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This thesis investigates how clinical perspectives grounded in Acceptance and Commitment Therapy (ACT) can shed light upon sport psychological issues on an individual level and how these issues may be addressed to enhance the performance of elite athletes. In the thesis it is asked 1) what Acceptance and Commitment Therapy is, and what scientific theoretical philosophies it assumes, 2) which psychological issues are particularly relevant to negatively impact individual sports performances, and 3) what aspects and methods of Acceptance and Commitment Therapy are particularly relevant for a performance-oriented practice in individual sport psychological work. The thesis uses a qualitative approach consisting of three case studies of elite athletes from martial arts, cycling and dressage riding. These case studies are presented as case examples with the purpose of illuminating and exemplifying hypotheses, assumptions and postulations presented throughout the thesis. ACT is a practice-oriented theoretical framework based on functional contextualism which seeks to promote psychological flexibility within the client. It is a psychology of the normal rather than of syndromes. ACT takes a pragmatic and ideographic approach and is characterized by using whatever methods that works best as well as being flexible in the development, selection, and adaption of therapeutic methods for the individual client. Through the case examples a sample of psychological issues are highlighted. These involve giving up, sports related anxiety, fixating on negative aspects of the athlete’s own performance, and intense nervousness. The focal point of therapeutic methods in relation to ACT in the thesis is the six therapeutic core processes of ACT. These consist of acceptance, cognitive defusion, self-as-context, present moment, commitment, and values. Through these processes it is assumed that psychological flexibility of the athletes is promoted. It is found that the concept of the six therape

Background: Social anxiety disorder (SAD) is common in youths. However, our understanding of SAD in children is inferior to that of SAD in adolescents or adults, and it is unclear if known adult SAD maintenance mechanisms may also operate in children with SAD. Aim: The paper sets out to investigate the specificity of positive automatic thoughts, social threat negative automatic thoughts, repetitive negative thinking, positive and negative metacognitions in predicting SAD symptoms and diagnoses in clinically anxious children. Method: We enrolled 122 clinically anxious children aged 7-13 years; of these, 33 had an SAD diagnosis. Results: SAD symptoms correlated positively with social threat negative automatic thoughts, repetitive negative thinking, and negative metacognitions, and negatively with positive automatic thoughts. Linear regression indicated that, of these variables, only social threat negative automatic thoughts predicted social anxiety symptoms. Logistic regression indicated that social threat negative automatic thoughts, a higher number of diagnoses and negative metacognitive beliefs specifically predicted the presence of SAD diagnosis. Conclusions: Our findings suggest that content-specific social threat negative automatic thoughts was the only variable that specifically distinguished both higher levels of social anxiety symptoms and diagnoses.

Theory and preliminary evidence suggests that parental beliefs and cognitions may be transmitted to their offspring. Transmission of maladaptive cognitions may play a role in the development of anxiety disorders in childhood. However, few studies have investigated such transmission using longitudinal designs. The objective of this study was to investigate the interaction between maternal and child metacognitions and their role in the development of childhood anxiety. We used a longitudinal design with self-report measures of maternal and child anxiety symptoms and metacognitions. Participants were 107 mothers and their children who were assessed when the children were between 7 and 12 years old and again 3 years later. Child metacognitions at baseline did not predict later child anxiety symptoms. Baseline maternal metacognitions approached significance in predicting anxiety symptoms in children at the follow-up, when controlling for known risk factors, including female gender and higher levels of anxiety in mother and child at baseline. Mediation analyses revealed that child metacognitions at baseline, as well as at follow-up fully mediated the relationship between maternal baseline metacognitions and child anxiety 3 years later. Examinations of how child and maternal metacognitions affect child anxiety levels after three years revealed that current levels of child metacognitions play a greater role in predicting child anxiety than child and maternal metacognitions at baseline.

Although cognitive behavioral therapy (CBT) is effective for childhood anxiety disorders, approximately 40% of youth remain anxious after treatment. Metacognitive therapy (MCT-c) for children with generalized anxiety disorder (GAD) has shown promising effects. The present study aimed to examine if CBT and MCT-c show differential effects in children with primary GAD based on baseline characteristics, in a quasi-experimental design. To investigate which treatment is most beneficial for whom, three potential moderators: age, symptom severity, and comorbid social anxiety were examined. Sixty-three children aged 7–14 completed CBT or MCT-c. Participants were assessed before and after treatment. Both CBT and MCT-c were highly effective in treatment of childhood GAD. None of the selected variables significantly moderated treatment outcomes. Subgroups of children with high symptom severity and social anxiety comorbidity showed trends of responding better to CBT. Methodologically stronger studies are needed to facilitate a better adaptation of treatment for children with GAD.

Objectives: Our study investigated the association between parental behaviour and anxiety in children and adolescents in a longitudinal 3-year follow-up design. Our study supplements widely used self-reports on parental behaviour with observations of the parent-child interactions. Methods: A community sample of 101 children and their mothers were included in the study. We hypothesized that anxiety symptoms in the child and mother at intake would influence levels of anxiety in the child at three-year follow-up. We also hypothesized that negative maternal behaviour both self-reported and observed would provide a unique variance in predicting increased levels of anxiety symptoms in the child after three years above and beyond child and maternal levels of anxiety symptoms at intake. Results: We found that children's anxiety symptom levels at intake, as well as female gender were significant and the most important contributors to the development of higher levels of anxiety symptoms at follow-up. Furthermore, observed maternal tension at intake significantly predicted child's anxiety levels at follow-up. Conclusion: Although maternal tension also significantly predicted higher levels of anxiety symptoms, the maternal variables were of less importance than child anxiety level at intake and female gender in predicting anxiety levels at follow-up.

Cognitive Behavior Therapy (CBT) is an effective treatment for child anxiety. However, access to treatment is limited. It has been suggested that low-intensity formats of parent-delivered CBT may improve access to treatment. Our aim was to develop and pilot-test the acceptability and effect of a low-intensity therapist-guided parent-delivered group program for anxious children (age 7–12 years) adjusted to the Scandinavian culture. The program required 1.5 hours of therapist-time per family. Mothers, fathers and children reported on revised child anxiety and depression scale (RCADS) at referral, pre- and post-treatment. Mothers and fathers also gave a qualitative account of their experiences. Thirty-one families were enrolled and only one family dropped out. Mean age of the children was 9 years. Intent-to-treat analyses revealed significant reductions in anxiety and depressive symptoms from pre- to post-treatment for all informants. Large effect sizes were found for child anxiety symptoms as reported by mothers and fathers, and for child depressive symptoms as reported by mothers. Medium to large effect sizes was found for the self-reported anxiety symptoms by the children, and for depressive symptoms reported by both children and fathers. More than 93% of the parents would recommend the program. Results suggest that our program may provide a new approach to improve access to treatment for anxious children in Scandinavia; however, further research must be conducted before firm conclusions can be drawn.