Profiles

Mårten Tyrberg

Mårten Tyrberg

Doktorand

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Arbetar vid Psykologiska institutionen
E-post marten.tyrberg@psychology.su.se
Besöksadress Frescati hagväg 8
Postadress Psykologiska institutionen 106 91 Stockholm

Om mig

Jag arbetar sedan 2008 som psykolog inom vuxenpsykiatrin på Västmanlands sjukhus Västerås. Mina arbetsuppgifter har varit behandling, utredning och diagnostik av främst psykospatienter. Jag har också arbetat med handledning i KBT-metod av personalgrupper. De sista åren har jag särskilt intresserat mig för hur psykologisk behandling skulle kunna implementeras i den psykiatriska slutenvården. Specifikt har jag fördjupat mig i Acceptance and Commitment Therapy (ACT). Sedan höstterminen 2014 är jag antagen som industridoktorand vid Psykologiska institutionen.

Undervisning

Jag undervisar om psykologisk behandling vid psykos på psykolog- och psykoterapeutprogrammen vid SU. Jag undervisar även om psykos på psykologprogrammets psykiatrikurs, samt har undervisat på psykoterapeutprogrammets kurs i självkännedom/egenterapi.

Forskning

Mitt forskningsprojekt handlar om implementering av psykologisk behandling i psykiatrisk slutenvård, på olika sätt. Projektets övergripande syfte är att undersöka om Acceptance & Commitment Therapy (ACT) är en verksam behandlingsmetod för akut sjuka psykospatienter i slutenvården. Metoden kommer dels tillämpas i individuell behandling, dels som en integrerad del i det övergripande arbetet på en psykosavdelning, genom utbildning och kontinuerlig handledning av skötare och sjuksköterskor. Individuell behandling kommer att undersökas i en mindre RCT-studie. ACT-modellens användbarhet för personalgrupp och patienter kommer att undersökas i både kvantitativa och kvalitativa delstudier. En kompletterande delstudie kommer också att utforska exekutiva funktionssvårigheter hos patienter med schizofreni med hjälp av Relational Frame Theory (RFT), i syfte att bättre förstå de hinder som kan uppstå vid psykologisk behandling av psykos. Projektet utformas i samarbete mellan Stockholms universitet och Region Västmanland, och är knutet till Centrum för klinisk forskning (CKF) vid Västmanlands Sjukhus, Västerås.

Publikationer

I urval från Stockholms universitets publikationsdatabas
  • 2019. Mårten Tyrberg (et al.).

    The psychiatric ward is a complex setting. This has to do partly with the severity of the patients’ suffering. Often, they present with such diagnoses as psychosis, self-harm, substance abuse, and suicidality. In fact, they often present with a combination of these. This renders the delivery of effective treatment a challenging task. Partly, the complexity of the ward has to do with aspects of the context itself. Admissions and discharges often happen fast and unexpectedly, staff members are expected to handle various challenging behaviors, they display quite high levels of burnout and work dissatisfaction, and the wards are often staffed by bank staff, leading to a lack of continuity of care. This adds to the challenge of delivering effective treatment. In the typical Swedish ward, treatment consists of medication, nursing, observation, and management of risk behaviors. Psychological treatment is seldom a routine part of inpatient care. However, there are sound arguments for adding psychological treatment in the form of cognitive behavior therapy (CBT) of various modalities. Further, there is promise in psychosocial interventions delivered by the nursing staff after appropriate training, and in providing supervision to the staff.

    The aim of the present thesis was to investigate the feasibility and potential efficacy of acceptance and commitment therapy (ACT), a CBT based psychotherapy model, as a broadly applied intervention in the context of psychiatric inpatient care. In three studies, ACT was evaluated as a brief individual psychotherapy intervention, and as a psychologically informed approach to dealing with patients performed by the nursing staff group in a psychiatric ward for psychosis patients.

    In study I, an average of two sessions of ACT was delivered to patients (n = 11) with a diagnosis of psychosis. Compared to a control group (n = 10), the risk for rehospitalization during a four-month follow-up period was significantly smaller for patients in the experimental group. There was also a trend toward increased values-based living scores in the experimental group, compared to controls.

