| 1. |
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| 2. |
- Andersson, Gerhard, et al.
(författare)
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Randomised controlled non-inferiority trial with 3-year follow-up of internet-delivered versus face-to-face group cognitive behavioural therapy for depression
- 2013
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Ingår i: Journal of Affective Disorders. - : Elsevier. - 0165-0327 .- 1573-2517. ; 151:3, s. 986-994
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Tidskriftsartikel (refereegranskat)abstract
- Background: Guided internet-delivered cognitive behaviour therapy (ICBT) has been found to be effective in the treatment of mild to moderate depression, but there have been no direct comparisons with the more established group-based CBT with a long-term follow-up. less thanbrgreater than less thanbrgreater thanMethod: Participants with mild to moderate depression were recruited from the general population and randomized to either guided ICBT (n =33) or to live group treatment (n=36). Measures were completed before and after the intervention to assess depression, anxiety, and quality of life. Follow-ups were conducted at one-year and three-year after the treatment had ended. Results: Data were analysed on an intention-to-treat basis using linear mixed-effects regression analysis. less thanbrgreater than less thanbrgreater thanResults on the self-rated version of the Montgomery-Asberg Depression Scale showed significant improvements in both groups across time indicating non-inferiority of guided ICBT, and there was even a tendency for the guided ICBT group to be superior to group-based CBT at three year follow-up. Within-group effect sizes for the ICBT condition at post treatment showed a Cohens d=1.46, with a similar large effect at 3-year follow-up, d=1.78. For the group CBT the corresponding within group effects were d =0.99 and d=1.34, respectively. less thanbrgreater than less thanbrgreater thanLimitations: The study was small with two active treatments and there was no placebo or credible control condition. less thanbrgreater than less thanbrgreater thanConclusions: Guided ICBT is at least as effective as group based CBT and long-term effects can be sustained up to 3 years after treatment.
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| 3. |
- Gentili, Charlotte, et al.
(författare)
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ACTsmart : Guided Smartphone-Delivered Acceptance and Commitment Therapy for Chronic Pain — A Pilot Trial
- 2021
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Ingår i: Pain medicine. - : Oxford University Press (OUP). - 1526-2375 .- 1526-4637. ; 22:2, s. 315-328
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundAcceptance and commitment therapy (ACT) is a behavioral health intervention with strong empirical support for chronic pain but, to date, widespread dissemination is limited. Digital solutions improve access to care and can be integrated into patients’ everyday lives.ObjectiveACTsmart, a guided smartphone-delivered ACT intervention, was developed to improve the accessibility of an evidence-based behavioral treatment for chronic pain. In the present study, we evaluated the preliminary efficacy of ACTsmart in adults with chronic pain.MethodsThe study was an open-label pilot trial. The treatment lasted for 8 weeks, and participants completed all outcome measures at pretreatment and posttreatment and at 3-, 6-, and 12-month follow-ups, with weekly assessments of selected measures during treatment. The primary outcome was pain interference. The secondary outcomes were psychological flexibility, values, insomnia, anxiety, depressive symptoms, health-related quality of life, and pain intensity. All outcomes were analyzed using linear mixed-effects models.ResultsThe sample consisted of 34 adults (88% women) with long-standing chronic pain (M=20.4 years, SD=11.7). Compliance to treatment was high, and at the end of treatment, we observed a significant improvement in the primary outcome of pain interference (d = –1.01). All secondary outcomes significantly improved from pretreatment to posttreatment with small to large effect sizes. Improvements were maintained throughout 12 months of follow-up.ConclusionThe results of this pilot study provide preliminary support for ACTsmart as an accessible and effective behavioral health treatment for adults with chronic pain and warrant a randomized controlled trial to further evaluate the efficacy of the intervention.
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| 4. |
- Gentili, Charlotte, et al.
(författare)
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ACTsmart - development and feasibility of digital Acceptance and Commitment Therapy for adults with chronic pain
- 2020
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Ingår i: npj Digital Medicine. - : NATURE PUBLISHING GROUP. - 2398-6352. ; 3
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Tidskriftsartikel (refereegranskat)abstract
- Accessibility of evidence-based behavioral health interventions is one of the main challenges in health care and effective treatment approaches are not always available for patients that would benefit from them. Digitization has dramatically changed the health care landscape. Although mHealth has shown promise in addressing issues of accessibility and reach, there is vast room for improvements. The integration of technical innovations and theory driven development is a key concern. Digital solutions developed by industry alone often lack a clear theoretical framework and the solutions are not properly evaluated to meet the standards of scientifically proven efficacy. On the other hand, mHealth interventions developed in academia may be theory driven but lack user friendliness and are commonly technically outdated by the time they are implemented in regular care, if they ever are. In an ongoing project aimed at scientific innovation, the mHealth Agile Development and Evaluation Lifecycle was used to combine strengths from both industry and academia in the development of ACTsmart - a smartphone-based Acceptance and Commitment Therapy treatment for adult chronic pain patients. The present study describes the early development of ACTsmart, in the process of moving the product from alpha testing to a clinical trial ready solution.
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| 5. |
- Gentili, Charlotte, et al.
