| 1. |
- 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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| 2. |
- Bauducco, Serena, 1988-, et al.
(författare)
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Sleep duration and patterns in adolescents : Correlates and the role of daily stressors
- 2016
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Ingår i: Sleep Health. - : Elsevier. - 2352-7218 .- 2352-7226. ; 2:3, s. 211-218
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The first aim of this study was to assess the prevalence of sleep deficit in a large sample of adolescents. Second, the study aimed to assess whether short sleep duration in the sample was associated with emotional and behavioral problems. Lastly, the study aimed to investigate the association between daily stressors-bedtime activities and sleep duration.Design: Cross-sectional survey.Setting: The questionnaires were completed during school hours in 17 municipal junior high schools in Sweden.Participants: A total of 2767 adolescents aged 12 to 16 years, 48% girls.Measurements and Results: Sleep measures included total sleep time (TST) for schooldays and weekends, obtained as combined measures of self-reported bed-time, wake-time, and sleep onset latency. We used the new National Sleep Foundation's guidelines to operationalize sleep duration. Overall 12% of younger adolescents (age 12-13 years) and 18% of older adolescents (14-16 years) slept less than recommended (TST < 7 hours). Adolescents reporting nonrecommended TST also reported more behavioral (ie, norm-breaking behaviors) and emotional problems (ie, depression, anxiety, and anger), with effects in the small-medium range. Finally, adolescents reporting bedtime arousal and use of information and communication technology in bed were more likely to report TST < 7 hours. Stress at home (for younger adolescents) and stress of school performance (for older adolescents) were also associated with TST less than 7 hours.Conclusions: The new National Sleep Foundation's recommendations were informative in this context. Future sleep interventions need to target barriers to good sleep practices, such as use of information and communication technology, stress, and worry that may contribute to arousal at bedtime.
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| 3. |
- Danielsson, Katarina, et al.
(författare)
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Cognitive Behavioral Therapy as an Adjunct Treatment to Light Therapy for Delayed Sleep Phase Disorder in Young Adults : A Randomized Controlled Feasibility Study
- 2016
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Ingår i: Behavioral Sleep Medicine. - : Informa UK Limited. - 1540-2002 .- 1540-2010. ; 14:2, s. 212-232
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Tidskriftsartikel (refereegranskat)abstract
- Delayed sleep phase disorder (DSPD) is common among young people, but there is still no evidence-based treatment available. In the present study, the feasibility of cognitive behavioral therapy (CBT) was evaluated as an additive treatment to light therapy (LT) in DSPD. A randomized controlled trial with participants aged 16 to 26 years received LT for two weeks followed by either four weeks of CBT or no treatment (NT). LT advanced sleep-wake rhythm in both groups. Comparing LT+CBT with LT+NT, no significant group differences were observed in the primary endpoints. Although anxiety and depression scores were low at pretreatment, they decreased significantly more in LT+CBT compared to LT+NT. The results are discussed and some suggestions are given for further studies.
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| 4. |
- Danielsson, Katarina, 1983-
(författare)
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Delayed Sleep Phase Disorder : Prevalence, Diagnostic aspects, Associated factors and Treatment concepts
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Delayed sleep phase disorder (DSPD) is the most common circadian rhythm sleep disorder. Persons with DSPD have great difficulties falling asleep and waking up at conventional times. To diagnose DSPD this delayed sleep-wake rhythm should cause social impairment and distress for the individual. Evening melatonin and morning bright light are the recommended treatments. The overall aim of this thesis was to evaluate at-home treatment with Light therapy (LT) and the feasibility of adding cognitive behavior therapy (CBT) to LT in DSPD, furthermore prevalence, diagnostic aspects and associated factors were investigated.Study I included 673 randomly selected individuals aged 16–26 years. The prevalence of DSPD was 4.0%. Unemployment (defined as an absence of educational or work activities) and an elevated level of anxiety were associated with DSPD.In study II, dim light melatonin onset (DLMO) was measured in healthy adults. Time for DLMO DLMO (Mean±SD) was 20:58±55 minutes.Studies III, IV, and V present results from a randomized controlled trial examining the feasibility of CBT as an additive treatment to LT with scheduled rise times, in persons with DSPD. Sleep onset and sleep offset was significantly advanced from baseline (03:00±1:20; 10:22±2:02 respectively) to the end of LT (01:27±1:41; 08:05±1:29, p<0.001 respectively). This advancement was predicted by consistent daily usage of the LT-lamp. At the follow-ups after LT and CBT or LT alone, sleep onset remained stable, sleep offset was delayed, and sleep difficulties were further improved, but there was no significant group interaction over time. There was a significant group interaction over time in the severity of anxiety and depressive symptoms, both in favor of the LT+CBT group.Conclusively, DSPD was common among adolescents and young adults and it was associated with unemployment and elevated levels of anxiety. DLMO appeared in the expected time range in healthy working adults. At-home treatment with LT with scheduled rise times advanced sleep-wake rhythm and improved sleep difficulties in DSPD. Even though sleep-wake rhythm was not further advanced or better preserved in the participants that received LT+CBT compared to LT alone, the addition of CBT to the treatment regimen was feasible and well accepted.
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| 5. |
- Danielsson, Katarina, 1983-, et al.
