Objectives: To evaluate the effectiveness of relapse prevention (RP) as a treatment for internet gaming disorder (IGD).

Design: Randomized controlled trial.

Setting: Three child and adolescent psychiatry (CAP) units in Region Skåne, Sweden.

Participants: Children aged 13-18 years, coming for their first visit to CAP during 2022, were screened for gaming behavior. Those who met the proposed DSM-5 criteria for IGD were offered participation in the trial, if they had the capacity to provide written informed consent and if they spoke Swedish. A total of 111 CAP patients agreed to participate. Out of those, 11 patients were excluded due to incorrect inclusion such as young age (n = 1), or due to the absence of responses to follow-up measures (n = 9). After exclusion, 102 participants remained (intervention = 47, control = 55).

Interventions: The intervention, RP, is based on cognitive behavioral treatment (CBT) and was provided individually, comprising of five to seven 45-min sessions over a period of 5 to 7 weeks versus treatment as usual.

Outcome measures: Participants were assessed with Game Addiction Scale for Adolescents pre-treatment (GASA) (baseline), post-treatment (treatment group only), and 3 months after baseline (follow-up).

Results: The repeated measures ANOVA showed a significant interaction effect between treatment and time. Both the control group and treatment group lowered their mean GASA score from baseline to follow-up significantly, but the improvement was greater in the treatment group (mean difference in control group -5.1, p < 0.001, 95% CI = - 3.390 to -6.755, mean difference in treatment group -9.9, p < 0.001, 95% CI = -11.746 to -8.105).

Conclusion: RP was found to be superior to treatment as usual in terms of reduction of IGD symptoms. Future research should address which aspects within a given treatment are effective, who benefits from treatment, in what aspects, and why.

BackgroundGiven the biological and psychological changes that occur during adolescence, adolescents’ experiences of the COVID-19 pandemic measures could significantly threaten their mental health and cause long-term consequences.

AimThis study aims to determine the impact of the COVID-19 pandemic restrictions on the psychological distress of Moroccan adolescents and identify the risk and protective factors that could influence their mental health.

MethodsThe participants in this study were Moroccan high school students who were recruited at two different times—before the COVID-19 pandemic (350 students, mean age: 16.55 years; 53.71% female) and during the COVID-19 pandemic (457 students, mean age: 16.84; 64.1% female). Students responded to the Brief Symptom Inventory and the Godin-Shephard Leisure-Time Physical Activity questionary, and reported information about their psychosocial environment, gender, and age. The scores on the Brief Symptom Inventory dimensions from the pre-pandemic period and during 2020 were compared. A comparison between the scores of the two genders of the 2020 sample was also carried out. In addition, binary regression analysis was performed to predict the associations between gender, frequency of physical activity, the presence of the number of negative psychosocial factors, and those dimensions of the Brief Symptom Inventory that significantly changed between the samples.

ResultsFemale students reported higher psychological distress than male students in both data collection periods. During the COVID-19 pandemic, students scored significantly (p < 0.001) higher in depression and paranoid ideation, and they scored significantly (p = 0.01) lower in hostility and anxiety compared with the pre-pandemic period. Female gender and the experience of physical or psychological abuse significantly increased the risk of reporting higher scores in depression and paranoid ideation symptoms during 2020. Moderate and frequent physical activities were significantly and negatively associated with depression (p = 0.003 and p=0.004; respectively).ConclusionsThis study confirms the stressful impact of the COVID-19 pandemic on Moroccan high school students, who reported more symptoms of depression and paranoid ideation compared with the pre-COVID-19 period. Female students reported higher psychological distress than male students did. The experience of physical /psychological abuse during the pandemic worsened mental health, while moderate/frequent physical activity improved it.

Background: The challenges facing people with chronic tinnitus include finding relief and rebuilding quality of life. However, previous traumatic episodes may influence adjustment and prolong suffering. Recovery implies reducing aggravating reactions and improving social roles, relationships and interests. Self-narratives about living with tinnitus have not yet received the attention they deserve in the research literature. Thus, the main goal of the present study was to illustrate how tinnitus suffering interacts with the participants’ unique life histories. Method: Four women and one man (ages 52–58) took part in the study after consulting a special hearing clinic for annoying tinnitus. Criteria for inclusion were that tinnitus was regarded as a problem with negative consequences for quality of life. The participants should be willing to share how the experience of tinnitus suffering interacts with their previous life story. Narrative methodology was employed in order to achieve the goals of the study. We used unstructured interviews with free conversation, which allowed for rich narratives with full contextual meaning. Results: The findings, based on the narrative analysis, revealed that three out of five participants presented a regressive form of narrative indicating ongoing struggles beyond tinnitus itself, which they were unable to bring to closure. For them, valued goals were continuously thwarted by frustrating circumstances in their lives, either past events or current unresolved issues. Progressive and stable narratives, as identified in the other two participants, demonstrated values that rely on others’ attitude and understanding toward their suffering, in sharp contrast to the regressive narratives. We suggest that a central issue in tinnitus rehabilitation should be to help suffering patients to overcome unresolved conflicts and thereby extend their ability for a fuller commitment in life. Conclusion: Considering enduring tinnitus as a chronic condition, whose course is likely to vary depending on the patient’s general health status, an alteration of progressive and stable narratives is likely to occur during the lifespan. A progressive narrative shows similarities to the core construct of the salutogenesis model of health promotion (1). In conclusion, a narrative approach in tinnitus rehabilitation can be health promoting by offering the patient the opportunity to engage in storytelling, which in turn can increase comprehensibility and a sense of coherence. © Copyright © 2020 Erlandsson, Lundin and Dauman.

