| 1. |
- 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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| 2. |
- 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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| 3. |
- Akerstedt, Torbjörn, et al.
(författare)
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Sleep homeostasis during repeated sleep restriction and recovery : support from EEG dynamics.
- 2009
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Ingår i: Sleep. - : Oxford University Press (OUP). - 0161-8105 .- 1550-9109. ; 32:2, s. 217-22
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Tidskriftsartikel (refereegranskat)abstract
- STUDY OBJECTIVES: Sleep reduction normally causes a homeostatic response during subsequent recovery sleep, but this does not seem to be true for repeated partial sleep loss. The aim of the present study was to test the response to repeated partial sleep loss through detailed focus on spectral data and parts of sleep. DESIGN: The experiment involved 4 h of sleep across 5 days in the laboratory (partial sleep deprivation [PSD]), followed by 3 days of recovery sleep. PSD was achieved through a delayed bedtime. Nine individuals participated. To avoid "laboratory monotony," subjects were permitted to leave the lab for a few hours each day. MEASUREMENTS AND RESULTS: All sleep stages and the latencies to sleep and slow wave sleep (SWS) showed a significant reduction during PSD. However, SWS and TST (total sleep time) during the first half of sleep increased gradually across days with PSD. During the first recovery sleep, SWS was significantly increased, while stage 1 and latency to stage 3 were reduced. All were back to baseline on the second night of recovery sleep. Summed spectral power during the first 3.8 h of sleep showed a gradual and robust increase (50% above baseline) in the range 1.25-7.25 Hz across days with PSD up to first recovery sleep and then returned to baseline. CONCLUSIONS: SWS and summed power density in a broad low-frequency band respond to repeated partial sleep deprivation in a dose-response fashion during the first 4 h sleep, apparently reflecting a robust and stable homeostatic response to sleep loss.
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| 4. |
- Andreasson, Anna, et al.
(författare)
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Brief report : Contemplate your symptoms and re-evaluate your health. A study on working adults
- 2019
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Ingår i: Journal of Health Psychology. - : SAGE Publications. - 1359-1053 .- 1461-7277. ; 24:11, s. 1562-1567
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Tidskriftsartikel (refereegranskat)abstract
- We investigated whether self-ratings of health are affected by a symptom rating. A diary including a one-item self-rating of health ("pre-self-rated health"; 1 = excellent, 7 = very poor), a subsequent 26-item rating of symptoms, and thereafter a second (identical) health rating ("post-self-rated health") was completed by 820 persons 21 times. Self-rated health worsened significantly ( p < .0001) after the symptom rating, from 2.72 pre-self-rated health (95% confidence interval: 2.70-2.74) to 2.77 post-self-rated health (95% confidence interval: 2.75-2.79) and more so in persons who reported more symptoms ( b = .058, p < .05). The results support the notion that subjective health perception is influenced by attending to symptoms, especially so in persons with a high symptom burden.
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| 5. |
- Andreasson, Anna N., et al.
(författare)
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Contemplate your symptoms and re-evaluate your health
- 2015
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Ingår i: Brain, behavior, and immunity. - : Elsevier BV. - 0889-1591 .- 1090-2139. ; 49, s. e38-e39
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Tidskriftsartikel (refereegranskat)abstract
- Bodily signals and how these are interpreted affect self-ratings of health. It is thus reasonable that appraisals of health are affected by imminent exposures and disease primes. We aimed to investigate whether self-ratings of health are affected by a symptom rating and if changes are substantiated in persons who report more symptoms. We used data from 813 persons who completed a questionnaire daily for 21 consecutive days. The questionnaire included a one-item self-rating of health (“pre-SRH”; 1 = excellent, 7 = very poor), a subsequent 26-item rating of physical and mental symptoms and thereafter a second (identical) self-rating of health (“post-SRH”). Paired t-tests were used to test for differences between pre-SRH and post-SRH. Mixed effect regression models were used to calculate the interaction effect of pre-SRH and symptom score on post-SRH adjusted for gender, age and if the person had been working that day (13545 observations). SRH worsened significantly (p <<.0001) after the symptom rating, from 2.72 pre-SRH (95%CI:−2.70–2.74) to 2.77 post-SRH (95%CI:2.75–2.79). There was a significant interaction between pre-SRH and symptoms on post-SRH so that persons who reported more symptoms changed their post-SRH rating to a higher degree than those who reported fewer symptoms, irrespective of their subjective health status. The results support the notion that subjective health perception is affected by focus of attention, and that the effect depends on level of symptoms.
