| 1. |
- Anniko, Malin, 1981-
(författare)
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Stuck on repeat : Adolescent stress and the role of repetitive negative thinking and cognitive avoidance
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Stress and stress-related mental health problems such as anxiety and depressive symptoms are common in adolescents and seem to be increasing, especially in mid- to late-adolescent girls. Although adolescence, as a period of rapid growth and profound change, is often marked by an increase in normal stressors (e.g. conflicts with parents, fitting in with peers, increased academic demands), most adolescents do not develop more persis-tent problems with stress. To be able to develop effective preventive interventions there is a need to understand both what adolescents are ascribing their stress to, how different stressor domains relate to outcomes, and why some adolescents go on to develop stress-related mental health problems while others do not. This dissertation aimed to answer some of these questions by investigating the role of cognitive avoidance and repetitive negative thinking (RNT) in the development of stress-related mental health problems (Study I & III). It also aimed to develop and validate a shortened version of a questionnaire designed to measure stressor load within different life domains in adolescence (Study II). Findings show that the shortened version of the Adolescents Stress Questionnaire seems to be a valid measure of stressor load within different domains in adolescence. School-related stressors were the most prevalent sources of stress, but social stressors seem to have a stronger link to increases in mental health symptoms. Also, adolescents who report higher levels of distress and stressor load tend to increase their engagement in cognitive avoidance and RNT over time which in turn predicts further increases in mental health symptoms. This suggests that cognitive avoidance and RNT may be important mechanisms in the development of stress-related mental health problems in adoles-cence.
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| 2. |
- Carstens Söderstrand, Johan, 1979-
(författare)
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Communication in the context of acute pain : Persuasion or validation?
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Historically, the dominating theoretical framework for communication in the context of acute pain is reassurance. An inherent assumption of this framework is that the person in pain needs to have their fears and doubts removed and be educated, or persuaded, that the pain problem is not dan-gerous. This is then thought to lead to a shift in beliefs that later explain future beneficial outcomesIn later years, another communication technique known as validation has started to gain traction in the pain field. This technique focuses on le-gitimizing the thoughts and emotions of pain patients and is instead thought to influence outcomes through better emotion regulation.The overall aim of this dissertation is to extend current knowledge on effective communication in the context of acute pain. In one observational study a variable supposedly sensitive to shifts in beliefs was observed in a cohort of acute pain patients over the course of the first three months after pain onset. Also, in two controlled experiments we explored the impact of validating communication on pain relevant variables while investigating if this effect was due to improved emotion regulation.Taken together, this dissertation indicates that validating communica-tion shows promise as a form of effective communication in the context of acute pain, in that it influences both pain catastrophizing and recall. The dissertation does not give support to either changes in beliefs nor emotion regulation being the mechanism of change for effective communication. Thus, this dissertation propose a new model of effective communication based both on previous research highlighting the effectiveness of infor-mation and the research presented in this dissertation, more focused on the role of psychological processes such as pain catastrophizing.
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| 3. |
- Golovchanova, Nadezhda, 1983-
(författare)
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Older and Feeling Unsafe? Unravelling the Role of Perceived Unsafety in the Well-being of Older Adults Residing in Senior Apartments
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Feeling safe in one’s place of residence is important for the well-being of older adults when ageing in place; in contrast, feeling unsafe is likely to have negative consequences for well-being while ageing. Although substantial knowledge of perceived unsafety has been accumulated within various disciplines, there are certain knowledge gaps related to perceived unsafety in older age. What perceived reasons for feeling unsafe are the most central to older adults? Can emotion regulation strengthen or buffer the negative effects of perceived unsafety on the well-being of older people? What differences exist among older adults regarding why they feel unsafe?This dissertation aimed to address these questions while investigating perceived unsafety and its associations with well-being in the context of ageing, focusing on senior apartment residents. This dissertation adopted an interdisciplinary approach integrating knowledge of perceived unsafety from psychology, gerontology, and criminology. The findings suggest that perceived unsafety in advanced age is a multifaceted phenomenon. Specifically, perceived unsafety could be explained by different perceived reasons (i.e., fear of crime, unattractive social climate in the neighbourhood, and inconvenient infrastructure at home; Study I). Furthermore, maladaptive cognitive emotion regulation strategies were associated with fear of crime and strengthened its negative association with life satisfaction (Study II). Moreover, distinct profiles of older adults could be identified based on compromises in their key life domains. Older adults belonging to different profiles differed in their perceived unsafety and well-being (Study III).Overall, this dissertation findings indicate that feeling unsafe is associated with being less satisfied with life, experiencing more anxiety and depressive feelings, and relying on more maladaptive emotion regulation strategies. Therefore, safety-promotion efforts are considered an important investment in the quality of life of older adults living in senior apartments.
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| 4. |
- Wurm, Matilda, 1975-
(författare)
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Understanding Comorbid Pain and Emotions : A transdiagnostic approach
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Experiencing pain, including an emotional reaction, is part of being human. Emotional comorbidity is common in pain patients, and correlated to higher symptomatology and worse treatment outcome. The shared vulnerability model suggests that many vulnerability and maintaining factors may be involved in both pain and emotional problems. Hence, they may be transdiagnostic. Since our knowledge about these shared factors is lacking, potential targets for risk assessment, prevention, and treatment are likely underutilized. The overarching aim of this dissertation was to further our understanding of comorbid musculoskeletal pain and emotional problems by investigating the role of transdiagnostic factors. Specifically, it was studied if levels of shared vulnerabilities (negative affect and anxiety sensitivity) and symptomatology covary in pain patients depending on the occurrence of comorbid social anxiety symptoms (Study I); if peer-related stress predicts musculoskeletal pain problems over time in adolescents, and if this is mediated by worry and moderated by gender (Study II); and if symptomatology can be decreased in pain patients with comorbid emotional problems by using an internet delivered unified protocol for emotional disorders (Study III). Results show that vulnerabilities covaried with comorbid pain and social anxiety. Also, peer-related stress predicted musculoskeletal pain problems in adolescents and was mediated by worry for girls. However, the internet-delivered unified protocol did not unequivocally decrease symptomatology. In sum, the studies in this dissertation provide partial support for the role of transdiagnostic factors in comorbid musculoskeletal pain and emotional problems. A transdiagnostic approach may offer a parsimonious understanding of the development and maintenance of this comorbid symptomatology.
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| 5. |
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| 6. |
- Bauducco, Serena, 1988-, et al.
(författare)
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Adolescents' sleep trajectories over time : school stress as a potential risk factor for the development of chronic sleep problems
- 2019
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Ingår i: Sleep Medicine. - : Elsevier. - 1389-9457 .- 1878-5506. ; 64:Suppl. 1, s. S27-S27
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Sleep is a complex behavior affected by biological, psychosocial and contextual factors typically present during adolescent development (Becker, Langberg, & Byars, 2015), including increasing autonomy from parents, increasing school demands, and socializing more with peers. However, these normative changes do not explain temporary vs chronic sleep disturbances. Who are the adolescents at risk for developing chronic sleep problems? Some risk factors have been identified as crucial, such as poor sleep hygiene and family stressors, others are not as clear, such as technology use (Bartel et al., 2015). The impact of another important stressor for youths other than family, the school context, has received less attention (Meldrum, 2018). The aim of this study was twofold; first, we explored sleep trajectories from early to mid-adolescence to be able to identify a risk group showing persistent sleep problems (including insomnia and short sleep duration); then, we investigated the role of school stressors (i.e., conflicts with teachers, performance, school-leisure conflict, attendance), controlling for well-established risk factors, in the development of chronic sleep problems in a large cohort of adolescents.Materials and methods: We used three longitudinal waves of questionnaire data collected annually from a sample of Swedish adolescents (n = 1457; Mage = 13.2 [range: 12- 15 years], SD = .43; 52.7% boys). We collected the data from all schools in three communities in central Sweden, during school hours. Using established measures, the students reported on their sleep duration (calculated from reported bedtime, wake-time, and sleep onset latency; SSHS [Wolfson & Carskadon, 1998]), insomnia symptoms (ISI; Morin, 1993), sleep hygiene (ASHS; LeBourgeois, Giannotti, Cortesi, Wolfson, & Harsh, 2005), technology use, and perceived stress (including school, home and peer related stress) (ASQ; Byrne, Davenport, & Mazanov, 2007).First we used latent class analysis (LCA) to identify adolescents' sleep trajectories, then we used regression analyses to predict the risk-group trajectory of chronic insomnia and short sleep duration, controlling for gender.Results: We found four trajectories for adolescents' insomnia; 1) low-stable (69%), 2) low-increasing (18%), 3) high-decreasing (8%), 4) high-increasing (5%; 'risk-group'). For sleep duration, we found two trajectories; 1) ∼8 h slightly decreasing (79%), 2) ∼7 h decreasing (21%; 'risk-group').School stressors including stress of fitting in with peers, stress of schoolwork leaving too little leisure time, a stressful home environment, poor sleep hygiene, and being female were risk factors for chronic insomnia symptoms. Conflicts with teachers, poor sleep hygiene, and being female were risk-factors for chronic insufficient sleep.Conclusions: Over and above well-known risk-factors for poor sleep, such as poor sleep hygiene, (Bartel et al., 2015), school-related stress was a significant predictor of persistent sleep problems in adolescents. Therefore, helping adolescents to handle school stress might be a promising strategy to improve sleep health in this population.