Recent studies have established yoga practice as a mainstream complementary clinical tool within correctional environments. It is shown that regular yoga practice is coupled with improved impulse control, sustained attention, attenuated antisocial and self-harm behaviors, reduced stress, and psychological distress. No academic research until now has provided evidence of mental health benefits of yoga for institutionalized young people. In Sweden, each year more than thousand adolescents receive compulsory care at juvenile institutions run by the Swedish National Board of Institutional Care. These young people are characterized by substance abuse, aggressive and antisocial behaviors, high frequency of self-harm, and the experience of abuse. Most of them manifest attention problems, depression, anxiety, and impulsivity. They have a dramatically increased risk for recidivistic criminal behavior, continuous medical, and social care and untimely death. The present study plan aims at evaluating, with previously validated psychological measures, in a quasi-experimental design, the effects of yoga practice for institutionalized adolescents. Adolescents’ experiences of participating in yoga practice will also be assessed by semi-structured individual interviews. Ethical approval was given by the Swedish Ethical Review Authority. It is hypothesized that yoga practice (in combination with the standard treatment within institutional care) will reduce institutionalized adolescents’ aggression, antisocial behavior, anxiety, depression, and negative affect, and increase their cognitive flexibility (in the form of increased impulse control).

Background: A specific personality profile, characterized by low character maturity (low scores on the self-directedness and cooperativeness character dimensions) and high scores on the novelty seeking temperament dimension of the temperament and character inventory (TCI), has been associated with aggressive antisocial behavior in male prison inmates. It has also been shown that yoga practiced in Swedish correctional facilities has positive effects on the inmates' well-being and on risk factors associated with criminal recidivism (e.g., antisocial behavior). In this study, we aimed to investigate whether the positive effect of yoga practice on inmates' behaviors could be extended to include eventual changes in their personality profile. Methods: Male prison inmates (N = 111) in Sweden participated in a randomized controlled 10-week long yoga intervention trial. Participants were randomly assigned to either a yoga group (one class a week; n = 57) or a control group (free of choice weekly physical activity; n = 54). All the inmates completed the TCI questionnaire before and after the intervention period as part of an assessment battery. Results: After the 10-week-long intervention period male inmates scored significantly lower on the novelty seeking and the harm avoidance and significantly higher on the self-directedness dimensions of the TCI. There was a significant medium strong interaction effect between time and group belonging for the self-directedness dimension of character favoring the yoga group. Conclusion: A 10-week-long yoga practice intervention among male inmates in Swedish correctional facilities increased the inmates' character maturity, improving such abilities as their capability to take responsibility, feel more purposeful, and being more self-acceptant-features that previously were found to be associated with decreased aggressive antisocial behavior.

Background: The effect of yoga in the reduction of depressive symptoms, anxiety, stress, anger as well as in the increased ability of behavioral control has been shown. These effects of yoga are highly relevant for prison inmates who often have poor mental health and low impulse control. While it has been shown that yoga and mediation can be effective in improving subjective well-being, mental health, and executive functioning within prison populations, only a limited number of studies have proved this, using randomized controlled settings. Methods: A total of 152 participants from nine Swedish correctional facilities were randomly assigned to a 10-week yoga group (one class a week; N=77) or a control group (N=75). Before and after the intervention period, participants answered questionnaires measuring stress, aggression, affective states, sleep-quality and psychological well-being, and completed a computerized test measuring attention and impulsivity. Results: After the intervention period, significant improvements were found on 13 of the 16 variables within the yoga group. (e.g., less perceived stress, better sleep quality, an increased psychological and emotional well-being, less aggressive and antisocial behavior) and on two within the control group. Compared to the control group, yoga class participants reported significantly improved emotional well-being and less antisocial behavior after ten weeks of yoga. They also showed improved performance on the computerized test that measures attention and impulse control. Conclusion: It can be concluded that the yoga practiced in Swedish correctional facilities has positive effects on inmates’ well-being and on considerable risk factors associated with recidivism, such as impulsivity and antisocial behavior. Accordingly, the results show that yoga practice can play an important part in the rehabilitation of prison inmates.

