| 1. |
- Axelsson, Erland, et al.
(författare)
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Psychological treatments for irritable bowel syndrome : a comprehensive systematic review and meta-analysis
- 2023
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Ingår i: Cognitive Behaviour Therapy. - : Routledge. - 1650-6073 .- 1651-2316. ; 52:6, s. 565-584
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Forskningsöversikt (refereegranskat)abstract
- A wide range of psychological treatments have been found to reduce the symptoms of irritable bowel syndrome (IBS) but their relative effects are unclear. In this systematic review and meta-analysis, we determined the effects of psychological treatments for IBS, including subtypes of cognitive behavior therapy, versus attention controls. We searched 11 databases (March 2022) for studies of psychological treatments for IBS, reported in journal articles, books, dissertations, and conference abstracts. The resulting database comprised 9 outcome domains from 118 studies published in 1983–2022. Using data from 62 studies and 6496 participants, we estimated the effect of treatment type on improvement in composite IBS severity using random-effects meta-regression. In comparison with the attention controls, there was a significant added effect of exposure therapy (g = 0.52, 95% CI = 0.17–0.88) and hypnotherapy (g = 0.36, 95% CI = 0.06–0.67) when controlling for the pre- to post-assessment duration. When additional potential confounders were included, exposure therapy but not hypnotherapy retained a significant added effect. Effects were also larger with a longer duration, individual treatment, questionnaire (non-diary) outcomes, and recruitment outside of routine care. Heterogeneity was substantial. Tentatively, exposure therapy appears to be a particularly promising treatment for IBS. More direct comparisons in randomized controlled trials are needed. OSF.io identifier: 5yh9a.
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| 2. |
- Bonnert, Marianne, et al.
(författare)
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Internet-delivered cognitive-behaviour therapy for anxiety related to asthma : study protocol for a randomised controlled trial
- 2024
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Ingår i: BMJ Open Respiratory Research. - : BMJ Publishing Group Ltd. - 2052-4439. ; 11:1
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Tidskriftsartikel (refereegranskat)abstract
- Introduction There is an established association between asthma and anxiety. The overlap between asthma symptoms and symptoms of anxiety may cause individuals to overestimate their asthma severity and restrict their daily activities leading to a low quality of life. There is currently weak evidence for treatments targeting anxiety related to asthma, but cognitive–behavioural therapy (CBT) has shown some promising but mixed results. The current randomised controlled trial will investigate if exposure-based internet-delivered CBT (Internet-CBT) is more effective than treatment as usual+medical education (TAU+ME) to relieve symptoms of anxiety and asthma control.Methods and analysis 90 participants will be randomised 1:1 to 8 weeks of Internet-CBT or TAU+ME. The primary outcome, the patient-reported Catastrophising Asthma Scale, will be analysed from baseline to the primary endpoint at 16 weeks using hierarchical linear mixed model of the slope over time. Secondary outcomes, such as asthma control, quality of life and forced expiratory volume in 1 s, will be analysed correspondingly.Ethics and dissemination All participants will be informed about the study and leave their consent before study entry. All results will be analysed at group level and reported through publication in a peer-reviewed scientific journal within the field. The study received ethical approval by the Swedish Ethical Review Authority in January 2020 (ID: 2019-05985; 2022-01117-02).