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| 7. |
- Bauducco, Serena, 1988-, et al.
(författare)
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Trajectories of insomnia symptoms and insufficient sleep duration in early adolescents : associations with school stress
- 2022
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Ingår i: SLEEP Advances. - : Oxford University Press. - 2632-5012. ; 3:1
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Tidskriftsartikel (refereegranskat)abstract
- Study Objectives: We examined how adolescents’ sleep patterns (i.e. insomnia symptoms and sleep duration) change from early- to mid-adolescence and whether adolescents follow different trajectories. Furthermore, we also examined the characteristics of adolescents within different trajectories, with a specific focus on the role of school-related stress.Methods: We used three longitudinal waves of questionnaire data collected annually from a sample of Swedish adolescents (n = 1294; Mage = 13.2 [range: 12–15 years], SD = .42; 46.8% girls). Using established measures, the students reported on their sleep duration, insomnia symptoms, and perceived school-stress (including stress of school performance, peer and teacher relations, attendance, and school-leisure conflict). We used latent class growth analysis (LCGA) to identify adolescents’ sleep trajectories, and the BCH method to describe the characteristics of the adolescents in each trajectory.Results: We found four trajectories for adolescents’ insomnia symptoms; (1) low insomnia (69%), (2) low-increasing (17%, ‘emerging risk-group’), (3) high-decreasing (9%), (4) high-increasing (5%; ‘risk-group’). For sleep duration, we found two trajectories; (1) ~8 h sufficient-decreasing (85%), (2) ~7 h insufficient- decreasing (15%; ‘risk-group’). Adolescents in risk-trajectories were more likely to be girls and consistently reported higher levels of school stress, particularly regarding school performance and attending school.ConclusionsSchool stress was prominent among adolescents suffering from persistent sleep problems, especially insomnia, and deserves further attention.
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| 8. |
- Bayram Özdemir, Sevgi, 1981-, et al.
(författare)
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How Does Adolescents' Openness to Diversity Change Over Time? The Role of Majority-Minority Friendship, Friends' Views, and Classroom Social Context
- 2021
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Ingår i: Journal of Youth and Adolescence. - : Plenum Publishing. - 0047-2891 .- 1573-6601. ; 50:1, s. 75-88
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Tidskriftsartikel (refereegranskat)abstract
- Young people are growing up in increasingly “super-diverse” societies, and show variations in how they approach diversity and embrace differences. Developing a good understanding of why some youth appreciate and value diversity whereas others do not is crucial in identifying ways to promote social interactions among different groups in broader society. The current study examined whether adolescents follow different trajectories in their views on diversity, and identified possible factors behind how they change over time. The sample included 1362 adolescents residing in Sweden (Mage = 13.18, SD = 0.43, 48% girls). Adolescents reported on their openness to diversity and classroom social climate. The peer nominations method was used to measure majority-minority friendship, and friends’ views on diversity. Latent growth analysis showed that adolescents, on average, became more open to diversity over time, but with clear heterogeneity. Three distinct trajectories were identified as: high-increasing, average-increasing, and average-declining. Relative to the high-increasing group, the other two were more likely to be male and immigrant. Relative to the high-increasing group, adolescents on the average-increasing trajectory perceived their classroom climate as less cooperative, while the adolescents on the average-declining trajectory were less likely to have friends with positive views on diversity. The findings suggest that schools may serve as a shared ground for promoting openness to diversity.
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| 9. |
- Elvén, Maria, 1973-, et al.
(författare)
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Assessing clinical reasoning in physical therapy : discriminative validity of the Reasoning 4 Change instrument
- 2022
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Ingår i: Physiotherapy. - : Elsevier BV. - 0031-9406 .- 1873-1465. ; 117, s. 8-15
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To evaluate discriminative validity of the Reasoning 4 Change (R4C) instrument by investigating differences in clinical reasoning skills between first semester, final semester physical therapy students and physical therapy experts.Design:Cross-sectional designSetting: University and physical therapy practiceParticipantsStudents from the first (n = 87) and final semester (n = 47) of an entry-level physical therapy program and experts in physical therapy with a behavioral medicine approach (n = 14).Methods: The students and experts answered the web-based R4C instrument on one occasion. The R4C instrument includes four domains designed to assess physical therapists’ clinical reasoning skills with a focus on supporting clients’ behavior change and has demonstrated acceptable content validity, convergent validity and reliability. Data was analyzed with one-way analysis of variance and Games-Howell post hoc test.Results: Differences in all domains and subscale scores were found between the three groups. Pairwise comparisons demonstrated that experts scored higher (better clinical reasoning skills) than first semester students in all domains and subscales; and higher scores than final semester students, except for two subscales. Final semester students scored higher than first semester students, except for one subscale.Conclusions: The findings highlight differences in clinical reasoning skills focusing on clients’ behavior change among physical therapy students with different degrees of training and education in clinical reasoning and physical therapists with extensive experience and expertise. The results provide evidence for the discriminative validity of the R4C instrument which support the use of the R4C instrument in education, research and clinical practice.
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| 10. |
- Ponten, Moa, et al.
(författare)
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Association between expectations and clinical outcomes in online v. face-to-face therapy - an individual participant data meta-analysis
- 2024
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Ingår i: Psychological Medicine. - : Cambridge University Press. - 0033-2917 .- 1469-8978. ; 54:6, s. 1207-1214
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Tidskriftsartikel (refereegranskat)abstract
- Background. Online treatments are increasing in number and are currently available for a wide range of clinical problems. To date little is known about the role of treatment expectations and other placebo-like mechanisms in online settings compared to traditional face-to-face treatment. To address this knowledge gap, we analyzed individual participant data from randomized clinical trials that compared online and face-to-face psychological interventions.Methods. MEDLINE (Ovid) and PsycINFO (Ovid) were last searched on 2 February 2021. Randomized clinical trials of therapist guided online v. face-to-face psychological interventions for psychiatric or somatic conditions using a randomized controlled design were included. Titles, abstracts, and full texts of studies were independently screened by multiple observers. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline was followed. Authors of the matching trials were contacted for individual participant data. Ratings from the Credibility and Expectancy Questionnaire and the primary outcome measure from each trial were used to estimate the association between expectation ratings and treatment outcomes in online v. face-to-face interventions, using a mixed-effects model.Results. Of 7045 screened studies, 62 full-text articles were retrieved whereof six studies fulfilled the criteria and provided individual participant data (n = 491). Overall, CEQ ratings predicted clinical outcomes (beta = 0.27) at end of treatment with no moderating effect of treatment modality (online v. face-to-face).Conclusions. Online treatment appears to be equally susceptible to expectancy effects as face-to-face therapy. This furthers our understanding of the importance of placebo-like factors in online treatment and may aid the improvement of healthcare in online settings.
