| 1. |
- Tillfors, Maria, 1963-, et al.
(author)
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Prospective links between social anxiety and adolescent peer relations
- 2012
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In: Journal of Adolescence. - : Academic Press. - 0140-1971 .- 1095-9254. ; 35:5, s. 1255-1263
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Journal article (peer-reviewed)abstract
- This study examines bi-directional links between social anxiety and multiple aspects of peer relations (peer acceptance, peer victimization, and relationship quality) in a longitudinal sample of 1528 adolescents assessed twice with one year between (754 females and 774 males; M = 14.7 years of age). Lower levels of peer acceptance predicted increases in social anxiety. Social anxiety predicted decreases in relationship support for males and increases in peer victimization for females. Collectively our findings suggest that peers seem to play a significant role for adolescent mental health and social anxiety seems to interfere with healthy peer relations. Importantly, developmental pathways for social anxiety seem to differ for adolescent females and males.
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| 2. |
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| 4. |
- Holländare, Fredrik, 1972-, et al.
(author)
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Two-year outcome of internet-based relapse prevention for partially remitted depression
- 2013
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In: Behaviour Research and Therapy. - : Elsevier BV. - 0005-7967 .- 1873-622X. ; 51:11, s. 719-722
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Journal article (peer-reviewed)abstract
- The objective of the study was to investigate the long-term effects of internet-based relapse prevention for sufferers of partially remitted depression. Eighty-four individuals with partially remitted unipolar depression were randomized to either internet-based CBT (iCBT) or to a control group. After the ten week intervention period the participants were followed for 24 months and diagnostic interviews conducted to detect relapse. The intervention and monthly self-ratings of depressive symptoms were administered via an internet-based platform that ensured secure communication with all participants. Significantly fewer participants in the iCBT group had experienced a relapse compared with those in the control group two years after the internet-based intervention. The relapse rate in the iCBT group was 13.7% (CI 95% = 2.5–24.9) and in the control group it was 60.9% (CI 95% = 44.8–77). Furthermore, a significantly larger proportion of the iCBT group experienced remission two years after the intervention compared with the control group. Internet-based CBT seems promising for preventing relapse in sufferers of partially remitted depression.
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| 5. |
- Mörtberg, Ewa, et al.
(author)
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An atypical anxious-impulsive pattern of social anxiety disorder in an adult clinical population
- 2014
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In: Scandinavian Journal of Psychology. - : The Scandinavian Psychological Associations. - 0036-5564 .- 1467-9450. ; 55:4, s. 350-356
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Journal article (peer-reviewed)abstract
- An atypical subgroup of Social Anxiety Disorder (SAD) with impulsive rather than inhibited traits has recently been reported. The current study examined whether such an atypical subgroup could be identified in a clinical population of 84 adults with SAD. The temperament dimensions harm avoidance and novelty seeking of the Temperament and Character Inventory, and the Liebowitz Social Anxiety Scale were used in cluster analyses. The identified clusters were compared on depressive symptoms, the character dimension self-directedness, and treatment outcome. Among the six identified clusters, 24% of the sample had atypical characteristics, demonstrating mainly generalized SAD in combination with coexisting traits of inhibition and impulsivity. As additional signs of severity, this group showed low self-directedness and high levels of depressive symptoms. We also identified a typically inhibited subgroup comprising generalized SAD with high levels of harm avoidance and low levels of novelty seeking, with a similar clinical severity as the atypical subgroup. Thus, higher levels of harm avoidance and social anxiety in combination with higher or lower levels of novelty seeking and low self-directedness seem to contribute to a more severe clinical picture. Post hoc examination of the treatment outcome in these subgroups showed that only 20 to 30% achieved clinically significant change.
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| 7. |
- Norell-Clarke, A., 1979-, et al.
