Student Teachers And Beginning Teachers Coping With Emotionally Challenging Situations

Avhandlingen behandlar lärarstudenternas och nyblivna lärares erfarenheter av obehagliga situationer. Frågeställningar innefattar: Vilka situationer beskriver lärarstudenter och nyblivna lärare som emotionellt påfrestande? Hur hanterar lärarstudenter och nyblivna lärare emotionellt påfrestande situationer som beskrivs? Avhandlingen innefattar fyra artiklar som behandlar dessa frågeställningar. Resultat visar att lärarstudenters hanterandestrategier innefattar (1) att skjuta fram lärande att hantera känslomässigt påfrestande situationer när de börjar att arbeta samt (2) att acceptera att det inte går att påverka situationer som är känslomässigt påfrestande och då enbart acceptera de förhållanden som skapar känslomässigt utmanade situationer. Andra strategier som studierna har visat innefattade att verka för förändring, vara en del av ett kollektiv eller att förminska ansvar som sätt att hantera känslomässiga utmaningar. Lärarstudenter etablerade gränser som ett sätt att hantera påfrestande situationer i relation till känslomässigt arbetet och i förhållande till olika relationer. De nyblivna lärarna var tvungna att förhålla sig till konflikter. Detta gjorde nyblivna lärare i studien genom att verka för sin autonoma position, genom att engagera sig i samarbete, genom att försöka påverka eller genom att alliera sig med arbetsplatsens värdeförmedling. Dessa strategier verkar vara sammanlänkade med olika konsekvenser, där autonomi och att vara en påverkanskraft i större utsträckning verkar leda till tankar om att byta skola eller att sluta som lärare.

Understanding the Dynamics of Teacher Agency, Resilience, and Identity in the Neoliberal Age foregrounds how the neoliberal educational reforms contribute to the (trans)formation of teacher agency, resilience, and identity through various theoretical perspectives and methodological approaches.

Early Career Teachers in Higher Education explores the experiences of Early Career Teachers (ECTs) through 13 personal teaching journeys from academics working across Africa, Asia, Australasia, Europe and South America. This edited volume contains the subjective narrative of each contributor's entry into academia, their pedagogic practice and the development of their multiple teaching identities. Their personal narratives and testimonies presented here will provide a valuable resource for ECTs and academics around the world as they begin teaching in higher education. In addition, this edited book highlights contemporary issues, such as precarity, casualisation, fragmentation of academic responsibilities and intersectionality, that shape contemporary ECT workloads.

Psychotherapy research has shifted from mainly focusing on the average effects of different treatments to concentrating more on questions related to the individual patient. When research attention shifts, it can give rise to the implementation of new statistical methods that, in turn, can illuminate new challenges that must be addressed. The aim of the thesis was to study how traditional methods for predicting certain psychotherapy outcomes have been conducted in the past, and how more advanced statistical methods might be used to enhance knowledge of how to predict these outcomes today. Three studies were performed: Paper I focused on how Multi Level Modeling (MLM) can be used to study certain aspects of the relationship between working alliance and treatment outcome. In Paper II, Latent Profile Analysis (LPA) and item-level analysis were used to give nuance to the relationship between psychological distress at baseline and change rate during treatment. Finally, in Paper III, Machine Learning (ML) was used to detect dropout patients in the early phase of treatment by exploring complex patterns of symptom distress during the early phase of treatment. The thesis showed how different goals of scientific exploration can be studied in the context of routine care with the use of these statistical frameworks and discussed some of the challenges and opportunities worth noting when entering this line of research. Psykoterapiforskning har på senare tid gått från att fokusera på genomsnittliga effekter av olika behandlingsinriktningar, till att inrikta sig mer mot den enskilda patienten. När fokus förflyttas på det här sättet kan det leda till att nya statistiska metoder behöver tillämpas vilket i sin tur kan leda till nya utmaningar för psykoterapiforskaren. Syftet med avhandlingen var att undersöka hur traditionella statistiska metoder har använts för att studera olika typer av psykoterapiutfall i rutinmässig vård, och hur mer avancerade statistiska metoder kan tillämpas för att öka kunskapen om hur dessa utfall kan prediceras. Tre studier genomfördes. Studie I fokuserade på hur flernivåanalys kan användas för att studera relationen mellan arbetsallians och behandlingsutfall. I studie II användes latent profilanalys för att studera sambandet mellan psykologiska besvär vid det första besöket och symptomförändring under behandlingens gång. Slutligen, I studie III, tillämpades maskininlärning för att upptäcka patienter med risk att hoppa av behandlingen i förtid. Sammanfattningsvis belystes i avhandlingen hur olika typer av vetenskapliga frågeställningar kan studeras i en klinisk kontext med hjälp av dessa statistiska ramverk samt några av de fördelar och begräsningar som är viktiga att notera när de tillämpas.