(författare)
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Examining predictors of treatment effect in digital Acceptance and Commitment Therapy for chronic pain
- 2023
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Ingår i: Cognitive Behaviour Therapy. - : Taylor & Francis Group. - 1650-6073 .- 1651-2316. ; , s. 1-17
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Tidskriftsartikel (refereegranskat)abstract
- Digitally delivered behavioral interventions for chronic pain have been encouraging with effects similar to face-to-face treatment. Although many chronic pain patients benefit from behavioral treatment, a substantial proportion do not improve. To contribute to more knowledge about factors that predict treatment effects in digitally delivered behavioral interventions for chronic pain, the present study analyzed pooled data (N = 130) from three different studies on digitally delivered Acceptance and Commitment Therapy (ACT) for chronic pain. Longitudinal linear mixed-effects models for repeated measures were used to identify variables with significant influence on the rate of improvement in the main treatment outcome pain interference from pre- to post-treatment. The variables were sorted into six domains (demographics, pain variables, psychological flexibility, baseline severity, comorbid symptoms and early adherence) and analysed in a stepwise manner. The study found that shorter pain duration and higher degree of insomnia symptoms at baseline predicted larger treatment effects. The original trials from which data was pooled are registered at clinicaltrials.gov (registration number: NCT03105908 and NCT03344926).
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| 6. |
- Gentili, Charlotte, et al.
(författare)
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Exploring psychological flexibility as in-treatment behaviour during internet-delivered acceptance and commitment therapy for paediatric chronic pain : Occurrence and relation to outcome
- 2024
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Ingår i: Journal of Contextual Behavioral Science. - : Elsevier. - 2212-1447. ; 31
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Tidskriftsartikel (refereegranskat)abstract
- Acceptance and Commitment Therapy has gained preliminary evidence for paediatric chronic pain. Several studies show that psychological flexibility/inflexibility is a process driving treatment change in ACT for chronic pain. The literature supporting psychological flexibility as a change process in ACT is typically based on selfreport. The aim of the present study was to investigate psychological flexibility (i.e. acceptance, defusion, values formulation and committed action) as in-treatment behaviour during internet-delivered Acceptance and Commitment Therapy for paediatric chronic pain, by having two independent observers rating patient written statements. The sample was self-recruited and consisted of 28 girls between ages 13 and 17 years. Results showed that psychological flexibility could be operationalised as in-treatment behaviours and reliably assessed using observer ratings. Also, data illustrated a within subject variability in ratings of acceptance and defusion, with a considerable difference in degree of acceptance or defusion evoked by different experiential exercises. Furthermore, analyses showed that a higher average degree of acceptance in patient statements during the early phase of treatment was related to larger treatment effects. Defusion, values formulation and committed action showed no significant influence on outcome. Results should be interpreted with caution due to the small sample size.
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| 7. |
- Gentili, Charlotte, et al.
(författare)
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Psychological Flexibility as a Resilience Factor in Individuals With Chronic Pain
- 2019
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Ingår i: Frontiers in Psychology. - : FRONTIERS MEDIA SA. - 1664-1078. ; 10
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Tidskriftsartikel (refereegranskat)abstract
- Resilience factors have been suggested as key mechanisms in the relation between symptoms and disability among individuals with chronic pain. However, there is a need to better operationalize resilience and to empirically evaluate its role and function. The present study examined psychological flexibility as a resilience factor in relation to symptoms and functioning among 252 adults with chronic pain applying for participation in a digital ACT-based self-help treatment. Participants completed measures of symptoms (pain intensity, and anxiety), functioning (pain interference and depression), as well as the hypothesized resilience factor psychological flexibility (measured as avoidance, value obstruction, and value progress). As expected, symptoms, functioning and resilience factors were significantly associated. Hierarchical linear regression analyses showed that psychological flexibility significantly contributed to the prediction of pain interference and depression when adjusting for age, pain and anxiety. Also, participants with low levels of psychological flexibility were more likely to be on sick leave. Furthermore, a series of multiple mediation analyses showed that psychological flexibility had a significant indirect effect on the relationship between symptoms and functioning. Avoidance was consistently shown to contribute to the indirect effect. Results support previous findings and suggest the importance of psychological flexibility as a resilience factor among individuals with chronic pain and anxiety.
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| 8. |
- Hesser, Hugo, 1982-, et al.
(författare)
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A Randomized Controlled Trial of Internet-Delivered Cognitive Behavior Therapy and Acceptance and Commitment Therapy in the Treatment of Tinnitus
- 2012
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Ingår i: Journal of Consulting and Clinical Psychology. - Washington, DC, USA : American Psychological Association (APA). - 0022-006X .- 1939-2117. ; 80:4, s. 649-661
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Tidskriftsartikel (refereegranskat)abstract
- Objective:Our aim in this randomized controlled trial was to investigate the effects on global tinnitus severity of 2 Internet-delivered psychological treatments, acceptance and commitment therapy (ACT) and cognitive behavior therapy (CBT), in guided self-help format.Method: Ninety-nine participants (mean age 48.5 years; 43% female) who were significantly distressed by tinnitus were recruited from the community. Participants were randomly assigned to CBT (n 32), ACT (n 35), or a control condition (monitored Internet discussion forum; n 32), and they were assessed with standardized self-report measures (Tinnitus Handicap Inventory; Hospital Anxiety and Depression Scale; Quality of Life Inventory; Perceived Stress Scale; Tinnitus Acceptance Questionnaire) at pre-, posttreatment (8 weeks), and 1-year follow-up.Results: Mixed-effects linear regression analysis of all randomized participants showed significant effects on the primary outcome (Tinnitus Handicap Inventory) for CBT and for ACT compared with control at posttreatment (95% CI [17.03, 2.94], d 0.70, and 95% CI [16.29, 2.53], d 0.68, respectively). Within-group effects were substantial from pretreatment through 1-year-follow-up for both treatments (95% CI [44.65, 20.45], d 1.34), with no significant difference between treatments (95% CI [14.87, 11.21], d 0.16).Conclusions: Acceptance-based procedures may be a viable alternative to traditional CBT techniques in the management of tinnitus. The Internet can improve access to psychological interventions for tinnitus.
