Lars-göran Öst - Academia.edu (original) (raw)

Papers by Lars-göran Öst

Research on Child and Adolescent Psychopathology, Feb 8, 2022

Disruptive behavior problems are a frequent reason for children's referrals to psychological serv... more Disruptive behavior problems are a frequent reason for children's referrals to psychological services and can have negative effects on social and academic functioning. Most treatment programs involve parents as recipients and implementation of intervention programs in school is low. Deficits in emotion regulation have recently been implicated in the development of disruptive behavior disorders, making child directed early intervention programs focusing on increasing emotion regulation skills feasible. The purpose of this study was to assess the effects of Tuning Your Temper, a brief cognitive behavioral program for children with disruptive behavior problems, in a randomized controlled trial. A total of 125 children with disruptive behavior problems at school, aged 6-11 years old were randomized to either intervention or wait-list control condition. Treatment was conducted at school. Assessments included teacher and parent ratings on the Strengths and Difficulties Questionnaire (SDQ) and the Disruptive Behavior Rating Scale (DBRS) pre-and post-treatment and at 6-month follow-up. Results showed a significant reduction in behavior problems for the treatment condition on both measures and effects were maintained at 6-month follow-up. Results were more robust for teacher ratings, with medium to large effect sizes. Tuning Your Temper appears to be a promising early intervention program for children with disruptive behavior problems at school.

Frontiers in Psychology, Nov 4, 2020

Intensive care settings place specific work-related demands on health care professionals that may... more Intensive care settings place specific work-related demands on health care professionals that may elicit stress and negatively influence occupational health and work engagement. Psychological flexibility has emerged as a promising construct that could help explain variation in reported health. Understanding the role of psychological flexibility in occupational psychological health among intensive care medical staff may potentially guide the development of effective interventions. Thus, the present study evaluated the relationships between psychological flexibility (Work-related Acceptance and Action Questionnaire), distress (Perceived Stress Scale, General Health Questionnaire) and work engagement (Utrecht Work Engagement Scale) in a sample of 144 health care professionals from one adult (ICU, N = 98) and one pediatric (PICU, N = 46) intensive care unit. In addition to cross-sectional analyses, a subset of data (PICU, N = 46) was analyzed using a longitudinal design. Results illustrated that higher levels of distress were associated with lower levels of work engagement. Furthermore, psychological flexibility was related to greater work engagement, and psychological flexibility had a significant indirect effect on the relationship between distress and work engagement. Lastly, increased psychological flexibility over time corresponded with increased work engagement. Although tentative, the results suggest the importance of psychological flexibility for work engagement in health care professionals within intensive care settings.

Behaviour Research and Therapy, Mar 1, 2021

Family Practice, Mar 18, 2014

Background. The purpose was to test the effectiveness of two transdiagnostic group interventions ... more Background. The purpose was to test the effectiveness of two transdiagnostic group interventions compared to care as usual (CAU) for patients with anxiety, depressive or stress-related disorders within a primary health care context. Objectives. To compare the effects of cognitive-based-behavioural therapy (CBT) and multimodal intervention (MMI) on the quality of life and relief of psychological symptoms of patients with common mental disorders or problems attending primary health care centre. Methods. Patients (n = 278), aged 18-65 years, were referred to the study by the GPs and 245 were randomized to CAU or one of two group interventions in addition to CAU: (i) group CBT administered by psychologists and (ii) group MMI administered by assistant nurses. The primary outcome measure was the Mental Component Summary score of short form 36. Secondary outcome measures were Perceived Stress Scale and Self-Rating Scale for Affective Syndromes. The data were analysed using intention-to-treat with a linear mixed model. Results. On the primary outcome measure, the mean improvement based on mixed model analyses across post-and follow-up assessment was significantly larger for the MMI group than for the CBT (4.0; P = 0.020) and CAU (7.5; P = .001) groups. Participants receiving CBT were significantly more improved than those in the CAU group. On four of the secondary outcome measures, the MMI group was significantly more improved than the CBT and CAU groups. The course of improvement did not differ between the CBT group and the CAU group on these measures. Conclusions. Transdiagnostic group treatment can be effective for patients with common mental disorders when delivered in a primary care setting. The group format and transdiagnostic approach fit well with the requirements of primary care.

