Effects of panic-specific cognitive behavioural and psychodynamic psychotherapies on work ability in a doubly randomised clinical trial.

Objective: The effects of panic-specific psychotherapy on occupational functioning remain under-researched. This study tests whether two brief psychotherapies for Panic Disorder with or without Agoraphobia (PD/A) may generate improvement in work ability. Methods: Adults (N = 221) with a primary diagnosis of PD/A were randomised to wait-list, panic-focused psychodynamic psychotherapy (PFPP), panic control treatment (PCT), or to the choice between the two treatments. Participants completed the Work Ability Inventory (WAI) at baseline, post-treatment, and during 24-month follow-ups. Change in WAI scores were assessed using segmented multilevel linear growth models, and mediation was explored through path analysis. Results: WAI scores changed from the moderate to good range between baseline and post-treatment (SMD = 0.45; 95% CI [0.33, 0.57]) and continued to increase throughout the follow-up (SMD = 0.16; 95% CI [0.03, 0.28]) with no differences between treatments or allocation forms. In PFPP (but not in PCT) pre- to post-treatment change in WAI was mediated by reduction in panic symptoms and WAI predicted employment status and absences. Conclusions: Two brief panic specific psychotherapies, one cognitive behavioural and one psychodynamic, produced short and long-term increases in work ability.

Moderators of short- and long-term outcomes in panic control treatment and panic-focused psychodynamic psychotherapy.

OBJECTIVE: The objective was to test the hypothesis that externalizing and internalizing helpfulness beliefs and learning styles at baseline moderate panic severity and overall mental illness as short-term and long-term outcomes of two panic-focused psychotherapies, Panic Control Treatment (PCT) and Panic-Focused Psychodynamic Psychotherapy (PFPP). METHOD: Participants were 108 adults with DSM-IV Panic Disorder with or without Agoraphobia (PD/A) who were randomized to treatment in a trial of PCT and PFPP. Piece-wise/segmented multilevel modeling was used to test three-way interactions (Treatments × Moderator × Time), with participants and therapists as random factors. Outcome variables were clinician-rated panic severity and self-rated mental illness post-treatment and during follow-up. RESULTS: Patients' externalizing (but not internalizing) helpfulness beliefs moderated mental illness outcomes during follow-up (but not during treatment); low levels of Externalization were facilitative for PFPP but not PCT. Internalizing and externalizing helpfulness beliefs and learning style did not moderate clinician-rated panic severity, whether short- or long-term. CONCLUSIONS: These results suggest that helpfulness beliefs and learning style have limited use in assignment to either PCT or PFPP for PD/A. Although further research is needed, low levels of helpfulness beliefs about externalizing coping may play a role in mental illness outcomes for PFPP.

The Effect of Patient's Choice of Cognitive Behavioural or Psychodynamic Therapy on Outcomes for Panic Disorder: A Doubly Randomised Controlled Preference Trial.

INTRODUCTION: It remains unclear whether offering psychiatric patients their preferred treatment influences outcomes at the symptom level. OBJECTIVE: To assess whether offering patients with panic disorder with/without agoraphobia (PD/A) a choice between 2 psychotherapies yields superior outcomes to random assignment. METHODS: In a doubly randomised, controlled preference trial (DRCPT), 221 adults with PD/A were randomly assigned to: choosing panic-focused psychodynamic therapy (PFPP) or panic control treatment (PCT; a form of cognitive behavioural therapy); random assignment to PFPP or PCT; or waiting list control. Primary outcomes were PD/A severity, work status and work absences at post-treatment assessment. Outcomes at post-treatment assessment, 6-, 12-, and 24-month follow-ups were assessed using segmented multilevel linear growth models. RESULTS: At post-treatment assessment, the choice and random conditions were superior to the control for panic severity but not work status/absences. The choice and random conditions did not differ during treatment or follow-up for the primary outcomes. For panic severity, PCT was superior to PFPP during treatment (standardised mean difference, SMD, -0.64; 95% confidence interval, CI, -1.02 to -0.25); PFPP was superior to PCT during follow-up (SMD 0.62; 95% CI 0.27-0.98). There was no allocation by treatment type interaction (SMD -0.57; 95% CI -1.31 to 0.17). CONCLUSIONS: Previous studies have found that offering patients their preferred treatment yields small to moderate effects but have not employed designs that could rigorously test preference effects. In this first DRCPT of 2 evidence-based psychotherapies, allowing patients with PD/A to choose their preferred treatment was not associated with improved outcomes. Further DRCPTs are needed.