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| 9. |
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| 10. |
- Hesser, Hugo, 1982-, et al.
(författare)
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A systematic review and meta-analysis of randomized controlled trials of cognitive-behavioral therapy for tinnitus distress
- 2011
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Ingår i: Clinical Psychology Review. - : Elsevier. - 0272-7358 .- 1873-7811. ; 31:4, s. 545-553
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Forskningsöversikt (refereegranskat)abstract
- Tinnitus is defined as a sound in the ear(s) and/or head without external origin and is a serious health concern for millions worldwide. The aim of the present study was to determine whether Cognitive Behavior Therapy (CBT) is effective in reducing distress associated with tinnitus. Randomized, controlled trials that assessed the efficacy of CBT for tinnitus-related distress in adults were identified by searching electronic databases (PsychINFO, PubMed, the Cochrane Library), and by manual searches. Fifteen studies (total of 1091 participants) were included in the meta-analysis. CBT compared with a passive and active control at post-assessment yielded statistically significant mean effect sizes for tinnitus-specific measures (Hedges's g = 0.70. and Hedges's g = 0.44, respectively). The average weighted pre-to-follow-up effect size for the CBT group suggested that these effects were maintained over time. Smaller but yet statistically significant effects of CBT were found for mood outcome measures. Characteristics of the studies were unrelated to effect sizes. Methodological rigor, publication bias, and a series of sensitivity analyses did not influence the findings. The results suggest that CBT is an effective treatment of tinnitus distress. However, caution is warranted given that few large-scale, well-controlled trials were identified.
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| 11. |
- Hesser, Hugo, 1947-, et al.
(författare)
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Acceptance as a Mediator in Internet-delivered Acceptance and Commitment Therapy and Cognitive Behavior Therapy for Tinnitus
-
Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Despite demonstrated efficacy of behavioral and cognitive techniques in treating the impact of tinnitus (constant ringing in the ears), little is known about the mechanisms by which these techniques achieve their effect. The present study examined acceptance of tinnitus as a potential mediator of treatment changes on global tinnitus severity in internet-delivered acceptance and commitment therapy (iACT) and internet-delivered cognitive behavior therapy (iCBT). Data from 67 participants who were distressed by tinnitus and who were randomly assigned to 1 of the 2 treatments were analyzed using a multilevel moderated mediation model. We predicted that acceptance as measured with the two subscales of the tinnitus acceptance questionnaire (i.e., activity engagement and tinnitus suppression) would mediate the outcome in iACT, but not in iCBT. Results provided partial support to the notion that mediation was moderated by treatment: tinnitus suppression mediated changes in tinnitus severity in iACT, but not in iCBT. However, inconsistent with the view that the treatments worked through different processes of change, activity engagement mediated treatment changes across both iACT and iCBT. Acceptance is identified as a key source of therapeutic change in behavioral-based treatments for tinnitus.
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| 12. |
- Hesser, Hugo, et al.
(författare)
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Acceptance as a mediator in internet-delivered acceptance and commitment therapy and cognitive behavior therapy for tinnitus
- 2014
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Ingår i: Journal of behavioral medicine. - : Springer. - 0160-7715 .- 1573-3521. ; 37:4, s. 756-767
-
Tidskriftsartikel (refereegranskat)abstract
- Despite demonstrated efficacy of behavioral and cognitive techniques in treating the impact of tinnitus (constant ringing in the ears), little is known about the mechanisms by which these techniques achieve their effect. The present study examined acceptance of tinnitus as a potential mediator of treatment changes on global tinnitus severity in internet-delivered acceptance and commitment therapy (iACT) and internet-delivered cognitive behavior therapy (iCBT). Data from 67 participants who were distressed by tinnitus and who were randomly assigned to 1 of the 2 treatments were analyzed using a multilevel moderated mediation model. We predicted that acceptance as measured with the two subscales of the tinnitus acceptance questionnaire (i.e., activity engagement and tinnitus suppression) would mediate the outcome in iACT, but not in iCBT. Results provided partial support to the notion that mediation was moderated by treatment: tinnitus suppression mediated changes in tinnitus severity in iACT, but not in iCBT. However, inconsistent with the view that the treatments worked through different processes of change, activity engagement mediated treatment changes across both iACT and iCBT. Acceptance is identified as a key source of therapeutic change in behavioral-based treatments for tinnitus.
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| 13. |
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| 14. |
- Isaksson, Johan, et al.
