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Sjömark, J., Parling, T., Jonsson, M., Larsson, M. & Skoog Svanberg, A. (2018). A longitudinal, multi-centre, superiority, randomized controlled trial of internet-based cognitive behavioural therapy (iCBT) versus treatment-as-usual (TAU) for negative experiences and posttraumatic stress following childbirth: the JUNO study protocol. BMC Pregnancy and Childbirth, 18, Article ID 387.
Open this publication in new window or tab >>A longitudinal, multi-centre, superiority, randomized controlled trial of internet-based cognitive behavioural therapy (iCBT) versus treatment-as-usual (TAU) for negative experiences and posttraumatic stress following childbirth: the JUNO study protocol
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2018 (English)In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 18, article id 387Article in journal (Refereed) Published
Abstract [en]

Background: About one-third of women report their childbirth as traumatic and up to 10% have severe traumatic stress responses to birth. The prevalence of Posttraumatic stress disorder following childbirth (PTSD FC) is estimated to 3%. Women with PTSD FC report the same symptoms as other patients with PTSD following other types of trauma. The effect of psychological treatment for women with PTSD FC has only been studied in a few trials. Similarly, studies on treatment needs for women not diagnosed as having PTSD FC but who nevertheless face psychological problems are lacking. Methods/design: Women who rate their overall birth experience as negative on a Likert scale, and/or had an immediate caesarean section and/or a major postpartum haemorrhage are randomized to either internet delivered cognitive behaviour therapy (iCBT) plus treatment as usual (TAU) or TAU. The iCBT is to be delivered in two steps. The first step consists of six weekly modules for both the woman and her partner (if they wish to participate) with minimal therapeutic support. Step 2 consists of eight weekly modules with extended therapeutic support and will be offered to participants whom after step 1 report PTSD FC. Assessments will be made at baseline, 6 weeks, 14 weeks, and at follow-ups at 1, 2, 3 and 4 years after baseline. The primary outcome measures are symptoms of posttraumatic stress and depression. Secondary outcomes are quality of life, parent-child bonding, marital satisfaction, coping strategies, experience regarding the quality of care received, health-related quality of life, number of re-visits to the clinic and number of appointments for counselling during the 4 years' period after the negative childbirth experience, time until the woman gets pregnant again, and the type of birth in the subsequent pregnancy. A health economic evaluation in the form of a cost utility analysis will be conducted. Discussion: This study protocol describes a randomized controlled trial that will provide information about the effectiveness of iCBT in women with negative experiences, posttraumatic stress, and PTSD FC.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
Study protocol, iCBT, Immediate caesarean section, Negative birth experience, Postpartum haemorrhage, Posttraumatic stress following childbirth, PTSD following childbirth, PTSD
National Category
Obstetrics, Gynecology and Reproductive Medicine Psychiatry
Identifiers
urn:nbn:se:uu:diva-367411 (URN)10.1186/s12884-018-1988-6 (DOI)000446222700001 ()30285758 (PubMedID)
Funder
Swedish Research Council
Available from: 2018-12-03 Created: 2018-12-03 Last updated: 2018-12-03Bibliographically approved
Swenne, I., Parling, T. & Salonen-Ros, H. (2017). Family-based intervention in adolescent restrictive eating disorders: early treatment response and low weight suppression is associated with favourable one-year outcome. BMC Psychiatry, 17, Article ID 333.
Open this publication in new window or tab >>Family-based intervention in adolescent restrictive eating disorders: early treatment response and low weight suppression is associated with favourable one-year outcome
2017 (English)In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 17, article id 333Article in journal (Refereed) Published
Abstract [en]

Background: Family-based treatments are first-line treatments for adolescents with restrictive eating disorders (ED) but have to be improved since outcome is poor for some. We have investigated the one-year outcome of a family-based intervention programme with defined and decisive interventions at the start of treatment.

