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- Ekholm, Elin, 1981-
(author)
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Painful Sex in Context : Understanding Vulvodynia from a Relational Perspective
- 2024
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Doctoral thesis (other academic/artistic)abstract
- Vulvodynia is a multifactorial persistent pain condition, characterized by pain in the vulva upon touch or pressure. It negatively impacts sexual function, satisfaction, and relational wellbeing. Relational factors have been indicated as integral to the understanding and outcomes of vulvodynia. The overall aim of this dissertation was to further the understanding of women’s pain-related behaviors in relation to the dyadic and normative contexts of vulvodynia.Using a person-oriented approach, study I explored links between coping behaviors, i.e., avoidance and endurance on the one hand, and on the other, relational and pain catastrophizing, perceived partner responses, and motivational goals, in a sample of 128 women with vulvodynia. Study II explored the significance of normative context for the experience of vulvodynia by qualitatively investigating subjective experiences of five women living with dyspareunia in a queer relationship. Using behavioral observation and self-report, study III investigated patterns of sexual communication quality in heterosexual vulvodynia couples (n = 25) as compared to couples without pain (n = 37), and assessed potential associations with pain, self-disclosure, and sexual assertiveness.The findings from the three studies together highlight the significance of the normative context and relational factors such as the emotional quality of sexual communication and women’s relational cognitions, for women’s pain-related experiences and coping behaviors. A new theoretical model, the Interpersonal Pain Coping Model of Vulvodynia, is proposed as a way of integrating contextual factors such as partner behaviors and sexual scripts into the understanding of women’s behavioral response to vulvodynia.
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| 2. |
- Emilson, Christina, 1969-
(author)
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Long-term perspectives on musculoskeletal pain : Health care utilization and integration of behavioral medicine treatment into physical therapy
- 2017
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Doctoral thesis (other academic/artistic)abstract
- There are currently no effective methods for treating and preventing chronic pain. The aim of this thesis was to study prognostic factors for health care utilization, and the long-term outcomes of tailored behavioral medicine treatment for patients with musculoskeletal pain. Another aim was to increase knowledge about physical therapists’ assessment and analysis of patients’ pain conditions and to investigate the potential of subgrouping patients based on prognostic factors.Methods: In Study I, a prospective population-based cohort was followed over 21 years. Data from three measure points were analyzed: 1995 (n=2425), 2007 (n=1582) and 2016 (n=1184). Study II was a 10-year follow-up of randomized controlled trial (n=97), comparing tailored behavioral medicine treatment and exercise-based physical therapy. In Study III, a descriptive and explorative design was applied, using data from video-recordings of 12 physical therapists. In study IV, assignment to three subgroups based on the Örebro Musculoskeletal Pain Screening Questionnaire was validated against reference instruments, and the stability between two points of measurement was investigated in patients (n=40) who were seeking primary health care due to musculoskeletal pain.Results: Chronic pain, female gender and high age predict high health care utilization over 21 years, and a trajectory of stable high health care utilization over the entire period. The differences between groups in favor for tailored behavioral medicine treatment reported at post-treatment and after two years, were not maintained at the 10-year follow-up. A majority of the physical therapists assessed factors for poor prognosis. The analyses were mainly based on biomedical assessments and none of the physical therapists included behavioral factors. Subgroup assignment according to the Örebro Musculoskeletal Pain Screening Questionnaire appears to be valid and stable over time.Conclusion: Prognostic factors such as chronic pain and female gender need to be considered when allocating health care resources and planning treatment to improve long-term outcomes. The treatment should also be tailored based on individual functional behavioral analyses of key behaviors and on patient´s biomedical and psychosocial condition, including strategies for maintenance of behavioral changes. Evidence-based methods for integrating behavioral medicine treatment into physical therapy need to be further evaluated and improved.