Behaviour Research and Therapy, Sep 1, 2010

The purpose of the present study was twofold. In an analysis of data from an existing randomized ... more The purpose of the present study was twofold. In an analysis of data from an existing randomized control trial of brief cognitive behavioral treatment on specific phobias (One-Session Treatment, OST; Ollendick et al., 2009), we examined 1) the effect of comorbid specific phobias and other anxiety disorders on treatment outcomes, and 2) the effect of treatment of the specific phobia on these co-occurring disorders. These relations were explored in 100 youth presenting with animal, natural environment, situational, and "other" types of phobia. Youth were reliably diagnosed with the Anxiety Disorders Interview Schedule for DSM-IV: Child and Parent versions (Silverman & Albano, 1996). Clinician Severity Ratings at post-treatment and 6-month follow-up were examined as were parent and child treatment outcome satisfaction measures. Results indicated that the presence of comorbid phobias or anxiety disorders did not affect treatment outcomes; moreover, treatment of the targeted specific phobias led to significant reductions in the clinical severity of other co-occurring specific phobias and related anxiety disorders. These findings speak to the generalization of the effects of this time-limited treatment approach. Implications for treatment of principal and comorbid disorders are discussed, and possible mechanisms for these effects are commented upon.

Psychoneuroendocrinology, 2018

Preclinical studies have demonstrated that conditioned fear extinction is impaired in females wit... more Preclinical studies have demonstrated that conditioned fear extinction is impaired in females with low endogenous levels of the sex hormone estradiol, due to menstrual fluctuations or hormonal contraceptive use. As fear extinction is a laboratory model of exposure therapy for anxiety and trauma disorders, here we assessed the hypothesis that treatment outcomes may be diminished when exposure therapy occurs during periods of low estradiol. 90 women with spider phobia (60 cycling and 30 using hormonal contraceptives) underwent a one-session exposure treatment for spider phobia, following which, serum estradiol levels were assessed. A median split in estradiol level was used to divide cycling participants into two groups; lower and higher estradiol. Behavioral avoidance and self-reported fear of spiders were measured pre-treatment, post-treatment, and at a 12 week follow-up assessment. Women using hormonal contraceptives exhibited a significantly slower rate of improvement across treat...

Behaviour Research and Therapy, 2017

Brief, intensive and concentrated cognitive behavioral treatments for anxiety disorders in childr... more Brief, intensive and concentrated cognitive behavioral treatments for anxiety disorders in children: a systematic review and meta-analysis

Cognitive behaviour therapy, 2014

Among clinicians, it is common practice to include parents in treatment, and it has been taken fo... more Among clinicians, it is common practice to include parents in treatment, and it has been taken for granted that parents' involvement in their children's treatment is beneficial for therapy outcome, although research on this issue is far from clear. A meta-analysis was carried out in order to investigate whether parent involvement potentiates the outcome for children with anxiety disorders when treated with cognitive-behavior therapy. Sixteen studies, which directly compared parent-involved treatments with child-only treatments, were included in the meta-analysis. The results showed a small, nonsignificant effect size of - 0.10 in favor of the child-only treatments. There was no indication of publication bias in the analysis. Implications of the results are discussed.

The first book to describe evidence-based treatment of dental phobia using brief CBT, based on th... more The first book to describe evidence-based treatment of dental phobia using brief CBT, based on the pioneering single-session treatment for specific phobias developed by Lars-Göran Öst. • Brings together research, experience and techniques from clinical psychology and dentistry to describe evidence-based treatment of dental phobia in clinical and dental contexts • Chapters describe epidemiology, diagnosis and differential diagnosis, symptoms, clinical characteristics and consequences, and aetiology of dental phobia • Also covers related issues including intra-oral injection phobia, dental treatment of fearful children, and the use of medication to supplement psychological treatment of fear

