| 1. |
- Abrahamsson, Niclas, 1976-, et al.
(författare)
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Video-based CBT-E improves eating patterns in obese patients with eating disorder : A single case multiple baseline study
- 2018
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Ingår i: Journal of Behavior Therapy and Experimental Psychiatry. - : Elsevier BV. - 0005-7916 .- 1873-7943. ; 61, s. 104-112
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND OBJECTIVES:Cognitive Behavioral Therapy (CBT) is effective for treating eating disorders but it may be difficult to reach patients living far from urban centers. Mobile video-based psychotherapy may potentially improve service reach but has not yet been evaluated. The purpose of this study was to investigate the effects of mobile video-based CBT for eating disorder and to explore the feasibility to use this technology in clinical care.METHODS:A controlled single case multiple baseline design was used which allowed for statistical analyses with randomization tests and non-overlap of all pairs (NAP). Five patients in the first stage of eating disorder treatment were included and the main outcome variable was daily meal frequency. Secondary outcome variables included eating disorder symptoms, psychological distress and treatment satisfaction.RESULTS:The treatment resulted in a significant (p < .01) increase in daily meal frequency with medium to large effect sizes (combined NAP = .89). Four participants reported reliable improvements in eating disorder symptoms and three reported improvements in mood. The participants reported high satisfaction with the treatment and with the mobile video-application despite some technical problems.LIMITATIONS:Self-reported data on eating behavior is prone to be biased and the results of single case studies may have limited generalizability.CONCLUSION:CBT can be delivered effectively via a mobile video application and, despite some technological issues, can be well received by patients. All participants in this study had previous low access to mental health services and reported high satisfaction with the treatment format.
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| 2. |
- Alfonsson, Sven, 1977-, et al.
(författare)
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Differences in motivation and adherence to a prescribed assignment after face-to-face and online psychoeducation : A randomized experiment
- 2017
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Ingår i: BMC Psychology. - : Springer Science and Business Media LLC. - 2050-7283. ; 5:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Adherence to treatment homework is associated with positive outcomes in behavioral psychotherapy but compliance to assignments is still often moderate. Whether adherence can be predicted by different types of motivation for the task and whether motivation plays different roles in face-to-face compared to online psychotherapy is unknown. If models of motivation, such as Self-determination theory, can be used to predict patients’ behavior, it may facilitate further research into homework promotion. The aims of this study were, therefore, to investigate whether motivation variables could predict adherence to a prescribed assignment in face-to-face and online interventions using a psychotherapy analog model. Methods: A total of 100 participants were included in this study and randomized to either a face-to-face or online intervention. Participants in both groups received a psychoeducation session and were given an assignment for the subsequent week. The main outcome measurements were self-reported motivation and adherence to the assignment. Results: Participant in the face-to-face condition reported significantly higher levels of motivation and showed higher levels of adherence compared to participants in the online condition. Adherence to the assignment was positively associated with intrinsic motivation and intervention credibility in the whole sample and especially in the online group. Conclusions: This study shows that intrinsic motivation and intervention credibility are strong predictors of adherence to assignments, especially in online interventions. The results indicate that intrinsic motivation may be partly substituted with face-to-face contact with a therapist. It may also be possible to identify patients with low motivation in online interventions who are at risk of dropping out. Methods for making online interventions more intrinsically motivating without increasing external pressure are needed.
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| 3. |
- Alfonsson, Sven, et al.
