forcibly displaced refugees in Sweden originate from the Arab Republic of Syria and Iraq. Approximately half of all refugees are aged between 15 and 26 years. This particular group of youths is at a higher risk for developing various mental disorders. However, low use of mental health services across Europe has been reported. Previous research indicates that culturally adapted psychological interventions may be suitable for refugee youths. However, little is known about the feasibility, acceptability, and efficacy of such psychological interventions. Objective: This study aimed to explore the feasibility, acceptability, and preliminary efficacy of an individually tailored and culturally adapted internet-based cognitive behavioral therapy for Arabic-speaking refugees and immigrant youths in Sweden. Methods: A total of 17 participants were included to participate in an open trial study of an individually tailored and culturally adapted internet-based cognitive behavioral therapy targeting common mental health problems. To assess the intervention outcome, the Hopkins Symptom Checklist was used. To explore the acceptability of the intervention, in-depth interviews were conducted with 12 participants using thematic analysis. Feasibility was assessed by measuring treatment adherence and by calculating recruitment and retention rates. Results: The intervention had a high dropout rate and low feasibility. Quantitative analyses of the treatment efficacy were not possible because of the high dropout rate. The qualitative analysis resulted in 3 overarching categories: experiences with SahaUng (the treatment), attitudes toward psychological interventions, and personal factors important for adherence. Conclusions: The findings from this study indicate that the feasibility and acceptability of the current intervention were low and, based on the qualitative analysis, could be increased by a refinement of recruitment strategies, further simplification of the treatment content, and modifications to the cultural adaptation.

  • 19. Di Stasi, L. L.
    et al.
    Diaz-Piedra, C.
    Morales, J. M.
    Kurapov, A.
    Tagliabue, M.
    Bjärtå, Anna
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology and Social Work.
    Megias, A.
    Bernhardsson, Jens
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology and Social Work.
    Paschenko, S.
    Romero, S.
    Cándido, A.
    Catena, A.
    A cross-cultural comparison of visual search strategies and response times in road hazard perception testing2020In: Accident Analysis and Prevention, ISSN 0001-4575, E-ISSN 1879-2057, Vol. 148, article id 105785Article in journal (Refereed)
    Abstract [en]

    Road hazard perception is considered the most prominent higher-order cognitive skill related to traffic-accident involvement. Regional cultures and social rules that govern acceptable behavior may influence drivers’ interpretation of a traffic situation and, consequently, the correct identification of potentially hazardous situations. Here, we aimed to compare hazard perception skills among four European countries that differ in their traffic culture, policies to reduce traffic risks, and fatal crashes: Ukraine, Italy, Spain, and Sweden. We developed a static hazard perception test in which driving scenes with different levels of braking affordance were presented while drivers’ gaze was recorded. The test required drivers to indicate the action they would undertake: to brake vs. to keep driving. We assessed 218 young adult drivers. Multilevel models revealed that the scenes’ levels of braking affordance (i.e., road hazard) modulated drivers’ behavior. As the levels of braking affordance increased, drivers’ responses became faster and their gaze entropy decreased (i.e., visual search strategy became less erratic). The country of origin influenced these effects. Ukrainian drivers were the fastest and Swedish drivers were the slowest to respond. For all countries, the decrement in response times was less marked in the case of experienced drivers. Also, Spanish drivers showed the most structured (least erratic) visual search strategy, whereas the Italians had the most rigid (most constant) one. These results suggest that road hazard perception can be defined cross-culturally, with cultural factors (e.g., traffic climate, legislation) modulating response times and visual search strategies. Our results also support the idea that a multimodal assessment methodology is possible for mass testing of road hazard perception and its outcomes would be relevant to understand how different traffic cultures shape driving behavior. 

  • 20.
    Ekdahl, Johanna
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology.
    Sexualitet och sexuella problem: bedömning och behandling enligt KBT2017 (ed. 1:1)Book (Other academic)
  • 21.
    Ekdahl, Johanna
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology.
    Flink, Ida
    Örebro Universitet.
    Engman, Linnea
    Örebro Universitet.
    Linton, Steven James
    Örebro Universitet.
    Vulvovaginal pain from a fear-avoidance perspective: a prospective study among female university students in Sweden2018In: International Journal of Sexual Health, ISSN 1931-7611, E-ISSN 1931-762X, Vol. 30, no 1, p. 49-59Article in journal (Refereed)
    Abstract [en]

    Objectives: To examine how fear-avoidance influences vulvovaginal pain and sexual function over time.

    Method: At baseline and at 10-month follow-up, self-report measures for sexual- and fear avoidance factors were obtained from 483 female university students with and without self-reported vulvovaginal pain.

    Results: individuals with pain at both times reported lower sexual function, and higher levels of fear-avoidance compared to the pain-free group. Fear-avoidance beliefs predicted the occurrence of vulvovaginal pain at follow up and the level of pain intensity.

    Conclusion: The results points to the relevance of the components of the fear-avoidance model in vulvovaginal pain over time.

  • 22.
    Elmerstig, Eva
    et al.
    Malmö Högskola.
    Thomtén, Johanna
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology.
    Vulvar pain: associations between first-time vaginal intercourse, tampon insertion and later experiences of pain2016In: Journal of sex & marital therapy, ISSN 0092-623X, E-ISSN 1521-0715, Vol. 42, no 8, p. 707-720Article in journal (Refereed)
    Abstract [en]

    This study examines associations between the first experience ofvaginal intercourse/tampon insertion and later experiences of vul-var pain. The study is based on questionnaire data from 1,259Swedish female senior high-school students, aged 18 to 22 yearsold. Of these, 592 women reported present vulvar pain. Presentvulvar pain was associated with first-time experiences of vaginalintercourse (pain, negative experience, against will) and with painat tampon insertion. First-time experiences were also related totemporal aspects of present vulvar pain during vaginal intercourse(at the beginning, after a while during, and after). Implications offirst-time experiences of vaginal intercourse for future symptomsof vulvar pain are discussed.

