| 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. |
- Gedin, Filip, et al.
(författare)
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Placebo Response and Media Attention in Randomized Clinical Trials Assessing Cannabis-Based Therapies for Pain: A Systematic Review and Meta-analysis.
- 2022
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Ingår i: JAMA network open. - : American Medical Association (AMA). - 2574-3805. ; 5:11
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Tidskriftsartikel (refereegranskat)abstract
- Persistent pain is a common and disabling health problem that is often difficult to treat. There is an increasing interest in medicinal cannabis for treatment of persistent pain; however, the limited superiority of cannabinoids over placebo in clinical trials suggests that positive expectations may contribute to the improvements.To evaluate the size of placebo responses in randomized clinical trials in which cannabinoids were compared with placebo in the treatment of pain and to correlate these responses to objective estimates of media attention.A systematic literature search was conducted within the MEDLINE and Embase databases. Studies published until September 2021 were considered.Cannabinoid studies with a double-blind, placebo-controlled design with participants 18 years or older with clinical pain of any duration were included. Studies were excluded if they treated individuals with HIV/AIDS or severe skin disorders.The study followed the Preferred Reporting Items for Systematic Review and Meta-analyses reporting guideline. Data were extracted by independent reviewers. Quality assessment was performed using the Risk of Bias 2 tool. Attention and dissemination metrics for each trial were extracted from Altmetric and Crossref. Data were pooled and analyzed using a random-effects statistical model.Change in pain intensity from before to after treatment, measured as bias-corrected standardized mean difference (Hedges g).Twenty studies, including 1459 individuals (mean [SD] age, 51 [7] years; age range, 33-62 years; 815 female [56%]), were included. Pain intensity was associated with a significant reduction in response to placebo, with a moderate to large effect size (mean [SE] Hedges g, 0.64 [0.13]; P<.001). Trials with low risk of bias had greater placebo responses (q1=5.47; I2=87.08; P=.02). The amount of media attention and dissemination linked to each trial was proportionally high, with a strong positive bias, but was not associated with the clinical outcomes.Placebo contributes significantly to pain reduction seen in cannabinoid clinical trials. The positive media attention and wide dissemination may uphold high expectations and shape placebo responses in future trials, which has the potential to affect the outcome of clinical trials, regulatory decisions, clinical practice, and ultimately patient access to cannabinoids for pain relief.
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| 3. |
- Lalouni, Maria, et al.
(författare)
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Augmented pain inhibition and higher integration of pain modulatory brain networks in women with self-injury behavior
- 2022
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Ingår i: Molecular Psychiatry. - : Springer Nature. - 1359-4184 .- 1476-5578. ; 27:8, s. 3452-3459
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Tidskriftsartikel (refereegranskat)abstract
- Individuals who engage in nonsuicidal self-injury (NSSI) have demonstrated insensitivity to pain compared with individuals without NSSI. Yet, the neural mechanisms behind this difference are unknown. The objective of the present study was to determine which aspects of the pain regulatory system that account for this decreased sensitivity to pain. In a case-control design, 81 women, aged 18-35 (mean [SD] age, 23.4 [3.9]), were included (41 with NSSI and 40 healthy controls). A quantitative sensory testing protocol, including heat pain thresholds, heat pain tolerance, pressure pain thresholds, conditioned pain modulation (assessing central down-regulation of pain), and temporal summation (assessing facilitation of pain signals) was used. Pain-evoked brain responses were assessed by means of fMRI scanning during thermal pain. NSSI participants showed a more effective central down-regulation of pain, compared to controls, assessed with conditioned pain modulation. The neural responses to painful stimulation revealed a stronger relation between nociceptive and pain modulatory brain regions in NSSI compared to controls. In line with previous studies, pressure and heat pain thresholds were higher in participants with NSSI, however, there were no correlations between pain outcomes and NSSI clinical characteristics. The augmented pain inhibition and higher involvement of pain modulatory brain networks in NSSI may represent a pain insensitive endophenotype associated with a greater risk for developing self-injurious behavior.
