This study investigated efficacy of an online, preventive intervention program, Children of Divorce-Coping with Divorce (CoD-CoD; Boring, 2011). It extends previous findings to a sample of eight youth from high-conflict families who recently initiated legal divorce proceedings. CoD-CoD is a cognitive-behavioral intervention that targets coping efficacy, coping strategies, and divorce-related cognitive appraisals. A multiple-baseline single case experimental design evaluated change in daily use of active and avoidant coping strategies and corresponding coping efficacy ratings. Individual patterns of change were inspected for the program’s putative mediator variables and overall mental health functioning. Results indicate that daily coping efficacy ratings increased for four participants and decreased for the three participants who reported the highest levels of exposure to interparental conflict. The majority of participants increased use of at least one type of active coping strategy and half decreased use of at least one type of avoidant coping strategy. There were no observed patterns of systematic change in divorce-related cognitive appraisals and changes in mental health functioning were mixed. An exploratory analysis found that youth were classified as "high-risk" on a psychometrically-sound risk index in 100% of cases with documentation of two or more conflict-indicative legal events in the family court file. The study findings are consistent with previous evidence of a moderated program effect on coping efficacy, although positive effects on youth-reported mental health functioning were not replicated. Findings are discussed within the context of a high-conflict sample with temporal proximity to the legal divorce and in light of study limitations. Research directions toward effectively connecting at-risk youth with evidence-based prevention services are detailed.

Research has shown that positive emotions are important to optimal health, functioning, and well-being, and contribute to resilience against psychological dysfunction. However, many clinical disorders, particularly anxiety and mood disorders, are associated with deficits in positive emotion that may contribute to symptoms and inhibit full recovery. Despite accumulating data identifying disturbances in positive emotion and positive emotion regulation in anxiety and depressive disorders, these deficits have received insufficient attention in treatment. The present study represents a preliminary evaluation of the feasibility and utility of a novel augmentation intervention for enhancing positive emotion in anxiety and depressive disorders. Nine patients with a range of principal anxiety disorders who had previously completed an initial course of cognitive-behavioral treatment at the Center for Anxiety and Related Disorders at Boston University (CARD) completed the study. The study utilized a single case experimental design, specifically a multiple baseline across participants design, with participants randomized to 2-, 4-, or 6-week baseline periods to control for the effect of time on outcome variables. Primary outcome variables were assessed weekly during the baseline and intervention phases to permit analysis of functional relationships between individual factors, specific treatment components, and therapeutic outcomes. Major assessments were conducted at baseline, pre-, post-treatment, and a 3-month follow-up. These included both self-report and independent evaluator-rated components. Results indicated that the intervention was effective in improving positive emotion regulation skills for 5 of the 9 of participants. The intervention was associated with significant improvements in anxiety and depressive symptoms, and preliminary effects sizes for pre- to follow-up changes in positive emotion regulation, symptoms, positive and negative emotion, functioning, quality of life, and well-being were moderate to large. Participants reported high acceptability and satisfaction with the study intervention. Qualitative feedback from participants highlighted several areas for improvement in the format and delivery of the intervention, such as increasing the number of sessions and providing a patient workbook, and these changes may increase the effectiveness of the intervention. Future research is needed to confirm the validity of these findings and evaluate the generalizability of these effects across patients and settings.

No description available.

Objective: Conduct a meta-analysis of school-based interventions for anxious and depressed youth to evaluate the findings according to QUORUM guidelines. Method: A search of the literature was conducted using PubMed, PsycINFO, and manual searches, supplemented by contact with leading researchers. The present meta-analysis used 63 studies and investigated 8,225 participants receiving CBT and 6,986 participants in comparison conditions. Results: Mean pre-post effect size estimates indicate that anxiety-focused school-based CBT was moderately effective at improving symptomatology of anxiety (Hedge's g = 0.501) and depression-focused school-based CBT was mildly effective at improving depression symptomatology (Hedge's g = 0.298) for youth receiving active interventions as compared to those in anxiety intervention control conditions (Hedge's g = 0.193) and depression intervention controls (Hedge's g = 0.091). Moderators and mediators of treatment outcome were explored. Conclusions: School-based CBT interventions for youth anxiety and for youth depression hold considerable promise, though further investigation is still needed to identify features that optimize service delivery and outcome. / Psychology