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| 11. |
- Svanberg, Mikael, 1958-
(författare)
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Psykologiska faktorer vid rehabilitering av patienter med långvarig smärta
- 2022
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Chronic pain is common and a burden for both the individual and society. In chronic pain, the pain has lost its function as a warning system and instead has become a disease in itself. Neurobiologically, several areas of the brain are involved, but to gain a broader understanding of the long-term pain, the biopsychosocial model is the best starting point. In line with thisand many scientific studies since the late 90's, psychological factors have proven to be an important factor in the development and maintenance of chronic pain. Interdisciplinary multimodal rehabilitation programs (IMMRP) are the treatment currently given to patients with long-term pain in the specialized pain rehabilitation. When the IMMRP has been reviewed, patients have shown improvement over time, but it is not possible to say whether it is the IMMRP or which parts of the IMMRP that explain the improvement (1).In this licentiate thesis, I have studied the importance of psychological factors in the rehabilitation of patients with chronic pain. This has been done in three studies reported in three published articles. All the studies have been close to the clinic and have been performed on patients in the specialized pain rehabilitation care in Sweden.The first article studied the effect of the multimodal investigation (MMI). More specifically, it was investigated whether alliance building and feelings of validation in patients with chronic pain affected their acceptance of pain, pain management, catastrophic thoughts, and depression. This was performed in a "single case" study on six patients in MMI. The results showed that despite good alliance and sense of validation, acceptance increased only in one patient and no improvement was seen in pain management, catastrophizing, and depression.In study two, subgroups of patients with chronic pain were studied. The subgroup analysis showed that patients referred for IMMRP could be divided into groups with different profiles regarding emotional problems and pain avoidance. These profiles were important for how the patients relatedto their pain and the results of IMMRP. The results of the study can increase the understanding of which patients should be selected for IMMRP and how the treatment can be adapted to the patients' needs.In study three, opioid treatment in patients with long-term pain who were referred to IMMRP was studied. The result showed that opioid prescribing was common and 55% of the participants received at least one prescription for opioids during the two years after the first assessment. It also turns out that there was a connection between individual patient characteristics (especially pain and depressive symptoms) and opioid prescription. Understanding how individual patient characteristics relate to prescribing patterns and long-term opioid use is an important prerequisite for managing opioid prescribing and the basics for preventing overuse. Overall, this licentiate thesis shows that MMU has no therapeutic effect on patients with long-term pain. It also shows that patients with chronic pain are a heterogeneous group that can be divided into subgroups based on psychological characteristics. The subgroups, in turn, had different ways of managing their pain and absorbing the treatment offered. In addition, it emerged that opioid prescribing was common among patients with long-term pain and that there was a link between opioids and patient characteristics.
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| 12. |
- Anniko, Malin, 1981-, et al.
(författare)
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Development of a Shortened Version of the Adolescent Stress Questionnaire (ASQ-S) : construct validity and sex invariance in a large sample of Swedish adolescents
- 2018
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Ingår i: Scandinavian Journal of Child and Adolescent Psychiatry and Psychology. - New York, NY, USA : Exeley Inc.. - 2245-8875. ; 6:1, s. 4-15
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Tidskriftsartikel (refereegranskat)abstract
- Background: Stressor experience is an important topic of research concerning adolescent health and ill-health. For this, valid and reliable measures of adolescent stress are needed. The Adolescent Stress Questionnaire 2 was developed to tap into stressor domains specific for adolescence. Psychometric evaluations in Australian and European samples have indicated adequate psychometric properties. However, the ASQ-2 is quite extensive, which may render its use in large cohort studies, where several aspects of adolescent health are investigated, inconvenient and problematic.Objective: To evaluate the psychometric properties of a short version of the ASQ-2 (ASQ-S) in terms of construct validity and factorial invariance across gender.Method: The ASQ-2 was translated into Swedish and items were retained from nine of the ten scales based on factor loadings. One scale (stress of emerging adult responsibilities) was removed entirely due to low internal consistency and variance explained. The remaining 27 items were piloted and then included in an ongoing 5-year longitudinal study involving the participation of all students in the 7th and 8th grade in public schools from three Swedish municipalities (N = 2768, 47.5 % girls, mean age 13.64 years). For this study data from the first and second wave was used.Results: A nine factor Confirmatory Factor Analysis (CFA) showed a good fit to the data and invariance across sexes was supported. The nine scales correlated positively with depressive symptoms, anxiety and worry and negatively with self-esteem. Girls reported higher stress levels than boys in eight of the nine scales. Stressors related to peer pressure predicted reported levels of anxiety and worry one year later, whereas stressors related to romantic relationships predicted depressive symptoms.Conclusions: Overall this study suggests that the ASQ-S could be a valid measure of adolescent stressor experience and psychometrically equivalent to the full ASQ-2.
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| 13. |
- Anniko, Malin, 1981-, et al.
(författare)
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Investigating the mediating role of cognitive emotion regulation in the development of adolescent emotional problems
- 2018
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Ingår i: Nordic Psychology. - : Routledge. - 1901-2276 .- 1904-0016. ; 70:1, s. 3-16
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Tidskriftsartikel (refereegranskat)abstract
- Previous research has indicated that cognitive emotion regulation strategies contribute to the development and maintenance of emotional problems in adults and adolescents. However, there is a lack of longitudinal research with adolescent samples, hence knowledge of exactly how these strategies influence the development of emotional problems in adolescence is sparse. This study investigated maladaptive cognitive emotion regulation (cognitive avoidance and repetitive negative thinking) as a potential mediator in the development of anxiety and depressed mood over time in adolescence. Self-reported depressed mood, anxiety, and cognitive emotion regulation strategies were assessed during school hours in a sample of Swedish 10th graders (N=149; 53% girls), with follow-up assessments one and two years later. Repetitive negative thinking and cognitive avoidance formed a unidimensional factor of cognitive emotion regulation. Cognitive emotion regulation was found to mediate the development of both anxiety and depressed mood over time, lending support to the previous findings that cognitive emotion regulation strategies such as cognitive avoidance and repetitive negative thinking might act as transdiagnostic mechanisms in the development of emotional symptoms in adolescence. This suggests that maladaptive forms of cognitive emotion regulation could be important targets in prevention and treatment of emotional problems in adolescence.
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| 14. |
- Anniko, Malin, 1981-, et al.
(författare)
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Sources of stress and worry in the development of stress-related mental health problems : A longitudinal investigation from early- to mid-adolescence
- 2018
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Ingår i: Anxiety, Stress, and Coping. - London, United Kingdom : Taylor & Francis. - 1061-5806 .- 1477-2205. ; 32:2, s. 155-167
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Tidskriftsartikel (refereegranskat)abstract
- Background and Objectives: Stress and stress-related mental health complaints are common and increasing among adolescents, especially girls. Identifying typical sources of stress as well as central intervention targets is an important effort in the development of effective prevention and treatment protocols. This study investigated worry as potential mediator in the development of mental health problems in response to common stressors in adolescence. We also examined to what sources adolescents ascribe their stress over the years from the 7th through the 9th grade. Design: Prospective cohort study. Methods: Self-reported subjective stressor load, worry, anxiety and depressive symptoms were assessed in a sample of Swedish 7th graders (N = 1137; 46% girls, mean age 13.2) with follow-up assessments one and two years later. Results: School was the most common source of stress across all time-points, with girls reporting considerable more stress than boys. Worry mediated the relationship between overall stressor load and depressive symptoms and anxiety over time and was not moderated by gender. Conclusions: Worry may be an important target in stress prevention and efforts to prevent stress-related problems would benefit from focusing on early adolescence as especially school stress is already relatively common in grade 7.
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| 15. |
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| 16. |
- Bartels, Sara Laureen, et al.
(författare)
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Development, evaluation and implementation of a digital behavioural health treatment for chronic pain : study protocol of the multiphase DAHLIA project
- 2022
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 12:4
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Chronic pain affects about 20%-40% of the population and is linked to mental health outcomes and impaired daily functioning. Pharmacological interventions are commonly insufficient for producing relief and recovery of functioning. Behavioural health treatment is key to generate lasting benefits across outcome domains. However, most people with chronic pain cannot easily access evidence-based behavioural interventions. The overall aim of the DAHLIA project is to develop, evaluate and implement a widely accessible digital behavioural health treatment to improve well-being in individuals with chronic pain.METHODS AND ANALYSIS: The project follows the four phases of the mHealth Agile Development and Evaluation Lifecycle: (1) development and pre-implementation surveillance using focus groups, stakeholder interviews and a business model; (2) iterative optimisation studies applying single case experimental design (SCED) method in 4-6 iterations with n=10 patients and their healthcare professionals per iteration; (3) a two-armed clinical randomised controlled trial enhanced with SCED (n=180 patients per arm) and (4) interview-based post-market surveillance. Data analyses include multilevel modelling, cost-utility and indicative analyses.In October 2021, inter-sectorial partners are engaged and funding is secured for four years. The treatment content is compiled and the first treatment prototype is in preparation. Clinical sites in three Swedish regions are informed and recruitment for phase 1 will start in autumn 2021. To facilitate long-term impact and accessibility, the treatment will be integrated into a Swedish health platform (www.1177.se), which is used on a national level as a hub for advice, information, guidance and e-services for health and healthcare.ETHICS AND DISSEMINATION: The study plan has been reviewed and approved by Swedish ethical review authorities. Findings will be actively disseminated through peer-reviewed journals, conference presentations, social media and outreach activities for the wider public.TRIAL REGISTRATION NUMBER: NCT05066087.