(författare)
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Delayed sleep phase disorder in a Swedish cohort of adolescents and young adults : Prevalence and associated factors
- 2016
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Ingår i: Chronobiology International. - : Informa UK Limited. - 0742-0528 .- 1525-6073. ; 33:10, s. 1331-1339
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Tidskriftsartikel (refereegranskat)abstract
- A delayed sleep-wake and circadian rhythm often occurs during puberty. While some individuals only develop a delayed sleep phase (DSP), others will fulfill the criteria for the diagnosis of delayed sleep phase disorder (DSPD). All previous studies have however not separated DSP from DSPD, and, as a result, the prevalence and associated factors are largely unknown for the two conditions individually. We estimated the prevalence of DSP and DSPD in a Swedish cohort of adolescents and young adults. We also investigated associated factors in the two conditions relative to each other and individuals with no DSP. A questionnaire regarding sleep patterns, demographics, substance use/abuse and symptoms of depression, anxiety, worry and rumination was sent to 1000 randomly selected participants (16-26 years of age) in Uppsala, Sweden (response rate = 68%). DSP was defined as a late sleep onset and a preferred late wake-up time. The DSPD diagnosis was further operationalized according to the Diagnostic and Statistical Manual of Mental Disorders, Edition 5 (DSM-5) criteria including insomnia or excessive sleepiness, distress or dysfunction caused by the DSP and that the sleep problem had been evident for 3 months. DSP occurred at a frequency of 4.6% and DSPD at a frequency of 4% in the investigated cohort. DSP was more common in males and was associated with not attending educational activity or work, having shift work, nicotine and alcohol use and less rumination. DSPD was equally common in males and females and was associated with not attending educational activity or work and with elevated levels of anxiety. Both DSP and DSPD appear to be common in adolescents and young adults in this Swedish cohort. No educational activity or work was associated with both DSP and DSPD. However, there were also apparent differences between the two groups in shift work, substance use and mental health, relative to persons with no DSP. Thus, it seems reasonable to assess DSP and DSPD as distinct entities in future studies.
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| 6. |
- Danielsson, Katarina, 1983-, et al.
(författare)
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Light Therapy With Scheduled Rise Times in Young Adults With Delayed Sleep Phase Disorder : Therapeutic Outcomes and Possible Predictors
- 2018
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Ingår i: Behavioural Sleep Medicine. - : Informa UK Limited. - 1540-2002 .- 1540-2010. ; 16:4, s. 325-336
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Tidskriftsartikel (refereegranskat)abstract
- Clinical trials with light therapy (LT) for delayed sleep phase disorder (DSPD) are sparse and little is known about factors that are favorable for improvements. In this study, LT with scheduled rise times was conducted at home for 14 days by 44 participants with DSPD aged 16-26 years. Primary outcomes were sleep onset and sleep offset. Potential predictors were demographic characteristics, chronotype, dim light melatonin onset, the number of days the LT lamp was used, the daily duration of LT, daytime sleepiness, anxiety, depression, worry, and rumination. Significant advances were observed in sleep onset and sleep offset from baseline to the end of treatment. The number of days of LT predicted earlier sleep onset and sleep offset.
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| 7. |
- Danielsson, Katarina, 1983-, et al.
(författare)
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The reduced Morningness–Eveningness Questionnaire : Psychometric properties and related factors in a young Swedish population
- 2019
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Ingår i: Chronobiology International. - : Informa UK Limited. - 0742-0528 .- 1525-6073. ; 36:4, s. 530-540
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Tidskriftsartikel (refereegranskat)abstract
- During puberty, there is a delay in sleep patterns and the circadian clock, and the prevalence of sleep difficulties is high among young adults. Thus, it is important to be able to measure chronotype (CT) in this group, both in the clinic and for broader epidemiological studies, to better understand the sleep difficulties observed. The reduced version of one of the most widely used questionnaire to measure CT, the Horne & Östberg Morningness–Eveningness Questionnaire (MEQ), has been developed and validated in many languages. The aim of the present study was to investigate the reliability and validity of the Swedish reduced MEQ (rMEQ) and to investigate factors correlated with rMEQ scores in a random sample of young Swedish participants. We sent the rMEQ, sleep questions, demographic questions, the Insomnia Severity Index (ISI), the Epworth Sleepiness Scale, and the Hospital Anxiety and Depression Scale (HADS-A and HADS-D) to 1000 randomly selected individuals aged 16–26 years in Uppsala, Sweden (response rate = 68%). A parallel analysis of the rMEQ revealed a single factor solution. Inter-item correlations within the questionnaire were between 0.08 and 0.46. One of the rMEQ items displayed weak correlations with the other questions. Cronbach’s alpha of the rMEQ was 0.68. Low rMEQ scores (eveningness) were correlated with more frequent late bedtimes and difficulties getting up in the morning. Lower rMEQ scores were significantly related to male sex, no educational activity or work, nicotine use, younger age, and higher ISI and HADS-D scores. Even though the inter-item correlations of the rMEQ were very low to moderate, the rMEQ had a Cronbach’s alpha not far off from acceptable levels, and the strong correlations of the rMEQ scores with responses to the sleep questions indicated that the rMEQ had an adequate validity. To conclude, the rMEQ can be used to effectively estimate CT when a short questionnaire is required; however, caution should be taken when interpreting the results considering the reliability of the questionnaire.
