ESSI – Emotion regulation, Self-injury, Suicide, and Intervention – Johan Bjureberg's research group

Treating maladaptive anger with brief therapist-supported internet-delivered emotion regulation treatments

Drawing upon basic science on emotion regulation and our prior experiences with treating individuals with difficulties in emotion regulation, the overall aim of the project was to develop three internet-delivered cognitive behavior therapies for maladaptive anger to test the separate and combined effects of two types of regulation strategies, emotional awareness and cognitive reappraisal. The interventions were evaluated in a randomized controlled trial with 234 adults with elevated levels of anger and we concluded that brief therapist-supported internet-delivered emotional awareness and cognitive reappraisal treatments are effective interventions for maladaptive anger. Combining emotional awareness and cognitive reappraisal is especially effective in reducing anger expression and aggression, particularly, in individuals who report higher levels of initial anger pathology. Our ongoing studies aim to address the habitual tendency of experiencing intense anger while suppressing it.

Epidemiological studies

Towards Personalised Clinical Management of Suicide Risk through Data-Driven Clinical Decision Support using Transnational Electronic Registry Data (PERMANENS)​​

Another project targeting suicide risk is a newly started EU-funded project (ERAPerMed), where machine learning techniques will be used to develop accurate and clinically useful prediction models for suicide and adverse healthcare trajectories, including the identification of most important risk factors.

This project emerges from the limitations of effective suicide risk management in clinical practice but also that suicide is difficult to predict. Current recommendations for suicide risk assessment consist of national or local guidelines to be applied to all patients assuming a “one size fits all” approach.

The PERMANENS project aims to improve suicide prevention by developing a personalised Clinical Decision Support System (CDSS), i.e., a medical software programme that assists in the personalised clinical evaluation and management of suicide risk. Data for the project will be obtained from population-representative electronic registries from Ireland, Norway, Sweden, and Catalonia (Spain).

From that data the goal is to develop a system that enables the detection, assessment, and treatment of suicide risk for each unique patient across various healthcare settings based on patients’ unique characteristics and susceptibilities. 
For more information visit the homepage of PERMANENS.

Perceived Causal Networks in Adolescents – reliability, central psychiatric symptoms, and feasibility for treatment selection

In collaboration with Upplands-Bro municipality, this study builds on our group previous experience with the PECAN (Perceived Causal Networks) tool, combining teenagers' individual perceptions about how different problems they experience are causally linked, with an "expert network" from 20 child psychology experts. This integration aims to enhance the method's reliability and validity, while also providing targeted recommendations for treatment with high validity.

The study involves two video interviews with 85 teenagers from Upplands-Bro, assessing individual and combined networks for test-retest reliability and a 12-month follow-up for retrospective validity and well-being. A significant aspect is the external validation, checking if network characteristics correlate with key life aspects like school attendance and mental health.

The aim of the project is two-fold: describe what problems (symptoms / contextual factors) that adolescents in Upplands-Bro perceive as most central (i.e. causing other problems), and secondly to take the PECAN methodology one step closer to clinical application. If successful ,the PECAN can be used as formalized case-conceptualization tool, thus guiding clinical decisions in a structured manner.

Clinical and population-based register studies

We conduct epidemiological studies on nonsuicidal self-injury (NSSI), suicide, and aggression using clinical and national population-based registries. Our previous findings indicate that NSSI and suicide attempts are linked to a range of adverse outcomes, including violent crimes, substance use problems, and subsequent episodes of self-injury, emphasizing the need to address these behaviors early in their course.

Our ongoing registry studies aim to identify predictors of persistent self-injury, explore the psychosocial burden on family members of youth who engage in self-injury, and assess the cost-effectiveness of IERITA and Dialectical Behavior Therapy.

Experimental studies

Pre-self harm

We are conducting a study where we will investigate risk factors and mechanisms of self-harm in a clinical youth population before onset of self-harm with several follow-ups. This project involves a unique set of empirically supported measures such as pain tests and psychosocial measures that are mentioned in the majority of recent suicidal theories.

Does your child have contact with care for mental illness?

In this study we are intressed to investigate how pain-regulation among childreen and youth  is correlated to mental illness. 

You may join if you :

• already have contact in healtj care due to mental illness
• are between 11-15 years old
• speak and understand swedish

Research Projects Secure New Grants from Jerring foundation, Söderström-Königska Foundation and Thuring Foundation

2024-12-20 Several research projects have recently received funding for important scientific advancements. 

• Lars has been awarded a grant from the Jerring Foundation for his project on network studies. 
• The Safety Project has been granted an extension from the Söderström-Königska 
• Additionally, Moa and Oskar have both secured grants from the Thuring Foundation for their respective projects. Moa’s research focuses on pain and self-harm, while Oskar’s project aims to prevent future suicide attempts. 

