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Banner image for Maria Zetterqvist's research group.

Research projects

Preventing and treating nonsuicidal self-injury

Nonsuicidal self-injury (NSSI) is common in adolescents, especially in clinical samples. We examine different means of preventing and treating NSSI. We also investigate underlying transdiagnostic mechanisms which have been identified as core facilitators of NSSI, as well as psychophysiological and neurobiological markers. We will study the effectiveness of a preventive intervention that addresses NSSI by a whole-school approach, and also focus on knowledge dissemination. We will also test novel treatment approaches with real-time bio- and neurofeedback to increase emotion regulation and decrease NSSI. We also focus on increasing patient participation conduct several qualitative studies documenting the lived-experience of individuals with NSSI.

Prevention

NSSI is common in adolescents and in schools. There is currently a lack of preventive programs for NSSI in the school setting. Vi examine the effects of a universal school prevention program that focuses on mental health and NSSI. We use a whole-school approach and include adolescents, parents, teachers and school health services. With a cluster-randomized waitlist control design, we will examine whether the prevention program is feasible, and whether it can affect NSSI, mental health symptoms, self-criticism, emotion regulation, help-seeking, stigma and perceived social support. Measures are administered before and after, and at 6, 12, and 18-months follow-up.

Psychophysiological och neurobiological markersSad young woman. Image for CSAN.

We examine psychophysiological and neurobiological markers of difficulties with emotion regulation and NSSI. We have conducted studies using fMRI and facialEMG methods with adolescents with NSSI and found support for an increased emotional reactivity and negative bias during social exclusion compared to adolescents without NSSI. In a longitudinal five-year follow-up, we are examining whether it is possible to use the earlier fMRI and facialEMG data to predict progression and outcome. We are also conducting qualitative studies with interviews of the young adults’ experiences of NSSI cessation as well as their perception of the health care and treatment they received for their NSSI.

Neurofeedback and biofeedback

NSSI is associated with impairments in emotion regulation and NSSI serves as an attempt to regulate emotion. Vi are interested in further examining psychophysiological and neurobiologial markers of NSSI and difficulties with emotion regulation. In the project, examining the effects of real-time fMRI neurofeedback and biofeedback to improve emotion regulation in adolescents with nonsuicidal self-injury, we will investigate whether it is possible using repeated training with real-time fMRI feedback (rt-fMRI-NF) to help adolescents with NSSI down-regulate their hemodynamic activity of the salience network, which plays major roles in emotional processing, and improve emotion regulation and reduce NSSI.

Knowledge dissemination

School staff, parents and health-care personnel need more knowledge about NSSI in adolescents. We have developed brief online psychoeducation and longer workshops for parents, teachers and school mental-health staff that focuses on NSSI. We are interested in examining whether knowledge dissemination in this format, is appreciated and perceived as helpful and whether it can improve knowledge and competence and reduce negative attitudes and stress. We are examining the effects of our educational material before, after and at 6- and 12-months follow-up.

Emotion regulation difficulties in adolescents

Difficulties with emotion regulation have been identified as an underlying mechanism in mental health, such as nonsuicidal self-injury. Studies have shown that an increased capability to regulate emotions is advantageous in the treatment of several psychiatric diagnoses. We are conducting a randomized controlled trial to investigate the effects of a 7-session group skills training in emotion regulation for adolescents and parents at the child- and adolescent psychiatric clinics in Linköping and Norrköping. Outcomes are difficulties with emotion regulation, alexithymia, emotional awareness, quality of life and symptoms of depression and anxiety. Qualitative studies are also included where we examine adolescents’ and parents’ experiences of taking part in a joint emotion regulation skills training. We are also examining the validity of measures of difficulties with emotion regulation and how common difficulties with emotion regulation are in different adolescent populations.

Self-criticism

Self-criticism is a transdiagnostic construct that is associated with several psychiatric conditions, such as depression, nonsuicidal self-injury, eating disorders and social anxiety. We have developed a transdiagnostic treatment intervention that focuses on self-criticism and in a pilot study aim to examine whether the intervention can reduce self-criticism, symptoms of depression, social anxiety and nonsuicidal self-injury, and increase self-compassion, psychological flexibility and quality of life. The study has a single-case experimental design. The treatment includes psychoeducation and components from CBT, self-compassion and acceptance-based therapy. Adolescents are recruited from the child- and adolescent psychiatric (CAP) clinic in Linköping and the treatment is delivered at the CAP-clinic. Qualitative studies are also included in the project and adolescents are interviewed about their experience of targeting self-criticism in treatment.

Treating body image distortion in anorexia

Anorexia nervosa (AN) is characterized by self-starvation and weight loss accompanied by an intense fear of gaining weight and distorted body image. Targeting disturbances in body image in the treatment of AN is an area in need of further research. Here, we investigate a novel treatment approach, which combines transcranial magnetic stimulation and a psychological body intervention. Participants from the Eating disorder unit at the Child- and Adolescent Psychiatric Clinic and Psychiatric Clinic are randomized to one of three treatment conditions: treatment as usual, sham TMS + psychological intervention or TMS + psychological intervention. fMRI is also included before and after the treatment. Since AN is a severe and often long-lasting disorder, exploring novel treatment approach is of potentially great importance. We hope to contribute critical and novel insights to understanding and treating AN.