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| 8. |
- Forsström, David, et al.
(författare)
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Experiences of Playscan : Interviews with users of a responsible gambling tool
- 2017
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Ingår i: Internet Interventions. - : Elsevier BV. - 2214-7829. ; 8, s. 53-62
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Tidskriftsartikel (refereegranskat)abstract
- Online gambling, encompassing a wide variety of activities and around-the-clock access, can be a potential risk factor for gamblers who tend to gamble excessively. Yet, the advent of online gambling has enabled responsible gambling (RG) features that may help individuals to limit their gambling behaviour. One of these features is RG tools that track gamblers' behaviour, performs risk assessments and provides advice to gamblers. This study investigated users' views and experiences of the RG tool Playscan from a qualitative perspective using a semi-structured interview. The tool performs a risk assessment on a three-step scale (low, medium and high risk). Users from every risk category were included. Twenty interviews were carried out and analysed using thematic analysis. Two main themes with associated sub-themes were identified: “Usage of Playscan and the gambling site” and “Experiences of Playscan”. Important experiences in the sub-themes were lack of feedback from the tool and confusion when signing up to use Playscan. These experiences counteracted positive attitudes that should have promoted usage of the tool. Providing more feedback directly to users is a suggested solution to increase usage of the RG tool.
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| 9. |
- Forsström, David, 1981-
(författare)
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The use and experience of responsible gambling tools : An explorative analysis of user behavior regarding a responsible gambling tool and the consequences of use
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Responsible gambling tools are an intervention that is designed to decrease gambling among individuals with an at-risk gambling behavior. Studies have indicated that responsible gambling tools can decrease gambling behavior, but little is known about how this intervention is used by gamblers. The aim of the present thesis was to explore different facets of the use, experience and functions of these tools. Study I used descriptive statistics and latent class analysis (LCA) combined with multinomial regression to explore the use of the responsible gambling tool Playscan among 9528 gamblers (regular and at-risk gamblers). The participants had volunteered to use the tool. The functions of the tool had a high rate of initial use but a low rate of repeated use. The LCA identified five user classes. Two of the classes (self-testers and multifunctional users) were defined as high users of the tool and had a higher risk of developing gambling problems according to multinomial regression. The multifunctional users were characterized by an extensive use of all the functions while the other high usage class had an extensive use of the self-test. The three other classes were as follows: those who did not use the tool, those who visited the tool but did not engage in any of the functions, and those who only used the tool’s advice on how to decrease their gambling. Participants’ reasons for use and non-use of the tool were attributed to their degree of need of the tool and its functions. The tool’s most widely used function was the self-test that investigated the level of negative consequences faced by a user due to his or her gambling. Study II was a qualitative study investigating participants’ views, experiences and their reasons for using the tool. The study was conducted by interviewing 20 volunteer users of the tool. These semi-structured interviews were analyzed by thematic analysis. The results showed that the users had a positive attitude towards the tool and understood its purpose. The self-test was the most widely used function in this sample as well. However, the participants’ positive attitude toward the tool did not effectively encourage them to use it; they displayed low use of the tool’s functions. This paradox was explained by lack of feedback and the fact that some participants did not understand that they had registered to use the tool. Providing more feedback and tailoring the feedback to individual users were seen as ways of bridging the paradox. Study II also found that participants used the gambling website (which Playscan was linked to) in an analogue way, preparing their bets before placing them online. This limited the time they spent on the site and inhibited their use of Playscan. Study III was motivated by the extensive use of the self-test among users in Study I and Study II. The aim of Study III was to investigate the psychometric properties of the self-test (known as GamTest) to better understand how it could be used with Playscan in the most efficient way. Two thousand two hundred and thirty four respondents answered the questionnaire, along with instruments measuring depression, anxiety and another instrument measuring problems due to gambling. Factor analysis, parallel analysis, Cronbach’s alpha, and correlations were used to establish the tool’s psychometric properties. The results yielded a three-factor model, excellent reliability, and high correlation with the Problem Gambling Severity Index (PGSI), endorsing the validity of the self-test. The results also indicated that the questionnaire could be effectively shortened. Overall, the studies show that the tool has an initial high use, low repeated use and that the self-test is the most used feature. In addition, the self-test had good psychometric properties.
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| 10. |
- Hertenstein, Elisabeth, et al.
(författare)
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Insomnia as a predictor of mental disorders : A systematic review and meta-analysis
- 2019
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Ingår i: Sleep Medicine Reviews. - : Elsevier BV. - 1087-0792 .- 1532-2955. ; 43, s. 96-105
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Forskningsöversikt (refereegranskat)abstract
- Previous research has identified insomnia as a predictor for the onset of depression. The aim of this meta-analysis is to investigate whether insomnia also predicts the onset of other mental disorders. Longitudinal studies were eligible for inclusion if they investigated insomnia at baseline (including nighttime- and daytime-symptoms) as a predictor of the later onset of psychopathology within a follow-up time-frame of at least 12 mo. Thirteen primary studies were included. The results suggest that insomnia is a significant predictor for the onset of depression (10 studies, OR 2.83, CI 1.55-5.17), anxiety (six studies, OR 3.23, CI 1.52-6.85), alcohol abuse (two studies, OR 1.35, CI 1.08-1.67, and psychosis (one study, OR 1.28, CI 1.03-1.59). The overall risk of bias in the primary studies was moderate. This meta-analysis provides evidence that insomnia increases the risk for psychopathology. A future research agenda should include more prospective studies using established diagnostic criteria, assessing insomnia at baseline and including long-term follow-up intervals evaluating a wider range of mental disorders. In addition, prospective long-term interventional studies investigating the efficacy of insomnia treatment for the prevention of mental disorders are called for.
