To Örebro University

Background: Neighborhoods shape daily life through physical and social structures, such as socioeconomic conditions, population density, and resident turnover. Decades of research link neighborhood characteristics to health and behavioral outcomes. However, these factors are often studied independently, neglecting their interrelated nature.

Methods: Using Swedish population registry data, we employed latent class analyses to identify neighborhood typologies across six timepoints spanning 1991-2020. Neighborhoods, defined by Demographic Statistical Areas, were characterized by socioeconomic conditions, ethnic heterogeneity, residential instability, and urbanicity. Latent transition analyses examined changes over time.

Results: Four neighborhood types emerged in the early period (1991-2000): Rural Low-Diversity (45 %), Urban Professional (27 %), Urban Affluent (21 %), and Resource-Limited (7 %). From 2001 onwards, five types were identified, with the addition of Urban High-Diversity (9 %) and Rural Resource-Limited (3 %). Three types, Rural Low-Diversity, Urban Professional, and Urban Affluent, persisted across 30 years, representing 87-93 % of neighborhoods, with over 90 % of neighborhoods retaining their classification over time.

Conclusions: This multidimensional framework offers a foundation for future research, urban planning, and policy development.

Individuals with social anxiety disorder (SAD) experience overall emotion regulation difficulties, but less is known about the long-term role of such difficulties in cognitive behavior therapy (CBT) for SAD. Forty-six patients with SAD receiving internet-delivered CBT, and matched healthy controls (HCs; n = 39), self-reported the Difficulties in Emotion Regulation Scale (DERS), Liebowitz Social Anxiety Scale (LSAS-SR), and participated in anticipatory speech anxiety behavioral experiments. Patients were measured at seven time points before, during and after CBT over a total period of 28 months, and HCs at two timepoints. Disaggregated growth curve models with a total of 263 observations were used, as well as intra-class correlation coefficients and regression models. Patients' LSAS-SR and DERS ratings were reliable (ICC = .83 and .75 respectively), and patients, relative to controls, showed larger difficulties in emotion regulation at pre-treatment (p < .001). During CBT, within-individual improvements in emotion regulation significantly predicted later LSAS-SR reductions (p = .041, pseudo-R2 = 43%). Changes in emotion regulation may thus be important to monitor on an individual level and may be used to improve outcomes in future developments of internet-delivered CBT.

INTRODUCTION: Irritable bowel syndrome (IBS) is a common and debilitating disorder. When dietary and pharmacological interventions are not satisfactory, psychological treatment may produce good results. However, the access to such treatment is scarce, and therefore, it is of importance to make use of technical solutions. In this study, we wanted to investigate the real-world effectiveness of an Internet-delivered exposure-based cognitive behavior therapy (ECBT) for IBS and to replicate an earlier finding regarding the working mechanism of the treatment.

METHODS: A total of 309 consecutively recruited patients from the Internet Psychiatry Clinic in Stockholm received ECBT for 12 weeks. The patients' IBS symptoms, quality of life, avoidance behaviors, and gastrointestinal symptom-specific anxiety were monitored, and we used a bivariate cross-lagged panel model to investigate time-related change in symptoms and avoidance behaviors. RESULTS: IBS symptoms, measured with the Gastrointestinal Symptom Rating Scale for IBS, were reduced from 48.06 (SD = 11.26) before treatment to 33.06 (SD = 10.81) 6 months after treatment (P < 0.001). The effect size (calculated by Cohen d) was 1.30 (1.08-1.51). There was a significant (P < 0.001) cross-lagged effect from reduction in avoidance behavior to reduction in symptoms but not in the reverse direction, indicating that the treatment effect is mediated by behavioral change.

DISCUSSION: We conclude that ECBT is effective under real-world conditions, also when delivered through the Internet, and that an important treatment mechanism is the reduction of avoidance behaviors.

Despite documented risks associated with excessive anger inhibition, few treatments specifically target maladaptive anger inhibition. Building on a previously evaluated treatment for general anger, this study evaluated the feasibility, acceptability, and preliminary efficacy of a brief (4-week), therapist-supported online emotion-regulation treatment for maladaptive anger inhibition. In total 38 participants (89.5% female; M-age = 43.8, SD = 14.1) with elevated levels of maladaptive anger inhibition were offered treatment, which was evaluated using a pooled interrupted time series design (ITS). Treatment outcomes included measures of anger inhibition, anger rumination, and anger assertion that were assessed during a baseline phase (4 weeks) and a treatment phase (4 weeks). Feasibility was supported by high retention and adherence, and minor adverse events. Moreover, participants reported high treatment credibility and satisfaction, indicating good acceptability of the treatment. Piecewise growth curve analysis for ITS, comparing baseline and treatment phases, revealed significant and large immediate effects on all outcomes: anger inhibition (d = 1.26), anger rumination (d = 0.80), and anger assertion (d = 0.79), with small additional gains observed at 3-month follow-up. Taken together, the findings suggest that this brief online emotion-regulation treatment for maladaptive anger inhibition is feasible, acceptable, potentially effective, warranting further investigation in an RCT. ClinicalTrials.gov identifier: NCT06697587

IMPORTANCE: Mental health problems are common during adolescence, but access to effective treatments is limited. Transdiagnostic treatments could address this treatment gap, but their feasibility, acceptability, and effectiveness remain unknown.

