| 1. |
- Almén, Niclas, 1971-
(författare)
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Intervening Stress Recovery Behaviors in Everyday Life
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background. High levels of perceived stress and stress-related ill health, such as burnout, are common in many countries. Several theories postulate that stress behaviors promote adaption to environmental changes and if sustained they are potentially harmful for the body. In accordance, impaired stress recovery behaviors, i.e., psychophysiological deactivation after periods of stress behaviors, have been suggested to be a critical factor in explaining stress-related ill health. Whereas research shows that interventions targeting stress reactivity can have beneficial effects on stress-related variables, studies on interventions targeting stress recovery are surprisingly few. Also, the number of validated instruments for measuring behaviors important for stress recovery are few, in particular easily used self-rating scales. Aims. The primary aim of the thesis was to evaluate stress and health-related effects of an intervention targeting stress recovery behaviors in everyday life among people perceiving high levels of stress in life. A secondary aim was to validate a self-report scale measuring behaviors important for stress recovery in everyday life. Method. Three empirical studies were conducted to evaluate effects of the behavioral stress recovery intervention “balance in everyday life”, which solely aims at strengthening stress recovery behaviors in everyday life. First, a brief version of the intervention was investigated through a small pilot study in which a single-subject experimental design was used (study 1). After that, the intervention was exploratively tested in a group format in which a quasi-experimental design was used (study 2). Due to the positive results of these two studies, a larger scale study using a randomized controlled design was conducted in order to further investigate the effects of the intervention when delivered in a group format (study 3). To fulfill the secondary aim of the thesis, the Recovery Experience Questionnaire was translated into Swedish and analyzed using exploratory factor analysis and confirmatory factor analysis (study 4). Results. In study 1, data demonstrated immediate reduction of stress symptoms as a function of the intervention. The improvements were maintained at 1-year and 5-year follow-up assessments. In study 2, in comparison with a waiting-list-control group, the intervention yielded statistically significant improvements between pre- and postintervention assessment on eleven out of twelve stress and health-related variables. Medium to large between-groups effect sizes were demonstrated for the primary outcome measures covering (potential) recovery behaviors, perceived stress and rest and experiences of being recovered. In the third study, statistically significant improvements for all outcome measures at postintervention assessment and at the 3-month follow-up were demonstrated. The between-groups effect sizes for the primary measures - perceived stress, tension, and burnout - were medium-to-high at postintervention assessment and at follow-up. In addition, in all studies the intervention was associated with beneficial changes in levels of anxiety and depression. In the last study, support was found for the proposed four-factor structure of the Swedish version of the Recovery Experience Questionnaire. Conclusions. The results clearly indicate that the intervention “balance in everyday life” improves stress and health-related factors in a relatively satisfactory way among people perceiving high levels of stress in life. The empirical support is strongest for the reduction in tension, perceived stress, burnout, anxiety and depression, and to deliver the intervention in a group format. The studies demonstrated results that warrant further investigation of the effects of “balance in everyday life”, for example in different contexts, and to study other behavioral recovery interventions. To test (potential) recovery facilitating behaviors as mediators of intervention effects, such as reduction in burnout, the Swedish version of the Recovery Experience Questionnaire could be used.
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| 2. |
- Ejeby, Kersti, et al.
