CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • apa.csl
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Shifting the lens on heterogenous psychological suffering: Exploring and evaluating novel psychological treatment approaches to comorbid mental disorders
Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Department of Social and Psychological Studies (from 2013).ORCID iD: 0000-0002-1692-8941
2024 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This doctoral thesis addresses heterogeneous psychological suffering within a predominantly psychiatric paradigm, emphasizing the high prevalence of comorbid mental disorders. While much of the published empirical research focuses on trials targeting single disorders, this thesis aims to explore and evaluate novel treatment approaches for populations experiencing diverse psychological suffering. It seeks to bridge the gap between traditional disorder-based treatments and the emerging trend of idiographic designs and processes of change. The first clinical trial focused on treating co-morbid insomnia and social anxiety disorder using sequential cognitive behavioral therapy protocols (CBT-I and CBT-S). Findings suggest potential efficacy in reducing symptoms of both disorders, with notable improvements in insomnia symptoms. However, treatment effects still varied among participants, making it difficult to draw clear conclusions regarding efficacy. The second trial investigated group-based Rumination-Focused Cognitive Behavior Therapy (RFCBT) for individuals with depression, anxiety, and insomnia. Results indicate significant improvements in insomnia symptoms post-treatment and at the 2-month follow-up, with potential effectiveness for depression. However, no significant effects were found for anxiety, worry, or rumination. The third trial explored feasibility and preliminary effects of a process-based psychological treatment informed by Relational Frame Theory for individuals with comorbid mental disorders (Process-Based Behavioral Therapy; PBBT). Interpretative Phenomenological analysis revealed participants' varied experiences, emphasizing challenges in emotional engagement and the therapeutic process. Mixed findings from both the qualitative analyses and the suplementary self-rating scales underscored the complexity of treatment outcomes, highlighting the need of more research on treatment approaches based on Relational Frame Theory. Overall, the thesis contributes to addressing and understanding the complexities of heterogeneous psychological suffering and clinical research. Further research should continue to explore idiographic designs and process-based treatments while carefully defining and tracking processes of change. This is particularly important for individuals who do not benefit from current evidence-based treatment approaches.

Abstract [sv]

This doctoral thesis addresses the pervasive issue of psychological suffering, underscoring the high prevalence of and common comorbidity between mental disorders. Despite the undeniable efficacy of psychological treatments in alleviating suffering, a significant proportion of individuals fail to benefit from evidence-based approaches. Research on treatments for people who meet criteria for several disorders is scarce and current evidence-based treatment approaches still tends to target and or be evaluated on delimited disorders. This raises the question of how to address heterogeneous psychological suffering.

Acknowledging the multitude of angles and paths available for evaluating and developing psychological treatments, the overarching goal of this dissertation is to explore and evaluate novel treatment approaches in populations with heterogeneous psychological suffering. By bridging the gap between nomothetic designs, disorder-based treatments, and the emerging wave of idiographic designs and process-based treatment approaches, this thesis also aims to explore some of the scientific dilemmas that arise from developing and evaluating psychological treatments in a predominantly psychiatric paradigm.

 

Place, publisher, year, edition, pages
Karlstads universitet, 2024. , p. 112
Series
Karlstad University Studies, ISSN 1403-8099 ; 2024:10
Keywords [en]
process-based, transdiagnostic, comorbidity, psychotherapy, anxiety, depression, Insomnia, OCD, PTSD
National Category
Applied Psychology
Research subject
Psychology
Identifiers
URN: urn:nbn:se:kau:diva-98948DOI: 10.59217/zqap1593ISBN: 978-91-7867-446-6 (print)ISBN: 978-91-7867-447-3 (electronic)OAI: oai:DiVA.org:kau-98948DiVA, id: diva2:1845805
Public defence
2024-05-17, 11D 257, Aghardsalen, Universitetsgatan 2, Karlstad, 10:15 (English)
Opponent
Supervisors
Available from: 2024-04-22 Created: 2024-03-20 Last updated: 2024-04-22Bibliographically approved
List of papers
1. Treating co-morbid insomnia and social anxiety disorder with sequential CBT protocols: A single-case experimental study
Open this publication in new window or tab >>Treating co-morbid insomnia and social anxiety disorder with sequential CBT protocols: A single-case experimental study
Show others...
2021 (English)In: Behavioural and Cognitive Psychotherapy, ISSN 1352-4658, E-ISSN 1469-1833, Vol. 49, no 6, p. 641-657Article in journal (Refereed) Published
Abstract [en]