The role of explicit, declarative knowledge in general health care and in psychotherapy is a growing field of research. In many areas of healthcare, knowledge is regarded as an important factor for successful interventions. Participants within mental-health interventions should ideally gain knowledge about their specific conditions and strategies to improve, in order to manage their problems in more helpful ways. In Cognitive Behaviour Therapy (CBT), explicit knowledge is a core feature when treating clients and educating them about their symptoms, problems and potential solutions. Still, the role of knowledge and its relation to treatment outcome within CBT treatments is unclear. CBT administered over the internet (ICBT), is mainly based on psychoeducative texts and thus provides a suitable format for an initial evaluation of explicit knowledge within a clinical research context. The role of explicit knowledge could be of particular importance in the study of younger target groups, who probably have their first treatment experience. Their knowledge gain and its use could be of importance both as separate constructs but also in relation to symptom reduction following treatment. The overarching aim of this thesis was to explore the role of explicit knowledge in internet-delivered CBT for adolescents with depression and anxiety. Study I explored the role of explicit knowledge in a randomised controlled trial with adolescents suffering from primary depression. A knowledge test was constructed and administered at pre- and post-treatment. Results showed that explicit knowledge and certainty of knowledge about depression, anxiety and CBT increased during treatment, but that these variables were unrelated to treatment outcome. Lower pre-treatment knowledge levels (certainty) however predicted greater improvement in depressive symptoms. Study II describes the procedure of developing a new knowledge test in the context of ICBT for adolescents with depression and anxiety. An explorative factor analysis was performed and resulted in a three-factor solution with the following factors: Act in aversive states, Using positive reinforcement, and Shifting attention. The procedure presented could illustrate one way of creating a test for knowledge evaluation in ICBT, but its clinical use needs to be evaluated further. In Study III, participants from a randomised controlled trial of ICBT for adolescent depression were asked about their acquired knowledge and knowledge use six months later. Qualitative methodology (thematic analysis) was used. The results showed two overarching ways that clients can remember and relate to CBT-principles after treatment; one more explicit way related to the active application of CBT principles, and another vague way of recalling treatment content and the passive usage of CBT. Both ways of recalling CBT principles were related to experiencing the treatment as helpful. Study IV evaluated the role of learning strategies and chat-sessions in ICBT for adolescents with anxiety and depression. A total of 120 adolescents were randomised to one of four treatment groups, in a 2x2 factorial design with the two factors: with or without learning support and/or chat-sessions. Overall, the results showed general reductions of anxiety and depressive symptoms, and increased knowledge levels. Participants receiving learning strategies during treatment obtained more immediate benefits in treatment outcome and knowledge levels, but at six months follow-up participants without learning support had reached equal amounts of knowledge and symptom reduction. Chat-sessions did not add any effect on treatment outcome or knowledge levels. In conclusion, this thesis suggests that explicit knowledge is a construct that is independent of symptom reduction and increases during ICBT treatments for adolescents with depression and anxiety. Increased knowledge, and increased certainty of knowledge, are valuable outcomes since CBT emphasises educating clients about symptoms, therapeutic principles, and strategies that they can remember and use later on. The lack of association between explicit knowledge gain and symptom reduction could indicate that explicit knowledge is a necessary but insufficient factor for symptom reduction. Adding learning strategies within a treatment programme could be of importance for enhancing short-term treatment effects. There is a continued need for more research on the role of knowledge in ICBT, both as an outcome and as a way to improve treatment effects. The findings in this thesis however suggest that research on explicit knowledge is important to understand what makes ICBT work. Explicit kunskap och dess roll i psykoterapi är ett växande forskningsområde. I kognitiv beteendeterapi (KBT) har explicit kunskap en kärnfunktion då man behandlar klienter och utbildar dem om deras symptom, problemområden och potentiella lösningar. Trots detta är kunskapens roll och dess relation till behandlingsresultat vid KBT oklar. KBT som administreras via internet (IKBT) baseras huvudsakligen på psykoedukativa texter, och kan således vara ett lämpligt format för en initial utvärdering av explicit kunskap. Syftet med denna avhandling var att undersöka om kunskap ökar under IKBT för tonåringar med depression och ångest, dess relation till behandlingsutfall, och om lärandestöd kan öka effekten av behandling. De fyra inkluderade studierna visar att explicit kunskap är ett unikt konstrukt som, oberoende av symtomminskning, ökar under behandling. Deltagare kan komma ihåg behandlingsinnehåll och uppleva KBT kunskap som användbart i deras vardag. Detta är ett värdefullt resultat då KBT betonar vikten av att utbilda klienter om symtom, principer och strategier som de kan komma ihåg och använda. Ett nytt kunskapstest utvecklades och validerades initialt för potentiell användning i framtida kliniska studier. En av studierna visade, via experimentell design, att lärandestöd i behandlingsmoduler kan förbättra kortvariga behandlingseffekter. Sammanfattningsvis är forskning om explicit kunskap viktigt för att förstå vad som får IKBT att fungera.

