| 1. |
- Lappalainen, Paivi, et al.
(författare)
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Supporting parents of children with chronic conditions : A randomized controlled trial of web-based and self-help ACT interventions
- 2021
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Ingår i: Internet Interventions. - : Elsevier. - 2214-7829. ; 24
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Many parents of children with chronic conditions and developmental disabilities experience high rates of burnout and psychological distress. The aim of the current study was to examine the effects of two differently delivered interventions based on acceptance and commitment therapy (ACT) on symptoms of burnout, depression, quality of life, psychological flexibility, and mindfulness skills. Method: A total of 110 parents of children aged 0.8 to 17 years with chronic conditions and developmental disabilities participated in a randomized controlled trial lasting 13 weeks with two intervention groups: (1) an iACT intervention, including three psychologist-led video conferencing sessions, and (2) a self-help ACT, which received self-help material: an ACT-based booklet with the possibility of using ACT-based online exercises. Results: For the main outcome measure burnout, a similar decrease was found in both groups. The supported iACT intervention produced significantly larger improvements in depressive symptoms (d = 0.49), psychological flexibility (d = 0.64), and mindfulness (d = 0.55) compared to the self-help ACT intervention. For health-related quality of life, only the dimension of role limitations caused by emotional problems showed a significant difference in favor of the supported iACT (d = 0.58). Conclusions: The results suggest that the iACT intervention including three video conferencing sessions with a psychologist produced broader improvements in parents? psychological well-being than the self-help ACT. Overall, Internet-delivered interventions and video conferencing technology may offer a feasible alternative to psychological support and self-care for parents of children with chronic conditions. Further research is needed to investigate the long-term effects of the current delivery models.
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| 2. |
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| 3. |
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| 4. |
- Sairanen, Essi, et al.
(författare)
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Effects of an Online Acceptance and Commitment Therapy Intervention on Children's Quality of Life
- 2022
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Ingår i: Journal of Child and Family Studies. - : Springer. - 1062-1024 .- 1573-2843. ; 31, s. 1079-1093
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Tidskriftsartikel (refereegranskat)abstract
- The present study examined if an Acceptance and Commitment Therapy (ACT)-based online intervention for parents had indirect effects on their children's quality of life mediated by changes in parental well-being, psychological flexibility and mindfulness skills. Participants were 74 adults, who either received an ACT-based guided online intervention or were allocated to the wait list control group, and their children (n = 66) who had type 1 diabetes or functional disabilities. Structural equation modeling (SEM) and a bias-corrected bootstrap approach were applied to examine the indirect effects of the treatment on children's quality of life through changes in parents' well-being and psychological processes involving psychological flexibility, cognitive defusion, and mindfulness skills. Children's quality of life was assessed both by self-reports and parents' evaluations. Significant indirect effects on children's quality of life were found through improvements in parental well-being and mindfulness skills. The intervention had significant indirect effects on parents' evaluations of their children's quality of life concerning family and other social relationships, as well as on physical well-being. In regard to children's self-reported quality of life, the intervention had significant indirect effects on self-esteem, family relations, emotional well-being, and functioning at school/kindergarten. The results indicate that it is beneficial for children's quality of life to improve parents' ability to describe their experiences, being non-reactive to one's inner experiences and acting with awareness as well as cognitive defusion.
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| 5. |
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| 6. |
- Ahtinen, Aino, et al.
(författare)
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Mobile mental wellness training for stress management : feasibility and design implications based on a one-month field study.
