In Case of an Emergency: The Development and Effects of a Digital Intervention for Coping With Distress in Norway During the COVID-19 Pandemic

Background: The COVID-19 pandemic and its consequences has been found to negatively affect the general population’s psychological well-being. Objective: The objectives of this paper are to report on the development and clinical effects of a self-guided Internet-delivered intervention for adults in Norway who suffer from mild to moderate psychological distress during the COVID-19 pandemic. Methods: The participants, recruited between April and December 2020, were randomized to receive a new treatment module either every third or every fifth day. The clinical outcomes were self-reported depressive and anxiety symptoms and change in positive and negative emotions. Results: A total of 1256 individuals accessed the pre-screening survey, 407 were eligible and 92 provided contact information, where 82 were included in the study, n = 44 in the 3-day group and n = 38 in the 5-day group. Overall, the statistical analyses showed a significant decrease in depressive and anxiety symptoms and an increase in positive emotions, with small and moderate within group effect sizes. No significant differences between the groups were identified in clinical outcomes or adherence. Conclusion: These findings indicate that psychological distress in the general population during the COVID-19 pandemic may be reduced through the use of a scalable self-guided Internet-delivered intervention. Furthermore, the lack of significant differences between the 5-day and 3-day group may indicate that the intervention can be delivered at a more intensive pace without negatively affecting treatment outcomes. The results need to be interpreted with caution as the sample was self-selected, as well as the lack of passive control group. Hence the results may be attributed to external factors.publishedVersio

Goal management training for adults with ADHD – clients’ experiences with a group-based intervention

Background: There is growing evidence for the efficacy of group-based interventions for adults with ADHD. However, there is still a lack of research investigating how clients experience participating in such interventions. The aim of the current study was to explore how adults with ADHD experience participating in a group-based intervention (Goal Management Training) for ADHD. Method: We conducted individual, semi-structured, interviews with ten adults with ADHD who had participated in Goal Management Training administered as a group intervention. The interviews were transcribed verbatim and analyzed using thematic analysis within a hermeneutic phenomenological framework. Results: Our analysis identified three main themes. The participants’ starting point captured the participants’ motivation and expectations prior to treatment. The ambiguity of the group – the various meanings of the group consisted of three sub-themes (The group created a sense of belonging - “I am not alone”; The personal cost of participating in the group - “At times it was a hot mess”; and The group supported the learning experience - “We worked with it together”). The group promoted positive change – How the group affected the participants’ everyday lives consisted of two sub-themes (Managing ADHD in daily life - “It’s much easier to handle everyday life”, and Personal growth - “Gaining new perspectives”). Conclusion: The group format was experienced as a valuable aspect of treatment. The structure provided by Goal Management Training allowed participants to expand their perspectives and experience improved management of ADHD, as well as personal growth. The opportunity to exchange experiences with others in similar situations was seen as particularly beneficial and brought feelings of recognition and belonging. However, some also experienced the group as a burden at times, for instance by stealing one’s focus. This study expands existing knowledge by exploring clients’ experiences of participating in group-based interventions for ADHD and shows how the group format provided participants with more than they had hoped for. While expecting a more instrumental outcome of treatment, such as tools to manage ADHD, participants also gained a welcomed, but unexpected outcome of personal growth.publishedVersio

Designing Videos with and for Adults with ADHD for an Online Intervention: Participatory Design Study and Thematic Analysis of Evaluation

Background: Adults with attention deficit hyperactivity disorder (ADHD) represent a heterogeneous group with both strengths and difficulties associated with the diagnosis. An online intervention attuned to their needs may improve their everyday functioning. When designing online interventions, it is important to adapt the therapeutic content to the values and needs of the target group. Objective: This paper describes and evaluates a participatory process used to produce content for an online intervention for adults with ADHD by producing video vignettes clarifying core training principles grounded in the participants' everyday experiences. Methods: We report on the qualitative data from 2 research phases: the design and evaluation of video vignettes for an online intervention. In the first phase, 12 adults with ADHD, 2 clinicians, and 2 research assistants participated in the production of video vignettes for the online intervention. In the second phase, participants (n=109) gave feedback on the videos as part of a clinical trial of the intervention. A subgroup (n=7) was interviewed in-depth regarding their experiences with the videos. The qualitative data were analyzed using thematic analysis. Results: In the first phase, the participants with ADHD contributed with experiences from challenging everyday situations. In the process, we navigated between therapeutic principles and the participants' experiential perspectives to create content relevant and consistent with the target group's values and experiences. In the second phase, we identified 3 themes related to the participants' experiences and interpretation of the video vignettes: (1) recognition of ADHD-related challenges, (2) connection with the characters and the situations, and (3) video protagonists as companions and role models for change. Conclusions: A participatory design process for designing online mental health interventions can be used to probe and balance between the therapeutic principles defined by clinicians and the participants’ experiences with mental health issues in the production of therapeutic content. In our study, the inclusion of video vignettes in an online intervention enabled a contextualized and relevant presentation of everyday experiences and psychosocial factors in the life of an adult with ADHD.publishedVersio

