Brjánn Ljótsson

Emotion dysregulation is a potentially important process to target in eating disorder treatment. This study aimed to investigate whether emotion dysregulation may be improved in individuals with eating disorders using a brief online treatment designed specifically to increase emotion regulation skills. A replicated single-case experimental randomized AB-design was used to investigate the added effect of emotion regulation interventions (B phase), beyond the effects of eating disorder treatment focusing on normalization of eating and refrainment from compensatory behaviors (A phase). Twelve individuals with eating disorders were recruited from psychiatric outpatient services, and eight received an 8-week online treatment. The start of B phase in treatment (i.e. emotion regulation interventions) was randomized for each participant. Emotion dysregulation and negative affect were assessed every third day in both phases (20 assessments in total). Visual and baseline-corrected Tau analyses revealed short-term positive experimental effects on negative affect and emotion regulation for four participants, suggesting that emotion regulation interventions may be beneficial for some individuals. The study also demonstrated the feasibility and acceptability of delivering and evaluating treatment in this intensified online format, allowing for future detailed investigation of treatment processes and components at the intraindividual level.

Gambling activities—such as poker, casino games, slot machines, and sports betting, whether online or in physical venues—can lead to severe harms, including emotional distress, relationship breakdo...

Therapist-guided internet-based cognitive behavioural therapy (iCBT) has improved access to treatment for depression and anxiety, but scalability is limited by reliance on trained therapists. This feasibility trial evaluated a tailored digital self-help intervention for adults with depressive and anxiety symptoms, delivered with or without clinician guidance. In total, 124 participants in Sweden with at least mild depressive or anxiety symptoms were recruited through social media and randomized (1:1) to an eight-week program with (n = 63) or without (n = 61) clinician guidance. All participants completed telephone assessments before and after the intervention. The primary aim was to assess feasibility of both versions, while considering outcome advantages of guidance and reduced clinician time with self-help. Feasibility outcomes included adherence, credibility, satisfaction, and adverse events. The intervention was perceived as credible, with high satisfaction and engagement: most participants used the program weekly, and two thirds completed at least three of five modules. Outcomes were similar across groups, though participants with guidance reported higher satisfaction. Clinician time averaged 36 minutes for self-help participants and 66 minutes for those receiving guidance. Both groups showed large symptom reductions (Cohen's d = 1.05-1.10), supporting feasibility and motivating future trials comparing self-help and clinician-guided delivery.

People with type 1 diabetes mellitus (T1DM) may benefit from cognitive behavioural therapy (CBT) interventions; self-guided digital tools are a potentially scalable solution. Two promising components for T1DM from CBT are problem-solving and exposure. Our aim was to preliminarily explore whether two digital tools, namely a problem-solving tool and an exposure tool, could be helpful for people with T1DM, and to investigate types of problems reported. We recruited nine participants from a specialised diabetes unit. Following one drop-out, eight participants used the tools for 4 weeks and answered questionnaires on usability, mental health, and diabetes distress. Comments and ratings showed that there were two distinct types of users that can be matched to the types of digital tools: those with general problem areas in diabetes and those of an avoidant type, driven by fear of hypoglycaemia. All participants used problem-solving to some degree, typically solving one or two problems. Three participants used exposure, registering at least one exercise. Both exposure and problem-solving may be useful in future interventions for people with T1DM. A digital self-guided CBT intervention for T1DM could include problem-solving with exposure as an option and be evaluated as a full digital self-care programme.

Therapist-guided internet-based cognitive behavioural therapy has improved access to treatment for depression and anxiety, but scalability is limited by reliance on trained therapists. This feasibility trial evaluated a tailored digital self-help intervention for adults with depressive and anxiety symptoms, delivered with or without clinician guidance. In total, 124 participants in Sweden with at least mild depressive or anxiety symptoms were recruited mainly through social media and randomized (1:1) to an eight-week program with (n = 63) or without (n = 61) clinician guidance. All participants completed telephone assessments before and after the intervention. The primary aim was to assess feasibility of both versions, while also considering outcome advantages of guidance and reduced clinician time with self-help. Feasibility outcomes included adherence, credibility, acceptability, and adverse events. The intervention was perceived as credible, with high satisfaction and engagement: most participants used the program weekly, and two thirds completed at least three of five modules. Outcomes were similar across groups, though participants with guidance reported higher satisfaction. Clinician time averaged 36 minutes for self-help participants and 66 minutes for those receiving guidance. Both groups showed large symptom reductions (Cohen’s d = 1.05–1.10), supporting feasibility and motivating future trials comparing self-help and clinician-guided delivery.

