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Hursti, Timo
Publications (10 of 30) Show all publications
Myhr, P., Hursti, T., Emanuelsson, K., Löfgren, E. & Hjemdal, O. (2019). Can the Attention Training Technique Reduce Stress in Students?: A Controlled Study of Stress Appraisals and Meta-Worry. Frontiers in Psychology, 10, Article ID 1532.
Open this publication in new window or tab >>Can the Attention Training Technique Reduce Stress in Students?: A Controlled Study of Stress Appraisals and Meta-Worry
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2019 (English)In: Frontiers in Psychology, ISSN 1664-1078, E-ISSN 1664-1078, Vol. 10, article id 1532Article in journal (Refereed) Published
Abstract [en]

The present study tested the impact of attention training on cognition; secondary appraisal of perceived stress, and on metacognition; meta-worry in stressed students. Theoretically derived from the Self-Regulatory Executive Function model (S-REF model; Wells and Matthews, 1994a, 1996), the attention training technique (ATT; Wells, 1990) is intended to promote flexible, voluntary external attention and has been shown to reduce symptoms of psychological distress. The present experimental study explored the effects of ATT on cognitive and metacognitive levels of appraisal, namely perceived stress (primary outcome) and meta-worry (secondary outcome). Stressed students were randomized to an experimental ATT group (n = 23) or a control group (n = 23). The ATT group attended an initial training session followed by 4 weeks of individual (12 min) daily ATT practice. The control group waited for 4 weeks before receiving the intervention. The outcomes were scores on the Perceived Stress Scale 14 (PSS-14) and the Meta-Worry Questionnaire (MWQ) frequency and belief subscales at post study. Both measures decreased significantly following ATT with large pre- to post-effect sizes but there were minimal changes in the control group. The between-group differences were statistically significant. The results add to the literature on the potential effects of ATT by demonstrating effects on the content of cognitive stress appraisals and on meta-worry in an academic setting in a stressed student sample.

Place, publisher, year, edition, pages
FRONTIERS MEDIA SA, 2019
Keywords
attention training, stress, meta-worry, S-REF model, experimental study
National Category
Applied Psychology
Identifiers
urn:nbn:se:uu:diva-390795 (URN)10.3389/fpsyg.2019.01532 (DOI)000474813400001 ()31354569 (PubMedID)
Available from: 2019-08-14 Created: 2019-08-14 Last updated: 2019-08-14Bibliographically approved
Folke, F., Hursti, T., Kanter, J. W., Arinell, H., Tungström, S., Söderberg, P. & Ekselius, L. (2018). Exploring the relationship between activities and emotional experience using a diary in a mental health inpatient setting.. International Journal of Mental Health Nursing, 27(1), 276-286
Open this publication in new window or tab >>Exploring the relationship between activities and emotional experience using a diary in a mental health inpatient setting.
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2018 (English)In: International Journal of Mental Health Nursing, ISSN 1445-8330, E-ISSN 1447-0349, Vol. 27, no 1, p. 276-286Article in journal (Refereed) Published
Abstract [en]

Mental health inpatient milieus have repeatedly been found to be associated with passivity, social disengagement, and low levels of interaction with staff. However, little is known about patients' experiences related to different ward activities. In the present study, we aimed to study the reports of activities and associated experiences of patients admitted to acute psychiatric inpatient wards. Disengaged, inactive, and solitary activities were hypothesized to be associated with less reward and more distress than their counterparts. We also aimed to investigate if such activities predicted distress, and if they were associated with clinical severity. Participants (n = 102) recorded their activities along with concurrent ratings of reward and distress in a structured 1-day diary, and nurses provided clinical severity ratings. On average, 3.74 of the 11 hours assessed (34%) were spent doing nothing, only 0.88 hours (8%) were spent with staff, and most of the time was spent in solitude. Doing nothing, being alone, and passivity were associated with the greatest levels of distress and lowest levels of reward, whereas informal socializing demonstrated the opposite pattern. Distress was not predicted by activity or reward when adjusting for baseline distress. Clinical severity was not associated with the amount of time spent alone or the experience of reward during activity. In conclusion, the risk for passivity and social disengagement during admission prevails. This activity pattern could have detrimental emotional consequences and warrants action, but more studies are needed to determine if activity actually precedes emotional experience.