(författare)
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Psychological and social risk factors associated with development of psychopathology, controlling for biological influence.
- 2021
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Ingår i: Current Opinion in Psychiatry. - : Wolters Kluwer. - 0951-7367 .- 1473-6578. ; 34:6, s. 600-607
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE OF THE REVIEW: To evaluate and summarize recent research investigating psychological, social and environmental risk factors for development of psychopathology in childhood, while controlling for biological (genetic) influences by using a matched sibling, twin or adoptee design.RECENT FINDINGS: Nineteen studies were included, of which eleven were longitudinal and eight were cohort studies. Included studies used adequate designs and statistical methods, controlled for unmeasured confounders and, in many cases, for other measured risk factors. None of the studies used the framework for environmental factors presented in the International Classification of Functioning, Disability and Health (ICF). The outcome variable psychopathology was rarely assessed using a diagnostic standard. The findings were sorted in five themes based on included exposures: 'Social support, social rejection and perceived identity,' 'Early symptoms of psychopathology,' 'Antibiotic exposure,' 'Factors in the family' and 'Nature versus nurture'.SUMMARY: Using twin/sibling/adoptee designs, a number of unique predictors of psychopathology were found, even when controlling for familial confounders and other specified risk factors. Future studies of psychopathology development should benefit from longitudinal, genetically sensitive designs and from use of diagnostic standards for psychopathology outcome, and should also incorporate ICF for classification of risk factors.
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| 15. |
- 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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| 16. |
- Lindner, Philip, et al.
(författare)
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Cognitive flexibility does not predict symptom reduction in Internet interventions
- 2015
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- PURPOSE: Little is known about whether individual differences in executive functions predict outcomes after Internet-delivered psychological treatments. We hypothesized that learning and utilizing skills taught in treatment is reliant on cognitive flexibility, as measurable by perseverative errors (PE) on the 64-card Wisconsin Card Sorting Test (WCST). We tested this by correlating PE scores with symptom reduction following treatment for social anxiety disorder (n=116), depression (n=42) and tinnitus discomfort (n=28). METHOD: In all groups, the WCST was administered online prior to treatment and partial correlation (controlling for age) were calculated between PE and percentage symptom reduction on the respective primary outcome measure. RESULTS: Number of PE did not correlate with pre-treatment symptom scores in any group. There was no generic association between symptom reduction and PE, and, after outlier removal, no group-specific associations either. CONCLUSIONS: Lower cognitive flexibility does not appear to impede symptom reduction in Internet-delivered psychological treatments.
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| 17. |
- Lindner, Philip, et al.
(författare)
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Does cognitive flexibility predict treatment gains in Internet-delivered psychological treatment of social anxiety disorder, depression, or tinnitus?
- 2016
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Ingår i: PeerJ. - : PeerJ. - 2167-8359. ; 4
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Tidskriftsartikel (refereegranskat)abstract
- Little is known about the individual factors that predict outcomes in Internet-administered psychological treatments. We hypothesized that greater cognitive flexibility (i.e. the ability to simultaneously consider several concepts and tasks and switch effortlessly between them in response to changes in environmental contingencies) would provide a better foundation for learning and employing the cognitive restructuring techniques taught and exercised in therapy, leading to greater treatment gains. Participants in three trials featuring Internet-administered psychological treatments for depression (n = 36), social anxiety disorder (n = 115) and tinnitus (n = 53) completed the 64-card Wisconsin Card Sorting Test (WCST) prior to treatment. We found no significant associations between perseverative errors on the WCST and treatment gains in any group. We also found low accuracy in the classification of treatment responders. We conclude that lower cognitive flexibility, as captured by perseverative errors on the WCST, should not impede successful outcomes in Internet-delivered psychological treatments.
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| 18. |
- Meyer, Jenny, et al.
(författare)
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Moderators of long-term treatment outcome when comparing two group interventions for adolescents with ADHD : who benefits more from DBT-based skills training?
- 2022
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Ingår i: BMC Psychiatry. - : BioMed Central (BMC). - 1471-244X. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Psychosocial interventions for adolescents with attention-deficit/hyperactivity disorder (ADHD), targeting emotional dysregulation and impulsive behaviors, have been requested, but the heterogeneity within this group makes it unlikely that there is one treatment that fits all. The aim of this study was to identify which adolescents with ADHD might have an effect from a structured skills training group (SSTG) based on dialectical behavioral therapy, by exploring pre-treatment characteristics as potential moderators of long-term treatment outcome. Methods: This study was based on follow-up data from a randomized controlled trial comparing the SSTG (n = 71) to a psychoeducational control intervention (n = 57) for adolescents with ADHD (15–18 years old). Clinical characteristics (sex, age, medication status, ADHD presentation, severity of ADHD symptom, psychiatric comorbidity, impairment of emotional dysregulation and functional impairment) were explored as potential moderators of pre-treatment to follow-up change in ADHD symptoms and functional impairment. Moderation analyses were performed using the PROCESS macro for SPSS. Results: Three moderators (severity of hyperactivity/impulsivity, conduct problems and impairment of emotional dysregulation) were identified in regard to the outcome self-rated change in ADHD symptoms. Participants with elevated pre-scores on these variables had a better effect of the SSTG than of the psychoeducational control intervention. No moderators were found in regard to the parental-rated outcomes. Conclusions: The SSTG seems to be beneficial for adolescents with ADHD who perceive pronounced symptoms of hyperactivity/impulsivity, conduct problems and emotional dysregulation. Our findings need to be confirmed in future trials evaluating dialectical behavioral therapy-based skills training for adolescents with ADHD, where these moderators could be used as criteria for inclusion or stratification. Trial registration: https://doi.org/10.1186/ISRCTN17366720, retrospectively registered.
