| 1. |
- Hedman, Erik, et al.
(författare)
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Health anxiety in a disease-avoidance framework : Investigation of anxiety, disgust and disease perception in response to sickness cues
- 2016
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Ingår i: Journal of Abnormal Psychology. - : American Psychological Association (APA). - 0021-843X .- 1939-1846. ; 125:7, s. 868-878
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Tidskriftsartikel (refereegranskat)abstract
- Severe health anxiety is characterized by a debilitating fear of somatic illness, and avoidance of disease-related stimuli plays a key role in the maintenance of the disorder. The aim of this study was to investigate severe health anxiety within an evolutionary disease-avoidance framework. We hypothesized that, compared to healthy controls, participants with severe health anxiety would perceive others as sicker, more contagious, and less attractive. We also expected individuals with severe health anxiety to be more prone to avoid interaction with persons who appeared sick, as well as to respond with more health-related worry, more disgust, and more anxiety when confronting such individuals. In addition, this sensitivity was expected to be larger if people showed manifest sickness symptoms. Participants with and without severe health anxiety (N = 224) were exposed to facial photos with a varying degree of apparent sickness. Patients with severe health anxiety, compared to controls, rated apparently healthy people as being less healthy and less attractive. There were significant interaction effects showing that that the increase in disgust, anxiety, perceived contagiousness, and worry over one's own health as a function of how sick the person in the photo appeared, was significantly larger in the clinical sample compared to the healthy control sample (ps < .047). Results from regression analyses using health anxiety as a dimensional predictor also supported our hypotheses. We suggest that disgust and cognitive biases relating to the disease-avoidance model are significant features of severe health anxiety. (PsycINFO Database Record
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| 2. |
- Andersson, Erik, et al.
(författare)
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Internet-Based Extinction Therapy for Worry : A Randomized Controlled Trial
- 2017
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Ingår i: Behavior Therapy. - : ASSOC ADV BEHAVIOR THERAPY. - 0005-7894 .- 1878-1888. ; 48:3, s. 391-402
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Tidskriftsartikel (refereegranskat)abstract
- Worry is a common phenotype in both psychiatric patients and the normal population. Worry can be seen as a covert behavior with primary function to avoid aversive emotional experiences. Our research group has developed a treatment protocol based on an operant model of worry, where we use exposure -based strategies to extinguish the catastrophic worry thoughts. The aim of this study was to test this treatment delivered via the Internet in a large-scale randomized controlled trial. We randomized 140 high-worriers [PSWQ]) to either Internet-based extinction therapy (IbET) or to a waiting-list condition (WL). Results showed that IbET was superior to WL with an overall large between-group effect size of d 1.39 (95% confidence interval [1.04,1.73]) on the PSWQ. In the IbET group, 58% were classified as responders. The corresponding figure for WL participants was 7%. IbET was also superior to the WL on secondary outcome measures of anxiety, depression, meta-cognitions, cognitive avoidance, and quality of life. Overall treatment results were maintained for the IbET group at 4- and 12-month follow-up. The results from this trial are encouraging as they indicate that worry can be targeted with an accessible and novel intervention for worry. Replication trials with active control group are needed.
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| 3. |
- Axelsson, Erland, et al.
(författare)
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Mediators of treatment effect in minimal-contact cognitive behaviour therapy for severe health anxiety : A theory-driven analysis based on a randomised controlled trial
- 2020
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Ingår i: Journal of Anxiety Disorders. - : Elsevier. - 0887-6185 .- 1873-7897. ; 69
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Tidskriftsartikel (refereegranskat)abstract
- Cognitive behaviour therapy (CDT) is efficacious for severe health anxiety, but little is known about mechanisms. We analysed putative mediators of change based on 13 weekly assessments in a randomised controlled trial (N = 132) of exposure-based minimal-contact CBT (guided Internet-delivered CBT, unguided Internet-delivered CBT and bibliotherapy) vs. a waitlist control for severe health anxiety. We hypothesised that the effect of CBT on health anxiety would be mediated by non-reactivity to inner experiences, health anxiety behaviours and perceived competence. We also explored somatosensory amplification. In parallel process growth models, nonreactivity, health anxiety behaviours and perceived competence - but not somatosensory amplification - were influenced by CBT and associated with health anxiety. Random intercepts cross-lagged panel models were used to study within-individual ordering of change. None of the putative mediators systematically predicted subsequent changes in health anxiety. Rather, changes in health anxiety predicted subsequent changes in all putative mediators. In summary, CBT influenced health anxiety behaviours, non-reactivity to inner experiences and perceived competence, and these variables were associated with the outcome. However, their role as mediators was not corroborated because we found no evidence that changes in these variables predicted subsequent changes in health anxiety. We encourage further research into mediators of CBT for health anxiety.
