Clara Hellner´s research group

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Research program I: Deliberate self-harm, impulse control, emotion regulation and violence: Intervention and epidemiological studies

Deliberate self-harm (DSH) refers to both non-suicidal self-injury (such as cutting or burning one’s skin to manage emotional distress) as well as intentional self-poisoning or self-injury regardless of intent. DSH is a serious global health problem and is common also in Sweden; recent Swedish studies indicate that the frequency of those who had self-harmed >5 times is close to 8%. Common comorbid conditions are neuropsychiatric disorders, eating disorders, substance use, depression and anxiety.

Anger, aggression and impulsivity are psychological traits associated with several psychiatric diagnoses, e.g. ADHD, conduct disorder, and antisocial personality disorder. Such traits are also associated with both attempted and completed suicide as well as violent behaviours. Previous studies have identified higher prevalence of self-harm in prison populations; our recent study (see below) have now pointed to increased levels of violent behaviours among those who have received care for self-harm within the health care system. Theoretical and empirical literature emphasizes the central role of emotion regulation in the development and maintenance of self-injury; thus, several of our projects involve aspects of emotion regulation.

This project combines epidemiological and intervention studies. The register-based studies will hopefully help us understand more of the development of these conditions, e.g. the characteristics of those seeking care for self-harm, short and long term interactions with the health care system, possible risks associated with certain pharmacological interventions, and what other conditions are associated with self-harm.

We have completed one intervention study for adults with self-harm; ERGT or Emotion Regulation Group Therapy. For self-harming youth, few interventions have yielded significant and consistent positive outcomes. We are now testing an early intervention targeting 13-17 year olds and their caregivers; Emotion Regulation Individual Therapy for Adolescents (ERITA).

PhD-students:

  • Johan Bjureberg, psychologist, Department of Clinical Neuroscience, Unit of psychology, Karolinska Institutet
  • Hanna Sahlin, psychologist/psychotherapist, Department of Clinical Neuroscience, Unit of psychology, Karolinska Institutet
  • Anna Ohlis, child- and adolescent psychiatrist, Department of Clinical Neuroscience, Centre for psychiatry research, Karolinska Institutet

Collaborators

  • Brjann Ljotsson, psychologist, PhD, associate professor, Department of Clinical Neuroscience, Unit of psychology, Karolinska Institutet
  • Erik Hedman, psychologist/psychotherapist, PhD, associate professor,Department of Clinical Neuroscience, Unit of psychology, Karolinska Institutet
  • Jussi Jokinen,  PhD, professor, psychiatrist, Department of Clinical Neuroscience
  • Kim L Gratz, PhD, professor and Chair, Department of Psychology, University of Toledo, Ohio, USA
  • Matthew T Tull, PhD, professor, Department of Psychology, University of Toledo, Ohio, USA
  • Paul Lichtenstein, professor, Department of medical epidemiology and biostatistics, Karolinska Institutet
  • Ralf Kuja-Halkola, post doc, Department of medical epidemiology and biostatistics, Karolinska Institutet
  • Martin Cederlöf, post doc, Department of medical epidemiology and biostatistics, Karolinska Institutet
  • Sebastian Lundström, researcher, Gillberg Neuropsychiatry Centre, University of Gothenburg, Sweden

Research grants

This program is supported by the Marcus and Amalia Wallenberg Foundation, Kempe Carlgrenska Foundation, ALF and PPG (Stockholm County Council regional research grants), The Sven Jerring Foundation, Ingrid Thuring’s Foundation, Swedish Research Council for Health, Working Life and Welfare, and the Swedish Research Council.

Key references

Emotion regulation group therapy for deliberate self-harm: a multi-site evaluation in routine care using an uncontrolled open trial design.
Sahlin H, Bjureberg J, Gratz K, Tull M, Hedman E, Bjärehed J, et al
BMJ Open 2017 Oct;7(10):e016220

Association Between Deliberate Self-harm and Violent Criminality.
Sahlin H, Kuja-Halkola R, Bjureberg J, Lichtenstein P, Molero Y, Rydell M, et al
JAMA Psychiatry 2017 Jun;74(6):615-621

Autism and Convictions for Violent Crimes: Population-Based Cohort Study in Sweden.
Heeramun R, Magnusson C, Gumpert C, Granath S, Lundberg M, Dalman C, et al
J Am Acad Child Adolesc Psychiatry 2017 Jun;56(6):491-497.e2

Emotion regulation individual therapy for adolescents with nonsuicidal self-injury disorder: a feasibility study.
Bjureberg J, Sahlin H, Hellner C, Hedman-Lagerlöf E, Gratz K, Bjärehed J, et al
BMC Psychiatry 2017 12;17(1):411

Subthreshold and threshold attention deficit hyperactivity disorder symptoms in childhood: psychosocial outcomes in adolescence in boys and girls.
Norén Selinus E, Molero Y, Lichtenstein P, Anckarsäter H, Lundström S, Bottai M, et al
Acta Psychiatr Scand 2016 Dec;134(6):533-545