(författare)
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Randomized controlled trial of transdiagnostic group treatments for primary care patients with common mental disorders
- 2014
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Ingår i: Family Practice. - : Oxford University Press (OUP). - 0263-2136 .- 1460-2229. ; 31:3, s. 273-280
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Tidskriftsartikel (refereegranskat)abstract
- Background. The purpose was to test the effectiveness of two transdiagnostic group interventions compared to care as usual (CAU) for patients with anxiety, depressive or stress-related disorders within a primary health care context. Objectives. To compare the effects of cognitive-based-behavioural therapy (CBT) and multimodal intervention (MMI) on the quality of life and relief of psychological symptoms of patients with common mental disorders or problems attending primary health care centre. Methods. Patients (n = 278), aged 18-65 years, were referred to the study by the GPs and 245 were randomized to CAU or one of two group interventions in addition to CAU: (i) group CBT administered by psychologists and (ii) group MMI administered by assistant nurses. The primary outcome measure was the Mental Component Summary score of short form 36. Secondary outcome measures were Perceived Stress Scale and Self-Rating Scale for Affective Syndromes. The data were analysed using intention-to-treat with a linear mixed model. Results. On the primary outcome measure, the mean improvement based on mixed model analyses across post-and follow-up assessment was significantly larger for the MMI group than for the CBT (4.0; P = 0.020) and CAU (7.5; P = .001) groups. Participants receiving CBT were significantly more improved than those in the CAU group. On four of the secondary outcome measures, the MMI group was significantly more improved than the CBT and CAU groups. The course of improvement did not differ between the CBT group and the CAU group on these measures. Conclusions. Transdiagnostic group treatment can be effective for patients with common mental disorders when delivered in a primary care setting. The group format and transdiagnostic approach fit well with the requirements of primary care.
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| 3. |
- Ejeby, Kersti, et al.
(författare)
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Symptom reduction due to psychosocial interventions is not accompanied by a reduction in sick leave : Results from a randomized controlled trial in primary care
- 2014
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 32:2, s. 67-72
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To investigate whether interventions that have positive effects on psychological symptoms and quality of life compared with usual care would also reduce days on sick leave. Design. A randomized controlled trial. Setting. A large primary health care centre in Stockholm, Sweden. Intervention. Patients with common mental disorders were recruited by their GPs and randomized into one of two group interventions that took place in addition to usual care. These group interventions were: (a) group cognitive behavioural therapy (CBT), and (b) group multimodal intervention (MMI). Both types of intervention had previously shown significant effects on quality of life, and MMI had also shown significant effects on psychological symptoms. Patients. Of the 245 randomized patients, 164 were employed and had taken sick leave periods of at least two weeks in length during the study period of two years. They comprised the study group. Main outcome measures. The odds, compared with usual care, for being sick-listed at different times relative to the date of randomization. Results. The mean number of days on sick leave increased steadily in the two years before randomization and decreased in the two years afterwards, showing the same pattern for all three groups. The CBT and MMI interventions did not show the expected lower odds for sick-listing compared with usual care during the two-year follow-up. Conclusion. Reduction in psychological symptoms and increased well-being did not seem to be enough to reduce sickness absence for patients with common mental problems in primary care. The possibility of adding workplace-oriented interventions is discussed.
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| 4. |
- Jansson, Billy, 0063-
(författare)
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Does the way in which we perceive the world make us susceptible to anxiety?
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- One major focus of anxiety research in recent years has been the identification of cognitive factors that promote increased vulnerability to anxiety. Cognitive formulations propose that anxiety is characterised by an increased tendency to attend to negatively valenced emotional information, and that this bias may play a causal role in the development and maintenance of clinical anxiety. Evidence suggests that this anxiety-linked processing bias occurs even in conditions in which the stimuli are masked in order to prevent awareness of the content (i.e., preattentive bias). The present thesis focused principally on the preferential processing of threat-related information that occurs outside awareness. Two different outcome measures were used to index preferential preattentive processing of threat-related information in non-clinical populations: The emotional Stroop task was used to index selective attention to masked presentation of threatening word stimuli, whereas skin conductance responses were used to index selective autonomic responses to masked presentation of threatening pictorial stimuli. The empirical studies in the present thesis showed that elevated levels of trait anxiety promote preferential preattentive processing of negatively valenced information, whereas elevated levels of social desirability (interpreted as defensiveness) generally prevent preferential preattentive processing of negatively valenced information, especially among those at higher levels of trait anxiety, irrespective of outcome measure used. Moreover, previous research has demonstrated that a person’s most common emotional reaction when encountering a stressful event is causally influenced by that person’s habitual tendency to selectively encode the most threatening aspects of all available information. Thus, preattentive bias (as measured with the emotional Stroop task) was used to predict the emotional responses (as seen on self-reported emotional distress and autonomic reactivity) following exposure to a laboratory stressor. This study showed that preattentive bias to negative information had significant effects on both self-reported and physiological measures in response to a laboratory stressor, but in diametrically opposite directions. Specifically, whereas preattentive bias was positively associated with self-reported negative emotional response, it was negatively associated with a physiological indicator of emotional response. The results were discussed in terms of an inability to automatically inhibit the processing of threatening cues, which seems to be a vulnerability marker for anxiety. Whether this bias is ultimately sufficient for the development of clinical anxiety remains to be examined in future research. Additionally, more information is needed before it can be established that the emotional Stroop task can be viewed as a reliable diagnostic tool for determining an individual’s anxiety status.