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| 17. |
- Bartels, Sara Laureen, et al.
(författare)
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Using Personas in the development of eHealth interventions for chronic pain : A scoping review and narrative synthesis
- 2023
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Ingår i: Internet Interventions. - : Elsevier. - 2214-7829. ; 32
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Forskningsöversikt (refereegranskat)abstract
- Objectives: Behavioral eHealth interventions can enhance self-management and improve well-being in people with chronic pain. The development of these interventions calls for a user-centered approach to ensure that patient needs are appreciated. However, it may be challenging to involve patients; particularly during the early stages of the process. Fictional user profiles, known as Personas, can represent needs and guide designing eHealth interventions. This article provides a comprehensive overview of the use of Personas in the development of behavioral eHealth interventions for people with chronic pain with the aim to identify benefits and challenges. Methods: Bibliographic databases (Medline, Web of Science Core Collection, PsycInfo, CINAHL) and registries (PubMed Central, medaRxiv) were systematically searched. In a double-reviewing process, n = 6830 hits and n = 351 full-texts were screened and read. Ten peer-reviewed studies published between 2017 and 2022 were included in the narrative synthesis. Findings: Ten studies reported using "Pain Personas" in the development of eHealth interventions for such purposes as to gain a shared understanding of the user and to discuss solutions in team meetings, or for patients to identify with (if Personas are included in the intervention). Personas were based on qualitative and/or quantitative data. However, the procedure for creating Personas was only described in half of the included studies (n = 5). These five studies provided descriptive details of the Personas (i.e., picture, name, narrative of their pain behavior, technological skills, and motivation). Conclusions: Although Personas have been used by pain researchers in recent projects and were highlighted as an important ingredient in the development process, available design guidelines for the creation and use of Personas are not followed or communicated transparently. Benefits and challenges when using Personas in the development of eHealth interventions for people with chronic pain are discussed to support future eHealth efforts and to improve the quality of eHealth innovation in the field of pain.
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| 18. |
- Bauducco, Serena, 1988-, et al.
(författare)
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Bidirectional associations between adolescents’ sleep problems and impulsive behavior over time
- 2019
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Ingår i: Sleep Medicine. - : Elsevier. - 1389-9457 .- 1878-5506 .- 2590-1427. ; 1
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Tidskriftsartikel (refereegranskat)abstract
- Objective/Background: Adolescents who experience sleep problems are less able to resist impulses. Furthermore, youths who show more impulsive behaviors are, in turn, assumed to have more sleep problems, which sets the stage for a negative cycle over time. Empirical research has shown some evidence that sleep problems affect impulse control, but the bidirectional link has previously not been tested. Therefore, the aim of this study was to test this assumption.Methods: In this study, we used cross-lagged models to investigate the bidirectional association between sleep problems (ie, insomnia and sleep duration) and impulsive behaviors over two years in a cohort of young adolescents (n = 2767, mean age ∼13.7, 47.6% girls). We also investigated the moderating role of age and gender.Results: The results showed that the links between sleep duration/insomnia and impulsive behavior are bidirectional. Youths who experienced sleep problems also experienced increased difficulties with impulse control, and problems regulating impulses were also linked with increases in sleep problems, and these effects were systematic over two years. Moreover, age did not moderate these associations but impulsive behaviors had a larger impact on girls’ insomnia as compared to boys.Conclusions: By confirming the bi-directionality of this association, this study supports the importance of developing interventions to promote sleep health in adolescents but also the need to tailor such programs to adolescents’ development because adolescents might not be able to prioritize sleep if they cannot control their impulses.
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| 19. |
- Bauducco, Serena, 1988-, et al.
(författare)
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Interventioner för att förebygga sömnbrist hos tonåringar : fokus på individ eller samhälle?
- 2020
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Ingår i: Socialmedicinsk Tidskrift. - Stockholm : Socialmedicinsk tidskrift. - 0037-833X. ; 97:5-6, s. 866-877
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Tidskriftsartikel (refereegranskat)abstract
- Tonåren är en känslig tid i utvecklingen och sömnen är viktig för att ungdomar ska fungera bra. Sömnen förändras drastiskt under tonåren och många ungdomar sover för lite. Även om sömnbristen är tillfällig så kan konsekvenserna vara allvarliga (t.ex. nedstämdhet). Därför är det viktigt att satsa på sömnpromotion. Sömnpromotion kan rikta in sig på att ändra ungdomars sömnvanor direkt eller att senarelägga skoltider för att ge mer tid för sömn. Skolbaserade program med fokus på att förbättra ungdomars sömnrutiner har resulterat i små förändringar, men har visat potential att förebygga problem över tid. En senare skolstart har visat tydliga förbättringar i ungas sovtider, men eftersom svenska skolor börjar vid rekommenderade tider kan det vara bättre att satsa resurser på att lära ungdomar bra sömnrutiner. Denna kunskap kan gynna ungdomarna längre fram, även om de inte upplever bristande sömn just nu.
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| 20. |
- Bauducco, Serena, 1988-, et al.
(författare)
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Preventing sleep deficit in adolescents : Long-term effects of a quasi-experimental school-based intervention study
- 2020
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Ingår i: Journal of Sleep Research. - : Wiley-Blackwell. - 0962-1105 .- 1365-2869. ; 29:1
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Tidskriftsartikel (refereegranskat)abstract
- Adolescents are at risk of sleep deficit, which has serious consequences for their daytime functioning. However, school-based interventions to improve sleep have shown limited success. This might be due to the content of the programmes (e.g., not targeting central factors such as daytime stress and technology use) or because changes have not been captured due to a lack of long-term follow-ups. Hence, the aim of this study was to evaluate the long-term effects of a school-based sleep education curriculum including time-management training. The study used a quasi-experimental design. Participants were 3,622 adolescents (mean age 13.7, 48% girls); 286 were in the intervention group and 3,336 were followed as a natural control group. Data were collected before the intervention and at a 1-year follow-up. We divided participants into three groups according to baseline sleep duration (calculated from self-reported bed- and wake times, minus sleep onset latency): insufficient (<7 hr), borderline (7-8 hr) and adequate (>8 hr). Adolescents in the intervention group were ~2 times less likely to report insufficient sleep at follow-up as compared to controls. Sleep knowledge improved significantly in the intervention group but there were no changes in emotional sleep hygiene (e.g., bedtime worry) and perceived stress. Surprisingly, technology use increased and behavioural sleep hygiene worsened in the intervention group. Although the mechanisms of change need further investigation, the results of this study point to potential long-term benefits of school-based sleep programmes.
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| 21. |
- Bauducco, Serena, 1988-, et al.
(författare)
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Sleepy and popular? The association between popularity, sleep duration, and insomnia in adolescents
- 2024
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Ingår i: Frontiers in Sleep, section Pediatric and Adolescent Sleep. - : Frontiers Media S.A.. - 2813-2890.
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: During adolescence, peers gain a central role and with the availability of technology, socializing can occur around the clock. Very few studies have focused on the role of peers in adolescents’ sleep using social network analyses. These analyses describe peer relationships and social positions in a defined context (e.g., school) based on friendship nominations. Adolescents who receive many nominations can be defined as “popular”, which has been found to have its costs (i.e., shorter sleep duration) but also benefits (i.e., fewer insomnia symptoms). The aim of this study was to partially replicate and expand previous findings in a large Swedish sample of adolescents.Method: The sample included 1394 adolescents (46% girls, Mage = 15.3, SD = .53, range 14-18) from 16 public schools in middle Sweden. Adolescents reported on their weekly sleep duration, insomnia symptoms, anxiety, depression, alcohol use, demographics, and nominated up to three friends in school. We used R to calculate outgoing nominations and incoming nominations. Linear regressions were used to examine the association between popularity and sleep, controlling for confounding variables (demographics, emotional problems). Finally, we explored sex differences.Results: Controlling for confounders, popular adolescents reported shorter sleep duration (B=-3.00; 95% CI [-5.77, -0.19]), and popular girls reported more insomnia symptoms (B = 0.36; 95% CI [.04,.68]). There were no significant associations found for boys. Discussion: Popularity was linked to shorter sleep duration (up to -27 minutes for the most popular teens). Moreover, girls may pay a price for their popularity by experiencing more insomnia symptoms. Sex differences and potential mechanisms should be further explored.
