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- Harlacher, Uwe
(författare)
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"Elöverkänslighet" : En förklaringsmodell, några karakteristika hos drabbade och effekten av psykologisk behandling med kognitiv-beteendeterapeutiska metoder
- 1998
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The thesis examines various aspects of "electricity hypersensitivity" (EH). An empirical investigation of a group of persons suffering from EH was carried out, a part of the group being treated psychologically according to cognitive- behavioural principles in a controlled outcome study. The major findings concern an explanatory-model of EH, the the assessment of characteristics of EH-sufferers and the effects of the psychological treatment of EH. The explanatory model for the development and maintenance of EH can be summarized as follows. Persons suffering from symptoms for which they lack an explanation search for an explanation within and outside the medical system. If they consider EH to be a possible explanation, they test the hypothesis that this is the case through exposing themselves to electromagnetic fields and concomitantly performing self-observations in a manner making it probable that the experiencing of their symptoms will be intensified. They then attribute the intensification of their symptoms to electricity. Once their belief in their suffering from EH is established, they gradually develop a cognitive schema regarding EH, one that is self-validating. Belief in EH can lead to the experiencing of a variety of secondary symptoms. The characteristics of EH-sufferers on various psychometric measures appear to resmble much more those of a normal population than of a psychopathologic one. Certain characteristics suggest particular vulnerability to adverse stress-effects, which in turn could result in a proneness to develop EH. There was found to be a significant reduction in the degree of EH-suffering of patients trated with Cognitive Behaviour Therapy (CBT) as compared with controls (patients offered CBT treatment later). A conservative assessment of the treatment results indicated 50% of those treated to be "cured" or at least reliably improved in the sense of their physical symptoms having disappeared or diminished and their no longer considering the symptoms they had or have to be due to their exposure to elctromagnetic fields. The treatment principles employed are described and questions of the adequate assessment of EH and the adequacy of outcome predictors are discussed, as are the characteristics of EH-sufferers. Suggestions are made for empirical testing of the explanatory-model advanced. It is argued that EH can be regarded as a variant of disorders that develop in connection with perceived environmental threats.
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| 3. |
- Harlacher, Uwe, et al.
(författare)
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Using data from Multidimensional Pain Inventory subscales to assess functioning in pain rehabilitation.
- 2011
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Ingår i: International Journal of Rehabilitation Research. - 1473-5660. ; 34:1, s. 14-21
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to examine whether Multidimensional Pain Inventory (MPI) subscale score changes can be used for monitoring interdisciplinary cognitive behavioural pain rehabilitation programmes, using the Psychological General Well-Being (PGWB) index as an independent variable of rehabilitation outcome. Data from 434 consecutively referred patients disabled by chronic pain were analysed. The intervention was a 4-week interdisciplinary pain rehabilitation group programme (5 h/day), based on biopsychosocial and cognitive behavioural principles. Mean PGWB total scores improved after rehabilitation (P<0.0001) with clinically relevant effect sizes for patients with 'dysfunctional' and 'interpersonally distressed' MPI profiles. Substantial correlations (r=0.7-0.3; P<0.001) were found between the changes in PGWB total scores and four of the MPI subscale scores. These were combined into a composite variable ['pain severity', 'interference', 'life control' (given reversed scores) and 'affective distress'], and were labelled as the Pain Rehabilitation Index. The subscales, 'support' and 'general activity level', were omitted, as changes were ambiguous with respect to functioning. 