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  • 1.
    Alfonsson, Sven
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Parling, Thomas
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Ghaderi, Ata
    Group Behavioral activation for patients with severe obesity and Binge eating disorder: A randomized controlled trial2015In: Behavior modification, ISSN 0145-4455, E-ISSN 1552-4167, Vol. 39, no 2, p. 270-294Article in journal (Refereed)
    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.

  • 2.
    Alfonsson, Sven
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Parling, Thomas
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Ghaderi, Ata
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Screening of Adult ADHD Among Patients Presenting for Bariatric Surgery2012In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 22, no 6, p. 918-926Article in journal (Refereed)
    Abstract [en]

    In the field of bariatric surgery, research on symptoms of adult attention deficit hyperactivity disorder (ADHD) and their interrelationships with other psychological risk factors such as depression and anxiety is scarce. The symptoms of adult ADHD seem to be common in the obese population, but they are rarely investigated before bariatric surgery. ADHD-related symptoms such as impulsivity have at the same time been identified as potential risk factors for less successful weight loss among bariatric surgery patients. The aims of the current study were to screen for symptoms of adult ADHD and to investigate their relationships with other psychological risk factors. Candidates for bariatric surgery ( = 187) were anonymously screened for symptoms of anxiety, depression, and adult ADHD, in addition to disordered eating patterns, by means of questionnaires. The relations between these symptoms were investigated. In the current sample, 10% of patients screened positively for adult ADHD, and the symptoms of adult ADHD were significantly correlated with those of anxiety, depression, and disordered eating. The results show that adult ADHD is more common in this clinical group than in the general population (4%) and that adult ADHD is associated with disordered eating patterns, depression, and anxiety. Further prospective research, using multivariate analysis, is needed to investigate whether the symptoms of adult ADHD, and their interaction with anxiety, depression, or disordered eating, may possibly constitute a risk factor in terms of difficulties in adhering to the post-surgery regime and its potential unfavorable outcome.

  • 3.
    Alfonsson, Sven
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Parling, Thomas
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Ghaderi, Ata
    Department of Clinical Neuroscience, Karolinska Institutet.
    Self-€reported symptoms of adult attention deficit hyperactivity disorder among obese patients seeking bariatric surgery and its relation to alcohol consumption, disordered eating and gender2013In: Clinical Obesity, ISSN 1758-8103, E-ISSN 1758-8111, Vol. 3, no 5, p. 124-131Article in journal (Refereed)
    Abstract [en]

    What is already known about this subject

    • Symptoms of adult attention deficit hyperactivity disorder (ADHD) are common among people with obesity.
    • Symptoms of ADHD are associated with other impulsive behaviours.
    • Impulsivity can manifest differently in women and men.

    What this study adds

    • The prevalence of ADHD symptoms was equal in both sexes in this patient group.
    • ADHD symptoms were associated with hazardous alcohol consumption in men but not in women.
    • It may be important to investigate several comorbid conditions simultaneously instead of a single diagnosis.

    Eating disorders and adult attention deficit hyperactivity disorder (ADHD), both characterized by deficits in impulse control, are common among bariatric surgery patients. Previous studies in other groups have found gender differences in how symptoms of ADHD and eating disorders manifest as women show more disordered eating and men show more risk consumption of alcohol. In the present study, the association between symptoms of adult ADHD, eating disorders and hazardous alcohol consumption was investigated, while considering gender differences. Self-report questionnaires were obtained from 276 bariatric surgery patients 3–6 months before surgery. The prevalence rates of adult ADHD and binge eating disorder (BED) were 8.6% and 6.3%, respectively, with no evidence of gender difference in the prevalence rates. Hazardous alcohol consumption was reported by a significantly larger portion of men (16.9%) than women (8.6%). There was an association between adult ADHD and both BED and hazardous alcohol consumption. However, symptoms of adult ADHD were associated with hazardous alcohol consumption in men but not in women. Our results suggest gender differences in hazardous alcohol consumption and self-reported symptoms of disordered eating despite similar prevalence rate of BED, but no gender difference in symptoms of adult ADHD. Finally, as the associations between these variables seem to be different in women and men, future

