| 1. |
- Kanstrup, Marie, et al.
(författare)
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A validation of the pain interference index in adults with longstanding pain
- 2016
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Ingår i: Acta Anaesthesiologica Scandinavica. - : WILEY-BLACKWELL. - 0001-5172 .- 1399-6576. ; 60:2, s. 250-258
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Tidskriftsartikel (refereegranskat)abstract
- Background: Chronic pain is a major health problem and more knowledge is needed regarding the interference of pain on behaviors in different life domains. Clinically useful and statistically sound pain interference measures are highly important. Studies on youths have shown that the Pain Interference Index (PII) is a reliable and valid instrument that is sensitive to change following behavioral treatment. This measure may also have utility for adults, but no study has so far evaluated the statistical properties of the PII for long-standing pain in adults. Methods: Data were collected from 239 consecutive adults with non-specific chronic pain referred to a tertiary pain clinic. We investigated the factor structure of items using a principal component analysis. Cronbachs alpha was calculated to assess internal consistency. The questionnaires ability to predict levels of, e.g., disability was analyzed by means of regression analyses. Results: Analyses illustrated the adequacy of a one-factor solution with six items. Cronbachs alpha (0.85) suggested a satisfactory internal consistency among items. The PII explained significant amounts of variance in pain disability, physical, and mental health-related quality of life and depression, suggesting concurrent criteria validity. Conclusion: The PII is a brief questionnaire with reliable and valid statistical properties to assess pain interference in adults. Other studies support the reliability and validity of PII for use with youths, and now the PII can be used to analyze the influence of pain on behaviors across age groups. Potentially, the PII can also be used as an outcome measure in clinical trials.
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| 2. |
- Ahmed Pihlgren, Sara, et al.
(författare)
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Exploring healthcare workers' experiences of a simple intervention to reduce their intrusive memories of psychological trauma : an interpretative phenomenological analysis
- 2024
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Ingår i: European Journal of Psychotraumatology. - : Taylor & Francis. - 2000-8198 .- 2000-8066. ; 15:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Many healthcare workers (HCWs) endured psychologically traumatic events at work during the coronavirus disease 2019 (COVID-19) pandemic. For some, these events are re-experienced as unwanted, recurrent, and distressing intrusive memories. Simple psychological support measures are needed to reduce such symptoms of post-traumatic stress in this population. A novel intervention to target intrusive memories, called an imagery-competing task intervention (ICTI), has been developed from the laboratory. The intervention includes a brief memory reminder cue, then a visuospatial task (Tetris (R) gameplay using mental rotation instructions for approximately 20 min) thought to interfere with the traumatic memory image and reduce its intrusiveness. The intervention has been adapted and evaluated in a randomized controlled trial (RCT) with Swedish HCWs (ClinicalTrials.gov identifier: NCT04460014).Objective: We aimed to explore how HCWs who worked during the COVID-19 pandemic experienced the use of a brief intervention to reduce their intrusive memories of work-related trauma.Method: Interpretative phenomenological analysis was used for in-depth understanding of the lived experiences of HCWs who used the intervention. Seven participants from the RCT were interviewed by an independent researcher without prior knowledge of the intervention. Interviews were conducted via telephone and transcribed verbatim.Results: Four general themes were generated: 'Triggers and troublesome images', 'Five Ws regarding support - what, when, why, by/with who, for whom', 'Receiving it, believing it, and doing it' and 'The intervention - a different kind of help'; the last two included two subthemes each. The results reflect participants' similarities and differences in their lived experiences of intrusive memories, support measures, and intervention impressions and effects.Conclusion: HCWs' experiences of the novel ICTI reflect a promising appraisal of the intervention as a potential help measure for reducing intrusive memories after trauma, and gives us a detailed understanding of HCWs' needs, with suggestions for its adaption for future implementation.Trial registration: ClinicalTrials.gov identifier: NCT04460014. Many healthcare workers experience images or 'flashbacks' of traumatic experiences from their work during the COVID-19 pandemic.To ensure that individual needs are met, there is a need to tailor and refine current psychological support measures and their use for healthcare workers.The imagery-competing task intervention was perceived as acceptable, indicating its potential utility as a help measure to reduce intrusive memories after trauma. Antecedentes: Los trabajadores de la salud (HCW, por sus siglas en ingles) sufrieron eventos psicologicamente traumaticos en el trabajo durante la pandemia por COVID-19. Para algunos, estos acontecimientos se vuelven a experimentar como recuerdos intrusivos no deseados, recurrentes y angustiosos. Se necesitan medidas simples de apoyo psicologico para reducir estos sintomas de estres postraumatico en esta poblacion. En el laboratorio se ha desarrollado una nueva intervencion para abordar los recuerdos intrusivos, conocida como Intervencion de Tareas Competitivas de Imagenes (ICTI, por sus siglas en ingles). La intervencion incluye una breve senal de recordatorio de la memoria, luego una tarea visoespacial (juego de Tetris (R) que utiliza instrucciones de rotacion mental durante aproximadamente 20 minutos) que se cree que interfiere con la imagen de la memoria traumatica y reduce su intrusion. La intervencion se ha adaptado y evaluado recientemente en un ECA (ensayo controlado aleatorizado) con trabajadores sanitarios suecos (identificador de ClinicalTrials.gov: NCT04460014). Aqui nuestro objetivo es explorar como los participantes del ECA experimentaron la nueva intervencion.Objetivo: Explorar como los trabajadores sanitarios que trabajaron durante la pandemia por COVID-19 experimentaron el uso de una intervencion breve para reducir sus recuerdos intrusivos del trauma relacionado con el trabajo.Metodo: Se utilizo un analisis fenomenologico interpretativo para comprender en profundidad las experiencias vividas por los trabajadores sanitarios que utilizaron la intervencion. Siete participantes del ECA fueron entrevistados por un investigador independiente sin conocimiento previo de la intervencion. Las entrevistas se realizaron por telefono y se transcribieron palabra por palabra.Resultados: Se generaron cuatro temas generales, 'Desencadenantes e imagenes problematicas', 'Cinco preguntas sobre el apoyo: que, cuando, por que, por/con quien, para quien', 'Recibirlo, creerlo y hacerlo' y 'La intervencion. - una ayuda diferente', los dos ultimos incluian dos subtemas cada uno. Los resultados reflejan similitudes y diferencias de los participantes en sus experiencias vividas de recuerdos intrusivos, medidas de apoyo e impresiones y efectos de la intervencion.Conclusion: Las experiencias de los trabajadores sanitarios con el nuevo ICTI reflejan una evaluacion prometedora de la intervencion como una posible medida de ayuda para reducir los recuerdos intrusivos despues del trauma, y nos brinda una comprension detallada de las necesidades de los trabajadores sanitarios, con sugerencias sobre como adaptarse para una implementacion futura.
