Self-reported mental health problems have increased dramatically among young female high school (Swedish: gymnasium) and university students in Sweden since the 1990’s. The reasons for this increase are mostly unknown but self-esteem and body image might be important factors behind this problem. The aim of this study was to test whether self-esteem and body dissatisfaction predict health. All correlation directions were in accordance with previous studies on the subject. There was no age group difference in levels of self-esteem, body dissatisfaction or health among the women. Multiple regression analysis revealed that global self-esteem was the strongest single predictor of health. These results give support for the importance of global self-esteem for subjective health. This should be considered in future studies and in the battle against the development of depression, anxiety and eating disorders among women.

This study applies Hobfoll's notion of loss spirals to argue for a reciprocal relationship between role stress and 2 of its most commonly studied consequences: exhaustion and satisfaction. By means of structural equation modeling and a cross-lagged design of 116 business managers, the researchers found support for a relationship between role stress and exhaustion. They also found that satisfaction influences role stress, a relationship that the existing literature has not examined. The study contributes a more complex understanding of the relationship between role stress and its modeled outcomes than has been achieved previously.

I denna antologi samlas åtta bidrag kring samisk hälsoforskning. De inledande kapitlen är originalbidrag till antologin medan ytterligare två kapitel är omarbetade artiklar från internationella vetenskapliga tidskrifter. Fyra kapitel utgör omarbetade examensarbeten inom ramen för psykologutbildningen vid Umeå universitet och har ett antal år på nacken. Tillsammans ger bidragen en insikt i forskning kring samisk hälsa och frågor som påverkat samers hälsa sedan början av 2000-talet.

En befolknings hälsa och välbefinnande ska naturligt alltid stå i centrum av dess politiska liv. Texterna i denna antologi har varit aktuella och relevanta för det samiska samhället under lång tid, och därför är det med glädje vi ser att Sametinget nyligen antagit sitt första hälsopolitiska program, där de särskilt lyfter fram betydelsen av att arbeta för en god psykisk hälsa hos det samiska folket. Samiska perspektiv på hälsa ser ut att ha kommit för att stanna, i politiken och akademin såväl som i konkreta vårdmöten. Redaktörernas förhoppning är att kunskapen och kunskapsutbytet i antologin ska bidra till att vitalisera Sametingets och andra centrala aktörers arbete på området. För alla människors rätt till en god hälsa.

Hur avgör du som terapeut på ett tillförlitligt sätt att dina patienter blir bättre? Vad menas egentligen med begreppet evidens? Hur kan du bedöma om en studie är välgjord?

Denna bok hjälper dig som kliniker att utvärdera den behandling du bedriver på ett systematiskt och evidensbaserat sätt. Paradoxalt nog har forskning visat att psykoterapeuter har svårt att bedöma om deras patienter förbättras eller försämras under behandlingens gång. Därför har Lars-Göran Öst här samlat beprövade utvärderingsskalor som är lämpliga att använda session för session, samt före, efter och vid uppföljning av behandling. 

I boken finns även en mall för att granska och förstå den metodologiska kvaliteten hos psykoterapistudier i vetenskapliga tidskrifter. Med hjälp av denna kan du på ett säkrare sätt bedöma vilka slutsatser som kan dras och vilken användbarhet en studie har för ditt eget kliniska arbete. I grunden handlar detta om att dina patienter ska få bästa möjliga vård.

Boken vänder sig till både blivande och yrkesverksamma psykologer, psykoterapeuter samt till alla andra som vill veta mer om evidensbaserad psykoterapi.

Cognitive-behavior therapies (CBT) have been evaluated in randomized controlled studies (RCT) and anxiety disorders since 1966 and for each disorder there are at least two CBT methods that are considered evidence based (empirically supported) today. Numerous meta-analyses have evaluated the efficacy of these methods against various control conditions. However, none has looked at whether modern CBT studies lead to better treatment effects than were obtained 10-40 years ago. The aim of this paper is to present a meta-analysis focusing on the mean extent of change achieved by the CBT treatments across decades (from the 1970s onwards). Database searches yielded a total of 432 RCTs for the anxiety disorders combined and 364 of these allowed calculation of within-group effect size (ES) or percentage clinical improvement. Separate ESs were calculated for three central measures: independent assessor rating, self-report and behavioral approach test. The results showed that in most instances there was no significant change in ES across time. In a few instances, the treatment effects were greater in modern studies. However, it was more common with a negative development, or a mixed development (first positive then negative or vice versa). There was no significant change in proportion of clinical improvement. Treatment time and attrition either increased or remained stable. If the single studies that gave the highest ES each decade were compared, all anxiety disorders besides panic disorder and obsessive-compulsive disorder showed a positive development. Possible explanations to the results are discussed.

During the last two decades a number of therapies, under the name of the third wave of cognitive behavior therapy (CBT), have been developed: acceptance and commitment therapy (ACT), dialectical behavior therapy (DBT), cognitive behavioral analysis system of psychotherapy (CBASP), functional analytic psychotherapy (FAP), and integrative behavioral couple therapy (IBCT). The purposes of this review article of third wave treatment RCTs were: (1) to describe and review them methodologically, (2) to meta-analytically assess their efficacy, and (3) to evaluate if they currently fulfil the criteria for empirically supported treatments. There are 13 RCTs both in ACT and DBT, 1 in CBASP, 2 in IBCT, and none in FAP. The conclusions that can be drawn are that the third wave treatment RCTs used a research methodology that was significantly less stringent than CBT studies; that the mean effect size was moderate for both ACT and DBT, and that none of the third wave therapies fulfilled the criteria for empirically supported treatments. The article ends with suggestions on how to improve future RCTs to increase the possibility of them becoming empirically supported treatments.