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| 3. |
- Bonnert, Marianne
(författare)
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Internet-delivered exposure-based cognitive behavior therapy for adolescents with functional abdominal pain disorders
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Irritable bowel syndrome (IBS), functional abdominal pain (FAP), and functional dyspepsia (FD) belong to the functional abdominal pain disorders, and are common in adolescents all over the world. Adolescents with IBS, FAP or FD often report anxiety, depression, school absenteeism, and a quality of life as low as children with inflammatory bowel diseases. The treatment effects from pharmacological or dietary treatments are unsatisfactory for this age group, while cognitive behavioral therapies (CBT) have shown some promising effects. However, CBT is rarely available as there are very few CBT-therapists trained in functional abdominal pain disorders. For adult IBS, exposure-based internet-delivered CBT (Internet-CBT) has been very successful, but this kind of treatment has neither been evaluated for adolescent IBS, nor adapted to the age group. Aims: The overall aim of this thesis was to develop an effective and easily accessible treatment for adolescents with functional abdominal pain disorders. Specific aims were to investigate: ° The feasibility and potential efficacy of exposure-based Internet-CBT for adolescents with IBS, FAP or FD (Study I). ° The efficacy of exposure-based Internet-CBT for adolescents with IBS (Study II). ° Mechanisms of change in exposure-based Internet-CBT for adolescents with IBS (Study III). ° The feasibility and potential efficacy of a tailored exposure-based Internet-CBT for adolescents with FAP or FD (Study IV). Methods: The feasibility and potential efficacy of the treatment were evaluated in an open pilot including adolescents (age 13-17) with IBS, FAP or FD (Study I). The efficacy of the treatment for adolescents with IBS was tested in a randomized controlled trial (RCT) with a wait-list control (Study II). Treatment mechanisms were investigated on data from the RCT, through analysis of change during treatment of two proposed mediators (perceived stress and avoidant behavior), and primary outcome (global gastrointestinal symptoms) (Study III). Lastly, the feasibility and potential efficacy of the treatment, when tailored specifically for functional abdominal pain and functional dyspepsia, were evaluated in an open pilot (Study IV). All trials had somatic symptoms as primary outcome, global gastrointestinal symptoms in Study I-III, and pain intensity in Study IV. Assessments were made at pretreatment, posttreatment, and at 6-month follow-up (Study I-II and IV). In the RCT weekly assessments were included in the analyses (Study II). In Study IV, the follow-up assessments 6 months after treatment are still ongoing, and will therefore not be presented in the thesis. Results: In the first pilot treatment adherence was high, and the improvements were significant and moderately sized, with a stable treatment effect after 6 months (Study I). The RCT showed significant improvement on all relevant outcomes in favor of the treatment with small to moderate effect sizes, which were stable or significantly improved 6 months after treatment conclusion (Study II). The analysis of mediators showed that reduction in avoidant behavior, but not reduction in perceived stress, predicted improvement in gastrointestinal symptoms due to treatment (Study III). The open pilot for FAP and FD showed significant improvement with strong effect sizes on all relevant outcomes, from pretreatment to posttreatment (Study IV). Conclusion: Exposure-based Internet-CBT is a feasible and effective treatment for adolescent IBS. Feasibility and potential treatment effects may be increased with a tailored treatment for FAP and FD. Our results suggest that, it is by reducing avoidant behavior that gastrointestinal symptoms improve during exposure-based Internet-CBT, while a reduction in stress is not a necessary target in treatment.
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| 4. |
- Lalouni, Maria, et al.
(författare)
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Breaking the vicious circle of fear and avoidance in children with abdominal pain : A mediation analysis
- 2021
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Ingår i: Journal of Psychosomatic Research. - : Elsevier. - 0022-3999 .- 1879-1360. ; 140
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Exposure-based cognitive behavioral therapy via internet (Internet-CBT) has been shown to reduce symptoms and increase quality of life for children with functional abdominal pain disorders (FAPDs), but the mechanisms of change are unknown. The objective was to examine whether a change in symptom-specific fear and avoidance, i.e., gastrointestinal-specific anxiety (GI-anxiety) and gastrointestinal-specific avoidance (GI-avoidance), mediated changes in parent-reported abdominal symptoms for children receiving Internet-CBT compared with children receiving treatment as usual. A further aim was to assess if baseline levels of the proposed mediators moderated the mediation.METHODS: Weekly assessments of child-reported mediators and parent-reported outcome from 90 children aged 8-12 who were included in a randomized controlled trial were used in univariate and multivariate growth models to test the direct effect of treatment on outcome and the indirect effects via mediators and moderated mediation.RESULTS: Treatment condition significantly predicted the slope of the mediators (a-path), in favor of Internet-CBT, and mediators were correlated with the outcome (b-path). The indirect effects of the mediators on the outcome (cross-product of the a and b-paths) were significantly different from zero for both GI-avoidance, ab = 1.43, 95%CI [0.42, 3.23]; and GI-anxiety ab = 1.58, 95%CI [0.43, 3.62]. Baseline levels of the proposed mediators moderated the size of the mediation.CONCLUSIONS: GI-anxiety and GI-avoidance were mediators of change in Internet-CBT and high levels of the mediators at baseline were associated with larger mediated effects. Healthcare professionals should be aware of, and inform families about, the potential benefits of reducing symptom-specific fear and avoidance.