Method: Data pertaining 201 adolescents with restrictive ED with features of anorexia nervosa but not fulfilling the weight criterion starting treatment 2010-2015, had a wide range of body mass index (BMI) and of weight loss at presentation, and completed a one-year follow-up was analysed. Recovery from the ED was defined as an Eating Disorder Examination-questionnaire (EDE-Q) score < 2.0 or as not fulfilling criteria for an ED at a clinical interview.

Results: By EDE-Q 130 (65%) had recovered at 1 year and by clinical interview 106 (53%). According to the EDE-Q criterion recovery was independently associated with lower EDE-Q score at presentation, higher weight gain after 3 months of treatment and lower weight suppression at follow-up, weight suppression being defined as the difference between premorbid and current BMI. Not fulfilling criteria for an ED was associated with the same factors and also by higher BMI at presentation.

Conclusion: The observations that low weight and high ED cognitions confer a poor prognosis but that rapid weight gain at the start of treatment predicts a better prognosis are presently extended to adolescents with restrictive ED with a wide range of BMI at presentation. High weight suppression at follow-up is associated with a poor prognosis and indicates the importance of taking premorbid BMI into account when setting weight targets for treatment.

Keywords
Adolescents, Anorexia nervosa, Eating disorder, Family-based intervention, Weight suppression, Early treatment response
National Category
Pediatrics Psychiatry
Identifiers
urn:nbn:se:uu:diva-335187 (URN)10.1186/s12888-017-1486-9 (DOI)000410938600001 ()28915806 (PubMedID)
Funder
Sven Jerring Foundation
Available from: 2017-12-08 Created: 2017-12-08 Last updated: 2017-12-08Bibliographically approved
Lundgren, T. & Parling, T. (2017). Swedish Acceptance and Action Questionnaire (SAAQ): a psychometric evaluation. Cognitive Behaviour Therapy, 46(4), 315-326
Open this publication in new window or tab >>Swedish Acceptance and Action Questionnaire (SAAQ): a psychometric evaluation
2017 (English)In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 46, no 4, p. 315-326Article in journal (Refereed) Published
Abstract [en]

Psychological inflexibility and experiential avoidance are equivalent (with somewhat different connotations) concepts and refer to an unwillingness to remain in contact with particular private events. This concept is most often measured by the Acceptance and Action Questionnaire (AAQ-II) and is strongly related to psychopathology and behavioral effectiveness. In this study, the preliminary psychometric properties of the Swedish version of the AAQ-II (Swedish Acceptance and Action Questionnaire—SAAQ) are presented. The study is done in two steps. In the first step, the 10-item version of the AAQ-II is investigated through principal component analysis (n = 147). Secondly, due to problems with the component structure, the instrument is reduced to a six-item version and its validity and internal consistency are investigated (n = 154). The six-item version shows good concurrent and convergent validity as well as satisfying internal consistency (α = .85). Furthermore, the Swedish six-item version of the AAQ-II showed one strong component. Test–retest reliability was satisfactory (r = .80; n = 228). In future research, predictive and external validity would be important to investigate in order to further ensure that the SAAQ is a useful measure for clinical research. In conclusion, the SAAQ has satisfactory psychometric properties, but more data need to be gathered to further explore the possibilities for the instruments in Swedish contexts.

Place, publisher, year, edition, pages
Routledge, 2017
Keywords
Acceptance, action, experiential avoidance, psychological flexibility, AAQ-II
National Category
Applied Psychology
Identifiers
urn:nbn:se:uu:diva-310066 (URN)10.1080/16506073.2016.1250228 (DOI)000400369600004 ()27931161 (PubMedID)
Available from: 2016-12-09 Created: 2016-12-09 Last updated: 2017-06-26Bibliographically approved
Alfonsson, S., Spännargård, Å., Parling, T., Andersson, G. & Lundgren, T. (2017). The effects of clinical supervision on supervisees and patients in cognitive-behavioral therapy: a study protocol for a systematic review. Systematic Reviews, 6(94), 1-6
Open this publication in new window or tab >>The effects of clinical supervision on supervisees and patients in cognitive-behavioral therapy: a study protocol for a systematic review
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2017 (English)In: Systematic Reviews, E-ISSN 2046-4053, Vol. 6, no 94, p. 1-6Article, review/survey (Refereed) Published
Abstract [en]

