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van de Leur JC, Johansson F, McCracken LM, Åhs F, Brodda Jansen G, Buhrman M. Mediators during a Multimodal intervention for stress-induced exhaustion disorder. Cogn Behav Ther 2024; 53:235-253. [PMID: 38130175 DOI: 10.1080/16506073.2023.2295217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023]
Abstract
Our understanding of the underlying psychological processes of development, maintenance, and treatments for stress-induced exhaustion disorder (ED) remains limited. Therefore, the current study aimed to explore whether sleep concerns, pathological worry, perfectionistic concerns, and psychological flexibility mediate change in exhaustion symptoms during a Multimodal intervention for ED based on Cognitive behavioral therapy principles. Participants (N = 913) were assessed at three time points, and mediation was explored using a two-criteria analytical model with linear mixed-effects models (criterion one) and random intercepts cross-lagged panel modeling (criterion 2). Criterion one for mediation was successfully met, as the findings indicated significant associations between time in treatment, with all suggested mediators, and exhaustion symptoms (significant ab-products). However, criterion two was not satisfied as changes in the mediators did not precede changes in exhaustion symptoms. Therefore, mediation could not be established. Instead, changes in the suggested mediators appeared to result from changes in exhaustion symptoms. Consequently, sleep concerns, pathological worry, perfectionistic concerns, and psychological flexibility appear to improve in conjunction with exhaustion symptoms during treatment, where improvement in exhaustion is indicated as the main driving factor, based on this exploratory analysis. The implications of these findings are contextualized within a broader framework of process-based therapy.
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Affiliation(s)
| | - Fred Johansson
- Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden
| | | | - Fredrik Åhs
- Department of Psychology and Social Work, Mid Sweden University, Östersund, Sweden
| | - Gunilla Brodda Jansen
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Karolinska Institutet Danderyds University Hospital, Stockholm, Sweden
| | - Monica Buhrman
- Department of Psychology, Uppsala University, Uppsala, Sweden
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Guerrero E, Andreasson K, Larsen L, Buus N, Skovgaard Larsen JL, Krogh J, Thastum R, Lindberg L, Lindblad K, Erlangsen A, Nordentoft M. Zero Self-Harm app: a mobile phone application to reduce non-suicidal self-injury-study protocol for a randomized controlled trial. Trials 2024; 25:116. [PMID: 38341590 PMCID: PMC10859016 DOI: 10.1186/s13063-024-07932-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 01/16/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) is a growing healthcare problem. Individuals with NSSI have an increased risk of suicidality. Due to stigma, they may self-injure in secret, which means they might not seek help until events have escalated to include suicidal ideation or a mental disorder. Interventions delivered via mobile phone applications (apps) have been linked to reductions in self-injury. This protocol outlines a trial, which examines whether the Zero Self-Harm intervention, consisting of an app for people with NSSI, can reduce the number of NSSI episodes, suicide ideation, and depressive symptoms. METHODS The trial will be conducted as a 6-month 2-arm, parallel-group, multicentre, pragmatic, randomized clinical superiority trial. The intervention group will receive the app and instructions on how to use it, while the control group will be allocated to a waitlist and allowed to download the app after 6 months. After inclusion, participants will be asked to complete questionnaires at baseline, 3 months, and 6 months. The primary outcome is the number of NSSI episodes during the preceding month, as measured at the 6 months follow-up with the Deliberate Self-Harm Inventory. A total of 280 participants, 140 in each arm, will be included. DISCUSSION This trial will assess the effectiveness of the Zero Self-Harm intervention to reduce the number of NSSI episodes. If effective, the app will have the potential to support a large group of people with NSSI. Considering the stigma related to NSSI, the fact that the app may be used in private and anonymously might make it an appealing and acceptable option for support. The app was developed in collaboration with people with lived experiences related to current and/or previous NSSI. As a result of this, the app focuses on minimizing harm, rather than stopping NSSI. This might enhance its utilization. TRIAL REGISTRATION ClinicalTrials.gov NCT04463654 . Registered on 7 June 2020.
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Affiliation(s)
- Evelyn Guerrero
- Psychiatric Centre North Zealand, University Hospital of Hillerød, Dyrehavevej 48, 3400, Hillerød, Denmark
- Danish Research Institute for Suicide Prevention (DRISP), Mental Health Centre Copenhagen, Gentofte hospitalsvej 15, 4th floor, 2900, Hellerup, Denmark
| | - Kate Andreasson
- Psychiatric Centre North Zealand, University Hospital of Hillerød, Dyrehavevej 48, 3400, Hillerød, Denmark.
- Danish Research Institute for Suicide Prevention (DRISP), Mental Health Centre Copenhagen, Gentofte hospitalsvej 15, 4th floor, 2900, Hellerup, Denmark.
| | - Lene Larsen
- Psychiatric Centre North Zealand, University Hospital of Hillerød, Dyrehavevej 48, 3400, Hillerød, Denmark
| | - Niels Buus
- Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C., Denmark
- Faculty of Medicine, Nursing, and Health Sciences, Monash University, Wellington Road, Clayton, 3800, Australia
| | - Jette Louise Skovgaard Larsen
- Danish Research Institute for Suicide Prevention (DRISP), Mental Health Centre Copenhagen, Gentofte hospitalsvej 15, 4th floor, 2900, Hellerup, Denmark
| | - Jesper Krogh
- Mental Health Centre Copenhagen, Gentofte hospitalsvej 15, 4th floor, 2900, Hellerup, Denmark
| | - Rasmus Thastum
- Children's Rights National Association, Trekronergade 26, 2500, Valby, Denmark
| | - Lone Lindberg
- Psykiatrisk Praksis, Arresødalsvej 79, 3300, Frederiksværk, Denmark
| | - Katrine Lindblad
- Centre of Eating Disorders and Self-Harm (VIOSS), Krumtappen 2, 2500, Valby, Denmark
| | - Annette Erlangsen
- Mental Health Centre Copenhagen, Gentofte hospitalsvej 15, 4th floor, 2900, Hellerup, Denmark
- Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C., Denmark
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Hampton House 624 N. Broadway 8th floor, Baltimore, MD, 21205, USA
- Center of Mental Health Research, Australian National University, Building 63, Canberra, ACT, 2601, Australia
| | - Merete Nordentoft
- Mental Health Centre Copenhagen, Gentofte hospitalsvej 15, 4th floor, 2900, Hellerup, Denmark
- Danish Research Institute for Suicide Prevention (DRISP), Mental Health Centre Copenhagen, Gentofte hospitalsvej 15, 4th floor, 2900, Hellerup, Denmark
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Andersson H, Svensson E, Magnusson A, Holmqvist R, Zetterqvist M. Young adults looking back at their experiences of treatment and care for nonsuicidal self-injury during adolescence: a qualitative study. Child Adolesc Psychiatry Ment Health 2024; 18:16. [PMID: 38245758 PMCID: PMC10800066 DOI: 10.1186/s13034-024-00706-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/05/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Nonsuicidal self-injury (NSSI) is associated with stigma, and negative attitudes among healthcare professionals toward NSSI have been reported. A person-centered approach that focuses on how individuals with lived experience of NSSI perceive the treatment and care they receive is invaluable in reducing barriers to help-seeking and improving treatment and mental healthcare services. The aim of the current qualitative study was to explore the perceptions of young adults when they look back upon their experiences of psychiatric treatment for NSSI during adolescence. METHODS Twenty-six individuals with lived experience of NSSI who were in contact with child and adolescent psychiatry during adolescence were interviewed. The interviews were analyzed using thematic analysis. RESULTS Three main themes were developed: Changed perceptions in retrospect, The importance of a collaborative conceptualization and Lasting impression of the relationship. Participants' perception of themselves as well as the treatment changed over time. The importance of a joint understanding of NSSI and an agreed-upon treatment focus was emphasized. The relationship to the mental health professionals, and experiences of how NSSI was communicated, were salient several years later. CONCLUSIONS Healthcare professionals need to communicate about NSSI in a respectful manner and include the perspective of the adolescent with lived experience of NSSI in a joint conceptualization of NSSI and treatment focus.