Background: Although insomnia disorder and social anxiety disorder are among the most prevalent psychiatric disorders, no studies have yet evaluated the use of sequential evidence-based treatment protocols in the population with co-morbid social anxiety disorder and insomnia disorder. Aims: This study aimed to investigate the effects of sequential treatments on co-morbid insomnia disorder and social anxiety disorder. As depression is a common co-morbid syndrome for both insomnia and social anxiety, a secondary aim was to examine depressive symptoms. Method: A single-case repeated crossover AB design was used. Ten participants between 18 and 59 years of age with co-morbid DSM-5 diagnoses of insomnia disorder and social anxiety disorder received sequential treatments with cognitive behavioural therapy (CBT). Seven participants completed the treatment course. The primary outcomes were symptoms of insomnia and social anxiety, and the secondary outcome was symptoms of depression. Results: The effects of CBT on people with co-morbid social anxiety disorder and insomnia disorder were mixed. The majority of participants improved their sleep quality and lessened symptoms of social anxiety and depression. However, participants differed in their degree of improvement concerning all three disorders. Conclusions: Sequential CBT treatments are potentially effective at decreasing symptoms of social anxiety and insomnia for people with co-morbid social anxiety disorder and insomnia disorder. The variation in outcome across participants makes firm conclusions about the treatment efficacy difficult to draw.

Place, publisher, year, edition, pages
Cambridge University Press, 2021
Keywords
co-morbidity, cognitive behavioural therapy, depression, insomnia, Keywords:, single case experimental design, social anxiety
National Category
Applied Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:kau:diva-85900 (URN)10.1017/S1352465821000278 (DOI)000841436400001 ()2-s2.0-85109843438 (Scopus ID)
Available from: 2021-09-07 Created: 2021-09-07 Last updated: 2024-03-20Bibliographically approved
2. Treatment of worry and comorbid symptoms within depression, anxiety, and insomnia with a group-based rumination-focused cognitive-behaviour therapy in a primary health care setting: a randomised controlled trial
Open this publication in new window or tab >>Treatment of worry and comorbid symptoms within depression, anxiety, and insomnia with a group-based rumination-focused cognitive-behaviour therapy in a primary health care setting: a randomised controlled trial
Show others...
2023 (English)In: Frontiers in Psychology, E-ISSN 1664-1078, Vol. 14, article id 1196945Article in journal (Refereed) Published
Abstract [en]

IntroductionRepetitive negative thinking (RNT) has been described as a maintaining transdiagnostic factor for psychopathology within the areas of depression, anxiety and insomnia. We investigated the effects of rumination-focused cognitive-behaviour therapy (RF-CBT) in a group format at a primary health care centre on symptoms of depression, anxiety, insomnia, RNT, and quality of life. The participants presented clinical symptom levels of worry and at least two disorders among anxiety disorders, major depressive disorder, and insomnia disorder.MethodsA randomised controlled superiority parallel arm trial was used. 73 participants were included and randomised in pairs to either group-administered RF-CBT or a waiting list condition. The primary outcomes were self-rated worry and transdiagnostic symptoms (depression, anxiety, and insomnia). Intention-to-treat analyses of group differences were conducted using linear mixed models. Adverse side effects and incidents were presented descriptively.ResultsGroup RF-CBT significantly reduced self-reported insomnia at post-treatment and self-reported insomnia and depression at the 2 month-follow-up, relative to the wait-list control group. There was no significant difference in change in RNT, anxiety, or quality of life.DiscussionThe current study suggests that group-administered RF-CBT may be effective for insomnia and potentially effective for depression symptomatology. However, the study was underpowered to detect small and moderate effects and the results should therefore be interpreted with caution.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2023
Keywords
anxiety, depression, group therapy, insomnia, repetitive negative thinking, rumination-focused CBT
National Category
Psychiatry Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:kau:diva-97097 (URN)10.3389/fpsyg.2023.1196945 (DOI)001068886700001 ()37744585 (PubMedID)2-s2.0-85171892073 (Scopus ID)
Available from: 2023-10-19 Created: 2023-10-19 Last updated: 2024-03-20Bibliographically approved
3. Exploring feasibility and preliminary effects of Process-Based Behaviour Therapy: A mixed method study in a sample with comorbid mental disorders
Open this publication in new window or tab >>Exploring feasibility and preliminary effects of Process-Based Behaviour Therapy: A mixed method study in a sample with comorbid mental disorders
Show others...
(English)Manuscript (preprint) (Other academic)
National Category
Applied Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:kau:diva-98962 (URN)
Available from: 2024-03-20 Created: 2024-03-20 Last updated: 2024-03-20Bibliographically approved

Open Access in DiVA

Kappan(7373 kB)62 downloads
File information
File name FULLTEXT01.pdfFile size 7373 kBChecksum SHA-512
a8f058512e1f98af0c279b5e64eb28d15a5076f217c82827999b6fb68a192293c5879f45d6f75960ae9e5ff751436d755ce6e0660851df1a14308c16086ea030
Type fulltextMimetype application/pdf

Other links

Publisher's full text

Authority records

Wallsten, Daniel

Search in DiVA

By author/editor
Wallsten, Daniel
By organisation
Department of Social and Psychological Studies (from 2013)
Applied Psychology

Search outside of DiVA

GoogleGoogle Scholar
Total: 62 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

doi
isbn
urn-nbn

Altmetric score

doi
isbn
urn-nbn
Total: 653 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • apa.csl
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf