Internet-delivered interventions are generally effective for psychological problems. While the presence of a clinician guiding the client via text messages typically leads to better outcomes, the characteristics of what constitutes high-quality communication are less well investigated. This study aimed to identify how an internet therapist most effectively communicates with clients in internet-delivered cognitive behavioral therapy (ICBT). Using data from a treatment study of depressed adolescents with a focus on participants who had a positive outcome, messages from therapists were analyzed using thematic analysis. The study focused on the therapist's 1) encouragement and 2) affirmation, and how the therapists used 3) personal address. The analysis resulted in a total of twelve themes (Persistence Wins, You Are a Superhero, You Make Your Luck, You Understand, Hard Times, You Are Like Others, My View on the Matter, Time for a Change, Welcome In, Let Me Help You, You Affect Me, and I Am Human). Overall, the themes form patterns where treatment is described as hard work that requires a motivated client who is encouraged by the therapist. The findings are discussed based on the cognitive behavioral theoretical foundation of the treatment, prior research on therapist behaviors, and the fact that the treatment is provided over the internet.

Attention deficit hyperactivity disorder is a disorder characterized by, hyperactivity, impulsivity, lack of attention.The condition results in several impairments that can impair everyday functioning and lead to underperformance. At present, there are not many large scale studies that have investigated the effect of Internet-based Cognitive Behavioral Therapy (iCBT) for ADHD symptoms. This study presents the outcome of a clinical trial of internet- based cognitive behavioral therapy (iCBT), using a randomized controlled study design, with the primary aim to increase quality of life, as well as to reduce symptoms of ADHD, anxiety, depression, and stress. Approximately a hundred participants with symptoms of ADHD will be included in the first wave (recruitment for the second wave comprised of an additional 100 participants is ongoing) and randomized to two conditions (treatment and wait-list control). The treatment period is comprised of ten weeks, with two mandatory modules and ten modules from which the participants can choose freely. The study utilizes an intention to treat design, with ANOVAs and Reliable Change Index to evaluate treatment effects both on an individual and group level. Implications for iCBT for ADHD symptoms will be discussed.

Attention deficit hyperactivity disorder (ADHD) is a disorder characterized by hyperactivity, impulsivity and lack of attention. It can have a major impact on everyday life and result in negative consequences for one's personal, academic, and work situation. For individuals with symptoms of ADHD, increased levels of anxiety and depression are common, and an overall reduction of quality of life is often present. This study protocol describes a clinical trial of internet-based cognitive behavioral therapy (iCBT), using a randomized controlled study design, with the primary aim to increase quality of life, as well as to reduce symptoms of ADHD, anxiety, depression, and stress. A second aim is to investigate, by qualitative means, what aspects of treatment were perceived as helpful and hindering when it comes to completing iCBT. Two hundred participants with symptoms of ADHD will be included and randomized to two conditions (treatment and wait-list control). The treatment period is comprised of a maximum of ten weeks, with two mandatory modules and ten modules from which the participants can choose freely. Self-report measures will be completed by the participants at baseline and end of treatment, as well as at a six-month follow-up. The treatment is guided by therapists and consists of weekly correspondence with the participants. The study will utilize an intention to treat design, with ANOVAs and Reliable Change Index to evaluate treatment effects. The qualitative part of the project will be interview-based and employ thematic analysis. Lastly, a psychometric evaluation of a common instrument for determining ADHD-symptoms will also be made. The results will hopefully contribute to the evidence base for iCBT for individuals with symptoms of ADHD and help disseminate potentially effective interventions.