  • 4.
    Alfonsson, Sven
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Psychology in Healthcare. Centre for Psychiatry Research, Department of Clinical Neuroscience Karolinska Institutet and Stockholm, Sweden.
    Spännargård, Åsa
    Parling, Thomas
    Centre for Psychiatry Research, Department of Clinical Neuroscience Karolinska Institutet and Stockholm, Sweden.
    Andersson, Gerhard
    Lundgren, Tobias
    The effects of clinical supervision on supervisees and patients in cognitive-behavioral therapy: a study protocol for a systematic review2017In: Systematic Reviews, E-ISSN 2046-4053, Vol. 6, no 94, p. 1-6Article, review/survey (Refereed)
    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.

  • 5.
    Arnberg, Filip K
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, National Center for Disaster Psychiatry.
    Alaie, Iman
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Parling, Thomas
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Jonsson, Ulf
    Karolinska institutet; Statens beredning för medicinsk utvärdering.
    Recent randomized controlled trials of psychological interventions in healthcare: A review of their quantity, scope, and characteristics2013In: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 75, no 5, p. 401-408Article, review/survey (Refereed)
    Abstract [en]

    Objective: This study aimed to describe the quantity, scope, and fundamental characteristics of recently published randomized controlled trials (RCTs) of psychological interventions.

    Methods: We queried two major databases (PsycINFO and PubMeD) for primary reports published in 2010 of RCTs of psychological interventions for participants with a medical condition. We collected data on the characteristics of the trials, participants, interventions, outcomes, and reports.

    Results: Of 3,696 retrieved reports 295 primary publications were included. About half (53%) of trials included participants with a mental disorder and more than half evaluated interventions based on a cognitive behavioral therapy (CBT) framework. A majority of trials recruited participants in North America and Europe (79%). A minority of the trials focused on children and adolescents (17%) or the elderly (8%). The median sample size of the intervention arm was n = 41. Thirty-nine percent of trials reported solely patient-reported outcomes. Only 5% of reports indicated funding from for-profit organizations. The median 2010 impact factor of the journals in which reports were published was 2.96.

    Conclusion: This snapshot of the research on psychological interventions suggests that the evidence base for psychological interventions is expanding mainly for CBT interventions for adults in high-income countries. Although the restrictive inclusion criteria limit the generalizability of these results, researchers and funding agencies might be advised to strive for greater diversity regarding interventions, geographical/cultural settings and age groups. Regularly updated reviews of this research field, with gradually refined methodology and increased scope, may further inform funders and researchers.

  • 6.
    Fogelkvist, Maria
    et al.
    University Health Care Research Center, Faculty of Medicine and Health, Örebro University, SE 701 82 Örebro, Sweden..
    Parling, Thomas
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Kjellin, Lars
    University Health Care Research Center, Faculty of Medicine and Health, Örebro University, SE 701 82 Örebro, Sweden..
    Gustafsson, Sanna Aila
    University Health Care Research Center, Faculty of Medicine and Health, Örebro University, SE 701 82 Örebro, Sweden..
    A qualitative analysis of participants’ reflections on body image during participation in a randomized controlled trial of acceptance and commitment therapy2016In: Journal Of Eating Disorders, ISSN 2050-2974, Vol. 4, article id 29Article in journal (Refereed)
    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.