När elever blir utsatta för kränkningar finns ofta andra elever närvarande som åskådare. Dessa åskådare kan anta olika sociala roller: de kan assistera eller förstärka de som utsätter, försvara de som blir utsatta eller förbli passiva. Syftet med den här avhandlingen var att undersöka hur elevers åskådarbeteenden vid kränkningssituationer hänger samman med moraliskt disengagemang, elev-lärarrelationer och tillit till sin egen och klassens förmåga att försvara de som blir utsatta. Självrapporterade enkätdata samlades in från elever i årskurs 4–8 och analyserades med hjälp av olika statistiska metoder såsom flernivåanalys och strukturella ekvationsmodeller. Resultaten visar att de tre åskådarbeteendena hänger samman med faktorer på både individ- och klassnivå. Att assistera och förstärka de som utsätter hade starkast samband (positivt) med moraliskt disengagemang. Att försvara de som blir utsatta och att förbli passiv hade starkast samband (positivt respektive negativt) med självtillit. Resultaten pekar också på att det positiva sambandet mellan att försvara utsatta och självtillit går åt båda håll: försvararbeteenden predicerar självtillit och själv­tillit predicerar försvarar­beteenden. I enlighet med socialkognitiv teori visar den här avhandlingen på betydelsen av att beakta ett komplicerat mönster av faktorer på olika nivåer när man studerar elevers åskådarbeteenden. Peer victimization most often occurs in the presence of bystanders, who play different social roles. They may assist or reinforce those who victimize, defend those who are victimized, or remain passive. The aim of this thesis was to investigate how students’ bystander behaviors in peer victimization are associated with moral disengagement, efficacy beliefs, and student-teacher relationship quality. Self-report questionnaire data were collected from students in grades 4 to 8, and were analyzed using different statistical methods, such as multilevel modeling and structural equation modeling. The findings show that the three types of bystander behaviors are associated with both individual- and classroom-level characteristics. Assisting and reinforcing those who victimize were most strongly associated (positively) with moral disengagement. Defending those who are victimized and remaining passive were most strongly associated (positively and negatively, respectively) with self-efficacy to defend victims. The findings also indicate that the positive association between students’ defending bystander behaviors and their self-efficacy to defend is bidirectional: defending predicts self-efficacy and self-efficacy predicts defending. In line with social cognitive theory, this thesis highlights the importance of considering a complex pattern of factors at different levels when addressing students’ bystander behaviors.

Stress has become one of the major challenges of modern society, especially within the working population, causing significant costs and personal problems. However, the range of prevention and treatment is not at all proportionate to the needs of the public. Internet provides new options for broad dissemination and a growing body of evidence suggest that internet-based interventions for stress could be effective. However, few studies have examined the efficacy in clinical samples or how participants experience these new treatment delivery formats. Further, only a limited number of studies have evaluated the efficacy of work-focused stress interventions on work-related outcomes (e.g., absenteeism), and if recovery has the potential in stress-prevention. In the present thesis, internet-based cognitive behavioural stress interventions (iCBT), designed to reduce symptoms of stress and increase recovery and workparticipation among 117 managers and 260 employees, were evaluated in three randomized controlled trials (Study I, III and IV) and a qualitative study (Study II). Results of Study I and III indicate that the iCBT for managers and employees with stress-related disorders was effective in reducing symptoms of chronic stress. In Study III effects on work-related outcomes, e.g., work ability and absenteeism, were only seen in the work-focused iCBT. In Study II, participants found the work-focused iCBT to be accessible and feasible and reported positive experiences on stress and well-being in both life and at work. Finally, preliminary results in Study IV suggest that recovery experiences, an important protective factor against chronic stress, could be improved by a brief internet-based recovery intervention. In conclusion, if implemented, these relatively brief and accessible interventions could be a feasible way to increase access to treatment and learning distressed employees and others how to prevent and recover from stress-related disorders.

