| 1. |
- Nieminen, Katri, 1965-
(author)
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Clinical aspects of childbirth-related anxiety
- 2016
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Doctoral thesis (other academic/artistic)abstract
- Background: Although giving birth is a positive experience for many, some 10% of pregnant Swedish women suffer from severe fear of childbirth (FOC), which impairs their daily functioning and poses a risk for a negative delivery experience. This thesis focuses on the mental and health-economic effects of severe FOC, and explores new treatment options for childbirth-related anxiety.Aims: (i) to investigate the prevalence of and variables associated with severe FOC, (ii) to estimate the cost of illness of severe FOC and (iii) to explore whether Internetbased cognitive behaviour therapy (ICBT) is feasible for treating pregnant women with severe FOC and those with childbirth-related symptoms of posttraumatic stress disorder (PTSD).Design and Results: Study 1: In a cross-sectional study 1635 pregnant women were asked about their FOC via the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ), and provided socio-demographic data and information of their preferred mode of delivery. It was found that 15.6% of the participants had a severe FOC, which also strongly correlated with the preference of a caesarean section. Study 2: In a prospective case-control cohort study we mapped all visits, in-patient care, sick leave and delivery variables from medical records and estimated the societal costs in two groups of women; one group with severe FOC and one with low FOC. The costs for the group with severe FOC were 38% higher than for the low FOC group. Study 3: Twenty-eight nulliparous women with severe FOC were self-recruited to an eight weeks ICBT program for severe FOC. Fifteen women followed the entire program. Their FOC decreased significantly after treatment (Cohen’s d=0.95, p<0.0001), which means that ICBT is feasible and an option for treating women with severe FOC. Study 4: Fifteen participants in Study 3 wrote narratives of the imminent delivery before as well as after therapy. After treatment, the women had a more realistic attitude towards childbirth, more self-confidence and more active coping strategies. Partners and staff were perceived as more helpful, and the women were more aware of the child they were bearing. Study 5: Fifty-six women with a traumatic delivery experience were included in a randomized wait-list controlled study (RCT) of the effects of an eight week long ICBT program for childbirth-related PTSD symptoms. These symptoms decreased in both groups during active therapy, while the between-group effect size varied depending on measurements. Psychiatric comorbidity decreased in both groups after active treatment.Conclusion: Severe FOC is prevalent among Swedish pregnant women, and the cost of illness of this marker of peripartum psychological vulnerability is considerable when treated using standard care. A new treatment option for this group with ICBT seems feasible and is associated with more realistic attitudes towards the imminent delivery. An RCT with eight weeks of ICBT for parous women with PTSD symptoms also had promising results.As severe FOC is prevalent and associated with mental and economic burdens for the individual and the society, there is an urgent need to expand the research field. It is important to find feasible and effective treatments that can be applied on a large scale.
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| 2. |
- Westman, Anders, 1946-
(author)
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Musculoskeletal pain in primary health care : a biopsychosocial perspective for assessment and treatment
- 2010
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Doctoral thesis (other academic/artistic)abstract
- Long-term musculoskeletal pain is a large public health problem with serious consequences for both the individual and society. Psychosocial factors have been shown to be good predictors of long-term disability and play an important role in the transition from acute to chronic pain. Early identification and intervention of those that run the risk of developing long-term disability would offer a great opportunity for reducing costs and personal suffering. The overall aim of this thesis was to assess a biopsychosocial approach to the assessment and management of musculoskeletal pain patients in primary health care. To this end, biopsychosocial assessment and treatment methods were tested in two different populations of primary care patients suffering pain. Results indicated that improvements in quality of life and work capacity one year after early multimodal rehabilitation were basically maintained after five years. The most salient prognostic factors determining return to work were educational level and the individual’s perceived health (Study I). Psychosocial factors as measured by the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) were related to disability and perceived health three years after treatment for non-acute pain problems (Study II). The experimental group in the controlled multimodal pain rehabilitation programme had lower health care utilization and a reduced risk of using large amounts of medication after three years compared with the participants in the control group. However, there were no significant differences between the groups on variables such as work capacity, function, catastrophizing and pain (Study III). Distinct profiles of catastrophizing, fear-avoidance beliefs, and distress were extracted and meaningfully related to future sick leave and dysfunction (Study IV). Our findings provide support for the biopsychosocial model and highlight the importance of psychosocial factors in long-term outcome. The results underscore the need for early identification of patients at risk. Further, multimodal treatment that covers not only biological but also psychosocial factors seems to be a key to successful treatment, and ideally this intervention should be matched to the patients' needs.
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| 3. |
- Danielsson, Nanette S.