- 2013
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Ingår i: JMIR mHealth and uHealth. - Toronto : JMIR Publications. - 2291-5222. ; 1:2
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Tidskriftsartikel (refereegranskat)abstract
- Prevention and management of work-related stress and related mental problems is a great challenge. Mobile applications are a promising way to integrate prevention strategies into the everyday lives of citizens.OBJECTIVE: The objectives of this study was to study the usage, acceptance, and usefulness of a mobile mental wellness training application among working-age individuals, and to derive preliminary design implications for mobile apps for stress management.METHODS: Oiva, a mobile app based on acceptance and commitment therapy (ACT), was designed to support active learning of skills related to mental wellness through brief ACT-based exercises in the daily life. A one-month field study with 15 working-age participants was organized to study the usage, acceptance, and usefulness of Oiva. The usage of Oiva was studied based on the usage log files of the application. Changes in wellness were measured by three validated questionnaires on stress, satisfaction with life (SWLS), and psychological flexibility (AAQ-II) at the beginning and at end of the study and by user experience questionnaires after one week's and one month's use. In-depth user experience interviews were conducted after one month's use to study the acceptance and user experiences of Oiva.RESULTS: Oiva was used actively throughout the study. The average number of usage sessions was 16.8 (SD 2.4) and the total usage time per participant was 3 hours 12 minutes (SD 99 minutes). Significant pre-post improvements were obtained in stress ratings (mean 3.1 SD 0.2 vs mean 2.5 SD 0.1, P=.003) and satisfaction with life scores (mean 23.1 SD 1.3 vs mean 25.9 SD 0.8, P=.02), but not in psychological flexibility. Oiva was perceived easy to use, acceptable, and useful by the participants. A randomized controlled trial is ongoing to evaluate the effectiveness of Oiva on working-age individuals with stress problems.CONCLUSIONS: A feasibility study of Oiva mobile mental wellness training app showed good acceptability, usefulness, and engagement among the working-age participants, and provided increased understanding on the essential features of mobile apps for stress management. Five design implications were derived based on the qualitative findings: (1) provide exercises for everyday life, (2) find proper place and time for challenging content, (3) focus on self-improvement and learning instead of external rewards, (4) guide gently but do not restrict choice, and (5) provide an easy and flexible tool for self-reflection.
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| 7. |
- Ahtinen, Aino, et al.
(författare)
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Oiva – A mobile phone intervention for psychological flexibility and wellbeing
- 2012
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Ingår i: Designing for Wellness and Behavior Change workshop.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- To provide a scalable solution to mental health problems caused by stress, we developed Oiva, a mobile phone intervention for improving mental and physical wellbeing. Oiva is based on Acceptance and Commitment Therapy (ACT) and its aim is to teach the users skills to increase their psychological flexibility. The application contains 45 text, audio, and video exercises. Two user studies demonstrated the usability and acceptability of the application and concept. The evaluations also revealed that the users expected guidance on the application for performing the intervention program. They also wanted to have possibilities to individualize the application by saving their own reflections about the exercises as notes. The preliminary evaluation results indicate that Oiva is a good starting point for the further design and research of mobile applications for reducing stress and improving wellness.
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| 8. |
- Anclair, Malin, et al.
(författare)
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Cognitive behavioural therapy and mindfulness for stress and burnout : a waiting list controlled pilot study comparing treatments for parents of children with chronic conditions
- 2018
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Ingår i: Scandinavian Journal of Caring Sciences. - : John Wiley & Sons. - 0283-9318 .- 1471-6712. ; 32:1, s. 389-396
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundParents of children with chronic conditions often experience a crisis with serious mental health problems for themselves as a consequence. The healthcare focus is on the children; however, the parents often worry about their children's health and future but are seldom offered any counselling or guidance.AimThe aim of this study was to investigate the effectiveness of two group-based behavioural interventions on stress and burnout among parents of children with chronic conditions.Design, participants and settingAfter a waiting list control period (n = 28), parents were offered either a cognitive behavioural (CBT, n = 10) or a mindfulness program (MF, n = 9).ResultsBoth interventions decreased significantly stress and burnout. The within-group effect sizes were large in both interventions (CBT, g = 1.28–1.64; MF, g = 1.25–2.20).ConclusionsHence, the results of this pilot study show that treating a group using either CBT or mindfulness can be an efficient intervention for reducing stress levels and burnout in parents of children with chronic conditions.