(författare)
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Factor structure and validity of the Depression Anxiety and Stress Scale-21 in Swedish translation
- 2017
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Ingår i: Journal of Psychiatric and Mental Health Nursing. - : Wiley. - 1351-0126 .- 1365-2850. ; 24:2-3, s. 154-162
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Tidskriftsartikel (refereegranskat)abstract
- Introduction There is a constant need for theoretically sound and valid self-report instruments for measuring psychological distress. Previous studies have shown that the Depression, Anxiety and Stress Scale-21 (DASS-21) is theoretically sound, but there have been some inconsistent results regarding its factor structure. Aims The aim of the present study was to investigate and elucidate the factor structure and convergent validity of the DASS-21. Methods A total of 624 participants recruited from student, primary care and psychotherapy populations. The factor structure of the DASS-21 was assessed by confirmatory factor analyses and the convergent validity by investigating its unique correlations with other psychiatric instruments. Results A bifactor structure with depression, anxiety, stress and a general factor provided the best fit indices for the DASS-21. The convergent validity was adequate for the Depression and Anxiety subscales but more ambiguous for the Stress subscale. Discussion The present study overall supports the validity and factor structure of the DASS-21. Implications for practice The DASS-21 can be used to measure symptoms of depression and anxiety as well as overall distress. It can be useful for mental health nurses, and other first-line psychiatric professionals, in need of a short, feasible and valid instrument in everyday care
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| 4. |
- Alfonsson, Sven, et al.
(författare)
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Group Behavioral activation for patients with severe obesity and Binge eating disorder : A randomized controlled trial
- 2015
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Ingår i: Behavior modification. - : SAGE Publications. - 0145-4455 .- 1552-4167. ; 39:2, s. 270-294
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the present study was to assess whether behavioral activation (BA) is an efficacious treatment for decreasing eating disorder symptoms in patients with obesity and binge eating disorder (BED). Ninety-six patients with severe obesity and BED were randomized to either 10 sessions of group BA or wait-list control. The study was conducted at an obesity clinic in a regular hospital setting. The treatment improved some aspects of disordered eating and had a positive effect on depressive symptoms but there was no significant difference between the groups regarding binge eating and most other symptoms. Improved mood but lack of effect on binge eating suggests that dysfunctional eating (including BED) is maintained by other mechanisms than low activation and negative mood. However, future studies need to investigate whether effects of BA on binge eating might emerge later than at post-assessment, as in interpersonal psychotherapy for bulimia nervosa.
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| 5. |
- Alfonsson, Sven, et al.
(författare)
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Is online treatment adherence affected by presentation and therapist support? : A randomized controlled trial
- 2016
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Ingår i: Computers in human behavior. - : Elsevier BV. - 0747-5632 .- 1873-7692. ; 60, s. 550-558
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Tidskriftsartikel (refereegranskat)abstract
- In both face to face and Internet based Cognitive Behavior Therapy, patients' adherence can be improved by different means such as by using motivational techniques or automatic reminders. The main aim of this study was to investigate whether enriched treatment material presentation and/or increased frequency and quality of support would increase participants' adherence to an online relaxation program. One hundred and sixty-two participants with mild to moderate symptoms of stress or worry were included in this study. Participants were randomized to either Normal or Enhanced intervention presentation and Normal or Enhanced support in a full factorial design. Main outcome variables were progress through the online intervention and adherence to prescribed exercises. Participants in the Enhanced support group progressed further through the program than participants in the Normal support group (Z = 2.11, p = .035, r = .17) but there were no significant differences found between the Normal and Enhanced presentation groups. Participants registered a mean of 60% of the prescribed exercises with no significant differences between groups. This study shows that adherence to online interventions can be increased by increased frequency and quality of therapeutic contact. Future studies may investigate how to increase adherence to prescribed homework assignments and whether parts of the therapeutic support may be substituted with automatic systems with retained effects.
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| 6. |
- Alfonsson, Sven, et al.
(författare)
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Motivation and Treatment Credibility Predicts Dropout, Treatment Adherence, and Clinical Outcomes in an Internet-Based Cognitive Behavioral Relaxation Program : A Randomized Controlled Trial.