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| 3. |
- Ahmed Pihlgren, Sara, et al.
(författare)
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Exploring healthcare workers' experiences of a simple intervention to reduce their intrusive memories of psychological trauma: an interpretative phenomenological analysis
- 2024
-
Ingår i: EUROPEAN JOURNAL OF PSYCHOTRAUMATOLOGY. - : Taylor & Francis. - 2000-8198 .- 2000-8066. ; 15:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Many healthcare workers (HCWs) endured psychologically traumatic events at work during the coronavirus disease 2019 (COVID-19) pandemic. For some, these events are re-experienced as unwanted, recurrent, and distressing intrusive memories. Simple psychological support measures are needed to reduce such symptoms of post-traumatic stress in this population. A novel intervention to target intrusive memories, called an imagery-competing task intervention (ICTI), has been developed from the laboratory. The intervention includes a brief memory reminder cue, then a visuospatial task (Tetris (R) gameplay using mental rotation instructions for approximately 20 min) thought to interfere with the traumatic memory image and reduce its intrusiveness. The intervention has been adapted and evaluated in a randomized controlled trial (RCT) with Swedish HCWs (ClinicalTrials.gov identifier: NCT04460014).Objective: We aimed to explore how HCWs who worked during the COVID-19 pandemic experienced the use of a brief intervention to reduce their intrusive memories of work-related trauma.Method: Interpretative phenomenological analysis was used for in-depth understanding of the lived experiences of HCWs who used the intervention. Seven participants from the RCT were interviewed by an independent researcher without prior knowledge of the intervention. Interviews were conducted via telephone and transcribed verbatim.Results: Four general themes were generated: 'Triggers and troublesome images', 'Five Ws regarding support - what, when, why, by/with who, for whom', 'Receiving it, believing it, and doing it' and 'The intervention - a different kind of help'; the last two included two subthemes each. The results reflect participants' similarities and differences in their lived experiences of intrusive memories, support measures, and intervention impressions and effects.Conclusion: HCWs' experiences of the novel ICTI reflect a promising appraisal of the intervention as a potential help measure for reducing intrusive memories after trauma, and gives us a detailed understanding of HCWs' needs, with suggestions for its adaption for future implementation.Trial registration: ClinicalTrials.gov identifier: NCT04460014. Many healthcare workers experience images or 'flashbacks' of traumatic experiences from their work during the COVID-19 pandemic.To ensure that individual needs are met, there is a need to tailor and refine current psychological support measures and their use for healthcare workers.The imagery-competing task intervention was perceived as acceptable, indicating its potential utility as a help measure to reduce intrusive memories after trauma. Antecedentes: Los trabajadores de la salud (HCW, por sus siglas en ingles) sufrieron eventos psicologicamente traumaticos en el trabajo durante la pandemia por COVID-19. Para algunos, estos acontecimientos se vuelven a experimentar como recuerdos intrusivos no deseados, recurrentes y angustiosos. Se necesitan medidas simples de apoyo psicologico para reducir estos sintomas de estres postraumatico en esta poblacion. En el laboratorio se ha desarrollado una nueva intervencion para abordar los recuerdos intrusivos, conocida como Intervencion de Tareas Competitivas de Imagenes (ICTI, por sus siglas en ingles). La intervencion incluye una breve senal de recordatorio de la memoria, luego una tarea visoespacial (juego de Tetris (R) que utiliza instrucciones de rotacion mental durante aproximadamente 20 minutos) que se cree que interfiere con la imagen de la memoria traumatica y reduce su intrusion. La intervencion se ha adaptado y evaluado recientemente en un ECA (ensayo controlado aleatorizado) con trabajadores sanitarios suecos (identificador de ClinicalTrials.gov: NCT04460014). Aqui nuestro objetivo es explorar como los participantes del ECA experimentaron la nueva intervencion.Objetivo: Explorar como los trabajadores sanitarios que trabajaron durante la pandemia por COVID-19 experimentaron el uso de una intervencion breve para reducir sus recuerdos intrusivos del trauma relacionado con el trabajo.Metodo: Se utilizo un analisis fenomenologico interpretativo para comprender en profundidad las experiencias vividas por los trabajadores sanitarios que utilizaron la intervencion. Siete participantes del ECA fueron entrevistados por un investigador independiente sin conocimiento previo de la intervencion. Las entrevistas se realizaron por telefono y se transcribieron palabra por palabra.Resultados: Se generaron cuatro temas generales, 'Desencadenantes e imagenes problematicas', 'Cinco preguntas sobre el apoyo: que, cuando, por que, por/con quien, para quien', 'Recibirlo, creerlo y hacerlo' y 'La intervencion. - una ayuda diferente', los dos ultimos incluian dos subtemas cada uno. Los resultados reflejan similitudes y diferencias de los participantes en sus experiencias vividas de recuerdos intrusivos, medidas de apoyo e impresiones y efectos de la intervencion.Conclusion: Las experiencias de los trabajadores sanitarios con el nuevo ICTI reflejan una evaluacion prometedora de la intervencion como una posible medida de ayuda para reducir los recuerdos intrusivos despues del trauma, y nos brinda una comprension detallada de las necesidades de los trabajadores sanitarios, con sugerencias sobre como adaptarse para una implementacion futura.
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| 4. |
- Eriksson, Gunilla, et al.
(författare)
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Same island, different diet : Cultural evolution of food practice on Öland, Sweden, from the Mesolithic to the Roman Period
- 2008
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Ingår i: Journal of Anthropological Archaeology. - : Elsevier BV. - 0278-4165 .- 1090-2686. ; 27:4, s. 520-543
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Tidskriftsartikel (refereegranskat)abstract
- The Mesolithic–Neolithic transition in north-west Europe has been described as rapid and uniform, entailing a swift shift from the use of marine and other wild resources to domesticated terrestrial resources. Here, we approach the when, what and how of this transition on a regional level, using empirical data from Öland, an island in the Baltic Sea off the Swedish east coast, and also monitor changes that occurred after the shift. Radiocarbon dating and stable carbon and nitrogen isotope analyses of bones and teeth from 123 human individuals, along with faunal isotope data from 27 species, applying to nine sites on Öland and covering a time span from the Mesolithic to the Roman Period, demonstrate a great diversity in food practices, mainly governed by culture and independent of climatic changes. There was a marked dietary shift during the second half of the third millennium from a mixed marine diet to the use of exclusively terrestrial resources, interpreted as marking the large-scale introduction of farming. Contrary to previous claims, this took place at the end of the Neolithic and not at the onset. Our data also show that culturally induced dietary transitions occurred continuously throughout prehistory. The availability of high-resolution data on various levels, from intra-individual to inter-population, makes stable isotope analysis a powerful tool for studying the evolution of food practices.
