To Örebro University

Background: Work related stress usually involves a variety of difficulties within the realm of emotional disorders, while CBT treatments are often disorder specific. To effectively address work stress, more versatile and parsimonious interventions are needed. Transdiagnostic treatments, targeting common psychological processes in emotion related disorders are now available. One such treatment, the Unified Protocol (Barlow et al., 2011), has shown promising results. It focuses on inflexible and maladaptive use of emotion regulation strategies. Research implies that maladaptive strategies such as excessive worrying and avoidance may also be important for stress prolongation. Thus, the implementation of a transdiagnostic treatment protocol for work stress needs to be evaluated.

Aim: To study whether treatment using the Unified Protocol, targeting generic emotional regulation, is feasible for patients who present with work stress. Furthermore, the aim is to investigate whether this treatment affects levels of stress as well as symptoms of anxiety and depression.

Method: Using a single case experimental design, we recruited six patients seeking treatment for work stress at an occupational health care center. After baseline assessments, they took part in an eight-session treatment using the Unified Protocol. Levels of perceived stress, emotional symptoms and use of regulatory strategies were daily monitored. A six month follow-up was also completed. Results: All participants completed and reported that they were satisfied with treatment. Four out of six participants also improved on reported stress-levels and emotional symptoms. Improvements were sustained at follow-up.

Discussion: Results showed that it is feasible to use a unified approach for emotional problems in patients with work stress. Treatment was also associated with symptom changes for most participants. Employing a unified CBT approach for stress would provide flexibility and parsimony for clinicians while retaining a strong theoretical framework and guiding principles. Although initial results were promising randomized controlled trials are needed. 

This interactive workshop explores various health-care interactions, through various scenarios, from the point of view of older LGBTQ adults and health-care professionals. We will divide into smaller groups and discuss the scenarios with the aim of creating safe interactions for older LGBTQ adults. The aim of the workshop is to normalize creating safe interactions for older LGBTQ adults, as well as increasing confidence in doing it.

There is a lack of research on older lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) adults. This systematic review aimed to synthesize Japanese and Swedish qualitative research on LGBTQ adults aged 60 years or older following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Japanese and Swedish articles, published in English, were searched across ASSIA, CINAHL, Medline, PsychINFO, PubMed, Scopus, and Sociological Abstracts databases. Additional searches were conducted to include studies in Japanese or Swedish. There were no papers from Japan, whereas five from Sweden were reviewed. One article was excluded due to the wrong phenomenon. Four articles were included, involving 48 participants aged 60-94 years. We summarized the findings using a deductive thematic synthesis. Two major themes emerged: (a) quality of life, minority joy, and resilience (positive aspects), and (b) discrimination, stigmatization, and minority stress (negative aspects). The participants wished to be acknowledged for their own assets and unique life histories, and to be treated as everyone else. They emphasized the importance of knowledge of LGBTQ issues among nursing staff, so that older LGBTQ people are treated in a competent and affirmative way. The study revealed several important topics for understanding older LGBTQ adults' life circumstances and the severe lack of qualitative studies in Japan and Sweden.

The aim of the present study was to assess the psychometric properties of a Swedish translation of the Sexual Orientation Microaggressions Scale (SOMS) in a convenience sample of 267 Swedish LGB+ people (Mean age = 36.41). Testing suggested some strengths in terms of factor structure and 2-week test-retest reliability (ICC > .79). Also, internal consistency (α = .80-.91) and convergent validity were supported for most subscales. However, the Assumption of Deviance subscale was associated with low response variability and internal consistency (α = .35), and the correlational pattern between the Environmental Microaggressions subscale and mental health variables diverged from the overall trend. Furthermore, measurement invariance between homo- and bisexual participants was not supported for most subscales, and although microaggressions would be theoretically irrelevant to a small comparison sample of heterosexual people (N = 76, Mean age = 40.43), metric invariance of the Environmental Microaggressions subscale was supported in comparison to LGB+ people. We argue that these limitations suggest a restricted applicability of the SOMS in a Swedish context, and this has consequences for the definition and operationalization of the construct of microaggressions as a whole. Therefore, more research on the latent properties of microaggressions in Swedish as well as in other contexts is required.

Background and aims: Validating and invalidating responses play an important role in communication with pain patients, for example regarding emotion regulation and adherence to treatment. However, it is unclear how patients’ perceptions of validation and invalidation relate to patient characteristics and treatment outcome. The aim of this study was to investigate the occurrence of subgroups based on pain patients’ perceptions of validation and invalidation from their physicians. The stability of these perceptions and differences between subgroups regarding pain, pain interference, negative affectivity and treatment outcome were also explored.

Methods: A total of 108 pain patients answered questionnaires regarding perceived validation and invalidation, pain severity, pain interference, and negative affectivity before and after pain rehabilitation treatment. Two cluster analyses using perceived validation and invalidation were performed, one on pre-scores and one on post-scores. The stability of patient perceptions from pre- to post-treatment was investigated, and clusters were compared on pain severity, pain interference, and negative affectivity. Finally, the connection between perceived validation and invalidation and treatment outcome was explored.