- 2016
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Ingår i: Journal of Medical Internet Research. - : JMIR Publications Inc.. - 1438-8871. ; 18:3
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Tidskriftsartikel (refereegranskat)abstract
- Background: In previous research, variables such as age, education, treatment credibility, and therapeutic alliance have shown to affect patients' treatment adherence and outcome in Internet-based psychotherapy. A more detailed understanding of how such variables are associated with different measures of adherence and clinical outcomes may help in designing more effective online therapy.Objective: The aims of this study were to investigate demographical, psychological, and treatment-specific variables that could predict dropout, treatment adherence, and treatment outcomes in a study of online relaxation for mild to moderate stress symptoms.Methods: Participant dropout and attrition as well as data from self-report instruments completed before, during, and after the online relaxation program were analyzed. Multiple linear and logistical regression analyses were conducted to predict early dropout, overall attrition, online treatment progress, number of registered relaxation exercises, posttreatment symptom levels, and reliable improvement.Results: Dropout was significantly predicted by treatment credibility, whereas overall attrition was associated with reporting a focus on immediate consequences and experiencing a low level of intrinsic motivation for the treatment. Treatment progress was predicted by education level and treatment credibility, whereas number of registered relaxation exercises was associated with experiencing intrinsic motivation for the treatment. Posttreatment stress symptoms were positively predicted by feeling external pressure to participate in the treatment and negatively predicted by treatment credibility. Reporting reliable symptom improvement after treatment was predicted by treatment credibility and therapeutic bond.Conclusions: This study confirmed that treatment credibility and a good working alliance are factors associated with successful Internet-based psychotherapy. Further, the study showed that measuring adherence in different ways provides somewhat different results, which underscore the importance of carefully defining treatment adherence in psychotherapy research. Lastly, the results suggest that finding the treatment interesting and engaging may help patients carry through with the intervention and complete prescribed assignments, a result that may help guide the design of future interventions.
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| 7. |
- Alfonsson, Sven
(författare)
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Replacing the term “binge eating” with “loss of control over eating” affects eating disorder screening in clinical care
- 2015
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Ingår i: Obesity Research and Clinical Practice. - : Elsevier BV. - 1871-403X .- 1878-0318. ; 9:5, s. 531-532
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Tidskriftsartikel (refereegranskat)abstract
- Having episodes of binge eating is central to the binge eating disorder (BED) and bulimia nervosa (BN) diagnoses but may be difficult to assess accurately through self-report instruments and estimates of prevalence varies [1,2]. Some researchers have reported lower levels of binge eating in clinical interviews where interviewers may use follow up questions and correct misunderstandings, compared with self-report questionnaires [3]. Another reason for mixed results may be the negative stigma of binge eating behaviours and thus the embarrassment of admitting having binge eating episodes [4,5].
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| 8. |
- Alfonsson, Sven, et al.
(författare)
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Self-Reported Hedonism Predicts 12-Month Weight Loss After Roux-en-Y Gastric Bypass
- 2017
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Ingår i: Obesity Surgery. - : Springer Science and Business Media LLC. - 0960-8923 .- 1708-0428. ; 27:8, s. 2073-2078
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Tidskriftsartikel (refereegranskat)abstract
- Introduction Research regarding psychological risk factors for reduced weight loss after bariatric surgery has yielded mixed results, especially for variables measured prior to surgery. More profound personality factors have shown better promise and one such factor that may be relevant in this context is time perspective, i.e., the tendency to focus on present or future consequences. The aim of this study was to investigate the predictive value of time perspective for 12-month weight loss after Roux-en-Y gastric bypass surgery.Methods A total of 158 patients were included and completed self-report instruments prior to surgery. Weight loss was measured after 12 months by medical staff. Background variables as well as self-reported disordered eating, psychological distress, and time perspective were analyzed with regression analysis to identify significant predictors for 12-month weight loss.Results The mean BMI loss at 12 months was 14 units, from 45 to 30 kg/m(2). Age, sex, and time perspective could significantly predict weight loss but only male sex and self-reported hedonism were independent risk factors for reduced weight loss in the final regression model.Conclusion In this study, self-reported hedonistic time perspective proved to be a better predictor for 12-month weight loss than symptoms of disordered eating and psychological distress. It is possible that a hedonistic tendency of focusing on immediate consequences and rewards is analogous to the impaired delay discounting seen in previous studies of bariatric surgery candidates. Further studies are needed to identify whether these patients may benefit from extended care and support after surgery.
