Doctoral Theses / Doktorsavhandlingar Psykologiska institutionen
https://hdl.handle.net/2077/37
2024-03-28T15:00:43ZTheory of Mind Development in Swedish Preschoolers: Relations with Language, Executive function, Temperament, and the Social Environment
https://hdl.handle.net/2077/79764
Theory of Mind Development in Swedish Preschoolers: Relations with Language, Executive function, Temperament, and the Social Environment
Sehlstedt, Isac
Understanding others in social situations is a cornerstone of any lifespan. A part of social understanding comes from appreciating other’s intentions, desires, and knowledge, which can be called an understanding of others’ Theory of Mind. However, the measurement of Theory of Mind has predominantly been performed using cross-sectional designs and one type of Theory of Mind test, measuring false belief. Other alternatives that capture a scale measure of Theory of Mind better reflecting a continuum of development across a wider age range are now available. The current thesis investigates this scale longitudinally in relation to previously affirmed, but also less or unexplored, individual and social factors. In brief, the present dissertation finds limited support for individual but some support for social factors. The crucial finding is that Theory of Mind is only marginally related to the investigated factors, apart from Theory of Mind itself. Three studies support the conclusions put forth. Study I is a psychometric investigation of the Theory of Mind scale in Swedish preschoolers ages 3–5. The scale was psychometrically examined longitudinally as a 3- and 4-step scale in separate age groups (i.e., at three, four, or five years of age) and for boys and girls, respectively. The results showed that the scale was longitudinally consistent for both versions of the scale. Concerning the separate age groups, the scale was reliable as a 3-step scale in almost all investigated groups. However, the 4-step scale was only reliable when including all age groups (i.e., 3–5-year-old children). This suggests that Theory of Mind scales that include more than three steps might not be appropriate for all preschool ages. Study II predominantly investigated the Theory of Mind scale in relation to individual factors, namely executive function, productive language, and temperament. Socioeconomic status was included as a control variable. The individual factors related to Theory of Mind ability were executive function (when analyzed against the 3-step scale) and the temperament variable Shyness (both for the 3- and 4-step scales). Socioeconomic status was also related to ToM at three years of age. Study III investigated relations between ToM development and social factors: socioeconomic status, number of siblings, and parental use of mental state words (i.e., mention of cognition, emotion, or desire words). The children’s executive function and productive language were included as control variables. Parental use of cognition words was most often found to be related to Theory of Mind, but emotion and desire words were also related, to a lesser extent. In addition, the parents' frequency of spoken cognition words and emotion vocabulary size were related to a faster Theory of Mind development in children. Socioeconomic status and children’s productive language were also associated with ToM at four years of age.
In summary, social factors received continued support as factors in Theory of Mind development. However, barely any individual factors surfaced in controlled analyses with Theory of Mind. With a specific focus on longitudinal studies of the development of children’s ability to understand other minds, the current thesis uniquely contributes to our understanding of Theory of Mind development in the preschool ages.
2024-02-26T00:00:00ZEnhancing the Patient’s Role: Exploring patient influence in acceptance-based cognitive behavior therapy delivered via internet
https://hdl.handle.net/2077/79655
Enhancing the Patient’s Role: Exploring patient influence in acceptance-based cognitive behavior therapy delivered via internet
Nissling, Linnea
Background: The global primary health care declaration emphasizes empowering patients to exert influence over their own health. A person-centered approach to care involves a shift from the traditional passive patient role to active involvement in health care decisions. Internet-delivered cognitive behavioral therapy (ICBT) increases access to care and is effective for various mental health conditions.
Aims: The overarching aim of this doctoral thesis was to enhance the patient’s role by exploring how patient influence can be conceptualized and integrated into acceptance-based transdiagnostic ICBT for anxiety disorders treated in Swedish primary care.
Results: Four studies were performed within the scope of this doctoral dissertation. Study I used mixed methods to investigate patient experiences and the feasibility and acceptability of adding peer support workers (PSWs) into acceptance-influenced ICBT for anxiety disorders. Incorporating PSWs into ICBT was practically feasible and well received by participants in a
small sample of primary care patients (n=9). The qualitative results emphasized the personal relationship in therapeutic guidance and the sense of empowerment from sharing experiences. Study II was an RCT investigating a patient-driven acceptance-influenced ICBT for patients with anxiety disorders treated in primary care (n=55). Participants in the patient-driven intervention chose and self-tailored their treatment, resulting in greater perceived control and reduced anxiety symptoms compared to standard treatment. A medium-sized association was observed between changes in anxiety symptoms and empowerment. Study III assessed the effectiveness of an internet-delivered acceptance and commitment therapy (ACT) for adolescents with anxiety
disorders in an RCT. Participants (n=52) were a self-selected group recruited from all over Sweden. The treatment was effective in increasing quality of life and psychological flexibility and had a positive effect on post-treatment diagnoses. A strong association was found between changes in psychological flexibility and anxiety symptoms. Study IV was a psychometric evaluation of the Swedish version of the Empowerment Scale – Making Decisions conducted on clinical patients in primary care (n=210) and psychiatric care (n=221) using confirmatory factor analysis (CFA). Results showed that none of the previously suggested factor solutions, tested through CFA, could be confirmed in our samples of primary care and psychiatric care patients and that it is doubtful whether the scale represents a single empowerment construct.