Bokinformation: Varje år berörs hundratusentals personer av psykosociala och pedagogiska interventioner. Det handlar exempelvis om behandling av missbruk, insatser för utsatta barn och läsundervisning i grundskolan. Endast undantagsvis har dessa interventioner utvärderats, vilket innebär att vi inte vet vilken effekt de har eller om de rentav kan skada. I antologin Att göra effektutvärderingar beskrivs hur man genomför effektutvärderingar, som ger kunskap om hur interventioner fungerar. Boken ger detaljerad och praktisk vägledning som är till nytta för alla som är intresserade av att lära sig mer om effektutvärderingar – både forskarstuderande och forskare som redan ansvarat för effektutvärderingar. Ämnen som tas upp är bland annat forskningsetik, studiedesign, mätinstrument, urval och rekrytering av undersökningspersoner, datainsamling, ekonomiska analyser, dataanalys och tolkning samt rapportskrivning. Bokens författare har lång erfarenhet inom området och representerar olika discipliner såsom psykologi, folkhälsovetenskap, socialt arbete, pedagogik, statistik, epidemiologi, sociologi, evolutionsbiologi, medicinsk vetenskap och datavetenskap. Redaktör för boken är Knut Sundell, docent i psykologi och socialråd på Socialstyrelsen, som har lång erfarenhet av att utvärdera interventioner inom förskola, skola och socialtjänst.

Gaudiano's criticism of one part of my review of ACT outcome research (Öst, 2008) is refuted on all issues but one. It is clear that the average amount of grant support for the ACT-studies was smaller than that of CBT-studies, even if the proportion of studies having grant support was not lower. However, that fact should only influence 25% (2 out of 8) of the methodology variables on which ACT-studies had lower mean scores than CBT-studies. It is not acceptable that a relatively new treatment, such as ACT, should be evaluated by more lenient criteria than already established therapies like CBT. If proponents of a new treatment wish to claim that their therapy is empirically supported then they have to accept to be evaluated by the APA Task Force criteria. It is time that ACT researchers start using the current psychotherapy research methodology.

Här beskrivs hur KBT kan tillämpas vid de vanligaste psykiatriska tillstånden hos barn och unga. Boken inleds med en beskrivning av vad som är utmärkande för arbete med barn, ungdomar, och deras familjer och nätverk. De diagnoser som tas upp är bland annat social ångest, generaliserat ångestsyndrom, tvångssyndrom, PTSD, stresstörning, depression, ADHD och autism. Författarna visar hur KBT-modellen och beteendeanalysen kan se ut, beskriver olika behandlingsvägar och ger belysande fallvinjetter. Boken avslutas med en genomgång av det ökande empiriska stödet för KBT vid de olika tillstånden.

Bokinformation: Varje år berörs hundratusentals personer av psykosociala och pedagogiska interventioner. Det handlar exempelvis om behandling av missbruk, insatser för utsatta barn och läsundervisning i grundskolan. Endast undantagsvis har dessa interventioner utvärderats, vilket innebär att vi inte vet vilken effekt de har eller om de rentav kan skada. I antologin Att göra effektutvärderingar beskrivs hur man genomför effektutvärderingar, som ger kunskap om hur interventioner fungerar. Boken ger detaljerad och praktisk vägledning som är till nytta för alla som är intresserade av att lära sig mer om effektutvärderingar – både forskarstuderande och forskare som redan ansvarat för effektutvärderingar. Ämnen som tas upp är bland annat forskningsetik, studiedesign, mätinstrument, urval och rekrytering av undersökningspersoner, datainsamling, ekonomiska analyser, dataanalys och tolkning samt rapportskrivning. Bokens författare har lång erfarenhet inom området och representerar olika discipliner såsom psykologi, folkhälsovetenskap, socialt arbete, pedagogik, statistik, epidemiologi, sociologi, evolutionsbiologi, medicinsk vetenskap och datavetenskap. Redaktör för boken är Knut Sundell, docent i psykologi och socialråd på Socialstyrelsen, som har lång erfarenhet av att utvärdera interventioner inom förskola, skola och socialtjänst.

When I started research and clinical work with specific phobics in the mid 1970s, very little differentiation was made in the research literature between agoraphobia, social phobia, and specific phobia regarding the number of therapy sessions. Thus, I used eight 1-hour sessions in my early studies on specific phobias. After having worked with that format for about 5 years I started getting bored seeing the same patients week after week. I also began to question why behavior therapists should follow the same format as devised by psychodynamic short-term therapy (i.e. one session per week for 12–20 weeks).

Atkins et al. strongly criticize my (Öst, 2014) systematic review and meta-analysis of ACT. The bulk of their re-examination of my article is divided into four parts: a) Selection of studies, b) Ratings of methodological quality, c) Meta-analysis, and d) Judgments of quality of evidence. It is evident from my paper that I have refuted their claims regarding each of these parts. Regarding a) Selection of studies I showed that only four studies had a cell size of less than 10 and their inclusion did not change the mean effect size or increased variability. Concerning b) Ratings of methodological quality I have showed that my ratings were reliable and had accuracy. As for c) Meta-analysis, I have demonstrated that I got very similar results to those of A-Tjak et al. (2015) that Atkins et al. describes as a much better meta-analysis. Regarding d) Judgments of quality of evidence, Atkins et al. brought up 23 studies for which they argued that I have done an incorrect evaluation but for every single study I have disproved their arguments and maintain my 2014 evaluation of the evidence base of ACT. Thus, there is no reason to follow Atkins et al. suggestion that my review “should now be set aside in making decisions regarding the treatment efficacy of ACT.”

This article presents a psychometric evaluation of the Claustrophobia Scale (CS), consisting of one subscale for measuring anxiety (20 items, 0-4) and one for avoidance (18 items, 0-2). Participants were 87 claustrophobic patients and 200 normal controls randomly selected from the community. The results show that CS has excellent internal consistency, high test--retest reliability, concurrent and discriminant validity. The patients and controls differ significantly on the total scores of anxiety and avoidance, as well as on each individual item scores. The CS was also found to be sensitive to change after cognitive behavioral treatment. Preliminary factor analyses yielded two factors for each subscale; "Being in small enclosed spaces" and "Other people present", accounting for large proportions of the variance. The CS is useful both as a state, and as an outcome self-report measure of claustrophobia.