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| 22. |
- Bergbom, Sofia, 1982-, et al.
(författare)
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Psykologer i primärvården - en förbisedd möjlighet
- 2017
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Ingår i: Nerikes Allehanda. - Örebro : Nerikes allehanda AB. - 1103-971X. ; :9 april
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- Psykologer har den expertkunskap som krävs för att behandla dagens ohälsa, och regionen riskerar skapa en närsjukvård som tillhör B-laget genom att inte ta vara på psykologers kompetens. Evidensen pekar tydligt ut psykologisk behandling som förstahandsval vid behandling av sömnsvårigheter, depression, ångest och stressproblematik – ändå ignoreras psykologers kunskap i den arbetsgrupp som tillsatts för att tackla nutidens problematik i primärvården.
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| 23. |
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| 24. |
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| 25. |
- Boersma, Katja, professor, 1973-, et al.
(författare)
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Efficacy of a transdiagnostic emotion-focused exposure treatment for chronic pain patients with comorbid anxiety and depression : a randomized controlled trial
- 2019
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Ingår i: Pain. - : Lippincott Williams & Wilkins. - 0304-3959 .- 1872-6623. ; 160:8, s. 1708-1718
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Tidskriftsartikel (refereegranskat)abstract
- The comorbidity between chronic pain and emotional problems has proven difficult to address with current treatment options. This study addresses the efficacy of a transdiagnostic emotion-focused exposure treatment ("hybrid") for chronic pain patients with comorbid emotional problems. Adults (n = 115) with chronic musculoskeletal pain and functional and emotional problems were included in a 2-centre, parallel randomized controlled, open-label trial comparing this treatment to an active control condition receiving a guided Internet-delivered pain management treatment based on CBT principles (iCBT). The hybrid treatment (n = 58, 10-16 sessions) integrates exposure in vivo for chronic pain based on the fear-avoidance model with an emotion-regulation approach informed by procedures in Dialectical Behavior Therapy. The iCBT (n = 57; 8 treatment modules) addresses topics such as pain education, coping strategies, relaxation, problem solving, stress, and sleep management using standard CBT techniques. Patient-reported outcomes were assessed before and after treatment as well as at a 9-month primary end point. Across conditions, 78% participants completed post-treatment and 81% follow-up assessment. Intent-to-treat analyses showed that the hybrid had a significantly better post-treatment outcome on pain catastrophizing (d = 0.39) and pain interference (d = 0.63) and significantly better follow-up outcomes on depression (d = 0.43) and pain interference (d = 0.51). There were no differences on anxiety and pain intensity. Observed proportions of clinically significant improvement favoured the hybrid on all but one comparison, but no statistically significant differences were observed. We conclude that the hybrid emotion-focused treatment may be considered an acceptable, credible, and efficacious treatment option for chronic pain patients with comorbid emotional problems.
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| 26. |
- Boersma, Katja, professor, 1973-, et al.
(författare)
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Emotion regulation in chronic pain patients with emotional difficulties : A DBT-inspired exposure treatment
- 2016
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Co-occuring pain and emotional difficulties are strikingly common and a true challenge in the clinic. Nearly all pain patients suffer from some kind of emotional distress. Difficulties with emotion regulation has been pointed out as one core process, which may explain the high co-occurrence of pain and emotional distress. Current treatments have not succeeded in helping pain patients with high levels of emotional distress, and therefore a new treatment approach has been developed, based on emotion regulation theory, DBT and exposure techniques. This presentation will describe the theory behind this new intervention and present preliminary data from a randomized controlled trial in patients with chronic pain and emotional distress. This trial compares the effectiveness of a DBT inspired exposure treatment with internet-based CBT for chronic pain.
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| 27. |
- Boersma, Katja, professor, 1973-, et al.
(författare)
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Expectancy, fear and pain in the prediction of chronic pain and disability : A prospective analysis
- 2006
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Ingår i: European Journal of Pain. - : John Wiley & Sons. - 1090-3801 .- 1532-2149. ; 10:6, s. 551-557
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Tidskriftsartikel (refereegranskat)abstract
- Studies with (sub) acute back pain patients show that negative expectancies predict pain and disability at a one-year follow up. Yet, it is not clear how expectations relate to other factors in the development of chronic disability such as pain and fear. This study investigates the relationship between expectations, pain-related fear and pain and studies how these variables are related to the development of chronic pain and disability. Subjects (N = 141) with back and/or neck pain (duration <1 year) were recruited via primary care. They completed measures on pain, expectancy, pain-related fear (pain-related negative affect and fear avoidance beliefs) and function. A one-year follow up was conducted with regard to pain and function. It was found that pain, expectancy, pain-related fear and function were strongly interrelated. In the cross-sectional analyses negative expectancies were best explained by frequent pain and a belief in an underlying and serious medical problem. Prospectively, negative expectancy, negative affect and a belief that activity may result in (re) injury or increased pain, explained unique variance in both pain and function at one-year follow up. In conclusion, expectancy, negative affect and fear avoidance beliefs are interrelated constructs that have predictive value for future pain and disability. Clinically, it can be helpful to inquire about beliefs, expectancy and distress as an indication of risk as well as to guide intervention. However, the strong interrelations between the variables call for precaution in treating them as if they were separate entities existing in reality.
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| 28. |
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| 29. |
- Boersma, Katja, professor, 1973-, et al.
(författare)
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Symposium : Pain and emotion – biological processes, emotion regulation and implications for treatment
- 2016
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Ingår i: EABCT 2016 Abstract Book. ; , s. 162-162
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Co-occurring pain and emotional difficulties are strikingly common and a true challenge in the clinic. Nearly all pain patients suffer from some kind of emotional distress. In the last decade, research in the field has started to focus on the role of underlying processes in concurrent problems with pain and emotional distress. This symposium is therefore focused on the link between pain and emotion and will highlight new perspectives on processes, theoretical as well as clinical. Talks will address the role of biological mechanisms, interpersonal contexts and the development of the new treatment approaches.Poor emotion regulation has been pointed out as one core process, which may explain the high co-occurrence of pain and emotional distress. Current treatments have not succeeded in helping paon patients with high levels of emotional distress, and therefore a new treatment approach has been developed, based on emotion regulation theory and exposure techniques. Dr. Katja Boersma will describe the theory beind this new intervention and present preliminary data from an RCT in patients with chronic pain and emotional distress.Another treatment approach with well documented effects in this area is ACT. However, large variability in treatment effects can be seen consistently across studies and predictors of outcome remain unclear. Few studies have yet investigated the role of biological processes in ACT. Dr. Rikard Wicksell will briefly describe ACT for patients with chronic pain, bring up recent findings on ACT and neuroscience, and discuss implications for future research and clinical development.Pain-related fear is a salient emotion in many pain patients, which tend to lead to avoidance of movements or activities. Avoidance behaviors are negatively reinfrced as they lead to less pain for the moment; in the long run, however, it often results in inactivity and disuse. Furthermore, a change in neural response profile, so called cortical reorganization, occurs in cortical sensory and motor areas. Targeting immobilisation and cortical reorganisation, using cognitive behavioral, sensory, and motor strategies, may improve function in individuals with chronic pain. Dr. Kristoffer Bothelius will present findings in this area and discuss possible treatment implications.One way of regulating pain and negative emotions is to share personal experiences with others. However, it is important to know where, when and with whom to share; in other terms, to be context sensitive. The opposite, context insensitivity, has been related to prolonged and exaggerated emotional distress. The theory, importance and potential clinical implications of context sensitivity in the area pf pain and emotional distress will serve the basis for the presentation by Dr. Ida Flink, and data from an ongoing project will be presented.The link between pain and emotional distress may become extra salient when the pain occurs in an intimate interpersonal context. Vulvovaginal pain in women has been neglected in pain research, but is closely linked to emotional reactions such as fear and anxiety. Dr. Johanna Thomtén will describe the link between pain and emotional distress among women suffering from vulvovaginal pain, presenting data from an ongoing longitudinal project.
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| 30. |
- Buhrman, Monica, et al.