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Affiliation(s)
- H Andersson
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping university, Linköping, Sweden
| | - E Svensson
- Department of Behavioural Sciences and Learning, Linköping university, Linköping, Sweden
| | - A Magnusson
- Department of Behavioural Sciences and Learning, Linköping university, Linköping, Sweden
| | - R Holmqvist
- Department of Behavioural Sciences and Learning, Linköping university, Linköping, Sweden
| | - M Zetterqvist
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping university, Linköping, Sweden.
- Department of Child and Adolescent Psychiatry, Region Östergötland, Linköping, Sweden.
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Holmqvist Larsson K, Thunberg M, Münger AC, Andersson G, Falkenström F, Zetterqvist M. "It's ok that I feel like this": a qualitative study of adolescents' and parents' experiences of facilitators, mechanisms of change and outcomes in a joint emotion regulation group skills training. BMC Psychiatry 2023; 23:591. [PMID: 37582695 PMCID: PMC10428531 DOI: 10.1186/s12888-023-05080-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 08/04/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Emotion regulation difficulties underlie several psychiatric conditions, and treatments that focus on improving emotion regulation can have an effect on a broad range of symptoms. However, participants' in-depth experiences of participating in emotion regulation treatments have not been much studied. In this qualitative study, we investigated participants' experiences of a joint emotion regulation group skills training in a child and adolescent psychiatric outpatient setting. METHODS Twenty-one participants (10 adolescents and 11 parents) were interviewed about their experiences after they had participated in a seven-session transdiagnostic emotion regulation skills training for adolescents and parents. The aim of the skills training was to decrease emotion regulation difficulties, increase emotional awareness, reduce psychiatric symptoms, and enhance quality of life. The skills training consisted of psychoeducation about emotions and skills for regulating emotions. The interviews were transcribed and analysed using reflexive thematic analysis. RESULTS The analysis resulted in three overarching themes: Parent - Child processes, Individual processes, and Group processes. The result showed that participants considered an improved parent-child relationship to be the main outcome. Increased knowledge, emotion regulation skills and behavioural change were conceptualised as both mechanisms of change and outcomes. The group format, and the fact that parents and adolescents participated together, were seen as facilitators. Furthermore, the participants experienced targeting emotions in skills training as meaningful and helpful. CONCLUSION The results highlight the potential benefits of providing emotion regulation skills training for adolescents and parents together in a group format to improve the parent-child relationship and enable the opportunity to learn skills.
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Affiliation(s)
- K Holmqvist Larsson
- Department of Child and Adolescent Psychiatry in Linköping, Region Östergötland, and Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | - M Thunberg
- Department of Child and Adolescent Psychiatry in Norrköping, Region Östergötland, Norrköping, Sweden
| | - A-C Münger
- Barnafrid at Department of Biomedical and Clinical Sciences, Swedish National Center on Violence Against Children, Linköping University, Linköping University, Linköping, Sweden
| | - G Andersson
- Department of Behavioural Sciences and Learning, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - F Falkenström
- Department of Psychology, Linnaeus University, Växjö, Sweden
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - M Zetterqvist
- Department of Child and Adolescent Psychiatry in Linköping, Region Östergötland, and Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Pérez Arqueros V, Ibáñez-Beroiz B, Goñi-Sarriés A, Galbete Jiménez A. Efficacy of psychotherapeutic interventions for non-suicidal self-injury in adolescent population: Systematic review and meta-analysis. SPANISH JOURNAL OF PSYCHIATRY AND MENTAL HEALTH 2023; 16:119-126. [PMID: 37689523 DOI: 10.1016/j.rpsm.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 08/30/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
Non-suicidal self-injury (NSSI) is the deliberate and self-inflicted damage to body tissue in the absence of fatal intent, and has become a serious health problem among adolescents. The aim of this study was to evaluate the efficacy of treatment for NSSI in this population through a systematic revision and meta-analysis (PROSPERO ID: 252355). Studies with therapies that reduced NSSI were included. The search was performed in the Medline, APA PsycINFO and PubPsych databases. The synthesis of measures for the main outcome (NSSI reduction) and for secondary outcomes (global functioning change and depressive symptomatology reduction) was performed using a random effects model. The search identified a total of 1881 studies. The systematic review included five studies and the meta-analysis four studies. The summary effect estimate for the standardized mean difference in NSSI was -0.53 (95% CI: -0.82, -0.25), in global functioning it was 0.62 (95% CI: 0.34, 0.91), and in depressive symptomatology it was -0.59 (95% CI: -0.82, -0.36). The certainty of the evidence using the GRADE method is low. We conclude that therapies specifically aimed at reducing NSSI are effective in reducing both NSSI and depressive symptoms while increasing global functioning.
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Affiliation(s)
| | - Berta Ibáñez-Beroiz
- Departamento de Salud, Universidad Pública de Navarra (UPNA), Pamplona, Spain; Navarrabiomed-HUN-UPNA, Pamplona, Spain; Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Pamplona, Spain; Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdISNA), Pamplona, Spain.
| | | | - Arkaitz Galbete Jiménez
- Navarrabiomed-HUN-UPNA, Pamplona, Spain; Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Pamplona, Spain; Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdISNA), Pamplona, Spain; Departamento de Estadística, Matemáticas e Informática. Universidad Pública de Navarra (UPNA), Pamplona, Spain
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Fekih-Romdhane F, Kanj G, Obeid S, Hallit S. Psychometric properties of an Arabic translation of the brief version of the difficulty in emotion regulation scale (DERS-16). BMC Psychol 2023; 11:72. [PMID: 36922893 PMCID: PMC10015724 DOI: 10.1186/s40359-023-01117-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 03/07/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND The current study aimed to examine the psychometric properties of an Arabic translation of the short form of the Difficulty in Emotion Regulation Scale (DERS-16) in an Arabic-speaking population-based adult sample in Lebanon. In particular, the factorial structure, composite reliability, convergent validity and gender invariance were investigated. METHODS A total of 411 Lebanese adult participants (mean age of 32.86 ± 11.98 years, 75.4% females) took part of this cross-sectional web-based study. The forward and backward translation method was applied. RESULTS Findings revealed good internal consistency of the Arabic DERS-16 total scale and five subscales (McDonald's ω ranging from 0.81 to 0.95). Confirmatory factor analyses confirmed the five-factor solution of the scale and demonstrated strong measurement invariance across gender at the configural, metric, and scalar levels. No significant differences were found in all DERS-16 domains between men and women participants. Finally, the DERS-16 scores and sub-scores showed strong correlations with the Borderline Personality Questionnaire (r > .40), thus indicating its convergent validity. CONCLUSION Overall, the present findings suggest that the Arabic version of the DERS-16 may be a reliable and valid self-report measure that assesses ER difficulties as a multidimensional construct. Making the Arabic version of the DERS-16 available will hopefully strengthen its utilization for clinical and research purposes to benefit the millions of Arabic-speaking people worldwide.