Acceptance and Commitment therapy (ACT) has attracted a lot of interest during the last 10-15 years with a strong increase of the number of randomized controlled trials (RCTs). The present review and meta-analysis includes 60 RCTs (4234 participants) on psychiatric disorders, somatic disorders, and stress at work. The mean effect size across all comparisons was small (0.42). Compared to the Ost (2008) meta-analysis there was no significant improvement in methodological quality and deterioration in effect size (from 0.68). When ACT was compared to various forms of cognitive or behavioral treatfnents a small and non-significant effect size of 0.16 was obtained. An evidence-base evaluation showed that ACT is not yet well-established for any disorder. It is probably efficacious for chronic pain and tinnitus, possibly efficacious for depression, psychotic symptoms, OCD, mixed anxiety, drug abuse, and stress at work, and experimental for the remaining disorders.

There is no formalized training for therapists to do one-session treatment (OST), at least not any which has been empirically evaluated. However, a description follows of the way the training for people aspiring to become a protocol therapist in a randomized controlled trial (RCT), or just wanting to work clinically with OST, has been arranged. The major part of this chapter consists of a detailed description of the different items included in the competence rating scale, and explanations of why the respective competencies are important for carrying out OST successfully. This means that the training should focus on providing therapists with adequate skills in the areas covered by the rating scale.

Objective: Cognitive behavior therapy (CBT) is a recommended treatment for eating disorders (ED) in adults given its evidence, mainly based on efficacy studies. However, little is known about how CBT works in routine clinical care. The goal of the present meta-analysis is to investigate how CBT works for various ED when carried out in routine clinical settings. Method: Ovid MEDLINE, Embase OVID, and PsycINFO were systematically searched for articles published until June 2023. The outcome of CBT, methodological quality, risk of bias (RoB), and moderators of treatment outcome were examined and benchmarked by meta-analytically comparing with efficacy studies for ED. Fifty studies comprising 4299 participants who received CBT were included. Results: Large within-group effect sizes (ES) were obtained for ED-psychopathology at post-treatment (1.12), and follow-up (1.22), on average 9.9 months post-treatment. Attrition rate was 25.5% and RoB was considerable in the majority of studies. The benchmarking analysis showed that effectiveness studies had very similar ESs as efficacy studies (1.20 at post-treatment and 1.28 at follow-up). Conclusion: CBT for ED is an effective treatment when delivered in routine clinical care, with ESs comparable to those found in efficacy studies. However, the evidence needs to be interpreted with caution due to the RoB in a high proportion of studies. Public Significance: Eating disorders are common in the population and often lead to multiple negative consequences. CBT has been found effective for ED and is recommended in clinical guidelines. Since these recommendations are primarily based on university studies we wanted to investigate how CBT performs in routine clinical care. Our meta-analysis found that CBT worked as well in routine care as in university setting studies.

Social phobia is one of the most common anxiety disorders in children and adolescents, and it runs a fairly chronic course if left untreated. The goals of the present study were to evaluate if a parent education course would improve the outcome for children with a primary diagnosis of social phobia and if comorbidity at the start of treatment would impair the outcome of the social phobia. A total of 55 children, 8-14 years old, were randomly assigned to one of three conditions: 1) Child is treated, 2) Child is treated and parent participates in the course, or 3) A wait-list for 12 weeks. The treatment consisted of individual exposure and group social skills training based on the Beidel, Turner, and Morris (2000) SET-C. Children and parents were assessed pre-, post-, and at one year follow-up with independent assessor ratings and self-report measures. Results showed that there was no significant difference between the two active treatments and both were better than the wait-list. The treatment effects were maintained or furthered at the follow-up. Comorbidity did not lead to worse outcome of social phobia. Comorbid disorders improved significantly from pre-to post-treatment and from post-to follow-up assessment without being targeted in therapy.

Applied relaxation (AR) is a behavioral coping technique consisting of seven steps and taught like a course, where each new step builds on the previous. The aim is that the patient learns a rapid relaxation skill that can be applied in natural anxiety-arousing situations. A meta-analysis of 66 randomized controlled studies showed a large within-group effect size which was maintained at follow-up. AR was significantly better than no or placebo treatment and did not differ from other active treatments. AR is recommended for anxiety disorders and menopausal symptoms since the effects were better for these than for pain and tinnitus.

Cognitive behavioral therapy (CBT) has strong research support for obsessive-compulsive disorder (OCD). However, less is known about how CBT performs when delivered in routine clinical care. A systematic review and meta-analysis was conducted of CBT for OCD in adults treated in routine clinical care. Ovid MEDLINE, Embase OVID, and PsycINFO were systematically searched for studies published until July 2021. The effectiveness of CBT, methodological quality, and moderators of treatment outcome were examined, and benchmarked by meta-analytically comparing with efficacy studies for OCD. Twenty-nine studies (8 randomized controlled trials) were included, comprising 1669 participants. Very large within-group effect sizes (ES) were obtained for OCD-severity at post-treatment (2.12), and follow-up (2.30), on average 15 months post-treatment. Remission rates were 59.2% post-treatment and 57.0% at follow-up. Attrition rate was 15.2%. Risk of bias was considerable in the majority of studies. The benchmarking analysis showed that effectiveness studies had almost exactly the same ES as efficacy studies at post-treatment and somewhat higher at follow-up. Furthermore, effectiveness studies had significantly higher remission rates than efficacy studies, both at post- and follow-up assessment. CBT for OCD is an effective treatment when delivered in routine clinical care, with ES comparable to those found in efficacy studies. However, the evidence needs to be interpreted with caution because of the risk of bias in a high proportion of studies.

