ADHD affects executive functions and pharmacological treatment is the most common intervention. Medication is ineffective for some and psychosocial interventions are scarcely available. CBT that teaches organizational skills for managing ADHD-symptoms has shown promising results. Smartphones can help individuals perform executive tasks such as planning and organizationand they could beefficacious as a support tool for ADHD patients. The current study is aRCT that compares an online course (n=29) based on previouslyeffective CBT treatments for ADHD to a wait-list control (n=29). Theintervention focused on teaching the use of an online calendar and smartphone apps. The intervention brought significant improvement (p < 0.001) to participants regarding ADHD symptoms and 38% of participants were considered clinically significantly improved. This indicates that online treatments using IT-tools for ADHD is effective and that smartphones can be used as a tool for aiding individuals with impairments in executive functions.

Rationale: This study was conducted to help improve mental health care for Black and Minority Ethnic (BME) clients as previous research carried out in non-western countries has suggested that western-developed psychotherapies often need to be culturally adapted to become more effective in treating this client group. The aim of this study was to explore how CBT therapists deliver manualised CBT with BME clients and if they make any adaptations, how and to what extent are they implemented. Method: Interpretative Phenomenological Analysis (IPA) guided the conduct and analysis of one-to-one, semi-structured interviews with six CBT therapists working in an Improving Access to Psychological Therapies (IAPT) service. The inclusion criteria for participants was accreditation with the BABCP, completion of an IAPT programme CBT diploma and to be currently working in an IAPT service, at least two years experience as a CBT therapist and at least four cases of completed therapy with BME clients. Findings: Four master themes emerged (1) CBT is based on western principles, (2) The complex nature of CBT, (3) Changing practice of manualised CBT and (4) The influence of therapist factors. Conclusion: The participants experienced many issues in their practice of manualised CBT with BME clients which led them to make changes including adaptations to manualised CBT. They described their current practice as being integrative as they incorporated therapeutic approaches other than pure manualised CBT, making them more flexible and adaptable. The adaptations involved altering the cognitive and behavioural interventions to better suit the individual needs of the client. The adaptations took into account the client’s culture, religion, language, psychological mindedness, acculturation to their host country, education and age. The participants’ confidence in CBT and their self-identity as therapists also influenced their overall practice of therapy. Recommendations for practice are discussed in relation to therapeutic practice, training of therapists, supervision and policy makers.

Afin de mieux comprendre la sensibilité du continent européen aux changements climatiques, le potentiel des tétraéthers de glycérol ramifiés (ou « méthylés »), supports de nouveaux indicateurs de température et du pH des sols, a été étudié dans 2 archives sédimentaires. Ces 2 carottes de sédiments marins prélevées à l’embouchure de grands fleuves (Danube et paléo fleuve Manche) de part et d’autre de l’ancienne calotte glaciaire fennoscandinave, offrent l’opportunité d’obtenir des enregistrements contenant une information intégrée à l’échelle de vastes bassins versants depuis le dernier cycle glaciaire. Des reconstitutions continues des températures glaciaires obtenues à partir de l’analyse des tétraéthers ramifiés dans ces carottes sont présentées. Ces enregistrements sont interprétés avec précaution du fait de la relative méconnaissance des organismes producteurs des tétraéthers ramifiés et leur possible production en milieu aquatique. La haute résolution temporelle des reconstitutions permet toutefois de mieux comprendre la variabilité climatique abrupte de la dernière période glaciaire, de part l’estimation des températures associées aux évènements de Heinrich et cycles de Dansgaard-Oeschger, notamment par une estimation quantitative en Europe centrale-est. De plus, l’apport des tétraéthers à la reconstitution du pH des paléosols de cette partie du continent est étudié. Par ailleurs, une méthode automatisée de purification des échantillons, préalable à l’analyse des tétraéthers par HPLC-MS a été mise au point, afin de faciliter le travail préparatoire et promouvoir l’analyse de paléo séquences à haute résolution temporelle utilisant les tétraéthers. / In order to better understand the sensibility of the European continent to climate changes, the potential of branched tetraether lipids, as bases of temperature and soil pH proxies, has been studied in two sedimentary archives. These two marine sediment cores have been chosen for their location at the mouth of major rivers (Danube and paleo Channel river) on both sides of the ancient Fennoscandian ice sheet. Indeed, they enable to get records containing information integrated at large drainage basin scale, since the last glacial cycle. Thus, continuous temperature reconstructions of the last glacial period in Europe, based on branched tetraethers extracted from these cores, are presented. These records are carefully interpreted, notably because of the uncertainties on the tetraether producers and their likely production in the aquatic environment. The high temporal resolution of the reconstruction however enables insights into the last glacial abrupt climate variability, with temperature estimates of Heinrich events and Dansgaard-Oeschger cycles, and especially, quantitative estimations in central eastern Europe. Moreover, the reconstruction of past soil pH in this part of the continent is investigated. Last, an automated purification method for archaeal and bacterial tetraethers in soils and sediments has been developed in order to contribute to enhancing the time resolution of paleosequences based on tetraether biomarkers.