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| 19. |
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| 20. |
- Rickardsson, Jenny, et al.
(författare)
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Assessing values : Psychometric properties of the Swedish version of the Valuing Questionnaire in adults with chronic pain
- 2019
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Ingår i: Journal of Contextual Behavioral Science. - : Elsevier BV. - 2212-1447. ; 14, s. 40-49
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Tidskriftsartikel (refereegranskat)abstract
- The ability to engage in valued activities in the presence of pain and distress is critical to maintain or improve functioning and quality of life. Therefore, treatments based on contextual behavioral science, such as Acceptance and Commitment Therapy (ACT), target values as a central change process and psychometrically adequate measures of the construct are needed. The Valuing Questionnaire (VQ) is a recent, generic and clinically relevant self-report questionnaire to assess values. There is yet a scarcity of psychometric evaluations, only one study has been conducted with chronic pain patients and the instrument is not yet available in Swedish. The present study evaluated the psychometric properties of a Swedish version of VQ in a sample of 252 persons seeking treatment for chronic pain. Confirmatory factor analyses supported a two-factor solution with ten items. Results showed an acceptable model fit, good internal consistencies and significant relationships with criteria variables. The construct validity of the questionnaire subscales was supported by moderate correlations with psychological inflexibility. Furthermore, VQ explained a significant amount of incremental variance in pain interference, quality of life, depressive symptoms, and psychological inflexibility with and without control for pain and distress. Results suggest that the Swedish translation of VQ has adequate psychometric properties, providing support for the utility of the instrument to assess values among individuals with chronic pain.
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| 21. |
- Rickardsson, Jenny, et al.
(författare)
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Internet-delivered acceptance and commitment therapy as microlearning for chronic pain : A randomized controlled trial with 1-year follow-up
- 2021
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Ingår i: European Journal of Pain. - : John Wiley & Sons. - 1090-3801 .- 1532-2149. ; 25:5, s. 1012-1030
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Tidskriftsartikel (refereegranskat)abstract
- Background: Studies of Internet-delivered acceptance and commitment therapy (ACT) for chronic pain have shown small to moderate positive effects for pain interference and pain acceptance. Effects on pain intensity, depression, anxiety and quality of life (QoL) have been less favourable, and improvements for values and sleep are lacking. In this randomized controlled trial iACT - a novel format of Internet-ACT using daily microlearning exercises - was examined for efficacy compared to a waitlist condition. Methods: Adult participants (mean age 49.5 years, pain duration 18.1 years) with diverse chronic pain conditions were recruited via self-referral, and randomized to iACT (n = 57) or waitlist (n = 56). The primary outcome was pain interference. The secondary outcomes were QoL, depression, anxiety, insomnia and pain intensity. The process variables included psychological inflexibility and values. Post-assessments were completed by 88% (n = 100) of participants. Twelve-month follow-up assessments were completed by 65% (iACT only, n = 37). Treatment efficacy was analysed using linear mixed models and an intention-to-treat-approach. Results: Significant improvements in favour of iACT were seen for pain interference, depression, anxiety, pain intensity and insomnia, as well as process variables psychological inflexibility and values. Between-group effect sizes were large for pain interference (d = 0.99) and pain intensity (d = 1.2), moderate for anxiety and depressive symptoms and small for QoL and insomnia. For the process variables, the between-group effect size was large for psychological inflexibility (d = 1.0) and moderate for values. All improvements were maintained at 1-year follow-up. Conclusions: Internet-ACT as microlearning may improve a broad range of outcomes in chronic pain. Significance: The study evaluates a novel behavioral treatment with positive results on pain interference, mood as well as pain intensity for longtime chronic pain sufferers. The innovative format of a digital ACT intervention delivered in short and experiential daily learnings may be a promising way forward.
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| 22. |
- Rickardsson, Jenny, et al.