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| 5. |
- Lundh, Lars-Gunnar, et al.
(författare)
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Sömnstörningar
- 2006
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Ingår i: Kognitiv beteendeterapi inom psykiatrin. - 912710947X ; , s. 195-210
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- I kapitlet beskrivs kognitiva och beteendeinriktade behandlingsmetoder vid sömnstörningar, i första hand insomni. En översikt ges av diagnos och analys utifrån en KBT-modell. Beteendeanalys med hjälp av intervju, sömndagbok och självskattningsskalor beskrivs. En sammanfattning görs av vanliga behandlingsmetoder som avslappningsmetoder, paradoxal intention, stimuluskontroll, sömnrestriktion och kognitiva metoder. Även andra typer av sömnstörningar (sömnapné, narkolepsi, parasomnier och dygnsrytmstörningar) berörs kort.
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| 6. |
- Lundh, Lars-Gunnar, et al.
(författare)
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Sömnstörningar
- 2013
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Ingår i: KBT inom psykiatrin. - 9789127135604 ; 2 rev. & utökade utgåvan, s. 265-282
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Bokkapitel (refereegranskat)
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| 7. |
- Saboonchi, Fredrik, et al.
(författare)
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Perfectionism and self-consciousness in social phobia and panic disorder with agoraphobia
- 1999
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Ingår i: Behaviour Research and Therapy. - 0005-7967 .- 1873-622X. ; 37:9, s. 799-808
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Tidskriftsartikel (refereegranskat)abstract
- Social phobics were compared to patients with panic disorder with agoraphobia and normal controls on perfectionism and self-consciousness. On concern over mistakes and doubts about action, social phobics scored higher than patients with panic disorder. Social phobics also demonstrated a higher level of public self-consciousness than patients with panic disorder and when this difference was controlled for the significant differences on perfectionism disappeared. Within each patient group, however, perfectionism was more robustly related to social anxiety than was public self-consciousness, which replicates the findings of Saboonchi and Lundh [Saboonchi, F. & Lundh, L. G. (1997). Perfectionism, self-consciousness and anxiety. Personality and Individual Differences, 22, 921–928.] from a non-clinical sample. The results are discussed in terms of public self-consciousness being a differentiating characteristic of the more severe kind of social anxiety which is typical of social phobia.
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| 8. |
- Santoft, Fredrik, et al.
