| 1. |
- Bring, Annika, 1967-
(författare)
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A Behavioural Medicine Perspective on Acute Whiplash Associated Disorders : Daily Coping, Prognostic Factors and Tailored Treatment
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to study the daily process of coping, potential prognostic factors for recovery and evaluating an individually tailored behavioural medicine intervention in the acute stage of Whiplash Associated Disorders (WAD). The studies comprised three samples of patients with acute Whiplash Associated Disorders (WAD). All patients were included within the first month after the whiplash occurrence and were recruited from hospital emergency wards in six Swedish communities.Study I and II included 51 participants generating 260 daily coping diaries (WAD-DCA) during seven days in the acute stage of WAD. In Study I daily stressors and primary appraisal were analysed and in Study II patterns between stressors, appraisals, coping strategy profiles, daily activity level and well-being were described. The results showed a large variety of situations that the individuals perceive as stressful, not only pain itself. High self-efficacy was associated with high degree of physical/mental well-being. Threatening stressors and catastrophic thoughts were associated with low degree of physical and mental well-being. In Study III potential prognostic factors for good as well as poor recovery were studied more closely in a mildly affected sample (MIAS) (n=98) from within the first month after the accident up to one year later. Pain-related disability at baseline emerged as the only indicator of prognosis after 12 months in MIAS. Study IV (n=55) was a randomised control study, were current clinical recommendations of standard self-care instructions (SC) for the management of acute WAD was compared to an individually tailored behavioural medicine intervention delivered via Internet or face-to-face. The results showed that SC was not as effective as the behavioural medicine intervention. By early identification of situation-specific factors and potential behavioural (physical, cognitive and affective) determinants of activity performance, it seems possible to tailor a self-management intervention that decreases pain-related disability, fear of movement and catastrophising and increases self-efficacy. The use of innovative methods such as the Internet of distributing treatment interventions showed to be a good alternative to more traditional forms.The results of this thesis uncover new insights in understanding the individual’s specific perspective as applied in a behavioural medicine approach in acute WAD.
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| 2. |
- Eklund, Caroline, 1983-
(författare)
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Development and evaluation of a web application for stress management : Supporting behaviour change in persons with work related stress
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Stress is the most common reason for sick leave in Sweden. Stress can lead to health-related problems such as burnout syndrome, depression, sleep disorders, cardiovascular disease and pain. It is important to handle stress at an early stage before it could lead to health-related problems. The web enables to reach many persons at a low cost. Web-applications have proven to be effective regarding several health-related problems. However, adherence is often low and many of the available stress management-programs have not been based on evidence. The overall aim of the thesis was to develop and evaluate a fully automated, evidence-based web-application for stress management for persons experiencing work related stress. The thesis compiles of four studies. Study I contained the systematic development of the program in three phases. Phase one included the development of the program's theoretical framework and content, and phase two consisted of structuring the content and developing the platform to deliver the content from. The third phase consisted of coding the behaviour change supporting content, validation of the program among experts and testing it with one possible end-user. The result was an interactive web-application tailored to the individual's need for stress management supporting behaviour change in several ways; My Stress Control (MSC). In study I, MSC was also tested regarding how to proceed through the program. The results showed that the participants had trouble to reach the program’s end. In study II the feasibility of the coming RCT study procedure was investigated as well as how feasible MSC, the web-application, was to be applied in a larger study. 14 persons participated in study II. The findings proved the scientific study procedure feasible with minor changes, but some changes were required for the web-application to increase the chance for success in a larger, more costly study. In study III nine of the 14 persons that participated in study II were interviewed. The interviews aimed for a better understanding of how the participants experienced the program to further develop it. One theme was identified: Struggling with what I need when stress management is about me. It described an understanding for that stress management takes time and is complex but that it was difficult to find the time for working with it. In study IV, a randomized controlled trial, MSC was evaluated regarding its effect on stress. One group with access to MSC was compared to a wait-list group. 92 persons participated in study IV. The results showed that there were no significant between- or within group differences on perceived stress. A small effect size of MSC on perceived stress was shown between intervention- and wait-list groups, but adherence to the program was low.These studies support that a web-application based on the evidence within multiple fields may have effect on perceived stress. However, to handle stress on one’s own is complex and the paradox in having one more thing to do when already stressed contribute to a conflict on how to handle the task. How to facilitate adherence to the fully automated program should be further investigated in future studies.