OBJECTIVE: To test the feasibility and acceptability of an online emotion regulation treatment for adolescents with mental health problems and investigate the preliminary effects on clinical outcomes and the target mechanism, emotion regulation.

DESIGN, SETTING, AND PARTICIPANTS: This single-blind randomized clinical trial was conducted between October 16, 2022, and July 28, 2023, in a primary care setting in Sweden. Participants in the intention-to-treat analysis were adolescents aged 12 to 17 years with mental health problems and their parents.

INTERVENTION: Participants were randomized 1:1 to 6 weeks of therapist-guided online transdiagnostic emotion regulation treatment or an active control condition consisting of 6 weeks of online supportive treatment.

MAIN OUTCOMES AND MEASURES: The primary outcomes were feasibility and acceptability measures, including consent rate, completion of assessments, adherence, credibility and expectancy ratings (Credibility/Expectancy Questionnaire), and treatment satisfaction (Client Satisfaction Questionnaire), immediately after treatment. Clinical outcomes, rated by blinded assessor, included global symptom severity and improvement, symptoms of depression and anxiety, global functioning, and emotion regulation.

RESULTS: A total of 30 adolescents (mean [SD] age, 14.2 [1.48] years; 28 females [93%]) were randomized to experimental treatment (n = 15) or active control treatment (n = 15). The consent rate (30 of 37 eligible participants [81%]) and rate of assessment completion immediately after treatment (28 [93%]) were high. Adherence, credibility, expectancy, and satisfaction in both groups were adequate. Participation in the experimental condition, but not the control condition, was associated with large within-group reductions in symptom severity (effect size, 1.30; 95% CI, 0.73-1.86) and symptoms of anxiety and depression (Cohen d, 1.07; 95% CI, 0.37-1.84), improved global functioning (Cohen d, 1.26; 95% CI, 0.66-1.85), and reductions in maladaptive cognitive coping (Cohen d, 1.10; 95% CI, 0.52-1.70) immediately after treatment.

CONCLUSION AND RELEVANCE: In this randomized clinical trial, a brief online transdiagnostic emotion regulation treatment targeting adolescents with mental health problems was found to be feasible, acceptable, and potentially efficacious in primary care and may increase treatment outreach and accessibility for this population.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05032547.

INTRODUCTION: Little is known about what pretreatment patient characteristics the outcome of Cognitive Therapy (CT) and Behavioral Therapy (BT) for insomnia disorder depends on. Identifying for whom treatment is most useful is essential for treatment optimization and personalized care. Therefore, this investigation aimed to examine both theory-driven constructs and insomnia-associated clinical variables as potential predictors and moderators of outcomes in CT and BT.

MATERIALS AND METHODS: One hundred forty-five participants diagnosed with insomnia disorder were randomly assigned to 10 weekly internet-delivered modules of CT or BT, along with 15 min of weekly telephone support. General clinical predictors and theory-driven moderators (cognitive and behavioral processes) assessed in a previous randomized controlled trial were analyzed using multiple linear regression, with insomnia severity as the outcome.

RESULTS: Bedtime variability and early morning awakening interacted with treatment and indicated that lower bedtime variability and early morning awakening were associated with a higher effect for CT, whereas the opposite was true for BT. Wake time after sleep onset, insomnia severity index, and sleep efficiency emerged as predictors, indicating prognostic value for treatment outcome.

CONCLUSIONS: In addition to identifying three insomnia-associated variables as predictors of outcome across both treatments, this trial showed that CT and BT could be differentially effective based on patient insomnia heterogeneity at baseline. The differential moderator findings are in line with the theoretical models of CT and BT and might clinically implicate the ability to match therapy to patient features to optimize outcomes.

INTRODUCTION: Therapist-guided internet interventions have increased access to care for a range of psychiatric and somatic conditions during the last decades. However, there is still a need for more easily accessible self-care interventions to improve treatment dissemination further. Brief digital self-care interventions, i.e. self-help interventions without therapist-guidance that are given together with a clinical assessment interview, reduce both patient burden and clinical resources.