Assertiveness training has been an essential component in cognitive-behavioral therapy (CBT), for example, in the treatment of social anxiety and in dialectical behavioral therapy. However, the assertiveness construct has garnered little attention in recent clinical research. The objective of this study was to investigate the efficacy of an eight-week transdiagnostic stand-alone internet-based CBT intervention specifically aimed at increasing levels of assertive behavior. Following inclusion, we randomized N = 210 participants into three groups: therapist-guided self-help, unguided self-help, and a wait-list control condition. After a one-year follow-up, we employed a linear mixed model to estimate the effects at both post-test and follow-up for the primary outcome measures of assertiveness, Adaptive and Aggressive Assertiveness Scales, the Rathus Assertiveness Schedule, and secondary outcome measures of anxiety, depression, and general well-being. We also assessed reliable clinical change. Compared to the wait list at the post-treatment, estimated between-group effect sizes on self-rated adaptive assertiveness were statistically equivalent for the two treatment groups both at the post and at the one-year follow-up time points, ranging from ES = 0.95 to 1.73, with reliable clinical recovery proportions from 19 % to 36 %. The increase in aggressive assertiveness ranged from ES = 0.62 to 0.90 compared to the wait-list condition at post. For social anxiety symptoms, the effects compared to the wait list at post-treatment ranged from ES = 0.67 to 0.93, with a reliable clinical recovery rate from 16 % to 26 %. For self-assessed well-being, the effects compared to the wait list at post ranged from ES = 0.70 to 1.05. No effects were observed for generalized anxiety, although within-group evidence was found for a medium effect on depression one year after treatment. Overall, the two treatment conditions produced similar effects. In general, participation increased healthy assertive expressions regardless of treatment condition, all the while reducing self-assessed social anxiety and, over time, possibly also depression. Participation also improved general well-being. The findings demonstrate that the assertiveness construct can be a suitable target for intervention, with reductions of both psychiatric symptoms and non-syndromal problems in daily life. The study was preregistered at ClinicalTrials.gov (NCT04240249).

Assertiveness training has been an essential component in cognitive-behavioral therapy (CBT), for example, in the treatment of social anxiety and in dialectical behavioral therapy. However, the assertiveness construct has garnered little attention in recent clinical research. The objective of this study was to investigate the efficacy of an eight-week transdiagnostic stand-alone internet-based CBT intervention specifically aimed at increasing levels of assertive behavior. Following inclusion, we randomized N = 210 participants into three groups: therapist-guided self-help, unguided self-help, and a wait-list control condition. After a one-year follow-up, we employed a linear mixed model to estimate the effects at both post-test and follow-up for the primary outcome measures of assertiveness, Adaptive and Aggressive Assertiveness Scales, the Rathus Assertiveness Schedule, and secondary outcome measures of anxiety, depression, and general well-being. We also assessed reliable clinical change. Compared to the wait list at the post-treatment, estimated between-group effect sizes on self-rated adaptive assertiveness were statistically equivalent for the two treatment groups both at the post and at the one-year follow-up time points, ranging from ES = 0.95 to 1.73, with reliable clinical recovery proportions from 19% to 36%. The increase in aggressive assertiveness ranged from ES = 0.62 to 0.90 compared to the wait-list condition at post. For social anxiety symptoms, the effects compared to the wait list at post-treatment ranged from ES = 0.67 to 0.93, with a reliable clinical recovery rate from 16% to 26%. For self-assessed well-being, the effects compared to the wait list at post ranged from ES = 0.70 to 1.05. No effects were observed for generalized anxiety, although within-group evidence was found for a medium effect on depression one year after treatment. Overall, the two treatment conditions produced similar effects. In general, participation increased healthy assertive expressions regardless of treatment condition, thereby reducing self-assessed social anxiety and, over time, possibly also depression. Participation also improved general well-being. The findings demonstrate that the assertiveness construct can be a suitable target for intervention, with reductions of both psychiatric symptoms and non-syndromal problems in daily life. The study was preregistered at ClinicalTrials.gov (NCT04240249).

Attention deficit hyperactivity disorder (ADHD) is a condition with symptoms such as hyperactivity, impulsivity, lack of attention. ADHD can affect every day for an individual in a comprehensive way leading to poor performance and negative consequences. However, little is known about what influences treatment success and what patients experience as helping and hindering in this context. The aim of this current study is to evaluate helping and hindering factors for undergoing iCBT for ADHD. An additional focus on helping and hindering factors outside the treatment setting also included. Participants are recruited from a randomized controlled trial and those who completed the treatment is asked to participate in the study. The goal of the treatment is to increase everyday functioning and decrease ADHD symptoms. Participants are interviewed via telephone using a semi-structured interview guide and transcribed ad verbatim. The interviews are analyzed using thematic analysis. The results regarding helping and hindering factors are discussed in relation to treatment adherence and outcome of treatment. The study will inform how future treatments can be implemented in a better way.