Results: Three clusters emerged both before and after treatment: (1) low validation and heightened invalidation, (2) moderate validation and invalidation, and (3) high validation and low invalidation. Perceptions of validation and invalidation were generally stable over time, although there were individuals whose perceptions changed. When compared to the other two clusters, the low validation/heightened invalidation cluster displayed significantly higher levels of pain interference and negative affectivity post-treatment but not pre-treatment. The whole sample significantly improved on pain interference and depression, but treatment outcome was independent of cluster. Unexpectedly, differences between clusters on pain interference and negative affectivity were only found post-treatment. This appeared to be due to the pre- and post-heightened invalidation clusters not containing the same individuals. Therefore, additional analyses were conducted to investigate the individuals who changed clusters. Results showed that patients scoring high on negative affectivity ended up in the heightened invalidation cluster post-treatment.

Conclusions: Taken together, most patients felt understood when communicating with their rehabilitation physician. However, a smaller group of patients experienced the opposite: low levels of validation and heightened levels of invalidation. This group stood out as more problematic, reporting greater pain interference and negative affectivity when compared to the other groups after treatment. Patient perceptions were typically stable over time, but some individuals changed cluster, and these movements seemed to be related to negative affectivity and pain interference. These results do not support a connection between perceived validation and invalidation from physicians (meeting the patients pre- and post-treatment) and treatment outcome. Overall, our results suggest that there is a connection between negative affectivity and pain interference in the patients, and perceived validation and invalidation from the physicians. Implications In clinical practice, it is important to pay attention to comorbid psychological problems and level of pain interference, since these factors may negatively influence effective communication. A focus on decreasing invalidating responses and/or increasing validating responses might be particularly important for patients with high levels of psychological problems and pain interference.

Across the world, people have seen their lives interrupted by the COVID-19 pandemic. Using an online survey, we explored how the psychosocial effects of the pandemic affected the mental health of LGBTQ+ young adults who were confined with their parents during the lockdown period (N = 1,934), from six countries: Portugal, UK, Italy, Brazil, Chile, and Sweden. South American participants experienced more negative psychosocial effects of the pandemic. Depression and anxiety were higher among participants who were younger, not working, living in Europe and who reported feeling more emotionally affected by the pandemic, uncomfortable at home, or isolated from non-LGBTQ friends. Not attending higher education predicted depression while not being totally confined at home, residing habitually with parents, and fearing more future infection predicted anxiety. LGBTQ+ community groups, as well as health and educational services should remain particularly attentive to the needs of LGBTQ+ young adults during health crises.

Across the world, people have seen their lives interrupted by the COVID-19 pandemic. Using an online survey, we explored how the psychosocial effects of the pandemic affected the mental health of LGBTQþ young adults who were confined with their parents during the lockdown period (N ¼ 1,934), from six countries: Portugal, UK, Italy, Brazil, Chile, and Sweden.

South American participants experienced more negative psychosocial effects of the pandemic. Depression and anxiety were higher among participants who were younger, not working, living in Europe and who reported feeling more emotionally affected by the pandemic, uncomfortable at home, or isolated from non-LGBTQ friends.

Not attending higher education predicted depression while not being totally confined at home, residing habitually with parents, and fearing more future infec-tion predicted anxiety. LGBTQþ community groups, as well as health and educational services should remain particularly attentive to the needs of LGBTQþ young adults during health crises.

Conflict of Interest and Disclosure Statement: No conflict of interest

The article explores the use of reflexive methodology to enhance mixed methods queer psychological research in Sweden, by analysing data from a qualitative research project on how LGBTQ people cope with minority stress from four epistemological perspectives. A descriptive, hermeneutically and phenomenologically inspired analysis showed that coping should be understood from temporal perspective, where ‘microcoping’ covers strategies used in specific here and now-situations, and ‘macrocoping’ addresses general strategies used over time. We suggest that this differentiation is explored in further research. The analysis then included a theoretically driven perspective using feminist theories and discursive perspectives. Three themes resulted describing different types of constant ongoing work, ‘existential’, ‘relational’ and ‘reflexive’, that participants utilized to carve out a livable existence in the world. We suggest that reflexive methodology can help produce results that can be useful in a local as well as an international context and in relation to different audiences.

Heteronormen, cisnormen och mononormen – varför bör vi känna till dem? Hur kan behandlare skapa ett samtalsklimat där klienterna kan känna sig trygga? Vilken kunskap om hbtq+-personers livsvillkor behövs för ett professionellt bemötande? Och varför räcker inte bara empati?

Den här boken tar ett omfattande grepp om frågor som rör homo, bi, trans, queer och en rad andra identitetskategorier som alla relaterar till sexualitet, relationsbildning, kön och könsuttryck – i boken samlade under akronymen hbtq+. Trots en positiv utveckling i samhället leder minoritetsstress fortfarande till ökad ohälsa hos hbtq+-personer, och kunskapsluckorna är stora inom samhälls- och vårdinstanser. Författarna sätter in dessa frågor i ett historiskt och teoretiskt ramverk och gör en grundläggande genomgång av aspekter som rör hälsa och ohälsa i relation till hbtq+. Fördjupande kapitel rör områden som barn och ungdomar, föräldraskap och migration. Praktisk kunskap om professionellt bemötande tas upp och handfasta råd vägleder läsaren. Boken vänder sig till dig som är studerande eller verksam inom ett människovårdande yrke.

