Many parents who have children suffering from some form of chronic illness or mental disorder may experience chronic stress reactions of various types. Cognitive behavioral therapy (CBT) has been proved to be effective in reducing stress-related problems, but there seems to be no study to date in which CBT has been tested on this specific parent group. Two case studies were therefore performed. Case 1 centered on a 47-year-old married woman, who has lived in Sweden for 12 months. She described how she had become increasingly exhausted, and she wanted help to find strategies enabling her to cope with everyday life. Case 2 featured a 45-year-old single mother, who had been on part-time sick leave due to depression and stress. She described how she had always been anxious and worried and had had two episodes of depression. Both women had sons diagnosed with autism/Asperger syndrome. One of the women met the criteria for pathological burnout, while the other woman was just below the limit. The focus of the therapy for both women was on exhaustion, depression, and sleeping difficulties. In addition, therapy in Case 1 involved under-stimulation and in Case 2, anxiety. When the therapy ended, genuine improvements were registered for both clients. The results show that CBT can be an effective treatment of symptoms for this group of parents so that they can provide adequate support to their children, thus facilitating everyday life for a child with a chronic illness or disorder.

Background: Research on parents of children with chronic conditions has shown that this parent group frequently suffers from psychological problems such as deteriorating life quality and stress-related disorders. Objective: The present feasibility study focuses on Health-Related Quality of Life (HRQOL) and life satisfaction of parents of children with chronic conditions. Method: The study was conducted using a repeated measures design and applied either group-based cognitive behavioural therapy (CBT; n = 10) or a group-based mindfulness programme (MF; n = 9). The study participants were wait-listed for six months. Results:The results indicate improvements for participants in both treatment groups regarding certain areas of HRQOL and life satisfaction. After eight group therapy sessions, parents in the two treatment groups significantly improved their Mental Component Summary (MCS) scores as well as their scores on the mental subscales Vitality, Social functioning, Role emotional and Mental health. In addition, some of the physical subscales, Role physical, Bodily pain and General health, showed considerable improvement for the MF group. When testing for clinical significance by comparing the samples with mean values of a norm population, the MCS scores were significantly lower at pre-measurements, but no significant differences were observed post-measurement. For the Physical component summary (PCS) scores, a significantly higher score was observed at post-measurement when compared to the norm population. Moreover, the results indicate improvement in life satisfaction regarding Spare time, Relation to child and Relation to partner. Conclusion: The study concludes that CBT and mindfulness may have a positive effect on areas of HRQOL and life satisfaction.

Background

Parents of children with chronic conditions often experience a crisis with serious mental health problems for themselves as a consequence. The healthcare focus is on the children; however, the parents often worry about their children's health and future but are seldom offered any counselling or guidance.

Aim

The aim of this study was to investigate the effectiveness of two group-based behavioural interventions on stress and burnout among parents of children with chronic conditions.

Design, participants and setting

After a waiting list control period (n = 28), parents were offered either a cognitive behavioural (CBT, n = 10) or a mindfulness program (MF, n = 9).

Results

Both interventions decreased significantly stress and burnout. The within-group effect sizes were large in both interventions (CBT, g = 1.28–1.64; MF, g = 1.25–2.20).

Conclusions

Hence, the results of this pilot study show that treating a group using either CBT or mindfulness can be an efficient intervention for reducing stress levels and burnout in parents of children with chronic conditions.

This case study illustrates the treatment of an adult woman who was diagnosed with anorexia nervosa (AN). For approximately 10 years, the client had suffered from various forms of eating disorders and had had several unsuccessful encounters with the health care services. In this study, she was treated with a modification of enhanced cognitive behavioral therapy (CBT-E). CBT-E is a relatively new treatment guide with a transdiagnostic perspective on eating disorders. In all, the treatment consisted of 14 sessions where most sessions were held on a weekly basis. Thereafter, a maintenance and follow-up was conducted via email and with the aid of self-help literature. Treatment time lasted for 8 months followed by a follow-up of 4 months. In this study, the content of each session is described, as are the modifications that were made. The modifications were made to increase motivation and self-esteem, as well as perceived control of eating, which, in itself, is a contribution to increased efficiency and a clarification of important treatment components. Apart from a description of treatment interventions, the study shows the weight gain and other clinically significant components regarding eating disorders that concern, among other things, self-esteem and general mental health. The results of this study demonstrate that this treatment, with the proposed modifications, has been highly effective for this client and hence provides a positive anticipation that this might be a more effective treatment in general for people with AN.