Perfectionism has been seen to predict treatment outcome and symptom severity in clinically relevant diagnoses such as depression and anxiety disorders. It has also been suggested to be a transdiagnostic phenomenon. The aim of this study was to investigate, for the first time, predictors of change in Internet-based cognitive behaviour therapy for perfectionism. The chosen predictors were perfectionism severity, comorbid diagnosis and degree of self-compassion. The study was a part of the Devin-project; a randomized controlled trial with 150 participants that were allocated to active treatment (N=73) or a waitlist condition (N=77). Multiple linear regression analysis was used for the analyses. Variables chosen a priori did not significantly predict the treatment outcome (R2=.10, p = .099). A post hoc-analysis showed that perfectionism severity, as measured with CPQ, predicted symptom change after treatment (B = .783, β = .56 p < .001). The results indicate that perfectionism severity doesn’t impair the treatment effects and that the treatment is effective, independent of comorbid diagnoses. Self-compassion was investigated on an explorative basis but the results can indicate that the variable is not a risk factor nor a protective factor for perfectionism. As Devin is the largest randomized controlled study of internet-based cognitive behaviour therapy for perfectionism to date, this study generates important implications and suggestions for future research. / Devin

Objectives: This thesis aims to explore evidence for the effectiveness of cognitive behavioural therapy (CBT) for non-cardiac chest pain (NCCP). Design: The systematic review aimed to evaluate evidence for CBT as an effective intervention for anxiety in the NCCP population. Study one describes the chest pain characteristics, illness beliefs and prevalence of anxiety in a NCCP sample in a cross-sectional design. Study two explores the acceptability and clinical effectiveness of a CBT-based self-help intervention for NCCP patients, using a between subjects, repeated measures design. Methods: A systematic review was completed via a comprehensive literature search for comparative studies examining CBT-based interventions for NCCP including a measure of anxiety. In the empirical study, participants completed measures of anxiety, illness beliefs and indices of chest pain (self-reported frequency, severity and impact on activities) at baseline. Comparisons between illness beliefs and anxiety were undertaken using descriptive statistics and Pearson correlations. Participants were randomised to receive a CBT-based self-help intervention booklet or treatment as usual, with questionnaires re-administered at three-month follow-up. ANOVAs were used to evaluate whether the intervention led to improvements in anxiety levels, or increased belief in participants’ personal control of symptoms. Results: Ten studies met inclusion criteria for the systematic review, with four studies showing evidence regarding the effectiveness of CBT for anxiety. Approximately two thirds of the thesis research sample reported on-going pain following clinic attendance, for the majority this was ‘very mild’ or ‘mild’ pain. Almost half (47%) reported experiencing clinically significant anxiety. Stress was the most common causal attribution advocated by the sample to explain their chest pain. Anxiety scores were significantly associated with psychological attribution scores, but not with personal control or illness coherence beliefs. In study two, 87 participants completed the study and ITT analyses were completed on 119. There were no significant differences between the groups in terms of reduced anxiety or self-reported belief in personal control of symptoms. The intervention booklet was evaluated largely positively by those who reported reading it. Conclusions: CBT-based self-help appears an acceptable intervention for those diagnosed with NCCP. Further research is needed to identify those who are most likely to benefit from such self-help intervention.