(författare)
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Mediators of Change in Cognitive Behavior Therapy for Clinical Burnout
- 2019
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Ingår i: Behavior Therapy. - : Elsevier BV. - 0005-7894 .- 1878-1888. ; 50:3, s. 475-488
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Tidskriftsartikel (refereegranskat)abstract
- Evidence supporting the effectiveness of cognitive behavior therapy (CBT) for stress-related illness is growing, but little is known about its mechanisms of change. The aim of this study was to investigate potential mediators of CBT for severe stress in form of clinical burnout, using an active psychological treatment as comparator. We used linear mixed models to analyze data from patients (N = 82) with clinical burnout who received either CBT or another psychological treatment in a randomized controlled trial. Potential mediators (i.e., sleep quality, behavioral activation, perceived competence, and therapeutic alliance) and outcome (i.e., symptoms of burnout) were assessed weekly during treatment. The results showed that the positive treatment effects on symptoms of burnout favoring CBT (estimated between-group d = 0.93) were mediated by improvements in sleep quality, ab = -0.017,95% CIasymmetric [-0.037, -0.002], and increase in perceived competence, ab = -0.037, 95% CIasymmetric [-0.070, -0.010]. Behavioral activation, ab = -0.004 [-0.016, 0.007], and therapeutic alliance, ab = 0.002 [-0.006, 0.011], did not significantly mediate the difference in effects between the treatments. Improving sleep quality and increasing perceived competence may thus constitute important process goals in order to attain symptom reduction in CBT for clinical burnout.
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| 9. |
- Santoft, Fredrik, et al.
(författare)
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Processes in cognitive behavior therapy for social anxiety disorder : Predicting subsequent symptom change
- 2019
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Ingår i: Journal of Anxiety Disorders. - : Elsevier BV. - 0887-6185 .- 1873-7897. ; 67
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Tidskriftsartikel (refereegranskat)abstract
- Although cognitive behavior therapy (CBT) is an effective treatment for social anxiety disorder, little is known about the processes during treatment that bring about change. The aim of this study was to investigate whether the proposed processes of change according to the cognitive model of social anxiety disorder predicted subsequent symptom reduction in CBT delivered as therapist-guided bibliotherapy. We analyzed data from patients with social anxiety disorder (N = 61) who participated in an effectiveness trial of CBT in primary care. Seven putative processes and outcome (i.e., social anxiety) were assessed on a weekly basis throughout treatment. We used linear mixed models to analyze within-person relations between processes and outcome. The results showed a unidirectional effect of reduced avoidance on subsequent decrease in social anxiety. Further, we found support for reciprocal influences between four of the proposed processes (i.e., estimated probability and cost of adverse outcome, self-focused attention, and safety behaviors) and social anxiety. The remaining two processes, (i.e., anticipatory and post-event processing) did not predict subsequent social anxiety, but were predicted by prior symptom reduction. The findings support that several of the change processes according to the cognitive model of social anxiety disorder are involved in symptom improvement.
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| 10. |
- Agdal, Maren Lillehaug, et al.
(författare)
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Quality-of-life before and after cognitive behavioral therapy (CBT) in patients with intra-oral injection phobia
- 2012
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Ingår i: Acta Odontologica Scandinavica. - : Informa UK Limited. - 0001-6357 .- 1502-3850. ; 70:6, s. 463-470
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To evaluate quality-of-life (QoL), before and after cognitive behavioral therapy (CBT) in patients diagnosed with intra-oral injection phobia according to DSM-IV and to compare with the general population. This study also aimed to evaluate if QoL was associated with self-reported injection anxiety, dental anxiety, time since last dental treatment and oral health. Materials and methods. Subjects were 55 patients (mean age 35.5 +/- 12.2, 78.2% women) who participated in a treatment study in which 89% managed an intra-oral injection at 1 year follow-up. The patients completed a set of questionnaires including Quality of Life Inventory (QOLI), Injection Phobia Scale-Anxiety, Dental Anxiety Scale and a single-item question assessing self-perceived oral health. Objective measures of oral health and treatment needs were based on clinical examination. QOLI-scores from a non-clinical sample were used for comparison. Results. Before treatment the general and health specific QoL were lower among intra-oral injection phobics than in the non-clinical sample. At 1 year follow-up the QoL in general had improved significantly and was similar to that of the non-clinical sample. Poor self-reported oral health and long-term avoidance of dental treatment were associated with lower general and health-specific QoL. Self-reported injection anxiety and dental anxiety were not associated with QoL. Conclusions. Patients with intra-oral injection phobia report lower QoL compared with a general population. Phobia treatment seems to increase QoL to normative levels. Self-perceived poor oral health is associated with reduced QoL in these patients.
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