20 Million SEK from the Swedish Research Council for the SAFETY Project

2024-11-28 The SAFETY project, a treatment program for teens and youths who have attempted suicide, has been awarded a 20 million SEK grant from the Swedish Research Council. This funding will enable the launch of a multi-center randomized controlled trial (RCT) in 2025 across five regions in Sweden.

"We are thrilled and grateful for this opportunity to start the project in 2025. Our goal is to support families in crisis and make a real difference in the lives of young people at risk. 

This initiative aims to improve interventions for vulnerable youth and contribute to suicide prevention efforts on a broader scale.

Three-Day Training for New iERITA Therapists​

2024-11-28 We have now finished a three day training program for our new iERITA therapists. These dedicated professionals comes from Region Stockholm, Region Skåne, and Västra Götalandsregionen. The training days were held online and were filled with enthusiasm and eager to start treating patients with self-harm. Our newly trained therapists are now well-prepared to start the study and bring their expertise to benefit the participants. We look forward to the positive impact these therapists will make as they begin their work, contributing to the advancement of the iERITA study. ​

Olivia and Oskar Receive FORTE Planning Grants and FORTE Establishment Grants for Research Projects

2024-10-23 Olivia has been awarded the planning grants from FORTE to support her research project, "iErita,” that will focus on implementation of the already evaluated project into regular health care. While Oskar's has been awarded FORTE Establishment Grants for his research centers on "Caring Contact," aiming to prevent new suicide attempt to occur. The funding will enable both researchers to advance their studies, contributing to important developments in their fields.

Moa Karemyr’s Half-Time Seminar on Self-Harm in Youth

2024-09-06 Moa Karemyr successfully held her half-time seminar titled "Self-harm in Youth – Predictors, Outcomes, and Targeted Psychosocial Treatment." The seminar, was attended by a panel of: Professor Laura Korhonen from the Department of Biomedical and Clinical Sciences, Linköping University; Associate Professor Johan Reutfors from the Department of Medicine, Karolinska Institute; and Dr. Jonas Bjärehed from the Department of Psychology, Lund University.
Moa presented her research on self-harm and suicidal behavior among youth, discussing both predictors and outcomes as well as psychosocial treatment approaches. Her presentation was met with great appreciation and her works is of great importance to this field. Congratulation Moa! 

Johan Bjureberg Discusses Anger on Radio Program "Kropp och Själ"

2024-06-18 Johan Bjureberg recently appeared on the radio program "Kropp och Själ," where he shared insights on the topic of anger. During the show, Bjureberg discussed findings from ILSKE-studien, shedding light on how individuals manage and express their emotions. The conversation covered various aspects of anger, including its triggers, effects on mental health, and strategies to cope with it. You can listen to the full episode here.

Thuring Fund Awards Research Grants to Moa Karemyr and Moa Pontén​

2024-01-09 Moa Karemyr and Moa Pontén have been granted funding from the Thuring Fund in support of their research project SAFETY and Pre-selfharm. This funding is of great support for their research and enable them to get further with their reseach.

2023

PhD candidate Katja Sjöblom secures funding from the Queen Silvia Jubilee Fund​

2023-12-21 Katja Sjöblom has been granted funding from the Queen Silvia Jubilee Fund in support of her research on POET. With aspirations to attend the 58th Annual Convention of the Association for Behavioral and Cognitive Therapies (ABCT) in Philadelphia, USA, Katja also aims to visit Professor James Gross from Stanford University, the developer of the theoretical model underpinning the POET study. This funding not only provides her the opportunity to deepen her understanding of emotion regulation but also allows her to forge connections within the field. Expressing her gratitude, Katja states, "I am truly honored to receive this funding, enabling me to participate in this conference and visit the Gross lab. This experience will not only broaden my network and learning opportunities but also contribute to the dissemination of knowledge from the POET study."

Olivia Excels as She Exceptionally Defends Her Thesis

2023-11-10 Today was a celebratory day for the lab as PhD student Olivia Ojala successfully defended her thesis titled Nonsuicidal Self-Injury in Adolescence: Attempts to Improve and Develop Treatment. Following an introduction to the field by the opponent Professor Dennis Ougrin of King's College in London, Olivia presented results from the studies included in her thesis (see below). A discussion between Olivia and Professor Ougrin then followed, as well as questions from the examination board and the audience.

Olivia's thesis includes four studies, of which three were related to internet-delivered emotion regulation individual therapy for adolescents with nonsuicidal self-injury disorder (IERITA), and one assessed the impact of symptoms of ADHD on subsequent self-injury and suicidal behavior. You can [read the thesis on the KI Open Archive]

Among the highlights from the dissertation are an in-depth discussion of the different terms deliberate self-harm and nonsuicidal self-injury that are both used to describe the same types of behavior, the need for brief assessments to accurately capture self-injurious behavior, and comparisons between theoretical models in the field.