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| 4. |
- Axelsson, Erland, et al.
(författare)
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Psychological treatments for irritable bowel syndrome : a comprehensive systematic review and meta-analysis
- 2023
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Ingår i: Cognitive Behaviour Therapy. - : Routledge. - 1650-6073 .- 1651-2316. ; 52:6, s. 565-584
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Forskningsöversikt (refereegranskat)abstract
- A wide range of psychological treatments have been found to reduce the symptoms of irritable bowel syndrome (IBS) but their relative effects are unclear. In this systematic review and meta-analysis, we determined the effects of psychological treatments for IBS, including subtypes of cognitive behavior therapy, versus attention controls. We searched 11 databases (March 2022) for studies of psychological treatments for IBS, reported in journal articles, books, dissertations, and conference abstracts. The resulting database comprised 9 outcome domains from 118 studies published in 1983–2022. Using data from 62 studies and 6496 participants, we estimated the effect of treatment type on improvement in composite IBS severity using random-effects meta-regression. In comparison with the attention controls, there was a significant added effect of exposure therapy (g = 0.52, 95% CI = 0.17–0.88) and hypnotherapy (g = 0.36, 95% CI = 0.06–0.67) when controlling for the pre- to post-assessment duration. When additional potential confounders were included, exposure therapy but not hypnotherapy retained a significant added effect. Effects were also larger with a longer duration, individual treatment, questionnaire (non-diary) outcomes, and recruitment outside of routine care. Heterogeneity was substantial. Tentatively, exposure therapy appears to be a particularly promising treatment for IBS. More direct comparisons in randomized controlled trials are needed. OSF.io identifier: 5yh9a.
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| 5. |
- Axelsson, Erland
(författare)
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Severe health anxiety : novel approaches to diagnosis and psychological treatment
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: It has long been known that severe health anxiety is a common psychiatric condition associated with significant distress, functional impairment, and societal costs. Nevertheless, challenges remain with regard to the diagnosis and treatment of this disorder. As to diagnostic assessment, a recent shift in diagnostic taxonomy for individuals with severe health anxiety has led to a need for reliable instruments to aid clinicians and researchers in assessing the new diagnoses somatic symptom disorder (SSD) and illness anxiety disorder (IAD). As to treatment, individual face-to-face cognitive behaviour therapy (FTF-CBT) is the most researched and widely recommended treatment for severe health anxiety, but the availability of FTF-CBT is poor. Therapist-guided internet cognitive behaviour therapy (G-ICBT) may improve the scalability of evidence-based treatment, but it is unclear if this treatment could be efficacious and cost-effective also if delivered without a therapist or as book-form bibliotherapy. It is also unclear if the effect of G-ICBT is non-inferior to that of FTF-CBT. Aims: To develop, and evaluate the inter-rater reliability of, a structured diagnostic interview for the assessment of SSD and IAD (Study I). Also, to evaluate the efficacy of three forms of minimal-contact cognitive behaviour therapy for severe health anxiety (Study II) and to investigate their long-term efficacy and cost-effectiveness (Study III). Last, to determine if G-ICBT is non-inferior to FTF-CBT in the treatment of severe health anxiety (Study IV). Methods: The inter-rater reliability of a new structured diagnostic interview for SSD and IAD was estimated based on concordance between the ratings of an interviewer and an independent clinician who listened to recorded interviews (Study I). The effects of different forms of minimal-contact cognitive behaviour therapy for severe health anxiety were also studied in two randomised controlled trials (RCTs). The first RCT (N=132) compared G-ICBT, unguided internet cognitive behaviour therapy (U-ICBT), and cognitive behavioural bibliotherapy (BIB-CBT) to a waiting-list control (WLC) condition. Primary outcome was short-term change in health anxiety, as measured with the 64-item Health Anxiety Inventory (Study II). Among the secondary outcomes of this trial were long-term symptom levels up to 1 year after treatment, and cost-effectiveness as based on the incremental cost-effectiveness ratio (ICER) vs. the WLC (Study III). The second RCT (N=204) compared G-ICBT to FTF-CBT based on a non-inferiority criterion of 2.25 points on the 18-item Short Health Anxiety Inventory (d=0.3), as assessed over the 12-week treatment period (Study IV). Results: The inter-rater reliability of diagnostic decisions regarding SSD and IAD based on the new structured instrument – the Health Preoccupation Diagnostic Interview (HPDI) – was moderate (κ=.59) for clinical trial applicants, perfect (κ not applicable) for healthy controls, and almost perfect (κ=.85) for the pooled sample (Study I). G-ICBT, U-ICBT, and BIB-CBT all produced large waiting-list controlled reductions (d=0.80–1.27) in health anxiety (Study II). These effects were then sustained one year after treatment, and cost-effectiveness was high (waiting-list controlled ICERs=£ -134–416) for all three treatment formats (Study III). In