Hoarding disorder is a mental illness that affects about 2-5 % of the population. The most prominent symptoms of hoarding disorder are the inability to discard things and the excessive acquisition of possessions. The home becomes cluttered, often to the point where one no longer can use the rooms for their intended purposes. For example, one can no longer sleep in the bed or use the kitchen for cooking because of the clutter that takes up space. People with hoarding disorder often experience shame because of their disability and as a consequence they withdraw from social engagements and risk isolation. The purpose of this study was to give a literary review of treatment methods for hoarding disorder and their efficacy in Swedish, but also to show the impact of shame on treatment effect through Thomas Scheff’s theory of shame. The primary treatment method is Cognitive behavioral therapy designed especially for hoarding disorder, and has been tested in different forms such as individual-, group-, and internet based treatment. New treatments using Compassion-focused therapy and Acceptance and commitment therapy have also been developed. Studies on hoarding disorder and shame have shown a correlation between shame, symptom severity and identity. These new treatments address the shame experienced and they can hopefully increase the efficacy rate for hoarding treatment. Important factors for treatment progress were, among others, continued high motivation, frequent contact with clinician and a supportive family. A surprising result was that one study showed almost equal result in treatment led by a non-professional as a professional. More research is needed to further develop effective treatment.

The purpose of this thesis was to investigate the feasibility of a treatment for hypersexual disorder (HD) by calculating and reporting the results with pre-collected data from a research project at ANOVA/Karolinska Universitetssjukhuset. The treatment was a cognitive behavioral group therapy (CBGT) developed for HD administered in a 7-session group setting with a sample of HD-diagnosed women (n = 16). Feasibility was explored through symptom change of hypersexuality, sexual compulsivity, psychological distress, and depression. Symptom change in relationship to treatment attendance was also explored. In this thesis, the results are considered in a broader context, discussing theoretical issues concerning women’s sexuality in relation to hypersexual problems and medicalization of hypersexual behaviors.   The treatment was shown to be feasible. Significant decrease was found on all measures. Attendance rate significantly correlated with a decrease in depressive symptoms, but not on other measures. Women’s sexuality might differ from men’s, but the treatment, which was first evaluated for men, is still feasible for women. Treatment for hypersexual problems in women and hypersexual problems in women in general have been understudied, which makes this study an important contribution to the research field. Further treatment studies could potentially investigate whether specific alterations based on gender and sexual orientation could be needed for further development of the treatment. There are issues concerning medicalization of hypersexual behaviors which should be considered when addressing the phenomenon, such as the influence of moral and cultural factors on the understanding of hypersexuality. Still, there is need for treatment for hypersexual behaviors experienced as problematic, and having these problems addressed within the medical and scientific field has potential for being beneficial and is preferred to having them left to alternative, unregulated health care providers.

Tanken bakom denna studie har varit att undersöka hur behandlare upplever sitt arbete med familjer där det förekommer våld. Studien syftar till de behandlare som arbetar med metoden KIBB som är en behandlingsmodell framtagen av Melissa Runyon och Esther Deblinger. Syftet med KIBB är att hjälpa föräldrar att sluta använda våld mot sina barn genom att ha förälderns våldsutövande i fokus, belysa konsekvenser och lära föräldrar positiva föräldrastrategier. Som behandlare ger man stöd till barn som upplevt våld genom att bearbeta upplevelserna, hantera känslor och skuldavlasta. Datan till studien samlades in genom sex semistrukturerade intervjuer med KIBB behandlare. Vidare har kognitiv beteendeterapi, systemteori och inlärningsteori använts som teoretiska utgångspunkter. Datan har sedan analyserats utifrån de valda teorierna samt tidigare forskning. En av utgångspunkterna var att ta reda på vad behandlare ser för fördelar och utmaningar med KIBB. Intervjupersonerna redogjorde för många fördelar och många svar liknande varandra. De verkar också vara överens om att det är ett roligt arbete och att en stor fördel är att få göra skillnad för familjer. Under utmaningar i arbetet rådde det mer delade meningar. Intervjupersonerna resonerade kring de olika utmaningar man som behandlare ställs inför i arbetet och svaren var väldigt individuella. En annan aspekt som intervjupersonerna skildrade var vikten av motivationsarbete och relationsarbete med familjen samt samarbetet med den andra behandlaren. / This paper examines how professional therapists experience their work with families where violence occurs. The study aims to examine therapists' experience in working with CPC-CBT, which is a treatment model developed by Melissa Runyon and Esther Deblinger. The main  purpose of the treatment model is to help parents stop using violence against their children by focusing on the parent's use of violence, as well as highlighting consequences and teaching parents positive parenting strategies. Therapists using the CPC-CBT method provide support to children who have experienced violence by processing their experiences, managing emotions and relieving guilt. The data were collected through six semi-structured interviews with CPC-CBT therapists. Furthermore, cognitive behavioral therapy, systems theory and learning theory have been used as theoretical starting points. Later on, the data was analyzed based on the selected theories and previous research. One of the purposes was to clarify therapists' view on benefits and challenges in their work with CPC-CBT. The interviewees described several benefits and many answers were similar to each other, they also seem to agree that it is a fun job and that a big advantage is to be able to make a difference for families. During the challenges of the work, there were more divided opinions. The interviewees reasoned about the different challenges therapists face in their work and the results occurred very individual. Another aspect the interviewees described was the importance of motivational work and relationship work with families and collaboration with other therapists.