(författare)
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Psychological treatment targeting acceptance and compassion in chronic pain patients : a randomized controlled, internet delivered, treatment trial
- 2023
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Ingår i: The Clinical Journal of Pain. - : Lippincott Williams & Wilkins. - 0749-8047 .- 1536-5409. ; 39:12, s. 672-685
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Objectives: Chronic pain is often associated with suffering. Self-criticism is associated with depressive symptoms. The purpose of this study was to explore if fusing acceptance and commitment therapy (ACT) and compassion focused therapy (CFT), could improve psychological wellbeing and disability in chronic pain patients with high levels of self-criticism in comparison to a wait-list control group. Methods: Individuals with chronic pain (n=71) were randomly assigned to an 8-week internet-based intervention focused on acceptance and compassion or a wait-list condition. Primary treatments outcomes were Chronic Pain Acceptance Questionnaire, Self-Compassion Scale, and Pain Disability index. Secondary outcomes were Montgomery Åsberg Depression Rating Scale, Anxiety sensitivity index, Quality of Life Inventor, Multidimensional Pain Inventory and Perseverative Thinking Questionnaire. Results: Missing data at post-intervention was 22.5%. ITT-analyses were conducted using linear mixed-models. Results revealed significantly greater levels of acceptance and self-compassion for the treatment group, which were primary outcomes, with effect sizes ranging from small to large and these results were maintained at six-month follow-up. Rates of clinical significant improvements were also greater for the treatment group in comparison to the wait-list control group on acceptance and compassion. Results in the third primary outcome showed also improvements in disability levels. Significant differences were also found in several of the secondary outcomes, in favour for the treatment group.Discussion: Internet-based ACT with CFT components shows promise as a viable treatment option in the management of chronic pain.
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| 31. |
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| 32. |
- Chen, Cen, et al.
(författare)
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Chronic Pain Conditions and Risk of Suicidal Behavior : A 10-Year Longitudinal Co-twin Control Study
- 2022
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Ingår i: Behavior Genetics. - : Springer. - 0001-8244 .- 1573-3297. ; 52:6, s. 351-351
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Understanding the relationship between chronic pain conditions and suicidal behavior is imperative for suicide prevention efforts. Although chronic pain conditions are associated with suicidal behaviors, these associations might be attributed to unmeasured confounding, or mediated via pain comorbidity. We linked a population-based Swedish twin study (N = 17 148 twins) with 10 years of longitudinal, nationwide records of suicidal behavior from health and mortality registers through 2016. To investigate whether pain comorbidity versus specific pain conditions were more important for later suicidal behavior, we modeled a general factor of pain and two independent specific pain factors (measuring pain-related somatic symptoms and neck-shoulder pain, respectively) based on 9 self-reported chronic pain conditions. To examine whether the pain-suicidal behavior associations were attributable to familial confounding, we applied a co-twin control model. Individuals scoring one standard deviation above the mean on the general pain factor had 51% higher risk of experiencing suicidal behavior (Odds Ratio (OR), 1.51; 95% Confidence Interval (CI), 1.34–1.72). The specific factor of somatic pain was also associated with increased risk for suicidal behavior (OR, 1.80; 95% CI, 1.45–2.22]). However, after adjustment for familial confounding, the associations were greatly attenuated and not statistically significant within monozygotic twin pairs (general pain factor OR, 0.89; 95% CI, 0.59–1.33; somatic pain factor OR, 1.02; 95% CI, 0.49–2.11) Clinicians might benefit from measuring not only specific types of pain, but also pain comorbidity; however, treating pain might not necessarily reduce future suicidal behavior, as the associations appeared attributable to familial confounding.
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| 33. |
- Chen, C., et al.
(författare)
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Chronic pain conditions and risk of suicidal behavior : a 10-year longitudinal co-twin control study
- 2023
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Ingår i: BMC Medicine. - : BioMed Central (BMC). - 1741-7015. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Understanding the relationship between chronic pain conditions and suicidal behavior-suicide attempt, other intentional self-harm, and death by suicide-is imperative for suicide prevention efforts. Although chronic pain conditions are associated with suicidal behaviors, these associations might be attributed to unmeasured confounding or mediated via pain comorbidity.METHODS: We linked a population-based Swedish twin study (N=17,148 twins) with 10 years of longitudinal, nationwide records of suicidal behavior from health and mortality registers through 2016. To investigate whether pain comorbidity versus specific pain conditions were more important for later suicidal behavior, we modeled a general factor of pain and two independent specific pain factors (measuring pain-related somatic symptoms and neck-shoulder pain, respectively) based on 9 self-reported chronic pain conditions. To examine whether the pain-suicidal behavior associations were attributable to familial confounding, we applied a co-twin control model.RESULTS: Individuals scoring one standard deviation above the mean on the general pain factor had a 51% higher risk of experiencing suicidal behavior (odds ratio (OR), 1.51; 95% confidence interval (CI), 1.34-1.72). The specific factor of somatic pain was also associated with increased risk for suicidal behavior (OR, 1.80; 95% CI, 1.45-2.22]). However, after adjustment for familial confounding, the associations were greatly attenuated and not statistically significant within monozygotic twin pairs (general pain factor OR, 0.89; 95% CI, 0.59-1.33; somatic pain factor OR, 1.02; 95% CI, 0.49-2.11)CONCLUSION: Clinicians might benefit from measuring not only specific types of pain, but also pain comorbidity; however, treating pain might not necessarily reduce future suicidal behavior, as the associations appeared attributable to familial confounding.
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| 34. |
- Edebol-Carlman, Hanna, 1984-, et al.
(författare)
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Cognitive behavioral therapy for irritable bowel syndrome : the effects on state and trait anxiety and the autonomic nervous system during induced rectal distensions - An uncontrolled trial
- 2018
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Ingår i: Scandinavian Journal of Pain. - : Walter de Gruyter. - 1877-8860 .- 1877-8879. ; 18, s. 81-91
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Tidskriftsartikel (refereegranskat)abstract
- Background and aims: Irritable bowel syndrome (IBS), is a common multifactorial gastrointestinal disorder linked to disturbances in the microbe gut-brain axis. Cognitive behavioral therapy (CBT), in face-to-face format has showed promising results on IBS and its associated psychological symptoms. The present study explored for the first time if CBT for IBS affects the autonomic nervous system (ANS) during experimentally induced visceral pain and cognitive stress, respectively. The levels of state and trait anxiety, current and perceived stress were also evaluated.Methods: In this uncontrolled trial, individual CBT was performed in face-to-face format for 12 weeks in 18 subjects with IBS. Heart rate variability and skin conductance were measured during experimentally induced visceral pain and during a cognitive task (Stroop color-word test), before and after intervention. The levels of state and trait anxiety as well as self-rated current and perceived stress were also measured before and after the intervention.Results: CBT did not affect ANS activity during experimentally induced visceral pain and cognitive stress. The sympathetic activity was high, typical for IBS and triggered during both visceral pain and cognitive stress. The levels of state and trait anxiety significantly decreased after the intervention. No significant changes in self-rated current or perceived stress were found.Conclusions: Results suggest that face-to-face CBT for IBS improved anxiety- a key psychological mechanism for the IBS pathophysiology, rather than the autonomic stress response to experimentally induced visceral pain and cognitive stress, respectively.
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| 35. |
- Engman, Linnea, 1987-, et al.
(författare)
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Avoiding or enduring painful sex? : A prospective study of coping and psychosexual function in vulvovaginal pain
- 2018
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Ingår i: European Journal of Pain. - : John Wiley & Sons. - 1090-3801 .- 1532-2149. ; 22:8, s. 1388-1398
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Tidskriftsartikel (refereegranskat)abstract
- Background: Recurring vulvovaginal pain is common, with evident effects on affected women's lives. Little is known about how affected women cope with painful sexual activities and how coping relates to pain intensity and psychosexual functioning over time. This prospective study explored the impact of avoidance and endurance on sexual function over time. Additionally, patterns of coping were studied on an individual level to increase knowledge about coping and its relation to psychosexual functioning.Methods: One hundred and seventeen women, 18-35years old, with recurring vulvovaginal pain answered questionnaires at two measurement points, five months apart, assessing avoidance and endurance coping, pain intensity and psychosexual functioning. A multiple regression model explored the predictive value of avoidance and endurance on sexual function over time. Cluster analyses investigated patterns of coping and stability within the clusters. These subgroups were compared on psychosexual outcomes.Results: Avoidance at baseline was the only significant predictor of sexual function five months later. Distinct and stable subgroups with different patterns of coping were identified, where avoidance and endurance coping were used both separately and combined. Women who both avoided and endured had the most unfavourable outcomes in terms of psychosexual functioning.Conclusions: Avoidance of sexual activities was related to reduced sexual function over time, which calls for attention and clinical interventions targeting avoidance. Additionally, women who both avoid and endure sexual activities despite pain possibly need tailored interventions, as women with this coping pattern reported the lowest levels of psychosexual functioning.Significance: In this prospective study, avoidance of sexual activities predicted sexual function over time, when controlling for pain intensity. Subgroups of women using distinct patterns of coping were identified. Those who both avoided and endured had the lowest levels of psychosexual functioning.