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| 11. |
- 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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| 12. |
- Jansson-Fröjmark, Markus, et al.
(författare)
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Cognitive Behavioural Therapy for Insomnia in Psychiatric Disorders
- 2016
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Ingår i: Current Sleep Medicine Reports. - : Springer Science and Business Media LLC. - 2198-6401 .- 1805-3742. ; 2:4, s. 233-240
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Tidskriftsartikel (refereegranskat)abstract
- Insomnia means difficulties in initiating or maintaining sleep and is commonly comorbid with psychiatric disorders. From being considered secondary to primary psychiatric disorders, comorbid insomnia is now considered an independent health issue that warrants treatment in its own right. Cognitive behavioural therapy for insomnia (CBT-I) is an evidence-based treatment for insomnia. The effects from CBT-I on comorbid psychiatric conditions have received increasing interest as insomnia comorbid with psychiatric disorders has been associated with more severe psychiatric symptomologies, and there are studies that indicate effects from CBT-I on both insomnia and psychiatric symptomology. During recent years, the literature on CBT-I for comorbid psychiatric groups has expanded and has advanced methodologically. This article reviews recent studies on the effects from CBT-I on sleep, daytime symptoms and function and psychiatric comorbidities for people with anxiety, depression, bipolar disorder, psychotic disorders and post-traumatic stress disorder. Future strategies for research are suggested.
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| 13. |
- Jansson-Fröjmark, Markus, et al.
(författare)
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Developing a cognitive behavioral therapy manual for delayed sleep-wake phase disorder
- 2016
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Ingår i: Cognitive Behaviour Therapy. - : Informa UK Limited. - 1650-6073 .- 1651-2316. ; 45:6, s. 518-532
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Tidskriftsartikel (refereegranskat)abstract
- This article reports the development of a treatment protocol, based on cognitive behavioral therapy (CBT) principles, for delayed sleep-wake phase disorder (DSWPD). The protocol consists of psychoeducation, presenting a CBT model for DSWPD, case formulation, motivational interviewing, registering sleep in a diary, strategies to improve the rhythm of sleep and wakefulness, relaxation training, cognitive restructuring, strategies to cope with daytime symptoms, constructing an individualized CBT program, and learning how to deal with relapses. Qualitative data, focusing on how the patients perceived the protocol, were collected within the realm of a trial exploring the efficacy of the protocol. These findings highlighted several advantages but also disadvantages of the therapy. It is our hope that this paper might act as a platform for further clinical work and future research efforts in patients with DSWPD.
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| 14. |
- Jansson-Fröjmark, Markus, 1971-, et al.
(författare)
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The cognitive treatment components and therapies of cognitive behavioral therapy for insomnia : A systematic review
- 2018
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Ingår i: Sleep Medicine Reviews. - : Elsevier. - 1087-0792 .- 1532-2955. ; 42, s. 19-36
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Tidskriftsartikel (refereegranskat)abstract
- Since the beginning of the twenty-first century, there has been an increased focus on developing and testing cognitive components and therapies for insomnia disorder. The aim of the current review was thus to describe and review the efficacy of cognitive components and therapies for insomnia. A systematic review was conducted on 32 studies (N = 1455 subjects) identified through database searches. Criteria for inclusion required that each study constituted a report of outcome from a cognitive component or therapy, that the study had a group protocol, adult participants with diagnosed insomnia or undiagnosed insomnia symptoms or reported poor sleep, and that the study was published until and including 2016 in English. Each study was systematically reviewed with a standard coding sheet. Several cognitive components, a multi-component cognitive program, and cognitive therapy were identified. It is concluded that there is support for paradoxical intention and cognitive therapy. There are also other cognitive interventions that appears promising, such as cognitive refocusing and behavioral experiments. For most interventions, the study quality was rated as low to moderate. We conclude that several cognitive treatment components and therapies can be viewed as efficacious or promising interventions for patients with insomnia disorder. Methodologically stronger studies are, however, warranted.
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| 15. |
- Jansson-Fröjmark, Markus, 1971-, et al.