(författare)
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Internet-delivered acceptance and commitment therapy (iACT) for chronic pain : feasibility and preliminary effects in clinical and self-referred patients
- 2020
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Ingår i: JMIR mhealth and uhealth. - : AME Publishing Company. - 2291-5222. ; 6
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Tidskriftsartikel (refereegranskat)abstract
- Background: Acceptance and commitment therapy (ACT) is an evidence-based treatment to improve functioning and quality of life (QoL) for chronic pain patients, but outreach of this treatment is unsatisfactory. Internet-delivery has been shown to increase treatment access but there is limited evidence regarding feasibility and effectiveness of web-based ACT for chronic pain. The aim of the study was to evaluate and iterate a novel internet-delivered ACT program, iACT, in a clinical and a self-referred sample of chronic pain patients. The intervention was developed in close collaboration with patients. To enhance learning, content was organized in short episodes to promote daily engagement in treatment. In both the clinical and self-referred samples, three critical domains were evaluated: (I) feasibility (acceptability, practicality and usage); (II) preliminary efficacy on pain interference, psychological inflexibility, value orientation, QoL, pain intensity, anxiety, insomnia and depressive symptoms; and (III) potential treatment mechanisms.Methods: This was an open pilot study with two samples: 15 patients from a tertiary pain clinic and 24 self-referred chronic pain participants, recruited from October 2015 until January 2017. Data were collected via an online platform in free text and self-report measures, as well as through individual oral feedback. Group differences were analyzed with Chi square-, Mann-Whitney U- or t-test. Preliminary efficacy and treatment mechanism data were collected via self-report and analyzed with multilevel linear modeling for repeated measures.Results: Feasibility: patient feedback guided modifications to refine the intervention and indicated that iACT was acceptable in both samples. User insights provided input for both immediate and future actions to improve feasibility. Comprehensiveness, workability and treatment credibility were adequate in both samples. Psychologists spent on average 13.5 minutes per week per clinical patient, and 8 minutes per self-referred patient (P=0.004). Recruitment rate was 24 times faster in the self-referred sample (24 patients in 1 month, compared to 15 patients in 15 months, P<0.001) and the median distance to the clinic was 40 km in the clinical sample, and 426 km in the self-referred sample (P<0.001). Preliminary effects: post-assessments were completed by 26 participants (67%). Significant effects of time were seen from pre- to post-treatment across all outcome variables. Within group effect sizes (Cohen’s d) at post-treatment ranged from small to large: pain interference (d=0.64, P<0.001), psychological inflexibility (d=1.43, P<0.001), value progress (d=0.72, P<0.001), value obstruction (d=0.42, P<0.001), physical QoL (d=0.41, P=0.005), mental QoL (d=0.67, P=0.005), insomnia (d=0.31, P<0.001), depressive symptoms (d=0.47, P<0.001), pain intensity (d=0.78, P=0.001) and anxiety (d=0.46, P<0.001). Improvements were sustained at 1-year follow-up. Psychological inflexibility and value progress were found to be potential treatment mechanisms.Conclusions: The results from the present study suggests that iACT was feasible in both the clinical and the self-referred sample. Together with the positive preliminary results on all outcomes, the findings from this feasibility study pave the way for a subsequent large randomized efficacy trial.
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| 23. |
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| 24. |
- Zetterqvist (f.d. Westin), Vendela, 1980-
(författare)
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Tinnitus – an acceptance-based approach
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Tinnitus is a highly prevalent health condition creating moderate or severe interference on mood, sleep and daily functioning for a group of those affected. The aims of this thesis were 1) to explore the role of acceptance and psychological flexibility in understanding tinnitus interference both experimentally and with a longitudinal design 2) to evaluate the immediate and long-term outcomes of an acceptance based behaviour therapy (Acceptance and Commitment Therapy; ACT) in the treatment of people with tinnitus and, 3) to investigate the relationship between treatment outcome and processes assumed to be the active ingredients of treatment (acceptance and cognitive defusion).Study I (n=47) was an experiment comparing the impact of acceptance to that of thought suppression or a neutral instruction on the ability to maintain attention on an imagery task. Results indicated that participants could benefit from an acceptance strategy when performing the task. Study II (n=47) was a longitudinal trial studying the mediating role of acceptance on the relationship between tinnitus interference at baseline and tinnitus interference, anxiety, life quality, and depression at a seven-month follow-up. Full mediation was found for life quality and depression, and partial mediation for tinnitus interference. Study IV (n=64) was a randomised controlled trial evaluating the immediate and long-term effects of ACT in comparison to those of Tinnitus Retraining Therapy (TRT) and to a wait list control. Results showed that ACT had large immediate effects on tinnitus interference in comparison to wait list, and medium long-term effects in comparison to TRT. Results were also seen on secondary outcome. Self-reported tinnitus acceptance significantly mediated the immediate outcome of ACT. Study III (n=24) was a process study where the video recorded sessions of ACT from study IV were observed and rated with regard to client behaviour. Results showed that in-session acceptance and defusion behaviours rated early in therapy were predictors of sustained positive treatment effects of ACT. These associations continued to be substantial even when controlling for the prior improvement in outcome. This whereas prior symptom change could not predict process variables rated late in therapy. Participants in all trials were chronic tinnitus patients, mainly from different departments of audiology. These findings implicate that 1) acceptance and psychological flexibility may contribute to the understanding of tinnitus interference 2) ACT can reduce tinnitus interference in a group of normal hearing tinnitus patients and 3) acceptance and cognitive defusion are important processes in ACT, related to outcome.
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| 25. |
- Zetterqvist, Vendela, et al.
