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

All people experience pain and for some people, acute pain may over time develop into long-term disabling problems. Already at an early stage, it is possible to identify people at risk for long-term problems and psychologically oriented interventions have been shown to successfully prevent future disability. However, not all people are helped by treatment and there is room for improvement. Moreover, subgroups of people suffering from pain, with different profiles of psychological factors have been identified, indicating that people with pain problems differ. The first aim of this dissertation was to improve the understanding of how people differ. The second aim was to use these individual differences and to match people to psychological treatment based on their psychological profile. The third aim was to explore what happens during treatment that might be important for treatment outcome. The findings show that people who belonged to subgroups with elevated levels of psychological factors had less favorable outcomes over time, despite treatment, than people with no elevations. Moreover, people with elevations in several psychological factors had even less favorable outcomes. Psychological treatments aimed at preventing future disability performed well, but using profiles to match people to treatment did not improve outcomes further; people who were matched to a treatment and people who were unmatched had similar outcomes. However, the profiles used for matching were unstable over time and there is need to improve the identification of psychological variables used for treatment matching. Finally, a number of psychological factors were shown to be valuable targets for treatment; if the treatments successfully produced change in people’s thoughts and emotions related to pain the treatment outcomes were better. The findings were summarized in a flow chart showing the recommended clinical approach to people seekinghealth care for acute pain problems.

Yes / Introduction The role of digital health in providing psychological treatment and support for the prevention of suicide is well documented. Particular emphasis has been placed on digital health technologies during the COVID-19 pandemic. Providing psychological support reduces the burden of mental health conditions. The challenge is to provide support in the context of patient isolation, which highlights the role of digital technology (video conferencing, smartphone apps and social media). There is, however, a dearth of literature where experts by experience have been involved in the end-to-end process of developing digital health tools for suicide prevention. Methods and analysis This study aims to codesign a digital health tool for suicide prevention focusing on the enablers and barriers. The scoping review protocol is phase I within a three-phase study. The protocol will inform the second phase of the study which is the scoping review. The results of the review will inform a funding application to National Institute for Health and Care Research to codesign a digital health tool for suicide prevention (the third phase). The search strategy will follow the Joanna Briggs Institute Reviewer’s Manual for Scoping Reviews and incorporates the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist to ensure reporting standards are maintained. The methodology will be supplemented by frameworks by Arksey and O’Malley and Levac et al. The search strategy dates for screening are from November 2022 to March 2023. Five databases will be searched: Medline, Scopus, CINAHL, PsycInfo and Cochrane Database of Systematic Reviews. Grey literature searches include government and non-government health websites, Google and Google Scholar. The data will be extracted and organised into relevant categories. The results will be synthesised into themes and inform phase II of the study. Ethics and dissemination Ethics granted by the University of Bradford on 15 August 2022, reference E995. The project team will design a digital health tool, results will be published in a peer-review journal and disseminated through conferences. Study registration number Safety (Mental Health) Innovation Challenge Fund 2022–2023 Protocol RM0223/42079 Ver 0.1. / This research was funded by the National Institute for Health and Care Research (NIHR) Yorkshire and Humber Patient Safety Translational Research Centre (NIHR Yorkshire and Humber PSTRC). Project Reference: SICF 2022-02.