Scandinavian Journal of Primary Health Care, 2014

Objective. To investigate whether interventions that have positive effects on psychological sympt... more Objective. To investigate whether interventions that have positive effects on psychological symptoms and quality of life compared with usual care would also reduce days on sick leave. Design. A randomized controlled trial. Setting. A large primary health care centre in Stockholm, Sweden. Intervention. Patients with common mental disorders were recruited by their GPs and randomized into one of two group interventions that took place in addition to usual care. These group interventions were: (a) group cognitive behavioural therapy (CBT), and (b) group multimodal intervention (MMI). Both types of intervention had previously shown signifi cant effects on quality of life, and MMI had also shown signifi cant effects on psychological symptoms. Patients. Of the 245 randomized patients, 164 were employed and had taken sick leave periods of at least two weeks in length during the study period of two years. They comprised the study group. Main outcome measures. The odds, compared with usual care, for being sick-listed at different times relative to the date of randomization. Results. The mean number of days on sick leave increased steadily in the two years before randomization and decreased in the two years afterwards, showing the same pattern for all three groups .The CBT and MMI interventions did not show the expected lower odds for sick-listing compared with usual care during the two-year follow-up. Conclusion. Reduction in psychological symptoms and increased well-being did not seem to be enough to reduce sickness absence for patients with common mental problems in primary care. The possibility of adding workplaceoriented interventions is discussed.

Journal of Traumatic Stress, 2005

Journal of Clinical Child & Adolescent Psychology, 2011

The present study investigated interpretation bias and reduced evidence for danger (RED) bias in ... more The present study investigated interpretation bias and reduced evidence for danger (RED) bias in 49 children with social phobia and 49 nonsocially anxious children between the ages of 8 and 14 years, using an ambiguous stories task. A posttreatment and follow-up measure was included for 26 of the socially phobic children to examine whether there would be a change in interpretation and RED bias after a 12-week behavior therapy program. Ambiguous scenarios were presented sentence by sentence. Participants gave interpretations and fear ratings after each sentence, and they rated negative emotions after each complete scenario. Compared to the nonsocially anxious children, children with social phobia displayed both a RED bias and an interpretation bias. After the treatment program, the children with social phobia displayed a reduced tendency to make biased interpretations, but there were no significant posttreatment changes in the RED bias. At 1 year follow-up there was a significant reduction in both interpretation and RED bias and clinical children no longer differed from nonsocially anxious controls. This study was supported by grants from the Swedish Council for Working Life and Social Research (F0129=2001) and from the Swedish Research Council (421-2001-4740). We gratefully acknowledge the help from Lisa Alexandersson and Evelina Pärnerud in collecting the normal group data, the valuable comments on the manuscript from Kia Å sberg and Jonas Ramnerö , and the thorough work of the anonymous reviewers.

Journal of Behavior Therapy and Experimental Psychiatry, 2007

Different aspects of change were examined in 62 patients who fulfilled the DSM-IV criteria for a ... more Different aspects of change were examined in 62 patients who fulfilled the DSM-IV criteria for a primary diagnosis of panic disorder with agoraphobia of moderate to severe magnitude, and who were treated with 16 sessions of behavioral therapy. The treatment resulted in substantial effects on panic attacks and agoraphobic avoidance. Panic-free status only differentiated the patients regarding mood at pre-and post-treatment. Changes in panic and avoidance were related to each other, but change in avoidance was more related to change in negative affect. Change in quality of life (QOL) was also more associated with change in avoidance at post-treatment. At follow-up change in QOL was more related to change in panic than change in avoidance.

Computers in Human Behavior, 2009

The current study was conducted to determine whether participants respond differently to online q... more The current study was conducted to determine whether participants respond differently to online questionnaires presenting all items on a single webpage versus questionnaires presenting only one item per page, and whether participants prefer one format over the other. Of participants seeking self-help treatment on the Internet (for depression, social phobia, or panic disorder), 710 completed four questionnaires

Computers in Human Behavior, 2007

The aim of this study was to investigate the psychometric properties of Internet administered que... more The aim of this study was to investigate the psychometric properties of Internet administered questionnaires used in panic research. Included were 494 people who had registered for an Internet-based treatment program for panic disorder (PD). Participants were randomly assigned to fill in the questionnaires either on the Internet or the paper-and-pencil versions, and then to fill in the same questionnaires again the next day using the other format. The questionnaires were the body sensations questionnaire [BSQ;

Behaviour Research and Therapy, 1998

The present clinical study was aimed at investigating predictors of treatment success, attrition ... more The present clinical study was aimed at investigating predictors of treatment success, attrition and the extent of treatment needed to achieve clinically signi®cant improvement in spider phobic patients. A total of 103 patients were included in the study after a detailed screening interview. There were four treatment conditions; self-help manual, video, group, and individual treatment, which the patients received in a hierarchical order providing they were not clinically signi®cantly improved after the previous treatment. Pre and post each treatment the patients went through a behavioral approach test and ®lled in a number of self-report questionnaires. The results showed that 38 patients dropped out during the manual treatment, and 59 ful®lled the treatments to become clinically improved. The patients achieving clinical improvement after the two self-help treatments were signi®cantly predicted, as was the extent of treatment needed. The signi®cant predictors were credibility of the manual treatment and motivation for psychotherapy in general.