Short-term psychodynamic infant-parent interventions at Child health centers: Outcomes on parental depression and infant social-emotional functioning.

Randomized controlled trials (RCTs) demonstrate efficacy of parent-infant psychotherapy, but its applicability and effectiveness in public health care are less known. The method followed is Naturalistic study evaluating Short-term Psychodynamic Infant-Parent Interventions at Child Health Centers (SPIPIC) in Stockholm, Sweden. One hundred distressed mothers with infants were recruited by supervised nurses. Six therapists provided 4.3 therapy sessions on average (SD = 3.3). Sessions typically included the mothers, often with the baby present, while fathers rarely attended sessions. The Edinburgh Postnatal Depression Scale (EPDS) and the Ages and Stages Questionnaire: Social-Emotional (ASQ: SE) were distributed at baseline and at 3 and 9 months later. Data from a nonclinical group were collected simultaneously to provide norm data. Multilevel growth models on the mothers' questionnaire scores showed significant decreases over time on both measures. Nine months after baseline, 50% achieved a reliable change on the EPDS and 14% on the ASQ: SE. Prepost effect-sizes (d) were 0.70 and 0.40 for EPDS and ASQ: SE, figures that are comparable to results of other controlled studies. Psychotherapists integrated with public health care seem to achieve good results when supporting distressed mothers with brief interventions in the postnatal period. SPIPIC needs to be compared with other modalities and organizational frameworks.

Los ensayos controlados al azar demuestran lo eficaz de de la sicoterapia progenitor-infante, pero su aplicabilidad y efectividad en el cuidado de la salud pública menos conocidas. Método: Estudio naturalista de evaluación de la Intervención Sicodinámica a Corto Plazo entre Infante y Progenitor en Centros de Salud Infantil (SPIPIC) en Estocolmo, Suecia. Se reclutaron 100 madres afligidas con infantes a través de enfermeras supervisadas. Seis terapeutas proveyeron 4.3 sesiones de terapia en promedio (SD = 3.3). Las sesiones típicamente incluyeron a las madres, a menudo con su bebé presente, mientras que los papás raramente asistieron a las sesiones. Se distribuyeron la Escala de Depresión Postnatal de Edimburgo (EPDS) y el Cuestionario de Edades y Estados: Socio-emocional (ASQ: SE) al punto de partida inicial básico, y a los tres y nueve meses después. Simultáneamente se recogió información de un grupo no clínico con el fin de proveer información de la norma. Resultados: Modelos de crecimiento de niveles múltiples basados en los puntajes de cuestionarios de las madres mostraron significativas bajas a lo largo del tiempo en ambas medidas. Nueve meses después del punto de partida inicial básico, el 50% logró un cambio confiable en la EPDS y 14% en el ASQ; SE. Los tamaños del efecto anterior y posterior (d) fueron 0,70 y 0.40 para la EPDS y el ASQ: SE, lo cual es comparable con resultados estudios controlados. Conclusiones: Los sicoterapeutas integrados con el cuidado de salud pública parecen lograr buenos resultados cuando apoyan a madres afligidas con intervenciones breves perinatalmente. La SPIPIC necesita ser comparada con otras modalidades y marcos de trabajo organizacionales.