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Affiliation(s)
- Feten Fekih-Romdhane
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry "Ibn Omrane", Razi Hospital, Manouba, 2010, Tunisia.,Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Gaelle Kanj
- School of Arts and Sciences, Holy Spirit University of Kaslik, Jounieh, P.O. Box 446, Lebanon
| | - Sahar Obeid
- Social and Education Sciences Department, School of Arts and Sciences, Lebanese American University, Jbeil, Lebanon
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, P.O. Box 446, Lebanon. .,Psychology Department, College of Humanities, Efat University, Jeddah, 21478, Saudi Arabia. .,Applied Science Research Center, Applied Science Private University, Amman, Jordan. .,Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.
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7
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Tschan T, Pfeiffer S, Gutzweiler R, In-Albon T. A comparison of expressed emotion between mothers and their adolescent daughters with and without a history of nonsuicidal self-injury. Child Adolesc Psychiatry Ment Health 2022; 16:64. [PMID: 35941688 PMCID: PMC9361609 DOI: 10.1186/s13034-022-00500-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Expressed Emotion refers to the extent to which close relatives express critical/hostile and/or emotionally overinvolved attitudes and feelings when speaking about a family member. High Expressed Emotion is a valuable predictor of clinical outcomes and is related to the presence of various mental disorders, including nonsuicidal self-injury (NSSI). Interpersonal factors have been shown to be relevant in initiating and in maintaining with NSSI, as interpersonal difficulties are often reported as triggers for emotional dysregulation. The parental role in the etiology and treatment of NSSI needs to be further investigated. This study assesses Expressed Emotion in adolescents who engage in NSSI and their mothers. METHOD We examined Expressed Emotion levels of mother-daughter dyads among adolescents who engage in NSSI, clinical controls (CCs), and nonclinical controls (NCs). The sample consisted of 70 female adolescents aged 12-20 years (M = 15.28 years, SD = 1.81; NSSI: n = 21, CC: n = 17, NC: n = 32) and 24 mothers aged 38-56 years (M = 46.47 years, SD = 4.61) using The Five-Minute Speech Sample (FMSS). RESULTS Adolescents who engage in NSSI exhibited significantly more covert criticism and critical tone toward their mothers than CCs (d = 0.65, d = 1.10) and NCs (d = 1.30, d = 1.10). CONCLUSION The findings highlight the importance of family-based interventions for the treatment of NSSI in order to enhance a positive relationship quality between parents and adolescents.
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Affiliation(s)
- Taru Tschan
- grid.5892.60000 0001 0087 7257Clinical Child and Adolescent Psychology, University of Koblenz-Landau, Landau, Ostbahnstraße 12, 76829 Landau, Germany
| | - Simone Pfeiffer
- grid.5892.60000 0001 0087 7257Clinical Child and Adolescent Psychology, University of Koblenz-Landau, Landau, Ostbahnstraße 12, 76829 Landau, Germany
| | - Raphael Gutzweiler
- grid.5892.60000 0001 0087 7257Clinical Child and Adolescent Psychology, University of Koblenz-Landau, Landau, Ostbahnstraße 12, 76829 Landau, Germany
| | - Tina In-Albon
- Clinical Child and Adolescent Psychology, University of Koblenz-Landau, Landau, Ostbahnstraße 12, 76829, Landau, Germany.
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Meheli S, Lewis SP. Support Seeking in the Context of Self-Injury Recovery: Perspectives From Individuals With Lived Experience. J Nerv Ment Dis 2022; 210:547-556. [PMID: 35044359 DOI: 10.1097/nmd.0000000000001481] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT A sample of 229 university students responded to open-ended questions for the present study, which aimed to gain a deeper understanding of lived experiences of support seeking in the context of self-injury recovery. Inductive thematic analysis of the responses indicated themes from two domains: the benefits of support seeking and the barriers to support seeking. The first domain highlighted benefits from both professional sources (such as receiving diagnosis and referrals to therapy, learning emotion regulation strategies, and developing an improved understanding of self) and informal sources (such as receiving tangible aid, having a support system, and having a compassionate space). The second domain indicated that barriers could be both intrapersonal (such as desire to continue nonsuicidal self-injury, embarrassment and shame, establishing agency without others' support, and minimizing self-injury) and interpersonal (such as fear of being stigmatized, concern for others, and unhelpful prior experiences) in nature. Implications for future research, outreach efforts, and clinical practice are discussed.
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Affiliation(s)
- Saha Meheli
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences (NIMHANS Hospital), Bengaluru, Karnataka, India
| | - Stephen P Lewis
- Department of Psychology, University of Guelph, Guelph, Ontario, Canada
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Seon Q, Mady N, Yang M, Karia M, Lashley M, Sescu C, Lalonde M, Puskas S, Outerbridge J, Parent-Racine E, Pagiatakis C, Gomez-Cardona L, Yiang D, Bouchard S, Linnaranta O. A Virtual Reality-Assisted Cognitive Behavioral Therapy (VR-CBT) for and with Inuit in Quebec - a protocol for a proof-of-concept randomized controlled trial (Preprint). JMIR Res Protoc 2022; 12:e40236. [DOI: 10.2196/40236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 12/19/2022] [Accepted: 01/10/2023] [Indexed: 01/12/2023] Open
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Calvo N, García-González S, Perez-Galbarro C, Regales-Peco C, Lugo-Marin J, Ramos-Quiroga JA, Ferrer M. Psychotherapeutic interventions specifically developed for NSSI in adolescence: A systematic review. Eur Neuropsychopharmacol 2022; 58:86-98. [PMID: 35325633 DOI: 10.1016/j.euroneuro.2022.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/18/2022] [Accepted: 02/24/2022] [Indexed: 11/27/2022]
Abstract
Non-suicidal self-injury (NSSI) is a clinically significant behavior with high relevance and prevalence, especially affecting approximately 17-18% of the adolescent population worldwide. The aim of this study is to perform a systematic review to evaluate the effectiveness of the available Specific Psychotherapeutic Interventions (SPI) focused on the reduction of NSSI behaviors. A systematic review was performed analyzing PsychINFO, MEDLINE, Web of Science, PubMed and Cochrane CentralRegister of Controlled Trials to identify studies of interest from January 2010 to December 2020. According to PRISMA guidelines, only 13 studies were included in the review. Six SPI were found to specifically and significantly reduce NSSI in adolescents: Developmental Group Psychotherapy (DGP), Therapeutic Assessment (TA), Cutting Down Program (CDP), Emotional Regulation Individual Therapy for Adolescents (ERITA), Treatment for Self-Injurious Behaviors (T-SIB) and Intensive Contextual Treatment (ICT). Furthermore, relevant improvements in anxiety and depression symptoms were observed. The results of this review demonstrate the effectiveness of these interventions, mainly the CPD and T-SIB, which are the only SPI that have been studied using Randomized Controlled Trial (RCT). Considering the clinical relevance and associated functional impairment of NSSI, more research is needed to replicate the results and to increase knowledge about SPIs.
