| 1. |
- Bernstein, Michael H, et al.
(författare)
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Primary care providers’ use of and attitudes towards placebos : An exploratory focus group study with US physicians
- 2020
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Ingår i: British Journal of Health Psychology. - : John Wiley & Sons. - 1359-107X .- 2044-8287. ; 25:3, s. 596-614
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Tidskriftsartikel (refereegranskat)abstract
- Objective To examine how primary care physicians define placebo concepts, use placebos in clinical practice, and view open-label placebos (OLPs).Design Semi-structured focus groups that were audio-recorded and content-coded.Methods Two focus groups with a total of 15 primary care physicians occurred at medical centres in the New England region of the United States. Prior experience using placebo treatments and attitudes towards open-label placebos were explored. Themes were analysed using an inductive data-driven approach.Results Physicians displayed a nuanced understanding of placebos and placebo effects in clinical contexts which sometimes focused on relational factors. Some respondents reported that they prescribed treatments with no known pharmacological effect for certain conditions and symptoms ('impure placebos') and that such prescriptions were more common for pain disorders, functional disorders, and medically unexplained symptoms. Opinions about OLP were mixed: Some viewed OLPs favourably or considered them 'harmless'; however, others strongly rejected OLPs as disrespectful to patients. Other issues in relation to OLPs included the following: lack of guidelines, legal and reputational concerns, and the notion that such treatments would run counter to customary medical practice.Conclusions A number of physicians reported prescribing impure placebos in clinical care. Although some primary care physicians were resistant to the possibility of recommending OLPs, others regarded OLPs more favourably, viewing them as potential treatments, albeit with restricted potential.
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| 2. |
- Druart, Leo, et al.
(författare)
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It’s not my greengrocer, it’s someone from the medical professional : A qualitative study regarding acceptability of deceptive and open-label placebo prescribing in France
- 2023
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Ingår i: British Journal of Health Psychology. - : John Wiley & Sons. - 1359-107X .- 2044-8287. ; 28:2, s. 273-290
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Tidskriftsartikel (refereegranskat)abstract
- ObjectivesTo explore participants' views regarding clinical use of deceptive placebo (DP) and open-label placebo (OLP) treatments.DesignQualitative thematic analysis.MethodsWe conducted eight semi-structured interviews with healthy participants in an experimental trial comparing the efficacy of OLP and DP (Clinical trials n°NCT03934138). Interviewees' opinions were solicited following administration of placebos during the trial. Interviews were analysed using data-driven analysis.ResultsWe identified three themes. First, participants considered trust central in judging a placebo treatment to be acceptable. They expressed the importance of an implicit trust both in their health care professionals' (HCPs') competency as well as in the profession at large. A second theme was the perception of how placebo treatments might solve health problems. Acceptability of both types of placebo treatments was dependent on the perception patients had about the treatment solving their problem and/or doubts regarding the effectiveness of placebos The third theme encompassed perceived risks associated with placebo prescribing. Some comments viewed placebos positively as facilitating reduced medication intake. However, participants also identified the potential of placebos to generate adverse side effects.ConclusionsTreatment acceptability by patients is a pre-requisite, alongside effectiveness, to harness OLPs in clinical care. Our study identified the importance of trust in HCPs prescribing placebos, the clinical effectiveness of placebos and the potential risks of these interventions in assessing their acceptability. Future research is needed to explore the contexts in which placebos might be used, and how best to communicate information about placebo interventions.
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| 3. |
- Flink, Ida K., 1980-, et al.
(författare)
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Understanding catastrophizing from a misdirected problem-solving perspective
- 2012
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Ingår i: British Journal of Health Psychology. - : Wiley-Blackwell. - 1359-107X .- 2044-8287. ; 17:2, s. 408-419
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Tidskriftsartikel (refereegranskat)abstract
- Objectives. The aim is to explore pain catastrophizing from a problem-solving perspective. The links between catastrophizing, problem framing, and problem-solving behaviour are examined through two possible models of mediation as inferred by two contemporary and complementary theoretical models, the misdirected problem solving model (Eccleston & Crombez, 2007) and the fear-anxiety-avoidance model (Asmundson, Norton, & Vlaeyen, 2004).Design. In this prospective study, a general population sample (n= 173) with perceived problems with spinal pain filled out questionnaires twice; catastrophizing and problem framing were assessed on the first occasion and health care seeking (as a proxy for medically oriented problem solving) was assessed 7 months later.Methods. Two different approaches were used to explore whether the data supported any of the proposed models of mediation. First, multiple regressions were used according to traditional recommendations for mediation analyses. Second, a bootstrapping method (n= 1000 bootstrap resamples) was used to explore the significance of the indirect effects in both possible models of mediation.Results. The results verified the concepts included in the misdirected problem solving model. However, the direction of the relations was more in line with the fear-anxiety-avoidance model. More specifically, the mediation analyses provided support for viewing catastrophizing as a mediator of the relation between biomedical problem framing and medically oriented problem-solving behaviour.Conclusion. These findings provide support for viewing catastrophizing from a problem-solving perspective and imply a need to examine and address problem framing and catastrophizing in back pain patients.