Les essais contrôlés randomisés démontrent l'efficacité de la psychothérapie parent-nourrisson mais son application et son efficacité pour le soin de santé publique sont moins connues. Méthode: étude naturelle évaluant l'Intervention Psychodynamique Nourrisson-Parent à Court Terme dans des Centres de Santé de l'Enfant (SPIPIC) à Stockholm en Suède. Cent mères en détresse avec des nourrissons ont été recrutées par des infirmières supervisées. Six thérapeutes ont offerts 4,3 séances thérapeutiques en moyenne (SD = 3,3). Les séances ont typiquement inclus les mères, souvent avec le bébé présent, alors que les pères sont rarement venus aux séances. L'échelle de dépression postnatale d'Edinbourg (EPDS) et le ASQ: SE, questionnaire Etapes et Ages sur le développement socio-développemental et comportemental a été distribué au départ, à trois mois et à neuf mois plus tard. Des données d'un groupe non-clinique ont été collectées simultanément afin d'offrir des données de normes. Résultats: des modèles de croissance multiniveau sur les scores aux questionnaires des mères ont fait preuve de baisses importantes au fil du temps sur les deux mesures. Neuf mois après le départ, 50% ont fait preuve d'un changement important pour ce qui concerne l'EPDS et 14% pour ce qui concerne l'ASQ: SE. Les effets pré-post observés (d) étaient de 0,70 et 0,40 pour l'EPDS et l'ASQ: SE, comparable aux résultats d'études de contrôle. Conclusions: les psychothérapeutes intégrés avec un soin de santé publique semblent être parvenus à de bons résultats alors qu'ils soutenaient les mères en détresse avec de brèves interventions périnatales. Le SPIPIC doit être comparé à d'autres modalités et d'autres structures organisationnelles.

Preferences for panic control treatment and panic focused psychodynamic psychotherapy for panic disorder - who chooses which and why?

Objective: Few studies have examined factors associated with patient's choice of particular psychological treatments. The present study explores possible associations to, and the reasons given for, patient's choice of Panic Control Treatment (PCT) or Panic-Focused Psychodynamic Psychotherapy (PFPP) for Panic Disorder with or without Agoraphobia (PD/A).Method: Both quantitative and qualitative analyses were applied to data obtained from 109 adults with PD/A who were randomized to the Choice condition in the doubly randomized controlled preference trial from which this data are drawn.Results: The strongest associations were between treatment credibility ratings and the treatment choice (d = -1.00 and 1.31, p < .01, for PCT and PFPP respectively). Treatment choice was also moderately associated with patient characteristics, treatment helpfulness beliefs, and learning style. Qualitative analysis revealed that patients gave contrasting reasons for their treatment choice; either a focus on the present, symptom reduction and problem-solving for those who chose PCT or a focus on the past, symptom understanding and reflection for those who chose PFPP.Conclusions: When offered a choice between two evidence-based psychotherapies for PD/A, the resulting choice was primarily a function of the patient's beliefs about the chosen therapy, its potential for success, and their preferred learning style.

Affect-Focused Psychodynamic Internet-Based Therapy for Adolescent Depression: Randomized Controlled Trial.