HBTQ+ är skriven av flera av Sveriges mest kunniga psykologer och forskare inom området. Antologins redaktörer är Tove Lundberg, leg. psykolog, fil.dr och forskare vid Lunds universitet; Anna Malmquist, leg. psykolog, fil.dr och forskare vid Linköpings universitet; Matilda Wurm, examinerad psykolog och doktorand i psykologi vid Örebro universitet.

The mobilisation of psychologists in Sweden working for lesbian, gay, bisexual, trans* and queer (LGBTQ) wellbeing and rights has so far not succeeded in creating continuity despite several attempts to establish some kind of organisation since the mid 1990s. A new attempt was made in 2013 when the Swedish LGBTQ network for psychologists was formed following a formal decision at the congress of the Swedish Psychological Association. Even though the establishment of the network is still a work in progress, the network consists of approximately 100 members and seems to be growing. This paper describes some historical highlights from Swedish LGBTQ psychology, as well as how the network came about, underpinning perspectives and what the network aims to achieve.

Transgender people report significantly poorer mental health than cisgender people. In psychological research, these health disparities are explained by theories of minority stress and microaggressions, while other disciplines use theories on normativity, livability, affective work, world making and utopias. Such theories are seldom picked up by psychologists even though they could serve to help psychological research and practice improve mental health in transgender people.

The aim of this interview study was twofold. Empirically, it was to explore how 29 transgender people in Sweden (aged 17-63 years), experience and cope with vulnerability to make life survivable/livable. Analytically, psychological theories of minority stress, microaggressions and coping were put in conversation with theories of livability and emotional labor. Queer phenomenology was used to orient our analysis of the empirical material, as well as orient us theoretically, to find new ways of understanding transgender people’s vulnerability psychologically.

While participants’ negative experiences are interpreted as covered by theories on minority stress and microaggressions, these theories do not explain all nuances of the exposure. In addition, theories on coping do not fully capture the constantly ongoing work participants need to do to manage everyday situations. The analysis resulted in three themes. One theme describes the ontic work that participants do in response to existential challenges of not being recognized as a subject. Another theme visualizes the relational work that participants do to deal with subtle exposure in their everyday life, trying to relate to oneself and others simultaneously. The final theme shows that participants utilize reactive and agentic reflexivity to try to achieve minority peace and a livable life. We hope that this dialogue between psychology and gender studies can continue in a Swedish context to better serve transgender people’s livability.

Providing new psychological treatments in clinical settings requires implementation strategies adapted to the organizational context. This study explored how licensed psychologists experienced their context when providing a new transdiagnostic psychological treatment, "the hybrid treatment", to treat comorbid pain and emotional problems in a clinical setting. We aimed to identify which contextual factors the therapists experienced as facilitating or hindering, to gain a better understanding of important considerations when planning a future implementation strategy. Contextual factors were identified using the Consolidated Framework of Implementation Research (CFIR) in data collection and analysis. Data were collected through semi-structured interviews (N = 9). Thematic analysis resulted in the identification of five main influencing factors: Perception of the intervention's adaptability, prioritization of the patient's needs, leadership engagement, structure for collaboration, and therapists' professional engagement. The results highlight the importance of ensuring a clearly stated mandate for the key individuals involved. The findings may guide future implementation of new psychological treatments into regular care, to enhance facilitators and overcome barriers.

The COVID-19 pandemic led to major restrictions of everyday life activities. This worsened the social situation of many people, and marginalized groups have been especially affected. This article explores how LGBTQ+ young adults in Sweden have been affected by the COVID-19 pandemic and the subsequent recommendations and restrictions. Fifteen participants between 20-29 years, who self-identified as lesbian, gay, bisexual, transgender, and queer (LGBTQ+), were interviewed about their experiences. A thematic analysis of the data showed that the participants perceived their psychological wellbeing to have been greatly affected by the pandemic. Several reported symptoms of clinical depression, as well as anxiety, worry, rumination, and a heightened sensitivity to stress. Stressors included fear of the disease itself, and fear of spreading the virus, as well as the negative consequences of adhering to the recommendations of social distancing, which constantly interplayed with the marginalized position of being a young LGBTQ+ person. Most participants experienced a decrease in minority stress in face-to-face interaction with social distancing measures in place, but an increase in minority stress online. Those who faced minority stress at home experienced the isolation as particularly stressful. Limited access to the LGBTQ+ community was a common stressor. For transgender participants, the effects on transgender healthcare, such as prolonged waiting times for gender dysphoria assessment and hormone treatment, were a major challenge. Our results have added valuable knowledge to research indicating how vulnerable young adults were highly affected by the COVID-19 pandemic restrictions.