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| 4. |
- Flink, Ida, 1980-, et al.
(författare)
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Responding to social cues : An experimental paradigm exploring the link between context sensitivity and pain
- 2019
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Ingår i: British Journal of Health Psychology. - : Wiley-Blackwell. - 1359-107X .- 2044-8287. ; 24:2, s. 443-459
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The term context sensitivity refers to whether a response is in tune with the ever changing demands of the context, while insensitivity is the lack of responding to these cues. To date, we know little about how well patients with pain respond emotionally to changes in the cues provided by the social context, that is, how emotionally context (in)sensitive they are and if this is related to problem severity. The aim of this experimental study was to test a method for determining levels of context sensitivity in individuals with subacute and chronic pain and to explore the link between context (in)sensitivity and pain-related problems. We operationalized context (in)sensitivity as participants' emotional responses (observed facial expressions and self-reported affect) and pain bothersomeness in these contexts and explored the association between these context-(in)sensitive social-emotional responses and pain-related problems.METHODS: Sixty-two participants with pain were cued to talk openly about three different topics consecutively in a counterbalanced order: (1) their pain, (2) a negative non-pain topic, and (3) a positive non-pain topic. We measured the participants' emotional responses (observed facial expressions and self-reported affect) and pain bothersomeness across these contexts and explored the effect of social-emotional responding on pain-related problems.RESULTS: The results showed that, irrespective of individuals' baseline levels of pain bothersomeness, positive affect, and negative affect, those who reacted with more negative affect and pain bothersomeness when prompted to discuss a positive topic had higher levels of pain-related problems. Moreover, those who showed more negative facial expressions and pain bothersomeness when prompted to discuss a negative non-pain topic also had higher levels of pain-related problems.CONCLUSIONS: These findings highlight a link between sensitivity to the social context and the severity of a pain problem. We showed that individuals with greater problem severity were less sensitive to social cues in their emotional responses, as compared to individuals with less pain-related problems. As predicted, context-insensitive responding appears to be most strongly associated with pain-related problems when dealing with negative emotions. Although the cross-sectional nature of the study prohibits causal conclusions, our findings demonstrate a link and future research is clearly needed to unravel the role of context sensitivity in the development of pain over time.Statement of contributionWhat is already known on this subject?Responding to social cues seems to be important for adaptation to pain. The term context sensitivity refers to whether a response is in tune with the provided social cue. To date, we know little about how well patients with persistent pain respond emotionally to changes in the social context, that is, how context (in)sensitive they are and if this is linked to problem severity.What does this study add?A test of a method for determining levels of context sensitivity in individuals with persistent pain.Information about to what extent individuals with chronic pain respond context sensitively.Knowledge on the link between social context sensitivity and level of pain problems.
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| 5. |
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| 6. |
- Galea Holmes, Melissa N., et al.
(författare)
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Physiotherapy informed by Acceptance and Commitment Therapy for chronic low back pain : A mixed-methods treatment fidelity evaluation
- 2022
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Ingår i: British Journal of Health Psychology. - : John Wiley & Sons. - 1359-107X .- 2044-8287. ; 27:3, s. 935-955
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Tidskriftsartikel (refereegranskat)abstract
- Objectives A randomized controlled trial of a new type of Physiotherapy informed by Acceptance and Commitment Therapy (PACT), found that it improved functioning in people with chronic low back pain compared to usual physiotherapy care. Fidelity evaluation is necessary to understand trial processes and outcomes. This study evaluated PACT treatment fidelity including delivery, receipt, and enactment. Design A mixed-methods study nested within a randomized controlled trial was conducted. Methods A total of 72 (20% of total) PACT treatment audio files were independently assessed by two raters, according to a novel framework developed to measure PACT treatment content adherence, therapeutic alliance, ACT competence, and treatment enactment. Interview transcripts from 19 trial participants randomized to PACT were analysed thematically for evidence of treatment receipt and enactment. Results PACT physiotherapists delivered treatment as intended with high content adherence and satisfactory therapeutic alliance, but ACT competence was low. Qualitative findings indicated participant receipt of 11/17 and enactment of 3/17 components; 89% (n = 17) and 47% (n = 9) of participants reported treatment receipt and enactment of at least one component, respectively. Conclusions This mixed-methods study of PACT treatment demonstrated high fidelity reflecting treatment content delivery and receipt, and therapeutic alliance. There was some evidence of treatment enactment in participants with chronic low back pain. Low ACT competence could be addressed through additional support and adaptations to therapeutic processes for delivery by physiotherapists.