Relatively little is known about the efficacy of clinically inexperienced student therapists carrying out cognitive behavior therapy (CBT) under supervision during a professional, psychologist training program. The current study evaluated this by collecting pre- and posttreatment data on 591 consecutive patients receiving treatment at the Psychotherapy Clinic of the Department of Psychology, Stockholm University, Sweden, over an 8-year period. The patients had mainly anxiety disorders or depression with a mean duration of 15 years, and received individual CBT for a mean of 18 sessions. They improved significantly on both general measures (Beck Anxiety Inventory [BAI], Beck Depression Inventory [BDI], and Quality of Life Inventory [QOLI]) and disorder-specific self-report scales. The proportions of recovered patients on the BAI (63%) and the BDI (60%) were higher than those of a comparison effectiveness study. On the specific self-report scales the current sample improved as much as the samples in extant efficacy trials. We conclude that clinically inexperienced student therapists who receive supervision from experienced supervisors can achieve treatment effects that are on a par with those of experienced licensed psychotherapists.

Anxiety disorders are among the most common disorders affecting youths in the general population, with up to 10% of children and 20% of adolescents meeting criteria for an anxiety disorder at any one point in time. Cognitive-behavior therapies (CBT), varying between 9 and 18 weeks of treatment, are considered evidence-based for the treatment of anxiety disorders in youth. During the last two decades treatments that are brief, intensive, or concentrated (BIC) have been developed and this meta-analysis includes 23 RCTs of these new approaches across the anxiety disorders. BIC yielded a lower attrition (2.3%) than standard CBT (6.5%). The effect sizes (ES) for comparison of BIC with waiting-list (1.47) and placebo (0.91) were significant, whereas that with standard CBT (0.01) was not. Regarding remission at post/recovery at follow-up BIC (54%/64%) and standard CBT (57%/63%) were comparable and both were significantly higher than placebo (26%/35%), which was higher than WLC (7%/9%). Within-group ES at post and follow-up were 1.50 and 1.53 for BIC, and 0.98 and 1.05 for standard CBT, indicating maintenance of the effects up to 12 months after therapy. Advantages and disadvantages of BIC are discussed and we suggest that BIC-interventions represent a paradigm shift in the delivery of services for youth with anxiety disorders.

This chapter summarizes the state of the art for the specific phobias, bringing both updates and discussion on the preliminary recommendations put forward to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) work group. It discusses diagnostic criteria for specific phobia, and two important issues: how we might categorize dental phobia and test anxiety, and the boundary between specific phobia and agoraphobia. It also highlights clinical features (e.g., age of onset, gender, focus of fear, neurobiology and physiology, comorbidity, impairment, risk factors, and treatment response) of specific phobia. Then, it presents a broad overview of evidence-based treatment methods (variants of cognitive behavioral therapy (CBT)) and the efficacy of these. The chapter concludes with a description of the treatment of a complex case of specific phobia.

Obsessive-compulsive disorder (OCD) is ranked by the World Health Organization (WHO) among the 10 most debilitating disorders. The treatments which have been found effective are cognitive behavior therapy (CBT) and serotonin reuptake inhibitors (SRI). This meta-analysis includes all RCTs of CBT (25) and SRI (9) for OCD in youth using the Children’s Yale-Brown Obsessive Compulsive Scale (C-YBOCS). CBT yielded significantly lower attrition (12.7%) than SRI (23.5%) and placebo (24.7%). The effect sizes for comparisons of CBT with waiting-list (1.53), placebo (0.93), and SRI with placebo (0.51) were significant, whereas CBT vs. SRI (0.22) and Combo (CBT + SRI) vs. CBT (0.14) were not. Regarding response rate CBT (70%) and Combo (66%) were significantly higher than SRI (49%), which was higher than placebo (29%) and WLC (13%). As for remission CBT (53%) and Combo (49%) were significantly higher than SRI (24%), placebo (15%), and WLC (10%), which did not differ from each other. Combo was not more effective than CBT alone irrespective of initial severity of the samples. The randomized controlled trials (RCTs) have a number of methodological problems and recommendations for improving research methodology are discussed as well as clinical implications of the findings.

Bokinformation: Varje år berörs hundratusentals personer av psykosociala och pedagogiska interventioner. Det handlar exempelvis om behandling av missbruk, insatser för utsatta barn och läsundervisning i grundskolan. Endast undantagsvis har dessa interventioner utvärderats, vilket innebär att vi inte vet vilken effekt de har eller om de rentav kan skada. I antologin Att göra effektutvärderingar beskrivs hur man genomför effektutvärderingar, som ger kunskap om hur interventioner fungerar. Boken ger detaljerad och praktisk vägledning som är till nytta för alla som är intresserade av att lära sig mer om effektutvärderingar – både forskarstuderande och forskare som redan ansvarat för effektutvärderingar. Ämnen som tas upp är bland annat forskningsetik, studiedesign, mätinstrument, urval och rekrytering av undersökningspersoner, datainsamling, ekonomiska analyser, dataanalys och tolkning samt rapportskrivning. Bokens författare har lång erfarenhet inom området och representerar olika discipliner såsom psykologi, folkhälsovetenskap, socialt arbete, pedagogik, statistik, epidemiologi, sociologi, evolutionsbiologi, medicinsk vetenskap och datavetenskap. Redaktör för boken är Knut Sundell, docent i psykologi och socialråd på Socialstyrelsen, som har lång erfarenhet av att utvärdera interventioner inom förskola, skola och socialtjänst.