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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
(författare)
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Guts over fear : internet therapy for abdominal pain in children
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Pediatric functional abdominal pain disorders (FAPDs) are prevalent and associated with painful symptoms, low quality of life, and functional impairments. The origin is likely multifactorial and includes psychological factors (e.g., anxiety and coping mechanisms), biological factors (e.g., visceral sensitivity and gut microbiota), and social factors (e.g., interaction with parents or teachers). There is limited support for dietary and pharmacological treatments in FAPDs, but support for the effectiveness of cognitive behavioral therapy (CBT) is growing. Aims: The overall aim of the thesis was to develop and evaluate a therapist-supported exposure-based CBT for children 8-12 years with FAPDs, which could, if proven effective, increase accessibility of treatments for children with FAPDs. The specific aims were to: - Assess feasibility, acceptability, and potential effectiveness of the preliminary protocol of exposure-based CBT in a face-to-face setting (Study I). - Assess feasibility, acceptability, and potential effectiveness of the exposure-based CBT converted to an internet platform (Internet-CBT, Study II). - Evaluate effectiveness and cost effectiveness of the Internet-CBT compared with treatment as usual (Study III). - Investigate if gastrointestinal-specific anxiety and avoidance behaviors mediated a change in gastrointestinal symptoms in Internet-CBT compared with treatment as usual and if baseline values of the proposed mediators moderated the mediation (Study IV). Methods: All participants were children 8-12 years with FAPDs referred to the studies by their physicians. Treatment consisted of therapist-supported exposure-based CBT, delivered face-to-face (Study I) or online (studies II-IV) along with parental sessions or modules. All measures were self-assessed by children and parents. Primary outcome was pain intensity (Study I) and gastrointestinal symptoms (Study II-IV). Secondary outcomes included quality of life, school absence, anxiety, and parental responses to their children´s symptoms (Studies I-III), cost effectiveness and parental catastrophizing (Study III), gastrointestinal-specific anxiety (Study II-IV), and avoidance behavior (Study I-IV). Statistical analyses used to test within- and between-group effects were t-tests (Study I) and multi-level linear mixed models (Study II and III). Differences in costs between groups were assessed with generalized linear models (Study III). Univariate and multivariate growth models were used to assess mediation and moderated mediation (Study IV). Results: Therapist-supported exposure-based CBT, delivered face-to-face or online, rendered high adherence and treatment completion (Study I-III). Participating children and parents were satisfied with the treatment and perceived it to be helpful in dealing with abdominal symptoms (Study I-III). There were significant treatment effects in gastrointestinal symptoms, quality of life, gastrointestinal-specific anxiety, avoidance behavior, anxiety, parental catastrophizing, and parental responses to their child’s symptoms for Internet-CBT when compared with treatment as usual (Study III). Internet-CBT was found to be cost effective and even cost saving compared with treatment as usual (Study III). A reduction in gastrointestinal-specific anxiety and avoidance behavior mediated a reduction in gastrointestinal symptoms for children receiving Internet-CBT compared with children receiving treatment as usual (Study IV). Baseline values of gastrointestinal specific-anxiety and avoidance behavior moderated the mediation (Study IV). Conclusions: Internet-CBT based on exposure exercises and parental support for children with FAPDs is feasible, acceptable, clinically effective, and cost effective compared with treatment as usual. Gastrointestinal-specific anxiety and avoidance behavior are potential mechanisms of change in exposure-based Internet-CBT compared with treatment as usual. Internet-CBT seems to be particularly effective for children with high levels of gastrointestinal-specific anxiety and avoidance behaviors. The treatment has the potential to increase the availability of evidence-based treatments a large group of children with FAPD
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| 6. |
- 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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| 7. |
- Mortazavi, Rebecca, et al.
(författare)
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Moderate-to-vigorous group aerobic exercise versus group leisure activities for mild-to-moderate depression in adolescents : study protocol for a multicentre randomised controlled trial
- 2022
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Ingår i: BMJ Open. - London : BMJ. - 2044-6055. ; 12:7, s. 1-10
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Depression is common, increasing among adolescents and carries risk of disability, lower educational achievements, cardiovascular disease, substance abuse, self-harm and suicide. The effects of evidence-based treatments with medication or psychotherapy are modest. Aerobic exercise is a promising intervention for adolescents with depression, but available studies are hampered by methodological shortcomings. This study aims to evaluate aerobic group exercise versus an active comparator of leisure group activities in adolescents from clinical services with mild-to-moderate depression.METHODS AND ANALYSIS: This study is a multicentre randomised controlled trial at four psychiatric clinics in Sweden. Participants (n=122) will be randomised 1:1 to group exercise delivered by exercise professionals and supported by mental health (MH) workers or leisure activities lead by the same MH workers for 1 hour three times a week for 12 weeks. Participants will be assessed at baseline, single blind after 13 weeks and 26 weeks and openly after 1 year. Participants randomised to the leisure group will be offered exercise in the open phase. The primary outcome is clinician-rated Children's Depression Rating Scale-Revised. Secondary outcomes are self-rated Quick Inventory of Depressive Symptomatology, self-rated functioning; clinician-rated improvement and functioning; objectively measured aerobic capacity, muscular strength, muscular endurance, body composition and presence or activity of selected biological markers of neuroprotection and neuroinflammation in blood samples. Further outcomes are cost-effectiveness and adolescents', parents' and coaches' experiences of the interventions and an exploration of how the adolescents' health and lifestyle are influenced by the interventions through qualitative interviews.ETHICS AND DISSEMINATION: The study is approved by the Swedish Ethical Review Authority (Ref. 2021-05307-01). Informed consent in writing will be provided from patients and parents of participants below 15 years of age. The results of this study will be communicated to the included participants and healthcare providers and also submitted for publication in peer-reviewed journals.TRIAL REGISTRATION NUMBER: NCT05076214.
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| 8. |
- Nordh, Martina, et al.