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| 5. |
- Fiehn, Anne-Marie Kanstrup, et al.
(författare)
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Distribution of histopathological features along the colon in microscopic colitis
- 2021
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Ingår i: International Journal of Colorectal Disease. - : Springer. - 0179-1958 .- 1432-1262. ; 36, s. 151-159
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Tidskriftsartikel (refereegranskat)abstract
- Purpose The diagnosis microscopic colitis (MC) consisting of collagenous colitis (CC) and lymphocytic colitis (LC) relies on histological assessment of mucosal biopsies from the colon. The optimal biopsy strategy for reliable diagnosis of MC is controversial. The aim of this study was to evaluate the distribution of histopathological features of MC throughout the colon. Methods Mucosal biopsies from multiple colonic segments of patients with MC who participated in one of the three prospective European multicenter trials were analyzed. Histological slides were stained with hematoxylin-and-eosin, a connective tissue stain, and CD3 in selected cases. Results In total, 255 patients were included, 199 and 56 patients with CC and LC, respectively. Both groups exhibited a gradient with more pronounced inflammation in the lamina propria in the proximal colon compared with the distal colon. Similarly, the thickness of the subepithelial collagenous band in CC showed a gradient with higher values in the proximal colon. The mean number of intraepithelial lymphocytes was > 20 in all colonic segments in patients within both subgroups. Biopsies from 86 to 94% of individual segments were diagnostic, rectum excluded. Biopsies from non-diagnostic segments often showed features of another subgroup of MC. Conclusion Conclusively, although the severity of the histological changes in MC differed in the colonic mucosa, the minimum criteria required for the diagnosis were present in the random biopsies from the majority of segments. Thus, our findings show MC to be a pancolitis, rectum excluded, questioning previously proclaimed patchiness throughout the colon.
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| 6. |
- Gamble, Beau, et al.
(författare)
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Digitalizing a Brief Intervention to Reduce Intrusive Memories of Psychological Trauma : Qualitative Interview Study
- 2021
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Ingår i: JMIR Mental Health. - : JMIR Publications. - 2368-7959. ; 8:2
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Tidskriftsartikel (refereegranskat)abstract
- Background: The COVID-19 pandemic has escalated the global need for remotely delivered and scalable interventions after psychological trauma. A brief intervention involving a computer game as an imagery-competing task has shown promising results for reducing the number of intrusive memories of trauma—one of the core clinical symptoms of posttraumatic stress disorder. To date, the intervention has only been delivered face-to-face. To be tested and implemented on a wider scale, digital adaptation for remote delivery is crucial. An important first step is to develop digitalized intervention materials in a systematic way based on feedback from clinicians, researchers, and students in preparation for pilot testing with target users.Objective: The first aim of this study is to obtain and analyze qualitative feedback on digital intervention materials, namely two animated videos and two quizzes that explain the target clinical symptoms and provide intervention instructions. The second aim is to refine the digitalized materials based on this feedback.Methods: We conducted semistructured interviews with 12 participants who had delivered or had knowledge of the intervention when delivered face-to-face. We obtained in-depth feedback on the perceived feasibility of using the digitalized materials and suggestions for improvements. Interviews were assessed using qualitative content analysis, and suggested improvements were evaluated for implementation using a systematic method of prioritization.Results: A total of three overarching themes were identified from the data. First, participants were highly positive about the potential benefits of using these digital materials for remote delivery, reporting that the videos effectively conveyed key concepts of the symptom and its treatment. Second, some modifications to the materials were suggested for improving clarity. On the basis of this feedback, we made nine specific changes. Finally, participants raised some key challenges for remote delivery, mainly in overcoming the lack of real-time communication during the intervention.Conclusions: Clinicians, researchers, and clinical psychology students were overall confident in the use of digitalized materials to remotely deliver a brief intervention to reduce intrusive memories of trauma. Guided by participant feedback, we identified and implemented changes to refine the intervention materials. This study lays the groundwork for the next step: pilot testing remote delivery of the full intervention to trauma survivors.
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| 7. |
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| 8. |
- Hoppe, Johanna M., et al.
(författare)
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Hotspots in the immediate aftermath of trauma : Mental imagery of worst moments highlighting time, space and motion
- 2022
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Ingår i: Consciousness and Cognition. - : Elsevier. - 1053-8100 .- 1090-2376. ; 99
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Tidskriftsartikel (refereegranskat)abstract
- Intrusive memories of trauma (memories that enter consciousness involuntarily) highjack cognitive processing, cause emotional distress, and represent a core symptom of posttraumatic stress disorder. Intrusive memories often contain the worst moment/s (‘hotspots’) of the trauma memory. Little is known about hotspots shortly after they are formed, i.e., in the first hours after trauma. We investigated the features of hotspots in trauma-exposed individuals (n = 21) within 72 h post-trauma, using linguistic analysis and qualitative coding. On average, participants reported three hotspots per traumatic event (M = 7.8 words/hotspot). Hotspots primarily contained words related to time, space, motion, and sensory processing. Most hotspots contained sensory features (97%) and motion (59%). Few cognitions and no emotion words were identified. Results indicate that hotspots collected shortly post-trauma are expressed as motion-rich sensory-perceptual experiences (mental imagery) with little detail about emotion/cognition. Findings are discussed in terms of the function of hotspots (e.g., preparedness for action) and clinical implications.
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| 9. |
- Iyadurai, Lalitha, et al.