Many parent factors have been associated with child anxiety, and researchers have examined how parents may be most beneficially involved in cognitive behavior therapy (CBT) for anxious youth. Results have been mixed as to whether parent CBT, family CBT, and parent interventions addressing parental anxiety or overcontrol have an added benefit over youth-focused CBT. The present study compared (a) a parent group intervention targeting autonomy granting, (b) a parent CBT skills group, and (c) a parent support control group, all provided in conjunction with individual CBT for anxious youth ages 7 to 17. Randomly assigned group conditions, as well as variance in overall parent attendance across conditions, were examined as predictors of change in parenting behaviors and in child anxiety. No significant differences in youth anxiety outcomes were found across parent group conditions, and parental beliefs and involvement improved most for the support control group. However, youth whose parents attended more group sessions showed a significantly greater decrease in anxiety severity than youth whose parents attended fewer (0, 1) sessions, which was mediated by a significantly greater decrease in parental avoidance of child anxiety. The results suggest that additional parent participation in treatment may have an added benefit, even with an unstructured support group format, but do not offer clarity about the benefit of targeted interventions for parents. / Psychology

Syfte: Syftet var att kartlägga effekten av kognitiv beteendeterapi och mindfulness baserad kognitiv terapi hos personer som lider av hypokondri/hälsoångest.Bakgrund: Hypokondri är en undergrupp till somatoforma syndrom, vilket är symtom som inte kan förklaras genom generell medicin. Hypokondri är svårdiagnostiserat och har en underklassificerad term vid namn hälsoångest. Olika behandlingsformer för hypokondri/hälsoångest kan bland annat vara kognitiv beteendeterapi eller mindfulness baserad kognitiv terapi med olika inriktningar.Metod: En litteraturstudie utfördes enligt Goodmans sju steg, där det sista steget exkluderades. Inklusionskriterier var studier som redovisade resultat med deltagare som uppfyllde kriterierna för hypokondri/hälsoångest. Artiklar som krävde en avgift exkluderas från studien. Databassökningar gjordes i PubMed, CINAHL och PsycINFO där tio vetenskapliga artiklar valdes ut och analyserades. Resultat: Behandlingstid var en avgörande faktor för reducering av hypokondri/hälsoångest, där gruppbehandling visade sig ge god effekt. Kognitiv beteendeterapi och mindfulness baserad kognitiv terapi reducerade den negativa synen och attityden på sjukdom och minskade uppmärksamheten över kroppsliga symtom. Konklusion: Graden av hypokondri/hälsoångest minskade med hjälp av kognitiv beteendeterapi, mindfulness baserad kognitiv terapi eller kognitiv terapi. Gruppbehandling gav positiv effekt och visade sig vara kostnadseffektivt för sjukvården. / Aim: The aim was to describe the effect cognitive behavior therapy and mindfulness-based cognitive therapy had on people who suffered from hypochondriasis/health anxiety.Background: Hypochondriasis is a subordinate group to somatoform disorders, which are disorders that cannot be explained by general medicine. Hypochondriasis is difficult to diagnose and has a subordinate term called health anxiety. Mindfulness-based cognitive therapy and cognitive behavioral therapy are different types of treatments for hypochondriasis/health anxiety. Method: A literature study was carried out according to Goodman’s seven steps, the last step was excluded. Inclusion criteria was studies that presented a result of participants who had criteria for hypochondriasis/health anxiety. Payment articles were excluded. Database searches were carried out in PubMed, CINAHL and PsycINFO, where ten scientific articles were chosen, and analyzed. Result: Time of treatment was a substantial factor for reduced hypochondriasis/health anxiety. Treatment in group had a significant effect on treatment outcome. Cognitive behavior therapy, and mindfulness-based cognitive therapy reduced the intrusive image and attitude of being sick, and reduced the attention of bodily symptoms.Conclusion: Hypochondriasis/health anxiety reduced due to treatment. Group treatment had a significant effect on outcome, and showed cost-effectiveness in health care.

Delayed sleep phase disorder (DSPD) is the most common circadian rhythm sleep disorder. Persons with DSPD have great difficulties falling asleep and waking up at conventional times. To diagnose DSPD this delayed sleep-wake rhythm should cause social impairment and distress for the individual. Evening melatonin and morning bright light are the recommended treatments. The overall aim of this thesis was to evaluate at-home treatment with Light therapy (LT) and the feasibility of adding cognitive behavior therapy (CBT) to LT in DSPD, furthermore prevalence, diagnostic aspects and associated factors were investigated. Study I included 673 randomly selected individuals aged 16–26 years. The prevalence of DSPD was 4.0%. Unemployment (defined as an absence of educational or work activities) and an elevated level of anxiety were associated with DSPD. In study II, dim light melatonin onset (DLMO) was measured in healthy adults. Time for DLMO DLMO (Mean±SD) was 20:58±55 minutes. Studies III, IV, and V present results from a randomized controlled trial examining the feasibility of CBT as an additive treatment to LT with scheduled rise times, in persons with DSPD. Sleep onset and sleep offset was significantly advanced from baseline (03:00±1:20; 10:22±2:02 respectively) to the end of LT (01:27±1:41; 08:05±1:29, p<0.001 respectively). This advancement was predicted by consistent daily usage of the LT-lamp. At the follow-ups after LT and CBT or LT alone, sleep onset remained stable, sleep offset was delayed, and sleep difficulties were further improved, but there was no significant group interaction over time. There was a significant group interaction over time in the severity of anxiety and depressive symptoms, both in favor of the LT+CBT group. Conclusively, DSPD was common among adolescents and young adults and it was associated with unemployment and elevated levels of anxiety. DLMO appeared in the expected time range in healthy working adults. At-home treatment with LT with scheduled rise times advanced sleep-wake rhythm and improved sleep difficulties in DSPD. Even though sleep-wake rhythm was not further advanced or better preserved in the participants that received LT+CBT compared to LT alone, the addition of CBT to the treatment regimen was feasible and well accepted.