In the present article we explore when, where, and how Swedish sexual minority women experience minority stress and microaggression. Drawing on deductive thematic analysis of forty-eight interviews, we show that minority stress and microaggressions were experienced in a wide range of everyday life areas. Exposure was described in the forms of physical violence, threats and verbal abuse, ignorance and prejudice, discrimination, microassaults, microinsults, microinvalidations, excessive focus, exotification, and silence. The exposure was described to cause negative emotions, hypervigilance, a feeling of being different, internalized homo- or biphobia, and mental health problems. Despite the Swedish population being among the most accepting towards sexual minorities, theories of minority stress and microaggressions are still useful for highlighting the lived experiences of sexual minority women. Focusing on lived experiences of minority stress and microaggressions provides us with a visualization of the texture of the experiences that helps us understand what various aspects of the theories mean in everyday life.

Introduction: Increased rates of mental health issues among LGBTQ+ people have been reported during the COVID-19 pandemic, particularly among young people.

Method: Semi-structured interviews were conducted in 2021 with 61 young adult LGBTQ+ people residing in France, Italy, Portugal, Sweden, and the UK. Each interview was summarized on a template covering the participants’ experiences of pandemic restrictions, mental health, and minority stress during this period. A thematic analysis was conducted on the templates.

Results: The pandemic restrictions had a large impact on the participants’ lives, leaving them stuck at home. Not having access to the LGBTQ+ community was an additional stress, as this is a venue for support. Half of the participants had suffered from mental health issues during the pandemic. Those who were living in non-affirmative households had a particularly difficult time and experienced overwhelming stress. Increased feelings of gender dysphoria were seen among trans participants due to the lack of access to gender-affirming healthcare. Most participants experienced less distal minority stress than usual due to social isolation restrictions.

Conclusion: The COVID-19 pandemic and the associated social restrictions had a large impact on the lives of LGBTQ+ young adults. Many experience worse mental health, although relief from distal minority stress was common.

Policy Implications: Policy makers must consider the needs of LGBTQ+ young adults as they seek to explore and establish their gender and/or sexual identity. During a pandemic, it is particularly important to help young LGBTQ+ people to engage with the LGBTQ+ community.

Families today exhibit a great deal of diversity, and LGBTQ parents are becoming more common. At the same time a normative idealised picture of the family prevails, consisting of a heterosexual couple with their biological children. Basic knowledge of LGBTQ peoples’ family life and paths to parenthood is central to a professional engagement with LGBTQ families. This article introduces the subject area and describes four types of families: same-sex female couples with children, same-sex male couples with children, families with more than two parents and families where a parent is transgender. The article also highlights encounters between LGBTQ families and professionals in psychological treatment.

Older LGBTQ adults face unique challenges compared to their heterosexual cisgender counterparts. When navigating public and private spaces, LGBTQ adults experience microaggressions in their everyday life, such as hostile looks, misgendering, and being asked personal questions (Lundberg et al.). In our systematic review, we found that it was common for LGBTQ individuals to feel the need to educate healthcare professionals on LGBTQ issues, and there was a concern within the community that they may be treated negatively by professionals (Bratt et al., 2023).

The current project aims to explore the attitudes and knowledge among healthcare professionals in Japan and Sweden with the purpose of finding ways to talk about LGBTQ topics and raise visibility for older LGBTQ adults. This would help to shift the responsibility for informing and educating health care professionals away from the LGBTQ community and enable a better and more equal care services. A partial goal is therefore also to design of a user-friendly, legally secure communication tool to contribute to increased inclusion and quality of life for older LGBTQ people.

In our pilot study, we interviewed health care professionals about how they perceive meeting older LGBTQ people. As a starting point in the interviews, we have used images, illustrated by Dr Muraya, showing various hypothetical scenarios within elderly care.

In both Japan and Sweden it was common for health care professionals to say that they have never encountered any older LGBTQ individuals. In Sweden, this was commonly followed by the comment that there would be no issues because “we treat everyone equal”. In Japan, similarly, professionals described that the topic was a non-issue. Hence, our study would help to make older LGBTQ people visible and to raise issues that are not focused on today. 

The poster will visualize the pictures used and present preliminary results. A future use of results will be discussed.

Background: Previous research mainly focused on responses to negative affect in relation to depression, and less on responses to positive affect. Cognitive responses to positive affect are interesting in the context of emotion regulation and emotion disorders: positive rumination is associated to hypomania risk and bipolar disorder. There is to date no questionnaire in Swedish that captures the phenomena of cognitive response styles.

Aims: The aim of this study was to investigate the replicability of the Responses to Positive Affect questionnaire (RPA) in a newly translated Swedish versionand to test its psychometric properties.

Methods: Swedish undergraduates (n 111) completed a set of self-report questionnaires in a fixed order.

Results: The hypothesized three-factor model was largely replicated in the subscales Self-focused positive rumination, Emotion-focused positive rumination and Dampening. The two positive rumination subscales were strongly associated with each other and current positive affect. The subscales showed acceptable convergent and incremental validity with concurrent measures of depression, hypomania, anxiety, repetitive negative thinking, and positive and negative affect. The model explained 25% of the variance in hypomania, but fell short in the explanation of depression.