Behaviour Research and Therapy, 1999

Self-observations of cognitions during episodes of anxiety were examined in 38 patients with gene... more Self-observations of cognitions during episodes of anxiety were examined in 38 patients with generalized anxiety disorder and 36 patients with panic disorder. Two independent observers who where blind to the diagnoses categorised the cognitions. The inter-rater reliability was high (mean kappa 0.82). The GAD-patients had signi®cantly more cognitions in the following categories: interpersonal confrontation, competence, acceptance, concern about others and worry over minor matters, while the PD-patients had signi®cantly more cognitions in the physical catastrophe category. Furthermore, GADpatients with a comorbidity of social phobia reported more cognitions regarding social embarrassment than did GAD-patients with other or no (axis-I) comorbidity. The results of this study support the cognitive theory regarding the cognitive speci®city of anxiety disorders. The implications of these results are discussed, along with the issues of reliability and validity of the instrument used.

Behaviour Research and Therapy, 1999

Social phobics were compared to patients with panic disorder with agoraphobia and normal controls... more Social phobics were compared to patients with panic disorder with agoraphobia and normal controls on perfectionism and self-consciousness. On concern over mistakes and doubts about action, social phobics scored higher than patients with panic disorder. Social phobics also demonstrated a higher level of public self-consciousness than patients with panic disorder and when this dierence was controlled for the signi®cant dierences on perfectionism disappeared. Within each patient group, however, perfectionism was more robustly related to social anxiety than was public self-consciousness, which replicates the ®ndings of Saboonchi and Lundh [Saboonchi, F. & Lundh, L. G. (1997). Perfectionism, self-consciousness and anxiety. Personality and Individual Dierences, 22, 921±928.] from a non-clinical sample. The results are discussed in terms of public self-consciousness being a dierentiating characteristic of the more severe kind of social anxiety which is typical of social phobia.

Behaviour Research and Therapy, 1998

Panic patients with agoraphobia were compared with normal controls on tasks of face recognition. ... more Panic patients with agoraphobia were compared with normal controls on tasks of face recognition. The subjects were presented with 20 photos, and were required to make a judgement of the persons on the photos; shortly afterwards they were unexpectedly presented with a recognition task. In the ®rst study, one task was to judge whether the persons on the photos were critical or accepting: unlike social phobics (Lundh and O È st, 1996b, Behaviour Research and Therapy, 34, 787±794), panic patients showed no bias for critical vs accepting faces on the recognition task. In a secondary study, the task was to judge whether the persons on the photos were`safe' or`unsafe', i.e. whether they could be relied on if the subject would need help in some situation. The results showed a recognition bias for safe vs neutral faces in panic patients. The index of recognition bias for safe faces correlated with avoidance of feared situations when accompanied by others, as measured by the Mobility Inventory. The possibility that memory bias in emotional disorders is a function of basic concern, or functional importance, rather than positive/negative valence is discussed. The results are also discussed in terms of degree of elaboration, exposure duration of the stimuli, and the generality of the ®ndings.

Behaviour Research and Therapy, 2000

The present study investigated the ecacy of a coping-technique, applied relaxation (AR) and cogni... more The present study investigated the ecacy of a coping-technique, applied relaxation (AR) and cognitive therapy (CT), in the treatment of generalized anxiety disorder. Thirty-six outpatients ful®lling the DSM-III-R criteria for generalized anxiety were assessed with independent assessor ratings and selfreport scales before and after treatment and at a 1 yr follow-up. The patients were randomized and treated individually for 12 weekly sessions. The results showed that both treatments yielded large improvements, which were maintained, or furthered at follow-up. There was no dierence between AR and CT on any measure. The drop-out rate was 12% for AR and 5% for CT. The proportions of clinically signi®cantly improved patients were 53 and 62% at post-treatment and 67 and 56% at followup for AR and CT, respectively. Besides aecting generalized anxiety the treatments also yielded marked and lasting changes on ratings of worry, cognitive and somatic anxiety and depression. The conclusion that can be drawn is that both AR and CT have potential as treatments for generalized anxiety disorder but they have to be developed further in order to increase the ecacy to the level usually seen in panic disorder, 80±85% clinically improved.