the comparison of G-ICBT to FTF-CBT, the upper limit of the one-sided 95% confidence interval for the difference in change over the 12-week treatment period was 1.98 based on intention-to-treat data, and 2.17 based on per-protocol data. Both estimates were below the non-inferiority margin of 2.25 points, indicating that G-ICBT is not inferior to FTF-CBT in the treatment of severe health anxiety (Study IV). Conclusions: As hypothesised, the inter-rater reliability of SSD and IAD can be satisfactory if diagnoses are based on the HPDI, though the psychometric properties of this instrument need be studied further (Study I). G-ICBT, U-ICBT, and BIB-CBT are efficacious and cost-effective treatments for severe health anxiety, with the potential to greatly increase treatment availability, not least in the primary and medical care context (Studies II and III). Because G-ICBT is not inferior to FTF-CBT (Study IV), G-ICBT may be regarded as a first-line treatment for severe health anxiety, which calls for further implementation of this treatment format in routine care.
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| 6. |
- Hedbom, Hans, et al.
(författare)
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A Comparison of the Security of Windows NT and UNIX
- 1998
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Konferensbidrag (refereegranskat)abstract
- This paper presents a brief comparison of two operating systems, Windows NT and UNIX. The comparison covers two different aspects. First, we compare the main security features of the two operating systems and then we make a comparison of a selection of vulnerabilities most of which we know have been used for making real intrusions. We found that Windows NT has slightly more rigorous security features than standard UNIX but the two systems display similar vulnerabilities. The conclusion is that there are no significant differences in the real level of security between these systems
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| 7. |
- Hedbom, Hans, et al.
(författare)
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Analysis of the Security of Windows NT
- 1998
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Rapport (refereegranskat)abstract
- This paper presents an analysis of the security in Windows NT 4.0, working in both stand-alone and networking mode. The objective of the work was to find out how secure this operating system actually is. A technical overview of the system, and in particular its security features is given. The system security was analyzed and practical intrusion attempts were made in order to verify vulnerabilities or to find new ones. All vulnerabilities are described in detail and classified according to a classification scheme. A comparison to commonly known UNIX weaknesses was made. It revealed generic similarities between the two systems to a surprisingly high degree. Finally a number of recommendations are given. The paper concludes that there are ample opportunities to improve the security of Windows NT. We have reason to believe that it is probably not higher than that of UNIX
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| 8. |
- Hedman, Erik, et al.
(författare)
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Cost effectiveness of internet-based cognitive behaviour therapy and behavioural stress management for severe health anxiety
- 2016
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 6:4
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Internet-delivered exposure-based cognitive behaviour therapy (ICBT) has been shown to be effective in the treatment of severe health anxiety. The health economic effects of the treatment have, however, been insufficiently studied and no prior study has investigated the effect of ICBT compared with an active psychological treatment. The aim of the present study was to investigate the cost effectiveness of ICBT compared with internet-delivered behavioural stress management (IBSM) for adults with severe health anxiety defined as Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) hypochondriasis. ICBT was hypothesised to be the more cost-effective treatment.SETTING: This was a cost-effectiveness study within the context of a randomised controlled trial conducted in a primary care/university setting. Participants from all of Sweden could apply to participate.PARTICIPANTS: Self-referred adults (N=158) with a principal diagnosis of DSM-IV hypochondriasis, of whom 151 (96%) provided baseline and post-treatment data.INTERVENTIONS: ICBT or IBSM for 12 weeks.PRIMARY AND SECONDARY MEASURES: The primary outcome was the Health Anxiety Inventory. The secondary outcome was the EQ-5D. Other secondary measures were used in the main outcome study but were not relevant for the present health economic analysis.RESULTS: Both treatments led to significant reductions in gross total costs, costs of healthcare visits, direct non-medical costs and costs of domestic work cutback (p=0.000-0.035). The incremental cost-effectiveness ratio (ICER) indicated that the cost of one additional case of clinically significant improvement in ICBT compared with IBSM was $2214. The cost-utility ICER, that is, the cost of one additional quality-adjusted life year, was estimated to be $10 000.CONCLUSIONS: ICBT is a cost-effective treatment compared with IBSM and treatment costs are offset by societal net cost reductions in a short time. A cost-benefit analysis speaks for ICBT to play an important role in increasing access to effective treatment for severe health anxiety.TRIAL REGISTRATION NUMBER: NCT01673035; Results.