    Study II evaluated the effects on staff members (n = 20) and patients (n = 9) of a brief ACT training intervention tailored to the staff group, the aim of which was to introduce ACT as a day-to-day approach to dealing with patients. After a total of 12 hours of ACT training, the staff group displayed a slight increase in work-related psychological flexibility, compared to before, while a non-randomized control group (n = 18) displayed a slight decrease. Patients being treated on the ward after the staff training displayed a slight increase in psychological flexibility during ward treatment, while patients being treated before displayed a slight decrease. In both cases, however, the differences were considered quite small (non-significant in statistical terms). Further, the study investigated ACT-consistent behavior changes among staff members following ACT training, using a multiple baseline single-subject design. Results revealed both expected and unexpected patterns of behavior.

    In study III, the usefulness of the ACT model was investigated using a qualitative content analysis. Staff members (n = 10) experienced ACT as useful in terms of dealing with patients’ struggles, enriching typical duties, and dealing with their own stress. Difficulties in using the model related to time restraints, complexities of the model itself, and the severity of patients’ illnesses.

    In summary, the present thesis adds to the research basis for ACT as a treatment for psychosis, delivered in an inpatient setting. It shows that the introduction of ACT as an add-on to traditional ward treatment in Sweden is for the most part feasible and acceptable. However, the thesis also discusses various challenges in the implementation of psychological treatment in such a complex context as the inpatient ward, both in terms of delivery of the treatment itself and the evaluation of its effectiveness.

  • 2018. Mårten Tyrberg, Per Carlbring, Tobias Lundgren.

    Changing the context surrounding patients treated in psychiatric wards is a great challenge, with barriers in terms of the organization, work culture and clinical skill. We propose a model to influence the ward context by adding psychological treatment in both individual form and by teaching inpatient staff how to use a simplified ACT model to inform their daily interactions with patients. We further discuss difficulties in the implementation of psychological treatment in inpatient milieus. Results from three empirical studies in a naturalistic setting in Sweden form the basis of a model describing how access to evidence-based psychological treatment might be increased using limited extra resources. Data suggest that 1) an average of two individual ACT sessions might lessen the need for future inpatient care for psychosis patients, 2) inpatients as well as staff members themselves might benefit from staff learning and using a simplified ACT model, and 3) staff find the ACT model useful both in terms of helping patients handle psychiatric symptoms and in terms of handling their own work-related stress.

  • 2017. Mårten J. Tyrberg, Per Carlbring, Tobias Lundgren. Journal of Psychiatric Intensive Care 13 (2), 73-82

    Psychiatric inpatient wards are inherently complex milieus. Staff in wards are expected to alleviate severe suffering in patients whilst handling an increasing administrative burden, resulting in less direct contact with patients. Reports from both patients and staff indicate institutional aimlessness and lack of care content beyond medication and containment. As a possible means of improving this situation, this pilot study investigated the feasibility, potential effectiveness and challenges of the implementation of a 12-hour training programme in acceptance and commitment therapy (ACT), a CBT-based psychotherapy model, on staff (n = 20) and patients (n = 9). The context was a psychiatric inpatient ward for psychosis patients. The staff members of a neighbouring unit acted as non-randomised controls. Feasibility of implementation, data collection and acceptance among staff of the intervention seemed acceptable, while data collection among patients was more challenging. Mean change scores suggest marginal positive changes in psychological flexibility for patients and staff post-intervention. Results are discussed in light of methodological and institutional limitations, and clinical experiences.