Keywords
activity, diary, hospitalized, mental health inpatient, reward
National Category
Other Medical Sciences not elsewhere specified
Identifiers
urn:nbn:se:uu:diva-330226 (URN)10.1111/inm.12318 (DOI)000419717100027 ()28220616 (PubMedID)
Available from: 2017-09-28 Created: 2017-09-28 Last updated: 2018-02-14Bibliographically approved
Åhlén, J., Hursti, T., Tanner, L., Tokay, Z. & Ghaderi, A. (2018). Prevention of Anxiety and Depression in Swedish School Children: a Cluster-Randomized Effectiveness Study. Prevention Science, 19(2), 147-158
Open this publication in new window or tab >>Prevention of Anxiety and Depression in Swedish School Children: a Cluster-Randomized Effectiveness Study
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2018 (English)In: Prevention Science, ISSN 1389-4986, E-ISSN 1573-6695, Vol. 19, no 2, p. 147-158Article in journal (Refereed) Published
Abstract [en]

Our study aimed at evaluating FRIENDS for Life, an intervention to prevent anxiety and depression in Swedish school children. A total of 695 children between the ages of 8 and 11 were recruited from 17 schools in Stockholm, Sweden, and cluster-randomized to either the intervention or control group. Teachers in the intervention group received a full day of training and administered FRIENDS for Life in their classrooms. We assessed the children's anxiety and depressive symptoms, general mental health, and academic performance at pre- and post-intervention as well as at the 12-month follow-up. A multi-informant approach was used with data collected from children, parents, and teachers. Assessment was done with the Spence Children's Anxiety Scale, Children's Depression Inventory, and the Strengths and Difficulties Questionnaire. Children's baseline symptoms, gender, and age as well as their teacher's use of supervision were examined as moderators of effect. Our study found no short- or long-term effects of the intervention for any outcome with regard to the entire sample. We found an enhanced effect of the intervention regarding children with elevated depressive symptoms at baseline. We found a decrease in anxiety symptoms among children whose teachers attended a larger number of supervision sessions, compared to children whose teachers attended fewer supervised sessions or the control group. Mediation analyses showed that this effect was driven by change in the last phase of the intervention, suggesting that supervision might play an important role in enhancing teachers' ability to administer the intervention effectively.

Place, publisher, year, edition, pages
Springer, 2018
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:uu:diva-332143 (URN)10.1007/s11121-017-0821-1 (DOI)000424262500005 ()28730396 (PubMedID)
Available from: 2017-10-24 Created: 2017-10-24 Last updated: 2019-06-28Bibliographically approved
Wallin, E., Maathz, P., Parling, T. & Hursti, T. (2018). Self-stigma and the intention to seek psychological help online compared to face-to-face. Journal of Clinical Psychology, 74(7), 1207-1218
Open this publication in new window or tab >>Self-stigma and the intention to seek psychological help online compared to face-to-face
2018 (English)In: Journal of Clinical Psychology, ISSN 0021-9762, E-ISSN 1097-4679, Vol. 74, no 7, p. 1207-1218Article in journal (Refereed) Published
Abstract [en]

Objectives: The present study aims to investigate the impact of helpseeking self-stigma on the preference and intention to seek psychologicaltreatment delivered online compared to face-to-face.

Design: This study uses survey data from two Swedish samples.Sample 1 consists of 267 students (78.7% women) with a mean ageof 24.5 (SD = 6.1). Sample 2 consists of 195 primary care patients(56.9% women) with a mean age of 45.3 (SD = 17.7).

Results: The number of participants who preferred online treatmentwas higher if seeking psychological help for a perceived stigmatized problem compared to mental health problems in general. The oddsratios for choosing treatment online over face-to-face were 6.41,95% CI [4.05, 10.14] in Sample 1 and 11.19, 95% CI [5.29, 23.67]in Sample 2. In addition, findings suggest that higher levels of helpseeking self-stigma predicted higher intention to seek treatmentonline compared to face-to-face.

Conclusions: Our results suggest that online interventions may facilitatehelp-seeking among individuals deterred by stigma.

