No description available.

In recent years, kindness-based meditation practices, including loving-kindness meditation (LKM), have gained empirical support for decreasing depression and anxiety symptoms. LKM is defined as the intentional transmission of unselfish kindness toward all beings. It is practiced by contemplating an object of meditation (e.g., self, difficult person) and offering goodwill by silently repeating phrases (e.g., “May you be happy”). Given LKM’s focus on cultivating positive emotional states, researchers have hypothesized that LKM may work by increasing positive affect (PA), promoting cognitive and behavioral flexibility, and reducing negative affect (NA). This study was the first to employ a multiple baseline, single-case design to evaluate the acceptability and clinical efficacy of a brief, individual LKM intervention for individuals (N = 9) with unipolar depressive disorders, social anxiety disorder, or generalized anxiety disorder and low PA. Participants were randomized to a 2-, 4-, or 6-week baseline and completed weekly assessments during baseline, 7 weeks of treatment, and at 1-, 2- and 4-week follow-up. LKM was hypothesized to be acceptable and effective for reducing depression and anxiety symptoms and increasing PA. Secondary hypotheses were that (1) improvements in PA would precede disorder symptom improvement and (2) LKM would lead to improvements in other treatment variables (e.g., NA, anger, mindfulness, affective regulation styles, quality of life, etc.) Results revealed that the study intervention had good feasibility and acceptability. Per visual inspection, LKM led to improvements in principal disorder symptoms for four participants during treatment and five participants at follow-up (three of whom showed clinically reliable change). Contrary to study hypotheses, only one participant demonstrated reliable improvements in PA during treatment. For this participant, increases in PA occurred simultaneously with reductions in depression. Across participants, LKM exerted moderate to large effects on disorder severity, depression and anxiety symptoms, quality of life, mindful nonreactivity, and tolerating affective style. Overall, individuals with principal unipolar depressive disorders showed the strongest response to the study intervention. In summary, this study provided preliminary evidence for the effectiveness of brief, individual LKM for reducing depression and anxiety in a transdiagnostic outpatient sample with low positive affect.

SammanfattningLångvarig smärta orsakar stort lidande för individen och belastar samhället ekonomiskt. Syftet med denna uppsats var att undersöka om en exponering in vivo-behandling inspirerad av Dialektisk beteendeterapi (DBT) för människor med långvarig ländryggssmärta var görbar samt om behandlingen gav effekt på smärtrelaterad problematik. Designen var en single case experimental design vilket är en beprövad design för att testa nya terapimetoder. Studien bestod av sex deltagare, alla med hög grad av smärtrelaterade katastroftankar, något som litteraturen visat predicera sämre behandlingsutfall. Behandlingen var DBT-inspirerad och indelad i tre faser; en första valideringsfas, en andra färdighetsfas och en tredje exponeringsfas. Fem av sex deltagare fick förbättringar på alla de primära utfallsmått, tre av sex deltagare fick förbättringar på samtliga primära- och sekundära utfallsmått. Framtida replikationer är motiverade. / AbstractChronic pain causes great suffering for the individual and burden society economically. The aim of this study was to examine whether an exposure in vivo treatment inspired by Dialectical Behavior Therapy (DBT) for people with chronic low back pain was feasible and whether the treatment had effect on pain-related problems. The design was a single case experimental design, which is a widely used design to test new therapy methods. The study consisted of six participants, all with high levels of pain catastrophizing, something that in the literature been linked to poor treatment outcomes. The treatment was inspired by DBT and divided into three phases: an initial validation phase, a second phase for skills training and a third exposure phase. The results were promising: five out of six participants had improved in all primary outcome measures. Three out of six participants had improvements in all primary and secondary outcome measures. Future replications are warranted.