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| 9. |
- Jarvela-Reijonen, Elina, et al.
(författare)
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The Effects of Acceptance and Commitment Therapy (ACT) Intervention on Inflammation and Stress Biomarkers : a Randomized Controlled Trial
- 2020
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Ingår i: International Journal of Behavioral Medicine. - : Springer Science and Business Media LLC. - 1070-5503 .- 1532-7558. ; 27:5, s. 539-555
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Tidskriftsartikel (refereegranskat)abstract
- Background Psychological processes can be manifested in physiological health. We investigated whether acceptance and commitment therapy (ACT), targeted on psychological flexibility (PF), influences inflammation and stress biomarkers among working-age adults with psychological distress and overweight/obesity. Method Participants were randomized into three parallel groups: (1) ACT-based face-to-face (n = 65; six group sessions led by a psychologist), (2) ACT-based mobile (n = 73; one group session and mobile app), and (3) control (n = 66; only the measurements). Systemic inflammation and stress markers were analyzed at baseline, at 10 weeks after the baseline (post-intervention), and at 36 weeks after the baseline (follow-up). General PF and weight-related PF were measured with questionnaires (Acceptance and Action Questionnaire, Acceptance and Action Questionnaire for Weight-Related Difficulties). Results A group x time interaction (p = .012) was detected in the high-sensitivity C-reactive protein (hsCRP) level but not in other inflammation and stress biomarkers. hsCRP decreased significantly in the face-to-face group from week 0 to week 36, and at week 36, hsCRP was lower among the participants in the face-to-face group than in the mobile group (p = .035, post hoc test). Age and sex were stronger predictors of biomarker levels at follow-up than the post-intervention PF. Conclusion The results suggest that ACT delivered in group sessions may exert beneficial effects on low-grade systemic inflammation. More research is needed on how to best apply psychological interventions for the health of both mind and body among people with overweight/obesity and psychological distress.
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| 10. |
- Järvelä-Reijonen, Elina, et al.
(författare)
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High perceived stress is associated with unfavorable eating behavior in overweight and obese Finns of working age.
- 2016
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Ingår i: Appetite. - : Elsevier. - 0195-6663 .- 1095-8304. ; 103, s. 249-258
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Tidskriftsartikel (refereegranskat)abstract
- Stress-related eating may be a potential factor in the obesity epidemic. Rather little is known about how stress associates with eating behavior and food intake in overweight individuals in a free-living situation. Thus, the present study aims to investigate this question in psychologically distressed overweight and obese working-aged Finns. The study is a cross-sectional baseline analysis of a randomized controlled trial. Of the 339 study participants, those with all the needed data available (n = 297, 84% females) were included. The mean age was 48.9 y (SD = 7.6) and mean body mass index 31.3 kg/m(2) (SD = 3.0). Perceived stress and eating behavior were assessed by self-reported questionnaires Perceived Stress Scale (PSS), Intuitive Eating Scale, the Three-Factor Eating Questionnaire, Health and Taste Attitude Scales and ecSatter Inventory. Diet and alcohol consumption were assessed by 48-h dietary recall, Index of Diet Quality, and AUDIT-C. Individuals reporting most perceived stress (i.e. in the highest PSS tertile) had less intuitive eating, more uncontrolled eating, and more emotional eating compared to those reporting less perceived stress (p < 0.05). Moreover, individuals in the highest PSS tertile reported less cognitive restraint and less eating competence than those in the lowest tertile (p < 0.05). Intake of whole grain products was the lowest among those in the highest PSS tertile (p < 0.05). Otherwise the quality of diet and alcohol consumption did not differ among the PSS tertiles. In conclusion, high perceived stress was associated with the features of eating behavior that could in turn contribute to difficulties in weight management. Stress-related way of eating could thus form a potential risk factor for obesity. More research is needed to develop efficient methods for clinicians to assist in handling stress-related eating in the treatment of obese people.