Objectives: SAINT is based on previous research on a CBT manual for adults with ADHD, now shortened to 5 individual-sessions with a follow-up session one month after treatment. It will be compared to an established self-help manual for adults with ADHD, provided through internet. Will SAINT produce an increased everyday function measured with AAQoL compared to control group? If so, is the increased function related to a higher adherence to treatment methods and homework in SAINT?

Methods: A randomized controlled study design is applied where SAINT is compared to an active control condition. Asessments are made before treatment, during treatment, immediately after treatment, one month and three months after treatment. Both groups receive treatment during five weeks with a booster session one month after the fifth session. Outcome measures include everyday function, quality of life and ADHD symptoms, among others. The study is conducted in a specialist health care clinic in Stockholm.

Results: To date, 71 participants have been randomized to one of two treatment conditions. 20 more participants will be recruited during 2023 and the final results will be analyzed in early 2024. Preliminary data on the outcome measures will be presented at the ADHD World Congress.

Conclusions: In case of promising results, SAINT could be offered to patients immediately after diagnosis, thus increasing access to CBT for adults with ADHD.

Varje år avlägger nästan en femtedel av svenskarna ett nyårslöfte, ofta med ambitionen att genomföra en positiv beteendeförändring. Syftet med föreliggande studie var att kartlägga svenskars nyårslöften, mäta hur väl deltagarna håller sina nyårslöften samt undersöka huruvida man kan öka sannolikheten att de lyckas genom att via internet förmedla stöd i form av information och övningar baserade på kognitiv beteendeterapi. Deltagarna randomiserades till tre grupper: en som fick lite stöd, en som fick mycket stöd och en aktiv kontrollgrupp. Totalt följdes 1 066 deltagare under tolv månader, de flesta med nyårslöften avseende fysisk hälsa. Efter ett år uppgav 55% av deltagarna som svarade (n = 699) att de fortfarande var framgångsrika. Deltagare i gruppen som fick lite stöd lyckades i genomsnitt signifikant bättre än deltagare i de andra två grupperna. Resultaten antyder att det finns anledning att vidare studera nyårslöften som ett potentiellt effektivt verktyg för beteendeförändring.

Despite the popularity of New Year’s resolutions, current knowledge about them is limited. We investigated what resolutions people make when they are free to formulate them, whether different resolutions reach differing success rates, and whether it is possible to increase the likelihood of a resolution’s success by administering information and exercises on effective goal setting. Participants (N = 1066) from the general public were randomized into three groups: active control, some support, and extended support. The most popular resolutions regarded physical health, weight loss, and eating habits. At a one-year follow-up, 55% of responders considered themselves successful in sustaining their resolutions. Participants with approach-oriented goals were significantly more successful than those with avoidance-oriented goals (58.9% vs. 47.1%). The group that received some support was exclusively and significantly more successful compared to the other two. This study reveals that New Year’s resolutions can have lasting effects, even at a one-year follow-up.

Introduction: The proportion of sickness absence due to psychiatric diagnoses has increased drastically. It is reasonable to assume that ADHD adults are overly represented in these cases. Thus, it is urgent to manage and prevent work-related mental illness in this population. Yet, the possibilities of doing so have not been studied extensively. Therefore, this project evaluates the feasibility, acceptability, and effects of an internet-based stress-management program developed specifically for this at-risk population. In this presentation, the protocol for developing and assessing the program is presented, including ADHD adults’ attitudes toward the program and comparing current interventions.

Methods: To assess attitudes toward the program, transcripts from 20 interviews with ADHD adults were explored using descriptive thematic analysis. The interviews focused on the scope, content, and duration of the proposed intervention and the design and possible inclusion of therapist support. The program will be based on existing support and interventions for ADHD adults. The development will include a thorough assessment of previous research, including quantitative and qualitative studies, meta-analyses, and literature reviews. The most relevant and effective material will be adapted to the internet format and the ADHD-adult population.

Results and discussion: This project will further the knowledge of possible ways to manage and prevent work-related mental illness among ADHD adults, including related sickness absence. If the proposed program shows promising results, it could quickly be made available to caregivers and/or the public, conceivably conserving considerable resources for individuals, employers, and society.