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| 6. |
- Axelsson, John, et al.
(författare)
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Sleepiness and performance in response to repeated sleep restriction and subsequent recovery during semi-laboratory conditions.
- 2008
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Ingår i: Chronobiol Int. - : Informa UK Limited. - 1525-6073 .- 0742-0528. ; 25:2, s. 297-308
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Tidskriftsartikel (refereegranskat)abstract
- Sleepiness and performance in response to repeated sleep restriction and subsequent recovery during semi-laboratory conditions.Axelsson J, Kecklund G, Akerstedt T, Donofrio P, Lekander M, Ingre M.Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. john.axelsson@ki.seThere is an ongoing debate of how best to measure the effects of sleep loss in a reliable and feasible way, partly because well controlled laboratory studies and field studies have come to different conclusions. The aims of the present study were to investigate both sleepiness and performance in response to long-term sleep restriction and recovery in a semi-laboratory environment, investigate order effects (i.e., whether levels return to baseline) in a study with seven days of recovery, and characterize individual differences in tolerance to restricted sleep. Nine healthy men (age 23-28 yrs) participated in the protocol, which included one habituation day (sleep 23:00-07:00 h), two baseline days (23:00-07:00 h), five days with restricted sleep (03:00-07:00 h), and seven recovery days (23:00-07:00 h). Participants went outdoors at least twice each day. Reaction-time tests were performed at 08:00, 14:00, and 20:00 h each day in the laboratory. Sleepiness was self-rated by the Karolinska Sleepiness Scale (KSS)after each test. The mixed-effect regression models showed that each day of restricted sleep resulted in an increase of sleepiness by 0.64+/- .05 KSS units (a nine-step scale, p < .001), increase of median reaction times of 6.6+/- 1.6 ms ( p = .003), and increase of lapses/test of 0.69 +/- .16 ms ( p < .001). Seven days of recovery allowed participants to return to the baseline for sleepiness and median reaction time, but not for lapses.The individual differences were larger for performance measures than for sleepiness; the between-subject standard deviation for the random intercept was in the magnitude of the effects of 1.1 days of restricted sleep for sleepiness, 6.6 days of restricted sleep for median reaction time, and 3.2 days for lapses. In conclusion, the present study shows that sleepiness is closely related to sleep pressure, while performance measures, to a larger extent, appear determined by specific individual traits. Moreover, it is suggested to measure sleepiness in a standardized situation so as to minimize the influences of contextual factors.
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| 7. |
- Axelsson, John, et al.
(författare)
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Sleepiness as motivation : a potential mechanism for how sleep deprivation affects behavior
- 2020
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Ingår i: Sleep. - : Oxford University Press (OUP). - 0161-8105 .- 1550-9109. ; 43:6
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Tidskriftsartikel (refereegranskat)abstract
- STUDY OBJECTIVES: To determine how sleepiness and sleep deprivation drive the motivation to engage in different behaviors.METHODS: We studied the sleepiness of 123 participants who had been randomized to sleep deprivation or normal sleep, and their willingness to engage in a range of everyday behaviors.RESULTS: Self-reported sleepiness was a strong predictor of the motivation to engage in sleep-preparatory behaviors such as shutting one's eyes (OR=2.78, 95%CI: 2.19-3.52 for each step up on the Karolinska Sleepiness Scale) and resting (OR=3.20, CI: 2.46-4.16). Sleepiness was also related to the desire to be cared for by a loved one (OR=1.49, CI: 1.22-1.82), and preparedness to utilize monetary and energy resources to get to sleep. Conversely, increased sleepiness was associated with a decreased motivation for social and physical activities (e.g., be with friends OR=0.71, CI: 0.61-0.82; exercise OR=0.65, CI: 0.56-0.76). Sleep deprivation had similar effects as sleepiness on these behaviors. Neither sleepiness nor sleep deprivation had strong associations with hunger, thirst, or food preferences.CONCLUSIONS: Our findings indicate that sleepiness is a dynamic motivational drive that promotes sleep-preparatory behaviors and competes with other drives and desired outcomes. Consequently, sleepiness may be a central mechanism by which impaired alertness, e.g., due to insufficient sleep, contributes to poor quality of life and adverse health. We propose that sleepiness helps organize behaviors toward the specific goal of assuring sufficient sleep, in competition with other needs and incentives. A theoretical framework on sleepiness and its behavioral consequences are likely to improve our understanding of several disease mechanisms.