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Affiliation(s)
- Natalia Calvo
- Psychiatry Department, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain; Psychiatry, Mental Health and Addictions Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; Grup TLP Barcelona.
| | - Sara García-González
- Psychiatry Department, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Citlalli Perez-Galbarro
- Psychiatry Department, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Christina Regales-Peco
- Psychiatry Department, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Jorge Lugo-Marin
- Psychiatry Department, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain; Psychiatry, Mental Health and Addictions Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Josep-Antoni Ramos-Quiroga
- Psychiatry Department, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain; Psychiatry, Mental Health and Addictions Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; Grup TLP Barcelona
| | - Marc Ferrer
- Psychiatry Department, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain; Psychiatry, Mental Health and Addictions Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; Grup TLP Barcelona
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Emotion Regulation Difficulties and Health-Risk Behaviours in Adolescents. BEHAVIOUR CHANGE 2022. [DOI: 10.1017/bec.2022.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Health-Risk Behaviours (HRBs) are significantly associated with avoidable mortality in adolescents, and preventing HRBs requires an adequate understanding of related factors. Among associated factors, emotion regulation difficulties may impact youths’ engagement in HRBs. Researchers explored the relation of emotion regulation with HRBs; however, specific emotion regulation difficulties for less severe and more prevalent HRBs, such as self-harming behaviour, risky-driving, violence, unhealthy dietary behaviour, and poor adherence to prescribed medication, has not been much explored. The current study aimed to explore the predictability of adolescents’ specific difficulties in emotion regulation in relation to their engagement in HRBs. For this purpose, six different HRBs, that is, self-harm, violence, risky-driving, unhealthy dietary behaviour, inadequate physical activity, and lack of medication adherence, were studied. A total of 617 (Males = 356) adolescents (Mage = 15.77) from five districts of Punjab state (India) provided required information on standardised self-report measures. The data were subjected to regression analysis, and the findings show that the participants who scored high on emotion regulation difficulties reported engagement in HRBs more than their counterparts. Some specific difficulties are more important than others for different forms of HRBs. It implies that the intervention programmes targeting specific HRBs should address specific facets of emotional dysregulation.
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Spitzen TL, Tull MT, Gratz KL. The Roles of Emotion Regulation Self-Efficacy and Emotional Avoidance in Self-Injurious Thoughts and Behaviors. Arch Suicide Res 2022; 26:595-613. [PMID: 32959731 DOI: 10.1080/13811118.2020.1818654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Little research has examined the role of emotion regulation self-efficacy (ERSE; i.e., beliefs in one's own ability to regulate emotions) in self-injurious thoughts and behaviors (SITBs) or the factors that may underlie this relation. This study investigated whether low ERSE relates to SITBs both directly and indirectly through avoidance of negative emotions. Participants (N = 364) completed measures of ERSE, emotional avoidance, suicide attempt history, nonsuicidal self-injury (NSSI), and current severity of suicidal ideation through Amazon's Mechanical Turk. Low ERSE was significantly associated with history of suicide attempts, recent NSSI, and current severity of suicidal ideation both directly and indirectly through avoidance of negative emotions. Furthermore, low ERSE was significantly associated with a greater number of SITB types both directly and indirectly through emotional avoidance.
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13
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Jiang Y, Li X, Harrison SE, Zhang J, Qiao S, Decker S, Zhao J, Zhao G. Long-term effects of a resilience-based intervention on mental health of children affected by parental HIV in China: Testing the mediation effects of emotion regulation and coping. CHILDREN AND YOUTH SERVICES REVIEW 2022; 133:106363. [PMID: 35068635 PMCID: PMC8782278 DOI: 10.1016/j.childyouth.2021.106363] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Resilience-based interventions have been suggested to improve mental health among children affected by parental HIV. Very few studies, however, have explicitly tested the mechanisms of change underlying the effects of resilience-based interventions on mental health among this group of children. The present study utilized a cluster randomized controlled trial to determine the effects of the Child-Caregiver-Advocacy Resilience (ChildCARE) intervention on mental health for children affected by parental HIV. Specifically, we examined the effects of the intervention on three mental health outcomes (i.e., depressive symptoms, school anxiety, loneliness) and whether emotion regulation and coping played mediating roles in the intervention's effectiveness. Child-caregiver dyads (N = 790) were randomly assigned by clusters to three intervention groups and a control group. Children reported on mental health outcomes for 36 months at 6-month intervals. Latent growth curve models showed that there were no direct impacts of the ChildCARE intervention on changes in mental health outcomes beyond 18-month follow-up. Mediation analyses showed that the ChildCARE intervention yielded significant improvements in positive coping, but not negative coping or emotion regulation at 18 months. Emotion regulation, positive coping, and negative coping were consistently associated with the intercepts (i.e., mean at 18 months) of mental health outcomes. Negative coping also significantly predicted the rates of change of mental health outcomes over time. Findings provide important implications for future resilience-based intervention development and highlight the promise of interventions that aim to strengthen emotion regulation and coping skills to improve mental health for children affected by parental HIV.
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Affiliation(s)
- Yanping Jiang
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina, United States
- Department of Psychology, Wayne State University, Detroit, Michigan, United States
| | - Xiaoming Li
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina, United States
| | - Sayward E. Harrison
- Department of Psychology, University of South Carolina, Columbia, South Carolina, United States
| | - JiaJia Zhang
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina, United States
| | - Shan Qiao
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina, United States
| | - Scott Decker
- Department of Psychology, University of South Carolina, Columbia, South Carolina, United States
| | - Junfeng Zhao
- International Research Center for Physical and Psychological Health of Vulnerable Populations, College of Educational Sciences, Henan University, Kaifeng, Henan, China
| | - Guoxiang Zhao
- Department of Psychology, Henan Normal University, Xinxiang, Henan, China
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14
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Monell E, Birgegård A, Nordgren L, Hesser H, Bjureberg J. Factor structure and clinical correlates of the original and 16-item version of the Difficulties In Emotion Regulation Scale in adolescent girls with eating disorders. J Clin Psychol 2021; 78:1201-1219. [PMID: 34855219 DOI: 10.1002/jclp.23286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 10/18/2021] [Accepted: 11/12/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The Difficulties in Emotion Regulation Scale (DERS) is increasingly used in adolescents. This study is the first to examine the factor structure, measurement, and structural invariance across age, reliability, and validity of the original 36-item and 16-item version of the DERS in adolescents with eating disorders. METHODS Several models were examined using confirmatory factor analysis. Measurement and structural invariance were studied across age groups, and Omega, Omega Hierarchical, and criterion validity were examined. RESULTS A bifactor model, with five subscales, showed acceptable fit in both DERS versions. Measurement and structural invariance held across age. The general factor had high reliability and accounted for a large proportion of variance in eating pathology and emotional symptoms. CONCLUSION The Awareness subscale had a negative effect on fit in DERS, but both DERS versions were reliable and valid measures in both younger and older adolescents with eating disorders when using only five subscales.