  • 2017. Mårten Tyrberg, Per Carlbring, Tobias Lundgren. Nordic Psychology 69 (2), 110-125

    Psychiatric inpatient care in Sweden is often described as lacking in content other than medication and mere containment. In an attempt to increase structured psychological content in the ward context, this study aims to investigate whether a brief form of acceptance and commitment therapy (ACT) is a feasible addition to standard care for psychotic inpatients. ACT has previously been administered to psychotic inpatients in the US, and the present study was an attempt at implementing this intervention in Sweden. In this feasibility study, 22 psychotic inpatients were randomized to one of two conditions: treatment as usual (TAU) or TAU plus an average of two ACT sessions. Measures of rehospitalization and values-based living were obtained before treatment, after treatment, and at four-month follow-up. Results indicate that participants in the TAU plus ACT group were rehospitalized at a lower rate than those who only received TAU (9% vs. 40%), though the difference was not statistically significant. Controlling for age, gender, and pretreatment values-based living scores, there was a significantly higher risk for TAU participants to be rehospitalized. There was a trend toward increased values-based living scores in the ACT group. These results suggest that it is feasible to add structured psychotherapeutic interventions to the existing care package at psychiatric inpatient wards in Sweden. However, the findings need to be explored in larger samples.

  • 2017. Mårten Tyrberg, Per Carlbring, Tobias Lundgren. Journal of Contextual Behavioral Science 6 (2), 208-214

    Alleviating the suffering of patients treated in psychiatric inpatient wards is a great challenge. Preliminary or multiple diagnoses, inherent complexities of the inpatient milieu and the lack of potentially effective psychological treatment form part of this challenge. The present study explored the usefulness of a transdiagnostic psychological treatment model (Acceptance & Commitment Therapy, ACT) as a means of improving inpatient care from the perspective of psychiatric nurses. Nurses (n = 10) participated in three ACT workshops, a total of 21 h, and were interviewed about the experienced usefulness and difficulties of the ACT model, as a tool for improving everyday ward work. Results, revealed by qualitative content analysis, suggest usefulness in the areas of alleviating patients symptoms, enriching typical ward duties, and handling one's own thoughts and feelings. Difficulties stemmed from lack of time, the model itself and patients' severe illness. Possible adjustments of the ward context are suggested.

  • 2016. Mårten Tyrberg, Per Carlbring, Tobias Lundgren.

    Conducting research in clinical psychiatric settings presents significant challenges. Patients’ suffering is often severe, and organizational aspects might hinder the implementation of structured psychological treatment. In this symposium, empirical data are presented from three different projects concerning ACT for different diagnoses –psychosis, body dysmorphic disorder (BDD) and high functioning autism spectrum disorder (ASD). The first talk concerns training inpatient ward staff in using the ACT model with psychosis patients. Data suggest slight positive changes in psychological flexibility for patients and staff. The second talk describes the evaluation of an ACT group treatment intervention for BDD outpatients, with results showing significant reductions in BDD symptomatology. The third talk covers a researchproject on ACT adapted for students and psychiatric outpatients with ASD, where data indicate reduced levels of stress and autistic core symptoms. Presenters will share their data, as well as common clinical experiences of implementing ACT in clinical psychiatric contexts.

  • 2015. Mårten Tyrberg (et al.).

    In recent years, the research base supporting ACT for psychosis has grown (e.g. Bach & Hayes, 2002; Gaudiano & Herbert, 2006; White et al., 2011; Bach, Hayes & Gallop, 2012; Shawyer et al., 2012). In this symposium, pilot results from a small study on a clinical sample in Sweden will be presented. A total of 21 psychotic inpatients were randomized to either treatment as usual (TAU) or TAU plus a short ACT intervention, on average 2 sessions. Groups were measured for rehospitalization and values-based living at pretreatment, posttreatment and four month follow-up. Results indicate that the ACT group was rehospitalized to a lesser extent than the TAU group, although the difference was not significant. Also, the ACT group scored higher on the Bull’s-Eye Values Survey at follow-up, the difference being marginally significant. All in all, the results expand somewhat upon previous findings in the same population (Bach & Hayes, 2002; Gaudiano & Herbert, 2006), by indicating that ACT might affect values-based living in addition to decreasing need for rehospitalization. The next step in this research project in Sweden will be implementing ACT in the ward context in a broader way. This will be done in two ways: 1) By training all ward staff in the method. The effects of this training, and of regular supervision, will be investigated by administering measures of work related acceptance to staff. 2) By investigating ACT as an individual treatment in a larger sample, where therapists will be ward staff using a manual that was custom-made for this particular project.

Visa alla publikationer av Mårten Tyrberg vid Stockholms universitet

Senast uppdaterad: 8 maj 2020

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