Depression och insomni är två vanliga former av psykisk ohälsa. I den här studien undersöktes om en bevisat effektiv behandling för insomni, (KBT-I), påverkade grad av depressiva symtom hos personer med konstaterade symtom på såväl depression som insomni. I studien kontrollerades för en minskning av nedstämdhet kunde tillskrivas en ökad fysisk aktivitetsnivå. En single case experimental design användes för ändamålet, med dagliga skattningar av sömn, nedstämdhet och fysisk aktivitetsnivå. Symtom på såväl insomi som nedstämdhet minskade signifikant hos tre av sex deltagare. Minskad nedstämdhet kunde inte förklaras av ökad fysisk aktivitetsnivå. Samvariation observerades mellan depression och insomni. Resultaten visar att insomni och depression kan påverkas av samma behandling, vilket antyder förekomst av gemensamma vidmakthållande mekanismer. / Insomnia and depression are two common mental health problems. This study investigated whether a proven effective treatment for insomnia CBT-I, would change the severity of depressive symptoms, for participants with comorbid insomnia and depression. It was controlled for, whether a reduction in depressive symptoms could be the result of increased physical activity. A single case experimental design, including daily measurements of sleep, depression and physical activity, was used as a means to answer the research questions. Symptoms of both depression and insomnia were significantly reduced for three out of six participants. Increased physical activity was not able to explain the decrease in depression scores. A correlation was observed, between depression and insomnia. The results shows that insomnia and depression can be affected by the same treatment, which implies existence of common perpetual mechanisms.

No description available.

Nonsuicidal self-injury (NSSI; i.e., the deliberate destruction of one’s own bodily tissue without suicidal intent and for reasons not socially sanctioned) is prevalent and associated with clinically serious consequences. There is a need for evidence-based, stand-alone treatments for this behavior as it presents across the full range of psychiatric disorders. Developing time-efficient and cost-effective interventions for NSSI has proven difficult given that the core components of treatment remain largely unknown. The aim of this study was to examine the specific effects on NSSI of mindful emotion awareness training and cognitive reappraisal, two transdiagnostic treatment strategies that directly address the functional processes that often maintain self-injury (i.e., relief or escape from aversive thoughts or feelings). Using a counterbalanced, combined series (multiple baseline and phase change) single-case experimental design, the unique and combined impact of these two four-week interventions was evaluated among diagnostically heterogeneous, self-injuring adults (N = 10; mean age = 21.3, range = 18 to 30 years). Hypotheses were that each intervention would produce clinically meaningful reductions in NSSI; adding the alternative intervention would have additive benefit for those who did not respond to the initial intervention alone; and reductions in NSSI would be maintained over a four-week follow-up phase. Results showed that 8 of 10 participants demonstrated clinically meaningful reductions in NSSI by the follow-up phase; six participants responded to one intervention alone, whereas adding the alternative intervention was associated with additive benefit for two participants. Group-based analyses indicated a statistically significant effect of study phase on NSSI (p < .001), with fewer NSSI urges and acts occurring after the interventions were introduced. The interventions were also associated with moderate to large reductions in anxiety (d = 0.89 – 1.09), depression (d = 0.79 – 1.09), and interference caused by symptoms (d = 0.61), and with improvements in skills-based mechanisms: mindful emotion awareness (d = 1.44) and reappraisal (d = 1.30). The results suggest that increasing mindful emotion awareness and cognitive reappraisal may be two key therapeutic strategies for reducing NSSI. Transdiagnostic, emotion-focused interventions delivered in time-limited formats can serve as practical yet powerful treatment approaches, especially for lower-risk self-injuring individuals.

No description available.

Kognitiv beteendeterapi (KBT) har mest evidens vid social fobi, och på senare år har även guidad självhjälp baserad på KBT visat goda resultat. Acceptance and commitment therapy (ACT) är en del av den tredje vågens KBT och har visat lovande resultat vid ångestsyndrom. Företrädare för ACT har varnat för riskerna med tekniker för att utmana negativa automatiska tankar. Studien syftar till att med en single case experimentell design med multipel baslinje (N=9) studera effekterna av kognitiv omstrukturering (KO) och kognitiv defusion (KD) i form av guidad självhjälp på social ångest, socialt undvikande, psykologisk flexibilitet, defusion, samt frekvens av och trovärdighet hos negativa automatiska tankar. Resultaten visade att KO och KD inte enbart påverkade de processer som teorierna predicerar utan även den andra behandlingens processer.