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| 9. |
- Alfonsson, Sven, et al.
(författare)
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Socio-demographic and clinical variables associated with psychological distress one and three years after a breast cancer diagnosis
- 2016
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Ingår i: Supportive Care in Cancer. - : Springer Science and Business Media LLC. - 0941-4355 .- 1433-7339. ; 24:9, s. 4017-4023
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: A large group of women (20-30%) report psychological distress shortly after breast cancer diagnosis, and some experience continued or increased symptoms over time. The aim of this study was to investigate socio-demographic and clinical variables associated with sustained psychological distress in this patient group. METHODS: Women with breast cancer (n=833) completed self-report questionnaires regarding socio-demographic and clinical variables shortly after (T1) and 3years after diagnosis (T2) while data on illness severity were collected from a quality register. The Hospital Anxiety and Depression Scale was used as a measure of psychological distress at both time points. RESULTS: The number of participants who reported elevated levels of anxiety was 231 (28%) at T1 and 231 (28%) at T2 while elevated depressive symptoms was reported by 119 (14%) women at T1 and 92 (11%) at T2. Despite non-significant differences in mean scores over time, 91 (15%) participants reported increased anxiety symptoms and 47 (7%) reported increased depressive symptoms. Poor financial situation, lack of social support, previous psychiatric treatment, and high levels of fatigue were associated with both anxiety and depressive symptoms. Reporting high levels of fatigue was the variable most strongly associated with increased psychological distress over time. CONCLUSION: Most participants reported decreased psychological distress over time, but there were subgroups of women who experienced sustained or increased symptoms of anxiety or depression. Participants with poor financial status, previous psychological problems, or high levels of fatigue may be at increased risk of psychological distress. Such individuals may benefit most from psychosocial interventions.
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| 10. |
- Alfonsson, Sven, 1977-, et al.
(författare)
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Tailored Text Message Prompts to Increase Therapy Homework Adherence : A Single-Case Randomised Controlled Study
- 2019
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Ingår i: Behaviour change. - : Cambridge University Press (CUP). - 0813-4839 .- 2049-7768. ; 36:3, s. 180-191
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Tidskriftsartikel (refereegranskat)abstract
- Background: Psychotherapy homework completion is associated with positive treatment outcomes, but many patients show low adherence to prescribed assignments. Whether text-message prompts are effective in increasing adherence to assignments is unknown. Aims: To evaluate whether tailored daily text-message prompts can increase homework adherence in a stress/anxiety treatment. Method: This study used a randomised controlled single-case alternating treatment design with parallel replication in seven participants. Participants received a five-week relaxation program for stress and anxiety with daily exercises. The intervention consisted of daily text messages tailored for each participant. Phases with or without text messages were randomly alternated over the study course. Randomisation tests were used to statistically analyse differences in mean number of completed relaxation exercises between phases. Results: There was a significant (combined p = .018) effect of daily text messages on homework adherence across participants with weak to medium effect size improvements. No negative effects of daily text messages were identified. Conclusions: Tailored text messages can marginally improve adherence to assignments for patients in CBT. Further studies may investigate how text messages can be made relevant for more patients and whether text messages can be used to increase homework quality rather than quantity.
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| 11. |
- Alfonsson, Sven, 1977-, et al.