Introduction: Autistic Spectrum Disorder (ASD) is often comorbid with Obsessive Compulsive Disorder (OCD). But to what extent can obsessional symptoms in individuals with ASD be considered “genuinely” comorbid OCD – or are there other mechanisms that are related to ASD? Which mechanisms in OCD with and without ASD share common features? People with ASD have a cognitive profile characterized by “mindblindness”; the antecedent is often referred to in terms of not knowing how to perform or behave and this is the cause of discomfort. This raises the question whether individuals with ASD and comorbid OCD share the same cognitive elements of responsibility interpretation and the same fear of causing harm as individuals who merely have OCD.

Objective: The aim of the present study is therefore to evaluate the extent of responsibility interpretation in individuals with OCD alone compared with people experiencing OCD in the context of ASD.

Methods: Two instruments, the Responsibility Attitude Scale (RAS) and the Responsibility Interpretations Questionnaire (RIQ), were administered to three groups of participants: (i) individuals diagnosed with OCD (n = 32); (ii) individuals with ASD and OCD (n = 19); and (iii) non-clinical control participants (n = 23).

Results: Results indicate significant differences in all measures of responsibility belief (interpretation of obsession and assumption of responsibility) between the OCD-only group and the two other groups.

Conclusion: The conclusion is that OCD in people with ASD is not as “genuine” as in people with only OCD, according to cognitive behavioral theory of OCD.

The current study investigates the possibility that athletes have more parallel ADHD symptoms than non-athletes. High-level youth sport athletes were compared with non-athletes in leisure time (i.e., sport) and in the school in ADHD symptoms. Athletes and students were evaluated by a trained psychotherapist using Adult ADHD Self-Report Scale (ASRS) on activities at school and during activities in leisure/sports time. They also filled in the Autism Spectrum Questionnaire (AQ) as a self-report assessment. Results showed significant differences in ASRS-scores for athletes in school and in their sport, with high scores in school and low scores in sport. No differences were found in AQ between the groups. The findings indicate that many athletes might display a cognitive profile of parallel of ADHD criteria. Future research needs to further investigate potential benefits of the cognitive profile in athletes and how they handle different contexts including sport and school settings.

The present study was carried out to examine the treatment effect of cognitive behavioral therapy provided by trainee therapists at a university clinic, focusing on health-related quality of life (HRQOL) optimism and symptoms. The study was conducted through a repeated measures design and included a treatment group (n = 21), which received cognitive behavioral therapy for an average of 10.7 therapy sessions and a control group (n = 14), that was put on a wait list for 8.6 weeks on average. After treatment, the treatment group improved significantly concerning general health (p = 0.028) and optimism (p = 0.027). In addition, clients improved in several areas within mental health and displayed some reduction in anxiety symptoms. Concurrently, the results also indicated some improvement within the control group, which may have been caused by the initial therapeutic contact, expectancy effects or spontaneous remission. The study concluded that cognitive behavioral therapy provided by trainee therapists may have a positive effect on areas within HRQOL and optimism.

Background/aims: The present study investigated the first 38 methadone maintenance treatment (MMT) patients in Stockholm. The aim was: (i) to investigate the possible predictive factors for successful treatment termination, and (ii) the long-term outcome effects and life situation of MMT patients and those who terminated the treatment. Methods: The patients were interviewed at the start and approximately 15 years later, and divided into four groups: (1) no withdrawal attempts, (2) forced to stop the treatment, (3) successful tapering and (4) non-successful tapering. Results: The predictive factor found that Group 1 showed a lower life quality compared with Groups 3 and 4. Fifteen years later, the life situations of Groups 3 and 4 were significantly more stable. Also the subjective well-being in Group 3 was significantly higher. Over all, Group 2 showed significantly more illicit drug use compared with Group 3. The social life situation was significantly improved for all patients during the 15 years. Conclusion: This study confirms our earlier findings that the ultimate goal of MMT for the motivated patients with good progress should be an opiate-free life. The life situation and subjective well-being seems to be higher after successful termination of MMT.