Research on Child and Adolescent Psychopathology, Feb 8, 2022

Disruptive behavior problems are a frequent reason for children's referrals to psychological serv... more Disruptive behavior problems are a frequent reason for children's referrals to psychological services and can have negative effects on social and academic functioning. Most treatment programs involve parents as recipients and implementation of intervention programs in school is low. Deficits in emotion regulation have recently been implicated in the development of disruptive behavior disorders, making child directed early intervention programs focusing on increasing emotion regulation skills feasible. The purpose of this study was to assess the effects of Tuning Your Temper, a brief cognitive behavioral program for children with disruptive behavior problems, in a randomized controlled trial. A total of 125 children with disruptive behavior problems at school, aged 6-11 years old were randomized to either intervention or wait-list control condition. Treatment was conducted at school. Assessments included teacher and parent ratings on the Strengths and Difficulties Questionnaire (SDQ) and the Disruptive Behavior Rating Scale (DBRS) pre-and post-treatment and at 6-month follow-up. Results showed a significant reduction in behavior problems for the treatment condition on both measures and effects were maintained at 6-month follow-up. Results were more robust for teacher ratings, with medium to large effect sizes. Tuning Your Temper appears to be a promising early intervention program for children with disruptive behavior problems at school.

Frontiers in Psychology, Nov 4, 2020

Intensive care settings place specific work-related demands on health care professionals that may... more Intensive care settings place specific work-related demands on health care professionals that may elicit stress and negatively influence occupational health and work engagement. Psychological flexibility has emerged as a promising construct that could help explain variation in reported health. Understanding the role of psychological flexibility in occupational psychological health among intensive care medical staff may potentially guide the development of effective interventions. Thus, the present study evaluated the relationships between psychological flexibility (Work-related Acceptance and Action Questionnaire), distress (Perceived Stress Scale, General Health Questionnaire) and work engagement (Utrecht Work Engagement Scale) in a sample of 144 health care professionals from one adult (ICU, N = 98) and one pediatric (PICU, N = 46) intensive care unit. In addition to cross-sectional analyses, a subset of data (PICU, N = 46) was analyzed using a longitudinal design. Results illustrated that higher levels of distress were associated with lower levels of work engagement. Furthermore, psychological flexibility was related to greater work engagement, and psychological flexibility had a significant indirect effect on the relationship between distress and work engagement. Lastly, increased psychological flexibility over time corresponded with increased work engagement. Although tentative, the results suggest the importance of psychological flexibility for work engagement in health care professionals within intensive care settings.

Behaviour Research and Therapy, Mar 1, 2021

Family Practice, Mar 18, 2014

Background. The purpose was to test the effectiveness of two transdiagnostic group interventions ... more Background. The purpose was to test the effectiveness of two transdiagnostic group interventions compared to care as usual (CAU) for patients with anxiety, depressive or stress-related disorders within a primary health care context. Objectives. To compare the effects of cognitive-based-behavioural therapy (CBT) and multimodal intervention (MMI) on the quality of life and relief of psychological symptoms of patients with common mental disorders or problems attending primary health care centre. Methods. Patients (n = 278), aged 18-65 years, were referred to the study by the GPs and 245 were randomized to CAU or one of two group interventions in addition to CAU: (i) group CBT administered by psychologists and (ii) group MMI administered by assistant nurses. The primary outcome measure was the Mental Component Summary score of short form 36. Secondary outcome measures were Perceived Stress Scale and Self-Rating Scale for Affective Syndromes. The data were analysed using intention-to-treat with a linear mixed model. Results. On the primary outcome measure, the mean improvement based on mixed model analyses across post-and follow-up assessment was significantly larger for the MMI group than for the CBT (4.0; P = 0.020) and CAU (7.5; P = .001) groups. Participants receiving CBT were significantly more improved than those in the CAU group. On four of the secondary outcome measures, the MMI group was significantly more improved than the CBT and CAU groups. The course of improvement did not differ between the CBT group and the CAU group on these measures. Conclusions. Transdiagnostic group treatment can be effective for patients with common mental disorders when delivered in a primary care setting. The group format and transdiagnostic approach fit well with the requirements of primary care.