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Affiliation(s)
- Elin Monell
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Andreas Birgegård
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Line Nordgren
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
| | - Hugo Hesser
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden.,School of Law, Psychology and Social Work, Center for Health and Medical Psychology, Örebro University, Örebro, Sweden
| | - Johan Bjureberg
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.,Department of Psychology, Stanford University, Stanford, California, USA
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15
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Eadeh HM, Breaux R, Nikolas MA. A Meta-Analytic Review of Emotion Regulation Focused Psychosocial Interventions for Adolescents. Clin Child Fam Psychol Rev 2021; 24:684-706. [PMID: 34275057 PMCID: PMC8600935 DOI: 10.1007/s10567-021-00362-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2021] [Indexed: 01/19/2023]
Abstract
Emotion regulation (ER) is the ability to monitor, evaluate, and modify one's emotional responses to be appropriate for environmental demands. Poor ER has been considered a transdiagnostic risk factor for a range of internalizing and externalizing disorders and overall decreased well-being in adolescents. A range of evidence-based interventions exist which may improve ER. However, much of the intervention research to date does not include a measure of ER to assess change pre and post treatment, with limited information about the efficacy of these interventions in youth across a range of sample types. There is a clear need for a comprehensive review of the literature examining ER-focused interventions in adolescents with a wide range of presenting disorders. A literature search was originally conducted in January 2020 and an updated search was conducted in February 2021 which elicited 1245 articles, of which 605 were duplicates and were removed. Abstracts of the remaining 640 articles were screened with 121 articles being reviewed in full. Of note, 16 additional articles were identified through references and other sources during this process and were also included in the full review. Of the 137 articles reviewed in full, 41 studies were ultimately included in the present review. The present paper provides a descriptive review of intervention approaches and findings from community prevention programs, programs for war-affected youth, programs for clinical populations, and programs for incarcerated and delinquent adolescents. The overall pooled effect was significantly different from zero based on the pre/post effects [Hedge's g = 0.29, 95% CI (0.22, 0.36)] and the intervention/control effects [Hedge's g = 0.19, 95% CI (0.06-0.32)]. Although neither sex nor age significantly accounted for heterogeneity in effect sizes, there were significant findings for population type (clinical vs. community), with community samples having significantly lower effect sizes on average. Impacts of the different ER measures used and significant methodological variability (e.g., use of control groups, length of intervention) across included studies are discussed. Implications and suggestions for future research are reviewed, specifically, that additional understanding of moderators of effects are needed and that measures used to assess change in ER, both dysregulation and adaptive skill use, may need to more directly align with the intervention's focus and the strategies taught as part of the intervention.
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Affiliation(s)
- Hana-May Eadeh
- Department of Psychological and Brain Sciences, University of Iowa, 340 Iowa Ave, Iowa City, IA, 52242, USA.
| | - Rosanna Breaux
- Department of Psychology, Virginia Tech, Blacksburg, VA, USA
| | - Molly A Nikolas
- Department of Psychological and Brain Sciences, University of Iowa, 340 Iowa Ave, Iowa City, IA, 52242, USA
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16
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Simonsson O, Engberg H, Bjureberg J, Ljótsson B, Stensils J, Sahlin H, Hellner C. Experiences of an Online Treatment for Adolescents With Nonsuicidal Self-injury and Their Caregivers: Qualitative Study. JMIR Form Res 2021; 5:e17910. [PMID: 34297001 PMCID: PMC8367103 DOI: 10.2196/17910] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/01/2020] [Accepted: 03/16/2021] [Indexed: 11/17/2022] Open
Abstract
Background Nonsuicidal self-injury (NSSI) is common in adolescence and is associated with several adverse outcomes. Despite this, few established treatment options exist. Online treatment seems promising for several conditions; however, knowledge on NSSI is scarce. It is important to explore how online treatment for NSSI is experienced to improve such interventions and learn more about factors that are important in the treatment of adolescents with NSSI. Objective This study aims to explore the experiences of a novel online treatment for adolescents with NSSI and their caregivers. Methods A qualitative study using thematic analysis was conducted through semistructured interviews with 9 adolescents and 11 caregivers at treatment termination or at the 6-month follow-up of the online emotion regulation individual therapy for adolescents. Results A total of 3 overarching themes were identified. The theme support can come in different shapes showed how support could be attained through both interaction with the therapist as well as through the format itself (such as through the fictional characters in the material and the mobile app). Caregivers found it helpful to have their own online course, and adolescents accepted their involvement. The theme self-responsibility can be empowering as well as distressing showed that self-responsibility was highly appreciated (such as deciding when and how to engage in treatment) but also challenging; it caused occasional distress for some. The theme acquiring new skills and treatment effects showed the advantages and challenges of learning several different emotion regulation skills and that decreased emotion regulation difficulties were important treatment outcomes for adolescents. In addition, several different skills seemed to facilitate emotion regulation, and having access to such skills could hinder NSSI. Conclusions Online emotion regulation individual therapy for adolescents seems to offer an accepted way to deliver family interventions for this target group; facilitate skills training with several means of support, including support from both the mobile app and the therapist; contribute to decreasing emotion regulation difficulties and teaching skills that could hinder NSSI; and cause (in some individuals) distress because of the self-responsibility that is inherent to online formats, which needs to be addressed.
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Affiliation(s)
- Olivia Simonsson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Hedvig Engberg
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Medical Unit of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Johan Bjureberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Julia Stensils
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Hanna Sahlin
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Clara Hellner
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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17
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Olsen MH, Morthorst B, Pagsberg AK, Heinrichsen M, Møhl B, Rubæk L, Bjureberg J, Simonsson O, Lindschou J, Gluud C, Jakobsen JC. An Internet-based emotion regulation intervention versus no intervention for non-suicidal self-injury in adolescents: a statistical analysis plan for a feasibility randomised clinical trial. Trials 2021; 22:456. [PMID: 34271984 PMCID: PMC8283974 DOI: 10.1186/s13063-021-05406-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/28/2021] [Indexed: 11/17/2022] Open
Abstract
Background Non-suicidal self-injury (NSSI) has a lifetime prevalence of 17% in adolescents in the general population and up to 74% in adolescents with psychiatric disorders. NSSI is one of the most important predictors of later suicidal behaviour and death by suicide. The TEENS feasibility trial was initiated to assess the feasibility and safety of Internet-based Emotion Regulation Individual Therapy for Adolescents (ERITA) as an add-on to treatment as usual in 13–17-year-old patients with NSSI referred to the Child and Adolescent Mental Health Services. Methods The TEENS feasibility trial is a randomised clinical trial with a parallel-group design. The trial intervention is an 11-week online therapy which is tested as an add-on to treatment as usual versus treatment as usual. The primary feasibility outcomes are the fraction of participants who (1) completed 12 weeks of follow-up interview or assessment, (2) consented to inclusion and randomisation out of all eligible participants, and (3) were compliant with the experimental intervention, assessed as completion of at least six out of eleven modules in the programme. Since this is a feasibility trial, we did not predefine a required sample size. The exploratory clinical outcome, the frequency of NSSI episodes, assessed using Deliberate Self-Harm Inventory – Youth version (DSHI-Y), at the end of intervention, is planned to be the future primary outcome in a larger pragmatic definitive randomised clinical trial. After completion of the feasibility trial, blinded data will be analysed by two independent statisticians blinded to the intervention, where ‘A’ and ‘B’ refer to the two groups. A third party will compare these reports, and discrepancies will be discussed. The statistical report with the analyses chosen for the manuscript is being tracked using a version control system, and both statistical reports will be published as a supplementary material. Based on the final statistical report, two blinded conclusions will be drawn by the steering group. Discussion We present a pre-defined statistical analysis plan for the TEENS feasibility trial, which limits bias, p-hacking, data-driven interpretations. This statistical analysis plan is accompanied by a pre-programmed version-controlled statistical report with simulated data, which increases transparency and reproducibility. Trial registration ClinicalTrials.govNCT04243603. Registered on 28 January 2020 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05406-2.