  • 23.
    Engman, Linnea
    et al.
    Örebro University.
    Flink, Ida
    Örebro University.
    Ekdahl, Johanna
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology.
    Boersma, Katja
    Örebro University.
    Linton, S.J.
    Örebro University.
    Avoiding or enduring painful sex?: A prospective study of coping and psychosexual function in vulvovaginal pain2018In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 22, no 8, p. 1388-1398Article in journal (Refereed)
    Abstract [en]

    Background

    Recurring vulvovaginal pain is common, with evident effects on affected women's lives. Little is known about how affected women cope with painful sexual activities and how coping relates to pain intensity and psychosexual functioning over time. This prospective study explored the impact of avoidance and endurance on sexual function over time. Additionally, patterns of coping were studied on an individual level to increase knowledge about coping and its relation to psychosexual functioning.

    Methods

    One hundred and seventeen women, 18–35 years old, with recurring vulvovaginal pain answered questionnaires at two measurement points, five months apart, assessing avoidance and endurance coping, pain intensity and psychosexual functioning. A multiple regression model explored the predictive value of avoidance and endurance on sexual function over time. Cluster analyses investigated patterns of coping and stability within the clusters. These subgroups were compared on psychosexual outcomes.

    Results

    Avoidance at baseline was the only significant predictor of sexual function five months later. Distinct and stable subgroups with different patterns of coping were identified, where avoidance and endurance coping were used both separately and combined. Women who both avoided and endured had the most unfavourable outcomes in terms of psychosexual functioning.

    Conclusions

    Avoidance of sexual activities was related to reduced sexual function over time, which calls for attention and clinical interventions targeting avoidance. Additionally, women who both avoid and endure sexual activities despite pain possibly need tailored interventions, as women with this coping pattern reported the lowest levels of psychosexual functioning.

    Significance

    In this prospective study, avoidance of sexual activities predicted sexual function over time, when controlling for pain intensity. Subgroups of women using distinct patterns of coping were identified. Those who both avoided and endured had the lowest levels of psychosexual functioning.

  • 24.
    Engman, Linnea
    et al.
    Center for Health and Medical Psychology (CHAMP), Örebro University.
    Flink, Ida
    Center for Health and Medical Psychology (CHAMP), Örebro University.
    Thomtén, Johanna
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology.
    Linton, Steven
    Center for Health and Medical Psychology (CHAMP), Örebro University.
    Avoiding or enduring painful sex?: A longitudinal study of coping patterns and sexual function in women with vulvovaginal pain2017Conference paper (Refereed)
  • 25.
    Engman, Linnea
    et al.
    Örebro universitet.
    Flink, Ida
    Örebro universitet.
    Thomtén, Johanna
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology.
    Linton, Steven
    Örebro universitet.
    When sex hurts: Avoid, endure or try something different?2016Conference paper (Refereed)
  • 26.
    Engman, Linnea
    et al.
    Örebro University.
    Johansson, Åsa
    Örebro University.
    Majonen, Linda
    Örebro University.
    Flink, Ida
    Örebro University.
    Thomtén, Johanna
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology.
    Linton, Steven
    Örebro University.
    A longitudinal study of coping strategies in women with vulvovaginal pain2016Conference paper (Refereed)
  • 27.
    Flink, Ida
    et al.
    Örebro Universitet.
    Engman, Linnea
    Örebro Universitet.
    Ter Kuile, Monique
    Leiden University, Netherlands.
    Ekdahl, Johanna
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology.
    Linton, Steven James
    Örebro Universitet.
    Coping with pain in intimate situations: applying the avoidance-endurance model to women with vulvovaginal pain2017In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 17, no October 2017, p. 302-308Article in journal (Refereed)
    Abstract [en]

    Background and aims

    Chronic vulvovaginal pain is strikingly common and has a serious impact on women's lives. Nevertheless, there are few longitudinal studies focusing on mechanisms involved in the pain development. One area of interest is how women cope with sexual activities and how this affects their pain. In this study, avoidance and endurance coping behaviors were explored as possible mediators of the relation between catastrophizing and pain, cross-sectionally and longitudinally.

    Methods

    251 women (18–35 years old) with vulvovaginal pain were recruited in university settings and filled out questionnaires about their pain, catastrophizing and coping behaviors at two occasions, with five months in between. Multiple mediation models were tested, exploring avoidance and endurance as mediators of the relation between catastrophizing and pain.

    Results

    The results showed that avoidance was an influential mediator of the link between catastrophizing and pain. Using multiple mediation models we found that although the indirect effects of both avoidance and endurance were significant cross-sectionally, only avoidance was a significant mediator in the combined model exploring associations over time.

    Conclusions

    This study indicates that the strategies women with vulvovaginal pain use for coping with sexual activities are important for the course of pain. Avoidance and, to a lesser degree, endurance strategies were identified as important mediators of the effects of catastrophizing on pain. When exploring the links over time, only avoidance emerged as a significant mediator.

    Implications

    In this longitudinal study, catastrophizing was linked to vulvovaginal pain, via avoidance and endurance of sexual activities. Hence, targeting catastrophizing early on in treatment, as well as addressing coping, may be important in clinical interventions.