Background: Premature ventricular contractions (PVCs) are a common cardiac condition often associated with disabling symptoms and impaired quality of life (QoL). Current treatment strategies have limited effectiveness in reducing symptoms and restoring QoL for patients with PVCs. Symptom preoccupation, involving cardiac-related fear, hypervigilance, and avoidance behavior, is associated with disability in other cardiac conditions and can be effectively targeted by cognitive behavioral therapy (CBT). Objective: The aim of this study was to evaluate the effect of a PVC-specific CBT protocol targeting symptom preoccupation in patients with symptomatic idiopathic PVCs. Methods: Nineteen patients diagnosed with symptomatic idiopathic PVCs and symptom preoccupation underwent PVC-specific CBT over 10 weeks. The treatment was delivered by a licensed psychologist via videoconference in conjunction with online text-based information and homework assignments. The main components of the treatment were exposure to cardiac-related symptoms and reducing cardiac-related avoidance and control behavior. Self-rated measures were collected at baseline, post treatment, and at 3- and 6-month follow-ups. The primary outcome was PVC-specific QoL at posttreatment assessment measured with a PVC-adapted version of the Atrial Fibrillation Effects on Quality of Life questionnaire. Secondary measures included symptom preoccupation measured with the Cardiac Anxiety Questionnaire. PVC burden was evaluated with 5-day continuous electrocardiogram recordings at baseline, post treatment, and 6-month follow-up. Results: We observed large improvements in PVC-specific QoL (Cohen d=1.62, P001) and symptom preoccupation (Cohen d=1.73, P<.001) post treatment. These results were sustained at the 3- and 6-month follow-ups. PVC burden, as measured with 5-day continuous electrocardiogram, remained unchanged throughout follow-up. However, self-reported PVC symptoms were significantly lower at posttreatment assessment and at both the 3- and 6-month follow-ups. Reduction in symptom preoccupation had a statistically significant mediating effect of the intervention on PVC-specific QoL in an explorative mediation analysis. Conclusions: This uncontrolled pilot study shows preliminary promising results for PVC-specific CBT as a potentially effective treatment approach for patients with symptomatic idiopathic PVCs and symptom preoccupation. The substantial improvements in PVC-specific QoL and symptom preoccupation, along with the decreased self-reported PVC-related symptoms warrant further investigation in a larger randomized controlled trial. Clinical Trial: ClinicalTrials.gov NCT05087238; https://clinicaltrials.gov/study/NCT05087238

Background: Cognitive‐behavioral therapy for avoidant/restrictive food intake disorder (ARFID; CBT‐AR) theoretically targets three prototypic motivations (sensory sensitivity, lack of interest/low appetite, fear of aversive consequences), aligned with three modularized interventions. As an exploratory investigation, we: (1) evaluated change in candidate mechanisms in relationship to change in ARFID severity, and (2) tested if assignment (vs. not) to a module resulted in larger improvements in the corresponding mechanism.Method: Males and females (N = 42; 10–55 years) participated in an open trial of CBT‐AR.Results: Decreases in scaled scores for each candidate mechanism had medium to large correlations with decreases in ARFID severity—sensory sensitivity: −0.7 decrease (r = .42, p = .01); lack of interest/low appetite: −0.3 decrease (r = .60, p < .0001); and fear of aversive consequences: −1.1 decrease (r = .33, p = .05). Linear mixed models revealed significant weekly improvements for each candidate mechanism across the full sample (ps < .0001). There were significant interactions for the sensory and fear of aversive consequences modules–for each, participants who received the corresponding module had significantly larger decreases in the candidate mechanism than those who did not receive the module.Discussion: Sensory sensitivity and fear of aversive consequences improved more if the CBT‐AR module was received, but lack of interest/low appetite may improve regardless of receipt of the corresponding module. Future research is needed to test target engagement in CBT‐AR with adaptive treatment designs, and to identify valid and sensitive measures of candidate mechanisms.Public Significance: The mechanisms through which components of CBT‐AR work have yet to be elucidated. We conducted an exploratory investigation to test if assignment (vs. not) to a CBT‐AR module resulted in larger improvements in the corresponding prototypic ARFID motivation that the module intended to target. Measures of the sensory sensitivity and the fear of aversive consequences motivations improved more in those who received the corresponding treatment module, whereas the lack of interest/low appetite measure improved regardless of if the corresponding module was received.