Congratulations Dr Ojala, we are very proud of you!

The studies included in the thesis were:

Simonsson O, Engberg H, Bjureberg J, Ljótsson B, Stensils J, Sahlin H, & Hellner C. (2021). Experiences of an Online Treatment for Adolescents With Nonsuicidal Self-injury and Their Parents: Qualitative Study. JMIR Formative Research.

Bjureberg J, Ojala O, Hesser H, Häbel H, Sahlin H, Gratz K.L, Tull M.T, Claesdotter Knutsson E, Hedman-Lagerlöf E, Ljótsson B, & Hellner C. (2023). Effect of Internet-Delivered Emotion Regulation Individual
Therapy for Adolescents With Nonsuicidal Self-Injury Disorder: A Randomized Clinical Trial. JAMA Network Open.

Ojala O, Hesser H, Gratz K.L, Tull M.T, Hedman-Lagerlöf E, Sahlin H, Ljótsson B, Hellner C, Bjureberg J. (2023). Moderators and Predictors of Treatment Outcome Following Adjunctive Internet-Delivered Emotion Regulation Individual Therapy Relative to Treatment as Usual Alone for Adolescents with Nonsuicidal Self-Injury Disorder. Manuscript in preparation.

Ojala O, Kuja-Halkola R, Bjureberg J, Ohlis A, Cederlöf M, Norén Selinus E, Lichtenstein P, Larsson H, Lundström S, & Hellner C. (2022). Associations of Impulsivity, Hyperactivity, and Inattention with
Nonsuicidal Self-injury and Suicidal Behavior: Longitudinal Cohort Study Following Children at Risk for Neurodevelopmental Disorders into Mid-
adolescence. BMC Psychiatry.

Johan and Oskar visting the International Summit on Suicide Research Conference

2023-11-02  Two weeks ago, Johan and Oskar attended the International Summit on Suicide Research in Barcelona, Spain. The conference gathered over 500 attendees from 32 countries to present and discuss recent science in the field of suicide research. Our lab also participated in the conference as Johan presented cost-effectiveness results from our recent IERITA trial, and Oskar presented our latest pre-print on sub-groups of non-suicidal self-injury from the same trial.

As the conference was relatively large, the science presented spanned all the way from the underlying biology of suicidal behaviour to implementation efforts of evidence-based treatment approaches. One recent highlight is the publication of a GWAS meta-analysis on suicide attempt, including over 40,000 cases and identifying 12 genome-wide significant loci. Another noteworthy presentation described the implementation of caring contacts via text messages for children with recent suicide attempts at a clinic in Ohio, USA. The researchers showed preliminary results that were encouraging and we look forward to reading the upcoming publication. We also attended several symposia that highlighted novel methodological approaches to identifying suicidal thinking, for example using network models and natural language processing.

When it comes to treatment approaches, there were multiple presentations with sobering results. Challenges include lack of engagement with digital treatments, finding a balance between ease of access and potency of the intervention, and replicating initially promising results in new contexts. It was clear that eliciting change in suicidal thinking and behaviour is a complex process that we do not yet fully understand.

The conference was also an opportunity for us to reconnect with collaborators and meet researchers from other countries with aligning research interests. We came back to Sweden with several ideas for future projects, stay tuned for updates!

Swedish Research Council Grants 9.7 Million SEK to our Projects about  Youth Mental Health Studies

2023-10-31  Our research group have been awarded two prestigious grants by the Swedish Research Council (VR).

The Medicine and Health Grant secures a substantial 2.4 million SEK to fund a study that integrates with the ongoing SAFETY-project, where the aim is to identify clinically applicable risk factors of self-harm, with a focus on adolescents aged 12 to 14 years. It marks a significant milestone by assessing youth at risk of self-harm prospectively, both before the onset of self-harm and at follow-up. Those identified individuals with self-harm tendencies will be enrolled in the SAFETY-RCT study. This multifaceted research project, through the identification of clinically applicable risk factors and the assessment of a potentially effective outpatient intervention, aspires to reduce the necessity for involuntary care and prevent suicide among youth.

In addition to the Medicine and Health Grant, our research group have also been awarded the Research Competence within Primary Care Grant, securing a remarkable 7.3 million SEK for the POET-study. This generous grant empowers the team to expand its research into multiple regions across Sweden, broadening the scope and impact of their investigations.

"We are extremely happy and grateful for both grants, which enable our research to continue. These grants signify a crucial step forward in advancing the understanding of youth mental health and promoting effective interventions to support those at risk, " says Johan.

With the funding provided by the Swedish Research Council, the research team will try to make substantial contributions to the field of youth mental health and reinforce its commitment to reducing self-harm, improving mental well-being, and ultimately preventing suicide among young individuals.