Varenicline and risk of psychiatric conditions, suicidal behaviour, criminal offending, and transport accidents and offences: population based cohort study.
Molero Y, Lichtenstein P, Zetterqvist J, Gumpert C, Fazel S
BMJ 2015 Jun;350():h2388

Selective Serotonin Reuptake Inhibitors and Violent Crime: A Cohort Study.
Molero Y, Lichtenstein P, Zetterqvist J, Gumpert C, Fazel S
PLoS Med. 2015 Sep;12(9):e1001875

Physical domestic violence exposure is highly associated with suicidal attempts in both women and men. Results from the national public health survey in Sweden.
Dufort M, Stenbacka M, Gumpert C
Eur J Public Health 2015 Jun;25(3):413-8

Research program II: Empathy disorders in children and youth

In this program, we investigate psychopathic traits with a focus on “callous-unemotional” (CU)-traits in different youth populations. CU-traits reflect deviant personality traits and behaviors including lack of empathy and guilt, unconcern about own performance and shallow affect. CU-traits could constitute a risk factor for antisocial behaviour, poor treatment adherence and distinct emotional difficulties. The latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), includes the specifier “with Limited Prosocial Emotions” to encourage assessment of CU-traits in children and youth with deviant behaviors. In register-based studies, we investigate prevalence and correlates of CU-traits,  including associations with trauma exposure – in large community samples of youth. This program also includes an ongoing clinical study where CU-traits are investigated in relation to empathy, fear responding, anxiety and attention in youth with different psychiatric disorders.

Postdocs

  • Karolina Sörman, Ph.D, Department of Clinical Neuroscience

Collaborators

  • Natalie Durbeej, Ph.D., Department of Public Health and Caring Sciences, Social Medicine/CHAP, Uppsala University
  • Charlotte Skoglund, M.D., Ph.D., Department of Clinical Neuroscience
  • Hans-Martin Engström, licensed psychologist
  • Sebastian Lundström, Ph.D., researcher, Gillberg Neuropsychiatry Centre, University of Gothenburg, Sweden
  • Henrik Andershed, Ph.D., professor, Örebro University 

Research program III: Interventions for problem gambling

Problem gambling (as opposed to gaming, where money is not involved) is characterized by the failure to control the amount of gambling despite negative financial, social and personal consequences. Approximately 2% of the Swedish population is estimated to be either problem gamblers or moderate risk gamblers. However, in association to each problem gambler there may be a higher number of significant others who are affected. These two studies both involve interventions that involve significant others. The “Spelfrihet tillsammans”-project (“Gambling free together”) compares internet mediated cognitive behavioural therapy with a joint intervention for couples (involving either a spouse, an adult relative or someone else who is close to the gamber). The “Anhörigstudien” (“The significant other-project”) focuses solely on those close to the gambler, comparing an intervention directed to the significant other to just providing brief information about gambling. The outcome in this project is whether the gambler will be more motivated to participate in treatment.

PhD-students

  • Anders Nilsson, psychologist, Department of Clinical Neuroscience
  • Kristoffer Magnusson, psychologist, Department of Clinical Neuroscience

Collaborators

  • Per Carlbring, professor, Stockholm university
  • Gerhard Andersson, professor, Linköping university and Karolinska Institutet

Research grants

This program is supported by grants from Svenska Spels Research Foundation.

Key references

The Development of an Internet-Based Treatment for Problem Gamblers and Concerned Significant Others: A Pilot Randomized Controlled Trial.
Nilsson A, Magnusson K, Carlbring P, Andersson G, Gumpert C
J Gambl Stud 2017 Jul;():

Internet-delivered cognitive-behavioural therapy for concerned significant others of people with problem gambling: study protocol for a randomised wait-list controlled trial.
Magnusson K, Nilsson A, Hellner Gumpert C, Andersson G, Carlbring P
BMJ Open 2015 Dec;5(12):e008724

Effects of added involvement from concerned significant others in internet-delivered CBT treatments for problem gambling: study protocol for a randomised controlled trial.
Nilsson A, Magnusson K, Carlbring P, Andersson G, Hellner Gumpert C
BMJ Open 2016 Sep;6(9):e011974

Group Members

Christina AnderssonGraduate Student
Anna Britta BjörkdahlAssociated
Lena BrorssonAssociated
Natalie DurbeejAssociated
Clara Hellner Research team leader, Adjunct professor
Kristoffer MagnussonGraduate Student
Anders An NilssonGraduate Student
Anna OhlisGraduate Student
Ingvar RosendahlAssociated
Olivia SimonssonAssociated
Charlotte SkoglundAssociated
Karolina SörmanPostdoc
Maria VinbergGraduate Student
Håkan WallGraduate Student

Psychiatry