  • 7.
    Folke, Fredrik
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Parling, Thomas
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Melin, Lennart
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Acceptance and Commitment Therapy for Depression: A Preliminary Randomized Clinical Trial for Unemployed on Long-Term Sick Leave2012In: Cognitive and Behavioral Practice, ISSN 1077-7229, E-ISSN 1878-187X, Vol. 19, no 4, p. 583-594Article in journal (Refereed)
    Abstract [en]

    This preliminaly study investigated the feasibility of a brief Acceptance and Commitment Therapy (ACT) in a Swedish sample of unemployed individuals on long-term sick leave due to depression. Participants were randomized to a nonstandardized control condition (N = 16) or to the ACT condition (N = 18) consisting of 1 individual and 5 group sessions. From pretreatment to 18-month follow-up the ACT participants improved significantly on measures of depression, general health, and quality of life compared to participants in the control condition. The conditions did not differ regarding sick leave and employment status at any time point. The results indicate that ACT is a promising treatment for depression. The need for further refinements of future ACT protocols for this population is discussed.

  • 8.
    Ghaderi, Ata
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Parling, Thomas
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Lev med din kropp: Om acceptans och självkänsla2009 (ed. 1)Book (Other (popular science, discussion, etc.))
  • 9.
    Jonsson, Ulf
    et al.
    Swedish Council on Health Technology Assessment; Karolinska Institutet.
    Alaie, Iman
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Parling, Thomas
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Arnberg, Filip K
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, National Center for Disaster Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, Ulleråker, University Hospital.
    Reporting of harms in randomized controlled trials of psychological interventions for mental and behavioral disorders: A review of current practice2014In: Contemporary Clinical Trials, ISSN 1551-7144, E-ISSN 1559-2030, Vol. 38, no 1, p. 1-8Article, review/survey (Refereed)
    Abstract [en]

    Background

    Data suggest that certain psychological interventions can induce harm in a significant number of patients. While the need for adequate reporting of harms in clinical trials has repeatedly been emphasized, it is uncertain whether such information routinely is collected and reported in trials within this research field.

    Method

    We used the two major databases in clinical psychology and medicine (PsycINFO and PubMed) to identify original publications from 2010 reporting randomized controlled trials of psychological interventions for patients with mental and behavioral disorders. Two reviewers searched the full-text reports for information about monitoring of adverse events, side effects, and deterioration.

    Results

    Totally 132 eligible trials were identified. Only 28 trials (21%) included information that indicated any monitoring of harms on patient level. Four (3%) of these trials provided a description of adverse events as well as the methods used for collecting these data. Five of the trials (4%) reported adverse events but gave incomplete information about the method. An additional four reports (3%) briefly stated that no adverse events occurred, whereas 15 trials (11%) only provided information on deterioration or indicated monitoring of deterioration. The probability of including harm-related information was related to the journal impact factor.

    Conclusion

    Important information about harms is not reported systematically within this research field, suggesting that the risk of reporting bias is nontrivial in conclusions about the risk-benefit ratio of psychological treatments. Guidelines on how to define, detect, and report harms related to psychological interventions could facilitate better reporting.

  • 10.
    Lundgren, Tobias
    et al.
    Department of Clinical neuroscience & Centre for psychiatry research and education, Karolinska institutet, Stockholm County Council, Stockholm, Sweden.
    Parling, Thomas
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology. Department of Clinical neuroscience & Centre for psychiatry research and education, Karolinska institutet, Stockholm County Council, Stockholm, Sweden..
    Swedish Acceptance and Action Questionnaire (SAAQ): a psychometric evaluation2017In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 46, no 4, p. 315-326Article in journal (Refereed)
    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.

  • 11.
    Månsson, Josefin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Parling, Thomas
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Swenne, Ingemar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Favorable effects of clearly defined interventions by parents at the start of treatment of adolescents with restrictive eating diorders2016In: International Journal of Eating Disorders, ISSN 0276-3478, E-ISSN 1098-108X, Vol. 49, no 1, p. 92-97Article in journal (Refereed)
    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.