POET RCT Launches with First Participant Enrolled

2023-10-16  POET RCT has officially kicked off, with its first participant among a total of 388 individuals now enrolled in the this psychological treatment study aimed at addressing mental health challenges in youth.

Study Coordinator Katja Sjöblom expressed her excitement, saying, "It feels excited to finally start this project."

To read more about this project visit poetstudien.se.

Visiting Expert, Jennifer Hughes, Leads Enthusiastic Workshops for the SAFETY Team

2023-10-12  Our research group is honored to host Dr. Jennifer Hughes, PhD, a distinguished Psychologist and Clinical Scholar in Behavioral Health at Nationwide Children’s Hospital. She is also an Associate Professor in the Department of Psychiatry and Behavioral Health within the College of Medicine, and the Division of Health Behavior and Health Promotion within the College of Public Health, at The Ohio State University.

Dr. Hughes held a two full-day workshops for the SAFETY team, imparting her expertise and knowledge in the field. The sessions were filled with enthusiasm and was informative, with a great learning environment for all the therapists.

A great gratitude to Dr. Jennifer Hughes for her contributions, and we look forward to the continued growth and success of the SAFETY team as a result of her visit and workshops.

Our Research Team Run for Mental Health in Stockholm's Djurgården Charity Run​

2023-09-30  This autumn, our research team took their running shoes to participate in the Mental Health Run, a charity event aimed at highlighting the crucial connection between physical activity and mental well-being. The 5K run took place around Djurgården in Stockholm.

Moa Pontén has been Selected as Recipient for the CPF Post Doc Salary Grant for 2024 and 2025​

2023-09-25  Big congratulation to our Post Doc Moa Pontén that is one of the postdoctoral candidates to promote clinical research with relevance to psychiatry that has been announced by CPF. "I feel very honored and thankful for this opportunity to keep researching on these important questions on youth mental health" says Moa. ​

POET Study Got Funding from NSV to Continue The RCT study​

2023-09-21  The POET study has received a significant grant of 600,000 SEK from Nätverkssjukvården to further its research on youth mental health through a randomized controlled study. The study is expected to span over a duration of 3-4 years. This funding will enable the POET study to provide answers to important questions about treatment efficacy and mechanisms of change in mental health problems in youth.

Welcome Melissa, our exchange student​

2023-09-18  A warm welcome to Melissa, a dedicated student from the Netherlands, who has joined our team for a 5-month visit to work on her master's thesis focusing on ERITA data.

Featured on "Barnpsykologerna" Podcast Discussing Self-Harming Behavior in Adolescents​

2023-09-25  Moa Kareymyr, our dedicated doctoral student involved in the SAFETY study, was recently featured as a guest on the "Barnpsykologerna" podcast. In this  episode, Moa dig into the topic of self-harming behavior among adolescents.

Her insightful discussion shed light on the complexities surrounding this issue, providing valuable perspectives and research insights.

We encourage everyone interested in this subject to tune in to the "Barnpsykologerna" podcast to hear Moa's valuable contributions to the conversation.

Three-Day Training for New POET Therapists​

2023-08-31  We are glad to announce the successful completion of a three-day training program for our new POET therapists. These dedicated professionals comes from Region Stockholm, Region Skåne, and Region Östergötland. The training days were filled with enthusiasm and a shared commitment to the study's objectives. Our newly trained therapists are now well-prepared to start the study and bring their expertise and passion to benefit the participants. We look forward to the positive impact these therapists will make as they begin their work, contributing to the advancement of the POET study. ​

The IERITA Study is Published and Shows Great Impact on Self-Harm Reduction​

2023-07-13  This summer the IERITA study got published in JAMA Network Open. The study's findings demonstrate that IERITA, when administered alongside regular care, yields 82 percent reduction in self-harm behaviors among youths compared to regular care alone. Moreover, it exhibited a notable improvement in emotional regulation, destructive behaviours and enhanced overall functioning among participants post-treatment, in contrast to a 47 percent reduction observed in patients receiving standard care exclusively.

Kavli Trust Foundation Awards 8 Million NOK Research Grant for the POET-study​

2022-10-12  We are excited to announce that our research group has been granted a generous research award of 8 million NOK from the Kavli Trust Foundation. This substantial funding will support a major study focused on assessing the effectiveness of the "Primary care Online Emotion-regulation Treatment" (POET) for youth struggling with mental health problems.

The ILSKE-Study Gains  Media Attention

The ILSKE study has been making headlines across various media outlets due to its significant success. Johan, in collaboration with researchers from Örebro University, has developed a four-week online intervention program targeting anger and aggression. The study has yielded promising results, aiding participants in effectively managing their anger.

2021-09-01 Dagens Nyheter
2023-01-31 Aftonbladet
2023-02-07 Svenska Dagbladet
2023-02-12 VI
2023-03-16 Modern psykologi