BACKGROUND: Adolescent depression is one of the largest health issues in the world and there is a pressing need for effective and accessible treatments. OBJECTIVE: This trial examines whether affect-focused internet-based psychodynamic therapy (IPDT) with therapist support is more effective than an internet-based supportive control condition on reducing depression in adolescents. METHODS: The trial included 76 adolescents (61/76, 80% female; mean age 16.6 years), self-referred via an open access website and fulfilling criteria for major depressive disorder. Adolescents were randomized to 8 weeks of IPDT (38/76, 50%) or supportive control (38/76, 50%). The primary outcome was self-reported depressive symptoms, measured with the Quick Inventory of Depressive Symptomatology for Adolescents (QIDS-A17-SR). Secondary outcomes were anxiety severity, emotion regulation, self-compassion, and an additional depression measure. Assessments were made at baseline, postassessment, and at 6 months follow-up, in addition to weekly assessments of the primary outcome measure as well as emotion regulation during treatment. RESULTS: IPDT was significantly more effective than the control condition in reducing depression (d=0.82, P=.01), the result of which was corroborated by the second depression measure (d=0.80, P<.001). IPDT was also significantly more effective in reducing anxiety (d=0.78, P<.001) and increasing emotion regulation (d=0.97, P<.001) and self-compassion (d=0.65, P=.003). Significantly more patients in the IPDT group compared to the control group met criteria for response (56% vs 21%, respectively) and remission (35% vs 8%, respectively). Results on depression and anxiety symptoms were stable at 6 months follow-up. On average, participants completed 5.8 (SD 2.4) of the 8 modules. CONCLUSIONS: IPDT may be an effective intervention to reduce adolescent depression. Further research is needed, including comparisons with other treatments. TRIAL REGISTRATION: International Standard Randomised Controlled Trial Number (ISRCTN) 16206254; http://www.isrctn.com/ISRCTN16206254.

Psychometric analysis of the Swedish panic disorder severity scale and its self-report version.

BACKGROUND: Panic disorder, with or without agoraphobia (PDA or PD, respectively), is a major public health problem. After having established a PD diagnosis based on the DSM or the ICD systems, the Panic Disorder Severity Scale (PDSS) is the most widely used interview-based instrument for assessing disorder severity. There is also a self-report version of the instrument (PDSS-SR); both exist in a Swedish translation but their psychometric properties remain untested. METHODS: We studied 221 patients with PD/PDA recruited to a randomized controlled preference trial of cognitive-behavioral and brief panic-focused psychodynamic psychotherapy. In addition to PDSS and PDSS-SR the participants completed self-reports including the Clinical Outcome in Routine Evaluation - Outcome Measure, Montgomery Åsberg Depression Rating Scale, Sheehan Disability Scale, Bodily Sensations Questionnaire and the Mobility Inventory for Agoraphobia. RESULTS: PDSS and PDSS-SR possessed excellent psychometric properties (internal consistency, test-retest reliability) and convergent validity. A single factor structure for both versions was not confirmed. In terms of clinical utility, the PDSS had very high inter-rater reliability and correspondence with PD assessed via structured diagnostic interview. Both versions were sensitive to the effects of PD-focused treatment, although subjects scored systematically lower on the self-report version. CONCLUSIONS: The study confirmed the reliability and validity of the Swedish versions of PDSS and PDSS-SR. Both versions were highly sensitive to the effects of two PD-focused treatments and can be used both in clinical and research settings. However, further investigation of the factor structures of both the PDSS and PDSS-SR is warranted. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01606592.

Secure attachment to therapist, alliance, and outcome in psychoanalytic psychotherapy with young adults.

Using a novel approach to assess attachment to therapist from patient narratives (Patient Attachment to Therapist Rating Scale; PAT-RS), we investigated the relationships between secure attachment to therapist, patient-rated alliance, and outcome in a sample of 70 young adults treated with psychoanalytic psychotherapy. A series of linear mixed-effects models, controlling for length of therapy and therapist effects, indicated that secure attachment to therapist at termination was associated with improvement in symptoms, global functioning, and interpersonal problems. After controlling for the alliance, these relationships were maintained in terms of symptoms and global functioning. Further, for the follow-up period, we found a suppression effect indicating that secure attachment to therapist predicted continued improvement in global functioning, whereas the alliance predicted deterioration when both variables were modeled together. Although limited by the correlational design, this study suggests that the development of a secure attachment to therapist is associated with treatment gains as well as predictive of posttreatment improvement in functioning. Future research should investigate the temporal development of attachment to therapist and its interaction with alliance and outcome more closely. To ensure differentiation from patient-rated alliance, observer-based measurement of attachment to therapist should be considered.

Maintaining everyday life in a family with a dying parent: Teenagers' experiences of adapting to responsibility.