Esta revisão de literatura apresenta uma análise dos trabalhos sobre Transtorno de Déficit de Atenção e Hiperatividade, TDAH, quanto às psicoterapias e aos tratamentos psicológicos ofertados a crianças e adolescentes, recuperados nas principais bases de dados da área. Transtorno de grande prevalência na população escolar, com sérios prejuízos pessoais e sociais, pois comportamentos de hiperatividade, desatenção e impulsividade, em graus atípicos, comprometem as funções executivas como concentração, planejamento de ações e controle sobre impulsos, o TDAH é conceito que gera controvérsias na comunidade científica. De um lado têm-se as perspectivas da terapia comportamental e cognitivo-comportamental, com o objetivo de reeducação comportamental, apoiada pela psiquiatria e psicofarmacologia. De outro, as linhas compreensivas e a psicanálise buscam não só comportamentos observáveis, mas a singularidade de cada envolvido, ou seja, a contribuição da família e/ou da cultura nesses quadros. A fim de mapear as publicações nessa área, foram analisadas as produções dos últimos dez anos (20002010) locadas nas bases de dados MEDLINE, PsycINFO, SciELO, LILACS e PSICODOC, por meio do termo TDAH, cruzado com tratamento psicológico e psicoterapia, respeitando-se o idioma da base de dados. Os resultados encontrados revelaram a supremacia de publicações sob a ótica comportamental ou cognitivo-comportamental, principalmente em seu modelo combinado, associado à medicação, tratamento validado através de evidências. As outras abordagens psicológicas, quando publicadas, não são absorvidas pelo modelo psiquiátrico, o que contribui para a sua invisibilidade queixas do transtorno são levadas primeiramente a pediatras, neurologistas e profissionais de orientação comportamental. Os bancos de dados, assim, revelaram ser amplamente usados por pesquisadores positivistas, o que pode vir a sugerir que seus tratamentos sejam os únicos disponíveis, o que não é fato. Existem métodos investigativos, como o estudo de caso que, embora pouco disseminados, apresentaram resultados favoráveis em seus tratamentos singulares / This literature review presents an analysis of the works about Attention-Deficit Hyperactivity Disorder, ADHD and psychotherapy and psychological treatments offered to children and adolescents recovered in the main database area. Disorder of high prevalence in school population, with serious personal and social impairments, since the hyperactivity, inattention e impulsivity behaviors, in atypical degrees, compromises executive functions such as concentration, action planning and impulses control, Attention Deficit Hyperactivity Disorder (ADHD) has been a controversy target among the scientific community. On one hand we have the behavioral therapy and cognitive-behavioral therapy, seeking for the behavioral rehabilitation, supported by psychiatry and psychopharmacology. On the other hand, comprehensive psychological approaches and the psychoanalysis does not aim to reduce these children to observable behaviors and, actually, to understand their symptoms as an expression of their singularity, explaining hyperactive and/or inattentive behavior in contemporary context. In order to map the publications in this area, it was analyzed the productions in the last decade (2000-2010) leased in the databases MEDLINE, PsycINFO, SciELO, LILACS and PSICODOC, through the term ADHD crossed with psychological treatment and psychotherapy, respecting the language of the database. The results showed the superiority of publications from the perspective of behavioral or cognitive-behavioral therapy, mainly in a combined model with medication, treatment validated by evidences. The others psychological approaches, when published, are not absorbed by the psychiatric model, which generates its invisibility complaints of disorder are taken primarily to pediatricians, neurologists and professional behavioral treatments. The databases thus shown to be widely used by researchers at positivism, which might suggest that their treatments are the only ones available, which is not fact. There are investigative methods, as the case study, although a little spread, showed favorable results in their singular treatments

Esta revisão de literatura apresenta uma análise dos trabalhos sobre Transtorno de Déficit de Atenção e Hiperatividade, TDAH, quanto às psicoterapias e aos tratamentos psicológicos ofertados a crianças e adolescentes, recuperados nas principais bases de dados da área. Transtorno de grande prevalência na população escolar, com sérios prejuízos pessoais e sociais, pois comportamentos de hiperatividade, desatenção e impulsividade, em graus atípicos, comprometem as funções executivas como concentração, planejamento de ações e controle sobre impulsos, o TDAH é conceito que gera controvérsias na comunidade científica. De um lado têm-se as perspectivas da terapia comportamental e cognitivo-comportamental, com o objetivo de reeducação comportamental, apoiada pela psiquiatria e psicofarmacologia. De outro, as linhas compreensivas e a psicanálise buscam não só comportamentos observáveis, mas a singularidade de cada envolvido, ou seja, a contribuição da família e/ou da cultura nesses quadros. A fim de mapear as publicações nessa área, foram analisadas as produções dos últimos dez anos (20002010) locadas nas bases de dados MEDLINE, PsycINFO, SciELO, LILACS e PSICODOC, por meio do termo TDAH, cruzado com tratamento psicológico e psicoterapia, respeitando-se o idioma da base de dados. Os resultados encontrados revelaram a supremacia de publicações sob a ótica comportamental ou cognitivo-comportamental, principalmente em seu modelo combinado, associado à medicação, tratamento validado através de evidências. As outras abordagens psicológicas, quando publicadas, não são absorvidas pelo modelo psiquiátrico, o que contribui para a sua invisibilidade queixas do transtorno são levadas primeiramente a pediatras, neurologistas e profissionais de orientação comportamental. Os bancos de dados, assim, revelaram ser amplamente usados por pesquisadores positivistas, o que pode vir a sugerir que seus tratamentos sejam os únicos disponíveis, o que não é fato. Existem métodos investigativos, como o estudo de caso que, embora pouco disseminados, apresentaram resultados favoráveis em seus tratamentos singulares / This literature review presents an analysis of the works about Attention-Deficit Hyperactivity Disorder, ADHD and psychotherapy and psychological treatments offered to children and adolescents recovered in the main database area. Disorder of high prevalence in school population, with serious personal and social impairments, since the hyperactivity, inattention e impulsivity behaviors, in atypical degrees, compromises executive functions such as concentration, action planning and impulses control, Attention Deficit Hyperactivity Disorder (ADHD) has been a controversy target among the scientific community. On one hand we have the behavioral therapy and cognitive-behavioral therapy, seeking for the behavioral rehabilitation, supported by psychiatry and psychopharmacology. On the other hand, comprehensive psychological approaches and the psychoanalysis does not aim to reduce these children to observable behaviors and, actually, to understand their symptoms as an expression of their singularity, explaining hyperactive and/or inattentive behavior in contemporary context. In order to map the publications in this area, it was analyzed the productions in the last decade (2000-2010) leased in the databases MEDLINE, PsycINFO, SciELO, LILACS and PSICODOC, through the term ADHD crossed with psychological treatment and psychotherapy, respecting the language of the database. The results showed the superiority of publications from the perspective of behavioral or cognitive-behavioral therapy, mainly in a combined model with medication, treatment validated by evidences. The others psychological approaches, when published, are not absorbed by the psychiatric model, which generates its invisibility complaints of disorder are taken primarily to pediatricians, neurologists and professional behavioral treatments. The databases thus shown to be widely used by researchers at positivism, which might suggest that their treatments are the only ones available, which is not fact. There are investigative methods, as the case study, although a little spread, showed favorable results in their singular treatments