Behaviour Research and Therapy, Sep 1, 2010

The purpose of the present study was twofold. In an analysis of data from an existing randomized ... more The purpose of the present study was twofold. In an analysis of data from an existing randomized control trial of brief cognitive behavioral treatment on specific phobias (One-Session Treatment, OST; Ollendick et al., 2009), we examined 1) the effect of comorbid specific phobias and other anxiety disorders on treatment outcomes, and 2) the effect of treatment of the specific phobia on these co-occurring disorders. These relations were explored in 100 youth presenting with animal, natural environment, situational, and "other" types of phobia. Youth were reliably diagnosed with the Anxiety Disorders Interview Schedule for DSM-IV: Child and Parent versions (Silverman & Albano, 1996). Clinician Severity Ratings at post-treatment and 6-month follow-up were examined as were parent and child treatment outcome satisfaction measures. Results indicated that the presence of comorbid phobias or anxiety disorders did not affect treatment outcomes; moreover, treatment of the targeted specific phobias led to significant reductions in the clinical severity of other co-occurring specific phobias and related anxiety disorders. These findings speak to the generalization of the effects of this time-limited treatment approach. Implications for treatment of principal and comorbid disorders are discussed, and possible mechanisms for these effects are commented upon.

Psychoneuroendocrinology, 2018

Preclinical studies have demonstrated that conditioned fear extinction is impaired in females wit... more Preclinical studies have demonstrated that conditioned fear extinction is impaired in females with low endogenous levels of the sex hormone estradiol, due to menstrual fluctuations or hormonal contraceptive use. As fear extinction is a laboratory model of exposure therapy for anxiety and trauma disorders, here we assessed the hypothesis that treatment outcomes may be diminished when exposure therapy occurs during periods of low estradiol. 90 women with spider phobia (60 cycling and 30 using hormonal contraceptives) underwent a one-session exposure treatment for spider phobia, following which, serum estradiol levels were assessed. A median split in estradiol level was used to divide cycling participants into two groups; lower and higher estradiol. Behavioral avoidance and self-reported fear of spiders were measured pre-treatment, post-treatment, and at a 12 week follow-up assessment. Women using hormonal contraceptives exhibited a significantly slower rate of improvement across treat...

Behaviour Research and Therapy, 2017

Brief, intensive and concentrated cognitive behavioral treatments for anxiety disorders in childr... more Brief, intensive and concentrated cognitive behavioral treatments for anxiety disorders in children: a systematic review and meta-analysis

Cognitive behaviour therapy, 2014

Among clinicians, it is common practice to include parents in treatment, and it has been taken fo... more Among clinicians, it is common practice to include parents in treatment, and it has been taken for granted that parents' involvement in their children's treatment is beneficial for therapy outcome, although research on this issue is far from clear. A meta-analysis was carried out in order to investigate whether parent involvement potentiates the outcome for children with anxiety disorders when treated with cognitive-behavior therapy. Sixteen studies, which directly compared parent-involved treatments with child-only treatments, were included in the meta-analysis. The results showed a small, nonsignificant effect size of - 0.10 in favor of the child-only treatments. There was no indication of publication bias in the analysis. Implications of the results are discussed.

The first book to describe evidence-based treatment of dental phobia using brief CBT, based on th... more The first book to describe evidence-based treatment of dental phobia using brief CBT, based on the pioneering single-session treatment for specific phobias developed by Lars-Göran Öst. • Brings together research, experience and techniques from clinical psychology and dentistry to describe evidence-based treatment of dental phobia in clinical and dental contexts • Chapters describe epidemiology, diagnosis and differential diagnosis, symptoms, clinical characteristics and consequences, and aetiology of dental phobia • Also covers related issues including intra-oral injection phobia, dental treatment of fearful children, and the use of medication to supplement psychological treatment of fear

Scandinavian Journal of Primary Health Care, 2014

Objective. To investigate whether interventions that have positive effects on psychological sympt... more Objective. To investigate whether interventions that have positive effects on psychological symptoms and quality of life compared with usual care would also reduce days on sick leave. Design. A randomized controlled trial. Setting. A large primary health care centre in Stockholm, Sweden. Intervention. Patients with common mental disorders were recruited by their GPs and randomized into one of two group interventions that took place in addition to usual care. These group interventions were: (a) group cognitive behavioural therapy (CBT), and (b) group multimodal intervention (MMI). Both types of intervention had previously shown signifi cant effects on quality of life, and MMI had also shown signifi cant effects on psychological symptoms. Patients. Of the 245 randomized patients, 164 were employed and had taken sick leave periods of at least two weeks in length during the study period of two years. They comprised the study group. Main outcome measures. The odds, compared with usual care, for being sick-listed at different times relative to the date of randomization. Results. The mean number of days on sick leave increased steadily in the two years before randomization and decreased in the two years afterwards, showing the same pattern for all three groups .The CBT and MMI interventions did not show the expected lower odds for sick-listing compared with usual care during the two-year follow-up. Conclusion. Reduction in psychological symptoms and increased well-being did not seem to be enough to reduce sickness absence for patients with common mental problems in primary care. The possibility of adding workplaceoriented interventions is discussed.