PURPOSE: Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) has not yet been systematically evaluated in the Caribbean context, particularly with Hispanic youth exposed to multiple disasters. The objective of this project was twofold: 1) to train mental health providers in Puerto Rico in TF-CBT as part of a clinical implementation project within the largest managed behavioral health organization (MBHO) on the island, and 2) to conduct a program evaluation to determine the feasibility of implementation and the effectiveness of the treatment. METHOD: Fifteen psychologists were trained in TF-CBT. These psychologists then provided TF-CBT to 56 children and adolescents, ages 5-18, in community-based mental health clinics and one primary care clinic with a co-located psychologist in Puerto Rico. The mean number of traumatic events reported by youth referred for TF-CBT was 4.11. RESULTS: Thirty-six out of 56 children enrolled in the project (64.3%) successfully completed all components of TF-CBT. Results demonstrated large effect sizes for reduction in youth-reported posttraumatic stress symptoms (PTSS) (Cohen's d = 1.32), depressive symptoms (Cohen's d = 1.32), and anxiety symptoms (Cohen's d = 1.18). CONCLUSIONS: These results suggest that it was feasible to train providers in TF-CBT, that providers were able to deliver TF-CBT in community-based settings both in person and via telehealth (due to the COVID-19 pandemic), and that TF-CBT was an effective treatment option to address trauma-related concerns for youth in Puerto Rico in a post-disaster context. This project is an important first step in the dissemination and implementation of evidence-based trauma-focused treatment for Hispanic youth and disaster-affected youth in the Caribbean.

