Substance use disorder (SUD) is a serious disorder with severe consequences for the individual, the family and for society. Comorbidity is common in the SUD population and the diversity of the disorder calls for a multiplicity of treatment options. The overall aim of this thesis was to explore the role of affects in psychotherapy for SUD. Further aims were to investigate affect-focused therapeutic orientations, demonstrate the importance of common factors and evaluate a measure of affect phobia. In Study I a naturalistic design was employed to examine how the discrepancy between patients' expectations and experience of psychotherapy related to alliance in 41 patients: 24 in individual therapy and 17 in group. An additional analysis concerned whether different dimensions of role expectations predicted retention in psychotherapy. Study II was the first psychometric evaluation of the Affect phobia test – a test developed to screen the ability to experience, express and regulate emotions. Data were collected from two samples: A clinical sample of 82 patients with depression and/or anxiety participating in a randomized controlled trial of Internet-based affect-focused treatment, and a university student sample of 197 students. Data analysed included internal consistency, test-retest reliability, factor analysis and calculation of an empirical cut-off. Study III focused on the feasibility of individual 10 week Affect Phobia Therapy (APT) for patients diagnosed with mild to moderate alcohol use disorder (AUD) and problematic affective avoidance in a nonconcurrent multiple baseline design. Study IV comprised an evaluation of the feasibility and preliminary effectiveness of APT adapted to a structured group format for patients (n=22) with comorbid substance use disorder and ADHD with core features of affective avoidance/emotion dysregulation in an open design. In Study I an overall discrepancy between role expectations and experiences was significantly related to a lower level of therapeutic alliance in group therapy. This relationship was not found in individual therapy. Expectations prior to psychotherapy characterized by defensiveness correlated negatively with therapy retention, even when controlling for waiting time for therapy. In Study II the internal consistency for the total score on the Affect phobia test was satisfactory but it was not for the affective domains, Anger/Assertion, Sadness/Grief, and Attachment/Closeness. Test retest reliability was satisfactory. The exploratory factor analysis resulted in a six-factor solution and only moderately matched the test´s original affective domains. An empirical cut-off between the clinical and the university student sample were calculated and yielded a cut-off of 72 points. In Study III patients reported no adverse events due to the treatment and finished the whole study period. The patients had different trajectories of alcohol consumption and craving and the hypothesis that heavy episodic drinking would subside during the time in therapy did not hold true. In Study IV patients reported significant pre-to post changes in increased self-compassion and decreased affect phobia but no change in psychological distress or emotion dysregulation. Craving fluctuated throughout the study period and patients’ drinking pattern changed in the direction of more social drinking. Main conclusions are the following: The Affect Phobia Test is a useful screening instrument for detecting emotional difficulties related to psychological malfunction. APT in both group and individual format are feasible treatments for the SUD population and has the potential to broaden the treatment options for some patients with SUD. Investigating expectations and fears prior to therapy may be means to prevent attrition. / Substansberoende är en allvarlig störning och samsjuklighet ofta förekommande Den stora variationen av svårigheter kräver olika behandlingsalternativ. Syftet med avhandlingen var att undersöka affekters roll i psykoterapi för populationen. Ytterligare syften var att undersöka betydelsen av gemensamma faktorer i psykoterapi samt normera ett självskattningsformulär för affektfobi. I studie I undersöktes skillnaden mellan patienters förväntningar, erfarenheter av terapi och allians. I studie II utvärderades de psykometriska egenskaperna hos affektfobitestet. I studie III och IV undersöktes genomförbarheten av affektfobiterapi individuellt och i grupp. Resultaten av studierna visade att större skillnad mellan rollförväntningar inför- och erfarenheter av terapi var signifikant korrelerade med lägre allians i gruppterapi. Affektfobitestets psykometriska egenskaper var tillfredsställande avseende skalan som helhet. Affektfobiterapi visade sig öka adaptiv affektiv förmåga och självmedkänsla, men behandlingen gav inget säkert stöd för påverkan på substansbruket. Slutsatserna är att fokus på affekter i terapi för substansberoende har betydelse och att affektfobiterapi är en genomförbar behandling för populationen. Genom att undersöka förväntningar och rädslor inför terapi kan avhopp förhindras. / <p>Information om opponent saknas Information about opponent is missing</p>

