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Aim: The aim of the study is to investigate if cognitive behavioral therapy given in agroup setting affects anxiety and depression, stress, pain, coping strategies duringdaily life, and health‐related quality of life (HRQoL), among frequent attenders (FAs)in primary care.

Methods: Cognitive behavioral therapy was offered to 331 FAs between 18 and65 years of age, of whom 89 accepted and 54 completed all steps in the protocol;patients were assigned to 1 of 3 groups: 0, 6, and 12‐month waiting time. The therapyconsisted of 12 sessions administered in group format. Outcome measures wereBeck's Anxiety Inventory (BAI), Beck's Depression Inventory (BDI), Hospital Anxietyand Depression Scale (HADS), Everyday Life Stress (ELS), Coping Strategy Question-naire, Multidimensional Pain Inventory‐Swedish version, and Short Form‐36.

Results: Mean age among patients who completed cognitive behavioral therapywas 49.9 years, with a female majority (79.6%). Anxiety and depression scores werereduced after treatment (BAI 16.7 vs 13.6; BDI 16.3 vs 15.7; HADS‐Anxiety 8.41 vs6.05; HADS‐Depression 7.09 vs 5.69). Because waiting time itself did not affectsymptoms, differences reflect treatment effects. Stress ratings were not affected bytreatment. Use of nonadaptive coping strategies likepraying and hopingandcatastrophizingdecreased. Frequent attenders experienced a higher sense of lifecontrol. Frequent attenders reported significantly lower HRQoL than general Swedishpopulation norms in all 8 Short Form‐36 domains including mental and physicalcomponent summary scores (MCS and PCS), and all domains were unaffected bytreatment.

Conclusion: Cognitive behavioral therapy exerts some beneficial effects in FAs.Content of treatment addressed musculoskeletal pain, stress, anxiety, and depression.This broad approach resulted in reduced anxiety, depression, and impact of painbecause of enhanced life control.

Background: Scratching and itch are common clinical signs of atopic dermatitis (AD). Studies of adult patients have shown that a decrease in scratching behaviour results in regression of inflammation and improved healing of the skin.

Objectives: To investigate whether a modified habit reversal (HR) treatment protocol could be used for the treatment of scratching in children to improve skin status.

Methods: The study is a single‐blind, randomized controlled trial of 39 patients who started with registration a week before randomization into one of two groups (intervention or control). The participants in the intervention group received a habit‐breaking therapy of their scratching behaviour (i.e. HR) in addition to a potent steroid (mometasone furoate), whereas the patients in the control group received the steroid alone. The patients were assessed by an independent dermatologist after the first week of registration (baseline assessment) and then after 3 and 8 weeks of treatment. The primary efficacy variable was a change in objective Scoring Atopic Dermatitis (SCORAD).

Results: At the end of the 3‐week treatment period, the change in mean objective SCORAD was significantly (P = 0·027) higher in the intervention group (−31·9 ± 9·5) than in the control group (−23·8 ± 10·1). After the 8‐week follow‐up, the change in mean objective SCORAD was significantly (P = 0·0038) higher in the intervention group (−31·7 ± 10·4) than in the control group (−19·7 ± 9·4).

Conclusions: The treatment of scratching with the HR method in combination with a potent steroid was found to improve skin status significantly after 3 and 11 weeks.

The relationship between psychosocial programming and neurocognition has been established in previous research, but has not been explored in the context of the Illness Management and Recovery Program (IMR). This study examined associations between neurocognition and illness self-management skills acquisition, based on two previous trials of IMR. Neurocognitive functioning was assessed at baseline and post-treatment in 53 participants with schizophrenia or schizoaffective disorder who completed the IMR. Illness self-management was measured by the client and clinician versions of the Illness Management and Recovery Scale. Statistical analyses investigated improvements in neurocognitive functioning and possible association between illness self-management skills acquisition and neurocognitive functioning. Speed of processing as measured by the Trail Making Test A, was related to client-reported acquisition of illness self-management skills, before and after controlling for psychiatric symptoms and medication, but did not predict improvement in clinician ratings of client illness self-management skills. However, when controlling for client session attendance rates, the association between speed of processing and client-reported illness self-management skills acquisition ceased to be statistically significant, which suggests that compromised neurocognitive functioning does not reduce response to training in illness self-management in itself. The association between the frequency of attended IMR sessions and outcome of the IMR seems to decrease the negative impact of compromised neurocognition on illness self-management skills acquisition. Also, clients with slower speed of processing may experience less benefit from the IMR and may attend fewer sessions.

Objective Lack of social support is a strong predictor for poor mental health after disasters. Psychosocial post-disaster interventions may benefit from targeting survivors at risk oflow support, yet it is unknown whether demographic and disaster exposure characteristics are associated with social support. This study assessed if age, gender, educational status, cohabitation, and disaster exposure severity predicted aspects of informal social support in a cohort of Swedish survivors from the 2004 Southeast Asian tsunami.

Methods The participants were 3,536 disaster survivors who responded to a mail survey 14 months after the disaster (49% response rate). Their perceptions of present emotional support, contact with others, tangible support, negative support and overall satisfaction with informal support were assessed with the Crisis Support Scale and analysed in five separate ordinal regressions.

Results Demographic factors and exposure severity explained variation in social supports although the effect size and predictive efficiency were modest. Cohabitation and female gender were associated with both more positive and more negative support. Single-household men were especially at risk for low emotional support and younger women were more likely to perceive negative support. Higher education was associated with more positive support, whereas no clear pattern was found regarding age as a predictor. Disaster exposure severity was associated with more negative support and less overall support satisfaction.