Cirka 3 % av kvinnor som fött barn uppfyller DSM-5 diagnostiska kriterier för PTSD, och minst en tredjedel uppger att de upplevt förlossningen som traumatisk. Prolonged exposure (PE) är en evidensbaserad traumafokuserad kognitiv beteendeterapi och en effektiv behandling för att reducera PTSD-symptom över en varierad traumatiserad population. Terapeutperspektivet gällande behandling av patienter med förlossningstrauma (PTSD-FC) är sällsynt i forskningen. Övergripande syfte var att belysa KBT-terapeuters perspektiv av att arbeta med behandlingsmetoden PE vid PTSD-FC med frågeställningar som; Vad kan vara utmärkande med att behandla patienter med PTSD-FC? Vilka kliniska erfarenheter har terapeuterna av att tillämpa PE-manualen med aktuell patientgrupp? Studien har en kvalitativ ansats. Semistrukturerade intervjuer har genomförts med åtta terapeuter. Bearbetning av data utgick från reflexiv tematisk analys. I resultatet genererades tre teman med subteman utifrån terapeuternas erfarenheter. ”Ett förlossningstrauma har vissa utmärkande drag”, ”Betydelsen av traumat”  samt ”PE-manualens möjligheter”. Terapeuterna ansåg att PE är en flexibel, hjälpsam och effektiv traumabehandling som fungerar väl med patientgruppen. Patienterna var vanligtvis motiverade och fullföljer terapin i hög grad. Tillgången till adekvat vård var god inom terapeuternas egna verksamheter medan en problematisk bild kom fram avseende andra vårdgivare. Utmaningar och möjligheter diskuteras angående det terapeutiska arbetet med patientgruppen. Kliniska implikationer som tas upp är till exempel behovet av ökade terapeutiska resurser inom kvinnosjukvården för adekvat bedömning och behandling vid PTSD-FC, där fördelen är samverkan mellan olika professioner. / Approximately 3% of women who have given birth, meet the DSM-5 diagnostic criteria for PTSD, and at least a third say they experienced childbirth as traumatic. Prolonged exposure (PE) is an evidence-based trauma-focused cognitive behavioral therapy and an effective treatment for reducing PTSD symptoms across a diverse traumatized population. The therapists’ perspective regarding the treatment of patients’ with postpartum trauma (PTSD-FC) is rare in research. The overall aim was to highlight CBT therapists' perspectives of working with the treatment method PE at PTSD-FC with questions such as; What may be distinctive about treating patients’ with PTSD-FC? What clinical experience do therapists’ have of applying the PE manual with the current patient group? The study has a qualitative approach. Semi-structured interviews have been conducted with eight therapists’. Processing of the data was based on reflexive thematic analysis. In the results, based on the therapists' experiences, three themes with subthemes were generated. “A postpartum trauma has some distinguishing features”, “The meaning of the trauma” and “The possibilities of the PE manual”. The therapists’ considered PE to be a flexible, helpful, and effective trauma treatment that works well with the patient group. The patients’ were usually motivated and completed the therapy to a high degree. Access to adequate care was good within the therapists' own settings, while a problematic picture emerged regarding other caregivers. Challenges and opportunities are discussed regarding the therapeutic work with the patient group. Clinical implications addressed are for example the need for increased therapeutic resources in women's healthcare for adequate assessment and treatment for PTSD-FC, where the advantage is collaboration between different professions. / <p>Linköpings universitet | Institutionen för beteendevetenskap och lärande Psykoterapeutexamensuppsats/magisteruppsats/uppsats på avancerad nivå, 15 hp | Psykoterapeutprogrammet (KBT) Höstterminen 2022 </p>

No description available.

<p>This report is the result of the course, Environment and Development in the South, at University of Södertörn in Stockholm, Sweden. The report is about “new tourism” especially community-based tourism (CBT) and socio-cultural aspects relating to tourism. It is based on a literature study and a three weeks field course in Babati district in Northern Tanzania. The aim of this study is to describe how host peoples (communities) get affected especially, socio-culturally, by tourism. The aim is also to describe new tourism (especially CBT). A case-study of a Swedish student excursion to Babati is used as an example of how it affects a community (especially socio-cultural aspects) and if it qualifies as CBT.</p><p>The theory of the study is based on sustainable development (especially socio-cultural aspects) supported by the rules of World Tourism Organization (WTO) and United Nation Environmental Program (UNEP). The theory is connected to the principles of CBT and used in the analysis to judge if the Swedish student excursion qualifies as CBT.</p><p>The results show that the Swedish student excursion is in line with important principles of CBT, and therefore also in line with sustainable local development in some way. The major advantage with the excursion is the cross-cultural learning and the major problem is jealousness of benefit sharing according to the interviews done.</p>