(författare)
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Reducing intrusive memories after trauma via an imagery-competing task intervention in COVID-19 intensive care staff : a randomised controlled trial
- 2023
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Ingår i: Translational Psychiatry. - : Springer Nature. - 2158-3188. ; 13:1
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Tidskriftsartikel (refereegranskat)abstract
- Intrusive memories (IMs) after traumatic events can be distressing and disrupt mental health and functioning. We evaluated the impact of a brief remotely-delivered digital imagery-competing task intervention on the number of IMs for intensive care unit (ICU) staff who faced repeated trauma exposure during the COVID-19 pandemic using a two-arm, parallel-group, single-blind randomised controlled trial, with the comparator arm receiving delayed access to active treatment (crossover). Eligible participants worked clinically in a UK NHS ICU during the pandemic and had at least 3 IMs of work-related traumatic events in the week before recruitment. Participants were randomly assigned (1:1) to immediate (weeks 1-4) or delayed (weeks 5-8) intervention access. Sequential Bayesian analyses to optimise the intervention and increase trial efficiency are reported elsewhere [1]. The primary endpoint for the pre-specified frequentist analysis of the final study population compared the number of IMs experienced in week 4 between the immediate and delayed access arms. Secondary outcomes included clinical symptoms, work functioning and wellbeing. Safety was assessed throughout the trial by scheduled questions and free report. All analyses were undertaken on an intention-to-treat basis (86 randomised participants). There were significantly fewer intrusive memories during week 4 in the immediate (median = 1, IQR = 0-3, n = 43), compared to the comparator delayed arm (median = 10, IQR = 6-17, n = 43), IRR 0.31, 95% CI: 0.20-0.48, p < 0.001. After crossover, the delayed arm also showed a significant reduction in IMs at week 8 compared to week 4. There were convergent findings for symptoms of PTSD, insomnia and anxiety, work engagement and burnout, general functioning and quality of life. The intervention was found safe and acceptable to participants. All adverse events were unrelated to the study. Our study provides the first evidence of a benefit on reducing IMs, improving other clinical symptoms, work functioning and wellbeing, as well as safety of a brief remotely-delivered digital imagery-competing task intervention. An efficacy trial with an active control and longer follow-up is warranted. The trial is registered at ClinicalTrials.gov (NCT04992390).
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| 10. |
- Kanstrup, Marie, et al.
(författare)
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A Clinical Pilot Study of Individual and Group Treatment for Adolescents with Chronic Pain and Their Parents : Effects of Acceptance and Commitment Therapy on Functioning
- 2016
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Ingår i: Children. - : MDPI AG. - 2227-9067. ; 3:4
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Tidskriftsartikel (refereegranskat)abstract
- Pediatric chronic pain is common and can result in substantial long-term disability. Previous studies on acceptance and commitment therapy (ACT) have shown promising results in improving functioning in affected children, but more research is still urgently needed. In the current clinical pilot study, we evaluated an ACT-based interdisciplinary outpatient intervention (14 sessions), including a parent support program (four sessions). Adolescents were referred to the clinic if they experienced disabling chronic pain. They were then randomized, along with their parents, to receive group (n = 12) or individual (n = 18) treatment. Adolescent pain interference, pain reactivity, depression, functional disability, pain intensity and psychological flexibility, along with parent anxiety, depression, pain reactivity and psychological flexibility were assessed using self-reported questionnaires. There were no significant differences in outcomes between individual and group treatment. Analyses illustrated significant (p < 0.01) improvements (medium to large effects) in pain interference, depression, pain reactivity and psychological flexibility post-treatment. Additionally, analyses showed significant (p < 0.01) improvements (large effects) in parent pain reactivity and psychological flexibility post-treatment. On all significant outcomes, clinically-significant changes were observed for 21%-63% of the adolescents across the different outcome measures and in 54%-76% of the parents. These results support previous findings and thus warrant the need for larger, randomized clinical trials evaluating the relative utility of individual and group treatment and the effects of parental interventions.
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| 11. |
- Kanstrup, Marie, et al.
(författare)
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A simple cognitive task intervention to prevent intrusive memories after trauma in patients in the Emergency Department : A randomized controlled trial terminated due to COVID-19
- 2021
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Ingår i: BMC Research Notes. - : BioMed Central (BMC). - 1756-0500. ; 14:1
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveThis randomised controlled trial (RCT) aimed to investigate the effects of a simple cognitive task intervention on intrusive memories ("flashbacks") and associated symptoms following a traumatic event. Patients presenting to a Swedish emergency department (ED) soon after a traumatic event were randomly allocated (1:1) to the simple cognitive task intervention (memory cue + mental rotation instructions + computer game "Tetris" for at least 20 min) or control (podcast, similar time). We planned follow-ups at one-week, 1-month, and where possible, 3- and 6-months post-trauma. Anticipated enrolment was N = 148.ResultsThe RCT was terminated prematurely after recruiting N = 16 participants. The COVID-19 pandemic prevented recruitment/testing in the ED because: (i) the study required face-to-face contact between participants, psychology researchers, ED staff, and patients, incurring risk of virus transmission; (ii) the host ED site received COVID-19 patients; and (iii) reduced flow of patients otherwise presenting to the ED in non-pandemic conditions (e.g. after trauma). We report on delivery of study procedures, recruitment, treatment adherence, outcome completion (primary outcome: number of intrusive memories during week 5), attrition, and limitations. The information presented and limitations may enable our group and others to learn from this terminated study.
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| 12. |
- Kanstrup, Marie, et al.
(författare)
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A single case series using visuospatial task interference to reduce the number of visual intrusive memories of trauma with refugees
- 2021
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Ingår i: Clinical Psychology and Psychotherapy. - : John Wiley & Sons. - 1063-3995 .- 1099-0879. ; 28:1, s. 109-123
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Tidskriftsartikel (refereegranskat)abstract
- The current worldwide so-called "refugee crisis" has led to an unprecedented increase in migration globally. Because of stigma and language barriers, mental health care for refugees is limited. There is a need for novel, scalable psychological interventions. We investigated whether a brief behavioural intervention involving a memory reminder cue and Tetris gameplay on a smartphone reduces intrusive memories in refugees using a single case (N= 4) ABAB withdrawal design. The baseline phase (A) included a no-intervention week; the intervention phase (B) included an in-person session with the researchers, comprised of the behavioural intervention followed by self-guided use in daily life the following week. All participants reported a decrease in intrusive memories after the intervention, as well as functional improvements (e.g., in concentration). Importantly, participants rated the intervention as feasible and acceptable. As one in-person session was effective in persistent intrusion reduction, ABAB proved not to be the optimal design as intrusions did not rebound in the withdrawal phase. Findings are promising and highlight the need for further evaluation of novel interventions for mental health problems in refugees.