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| 7. |
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| 8. |
- Hagger, Martin S., et al.
(författare)
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Predicting alcohol consumption and binge drinking in company employees: An application of planned behaviour and self-determination theories
- 2012
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Ingår i: British Journal of Health Psychology. - : Wiley. - 1359-107X. ; 17, s. 379-407
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Tidskriftsartikel (refereegranskat)abstract
- Objectives. This study tested an integrated model of the psychosocial determinants of alcohol-related behaviour among company employees from four nations. A motivational sequence was proposed in which motivational orientations from selfdetermination theory influenced intentions to consume alcohol within guideline limits and alcohol-related behaviour via the mediation of the theory of planned behaviour variables of attitude, subjective norms, and perceived behavioural control (PBC). Design. A three-wave prospective design using self-reported psychological and behavioural measures. Methods. Company employees (N = 486, males = 225, females = 261; M age = 30.41, SD = 8.31) from four nations (Estonia, Finland, Sweden, and UK) completed measures of autonomous and controlled motivation from self-determination theory,attitudes, subjective norms, PBC, intentions from the theory of planned behaviour, and self-reported measures of past alcohol consumption and binge-drinking occasions at the first time point (time 1). Follow-up psychological and behavioural measures were taken one month later (time 2) and follow-up behavioural measures taken a further 2 months later (time 3). Results. Path analyses supported the motivational sequence with identified regulation (time 1), predicting intentions (time 1), and alcohol units consumed (time 2). The effects were indirect via the mediation of attitudes and PBC (time 1). A similar pattern of effects was found for the effect of time 2 psychological variables on time 3 units of alcohol consumed. There was little support for the effects of the psychological variables on binge-drinking behaviour. Conclusions. Findings provide new information on the psychosocial determinants of alcohol behaviour in company employees and the processes involved. Results may provide impetus for the development of interventions to reduce alcohol consumption.
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| 9. |
- Jansson-Fröjmark, Markus, 1971-, et al.
(författare)
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Bidirectionality between pain and insomnia symptoms : a prospective study
- 2012
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Ingår i: British Journal of Health Psychology. - : Wiley-Blackwell. - 1359-107X .- 2044-8287. ; 17:2, s. 420-431
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The purpose of this study was to investigate whether there is a bidirectional relationship between pain and insomnia symptoms over the course of a year.Design: A longitudinal design with a 1-year follow-up was used. Methods. From a randomly selected sample of the adult general population (N = 3,000), 1,746 individuals filled out a baseline and 1-year follow-up survey on pain, insomnia symptoms, anxiety symptoms, and depressive symptoms.Results: Pain (OR = 1.64) and anxiety symptoms increased the risk for the incidence of insomnia symptoms (R-2 =.125) and pain (OR = 1.98), anxiety symptoms and depressive symptoms were related to the persistence of insomnia symptoms (R-2 =.212). Gender and anxiety symptoms increased the risk for the incidence of pain (R-2 =. 073); and age, insomnia symptoms (OR= 1.49), anxiety symptoms, and depressive symptoms were associated with the persistence of pain (R-2 =.187).Conclusion: While pain was linked to future insomnia symptoms and insomnia symptoms to the persistence of pain over the course of a year, insomnia symptoms was not associated with the incidence of pain. The results, thus, partly argue against bidirectionality between pain and insomnia symptoms.
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| 10. |
- Jansson-Fröjmark, Markus, et al.
(författare)
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How is persistent insomnia maintained? : A prospective study on 50-60 years old adults in the general population
- 2008
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Ingår i: British Journal of Health Psychology. - 1359-107X .- 2044-8287. ; 13:1, s. 121-133
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The purpose of this study was to examine whether arousal, distress, and sleep-related beliefs are related to the maintenance of insomnia in old adults.Design: From a randomly selected sample from the general population (N = 3,600; 50-60 year old), 2,239 participants filled out a baseline and 1-year follow-up survey.Methods: Logistic regressions were used to investigate whether psychological mechanisms were related to sleep status (insomnia: n = 230; poor sleep: n = 210; normal sleep: n = 658; good sleep: n = 253) over one year. Cluster analysis was employed to assess whether it was possible to classify the participants based on their profiles of psychological functioning.Results: The results showed that arousal, sleep-related beliefs about future consequences, and anxiety were significantly related to the maintenance of insomnia (14-66% of the variance). Of the individuals with persistent insomnia, 67% belonged to a cluster characterized by high scores on arousal, sleep-related beliefs, and anxiety, 24% to a cluster defined by medium scores on the three mechanisms, and 9% to a cluster characterized by low scores on the three mechanisms.Conclusions: This investigation shows that arousal, sleep-related beliefs, and anxiety are associated with the maintenance of persistent insomnia, but also that these mechanisms often co-occur in individuals with persistent insomnia.
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