'Dysfunctional' and 'interpersonally distressed' profile patients showed a marked improvement in Pain Rehabilitation Index after rehabilitation (effect sizes of 0.77 and 0.43; P<0.0001, respectively). Conversely, the 'adaptive copers' may have deteriorated somewhat (effect size -0.28; P=0.036). We propose that scores from four MPI subscales are integrated and the difference pre-post rehabilitation is used to indicate composite rehabilitation outcomes, making it possible to interpret all included MPI subscales in the same direction. Psychometric evaluation of the index is warranted.Mit der vorliegenden Studie sollte untersucht werden, ob Veränderungen in den Subskalen des Multidimensional Pain Inventory (MPI) zur Effektmessung von interdisziplinären kognitiv-verhaltenstherapeutischen Schmerzmanagement-Programmen verwendet werden können, wobei der PGWB-Index (Psychological General Well-Being) als unabhängige Variable des Reha-Ergebnisses hinzugezogen wird. Analysiert wurden Daten von 434, aufgrund ihrer chronischen Schmerzen als behindert eingestuften, konsekutiv überwiesenen Patienten. Die Intervention erfolgte in Form eines 4-wöchigen interdisziplinären Gruppenprogramms zur Schmerzrehabilitation (5 Std/Tag) auf der Grundlage biopsychosozialer und kognitiv-verhaltenstherapeutischer Prinzipien. Die durchschnittlichen PGWB-Gesamtscores verbesserten sich nach der Rehabilitation (P<0.0001) mit klinisch relevanten Effektgrößen für Patienten mit 'dysfunktionalen' und 'zwischenmenschlich gestörten' MPI-Profilen. Substanzielle Korrelationen (r=0.7-0.3; P<0.001) wurden zwischen den Änderungen bei den PGWB-Gesamtscores und vier der MPI-Subskalaen beobachtet. Sie wurden zu einer zusammengesezten Variable ['Schmerzintensität', 'Interferenz', 'Kontrolle über das eigene Leben' (unter Annahme umgekehrter Scores) und 'affektiver Stress'] unter dem Begriff 'Pain Rehabilitation Index' zusammengefasst. Die Subskalen 'Unterstützung' und 'allgemeine s Aktivitätsniveau' wurden weggelassen, da die Änderungen hinsichtlich der Funktionsfähigkeit in diesen Variablen zweideutig sind. Patienten mit einem 'dysfunktionalen' und 'zwischenmenschlich gestörtem' Profil wiesen nach der Rehabilitation eine signifikante Verbesserung des Pain Rehabilitation Index auf (Effektgröβen von jeweils 0.77 bzw. 0.43; P<0.0001). Demgegenüber haben sich die 'adaptiven Bewältiger' möglicherweise etwas verschlechtert (Effektgröβe -0.28; P=0.036). Wir schlagen vor, die Scores der vier MPI-Subskalen zu integrieren und die Differenz prä-post-Rehabilitation als zusammengesetzes Effektmass zu benutzen in dem Veränderungen in allen einbezogenen MPI-Subskalen in gleicher Richtung interpretierbar sind. Eine psychometrische Evaluation des Indexes ist erforderlich.El objetivo de este estudio fue investigar si las puntuaciones de las subescalas del Inventario Multidimensional del Dolor (IMD) podrían utilizarse en la evaluación de los programas interdisciplinarios de rehabilitación cognitiva-conductuales de pacientes con dolor crónico, para lo cual utilizamos el Índice de Bienestar Psicológico General (IBPG) como variable independiente del resultado de la rehabilitación. Se analizaron los datos correspondientes a 434 pacientes consecutivos aceptados por su discapacidad debida al dolor crónico. La intervención consistió en un programa interdisciplinario de 4 semanas de rehabilitación en grupo para pacientes con dolor crónico (5lh/día), basado en principios biopsicosociales y cognitivos. La media total de las puntuaciones del IBGP mejoró después de la rehabilitación (P<0.0001), y los tamaños del efecto fueron de importancia clínica en pacientes considerados 'disfuncionales' o 'con dificultades interpersonales' según los resultados del IMD. Se hallaron correlaciones importantes (r=0.7-0.3; P<0.001) entre los cambios obtenidos en las puntuaciones totales del IBPG y en cuatro de las puntuaciones de las subescalas del IMD. Estas se combinaron en una variable global ['Severidad del dolor', 'Interferencia del dolor', 'Autocontrol percibido sobre el dolor' (teniendo en cuenta las puntuaciones invertidas) y 'Emocionalidad negativa'] denominada Índice de Rehabilitación del dolor. Las subescalas 'apoyo' y 'grado general de actividad física' se omitieron debido a ambigüedades en los cambios relativos al funcionamiento. Los pacientes considerados 'disfuncionales' o 'con dificultades interpersonales' mostraron una marcada mejoría en el Índice de Rehabilitación del Dolor después de la rehabilitación (tamaño del efecto: 0.77 y 0.43, P<0.0001, respectivamente). Por el contrario, los 'afrontadores