OBJECTIVE: Teenagers are living through a turbulent period in their development, when they are breaking away from the family to form their own identities, and so they are particularly vulnerable to the stressful situation of having a parent affected by a progressive and incurable illness. The current study sought to gain more knowledge about the ways that teenagers themselves describe living in a family with a seriously ill and dying parent. More specifically, the aims were to describe how teenagers are emotionally affected by everyday life in a family with a dying parent and to determine how they attempt to adapt to this situation. METHOD: The study employed a descriptive and interpretive design using qualitative content analysis. A total of 10 teenagers (aged 14-19 years, 7 boys and 3 girls) participated through repeated, individual, informal interviews that were carried out as free-ranging conversations. RESULTS: While contending with their own vulnerable developmental period of life, the teenagers were greatly affected by their parent's illness and took on great responsibility for supporting their parents and siblings, and for maintaining family life. Lacking sufficient information and support left them rather unprepared, having to guess and to interpret the vague signs of failing health on their own, with feelings of uncertainty and loneliness as a consequence. SIGNIFICANCE OF RESULTS: Support from healthcare professionals should be designed to help and encourage parents to have open communications about their illness with their teenaged children. Our results add further support to the literature, reinforcing the need for an approach that uses a systemic perspective and considers the family to be the appropriate unit of care and offers a suitable support system.

Dropout revisited: patient- and therapist-initiated discontinuation of psychotherapy as a function of organizational instability.

OBJECTIVE: To explore the association between the stability or instability of services' organizational structure and patient- and therapist-initiated discontinuation of therapy in routine mental health. METHOD: Three groups, comprising altogether 750 cases in routine mental health care in eight different clinics, were included: cases with patient-initiated discontinuation, therapist-initiated discontinuation, and patients remaining in treatment. Multilevel multinomial regression was used to estimate three models: An initial, unconditional intercept-only model, another one including patient variables, and a final model with significant patient and therapist variables including the organizational stability of the therapists' clinic. RESULTS: High between-therapist variability was noted. Odds ratios and significance tests indicated a strong association of organizational instability with patient-initiated premature termination in particular. CONCLUSIONS: The question of how organizational factors influence the treatment results needs further research. Future studies have to be designed in ways that permit clinically meaningful subdivision of the patients' and the therapists' decisions for premature termination.

Heterogeneity in responses to a universal prevention program.

Because universal or primary prevention strategies often target heterogeneous populations, their effects may likewise be expected to be heterogeneous. We sought to explore the heterogeneity of outcomes of previously published results of a longitudinal Swedish study of a school-based socio-emotional learning program. By applying latent class regression analysis to two measures of well-being, we found three significantly different classes with different change trajectories that yielded different outcomes. We conclude that restricting outcome analyses of primary prevention programs to sample means may conceal important heterogeneity regarding individual outcomes.

Therapist-guided internet-based psychodynamic therapy versus cognitive behavioural therapy for adolescent depression in Sweden: a randomised, clinical, non-inferiority trial.