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| 11. |
- Järvelä-Reijonen, Elina, et al.
(författare)
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Sleep-time physiological recovery is associated with eating habits in distressed working-age Finns with overweight : Secondary analysis of a randomised controlled trial
- 2021
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Ingår i: Journal of Occupational Medicine and Toxicology. - : BioMed Central (BMC). - 1745-6673. ; 16:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Association of physiological recovery with nutrition has scarcely been studied. We investigated whether physiological recovery during sleep relates to eating habits, i.e., eating behaviour and diet quality. Methods: Cross-sectional baseline analysis of psychologically distressed adults with overweight (N = 252) participating in a lifestyle intervention study in three Finnish cities. Recovery measures were based on sleep-time heart rate variability (HRV) measured for 3 consecutive nights. Measures derived from HRV were 1) RMSSD (Root Mean Square of the Successive Differences) indicating the parasympathetic activation of the autonomic nervous system and 2) Stress Balance (SB) indicating the temporal ratio of recovery to stress. Eating behaviour was measured with questionnaires (Intuitive Eating Scale, Three-Factor Eating Questionnaire, Health and Taste Attitude Scales, ecSatter Inventory (TM)). Diet quality was quantified using questionnaires (Index of Diet Quality, Alcohol Use Disorders Identification Test Consumption) and 48-h dietary recall. Results: Participants with best RMSSD reported less intuitive eating (p = 0.019) and less eating for physical rather than emotional reasons (p = 0.010) compared to those with poorest RMSSD; participants with good SB reported less unconditional permission to eat (p = 0.008), higher fibre intake (p = 0.028), higher diet quality (p = 0.001), and lower alcohol consumption (p < 0.001) compared to those with poor SB, although effect sizes were small. In subgroup analyses among participants who reported working regular daytime hours (n = 216), only the associations of SB with diet quality and alcohol consumption remained significant. Conclusions: Better nocturnal recovery showed associations with better diet quality, lower alcohol consumption and possibly lower intuitive eating. In future lifestyle interventions and clinical practice, it is important to acknowledge sleep-time recovery as one possible factor linked with eating habits.
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| 12. |
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| 13. |
- Lappalainen, Raimo, et al.
(författare)
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The effectiveness and applicability of different lifestyle interventions for enhancing wellbeing : the study design for a randomized controlled trial for persons with metabolic syndrome risk factors and psychological distress.
- 2014
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Ingår i: BMC Public Health. - : BioMed Central. - 1471-2458. ; 14
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Obesity and stress are among the most common lifestyle-related health problems. Most of the current disease prevention and management models are not satisfactorily cost-effective and hardly reach those who need them the most. Therefore, novel evidence-based controlled interventions are necessary to evaluate models for prevention and treatment based on self-management. This randomized controlled trial examines the effectiveness, applicability, and acceptability of different lifestyle interventions with individuals having symptoms of metabolic syndrome and psychological distress. The offered interventions are based on cognitive behavioral approaches, and are designed for enhancing general well-being and supporting personalized lifestyle changes.METHODS/DESIGN: 339 obese individuals reporting stress symptoms were recruited and randomized to either (1) a minimal contact web-guided Cognitive Behavioral Therapy-based (CBT) intervention including an approach of health assessment and coaching methods, (2) a mobile-guided intervention comprising of mindfulness, acceptance and value-based exercises, (3) a face-to-face group intervention using mindfulness, acceptance and value-based approach, or (4) a control group. The participants were measured three times during the study (pre = week 0, post = week 10, and follow-up = week 36). Psychological well-being, lifestyles and habits, eating behaviors, and user experiences were measured using online surveys. Laboratory measurements for physical well-being and general health were performed including e.g. liver function, thyroid glands, kidney function, blood lipids and glucose levels and body composition analysis. In addition, a 3-day ambulatory heart rate and 7-day movement data were collected for analyzing stress, recovery, physical activity, and sleep patterns. Food intake data were collected with a 48 -hour diet recall interview via telephone. Differences in the effects of the interventions would be examined using multiple-group modeling techniques, and effect-size calculations.DISCUSSION: This study will provide additional knowledge about the effects of three low intensity interventions for improving general well-being among individuals with obesity and stress symptoms. The study will show effects of two technology guided self-help interventions as well as effect of an acceptance and value-based brief group intervention. Those who might benefit from the aforesaid interventions will increase knowledge base to better understand what mechanisms facilitate effects of the interventions.TRIAL REGISTRATION: Current Clinical Trials NCT01738256, Registered 17 August, 2012.