  • 12.
    Parling, Thomas
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Anorexia Nervosa: Emotion, Cognition, and Treatment2011Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Anorexia nervosa (AN) is a serious disorder with long-term consequences for those afflicted. No evidence-based care is available for adults with full or subthreshold AN. The thesis research investigated aspects of emotion and cognition relevant to the maintenance of AN that might inform psychological treatment. In addition, the effectiveness of a recent psychotherapy model of AN was investigated.

    Study I investigated alexithymia and emotional awareness and their associations with depression, anxiety, and perfectionism among patients with AN compared with a control group. The AN group exhibited the same level of emotional awareness as did the control group and the same level of alexithymia when controlling for depression and anxiety. Alexithymia and emotional awareness were not associated, despite representing an overlapping construct. The results of the present study indicate that those with AN can trust their emotional awareness.

    Study II explored implicit pro-thin and anti-fat attitudes (towards the self and others), striving for thinness (loosely corresponding to positive reinforcement), and avoidance of fatness (loosely corresponding to negative reinforcement). The AN and the control groups were found to have equally strong implicit pro-thin and striving for thinness attitudes. The AN group exhibited stronger implicit anti-fat and avoidance of fatness attitudes (loosely corresponding to negative reinforcement) than did the control group. There was no association between implicit and explicit measures. The results are in line with the over-evaluation of weight and shape as a core feature of eating disorders.

    Study III compared the effectiveness of Acceptance and Commitment Therapy (ACT) and treatment as usual (TAU) for adults with AN after day-care. Follow-up measures indicated no difference in improvement or deterioration between the two groups. The level of perfectionism was reduced in the ACT group relative to the TAU group. The study was compromised by a lower inflow of patients than anticipated and by a high drop-out rate, and thus fails to provide evidence of a difference between the two groups.

    The present thesis demonstrates that emotional awareness is intact in those with AN and that implicit attitudes concerning weight and shape reflect the explicit attitudes, although without association. The treatment study indicates that, when designing treatment, it is important to consider the ambivalence to treatment among those suffering from AN, which is reflected in the high drop-out rate in the present study.

    List of papers
    1. Alexithymia and emotional awareness in anorexia nervosa: time for a shift in the measurement of the concept?
    Open this publication in new window or tab >>Alexithymia and emotional awareness in anorexia nervosa: time for a shift in the measurement of the concept?
    2010 (English)In: Eating Behaviors, ISSN 1471-0153, E-ISSN 1873-7358, Vol. 11, no 4, p. 205-210Article in journal (Refereed) Published
    Abstract [en]

    The present study compared 35 patients with anorexia nervosa (AN) with an age matched control group using the Toronto Alexithymia Scale (TAS-20; a self-report instrument) and the Levels of Emotional Awareness Scale (LEAS; a performance-based instrument). Depression and anxiety have been shown to account for elevated levels of alexithymia in AN, and an elevated level of perfectionism might affect self-reporting in general. The AN-group reported a higher level of alexithymia on the TAS-20 compared to the control group, a difference that disappeared after controlling for depression or anxiety (but not for perfectionism). The findings suggest that the AN-patients believe that they have difficulties in identifying and reporting emotions, but actually perform as well as the control group when confronted with the task of identifying and reporting their emotions according to LEAS. It might be time to rethink the measurement of alexithymia. Maybe, similar to assessment of personality disorders, it should not be assessed when patients are depressed, or it should be assessed through instruments and modalities that are not sensitive to the mood state of the patient.

