| 1. |
- Hallman, David M., et al.
(författare)
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Effects of Heart Rate Variability Biofeedback in Subjects with Stress-Related Chronic Neck Pain : A Pilot Study
- 2011
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Ingår i: Applied Psychophysiology and Biofeedback. - : Springer Science and Business Media LLC. - 1090-0586 .- 1573-3270. ; 36:2, s. 71-80
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Tidskriftsartikel (refereegranskat)abstract
- Recent studies focusing on autonomic nervous system (ANS) dysfunctions, together with theoretical pathophysiological models of musculoskeletal disorders, indicate the involvement of ANS regulation in development and maintenance of chronic muscle pain. Research has demonstrated the effectiveness of heart rate variability (HRV) biofeedback (BF) in increasing HRV and reducing the symptoms of different disorders characterized by ANS aberration. The study investigated the effects of resonance frequency HRV BF on autonomic regulation and perceived health, pain, stress and disability in 24 subjects with stress-related chronic neck-shoulder pain. Twelve subjects participated in 10 weekly sessions of resonant HRV BF and were compared to a control group. Subjective reports and HRV measures during relaxation and in response to a standardized stress protocol were assessed for both groups pre- and post-intervention. Group × time interactions revealed a significantly stronger increase over time in perceived health (SF-36) for the treatment group, including vitality, bodily pain and social functioning. Interactions were also seen for HRV during relaxation and reactivity to stress. The present pilot study indicates improvement in perceived health over a 10 week intervention with HRV-biofeedback in subjects with chronic neck-pain. Increased resting HRV as well as enhanced reactivity to hand grip and cold pressor tests might reflect beneficial effects on ANS regulation, and suggest that this intervention protocol is suitable for a larger controlled trial.
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| 2. |
- Olsson, Erik, 1967-
(författare)
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Heart Rate Variability in Stress-related Fatigue, Adolescent Anxiety and Depression and its Connection to Lifestyle
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Heart rate varies constantly as a consequence of activity in the sympathetic and parasympathetic autonomic nervous systems (SNS and PNS). In short-term recordings, heart rate variability (HRV) is mostly related to the inhibitory activity of the vagal nerves, which are part of the PNS. HRV is lower when under stress as well as in several illnesses and psychiatric conditions. Decreased HRV is also related to cardiac disease, which is the leading cause of death worldwide. Autonomic imbalance, measured as HRV, is suggested as a mediator between psychosocial distress and cardiovascular disease. The aim of the present thesis was to investigate the connection between HRV and psychosocial distress, including psychiatric problems (studies I and II), and lifestyle factors (study III). In study I, additional physiological measures sensitive to autonomic activity and results from a continuous attention test were investigated in parallel with HRV. In studies II and III the participants were adolescents. The results show that HRV is lower in women with stress-related fatigue and adolescent girls with a psychiatric diagnosis compared to healthy control groups. However, these groups did not exhibit an increase in physiological measures of SNS origin, which supports the assumption that the observed hyperarousal is related to decreased vagal activity rather than increased SNS activity. Women with stress-related fatigue made more impulsive errors and had a “risky” response style in the continuous attention test. There was a negative correlation between test performance and HRV. Decreased vagal activity is thus associated with deficient behavioural inhibition. In study III, HRV in a group of healthy adolescent boys and girls was positively associated with physical activity but not with other lifestyle measures. Even at young age HRV is a sensitive marker of autonomic imbalance resulting from psychosocial stress. Future longitudinal research will show whether HRV can be used for early identification of people at risk of cardiovascular disease and whether such interventions will lower the risk of cardiac morbidity.
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| 3. |
- Olsson, Erik M G, et al.
(författare)
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Psychophysiological characteristics of women suffering from stress-related fatigue.
- 2010
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Ingår i: Stress and Health. - : Wiley. - 1532-3005 .- 1532-2998. ; 26:2, s. 113-126
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Tidskriftsartikel (refereegranskat)abstract
- Stress-related fatigue has been attributed to excessive sympathetic nervous system and hypothalamic-pituitary-adrenal (HPA) axis activation, but findings have been equivocal as to whether the HPA axis or the autonomic nervous system (ANS) are affected in this condition and how. Whether task performance deficits are associated with this condition is also uncertain. The present study investigated possible differences between women with stress-related fatigue and healthy women in heart rate variability (HRV) and other autonomic and respiratory measures, task performance and in salivary cortisol response to awakening. Thirty-six women with stress-related fatigue were compared with 19 female healthy controls matched in age. Four indices of HRV and other autonomic and respiratory measures were recorded during baseline, task performance and relaxation phases of a laboratory session. Saliva cortisol was measured four times during the hour after awakening. The fatigued group showed less HRV in three measures, higher temperature, lower O2 saturation at the surface of the finger, lower end-tidal pCO2, and greater cortisol response. This group responded faster on the task but with more errors. Women with stress-related fatigue show signs of hyperarousal on ANS, respiratory and HPA axis measures. The lower HRV may indicate greater cardiovascular risk. Results for task performance confirm subjectively reported deficits.