This thesis analyses the benefits of applying game elements to a Virtual Reality application for overcoming phobias, with a special focus on acrophobia, i.e. the fear of heights. Two different prototypes using the Oculus Rift head-mounted display were developed with a gradually exposure to heights. Both prototypes shared the same acrophobic scenario, but one included extra features from games such as engagement, motivation or goals. Twenty-four participants, divided into two groups of twelve, with moderate aversion to heights tested the prototypes. The participants’ heart rate and the time that they looked down from high altitudes were also measured and evaluated. The study showed slightly higher results regarding motivation for the prototype which included the additional game elements. Future studies should include a different head-mounted display, which would allow a longer time of play without motion sickness, and the participation of people diagnosed with acrophobia.

Obsessive-compulsive disorder (OCD), with a prevalence of 1-2 %, frequently leads a chronic course. Persons with OCD are often reluctant to seek help and, if they do, their OCD is often missed. This is unfortunate, since active treatment may substantially improve social function and quality of life. Serotonin reuptake inhibitors (SRIs) have welldocumented efficacy in OCD, but delayed response may be problematic. Methods to predict response have been lacking. Because SRIs are effective, pathophysiological research on OCD has focussed on serotonin. However, no clear aberrations of serotonin have been found, thus other mechanisms ought to be involved. Our aims were to facilitate clinical detection and assessment of OCD, to search for biochemical correlates of response and side-effects in SRI treatment of OCD and to identify any possible involvement of oxytocin in the pathophysiology of OCD. In study I, we tested in 402 psychiatric out-patients the psychometric properties of a concise rating scale, “Brief Obsessive Compulsive Scale” (BOCS). BOCS was shown to be easy to use and have excellent discriminant validity in relation to other common psychiatric diagnoses. Studies II-V were based on 36 OCD patients from a randomised controlled trial of paroxetine, clomipramine or placebo. In study II, contrary to expectation, we found that the change (decrease) of serotonin in whole blood was most pronounced in non-responders to SRI. This is likely to reflect inflammatory influence on platelet turnover rather than serotonergic processes within the central nervous system. In studies IV-V, we found relations between changes of oxytocin in plasma and the anti-obsessive response, and between oxytocin and the SRI related delay of orgasm, respectively. In both cases, the relation to central oxytocinergic mechanisms is unclear. In males, delayed orgasm predicted anti-obsessive response.

The overall aims of this thesis were to examine personal standards, self-evaluation and attitudes to eating and weight in the development of disturbed eating in adolescent girls, and to examine how adolescent girls with a clinical eating disorder reflect upon and deal with perceived expectations in daily life. Studies I and II were quantitative studies, conducted in a population-based longitudinal study. Studies III and IV were qualitative interview studies of girls who were suffering from eating disorders and the data were analysed using a phenomenographic approach. Study I showed that high personal standards expressed in a competitive way were specific for the girls with disturbed eating. These girls also reported a negative physical self-evaluation and often believed that thinness would make them more popular. In study II variables concerning attitudes to eating and weight and physical self-evaluation emerged as risk factors for disturbed eating, whereas personal standards or self-evaluation in general did not. Protective factors were a low BMI, healthy eating attitudes, an accepting attitude towards body size and a positive self-evaluation. Three categories of perceived expectations were described in study III: expectations from others, self-imposed expectations and conflicting expectations. Many informants had problems identifying expectations that were not explicit and they interpreted them as self-imposed. In study IV the various ways in which the informants reflected on dealing with these expectations were summarized into three qualitatively different conceptions: being oneself, adapting to different situations and presenting oneself in a positive light. These conceptions were expressed in five patterns of action, which could have various functions for different individuals and in different situations. The results suggest that in order to prevent and treat eating disorders and related problems it is essential to integrate both intrapersonal and contextual factors that contribute to the development and maintenance of these conditions.