Generalized anxiety disorder (GAD) is a chronic condition characterized by an excessive and uncontrollable worry. GAD has a highly negative impact on all aspects of life, and the costs for society are considerable. Cognitive behaviour therapy (CBT), delivered face-to- face or online, has been shown to be effective in treating GAD. However, there are still room for improvement, with treatment content and format of delivery being two areas to further investigate. Internet-based treatments are often based on a generic CBT model of GAD and include treatment strategies such as cognitive restructuring and relaxation. Furthermore, the impact of therapist support has shown inconclusive results. Overall, this thesis aimed to evaluate the effects of a new internet-based treatment for GAD, based on acceptance, mindfulness, and valued action, delivered with different types of support. Study I was a small pilot trial with a within-group design. The study included 16 participants diagnosed with GAD who received the newly developed treatment program with weekly therapist support. Statistically significant and large effect sizes were observed on self-rated worry at post-treatment, and the effects were maintained at a three-months follow-up. Study II included 103 participants diagnosed with GAD who were randomized to nine weeks of treatment with the treatment program and weekly support, or a waiting-list control group. Statistically significant moderate to large effects were observed on primary and secondary outcomes in favour of the treatment. The exception was a measure of quality of life, with no significant difference between the two groups. The treatment effects were maintained at a six-months follow-up. Study III was a pilot trial including 33 participants diagnosed with GAD. A within-group design was used to investigate the effects of the treatment program delivered with automated messages and support on demand. Significant and large within-group effects were observed on all outcome measures at post-treatment with the exception of quality of life, for which there was a small effect. Study IV was a pilot factorial design trial that compared the acceptance-based treatment program against a self-tailored treatment, as well as two types of support: scheduled support and support on demand. The study included 85 participants with GAD randomized to four different treatment groups. Significant moderate to large effects were observed in all treatment groups, with no statistically significant differences between the groups on self-rated outcome measures. Receiving scheduled support was rated as more positive than support on demand, and self-tailored treatment was rated as more positive than the acceptance-based treatment. Treatment satisfaction was high in all studies. In conclusion, the studies indicate that an internet-based treatment based on acceptance, mindfulness, and valued action is a viable option in the treatment of GAD. Generaliserat ångestsyndrom (GAD) är ett kroniskt tillstånd som kännetecknas av överdriven och okontrollerbar oro. Internetbaserad kognitiv beteendeterapi (IKBT) har visat sig vara effektiv vid behandling av GAD. Behandlingarna baseras ofta på en traditionell KBT modell med tekniker som kognitiv omstrukturering och avslappning. IKBT inkluderar ofta även stöd från en behandlare, men stödets inverkan på metodens behandlingseffekter har visat på blandade resultat. Det finns det fortfarande mycket att lära om hur behandlingarnas innehåll och grad av behandlarstöd påverkar utfallet. Syftet med avhandlingen var att utvärdera behandlingseffekterna av ett nytt acceptansbaserat behandlingsprogram för GAD, förmedlat via internet, med endera veckovist stöd eller stöd vid behov. De fyra inkluderade studierna visar att behandlingen resulterade i signifikanta effekter på oro, GAD-symtom och komorbida depressiva symtom. Behandlingen var effektivare än kontrollgrupp (väntelista). Vid jämförelse med en aktiv behandling var effekterna likvärdiga. Att förmedla behandlingen med veckovist stöd eller stöd vid behov resulterade i jämförbara effekter på symptomskattningar. Dock slutförde fler som fick veckovist stöd hela behandlingen och de var även mer nöjda både med stödet och behandlingen. Behandlingseffekterna var jämförbara med tidigare IKBT-studier för GAD och deltagarna rapporterade hög grad av nöjdhet i alla studier. Sammanfattningsvis är acceptansbaserad internetförmedlad behandling ett effektivt alternativ vid behandling av GAD.