At the psychotherapy training center at Karlstad University, a study was carried out to examine the levels of symptom change and satisfaction with therapy in a heterogeneous population of clients treated using cognitive behavioral therapy (CBT) by less experienced trainee therapists with limited theoretical education. The clients received an average of 11 therapy sessions. The results suggested that CBT performed by less experienced trainee therapists can be effective. According to client estimations, a statistically significant reduction in symptoms, measured using the Symptoms Checklist, was achieved for seven of nine variables (p ≤ .006), as well as a significant increase in satisfaction with life (p ≤ .001). Also, the pre- and posttherapy measurements using the Montgomery–Åsberg Depression Rating Scale showed a statistically significant improvement in the clients' condition. According to the therapists' estimations, 64% (SD = 32.01) of the clients experienced a significant improvement in their condition. In addition, the results of a survey of client satisfaction demonstrated that the clients were very pleased with the therapy received. Also the therapists were, to a great extent, satisfied with the treatment process itself, including the supervision received, and very satisfied with the client alliance. A correlation analysis between the clients' perceived level of improvement and therapist satisfaction showed a strong correlation between the two variables (r = .50, p < .005). By including the Comparative Psychotherapy Process Scale (CPPS) in our study it was possible to measure trueness to therapy form. An analysis of the CPPS results confirmed that the form of therapy used at the training site was more strongly CBT than psychodynamic interpersonal treatment (p ≤ .001). The CBT subscale score indicated that the therapy was characteristic of CBT, confirming that the interventions used in the therapy belong to the CBT genre.

The present study was intended to investigate personality characteristics and mental health of severe driving under influence (DUI) offenders in a Swedish cohort. More specifically the aim was to investigate the personality traits as assessed by The NEO personality inventory (NEO-PI-R) and aspects of mental health as assessed by the symptom checklist (SCL-90) as compared to the general population. The subjects were 162 severe DUI offenders (with the BAC >0.099%) with an age range of 18-88 years, 143 males and 19 females. It was found that the openness to experience and conscientiousness scales of NEO-PI-R differentiated Swedish DUI offenders from Swedish norm population. The differences between the DUI group and the general population on the on SCL-90 scales were all significant except on the Hostility scale. Two main subtypes of DUI offenders identified were roughly comparable to types I and II alcoholics, as in Cloninger's typology. Among all the scales used (personality traits, psychiatric comorbidity and alcohol use), the only factor that was predictive for future relapses to drunk driving was the factor of depression.

The cognitive intervention programme 'New Challenges' targeting adult men with a criminal lifestyle was evaluated in a pilot study. The participants were divided into a cognitive treatment group (n = 32) and a control group (n = 11). In the control group, six participants had no treatment and five participated in 12-step treatment. The participants were measured pre and post using the Psychological Inventory of Criminal Thinking Styles (PICTS), the abridged version of sense of coherence (SOC), Positive and Negative Affect Scale, and Bergström's quality of programme delivery (QPD). The results of the treatment group showed that criminal thinking patterns dropped significantly from high values to close to normal level. SOC and positive affect increased significantly in the treatment group. Both SOC and positive affect showed positive correlation with QPD. Regarding the possible influence of the 12-step treatment, there was no difference in the control group between participants receiving 12-step treatment and those not receiving treatment. The main conclusion is that the cognitive treatment programme 'New Challenges' can contribute to reduced criminal thinking and increased SOC and positive affect, which may prove to be important precursors of reduced criminality.

Experiential avoidance, cognitive defusion, and mindfulness have all been associated with psychological disorders and well-being. This study investigates whether they predict psychological distress, i.e., symptoms of burnout, depression, stress and anxiety, in parents of children with chronic conditions. We hypothesized that these factors would exhibit a large degree of common variance, and that when compared to mindfulness and defusion, experiential avoidance on its own would predict a larger proportion of unique variance. 75 parents of children with chronic conditions having burnout symptoms who participated in an intervention study completed measures of burnout, stress, anxiety, depression, experiential avoidance, cognitive defusion, and mindfulness at the beginning of the intervention study (baseline). We ran several regression analyses to assess the predictive ability of these different constructs. Experiential avoidance on its own accounted for 28-48% of the variance in different psychological symptoms. Cognitive defusion and mindfulness did not make a significant contribution to explaining burnout, stress and anxiety, but cognitive defusion contributed to explaining depression. The results confirmed our hypothesis, supporting research on the importance of psychological flexibility as a central factor in understanding the occurrence of psychological distress.