  • 28.
    Frenkel-Brunswik, Else
    Institution für Psychologie, Wien / Department of Child Research, Los Angeles University.
    Kapitel XIII. Övergripande resultat och sammanfattning av intervjuernas resultat2023Other (Other academic)
    Abstract [sv]

    I kapitel XIII i The Authoritarian Personality utvärderar Else Frenkel-Brunswik de intervjuer som genomförts av projektets forskarassistenter. Medan Adornos typologisering i kapitel XIX, som också ingår i det här tidskriftsnumret, omfattar en uppsättning psykiska syndrom (eller karaktärer) strävar Frenkel-Brunswik här snarare efter att förstå de övergripande skillnaderna mellan de mest och de minst fördomsfulla: hur de orienterar sig i både intima relationer och generellt i samhället och i deras förmåga att uthärda och hantera mångtydiga situationer. I freudiansk tradition diskuterar hon utförligt hur relationer till föräldrarna i den tidiga barndomen påverkar senare förhållningssätt, liksom förmågan till kreativt och självständigt tänkande. I detta använder hon också resultat från sin egen forskning om hur barns attityder formas i tidig ålder. Texten visar också Frenkel-Brunswiks metodologiska noggrannhet, som härrör från hennes skolning i närheten av Wienkretsens logiska positivister.

    Publiceringshistorik: Översättning av tredje avsnittet (C) i kapitel XIII, ”Comprehensive scores and summary of interview results”, i Theodor W. Adorno, Else Frenkel-Brunswik, Daniel J. Levinson & R. Nevitt Sanford, The Authoritarian Personality (Harper & Brothers 1950). Publicerad med tillstånd från rättighetsinnehavaren American Jewish Committee, https://www.ajc.org/.

  • 29.
    Gustafsson, Henrik
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Holmberg, Hans-Christer
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Psykofysiologisk träningsmonitorering - en förutsättning för optimal prestationsutveckling och en lyckad formtopp2008In: Svensk Idrottsforskning: Organ för Centrum för Idrottsforskning, ISSN 1103-4629Article in journal (Other academic)
  • 30.
    Hendry, Melissa C.
    et al.
    Department of Psychology, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada .
    Douglas, Kevin S.
    Mid Sweden University, Faculty of Human Sciences, Department of Social Sciences. Department of Psychology, Simon Fraser University, Burnaby, Canada .
    Winter, Elizabeth A.
    Department of Psychology, Simon Fraser University, Burnaby, Canada .
    Edens, John F.
    Department of Psychology, Texas A and M University, College Station, TX, United States .
    Construct Measurement Quality Improves Predictive Accuracy in Violence Risk Assessment: an Illustration Using the Personality Assessment Inventory2013In: Behavioral sciences & the law (Print), ISSN 0735-3936, E-ISSN 1099-0798, Vol. 31, no 4, p. 477-493Article in journal (Refereed)
    Abstract [en]

    Much of the risk assessment literature has focused on the predictive validity of risk assessment tools. However, these tools often comprise a list of risk factors that are themselves complex constructs, and focusing on the quality of measurement of individual risk factors may improve the predictive validity of the tools. The present study illustrates this concern using the Antisocial Features and Aggression scales of the Personality Assessment Inventory (Morey, 1991). In a sample of 1,545 prison inmates and offenders undergoing treatment for substance abuse (85% male), we evaluated (a) the factorial validity of the ANT and AGG scales, (b) the utility of original ANT and AGG scales and newly derived ANT and AGG scales for predicting antisocial outcomes (recidivism and institutional infractions), and (c) whether items with a stronger relationship to the underlying constructs (higher factor loadings) were in turn more strongly related to antisocial outcomes. Confirmatory factor analyses (CFAs) indicated that ANT and AGG items were not structured optimally in these data in terms of correspondence to the subscale structure identified in the PAI manual. Exploratory factor analyses were conducted on a random split-half of the sample to derive optimized alternative factor structures, and cross-validated in the second split-half using CFA. Four-factor models emerged for both the ANT and AGG scales, and, as predicted, the size of item factor loadings was associated with the strength with which items were associated with institutional infractions and community recidivism. This suggests that the quality by which a construct is measured is associated with its predictive strength. Implications for risk assessment are discussed. 

  • 31.
    Holmberg, Hans-Christer
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Gustafsson, Henrik
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Tänk dig uthålligare2008In: Glid, ISSN 1652-2737, Vol. 1, p. 49-51Article in journal (Other (popular science, discussion, etc.))
  • 32. Hooper, Nic
    et al.
    Larsson, Andreas
    The Research Journey of Acceptance and Commitment Therapy (ACT)2015Book (Other academic)
  • 33. Johansson, Maria
    et al.
    Flykt, Anders
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology and Social Work.
    Frank, Jens
    Hartig, Terry
    Appraisals of Wildlife During Restorative Opportunities in Local Natural Settings2021In: Frontiers in Environmental Science, E-ISSN 2296-665X, Vol. 9, article id 635757Article in journal (Refereed)
    Abstract [en]

    Many call for a broad approach to valuation of nature’s contribution to people, one that provides a contextualized understanding of what may be experienced as a value in different cultures, groups and settings. In the present paper we address contributions of nature to psychological well-being as realized through restorative processes during encounters with wildlife. Although restorative benefits of nature experience have received much consideration, sparse attention has been given to the role of the presence or absence of different animals in the settings investigated. The presence of a liked species may increase appreciation for and engagement with a natural setting, but fear of encountering some species may counter the desire to visit a setting with otherwise high restorative quality. This paper proposes a psychological framework for understanding how wildlife may contribute to or hinder people’s opportunities to restore in local natural settings. The framework addresses the transaction between the individual and their surroundings, making use of an appraisal theory of emotion and theories about the restorative benefits of nature experience. We focus upon encounters in landscapes shared by humans and wildlife, and we elaborate on our reasoning with scenarios from Sweden involving local people’s appraisal of wolves and roe deer. An integrated understanding of the psychological processes at work would facilitate communication and decision-making about the contribution of wildlife in nature conservation and management. 

