Science, Samba & Soccer: our visit to São Paulo in August 2022

Last week, Oskar Flygare, Volen Ivanov and Christian Rück visited our collaborators in São Paulo, Brazil to work on current projects and discuss new ones. This was the third meeting in person between the two collaborating groups, the previous ones being Alice de Mathis’ visit to Stockholm and a visit by Oskar and Christian to São Paulo in 2019. The OCD research group at São Paulo is led by professor Euripedes Constantino Miguel and our visits always involve a rich exchange of ideas relating to our research.


One ongoing research project is a pilot study of an internet-delivered treatment for obsessive-compulsive disorder (OCD-NET) which has been translated to Portuguese and is now being evaluated in Brazil. After a brief suspension due to the pandemic, the project is now well underway with ongoing recruitment and treatment of patients. So far the feedback from both therapists and patients has been encouraging. In addition to discussing the ongoing project, Oskar presented results and lessons learned from two recent clinical trials on OCD-NET in Sweden and England.

Volen shared his knowledge about hoarding disorder, from research projects and clinical work. Expertise in diagnosing and treating hoarding disorder is sorely lacking in Brazil, and our colleagues were eager to learn as much as possible in order to provide effective care. Interestingly, just months before our visit a podcast about an individual with likely hoarding disorder in São Paulo has stoked public interest and increased awareness about the condition. It is clear that our research groups have plenty of opportunities for collaboration on projects related to hoarding.

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The visit was also an opportunity to plan an upcoming project led by Arthur Caye that will evaluate internet-delivered treatments for OCD, depression, insomnia and anxiety in two municipalities outside of São Paulo: Jaguariúna and Indaiatuba. The access to psychotherapy in these cities is limited and the project is an opportunity to increase access to effective treatments for common disorders. The project will evaluate the feasibility of using internet-delivered treatments in primary care, where most of the patients with mental disorders are seen.


We were once again moved by the hospitality and warmth our hosts showed us. There was a rich social programme outside the work activities and we had the opportunity to enjoy samba with Daniel Costa, soccer with Rodolfo Furlan Damiano and several restaurants together with our Brazilian colleagues Nil Morales, Sonia Borcato and Roseli Shavitt. Thanks to their generosity with their time, we got a true taste of Brazilian culture!

Introducing Max Sannemalm and the Bergen 4-Day Treatment for OCD

Sunny midsummer was great, but we are even happier that Max Sannemalm just joined our group!

Max is a licensed psychologist and will be joining us as the project coordinator for the randomized controlled non-inferiority trial study comparing the Bergen 4-Day Treatment (B4DT) to gold-standard CBT for OCD.

The Bergen 4-Day Treatment (B4DT) is a new concentrated treatment for OCD developed by Gerd Kvale and Bjarne Hansen from Bergen. In B4DT, patients receive ERP at a clinic during 4 consecutive days. The B4DT has shown to achieve remission in around 70% of patients when delivered in regular care in several uncontrolled treatment trials, and one randomized controlled trial (RCT) including a self-help group and a waitlist group. However, it has yet to be directly compared to gold-standard CBT.

The study will test the non-inferiority, speed of recovery, and cost-effectiveness of B4DT, compared to gold-standard.

To summarize: Exciting things ahead, and welcome to the group, Max!

Two new research assistants needed

Interested in psychiatry research? Want to join the group? We are hiring not one but TWO new research assistants!

The group is certainly expanding. Team leader John Wallert just advanced to Assistant Professor within the group, congratulations! 🎯

We are also hiring two new research assistants for two slightly different employments.

One is for The Joining Forces RCT crew, working with Volen Ivanov and Sofia Jägholm. In this job you will do different tasks related to their RCT on a new combination treatment for hoarding disorder, including screening interviews and home visits with hoarding patients, interviews with housing supporters and managers in the social services and monitoring of data collection as well contact with the project’s various collaboration partners. Read more and apply here. Last day to apply is July 31.

The other one is for John Wallert’s interdisciplinary modeling team, an employment in a project in precision psychiatry. This employment includes assisting John and three others with tasks such as database work, archiving of completed projects, meeting documentation and planning, create and then support a structure for work in the steering group for one of our larger projects and write research information texts. Read more and apply here. Last day to apply is July 31.

Oskar Flygare dissertation

Big day today! Oskar Flygare received his PhD after successfully defending his thesis. Congratulations!

Oskar defended his dissertation “Improving access and outcomes in the treatment of Obsessive-Compulsive Disorder”, today June 10th 9am at the Erna Möller hall at Karolinska Institutet, Huddinge.

The opponent was the excellent associate prof. Carolyn Rodriguez from Stanford University who participated via video link. Oskar was accompanied by supervisor prof. Christian Rück and co-supervisor associate prof. Erik Andersson. Co-supervisor prof. David Mataix-Cols participated via video link. The examination board consisted of associate prof. Monica Buhrman, prof. Bo Melin and associate prof. Armita Golkar.

The Rüch lab is certain that there is yet much to come from the brilliant mind of doctor Oskar Flygare!

Sofia Jägholm talks about hoarding on TV4 Nyhetsmorgon

Sofia Jägholm participated in TV4 Nyhetsmorgon, Swedish morning news and talk show, and talked about the on-going recruitment to the Joining Forces randomized controlled trial.