(författare)
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The effects of clinical supervision on supervisees and patients in cognitive behavioral therapy : a systematic review
- 2018
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Ingår i: Cognitive Behaviour Therapy. - : Informa UK Limited. - 1650-6073 .- 1651-2316. ; 47:3, s. 206-228
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Forskningsöversikt (refereegranskat)abstract
- Clinical supervision is a central part of psychotherapist training but the empirical support for specific supervision theories or features is unclear. The aims of this study were to systematically review the empirical research literature regarding the effects of clinical supervision on therapists’ competences and clinical outcomes within Cognitive Behavior Therapy (CBT). A comprehensive database search resulted in 4103 identified publications. Of these, 133 were scrutinized and in the end 5 studies were included in the review for data synthesis. The five studies were heterogeneous in scope and quality and only one provided firm empirical support for the positive effects of clinical supervision on therapists’ competence. The remaining four studies suffered from methodological weaknesses, but provided some preliminary support that clinical supervision may be beneficiary for novice therapists. No study could show benefits from supervision for patients. The research literature suggests that clinical supervision may have some potential effects on novice therapists’ competence compared to no supervision but the effects on clinical outcomes are still unclear. While bug-in-the-eye live supervision may be more effective than standard delayed supervision, the effects of specific supervision models or features are also unclear. There is a continued need for high-quality empirical studies on the effects of clinical supervision in psychotherapy.
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| 12. |
- Alfonsson, Sven, et al.
(författare)
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The effects of clinical supervision on supervisees and patients in cognitive-behavioral therapy : a study protocol for a systematic review
- 2017
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Ingår i: Systematic Reviews. - : Springer Science and Business Media LLC. - 2046-4053. ; 6:94, s. 1-6
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Forskningsöversikt (refereegranskat)abstract
- Background: Clinical supervision by a senior therapist is a very common practice in psychotherapist training and psychiatric care settings. Though clinical supervision is advocated by most educational and governing institutions, the effects of clinical supervision on the supervisees ’ competence, e.g., attitudes, behaviors, and skills, as well as on treatment outcomes and other patient variables are debated and largely unknown. Evidence-based practice is advocated in clinical settings but has not yet been fully implemented in educational or clinical training settings. The aim of this systematic review is to synthesize and present the empirical literature regarding effects of clinical supervision in cognitive-behavioral therapy. Methods: This study will include a systematic review of the literature to identify studies that have empirically investigated the effects of supervision on supervised psychotherapists and/or the supervisees ’ patients. A comprehensive search strategy will be conducted to identify published controlled studies indexed in the MEDLINE, EMBASE, PsycINFO, and Cochrane Library databases. Data on supervision outcomes in both psychotherapists and their patients will be extracted, synthesized, and reported. Risk of bias and quality of the included studies will be assessed systematically. Discussion: This systematic review will rigorously follow established guidelines for systematic reviews in order to summarize and present the evidence base for clinical supervision in cognitive-behavioral therapy and may aid further research and discussion in this area.
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| 13. |
- Alfonsson, Sven, et al.
(författare)
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The effects of therapist support and treatment presentation on the clinical outcomes of an Internet based applied relaxation program
- 2015
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Ingår i: Internet Interventions. - : Elsevier BV. - 2214-7829. ; 2:3, s. 289-296
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Tidskriftsartikel (refereegranskat)abstract
- Symptoms of stress are common in the general population and associated with health risks and economic costs. Applied relaxation training has shown to be effective for reducing stress and worry both as a self-help treatment and as an internet-based intervention with therapist support. However, what factors may affect the outcome of internet based relaxation training is unclear. The aims of the present study were to investigate the effect of a brief internet based relaxation program for people with symptoms of stress or worry and to assess whether enhancing the quality of intervention presentation or therapist support had an impact on outcomes.Participants were randomized in a full factorial design to either Normal or Enhanced treatment Presentation and either Normal or Enhanced therapist Support in a four-week online program with applied relaxation. The main outcome measures were self-report instruments of stress and worry.A total of 162 participants were included in the study and 94 and 84 participants completed the post and follow-up measurements respectively. Participants in all conditions improved significantly on the main outcome measures, and the different levels of Presentation or therapist Support did not significantly affect treatment outcome. Registered number of completed exercises was a predictor of better treatment outcome, but this effect was independent of treatment condition. Enhancing internet based interventions by improving presentations and the quality of support may thus not be the best way to further improve the effect of internet based interventions. More specific knowledge of the mechanisms that affect outcomes in online psychotherapy is needed.