(författare)
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The role of emotion dysregulation in insomnia : Longitudinal findings from a large community sample
- 2016
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Ingår i: British Journal of Health Psychology. - : Wiley-Blackwell. - 1359-107X .- 2044-8287. ; 21:1, s. 93-113
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The purpose of this longitudinal investigation was to examine the association between emotion regulation and future insomnia (incidence and persistence).DESIGN: A longitudinal study in the general population.METHODS: A survey was sent out to 5,000 individuals in the community. To those who returned the baseline questionnaire (n = 2,333), two follow-up surveys, 6 and 18 months later, were sent out and then completed by 1,887 and 1,795 individuals, respectively. The survey contained information about demographic factors, insomnia symptomatology, the Difficulties in Emotion Regulation Scale, anxiety, and depression.RESULTS: The findings suggested that emotion regulation at baseline was not associated with the incidence or persistence of insomnia. Overall, the effect sizes were very small to medium. When examining changes in emotion regulation over time, a different pattern emerged. Partial support was established for the notion that decreases in emotion regulation were related to incident and persistent insomnia, as a decrease in emotion regulation was associated with a higher likelihood of future insomnia. Yet, the effect sizes were very small to small.CONCLUSION: This study does partly point towards a longitudinal association between emotion dysregulation and insomnia. This might have implications for the conceptualization and management of insomnia as well as for future research.Statement of contribution: What is already known on this subject?Previous research has indicated that emotion dysregulation might be enhanced in patients with insomnia.A number of limitations have however hindered progress in understanding how emotion dysregulation is related to insomnia, such as limited research on the topic and relying solely on cross-sectional data.What does this study add?The current investigation showed that emotion dysregulation is a risk factor for the development of incident and persistent insomnia.This study also shows that increased emotion dysregulation over time heightens the risk of incident and persistent insomnia.
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| 16. |
- Jansson-Fröjmark, Markus, et al.
(författare)
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The role of psychiatric and somatic conditions in incidence and persistence of insomnia : A longitudinal, community study
- 2016
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Ingår i: Sleep Health. - : Elsevier BV. - 2352-7218 .- 2352-7226. ; 2:3, s. 229-238
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The objective was to investigate the role of psychiatric and somatic conditions in incident and persistent insomnia. Design: This was a prospective study with 3 measurement points over 1.5 years. Setting: The participants were sent a survey to their home addresses. Participants: A survey was sent out to 5000 random individuals (18-70 years) in 2 Swedish counties. To those who returned the baseline questionnaire (n = 2333), 2 follow-up surveys (6 and 18 months later) were sent out and completed by 1887 and 1795 individuals, respectively. Measurements: The survey contained questions about sociodemographic factors and insomnia symptomatology, the Hospital Anxiety and Depression Scale, and items assessing 12 forms of somatic conditions (eg, heart disease and headache). Results: Baseline depression, headache, and number of psychiatric and somatic conditions were found to be independent risk factors for incident insomnia. Also, deterioration in depression and heart disease status and increased number of conditions over time increased the risk for insomnia incidence. Anxiety; depression; pain in neck, back, or shoulders; and headache at baseline were found to significantly discriminate between those with persistent insomnia and those with persistent normal sleep. Those with persistent insomnia also reported a higher number of conditions relative to those with persistent normal sleep. None of the psychiatric or somatic conditions were found to be associated with persistence of insomnia relative to remission of insomnia. Conclusion: The current study suggests that both psychiatric and somatic conditions are involved in the incidence but not in the persistence of insomnia. Clinical and theoretical implications of the results are discussed.
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| 17. |
- Mörtberg, Ewa, et al.
(författare)
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Psychometric Evaluation of the Social Phobia Inventory and the Mini-Social Phobia Inventory in a Swedish University Student Sample
- 2019
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Ingår i: Psychological Reports. - : SAGE Publications. - 0033-2941 .- 1558-691X. ; 122:1, s. 323-339
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Tidskriftsartikel (refereegranskat)abstract
- Social anxiety is common in the general population, as well as among students in higher education. For screening of social anxiety, there is a need for brief scales. In the present study, the psychometric properties were examined in a Swedish version of the Social Phobia Inventory (SPIN) and the Mini-Social Phobia Inventory (Mini-SPIN) in a university student sample (n = 161). In addition to the SPIN and Mini-SPIN, participants completed measures of fear of public speaking, general anxiety, depression, and quality of life. Exploratory factor analyses were used to investigate the underlying dimensions of the SPIN, and reliability, convergent, and divergent validity of SPIN and Mini-SPIN were examined by Cronbach’s alpha and correlation analyses. It was found that a shorter eight-item version of the SPIN was associated with two solid factors (fear and avoidance of social interaction and fear and avoidance of criticism), and acceptable internal consistency, convergent, and divergent validity. In addition, the Mini-SPIN was associated with satisfactory convergent validity, but the reliability was not acceptable. It is concluded that the SPIN-8 is a viable screening tool for social anxiety in a university student population.
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| 18. |
- Mörtberg, Ewa, et al.
(författare)
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Psychometric Properties of the Personal Report of Public Speaking Anxiety (PRPSA) in a Sample of University Students in Sweden
- 2018
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Ingår i: International Journal of Cognitive Therapy. - : Springer Science and Business Media LLC. - 1937-1209 .- 1937-1217. ; 11:4, s. 421-433
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Tidskriftsartikel (refereegranskat)abstract
- Existing measures for examining fear of public speaking are somewhat limited in content and there is a need for scales that assess a broader area including cognitive, behavioral, and physiological dimensions of the fear. This study examined the psychometric properties of the Personal Report of Public Speaking Anxiety (PRPSA) in a sample of university students (n, 273). Participants completed the PRPSA and measures of depression, social and general anxiety, and quality of life. A reduced version of the PRPSA, the PRPSA-18, was found to demonstrate satisfactory internal consistency as well as discriminant and convergent validity. The PRPSA-18 was associated with two solid factors, “Anticipatory anxiety and physiological symptoms during speech performance,” and “Lack of control during speech performance.” A PRPSA-18 score of 58 was found to discriminate participants with higher and lower fear of public speaking. It is concluded that the shorter and more easily administered PRPSA-18 is a credible option for assessing fear of public speaking among university students.