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  • 34.
    Johansson, Maria
    et al.
    Lund Univ, Dept Architecture & Built Environm, Environm Psychol, Lund, Sweden..
    Hartig, Terry
    Uppsala Univ, Inst Housing & Urban Res, Uppsala, Sweden.;Uppsala Univ, Dept Psychol, Uppsala, Sweden..
    Frank, Jens
    Swedish Univ Agr Sci, Dept Ecol, Grimso Wildlife Res Stn, Riddarhyttan, Sweden..
    Flykt, Anders
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology and Social Work.
    Wildlife and public perceptions of opportunities for psychological restoration in local natural settings2024In: People and Nature, E-ISSN 2575-8314, Vol. 6, no 2, p. 800-817Article in journal (Refereed)
    Abstract [en]

    Wildlife might be important to psychologically restorative values and disvalues of nature, as interactions with wildlife could trigger both positive and negative feelings. Research on positive experiences of human-wildlife interactions has largely involved participants who voluntarily sought out wildlife experiences or it has addressed encounters with non-threatening animals in urban green spaces. Less is known about the opportunities for psychological restoration in landscapes shared with mammals that are perceived to pose a threat to human activities and health. This study provides a nuanced understanding of the role of wildlife in public perceptions of the restorative potential and experience of psychological restoration in local natural settings. Twenty-eight participants (15 women, 13 men, 18-75 years) took part in focus group interviews subject to a reflexive thematic analysis. As an analytical framework, we used a theoretical model for how people appraise the relevance, implications, coping potential and norm congruence of human-wildlife interactions and how such appraisals may support or hinder the restoration experienced in local natural settings. Relevance appraisals revealed shifts in consideration of the presence of wildlife from an integrated part of the natural scenery (background) to a distinct figure (foreground). Implication appraisals revealed that wildlife encounters would hinder the experienced psychological restoration if the animal was appraised as dangerous, disgusting, causing a nuisance or destructive. Wildlife encounters would promote restoration if the animal displayed attractive traits, features or fascinating behaviour or movements, and if it opened engaging interaction situations. Coping strategies perceived as feasible to deal with negative implications of wildlife involved avoidance of the local natural setting, preparatory behaviour displayed before a visit and precautionary behaviour displayed during the visit. Important public health effects might be gained if wildlife policy and management explicitly consider what animals mean to the perceived restorative potential of local natural settings.Read the free Plain Language Summary for this article on the Journal blog. Forekomst av vilt levande djur kan ha betydelse for manniskors mojlighet till mental aterhamtning i naturen eftersom djurlivet kan ge upphov till bade positiva och negativa kanslor. Tidigare forskning om positiva upplevelser av vilt har foretradesvis handlat om situationer dar manniskor medvetet har sokt sig till en plats for att se djur, fokuserat djurarter som vanligtvis inte betraktas som farliga for manniskor, eller varit begransade till smavilt i urbana gronomraden. Daremot saknas kunskap om mojligheter till mental aterhamtning i naturomraden med storre daggdjur som ocksa kan upplevas utgora ett hot mot manniskors aktiviteter och halsa. Den har studien bidrar till en nyanserad forstaelse av viltets betydelse for allmanhetens upplevda mojligheter till mental aterhamtning i lokala naturomraden. Vi intervjuade 28 deltagare (15 kvinnor, 13 man, 18-75 ar) i fokusgrupper. Intervjuerna analyserades med sk reflexiv tematisk analys. I analyserna utgick vi ifran en teoretisk modell for manniskors bedomning av relevans och konsekvenser av interaktioner mellan manniska och vilt samt tillgang till strategier for att hantera sadana interaktioner och samstammighet med normer i dessa situationer. Modellen beskriver ocksa hur bedomningar kan stodja eller hindra upplevelsen av mental aterhamtning. Deltagarnas bedomning av viltets relevans for mental aterhamtning varierade avseende om djuren betraktades som en integrerad eller en unik framtradande del av naturlandskapet. Bedomningen av konsekvenser visade att moten med vilt levande djur upplevdes hindra den mentala aterhamtningen om djuret ansags vara farligt eller ackligt, orsaka olagenhet eller forstora for manniskor. Moten med vilt upplevdes stodja aterhamtning om djuret ansags ha ett attraktivt utseende eller positiva egenskaper, fascinerande beteenden eller rorelsemonster, eller om djuret skapade sarskilt engagerande situationer. De strategier som deltagarna bedomde som mojliga och tillgangliga for att hantera negativa konsekvenser av vilt var undvikande av lokala naturomraden, forberedelser som vidtogs innan ett eventuellt besok i naturomradet och forsiktighetsatgarder under tiden deltagarna vistades i naturomradet. Det kan finnas positiva effekter for folkhalsan om viltpolicy och forvaltning explicit beaktar betydelsen av vilt for manniskors upplevda mojlighet till mental aterhamtning i lokala naturomraden. Read the free Plain Language Summary for this article on the Journal blog.

  • 35.
    Karlsson, Lena
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology.
    The effects of mindfulness and self-esteem on adolescents´ perceived stress and symptoms of burnout2013Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Perceived stress and stress-related illness as symptoms of burnout have increased in adolescents. The aim of the present study was to investigate if mindfulness, global- and competence-based self-esteem are potential predictors for perceived stress and symptoms of burnout in adolescents. 143 upper secondary students participated in the study. The results of hierarchical regression analyses showed that higher levels of mindfulness and global-self-esteem were associated with decreased levels of perceived stress and symptoms of burnout. Competence-based self-esteem was only trend-significant associated with symptoms of burnout. Mediation analysis revealed that global self-esteem was a fully mediator for the relationship between competence-based self-esteem and perceived stress. The results were discussed in terms of the importance of individual factors, such as, mindfulness and self-esteem to predict perceived stress and symptoms of burnout.