Keywords
E-mental health, help-seeking, Internet based intentions, mental health services, online therapy
National Category
Psychology
Identifiers
urn:nbn:se:uu:diva-343472 (URN)10.1002/jclp.22583 (DOI)000435275800010 ()29315545 (PubMedID)
Available from: 2018-02-27 Created: 2018-02-27 Last updated: 2018-08-29Bibliographically approved
Hensler, I., Bondjers, K., Hursti, T. & Arnberg, F. (2018). The Relation between Disgust and PTSD Symptom Severity. In: : . Paper presented at The International Society for Traumatic Stress Studies 34th Annual meeting, Washington D.C., USA, November 8-10.
Open this publication in new window or tab >>The Relation between Disgust and PTSD Symptom Severity
2018 (English)Conference paper, Poster (with or without abstract) (Refereed)
National Category
Psychology
Identifiers
urn:nbn:se:uu:diva-382959 (URN)
Conference
The International Society for Traumatic Stress Studies 34th Annual meeting, Washington D.C., USA, November 8-10
Available from: 2019-05-07 Created: 2019-05-07 Last updated: 2019-08-22
Alfonsson, S., Johansson, K., Uddling, J. & Hursti, T. (2017). Differences in motivation and adherence to a prescribed assignment after face-to-face and online psychoeducation: A randomized experiment. BMC Psychology, 5(1), Article ID 3.
Open this publication in new window or tab >>Differences in motivation and adherence to a prescribed assignment after face-to-face and online psychoeducation: A randomized experiment
2017 (English)In: BMC Psychology, E-ISSN 2050-7283, Vol. 5, no 1, article id 3Article in journal (Refereed) Published
Abstract [en]

Background: Adherence to treatment homework is associated with positive outcomes in behavioral psychotherapy but compliance to assignments is still often moderate. Whether adherence can be predicted by different types of motivation for the task and whether motivation plays different roles in face-to-face compared to online psychotherapy is unknown. If models of motivation, such as Self-determination theory, can be used to predict patients’ behavior, it may facilitate further research into homework promotion. The aims of this study were, therefore, to investigate whether motivation variables could predict adherence to a prescribed assignment in face-to-face and online interventions using a psychotherapy analog model. Methods: A total of 100 participants were included in this study and randomized to either a face-to-face or online intervention. Participants in both groups received a psychoeducation session and were given an assignment for the subsequent week. The main outcome measurements were self-reported motivation and adherence to the assignment. Results: Participant in the face-to-face condition reported significantly higher levels of motivation and showed higher levels of adherence compared to participants in the online condition. Adherence to the assignment was positively associated with intrinsic motivation and intervention credibility in the whole sample and especially in the online group. Conclusions: This study shows that intrinsic motivation and intervention credibility are strong predictors of adherence to assignments, especially in online interventions. The results indicate that intrinsic motivation may be partly substituted with face-to-face contact with a therapist. It may also be possible to identify patients with low motivation in online interventions who are at risk of dropping out. Methods for making online interventions more intrinsically motivating without increasing external pressure are needed.

Keywords
Adherence, Motivation, Psychoeducation, Internet, Homework assignments
National Category
Applied Psychology
Identifiers
urn:nbn:se:uu:diva-280799 (URN)10.1186/s40359-017-0172-5 (DOI)28126022 (PubMedID)
Available from: 2016-03-15 Created: 2016-03-15 Last updated: 2018-05-08Bibliographically approved
Andersson, E., Hedman, E., Wadstrom, O., Boberg, J., Andersson, E. Y., Axelsson, E., . . . Ljotsson, B. (2017). Internet-Based Extinction Therapy for Worry: A Randomized Controlled Trial. Behavior Therapy, 48(3), 391-402
Open this publication in new window or tab >>Internet-Based Extinction Therapy for Worry: A Randomized Controlled Trial
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2017 (English)In: Behavior Therapy, ISSN 0005-7894, E-ISSN 1878-1888, Vol. 48, no 3, p. 391-402Article in journal (Refereed) Published
Abstract [en]