Fibromyalgia is a debilitating pain condition for which treatment effects are typically modest. The most evaluated psychological treatment is traditional cognitive behavior therapy (T-CBT), but promising effects have recently been seen in exposure-based cognitive behavior therapy (Exp-CBT). We investigated whether Exp-CBT was superior to T-CBT in a randomized controlled trial. Self-referred participants with fibromyalgia (N = 274) were randomized (1:1) to 10 weeks of Exp-CBT or T-CBT. Treatments were delivered online and presented as “CBT for fibromyalgia.” Participants were assessed at baseline, weekly during treatment, posttreatment, and at 6- and 12-month follow-up. Primary outcome was the difference in reduction in fibromyalgia severity as measured using the Fibromyalgia Impact Questionnaire (FIQ) over 11 assessment points from baseline to posttreatment, modelled within an intention-to-treat framework using linear mixed effects models fitted on multiple imputed data. Approximately 91% of weekly FIQ scores were collected over the main phase. There was no significant difference between Exp-CBT and T-CBT in the mean reduction of fibromyalgia severity from pretreatment to posttreatment (b = 1.3, 95% CI −3.0 to 5.7, P = 0.544, d = −0.10). Minimal clinically important improvement was seen 60% in Exp-CBT vs 59% in T-CBT. Effects were sustained up to 12 months posttreatment. This well-powered randomized trial indicated that Exp-CBT was not superior to T-CBT for fibromyalgia. Both treatments were associated with a marked reduction in fibromyalgia severity, and the online treatment format might be of high clinical utility. T-CBT can still be regarded a reference standard treatment that remains clinically relevant when compared to novel treatment approaches.

Background:The measurement of process variables derived from cognitive behavioural theory can aid treatment development and support the clinician in following treatment progress. Self-report process measures are ideally brief, which reduces the burden on patients and facilitates the implementation of repeated measurements.Aims:To develop 13 brief versions (3–6 items) of existing cognitive behavioural process scales for three common mental disorders: major depression, panic disorder, and social anxiety disorder.Method:Using data from a real-world teaching clinic offering internet-delivered cognitive behavior therapy (n=370), we drafted brief process scales and then validated these scales in later cohorts (n=293).Results:In the validation data, change in the brief process scales significantly mediated change in the corresponding domain outcomes, with standardized coefficient point estimates in the range of –0.53 to –0.21. Correlations with the original process scales were substantial (r=.83–.96), internal consistency was mostly adequate (α=0.65–0.86), and change scores were moderate to large (|d|=0.51–1.18). For depression, the brief Behavioral Activation for Depression Scale-Activation subscale was especially promising. For panic disorder, the brief Agoraphobic Cognitions Questionnaire-Physical Consequences subscale was especially promising. For social anxiety disorder, the Social Cognitions Questionnaire, the Social Probability and Cost Questionnaire, and the Social Behavior Questionnaire-Avoidance and Impression Management subscales were all promising.Conclusions:Several brief process scales showed promise as measures of treatment processes in cognitive behaviour therapy. There is a need for replication and further evaluation using experimental designs, in other clinical settings, and preferably in larger samples.