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Affiliation(s)
- Markus Harboe Olsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark. .,Department of Neuroanaesthesiology, Neuroscience Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
| | - Britt Morthorst
- Research Unit, Child and Adolescent Mental Health Services, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Anne Katrine Pagsberg
- Research Unit, Child and Adolescent Mental Health Services, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health, Copenhagen University, Copenhagen, Denmark
| | - Michella Heinrichsen
- Research Unit, Child and Adolescent Mental Health Services, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Bo Møhl
- Department of Communication and Psychology, Aalborg University, Aalborg, Denmark
| | - Lotte Rubæk
- Team of Self-Injury, Child and Adolescent Mental Health Services, Copenhagen, Denmark
| | - Johan Bjureberg
- Department of Psychology, Stanford University, Stanford, CA, USA.,Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Olivia Simonsson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Jane Lindschou
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Janus Christian Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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18
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Vieira AI, Rodrigues TF, Brandão I, Timóteo S, Nunes P, Gonçalves S. Group-based intervention for eating disorders with non-suicidal-self-injury: a case series. CLIN PSYCHOL-UK 2021. [DOI: 10.1080/13284207.2021.1892454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Ana Isabel Vieira
- Psychology Research Center (Cipsi), School of Psychology, University of Minho, Braga, Portugal
| | - Tânia F. Rodrigues
- Psychology Research Center (Cipsi), School of Psychology, University of Minho, Braga, Portugal
| | - Isabel Brandão
- Department of Psychiatry, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Sertório Timóteo
- Department of Psychiatry, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Patrícia Nunes
- Department of Psychiatry, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Sónia Gonçalves
- Psychology Research Center (Cipsi), School of Psychology, University of Minho, Braga, Portugal
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19
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Lawlor C, Vitoratou S, Hepworth C, Jolley S. Self-reported emotion regulation difficulties in psychosis: Psychometric properties of the Difficulties in Emotion Regulation Scale (DERS-16). J Clin Psychol 2021; 77:2323-2340. [PMID: 33971018 DOI: 10.1002/jclp.23164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/25/2021] [Accepted: 04/12/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Individuals with psychosis self-report difficulties in understanding, relating, and responding to emotions as treatment priorities, yet we lack comprehensive, reliable, and valid assessments for routine clinical use. METHODS The psychometric properties of a brief version of the Difficulties in Emotion Regulation Scale-16 (DERS-16) were examined using anonymized data from a sample of 150 outpatients with psychosis. RESULTS Confirmatory factor analysis supported the five-factor structure of the DERS-16. The model fit was further improved by omitting two items. Measurement invariance was shown with respect to age and gender. The DERS-16 demonstrated good internal consistency, well comparable to the original DERS. Evidence toward convergent validity is also presented. CONCLUSION Findings suggest that the DERS-16 is a reliable and valid measure of self-reported emotion regulation difficulties in individuals with psychosis. Further research on the clinical utility of the DERS-16 is needed, including examination of its test-retest reliability and predictive validity in response to targeted interventions.
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Affiliation(s)
- Caroline Lawlor
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.,North Lambeth Promoting Recovery Team, South London and Maudsley NHS Foundation Trust, London, UK
| | - Silia Vitoratou
- Psychometrics and Measurement Lab, Biostatistics and Health Informatics, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Claire Hepworth
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Suzanne Jolley
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.,North Lambeth Promoting Recovery Team, South London and Maudsley NHS Foundation Trust, London, UK
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20
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Hall K, Youssef G, Simpson A, Sloan E, Graeme L, Perry N, Moulding R, Baker AL, Beck AK, Staiger PK. An Emotion Regulation and Impulse Control (ERIC) Intervention for Vulnerable Young People: A Multi-Sectoral Pilot Study. Front Psychol 2021; 12:554100. [PMID: 33868064 PMCID: PMC8047628 DOI: 10.3389/fpsyg.2021.554100] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 03/08/2021] [Indexed: 01/01/2023] Open
Abstract
Objective: There is a demonstrated link between the mental health and substance use comorbidities experienced by young adults, however the vast majority of psychological interventions are disorder specific. Novel psychological approaches that adequately acknowledge the psychosocial complexity and transdiagnostic needs of vulnerable young people are urgently needed. A modular skills-based program for emotion regulation and impulse control (ERIC) addresses this gap. The current one armed open trial was designed to evaluate the impact that 12 weeks exposure to ERIC alongside usual care had on young people's ability to regulate emotions, as well as examine potential moderating mechanisms. Methods: Seventy nine young people (50.6% male; M = 19.30; SD = 2.94) were enrolled to the 12 week intervention period. Twenty one practitioners from youth and community health services delivered relevant ERIC modules adjunct to usual care. Linear mixed effects regression (with random intercept) was used to examine change over time across the primary outcome of emotion dysregulation and secondary outcomes of depression, anxiety, stress, experiential avoidance and mindfulness. Moderation analyses were conducted to test whether the magnitude of change in emotion dysregulation moderated change over time in secondary outcomes. Results: Analyses revealed significant improvement in the primary outcome of emotion dysregulation with a moderate effect size (Mean Change = -10.24, 95% CI (-14.41, -6.06; Cohen's dav = -0.53), in addition to decreases in the secondary outcomes of depression, anxiety, stress and experiential avoidance. No improvements in mindfulness were reported. Moderation analyses revealed that the residualised change over time in emotion dysregulation moderated the change over time in symptoms of distress, depression, anxiety, stress, experiential avoidance, and mindfulness. Conclusion: Reductions in the severity of emotion dysregulation, depression, anxiety, stress and experiential avoidance are promising, and were evident despite the complexity of the participants and the diversity of the service setting. The improvements found in each outcome were only observed for those young people whose emotion regulation also improved, providing preliminary evidence for the role of emotion regulation as a key treatment target in this population.
