| 1. |
- Alimoradi, Zainab, et al.
(författare)
-
Effects of cognitive behavioral therapy for insomnia (CBT-I) on quality of life : A systematic review and meta-analysis
- 2022
-
Ingår i: Sleep Medicine Reviews. - : Elsevier. - 1087-0792 .- 1532-2955. ; 64
-
Forskningsöversikt (refereegranskat)abstract
- The effects of cognitive behavioral therapy for insomnia (CBT-I) have consistently been shown to improve insomnia symptoms and other health-related outcomes, but the effects on QoL have been inconsistent. Many factors including the type CBT-I delivery and type of instrument used to assess QoL make the topic complex. The present systematic review and meta-analysis synthesized the evidence of CBT-I efficacy on QoL outcomes across different populations, delivery modes, and methodological aspects. Following the guidelines on preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), a literature search was conducted through PubMed, Web of Science, Scopus, and PsycINFO using keywords from relevant MeSH terms based on PICOS (Participants, Intervention, Comparison, Outcome and Study) criteria. Clinical trials investigating the effect of CBT-I as an intervention on QoL with any kind of control group were eligible if they reported mean scores and variation of QoL. Meta-analysis using a random-effect model was conducted to calculate the standardized mean differences (SMDs) in a set including all identified studies, as well as in three sub-sets: face-to-face CBT-I using randomized controlled trials (RCTs), online CBT-I using RCTs, and one-group pre- and post-treatment design. A total of 24 studies comprising 1977 participants (808 in an intervention group) from 12 countries were eligible for meta-analysis. The overall pooled estimate of SMD of QoL when all 24 studies were included was 0.47 (95% CI: 0.22; 0.72; I-2 = 84.5%; tau(2) = 0.31; p < 0.001). The overall pooled estimate of SMD of QoL was 0.46 (95% CI: 0.01-0.90; I-2 = 87.5%; tau(2) = 0.48, p < 0.001) for intervention groups with face-to-face CBT-I compared to controls; 0.47 (95% CI: 0.02-0.92; I-2 = 88.3%; tau(2) = 0.36; p = 0.04) for intervention groups with digital CBT-I compared to controls, and 0.46 (95% CI: 0.12-0.80; I-2 = 52.9%; tau(2) = 0.07; p = 0.08) for one-group pre- and post-comparison using CBT-I intervention compared to baseline. Moreover, effects of CBT-I on QoL were different across populations (pooled SMD = 0.59 for patients with insomnia; 0.29 for patients with insomnia comorbid with another major disorder; and 0.48 for other conditions) and types of QoL instruments (pooled SMD = 0.36 for disease-specific QoL instrument not on insomnia, 0.43 for generic QoL instrument, and 0.67 for a single-QoL-item instrument). The probability of publication bias was ruled out in overall and design specific sub-group analysis based on funnel plot and Egger's test. In conclusion, this meta-analysis confirmed a moderate, overall effect of CBT-I in improving QoL. However, due to small power and heterogeneity, future studies are needed to better explore the impact of moderating factors such as mode of delivery and type of QoL measure for assessment used. (C) 2022 The Author(s). Published by Elsevier Ltd.
|
|
| 2. |
- Andersson, Gunnel, 1958-, et al.
(författare)
-
Accepting and adjusting : Older women's experiences of living with urinary incontinence
- 2008
-
Ingår i: Urologic Nursing. - 1053-816X. ; 28:2, s. 115-121
-
Tidskriftsartikel (refereegranskat)abstract
- In-depth interviews were performed with 11 Swedish women who contacted a district nurse to obtain sanitary protection. Three key constituents (themes) emerged: "learning to live with it despite difficulties," "other illnesses are more important," and "reluctance to seek care." The essence of the phenomenon of living with urinary incontinence (Ul) was expressed as "a situation to accept and adjust to."
|
|
| 3. |
- Andersson, Gunnel, 1958-, et al.