adaptativos' mostraron cierto empeoramiento (tamaño del efecto -0.28, P=0.036). Proponemos que se utilicen las puntuaciones de las cuatro subescalas del IMD referidasy las diferencias entre los valores de éstas antes y después de la rehabilitación, para determinar los resultados globales de la rehabilitación. Esto permitiría interpretar de forma uniforme todas las subescalas del IMD utilizadas. Además, recomendamos realizar una evaluación psicométrica del Índice.Cette étude avait pour objet d'examiner si les changements de scores sur la sous-échelle MPI (Multidimensional Pain Inventory) pouvaient être utilisés pour la surveillance des programmes interdisciplinaires de rééducation de la douleur comportementale cognitive en utilisant l'indice PGWB (Psychological General Well-Being) comme variable indépendante des résultats de rééducation. Les données de 434 patients handicapés par la douleur chronique référés consécutivement ont été analysées. L'intervention a adopté la forme d'un programme interdisciplinaire de rééducation de la douleur en groupe sur 4 semaines (5 h/jour), reposant sur des principes comportementaux biopsychosociaux et cognitifs. Les scores moyens PGWB totaux se sont améliorés après la rééducation (P<0.0001) avec des tailles d'effet cliniquement significatives pour les patients présentant des profils MPI de «dysfonctionnement » et de «détresse interpersonnelle». Des corrélations substantielles (r=0.7-0.3; P<0.001) ont été identifiées entre les variations des scores PGWB totaux et quatre des scores sur la sous-échelle MPI. Ces derniers ont été regroupés en une variable composite [«sévérité de la douleur», «interférence», «contrôle de vie» (scores négatifs) et «détresse affective»], pour former un indice de rééducation de la douleur. Les sous-échelles «soutien» et «niveau d'activité général» ont été omis, car les changements étaient ambigus en ce qui concerne le fonctionnement. Les patients présentant un profil «dysfonctionnel» et de «détresse interpersonnelle» ont affiché une amélioration marquée de la douleur sur l'indice de rééducation de la douleur (tailles d'effet de 0.77 et 0.43; P<0.0001, respectivement). Inversement, les patients «maîtrisant» leur adaptation semblent s'être quelque peu détériorés (taille d'effet -0.28; P=0.036). Nous proposons que les scores de quatre sous-échelles MPI soient intégrés et que la différence avant/après rééducation soit utilisée pour indiquer les résultats de rééducation composites, ce qui permettrait d'interpréter toutes les sous-échelles MPI incluses dans le même sens. L'évaluation psychométrique de l'indice est justifiée.
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| 5. |
- Holmberg, Johan, et al.
(författare)
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One-year follow-up of cognitive behavioral therapy for phobic postural vertigo
- 2007
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Ingår i: Journal of Neurology. - : Springer Science and Business Media LLC. - 1432-1459 .- 0340-5354. ; 254:9, s. 1189-1192
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Tidskriftsartikel (refereegranskat)abstract
- Background Phobic postural vertigo is characterized by dizziness in standing and walking despite normal clinical balance tests. Patients sometimes exhibit anxiety reactions and avoidance behavior to specific stimuli. Different treatments are possible for PPV, including vestibular rehabilitation exercises, pharmacological treatment, and cognitive behavioral therapy. We recently reported significant benefits of cognitive behavioural therapy for patients with phobic postural vertigo. This study presents the results of a one-year follow-up of these patients. Methods Swedish translations of the following questionnaires were administered: (Dizziness Handicap Inventory, Vertigo Symptom Scale, Vertigo Handicap Questionnaire, and Hospital Anxiety and Depression Scale) were administered to 20 patients (9 men and 11 women; mean age 43 years, range 23-59 years) one year after completion of cognitive behavioral therapy. Results Test results were similar to those obtained before treatment, showing that no significant treatment effects remained. Conclusion Cognitive behavioral therapy has a limited long-term effect on phobic postural vertigo. This condition is more difficult to treat than panic disorder with agoraphobia. Vestibular rehabilitation exercises and pharmacological treatment might be the necessary components of treatment.
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