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| 14. |
- Pöllänen, Raimo, et al.
(författare)
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The effect of loading and material on the biomechanical properties and vitality of bovine cartilage in vitro.
- 2011
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Ingår i: Journal of Applied Biomaterials and Biomechanics. - : Wichtig Editore Srl. - 1722-6899. ; 9:1, s. 47-53
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: New methodology for long-term (270 h) biomechanical testing with living cartilage was developed. Polyurethane (PU) implant material was compared with stainless steel and reference samples in static unconfined compressive loading conditions on cartilage to provide a basis for dynamic testing of novel PU implant materials under conditions that simulate an articulating human knee joint.METHODS: Custom-made tools and techniques were developed to prepare cylindrical samples from bovine patella with cartilage including subchondral bone. Specific incubator cups with static loading setups for a culture incubator were manufactured to keep bovine cartilage explants alive in cell culture conditions under unconfined static compressive loading (0.25 MPa) for 270 h (11.25 d). Four loading conditions of cartilage were studied: free (FREE), restrained minimal loading (RESTR), loading with a metal plate (MEW) and loading with polyurethane (PUW).RESULTS: After static loading for 270 h, cartilage biomechanical tests indicated clear differences between the groups in frequency dependent dynamic stiffness curves. Surprisingly, the PU curves were closest to the FREE sample curves. Those with load and direct contact with metal (MEW) became significantly stiffer, while restrained samples became softer. Significant differences (p<0.05, Mann-Whitney's U test) in cell vitality between samples from various groups could be seen in fluorescein diacetate (FDA) and propidium iodide (PI) stained samples by confocal microscopic analysis. The approximate mean percentages of living cells after 270 hours cultivation were: FREE 87%, MEW 3%, PUW 35%, and RESTR 66%. Test results indicate that it is possible to keep cartilage cells alive in cell culture incubator conditions for two weeks period under a 0.25 MPa unconfined static loading. The FREE samples were most successful and cells loaded with PU were more vital than cells loaded with metal.CONCLUSIONS: Based on the results, PU seems to be more compatible material than surgical steel in contact with living cartilage. Because of a large variation in the quality of bovine cartilage material from different animals, special care is necessary when selecting specimens to guarantee reliable and reproducible results.
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| 15. |
- Ronkainen, Hannaleena, et al.
(författare)
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Psychological Flexibility Skills and Mental Wellbeing in Athletes: An Exploration of Associations and Gender Differences
- 2024
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Ingår i: Psychology and Behavioral Sciences. - : Science Publishing group. - 2328-7837 .- 2328-7845. ; 13:2, s. 43-55
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Tidskriftsartikel (refereegranskat)abstract
- Psychological flexibility skills (PFS) have shown to be an important aspect of wellbeing among the general population, however, there is a gap in research exploring flexibility skills among athletes. The present study examined the effects of PFS on young athletes’ (n = 106, M = 19.9) psychological wellbeing, symptomatology, and gender differences. Data was investigated using correlations and linear regression analyses. Higher PFS was associated with subjective wellbeing, recovery experiences, self-esteem, and lower levels of perceived stress, and depression symptoms (r = 0.30-0.53). Among the PFS, value-based actions acted as the strongest predictor for mental wellbeing and symptoms. In addition, avoidance of distressing thoughts and emotions related to sport was a significant predictor for self-esteem, symptoms of stress and depression but not for subjective wellbeing and recovery experience. Also, our results highlighted gender disparities, with female athletes reporting higher stress and depressive symptoms, while males exhibited better mental wellbeing, psychological recovery, self-esteem, and higher psychological flexibility skills. Overall, engagement in value-based actions may enhance athletes’ mental wellbeing. Further, it might be important to pay attention to individual differences related to gender both when assessing psychological flexibility skills and when applying interventions aimed at enhancing mental wellbeing among athletes.