Social anxiety disorder (SAD) is a common psychiatric disorder associated with considerable suffering. Cognitive behaviour therapy (CBT) has been shown to be effective but a significant proportion does not respond or relapses, stressing the need of augmenting treatment. Using neuroimaging could elucidate the psychological and neurobiological interaction and may help to improve current therapeutics. To address this issue, functional and structural magnetic resonance imaging (MRI) were repeatedly conducted on individuals with SAD randomised to receive CBT or an active control condition. MRI was performed pre-, and post-treatment, as well as at one-year follow-up. Matched healthy controls were also scanned to be able to evaluate disorder-specific neural responsivity and structural morphology. This thesis aimed at answering three major questions. I) Does the brain’s fear circuitry (e.g., the amygdala) change, with regard to neural response and structural morphology, immediately after CBT? II) Are the immediate changes in the brain still present at long-term follow-up? III) Can neural responsivity in the fear circuitry predict long-term treatment outcome at the level of the individual? Thus, different analytic methods were performed. Firstly, multimodal neuroimaging addressed questions on concomitant changes in neural response and grey matter volume. Secondly, two different experimental functional MRI tasks captured both neural response to emotional faces and self-referential criticism. Thirdly, support vector machine learning (SVM) was used to evaluate neural predictors at the level of the individual. Amygdala responsivity to self-referential criticism was found to be elevated in individuals with SAD, as compared to matched healthy controls, and the neural response was attenuated after effective CBT. In individuals with SAD, amygdala grey matter volume was positively correlated with symptoms of anticipatory speech anxiety, and CBT-induced symptom reduction was associated with decreased grey matter volume of the amygdala. Also, CBT-induced reduction of amygdala grey matter volume was evident both at short- and long-term follow-up. In contrast, the amygdala neural response was weakened immediately after treatment, but not at one-year follow-up. In extension to treatment effects on the brain, pre-treatment connectivity between the amygdala and the dorsal anterior cingulate cortex (dACC) was stronger in long-term CBT non-responders, as compared to long-term CBT responders. Importantly, by use of an SVM algorithm, pre-treatment neural response to self-referential criticism in the dACC accurately predicted (&gt;90%) the clinical response to CBT. In conclusion, modifying the amygdala is a likely mechanism of action in CBT, underlying the anxiolytic effects of this treatment, and the brain’s neural activity during self-referential criticism may be an accurate and clinically relevant predictor of the long-term response to CBT. Along these lines, neuroimaging is a vital tool in clinical psychiatry that could potentially improve clinical decision-making based on an individual’s neural characteristics. / Social ångest är en av de vanligaste psykiska sjukdomarna. Mer än en miljon svenskar bedöms lida av detta. Social ångest leder ofta till svåra konsekvenser för den som drabbas, men även ökade kostnader för samhället har noterats, t ex i form av ökad sjukfrånvaro. Även om många som drabbas inte söker hjälp så finns effektiva behandlingar för social ångest, både farmakologiska och psykologiska behandlingar rekommenderas av Socialstyrelsen. Kognitiv beteendeterapi (KBT) är en evidensbaserad och rekommenderad psykologisk behandling för social ångest. Trots att nuvarande interventioner är effektiva så är det fortfarande en andel individer som inte blir förbättrade. Det finns en stor andel studier som visar att individer med social ångest, i jämförelse med friska individer, karakteriseras av överdriven aktivitet i ett nätverk som har till uppgift att tolka och reagera på hotfull information. Denna aktivitet är lokaliserad i rädslonätverket där området amygdala spelar en central roll. Det finns ett behov att utveckla nuvarande behandlingar och denna avhandling syftar till att öka vår förståelse för en neurobiologisk verkningsmekanism bakom KBT för social ångest. I detta forskningsprojekt har magnetresonanstomografi (MRT) använts för att undersöka personer som lider av social ångest. Upprepade mätningar har genomförts, innan, efter, och vid uppföljning ett år efter ångestlindrande behandling. Utöver detta har individer som inte lider av social ångest undersökts för att förstå hur patienter skiljer sig från friska personer, men också för att undersöka om behandlingen normaliserar patientens hjärna. Under tiden som deltagarna undersöktes med MRT genomfördes två experiment för att ta reda på hur hjärnan reagerar på affektiv information. Deltagarna tittade på bilder med ansikten som uttrycker emotioner, t ex arga och rädda ansiktsuttryck, samt information som innehöll kritiska kommentarer riktade till personen själv eller någon annan, t ex ”ingen tycker om dig” eller ”hon är inkompetent”. Strukturella bilder på deltagarnas hjärnor har också samlats in vid varje mättillfälle. Utöver detta fick alla deltagare instruktioner om att de efter MRT skulle hålla en muntlig presentation inför en publik. Denna uppgift är oftast den värsta tänkbara för individer med social ångest, och syftet med uppgiften var att relatera hjärnans struktur och aktivitet till hur mycket ångest som individerna upplevde inför denna situation. I arbetet med denna avhandling har tre frågor ställts. a) Uppstår strukturella och funktionella förändringar i rädslonätverket direkt efter avslutad KBT (Studie I och II)? b) Är de tidiga förändringarna efter behandlingen även kvarstående ett år senare (Studie III)? c) Kan hjärnans reaktioner i rädslonätverket förutspå vilka individer som kommer att bli förbättrade av en ångestlindrande psykologisk behandling på lång sikt? Resultat från studierna i denna avhandling sammanfattas nedan: Reaktioner till självriktad kritik i amygdala är överdrivna hos individer med social ångest, i jämförelse med friska individer Reaktioner i amygdala minskar efter att individerna blivit behandlade med KBT och minskningarna korrelerar till minskade symptom av social ångest Den strukturella volymen av amygdala korrelerar positivt med hur mycket ångest individerna upplever inför en muntlig presentation, och minskningen av dessa symptom korrelerar även med hur mycket volymen av amygdala minskar efter KBT Minskningen av amygdalavolym och den samtidigt minskade reaktiviteten i amygdala till självriktad kritik är korrelerade. Medieringsanalyser antyder att det är den minskade volymen som driver förhållandet mellan minskad reaktivitet och minskad ångest inför att hålla en muntlig presentation Den strukturella minskningen av amygdala ses både direkt efter behandlingens avslut, men även vid uppföljning ett år senare. Hjärnans reaktivitet till självriktad kritik i amygdala minskar direkt efter behandling, men är inte kvarstående vid uppföljning ett år senare Kopplingen mellan hjärnans reaktivitet till självriktad kritik i amygdala och dorsala främre cingulum var starkare hos de som inte blev förbättrade (jämfört med de som blev bättre) av en ångestlindrande behandling på lång sikt Med hjälp av en stödvektormaskin (en. support vector machine learning) och ett mönster av hjärnaktivitet i dorsala främre cingulum innan behandling påbörjades, predicerades (med 92% träffsäkerhet) vilka individer som ett år senare var fortsatt förbättrade av en effektiv psykologisk behandling Utifrån dessa observationer är slutsatserna att strukturell och funktionell påverkan på amygdala är en möjlig neurobiologisk mekanism för minskad social ångest efter KBT, samt att reaktivitet i främre cingulum kan ge kliniskt relevant data om vem som kommer att bli förbättrad av en psykologisk behandling. Denna information kan potentiellt vara viktig i framtidens psykiatri för att utveckla existerande behandlingar, men även för att stödja klinikers beslutsfattande huruvida en viss individ bör erbjudas en specifik behandling eller ej. / <p>Illustration on the cover by Jan Lööf. Cover image printed with permission from Jan Lööf and Bonnier Carlsen Förlag. The cover was art directed by Staffan Lager.</p><p>The thesis is reprinted and the previous ISBN was 9789176856888.</p>