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| 3. |
- Engman, Linnéa, 1987-
(author)
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Vulvodynia : Understanding the Role of Pain-related Behavior
- 2021
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Doctoral thesis (other academic/artistic)abstract
- Over the last decades, psychological mechanisms have been identified as key in the understanding of pain development and maintenance of vulvodynia. Furthermore, psychological treatments in the form of cognitive behavioral therapy (CBT) have proven helpful for those suffering. Still, prospective studies investigating psychological mechanisms over time are lacking, as are clinical studies investigating their role in treatment.The overall aim of this dissertation is to further the understanding of pain-related behavior and its role in the development and maintenance of vulvodynia by applying a fear-avoidance-endurance theoretical framework. It further aimed at consolidating the understanding of such a framework through a clinical proof of concept investigating the effect of a CBT treatment. Study I investigated the mediating role of avoidance and endurance behavior on the relationship between pain catastrophizing and pain. Study II prospectively investigated the predictive value of avoidance and endurance behavior on sexual function. Further, avoidance and endurance behavior were examined on an individual level to gain information on potential patterns of behavior. Study III investigated the effect of a CBT group treatment with partner involvement on pain and associated outcomes.Taken together, the overall findings of this dissertation further point at the importance of psychological mechanisms such as pain catastrophizing, avoidance behavior, and endurance behavior in the development and maintenance of vulvodynia. While further manifesting similarities between mechanisms involved in vulvodynia and those involved in other persistent pain conditions, the findings also verify the relevance of the Fear-avoidance model and the complementary Avoidance-endurance model for vulvodynia. Finally, a new model of understanding was proposed: the Fear-avoidance-endurance model of vulvodynia, summarizing pain-related behavior involved in the development and maintenance of vulvodynia.
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| 4. |
- Hess Engström, Andrea
(author)
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Internet-based treatment for vulvodynia
- 2022
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Doctoral thesis (other academic/artistic)abstract
- Localized provoked vulvodynia is the most common cause of sexual pain and most often affects women between 20 and 30 years old. The etiology of provoked vulvodynia remains unclear, but an interplay of biomedical and psychosocial mechanisms is believed to contribute to the onset. The choice of treatment for provoked vulvodynia depends on locally available resources. Internet interventions can reach patients in distant geographical areas and may thus promote equal access to healthcare services. A few studies have investigated the effects of cognitive behavioral therapy on provoked vulvodynia. However, there appear to be no studies of the effects of an internet intervention using an acceptance and commitment therapy approach, also called third-wave cognitive behavioral therapy, for women with provoked vulvodynia.The aim of this thesis was to investigate the effects and patient experiences of a guided internet-based intervention for women with provoked vulvodynia during the waiting period for clinical treatment. All four studies included in this thesis were tied to a multicenter randomized controlled study: the EMBLA study. Participants were randomized to a six-week guided internet intervention or a waiting list before treatment as usual. Pain during intercourse, other pain-related variables, and pain acceptance were variables used to assess the effects of the intervention. Later, interviews were carried out with participants to ascertain their experiences of this internet-based treatment. Lastly, health-related quality of life and healthcare utilization were assessed to obtain a health economic evaluation of the intervention. Internet-based treatment had a positive effect on pain during intercourse and pain acceptance, but the results should be interpreted with caution due to the small sample size. This form of treatment was perceived as credible and helpful for managing provoked vulvodynia, but some difficulties related to the internet-based treatment were also reported. The intervention contributed to meaningful clinical effects at low costs per patient, indicating that internet-based treatment is not inferior to the standard of care. Internet-based treatment may serve as a complement to regular care, especially for patients living in geographical locations with low access to specialized care or where there are long waiting lists to initiate treatment.
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| 5. |
- Anclair, Malin
(author)
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Fears, Stress and Burnout in Parents of Children with Chronic Conditions : Treatment with Cognitive Behavioural Therapy and Mindfulness
- 2017
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Doctoral thesis (other academic/artistic)abstract
- The aim of the present research was threefold: to investigate the fears of parents of children with chronic conditions; to evaluate the effectiveness of their treatment with either mindfulness-based therapy or cognitive behavioural therapy (CBT); and to assess treatment outcome in terms of health-related quality of life (HRQoL). Long-term stress can lead to some form of chronic stress reaction. In study one, fears of future cancer recurrence and of late effects of treatment were most prominent among parents of CNS tumour patients. Study two investigated the effectiveness of two group-based interventions on stress and burnout among parents of children with chronic conditions. Parents were offered either a CBT or a mindfulness programme. Both interventions significantly decreased stress and burnout. Study three focused on the HRQoL and life satisfaction of the parents in study two. The results indicate improvements for participants in both treatment groups regarding certain areas of HRQoL and life satisfaction. To conclude, fears concerning future cancer recurrence and late effects of treatment are most prominent among parents of children with cancer. Another conclusion is that CBT and mindfulness decrease stress and burnout and may have a positive effect on areas of HRQoL and life satisfaction.