(författare)
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Acceptance-based behavioural treatment for insomnia in chronic pain : A clinical pilot study
- 2018
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Ingår i: Journal of Contextual Behavioral Science. - : Elsevier. - 2212-1447. ; 9, s. 72-79
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundFor patients with chronic pain the prevalence of insomnia is 5–8 times higher as compared to the general population. Acceptance and Commitment Therapy (ACT) has gained strong empirical support in the treatment of chronic pain and is today increasingly used in pain clinics. However, no ACT-consistent treatment for insomnia in chronic pain has yet been empirically evaluated, although preliminary data show a relation between acceptance and aspects of insomnia. The aim of this clinical pilot study was to develop and evaluate the feasibility and preliminary outcome of an acceptance-based behavioural group treatment protocol for insomnia in patients with chronic pain.MethodsPatients with chronic pain who had completed an ACT program to improve behavioural flexibility and functioning, and continued to have poor sleep to an extent that met the diagnostic criteria for insomnia, were considered eligible for participation in an acceptance-based behavioural group treatment for insomnia. Sixteen patients were enrolled in the study. Feasibility and treatment effects (primary outcome measure: Insomnia Severity Index, ISI) were assessed pre- and post treatment, as well as three months post- treatment.ResultsThere was a satisfying degree of retention and treatment compliance. On average patients participated in 5.31 (SD=0.70) out of six group sessions and completed 4.63 (SD = 0.62) of the five homework assignments. Overall, the completion rate of planned assessments was acceptable. However, assessment of sleep diary data at follow-up had 37.5% missing data and the recruitment rate averaged one patient per month. Significant improvements were seen in most outcomes, and results were maintained at follow-up, with large effects on primary outcome (ISI) at post-treatment g′= 2.02, 95% CI [0.90–3.14], and at follow-up g′= 1.69, 95% CI [.59, 2.78]. At follow-up twelve (75.0%) of the patients were classified as responders, of which five (31.2%) were remitters.ConclusionResults overall showed a satisfying degree of feasibility with regards to retention, treatment compliance and completion of planned assessments. Changes in procedure are required in order to optimise recruitment rate. The treatment is potentially promising in terms of improved sleep for patients with longstanding pain. Larger, randomised controlled studies are needed to evaluate the treatment.
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| 26. |
- Zetterqvist, Vendela, et al.
(författare)
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Internet-Delivered Acceptance and Commitment Therapy for Adolescents with Chronic Pain and Their Parents : A Nonrandomized Pilot Trial
- 2020
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Ingår i: Journal of Pediatric Psychology. - : Oxford University Press (OUP). - 0146-8693 .- 1465-735X. ; 45:9, s. 990-1004
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Tidskriftsartikel (refereegranskat)abstract
- Background: Acceptance and Commitment Therapy (ACT) is an empirically supported treatment for chronic pain in adults. There is also a small but growing evidence base of ACT for pediatric chronic pain. However, because of limited access to psychological treatment for pain, and geographical distances from pain facilities, many patients will not receive such treatment. Objective: The aim of the study was to evaluate the feasibility and preliminary effects of an internet-delivered ACT for adolescents with chronic pain, and their parents. Methods: In this nonrandomized pilot study 28 self-recruited adolescents, aged 13-17 years, received 8 weeks of internet-delivered ACT, while outcomes were assessed at pre-, posttreatment, and at follow-up (17-25 weeks). Parents of the adolescents received an 8-week internet-delivered parental program, and their outcomes were assessed at the same timepoints. Both treatments were guided by a therapist experienced in ACT and chronic pain. Results: Some threats to feasibility were identified such as slow recruitment rate, low compliance and a delay in completion of follow-up assessments. Preliminary outcome evaluation showed that adolescents showed a large significant improvement on their main outcome (pain interference, d = 1.09), and parents a medium improvement on their main outcome, pain reactivity (d = 0.70). Improvements were also seen in adolescents' depressive symptoms and insomnia severity. Conclusion: The preliminary results of internet-delivered ACT are promising with regards to improvements in adolescent and parent outcome. Measures to improve feasibility are needed prior to conducting a larger randomized trial.
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| 27. |
- Zetterqvist, Vendela, 1980-, et al.
(författare)
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Internet-delivered cognitive behaviour therapy for adolescents with insomnia comorbid to psychiatric conditions : A non-randomised trial
- 2021
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Ingår i: Clinical Child Psychology and Psychiatry. - : Sage Publications. - 1359-1045 .- 1461-7021. ; 26:2, s. 475-489
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Tidskriftsartikel (refereegranskat)abstract
- Insomnia is highly prevalent among adolescents with psychiatric conditions and is known to aggravate psychiatric symptoms. Research on cognitive behaviour therapy for adolescents with comorbid insomnia (CBT-I) is still limited. The aim of this study was to investigate feasibility and preliminary effects of internet-delivered CBT for adolescents with insomnia comorbid to a psychiatric condition. Twenty-one patients (13–17 years) with comorbid insomnia were recruited from Child and Adolescent Psychiatry. All patients received 7 weeks of internet-delivered CBT-I with therapist support. Outcomes were assessed at baseline, post-treatment, and at a 4-month follow-up. The proportion of completed assessments was overall acceptable. Participants on average completed 4.48 (sd = 1.97) of the seven treatment modules and therapists on average spent 12.80 minutes (sd = 6.23) per patient and week. Results showed large statistically significant improvements on insomnia severity, sleep efficiency, sleep onset latency and sleep quality. Medium to large improvements were also seen on the psychiatric symptoms of depression, obsessive-compulsive symptoms, interpersonal sensitivity, paranoid ideation and psychoticism. These findings indicate that internet-delivered CBT is feasible and potentially promising for improving sleep and reducing psychiatric symptoms in adolescent psychiatric patients with insomnia and co-morbid psychiatric disorders. A larger randomised trial is warranted to verify these preliminary results.