The present study examined if an Acceptance and Commitment Therapy (ACT)-based online intervention for parents had indirect effects on their children's quality of life mediated by changes in parental well-being, psychological flexibility and mindfulness skills. Participants were 74 adults, who either received an ACT-based guided online intervention or were allocated to the wait list control group, and their children (n = 66) who had type 1 diabetes or functional disabilities. Structural equation modeling (SEM) and a bias-corrected bootstrap approach were applied to examine the indirect effects of the treatment on children's quality of life through changes in parents' well-being and psychological processes involving psychological flexibility, cognitive defusion, and mindfulness skills. Children's quality of life was assessed both by self-reports and parents' evaluations. Significant indirect effects on children's quality of life were found through improvements in parental well-being and mindfulness skills. The intervention had significant indirect effects on parents' evaluations of their children's quality of life concerning family and other social relationships, as well as on physical well-being. In regard to children's self-reported quality of life, the intervention had significant indirect effects on self-esteem, family relations, emotional well-being, and functioning at school/kindergarten. The results indicate that it is beneficial for children's quality of life to improve parents' ability to describe their experiences, being non-reactive to one's inner experiences and acting with awareness as well as cognitive defusion.

Background: Previous researches have indicated that self-reported positive affect and negative affect is changing in a healthy direction during Cognitive Behavioural Therapy (CBT).Objective:The aim of the present study was to examine how affective personality is related to psychopathology before and after CBT.

Method: A group of clients (n = 73) was measured before and after CBT, differentiated by their problem areas at pre-therapy (i.e., depressive, anxious and mixed).

Results: After therapy, clients experienced higher positive affect (p < .02, d=0.66), lower negative affect (p < .001, d=0.98) and there was a significant change in the distribution of affective personality regardless of problem area, χ2 = 8.41, df = 3, two-tailed p = .04, 99% CI [0.03, 0.04]. The change in the distribution was largest for the two most relevant personality types, self-actualization and self-destructive affective personality.

Conclusion: Results indicate that CBT can achieve changes in affect and affective personality.

This study is based on two previous studies that showed a post-treatment decrease in total criminal thinking (PICTS) and an increase in total sense of coherence (SOC) among youths and adults. The current study investigated whether these interventions changed the sub-scales of PICTS and SOC, and whether an increase in SOC would mediate a decrease in PICTS. Among both groups, the mean value of the sub-factors of PICTS decreased by the interventions, and increased for SOC sub-factors meaningfulness and manageability. Only among the adults, the increase in total sense of coherence and the sub-factor of manageability mediated the decrease of criminal thinking. 

Background: Benzodiazepines (BZD) are the most widely used sedative-hypnotics, and evidence is rapidly accumulating suggesting potential BZD dependence, association of chronic use with adverse effects and a definite abstinence syndrome produced by withdrawal. Aims: The present investigation followed prospectively long-term BZD users over 1 year following graded BZD withdrawal in terms of clinical and withdrawal symptoms. Methods: Clinical symptoms were measured by the Comprehensive Psychopathological Rating Scale (CPRS) and by the Newcastle Anxiety and Depression Diagnostic Index (NADDI) in a sample of BZD users over a 50-week period following graded BZD withdrawal. Results: The results showed that the frequency and severity of clinical symptomatology measured by both scales significantly decreased over time. A detailed analysis of possible patterns of symptoms on both scales revealed four patterns: 1) a gradual decrease over the 50-week time period; 2) an increase in the severity of symptoms at the onset of tapering and a decrease in severity post-tapering; 3) an increase in the severity of symptoms 4 weeks after the cessation of BZD tapering; and 4) no change over the 50-week time period. Rate of BZD withdrawal was associated with CPRS ratings of global illness at admission and at end of treatment, but was not associated with duration or dosage of BZDs, type of BZD, prescriptive and/or non-prescriptive drug use prior to admission, marital status, sex or age. Conclusions: The results of the present study provide a detailed picture of the pattern of symptoms, their time course and multidimensional determinants of the BZD withdrawal symptoms.