Background: It´s obvious that stigma reduces life opportunities and make people act throughout an outcast role. Stigma enters spheres where it is made up to protect a group, but only results in painful feelings for the vulnerable. Individuals suffering from psychosis are exposed to discrimination because of fear and prejudices. These are applied upon individuals whereas they stigmatize themselves.  Aim: To investigate the experience of self-stigma and stigmas effects on life for patients suffering from psychosis. Method: 24 scientific articles have been used and analyzed together with Whittemore and Knalfs integrative method (2005) for the result in this literature review.   After formulating a problem literature has been searched, evaluated, and analyzed in four steps which are presented. The literature was found through databases, free searching compounds and through references. As a theoretic framework the figure Existentiell ensamhet hos personer med psykiska funktionshinder from the doctoral Berättelser om ensamhetens vardag has been used.  Results: The psychiatric contact, to be a psychiatric patient and being labeled with a psychiatric diagnosis affected the way individuals labeled themselves. Individuals wanted to be seen as unique and listened to. The diagnosis contributed to feelings of shame and affected self-esteem and self-ability. Through acceptance of the disease participants could become something different than just a patient in the psychiatric services. Through other people the participant’s self-image could be built up. Social stigmas were described in all levels of society and also within the family. Relationships were important and a link to live a normal life and recover. Normality was desirable and said to occur through activities such as work and studies. Discussion: Was discussed through relevant research and Anette Erdners figure Existentiell ensamhet hos personer med psykiska funktionshinder from the doctoral Berättelser om ensamhetens vardag.

The rapidly spreading pandemic of SARS-CoV-2 (COVID-19) infection with high morbidity and mortality has overwhelmed the global healthcare services. With mysterious origins and the capacity of affecting multiple types of tissues, SARS-CoV-2 has baffled many scientists - which has posed great challenges in the development of pharmaceutical treatments and preventions (i.e., vaccination). The COVID-19 pandemic has also led to a slew of non-pharmaceutical interventions (NPIs) to slow down the spread of the virus. The sudden imposition of these NPIs including social distancing, lock-down, school closures, isolation, and quarantine of suspected cases or contacts, has greatly affected the mental health of children and adolescents. Concerns about the impact of these NPIs on mental health, especially for vulnerable populations such as children and adolescents, have emerged. This study discusses several different aspects of the impact of the COVID-19 pandemic on the mental health of children and adolescents.Accumulating evidence has shown that the vast majority of children and adolescents exposed to the SARS-CoV-2 virus are asymptomatic, although few cases turned unfortunately severely ill. The genomics, microbiology, and biochemistry of this novel coronavirus reveal several peculiarities, making it a tough entity. The profound impact of social distancing along with the closure of schools, parks, and other recreational activities on the delicate minds of children and adolescents makes them irritable, angry, and rebellious. This assumes a major challenge in children with mental health issues or in those with special needs. Lock-down, quarantine and isolation further complicate the mental health issues and are discussed along with remedial measures. The impact of an already overwhelmed medical care system on the mental healthcare quality can be profound and needs a specially chartered approach by the psychiatrists supplementing the COVID-19 control activities. Children/adolescents with neuropsychiatric issues need special care, as they have abnormal impulsive behaviour and actions such as running away, unhygienic acts, spitting etc. All these mental health issues in children and adolescents, who form a sizable population of the society and are the future of the planet, forms the subject matter of this work. Thus, all programmes of COVID-19 control must simultaneously address these important mental health issues of children and adolescents to prevent this ‘parallel pandemic’ of psychiatric disorders. The latter may persist much longer and prove equally challenging and costly.