    Keywords
    Alexithymia, Emotional awareness, Anorexia nervosa, Anxiety, Depression, Perfectionism
    National Category
    Psychology
    Identifiers
    urn:nbn:se:uu:diva-133742 (URN)10.1016/j.eatbeh.2010.04.001 (DOI)000283484700001 ()
    Available from: 2010-11-16 Created: 2010-11-15 Last updated: 2017-12-12Bibliographically approved
    2. Using the Implicit Relational Assessment Procedure to Compare Implicit Pro-Thin/Anti-Fat Attitudes of Patients with Anorexia Nervosa and Non-clinical Controls
    Open this publication in new window or tab >>Using the Implicit Relational Assessment Procedure to Compare Implicit Pro-Thin/Anti-Fat Attitudes of Patients with Anorexia Nervosa and Non-clinical Controls
    Show others...
    2012 (English)In: Eating Disorders, ISSN 1064-0266, E-ISSN 1532-530X, Vol. 20, no 2, p. 127-143Article in journal (Refereed) Published
    Abstract [en]

    Implicit pro-thin/anti-fat attitudes was investigated among a mixed group of patients with full and sub-threshold Anorexia Nervosa (n = 17), and a matched-age control group (n = 17). The Implicit Relational Assessment Procedure (IRAP) was employed to measure implicit pro-thin and anti-fat attitudes towards Self and Others in addition to ‘striving for thinness’ and ‘avoidance of fatness’. The clinical group showed an implicit pro-fat attitude towards Others and stronger anti-fat attitudes towards Self and avoidance of fatness compared with controls. The findings are discussed in relation to the over-evaluation of weight and shape in the clinical group.

    Keywords
    Anorexia Nervosa, Implicit attitudes, Relational Frame Theory, Anorexia Nervosa, Implicit attitudes, Relational Frame Theory, Anorexia Nervosa, Implicit attitudes, Relational Frame Theory, Anorexia Nervosa, Implicit attitudes, Relational Frame Theory
    National Category
    Psychology
    Research subject
    Psychology
    Identifiers
    urn:nbn:se:uu:diva-156524 (URN)10.1080/10640266.2012.654056 (DOI)000208962500004 ()22364344 (PubMedID)
    Available from: 2011-07-29 Created: 2011-07-29 Last updated: 2017-12-08Bibliographically approved
    3. A randomised trial of Acceptance and Commitment Therapy for Anorexia Nervosa after daycare treatment, including five-year follow-up
    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
    Show others...
    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
  • 13.
    Parling, Thomas
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Att hantera stora förändringar i livet2014In: 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)
  • 14. Parling, Thomas
    Kroppsuppfattning och kirurgisk behandling av fetma2014In: 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)
  • 15.
    Parling, Thomas
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Cernvall, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Psychology in Healthcare.
    Ramklint, Mia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Holmgren, Sven
    Uppsala University Hospital, Uppsala, Sweden.
    Ghaderi, Ata
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden.
    A randomised trial of Acceptance and Commitment Therapy for Anorexia Nervosa after daycare treatment, including five-year follow-up2016In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 16, article id 272Article in journal (Refereed)
    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.

  • 16.
    Parling, Thomas
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Cernvall, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Psychosocial oncology and supportive care.
    Stewart, Ian
    School of Psychology, National University of Ireland, Galway.
    Barnes-Holmes, Dermot
    Department of Psychology, National University of Ireland, Maynooth.
    Ghaderi, Ata
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Using the Implicit Relational Assessment Procedure to Compare Implicit Pro-Thin/Anti-Fat Attitudes of Patients with Anorexia Nervosa and Non-clinical Controls2012In: Eating Disorders, ISSN 1064-0266, E-ISSN 1532-530X, Vol. 20, no 2, p. 127-143Article in journal (Refereed)
    Abstract [en]

    Implicit pro-thin/anti-fat attitudes was investigated among a mixed group of patients with full and sub-threshold Anorexia Nervosa (n = 17), and a matched-age control group (n = 17). The Implicit Relational Assessment Procedure (IRAP) was employed to measure implicit pro-thin and anti-fat attitudes towards Self and Others in addition to ‘striving for thinness’ and ‘avoidance of fatness’. The clinical group showed an implicit pro-fat attitude towards Others and stronger anti-fat attitudes towards Self and avoidance of fatness compared with controls. The findings are discussed in relation to the over-evaluation of weight and shape in the clinical group.