Conclusions: The Swedish version of the RPA shows satisfactory reliability and initial fi ndings from a student sample indicate that it is a valid measure comparable with the original RPA questionnaire. Results give emphasis to the importance of further exploration of cognitive response styles in relation to psychopathology.

Cognitive responses to positive affect (PA) are interesting in the context of emotion dysregulation and emotion disorders. Previous research mainly focused on ruminative responses to negative affect in relation to psychopathology. The aim of this study was to explore the interaction between cognitive response styles as measured with the Responses to Positive Affect questionnaire (RPA) and changes in emotional state during an experimental manipulation in a non-clinical sample. Using a pre-test post-test design, Swedish undergraduate students (n = 60) were randomized into either a mood induction procedure designed to evoke positive mood or a control condition. Results revealed that the two positive rumination subscales of the RPA were associated with each other and with PA. However, none of the RPA subscales interacted with participants’ mood reactivity, thus meaning that cognitive response styles did not predict changes in mood as the participants were exposed to a mood induction procedure. The results postulate new questions on the conceptualization and functioning of cognitive response styles, as their role concerning reactivity to elevated mood states remain unclear.

Hur är det att leva som transperson i Sverige idag? Ges könsbekräftande vård för lättvindigt eller får man tvärtom vänta alldeles för länge? Ökar antalet unga transpersoner? Vad finns det för vägar till att få barn som transperson? 

Transfrågor har synts på ett helt nytt sätt i samhällsdebatten de senaste åren.

Samtidigt känner sig många osäkra på vad olika ord innebär, vad ett gott bemötande kan innebära samt hur hälsa och livsvillkor ser ut för transpersoner. Ökad kunskap är avgörande för att alla delar av samhället ska kunna främja hälsa och trygghet för transpersoner. 

Denna antologi tar ett helhetsgrepp kring ämnet och förmedlar befintlig forskning och kunskap på ett tillgängligt sätt, där ämnet också tillåts vara komplext. Korta intervjuer ger inblickar i transpersoners olika erfarenheter och livsvillkor. Boken är skriven för alla som vill lära sig mer om transfrågor. Den ger även guidning och trygghet för både transpersoner och deras närstående.

People with gender-incongruent behaviors have a higher risk for psychiatric problems compared to others. A professional approach is an important part of the treatment process and will influence the therapeutic outcome. Earlier research shows deficits in the contact between care personnel and people with gender-incongruent behaviours. There are no studies focusing on psychologists and their work with this client group. The aim of this study is to research psychologists’ subjective experience of clients with gender-incongruent behaviours. The study uses a qualitative method. The research data was collected with semi-structured interviews with five psychologists that had some experience with clients with gender-incongruent behaviours. The results point to gender-incongruent behaviors being a topic that evokes both interest and commitment, but also some insecurity in psychologists. Psychologists’ preconceptions and personal beliefs play a big role during the work with these clients when education and access to information on the topic is limited. A non-pathologizing outlook on gender-incongruent behaviours dominates, but the opposite also exists. More research is needed to map out in which way psychologist-related factors influence treatment of people with gender-incongruent behaviours. Another important aspect is how existing knowledge can be implemented in psychologists’ basic training and how it can be spread effectively amongst professionals.

This is a qualitative study where the interview data from seven pre-pubertal and gender creative children 4-12 years old, was analyzed according to Interpretative Phenomenological Analysis, IPA. The data was drawn from a bigger qualitative doctoral project about the lived experiences of gender creative children and youth between 4-17 years and their parents, related to the children’s gender identities. Due to the greater verbal and cognitive functioning of the teenagers, we chose to split the analysis of the children’s interview material in two, as not to let the voices of the young ones drown in the greater verbal and reflective flood of the teenagers. As far as we know this is the first study made where gender creative children from 4 years old describe their lived experience related to gender identity in everyday life, not only in retrospect as for most research on transgender childhood experiences, but whileen actually happening. 

The overarching aim of the study was to learn more about pre-pubertal and gender creative children’s experiences related to their affirmed gender identity, in everyday life, as described by the children themselves. A dominating part of research on transgender children comes from children recruited from gender clinics and is based on quantitative data (i.e. from symptom scales or other diagnostic measurements for example) from a medical and/or psychiatric perspective. To broaden the scope, important aims for us were therefore to center the children’s own voices and focus on the children’s lived experience before and outside the gender-affirming care. 

Background: Research on the daily experiences of transgender and gender diverse (TGD) youth 18 years or younger is limited, making it essential to gain a comprehensive understanding of their internal and external experiences related to gender identity.

Aim: This systematic review and qualitative research synthesis fills this research gap by examining the lived experiences and coping of TGD youth, including prepubertal children.

Methods: The review was pre-registered according to PROSPERO on the Open Science Framework and followed the ENTREQ reporting guidelines. A Qualitative research synthesis, according to Howell Major and Savin-Baden, was conducted.