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| 14. |
- Alfonsson, Sven, et al.
(författare)
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The meal pattern questionnaire : A psychometric evaluation using the eating disorder examination
- 2016
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Ingår i: Eating Behaviors. - : Elsevier BV. - 1471-0153 .- 1873-7358. ; 21, s. 7-10
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveMeal pattern is an important variable in both obesity treatment and treatment for eating disorders. Momentary assessment and eating diaries are highly valid measurement methods but often cumbersome and not always feasible to use in clinical practice. The aim of this study was to design and evaluate a self-report instrument for measuring meal patterns.MethodThe Pattern of eating item from the Eating Disorder Examination (EDE) interview was adapted to self-report format to follow the same overall structure as the Eating Disorder Examination Questionnaire. The new instrument was named the Meal Patterns Questionnaire (MPQ) and was compared with the EDE in a student sample (n = 105) and an obese sample (n = 111).ResultsThe individual items of the MPQ and the EDE showed moderate to high correlations (rho = .63–89) in the two samples. Significant differences between the MPQ and EDE were only found for two items in the obese sample. The total scores correlated to a high degree (rho = .87/.74) in both samples and no significant differences were found in this variable.DiscussionThe MPQ can provide an overall picture of a person's eating patterns and is a valid way to collect data regarding meal patterns. The MPQ may be a useable tool in clinical practice and research studies when more extensive instruments cannot be used. Future studies should evaluate the MPQ in diverse cultural populations and with more ecological assessment methods.
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| 15. |
- Alfonsson, Sven
(författare)
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Treatment Adherence in Internet-Based CBT : The Effects of Presentation, Support and Motivation
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Homework assignments that patient work with between sessions is a key component in both face-to-face and Internet-based Cognitive Behavior Therapy (CBT). However, adherence to assignments is often low and it is largely unclear what factors predict or affect treatment adherence, and in the end, treatment outcomes. The overall aim of this thesis was to investigate if treatment presentation and therapist support can affect adherence and treatment outcome in internet-based CBT, whether adherence can be predicted by motivation variables and to compare differences in face-to-face and online conditions in this regard.A randomized controlled trial with a brief online relaxation program for people with stress and anxiety symptoms was conducted (n = 162). Participants in the enhanced support conditions completed a larger proportion of the online treatment but adherence was not affected by enhanced treatment presentation (Study I). Participants reported reduced symptoms of stress and anxiety after the relaxation program but there were no significant additional effects of enhanced presentation or support (Study II). Participants who adhered to the prescribed assignments reported lower symptom levels at study end, regardless of treatment conditions. Adherence to the online treatment was predicted by subject factors such as treatment credibility prior to the treatment and intrinsic motivation during the treatment (Study III). To further elucidate how motivation may affect adherence, an experiment with a one-session psychotherapy model was subsequently conducted (n = 100). Participants who were randomized to the face-to-face condition reported higher motivation for the assignment and completed significantly more of the homework compared to participants in the online condition (Study IV). Self-reported intrinsic motivation could predict adherence in both conditions while new motivational variables were identified specifically for the online condition.The results from these studies confirm that adherence to assignments in Internet-based CBT is difficult to affect with treatment features but can be predicted early in treatment by subject factors such as treatment credibility and motivation. How such motivational variables can be affected to improve treatments is still unclear.
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| 16. |
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| 17. |
- Hauffman, Anna, et al.