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  • 36.
    Larsson, Andreas
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology and Social Work.
    Stepping back AND reappraising: A functional contextual approach to moving from cognitive modification to acceptance and defusion strategies with flexibility and purpose2023Conference paper (Refereed)
    Abstract [en]

    Are you a CBT-trained Clinician or an ACT-head that wants to dip your toes in cognitive change? This workshop focuses on a process-based approach to CBT, from the Extended Evolutionary Meta-Model (EEMM) understanding of maladaptive and adaptive variations, selection, and retention of cognitions. Participants will learn how to make cognitive modification strategies more contextual and flexible, and practice using defusion-based techniques to support clients in acting purposefully in line with their values. Additionally, the workshop will introduce participants to RFT conceptualizations, to enhance their flexibility in applying these processes. This is an opportunity to grow your abilities, expand your understanding, and provide better outcomes for your clients. Educational Objectives: 1. Discuss when and how cognitive modification strategies can be used even within ACT with a focus on workability. 2. Practice using a number of defusion based strategies in valued directions within role play/real play. 3. Demonstrate skill and confidence in working with thinking in a CBS consistent way.

  • 37.
    Larsson, Andreas B.
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology and Social Work.
    Sundström, Felicia
    Optimizing Process-Based Therapy: A Boruta-Driven Approach to Identifying Key Clinical Outcomes in a Swedish validation of the Process-Based Assessment Tool (PBAT)2024In: Journal of Contextual Behavioral Science, ISSN 2212-1447, Vol. 33, article id 100794Article in journal (Refereed)
    Abstract [en]

    BackgroundThe Process-Based Assessment Tool (PBAT), is an item pool showing promising results in assessing psychological processes of change relevant for both psychotherapy and research in its original English version. However, further research focusing on translation and validation in other languages is needed for broader applicability. This study aims to translate and validate the PBAT in Swedish, and to examine the relationship with common clinical outcome variables.MethodsThe PBAT and STOP-D were translated and culturally adapted to Swedish. The study included 427 Swedish-speaking participants recruited online, with a mean age of 48. The PHQ-4 and Single Item Stress Scale were used as criterion variables. Correlational analyses and the Boruta feature selection algorithm were employed for data analysis.ResultsThe translated PBAT demonstrated significant correlations with clinical outcomes, indicating its effectiveness in a Swedish context. Positive PBAT items correlated with higher vitality and health, while negative items were predictive of sadness, anxiety, and stress. The Boruta analysis highlighted the importance of specific PBAT items to different clinical outcomes, underscoring the tool's validity.ConclusionThe Swedish version of the PBAT shows strong validity and reliability in assessing psychological health. This study contributes to the cross-cultural applicability of the PBAT, offering a valuable tool for psychological assessment in the Swedish context.

  • 38.
    Larsson, Andreas
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology and Social Work. Swansea University, Swansea, Wales, Uk.
    Hartley, Sinéad
    University College Dublin, Dublin, Ireland.
    McHugh, Louise
    University College Dublin, Dublin, Ireland.
    A randomised controlled trial of brief web-based acceptance and commitment Therapy on the general mental health, depression, anxiety and stress of college Students2022In: Journal of Contextual Behavioral Science, ISSN 2212-1447, Vol. 24, p. 10-17Article in journal (Refereed)
    Abstract [en]

    The college years are frequently understood as being a carefree time in a young person's life, however, research suggests that these are formative and challenging times for many. The purpose of the study was to examine the effectiveness of a brief internet intervention based on Acceptance and Commitment Therapy (ACT) for promoting general mental health among college students. As far as can be determined, the impact of an online guided self-help version of (i) contact with the present moment, (ii) cognitive defusion and (iii) self-as-context processes of ACT on mental health has never been tested in a student-based randomized trial. The current study was a randomized controlled wait-list trial consisting of a 3-week intervention and a 3-week follow-up phase. Out of 174 participants, 113 were included in the analysis. Inclusion criteria were: (1) no formal diagnosis of mental health disorders, (2) no previous experience of ACT, mindfulness or mindfulness-based exercises, (3) over 18 years of age, and (4) currently registered as a university or college student. Participants were randomly assigned to an ACT-based intervention (N = 87) or a wait-list control (N = 87). Neither investigators nor participants were blinded to group assignment. The primary outcome measure was general mental health (GHQ-12). Depression, Anxiety and Stress were also measured (DASS-21) as well as psychological flexibility (AAQ-2) at pre- and post-intervention, and 3-week follow-up. The results indicated significant improvements in general mental health in the ACT processes group compared with the wait-list control group (p = .005, d = 0.48) at post treatment but not at follow-up. There were no significant differences between the groups on any other outcome measures. The results from this study provide some support for the effectiveness of a brief web-based ACT intervention to enhance general mental health. However, there were no significant comparative improvements, but trends, for depression, anxiety or stress.

  • 39. Larsson, Andreas
    et al.
    Hooper, Nic
    Osborne, Lisa A.
    Bennett, Paul
    McHugh, Louise
    Using Brief Cognitive Restructuring and Cognitive Defusion Techniques to Cope With Negative Thoughts2016In: Behavior Modification, Vol. 40, no 3, p. 452-482Article in journal (Refereed)
    Abstract [en]

    Negative thoughts, experienced by 80% to 99% of the non-clinical population, have been linked to the development of psychopathology. The current study aimed to compare a cognitive restructuring and cognitive defusion technique for coping with a personally relevant negative thought. Over a 5-day period, participants used either a restructuring, defusion, or control strategy to manage a negative thought. Pre- and post-intervention participants reported (a) believability of the thought, (b) discomfort associated with the thought, (c) negativity associated with the thought, and (d) willingness to experience the thought. Daily online questionnaires assessing the total frequency of negative thought intrusions and their level of willingness to experience the negative thought were also used. Also, 10 positive and negative self-statements were rated on the same scales, and self-report measures of mood and psychological flexibility were completed. Findings indicated that defusion lowered believability, increased comfort and willingness to have the target thought, and increased positive affect significantly more than the control and cognitive restructuring. Within groups, cognitive restructuring also made significant gains in target thought discomfort, negativity, and “willingness to have” in the same direction as defusion but the no-instruction control did not. Negative thought frequency was reduced in the defusion group, maintained in the restructuring group, and increased in the no-instruction control group. Similar trends emerged from the secondary outcome measures, that is, the effects of the strategies on the positive and negative self-statements. The current findings support the efficacy of using defusion as a strategy for managing negative thoughts.