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| 5. |
- Lalouni, Maria, et al.
(författare)
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Parental responses and catastrophizing in online cognitive behavioral therapy for pediatric functional abdominal pain : A mediation analysis of a randomized controlled trial
- 2022
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Ingår i: Frontiers in Pain Research. - : Frontiers Media SA. - 2673-561X. ; 3
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To test if decreased parental protective behaviors, monitoring behaviors, and parental catastrophizing mediate relief of gastrointestinal symptoms in children 8–12 years with functional abdominal pain disorders(FAPDs). The study uses secondary data analyses of a randomized controlled trial in which exposure-based online cognitive behavioral therapy (ICBT) was found superior to treatment as usual in decreasing gastrointestinal symptoms.Methods: The ICBT included 10 weekly modules for children and 10 weekly modules for parents. Treatment as usual consisted of any medication, dietary adjustments, and healthcare visits that the participants engaged in during 10 weeks. All measures were self-assessed online by parents. Biweekly assessments of the Adult Responses to Children’s Symptoms (ARCS), Protectand Monitor subscales, and the Pain Catastrophizing Scale, parental version (PCS-P) were included in univariate and multivariate growth models to test their mediating effect on the child’s gastrointestinal symptoms assessed withthe Pediatric Quality of Life Gastrointestinal Symptoms Scale (PedsQL).Results: A total of 90 dyads of children with FAPDs and their parents were includedin the study, of which 46 were randomized to ICBT and 44 to treatment as usual. The PCS-P was found to mediate change in the PedsQL ab = 0.639 (95% CI0.020–2.331), while the ARCS Monitor ab = 0.472 (95% CI −1.002 to 2.547), and Protect ab= −0.151 (95% CI −1.455 to 0.674) were not mediators of change.Conclusions: To target parental catastrophizing in ICBT for pediatric FAPDs is potentially important to reduce abdominal symptoms in children.
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| 6. |
- Vigerland, Sarah, et al.
(författare)
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Internet-delivered cognitive behavior therapy for children and adolescents : A systematic review and meta-analysis
- 2016
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Ingår i: Clinical Psychology Review. - : Elsevier BV. - 0272-7358 .- 1873-7811. ; 50, s. 1-10
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Forskningsöversikt (refereegranskat)abstract
- Internet-delivered cognitive behavior therapy (ICBT) is a relatively novel treatment format with the potential to increase accessibility of evidence-based care. However, little is known about the feasibility and efficacy of ICBT in children and adolescents. We conducted a comprehensive systematic review and meta-analysis of ICBT for children and adolescents to provide an overview of the field and assess the efficacy of these interventions. A systematic literature search of six electronic databases was performed to identify ICBT intervention studies for children with a psychiatric condition, such as social anxiety disorder, or a somatic condition, such as chronic pain. Two reviewers independently rated study quality. Twenty-five studies, targeting 11 different disorders, were included in the review. Study quality and presentation of treatment variables, such as therapist time and treatment adherence, varied largely. Twenty-four studies (N = 1882) were included in the meta-analysis and ICBT yielded moderate between-group effect sizes when compared with waitlist, g = 0.62, 95% CI [0.41, 0.84]. The results suggest that CBT for psychiatric and somatic conditions in children and adolescents can be successfully adapted to an intemet-delivered format.
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