(författare)
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The development of a Nurse-led Internet-based Learning and Self-care program for cancer patients with symptoms of anxiety and depression : a part of U-CARE
- 2017
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Ingår i: Cancer Nursing. - 0162-220X .- 1538-9804. ; 40:5, s. E9-E16
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:Having access to information about the disease and being encouraged to participate in self-care activities may reduce anxiety and depression symptoms in cancer patients. Internet-based interventions may be one way to support effective self-care strategies to improve emotional well-being and health-related quality of life.OBJECTIVE:The aim of this study was to describe the development and acceptance of an Internet-based program intended to support cancer patients with anxiety and depression symptoms.METHODS:A structured collaboration between patients, clinicians, and researchers was used to develop a theory- and evidence-based interactive health communication application (IHCA) based on Orem's self-care deficit nursing theory with influences from Bandura's social learning theory and psychoeducation.RESULTS:The result is an IHCA described as a Nurse-led, Internet-based Learning and Self-care program that helps patients to perform self-care using different types of material in interaction with patients and healthcare staff. The acceptance of the program is consistent with the results of similar studies.CONCLUSIONS:Collaboration between patients, clinicians, and researchers seems to be a fruitful approach in the development of an IHCA aiming to support cancer patients' self-care strategies. Well-designed intervention studies are needed to evaluate the effects of the IHCA.IMPLICATIONS FOR PRACTICE:This article suggests a theoretical foundation for an IHCA and allows researchers and healthcare providers to take part in the discussion regarding format and content of IHCAs.
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| 18. |
- Jansson-Fröjmark, Markus, et al.
(författare)
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Are sleep hygiene practices related to the incidence, persistence and remission of insomnia? : Findings from a prospective community study
- 2019
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Ingår i: Journal of behavioral medicine. - : Springer Science and Business Media LLC. - 0160-7715 .- 1573-3521. ; 42:1, s. 128-138
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Tidskriftsartikel (refereegranskat)abstract
- The purpose was to examine whether sleep hygiene practices are associated with the course of insomnia (incidence, persistence and remission) over 1 year in the general population. This longitudinal study was carried out in the general population. After excluding anyone with other primary sleep disorder than insomnia, 1638 participants returned a baseline and a 1-year follow-up survey. Questions regarding sleep hygiene practices were administered at baseline, and the status of insomnia was assessed at baseline (T1) and at the 1-year follow-up (T2). Age, gender, mental ill-health, and pain were used as covariates in the analyses. Nicotine use, mental ill-health and pain were independently associated with an increased risk for concurrent insomnia at T1, while mental ill-health was the only risk factor for incident insomnia at T2. Relative to not reporting insomnia at the two time-points, nicotine use, light or noise disturbance, mental ill-health, and pain significantly increased the risk for persistent insomnia over 1 year. In comparison with those whose insomnia had remitted at the follow-up, reporting an irregular sleep schedule was a significant risk factor for persistent insomnia. Of the nine sleep hygiene practices examined in this study, only three were independently linked to concurrent and future insomnia, respectively; using nicotine late in the evening, light or noise disturbance, and having an irregular sleep schedule. This may have implications for the conceptualization and management of insomnia as well as for future research.
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| 19. |
- Lindholm Olinder, Anna, 1960-, et al.
(författare)
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A randomised wait-list controlled clinical trial of the effects of acceptance and commitment therapy in patients with type 1 diabetes : a study protocol
- 2015
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Ingår i: BMC Nursing. - : Springer Science and Business Media LLC. - 1472-6955. ; 14
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUNDIn order to manage the acute and long-term effects of living with a chronic disease such as diabetes, both medical treatment and good psychosocial support are needed. In this study, we wish to examine whether a psychological group intervention targeting people with poorly controlled type 1 diabetes can be helpful in augmenting quality of life while also lowering participants' HbA1c level. The group intervention will consist of a brief treatment developed from a branch of cognitive behavioural therapy called acceptance and commitment therapy, which is part of the so-called third wave of cognitive behavioural therapy. Common for these third-wave therapies, the focus is less on the content and restructuring of thoughts and more on the function of behaviour. Here, we describe the protocol and plans for study enrolment.METHODS/DESIGNThis on-going study is designed as a randomised wait-list controlled trial. Eighty patients aged 26-55 years and with an HbA1c level >70 mmol/mol at the time of enrolment will be included.DISCUSSIONIn this study, we will assess the effect of starting acceptance and commitment therapy group treatment for patients with type 1 diabetes and its effect on glycaemic control and well-being.TRIAL REGISTRATIONCurrent controlled trials: ISRCTN17006837, registered 12(th) January 2015.