Worry is a common phenotype in both psychiatric patients and the normal population. Worry can be seen as a covert behavior with primary function to avoid aversive emotional experiences. Our research group has developed a treatment protocol based on an operant model of worry, where we use exposure -based strategies to extinguish the catastrophic worry thoughts. The aim of this study was to test this treatment delivered via the Internet in a large-scale randomized controlled trial. We randomized 140 high-worriers [PSWQ]) to either Internet-based extinction therapy (IbET) or to a waiting-list condition (WL). Results showed that IbET was superior to WL with an overall large between-group effect size of d 1.39 (95% confidence interval [1.04,1.73]) on the PSWQ. In the IbET group, 58% were classified as responders. The corresponding figure for WL participants was 7%. IbET was also superior to the WL on secondary outcome measures of anxiety, depression, meta-cognitions, cognitive avoidance, and quality of life. Overall treatment results were maintained for the IbET group at 4- and 12-month follow-up. The results from this trial are encouraging as they indicate that worry can be targeted with an accessible and novel intervention for worry. Replication trials with active control group are needed.

Place, publisher, year, edition, pages
ASSOC ADV BEHAVIOR THERAPY, 2017
Keywords
worry, exposure, extinction, internet
National Category
Psychology
Identifiers
urn:nbn:se:uu:diva-322677 (URN)10.1016/j.beth.2016.07.003 (DOI)000400123500010 ()28390501 (PubMedID)
Available from: 2017-06-08 Created: 2017-06-08 Last updated: 2017-06-08Bibliographically approved
Alfonsson, S., Olsson, E., Linderman, S., Winnerhed, S. & Hursti, T. (2016). Is online treatment adherence affected by presentation and therapist support?: A randomized controlled trial. Computers in human behavior, 60, 550-558
Open this publication in new window or tab >>Is online treatment adherence affected by presentation and therapist support?: A randomized controlled trial
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2016 (English)In: Computers in human behavior, ISSN 0747-5632, E-ISSN 1873-7692, Vol. 60, p. 550-558Article in journal (Refereed) Published
Abstract [en]

In both face to face and Internet based Cognitive Behavior Therapy, patients' adherence can be improved by different means such as by using motivational techniques or automatic reminders. The main aim of this study was to investigate whether enriched treatment material presentation and/or increased frequency and quality of support would increase participants' adherence to an online relaxation program. One hundred and sixty-two participants with mild to moderate symptoms of stress or worry were included in this study. Participants were randomized to either Normal or Enhanced intervention presentation and Normal or Enhanced support in a full factorial design. Main outcome variables were progress through the online intervention and adherence to prescribed exercises. Participants in the Enhanced support group progressed further through the program than participants in the Normal support group (Z = 2.11, p = .035, r = .17) but there were no significant differences found between the Normal and Enhanced presentation groups. Participants registered a mean of 60% of the prescribed exercises with no significant differences between groups. This study shows that adherence to online interventions can be increased by increased frequency and quality of therapeutic contact. Future studies may investigate how to increase adherence to prescribed homework assignments and whether parts of the therapeutic support may be substituted with automatic systems with retained effects.

Keywords
Internet; Psychotherapy; Stress; Adherence
National Category
Psychology Engineering and Technology
Identifiers
urn:nbn:se:uu:diva-279739 (URN)10.1016/j.chb.2016.01.035 (DOI)000375811900056 ()
Available from: 2016-03-03 Created: 2016-03-03 Last updated: 2017-11-30Bibliographically approved
Alfonsson, S., Olsson, E. & Hursti, T. (2016). Motivation and Treatment Credibility Predicts Dropout, Treatment Adherence, and Clinical Outcomes in an Internet-Based Cognitive Behavioral Relaxation Program: A Randomized Controlled Trial.. Journal of Medical Internet Research, 18(3), Article ID e52.
Open this publication in new window or tab >>Motivation and Treatment Credibility Predicts Dropout, Treatment Adherence, and Clinical Outcomes in an Internet-Based Cognitive Behavioral Relaxation Program: A Randomized Controlled Trial.
2016 (English)In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 18, no 3, article id e52Article in journal (Refereed) Published
Abstract [en]

Background: In previous research, variables such as age, education, treatment credibility, and therapeutic alliance have shown to affect patients' treatment adherence and outcome in Internet-based psychotherapy. A more detailed understanding of how such variables are associated with different measures of adherence and clinical outcomes may help in designing more effective online therapy.