(författare)
-
Perceptions of urinary incontinence among syrian Christian women living in Sweden
- 2009
-
Ingår i: Journal of Transcultural Nursing. - : SAGE Publications. - 1043-6596 .- 1552-7832. ; 20:3, s. 296-303
-
Tidskriftsartikel (refereegranskat)abstract
- The purpose of this study was to describe the perception of urinary incontinence (UI) among Syrian women living in Sweden. DESIGN: A qualitative, descriptive design with focus group discussions (FGDs) was used and analyzed with content analysis. Fourteen Syrian women were interviewed in three FGDs. FINDINGS: Three categories emerged, "Thoughts on UI," "Managing UI," and "Communication With the Health Care System." Among the interviewees, UI was a common, and expected, problem, which could be managed. However, some expressed shame and embarrassment. Some talked about communication problems with health care. DISCUSSION: and Implications for Practice: The health care system should be adjusted to the women's needs, with awareness of the communication difficulties, which could result in misunderstanding and neglected treatments.
|
|
| 4. |
- Andersson, Gunnel, 1958-
(författare)
-
Urinary incontinence : prevalence, treatment seeking behaviour, experiences, and perceptions among persons with and without urinary leakage
- 2009
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis is to describe urinary incontinence (UI) from a population perspective and to describe experiences and perceptions of UI from an individual perspective. This includes assessing the prevalence of urinary incontinence as well as describing treatment seeking and experiences of living with UI. A secondary aim was to describe the perception of UI among cultures other than the Swedish mainstream, exemplified in this case by Syrian women living in Sweden. Both quantitative and qualitative methods were used, including questionnaires and interviews. Studies I and II were quantitative studies based on a population-based study. Together with a postal survey on general health and living conditions “Life & Health”, a questionnaire on urinary incontinence was sent out to 15 360 randomly-selected residents aged 18-79 in Orebro County, Sweden. In Study I, UI was found to affect 19%. The majority of the respondents experienced minor problems, and only 18% of those reporting UI wanted treatment. However, there was also a group who reported severe problems, but despite this 42% of them did not want treatment. Study II investigated why people with UI refrain from seeking care and treatment. It was found that the desire for treatment was regulated by the frequency of UI, being restricted from participating in various activities, the degree of inconvenience, and the type of UI. Studies III and IV were both qualitative interview studies, describing older women’s experiences of living with UI (Study III) and Syrian women’s perceptions of UI (Study IV). There were similarities between the results of these two studies; the women described UI as a normal and expected problem, and they knew that the district nurse could prescribe incontinence protections and that treatments existed. In both studies, the women expressed difficulties in making contact with the health care service, while the women who did not speak Swedish (Study IV) also had difficulties due to different communication problems. In conclusion, it is important that health care resources are optimized to identify and meet the needs of those who experience major problems with UI, and that there is awareness of the communication difficulties that can be present in meeting with people who speak other languages. However it is also important not to medicalize those who experience minor problems and who have the desire to manage on their own.
|
|
| 5. |
- Andersson, Gunnel, 1958-, et al.
(författare)
-
Urinary incontinence - why refraining from treatment? : a population based study
- 2005
-
Ingår i: Scandinavian Journal of Urology and Nephrology. - London : Taylor & Francis. - 0036-5599 .- 1651-2065. ; 39:4, s. 301-307
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate why persons with urinary incontinence (UI) refrain from seeking care and treatment.MATERIAL AND METHODS: A population-based study was undertaken in which a public health survey and a specific UI questionnaire were sent to 15 360 randomly selected residents (age 18-79 years) of Orebro County, Sweden. For all persons reporting UI, the expressed wish for treatment or no treatment was analyzed in relation to relevant variables from both inquiry forms using binary logistic regression analysis.RESULTS: The response rate was 64.5%. UI was reported by 2194 persons, 1724 of whom comprised the study population. A statistically significant association was found between the degree of UI and a desire for treatment. Persons who did not experience daily leakage and those who did not perceive the leakage as troublesome or having an affect on their daily life mostly stated that they did not desire treatment. Socioeconomic or other health-related factors were not associated with desiring or not desiring treatment for UI.CONCLUSIONS: Our results show that it is the perceived severity of UI that determines whether afflicted persons desire treatment or not. Other factors, relating to seeking healthcare in general, were not found to be of importance. Interventions to identify those in need of treatment for UI should primarily be directed towards those with severe symptoms.
|
|
| 6. |
- Baglioni, Chiara, et al.