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| 36. |
- Fine, Kimberly L., et al.
(författare)
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Association Between Early Prescribed Opioid Initiation and Risk of Suicidal Behavior
- 2020
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Prescription opioid use has been linked to increased risk of suicidal behavior in adults. However, little research exists examining the role of prescription opioid use on risk of suicidal behavior in children and adolescents. This population is at high risk for suicidal behavior, as suicide is the second leading cause of death for people ages 10 to 34. Using healthcare data from Swedish population registers, we aimed to characterize the extent to which exposure to opioids at a young age leads to an increased risk of new onset suicidal behavior, for those with no history of suicidal behavior. Compared to demographically matched non-recipients, young people who initiated prescription opioids had just under three times the rate of subsequent suicidal behavior (HR = 2.64, 95% CI, 2.47-2.81). Compared to their unexposed siblings, young people who initiated prescription opioids had roughly two times the rate of subsequent suicidal behavior (HR = 1.83, 95% CI, 1.67-2.01). Finally, compared to young people initiating prescription NSAIDs, young people who initiated prescription opioids had only 19% relatively greater rates of suicidal behavior (HR, 1.19, 95% CI, 1.11-1.27). These results suggest the association between prescription opioids and suicidal behavior may be driven by the underlying pain indication.
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| 37. |
- Fine, Kimberly L., et al.
(författare)
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Initiation of Opioid Prescription and Risk of Suicidal Behavior Among Youth and Young Adults
- 2022
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Ingår i: Pediatrics. - : American Academy of Pediatrics. - 0031-4005 .- 1098-4275. ; 149:3
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND OBJECTIVES: Opioids are involved in an increasing proportion of suicide deaths. This study examined the association between opioid analgesic prescription initiation and suicidal behavior among young people.METHODS: We analyzed Swedish population-register data on 1 895 984 individuals ages 9 to 29 years without prior recorded opioid prescriptions. We identified prescriptions dispensed from January 2007 onward and diagnosed self-injurious behavior and death by suicide through December 2013. We first compared initiators with demographically matched noninitiators. To account for confounding, we applied an active comparator design, which examined suicidal behavior among opioid initiators relative to prescription nonsteroidal antiinflammatory drug (NSAID) initiators while inverse-probability-of-treatment weighting with individual and familial covariates.RESULTS: Among the cohort, 201 433 individuals initiated opioid prescription. Relative to demographically matched noninitiators, initiators (N = 180 808) had more than doubled risk of incident suicidal behavior (hazard ratio = 2.64; 95% confidence interval [CI], 2.47-2.81). However, in the active comparator design, opioid initiators (N = 86 635) had only 19% relatively greater risk of suicidal behavior compared with NSAID initiators (N = 255 096; hazard ratio = 1.19; 95% CI,: 1.11-1.28), corresponding to a weighted 5-year cumulative incidence of 2.2% (95% CI, 2.1-2.4) for opioid and 1.9% (95% CI, 1.9-2.0) for NSAID initiators. Most sensitivity analyses produced comparable results.CONCLUSIONS: Opioid initiation may make only a small contribution to the elevated risk of suicidal behavior among young people receiving pharmacologic pain management. In weighing benefits and harms of opioid initiation, our results suggest that increased risk of suicidal behavior may not be a major concern.
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| 38. |
- Flink, Ida, 1980-, et al.
(författare)
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Kognitiv beteendeterapi
- 2021
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Ingår i: Långvarig smärta. - : Liber. - 9789147112883 ; , s. 293-299
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 39. |
- Flink, Ida, 1980-, et al.
(författare)
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Pain psychology in the 21st century : lessons learned and moving forward
- 2020
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Ingår i: Scandinavian Journal of Pain. - : Elsevier. - 1877-8860 .- 1877-8879. ; 20:2, s. 229-238
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Tidskriftsartikel (refereegranskat)abstract
- Background and aims: In the spring of 2019, Professor Steven J. Linton, the founder of the Center for Health and Medical Psychology (CHAMP) at Örebro University, Sweden, formally retired. As a tribute to his scholarly work covering decades of influence and inspiration to the field of pain psychology, the research center organized a topical conference titled "Pain in the 21st century: Where do we come from and where are we going?", which resulted in this state-of the-art synthesis. The aim of this declaration is to highlight lessons learned but not in the least is meant to inspire and guide our continued journey forward, developing pain psychology into the 21st century.Methods: Several collaborators of Professor Linton have summarized and reflected on the current state-of-the-art of pain psychology from the perspective of his input to the field, as well as on developments from the last years of advancements in pain psychology.Results: The topics have been divided into six themed sections covering the fear avoidance model, transdiagnostics, secondary prevention, risk- and protective factors, communication and contextual factors. The sections cover a broad spectrum, from basic experimental studies, integrating emotion and motivational theories into current theoretical models, to applied research on the effect of early interventions as well as sophisticated emotion-focused treatment models for pain patients with concurrent emotional ill-health.Conclusions: There have been major advancements within pain psychology research during the last decades, moving the field towards a more comprehensive picture, taking emotional and motivational aspects into account to understand pain sufferers. Although psychologically informed interventions in general mainly focus on the individual, it has been put forward that pain management is highly influenced by the surrounding environment, including communication with health care providers, and the occupational and social context.Implications: Professor Steven J. Linton has been at the forefront of pain psychology research during the last decades, and inspired by his work this journey will continue into the 21st century, with the ultimate goal of enhancing the understanding and treatment for all people suffering from persistent and disabling pain.
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| 40. |
- 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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| 41. |
- Gerdle, Björn, et al.
(författare)
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Influences of Sex, Education, and Country of Birth on Clinical Presentations and Overall Outcomes of Interdisciplinary Pain Rehabilitation in Chronic Pain Patients : A Cohort Study from the Swedish Quality Registry for Pain Rehabilitation (SQRP)
- 2020
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Ingår i: Journal of Clinical Medicine. - : MDPI. - 2077-0383. ; 9:8
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Tidskriftsartikel (refereegranskat)abstract
- This study investigates the effects of sex, education, and country of birth on clinical presentations and outcomes of interdisciplinary multimodal pain rehabilitation programs (IMMRPs). A multivariate improvement score (MIS) and two retrospective estimations of changes in pain and ability to handle life situations were used as the three overall outcomes of IMMRPs. The study population consisted of chronic pain patients within specialist care in the Swedish Quality Registry for Pain Rehabilitation (SQRP) between 2008 and 2016 at baseline (n = 39,916), and for the subset participating in IMMRPs (n = 14,666). A cluster analysis based on sex, education, and country of origin revealed significant differences in the following aspects: best baseline clinical situation was for European women with university educations and the worst baseline clinical situation was for all patients born outside Europe of both sexes and different educations (i.e., moderate-large effect sizes). In addition, European women with university educations also had the most favorable overall outcomes in response to IMMRPs (small effect sizes). These results raise important questions concerning fairness and equality and need to be considered when optimizing assessments and content and delivery of IMMRPs for patients with chronic pain.
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| 42. |
- Gerdle, Björn, et al.