Forskning på vad som motiverar Generation Y är begränsad då generationen är relativt ny på arbetsmarknaden. Trots detta finns det mycket föreställningar om hur denna generation beter sig. Dagens arbetsgivare står inför utmaningen att uppfatta vad den nya generationen på väg in på arbetsmarknaden drivs av i arbetet samt att kunna tillgodose detta. Syftet med studien var att beskriva vilka drivkrafter den svenska Generation Y upplever att de har i relation till arbetet. Undersökningen utgick från en kvalitativ ansats och utgjordes av semistrukturerade intervjuer. Deltagarna bestod av sex personer som var mellan 21 och 31 år. Resultatet indikerar att deltagarna drivs av återkoppling, utvecklingsmöjligheter, varierande arbetsuppgifter samt möjligheten till att kunna påverka sina arbetstider och uttrycka sina åsikter. Deltagarna är oavsett ålder, roll och branschtillhörighet relativt samstämmiga om vilka drivkrafter som de upplever att de har i relation till arbetet. Resultatet går i linje med vad tidigare forskning och studier har indikerat på.

Aims: To explore the association between tooth loss and obesity in an adult Swedish population, and to investigate the influence of socioeconomy, life-style, and co-morbidity.

Methods: A cross-sectional population health survey conducted in 2001-2005 in 2816 randomly selected Swedish men and women (age: 30-74 years; participation rate 76%). Main measures were; tooth loss: < 20 remaining teeth (self-reported), general obesity: BMI[≥]30 kg m-2, abdominal obesity: waist circumference > 88 in women and > 102 cm in men. Adjustments were made for socioeconomy, life-style, and co-morbidity.

Results: 420 individuals (21.2%) had < 20 remaining teeth: 30-59 years 6.0%, 60-74 years 53.5%. Mean BMI was similar in men and women (26.9 kg m-2), however, both general and abdominal obesity was still more frequent among women (both p < 0.001). There was a significant interaction between age and tooth loss in the association with both general (p = 0.004) and abdominal obesity (p < 0.011) in men. In participants below 60 years of age, the association between tooth loss and general obesity (OR 2.17 [95% CI 1.51 - 3.12]) and abdominal obesity (2.23 [1.58 - 3.15]), respectively, was statistically significant independent of age and gender, and remained so also when accounting for differences in socioeconomy, life-style, and co-morbidity. There was no similar association in those 60 years or older. The findings in men and women were robust and concordant.

Conclusions: Common mechanisms for oral health and obesity should be explored more also including longitudinal designs. The findings are important for targeting comprehensive interventions against obesity and tooth loss, especially among younger adults.

Self-rated health (SRH) consists of a single question wherein individuals are asked to evaluate their general health status on a 5-point scale. This study investigated the relationship between SRH and depression/anxiety, with the purpose of getting a better understanding of how the two disorders are related to perceived general health, and to examine the possibility of using SRH as clinical tool for identifying individuals with increased risk for onset and persistent states of depression and anxiety. The study used cross-sectional and longitudinal data from the Västerbotten Environmental Health Study, a large questionnaire-based population study in northern Sweden. 2336 individuals participated at baseline (T1) and 3-year follow-up (T2). The Hospital Anxiety and Depression Scale was used to measure symptoms of depression and anxiety. The results showed that those with poor SRH rated more severe symptoms of depression and anxiety, than those with good SRH. Those with poor SRH at T1 had more than twofold increased risk of falling into the depression and anxiety case groups at T2. Specifically, they more often experienced onset of symptoms at T2 as well as symptoms that persisted across the two occasions. The results corresponds in large with those from previous studies and supports the utility of SRH as a clinical tool, with the reservation that it may not be strong enough predictor on its own.

High parenting stress has been connected with negative consequences for both parent and child. The aim of the present thesis was to examine factors contributing to high stress, and to develop a psychometrically sound, reliable, and valid instrument for measuring parenting stress. Self-reported parenting stress was investigated using a revised Swedish version of the Parent Domain of the American Parenting Stress Index. Dimensionality was examined in factor analyses (FA) on data from a nation-wide representative sample and cross-validated on another sample. Based on FA, new subscales, measuring different aspects of parents' perception of stress in their parenting role, were constructed. High internal consistencies, as well as a good stability over amean interval of 30 days, were found.

Different aspects of construct validity were examined in four samples. Mothers in a clinical sample indicated higher levels of parenting stress compared to fathers in the same families, and to mothers in a normal sample. A multidimensional model of determinants of parenting stress was tested and cross-validated using a structural equation modeling procedure. The results provided general support for the proposed model, and socialsupport was shown to have both a direct and a moderating influence on parenting stress.

Within the examined age-range (6 months to 3 years), child gender or age did not relate to parenting stress. Older, less educated and single mothers reported more stress. A higher stress experience was also associated with more caretaking hassles, psychosocial problems, high work load and low social support. Mothers with high stressreported more depressive mood and were judged to be more unresponsive to their children; they also regarded their children as more temperamentally difficult. Clinical implications conserning the use of the scale in intervention contexts were discussed.

Background: Several parent training programmes and behavioural teacher training programmes built on learning theory have been developed for problem prevention and treatment of attention-deficit/hyperactivity disorder (ADHD) and/or oppositional defiant disorder (ODD) during the last few decades. Group format has often been used for parent training but single-subject designs are more common in teacher training. More studies have focussed on pre-school children than on older children, and a minority have been conducted in public mental health settings. Aim: This study aimed to evaluate a combined parent and teacher manual-based group training programme for children with ADHD conducted by the staff at a child and adolescent psychiatric clinic in Sweden. Method: The intervention was a modified version of Barkley's programme. Children were randomized to an Intervention or a Control group. Sixty-one parents and 68 teachers answered questions about ADHD and ODD symptoms, and about behavioural problems when the study started and at a 3-month follow-up. Results: Results showed that the intervention resulted in a reduction of the number of children who met DSM-IV criteria for ADHD and/or ODD. Effects were more pronounced in the home setting than in the school setting, and were further accentuated when both parents and teachers of the same child took part in the intervention. Teachers with more problematic classroom situations benefited most from the intervention. Conclusion: The programme, "Strategies in Everyday Life", has, in a regular clinical setting, demonstrated promising effects on children's disruptive behaviour, and a clinical implication was to recommend involving both parents and teachers in the programme.

