Johan Bjureberg and Clara Hellner's research group

Our research group focus on maladaptive behaviors in youth and adults, such as self-injury, suicide and aggression, theorized – at least in part – to arise from emotion-regulation difficulties. We study these behaviors and their proposed underlying mechanisms from an epidemiological and intervention perspective with the overall goal to prevent adverse outcomes such as mental health disorders, violence, and suicide.

Research program I: Epidemiological studies

We conduct epidemiological studies on nonsuicidal self-injury (NSSI), suicide, and aggression using regional and national registries. Our ongoing registry studies include using registries to explore the temporal relationship between NSSI and suicide attempts, the relationship between Attention-Deficit/Hyperactivity Disorder (ADHD) subdimensions and NSSI and suicide attempts, possible risks associated with certain pharmacological interventions, and the psychosocial burden of family members of youth engaged in self-injury. We have previously found that NSSI and suicide attempts are associated with a range of adverse outcomes such as violent crimes, substance use problems, and subsequent self-injury episodes, underscoring the importance of addressing these behaviors early in their trajectory.

Collaborators

Paul Lichtenstein, PhD, professor, Karolinska Institutet, Sweden
Brian D’Onofrio, PhD, professor, Indiana University, USA
Ralf Kuja-Halkola, PhD, associate professor, Karolinska Institutet, Sweden
Martin Cederlöf, PhD, Örebro University, USA
Zheng Chang, PhD, Karolinska Institutet, Sweden

Key references

Adverse clinical outcomes among youths with nonsuicidal self-injury and suicide attempts: a longitudinal cohort study
Bjureberg J, Kuja-halkola R, Ohlis A, Lichtenstein P, D'onofrio Bm, Hellner C, Cederlof M JOURNAL OF CHILD PSYCHOLOGY AND PSYCHIATRY 2021. [published online ahead of print, 2021 Dec 2]

Columbia-Suicide Severity Rating Scale Screen Version: initial screening for suicide risk in a psychiatric emergency department
Bjureberg J, Dahlin M, Carlborg A, Edberg H, Haglund A, Runeson B
Psychological medicine 2021;():1-9

Comparison of suicide risk and other outcomes among boys and girls who self-harm
Ohlis A, Bjureberg J, Lichtenstein P, D'onofrio Bm, Fruzzetti Ae, Cederlöf M, Hellner C
European child & adolescent psychiatry 2020;29(12):1741-1746

Adolescent self-harm with and without suicidality: cross-sectional and longitudinal analyses of a Swedish regional register
Bjureberg J, Ohlis A, Ljótsson B, D'onofrio Bm, Hedman-lagerlöf E, Jokinen J, Sahlin H, Lichtenstein P, Cederlöf M, Hellner C Journal of child psychology and psychiatry, and allied disciplines 2019;60(3):295-304

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 06;74(6):615-621

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

Research program II: Intervention studies

Emotion Individual Therapy for Adolescents (ERITA)

Our research group conducted a multi-site evaluation of Emotion Reglation Group Therapy (ERGT) for nonsuicidal self-injury (NSSI) among adults. This inspired the research group to further develop two treatment models for adolescents and their parents; 1) emotion regulation individual therapy for adolescents (ERITA) delivered face-to-face and 2) online (Online ERITA).

We have just completed a randomized controlled trial (RCT; N=166) comparing Online ERITA to enhanced treatment as usual and a manuscript assessing treatment effects and mechanisms of change is under review. Secondary aims that will be presented in subsequent publications include, parental outcomes, cost-effectiveness analyses and moderator analyses.

Research grants:

This research program was supported by the National Self Injury Project in Sweden and got grants from Marcus & Amalia Wallenberg Foundation, Kempe-Carlgrenska Foundation, ALF Medicin, PPG (Stockholms läns landsting), The Sven Jerring Foundation, Fredrik and Ingrid Thuring’s Foundation, The psychiatry fund (Psykiatrifonden), Clas Groschinskys Minnesfond, Bror Gadelius minnesfond.

Collaborators:

Brjánn Ljótsson, PhD, associate professor, psychologist, Karolinska Institutet, Sweden
Erik Hedman-Lagerlöf, PhD, associate professor, psychologist, Karolinska Institutet, Sweden
Hanna Sahlin, PhD, psychologist, Karolinska Institutet, Sweden
Kim L. Gratz, PhD, professor, psychologist, Toledo University, USA 
Matthew T. Tull, PhD, professor, psychologist, Toledo University, USA

Key references

Experiences of an Online Treatment for Adolescents With Nonsuicidal Self-injury and Their Caregivers: Qualitative Study
Simonsson O, Engberg H, Bjureberg J, Ljótsson B, Stensils J, Sahlin H, Hellner C
JMIR formative research 2021;5(7):e17910-

Extending research on Emotion Regulation Individual Therapy for Adolescents (ERITA) with nonsuicidal self-injury disorder: open pilot trial and mediation analysis of a novel online version
Bjureberg J, Sahlin H, Hedman-lagerlöf E, Gratz Kl, Tull Mt, Jokinen J, Hellner C, Ljótsson B
BMC psychiatry 2018;18(1):326-