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| 16. |
- Sairanen, Essi, et al.
(författare)
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Flexibility in weight management.
- 2014
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Ingår i: Eating Behaviors. - Amsterdam : Elsevier. - 1471-0153 .- 1873-7358. ; 15:2, s. 218-24
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of the study was to investigate the relationships between changes in flexible vs. rigid restraints of eating during weight management, as well as how changes in the cognitive restraint of eating were related to psychological well-being and flexibility. The data includes information on 49 overweight persons who participated in a weight loss and maintenance (WLM) intervention and a follow-up assessment after 8-9 months. An increase in flexible cognitive restraint during the weight loss intervention was related to better weight loss maintenance and well-being. The more flexible restraint increased during the WLM intervention, the more psychological distress decreased. Moreover, larger reduction of rigid restraint during the follow-up period (between the WLM intervention and the follow-up assessment) was related to a better maintenance of improved psychological well-being at the follow-up endpoint. These results suggest that increasing flexible control while reducing rigid control of eating after an active weight loss phase improves success in weight management and the psychological well-being of weight losers.
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| 17. |
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| 18. |
- Sairanen, Essi, et al.
(författare)
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Psychological flexibility and mindfulness explain intuitive eating in overweight adults
- 2015
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Ingår i: Behavior modification. - Beverly Hills : Sage Publications. - 0145-4455 .- 1552-4167. ; 39:4, s. 557-79
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Tidskriftsartikel (refereegranskat)abstract
- The current study investigated whether mindfulness and psychological flexibility, independently and together, explain intuitive eating. The participants were overweight or obese persons (N = 306) reporting symptoms of perceived stress and enrolled in a psychological lifestyle intervention study. Participants completed self-report measures of psychological flexibility; mindfulness including the subscales observe, describe, act with awareness, non-react, and non-judgment; and intuitive eating including the subscales unconditional permission to eat, eating for physical reasons, and reliance on hunger/satiety cues. Psychological flexibility and mindfulness were positively associated with intuitive eating factors. The results suggest that mindfulness and psychological flexibility are related constructs that not only account for some of the same variance in intuitive eating, but they also account for significant unique variances in intuitive eating. The present results indicate that non-judgment can explain the relationship between general psychological flexibility and unconditional permission to eat as well as eating for physical reasons. However, mindfulness skills-acting with awareness, observing, and non-reacting-explained reliance on hunger/satiety cues independently from general psychological flexibility. These findings suggest that mindfulness and psychological flexibility are interrelated but not redundant constructs and that both may be important for understanding regulation processes underlying eating behavior.
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| 19. |
- Sairanen, Essi, et al.
(författare)
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Psychological flexibility mediates change in intuitive eating regulation in acceptance and commitment therapy interventions
- 2017
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Ingår i: Public Health Nutrition. - : Cambridge University Press. - 1368-9800 .- 1475-2727. ; 20:9, s. 1681-1691
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Despite the promising results related to intuitive eating, few studies have attempted to explain the processes encouraging this adaptive eating behaviour. The focus of the present study was on exploring mechanisms of change in intuitive eating and weight in acceptance and commitment therapy (ACT) interventions. Mediation provides important information regarding the treatment processes and theoretical models related to specific treatment approaches. The study investigates whether psychological flexibility, mindfulness skills and sense of coherence mediated the interventions' effect on intuitive eating and weight.DESIGN: Secondary analysis of a randomized control trial. Mediation analysis compared two ACT interventions - face-to-face (in a group) and mobile (individually) - with a control group using a latent difference score model. Settings Data were collected in three Finnish towns.SUBJECTS: The participants were overweight or obese (n 219), reporting symptoms of perceived stress.RESULTS: The effect of the interventions on participants' (i) BMI, (ii) intuitive eating and its subscales, (iii) eating for physical rather than emotional reasons and (iv) reliance on internal hunger and satiety cues was mediated by changes in weight-related psychological flexibility in both ACT groups.CONCLUSIONS: These findings suggest that ACT interventions aiming for lifestyle changes mediate the intervention effects through the enhanced ability to continue with valued activities even when confronted with negative emotions and thoughts related to weight.