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| 19. |
- Norell-Clarke, Annika, 1979-, et al.
(författare)
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Does Mid-Treatment Insomnia Severity Mediate between Cognitive Behavioural Therapy for Insomnia and Post-Treatment Depression? : An Investigation in a Sample with Comorbid Insomnia and Depressive Symptomatology
- 2018
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Ingår i: Behavioural and Cognitive Psychotherapy. - : Cambridge University Press. - 1352-4658 .- 1469-1833. ; 46:6, s. 726-737
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Recent treatment studies with cognitive behavioural therapy for insomnia (CBT-I) have demonstrated effects on both sleep problems and depression. Two previous studies have indicated that the beneficial effect from CBT-I on depression may come through improved sleep, although insomnia severity during treatment had not previously been investigated as a mediator.AIMS: Our aim was to investigate if insomnia severity during treatment mediated between CBT-I and depression severity after treatment, in a sample with co-morbid insomnia and depressive symptomology. We also examined whether depressive severity during treatment mediated between CBT-I and insomnia after treatment.METHOD: The participants were recruited from advertisements and fulfilled criteria for insomnia diagnosis, and had depressive symptomatology (Beck Depression Inventory-second edition: BDI-II > 13). Two-thirds of the participants were diagnosed with major depressive disorder. The participants received four biweekly group sessions of CBT-I or relaxation training (active control). Insomnia severity (Insomnia Severity Index) and depressive severity (BDI-II) were measured at baseline, mid-treatment, post-treatment and 6-month follow-up. The mid-treatment measures were used as mediators.RESULTS: Mediational analyses demonstrated a significant reciprocal relationship between insomnia severity and depressive severity throughout CBT-I, although mid-treatment insomnia had a stronger effect on depression than mid-treatment depression had on insomnia. The results were similar for both post-treatment and follow-up.DISCUSSION: Some improvement in depressive severity after CBT-I is explained by improved sleep. The findings emphasize the importance of making comorbid insomnia a treatment focus in its own right.
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| 20. |
- Norell-Clarke, Annika, 1979-, et al.
(författare)
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Does Mid-Treatment Insomnia Severity Mediate between Cognitive Behavioural Therapy for Insomnia and Post-Treatment Depression? An Investigation in a Sample with Comorbid Insomnia and Depressive Symptomatology
- 2018
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Ingår i: Behavioural and Cognitive Psychotherapy. - : Cambridge University Press. - 1352-4658 .- 1469-1833. ; 46:6, s. 726-737
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Tidskriftsartikel (refereegranskat)abstract
- Background: Recent treatment studies with cognitive behavioural therapy for insomnia (CBT-I) have demonstrated effects on both sleep problems and depression. Two previous studies have indicated that the beneficial effect from CBT-I on depression may come through improved sleep, although insomnia severity during treatment had not previously been investigated as a mediator.Aims: Our aim was to investigate if insomnia severity during treatment mediated between CBT-I and depression severity after treatment, in a sample with co-morbid insomnia and depressive symptomology. We also examined whether depressive severity during treatment mediated between CBT-I and insomnia after treatment.Method: The participants were recruited from advertisements and fulfilled criteria for insomnia diagnosis, and had depressive symptomatology (Beck Depression Inventory-second edition: BDI-II > 13). Two-thirds of the participants were diagnosed with major depressive disorder. The participants received four biweekly group sessions of CBT-I or relaxation training (active control). Insomnia severity (Insomnia Severity Index) and depressive severity (BDI-II) were measured at baseline, mid-treatment, post-treatment and 6-month follow-up. The mid-treatment measures were used as mediators.Results: Mediational analyses demonstrated a significant reciprocal relationship between insomnia severity and depressive severity throughout CBT-I, although mid-treatment insomnia had a stronger effect on depression than mid-treatment depression had on insomnia. The results were similar for both post-treatment and follow-up.Discussion: Some improvement in depressive severity after CBT-I is explained by improved sleep. The findings emphasize the importance of making comorbid insomnia a treatment focus in its own right.
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| 21. |
- Norell-Clarke, Annika, 1979-, et al.
(författare)
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Group cognitive behavioural therapy for insomnia : Effects on sleep and depressive symptomatology in a sample with comorbidity
- 2015
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Ingår i: Behaviour Research and Therapy. - : Elsevier. - 0005-7967 .- 1873-622X. ; 74, s. 80-93
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To investigate the effects of group CBT for insomnia (CBT-I) on insomnia and depressive symptomatology in a comorbid sample through a randomised controlled trial with a 6 month follow-up.Methods: 64 participants were recruited through advertisements and randomised to receive CBT-I or an active control (relaxation training: RT) during four group sessions. Insomnia Severity Index and BDI-II were the primary outcome measures, assessed pre-treatment, post-treatment and at 6 month follow-up. Insomnia and depressive diagnoses, and functional impairment were assessed before and after treatment, whereas sleep diary data was gathered continuously from one week before treatment until after treatment.Results: CBT-I was more efficient than RT in reducing insomnia severity and equally effective in reducing depressive symptoms, although CBT-I was associated with a higher proportion of remitted persons than RT, regarding both insomnia and depression diagnoses. Also, CBT-I was associated with less functional impairment, shorter sleep onset latency and wake after sleep onset but both treatments had equal improvements of sleep quality, early morning awakenings and total sleep time.Conclusion: Group CBT-I is an efficient form of insomnia-treatment for people with insomnia comorbid with depressive symptomatology. The mixed results regarding depression outcomes warrants replication and further studies into treatment mechanisms. (C) 2015 Elsevier Ltd. All rights reserved.