Results: Seventeen peer-reviewed articles published between 2000 and 2023 fulfilled inclusion criteria and quality assessment. Synthesized themes were: (1) “Navigating gender identity”, with two sub-themes, Meaning-making and Considering visibility (2) “Navigating relations”, with four sub-themes: Longing for belonging, Supportive actions, Lack of safety and Coping inside out (3) “Navigating society with two sub-themes Inclusion and exclusion and Beyond control. Our findings demonstrate that TGD youth view gender identity as fluid and benefit from a supportive environment that facilitates genuine exploration. Coping strategies develop intricately, influenced by multifaceted factors.

Discussion: Unlike previous research on the negative effects of minority stress, our review underscores the cumulative impact of subtle daily stressors on TGD youth’s well-being, highlighting the significance of an environment where gender is not a constant concern. By shedding light on these dynamics, this synthesis contributes to a comprehensive understanding of TGD youth’s perspectives for professionals and a broader audience.

Knowledge of prepubertal transgender and gender diverse (TGD) children is limited. This study fills a gap in the research literature by exploring the lived experiences of prepubertal TGD children related to gender identity, centering their voices. Interviews with 10 TGD Swedish children 4–12 years old were analyzed through Thematic Analysis. The analysis resulted in two main themes: (1) “The journey of gender exploration,” with subthemes Discovering me and The joys, and challenges of being me; (2) “Meeting the outside world,” with subthemes Can I belong? and Staying me: my tips, tricks and help from others. The children’s evolving gender identity was traced, emphasizing emotional aspects and pivotal milestones like affirmed names. Even though the children had supportive environments, challenges of misgendering and the need for continual self-assertion were exposed. Despite struggles for recognition, the study highlights TGD children’s resilient coping and well-being. Still, cisgender norms were observed to challenge their prevalent pride and positive self-images, emphasizing the need for enhanced knowledge of gender diversity for a broader societal change. This study expands the literature on TGD children’s gender identity development, informs professionals and abroad audience and provides an enhanced understanding of TGD prepubertal children through their own words.

The COVID-19 pandemic has been associated with poor mental health symptoms, particularly among vulnerable populations such as LGBTQ+ individuals. In the present study, we aimed to (i) identify different psychological adjustment profiles among LGBTQ+ young adults during the COVID-19 pandemic and compare LGBTQ+ young adults in relation to (ii) sociodemographic characteristics and COVID-19-related experiences and (iii) the internal and external protective resources associated with each adjustment profile. An online questionnaire was administered to 1699 LGBTQ+ young adults from six countries (Brazil, Chile, Italy, Portugal, Sweden, and the UK). A cluster analysis was conducted, and four profiles of psychological adjustment were identified: unchallenged, resilient, distressed, and at-risk. The at-risk cluster scored lowest in social support (particularly from family). The profiles of participants who experienced the highest levels of pandemic adversity (at-risk and resilient) comprised mostly South American participants, those under lockdown at the time of survey completion, those who self-identified as transgender and non-binary, and those with a plurisexual sexual orientation. Interventions should consider strategies to help young adults maintain support systems and reinforce the value of positive family relationships. Specific groups within the LGBTQ+ community that seem to be in a particularly vulnerable situation may need additional tailored support.

Experiencing pain, including an emotional reaction, is part of being hu­man. Emotional comorbidity is common in pain patients, and corre­lated to higher symptomatology and worse treatment outcome. The shared vulnerability model suggests that many vulnerability and main­taining factors may be involved in both pain and emotional problems. Hence, they may be transdiagnostic. Since our knowledge about these shared factors is lacking, potential targets for risk assessment, preven­tion, and treatment are likely underutilized. The overarching aim of this dissertation was to further our understanding of comorbid musculo­skeletal pain and emotional problems by investigating the role of trans­diagnostic factors. Specifically, it was studied if levels of shared vulner­abilities (negative affect and anxiety sensitivity) and symptomatology covary in pain patients depending on the occurrence of comorbid social anxiety symptoms (Study I); if peer-related stress predicts musculoskel­etal pain problems over time in adolescents, and if this is mediated by worry and moderated by gender (Study II); and if symptomatology can be decreased in pain patients with comorbid emotional problems by using an internet delivered unified protocol for emotional disorders (Study III). Results show that vulnerabilities covaried with comorbid pain and social anxiety. Also, peer-related stress predicted musculoskel­etal pain problems in adolescents and was mediated by worry for girls. However, the internet-delivered unified protocol did not unequivocally decrease symptomatology. In sum, the studies in this dissertation pro­vide partial support for the role of transdiagnostic factors in comorbid musculoskeletal pain and emotional problems. A transdiagnostic ap­proach may offer a parsimonious understanding of the  development and maintenance of this comorbid symptomatology.

Objective: Adolescence is a time of change during which several health problems, such as pain problems, increase. Psychosocial mechanisms involved in this development, such as interpersonal stressors and worry, are still understudied, especially longitudinally. The first aim of this study was to investigate the prevalence of musculoskeletal pain in Swedish adolescents between the ages 13 and 15 using pain grades. The second aim was to study the role of peer-related stress, worry, and gender in the development of musculoskeletal pain problems over time.

Methods: Adolescents in 18 public schools were followed from 7th to 9th grade (N=1181) and answered selfreport questionnaires at three time points. Prevalence was assessed at all three time points and a moderated mediation analysis investigated if peer-related stress in 7th grade predicted musculoskeletal pain two years later and if this relationship was mediated by worry in 8th grade. Gender was entered as a moderator.