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| 4. |
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| 5. |
- Wicksell, Rikard, et al.
(författare)
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Avoidance and cognitive fusion – Central components in pain related disability? : Development and preliminary validation of the Psychological Inflexibility in Pain Scale (PIPS)
- 2008
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Ingår i: European Journal of Pain. - : Wiley. - 1090-3801 .- 1532-2149. ; 12:4, s. 491-500
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Tidskriftsartikel (refereegranskat)abstract
- Acceptance of pain and other associated negative private experiences has received increasing attention in recent years. This approach is in stark contrast to the traditional approach of reducing or controlling symptoms of pain. The empirical support for treatments emphasizing exposure and acceptance, such as Acceptance and Commitment Therapy, is growing. However, to date, few instruments exist to assess the core processes in these types of treatments. This study describes the development and preliminary validation of the Psychological Inflexibility in Pain Scale. Principal components analysis (PCA) suggests a 2-factor solution with a total of 16 items measuring avoidance of pain and cognitive fusion with pain. Results also indicate adequate reliability and validity for the scale. Implications of these findings for clinical assessment, as well as for research on pain related disability, are discussed along with suggestions for further research in this area.
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| 6. |
- Wicksell, Rikard, et al.
(författare)
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Can exposure and acceptance strategies improve functioning and life satisfaction in people with chronic pain and whiplash-associated disorders (WAD)? A randomized controlled trial
- 2008
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Ingår i: Cognitive Behaviour Therapy. - : Informa UK Limited. - 1650-6073 .- 1651-2316. ; 37:3, s. 169-182
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Tidskriftsartikel (refereegranskat)abstract
- Although 14% to 42% of people with whiplash injuries end up with chronic debilitating pain, there is still a paucity of empirically supported treatments for this group of patients. In chronic pain management, there is increasing consensus regarding the importance of a behavioural medicine approach to symptoms and disability. Cognitive behaviour therapy has proven to be beneficial in the treatment of chronic pain. An approach that promotes acceptance of, or willingness to experience, pain and other associated negative private events (e.g. fear, anxiety, and fatigue) instead of reducing or controlling symptoms has received increasing attention. Although the empirical support for treatments emphasizing exposure and acceptance (such as acceptance and commitment therapy) is growing, there is clearly a need for more outcome studies, especially randomized controlled trials. In this study, participants (N = 21) with chronic pain and whiplash‐associated disorders were recruited from a patient organization and randomized to either a treatment or a wait‐list control condition. Both groups continued to receive treatment as usual. In the experimental condition, a learning theory framework was applied to the analysis and treatment. The intervention consisted of a 10‐session protocol emphasizing values‐based exposure and acceptance strategies to improve functioning and life satisfaction by increasing the participants' abilities to behave in accordance with values in the presence of interfering pain and distress (psychological flexibility). After treatment, significant differences in favor of the treatment group were seen in pain disability, life satisfaction, fear of movements, depression, and psychological inflexibility. No change for any of the groups was seen in pain intensity. Improvements in the treatment group were maintained at 7‐month follow‐up. The authors discuss implications of these findings and offer suggestions for further research in this area.
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| 7. |
- Wicksell, Rikard K., et al.