Background: Antisocial personality and psychopathic traits have constantly been found to accompany criminal and aggressive behaviors, but little attention has been given to aspects of character maturity and its relation to such behaviors. The present study investigated (1) whether level of character maturity (low, medium, and high) is associated with amount of aggressive antisocial behaviors (AABs) and psychopathic traits in young men imprisoned for violent criminality, and (2) whether such an association is independent of coexisting attention-deficit hyperactivity disorder (ADHD). Methods: Swedish males (N =  270, aged 18–25) sentenced to prison for violent and/or sexual criminality in the western region of the Swedish Prison and Probation Service underwent a thorough clinical examination during their in carceration. Data on character maturity, as measured by the character dimensions Self-Directedness and Cooperativeness of the Temperament and Character Inventory, were available for n = 148 subjects and were used to divide these offenders into three groups with low, medium, and high character maturity. These groups were then compared for variables reflecting criminal history, a DSM-IV diagnosis of ADHD, conduct disorder (CD) and substance use disorders (SUD), aggressive behaviors, and psychopathic traits. Results: Character maturity was consistently associated with less AABs and psychopathic personality traits; the group with the highest character maturity showed: (i) a later age at on set of criminality, (ii) a smaller number of prior violent criminal acts, (iii) lower prevalence of ADHD, CD, and SUD, (iv) less self-rated and expert-rated aggressive behaviors, and (v) less psychopathic traits. The association between character maturity and aggressive behaviors/psychopathic personality traits remained even when ADHD was controlled for. The only exception was sexual criminality, where the group with the highest character maturity contained the largest amount of sexual offenders. Conclusion: Higher character maturity appeared to be a protective factor among young male violent offenders, associated with less AABs, suggesting that character maturity isa promising target for treatment interventions for this group of individuals.

Background: Psychiatric ill-health is prevalent among prison inmates and often hampers their rehabilitation. Rehabilitation is crucial for reducing recidivistic offending. A few studies have presented evidence of the positive effect of yoga on the well-being of prison inmates. The conclusion of those previous studies that yoga is an effective method in the rehabilitation process of inmates, and deserves and requires further attention.Aims: The current study aimed to evaluate the effect of 10 weeks of yoga practice on the mental health profile, operationalized in the form of psychological distress, of inmates. Methods: 152 volunteer participants (133 men; 19 women) were randomly placed in either of two groups: to participate in weekly 90-minute yoga class (yoga group) or a weekly 90-minute free-choice physical exercise (control group). The study period lasted for 10 weeks. Prior to and at the end of the study period the participants completed a battery of self-reported inventories, including the Brief Symptom Inventory (BSI). Results: Physical activity (including yoga) significantly reduced the inmates’ levels of psychological distress. Yoga practice improved all primary symptom dimensions and its positive effect on the obsessive-compulsive, paranoid ideation, and somatization symptom dimensions of the BSI stayed significant even when comparing with the control group. Conclusions: Yoga as a form of physical activity is effective for reducing psychological distress levels in prison inmates, with specific effect on symptoms such as suspicious and fearful thoughts about losing autonomy, memory problems, difficulty in making decisions, trouble concentrating, obsessive thought and perception of bodily dysfunction.

Background: Clear and effective communication is a prerequisite to provide help and support in healthcare situations, especially in health, and social care services for persons with intellectual disabilities, as these clients commonly experience communication difficulties. Knowledge about how to communicate effectively is integral to ensuring the quality of care. Currently, however, there is a lack of such knowledge among staff working in the disabilities sector, which is exacerbated by challenges in the competence provision in municipal health and social care services. Therefore, the aim of the study was to explore staffs' experience of web-based training in relation to their professional caring for persons with intellectual disabilities and challenging behavior. The intention is to move toward well-evaluated and proven web-based training in order to contribute to competence provision in this specific context.

Methods: Fourteen semi-structured interviews were carried out with individual staff members to gather data regarding their experiences with web-based training in relation to their profession. The collected data were analyzed using qualitative content analysis with a focus on both manifest and latent content.

Results: The staff's experiences with the web-based training program were presented as a single main theme: "Web-based training for staff initiates a workplace learning process by promoting reflections on and awareness of how to better care for persons with intellectual disabilities and challenging behavior." This theme contained three categories which are based on eight sub-categories.

Conclusion and clinical implications: The benefits of web-based training for workplace learning could clearly be observed in the strengthening of professional care for persons with intellectual disabilities and challenging behavior. Staff members claimed to have gained novel insights about how to better care for clients as well as about the importance of interactions in their encounters with clients. Professional teamwork is crucial to providing effective care for persons with intellectual disabilities and challenging behavior. Hence, future research aimed at investigating the views of other healthcare professionals, such as registered nurses, is recommended to improve the competence provision within municipal health and social care services and thereby enhance the quality of care.