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| 13. |
- Kanstrup, Marie
(författare)
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More than pain : assessment and treatment of pain-related dysfunction in pediatric chronic pain
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Pediatric chronic pain is prevalent, affecting between 11-38% of children and adolescents, with a subset of individuals suffering from substantial pain-related disability. Dysfunction in emotional, social and physical domains, as well as parental distress, commonly co-occurs with pediatric chronic pain. The effectiveness of behavior oriented treatments for child pain intensity and disability is today well known, but there is still a need for further development of such treatments, including evaluations of different treatment formats and parent support programs. There is also a need to further develop and evaluate instruments to assess pain-related dysfunction in pediatric chronic pain. Purpose and aims: The purpose of this doctoral project was to develop effective ways to assess and treat dysfunction in pediatric chronic pain. The aims were to 1) evaluate the psychometric properties of the Insomnia Severity Index (ISI) for youths (study I) and the psychometric properties of the Pain Interference Index (PII) (study II), 2) investigate the prevalence of insomnia and the relationships between sleep and functioning (emotional and physical) (study I), 3) identify and evaluate existing research on intensive interdisciplinary treatment (IIPT) for pediatric chronic pain (study III), 4) investigate the effects of Acceptance and Commitment Therapy (ACT) on functioning in a clinical pilot study of individual and group treatment for adolescents with chronic pain (study IV) and 5) investigate the effects of parental support based on ACT on functioning in a clinical pilot study of individual and group treatment for parents of adolescents with chronic pain (study IV). Methods: Psychometric properties of the ISI and the PII were evaluated using cross-sectional data from pediatric participants with chronic debilitating pain. Evaluations included principal component analysis, correlational and regression analyses, and analysis of internal consistency. The importance of insomnia for the relationships between pain intensity, depression and functional disability were assessed by examining the indirect effects of insomnia in the relationship between pain and depression, and between pain and functional disability. To evaluate the current evidence for IIPT for pediatric chronic pain, a systematic review and meta-analysis was conducted. Finally, to investigate the effects of individual and group ACT treatment for adolescents with chronic pain and their parents, non-parametric analyses of differences between groups and over time were conducted, as well as analyses of clinically significant changes for adolescent and parent outcomes. Results: Results from the psychometric evaluations in study I and II supported the concurrent criteria validity and reliability for the ISI and the PII in this sample. The principal component analysis supported a 1-factor solution for PII. More than half of the sample reported clinically relevant scores of insomnia, and indirect effects of insomnia were found for the relationships between pain and depression, and between pain and functional disability. In study III, the systematic searches resulted in 10 studies matching criteria for inclusion (1 randomized controlled trial and 9 non randomized studies), and the meta-analysis yielded preliminary evidence for positive treatment effects of IIPT, but findings showed substantial heterogeneity. In study IV, adolescents reported significant improvements in functioning outcomes (i.e. pain interference, pain reactivity, depression, and psychological flexibility). Parents reported improvements in parental pain reactivity and psychological flexibility. There were no differences between group and individual treatment, and the pattern of results illustrated significant changes during the second half of treatment. Clinically significant changes were reported to a large extent in adolescent (21-63%) and parent (54-76%) variables. Conclusions and further directions: The PII and ISI are reliable and valid instruments that can be used to assess pain interference and insomnia in children and adolescents presenting with chronic pain. IIPT holds promise as a treatment format for addressing pain and painrelated dysfunction, but due to a small number of studies and methodological weaknesses, more research in this field is needed. The treatment evaluation of ACT for adolescents with chronic pain supported the promising findings from previous studies, illustrating improvements in adolescent functioning after treatment. Also, results indicate the utility of the ACT based parent support. Particularly, larger clinical trials with rigorous methodology are needed to evaluate the relative utility of individual and group treatment formats, mechanisms of change and the effects of parental support programs.
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| 14. |
- Kanstrup, Marie, et al.
(författare)
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Reaching people soon after a traumatic event : an exploratory observational feasibility study of recruitment in the emergency department to deliver a brief behavioral intervention via smartphone to prevent intrusive memories of trauma.
- 2021
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Ingår i: Pilot and feasibility studies. - : Springer Science and Business Media LLC. - 2055-5784. ; 7:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The current study explored how to recruit patients soon after a traumatic event, to deliver a novel intervention in a new emergency department in Sweden. This brief behavioral intervention aims to prevent intrusive memories and is delivered soon after trauma in the emergency department. In the UK, it has shown promising results. Traumatic events resulting in admission to the emergency department (e.g., road traffic accidents) may result in subsequent mental health problems such as post-traumatic stress disorder, where intrusive memories of the trauma constitute a core clinical feature. Early interventions that prevent intrusive memories after psychological trauma are lacking. Specific aims were to explore identification of eligible patients (aim 1), fitting in with emergency department staff routines to deliver the study protocol (aim 2), and using the patients' own smartphones to deliver intervention/control task (aim 3). Two changes to the previous study were (i) extending the trauma types included (ii) a new control condition, also by smartphone.METHODS: This is an explorative observational study. Data was both analyzed descriptively and using the Framework method.RESULTS: We identified several possible ways to recruit patients, and establish a sense of embeddedness in the Swedish emergency department context and a positive appreciation from staff. The study protocol was tested with 8 participants. Tasks both in the intervention and control condition were readily delivered via patients' own smartphones.CONCLUSION: Recruitment of patients and smartphone delivery of the intervention indicates initial feasibility. Researcher presence and administration of study procedures was successfully fitted to emergency department routines and well received by staff. Further pilot work is warranted, underscoring the importance of our collaboration between nursing and psychology.
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| 15. |
- Kanstrup, Marie, et al.