Studiens syfte var att undersöka leg. psykoterapeuters uppfattningar om och erfarenheter av att identifiera och reparera rupturer i den terapeutiska relationen (alliansen) i kognitiv beteendeterapi (KBT). Datainsamlingen bestod av narrativa intervjuer. Den kvalitativa metoden fenomenologisk hermeneutik (Lindseth & Norberg, 2004), där intresset riktas mot den levda erfarenheten, användes vid analys och tolkning av texten. Resultatet visade att de terapeutiska färdigheterna medveten närvaro och metakommunikation används för att identifiera, förebygga och reparera rupturer i alliansen. Slutsatsen är att psykoterapeuternas berättelser bär på den dolda innebörden att alla slags terapeutiska interventioner i KBT samtidigt utgör relationella handlingar, och att ett språk för detsamma är önskvärt. Meningsfullhet och yrkesstolthet kan dessutom tillägnas, om uppmärksamheten vänds från misslyckanden till mod att ta ansvar för det terapeutiska förloppet och relationen. / The aim of the study was to investigate psychotherapists perceptions about and experiences of identifying ruptures in the therapeutic alliance in cognitive behavioural therapy (CBT). The data collection consisted of narrative interviews. The qualitative method, a phenomenological hermeneutical method for researching lived experience (Lindseth & Norberg, 2004), was used in the analysis and interpretation of the texts. The result showed that the therapeutic skills awareness and metacommunication was used to identify, prevent and resolve ruptures in the alliance. The conclusion is that psychotherapists stories carries a hidden meaning of any therapeutic interventions in CBT at the same time constitutes relational actions, and a language for the same is desirable. Meaningfulness and professional pride can also be adopted, by shifting attention from failures, into courage to take responsibility for the therapeutic process and the relationship.

This document proposes a study to ascertain if a relationship exists between levels of child and parent anxiety symptoms during an intervention designed to decrease anxiety in youth. This document systemically describes family variables related to anxiety in youth at the individual, parent-child, marital, whole family, and extra familial subsystem levels, in addition to previous research analyzing parental anxiety and the direction of change between child and parent anxiety during youth-focused interventions. The study involves gathering anxiety symptom data from parent and child participants at 14 time points and analyzing it using dependent samples t-test, regression, and ANOVA repeated measure analyses. These analyses serve to answer the research questions of whether child and parent anxiety symptoms improve in a youth-focused CBT intervention for anxiety from pre- to post-treatment, whether there exists a significant relationship between the severity of anxiety symptoms in youth and parents surrounding a youth-focused anxiety intervention, and whether this relationship is consistent. / text

Depression is an increasingly common health problem among youth. There is growing empirical evidence that CBT is a promising treatment for childhood depression. It remains unclear what treatment-specific effects of CBT contribute to therapeutic gains. Cognitive theories propose that a primary mechanism of change in CBT are cognitive interventions that target depressogenic cognitions regarding the self, world, and future (cognitive triad), which are thought to mediate depression. The effects of cognitive interventions on depressive symptoms are thus hypothesized to be mediated by changes in the cognitive triad. No studies have investigated whether CBT for depressed youth works by treating the cognitive triad through the implementation of cognitive techniques. As part of a larger study analyzing the mechanisms of change in CBT for depressed youth, the purpose of this study was to investigate: (1) whether specific cognitive techniques are related to depressive symptom reduction in youth, and (2) if improvements in depressive symptoms are mediated through the cognitive triad of depressed youth. Participants were 42 girls, aged 8 to 14, who completed a manualized CBT protocol for depression in group format. Girls completed a diagnostic interview for depression and self-report measures assessing the cognitive triad. Group therapy sessions were coded for cognitive interventions. Results indicated a non-significant relation between levels of cognitive interventions and post-treatment depression scores, after controlling for pre-treatment depression. Therefore, tests of mediation were discontinued. Relevant control variables were added to the model to reduce error variance. After controlling for pre-treatment depression, age, presence of learning disorder, mastery of therapeutic skills, and behavioral interventions, cognitive interventions were significantly and positively associated with post-treatment depression. The relation between cognitive interventions and the cognitive triad was non-significant and meditational analyses were discontinued. Exploratory factor analysis revealed four cognitive interventions factors that were consistent with CBT theory. Further analyses revealed that all factors were not significantly related to post-treatment depression. Tests of interactions between cognitive interventions and behavioral interventions, age, and mastery level of therapeutic skills were also non-significant. Implications, limitations, and recommendations for further areas of research are presented. / text