Conclusions: This doctoral thesis contributes to the field of internet-delivered mental health interventions by exploring the integration of patient influence through acceptance and commitment therapy, incorporating patient-driven components, and making patients’ experiences part of treatment. The research underscores the potential for improving treatment outcomes and quality of life, promoting psychological flexibility, belonging, and a sense of control over one’s care. The studies serve as a foundation for future research and development, paving the way for person-centered and tailored approaches in digital mental health treatments
2024-02-23T00:00:00ZTo Love and Work - Romantic and Occupational Identity in Early Adulthood
https://hdl.handle.net/2077/79392
To Love and Work - Romantic and Occupational Identity in Early Adulthood
Järdmo, Caroline
The general aim of this thesis was to explore aspects of identity in early
adulthood, namely occupation and romantic relationships, in the cultural
context of Sweden in the 21st century. In order to explore narrative identity
concerning occupation, Studies I and II examined narratives about
occupational experiences, which were repeated across interview occasions by
59 early adults (ages 25, 29, and 33). Study I investigated identity content in
the repeated narratives to determine which experiences continued to be part of
the occupational identity across early adulthood. Participants repeated
narratives that concerned: the birth of an interest that led to occupational
orientation; outcomes of occupational exploration; having a compass for
occupational direction; and passively ending up in an occupation. They also
repeatedly narrated about external influence on their occupational choices.
This study thus illustrates which experiences continue to be part of the
occupational identity across early adulthood. Study II, in order to investigate
the meaning of change in narrative identity concerning occupation, examined
how repeated narratives changed across early adulthood. The results showed
that, over time, early adults changed their repeated narratives about their
occupational identity into stories about gained insights, transformed views on
past challenges, and increased agency. Participants also added content that
accentuated their competence and showed how their motivation for their
present occupation had increased. Thus, the findings show how narrators create
something new from their past experiences in order to continue to make sense
of their lives. While Studies I and II investigated narrative identity concerning
occupational experiences, Study III focused on romantic relationships. This
study explored romantic identity content among 12 early adults, aged 33, who
were in long-term relationships but did not select their partner as the most
important person to them when they needed love and support. The results showed that these early adults’ everyday experiences of romantic relationships were characterized by ambivalence, a strive for independence, and relating to their partner as a person to have fun with rather than someone to share a deep connection with. Participants also expressed disagreement with what they perceived as norms concerning romantic relationships in Swedish society. Study III thus shows that these early adults, who did not consider their long-term partner the most important person to them when in need of love and support, had a complex approach to relational norms, whereby they followed the norm of being in a long-term relationship while in different ways expressing distance regarding romantic relationships. To conclude, the three studies in this thesis highlight the impact of cultural context, social roles, and the individual’s everyday experiences on two of the most important aspects of identity in early adulthood – love and work. By studying individuals’ repeated narratives and accounts of their own experiences across early adulthood, we can better understand how identity is complex, continuous, and changing at this time in life.
2024-01-23T00:00:00ZThe family and the patient An investigation of mental health problems, risk factors, and support for members of the families of psychiatric patients
https://hdl.handle.net/2077/75948
The family and the patient An investigation of mental health problems, risk factors, and support for members of the families of psychiatric patients
Wirehag Nordh, Emme-Lina
The aim of this thesis was to improve knowledge of the members of the families of patients in contact with psychiatry by investigating mental health problems, risk factors, and support received. The thesis is based on three studies from two clinical research projects, one in adult psychiatry and one in child and adolescent mental health services (CAMHS). Parent-rated questionnaire data were used in all three studies. Study I was cross-sectional and investigated mental health problems and risk factors experienced by 8–17-year-old children (N = 87) of parents in treatment for depression, anxiety, or bipolar disorder in adult psychiatry. Findings indicate more mental health problems in these children than children in the general population, and that one third had symptoms at clinical levels. Risk factors associated with more children’s symptoms were younger child age and exposure to multiple risk factors, as well as parents reporting low perceived parental control relating to how they can handle their child’s behaviour. In Study II, data from three waves of measurement (baseline, 6, and 12 months) were used to evaluate the effectiveness of preventive interventions used in routine care in adult psychiatry to support 8–17-year-old children of parents in treatment for depression, anxiety, or bipolar disorder. Families (N = 62), including 89 children, received the intervention available at the patient’s psychiatry unit: Family Talk Intervention (FTI), n = 35; Let’s Talk about Children (LTC), n = 16; or intervention as usual (IAU), n = 38. Findings indicate that the development of child mental health problems over time differed significantly between groups. Mental health problems did not increase in children receiving the FTI and LTC interventions but did increase in children in the IAU group. Furthermore, parents receiving the FTI and LTC reported strengthened perceived parental control in relation to handling rearing situations with their children, compared with the IAU group. Study III investigated mental health problems in parents (N = 111) of 5–17-year-old children (N = 98) referred to CAMHS. Findings indicate that many parents (41%) experienced elevated levels of mental health problems at the time of the child’s first appointment and that, in these families, children were reported to have more symptoms and the proportion of families experiencing problematic family functioning was higher. Parents with elevated mental health problems reported having received group-based parent training/education to a greater extent during the first year of contact with CAMHS, and they rated participation in treatment planning significantly lower, than did parents below the cut-off for their own mental health problems. Taken together, the studies show that mental health problems in the members of the families of psychiatric patients are common, which underscore the importance of identifying the needs of the whole family when a patient is seen in psychiatry, to ensure that appropriate support is initiated. In adult psychiatry, investigating multiple relevant risk factors relating to the child, parent, and family can provide information about the child’s and family’s needs. Findings support the continued use of two preventive interventions to support the children of patients with depression, anxiety, or bipolar disorder. In child psychiatry, findings underscore the importance of addressing co-occurring parental mental health problems and that families experiencing co-occurring problems could need more extensive support, as the children were reported to have higher levels of mental health problems and more families were reported to have problematic family functioning. To meet the varying needs of families of psychiatric patients, findings indicate that interventions are needed at different levels of prevention and treatment.
2023-04-28T00:00:00Z