Bakgrund: Smärta från axelleden är vanligt förekommande hos simmare, därav finns begreppet ”simmaraxel”. Etiologin till tillståndet och smärtan är dock ännu inte fastställd, flertalet studier visar på varierande orsaker och symtom. Den oklara etiologin, skapar delade meningar sett till lämplig behandling för simmaraxlar. Flera teorier finns kring den bästa behandlingsmetoden för axelsmärta hos simmare. Många olika studier har gjorts med syfte att undersöka sambandet mellan axelspecifik styrketräning på axelfunktion hos simmare med axelsmärta. Få studier har gjorts med syfte att undersöka effekten av axelspecifik styrketräning på just smärtan vid simmaraxlar. Syfte: Syftet med denna studie var att på individnivå undersöka hur axelspecifik styrketräning påverkar simmare med axelsmärta gällande smärta och funktion. Metod: Studien baseras på single-case experimentell design (SCED), med en AB-design. I studien medverkade tre deltagare från en simklubb i Stockholm. Deltagarna fick under totalt nio veckor skatta smärta via Numeric Rating Scale (NRS) och axelfunktion via Western Ontario Shoulder Instability Index (WOSI), för att undersöka förändringen på smärta och funktion över tid. Resultatsammanfattning: En deltagare uppnådde signifikant förbättring sett till självskattad smärta. Sett till självskattad funktion fanns signifikant försämring hos två deltagare. En deltagare uppnådde en stabil baslinje. Resterande två deltagare uppgav spridda värden under samtliga faser för NRS och WOSI.  Slutsats: Inga specifika slutsatser går att dras utifrån studiens resultat eftersom endast en deltagare uppnådde en stabil baslinje och på grund av oklarheten kring orsakerna till deltagarnas smärta. / Background: Pain originating from the shoulder joint is frequent among swimmers, therefore the term “swimmer’s shoulder” was constructed. However, the etiology of the condition has not yet been established and numerous studies indicate varying origins. Divided opinions have formed about effective interventions due to the confusion regarding swimmer’s shoulder. Several studies have investigated the interaction between various interventions and their effect on swimmer’s shoulders, however only a few have studied the effect strength training has on pain in the shoulder joint due to the condition.  Purpose: The aim of this study was to investigate at an individual level, how strength training of the shoulders affects active swimmers with shoulder pain, concerning pain and function. Method: This study is designed after a single-case experimental design (SCED), with an AB-design. Three swimmers from a swimming club in Stockholm participated. During a total of nine weeks, the participants had to assess pain via the numeric rating scale (NRS) and shoulder function via the Western Ontario Shoulder Instability Index (WOSI). Results: One participant acquired significant improvement in self-rated pain. Regarding self-rated function two participants showed significant impairment. One participant acquired a stable baseline. The remaining two participants reported scattered values during all phases for both NRS and WOSI.  Conclusion: No specific conclusions can be made based on the results of the study as only one participant achieved a stabile baseline, and there is ambiguity regarding the causes of pain among the swimmers.