  • 40.
    Leiler, Anna
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology and Social Work.
    Bjärtå, Anna
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology and Social Work.
    Ekdahl, Johanna
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology and Social Work.
    Wasteson, Elisabet
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology and Social Work.
    Mental Health and Quality of Life among Asylum Seekers and Refugees Living in Refugee Housing Facilities in Sweden2019In: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 54, no 5, p. 543-551Article in journal (Refereed)
    Abstract [en]

    In 2015, there was a high influx of refugees to Sweden, creating an extreme situation where individuals were forced to remain in large housing facilities for long periods. The present study aims to describe the mental health and quality of life of these individuals. 

    Methods. Data, based on 510 individuals, were obtained by means of a questionnaire at open screenings conducted at or nearby refugee housing facilities. Of the participating refugees, 367 were asylum seekers and 143 had received a residence permit but were still awaiting a more permanent housing solution. The questionnaire included measures of depressive symptoms (PHQ-9), symptoms of anxiety (GAD-7), risk of having post traumatic stress disorder (PC-PTSD), and quality of life (WHOQOL-BREF).

    Results. Of the total sample, 56-58.4% reported clinically significant levels of symptoms of depression, anxiety and risk of having PTSD. Prevalence estimates were higher among asylum seekers than among those who had received their residence permit. Quality of life was generally rated below population norms and correlated negatively with mental health outcomes.

    Conclusions. Individuals residing in refugee housing facilities show high levels of psychological distress and rate their quality of life as low. Asylum seekers score higher than those having received a residence permit. These results are troublesome since the wait time for asylum decisions has lengthened considerably after 2015. The results of the present study calls for the urgency of societal actions to shorten the asylum process wait time and improve conditions at the housing facilities.  

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  • 41.
    Leiler, Anna
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology and Social Work.
    Hollifield, Michael
    War Survivors Institute, Long Beach, CA, USA.
    Wasteson, Elisabet
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology and Social Work.
    Bjärtå, Anna
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology and Social Work.
    Suicidal ideation and severity of distress among refugees residing in asylum accommodations in Sweden2019In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 16, no 15, article id 2751Article in journal (Refereed)
    Abstract [en]

    Refugees worldwide suffer high levels of distress and are at increased risk for death by suicide. The Refugee Health Screener (RHS) was developed to screen for emotional distress among refugees and can be used to assess distress severity. This paper examines the association between distress severity and suicidal ideation in a sample of refugees residing in asylum accommodations. Data from the RHS and item 9 on the Patient Health Questionnaire-9 (PHQ-9) was analyzed. Results showed that individuals at moderate and severe levels of distress were much more likely to exhibit suicidal ideation than individuals with low levels of distress. Even though we cannot conclude that individuals with low levels of distress do not have thoughts of ending their lives, further suicide assessment is warranted in asylum seekers with moderate to severe distress on the RHS. 

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  • 42. Lindegaard, T.
    et al.
    Wasteson, Elisabet
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology and Social Work.
    Demetry, Y.
    Andersson, G.
    Richards, D.
    Shahnavaz, S.
    Investigating the potential of a novel internet-based cognitive behavioural intervention for Dari and Farsi speaking refugee youth: A feasibility study2022In: Internet Interventions, ISSN 2214-7829, Vol. 28, article id 100533Article in journal (Refereed)
    Abstract [en]

    Objective: Over half of the world's forcibly displaced persons are under the age of 25, with many suffering from symptoms of psychological disorders. Many refugees from Afghanistan or Iran speak either Dari or Farsi, which are mutually intelligible dialects of the Persian language. Previous research on adult refugees and immigrants have shown that internet-based cognitive behavioural therapy (ICBT) can be a valuable complement to other forms of treatment. However, there is a lack of knowledge if ICBT is a feasible and acceptable treatment for adolescents and young adults with a refugee background. Method: Fifteen Dari/Farsi-speaking adolescents and young adults between 15 and 26 years of age participated in a feasibility study of a novel individually tailored guided ICBT intervention targeting symptoms of common mental disorders such as anxiety and depression. Self-reported symptoms of anxiety and depression were assessed using the Hopkins Symptom Checklist-25 (HSCL-25) as the primary outcome measure. Four of the treatment participants and three additional non-treatment participants consented to be interviewed regarding the programme's acceptability. The interviews were analysed using Thematic Analysis. Results: The intervention suffered from low adherence, with only 3 participants completing the post-treatment assessment and with participants completing 0.9 modules on average, which meant that the intended quantitative analysis of the pre to post change was not possible. The thematic analysis resulted in two overarching categories, barriers and facilitators, that each contained four themes and related subthemes. Overall, the intervention was deemed culturally relevant and easy to understand. The most salient barriers to participation across interviews concerned interference of symptoms such as concentration difficulties, low energy, and a lack of human contact and support. Conclusion: The current version of the ICBT program demonstrated low feasibility and acceptability in the target population, which mainly seemed to be related to the delivery format. Future studies should investigate if a blended treatment format with regular phone/video calls with a therapist can increase adherence to the intervention. 