Towards Adaptive Technology in Routine Mental Healthcare

This paper summarizes the information technology-related research findings after 5 years with the INTROducing Mental health through Adaptive Technology project. The aim was to improve mental healthcare by introducing new technologies for adaptive interventions in mental healthcare through interdisciplinary research and development. We focus on the challenges related to internet-delivered psychological treatments, emphasising artificial intelligence, human-computer interaction, and software engineering. We present the main research findings, the developed artefacts, and lessons learned from the project before outlining directions for future research. The main findings from this project are encapsulated in a reference architecture that is used for establishing an infrastructure for adaptive internet-delivered psychological treatment systems in clinical contexts. The infrastructure is developed by introducing an interdisciplinary design and development process inspired by domain-driven design, user-centred design, and the person based approach for intervention design. The process aligns the software development with the intervention design and illustrates their mutual dependencies. Finally, we present software artefacts produced within the project and discuss how they are related to the proposed reference architecture. Our results indicate that the proposed development process, the reference architecture and the produced software can be practical means of designing adaptive mental health care treatments in correspondence with the patients’ needs and preferences. In summary, we have created the initial version of an information technology infrastructure to support the development and deployment of Internet-delivered mental health interventions with inherent support for data sharing, data analysis, reusability of treatment content, and adaptation of intervention based on user needs and preferences.publishedVersio

«Jeg kunne ønske at lærere vet at jeg ikke kan skrive så mye». Tilpasset opplæring for elever med lese- og skrivevansker

Formålet med denne studien var å undersøke hvordan lærere tilpasser opplæringen for elever med lese- og skrivevansker. Vi valgte å benytte oss av en kvalitativ tilnærming. Datamaterialet er hentet inn gjennom seks kvalitative intervjuer med lærere, samt observasjon i deres klasserom. Informantutvalget består av seks lærere fra fem forskjellige skoler, som arbeider på 1.-5. trinn. To av lærerne i utvalget arbeider på en dysleksivennlig skole. Resultatene fra studien viser at lærerne i informantutvalget tilpasser opplæringen for elever med lese- og skrivevansker på ulike måter gjennom sin pedagogiske praksis. Undersøkelsen konstaterer variasjon i hvilke tilrettelegginger som gjøres, samt graden av dem. Studien belyser lærernes bruk av undervisningsmetoder, pedagogisk- og organisatorisk differensiering og digitale verktøy. Det kommer frem i resultatene at lærerne i større grad tilpasser på gruppenivå, heller enn individnivå. Undersøkelsen viser også forskjeller i tilgangen de ulike informantene har på ulike digitale verktøy. Videre presiseres det i undersøkelsen at manglende tilrettelegging for elever med lese- og skrivevansker kan gi store konsekvenser for elevene det gjelder. Samtlige lærere i informantutvalget understreker viktigheten av at elevene jevnlig kartlegges, slik at eventuelle vansker oppdages tidlig og tiltak kan igangsettes. I tillegg nevnes lærerens evaluering av egen undervisning som viktig for å kunne sikre en god tilrettelegging, med en positiv effekt på elevens utbytte av opplæringen. Tid og ressurser fremheves i studien som to av de største utfordringene lærerne opplever å møte når de skal tilpasse opplæringen for elever med lese- og skrivevansker. Lærerne forteller om en travel skolehverdag hvor det å tilrettelegge for elever med lese- og skrivevansker er utfordrende da tiden de har til rådighet er liten. Videre gjør også få ressurser i klasserommet det vanskelig å kunne gi så god tilrettelegging som de selv ønsker. Studien belyser dermed viktigheten av lærerens kompetanse, mulighet og tid til å tilpasse opplæringen for elever med lese- og skrivevanske

A self-guided Internet-delivered intervention for adults with ADHD: A feasibility study

Background Attention Deficit Hyperactivity Disorder (ADHD) is a prevalent neurodevelopmental disorder that tends to persist into adulthood. Many adults with ADHD seek non-pharmacological treatment in addition to pharmacological treatment. Still, there are few non-pharmacological treatment options available. The aim of the current study was to explore the feasibility of a self-guided Internet-delivered intervention for adults with ADHD. Methods The study has an uncontrolled, within-group, pre-post design. Thirteen participants with an ADHD diagnosis were included and given access to the first three modules of a seven-module intervention. To explore the feasibility of the intervention, the adherence, credibility, and treatment satisfaction were examined. Preliminary efficacy of the intervention was examined through self-report measures of inattention, hyperactivity, depression, anxiety, stress, and quality of life. Results In terms of adherence, seven participants (54%) completed all three intervention modules (M = 1.85, SD = 1.3). The participants reported both good credibility and treatment satisfaction with the intervention. The participants also reported challenges related to usability and technical issues. Although the clinical outcomes must be interpreted with caution due to the study design and the small sample size, a statistically significant reduction in severity of inattention was reported by the participants following the intervention (p = .006, d = 1.57). The reduction was non-significant for hyperactivity (p = .326, d = 0.33). The participants who completed all three modules in the intervention (n = 7) also reported a significant decrease in stress (p = .042, d = 0.67) and a significant increase in quality of life (p = .016, d = 0.99). No significant changes were found on measures of anxiety and depression. Conclusion The adherence to the intervention was relatively low, but the participants who completed the study reported good credibility and satisfaction with the intervention. These results indicate that there is a need to improve the intervention to make it more engaging before conducting a randomized-controlled trial investigating the clinical effects of the full seven-module intervention