Syftet har varit att undersöka och skapa en fördjupad förståelse för hur kuratorer inom psykiatrin upplever sitt arbete med att stödja barn som anhöriga till förälder med psykisk sjukdom/ohälsa. Utifrån ett kombinerat urval bestående av målinriktat urval och bekvämlighetsurval rekryterades fem respondenter från två orter i Sverige. Kvalitativ metod har använts bestående av semistrukturerade intervjuer, vilka analyserats med tematisk analys. Resultaten visar att kuratorer arbetar på olika sätt med att ge stöd till barn som anhörig till förälder med psykisk ohälsa/sjukdom. Hinder som identifierats handlar om dels om förhållningssätt i form av fokus på de vuxna klienterna och rädsla för att bryta en allians till klienten om för mycket fokus läggs på ett barnperspektiv. Ett annat hinder är enligt kuratorerna resursbrist. Möjligheter som lyfts utgörs av förebyggande arbete. Slutsatserna från denna studie visar att kuratorers arbete med att stödja barn är komplext och att det kan behövas utvecklingsarbete för att komma till rätta med hinder och öka möjligheter att stödja barn som är anhörig till förälder med psykisk ohälsa/sjukdom. / The purpose of this study has been to investigate and provide an in-depth understanding of how counselors in psychiatry experience their work in supporting children as relatives of parents with mental illness/ill health. Based on a combined sample consisting of goal-oriented selection and convenience selection, five respondents were recruited from two locations in Sweden. A qualitative method has been used consisting of semi-structured interviews, and a thematic analysis has been carried out. The results show that counselors work in several different ways to provide support to children to a parent with mental ill-health/mental illness. Obstacles regarding providing support to children is a predominant focus on adults, fear of breaking an alliance with the adult client, and lack of resources. The results also show that the councelors’ view of opportunities is about preventive work. The conclusion from this study is that providing support to children is complex, and that development of work practices may be needed to come to terms with obstacles and create increased opportunities to support children to parents with mental ill health/mental illness.

This degree project is particularly interested in how people with mental health difficulties use the social media platform TikTok to share their experiences. It aims to contribute to meaningful conversations about the role of social media concerning mental health awareness and the effectiveness of social media for social change. A qualitative content analysis methodology is applied to 50 TikTok videos shared under the TikTok hashtag #mentalhealthuk to determine how people share their experiences. In addition, four semistructured interviews were conducted with video creators sharing content on #mentalhealthuk. The theoretical lens through which this study looks is Media for Development (M4D) and the importance of Voice for development. In addition, there is a special focus on storytelling and performativity in the digital realm. The findings from this study reveal that TikTok has been an effective site for the recovery process of people dealing with metal health difficulties, because it provided a source of connectedness and room for creative expression. However, the findings also reveal the restraints TikTok users face when using social media to share genuine experiences, and the negative effects, for example cyber bullying, had on their mental health.

