Many children and their families who seek assistance for childhood behaviour disorders experience comorbid disorders, namely the presence of two or more disorders. Although comorbid disorders are recognized as a frequent clinical complication, minimal direction exists within the literature about the risk factors for comorbid conditions and how best to provide intervention services. In this study an ecological framework was used to compare the individual, family, and community environmental contexts of young girls who presented at intake at a children’s mental health centre with comorbid externalizing and internalizing disorders, and girls who presented at intake with externalizing disorders only. The treatment response to a cognitive-behavioural intervention for externalizing behaviour disorders was examined, by comparing externalizing scores over time between girls with comorbid externalizing and internalizing disorders and girls with externalizing disorders only. Additionally, internalizing scores over time for girls with comorbid disorders were examined. Results indicated that a history of abuse and a cluster of individual characteristics placed girls at higher risk to present with comorbid conditions. The results also indicated that girls with comorbid disorders experienced a reduction of both externalizing and internalizing symptoms. Only 1 in 7.4 girls, however, scored below the clinical range for both externalizing and internalizing disorders at the end of the treatment phase, in comparison to 1 in 5 girls scoring below the clinical range for externalizing disorders in the noncomorbid group.

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Goal: To determine whether the Cortisol Awakening Response (CAR) associates with treatment response and course in hospital for inpatients with major depressive disorder (MDD). Methods: The CAR was measured at admission and discharge in patients completing a four-week inpatient program for MDD. Self-report questionnaires were used to assess changes in depression, anxiety, and perceived stress. Results: Over the four week hospital stay measures of CAR reactivity (Delta, AUCi) decreased, but there was no significant correlation between the change in CAR reactivity and change in clinical symptoms. Cross-sectional measurements of the CAR reactivity at both admission and discharge were strongly correlated with the drop in depression scores in hospital. Furthermore, poor treatment responders had a significantly lower CAR reactivity at both admission and discharge than did good responders. Conclusion: Individuals with higher CAR reactivity at admission and discharge had the greatest reduction in depression over the course of treatment.

Goal: To determine whether the Cortisol Awakening Response (CAR) associates with treatment response and course in hospital for inpatients with major depressive disorder (MDD). Methods: The CAR was measured at admission and discharge in patients completing a four-week inpatient program for MDD. Self-report questionnaires were used to assess changes in depression, anxiety, and perceived stress. Results: Over the four week hospital stay measures of CAR reactivity (Delta, AUCi) decreased, but there was no significant correlation between the change in CAR reactivity and change in clinical symptoms. Cross-sectional measurements of the CAR reactivity at both admission and discharge were strongly correlated with the drop in depression scores in hospital. Furthermore, poor treatment responders had a significantly lower CAR reactivity at both admission and discharge than did good responders. Conclusion: Individuals with higher CAR reactivity at admission and discharge had the greatest reduction in depression over the course of treatment.

Group psychotherapy is the most widely utilized treatment modality for convicted sex offenders, and the therapeutic alliance is considered a fundamental concept in virtually all applications of psychotherapy. However, empirical examination of how the therapeutic alliance impacts upon treatment effectiveness for sex offenders has been neglected. In a prospective design, a sample of 95 consecutive admissions to an inpatient treatment program for convicted adult male sex offenders was studied with regard to their experience of the therapeutic alliance with treatment staff, with their copatients, and with the overall treatment program. Patients of the Phoenix Program (Alberta Hospital Edmonton) rated their sense of alliance at monthly intervals. The therapists who worked with them (n = 21) also completed monthly evaluations of their own emotional responses toward these same patients. Pre- to post-treatment comparisons on personality tests, interpersonal distress, and interpersonal functioning showed a number of statistically significant changes consistent with treatment goals. Patients self-report over time in treatment showed a gradual, consistent increase of large effect size on all three alliance targets. Sex offenders in this sample were able to experience positive alliance with therapists and peers and the sense of alliance was shown to grow stronger over time. Staff ratings revealed that positive and negative affect increased as patients time in treatment increased. Significant associations between patient-rated alliance and outcome were found to be positive and in desired directions. The growth rate in alliance toward therapists was positively and significantly associated with the growth rate of conflict within oneself among female therapists. Male therapists also reported significant growth in conflict within oneself but this was independent of patient-rated alliance growth rates. Thus, female therapists experienced heightened affect in the face of greater patient alliance, while male therapists also experienced heightened affect but for reasons unrelated to patient alliance. There was virtually no reduction in negative affect toward patients despite moderate increases in positive affect toward patients. This study represents an important endorsement of a treatment model that seeks to improve general adjustment and ameliorate risk factors associated with recidivism, via positive changes in interpersonal relationships. / Psychiatry

Diss. (sammanfattning) Göteborg : Göteborgs universitet, 2007. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. Inst., 2002. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 6 uppsatser.

Diss. Stockholm : Karol. inst., 2002. / S. [1] -53: sammanfattning. s. 57-117: 4 uppsatser.