We assessed verb fluency vs. noun and letter-based fluency in 199 subjects referred for cognitive complaints including Subjective Cognitive Impairment, Mild Cognitive Impairment, and Alzheimer's disease. ANCOVAs and factor analyses identified verb, noun, and letter-based fluency as distinct tasks. Verb fluency performance in Mild Cognitive Impairment differed significantly from Subjective Cognitive Impairment and Alzheimer's disease. Reduced verb fluency thus appears to be a linguistic marker for incipient dementia. One possibility is that the verb fluency deficit in Mild Cognitive Impairment results from degenerative processes known to occur in the parahippocampal region.

In many Western countries adolescents, especially girls, report high levels of stress and stress-related health complaints. In this study we investigate the concept of stress in a group of 14-15 year-olds (grade 8 in two Stockholm schools) using a multiple methods approach. The aim is to analyse stress, and gender differences in stress, as indicated by a measure of perceived stress (questionnaires, n = 212), the diurnal variation in the biomarker cortisol (saliva samples, n = 108) and the students' own accounts of stress (semi-structured interviews, n = 49). The results were generated within the traditional framework of each method and integrated at the point of interpretation. The hypothesis that adolescent girls experience more stress than boys was confirmed by all methods used. In the questionnaire, the most commonly experienced aspects of perceived stress were the same among girls and boys, but girls consistently reported higher frequencies. The saliva samples showed that girls had greater cortisol output in the morning. In the individual semi-structured interviews, girls and boys discussed stress in similar ways but both acknowledged a gender gap to the disadvantage of girls. The results as a whole suggests an interpretation of gender differences that focuses girls' attitudes, perceived expectations and coping strategies in relation to school performance, with their focus on achievement, marks, hard work, and worries about the future. The findings point to a need of an increased awareness about the role of perceived expectations in the stress process, and that these expectations and their impact on stress may differ by the gender of the student.

Large scale surveys show that perceived stress and stress-related complaints are common among young people. Perceived stress increase with age and are more common in girls than boys, resulting in late adolescent girls reporting the highest frequencies. The knowledge is however more limited regarding other measurements and meanings of stress. The purpose of this study is to use a small-scale multiple methods data collection to perform an empirical triangulation of stress in the age group 14–15 years, i.e. to analyse stress, and gender differences in stress, as it appears in questionnaires, biomarkers and interviews within the same population. The study population includes all pupils in the 8th and 9th grades (ages 14–16 years) in two elementary schools in Stockholm, Sweden (n = 545). The data collection was divided into three parts where information was gathered through class room questionnaires (n = 413), saliva sampling (5 time points during the day, number of students delivering complete samples = 190) and semi-structured qualitative interviews (49 pupils in grade 8, mean length 50 minutes).

In the questionnaires, girls consistently report higher levels of perceived stress. This is true for the activation scale (mean value boys = 2.51, girls = 3.11, p < 0.00) and the pressure scale (boys = 2.62, girls = 3.33, p < 0.00). According to the saliva sampling, girls have higher cortisol concentration both at awakening and 30 minutes later (p < 0.00). According to the qualitative interviews, no distinct differences in boys’ and girls’ associations with the word “stress” were found. However, both male and female interviewees had a perception of girls being more stressed about schoolwork than boys. Many times they linked this to girls way of thinking or coping with life demands, including worries about the future. In conclusion, the picture of adolescent girls being more stressed than boys is largely confirmed by all methods used here.

Aim: The aim of the current study was to analyze if exposure to bullying among mid-adolescent girls and boys was associated with a range of self-reported stress measures in terms of somatic pain, perceived global stress, pressure and activation (measured through the validated PAS scale), as well as output of salivary cortisol, which is a hormone of the hypothalamic-pituitary-adrenocortical (HPA) system that reflects stress. Theoretical framework: Bullying is a serious problem in schools and a major stressor for those who are exposed. Exposure to bullying has been linked to adverse mental health outcomes in both cross-sectional and longitudinal studies, and it is reasonable to assume that it is associated with outcomes such as perceived stress and biomarkers of stress. Methodology: The data were derived from the School Stress and Support Study (TriSSS), conducted in 2010. The study population comprised all students in grades 8 and 9 (ages 14-16 years) in two elementary schools in Stockholm, Sweden (n=545). A questionnaire was distributed in classrooms and students were asked to sample saliva five times a day during two school days. The questionnaire was completed by 413 students and complete information for all variables used in the present study was available for 95% of these (n=392). Exposure to bullying was self-reported and measured by multiple items. Data on cortisol was derived from the saliva samples; in the current study, we used saliva samples from day 1 (n=180). The statistical methods used were binary logistic and linear (OLS) regression. Findings: The results showed that being bullied on a weekly basis was associated with an excess risk of somatic pain and perceived global stress, pressure and activation. Students who were bullied had lower diurnal cortisol output (AUCG) as compared to those who were not bullied. Among boys, exposure to bullying was also associated with a lower cortisol awakening response (CARG). The lower cortisol output among bullied students indicates that this group may exhibit HPA-axis dysregulation following chronic stress exposure. Conclusions: The study supports the assumption that exposure to bullying, as a chronic stressor, is related to self-reported somatic pain and stress, but also to one of the major bodily stress systems. This underlines the importance of continuously working against bullying in schools.