Predictors of improvement in an open-trial multisite evaluation of emotion regulation group therapy
Sahlin H, Bjureberg J, Gratz Kl, Tull Mt, Hedman-lagerlöf E, Bjärehed J, Jokinen J, Lundh Lg, Hellner C, Ljótsson B
Cognitive behaviour therapy 2019;48(4):322-336

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 Kl, Tull Mt, Hedman E, Bjärehed J, Jokinen J, Lundh Lg, Ljótsson B, Hellner C BMJ open 2017;7(10):e016220-

Emotion regulation individual therapy for adolescents with nonsuicidal self-injury disorder: a feasibility study
Bjureberg J, Sahlin H, Hellner C, Hedman-lagerlöf E, Gratz Kl, Bjärehed J, Jokinen J, Tull Mt, Ljótsson B
BMC psychiatry 2017;17(1):411-

Primary care Online Emotion-regulation Treatment (POET)

Given that increased skills in emotion regulation may prevent future mental health problems among youth with subclinical problems, we are extending our previous work by initiating a new study with the overall objective to build an evidence base for a highly scalable transdiagnostic intervention called the Primary care Online Emotion-regulation Treatment (POET) for youth. This research program emerges from the need to find a way to help youths that seeking treatment for mild to moderate mental health problems in the primary care. In this newly started research program, we will investigate the impact of a six week long internet-delivered transdiagnostic emotion regulation treatment for youth and their parents. We will recruit youths aged 12-17 years and their parents. They will be randomly allocated to either POET or to an active control condition. The study will provide answers to questions about treatment efficacy and mechanisms of change. The broad long-term goal is also to provide health care services and politicians with estimates of cost-effectiveness, provide evidence for whom the treatment is efficacious, and show how a brief treatment provided in youth may change the trajectory into young adulthood, preventing important adverse outcomes.

Research grants:

The Kavli Trust Programme on Health Research and Region Stockholm (NSV project).

Collaborators:

Erik Hedman-Lagerlöf, PhD, associate professor, psychologist, Karolinska Institutet, Sweden
Hugo Hesser, PhD, professor, psychologist, Örebro University, Sweden
Maria Zetterqvist, PhD, Associate professor, Linköping University, Sweden
James Gross, PhD, professor, psychologist, Stanford University, USA

Preventing Suicide With Safe Alternatives for Teens and Youths (SAFETY):

Online ERITA and POET are digital scalable interventions that may prevent adolescents from developing serious mental health problems in young adulthood. However, there is a scarcity of widely available evidence-based treatments for adolescents who are not considered safe to treat using these types of remote treatment modalities. To bridge this gap, we aim to build an evidence base for a suicide prevention program for youth seeking treatment within child and adolescent mental health care after a suicide attempt. In this newly started research program we will investigate if an already developed suicide prevention program, Preventing Suicide with Safe Alternatives for Teens and Youths (SAFETY), is effective on repeated suicide attemps (as well as nonsuicidal self-injury and other measures of psychopathology) in a clinical setting in Sweden. The SAFETY-program is developed by members of a research group at UCLA (California, USA) and has shown promise in reducing suicide attempts in two small-N trials. In the present study, we aim to evaluate the effect of SAFETY on youth suicide attempts by comparing SAFETY to the active control condition Supportive Therapy in an adequately powered randomized controlled trial (N = 200) conducted within BUP Region Stockholm. We will also studying potential mediators and predictors/moderators of treatment effect, cost-effectiveness, as well as treatment effect on distal registry-based outcomes 24 to 60 months post treatment.

Collaborators:

David Mataix-Cols, PhD, professor, psychologist, Karolinska Institutet, Sweden
Ralf Kuja-Halkola, PhD, associate professor, Karolinska Institutet, Sweden
Gergö Hadlaczky, PhD, Karolinska Institutet, Sweden
Joan Asarnow, PhD, professor, UCLA, USA
Jennifer Hughes, associate professor, The Ohio State University , USA
James Gross, PhD, professor, psychologist, Stanford University, USA

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 self-recruited adults with elevated levels of anger. The particular aims were to examine (1) the separate and combined effects of emotional awareness and cognitive reappraisal training on anger and aggression; (2) whether treatment effects were differentially moderated by baseline levels of anger; and (3) whether the treatment effects were differentially mediated by changes in emotional awareness and cognitive reappraisal. Our expectations are that this study will provide new insights that will advance our understanding of the link between emotion regulation and anger and demonstrate new ways of disseminating evidence-based treatments. Manuscripts are under preparation and under review.

Research grants:

Knut and Alice Wallenberg Foundation (KAW 2018.0426)

Collaborators:

Hugo Hesser, PhD, professor, psychologist, Örebro University, Sweden
James Gross, PhD, professor, psychologist, Stanford University

Group members