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Affiliation(s)
- Kate Hall
- School of Psychology, Deakin University, Geelong, VIC, Australia
- Centre of Drug Use, Addictive and Antisocial Behavior Research, Deakin University, Geelong, VIC, Australia
| | - George Youssef
- School of Psychology, Deakin University, Geelong, VIC, Australia
- Centre of Drug Use, Addictive and Antisocial Behavior Research, Deakin University, Geelong, VIC, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Angela Simpson
- School of Psychology, Deakin University, Geelong, VIC, Australia
- Centre of Drug Use, Addictive and Antisocial Behavior Research, Deakin University, Geelong, VIC, Australia
| | - Elise Sloan
- School of Psychology, Deakin University, Geelong, VIC, Australia
- Centre of Drug Use, Addictive and Antisocial Behavior Research, Deakin University, Geelong, VIC, Australia
| | - Liam Graeme
- School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Natasha Perry
- School of Medicine and Public Health (Psychiatry), University of Newcastle, Newcastle, NSW, Australia
| | - Richard Moulding
- School of Psychology, Deakin University, Geelong, VIC, Australia
- Centre of Drug Use, Addictive and Antisocial Behavior Research, Deakin University, Geelong, VIC, Australia
| | - Amanda L. Baker
- School of Medicine and Public Health (Psychiatry), University of Newcastle, Newcastle, NSW, Australia
| | - Alison K. Beck
- School of Medicine and Public Health (Psychiatry), University of Newcastle, Newcastle, NSW, Australia
| | - Petra K. Staiger
- School of Psychology, Deakin University, Geelong, VIC, Australia
- Centre of Drug Use, Addictive and Antisocial Behavior Research, Deakin University, Geelong, VIC, Australia
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21
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Slesinger NC, Hayes NA, Washburn JJ. Understanding predictors of change in a day treatment setting for non-suicidal self-injury. Psychol Psychother 2021; 94 Suppl 2:517-535. [PMID: 32662182 DOI: 10.1111/papt.12295] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 06/29/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To examine change in non-suicidal self-injury (NSSI) frequency, quality of life, and functional impairment from admission to discharge in patients enrolled in partial hospitalization and intensive outpatient programmes (PHP/IOP) designed to treat NSSI. Demographic, clinical, and treatment-related predictors of changes were also examined. DESIGN Data were collected as part of routine clinical assessment procedures at admission and discharge from patients enrolled in a PHP/IOP programme designed to treat NSSI. The clinical assessment included measures examining quality of life, functional impairment, and NSSI behaviour. METHODS Paired t-tests were used to examine change in NSSI frequency, quality of life, and functional impairment. Reliable clinical change analyses were used to identify clinically significant change in quality of life and functional impairment. Multilevel mixed-effects regression was used to examine predictors of change for quality of life and functional impairment. Negative binomial regression was used to examine predictors of change for NSSI frequency. RESULTS From admission to discharge, NSSI frequency significantly decreased and quality of life and functional impairment evidenced clinically significant change. Age, race/ethnicity, and insurance type predicted change in functional impairment, while gender predicted change in quality of life. Urge to self-injure predicted change in NSSI frequency. Borderline symptoms predicted change across all outcome variables. CONCLUSIONS Patients who completed a day treatment programme for NSSI evidenced significant change in NSSI frequency, functional impairment, and quality of life at discharge; however, several demographic and clinical variables were associated with change. PRACTITIONER POINTS Patients who engage in NSSI show significant change from admission to discharge in a day treatment programme dedicated to the treatment of NSSI. Quality of life and functional impairment are important outcome variables to consider and evaluate in higher levels of care. It is important to consider demographic and clinical variables when creating a treatment plan for NSSI. Although BPD symptoms may be important to consider in day treatment for NSSI, interpersonal dysfunction, depressive symptoms, and mood lability may also affect change in symptoms.
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Affiliation(s)
- Noël C Slesinger
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Nicole A Hayes
- Counseling and Psychological Services, University of California Los Angeles, California, USA
| | - Jason J Washburn
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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22
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Morthorst B, Rubæk L, Lindschou J, Jakobsen JC, Gluud C, Bjureberg J, Hellner C, Møhl B, Pagsberg AK. An internet-based emotion regulation intervention versus no intervention for nonsuicidal self-injury in adolescents: study protocol for a feasibility trial. Pilot Feasibility Stud 2021; 7:44. [PMID: 33549128 PMCID: PMC7866693 DOI: 10.1186/s40814-021-00785-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 01/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) has gained increased attention in recent years due to increased prevalence, especially among adolescents. Evidence-based interventions for NSSI are sparse. Emotion regulation individual therapy for adolescents (ERITA) is an online intervention that needs investigation. Non-randomised studies suggest ERITA improves emotion regulations skills and reduces NSSI frequency. Before conducting a large pragmatic randomised clinical trial, we aim to investigate the feasibility of ERITA in Denmark. METHODS A randomised, parallel group feasibility trial comparing ERITA as add on to treatment as usual versus treatment as usual in 30 adolescents age 13-17 years with recurrent NSSI referred to outpatient clinics in The Child and Adolescent Mental Health Services in the Capital Region of Denmark. Feasibility outcomes are (1) completion of follow-up, (2) the fraction of eligible participants who consent to inclusion and randomisation and (3) compliance with the intervention. Clinical outcomes such as self-injury frequency and the ability to regulate emotions will be investigated exploratorily. DISCUSSION Internet-based interventions are assumed to be appealing to adolescents by being easily accessible and easy to navigate by tech natives. Disclosure of self-injury behaviour may be facilitated by an online intervention. The evidence for self-injury specific treatment needs to be extended but prior to a large clinical trial, the feasibility of methods and procedures must be assessed. TRIAL REGISTRATION ClinicalTrials.Gov Identifier: NCT04243603 .
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Affiliation(s)
- Britt Morthorst
- Research Unit, Child and Adolescent Mental Health Services, The Capital Region of Denmark, Gentofte Hospitalsvej 15, 2900 Hellerup, Denmark
| | - Lotte Rubæk
- Team of Self-Injury, Child and Adolescent Mental Health Services, The Capital Region of Denmark, Lersøpark allé 107, 2100 Copenhagen Ø, Denmark
| | - Jane Lindschou
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - Janus Christian Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
- Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - Johan Bjureberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Stockholms läns sjukvårdsområde (SLSO), Sachsgatan 10, 118 61 Stockholm, Sweden
| | - Clara Hellner
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Stockholms läns sjukvårdsområde (SLSO), Sachsgatan 10, 118 61 Stockholm, Sweden
| | - Bo Møhl
- Department of Communication and Psychology, Aalborg University, Teglgårds Plads 1 (Nordkraft), 9200 Aalborg, Denmark
| | - Anne Katrine Pagsberg
- Research Unit, Child and Adolescent Mental Health Services, The Capital Region of Denmark, Gentofte Hospitalsvej 15, 2900 Hellerup, Denmark
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Abstract
Suicide is the second leading cause of death among adolescents worldwide, yet adequate mental health services for children and adolescents are lacking across the globe. Likewise, youth who engage in non-suicidal self-injury (NSSI) are at heightened risk for suicide, but few pediatric settings have established protocols for screening and responding to youth who engage in NSSI and/or endorse thoughts of suicide. In this article, we highlight similarities and differences of managing suicide and NSSI across cultures, including persisting stigma associated with youth at risk for self-harm. We summarize current guidelines for screening youth at risk for suicide and NSSI across services, consider the use of online and telehealth services, and offer recommendations for a multidisciplinary approach to treating youth who engage in self-harming behaviors as well as how healthcare professionals can communicate with each other using common, non-stigmatizing language. We conclude with a discussion of future policy recommendations and areas for research.
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Affiliation(s)
- Nicholas J Westers
- Department of Psychiatry, Children's Medical Center of Dallas, University of Texas Southwestern Medical Center, USA
| | - Paul L Plener
- Department of Child and Adolescent Psychiatry, Medical University Vienna, Austria
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Zetterqvist M, Perini I, Mayo LM, Gustafsson PA. Nonsuicidal Self-Injury Disorder in Adolescents: Clinical Utility of the Diagnosis Using the Clinical Assessment of Nonsuicidal Self-Injury Disorder Index. Front Psychiatry 2020; 11:8. [PMID: 32116833 PMCID: PMC7034359 DOI: 10.3389/fpsyt.2020.00008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 01/06/2020] [Indexed: 11/19/2022] Open
Abstract
Nonsuicidal self-injury disorder (NSSID) is a condition in need of further study, especially in adolescent and clinical populations where it is particularly prevalent and studies are limited. Twenty-nine clinical self-injuring adolescents were included in the study. The Clinical Assessment of Nonsuicidal Self-Injury Disorder Index (CANDI) was used to assess prevalence of NSSID. The NSSID diagnosis criteria were met by 62.1% of adolescents. The impairment or distress criterion was least often met. Criteria B and C (assessing reasons for NSSI and cognitions/emotions prior to NSSI) were confirmed by 96-100% of all participants. Adolescents with NSSI in this clinical sample had several comorbidities and high levels of psychopathology. NSSID occurred both in combination with and independently of borderline personality disorder traits as well as suicide plans and attempts. Those with NSSID had a significantly higher cutting frequency than those not meeting full NSSID criteria. Other NSSI characteristics, comorbidity, psychopathology, and trauma experiences did not differ between groups. CANDI was a feasible tool to assess NSSID in adolescents. It is important to use structured measures to assess the validity of the NSSID diagnosis across development in both community and clinical samples. The clinical utility of the NSSID diagnosis is discussed.