METHODS: A new individually tailored self-care intervention for anxiety and low mood has been developed and will be tested in a pilot study. The study is a single-blind randomized controlled trial with parallel arms design. Participants are randomized to one of two groups: with or without weekly support from a therapist during the intervention. The intervention is eight weeks long and consists of less text and less number of exercises compared to the more comprehensive therapist-guided internet interventions used in Swedish routine care. A telephone interview evaluating the intervention will take place at the end of the eight weeks. The goal is to recruit 160 participants.

RESULTS AND CONCLUSIONS: The design of the self-care intervention and preliminary efficacy data from the trial will be presented. Data on participant characteristics, adherence and choice of tailored problem area will also be shown. If successful, self-care interventions can further increase accessibility to care for people suffering with low mood and anxiety. Future studies aim to adapt the level of support by a clinician based on participant response to the self-care intervention, i.e. offering more support to participants that have a predicted negative outcome of the intervention.

Aims: The objective was to compare anxiety, depression, and quality of life (QoL) in individuals living with type 1 (T1D) and type 2 (T2D) diabetes with matched controls during the second wave of the COVID-19 pandemic.

Methods: Via randomization, individuals living with diabetes T1D (n = 203) and T2D (n = 413), were identified during February-July 2021 through health-care registers. Population controls (n = 282) were matched for age, gender, and residential area. Questionnaires included self-assessment of anxiety, depression, QoL, and demographics in relation to SARS-CoV-2 exposure. Blood was collected through home-capillary sampling, and SARS-CoV-2 Nucleocapsid (NCP) and Spike antibodies (SC2_S1) were determined by multiplex Antibody Detection by Agglutination-PCR (ADAP) assays.

Results: Younger age and health issues were related to anxiety, depression, and QoL, with no differences between the study groups. Female gender was associated with anxiety, while obesity was associated with lower QoL. The SARS-CoV-2 NCP seroprevalence was higher in T1D (8.9 %) compared to T2D (3.9 %) and controls (4.0 %), while the SARS-CoV-2 SC2_S1 seroprevalence was higher for controls (25.5 %) compared to T1D (16.8 %) and T2D (14.0 %).

Conclusions: A higher SARS-CoV-2 infection rate in T1D may be explained by younger age and higher employment rate, and the associated increased risk for viral exposure.

INTRODUCTION: A best practice physiotherapy model of care (BetterBack MoC) for low back pain (LBP) aimed to improve patients' illness perceptions and self-care enablement, according to the Common-Sense Model of Self-Regulation (CSM).

OBJECTIVE: To confirm if illness perceptions and patient self-care enablement, in line with the CSM, are mediators of treatment effects on disability and pain of the BetterBack MoC for patients with LBP compared to routine primary care. A secondary aim was to explore if illness perceptions and patient self-care enablement are mediators of guideline adherent care.

METHODS: Pre-planned single mediation analyses tested whether hypothesized mediators at 3 months mediated the treatment effect of the MoC (n = 264) compared to routine care (n = 203) on disability and pain at 6 months. Secondary mediation analyses compared guideline adherent care with non-adherent care.

RESULTS: No indirect effects were identified. The BetterBack intervention did not have superior effects over routine care on the hypothesized mediators. Illness perceptions and self-care enablement were significantly associated with disability and pain at 6 months. Secondary analyses showed significant indirect effects of guideline adherent care through tested mediators.

CONCLUSION: Despite no indirect effects, patients' illness perceptions and self-care enablement were associated with disability and back pain intensity outcomes and are potentially relevant treatment targets.

Acceptance and Commitment Therapy has gained preliminary evidence for paediatric chronic pain. Several studies show that psychological flexibility/inflexibility is a process driving treatment change in ACT for chronic pain. The literature supporting psychological flexibility as a change process in ACT is typically based on selfreport. The aim of the present study was to investigate psychological flexibility (i.e. acceptance, defusion, values formulation and committed action) as in-treatment behaviour during internet-delivered Acceptance and Commitment Therapy for paediatric chronic pain, by having two independent observers rating patient written statements. The sample was self-recruited and consisted of 28 girls between ages 13 and 17 years. Results showed that psychological flexibility could be operationalised as in-treatment behaviours and reliably assessed using observer ratings. Also, data illustrated a within subject variability in ratings of acceptance and defusion, with a considerable difference in degree of acceptance or defusion evoked by different experiential exercises. Furthermore, analyses showed that a higher average degree of acceptance in patient statements during the early phase of treatment was related to larger treatment effects. Defusion, values formulation and committed action showed no significant influence on outcome. Results should be interpreted with caution due to the small sample size.