The aims of this thesis were to increase the knowledge about the long-term psychological consequences in parents of children diagnosed with cancer, including parents of childhood cancer survivors (CCSs) and bereaved parents, and to take the first steps towards developing a psychological treatment for parents of CCSs. Study I was a systematic review synthesizing the literature on psychological long-term consequences in parents of CCSs. Study II had a longitudinal design assessing posttraumatic stress symptoms (PTSS) from shortly after the child’s diagnosis (T1, N=259) up to five years after end of the child’s treatment or death (T7, n=169). Study I and II concluded that while most parents show resilience in the long-term, a subgroup report high levels of general distress and/or PTSS. In Study III, interview data from the last assessment in the longitudinal project (T7, n=168) was used. Participants described particularly negative and/or positive experiences in relation to their child’s cancer, and results pointed to the wide range of such experiences involved in parenting a child with cancer. In Study IV and V, parents of CCSs reporting cancer-related psychological distress were included (N=15). In Study IV, a conceptualization of this distress was generated by aggregation of individual behavioral case formulations. The conceptualization consisted of two separate but overlapping paths describing development and maintenance of symptoms of traumatic stress and depressive symptoms. In Study V, cognitive behavior therapy (CBT) based on the individual case formulations were preliminarily evaluated in an open trial. The CBT appeared feasible, and at post-assessment participants reported significant decreases in PTSS (p<.001), depression (p<.001), and anxiety (p<.01) with medium to large effect sizes (Cohen’s d=0.65-0.92). Findings indicate that psychological long-term consequences in parents of children with cancer consist of a broad range of negative as well as positive experiences, and that while most parents show resilience in the long-term, a subgroup report high levels of psychological distress. For parents of CCSs this distress is suggested to primarily consist of symptoms of traumatic stress and depression, and a preliminary evaluation of CBT targeting hypothesized maintaining mechanisms showed promise in terms of feasibility and treatment effect. / Behandling av traumatisk stress hos föräldrar till cancerdrabbade barn med kognitiv beteendeterapi via internet / Förekomst, utveckling och behandling av posttraumatiskt stressymptom hos föräldrar till barn med cancer / Utveckling och utvärdering av ett webbaserat psykologiskt självhjälpsprogram för föräldrar till barn som tidigare behandlats mot cancer

No description available.

Hearing distressing voices (also known as auditory verbal hallucinations) is a common symptom associated with a number of mental health problems. Psychological therapies, specifically cognitive behaviour therapy (CBT) can be an effective intervention for this patient group. The aim of CBT for voices (CBTv) is to reduce the distress associated with the experience, by encouraging the patient to re-evaluate their beliefs about the voice's omnipotence, omniscience, and malevolence. Despite the evidence for CBTv, very few patients are offered this therapy; largely due to a lack of resources. The aim of this thesis was to develop and begin to evaluate a CBT-based intervention for voices that was resource-light; in the hope that it could be more easily be implemented into clinical services, and therefore increase access. This thesis begins with an introduction to the research area, and is followed by a review and evaluation of the methods used in this thesis. Chapter 6 is a systematic review and meta-analysis of the current literature on brief (< 16 NICE recommended sessions) CBT for psychosis (CBTp). Chapters 7 and 8 describe the process of developing a brief CBT intervention for voices, based on the CBT self-help book ‘Overcoming Distressing Voices'. Both people who hear voices, and mental health clinicians were consulted on the intervention concept and design. The outcome of these studies was guided self-help CBTv, and an accompanying therapy workbook to guide the intervention. Chapters 9 and 10 detail the design and findings of a randomised controlled trial of guided self-help CBTv delivered by Clinical Psychologists, versus a wait-list control group. Data was collected at baseline (pre-randomisation) and 12 weeks post-randomisation. The primary outcome was voice-related distress. The findings across all of the studies are then summarised and reflected upon within the Discussion chapter – including consideration of the extent to which the overall aim of this thesis (increasing access) has been achieved.