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| 28. |
- Zetterqvist, Vendela, et al.
(författare)
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Leva med tinnitus
- 2013. - 1
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Bok (populärvet., debatt m.m.)abstract
- Har du ett klingande, ringande, tjutande, brusande, surrande, visslande ljud i huvudet eller öronen som påverkar ditt dagliga liv? Ett stort antal personer i Sverige upplever att tinnitus inverkar på deras mående, sömn, koncentrationsförmåga och livskvalitet.Ljudet kan uppfattas störande i ett flertal situationer och ljudmiljöer såsom i tystnad, vid restaurangbesök eller vid samtal. Vissa upplever inte längre samma glädje i aktiviteter som de tidigare uppskattade. Andra känner en oro och frågar sig om deras tinnitus kommer att bli värre, eller om den är tecken på något allvarligt fel.Leva med tinnitus är en självhjälpsbok som bygger på material som arbetats fram och prövats med goda resultat under flera år av forskning och som tillvaratar den senaste utvecklingen inom tinnitusbehandling. Metoderna i boken är hämtade från kognitiv beteendeterapi (KBT) och acceptance and commitment therapy (ACT). Läsaren får arbeta med olika beprövade tekniker och tillägnar sig nya förhållningssätt. Syftet är att tinnitus inte längre ska behöva ta lika stor plats i den enskildes liv.
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| 29. |
- Zetterqvist, Vendela, et al.
(författare)
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Leva med tinnitus
- 2020
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Bok (populärvet., debatt m.m.)abstract
- Har du ett klingande, ringande, tjutande, brusande, surrande, visslande ljud i huvudet eller öronen som påverkar ditt dagliga liv? Ett stort antal personer i Sverige upplever att tinnitus inverkar på deras mående, sömn, koncentrationsförmåga och livskvalitet. Ljudet kan uppfattas störande i ett flertal situationer och ljudmiljöer såsom i tystnad, vid restaurangbesök eller vid samtal.
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| 30. |
- Zetterqvist, Vendela, et al.
(författare)
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Pain avoidance predicts disability and depressive symptoms three years later in individuals with whiplash complaints
- 2017
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Ingår i: Acta Anaesthesiologica Scandinavica. - : John Wiley & Sons. - 0001-5172 .- 1399-6576. ; 61:4, s. 445-455
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Tidskriftsartikel (refereegranskat)abstract
- Background Longstanding symptoms due to whiplash are commonly associated with decreased levels of emotional and physical functioning. To date, there is strong empirical support for the relationship between psychological in/flexibility and pain-related functioning, but the predictive role for future health is largely unknown. Hence, the aim of this study was to investigate if psychological in/flexibility (i.e. avoidance and cognitive fusion) predicted pain disability and depressive symptoms 3 years later in individuals with whiplash complaints. Methods Data were collected at baseline and at a 3 year follow-up from 368 members of a national patient organization for people with whiplash-associated disorder. In a series of hierarchical regression analyses, background variables, pain related variables, psychological distress and psychological inflexibility at baseline were evaluated as predictors of levels of pain disability and depressive symptoms at follow-up. Results Results showed that psychological inflexibility, and more specifically avoidance, was a unique predictor of pain disability and depressive symptoms, also when controlling for background variables, pain related variables and psychological distress. Level of education was also found to predict both pain disability and symptoms of depression. Lastly, pain variability predicted pain disability, and anxiety predicted depressive symptoms. Conclusion Pain avoidance significantly predicted pain disability and depressive symptoms 3 years later. Although tentative, results warrant more studies to further explore the importance of pain avoidance for future health.
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| 31. |
- Zetterqvist Westin, Vendela, et al.
(författare)
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Acceptance and Commitment Therapy versus Tinnitus Retraining Therapy in the treatment of tinnitus : A randomised controlled trial
- 2011
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Ingår i: Behaviour Research and Therapy. - : Elsevier. - 0005-7967 .- 1873-622X. ; 49:11, s. 737-747
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Tidskriftsartikel (refereegranskat)abstract
- The study compared the effects of Acceptance and Commitment Therapy (ACT) with Tinnitus Retraining Therapy (TRT) on tinnitus impact in a randomised controlled trial. Sixty-four normal hearing subjects with tinnitus were randomised to one of the active treatments or a wait-list control (WLC). The ACT treatment consisted of 10 weekly 60 min sessions. The TRT treatment consisted of one 150 min session, one 30 min follow-up and continued daily use of wearable sound generators for a recommended period of at least 8 h/day for 18 months. Assessments were made at baseline, 10 weeks, 6 months and 18 months. At 10 weeks, results showed a superior effect of ACT in comparison with the WLC regarding tinnitus impact (Cohen's d = 1.04), problems with sleep and anxiety. The results were mediated by tinnitus acceptance. A comparison between the active treatments, including all assessment points, revealed significant differences in favour of ACT regarding tinnitus impact (Cohen's d = 0.75) and problems with sleep. At 6 months, reliable improvement on the main outcome measure was found for 54.5% in the ACT condition and 20% in the TRT condition. The results suggest that ACT can reduce tinnitus distress and impact in a group of normal hearing tinnitus patients.
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