(författare)
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Evaluating the effectiveness of exposure and acceptance strategies to improve functioning and quality of life in longstanding pediatric pain : a randomized controlled trial
- 2009
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Ingår i: Pain. - : Ovid Technologies (Wolters Kluwer Health). - 0304-3959 .- 1872-6623. ; 141:3, s. 248-257
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Tidskriftsartikel (refereegranskat)abstract
- Although several studies have illustrated the effectiveness of cognitive behavior therapy (CBT) on adult pain patients, there are few randomized controlled trials on children and adolescents. There is particularly a need for studies on pediatric patients who are severely disabled by longstanding pain syndromes. Acceptance and Commitment Therapy, as an extension of traditional CBT, focuses on improving functioning and quality of life by increasing the patient's ability to act effectively in concordance with personal values also in the presence of pain and distress. Following a pilot study, we sought to evaluate the effectiveness of an ACT-oriented intervention based on exposure and acceptance strategies and to compare this with a multidisciplinary treatment approach including amitriptyline (n=32). The ACT condition underwent a relatively brief treatment protocol of approximately 10 weekly sessions. Assessments were made before and immediately after treatment, as well as at 3.5 and 6.5 months follow-up. Prolonged treatment in the MDT group complicated comparisons between groups at follow-up assessments. Results showed substantial and sustained improvements for the ACT group. When follow-up assessments were included, ACT performed significantly better than MDT on perceived functional ability in relation to pain, pain intensity and to pain-related discomfort (intent-to-treat analyses). At post-treatment, significant differences in favor of the ACT condition were also seen in fear of re/injury or kinesiophobia, pain interference and in quality of life. Thus, results from the present study support previous findings and suggest the effectiveness of this ACT-oriented intervention for pediatric longstanding pain syndromes.
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| 8. |
- Wicksell, Rikard K., et al.
(författare)
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Exposure and acceptance in the rehabilitation of adolescents with idiopathic chronic pain - a pilot study
- 2007
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Ingår i: European Journal of Pain. - : Wiley. - 1090-3801 .- 1532-2149. ; 11:3, s. 267-274
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Tidskriftsartikel (refereegranskat)abstract
- For chronic pain of unclear origin (idiopathic), pharmacological therapy is often insufficient. Psychological treatment strategies have been developed and evaluated for adults with chronic pain. However, few such studies are seen with youths, and to date there is limited empirical evidence regarding the effectiveness of psychological treatment for generalized musculoskeletal pain syndromes in adolescents. Acceptance and commitment therapy (ACT) is a development of cognitive behaviour therapy emphasizing exposure and acceptance. In this pilot study, 14 adolescents referred to the pain treatment service due to chronic debilitating pain were treated using an ACT-based approach. It was hypothesized that avoidance of pain and related stimuli was central to the disability seen among these patients, and that exposure and acceptance strategies could increase functioning and decrease pain. In contrast to emphasizing reductions in pain and distress, the treatment objective was to improve functioning by increasing the patient's ability to act in line with personal values in the presence of negative thoughts, emotions or bodily sensations. Following treatment, and retained at 3- and 6-month follow-up, improvements in functional ability, school attendance, catastrophizing and pain (i.e., intensity and interference) were seen. The outcome of this pilot study indicates that exposure and acceptance can been useful in the rehabilitation of adolescents with chronic debilitating pain. Randomized controlled studies are needed to empirically evaluate the effectiveness of this approach.
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| 9. |
- Wicksell, Rikard K., et al.
(författare)
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The Chronic Pain Acceptance Questionnaire (CPAQ)-further validation including a confirmatory factor analysis and a comparison with the Tampa Scale of Kinesiophobia
- 2009
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Ingår i: European Journal of Pain. - : Wiley. - 1090-3801 .- 1532-2149. ; 13:7, s. 760-768
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Tidskriftsartikel (refereegranskat)abstract
- Acceptance of pain and distress has lately appeared as an important factor in determining peoples' ability to restore functioning in the presence of chronic pain. Although treatments based on cognitive behaviour therapy are beginning to incorporate acceptance strategies, there is still a lack of reliable and valid instruments to assess relevant processes in such interventions. The Chronic Pain Acceptance Questionnaire (CPAQ) was originally constructed as part of the development of an acceptance oriented treatment approach for pain patients. A revised 20-item version of the instrument with two subscales has shown adequate reliability and validity. In the present study, a Swedish translation of CPAQ was evaluated with 611 participants reporting chronic pain and symptoms of whiplash associated disorders. This study sought to further assess the psychometric properties of the instrument and to investigate its relation to another important measure of pain adjustment, the Tampa Scale of Kinesiophobia. Due to low intercorrelations with other items, item 16 was excluded. Exploratory and confirmatory factor analyses supported the previously suggested two-factor solution. Furthermore, the internal consistencies were good for the subscales (activities engagement and pain willingness) as well as the total scale. Hierarchical regression analyses illustrated strong relations with criteria variables (e.g. disability and life satisfaction). In general, the activities engagement subscale contributed more than pain willingness to the prediction of criteria variables. Furthermore, results illustrated that CPAQ explained more variance than the Tampa Scale of Kinesiophobia in pain intensity, disability, life satisfaction, and depression.
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