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Affiliation(s)
- Maria Zetterqvist
- Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,Department of Child and Adolescent Psychiatry, Region Östergötland, Linköping, Sweden
| | - Irene Perini
- Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Leah M Mayo
- Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Per A Gustafsson
- Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,Department of Child and Adolescent Psychiatry, Region Östergötland, Linköping, Sweden
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Belastende Kindheitserfahrungen und selbstverletzendes Verhalten – die Rolle der Emotionsregulation. Prax Kinderpsychol Kinderpsychiatr 2019; 68:623-638. [DOI: 10.13109/prkk.2019.68.7.623] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Gratz KL. Clinical Applications of Research on the Psychometric Properties of Self-Report Measures of Emotional Responding. J Pers Assess 2019; 101:675-676. [PMID: 31618083 DOI: 10.1080/00223891.2019.1673761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Kim L Gratz
- Department of Psychology, University of Toledo
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27
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Affiliation(s)
- Nicholas J Westers
- Department of Psychiatry, Children's Medical Center Dallas, The University of Texas Southwestern Medical Center, USA
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Hasking P, Boyes M, Greves S. Self-efficacy and emotionally dysregulated behaviour: An exploratory test of the role of emotion regulatory and behaviour-specific beliefs. Psychiatry Res 2018; 270:335-340. [PMID: 30292086 DOI: 10.1016/j.psychres.2018.09.045] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 09/19/2018] [Accepted: 09/19/2018] [Indexed: 10/28/2022]
Abstract
We examined the relationship between self-efficacy and three behaviours that can serve similar affect-regulatory functions (self-injury, risky alcohol use, disordered eating). We proposed that general self-efficacy would be indirectly related to each outcome, operating via emotion regulatory self-efficacy and behaviour-specific self-efficacy. A path analysis confirmed this proposal in a sample of 490 university students, who completed questionnaires assessing the constructs of interest. Emotion regulatory self-efficacy was a salient predictor of self-injury and disordered eating, evidencing both direct and indirect relationships. Self-efficacy to resist each of the behaviours was uniquely related to its target behaviour. We discuss these findings, outlining the implications for a theoretical understanding of emotion-regulatory behaviours, and offer suggestions for prevention and early intervention initiatives.
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Affiliation(s)
- Penelope Hasking
- School of Psychology and Speech Pathology, Curtin University Kent St, Bentley, 6845, Australia.
| | - Mark Boyes
- School of Psychology and Speech Pathology, Curtin University Kent St, Bentley, 6845, Australia.
| | - Stuart Greves
- School of Psychology and Speech Pathology, Curtin University Kent St, Bentley, 6845, Australia.
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Bjureberg J, Sahlin H, Hedman-Lagerlöf E, Gratz KL, Tull MT, Jokinen J, Hellner C, Ljótsson B. Extending research on Emotion Regulation Individual Therapy for Adolescents (ERITA) with nonsuicidal self-injury disorder: open pilot trial and mediation analysis of a novel online version. BMC Psychiatry 2018; 18:326. [PMID: 30305103 PMCID: PMC6180600 DOI: 10.1186/s12888-018-1885-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 09/13/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Nonsuicidal self-injury (NSSI) is common among adolescents and associated with negative outcomes. However, treatments developed specifically for NSSI and the proposed NSSI disorder (NSSID) are scarce, and access to empirically supported treatments for NSSI in many areas is limited. Online treatments carry the potential to increase the availability of evidence-based treatments. Emotion regulation individual therapy for adolescents (ERITA) has shown promise in the treatment of adolescents with NSSID. METHOD The present study examined the feasibility, acceptability, and utility of an online version of ERITA. Twenty-five adolescents (aged 13-17) with NSSID and their parents were included in an uncontrolled open trial. Self-report and clinician-rated assessments of outcomes such as NSSI, self-destructive behaviors, emotion dysregulation, and global functioning were administered at pre-treatment, post-treatment, 3- and 6- month follow-up. Measures of NSSI, self-destructive behaviors, and emotion dysregulation were also assessed weekly during treatment. RESULTS Ratings of treatment credibility, expectancy, and satisfaction were acceptable, and the therapeutic alliance and treatment completion rate (96%) were high. Adolescent participation in the treatment was associated with a statistically significant increase in past-month NSSI abstinence (p = .007), large-sized improvements in past-month NSSI frequency (55% reduction, 95% confidence interval [CI]: 29, 72; Cohen's d = 0.88, 95% CI: 0.73, 1.06) and global functioning (d = 1.01, 95% CI: 0.77, 1.32), and medium-sized improvements in emotion dysregulation (d = 0.75, 95% CI: 0.59, 0.90) and NSSI versatility (d = 0.63, 95% CI: 0.54, 0.77) from pre- to post-treatment. These improvements were further strengthened at 3-month follow-up and maintained at 6-month follow-up. The online therapist-guided parent program was associated with small- to large-sized (ds = 0.47-1.22) improvements in adaptive parent behaviors, and these improvements were maintained or further improved upon at 6-month follow-up. Moreover, in line with the theoretical model underlying ERITA, change in emotion dysregulation mediated changes in both NSSI frequency and self-destructive behaviors over the course of treatment. CONCLUSIONS Together, results suggest that online ERITA is an acceptable, feasible, and promising low-intensity treatment for adolescents with NSSID. The results of this open trial must be replicated in controlled studies. TRIAL REGISTRATION ClinicalTrials.gov ( NCT02697019 ). Registered 2 March 2016.
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Affiliation(s)
- Johan Bjureberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Norra stationsgatan 69, SE-11364, Stockholm, Sweden.
| | - Hanna Sahlin
- 0000 0004 1937 0626grid.4714.6Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Norra stationsgatan 69, SE-11364 Stockholm, Sweden
| | - Erik Hedman-Lagerlöf
- 0000 0004 1937 0626grid.4714.6Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Nobels väg 9, SE-171 65 Stockholm, Sweden
| | - Kim L. Gratz
- 0000 0001 2184 944Xgrid.267337.4Department of Psychology, University of Toledo, 2801 W. Bancroft Street, Toledo, OH 43606 USA
| | - Matthew T. Tull
- 0000 0001 2184 944Xgrid.267337.4Department of Psychology, University of Toledo, 2801 W. Bancroft Street, Toledo, OH 43606 USA
| | - Jussi Jokinen
- 0000 0004 1937 0626grid.4714.6Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Norra stationsgatan 69, SE-11364 Stockholm, Sweden ,0000 0001 1034 3451grid.12650.30Department of Clinical Sciences/Psychiatry, Umeå University, By 23, Enheten för psykiatri, 901 85 Umeå, Sweden
| | - Clara Hellner
- 0000 0004 1937 0626grid.4714.6Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Norra stationsgatan 69, SE-11364 Stockholm, Sweden
| | - Brjánn Ljótsson
- 0000 0004 1937 0626grid.4714.6Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Norra stationsgatan 69, SE-11364 Stockholm, Sweden ,0000 0004 1937 0626grid.4714.6Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Nobels väg 9, SE-171 65 Stockholm, Sweden
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