Insomnia is a common health complaint that often becomes a persistent problem. The theoretical frameworks for understanding and treating insomnia have mostly been behavioural, yet the importance of cognitive processes has received greater attention over the years. The overall aim of this dissertation was to expand the knowledge on the processes from the Cognitive Model of Insomnia by investigating them in novel contexts. Study I examined the outcomes from cognitive therapy for insomnia on adolescents. Study II explored the relationship between cognitive processes and the association with remission and persistence of insomnia in the general population. Lastly, Study III investigated if cognitive processes mediated between cognitive behavioural therapy for insomnia (CBT-I) and outcomes of insomnia and depressive severity in a sample of people with insomnia comorbid with depressive problems. The findings show that cognitive therapy for insomnia affected sleep for adolescents, thus this is a promising treatment option for this age group. Further, it was found that cognitive processes distinguished between adults with normal sleep and persistent insomnia. For people with insomnia, elevated sleep-related worry at baseline increased the risk of reporting persistent insomnia later on, whereas a lowering of selective attention and monitoring, and safety behaviours over time increased the likelihood of remission from insomnia. This has clinical implications for insomnia assessment and treatment, as well as theoretical implications, and warrants further research. CBT-I was associated with greater reductions in dysfunctional beliefs and sleep-related safety behaviours compared to control treatment. Dysfunctional beliefs mediated between CBT-I and insomnia severity and depressive severity respectively. This supports the importance of negative thought content in both insomnia and depression.

Sleep disturbances are a core and salient feature of PTSD and can maintain or exacerbate associated symptoms. Recent research demonstrates that cognitive-behavioral sleep-focused interventions improve sleep disturbances as well as PTSD symptoms. The present study is a randomized controlled trial comparing Cognitive Behavioral Therapy for Insomnia (CBT-I) to a waitlist control group. Conducted at a Veterans Affairs Medical Center, the study: 1) compared subjective outcome measures of sleep amongst veterans assigned to either a treatment group (CBT-I) or a waitlist control group; (2) examined the influence of the intervention on measures of PTSD, general mood and daytime functioning, comparing veterans in a treatment group to those in a waitlist control group and (3) examined the effect of the CBT-I intervention using objective measures of sleep for veterans included in the treatment arm of the study. Study participants were (n = 40) combat veterans who served in Afghanistan and/or Iraq (OEF/OIF). Participants were randomized to either a CBT-I treatment group or a wait-list control group. Those in the treatment condition participated in four CBT-I sessions over six weeks. CBT-I included sleep restriction, stimulus control, cognitive restructuring, sleep education, sleep hygiene and imagery rehearsal therapy. All participants completed subjective and objective measures at baseline and post-treatment. At six weeks post treatment, veterans who participated in CBT-I reported improved sleep, a reduction in PTSD symptom severity and PTSD-related nightmares, as well as a reduction in depression and distressed mood compared to veterans in the waitlist control group. When controlling for current participation in evidence-based PTSD treatment, veterans in the CBT-I group reported a reduction in PTSD symptom severity while their waitlist counterparts demonstrated an increase in these PTSD symptoms. Veterans in the treatment group also reported improved objectively measured sleep quality between baseline and posttreatment. These data suggest that CBT-I is an effective treatment for insomnia, nightmares and PTSD symptoms in OEF/OIF veterans with combat related PTSD and should be used as an adjunctive therapy to standard PTSD treatment.