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| 9. |
- Hedman, Erik, et al.
(författare)
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Exposure-based cognitive-behavioural therapy via the internet and as bibliotherapy for somatic symptom disorder and illness anxiety disorder : randomised controlled trial
- 2016
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Ingår i: British Journal of Psychiatry. - : Royal College of Psychiatrists. - 0007-1250 .- 1472-1465. ; 209:5, s. 407-413
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: In DSM-5 two new diagnoses, somatic symptom disorder (SSD) and illness anxiety disorder (IAD), have replaced DSM-IV hypochondriasis. There are no previous treatment studies for these disorders. Cognitive-behavioural therapy (CBT) delivered as therapist-guided or unguided internet treatment or as unguided bibliotherapy could be used to increase treatment accessibility.AIMS: To investigate the effect of CBT delivered as guided internet treatment (ICBT), unguided internet treatment (U-ICBT) and as unguided bibliotherapy.METHOD: A randomised controlled trial (RCT) where participants (n = 132) with a diagnosis of SSD or IAD were randomised to ICBT, U-ICBT, bibliotherapy or to a control condition on a waiting list (trial registration: Clinicaltrials.gov identifier NCT01966705).RESULTS: Compared with the control condition, all three treatment groups made large and significant improvements on the primary outcome Health Anxiety Inventory (between-group d at post-treatment was 0.80-1.27).CONCLUSIONS: ICBT, U-ICBT and bibliotherapy can be highly effective in the treatment of SSD and IAD. This is the first study showing that these new DSM-5 disorders can be effectively treated.
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| 10. |
- Hedman, Erik, et al.
(författare)
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Health anxiety in obsessive compulsive disorder and obsessive compulsive symptoms in severe health anxiety : An investigation of symptom profiles.
- 2017
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Ingår i: Journal of Anxiety Disorders. - : Elsevier. - 0887-6185 .- 1873-7897. ; 45, s. 80-86
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Tidskriftsartikel (refereegranskat)abstract
- Severe health anxiety (SHA) shares features with obsessive-compulsive disorder (OCD) and in recent years there has been a debate as to whether the two disorders may represent two facets of the same condition. Few studies have however investigated the overlap and differences in symptom profiles between the disorders. The primary aim of the present study was to investigate these aspects using one sample of participants with a principal diagnosis of SHA and one sample of participants with a principal OCD diagnosis. The second aim was to examine differences in improvement trajectories on measures of health anxiety and OCD symptoms in patients with SHA receiving treatment with exposure and response prevention. We compared persons participating in clinical trials with a principal diagnosis of SHA (N=290) to persons with a principal diagnosis of OCD (n=95) on measures of health anxiety, OCD symptoms, and depressive symptoms. A subsample of SHA participants (n=99) received exposure and response prevention (ERP) for SHA over 12 weeks and was assessed at baseline and post-treatment. The results showed large and significant differences between SHA and OCD patients on measures of health anxiety (ds=2.99-3.09) and OCD symptoms (ds=1.64-2.14), while they had equivalent levels of depressive symptoms (d=0.19, 95% CI [-0.04, 0.43]). In the SHA sample 7.6% had comorbid OCD, and in the OCD sample 9.5% had SHA. For participants with a principal diagnosis of SHA, ERP led to large reductions of health anxiety, but effects on OCD symptoms were small to moderate. Among participants with comorbid OCD, effect sizes were large on measures of health anxiety and moderate to large on OCD measures. We conclude that SHA and OCD are separate psychiatric disorders with limited overlap in symptom profiles.
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