BACKGROUND: Adolescent major depressive disorder (MDD) is highly prevalent and associated with lifelong adversity. Evidence-based treatments exist, but accessible treatment alternatives are needed. We aimed to compare internet-based psychodynamic therapy (IPDT) with an established evidence-based treatment (internet-based cognitive behavioural therapy [ICBT]) for the treatment of adolescents with depression. METHODS: In this randomised, clinical trial, we tested whether IPDT was non-inferior to ICBT in the treatment of adolescent MDD. Eligible participants were 15-19 years old, presenting with a primary diagnosis of MDD according to DSM-5. Participants were recruited nationwide in Sweden through advertisements on social media, as well as contacts with junior and senior high schools, youth associations, social workers, and health-care providers. Adolescents who scored 9 or higher on the Quick Inventory of Depressive Symptomatology for Adolescents (QIDS-A17-SR) in an initial online screening were contacted by telephone for a diagnostic assessment using the Mini International Neuropsychiatric Interview. Participants were randomly assigned to ICBT or IPDT. Both interventions comprised eight self-help modules delivered over 10 weeks on a secure online platform. The primary outcome was change in depression severity measured weekly by the QIDS-A17-SR. Primary analyses were based on an intention-to-treat sample including all participants randomly assigned. A non-inferiority margin of Cohen's d=0·30 was predefined. The study is registered at ISRCTN, ISRCTN12552584. FINDINGS: Between Aug 19, 2019, and Oct 7, 2020, 996 young people completed screening; 516 (52%) were contacted for a diagnostic interview. 272 participants were eligible and randomly assigned to ICBT (n=136) or IPDT (n=136). In the ICBT group, 51 (38%) of 136 participants were classified as remitted, and 54 (40%) of 136 participants were classified as remitted in the IPDT group. Within-group effects were large (ICBT: within-group d=1·75, 95% CI 1·49 to 2·01; IPDT: within-group d=1·93, 1·67 to 2·20; both p<0·0001). No statistically significant treatment difference was found in the intention-to-treat analysis. Non-inferiority for IPDT was shown for the estimated change in depression during treatment (d=-0·18, 90% CI -0·49 to 0·13; p=0·34). All secondary outcomes showed non-significant between-group differences. INTERPRETATION: IPDT was non-inferior to ICBT in terms of change in depression for the treatment of adolescents with MDD. This finding increases the range of accessible and effective treatment alternatives for adolescents with depression. FUNDING: Kavli trust.

Searching for recognition: the professional development of psychodynamic psychotherapists during training and the first few years after it.

The aim of the present study was to investigate the development of psychotherapists' professional self during training and the first few years after it. Constant comparison analysis was conducted on interviews with former students (N = 18) at a training institute for psychoanalytic psychotherapy. The resulting core category "searching for recognition" indicated that participants' ambition during the studied time period was to reach high status by becoming psychotherapists. During training, this was expressed by the category "attachment to preformed professional self," meaning that students wanted their preconceptions about therapy to be acknowledged by teachers. After training, participants experienced achieved recognition and, as a result, a sense of freedom to use their own judgment.

Exploring termination setback in a psychodynamic therapy for panic disorder.

OBJECTIVE: Termination in psychodynamic therapy (PDT) is a potentially conflictual and turbulent phase for patients, with a risk for increases in symptoms. However, few studies of PDT have assessed symptoms frequently enough during the treatment to determine whether such setbacks are in fact common in PDT. METHOD: In a doubly randomized clinical preference trial, 217 adults, female = 163; M age = 34.8 (12.6), with panic disorder with or without agoraphobia were treated with panic-focused psychodynamic psychotherapy (PFPP) or panic control treatment (PCT), a form of cognitive behavioral therapy. Participants completed the Panic Disorder Severity Scale Self-Report (PDSS-SR) weekly during treatment (Weeks 1-12), and 6, 12, and 24 months after treatment. Using piecewise latent growth curve modeling, we tested the trajectories of change focusing on the termination phase in PFPP. RESULTS: Week-to-week improvement on the PDSS-SR stopped (a termination setback [TS]) in PFPP during Weeks 10-12, whereas PCT participants continued to improve. Larger symptom reductions up to Week 10 in PFPP predicted a more severe TS. Less avoidant attachment and less severe interpersonal problems also predicted more severe TS. The TSs tended to last, as evidenced by inferior outcomes, up to the 12-month follow-up. CONCLUSIONS: This study provides evidence of a TS in PDT. Resurgence of symptoms as termination approached was more common in PFPP than in PCT. Studies involving weekly assessment of primary and comorbid symptoms, as well as qualitative analyses of the patient experiences of the therapeutic process during termination, in different forms of PDT, are warranted. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Internet-based psychodynamic versus cognitive behaviour therapy for adolescents with depression: study protocol for a non-inferiority randomized controlled trial (the ERiCA study).