The study aims to determine the clinical efficacy of in-home decluttering (delivered by a team from a social service unit) augmentation of group CBT for reducing hoarding severity in adults with hoarding disorder. 

Participants will receive protocol-driven group CBT for HD for 12 weeks. After group CBT, participants are immediately randomized to one of two trial arms. In the experimental arm, participants receive 10 weeks of in-home decluttering. In the waitlist arm, participants receive no intervention but fill out questionnaires with identical procedures as in the intervention group. 

Hoarding disorder is a mental disorder on the OCD-spectrum. It is characterized by significant difficulties of discarding or parting with possessions and strong urges to save and often also strong desires to acquire items. Together, these symptoms result in the accumulation of large amounts of items that are kept in a disorganized manner at home, to the degree that normal use of the space is difficult, causing significant impairment in function. 

Click here to watch the clip online at tv4play (in Swedish).

Är du intresserad av att delta i studien och bor i Stockholms kommun? Läs vidare och anmäl intresse här.

Maria Bragesjö new grant and expert in Red Cross committee

Maria Bragesjö has been appointed one of the experts in the Red Cross University advisory committee, a committee with the mission to contribute with external monitoring, expertis and a critical eye at the Red Cross research projects.

She also just received 350 000 kr from Region Stockholm Innovation fund for the development of an internet-delivered CBT treatment for PTSD.

About the project
The overall purpose is to increase accessibility to evidence based treatment for PTSD. The current project is a pilot study is planned to contain n=35 to evaluate the feasibility, acceptability, safety and preliminary treatment effects of the intervention.

There is prejudice that internet-mediated treatment would not be possible to give traumatized individuals, but there is research that it is a safe and effective way to give treatment. In earlier research, Maria and others have shown that this type of intervention is effective and acceptable for newly traumatized patients. In the current study, this intervention has developed to fit patients with PTSD.

If the treatment proves to be effective and acceptable, it would increase the health care’s ability to offer evidence treatment to a large group of patients that today are missing out.

Photo: Micke Sandström

Maria is a Lic. psychologist, PhD, Lic. psychotherapist and a Specialist in clinical psychology. Her research focuses on trauma and PTSD, specifically on early interventions for potentially traumatic events and different ways to effectively treat PTSD and complex PTSD.

Review and debate on exhaustion disorder

Recently, a number of members of the research group together with colleagues from the Stress Research Institute at Stockholm University, published a scoping review on exhaustion disorder where they gathered all empirical studies of exhaustion disorder. The review showed that the existing state of knowledge is scarce and the authors concluded that more research is needed to build a solid knowledge base for exhaustion disorder.

Today, May 13th, the authors also debated the subject in Dagens Nyheter “The exhausted must have access to the right care” (in Swedish), highlighting the fact that new criteria are being developed without first being scientifically evaluated, arguing that there is a great risk for unsafe care and unneccesary suffering for the patients.

The authors are Elin Lindsäter, Frank Svärdman, John Wallert, Ekaterina Ivanova, Anna Söderholm, Robin Fondberg, Gustav Nilsonne, Simon Cervenka, Mats Lekander and Christian Rück. They are affiliated to Karolinska Institutet, Stress Research Institute at Stockholm University and the new in-formal research network Stockholm Stress Collaborative.

Click here for the review Exhaustion Disorder: A Scoping Review of Research on a Recently Introduced Stress.

Click here for the debate article.

Elin Lindsäter i podden Medicinvetarna

Elin Lindsäter medverkar i senaste avsnittet av Karolinska Institutets podcast Medicinvetarna på tema Utmattningssyndrom: Vad vet vi idag?

Podcasten handlar om utmattningssyndrom, en diagnos som har fortsatt att öka. Elin talar om dess utmaningar, dels när det kommer till den diagnostiska gränssättningen mellan utmattning och depression, och dels att det saknas vetenskapligt underlag för att rekommendera olika behandlingar.

– De här patienterna lider och behöver hjälp. Men idag saknas underlaget för att veta hur vi bäst kan hjälpa dem, säger Elin Lindsäter.

Avsnittet hittar du i din podd-app eller genom att klicka här.

Photo: Micke Sandström

English translation: Elin Lindsäter talks about the Swedish diagnosis utmattningssyndrom (exhaustion disorder) and its challenges in diagnostics and treatment, in the latest episode of Karolinska Institutets podcast Medicinvetarna (in Swedish).

Genetics in patients with severe treatment refractory OCD – Grant to Long Chen

Research group member Long Chen recently received a grant from the Bror Gadelius memorial fund for his project about genetics in patients with severe treatment refractory obsessive-compulsive disorder (OCD).

The purpose of the study is to accurately map unusual genetic variations in patients with severe treatment refractory OCD. This will be executed by using whole exome sequencing, a method where the protein-coding parts of the gene (the exome) is sequenced. The aim is also to study wether unusual genetic variations have any predictive value for treatment outcomes after deep brain stimulation (DBS), a method that has been shown to benefit patients that are not helped by the current evidence-based medical and psychotherapeutic treatment methods.