(författare)
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Reducing intrusive memories after trauma via a brief cognitive task intervention in the hospital emergency department : an exploratory pilot randomised controlled trial
- 2021
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Ingår i: Translational Psychiatry. - : Springer Nature. - 2158-3188. ; 11:1
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Tidskriftsartikel (refereegranskat)abstract
- Intrusive memories are common after trauma, and can cause significant distress. Interventions to prevent/reduce the occurrence of this core clinical feature of posttraumatic stress disorder are needed; they should be easy to deliver, readily disseminated and scalable. A novel one-session intervention by Iyadurai et al. 2018, Molecular Psychiatry, resulted in intrusion reduction over the subsequent week. Its feasibility in a different setting and longer-term effects (>1 month) need investigation. We conducted an exploratory open-label pilot randomised controlled trial (RCT) to investigate the feasibility and effects of a brief behavioural intervention to reduce intrusive memories in trauma-exposed patients in a Swedish hospital emergency department (ED). Participants (final N = 41) were randomly allocated to either intervention (including memory reminder cue then visuospatial cognitive task “Tetris” with mental rotation instructions) or active control (podcast) condition within 72 h of presenting to the ED (both conditions using their smartphone). Findings were examined descriptively. We estimated between-group effect sizes for the number of intrusive memories post-intervention at week 1 (primary outcome) and week 5 (secondary outcome). Compared to the control condition, participants in the intervention condition reported fewer intrusive memories of trauma, both at week 1 and week 5. Findings extend the previous evaluation in the UK. The intervention was readily implemented in a different international context, with a mixed trauma sample, with treatment gains maintained at 1 month and associated with some functional improvements. Findings inform future trials to evaluate the capacity of the cognitive task intervention to reduce the occurrence of intrusive memories after traumatic events.
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| 16. |
- Lasselin, Julie, et al.
(författare)
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Low-grade inflammation may moderate the effect of behavioral treatment for chronic pain in adults
- 2016
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Ingår i: Journal of behavioral medicine. - : Springer Science and Business Media LLC. - 0160-7715 .- 1573-3521. ; 39:5, s. 916-924
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of the present pilot study was to explore the moderating role of basal inflammation on the effects of behavioral pain treatment in 41 patients with long-standing pain. Baseline pro-inflammatory status moderated behavioral treatment outcomes: higher pre-treatment levels of Tumor Necrosis Factor (TNF)-α and Interleukin (IL)-6 were related to less improvement in pain intensity, psychological inflexibility and in mental health-related quality of life. The treatment outcomes improved in the subgroup that had low levels of pro-inflammatory cytokines at baseline, while the subjects with higher pro-inflammatory status did not. Altogether, results indicate that low-grade inflammation may influence the behavioral treatment outcomes and provide a possible explanation of the heterogeneity in treatment response.
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| 17. |
- Miehlke, Stephan, et al.
(författare)
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European guidelines on microscopic colitis : United European Gastroenterology (UEG) and European Microscopic Colitis Group (EMCG) statements and recommendations
- 2021
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Ingår i: United European Gastroenterology journal. - : Sage Publications. - 2050-6406 .- 2050-6414. ; 9:1, s. 13-37
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Forskningsöversikt (refereegranskat)abstract
- Introduction: Microscopic colitis is a chronic inflammatory bowel disease characterised by normal or almost normal endoscopic appearance of the colon, chronic watery, non-bloody diarrhoea and distinct histological abnormalities, which identify three histological subtypes, the collagenous colitis, the lymphocytic colitis and the incomplete microscopic colitis. With ongoing uncertainties and new developments in the clinical management of microscopic colitis, there is a need for evidence-based guidelines to improve the medical care of patients suffering from this disorder.Methods: Guidelines were developed by members from the European Microscopic Colitis Group and United European Gastroenterology in accordance with the Appraisal of Guidelines for Research and Evaluation II instrument. Following a systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation methodology was used to assess the certainty of the evidence. Statements and recommendations were developed by working groups consisting of gastroenterologists, pathologists and basic scientists, and voted upon using the Delphi method.Results: These guidelines provide information on epidemiology and risk factors of microscopic colitis, as well as evidence-based statements and recommendations on diagnostic criteria and treatment options, including oral budesonide, bile acid binders, immunomodulators and biologics. Recommendations on the clinical management of microscopic colitis are provided based on evidence, expert opinion and best clinical practice.Conclusion: These guidelines may support clinicians worldwide to improve the clinical management of patients with microscopic colitis.
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| 18. |
- Nielsen, Annette Cleveland, et al.
(författare)
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User-Innovated eHealth Solutions for Service Delivery to Older Persons With Hearing Impairment
- 2018
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Ingår i: American Journal of Audiology. - : AMER SPEECH-LANGUAGE-HEARING ASSOC. - 1059-0889 .- 1558-9137. ; 27:3, s. 403-416
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The successful design and innovation of eHealth solutions directly involve end users in the process to seek a better understanding of their needs. This article presents user-innovated eHealth solutions targeting older persons with hearing impairment. Our research question was: What are the key users needs, expectations, and visions within future hearing rehabilitation service delivery? Method: We applied a participatory design approach to facilitate the design of future eHealth solutions via focus groups. We involved older persons with hearing impairment (n = 36), significant others (n = 10), and audiologists (n = 8) following 2 methods: (a) human-centered design for interactive systems and (b) user innovation management. Through 3 rounds of focus groups, we facilitated a process progressing from insights and visions for requirements phase 1), to app such as paper version wireframes (Phase 2), and to digital prototypes envisioning future eHealth solutions (Phase 3). Each focus group was video-recorded and photographed, resulting in a rich data set that was analyzed through inductive thematic analysis. Results: The results are presented via (a) a storyboard envisioning future client journeys, (b) 3 key themes for future eHealth solutions, (c) 4 levels of interest and willingness to invest time and effort in digital solutions, and (d) 2 technical savviness types and their different preferences for rehabilitation strategies. Conclusions: Future eHealth solutions must offer personalized rehabilitation strategies that are appropriate for every person with hearing impairment and their level of technical savviness. Thus, a central requirement is anchoring of digital support in the clients everyday life situations by facilitating easy access to personalized information, communication, and leaning milieus. Moreover, the participants visions for eHealth solutions call for providing both traditional analogue and digital services.
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| 19. |
- Olsen, Laerke Müller, et al.
(författare)
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Histological disease activity in patients with microscopic colitis is not related to clinical disease activity or long-term prognosis
- 2021
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Ingår i: Alimentary Pharmacology and Therapeutics. - Chichester, United Kingdom : Wiley-Blackwell. - 0269-2813 .- 1365-2036. ; 54:1, s. 43-52
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Tidskriftsartikel (refereegranskat)abstract
- Background Microscopic colitis (MC) is a common cause of chronic watery diarrhea. Biopsies with characteristic histological features are crucial for establishing the diagnosis. The two main subtypes are collagenous colitis (CC) and lymphocytic colitis (LC) but incomplete forms exist. The disease course remains unpredictable varying from spontaneous remission to a relapsing course.Aim To identify possible histological predictors of course of disease.Methods Sixty patients from the European prospective MC registry (PRO-MC Collaboration) were included. Digitised histological slides stained with CD3 and Van Gieson were available for all patients. Total cell density and proportion of CD3 positive lymphocytes in lamina propria and surface epithelium were estimated by automated image analysis, and measurement of the subepithelial collagenous band was performed. Histopathological features were correlated to the number of daily stools and daily watery stools at time of endoscopy and at baseline as well as the clinical disease course (quiescent, achieved remission after treatment, relapsing or chronic active) at 1-year follow-up.Results Neither total cell density in lamina propria, proportion of CD3 positive lymphocytes in lamina propria or surface epithelium, or thickness of collagenous band showed significant correlation to the number of daily stools or daily watery stools at any point of time. None of the assessed histological parameters at initial diagnosis were able to predict clinical disease course at 1-year follow-up.Conclusions Our data indicate that the evaluated histological parameters were neither markers of disease activity at the time of diagnosis nor predictors of disease course.