  • 43.
    Lisspers, Jan
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Social Sciences.
    Almén, Niclas
    Mid Sweden University, Faculty of Human Sciences, Department of Social Sciences.
    Föllingemodellen: En KBT-inriktad och internatsbaserad interventionsmodell för beteendeförändring vid livsstils- och stressrelaterad ohälsa2009Report (Other academic)
  • 44. Lundgren, Tobias
    et al.
    Larsson, Andreas
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology and Social Work.
    Values Choice and Clarification2018In: Process-based CBT / [ed] Hayes, Steven C; Hofmann, Stefan G, New Harbinger Publications , 2018Chapter in book (Other academic)
    Abstract [en]

    Values and discussions of valued choices are a core part of acceptance and commitment therapy, behavioral activation, motivational interviewing, and a wide variety of other evidence-based methods. Values work can function in therapy as a motivator for change, as a metric for the effectiveness of actions, and as a guide in the development of new behavioral repertoires. Values work can be done at any point in the therapeutic process. Values interventions are used to help clients stop vicious, negative life cycles and get in contact with more effective behavior patterns. This chapter gives an extended example of values work using the Bull’s-Eye Values Survey (BEVS). During the last decade, the BEVS has also been developed and investigated as an outcome and mediator measure in research. Changes in valued living as measured by the BEVS are associated with higher quality of life and lower depression, anxiety, and stress. BEVS scores mediate changes in behavioral health and mental health areas. Values work can empower most forms of evidence-based therapy by linking behavior change to meaning and purpose. Choosing and clarifying values appears to be a key process with wide applicability across problem types and treatment methods.

  • 45.
    Löfdahl, Tomas
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology.
    Wretman, Mattias
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology.
    Effekter av en internetbaserad återhämtningsfokuserad stressintervention: En pilotstudie2013Independent thesis Advanced level (professional degree), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Syftet med denna pilotstudie var att skapa hypoteser om vilken påverkan en internetbaserad återhämtningsfokuserad stressintervention kan ha på beteendemönster och generellt hälsotillstånd. 22 vuxna svenskar rekryterades initialt till studien. 15 individer valde att fullfölja hela interventionsprogrammet. Mätningar med internetbaserade frågeformulär genomfördes innan interventionens start och efter interventionens slut. De primära ändpunkterna för mätningarna utgjordes av beteendeförändringar (frekvens av återhämtningsbeteenden) och kliniska effekter (upplevelser av stress och återhämtning). Resultatet visade att deltagarna vid interventionens avslut hade ökat frekvensen återhämtningsbeteenden samt förbättrat sina upplevelser av stress och återhämtning. Majoriteten av resultaten frambringade stora effektstyrkor. Resultatet visade även att inga signifikanta effektskillnader av interventionen kunde observeras mellan könen sett över studiens två primära ändpunkter. Rekommendationer gjordes till framtida forskning om att tydligare klargöra hur internetbaserade metoder med primärt fokus mot beteendeförändringar inom domänen återhämtningsbeteenden på bästa sätt kan bidra till prevention och behandling av stressrelaterad ohälsa.

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    Effekter av en internetbaserad återhämtningsfokuserad stressintervention: En pilotstudie
  • 46.
    Löfdahl, Tomas
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Social Sciences.
    Wretman, Mattias
    Mid Sweden University, Faculty of Human Sciences, Department of Social Sciences.
    Långsammare igenkänning av emotioner i ansiktsuttryck hos individer med utmattningssyndrom: En pilotstudie2012Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syftet med denna pilotstudie var att skapa hypoteser om och hur utmattningssyndrom påverkar förmågan att känna igen emotioner i ansiktsuttryck. En grupp patienter med utmattningssyndrom jämfördes med en matchad frisk kontrollgrupp (N=14). Grupperna undersöktes med ett datorbaserat test beståendes av färgbilder av autentiska ansiktsuttryck som gradvis i steg om 10% förändrades från ett neutralt ansiktsuttryck till någon av de fem grundemotionerna ilska, avsky, rädsla, glädje och ledsenhet. Mätningarna gjordes i termer av igenkänningsprecision och responshastighet. Resultatet visade att patientgruppen responderade signifikant långsammare än kontrollgruppen sett över samtliga emotioner i testet. Inga emotionsspecifika skillnader såväl som skillnader i igenkänningsprecision kunde påvisas mellan grupperna. Orsakerna till diskrepansen i responshastighet diskuterades utifrån fyra tänkbara förklaringsområden: ansiktsperceptuell funktion, visuell uppmärksamhet, självfokuserad uppmärksamhet samt noggrannhet/oro. Rekommendationer gjordes till framtida forskning om att utforska dessa områden närmare.