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| 22. |
- Norell-Clarke, Annika, 1979-, et al.
(författare)
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How does cognitive behavioral therapy for insomnia work? : An investigation of cognitive processes and time in bed as outcomes and mediators in a sample with insomnia and depressive symptomatology
- 2017
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Ingår i: International Journal of Cognitive Therapy. - : Guilford Publications. - 1937-1209 .- 1937-1217. ; 10:4, s. 304-329
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to gain a greater understanding of the five cognitive processes from the cognitive model of insomnia, negative automatic thoughts, and time in bed as outcomes and potential mediators of cognitive behavioral therapy for insomnia (CBT-I), in a sample with insomnia and depressive symptomatology. Sixty-four participants were randomized to receive either CBT-I or an active control (relaxation training: RT) in groups during four biweekly sessions. Insomnia, depressive severity, and the potential processes of change were measured pre-, mid-, and post-treatment. CBT-I was associated with greater reductions of dysfunctional beliefs about sleep, sleep-related safety behaviors, and time in bed compared to RT. Mid-treatment dysfunctional beliefs about sleep was the only process that mediated between CBT-I and outcomes on insomnia and depressive severity, respectively. The relationships were reciprocal. Dysfunctional beliefs about sleep may be a transdiagnostic process of both insomnia and depression.
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| 23. |
- Norell-Clarke, Annika, 1979-, et al.
(författare)
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Insomnia severity mediates between cognitive behavioural therapy for insomnia and depression in a sample with insomnia and depression : New possibilities for treatments of comorbid patients
- 2016
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Ingår i: EABCT 2016 Abstract Book. - : The European Association for Behavioural and Cognitive Therapies. ; , s. 544-544, s. 544-544
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Konferensbidrag (refereegranskat)abstract
- Clinical trials have shown that cognitive behavioural therapy for insomnia (CBT-I) may have an effect on both insomnia and depression in comorbid samples, but there is a gap in the knowledge on why CBT-I has an impact on depression. Neuropsychological theories suggest that disturbed sleep may work as a transdiagnostic process that maintains psychopathology. The aim was to test whether CBT-I impacts depressive symptoms through improved sleep, in a sample with insomnia comorbid with major depression and subthreshold depressive symptoms. 64 participants were recruited through advertisements and randomised to receive either CBT-I or an active control (relaxation training: RT) in groups during four bi-weekly sessions. Insomnia (ISI) and depressive severity (BDI-II) were measured pre-, mid- and post-treatment. Mediational analyses were conducted. Insomnia and depressive severity lowered over the course of treatments. CBT-I was superior in reducing insomnia. The main treatment outcomes have been published elsewhere (Norell-Clarke et al, 2015). The relationship between CBT-I and post-treatment depressive severity was mediated by mid-treatment insomnia severity, which indicates that the effect of CBT-I on depression goes through improved sleep (b = -4.87, BCa CI = -9.21, -1.97). The results were maintained when pre-treatment insomnia and depressive severity were controlled for (b = -3.36, BCa CI = -8.86, -0.45). Testing for reciprocity, we found that mid-treatment depressive severity did not mediate between CBT-I and post-treatment insomnia severity. The results support the perpetuating role of insomnia in depression. This may have implications for other psychiatric patient groups with comorbid insomnia. Also, the results indicate that CBT for comorbid patient groups may need to target sleep specifically.
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| 24. |
- Sundqvist, Kristina, 1973-
(författare)
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Beyond Recreational Gambling : a Psychological Perspective on Risk- and Problem Gambling
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The general aim of this thesis was to examine risk gambling in the general population from a psychological perspective. This was done in three studies targeting personality, risky alcohol habits and gambling motives, respectively. Initially, 19 530 randomly assigned Swedish citizens were screened for problem gambling via telephone using the two questions in the Lie/Bet questionnaire. This sample constitutes the basis for one of the studies in the thesis. For the other studies, individuals answering yes to one of the questions in the Lie/Bet questionnaire and agreeing to participate further were sent a postal questionnaire. The questionnaire included questions about gambling, personality and gambling motives. Some of the main results showed that:Negative consequences of gambling were associated with higher levels of impulsivity and negative affectivity.Risk gamblers reported lower levels of negative affectivity compared to the general population.Compared to non-risk gamblers, twice as many of the risk gamblers reported weekly binge drinking during the past 12 months. This association, however, seemed to be explained by shared demographic characteristics, rather than by the risk gambling causing binge drinking.High risk gamblers more often reported that they gambled for the challenge and for coping reasons, compared to low risk gamblers.High risk gamblers had overall stronger motives for gambling.The results also indicated that the level of risk gambling was highly intertwined with gambling motives and could explain some differences in gambling motives between, for example, women/men and younger/older gamblers.One of the focal points in the discussion was that higher levels of negative affectivity may be a cause of elevated problems rather than a cause of risk gambling. Another issue discussed was that the level of risk- /problem gambling may be important to consider when comparing gambling motives across subgroups of gamblers.