Journal of Traumatic Stress, 2005

Journal of Clinical Child & Adolescent Psychology, 2011

The present study investigated interpretation bias and reduced evidence for danger (RED) bias in ... more The present study investigated interpretation bias and reduced evidence for danger (RED) bias in 49 children with social phobia and 49 nonsocially anxious children between the ages of 8 and 14 years, using an ambiguous stories task. A posttreatment and follow-up measure was included for 26 of the socially phobic children to examine whether there would be a change in interpretation and RED bias after a 12-week behavior therapy program. Ambiguous scenarios were presented sentence by sentence. Participants gave interpretations and fear ratings after each sentence, and they rated negative emotions after each complete scenario. Compared to the nonsocially anxious children, children with social phobia displayed both a RED bias and an interpretation bias. After the treatment program, the children with social phobia displayed a reduced tendency to make biased interpretations, but there were no significant posttreatment changes in the RED bias. At 1 year follow-up there was a significant reduction in both interpretation and RED bias and clinical children no longer differed from nonsocially anxious controls. This study was supported by grants from the Swedish Council for Working Life and Social Research (F0129=2001) and from the Swedish Research Council (421-2001-4740). We gratefully acknowledge the help from Lisa Alexandersson and Evelina Pärnerud in collecting the normal group data, the valuable comments on the manuscript from Kia Å sberg and Jonas Ramnerö , and the thorough work of the anonymous reviewers.

Journal of Behavior Therapy and Experimental Psychiatry, 2007

Different aspects of change were examined in 62 patients who fulfilled the DSM-IV criteria for a ... more Different aspects of change were examined in 62 patients who fulfilled the DSM-IV criteria for a primary diagnosis of panic disorder with agoraphobia of moderate to severe magnitude, and who were treated with 16 sessions of behavioral therapy. The treatment resulted in substantial effects on panic attacks and agoraphobic avoidance. Panic-free status only differentiated the patients regarding mood at pre-and post-treatment. Changes in panic and avoidance were related to each other, but change in avoidance was more related to change in negative affect. Change in quality of life (QOL) was also more associated with change in avoidance at post-treatment. At follow-up change in QOL was more related to change in panic than change in avoidance.

Computers in Human Behavior, 2009

The current study was conducted to determine whether participants respond differently to online q... more The current study was conducted to determine whether participants respond differently to online questionnaires presenting all items on a single webpage versus questionnaires presenting only one item per page, and whether participants prefer one format over the other. Of participants seeking self-help treatment on the Internet (for depression, social phobia, or panic disorder), 710 completed four questionnaires

Computers in Human Behavior, 2007

The aim of this study was to investigate the psychometric properties of Internet administered que... more The aim of this study was to investigate the psychometric properties of Internet administered questionnaires used in panic research. Included were 494 people who had registered for an Internet-based treatment program for panic disorder (PD). Participants were randomly assigned to fill in the questionnaires either on the Internet or the paper-and-pencil versions, and then to fill in the same questionnaires again the next day using the other format. The questionnaires were the body sensations questionnaire [BSQ;

Behaviour Research and Therapy, 1998

The present clinical study was aimed at investigating predictors of treatment success, attrition ... more The present clinical study was aimed at investigating predictors of treatment success, attrition and the extent of treatment needed to achieve clinically signi®cant improvement in spider phobic patients. A total of 103 patients were included in the study after a detailed screening interview. There were four treatment conditions; self-help manual, video, group, and individual treatment, which the patients received in a hierarchical order providing they were not clinically signi®cantly improved after the previous treatment. Pre and post each treatment the patients went through a behavioral approach test and ®lled in a number of self-report questionnaires. The results showed that 38 patients dropped out during the manual treatment, and 59 ful®lled the treatments to become clinically improved. The patients achieving clinical improvement after the two self-help treatments were signi®cantly predicted, as was the extent of treatment needed. The signi®cant predictors were credibility of the manual treatment and motivation for psychotherapy in general.