(författare)
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The importance of emotional distress, cognitive behavioural factors and pain for life impact at baseline and for outcomes after rehabilitation - a SQRP study of more than 20,000 chronic pain patients
- 2019
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Ingår i: Scandinavian Journal of Pain. - : Walter de Gruyter GmbH. - 1877-8860 .- 1877-8879. ; 19:4, s. 693-711
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Tidskriftsartikel (refereegranskat)abstract
- Background and aims Although literature concerning chronic pain patients indicates that cognitive behavioural variables, specifically acceptance and fear of movement/(re)injury, are related to life impact, the relative roles of these factors in relation to pain characteristics (e.g. intensity and spreading) and emotional distress are unclear. Moreover, how these variables affect rehabilitation outcomes in different subgroups is insufficiently understood. This study has two aims: (1) to investigate how pain, cognitive behavioural, and emotional distress variables intercorrelate and whether these variables can regress aspects of life impact and (2) to analyse whether these variables can be used to identify clinically meaningful subgroups at baseline and which subgroups benefit most from multimodal rehabilitation programs (MMRP) immediately after and at 12-month follow-up. Methods Pain aspects, background variables, psychological distress, cognitive behavioural variables, and two life impact variables were obtained from the Swedish Quality Registry for Pain Rehabilitation (SQRP) for chronic pain patients. These data were analysed mainly using advanced multivariate methods. Results The study includes 22,406 chronic pain patients. Many variables, including acceptance variables, showed important contributions to the variation in clinical presentations and in life impacts. Based on the statistically important variables considering the clinical presentation, three clusters/subgroups of patients were identified at baseline; from the worst clinical situation to the relatively good situation. These clusters showed significant differences in outcomes after participating in MMRP; the subgroup with the worst situation at baseline showed the most significant improvements. Conclusions Pain intensity/severity, emotional distress, acceptance, and life impacts were important for the clinical presentation and were used to identify three clusters with marked differences at baseline (i.e. before MMRP). Life impacts showed complex relationships with acceptance, pain intensity/severity, and emotional distress. The most significant improvements after MMRP were seen in the subgroup with the lowest level of functioning before treatment, indicating that patients with complex problems should be offered MMRP. Implications This study emphasizes the need to adopt a biopsychosocial perspective when assessing patients with chronic pain. Patients with chronic pain referred to specialist clinics are not homogenous in their clinical presentation. Instead we identified three distinct subgroups of patients. The outcomes of MMRP appears to be related to the clinical presentation. Thus, patients with the most severe clinical presentation show the most prominent improvements. However, even though this group of patients improve they still after MMRP show a complex situation and there is thus a need for optimizing the content of MMRP for these patients. The subgroup of patients with a relatively good situation with respect to pain, psychological distress, coping and life impact only showed minor improvements after MMRP. Hence, there is a need to develop other complex interventions for them.
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| 43. |
- Gerdle, Björn, et al.
(författare)
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Who benefits from multimodal rehabilitation - an exploration of pain, psychological distress, and life impacts in over 35,000 chronic pain patients identified in the Swedish Quality Registry for Pain Rehabilitation
- 2019
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Ingår i: Journal of Pain Research. - : DOVE Medical Press Ltd.. - 1178-7090. ; 12, s. 891-908
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Tidskriftsartikel (refereegranskat)abstract
- Background: Chronic pain patients frequently suffer from psychological symptoms. There is no consensus concerning the prevalence of severe anxiety and depressive symptoms and the strength of the associations between pain intensity and psychological distress. Although an important aspect of the clinical picture is understanding how the pain condition impacts life, little is known about the relative importance of pain and psychological symptoms for individual's life impact. The aims of this study were to identify subgroups of pain patients; to analyze if pain, psychological distress, and life impact variables influence subgrouping; and to investigate how patients in the subgroups benefit from treatments.Methods: Background variables, pain aspects (intensity/severity and spreading), psychological distress (depressive and anxiety symptoms), and two life impact variables (pain interference and perceived life control) were obtained from the Swedish Quality Registry for Pain Rehabilitation for chronic pain patients and analyzed mainly using advanced multivariate methods.Results: Based on >35,000 patients, 35%-40% had severe anxiety or depressive symptoms. Severe psychological distress was associated with being born outside Europe (21%-24% vs 6%-8% in the category without psychological distress) and low education level (20.7%-20.8% vs 26%-27% in the category without psychological distress). Dose relationships existed between the two psychological distress variables and pain aspects, but the explained variances were generally low. Pain intensity/severity and the two psychological distress variables were significantly associated (R2=0.40-0.48; P>0.001) with the two life impact variables (pain interference and life control). Two subgroups of patients were identified at baseline (subgroup 1: n=15,901-16,119; subgroup 2: n=20,690-20,981) and the subgroup with the worst situation regarding all variables participated less in an MMRP (51% vs 58%, P<0.001) but showed the largest improvements in outcomes.Conclusion: The results emphasize the need to assess both pain and psychological distress and not take for granted that pain involves high psychological stress in the individual case. Not all patients benefit from MMRP. A better matching between common clinical pictures and the content of MMRPs may help improve results. We only partly found support for treatment resistance in patients with psychological distress burden.
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| 44. |
- Glatz, Terese, 1983-, et al.
(författare)
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Parental Child-Invested Contingent Self-Esteem as a Source of Acculturation-Related Parent-Child Conflicts Among Latino Families
- 2022
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Ingår i: Journal of Family Issues. - : Sage Publications. - 0192-513X .- 1552-5481. ; 43:7, s. 1826-1849
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Tidskriftsartikel (refereegranskat)abstract
- Most parents want their children to succeed well. For some parents, however, children's successes are strongly related to beliefs about their own self-worth; a concept known as parental child-invested contingent self-esteem, which has shown links to negative parenting practices (e.g., psychological control). Less is known about associations with aspects of the parent-child relationship that are particularly relevant among families with immigrant backgrounds. We examine the associations with acculturation-related conflicts in a sample of 180 Latino parents of children in 6th to 12th grade. Results showed that higher levels of parental child-invested contingent self-esteem was significantly linked to higher levels of acculturation conflicts, but this link was especially strong if the parent reported that their child was unresponsive to their corrections. When parents base their self-worth on their child's successes and the child acts in ways that are not in line with parents' expectations, parents report more acculturation-related conflicts.
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| 45. |
- Golovchanova, Nadezhda, 1983-, et al.
(författare)
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Affective Fear of Crime and Its Association with Depressive Feelings and Life Satisfaction in Advanced Age : Cognitive Emotion Regulation as a Moderator?
- 2021
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 18:9
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Tidskriftsartikel (refereegranskat)abstract
- Fear of crime is a substantial problem for older adults and is associated with reduced subjective well-being. However, less is known about factors that could moderate the associations between fear of crime and mental health problems and well-being in advanced age. Cognitive emotion regulation could serve as a potentially buffering factor for adverse health outcomes related to fear of crime due to its potential importance in managing feelings when facing threatening situations. The current study investigated the associations between affective fear of crime with depressive feelings and life satisfaction and examined whether adaptive and maladaptive cognitive emotion regulation strategies moderated these associations in a sample of older adults (age 64–106) in Sweden (N = 622). The results showed that affective fear of crime was associated with more depressive feelings, less life satisfaction, and more frequent use of such maladaptive cognitive emotion regulation strategies as rumination, catastrophizing, and blaming others. Moreover, rumination and self-blame moderated the associations between affective fear of crime and life satisfaction. Adaptive emotion regulation strategies were not associated with affective fear of crime and did not decrease the strength of its association with depressive feelings and with life satisfaction. These findings allow us to conclude that maladaptive emotion regulation could be considered a vulnerability factor in the association of fear of crime with life satisfaction.
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| 46. |
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| 47. |
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| 48. |
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| 49. |
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| 50. |
- Golovchanova, Nadezhda, 1983-, et al.
(författare)
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Older and feeling unsafe? Differences in underlying vulnerability, anxiety and life satisfaction among older adults
- 2023
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Ingår i: Aging & Mental Health. - : Routledge. - 1360-7863 .- 1364-6915. ; 27:8, s. 1636-1643
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Feeling safe in the daily environment is important in late life. However, research on configuration of vulnerability factors for perceived unsafety in older adults is scarce. The current study aimed to identify latent subgroups of older adults based on their vulnerability for perceived unsafety.Method: We analyzed the data from a cross-sectional survey of residents in senior apartments in a mid-sized Swedish municipality (N = 622).Results: The results of the latent profile analysis based on frailty, fear of falling, social support, perceived neighborhood problems, and trust in others in the neighborhood indicated the presence of three profiles. These profiles were labelled as compromised body and social networks (7.2%), compromised context (17.9%) and non-vulnerable (74.9%). Profile membership was statistically predicted by age, gender, and family status and profiles differed in perceived unsafety, anxiety and life satisfaction.Conclusion: Overall, the study findings suggested the existence of latent subgroups of older people based on patterns of vulnerability.
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