Background: Clinical supervision by a senior therapist is a very common practice in psychotherapist training and psychiatric care settings. Though clinical supervision is advocated by most educational and governing institutions, the effects of clinical supervision on the supervisees ’ competence, e.g., attitudes, behaviors, and skills, as well as on treatment outcomes and other patient variables are debated and largely unknown. Evidence-based practice is advocated in clinical settings but has not yet been fully implemented in educational or clinical training settings. The aim of this systematic review is to synthesize and present the empirical literature regarding effects of clinical supervision in cognitive-behavioral therapy. Methods: This study will include a systematic review of the literature to identify studies that have empirically investigated the effects of supervision on supervised psychotherapists and/or the supervisees ’ patients. A comprehensive search strategy will be conducted to identify published controlled studies indexed in the MEDLINE, EMBASE, PsycINFO, and Cochrane Library databases. Data on supervision outcomes in both psychotherapists and their patients will be extracted, synthesized, and reported. Risk of bias and quality of the included studies will be assessed systematically. Discussion: This systematic review will rigorously follow established guidelines for systematic reviews in order to summarize and present the evidence base for clinical supervision in cognitive-behavioral therapy and may aid further research and discussion in this area.

Keywords
Systematic review, Clinical supervision, psychotherapy, Training
National Category
Psychology
Identifiers
urn:nbn:se:uu:diva-324208 (URN)10.1186/s13643-017-0486-7 (DOI)000453154500094 ()28490376 (PubMedID)
Available from: 2017-06-13 Created: 2017-06-13 Last updated: 2019-01-16Bibliographically approved
Fogelkvist, M., Parling, T., Kjellin, L. & Gustafsson, S. A. (2016). A qualitative analysis of participants’ reflections on body image during participation in a randomized controlled trial of acceptance and commitment therapy. Journal Of Eating Disorders, 4, Article ID 29.
Open this publication in new window or tab >>A qualitative analysis of participants’ reflections on body image during participation in a randomized controlled trial of acceptance and commitment therapy
2016 (English)In: Journal Of Eating Disorders, ISSN 2050-2974, Vol. 4, article id 29Article in journal (Refereed) Published
Abstract [en]

Background: Negative body image is a risk factor for development and relapse in eating disorders (ED). Many patients continue to be dissatisfied with their body shape or weight after treatment. This study presents a qualitative analysis of written reflections on body image from patients with an ED and a negative body image before and after an Acceptance and Commitment Therapy group treatment at a specialized ED-unit. Method: Before and after the treatment participants (n = 47) answered a questionnaire with open ended questions on their thoughts on body image. Data were analyzed through conventional content analysis. Results: Body image meant different things for different participants. For some it had to do with how you evaluate your body, whereas others focused on whether their body image was realistic or not. Some emphasized their relationship with their body, while some described body image as strongly related to global self-esteem. These different views on the concept of body image affected the participants' descriptions of their own body image, and how they wanted it to change. Body image was considered a state that fluctuated from day to day. After treatment the participants described changes in their body image, for instance perceiving oneself as less judgmental towards one's body, and a shift in focus to the important things in life. Conclusions: The participants had different views on body image and how they wished it to change. Thus treatment interventions targeting negative body image needs to address various aspects of this complex construct.