The effects of cultural mistrust level and race of counselor on the willingness of Mexican-American adolescents to seek psychological help were examined in this experiment. A total of 79 Mexican-American adolescents consisting of 50 females and 29 males completed a Background Information Inventory, a modified version of the Cultural Mistrust Inventory, and the Help Seeking Attitude Scale. Five regression analyses were performed resulting in a significant interaction between cultural mistrust level and willingness to seek help. Mexican-American adolescents with high levels of mistrust were less willing to seek psychological treatment than those with a low level of mistrust. Results also indicated that females as well as individuals with higher levels of education were more willing to seek help than males and those with lower levels of education. Theoretical and practical implications are discussed.

Les peines d’emprisonnement constituent à ce jour la première réponse aux exigences de répression de la délinquance dans le paysage français. Alors que bon nombre de détenus, dès leur entrée dans le système pénitentiaire, se trouvent être sans-abri, sans couverture sociale, malades physiquement et/ou psychologiquement, consommateurs de drogues, d’alcool ou encore de médicaments, le système pénal se trouve confronté à un paradoxe entre besoins des détenus en matière de soins d’une part et répression des crimes et délits d’autre part. Cette contradiction aboutit bien souvent à ce que les problématiques d’ordre médico-psychologique des détenus ne trouvent pas de solutions en prison et persistent à la sortie, une situation préjudiciable tant pour les individus que pour les systèmes judiciaires et pénitentiaires. Face au tiraillement entre soin, punition et réinsertion, cette thèse adopte un double point de vue prospectif et empirique avec pour ambition d’articuler les récentes réformes législatives et les pratiques de traitement médico-psychologique exercées au sein d’une maison d’arrêt. / Prison sentences constitute the first response to the requirements of delinquency repression in France. Since many prisoners, as they enter the penitentiary system, happen to be homeless, with no social security cover, physically and/or mentally ill, drug, alcohol or medicine addicts, the penal system finds itself confronted to a paradox between the needs of the detainees regarding health care on the one hand and crime repression on the other. This contradiction often has for a result that the prisoners’ medico-psychological problems find no solution in jail and remain as they get out. This situation may become prejudicial as much for the individuals than for the penal and judiciary systems. In front of the conflict between health care, punition and rehabilitation, this Ph. D. adopts a double perspective, both prospective and empirical: it aims at hanging together the recent legal reforms and the medico-psychological treatment practices that are currently at stake in a specific detention center.