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| 25. |
- Sunnhed, Rikard, et al.
(författare)
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Cognitive Arousal, Unhelpful Beliefs and Maladaptive Sleep Behaviors as Mediators in Cognitive Behavior Therapy for Insomnia : A Quasi-Experimental Study
- 2015
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Ingår i: Cognitive Therapy and Research. - : Springer-Verlag New York. - 0147-5916 .- 1573-2819. ; 39:6, s. 841-852
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Tidskriftsartikel (refereegranskat)abstract
- The purpose with the investigation was to examine whether improvements in pre-sleep cognitive arousal, unhelpful beliefs about sleep, and maladaptive sleep behaviors mediate the outcomes in in-person CBT-I. Fifty-eight participants with insomnia were administered either cognitive behavioral therapy or belonged to a waitlist. At pre- and post-treatment, participants completed questionnaires and sleep diaries assessing cognitive arousal, unhelpful beliefs about sleep, maladaptive sleep behaviors, insomnia severity, dysfunction, and subjective sleep parameters. Outcome measures were re-administered at a 3-month follow-up. Decreases in cognitive arousal mediated the effect on dysfunction. Reductions in unhelpful beliefs mediated the treatment effect on insomnia severity and dysfunction. Decreases in bedtime variability mediated the outcome on insomnia severity, and reductions in time in bed had a mediating effect on total wake time. Neither rise time variability nor napping mediated the improvements. A reversed model, in which the outcomes were used as mediators, showed less fit with the current data, indicating that change in the psychological processes as mediators of improvement in the outcomes was the most plausible conclusion. These findings are clearly supportive of cognitive-behavioral models of insomnia by highlighting cognitive arousal, unhelpful beliefs about sleep, and maladaptive sleep behaviors as mediators in the treatment of insomnia. The results are also important for clinical work and for testing new approaches in future research.
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| 26. |
- Tillfors, Maria, 1963-, et al.
(författare)
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Allowing or fighting social anxiety : The role of psychological inflexibility in a non-clinical population
- 2015
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Ingår i: Journal of Person-Oriented Research. - : Journal for Person-Oriented Research. - 2002-0244. ; 1:3, s. 151-161
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Tidskriftsartikel (refereegranskat)abstract
- In an acceptance-based model of what maintains social anxiety, the focus is on counterproductive attempts to control unpleasant internal experiences through avoidance of them. An example of such an avoidance strategy, especially prominent among socially anxious women, is rumination. According to this model, the road to recovery for people suffering from social anxiety is through increased acceptance of internal experiences. This process is also referred to as decreasing an individual’s ‘psychological inflexibility’. The overall aim of the current study was to examine the relationship between psychological inflexibility and social anxiety in a non-clinical population. We used cluster analysis to examine subgroups with different individual profiles of symptoms of social anxiety/avoidance and psychological inflexibility. The clusters were examined in relation to depressive symptoms, rumination, and the moderating effect of gender. The design was cross-sectional and consisted of 219 university students (101 men, 118 women; M age = 23 years). Four clusters were generated, whereof two (the Multidimensional Problem cluster and the No Problem cluster) reflected a strong positive relationship between social anxiety/avoidance and psychological inflexibility, however in different ways. Gender did not act as a mod-erator. However, people in the Multidimensional Problem cluster reported higher degree of depressive symptoms as well as higher levels of rumination compared to the other clusters. To conclude, psychological inflexibility seems to be related not only to symptoms of ill-health such as social anxiety and depressive symptoms but also to control strategies such as rumination.
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| 27. |
- Åhlin, Julia K., et al.
(författare)
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Job demands, control and social support as predictors of trajectories of depressive symptoms
- 2018
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Ingår i: Journal of Affective Disorders. - : Elsevier BV. - 0165-0327 .- 1573-2517. ; 235, s. 535-543
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Tidskriftsartikel (refereegranskat)abstract
- Background: Job demands, job control and social support have been associated with depressive symptoms. However, it is unknown how these work characteristics are associated with different trajectories of depressive symptoms, which this study aimed to examine. Methods: We included 6679 subjects in the Swedish Longitudinal Occupational Survey of Health (SLOSH), who completed biennial questionnaires in 2006-2016. Group-based trajectory models identified groups with similar development of depressive symptoms. Multinomial logistic regression estimated associations between baseline demands, control, social support and trajectories of depressive symptoms. Results: We identified six depression trajectories with varying severity and stability across four measurements. High job demands and low social support, but not low control, were associated with higher probability of belonging to subsequent trajectories with higher symptom level compared to very low symptom level. Adjusted risk ratios ranged from 1.26, 95% CI = 1.06-1.51 (low symptom trajectory) to 2.51, 95% CI = 1.43-4.41 (persistent severe symptom trajectory). Results also indicated that onset of high demands, low control and low social support increases depressive symptoms over time. Limitations: The results were based on self-reported data and all individuals did not have complete data in all waves. Conclusions: The results indicated that especially perceptions of high job demands and low social support are associated with higher or increasing levels of depressive symptoms over time. This support the supposition that high job demands, and low social support may have long-term consequences for depressive symptoms and that interventions targeting job demands and social support may contribute to a more favourable course of depression.
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