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| 3. |
- Lekander, Mats
(författare)
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Psychosocial factors and immune parameters during cancer chemotherapy
- 1996
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Cancer patients are exposed to side-effects during chemotherapy, such as nausea and vomiting elicited by drug administration, or in anticipation of treatment. Chemotherapy also results in bone marrow suppression. Psychosocial factors including stress relate to immune parameters in humans and learned immune responses to neutral stimuli have been shown in animals. The aim of this research was to examine anticipatory immune reactions, and the relations between psychosocial factors and immune parameters, in patients treated with cyclic combination chemotherapy for breast or ovarian cancer. To assess immune changes in anticipation of cancer treatment, blood samples were collected in 73 patients' homes two days before chemotherapy and compared to samples obtained at the hospital prior to chemotherapy course 3, 4, or 5. The numbers of white blood cells increased significantly between blood sampling at home and at the hospital before infusion. No changes were observed in the female hospital staff serving as controls. Patients were characterized by increased numbers of granulocytes, and decreased numbers of lymphocytes. In percentages, increases were observed in granulocytes, while percentages of lymphocytes and monocytes were lower at the hospital. State anxiety levels did not predict changes in white blood cell counts. When a saline infusion mimicked a course of chemotherapy after completion of ordinary treatment in a sample of fully informed patients, elevated leukocyte counts were observed only in patients with high levels of trait anxiety. The observed effects are consistent with an interpretation in terms of associative learning and anticipatory stress. In 38 breast cancer patients, high social support was associated with significantly higher levels of white blood cells after completed chemotherapy, consonant with the proposition that physical recovery is promoted by social support. Relaxation training has previously been shown to affect health aspects and immune variables in healthy subjects and in cancer patients before chemotherapy. Therefore, 22 ovarian cancer patients were allocated to a relaxation or a control group. The intervention group had significantly higher lymphocyte counts, and a tendency to higher white blood cell counts as compared to the controls. The observed relations are consistent with a concept of neuroendocrine - immune interaction, as reflected in changes in various immune parameters during or after chemotherapy for neoplastic disease.
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| 4. |
- Paul, Elisabeth R., 1991-
(författare)
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Immunological Changes and Brain Function over a Psychotic-Depressive Spectrum
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Psychotic and depressive disorders are severe psychiatric disorders that contribute significantly to the global burden of disease. They are distinct disorders with different symptom profiles according to both the Diagnostic and Statistical Manual and the International Classification of Diseases. However, these disorders share commonalities in various aspects, such as high comorbidity, prevalence of subclinical symptoms, and shared genetics. Furthermore, both disorders have been associated with a dysregulated immune system functioning.In this thesis, we aimed to identify common biological dimensions of both depression and psychosis by first investigating proteins related to immune system activation in depression and psychosis separately, and then identifying biological underpinnings of psychotic-like symptoms in depression.Specifically, we first assessed in major depressive disorder central nervous system levels of metabolites along the kynurenine pathway, a pathway that is regulated by the immune system and implicated in depressive and psychotic disorders (paper I). We found an imbalance between neuroprotective versus neurotoxic metabolites in blood and decreased levels of a neuroprotective metabolite in cerebrospinal fluid of patients with depression.Next, we assessed patterns of proteins implicated in immune-system function that distinguish first episode psychosis and healthy controls (paper II). Results indicate prominent changes in patients compared to controls, partially replicating previous findings and partially highlighting proteins that have not previously been assessed in psychosis.Lastly, we investigated psychotic-like symptoms in patients with major depressive disorder, finding a relation to immune system markers (paper III) and changes in connectivity between brain structures that integrate information about the physical body and autobiographic information into a sense of self (paper IV).In summary, the results from this thesis suggest that both in major depressive disorder and first episode psychosis there might be a dysregulation of the immune system and closely related systems such as the kynurenine pathway. These commonalities could further underlie the prevalence of subclinical psychotic-like symptoms in major depressive disorder. Ultimately, a better understanding of the underlying biological mechanisms of psychiatric disorders and, transdiagnostically, their symptoms will help formulate empiricallyinformed frameworks to guide clinical diagnostic processes and treatments.