Conclusions After a disaster that entailed little disruptions to the community the associations between demographic characteristics and social support concur with findings in the general population. The findings suggest that psychosocial disaster interventions may benefit from targeting specific groups of survivors.

This study reports the results from a Swedish randomized controlled trial of a standardized behavior management intervention. The intervention targeted students with externalizing behavior in a regular education setting. First- and second-grade students (N = 100) from 38 schools were randomly assigned to either the intervention or an active comparison group. Observer, teacher, and peer ratings were collected at pretest, posttest (6 months later), and follow-up (14 months after pretest). Significant intervention effects were found on student externalizing behavior and teacher behavior management at both posttest and follow-up. The intervention effect on student externalizing behavior was mediated by change in teacher behavior. Moderating effects of demographic and classroom variables were explored, as well as the social validity of the intervention. The results are discussed in relation to cost-effectiveness and feasibility of behavioral interventions in typical school settings.

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.

Purpose: Two studies were conducted to develop and evaluate an instrument attempting to identify and measure personal values, values attainment and believability in thoughts functioning as obstacles in living a valued life.  Study one describes a content validity approach to the construction and preliminary validation of the Bull’s Eye Values Survey (BEVS), using a sample of institutionalized patients suffering from Epilepsy. Study Two investigated the psychometric properties of the BEVS with a sample of Swedish university students. Results indicate that the BEVS is sensitive to treatment effects and can differentiate between clients who receive values based interventions and those that do not. The BEVS subscales and total score appear to measure an independent dimension of psychological functioning that is negatively correlated with measures of depression, anxiety and stress and positively correlated with a measure of psychological flexibility. The BEVS also exhibits acceptable temporal stability and internal consistency. The study provides preliminary support for the BEVS as both a research and clinical tool for measuring values, valued action discrepancies and barriers to value based living.

Objective: The aim of the study was to evaluate the effects of the illness management and recovery (IMR) program on symptoms and psychosocial functioning of individuals with schizophrenia or schizoaffective disorder in an outpatient setting in Sweden. Methods: A total of 41 persons with schizophrenia or schizoaffective disorder who were receiving treatment at six psychiatric outpatient rehabilitation centers were randomly assigned to either an IMR group for nine months or to treatment as usual (control condition). Assessments were conducted at baseline, posttreatment (nine months), and follow-up (21 months) and included self-reports and ratings by clinicians (both blind and nonblind to treatment assignment) of illness management, psychiatric symptoms, recovery, coping, quality of life, hospitalization, insight, and suicidal ideation. Results: As measured by self-report and ratings of nonblinded clinicians, IMR program participants demonstrated significantly greater improvement in illness management than participants in the control condition. Ratings of psychiatric symptoms by blinded clinicians using the Psychosis Evaluation Tool for Common Use by Caregivers and self-reported ratings of psychosocial functioning on the Ways of Coping Questionnaire also showed better outcomes than for participants in treatment as usual. A statistically significant decrease in suicidal ideation between baseline and follow-up was found for IMR program participants. Conclusions: The study supports previous findings and suggests that the IMR program is effective in improving the ability of individuals with schizophrenia to better manage their illness.

The aim of the present study was to evaluate the psychometric properties of the parallel client and clinician versions of the Illness Management and Recovery Scale (IMRS) developed to monitor the clients' progress in the Illness Management and Recovery (IMR) program in schizophrenia. A total of 107 study participants completed assessments of the IMRS, interview-based ratings of psychiatric symptoms, self-ratings of psychiatric symptoms, perception of recovery, and quality of life. Case managers completed the clinician version of the IMRS. Both versions of the scale demonstrated satisfactory internal reliability and strong test-retest reliability. The results also indicated convergent validity with interview-based ratings of psychiatric symptoms, self-rated symptoms, perception of recovery, and quality of life for both versions of the IMRS. These findings support the utility of the IMRS as a measure of illness self-management and recovery in clients with schizophrenia.

Although 14% to 42% of people with whiplash injuries end up with chronic debilitating pain, there is still a paucity of empirically supported treatments for this group of patients. In chronic pain management, there is increasing consensus regarding the importance of a behavioural medicine approach to symptoms and disability. Cognitive behaviour therapy has proven to be beneficial in the treatment of chronic pain. An approach that promotes acceptance of, or willingness to experience, pain and other associated negative private events (e.g. fear, anxiety, and fatigue) instead of reducing or controlling symptoms has received increasing attention. Although the empirical support for treatments emphasizing exposure and acceptance (such as acceptance and commitment therapy) is growing, there is clearly a need for more outcome studies, especially randomized controlled trials. In this study, participants (N = 21) with chronic pain and whiplash‐associated disorders were recruited from a patient organization and randomized to either a treatment or a wait‐list control condition. Both groups continued to receive treatment as usual. In the experimental condition, a learning theory framework was applied to the analysis and treatment. The intervention consisted of a 10‐session protocol emphasizing values‐based exposure and acceptance strategies to improve functioning and life satisfaction by increasing the participants' abilities to behave in accordance with values in the presence of interfering pain and distress (psychological flexibility). After treatment, significant differences in favor of the treatment group were seen in pain disability, life satisfaction, fear of movements, depression, and psychological inflexibility. No change for any of the groups was seen in pain intensity. Improvements in the treatment group were maintained at 7‐month follow‐up. The authors discuss implications of these findings and offer suggestions for further research in this area.