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| 20. |
- Söderström, Sophia, et al.
(författare)
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Salutogenesis as a Mediator in Decreased Criminal Thinking : An Evaluation of Cognitive Programs for Juvenile and Adult Offenders
- 2024
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Ingår i: Journal of Forensic Psychology Research and Practice. - : Routledge. - 2473-2850 .- 2473-2842.
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Tidskriftsartikel (refereegranskat)abstract
- This study is based on two previous studies that showed a post-treatment decrease in total criminal thinking (PICTS) and an increase in total sense of coherence (SOC) among youths and adults. The current study investigated whether these interventions changed the sub-scales of PICTS and SOC, and whether an increase in SOC would mediate a decrease in PICTS. Among both groups, the mean value of the sub-factors of PICTS decreased by the interventions, and increased for SOC sub-factors meaningfulness and manageability. Only among the adults, the increase in total sense of coherence and the sub-factor of manageability mediated the decrease of criminal thinking.
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| 21. |
- Wallin, Emma, 1981-
(författare)
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Remote delivery of psychological interventions : Impact and acceptability of preventive strategies to improve risk factors associated with coronary heart disease
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Depression, anxiety and excessive weight are public health concerns that have been associated with an increased risk and worse prognosis of coronary heart disease. Remote delivery of psychological interventions may be an effective preventive strategy to improve these lifestyle-related risk factors as treatment may be delivered to many people at a low cost and reduce stigma related to seeking help. The general contribution of this thesis is to investigate the impact and indicators of treatment acceptability in contexts where this type of delivery may improve access to psychological interventions. The aim of Study I was to investigate whether stigma predicts the intention to seek help via the Internet compared to face to face among undergraduate students (N=267) and primary care patients (N=195). The results indicate that Internet-based interventions may improve intentions to seek help among individuals who are reluctant to seek psychological treatment face to face due to stigma. In Study II, the effect of a guided Internet-based Cognitive Behavior Therapy (iCBT) and Treatment-As-Usual (TAU) was compared to TAU only to reduce symptoms of depression and anxiety among patients with a recent myocardial infarction (N=239) in a randomized controlled trial. The results indicate no difference in symptoms of depression and anxiety between the groups. Study III describe treatment activity among participants allocated to the iCBT intervention in Study II (N=117). Furthermore, user experiences were explored using a semi-structured interview with 21 of these participants. The results indicate overall low treatment activity and different preferences regarding the web-based portal, treatment program and therapist communication. The aim of Study IV was to evaluate the impact and investigate indicators of treatment acceptability of a guided Acceptance and Commitment Therapy (ACT) self-help intervention to improve value attainment related to health and reduce experiential avoidance among individuals with overweight or obesity using a multiple baseline design (N=13). The results indicate that theACT intervention may be an acceptable intervention to improve value attainment related to health and decrease experiential avoidance. In conclusion, the studies in this thesis illustrate several challenges related to the willingness to seek and engage in Internet-based interventions. Furthermore, the results indicate varying responses to the remote delivery of ACT. The principal findings are discussed in relation to methodological limitations. Possible strategies to improve the take-up rates, adherence and treatment satisfaction are suggested as well as areas of future research.
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