Objective: The aims of this study were to investigate demographical, psychological, and treatment-specific variables that could predict dropout, treatment adherence, and treatment outcomes in a study of online relaxation for mild to moderate stress symptoms.

Methods: Participant dropout and attrition as well as data from self-report instruments completed before, during, and after the online relaxation program were analyzed. Multiple linear and logistical regression analyses were conducted to predict early dropout, overall attrition, online treatment progress, number of registered relaxation exercises, posttreatment symptom levels, and reliable improvement.

Results: Dropout was significantly predicted by treatment credibility, whereas overall attrition was associated with reporting a focus on immediate consequences and experiencing a low level of intrinsic motivation for the treatment. Treatment progress was predicted by education level and treatment credibility, whereas number of registered relaxation exercises was associated with experiencing intrinsic motivation for the treatment. Posttreatment stress symptoms were positively predicted by feeling external pressure to participate in the treatment and negatively predicted by treatment credibility. Reporting reliable symptom improvement after treatment was predicted by treatment credibility and therapeutic bond.

Conclusions: This study confirmed that treatment credibility and a good working alliance are factors associated with successful Internet-based psychotherapy. Further, the study showed that measuring adherence in different ways provides somewhat different results, which underscore the importance of carefully defining treatment adherence in psychotherapy research. Lastly, the results suggest that finding the treatment interesting and engaging may help patients carry through with the intervention and complete prescribed assignments, a result that may help guide the design of future interventions.

National Category
Psychology (excluding Applied Psychology)
Identifiers
urn:nbn:se:uu:diva-279736 (URN)10.2196/jmir.5352 (DOI)000380777800004 ()26957354 (PubMedID)
External cooperation:
Available from: 2016-03-03 Created: 2016-03-03 Last updated: 2017-11-30Bibliographically approved
Alfonsson, S., Olsson, E., Hursti, T., Høyer Lundh, M. & Johansson, B. (2016). Socio-demographic and clinical variables associated with psychological distress one and three years after a breast cancer diagnosis. Supportive Care in Cancer, 24(9), 4017-4023
Open this publication in new window or tab >>Socio-demographic and clinical variables associated with psychological distress one and three years after a breast cancer diagnosis
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2016 (English)In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 24, no 9, p. 4017-4023Article in journal (Refereed) Published
Abstract [en]

PURPOSE: A large group of women (20-30%) report psychological distress shortly after breast cancer diagnosis, and some experience continued or increased symptoms over time. The aim of this study was to investigate socio-demographic and clinical variables associated with sustained psychological distress in this patient group. METHODS: Women with breast cancer (n=833) completed self-report questionnaires regarding socio-demographic and clinical variables shortly after (T1) and 3years after diagnosis (T2) while data on illness severity were collected from a quality register. The Hospital Anxiety and Depression Scale was used as a measure of psychological distress at both time points. RESULTS: The number of participants who reported elevated levels of anxiety was 231 (28%) at T1 and 231 (28%) at T2 while elevated depressive symptoms was reported by 119 (14%) women at T1 and 92 (11%) at T2. Despite non-significant differences in mean scores over time, 91 (15%) participants reported increased anxiety symptoms and 47 (7%) reported increased depressive symptoms. Poor financial situation, lack of social support, previous psychiatric treatment, and high levels of fatigue were associated with both anxiety and depressive symptoms. Reporting high levels of fatigue was the variable most strongly associated with increased psychological distress over time. CONCLUSION: Most participants reported decreased psychological distress over time, but there were subgroups of women who experienced sustained or increased symptoms of anxiety or depression. Participants with poor financial status, previous psychological problems, or high levels of fatigue may be at increased risk of psychological distress. Such individuals may benefit most from psychosocial interventions.

Keywords
Anxiety; Breast cancer; Depression; Distress; Longitudinal
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:uu:diva-287632 (URN)10.1007/s00520-016-3242-y (DOI)000380677200041 ()27129841 (PubMedID)
Available from: 2016-04-25 Created: 2016-04-25 Last updated: 2017-11-30Bibliographically approved
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