(författare)
-
The European Academy for Cognitive Behavioural Therapy for Insomnia : An initiative of the European Insomnia Network to promote implementation and dissemination of treatment
- 2020
-
Ingår i: Journal of Sleep Research. - : Wiley. - 0962-1105 .- 1365-2869. ; 29:2
-
Tidskriftsartikel (refereegranskat)abstract
- Insomnia, the most prevalent sleep disorder worldwide, confers marked risks for both physical and mental health. Furthermore, insomnia is associated with considerable direct and indirect healthcare costs. Recent guidelines in the US and Europe unequivocally conclude that cognitive behavioural therapy for insomnia (CBT-I) should be the first-line treatment for the disorder. Current treatment approaches are in stark contrast to these clear recommendations, not least across Europe, where, if any treatment at all is delivered, hypnotic medication still is the dominant therapeutic modality. To address this situation, a Task Force of the European Sleep Research Society and the European Insomnia Network met in May 2018. The Task Force proposed establishing a European CBT-I Academy that would enable a Europe-wide system of standardized CBT-I training and training centre accreditation. This article summarizes the deliberations of the Task Force concerning definition and ingredients of CBT-I, preconditions for health professionals to teach CBT-I, the way in which CBT-I should be taught, who should be taught CBT-I and to whom CBT-I should be administered. Furthermore, diverse aspects of CBT-I care and delivery were discussed and incorporated into a stepped-care model for insomnia.
|
|
| 7. |
- Blom, Kerstin, et al.
(författare)
-
An investigation and replication of sleep-related cognitions, acceptance and behaviours as predictors of short- and long-term outcome in cognitive behavioural therapy for insomnia
- 2021
-
Ingår i: Journal of Sleep Research. - : John Wiley & Sons. - 0962-1105 .- 1365-2869. ; 30:5
-
Tidskriftsartikel (refereegranskat)abstract
- The objectives were to investigate the potential for sleep-related behaviours, acceptance and cognitions to predict outcome (insomnia severity) of cognitive behavioural therapy for insomnia (CBT-I). Baseline and outcome data from four randomised controlled trials (n = 276) were used. Predictors were the Dysfunctional Beliefs and Attitudes about Sleep-10 (DBAS-10), Sleep-Related Behaviours Questionnaire (SRBQ), and Sleep Problems Acceptance Questionnaire (SPAQ), and empirically derived factors from a factor analysis combining all items at baseline (n = 835). Baseline values were used to predict post-treatment outcome, and pre-post changes in the predictors were used to predict follow-up outcomes after 3-6 months, 1 year, or 3-10 years, measured both as insomnia severity and as better or worse long-term sleep patterns. A majority (29 of 52) of predictions of insomnia severity were significant, but when controlling for insomnia severity, only two (DBAS-10 at short-term and SRBQ at mid-term follow-up) of the 12 predictions using established scales, and three of the 40 predictions using empirically derived factors, remained significant. The strongest predictor of a long-term, stable sleep pattern was insomnia severity reduction during treatment. Using all available predictors in an overfitted model, 21.2% of short- and 58.9% of long-term outcomes could be predicted. We conclude that although the explored constructs may have important roles in CBT-I, the present study does not support that the DBAS-10, SRBQ, SPAQ, or factors derived from them, would be unique predictors of outcome.
|
|
| 8. |
- Blom, Kerstin, et al.