(author)
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Disturbed sleep and emotion : a developmental perspective
- 2013
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Doctoral thesis (other academic/artistic)abstract
- Sleep disturbances are not only defining features, but also diagnostic criteria for most psychiatric disorders. Recently, researchers have proposed a theoretic role for sleep disturbances in emotion dysregulation, subsequently linking neurobiological processes and psychopathology. Most prior research examining the potential role for sleep disturbance in emotion dysregulation is from a neurophysiological or clinical perspective, or primarily focused on maintaining processes. Less well understood are how sleep disturbances may be involved at the levels of predisposition, precipitation, and perpetuation of emotion dysregulation concurrently and over time.This dissertation presents findings from three studies that were designed to expand on what is known about sleep disturbance in the predisposition, precipitation, and perpetuation of emotion dysregulation. Study 1 examined the long-term relation between sleep-onset problems and neuroticism over twenty-years. Adolescent sleep-onset posed risk (predisposition) for neuroticism in midlife, not vice versa. Study 2 investigated the effects of 3-nights partial sleep deprivation (5-hours total time in bed) on the positive and negative affect and emotions of otherwise healthy adults. Following partial sleep deprivation, people reported significant reductions in positive affect and emotions compared to rested people (precipitation). The only impact on negative emotions was on the discrete level. Sleep deprived peo-ple reported significantly more irritability, loathing, hostility, and shakiness compared to controls. Study 3 measured adolescent sleep disturbances, depressive symptoms, and catastrophic worry. In addition to direct risk, sleep disturbances posed a non-gender specific risk for depressive symptoms one-year later through catastrophic worry (perpetuation). Overall, the results provide support for the role of sleep disturbances in the predis-position, precipitation, and perpetuation of emotion dysregulation. An implication is that sleep disturbances and catastrophic worry are two po-tentially modifiable markers of risk for emotion dysregulation.
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| 4. |
- Edlund, Sara, 1983-
(author)
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Calm down : strategies for emotion regulation in clinical practice
- 2017
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Doctoral thesis (other academic/artistic)abstract
- Problems with emotion regulation are common in people who seek help from health care professionals working with problems featuring psychological factors. Two such patient groups, chronic pain patients and patients with severe anxiety, are of interest in this dissertation. Effectively regulating and increasing functional emotion regulation in these patients is often challenging for clinicians, and effective strategies are needed. One treatment that greatly emphasizes the importance of functional emotion regulation is dialectical behavior therapy (DBT). DBT has a strong empirical basis in other patients with severe problems with emotion regulation, raising the question of whether the treatment and its more specific components (e.g., validation, which means communicating understanding and acceptance) could be effec-tive in the groups of patients of interest here.Accordingly, the overall aim of this dissertation was to expand our knowledge of how to use functional emotion-regulation strategies from DBT to regulate emotions in patients with chronic pain or treatment-resistant anxiety disorders. Study I examined whether brief training was enough to increase validation in partners of people with chronic pain, and whether this was associated with better-regulated emotion in the people with chronic pain. Study II explored patient perceptions of validation and invalidation by the physician in a clinical chronic pain context. Lastly, study III investi-gated whether a more extensive treatment intervention inspired by DBT was feasible and effective in patients suffering from treatment-resistant anxiety disorders.The findings indicate that emotion-regulation strategies from DBT can be effective in regulating emotions in these patients. The dissertation also illus-trates some of the difficulties in doing this, providing important information for future work, such as suggestions for modifications that might further increase positive outcomes.
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| 5. |
- Bauducco, Serena, 1988-
(author)
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Adolescents' sleep in a 24/7 society : Epidemiology and prevention
- 2017
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Doctoral thesis (other academic/artistic)abstract
- Sleep undergoes important changes during adolescence and many teenagers experience problems sleeping. These in turn affect adolescents´ academic, physical and psychosocial functioning. Moreover, there are some indications that sleep problems in this age group may be increasing, possibly as a consequence of societal changes, e.g., internet availability. Research on adolescents´ sleep is growing, but more epidemiological studies are needed to clarify the prevalence of poor sleep, long and short-term outcomes associated with it, and potential risk and protective factors to target in preventive interventions. The aim of this dissertation was to contribute to each of these goals; Study I investigated the longitudinal association between sleep problems, defined as symptoms of insomnia, and school absenteeism; Study II explored the prevalence of poor sleep, defined as sleep deficit, in an adolescent population and psychosocial and contextual factors associated with it, including emotional and behavioral problems, stress, sleep hygiene and technology use; finally, Study III evaluated the short-term effects of a novel universal school-based intervention to improve adolescents´ sleep health.The findings show that poor sleep was strongly related to adolescents´ functioning, including emotional and behavioral problems and school attendance, and that sleep deficit was prevalent in adolescents. This supports the need for prevention. Moreover, sleep deficit was associated with stress, technology use and arousal at bedtime, which may represent important barriers to sleep. A preventive intervention targeting these barriers to promote adolescents´ sleep health was successful with the individuals most at risk. However, it remains to be seen whether these changes will be maintained after the intervention and whether incidence of sleep problems will be lower relative to a control group. Implications for theory and practice are discussed.