(författare)
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Therapist-Guided Internet-Delivered Cognitive Behavioral Therapy vs Internet-Delivered Supportive Therapy for Children and Adolescents With Social Anxiety Disorder : A Randomized Clinical Trial
- 2021
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Ingår i: JAMA psychiatry. - : American Medical Association (AMA). - 2168-6238 .- 2168-622X. ; 78:7, s. 705-713
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Tidskriftsartikel (refereegranskat)abstract
- Importance Social anxiety disorder (SAD) is a prevalent childhood-onset disorder associated with lifelong adversity and high costs for the individual and society at large. Cognitive behavioral therapy (CBT) is an established evidence-based treatment for SAD, but its availability is limited.Objective To assess the efficacy and cost-effectiveness of therapist-guided internet-delivered cognitive behavioral therapy (ICBT) for SAD in youths vs an active comparator, internet-delivered supportive therapy (ISUPPORT).Design, Setting, and Participants This single-masked, superiority randomized clinical trial enrolled participants at a clinical research unit integrated within the child and adolescent mental health services in Stockholm, Sweden, from September 1, 2017, to October 31, 2018. The final participant reached the 3-month follow-up (primary end point) in May 2019. Children and adolescents 10 to 17 years of age with a principal diagnosis of SAD and their parents were included in the study.Interventions ICBT and ISUPPORT, both including 10 online modules, 5 separate parental modules, and 3 video call sessions with a therapist.Main Outcomes and Measures The Clinician Severity Rating (CSR), derived from the Anxiety Disorder Interview Schedule, rated by masked assessors 3 months after the end of treatment. The CSR ranges from 0 to 8, with scores of 4 or higher indicating caseness. Secondary outcomes included masked assessor–rated diagnostic status of SAD and global functioning, child- and parent-reported social anxiety and depressive symptoms, and health-related costs.Results Of the 307 youths assessed for eligibility, 103 were randomized to 10 weeks of therapist-guided ICBT (n = 51) or therapist-guided ISUPPORT (n = 52) for SAD. The sample consisted of 103 youths (mean [SD] age, 14.1 [2.1] years; 79 [77%] female). Internet-delivered cognitive behavioral therapy was significantly more efficacious than ISUPPORT in reducing the severity of SAD symptoms. Mean (SD) CSR scores for ICBT at baseline and at the 3-month follow-up were 5.06 (0.95) and 3.96 (1.46), respectively, compared with 4.94 (0.94) and 4.48 (1.30) for ISUPPORT. There was a significant between-group effect size of d = 0.67 (95% CI, 0.21-1.12) at the 3-month follow-up. Similarly, all of the secondary outcome measures demonstrated significant differences with small to large effect sizes, except for child-rated quality of life (nonsignificant). The cost-effectiveness analyses indicated cost savings associated with ICBT compared with ISUPPORT, with the main drivers of the savings being lower medication costs (z = 2.38, P = .02) and increased school productivity (z = 1.99, P = .047) in the ICBT group. There was 1 suicide attempt in the ISUPPORT group; no other serious adverse events occurred in either group.Conclusions and Relevance In this randomized clinical trial, internet-delivered cognitive behavioral therapy was an efficacious and cost-effective intervention for children and adolescents with SAD. Implementation in clinical practice could markedly increase the availability of effective interventions for SAD.Trial Registration ClinicalTrials.gov Identifier: NCT03247075
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| 9. |
- Ruehr, Livia, et al.
(författare)
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Back morphology and walking patterns mean 13.8 years after surgery for lumbar disk herniation in adolescents
- 2024
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Ingår i: Pain Reports. - : Lippincott Williams & Wilkins. - 2471-2531. ; 9:2
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: In many pain conditions, there is lingering pain despite healed tissue damage. Our previous study shows that individuals who underwent surgery for lumbar disk herniation (LDH) during adolescence have worse health, more pain, and increased disk degeneration mean 13 years after surgery compared with controls. It is unclear if walking patterns segregate surgically treated LDH adolescents and controls at mean 13-year follow-up.Objectives: Here, we analyzed the relationship between gait, back morphology and other health outcomes in a cohort of individuals treated surgically because of lumbar disk herniation compared with controls.Methods: We analyzed gait during a walking paradigm, back morphology at the site of surgery, and standardized health outcomes, among individuals who received surgery for LDH as adolescents, “cases” (n = 23), compared with “controls” (n = 23).Results: There were gait differences in head (P = 0.021) and trunk angle (P = 0.021) between cases and controls in a direction where cases exhibited a posture associated with sickness. The gait variance was explained by subjective pain and exercise habits rather than objective disk degeneration.Conclusion: Over a decade after surgery for LDH during adolescence, health among cases is worse compared with controls. The head and trunk angles differ between cases and controls, indicating that the residual pain lingers and may cause changes in movement patterns long after a painful episode in early life. Gait may be a useful target for understanding maintenance of pain and disability among individuals treated surgically for LDH during adolescence.
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| 10. |
- 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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