(författare)
-
Effectiveness of two guided Internet treatments in a routine care setting at the eMeistring clinic, Norwegian public health care : Panic disorder and major depression
- 2018
-
Ingår i: Abstract book. ; , s. 34-34
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Goals: To investigate the effectiveness of therapist-guided internet treatment for panic disorder (PD), and major depression (MD), in a routine care setting, the eMeistring clinic, within the public health care in Norway. Methods: Approximately 300 patients are included in two effectiveness studies, one per treatment (PD, MD). Assessment points are pretreatment, posttreatment and 6 months follow-up. Within group effect sizes, responder and remission rates are investigated. All analyses are Internet to treat. Results: Effect sizes for PD were large, d = 1.24 pre - post and 1.39 pre - 6 months follow-up. 56 % had recovered or were improved at posttreatment. Results for MD are preliminary and will be presented at the conference. Conclusion: Final conclusions will be presented at the conference. Results so far indicate that the treatments, after implementation into routine care in Norwegian public health care, are equally effective as in preceding effectiveness and randomized efficacy trials. The results so far thereby strengthen the notion that therapist guided Internet-based treatments are a viable alternative to other modes of treatment delivery.
|
|
| 9. |
- Blom, Kerstin, et al.
(författare)
-
Facilitating and hindering factors in Internet-delivered treatment for insomnia and depression
- 2016
-
Ingår i: Internet Interventions. - : Elsevier. - 2214-7829. ; 4, s. 51-60
-
Tidskriftsartikel (refereegranskat)abstract
- Insomnia and depression is a common and debilitating comorbidity, and treatment is usually given mainly for depression. Guided Internet-based cognitive behavioral therapy for insomnia (ICBT-i) was, in a recent study on which this report is based, found superior to a treatment for depression (ICBT-d) for this patient group, but many patients did not reach remission.
|
|
| 10. |
- Blom, Kerstin
(författare)
-
Guided internet-based treatment for insomnia and depression
- 2016
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background. Insomnia and depression are two of the most prevalent and costly disorders, and comorbidity between the two is common. Treatment of insomnia, other than pharmacological, is often overlooked in spite of the existence of effective psychological treatments. When insomnia is comorbid with depression, treatment of depression is usually prioritized, but not quite sufficient. The insomnia treatment with the strongest evidence is Cognitive Behavioral Therapy for insomnia (CBT-i). Due to a lack of trained CBT-i-therapists, therapist-guided Internet-based CBT-i (ICBT-i) has emerged as an alternative to face-to-face treatments. Aims. To challenge the treatment paradigm for comorbid insomnia and depression by comparing ICBT-i to ICBT-d (Internet-based CBT for depression) (Study I). To strengthen the evidence for ICBT-i by comparing ICBT-i to face-to-face treatment (Study II) and by doing a 3-year follow-up of a previous trial (Study III). To investigate qualitative aspects of Study I (Study IV). Studies. Four studies were done: Study I, a randomized controlled trial (RCT, n=43) comparing ICBT-i to ICBT-d in a sample with comorbid insomnia and depression. Study II, a non-inferiority RCT (n=48) comparing ICBT-i to group-delivered CBT-i in a sample with insomnia and various comorbidities, including mild to moderate depression. Study III, a 3-year follow-up of an RCT (n=148) comparing ICBT-i to an active control treatment. Study IV, a qualitative study investigating facilitating and hindering factors in participants’ work with the treatments in Study I. Results. Study I: ICBT-i turned out to be overall more beneficial than ICBT-d for patients with both insomnia and depression regarding e.g. effects on insomnia severity (effects on depression were similar) and reduction of sleep medication use. Study II: ICBT-i turned out to be highly effective and non-inferior to group-delivered CBT-i regarding insomnia severity, both directly after treatment and after six months. Study III: The 3-year follow-up of ICBT-i showed that the large effect on insomnia severity observed directly after treatment was maintained over time, and led to reduced consumption of sleep medication and other insomnia treatments compared to participants in the active control group. Both studies II and III showed that ICBT-i also reduced depressive symptom severity significantly. Study IV: The qualitative analyses showed that ICBT-i was easier to work with, and more positively regarded than ICBT- d, according to the participants. Multiple comorbidities were more hindering in ICBT-d than in ICBT-i. Conclusions. ICBT-i is effective in reducing insomnia severity, also in patients with comorbid disorders, and that the effects are maintained over time. ICBT-i can lead to reduced sleep medication use and decreased depressive symptoms. The findings for comorbid insomnia and depression indicate that insomnia needs to be prioritized for evidence-based treatment, also when it is comorbid with depression.
|
|