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| 6. |
- Bartels, Sara Laureen, et al.
(author)
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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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In: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 12:4
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Journal article (peer-reviewed)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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| 7. |
- Bauducco, Serena, 1988-
(author)
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Adolescents' sleep in a 24/7 society : Epidemiology and prevention
- 2017
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Doctoral thesis (other academic/artistic)abstract
- Sleep undergoes important changes during adolescence and many teenagers experience problems sleeping. These in turn affect adolescents´ academic, physical and psychosocial functioning. Moreover, there are some indications that sleep problems in this age group may be increasing, possibly as a consequence of societal changes, e.g., internet availability. Research on adolescents´ sleep is growing, but more epidemiological studies are needed to clarify the prevalence of poor sleep, long and short-term outcomes associated with it, and potential risk and protective factors to target in preventive interventions. The aim of this dissertation was to contribute to each of these goals; Study I investigated the longitudinal association between sleep problems, defined as symptoms of insomnia, and school absenteeism; Study II explored the prevalence of poor sleep, defined as sleep deficit, in an adolescent population and psychosocial and contextual factors associated with it, including emotional and behavioral problems, stress, sleep hygiene and technology use; finally, Study III evaluated the short-term effects of a novel universal school-based intervention to improve adolescents´ sleep health.The findings show that poor sleep was strongly related to adolescents´ functioning, including emotional and behavioral problems and school attendance, and that sleep deficit was prevalent in adolescents. This supports the need for prevention. Moreover, sleep deficit was associated with stress, technology use and arousal at bedtime, which may represent important barriers to sleep. A preventive intervention targeting these barriers to promote adolescents´ sleep health was successful with the individuals most at risk. However, it remains to be seen whether these changes will be maintained after the intervention and whether incidence of sleep problems will be lower relative to a control group. Implications for theory and practice are discussed.
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| 8. |
- Silfvernagel, Kristin
(author)
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Individually tailored internet-based cognitive behavioural therapy for adolescents, young adults and older adults with anxiety
- 2017
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Doctoral thesis (other academic/artistic)abstract
- Anxiety disorders share the feature of excessive fear, anxiety and related behavioural disturbances. Fear is defined as the emotional response to a real or a perceived imminent threat and anxiety is the anticipation of a future threat. The anxiety disorders covered in this thesis are panic disorder with or without agoraphobia, social phobia, post-traumatic stress disorder, generalized anxiety disorder and anxiety disorder not otherwise specified.Cognitive behavioural treatment protocols are typically designed to target one specific disorder and falls under the definition of disorder-specific cognitive behavioural therapy. It is however unclear if this is the most optimal approach in regards to the high comorbidity between anxiety disorders and depressive disorders. Internet-based cognitive behavioural therapy has in the past generally been disorder-specific and from above mentioned predicament two alternative treatment approaches emerged, the tailored and the transdiagnostic approach that aims to simultaneously treat both principal and comorbid disorders. Previous trials on internet-based cognitive behavioural therapy have targeted adults in general and relatively few target adolescents, young adults and older adults.The aims of this thesis were to further develop and test the effects of tailored internet-based cognitive behavioural therapy on the basis of age, for adolescents, young adults and older adults. Specifically by developing and testing the effects of individually tailored internet-based cognitive behavioural therapy for adolescents with anxiety and comorbid depressive symptoms and by adapting and testing the effects of individually tailored internet-based cognitive behavioural therapy for young adults and older adults with anxiety and comorbid depressive symptoms. These aims were tested in two pilot effectiveness studies (Paper I and III) and two efficacy randomised controlled trials (Paper II and IV). The results from these four trials showed significant results across all outcome measures with overall moderate to large effect sizes. The tentative conclusion based on these results is that tailoring internet-based cognitive behavioural therapy can be a feasible approach in the treatment of anxiety symptoms and comorbid depressive symptoms for adolescents, young adults and older adults. Despite the positive findings of the studies in this thesis, there is a need for more research examining the acceptability and effectiveness of internet-based cognitive behavioural therapy for adolescents, young adults and older adults with anxiety and depression before implementation on a larger scale.
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