Behaviour Research and Therapy, 1999

Self-observations of cognitions during episodes of anxiety were examined in 38 patients with gene... more Self-observations of cognitions during episodes of anxiety were examined in 38 patients with generalized anxiety disorder and 36 patients with panic disorder. Two independent observers who where blind to the diagnoses categorised the cognitions. The inter-rater reliability was high (mean kappa 0.82). The GAD-patients had signi®cantly more cognitions in the following categories: interpersonal confrontation, competence, acceptance, concern about others and worry over minor matters, while the PD-patients had signi®cantly more cognitions in the physical catastrophe category. Furthermore, GADpatients with a comorbidity of social phobia reported more cognitions regarding social embarrassment than did GAD-patients with other or no (axis-I) comorbidity. The results of this study support the cognitive theory regarding the cognitive speci®city of anxiety disorders. The implications of these results are discussed, along with the issues of reliability and validity of the instrument used.

Behaviour Research and Therapy, 1999

Social phobics were compared to patients with panic disorder with agoraphobia and normal controls... more Social phobics were compared to patients with panic disorder with agoraphobia and normal controls on perfectionism and self-consciousness. On concern over mistakes and doubts about action, social phobics scored higher than patients with panic disorder. Social phobics also demonstrated a higher level of public self-consciousness than patients with panic disorder and when this dierence was controlled for the signi®cant dierences on perfectionism disappeared. Within each patient group, however, perfectionism was more robustly related to social anxiety than was public self-consciousness, which replicates the ®ndings of Saboonchi and Lundh [Saboonchi, F. & Lundh, L. G. (1997). Perfectionism, self-consciousness and anxiety. Personality and Individual Dierences, 22, 921±928.] from a non-clinical sample. The results are discussed in terms of public self-consciousness being a dierentiating characteristic of the more severe kind of social anxiety which is typical of social phobia.

Behaviour Research and Therapy, 1998

Panic patients with agoraphobia were compared with normal controls on tasks of face recognition. ... more Panic patients with agoraphobia were compared with normal controls on tasks of face recognition. The subjects were presented with 20 photos, and were required to make a judgement of the persons on the photos; shortly afterwards they were unexpectedly presented with a recognition task. In the ®rst study, one task was to judge whether the persons on the photos were critical or accepting: unlike social phobics (Lundh and O È st, 1996b, Behaviour Research and Therapy, 34, 787±794), panic patients showed no bias for critical vs accepting faces on the recognition task. In a secondary study, the task was to judge whether the persons on the photos were`safe' or`unsafe', i.e. whether they could be relied on if the subject would need help in some situation. The results showed a recognition bias for safe vs neutral faces in panic patients. The index of recognition bias for safe faces correlated with avoidance of feared situations when accompanied by others, as measured by the Mobility Inventory. The possibility that memory bias in emotional disorders is a function of basic concern, or functional importance, rather than positive/negative valence is discussed. The results are also discussed in terms of degree of elaboration, exposure duration of the stimuli, and the generality of the ®ndings.

Behaviour Research and Therapy, 2000

The present study investigated the ecacy of a coping-technique, applied relaxation (AR) and cogni... more The present study investigated the ecacy of a coping-technique, applied relaxation (AR) and cognitive therapy (CT), in the treatment of generalized anxiety disorder. Thirty-six outpatients ful®lling the DSM-III-R criteria for generalized anxiety were assessed with independent assessor ratings and selfreport scales before and after treatment and at a 1 yr follow-up. The patients were randomized and treated individually for 12 weekly sessions. The results showed that both treatments yielded large improvements, which were maintained, or furthered at follow-up. There was no dierence between AR and CT on any measure. The drop-out rate was 12% for AR and 5% for CT. The proportions of clinically signi®cantly improved patients were 53 and 62% at post-treatment and 67 and 56% at followup for AR and CT, respectively. Besides aecting generalized anxiety the treatments also yielded marked and lasting changes on ratings of worry, cognitive and somatic anxiety and depression. The conclusion that can be drawn is that both AR and CT have potential as treatments for generalized anxiety disorder but they have to be developed further in order to increase the ecacy to the level usually seen in panic disorder, 80±85% clinically improved.