Relapse prevention after pain management is a neglected area and Internet-based interventions have the potential to partly fill this gap. A challenge in designing effective relapse prevention program is how to motivate patients to persist throughout the full length of treatment. Following a regular pain management program, 29 participants underwent a 20 week long Internet–based relapse prevention program based on acceptance-oriented CBT. Qualitative analyses showed changes in attitudes towards their pain and body during the course of treatment. Degree of personal commitment in treatment goals seemed to affect gains relating to new perspective on self and future. Therapeutic strategies of defusion and mindfulness seemed to ease perspective changes and persistence to comply. Values interventions are hypothesized to be a plausible therapeutic strategy to engage participants in continuous behavior change. Further studies on non-compliers and drop-outs could enhance understanding of interventions necessary to maintaining motivation. When and how to give therapist support during Internet-based treatment for chronic pain is another area in need of further studies.

The changes in emotivity and behavior are common after acquired brain injury, which complicates the readaptation of an individual to his environment. Compared to cognitive problems, these changes are not so greatly regarded because their complexity requires care in the context of its special neuropsychological treatment. The objective of the theoretical part of this thesis was to elucidate the issue of acquired brain injury and summarize current knowledge and experience in the field of therapeutic work with this specific group of people. The aim of the empirical part of this thesis was to design an appropriate educationally based preventive program that would focus on the experience of personality change after ABI. The goal of this program was to provide patients with information about the usual consequences of ABI and to provide a place to share the problems they experience. The effectiveness of this program was measured via the European Brain Injury Questionnaire (EBIQ) and the Zung Self-rating Depression Scale (ZSDS). The results were compared in the experimental group (N=30) before and after the completion of the program and in the control group (N=30). In the group that undertook the intervention, the EBIQ-P showed significant improvement in the subscale Physical. The ZSDS results showed...