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| 5. |
- Schiller, Helena, 1976-
(författare)
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How to work for a good night's sleep
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Stress and sleep problems are common in the working population and cause considerable costs for society. Sleep is the most important part of recovery, and poor sleep has a negative impact on overall functioning, which might have important consequences for both the employee, the employer and society. In order to find strategies to alleviate this contemporary public health concern of stress and poor sleep in the working population, this thesis evaluated interventions performed at the workplace to target these issues.The first intervention is a randomized controlled trial of a 25% work time reduction for full-time workers within the public sector in Sweden. Study I evaluated the impact of work time reduction on subjective sleep quality, sleep duration, sleepiness, perceived stress, and bedtime worries. Assessments included diary data from one week at three occasions over 18 months. Study II investigated time-use patterns through activity reporting sheets used during the work time reduction by evaluating the amount of total workload, paid work, non-paid work and recovery activities. Both studies investigated workdays and days off separately as well as the importance of gender, family status and work situation (only Study II). The second randomized controlled intervention of the thesis is a group cognitive behavioral therapy (CBT) intervention at the workplace targeting sleep disturbances among employees within the retail sector in Sweden (Study III). Data were collected through questionnaires, diaries and objective sleep measurement (actigraphy) over a period of ten days before and after the intervention, as well as at a three-month follow up. The study evaluated the effects of the intervention on sleep and explored the moderating effect of burnout-levels at baseline.In our studies, an economically fully compensated reduction of work hours for full-time workers lead to long-term positive effects on sleep duration and sleep quality, sleepiness and levels of perceived stress. During this work time reduction, the total workload of both paid and non-paid work was reduced and time spent in recovery activities increased. The results indicate that a more balanced relation between effort and recovery was established. The second intervention, which targets the individual through a group CBT-intervention for insomnia at the workplace, was shown to improve insomnia symptoms in daytime workers who did not suffer from concurrent burnout. Such an intervention could support the individual in handling sleep problems and preventing the development of more severe and chronic sleep disorders, as opposed to interventions aimed at making environmental changes at the workplace. However, the CBT-intervention evaluated within this thesis will need to be further developed in order to be beneficial for more groups of employees. The positive effects of these interventions might be beneficial for public health and help improve employee’s life satisfaction, daily functioning and health development.
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| 6. |
- Zetterberg, Hedvig
(författare)
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A Behavioral Medicine Perspective on Pain Disability in a Work Context : Prevention, Assessment, and Tailored Physiotherapy
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Chronic pain (>3 months) is associated with work limitations and sick leave. This thesis aimed to evaluate assessments and interventions targeting work disability for individuals at risk of or with chronic pain. Specific aims for studies I and II were to compare the preventive effects of a brief psychosocial program with an active educational control. Study III aimed to evaluate the construct validity and internal consistency of the Work Ability Index (WAI). Study IV aimed to systematically replicate a behavioral medicine physiotherapy intervention within a return-to-work context and evaluate its effects on an individual level. Methods: Studies I and II were based on a cluster-randomized controlled trial, including 191 employees with reported pain and/or stress-related ill-health and 53 supervisors. Study I reported on the primary outcome of sick leave and secondary health-related outcomes on employees at 6-months follow-up; study II reported on the supervisors’ communication behavior and perceived stress. Study III was a cross-sectional study including 118 patients with chronic pain referred to specialized care. Study IV was a single case experimental design study including five participants with chronic pain on long-term sick leave. Results: In studies I and II, no effects of the brief psychosocial program were found on outcomes on employees or supervisors. In study III, the construct validity and internal consistency of the WAI were supported. In study IV, the physiotherapy protocol was successfully replicated, and the results indicated an effect on task-specific self-efficacy for target activities at work, but not on experience of target activities or work ability.Conclusion: The results highlight the importance of selecting participants for preventive workplace interventions based on their assessed risk profiles for long-term pain disability, and that targeting mainly the supervisors might be insufficient. The WAI appears to be a valid measurement of work ability for patients with chronic pain in specialized care. Accordingly, behavioral medicine physiotherapy can be successfully adapted to work disability needs for patients with chronic pain. Large-scale trials are needed to evaluate its effects on return-to-work. A behavioral medicine perspective on pain disability in a work context motivates a focus on target activities at work, which can be seen to mediate the incorporation of behavioral knowledge in assessments and interventions for individuals with pain.
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