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| 8. |
- Gerhardsson, Andreas, et al.
(författare)
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Emotional working memory in older adults after total sleep deprivation
- 2017
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Ingår i: Sleep Medicine. - : Elsevier BV. - 1389-9457 .- 1878-5506. ; 40:Suppl. 1, s. e110-e110
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Even though the occurrence of sleep problems increases with age, few studies have focused on the cognitive effects of acute sleep deprivation in elderly. Most previous research indicate that, compared to young, older adults show less impairment in e.g. attention after sleep deprivation. However, little is known of whether the same pattern holds for higher cognitive functions. In addition, while old age is usually related to a general decrease in working memory abilities, performance on working memory tasks may differ depending on the emotional valence of the stimuli, where positive stimuli seem to be beneficial for working memory performance in older adults. The aim of the present study was to investigate the effect of sleep deprivation on emotional working memory in older adults using two levels of working memory load.Materials and methods: A healthy sample of 48 old adults (MAge=66.69 years, SDAge=3.44 years) was randomized into a total sleep deprivation group (TSD; n=24) or a sleep control group (SC; n=24). They performed a working memory task (n-back) containing positive, negative and neutral pictures in a low (1-back) and a high (3-back) working memory load condition. Performance was measured as Accuracy (d'), Omissions and Reaction Time (RT).Results: For the d' and Omissions we performed two separate 2x2x3 (sleep, working memory load, valence) repeated measures analyses of variance (rmANOVA). For the RTs, we applied a mixed-effects model. For both d' and RT we found no effect of sleep deprivation (Ps > .05). For valence, we found main effects on both d' (F1,46 = 5.56, P=.005) and RT (F1,95.7 = 4.84, P=.01). d' did not differ for positive and neutral pictures, but was in both cases significantly better than for negative pictures. RTs were significantly faster for positive pictures. However, a working memory load∗valence interaction (F1,95.7 = 4.50, P=.01) further revealed an effect of valence in the low, but not in the high load condition. In the low load condition, RTs were faster for positive than for neutral pictures and faster for neutral than for negative pictures. There was no significant effect of Omissions.Conclusions: Our results showed that emotional working memory performance was not significantly affected by one night of sleep deprivation in older adults, which contrast what we found in a sample of young adults from the same project. In line with previous research, our results indicate a beneficial effect of positive stimuli on working memory in older adults. This effect was present in both groups and most pronounced for reaction times in the condition with a lower cognitive demand. We can conclude that, among older adults, the working memory performance is not impaired by sleep deprivation and that the benefits of positive stimuli on working memory seem intact. These findings contribute to a better understanding of older adults' cognitive functioning after sleep deprivation.
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| 9. |
- Gerhardsson, Andreas, et al.
(författare)
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Positivity Effect and Working Memory Performance Remains Intact in Older Adults After Sleep Deprivation
- 2019
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Ingår i: Frontiers in Psychology. - : Frontiers Media SA. - 1664-1078. ; 10
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Tidskriftsartikel (refereegranskat)abstract
- Background: Older adults perform better in tasks which include positive stimuli, referred to as the positivity effect. However, recent research suggests that the positivity effect could be attenuated when additional challenges such as stress or cognitive demands are introduced. Moreover, it is well established that older adults are relatively resilient to many of the adverse effects of sleep deprivation. Our aim was to investigate if the positivity effect in older adults is affected by one night of total sleep deprivation using an emotional working memory task.Methods: A healthy sample of 48 older adults (60-72 years) was either sleep deprived for one night (n = 24) or had a normal night's sleep (n = 24). They performed an emotional working memory n-back (n = 1 and 3) task containing positive, negative and neutral pictures.Results: Performance in terms of accuracy and reaction times was best for positive stimuli and worst for negative stimuli. This positivity effect was not altered by sleep deprivation. Results also showed that, despite significantly increased sleepiness, there was no effect of sleep deprivation on working memory performance. A working memory load x valence interaction on the reaction times revealed that the beneficial effect of positive stimuli was only present in the 1-back condition.Conclusion: While the positivity effect and general working memory abilities in older adults are intact after one night of sleep deprivation, increased cognitive demand attenuates the positivity effect on working memory speed.
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| 10. |
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