BACKGROUND: Adolescent depression is a common mental health problem and there is an urgent need for effective and accessible treatments. Internet-based interventions solve many obstacles for seeking and receiving treatment, thus increasing access to effective treatments. Internet-based cognitive behavioural therapy (ICBT) for adolescent depression has demonstrated efficacy in previous trials. In order to broaden the range of evidence-based treatments for young people, we evaluated a newly developed affect-focused Internet-based psychodynamic treatment (IPDT) in a previous study with promising results. The purpose of the planned study is to evaluate the efficacy of IPDT for adolescent depression in a non-inferiority trial, comparing it to ICBT. METHODS: The study will employ a parallel randomized non-inferiority design (ratio 1:1; n = 270). Eligible participants are adolescents 15-19 years suffering from depression. The primary hypothesis is that IPDT will be non-inferior to ICBT in reducing depressive symptoms from pre-treatment to end of treatment. Secondary research questions include comparing outcomes of IPDT and ICBT regarding anxiety symptoms, emotion regulation and self-compassion. Additional data will be collected to evaluate cost-effectiveness as well as investigating predictors, moderators and mediators of outcome. In addition, we will examine long-term outcome up to 1 year after end of treatment. Diagnostic interviews with MINI 7.0 will be used to establish primary diagnosis of depression as well as ruling out any exclusion criteria. Both treatments consist of eight modules over 10 weeks, complemented with therapist support through text messages and weekly chat sessions. Primary outcome measure is the Quick Inventory of Depressive Symptomatology in Adolescents Self-Rated (QIDS-A17-SR). Primary outcome will be analysed using data from all participants entering the study using a multilevel growth curve strategy based on the weekly measurements of QIDS-A17-SR. The non-inferiority margin is defined as d = 0.30. DISCUSSION: This trial will demonstrate whether IPDT is non-inferior to ICBT in the treatment of adolescent depression. The study might therefore broaden the range of evidence-based treatment alternatives for young people struggling with depression. Further analyses of data from this trial may increase our knowledge about "what works for whom" and the pathways of change for two distinct types of interventions. TRIAL REGISTRATION: ISRCTN12552584 , Registered on 13 August 2019.

Prevention of substance use among adolescents through social and emotional training in school: a latent-class analysis of a five-year intervention in Sweden.

The study considers the impact of a program for social and emotional learning in Swedish schools on use of drugs, volatile substances, alcohol and tobacco. The program was evaluated in an effectiveness study. Intervention students were compared longitudinally with non-intervention students using nonparametric latent class analysis to identify subgroups of students with similar use levels and trajectories. Statistically significant intervention-by-duration interactions, with medium to large effect sizes to the advantage of the SET students were found for all substances in one or more, but not all, of the latent classes. Favorable trajectories were found for non-users/light users of drugs, moderate sniffers, non-users/light users of alcohol, and occasional smokers. Only among heavy smokers was there a possible iatrogenic effect of SET. Such programs, given a duration of two years or more, may dampen increases in use with age and discourage early debut, although they are not specifically targeted at use itself.

The role of learning style in choosing one's therapeutic orientation.

The motives of the beginning psychotherapist for choosing his or her orientation are an underresearched issue in psychotherapy training. This study focuses on the role of personality-based factors, specifically the epistemological preferences of the therapist that Kolb (1984) has termed "learning style" (LS). The aim of the present study was to explore possible associations between psychology students' developing LSs and their choice of psychotherapeutic orientation (psychodynamic [PDT] vs. cognitive-behavioural [CBT]). Students in a psychologist's program (N=175) took the Learning Style Inventory in their third semester and, before their formal choice, in their seventh semester. Besides a common trend toward radicalization or purification of their LS, the average PDT student tended to stick to the "feel and watch" style from the third semester to the seventh, whereas the CBT student tended to move toward "think and do." A cluster analysis revealed that the average movement among the CBT students was the result of the forces in two different subgroups, one toward "think" (and, more weakly, "watch"), the other toward "do" (and, more weakly, "feel").