The overarching goal of this thesis has been to enhance Internet-delivered psychological treatments for depression and its comorbidity. To this end, three randomized controlled trials (Study II, III and IV) with a total of 313 participants were conducted. A prevalence study (Study I) was also conducted to provide an up-to-date estimate of the prevalence of depression, anxiety disorders, and their comorbidity in the Swedish general population. Study I showed that more than every sixth individual in Sweden suffers from symptoms of depression and/or anxiety. Comorbidity between depression and anxiety was substantial and associated with higher symptom burden and lower health-related quality of life. Study II showed that a tailored Internet-based CBT protocol (ICBT) was effective in reducing symptoms of depression when compared to a control group. Among individuals with more severe depression and comorbidities, the tailored ICBT treatment worked better than standardized ICBT. Study III showed that a psychodynamic Internet-based psychotherapy was highly effective in the treatment of depression, when compared to a group who received psychoeducation and online support. In Study IV, an Internet-delivered affect-focused psychodynamic psychotherapy proved to have a large effect on depression and a moderately large effect on anxiety disorders. In conclusion, this thesis shows that in the context of treating depression and its comorbidity, Internet-delivered psychological treatments can be potentially enhanced by psychodynamic psychotherapy and by individualization. / Det övergripande syftet med denna avhandling har varit att vidareutveckla internetbaserad psykologisk behandling för depression och dess komorbiditet. Tre randomiserade kontrollerade studier (Studie II, III och IV) med totalt 313 deltagare genomfördes i linje med detta syfte. En prevalensstudie (Studie I) genomfördes också för att tillhandahålla ett uppdaterat estimat av prevalensen av depression, ångest och deras komorbiditet i Sverige. Studie I visade att mer än var sjätte individ i Sverige lider av symptom på depression och/eller ångest. Det fanns påtaglig komorbiditet mellan depression och ångest, vilket var associerat med högre symptombörda och lägre livskvalitét. Studie II visade att en skräddarsydd internetbaserad KBT-behandling var effektiv för att reducera symptom på depression, i jämförelse med en kontrollgrupp. Bland individer med svårare depression och komorbiditet, fungerade den skräddarsydda interventionen bättre än en standardiserad. Studie III visade att psykodynamisk internetbehandling var effektiv vid behandling av depression, i jämförelse med en grupp som fick psykoedukation och stödsamtal online. I Studie IV visades att en affektfokuserad psykodynamisk internetbehandling hade stor effekt vad gällde att reducera symptom på depression, och medelstor effekt vad gällde att reducera symptom på ångest. Sammanfattningsvis visar denna avhandling att internetbaserad psykologisk behandling kan potentiellt vidareutvecklas av psykodynamisk psykoterapi och individanpassning, vid behandling av depression och dess komorbiditet.

Den psykiska ohälsan ökar stadigt i omvärlden, därav genomgår fler människor psykologiska behandlingar för att öka sitt välmående. Den tidigare forskningen har uppvisat att negativa effekter i samband med en psykologisk behandling existerar. Syftet med genomförandet av studien var att undersöka om det fanns negativa eller oönskade effekter hos personer som genomgått någon evidensbaserad psykologisk behandling samt att undersöka vilka de mest förekommande oönskade effekter var hos den rekryterade gruppen. Studien genomfördes genom en enkätstudie med totalt 63 deltagare (M = 33 år, SD = 8.4, åldersspann 20 - 57 år,67% kvinnor). Instrumentet som användes var The Negative Effects Questionnaire med 32 påståenden, vilka utgör en sex faktorsmodell (symptom, kvalitet, beroende, stigma, hopplöshet och misslyckande). Instrumentet mäter huruvida deltagarna upplevt att behandlingen lett till några negativa eller oönskade effekter. Resultatet på frågeställning A ”Vilka är de mestförekommande biverkningarna hos den rekryterade gruppen?” visar att den mest rapporterade negativa effekten var “känner du dig sorgsen”. Resultatet från frågeställningen B ”Finns det könsskillnader i medelvärden av faktorerna hos NEQ?” visar att kvinnor generellt rapporterat fler biverkningar jämfört med männen. Studien går i linje med tidigare forskning och svarar på samtliga frågeställningar. Studiens låga antal deltagare (N = 63), och dess bekvämlighetsurval gör att studien inte kan generalisera sitt resultat. Spridningen blir inte lika omfattande och representativ som den hade varit med en större urvalsgrupp. / Mental illness is steadily increasing in the world, because of which more people are undergoing psychological treatments to increase their well-being. Previous research has shown that negative effects in connection with a psychological treatment exist. The purpose of conducting the study was to investigate whether there were negative or unwanted effects inpeople who had undergone any evidence-based psychological treatment and to investigate what the most common unwanted effects were in the recruited group. The study was conducted through a questionnaire study with a total of 63 participants (M = 33 years, SD =8.4, age range 20 - 57 years, 67% women). The instrument used was The Negative Effects Questionnaire with 32 statements, which constitute a six-factor model (symptom, quality, dependence, stigma, hopelessness and failure). The instrument measures whether the participants experienced that the treatment led to some negative or unwanted effects. The result of question A shows that the most reported negative effect was "do you feel sad". The results from question B show that women generally reported more side effects compared to men. The study is in line with previous research and answers all questions. The study's low number of participants (N = 63), and its convenience selection means that the study can notgeneralize its results, the spread will not be as extensive and representative as it would have been with a larger sample group.