A Psicoterapia Analítica Funcional (FAP) aponta a relação terapêutica como meio de promoção de mudanças clínicas. Os comportamentos do cliente em sessão são classificados como CCR1s (comportamentos problema), CCR2s (comportamentos de melhora) e CCR3 (descrições funcionais a respeito do próprio comportamento). É papel do terapeuta atuar sobre esses CCRs com o intuito de aumentar CCR2 e CCR3, bem como diminuir a emissão de CCR1, o que é planejado por meio das regras: estar atento aos CCRs (regra 1), evocar diretamente CCRs (regra 2), consequenciar CCRs (regra 3), observar os efeitos do seu comportamento sobre o comportamento do cliente (regra 4) e fornecer interpretações analítico-funcionais e implementar estratégias de generalização (regra 5). Compreende-se que a similaridade funcional do contexto terapêutico com outros ambientes do cliente possibilita o acesso do terapeuta à classe de comportamentos alvo de intervenção clínica e que, ainda, é papel do terapeuta evocá-los diretamente, componente da FAP expresso pela regra 2. As pesquisas que investigam o mecanismo de mudança da FAP têm enfatizado o papel da consequenciação (regra 3) sobre a mudança comportamental observada nos clientes, entretanto, há indícios de que tal mudança seja também resultado de um processo evocativo ocorrendo em sessão, responsável por produzir o aumento da emissão de CCR2s e diminuição de CCR1s quando a FAP é conduzida. Sendo assim, o objetivo do presente estudo foi o identificar quais os efeitos da evocação direta pelo terapeuta na FAP (variável independente) sobre os CCRs do cliente em sessão (variáveis dependentes), sendo utilizado delineamento experimental de caso único de reversão, com arranjo A-B1-BC1-B2-BC2 para uma cliente, com controle da inserção da evocação (arranjo A-BC1-B1-BC2-B2) para outro cliente. A fase A foi correspondente à linha de base, com realização de análise de contingências externas, as fases B corresponderam à condução de FAP sem evocação direta e as fases BC, à FAP completa. As sessões foram categorizadas com o Functional Analytic Psychotherapy Rating Scale (FAPRS) pela terapeuta e aferidoras de concordância, foi aplicado semanalmente o Outcome Questionnaire (OQ-45.2) que possibilitou o acompanhamento da evolução global dos clientes. Após três meses do encerramento do estudo, foi realizada uma sessão de follow-up com cada cliente, a qual indicou a manutenção de progressos com os mesmos. Como resultado no FAPRS, registrou-se o abrupto aumento de CCR2s e diminuição de CCR1s quando a evocação direta foi inserida, o aumento de CCR1 e diminuição de CCR2 quando a mesma foi retirada, bem como a replicação dessas duas fases e de seus efeitos sobre os comportamentos dos dois clientes. Nas fases em que a evocação não esteve presente, as porcentagens de CCRs assemelharam-se às observadas na linha de base. Observou-se também a importância da consequenciação com função evocativa, o que sustenta que a evocação e a consequenciação atuam de forma complementar. Tais resultados solidificam a proposta de que a produção de CCR2 nas sessões FAP tenha também por base a existência de processos evocativos atuantes, já que diante da ausência da evocação, registrou-se imediata diminuição de sua ocorrência. Nesse sentido, a evocação direta pode ser destacada como possuindo impacto relevante no mecanismo de mudança dessa psicoterapia / Functional Analytic Psychotherapy (FAP) points to the therapeutic relationship as a way of promoting clinical changes. The client behaviors in session are classified as CRB1s (problem behaviors), CRB2s (improvement behaviors) and CRB3 (functional descriptions regarding any client´s behavior). FAP therapist should act on these CRBs in order to increase CRB2 and CRB3 and to reduce the emission of CRB1, which is planned by using the rules: to be aware of CRBs (rule 1), to evoke CRBs directly (rule 2), to contingently respond to CRBs (rule 3), to observe the effects of therapist´s behavior on client´s behavior (rule 4) and to provide analytic-functional interpretations and implement generalization strategies (rule 5). It is understood that the functional similarity of the therapeutic context to other client environments allows the therapist to access the class of target behaviors of clinical intervention and that it is also the role of the therapist to directly evoke them, a component of FAP expressed by rule 2. Researches focused on investigate the mechanism of change in FAP have emphasized the role of consequence (rule 3) on behavioral change observed in clients, however, there is evidence that such a change is the result of an evocative process occurring in session, which is responsible for producing increased CRB2s and decreased CRB1s emissions when FAP is conducted. Thus, the goal of this investigation was to identify the effects of direct evocation by the therapist in FAP (independent variable) on client CRBs in session (dependent variables), using an experimental design of a single-case experimental procedure, with design A -B1-BC1-B2-BC2 for one client, with control of the insertion of the independent variable (design A-BC1-B1-BC2-B2) to another client. Phase A corresponded to the baseline, without systematic use of FAP, phases B corresponded to FAP without direct evocation and phases BC, to the use of complete FAP. The sessions were categorized with the instrument Functional Analytical Psychotherapy Rating Scale (FAPRS) by the therapist and independent coders. The Outcome Questionnaire (OQ-45.2) was applied weekly, allowing the therapist to monitor the overall evolution of clients and after three months of the end of the phases, a follow-up session was conducted with each client, which indicated the maintenance of the observed effects. As a result in FAPRS, it occurred the abrupt increase of CRB2s and decrease of CCR1s when direct evocation was inserted, the increase of CRB1 and decrease of CRB2 when it was withdrawn, as well as the replication of these two phases and their effects on the behaviors of the two clients. In the phases in which evocation was not present, the percentages of CRBs were similar to those observed in baseline. It was also observed the importance of the consequences with evocative function, which maintains that the evocation and the consequences provided by the therapist act in a complementary way. These results solidify the proposal that the increase of CRB2 in FAP is also based on the existence of evocative processes, since in the absence of evocation it is observed its immediate decrease. Therefore, direct evocation can be highlighted as having a relevant impact on the mechanism of change of this psychotherapy