Abstrakt   Bakgrund: Psykisk ohälsa är ett fenomen som har existerat sedan tidens början. Ett perspektiv på psykisk ohälsa i sin helhet som då är grundad på kulturella värderingar/uppfattningar kallas i den moderna kontexten för, kulturell psykiatri. Liksom hur psykisk ohälsa rent generellt (ingen specifik psykisk sjukdom) tolkas/uppfattas, bearbetas och inte minst vilka tillvägagångssätt det finns för att behandla olika psykiska sjukdomar beror helt enkelt på bland annat vilka kulturella uppfattningar en individ/grupp besitter. Härmed ligger fokuset på att ta upp vissa av dessa kulturer och undersöka deras synsätt på psykisk ohälsa i sin helhet. Några avgränsningar som har gjorts under arbetet är bland annat att ta upp vissa av kulturerna som existerar i andra delar av världen än inom västvärlden då författaren själv befinner sig där. Det för att uppmärksamma läsarna om hur vissa andra kulturer av världen tolkar psykisk ohälsa. Syfte: Syftet med arbetet är att undersöka vilka sociala faktorer spelar roll i hur psykisk ohälsa uppfattas och bearbetas i vissa kulturer. Centrala begrepp: Några upprepade centrala begrepp i uppsatsen är bland annat kultur och stigma som har definierats i ett avsnitt. Teorier: I uppsatsen har författaren använt sig av tre teorier. Den första teorin är av Cecil G Helman (2015) som presenterar de fyra olika sociala beteenden utifrån ett kulturellt perspektiv. De andra teorin av Erving Goffman och den tredje teorin av både  Bruce &amp; Pilan (2011), diskuterar begreppet stigma och ställer den i relation till kulturell psykiatri. Metod: Den metodik som har använts för att undersöka syftet och samla in data är kvalitativ litteraturstudie. All information presenterat i arbetet är framtaget av både primära samt sekundära källor såsom, vetenskapliga artiklar och dokumentärer. Resultat &amp; Slutsats: Ett väldigt upprepande begrepp som har nämnts från början av arbetet till dess slut är nämligen termen “stigma”. Ett tydligt resultat av arbetet påvisade att stigma och tabu kring psykisk ohälsa existerade i alla kulturer till en viss grad. Några bakomliggande orsaker till detta var bland annat de redan existerande  traditionella och kulturella värderingarna som präglade till en stor del av synen på psykisk ohälsa. De intervjuade i dem olika dokumentärerna, förklarade hur de har blivit kallade olika namn såsom exempelvis “dum”, och “galen”, men även hur deras egna familjer på grund av vissa extrema värderingar och den redan existerande stigman vände ryggen mot dem. Bra att observera är att både resultatet och slutsatsen inte går att generalisera till en hel kulturs och lands uppfattning kring psykisk ohälsa. / Abstract   Background: Mental illness is a phenomenon that has existed since the beginning of time. A perspective on mental illness in its entirety, which is then also based on cultural values ​​/ traditions, is called in the modern context, cross cultural psychiatry. It shows how mental illness in general is interpreted / perceived, processed and at last what kind of approaches are made to treat various mental illnesses. It simply depends on, among other things, what cultural values one does possess. Therefore this essay’s purpose is to address some of these cultures and examine their views on mental illness in its entirety. Some delimitations that have been made during this essay include addressing only some of the cultures that exist in other parts of the world than in the western world. This is to draw readers' attention to how certain other cultures in the world interpret mental illness. Aim: The aim of this study is to investigate which social factors play a role in how mental illness is perceived and processed in certain cultures. Key words: Some of the most repeated key words in this essay include culture and stigma that have been defined in a seperate section.Theories: In the essay, the author has used three theories. The first theory is by Cecil G Helman (2015) who presents the four different social behaviors from a cultural perspective. The second theory by Erving Goffman and the third theory by both Bruce &amp; Pilan (2011), discuss the concept of stigma and place it in relation to cross cultural psychiatry. Method: The methodology that has been used to investigate the purpose and collect data is qualitative literature study. All information presented in the work is produced by both primary and secondary sources such as scientific articles and documentaries. Results &amp; Conclusion: A very repetitive concept that has been mentioned from the beginning of the work to its end is namely the term “stigma”. A clear result of the work showed that the stigma and taboo surrounding mental illness existed in all cultures to a certain degree. Some of the underlying reasons for this were, among other things, the already existing traditional and cultural values ​​that characterized a large part of the view of mental illness. They interviewed individual in various documentaries, explained how they have been called different names such as "stupid", and "crazy", but also how their own families due to certain extreme values ​​and the already existing stigma turned their backs on them. It is good to note that both the result and the conclusion cannot be generalized to an entire culture or a country's perception of mental illness.

Återhämtning som begrepp återkommer ofta inom socialpsykiatriskt arbete, men vad återhämtning innebär kan skilja sig mellan medicinska respektive sociala och psykologiska diskurser. I denna studie intervjuas sju respondenter som är yrkesverksamma i socialpsykiatriska verksamheter, för att identifiera främjande respektive hindrande aspekter för återhämtning från svåra psykiska problem inom socialpsykiatriskt arbete. I studien tillämpas en kvalitativ metod, med påföljande tematisk analys. Resultaten av studien sammanfattas i fyra kärnteman som främst behandlar ekonomi, ansvar, meningsfullhet, samt relationer och identitet. I dessa teman identifieras främjande respektive hindrande aspekter för återhämtning. Den huvudsakliga slutsatsen som denna studie visar på är att ekonomi är den aspekt som i högsta grad påverkar återhämtning från svåra psykiska problem inom socialpsykiatriskt arbete idag. / Recovery is an often-recurring term within the field of social psychiatry. However, the medical and the social and psychological discourses have conflicting definitions of what recovery entails. In this study seven respondents who are working within social psychiatric agencies have been interviewed, in order to identify aspects which are promoting versus impeding recovery from severe mental health problems within social psychiatric work. This study applies a qualitative method, with a subsequent thematic analysis. The results are summarised using four core themes, which mainly relates to economy, responsibility, meaningfulness, as well as relationships and identity. Within these four themes aspects that are either promoting or impeding recovery are identified. The primary conclusion of this study suggests that economy is the aspect that most impacts recovery from severe mental health problems within social psychiatric work today.