Sammanfattning: E-hälsa och digitala arbetssätt är ett växande område som fyller en viktig funktion inom hälso-och sjukvården. Digitala arbetssätt som integreras i hälso- och vården kan ge en ökad tillgänglighet till vårdkontakt och innebära möjligheter för en mer individualiserad vård samt kan innebära en mer kostnadseffektiv vård. För att implementera digitala arbetssätt på ett lyckat sätt så behöver personalen anpassa sig till den nya tekniken, en övergång som kräver såväl samarbete som god integrering av de digitala verktyg som införs. Mer kunskap behövs om användarna, till exempel hälso-och sjukvårdspersonalens perspektiv vid integrering av digitala vårdplattformar. Syfte: Att undersöka psykologers upplevelser av den digitala plattformen Stöd och behandling (SOB). Metod: Kvalitativ analys av individuella intervjuer (n=8) som genomfördes över Zoom. Intervjuguiden innefattade tio frågor och intervjuerna varade i mellan 30-50 minuter. Materialet analyserades sedan med kvalitativ innehållsanalys. Samtliga informanter var Legitimerade Psykologer mellan 30-59 år gamla med en medelålder på 40 år. Informanterna rekryterades via ett nätverk för psykologer på Facebook och enbart kvinnor deltog i studien. Resultat: Analysen resulterade i två teman, tre kategorier och flera underkategorier som beskriver psykologers upplevelser av plattformen Stöd och behandling. Det första temat var ”Ökade krav” och det andra ”Potential för ökade möjligheter till jämlik vård”. Flera av informanterna menar att det är svårare för vissa patienter att ta till sig behandling digitalt via Stöd och behandling.Informanterna själva beskriver å ena sidan ökad frihet, effektivitet och flexibilitet, å andra sidan ökade krav, inte minst på egna tekniska färdigheter. Vidare diskuterades plattformens potential att bidra till en mer tillgänglig och jämlik vård. Slutsatser: Informanterna beskriver att det finns fördelar med digital behandling som kan vara gynnsamma för hälso-och sjukvården i framtiden. Men det finns också nackdelar, exempelvis svårigheter för vissa grupper att ta till sig behandling via Stöd och behandling och liknande plattformar. Ytterligare svårigheter som diskuterats är hur implementeringen ska gå till vid införandet av en digital lösning. / ABSTRACT Introduction: E-health and digital interventions are a growing area that fulfills an important function in health care. Digital interventions that are integrated into routine can provide increased accessibility to healthcare and provide opportunities for more individualized care and can mean more cost-effective care. To implement digital ways of working successfully, staff need to adapt to the new technology, a transition that requires both collaboration and good integration of the digital tools that are introduced. More knowledge is needed about users' perspectives when integrating and using digital healthcare platforms. Purpose: To investigate Psychologists' perceptions of the digital platform Support and treatment. Method: Qualitative analysis of individual interviews (n=8) conducted over Zoom. The interview guide included ten questions and the interviews lasted between 30-50 minutes. The material was then analyzed with qualitative content analysis. All informants were Licensed psychologists with an average age of 40 years (30-59 years old) and only women participated in the study. The informants were recruited through a network for psychologists on Facebook. Results: The analysis resulted in two themes, three categories and several subcategories that describe psychologists' experiences of the platform Support and treatment. The first theme was "Increased demands" and the second "Potential for increased opportunities for equal care". Several of the informants believed that it is more difficult for some patients to access treatment digitally via SOB. The informants themselves described on the one hand increased freedom, efficiency, and flexibility, on the other hand increased demands, not least regarding the staff´s technical skills. Furthermore, the platform's potential to contribute to more accessible and equal care was discussed. Conclusion: The informants describe that there are advantages to digital treatment that can be beneficial for health care in the future. But there are also disadvantages, for example difficulties for certain patients to adopt treatment via Support and Treatment and similar platforms. Further difficulties that were discussed were implementation strategies when introducing a digital solution.