Objectives: Many adults with attention deficit hyperactivity disorder (ADHD) underperform professionally, are more stressed, and have more days of sickness absence than adults without ADHD. Still, few studies have explored ADHD adults’ experiences of working life. This study aimed to explore the broad experience of working as an adult with ADHD, specifically explore stress and work-related mental illness among adults with ADHD, and identify needs to prevent these negative outcomes.

Methods: In-depth semi-structured telephone interviews were conducted with 20 working adults with ADHD. Topics in the interviews included how the ADHD diagnosis and/or symptoms of ADHD may have affected participants on the job, how work may have affected participants’ well-being, and the need for support and accommodation. A conventional approach to qualitative content analysis was used to explore verbatim transcripts from the interviews.

Results: The analysis yielded three themes of everyday experiences of working with ADHD: Working and living with ADHD, Needs, and Special abilities. These themes included eight subcategories: Specific challenges; Relationships and cooperation; Negative consequences; Planning, prioritization, organization, and structure; Support, interventions, accommodations, and aids; Openness, understanding, and acceptance; Strategies; Strengths and qualities.

Conclusions: The results suggest that further knowledge about the challenges of working with ADHD is needed in workplaces; where organizational support is lacking, much in terms of accommodations and aids is up to the employee, and the disclosure of diagnoses may be associated with a great dilemma. The results may also inform other social partners, e.g., labor organizations and work environment authorities, and advise regulations, recommendations, and legislation.

Background: Though many adults with ADHD underperform professionally, are more stressed, and have more days of sickness absence compared to adults without ADHD, few studies have explored the experience of working as an adult with ADHD. This study explores the general experience of working with ADHD, including stress and work-related mental illness.

Methods: Semi-structured telephone interviews were conducted with 20 working adults with ADHD. Interview topics included how the ADHD diagnosis and/or symptoms of ADHD may have affected participants on the job, how work may have affected participants’ well-being, and the need for support and accommodation. Qualitative content analysis was used to explore verbatim transcripts from the interviews.

Results: The analysis yielded three themes that describe some of the challenges of working with ADHD: Working and living with ADHD, Needs, and Special abilities, with a total of eight subcategories. Subcategories were Specific challenges; Relationships and cooperation; Negative consequences; Planning, prioritization, organization, and structure; Support, interventions, accommodations, and aids; Openness, understanding, and acceptance; Strategies; Strengths and qualities.

Conclusion: Further knowledge about the challenges of working with ADHD is needed in workplaces; where organizational support is lacking, much in terms of accommodations and aids is up to the employee, and the disclosure of diagnoses may be associated with great dilemma.

Introduction: At the start of every new year, millions of people around the world pledge to change some aspect of their lives. More often than not, New Year’s resolutions relate to positive behavior changes, such as quitting bad habits and forming new and more beneficial ones. Unfortunately, most people who try to lose weight, quit smoking or start exercising fail, most of them during the first three months. The aim of this ongoing study is to investigate the different categories of New Year’s resolutions among Swedes, to what degree they succeed in keeping their resolutions, and whether internet-administered support based on cognitive behavior therapy may increase the participants’ chances of keeping their resolutions.

Methods: The study is a three-arm randomized control trial comparing two different levels of support and one control condition. During the year, participants rate their perceived success in keeping their resolutions. Data from online questionnaires regarding subjective well-being, quality of life, procrastination and self-efficacy is also collected at baseline as well as at follow-up three weeks into the following year.

Results: A total of 1 066 participants were included in the study. Ten months in we have preliminary results regarding the categories of New Year’s resolutions. More than 70% of the participants report one or more resolutions falling into the “physical health” category. The second largest category is “self-improvement” (10%), followed by “psychological health” (5%). A majority of resolutions, 64%, are phrased as approach-oriented goals and 34% as avoidance-oriented goals.

Discussion: We believe that this is the largest study of its kind to date. Smaller longitudinal studies of New Year’s resolvers have been published, but none in Sweden. Furthermore, very few studies on positive behavior change have evaluated active interventions to increase participants’ chances of success. Future analyses will provide insight into New Year’s resolutions among Swedes and whether short, non-personal information and exercises administered via email may increase their chances of success.