  • 17.
    Parling, Thomas
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Mortazavi, Modtjaba
    Ghaderi, Ata
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Alexithymia and emotional awareness in anorexia nervosa: time for a shift in the measurement of the concept?2010In: Eating Behaviors, ISSN 1471-0153, E-ISSN 1873-7358, Vol. 11, no 4, p. 205-210Article in journal (Refereed)
    Abstract [en]

    The present study compared 35 patients with anorexia nervosa (AN) with an age matched control group using the Toronto Alexithymia Scale (TAS-20; a self-report instrument) and the Levels of Emotional Awareness Scale (LEAS; a performance-based instrument). Depression and anxiety have been shown to account for elevated levels of alexithymia in AN, and an elevated level of perfectionism might affect self-reporting in general. The AN-group reported a higher level of alexithymia on the TAS-20 compared to the control group, a difference that disappeared after controlling for depression or anxiety (but not for perfectionism). The findings suggest that the AN-patients believe that they have difficulties in identifying and reporting emotions, but actually perform as well as the control group when confronted with the task of identifying and reporting their emotions according to LEAS. It might be time to rethink the measurement of alexithymia. Maybe, similar to assessment of personality disorders, it should not be assessed when patients are depressed, or it should be assessed through instruments and modalities that are not sensitive to the mood state of the patient.

  • 18.
    Sjömark, Josefin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Reproductive Health.
    Parling, Thomas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Reproductive Health. Karolinska Inst, Ctr Psychotherapy Educ & Res, Stockholm Hlth Care Serv, Stockholm Cty Council, Liljeholmstorget 7B, SE-11364 Stockholm, Sweden;Karolinska Inst, Dept Clin Neurosci, Liljeholmstorget 7B, SE-11364 Stockholm, Sweden.
    Jonsson, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Larsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Skoog Svanberg, Agneta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Reproductive Health.
    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 protocol2018In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 18, article id 387Article in journal (Refereed)
    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.

  • 19.
    Swenne, Ingemar
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Pediatric Endocrinology.
    Parling, Thomas
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology. Karolinska Inst, Dept Clin Neurosci, Ctr Psychiat Res, Stockholm, Sweden.;Stockholm Cty Council, Stockholm Hlth Care Serv, Stockholm, Sweden..
    Salonen-Ros, Helena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Family-based intervention in adolescent restrictive eating disorders: early treatment response and low weight suppression is associated with favourable one-year outcome2017In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 17, article id 333Article in journal (Refereed)
    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.

  • 20.
    Welch, Elisabeth
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Birgegård, Andreas
    Parling, Thomas
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Ghaderi, Ata
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Eating Disorder Examination Questionnaire and Clinical Impairment Assessment Questionnaire: General population and clinical norms for young adult women in Sweden2011In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 49, no 2, p. 85-91Article in journal (Refereed)
    Abstract [en]

    Optimal use of assessment instruments for the detection and diagnosis of eating disorders (ED) depends on the availability of normative data. The aim of this work was to, for the first time, collect norms for both the Eating Disorder Examination Questionnaire (EDE-Q) and the newly developed Clinical Impairment Assessment (CIA) Scale from a general population of young women in Sweden, as well as from a clinical population of ED patients in Sweden. Participants were composed of both a randomized sample from the general population of women aged 18-30 years (N = 760) as well as from a clinical population aged 18-66 years (N = 2383). Data for the clinical population was extracted from the Stepwise database. Mean scores, standard deviations and percentile ranks for the global for the EDE-Q (as well as its subscales) and the CIA are presented. Prevalence figures of key eating disorder behaviors are also reported. Comparisons are made between the results in the present study with other existing normative studies on the EDE-Q and the CIA. The present study contributes to improving the accuracy of the interpretation of scores of the widely used self-report measure of ED, the EDE-Q, and the CIA, both of which play important roles in for diagnosis, prevention and intervention of ED.

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