Keywords
Acceptance and commitment therapy, Body dissatisfaction, Body image, Content analysis, Eating disorders, Qualitative research
National Category
Applied Psychology
Research subject
Psychiatry
Identifiers
urn:nbn:se:uu:diva-310105 (URN)10.1186/s40337-016-0120-4 (DOI)000395714600001 ()27999670 (PubMedID)
Available from: 2016-12-09 Created: 2016-12-09 Last updated: 2017-06-30Bibliographically approved
Parling, T., Cernvall, M., Ramklint, M., Holmgren, S. & Ghaderi, A. (2016). A randomised trial of Acceptance and Commitment Therapy for Anorexia Nervosa after daycare treatment, including five-year follow-up. BMC Psychiatry, 16, Article ID 272.
Open this publication in new window or tab >>A randomised trial of Acceptance and Commitment Therapy for Anorexia Nervosa after daycare treatment, including five-year follow-up
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2016 (English)In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 16, article id 272Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: No specific psychotherapy for adult anorexia nervosa (AN) has shown superior effect. Maintenance factors in AN (over-evaluation of control over eating, weight and shape) were addressed via Acceptance and Commitment Therapy (ACT). The study aimed to compare 19 sessions of ACT with treatment as usual (TAU), after 9 to 12weeks of daycare, regarding recovery and risk of relapse up to five years. METHODS: Patients with a full, sub-threshold or partial AN diagnosis from an adult eating disorder unit at a hospital were randomized to ACT (n=24) and TAU (n=19). The staff at the hospital, as well as the participants, were unaware of the allocation until the last week of daycare. Primary outcome measures were body mass index (BMI) and specific eating psychopathology. Analyses included mixed model repeated measures and odds ratios. RESULTS: Groups did not differ regarding recovery and relapse using a metric of BMI and the Eating Disorder Examination Questionnaire (EDE-Q). There were only significant time effects. However, odds ratio indicated that ACT participants were more likely to reach good outcome. The study was underpowered due to unexpected low inflow of patients and high attrition. CONCLUSION: Longer treatment, more focus on established perpetuating factors and weight restoration integrated with ACT might improve outcome. Potential pitfalls regarding future trials on AN are discussed. Trial registration number ISRCTN 12106530. Retrospectively registered 08/06/2016.

Keywords
Anorexia Nervosa, sub-threshold Anorexia Nervosa, Acceptance and Commitment Therapy, Eating Disorders
National Category
Psychology Psychiatry
Research subject
Psychology
Identifiers
urn:nbn:se:uu:diva-156526 (URN)10.1186/s12888-016-0975-6 (DOI)000382223600003 ()27473046 (PubMedID)
Funder
Swedish Research Council
Available from: 2011-07-29 Created: 2011-07-29 Last updated: 2017-12-08Bibliographically approved
Månsson, J., Parling, T. & Swenne, I. (2016). Favorable effects of clearly defined interventions by parents at the start of treatment of adolescents with restrictive eating diorders. International Journal of Eating Disorders, 49(1), 92-97
Open this publication in new window or tab >>Favorable effects of clearly defined interventions by parents at the start of treatment of adolescents with restrictive eating diorders
2016 (English)In: International Journal of Eating Disorders, ISSN 0276-3478, E-ISSN 1098-108X, Vol. 49, no 1, p. 92-97Article in journal (Refereed) Published
Abstract [en]

Objective

To study the effect of clearly defined and decisive parental interventions at the start of treatment of restrictive eating disorders (ED) in adolescents.

Method

Forty-seven adolescents with ED (anorexia nervosa = 6, bulimia nervosa = 1, EDNOS = 40) and their families participated. Parents were advised to (1) keep the adolescent home from school, (2) eat all meals together with the adolescent, (3) prevent any form of exercise, and (4) prevent vomiting during the first week of treatment. Weight change was followed up to three months and EDE-Q administered at start of treatment and at three months.

Results

Thirty (64%) of the families accomplished all four interventions during the first week of treatment. Their adolescents gained ∼1 kg of weight at one week, 2 kg at one month, and 4 kg at three months while adolescents in families who did not accomplish all four interventions gained only 1.4 kg up to three months. Scores on the EDE-Q decreased during treatment and in adolescents of families who accomplished all four interventions they were in the range of a reference population.