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| 20. |
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| 21. |
- Singh, Laura, et al.
(författare)
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A first remotely-delivered guided brief intervention to reduce intrusive memories of psychological trauma for healthcare staff working during the ongoing COVID-19 pandemic : Study protocol for a randomised controlled trial
- 2022
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Ingår i: Contemporary Clinical Trials Communications. - : Elsevier BV. - 2451-8654. ; 26
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Tidskriftsartikel (refereegranskat)abstract
- Addressing the mental health needs of healthcare staff exposed to psychologically traumatic events at work during the COVID-19 pandemic is a pressing global priority. We need to swiftly develop interventions to target the psychological consequences (e.g., persistent intrusive memories of trauma). Interventions for healthcare staff must be brief, flexible, fitted around the reality and demands of working life under the pandemic, and repeatable during ongoing/further trauma exposure. Intervention delivery during the pandemic should be remote to mitigate risk of infection; e.g., here using a blend of digitalized self-administered materials (e.g., video instructions) and guided (remote) support from a researcher. This parallel groups, two-arm, randomised controlled trial (RCT) with healthcare staff working during the COVID-19 pandemic is the first evaluation of whether a digitalized form of a brief cognitive task intervention, which is remotely-delivered (guided), reduces intrusive memories. Healthcare staff who experience intrusive memories of work-related traumatic event(s) during the COVID-19 pandemic (≥2 in the week before inclusion) will be randomly allocated (1:1) to receive either the cognitive task intervention or an active (attention placebo) control, and followed up at 1-week, 1-month, 3-months, and 6-months post-intervention. The primary outcome will be the number of intrusive memories reported during Week 5; secondary and other outcomes include the number of intrusive memories reported during Week 1, and other intrusive symptoms. Findings will inform further development and dissemination of a brief cognitive task intervention to target intrusive memories.
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| 22. |
- Singh, Laura, et al.
(författare)
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Digitalizing a brief intervention to reduce intrusive memories of psychological trauma for health care staff working during COVID-19 : Exploratory pilot study with nurses
- 2021
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Ingår i: JMIR Formative Research. - : JMIR Publications Inc.. - 2561-326X. ; 5:5
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The COVID-19 pandemic has accelerated the worldwide need for simple remotely delivered (digital) scalable interventions that can also be used preventatively to protect the mental health of health care staff exposed to psychologically traumatic events during their COVID-19-related work. We have developed a brief behavioral intervention that aims to reduce the number of intrusive memories of traumatic events but has only been delivered face-to-face so far. After digitalizing the intervention materials, the intervention was delivered digitally to target users (health care staff) for the first time. The adaption for staff's working context in a hospital setting used a co-design approach.OBJECTIVE: The aims of this mixed method exploratory pilot study with health care staff who experienced working in the pandemic were to pilot the intervention that we have digitalized (for remote delivery and with remote support) and adapted for this target population (health care staff working clinically during a pandemic) to explore its ability to reduce the number of intrusive memories of traumatic events and improve related symptoms (eg, posttraumatic stress) and participant's perception of their functioning, and to explore the feasibility and acceptability of both the digitalized intervention and digitalized data collection.METHODS: We worked closely with target users with lived experience of working clinically during the COVID-19 pandemic in a hospital context (registered nurses who experienced intrusive memories from traumatic events at work; N=3). We used a mixed method design and exploratory quantitative and qualitative analysis.RESULTS: After completing the digitalized intervention once with remote researcher support (approximately 25 minutes) and a brief follow-up check-in, participants learned to use the intervention independently. All 3 participants reported zero intrusive memories during week 5 (primary outcome: 100% digital data capture). Prior to study inclusion, two or more intrusions in the week were reported preintervention (assessed retrospectively). There was a general pattern of symptom reduction and improvement in perceived functioning (eg, concentration) at follow-up. The digitalized intervention and data collection were perceived as feasible and rated as acceptable (eg, all 3 participants would recommend it to a colleague). Participants were positive toward the digital intervention as a useful tool that could readily be incorporated into work life and repeated in the face of ongoing or repeated trauma exposure.CONCLUSIONS: The intervention when delivered remotely and adapted for this population during the pandemic was well received by participants. Since it could be tailored around work and daily life and used preventatively, the intervention may hold promise for health care staff pending future evaluations of efficacy. Limitations include the small sample size, lack of daily intrusion frequency data in the week before the intervention, and lack of a control condition. Following this co-design process in adapting and improving intervention delivery and evaluation, the next step is to investigate the efficacy of the digitalized intervention in a randomized controlled trial.
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| 23. |
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| 24. |
- Thorarinsdottir, Kristjana, et al.