Results: In 7th grade, 8.4% of adolescents reported musculoskeletal pain with some functional impairment. In 8th and 9th grade around 10% of adolescents reported musculoskeletal pain problems, with girls reporting a higher prevalence than boys. Peer-related stress in 7th grade predicted musculoskeletal pain problems in 9th grade, mediated by worry in 8th grade. The mediation was moderated by gender: peer-related stress predicted worry for girls, but not for boys.

Conclusion: Peer-related stress and worry seem to be involved in the development of pain over time. These factors should therefore be targeted in preventative interventions and during treatment.

Background and aims: Chronic pain problems are related to specific pain related fears and maladaptive pain-coping but also commonly co-occur with other anxiety problems. Shared emotional vulnerabil-ity factors may explain this comorbidity and may influence treatment outcome. Indeed, pain patients going through multimodal pain treatment are a heterogeneous group and treatment results vary. One understudied anxiety disorder co-occurring with pain is social anxiety. This may be relevant as many pain-related challenges are situated in social contexts. The aim of this study is to investigate the occur-rence of subgroups with differential patterns of social anxiety and pain related fear in a sample of chronic pain patients who receive multimodal pain treatment. The aim is also to study the characteristics of these potential subgroups and the consequences of different patterns of social anxiety and pain related fear.

Methods: 180 patients with chronic musculoskeletal pain answered questionnaires before and after a multimodal pain treatment in a hospital rehabilitation setting in middle Sweden. A cluster analysis using pre-treatment scores on the Social Phobia Screening Questionnaire and the Tampa Scale of Kinesiophobia was performed. Subgroups were thereafter validated and compared on impairment due to social anxi-ety, pain catastrophizing, anxiety, and depression. Moreover, subgroups were described and compared on vulnerability factors (anxiety sensitivity, negative affect) and outcome factors (pain intensity, pain interference, and return to work self-efficacy).

Results: Four distinct clusters emerged: (1) low scores, (2) pain-related fear only, (3) social concern only, and (4) high social anxiety and pain-related fear. Patients high on social anxiety and pain-related fear had significantly higher levels of anxiety sensitivity, negative affect, and higher general emotional symptomatology. They also had remaining problems posttreatment.

Conclusions: A subgroup of patients with clinical levels of social anxiety has suboptimal rehabilitation results, with residual emotional problems and high levels of emotional vulnerability.

Implications: These patients may be in need of additional treatment efforts that are not being met today. To prevent insufficient treatment results and prolonged work disability, these patients need to be detected during screening and may benefit from pain treatment that takes their emotional problems into account.

Background and aim: Back/neck pain is common in adolescents. Studies show correlations with social factors, such as bully victimization and individual social functioning (social anxiety). In adult pain populations, comorbid social anxiety has been correlated with higher symptomatology and worse treatment outcome. The aim of this study was to describe the prevalence of back/neck pain and to analyze the influence of bullying and social anxiety on back/neck pain over time in a general population sample of Swedish adolescents.

Method: Data consisted at baseline of all pupils in 7’th grade attending public schools in three Swedish municipalities (N= 1453, Mage= 13.19, sd= .43, 52.6 % boys), followed up yearly. Pupils were categorized as having a pain-problem based on self-reported pain frequency, pain intensity, and functional limitation. A multivariate logistic regression was conducted with bullying victimization, social anxiety, back/neck pain and gender at time 1 as predictors for back/neck pain at time 3.

Results: The prevalence of problematic back/neck pain was 8.4% (N= 122) at time 1, 10.5% (N=144) at time 2 and 9.9% (N=117) at time 3. The regression model was statistically significant (X² (4, N= 1181) = 84.46, p=.000). Gender, back/neck pain and bully victimization at time 1, but not social anxiety, significantly predicted pain problem at time 3.

Conclusions: External social factors rather than individual social function predicted back/neck pain. Since studies have found correlations between bully victimization and social anxiety and social anxiety may be prevalent and influence treatment outcomes in adult pain populations, this relationship should be studied further.

INTRODUCTION: Transgender and gender-diverse (TGD) youth experience more stressors and are therefore at a higher risk of health problems compared with their cisgender peers. The aim of this study was to investigate the prevalence of TGD youth in a general population sample and to explore a wide variety of health-related factors. We investigate differences in stressors and health outcomes between TGD youth and cisgender girls and boys and the influence of stressors and demographic factors on health outcome in the whole group.

METHODS: Cross-sectional survey data from a Swedish school-based study were used (N = 3,067, M = 17.8 years). Those who had reported their gender identity as "other" or other than their assigned gender (N = 41) were compared with cisgendered girls (n = 1,544) and boys (n = 1,482). Regression models in the whole group explored if demographics and stressors statistically predicted health outcomes.