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    Långsammare igenkänning av emotioner i ansiktsuttryck hos individer med utmattningssyndrom
  • 47.
    Meurling, Jennifer
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology and Social Work.
    Rondung, Elisabet
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology and Social Work.
    Leiler, Anna
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology and Social Work.
    Wasteson, Elisabet
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology and Social Work.
    Andersson, Gerhard
    Richards, Derek
    Shahnavaz, Shervin
    Bjärtå, Anna
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology and Social Work.
    An online tiered screening procedure to identify mental health problems among refugees2023In: BMC Psychiatry, E-ISSN 1471-244X, Vol. 23, no 1, article id 7Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Many refugees suffer from mental health problems due to stressful and traumatic events before, during, and after migration. However, refugees are facing a wide variety of barriers, limiting their access to mental health care. Internet-based tools, available in several languages, could be one way to increase the availability of mental health services for refugees. The present study aimed to develop and test a screening tool to screen for clinically relevant symptoms of psychiatric disorders common among refugees (i.e. Depression, Anxiety, Post-traumatic stress disorder, and Insomnia). We, designed, translated, and adapted an internet-based tiered screening procedure suitable for use with the largest refugee populations residing in Sweden. The tool aims to accurately identify symptoms of mental distress (Tier 1), differentiate between symptoms of specific psychiatric disorders (Tier 2), and assess symptom severity (Tier 3). We tested the overall efficiency of using a tiered screening procedure. METHODS: Seven hundred fifty-seven refugees residing in Sweden, speaking any of the languages Arabic, Dari, Farsi, English, or Swedish, completed an online questionnaire following a three-tiered procedure with screening instruments for each tier. In this study, the Tier 3 scales were used as reference standards for clinically relevant symptoms, to evaluate screening efficiency in terms of accuracy and reduction of item burden in previous tiers. RESULTS: The results show that the tiered procedure could reduce the item burden while maintaining high accuracy, with up to 86% correctly assessed symptoms and few false negatives with moderate symptoms and above (at most 9%), and very few with severe symptoms (at most 1.3%). DISCUSSION: This study generated an accurate screening tool that efficiently identifies clinically relevant symptoms of common psychiatric disorders among refugees. Using an adapted online tiered procedure to screen for multiple mental health issues among refugees has the potential to facilitate screening and increase access to mental health services for refugees. We discuss the utility of the screening tool and the necessity of further evaluation. 

  • 48.
    Moran, Orla
    et al.
    University College Dublin, Dublin, Ireland.
    Larsson, Andreas
    University College Dublin, Dublin, Ireland.
    McHugh, Louise
    University College Dublin, Dublin, Ireland.
    Investigating cognitive fusion, mindfulness and experiential avoidance in relation to psychosis-like symptoms in the general population2021In: Journal of Contextual Behavioral Science, ISSN 2212-1447, Vol. 21, no June, p. 136-143Article in journal (Refereed)
    Abstract [en]

    Acceptance and Commitment Therapy (ACT) has demonstrated promising outcomes to date with clinical populations affected by psychosis, however there is a dearth of such investigations involving non-clinical samples despite evidence that symptoms of psychosis exist on a continuum in the general population. The present study aimed to investigate how key ACT processes relate to psychosis-like symptoms in the general population. A convenience sample of 77 adults completed self-report measures of cognitive fusion, mindfulness, experiential avoidance, and psychosis-like symptoms, and relative distress, intrusiveness and frequency. A series of correlational and hierarchical regression analyses investigated the relationship between target variables. Higher mindfulness was related to lower levels of psychosis-like symptoms as well as lower distress, intrusiveness, and frequency in relation to these experiences, as were lower levels of cognitive fusion and experiential avoidance. Higher levels of cognitive fusion and experiential avoidance, as well as lower levels mindfulness, emerged as significant predictors of higher levels of psychosis-like symptoms, and higher relative distress, intrusiveness, and frequency. Findings are discussed in relation to implications for future clinical research.

  • 49.
    Partanen, Petri
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology.
    Assessment and Remediation for Children with Special Educational Needs: The role of Working Memory, Complex Executive Function and Metacognitive Strategy Training2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The overall aim of this thesis was to explore the role of different assessment tools and training regimens in assessment and remediation for children with special educational needs in school. A central purpose of assessment explored was that it should inform remediation, teaching and instruction. The concepts of working memory, complex executive function and metacognitive strategy training for children with special educational needs were specifically explored in relation to this purpose of assessment. Complex executive function refers to planning and metacognitive ability, that many children with special educational needs struggle with, and which they are expected to handle in learning during school day. Of particular interest in the thesis was the contrast between working memory and complex executive function and how these concepts inform assessment and remediation practices. In this context, special attention was given to mathematical learning difficulties.

    The thesis was based on four studies (I‑IV). Study I explored the prevalence of different assessment tools, and dilemmas and challenges as perceived by assessment professionals, teachers and parents, in the work with children with special educational needs in Europe. In Study II, a metacognitive strategy training framework was developed as a training regimen, guided by research on complex executive function, and applied on working memory training. Effects of working memory training were compared between the two training regimens, with and without metacognitive strategy training, and also the overall effect of working memory training on cognitive functioning and the school related skills of reading, writing and arithmetic. In Study III, different types of measures of working memory and their predictive capacities in relation to mathematics achievement in national curriculum assessments were explored, as well as the effects of working memory training on mathematics achievement. In Study IV the role of working memory and complex executive function in identifying risk for mathematical learning difficulties in children with special educational needs was explored.

    The results from Study I suggested that assessment and remediation practices can contribute to a deficiency‑oriented outlook on children with special educational needs. In contrast parents and teachers in Sweden also reported that assessment could help them to better understand the needs of the child. Results from studies II-IV showed that only the use of a metacognitive strategy training regimen targeting complex executive function resulted in improvements following working memory training. The results also indicated that working memory training strongly predicted mathematical performance in national curriculum assessments of mathematics in school, and that a more complex change measure of working memory was a better predictor than simple working memory measures in this regard. Finally, the results also showed that complex executive function, defined as planning ability, was a better predictor than simple working memory in the assessment of risk for mathematical learning difficulties.

    The results from the studies were discussed in relation to the purpose of assessment to inform remediation, teaching and instruction for children with special educational needs. It was concluded that, in addition to working memory, as complex executive function – planning and metacognitive ability - seems to be an important cognitive function related to learning, this should be addressed both in the assessment of children with special educational needs as well as in the remediation when designing training regimens and interventions for children with special educational needs in general, and children at risk for mathematic learning difficulties in particular. It was also highlighted that in remediation, the role of the teacher as a mediator of metacognition and complex executive function seems vital.

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  • 50.
    Partanen, Petri
    Mid Sweden University, Faculty of Human Sciences, Department of Social Sciences.
    Att utveckla elevhälsa2012Book (Other (popular science, discussion, etc.))
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