Improving pulmonary function through exercise training in children with Cystic Fibrosis

Bakgrunn: Cystisk fibrose (CF) er en progressiv autosomal-recessiv arvelig sykdom som rammer omtrent 75 000 personer på verdensbasis. Tidligere forskning viser at trening kan ha en positiv effekt på lungesykdommer. Hensikten med denne litteraturstudien var å undersøke bevisene for bruken av ulike treningsintervensjoner for å forbedre lungefunksjonen hos barn med cystisk fibrose (CF). Metode: Litteratursøk ble gjort i de elektroniske databasene PubMed og Google Scholar med søkeord ´CF´ og nøkkelord relatert til ´trening´ og ´lungefunksjon´. I forhold til inklusjonskriterier måtte artiklene være 1) randomiserte kontrollerte studier, 2) bestå av et utvalg på barn mellom 0-18 år med klinisk diagnostisert cystisk fibrose (uspesifisert alvorlighetsgrad) og 3) en type treningsintervensjon. Resultat: Syv randomiserte kontrollerte studier møtte kvalifikasjonskriteriene for litteraturstudien. Enkelte av studiene viste en liten forbedring i lungefunksjon, men ingen signifikante endringer ble observert. Konklusjon: Det er fremdeles usikkerhet knyttet til hvilken effekt trening har på lungefunksjon. Treningsintervensjonene ser ut til å ha en viss effekt på opprettholdelsen av lungefunksjon – flere studier trengs på området

In Case of an Emergency: The Development and Effects of a Digital Intervention for Coping With Distress in Norway During the COVID-19 Pandemic

Background: The COVID-19 pandemic and its consequences has been found to negatively affect the general population’s psychological well-being. Objective: The objectives of this paper are to report on the development and clinical effects of a self-guided Internet-delivered intervention for adults in Norway who suffer from mild to moderate psychological distress during the COVID-19 pandemic. Methods: The participants, recruited between April and December 2020, were randomized to receive a new treatment module either every third or every fifth day. The clinical outcomes were self-reported depressive and anxiety symptoms and change in positive and negative emotions. Results: A total of 1256 individuals accessed the pre-screening survey, 407 were eligible and 92 provided contact information, where 82 were included in the study, n = 44 in the 3-day group and n = 38 in the 5-day group. Overall, the statistical analyses showed a significant decrease in depressive and anxiety symptoms and an increase in positive emotions, with small and moderate within group effect sizes. No significant differences between the groups were identified in clinical outcomes or adherence. Conclusion: These findings indicate that psychological distress in the general population during the COVID-19 pandemic may be reduced through the use of a scalable self-guided Internet-delivered intervention. Furthermore, the lack of significant differences between the 5-day and 3-day group may indicate that the intervention can be delivered at a more intensive pace without negatively affecting treatment outcomes. The results need to be interpreted with caution as the sample was self-selected, as well as the lack of passive control group. Hence the results may be attributed to external factors

Current and Retrospective Childhood Ratings of Emotional Fluctuations in Adults With ADHD

Introduction: Emotional fluctuations and mood swings are common among adults with Attention Deficit/Hyperactivity Disorder (ADHD). Here we investigated if these problems could be retrospectively traced back to childhood behavior. Methods: Adults with an ADHD diagnosis (n = 502, 48% female) and a population-based control sample (n = 818, 59% female) completed the Adult ADHD Self-report Scale (ASRS), the Wender Utah Rating Scale (WURS) and the Mood Disorder Questionnaire (MDQ). All participants also provided self-reported information about co-existent psychiatric and somatic diseases, and demographic data. Reports on the MDQ were used to define subgroups with [MDQ(+)] and without [MDQ(–)] life-time periods of emotional fluctuations and the WURS scale was used to retrospectively assess childhood ADHD related behaviors and symptoms. Results: 50.2% of the ADHD group and 5% of the controls were defined with emotional fluctuations [MDQ(+)]. Childhood behavior ratings of “impulsivity,” “loosing of control,” and “trouble with authorities” independently predicted emotional fluctuations reported in adulthood via logistic regression analyses. Inclusion of these three items in a classification analysis gave an accuracy score around 70% in identifying each of the two MDQ categories in the ADHD group. Discussion: The strong association between self-reported features of emotional problems in childhood and in adulthood suggests a trajectory that should be detected and remediated at an early age. Future longitudinal studies should prioritize the examination of developmental mechanisms explaining the persistence of emotional problems from childhood into adulthood