Social and emotional training in Swedish classrooms for the promotion of mental health: results from an effectiveness study in Sweden.

Mental ill-health is a major problem worldwide. It includes depression, aggressive behavior, feeling down and alcohol and drug abuse. Since all children go to school, the school is an obvious arena for health interventions. A set of educational techniques named Social and Emotional Learning, based on the use by teachers of cognitive and behavioral methods, which teaches students self-control, social competence, empathy, motivation and self-awareness, has shown promising results in the USA. This paper reports on the application of similar techniques in Sweden (the Social and Emotional Training [SET] program). The study has a quasi-experimental longitudinal design, with two intervention and two control schools. A wide range of instruments, both Swedish and international, are employed. In this paper, results from the school years 1999-2000 (baseline) through to 2001-2002 are reported. Both the intervention and the data collection were performed by ordinary school staff in a routine school setting. Independent bi-annual ratings of teachers' performance were moderate to high, and teachers' perceptions of the program were generally, although by no means universally, high. However, their performance was poorer with regard to the collection of data. In terms of promotion, findings with regard to the impact of the program on mental health are generally favorable-in particular through the promotion of aspects of self-image, including well-being and the hindering of aggressiveness, bullying, attention-seeking and alcohol use. There was, however, no differential effect on social skills. It seems that SET has the potential to operate effectively as a health-promoting intervention during the school period, although its main impact may rather be to act as a brake on the deterioration in some aspects of mental health that is common during adolescence. Positively significant relationships were found on some but not all of the instrument scales, and effect sizes were medium.

Subjective health and ill health-related behaviour.

OBJECTIVE: The aim of this study was to investigate the relation between self-rated health measures and ill healthrelated behaviour. DESIGN: The study design was based on a self-report questionnaire taken for three consecutive years. METHOD: Path analysis was used to test the relations between (a) The Self-rated Health Scale (SRH) and the General Symptom Index (GSI) from the Symptom Checklist-90 (SCL-90), and (b) self-reports on sick leave, health care utilization and medication, in a group of 155 persons who had terminated psychotherapeutic treatment the year before our three-year panel survey. To investigate the potential moderating function of ongoing psychotherapeutic treatment, we repeated each test in a group of 152 patients in the midst of psychotherapeutic treatment. RESULTS: Only weak or zero relations were found between the self-rated health measures and ill health-related behaviour. The multi-group analyses indicated between-group differences in model fit. The few significant specific between-group differences all concerned autoregressive relations. CONCLUSIONS: Subjective health did not predict ill health-related behaviour. Ongoing psychotherapeutic treatment did not affect the predictive value of subjective health variables. The weak relations found in the current study illuminate paradoxical outcome differences between subjective well-being and ill health-related behaviour. Our findings are discussed in the light of cultural and personality factors.

How do experiences of psychiatric care affect the perceived credibility of different forms of psychotherapy?

BACKGROUND: The study examined the influence of experience with psychiatric treatment on the perceived credibility of psychodynamic (PDT), cognitive (CT) and cognitive-behavioural psychotherapy (CBT). METHODS: Written descriptions of the three forms of psychotherapy were rated by three groups of subjects with different levels of experience of psychiatric treatment, a random community sample with the normal level of psychiatric treatment (N=121), psychiatric out-patients with limited previous experience of psychiatric care (N=118), and a group of psychiatric veterans with long experience of psychiatric care (N=48). RESULTS: Besides a significant main effect of psychotherapy form on credibility, the interaction between psychotherapy form and level of previous experience of psychiatric care was highly significant. When respondents ranked the three forms of psychotherapy, there was an overrepresentation of preferences for CBT (and 'don't know' responses) among the general public, whereas the two patient samples were less indecisive and more often preferred PDT and, in particular, CT. CONCLUSIONS: Different forms of psychotherapy appear to have their own market segments, the size of which varies depending on previous experiences of psychological distress and psychiatric treatment.