Bullying involves repeated exposure to negative actions while also invoking a power asymmetry between the involved parties. From a stress perspective, being bullied can be seen as a severe and chronic stressor, and an everyday social-evaluative threat, coupled with a shortage of effective social resources for dealing with this particular stressor. The aim of this study was to investigate whether exposure to bullying among mid-adolescent girls and boys is associated with subjective and objective stress-related outcomes in terms of perceived stress, recurrent pain, and salivary cortisol. The data came from the School Stress and Support Study (TriSSS) including students in grades 8–9 in two schools in Stockholm, Sweden, in 2010 (study sample n = 392; cortisol subsample n = 198). Bullying was self-reported and measured by multiple items. The statistical analyses included binary logistic and linear (OLS) regression. Being bullied was associated with greater perceived stress and an increased risk of recurrent pain, among both boys and girls. Also, bullied students had lower cortisol output (AUC_G) and lower cortisol awakening response (CAR_G) as compared to those who were not bullied. Gender-stratified analyses demonstrated that these associations were statistically significant for boys but not for girls. In conclusion, this study demonstrated that being bullied was related to both subjective and objective stress markers among mid-adolescent girls and boys, pointing to the necessity of continuously working against bullying.

Stress, and stress-related health complaints, are common among young people, especially girls. Since studies have shown that school demands are an important driver of stress in adolescents, identifying if school-based resources can protect against stress is highly relevant. The aim of this study was to analyse task-related demands and task-related coping resources as aspects of the school work environment of potential relevance for stress in mid-adolescent girls and boys. The data came from “The School Stress and Support study” (TriSSS) conducted among students in grades 8 and 9 (aged 14–16 years). Self-reports of demands, coping resources, stress, as well as recurrent pain, were collected through questionnaires (n = 411). A subsample of students (n = 191–198) also provided salivary samples, which were analysed for the stress marker cortisol. Linear (OLS) and binary logistic regression analyses showed that higher demands were associated with more perceived stress, a higher likelihood of recurrent pain, and a lower cortisol awakening response. Greater coping resources were associated with less perceived stress and a lower likelihood of recurrent pain, but there was no association with cortisol. The strength of the associations differed by gender. The findings suggest that schools can promote student wellbeing by providing clear and timely information and teacher support to the students, especially for boys. Identifying specific features of the schoolwork that give rise to stress and to modify these accordingly is also of importance, especially for girls.

Föreliggande studie är en kvalitativ studie om personer vilka arbetar inom psykiatrisk vård och deras upplevelse av sitt arbete och sin arbetssituation. För att undersöka detta har fyra personer vilka arbetar med psykiatrisk vård intervjuats i mellan 30 till 50 minuter. Det som sades under intervjuerna är materialet vilket studiens resultat baserats på.

        Materialet har bearbetats med hjälp av tematisk analys som genom en sexstegsprocess genererat fyra teman: brist på kommunikation och förståelse, ansvar och kompetens leder till känsla av meningsfullhet, tillfredsställelsen kring att ingen människa är den andra lik och vikten av att ha bra och goda relationer med kollegor.

        Slutsatser vilka är möjliga att dra utifrån studiens resultat är att det är påfrestande för personalen att arbeta och leva i tider av förändringar och ovisshet men att det är arbetet med människan som är det centrala kring att personer väljer att arbeta med detta. Det är också möjligt att förstå vikten av hur graden av kontroll spelar in på de anställda och deras mående samt hur socialt stöd i form av goda relationer med kollegor är avgörande för trivsel på arbetsplatsen och hur väl de anställda klarar av att hantera stress och svåra situationer.

Follow-up studies on art therapy are lacking. In a randomised art therapy intervention study from 2001 to 2004 with women with breast cancer, results showed that patients benefitted from participating in art therapy for up to four months after the intervention. The aim of this study was to describe the coping resources and quality of life amongst women treated for breast cancer five to seven years after participating in individual art therapy during radiotherapy as compared to a control group. In 2009, thirty-seven women, 18 from the intervention group and 19 from the control group, answered questionnaires about their coping resources and quality of life. The results showed no significant difference between the groups regarding their coping resources or quality of life, except for an unexpected significantly lower score in the domain 'Social relations' in the study group as compared to baseline, at the time of the follow up. However, our study from 2001 to 2004 supports various positive effects of art therapy within six months of participation as compared to a control group. Consequently, attending art therapy during the treatment period for breast cancer can be of great importance to support health, coping and quality of life in a short-term perspective.

Follow-up studies on art therapy are lacking. In a randomised art therapy intervention study from 2001-2004 with women with breast cancer, results showed that patients benefitted from participating in art therapy for up to at least four months after the intervention. The aim of this study was to describe the coping resources and quality of life amongst women treated for breast cancer five - seven years after participating in individual art therapy during radiotherapy as compared to a control group. In 2009, thirty-seven women, 18 from the intervention group and 19 from the control group, answered questionnaires about their coping resources and quality of life. The results showed no significant difference between the groups regarding their coping resources or quality of life, except for an unexpected significantly lower score in the domain ‘Social relations’ in the study group as compared to baseline, at the time of the follow up. However, our study from 2001–2004 supports various positive effects of art therapy within six months of participation as compared to a control group. Consequently, attending art therapy during the treatment period for breast cancer can be of great importance to support health, coping and quality of life in a short-term perspective.

Short rest (<11h) between evening and day shifts – known as quick returns (QRs) – impede recovery and may impair health. Nevertheless, QRs remain popular among some shift workers. This study explores nurses’ and nursing assistants’ perceptions of the merits and demerits of QRs from individual and organizational perspectives. Participants were recruited from eleven wards at two Swedish hospitals as part of a larger quasi-experimental intervention study. The majority (79%) had influence over their work schedules. Frequency distributions of responses are presented. Ninety six undertook a baseline survey regarding recovery, tolerance and work performance in relation to QRs. A majority experienced difficulties unwinding before bedtime (76%), insufficient sleep (80%), and daytime fatigue (72%). A third experienced an increased risk of errors and mistakes. However, QRs appeared to facilitate taking reports from patients and planning work, as this task was more often rated as ‘very easy’ following a QR compared to other shift combinations. Tolerance of QRs varied substantially. In conclusion, QRs seem to benefit continuity in work processes, but may do so at the expense of recovery and safety. Wards planning to reduce QRs –through participatory or fixed schedule models – should consider impacts on work processes.

Begreppet kritisk tänkande har breddats genom att fler aspekter börjar accepteras. Den emotionella aspekten sägs ingå i den nya synen. Med denna teoretiska bakgrund var syftet att undersöka om det fanns ett positivt samband mellan kritisk disposition, det vill säga att ha en reflekterande inställning över sin omgivning, och emotionell empati på 55 gymnasieelever. Studiens deltagare var lämpliga därför att läroplanen innefattade dessa begrepp samt att skolan är en fas i livet som alla ska genomföra. Resultaten bekräftade inte sambandet men uppvisade att kvinnorna hade högre värden än männen i emotionell empati medan det inte var någon skillnad i kritisk disposition mellan könen. Dock bör det göras fler undersökningar därför att begreppen har gemensamt perspektivtagande aspekter samt att läroplanen lägger stor vikt att undervisa eleverna att vara kritiska i grupp som benämns som demokratisk värdegrund, där medkänsla till andras åsikter bör tänkas över, som är en av aspekterna på emotionell empati.

Svensk lönestatistik visar att manliga och kvinnliga ingenjörer har ojämnlika lönenivåer, till männens fördel. Tidigare studier har belyst att kvinnor har bristande tillit till sin förhandlingsförmåga och många studier har också visat att män har högre löneanspråk än kvinnor. Aktuell studie har ämnat identifiera faktorer som påverkar studenters förväntade löneanspråk för ingångslön. Resultaten här baseras på en enkätundersökning besvarad av 137 ingenjörsstudenter. Studiens resultat bekräftar tidigare studiers gällande mäns och kvinnors löneanspråk och förhandlingsförmåga, män anger högre värden för båda dessa variabler. Studien har kunnat synliggöra avgörande faktorer för studenters löneanspråk. Starkast prediktor för deltagarnas förväntade löneanspråk är variablerna kön, examensgrad och ålder. Könskillnader diskuteras för dessa resultat.

Föreliggande studie har undersökt psykopati som begrepp i populärkulturen och i relation till film. Psykopaten i film framställs som alltifrån en sadistisk våldtäktsman, en charmig gentleman till en våldsam seriemördare. Syftet med studien var att undersöka hur väl bilden av filmpsykopaten stämmer överens med den kliniska definitionen och Hares Psykopatichecklista, PCL-R.

Nitton filmer valdes ut som underlag där minst en karaktär beskrevs som psykopat. Vid analys noterades huruvida en specifik bedömningspunkt på PCL-R förekom hos en filmkaraktär eller inte. Således jämfördes karaktärerna med den kliniska psykologins bedömning av psykopati. Resultatet antydde att endast 6 av 20 filmkaraktärer kunde klassas som psykopater. Detta på grund av att filmskapare eftertraktar en intressant karaktär, och kan då överdriva vissa drag samt utnyttja de rådande stereotyperna av psykopati för att skapa spänning. Konsekvensen av detta kan bli att allmänheten får en förvrängd bild av psykopati på grund av hur det porträtteras i populärkulturen.

Studiens syfte är att kartlägga begreppet coachning samt att undersöka vilka faktorer som utmärker framgångsrik coachning ur coachernas egna synpunkter. Grunden till undersökningen är att allt fler företag använder sig av coachning då dagens förändringstakt är snabb inom arbetslivet och i samhället. Coachning härstammar från den positiva psykologins rörelse och omfattar numera flera underarter såsom chefscoachning, karriärcoachning, relations- coachning. En kvalitativ personintervju gjordes med 19 stycken coacher och resultatet visade att de mest framgångsrika faktorerna för god coachning var personkemi, att inge förtroende, att vara närvarande, empati, lyhördhet och att kunna ställa kraftfulla frågor. Egenskaper som lyftes fram var självkänsla, självförtroende, att få bättre balans i livet, att hitta sig själv och att sätta gränser.

Key words: Coaching, coach, personal growth, self-training

The purpose of this thesis was to study the prerequisites for the Swedish Armed Forces (SAF) in order to recruit sufficient numbers of suitable individuals to the organization, and to retain those within the organization.

The thesis comprises three studies (Study 1-3) where Study One comprises data gathered, with a longitudinal design, when Sweden relied on conscription for the manning of the Armed Forces. Results show that those wanting to do international military service assessed themselves higher for required qualities than those individuals not volunteering for international military service. Study Two shows that job satisfaction, according to Hackman and Oldham´s Job satisfaction model, is higher when job characteristics are good, and they in turn affect the Critical Psychological States, as proposed by Hackman and Oldham. Study Three indicates that there is a relation between performance orientation, job characteristics, job satisfaction and retention. In sum, this thesis suggests that there are different incentives for recruiting and retaining personnel to a conscripted force, and an all-volunteer force. Furthermore, the thesis indicates that an all-volunteer force concept is not the best way of manning the armed forces, for Sweden and countries with similar society, size and likewise a critical geopolitical position. 

The purpose of this thesis was to study the prerequisites for the Swedish Armed Forces (SAF) in order to recruit sufficient numbers of suitable individuals to the organization, and to retain those within the organization.

The thesis comprises three studies (Study 1-3) where Study One comprises data gathered, with a longitudinal design, when Sweden relied on conscription for the manning of the Armed Forces. Results show that those wanting to do international military service assessed themselves higher for required qualities than those individuals not volunteering for international military service. Study Two shows that job satisfaction, according to Hackman and Oldham´s Job satisfaction model, is higher when job characteristics are good, and they in turn affect the Critical Psychological States, as proposed by Hackman and Oldham. Study Three indicates that there is a relation between performance orientation, job characteristics, job satisfaction and retention. In sum, this thesis suggests that there are different incentives for recruiting and retaining personnel to a conscripted force, and an all-volunteer force. Furthermore, the thesis indicates that an all-volunteer force concept is not the best way of manning the armed forces, for Sweden and countries with similar society, size and likewise a critical geopolitical position.