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| 20. |
- Mattsson, Susanne, et al.
(författare)
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Measuring Use of Health-Related Support on the Internet : Development of the Health Online Support Questionnaire (HOSQ)
- 2015
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Ingår i: Journal of Medical Internet Research. - : JMIR Publications Inc.. - 1438-8871. ; 17:11
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Tidskriftsartikel (refereegranskat)abstract
- Background: Social support plays an important role for the perceived health in people with health problems and chronic diseases.Provision of different kinds of support during the disease trajectory is crucial for many people. Online support is ubiquitous andrepresents a promising modality for people with chronic diseases. There are no existing instruments that measure various aspectsof online support.Objective: The objective of this study was to create a generic questionnaire regarding health-related support online that can beapplied to people with various health problems and illnesses. Additionally, we wanted to test the questionnaire in a cancerpopulation to assess its adequacy in the context of severe disease.Methods: Initial items for the Health Online Support Questionnaire (HOSQ) were inspired by sociologist James House regardingsocial support. An exploratory factor analysis was conducted in healthy persons or with minor health problems (n=243) on 31initial items. The scale was reduced to 18 items and the internal consistency and reliability of the scale was examined along withcontent validity. Further validation was conducted by a confirmatory analysis on the 18-item scale in a cancer population (n=215).In addition, data on demographics, health problems experienced, and Internet use were collected.Results: The exploratory factor analysis on the final 18-item scale resulted in 2 factors. After scrutinizing the content, thesefactors were labeled “reading” and “interacting” and they demonstrated good internal consistency (Cronbach alphas .88 and .77,respectively). The factors were confirmed in the cancer population. The response pattern revealed expected differences bothbetween the interaction and reading scales and according to age, gender, education, and health problems thereby supporting thevalidity of the HOSQ.Conclusions: The HOSQ may be a reliable and valid instrument for measuring the use of online support for people with healthproblems, but the results ought to be replicated in more studies to confirm the results for different diagnoses. If the results of thisstudy are corroborated by future studies, the HOSQ may be used as a basis for the development of different forms of support onthe Internet.
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| 21. |
- Toft, Teolinda, et al.
(författare)
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Feeling excluded and not having anyone to talk to : Qualitative study of interpersonal relationships following a cancer diagnosis in a sibling
- 2019
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Ingår i: European Journal of Oncology Nursing. - : Elsevier BV. - 1462-3889 .- 1532-2122. ; 42, s. 76-81
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To explore experiences related to interpersonal relationships following a cancer diagnosis in a sibling.METHODS: Respondents (n = 7 females) were recruited by means of convenience sampling during a camp for children affected by childhood cancer and their siblings. Data from children and adolescents with a sibling diagnosed with cancer was collected through individual face-to-face interviews and analyzed using systematic text condensation.RESULTS: Two categories portrayed the experiences related to interpersonal relationships following a cancer diagnosis in a sibling. Feeling excluded while wanting to maintain a relationship with their ill sibling and be involved in the care portrayed that trying to be involved in the care of their ill sibling was a stressful and difficult experience, since they were simultaneously expected to also manage household chores and attend school. Feeling stigmatized and exposed in social contexts while needing an allowing space to talk about their experiences portrayed the emotional difficulties evoked by social situations and behaviors of others, which left respondents feeling exposed and mistreated. Having the possibility to talk about their experiences and receiving social support was described as essential in order to cope with the situation.CONCLUSIONS: Health professionals need to take into consideration the emotional difficulties and vulnerable situation that children and adolescents who have a sibling diagnosed with cancer are at risk of experiencing. Stigmatization and social exposure present a risk of psychological distress. Having an allowing space to communicate feelings and experiences is desired. Interventions may be necessary to help these individuals psychologically cope.
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