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| 6. |
- Bergbom, Sofia, 1982-
(author)
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Matchmaking in pain practice : challenges and possibilities
- 2014
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Doctoral thesis (other academic/artistic)abstract
- All people experience pain and for some people, acute pain may over time develop into long-term disabling problems. Already at an early stage, it is possible to identify people at risk for long-term problems and psychologically oriented interventions have been shown to successfully prevent future disability. However, not all people are helped by treatment and there is room for improvement. Moreover, subgroups of people suffering from pain, with different profiles of psychological factors have been identified, indicating that people with pain problems differ. The first aim of this dissertation was to improve the understanding of how people differ. The second aim was to use these individual differences and to match people to psychological treatment based on their psychological profile. The third aim was to explore what happens during treatment that might be important for treatment outcome.The findings show that people who belonged to subgroups with elevated levels of psychological factors had less favorable outcomes over time, despite treatment, than people with no elevations. Moreover, people with elevations in several psychological factors had even less favorable outcomes. Psychological treatments aimed at preventing future disability performed well, but using profiles to match people to treatment did not improve outcomes further; people who were matched to a treatment and people who were unmatched had similar outcomes. However, the profiles used for matching were unstable over time and there is need to improve the identification of psychological variables used for treatment matching. Finally, a number of psychological factors were shown to be valuable targets for treatment; if the treatments successfully produced change in people’s thoughts and emotions related to pain the treatment outcomes were better. The findings were summarized in a flow chart showing the recommended clinical approach to people seekinghealth care for acute pain problems.
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| 7. |
- Ekholm, Elin, 1981-
(author)
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Painful Sex in Context : Understanding Vulvodynia from a Relational Perspective
- 2024
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Doctoral thesis (other academic/artistic)abstract
- Vulvodynia is a multifactorial persistent pain condition, characterized by pain in the vulva upon touch or pressure. It negatively impacts sexual function, satisfaction, and relational wellbeing. Relational factors have been indicated as integral to the understanding and outcomes of vulvodynia. The overall aim of this dissertation was to further the understanding of women’s pain-related behaviors in relation to the dyadic and normative contexts of vulvodynia.Using a person-oriented approach, study I explored links between coping behaviors, i.e., avoidance and endurance on the one hand, and on the other, relational and pain catastrophizing, perceived partner responses, and motivational goals, in a sample of 128 women with vulvodynia. Study II explored the significance of normative context for the experience of vulvodynia by qualitatively investigating subjective experiences of five women living with dyspareunia in a queer relationship. Using behavioral observation and self-report, study III investigated patterns of sexual communication quality in heterosexual vulvodynia couples (n = 25) as compared to couples without pain (n = 37), and assessed potential associations with pain, self-disclosure, and sexual assertiveness.The findings from the three studies together highlight the significance of the normative context and relational factors such as the emotional quality of sexual communication and women’s relational cognitions, for women’s pain-related experiences and coping behaviors. A new theoretical model, the Interpersonal Pain Coping Model of Vulvodynia, is proposed as a way of integrating contextual factors such as partner behaviors and sexual scripts into the understanding of women’s behavioral response to vulvodynia.
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| 8. |
- Engman, Linnéa, 1987-
(author)
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Vulvodynia : Understanding the Role of Pain-related Behavior
- 2021
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Doctoral thesis (other academic/artistic)abstract
- Over the last decades, psychological mechanisms have been identified as key in the understanding of pain development and maintenance of vulvodynia. Furthermore, psychological treatments in the form of cognitive behavioral therapy (CBT) have proven helpful for those suffering. Still, prospective studies investigating psychological mechanisms over time are lacking, as are clinical studies investigating their role in treatment.The overall aim of this dissertation is to further the understanding of pain-related behavior and its role in the development and maintenance of vulvodynia by applying a fear-avoidance-endurance theoretical framework. It further aimed at consolidating the understanding of such a framework through a clinical proof of concept investigating the effect of a CBT treatment. Study I investigated the mediating role of avoidance and endurance behavior on the relationship between pain catastrophizing and pain. Study II prospectively investigated the predictive value of avoidance and endurance behavior on sexual function. Further, avoidance and endurance behavior were examined on an individual level to gain information on potential patterns of behavior. Study III investigated the effect of a CBT group treatment with partner involvement on pain and associated outcomes.Taken together, the overall findings of this dissertation further point at the importance of psychological mechanisms such as pain catastrophizing, avoidance behavior, and endurance behavior in the development and maintenance of vulvodynia. While further manifesting similarities between mechanisms involved in vulvodynia and those involved in other persistent pain conditions, the findings also verify the relevance of the Fear-avoidance model and the complementary Avoidance-endurance model for vulvodynia. Finally, a new model of understanding was proposed: the Fear-avoidance-endurance model of vulvodynia, summarizing pain-related behavior involved in the development and maintenance of vulvodynia.