(författare)
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Reducing Intrusive Memories of Childhood Trauma Using a Visuospatial Intervention: Case Study in Iceland
- 2021
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Ingår i: JMIR Formative Research. - : JMIR Publications. - 2561-326X. ; 5:11, s. e29873-
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Tidskriftsartikel (refereegranskat)abstract
- Background: Additional interventions are needed for survivors of psychological trauma because of several barriers to and limitations of existing treatment options (eg, need to talk about the trauma in detail). Case studies are an important step in exploring the development of novel interventions, allowing detailed examination of individual responses to treatment over time. Here, we present a case study that aims to test a novel intervention designed to disrupt memory reconsolidation, taking a single-symptom approach by focusing on intrusive memories of a traumatic event.Objective: This study aims to examine a novel brief cognitive intervention to reduce the number of intrusive memories of trauma in an Icelandic setting and to extend previous studies by examining long-term effects for up to 3 months. The intervention was guided by a clinical psychologist and comprised a brief memory reminder, followed by Tetris gameplay with mental rotation, targeting one memory at a time in each session.Methods: This was a single case study in Iceland with a woman in her 50s (drawn from an epidemiological study of trauma) with subthreshold posttraumatic stress disorder and a diagnosis of obsessive-compulsive disorder and social anxiety disorder. The participant had four different intrusive memories from a traumatic event that happened in her childhood. The primary outcome was the change in the number of intrusive memories from baseline to intervention phase and to follow-ups. The number of intrusions was monitored in a daily diary for 4 weeks preintervention, 8 weeks during the intervention, and 1 week at 1-month and 3-month follow-ups. Intrusions were targeted one by one over six intervention sessions, creating four repetitions of an AB design (ie, length of baseline A and intervention phase B varied for each memory). We examined changes in both the total number of intrusions (summed across all four memories) and individually for each memory. In addition, we explored whether having fewer intrusive memories would have an impact on functioning, posttraumatic stress, and depression or anxiety symptoms.Results: The total number of intrusions per week was 12.6 at baseline, 6.1 at the intervention phase (52% reduction from baseline), 3.0 at the 1-month follow-up (76% reduction), and 1.0 at the 3-month follow-up (92% reduction). Reductions in the symptoms of posttraumatic stress and depression were observed postintervention. Sleep, concentration, stress, and functioning improved. The participant considered the gameplay intervention acceptable and helpful in that she found that the memories disappeared while she was playing.Conclusions: This guided brief cognitive intervention reduced the number of intrusive memories over the intervention phase and follow-ups. The brief memory reminder was well tolerated, removing the need to discuss trauma in detail. The next steps require an extension to more cases and exploring remote delivery of the intervention.
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| 25. |
- Thorarinsdottir, Kristjana, et al.
(författare)
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Using a Brief Mental Imagery Competing Task to Reduce the Number of Intrusive Memories : Exploratory Case Series With Trauma-Exposed Women
- 2022
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Ingår i: JMIR Formative Research. - : JMIR Publications. - 2561-326X. ; 6:7
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Tidskriftsartikel (refereegranskat)abstract
- Background:Novel interventions should be developed for people who have undergone psychological trauma. In a previous case study, we found that the number of intrusive memories of trauma could be reduced with a novel intervention. The intervention included a brief memory reminder, a visuospatial task and mental rotation, and targeted trauma memory hotspots one at a time in separate sessions.Objective:This case series (N=3) extended the first case study with 3 new cases to determine whether a similar pattern of beneficial results is observed. We explored whether the brief intervention would result in reduced numbers of intrusive memories and whether it would impact symptoms of posttraumatic stress, depression and anxiety, and general functioning. Acceptability of the intervention was also explored.Methods:A total of 3 women completed the study: 2 with posttraumatic stress disorder and other comorbidities and 1 with subthreshold posttraumatic stress disorder. The primary outcome was the change in the number of intrusive memories from the baseline phase to the intervention phase and at the 1-month follow-up, with an assessment of the intrusion frequency at 3 months. Participants monitored the number of intrusive memories in a daily diary for 1 week at baseline, for maximum of 6 weeks during the intervention phase and for 1 week at the 1-month and 3-month follow-ups. The intervention was delivered in person or digitally, with guidance from a clinical psychologist. A repeated AB design was used (A was a preintervention baseline phase and B intervention phase). Intrusions were targeted individually, creating repetitions of an AB design.Results:The total number of intrusive memories was reduced from the baseline to the intervention phase for all participants. The total number for participant 3 (P3) reduced from 38.8 per week during the baseline phase to 18.0 per week in the intervention phase. It was 13 at the 3-month follow-up. The total number for P4 reduced from 10.8 per week at baseline to 4.7 per week in the intervention phase. It was 0 at the 3-month follow-up. The total number for P5 was reduced from 33.7 at baseline to 20.7 per week in the intervention phase. It was 8 at the 3-month follow-up. All participants reported reduction in posttraumatic stress symptoms in the postintervention phase. Depression and anxiety symptoms reduced in 2 of the 3 participants in the postintervention phase. Acceptability was favorable.Conclusions:We observed good compliance with the intervention and intrusive memory diary in all 3 cases. The number of intrusive memories was reduced for all participants during the intervention phase and at the 1-month follow-up, with some improvement in other symptoms and functioning. Further research should explore the remote delivery of the intervention and whether nonspecialists can deliver the intervention effectively.
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| 26. |
- Åslund, Lie, et al.
(författare)
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Cognitive and Behavioral Interventions to Improve Sleep in School-Age Children and Adolescents : A Systematic Review and Meta-Analysis
- 2018
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Ingår i: Journal of Clinical Sleep Medicine (JCSM). - : American Academy of Sleep Medicine (AASM). - 1550-9389 .- 1550-9397. ; 14:11, s. 1937-1947
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Forskningsöversikt (refereegranskat)abstract
- Study ObjectivesSleep problems are common in children and adolescents and can aggravate comorbid disorders. This meta-analysis examined the effect of cognitive and behavioral sleep interventions (with four or more treatment sessions) from randomized controlled trials on school-age children and adolescents.MethodsIn a systematic literature search, six randomized controlled trials were identified (n = 528; mean age = 14.6 years; female = 63%) that reported total sleep time (TST), sleep onset latency (SOL), wake after sleep onset, and daytime sleepiness from ratings and actigraphy.ResultsAfter intervention, no effect was seen on self-reported TST, but when measured with actigraphy, an effect favoring the intervention group was observed (+11.47 minutes, P = .05). SOL decreased in the intervention group compared to the control group after intervention as measured by both sleep diaries (−9.31 minutes, P = .007) and actigraphy (−19.48 minutes, P < .0001). Effect sizes ranged from small to large. No effect was found for wake after sleep onset or daytime sleepiness. Short-term (4 to 8 weeks) follow-up data from four studies indicated maintained positive effects on SOL: sleep diaries −15.85 minutes (P = .01) and actigraphy −23.67 minutes (P < .0001). At follow-up, the effects on wake after sleep onset from ratings (−14.41 minutes, P = .001) and actigraphy (−7.54 minutes, P = .01) were significant, favoring the intervention group (moderate to large effect sizes). No effect on TST was indicated.ConclusionsCognitive and behavioral sleep interventions are indicated to improve sleep in school-age children and adolescents. However, because treatment protocols were heterogeneous and risk of bias high, results should be interpreted with caution. Large and rigorous trials are needed.
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