Discussion

Decisive parental management of eating disturbed behaviors at the start of treatment of adolescents with ED promotes later clinical outcome. The finding supports the view that family based therapies are effective in adolescent ED. Results has to be followed up for evaluation of the long term effects of this type of intervention.

Keywords
eating disorder, adolescent, family-based treatment
National Category
Psychiatry
Identifiers
urn:nbn:se:uu:diva-268505 (URN)10.1002/eat.22379 (DOI)000367663200010 ()25808555 (PubMedID)
Available from: 2015-12-07 Created: 2015-12-07 Last updated: 2017-12-01Bibliographically approved
Alfonsson, S., Parling, T. & Ghaderi, A. (2015). Group Behavioral activation for patients with severe obesity and Binge eating disorder: A randomized controlled trial. Behavior modification, 39(2), 270-294
Open this publication in new window or tab >>Group Behavioral activation for patients with severe obesity and Binge eating disorder: A randomized controlled trial
2015 (English)In: Behavior modification, ISSN 0145-4455, E-ISSN 1552-4167, Vol. 39, no 2, p. 270-294Article in journal (Refereed) Published
Abstract [en]

The aim of the present study was to assess whether behavioral activation (BA) is an efficacious treatment for decreasing eating disorder symptoms in patients with obesity and binge eating disorder (BED). Ninety-six patients with severe obesity and BED were randomized to either 10 sessions of group BA or wait-list control. The study was conducted at an obesity clinic in a regular hospital setting. The treatment improved some aspects of disordered eating and had a positive effect on depressive symptoms but there was no significant difference between the groups regarding binge eating and most other symptoms. Improved mood but lack of effect on binge eating suggests that dysfunctional eating (including BED) is maintained by other mechanisms than low activation and negative mood. However, future studies need to investigate whether effects of BA on binge eating might emerge later than at post-assessment, as in interpersonal psychotherapy for bulimia nervosa.

National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:uu:diva-226371 (URN)10.1177/0145445514553093 (DOI)000349992100002 ()25268019 (PubMedID)
Available from: 2014-06-16 Created: 2014-06-16 Last updated: 2017-12-05Bibliographically approved
Parling, T. (2014). Att hantera stora förändringar i livet (1ed.). In: Klara Edlund, Arvo Hänni (Ed.), Kirurgisk behandling av fetma: Medicinska och psykologiska aspekter (pp. 87-95). Lund: Studentlitteratur AB
Open this publication in new window or tab >>Att hantera stora förändringar i livet
2014 (Swedish)In: Kirurgisk behandling av fetma: Medicinska och psykologiska aspekter / [ed] Klara Edlund, Arvo Hänni, Lund: Studentlitteratur AB , 2014, 1, p. 87-95Chapter in book (Other academic)
Place, publisher, year, edition, pages
Lund: Studentlitteratur AB, 2014 Edition: 1
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-237143 (URN)9789144069029 (ISBN)
Available from: 2014-11-27 Created: 2014-11-27 Last updated: 2018-05-18
Parling, T. (2014). Kroppsuppfattning och kirurgisk behandling av fetma (1ed.). In: Klara Edlund, Arvo Hänni (Ed.), Kirurgisk behandling av fetma: Medicinska och psykologiska aspekter (pp. 81-85). Lund: Studentlitteratur AB
Open this publication in new window or tab >>Kroppsuppfattning och kirurgisk behandling av fetma
2014 (Swedish)In: Kirurgisk behandling av fetma: Medicinska och psykologiska aspekter / [ed] Klara Edlund, Arvo Hänni, Lund: Studentlitteratur AB, 2014, 1, p. 81-85Chapter in book (Other academic)
Place, publisher, year, edition, pages
Lund: Studentlitteratur AB, 2014 Edition: 1
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-237146 (URN)9789144069029 (ISBN)
Available from: 2014-11-27 Created: 2014-11-27 Last updated: 2018-05-18
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-6159-598X

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