RESULTS: In comparison with cisgender girls and boys, TGD youth (1.3% of the whole sample) reported a higher prevalence of self-harm and pain problems. Both TGD youth and cisgender girls more frequently reported insomnia, social anxiety, depressive symptoms, pain, and stressors compared with cisgender boys. When only demographic variables were entered, but not when stressors were added to the model, being TGD magnified the odds of depressive symptoms, sub-diagnostic social anxiety, and pain problems. Stressors magnified the odds of reporting health problems for the whole group.

CONCLUSION: TGD youth generally reported more stressors, which negatively influence health outcomes. Results are important for professionals who meet TGD youth.

In pain patients, comorbid emotional problems have been linked to negative outcomes, including suboptimaltreatment gains. Developing parsimonious and accessible treatment options is therefore important. The overarchingaim of this study was to test an internet delivered therapist guided transdiagnostic treatment withtelephone support. An adapted version of the Unified Protocol for Transdiagnostic Treatments of EmotionalDisorders was used as an intervention for pain patients with residual pain problems and comorbid emotionalproblems after having received a multimodal pain rehabilitation. The study used a replicated AB single caseexperimental design (N =5; 3 females). Outcome measures were depressive and general anxiety symptoms, painintensity, pain coping problems, and diagnostic status. Feasibility measures (completion and compliance) andpatient satisfaction were also assessed. Scores on Nonoverlap of All Pairs (NAP) indicate a decrease of anxiety forthree participants and a decrease of depression for four participants. Decreases were small and did not alwaysreach statistical significance. Also, Tau-U scores could only confirm a reliable trend for one participant. Two outof four patients who were diagnosed with psychiatric disorders before treatment did no longer fulfill diagnosticcriteria posttreatment. No improvements could be seen on pain problems. The treatment was feasible and patientsatisfaction was high. Hence, while an internet delivered transdiagnostic treatment with telephone support maybe a feasible and accepted secondary intervention for pain patients with comorbid emotional problems, theeffects are unclear. The gap between high patient satisfaction and small changes in symptomatology should beexplored further.

Syftet med den här texten är att beskriva olika former av mikroaggressioner och ge exempel på hur de kan ta sig uttryck. Vi kommer att gå igenom hur de hanteras av de som utsätts, samt diskutera varför yrkesverksamma som träffar människor i sitt arbete behöver ha kunskap om mikroaggressioner. I den här texten kommer vi framför allt att belysa situationen för hbtq-personer, alltså personer som är homosexuella, bisexuella, transpersoner eller queera. Liknande mekanismer är också verksamma för andra minoriteter, exempelvis tog forskning om mikroaggressioner sin början inom rasismforskning.

Trans* people are at an increased risk for developing mental and physical illness compared to cis people. This is explained by the higher risk of experiencing minority stress, that is, the increased risk for being exposed to both external stressors, such as violence, threats, and questioning, as well as internal stressors, such as worry about being exposed and internalized transphobia.

Despite this, many trans* people do well and are generally satisfied with their lives. The important, focus on stressors and ill-health can therefore be problematized as giving a one-sided picture of trans* peoples lives. It can be assumed that a trans* identity can open up new possibilities and experiences that are experienced as positive. Few international studies and no Swedish study had been done to investigate positive aspects of identifying as trans*.

The present study aims to answer the question if positive aspect, here called minority joy, exist and how they are experienced and described by trans* people. Preliminary data has been analyzed, based on interviews with five trans men and six trans women. Interviews with people with non-binary identities are ongoing and additional interviews will be held during the winter.

Preliminary results show that trans* people describe positive aspects in several areas: Authenticity, Gender euphoria, To break norms, Activism, Unique understanding from living in two genders, Community, and Absence of negative emotions.

The findings are in line with previous positive aspects, but also contribute important information that has not been conceptualized in a Swedish context before. This information can potentially be important for both trans* people, health care givers, and society at large to nuance the ongoing debate.

LGBTQ+ people and especially trans* people are at an increased risk for developing mental and physical illness compared to cis people. This is explained by the higher risk of experiencing minority stress, that is, the increased risk for being exposed to both external stressors, such as violence, threats, and questioning, as well as internal stressors, such as worry about being exposed and internalized transphobia.

Despite this, many trans* people do well and are generally satisfied with their lives. The important, focus on stressors and ill-health can therefore be problematized as giving a one-sided picture of trans* peoples' lives. It can be assumed that a trans* identity can open up new possibilities and experiences that are experienced as positive. Few international studies and no Swedish study had been done to investigate positive aspects of identifying as trans*.

The present study aims to answer the question if positive aspects, here called minority joy, exist and how they are experienced and described by trans* people. Preliminary data has been analyzed, based on interviews with five trans men and six trans women. Ten more interviews have been done and are being transcribed. And more interviews specifically with people with non-binary identities are ongoing.

Preliminary results show that trans* people describe positive aspects in several areas: Authenticity, Gender euphoria, To break norms, Activism, Unique understanding from living in two genders, Community, and Absence of negative emotions.

The findings are in line with previous positive aspects, but also contribute important information that has not been conceptualized in a Swedish context before. This information can potentially be important for both trans* people, health care givers, and society at large to nuance the ongoing debate. The concept of minority joy could hopefully be a vital part of LGBTQ+ research and minority research in general and contribute to a less problem focused perspective on minority peoples' lives.