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| 9. |
- Jansson, Markus, 1971-
(author)
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Insomnia: psychological mechanisms and early intervention : a cognitive-behavioral perspective
- 2005
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Doctoral thesis (other academic/artistic)abstract
- This dissertation focused on the role of psychological mechanisms in the development of insomnia and the effectiveness of an early cognitive-behavioral intervention for insomnia. The first aim was to examine whether distress, worry, and dysfunctional beliefs and attitudes about sleep were related to the development of insomnia. The findings from study I indicated that distress (anxiety and, to some extent, depression) was related to the development of insomnia. In study II, the relationship between sleep-related worry and subjective sleep perception was demonstrated to intensify over time, indicating that sleep-related worry was also linked to the development of insomnia. This indicates that both distress and sleep-related worry may be mechanisms that can be regarded as two of several pathways to insomnia. While distress was related to developing an onset of insomnia, worry was linked to the early development of insomnia. In study IV, dysfunctional beliefs and attitudes about sleep were not related to clinical improvement following cognitive behavior therapy for early insomnia. However, reductions in dysfunctional beliefs and attitudes about sleep were consistently linked to improvements in daytime symptoms, but not to sleep improvements. Instead of implying that such beliefs and attitudes are less important than distress and worry in the development of insomnia, it may rather suggest that dysfunctional beliefs and attitudes about sleep play a slightly different role in insomnia than previously envisioned. The second aim of this dissertation was to compare the effects of cognitive-behavioral therapy for insomnia with self-help information in patients with a short history of insomnia. In study III, the results showed that an early cognitive-behavioral intervention was effective for individuals with insomnia. To the benefit of the patients with insomnia and to society, cognitive behavior therapy may have a deserving and vital role as an early intervention for patients with insomnia. Taken together, the results in this dissertation indicate that psychological mechanisms play an important role in the development of insomnia. The findings might thus add to the elaboration of cognitive-behavioral models of insomnia. While most previous research has examined insomnia only in its persistent form, the focus of this dissertation was to study insomnia in its early phase. An approach where insomnia is studied in its early phase of development has not only heuristic value to the development of cognitive-behavioral models of the condition, but might also have implications for how cognitive-behavioral therapy for insomnia can be elaborated in future research and integrated in clinical settings.
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| 10. |
- Johansson, Ann-Christin
(author)
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Psychosocial factors in patients with lumbar disc herniation : enhancing postoperative outcome by the identifiction of predictive factors and optimised physiotherapy
- 2008
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Doctoral thesis (other academic/artistic)abstract
- Psychosocial factors have been advanced as an explanation for the development of chronic disability in 20 to 30% of patients treated by lumbar disc surgery. Aims: The overall aim of this thesis was to study the role of psychosocial factors in patients undergoing first-time lumbar disc surgery in relation to the outcome of both surgery and subsequent physiotherapy. Methods: Sixty-nine patients with lumbar disc herniation undergoing first-time disc surgery participated in the studies; in addition, Study I included 162 knee patients for comparison. Psychosocial factors were assessed preoperatively, as was the activation of the physiological stress response system. Pain, disabil-ity and quality of life were assessed before, and 3 and 12 months after surgery. Coping and kinesiophobia were analysed before and one year after surgery. The results of two different postoperative training programmes were compared. Results: There were no differences between disc and knee patients regarding the presence of psychosocial stress factors preoperatively (Study I). Disc patients with low diurnal cortisol variability had lower physical function, perceived fewer possibilities to influence their pain and were more prone to catastrophise than patients with high diurnal cortisol variability (Study II). The results of clinic-based physiotherapy and home training did not differ regarding postoperative disability and pain 3 months after surgery. The home-based group had less pain and higher quality of life in comparison to the clinic-based group 12 months after surgery (Study III). Patients’ expectations of returning to work could best predict pain, disability, quality of life and sick leave one year after surgery (Study IV). Psychosocial factors were only weakly asso-ciated to pain, disability, quality of life and sick leave preoperatively. However, these associations were stronger in patients with residual pain one year after surgery. Conclusion: Psychosocial factors and, in particular, patients’ expectations regarding outcome are associated with the results of lumbar disc surgery. Assessing psychosocial factors preoperatively and developing an active home training programme after surgery could create options leading to better results for these patients.
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