Introduction: In the last few decades, the proportion of sickness absence due to psychiatric diagnoses has increased drastically. This can be attributed to several factors, including a transition from physical to psychosocial strain at work, and difficulties balancing full-time employment alongside family obligations. A population that may have certain difficulties balancing work, leisure, and family, is adults with attention deficit hyperactivity disorder (ADHD). Adults with ADHD are more stressed, more often on sick leave, and receive sickness absence recommendations to a greater extent than adults without ADHD. Thus, it is urgent to manage and prevent stress and other work- related mental illnesses in this population. This project evaluates the feasibility, acceptability, and effects of an internet-based cognitive- behavioral stress-management program, developed specifically for this at-risk population.

Method: The novel stress-management program is based on existing support and interventions for ADHD adults. It is also inspired by existing support and interventions for relevant psychological disorders based on cognitive behavioral therapy (CBT) principles. This includes both tailored and transdiagnostic CBT applications. The development includes thoroughly assessing previous research, including quantitative and qualitative studies, meta-analyses, and literature reviews. The most relevant and effective material is adapted to the internet format and the ADHD-adult population. Modules include information and exercises on: how ADHD symptoms affect work, leisure, and relationships; planning and prioritizing on and off the job; communication, assertiveness, and setting boundaries; sleep and recovery; and more. The program will be evaluated in a pilot study during the spring of 2023, revised, and later tested in a randomized controlled trial.

Results: At the time of writing, recruitment to the pilot study is about to begin. Preliminary results are expected to be presented at the 10th World Congress of Cognitive and Behavioral Therapies in Seoul.

Discussion: Despite the fact that many adults with ADHD are more stressed, more often on sick leave, and receive sickness absence recommendations to a greater extent than adults without ADHD, few studies have explored the possibility to manage and prevent these negative outcomes. This project will further the knowledge of possible ways to manage and prevent stress and other work-related mental illness among ADHD adults. If the internet-based CBT stress-management program shows promising results, it could quickly be made available to caregivers and/or the public, conceivably conserving considerable resources for individuals, employers, and society.

Introduction and objectives: Adults with attention deficit hyperactivity disorder (ADHD) are more stressed, more often on sick leave, and receive sickness absence recommendations to a greater extent than adults without ADHD. This project evaluates the feasibility, acceptability, and effects of an internet-based stress-management program, developed specifically for this at-risk population.

Methods: The intervention is based on existing support and interventions for ADHD adults, and inspired by support and interventions for relevant psychological disorders. The development includes a thorough assessment of previous research. The most relevant and effective material is adapted to the internet format and the ADHD-adult population. The program is evaluated in a pilot study during the spring of 2023, and will later be tested in a randomized controlled trial.

Results: At the time of writing, 36 participants have recently started the intervention. Preliminary results are expected to be presentable at the 9th World Congress on ADHD in Amsterdam.

Discussion: Although adults with ADHD experience more stress and are more often on sick leave than their non-ADHD peers, there has been limited research on methods to manage and prevent these negative outcomes. If this stress-management program shows promising results, it could quickly be made available to caregivers and/or the public, possibly saving considerable resources for individuals, employers, and society.

Introduction: Attention deficit hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder, affecting 2-7% of adults worldwide. Adults with ADHD face increased levels of stress and fatigue, frequently contributing to exhaustion. They are at higher risk for stressful life events and mental health issues, with a majority of meeting criteria for at least one comorbid psychiatric disorder. Additionally, adults with ADHD have more sickness absence days compared to controls, possibly twice or several times as many. Although research on assessing and treating adult ADHD is growing, many individuals remain undiagnosed and untreated due to lack of recognition, misconceptions, and limited access to psychiatric care. Internet-delivered interventions offer a promising solution for improving access to care and effec- tively disseminating psychological treatments. However, their efficacy for adult ADHD remains underexplored.

Methods: This study will involve 240 participants, randomly assigned to one of three conditions: Internet-based cognitive-be- havioral stress-management; Internet-based mindfulness stress-management; or a wait-list control. Participants in the intervention groups will engage in twelve-week, twelve-module programs, with clinical support available on demand. Both interventions have an explicit focus on workplace functioning, but differ in their content. The cognitive behavioral program is based on cognitive behavioral therapy (CBT) principles, including both tailored and transdiag- nostic applications. The mindfulness program is based on a well-established skills-training manual for adult ADHD. Outcome measures include self-reported quality of life (primary outcome), symptoms of ADHD, perceived stress, symptoms of exhaustion, depression, and anxiety. Additionally, participants from both intervention groups will be interviewed to explore their experiences with the programs.

Discussion: Previous research indicates a positive attitude toward internet-delivered psychological interventions among adults with ADHD. A previous single-arm open trial has also indicated the potential of the current cognitive-behavioral stress-management intervention. This study aims to further assess its efficacy by comparing it to an active control intervention, thereby accounting for the expectation of benefit and common factors of internet interventions. The additional inclusion of a wait-list control will help account for spontaneous improvement and regression toward the mean. If the cognitive-behavioral intervention shows further promise, it could be further developed and potentially disseminated more broadly, either through routine healthcare systems or as a product. Given the position of ADHD adults in the labor market and the costs of sickness absence for all social partners, demonstrating effective inter- ventions for this population could have significant socio-economic benefits, reducing both individual and societal burdens.

INTRODUCTION Attention deficit hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder, affecting 2-7% of adults worldwide. Adults with ADHD experience heightened levels of stress and fatigue, and ADHD is likely to be an underlying factor in cases of exhaustion. Despite growing evidence on the assessment and treatment of adult ADHD, many patients remain underdiagnosed and undertreated, largely due to barriers such as lack of recognition, misunderstandings, and limited access to specialized care. Internet-delivered cognitive behavior therapy presents an opportunity for increasing access to psychological interventions, though the evidence for its efficacy remains underexplored for adult ADHD. METHODS A total of 240 participants will be recruited and randomly assigned to one of three conditions: Internet-based cognitive-behavioral stress-management (42%); Internet-based mindfulness stress-management (42%); or Wait-list control (16%). Participants in the intervention groups take part in twelve-module, twelve-week interventions with clinical support on demand. Outcome measures include self-reported quality of life (primary outcome measure), symptoms of ADHD, perceived stress, symptoms of exhaustion, depression, and anxiety. DISCUSSION The cognitive-behavioral stress- management intervention has shown promise in a previous single-arm open trial. In this study, we aim to further evaluate its efficacy by comparing it to an active mindfulness intervention and a wait-list control. This allows us to control for the expectation of benefit and common factors of internet interventions. Additionally, the inclusion of a wait-list control condition enables us to account for spontaneous improvement and regression toward the mean. Should the cognitive-behavioral intervention prove beneficial and efficacious, it could undergo further development and potentially be disseminated to a wider audience, either through routine healthcare or as a packaged product.

När det börjar dra ihop sig till tolvslag nyårsnatten är vi många lovar att ta tag i saker under det nya året enligt undersökningar avger var åttonde man och var femte kvinna i Sverige ett nyårslöfte. Ofta håller dock våra föresatser inte särskilt länge, framåt februari är det redan glesare på gymmen. Det är vanligt att gå ut för hårt i början samtidigt som det är lätt att falla tillbaka i gamla ovanor. Efter ett bakslag eller två är det lätt att ge upp.

Trots detta visar psykologisk forskning att nyårslöften är förvånansvärt bra på att skapa varaktiga beteendeförändringar. Det gäller bara att komma lite mer förberedd till tolvslaget, ha realistiska förutsättningar och understryka att förändringsarbetet inte handlar om en kort sprint utan snarare utgör ett maratonlopp kombinerat med hinderbana.

Tio i tolv förklarar varför nyårslöften är ett smart sätt att komma igång med nya vanor och överge gamla. Med hjälp av studier och undersökningar inom bland annat målsättning, rutiner och prokrastinering får läsaren kunskap om hur hen lättare kan lyckas med en förändring. Intressanta rön om svenskar egna nyårslöften presenteras, varvat med handfasta tips för att lättare uppnå våra mål vare sig det handlar om ett nyårslöfte eller en nystart efter semestern.

Boken bygger på världens största vetenskapliga studie kring människors nyårslöften, utförd av Per Carlbring, Alexander Rozental och Martin Oscarsson vid Stockholms universitet.