(author)
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Cognitive behavioural therapy for comorbid insomnia and depression : A randomised, controlled study
- 2013
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In: Sleep Medicine. - Amsterdam : Elsevier. - 1389-9457 .- 1878-5506. ; 14:Suppl. 1, s. e99-e99
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Journal article (other academic/artistic)abstract
- Introduction: Insomnia and depression is a common comorbidity and several pilot studies have demonstrated promising results on both conditions by targeting insomnia only. The aim was to investigate the effects of CBT for insomnia (CBT-I) on both sleep and depressive symptoms in a sample with insomnia comorbid with major depression, minor depression or depressive symptoms, using a randomized controlled study.Materials and methods: 64 participants were recruited through advertisements and randomised to receive either CBT-I or an active control (relaxation training: RT) in groups during four sessions over seven weeks. Insomnia and depressive severity was measured before, during and after treatment, using Insomnia Severity Index (ISI) and Beck Depression Inventory (BDI- II).Results: We used independent t-tests to investigate if groups were different on symptom severity prior to treatment. There was no difference between CBT-I and RT regarding insomnia severity (t (55) = 1.30, p = 0.20) or depression severity (t (53) = −0.77, p = 0.44). Looking at development over time, mixed between-within subjects ANOVAs demonstrated a significant interaction between treatment type and time for both insomnia and depression (ISI: F (2, 54) = 4.96, p = 0.01; BDI: F (2, 58) = 2.80, p = 0.07) meaning that CBT-I meant a larger decrease of both insomnia and depressive severity compared to control treatment. There was also a significant main effect for time with decreasing scores for both groups over time on ISI (F (2, 52) = 28.86, p = 0.0005) and BDI-II (F (2, 58) = 7.11, p = 0.002) and a main effect for group on ISI (F (1, 53) = 9.25, p = 0.01) but not on BDI-II (F (1, 59) = 0.27, p = 0.60). A six months follow-up assessment is currently conducted and those results will also be presented during the conference.Conclusion: CBT-I was associated with a greater reduction in insomnia and depression severity compared to control treatment. These results show that it is possible to have an effect on both insomnia and depression during a relatively short and cost effective group treatment, targeting insomnia only.
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| 8. |
- Norell-Clarke, Annika, 1979-, et al.
(author)
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Cognitive processes and their association with persistence and remission of insomnia : Findings from a longitudinal study in the general population
- 2014
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In: Behaviour Research and Therapy. - : Elsevier. - 0005-7967 .- 1873-622X. ; 54, s. 38-48
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Journal article (peer-reviewed)abstract
- Aim: Insomnia is a common health problem that affects about 10% of the population. The purpose of this investigation was to examine the association between cognitive processes and the persistence and remission from insomnia in the general population.Methods: In a longitudinal design, 2333 participants completed a survey on night time and daytime symptoms, and cognitive processes. Follow-up surveys were sent out six months and 18 months after the first assessment. Participants were categorised as having persistent insomnia, being in remission from insomnia or being a normal sleeper.Results: Cognitive processes distinguished between people with persistent insomnia and normal sleepers. Specifically, worry, dysfunctional beliefs, somatic arousal, selective attention and monitoring, and safety behaviours increased the likelihood of reporting persistent insomnia rather than normal sleep. For people with insomnia, more worry about sleep at baseline predicted persistent insomnia but not remission later on. Lower selective attention and monitoring, and use of safety behaviours over time increased the likelihood of remission from insomnia. In general, these results remained, when psychiatric symptoms and medical complaints were added to the models.Conclusions: The findings support that certain cognitive processes may be associated with persistence and remission of insomnia. Clinical implications are discussed.
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| 9. |
- Norell-Clarke, Annika, 1979-, et al.
(author)
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Movement between insomnia, poor sleep and normal sleep in the general population
- 2011
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Conference paper (peer-reviewed)abstract
- Introduction: The purpose was to explore the development and remission of insomnia in the general population. Models of chronic insomnia suggest that cognitive and behavioural factors may maintain and worsen sleep problems. This had not been investigated prospectively before.Method: A survey with sleep related questionnaires was sent out to 5000 in the general public three times over 1, 5 years. Respondents were classified as normal sleepers, poor sleepers, and insomniacs.Results: Statistical software EXACON was used to examine expected and unexpected movement between sleep classifications over time. It was typical to remain in the same sleep category (p<.0001), and typical to move from insomnia to poor sleep (p<.0001). It was atypical to move from normal sleep to poor sleep or insomnia (p<.0001), and atypical to move from poor sleep or insomnia to normal sleep (p<.0001). Poor sleepers showed most classification movements. A multinomial logistic regression explored if worry (APSQ), somatic arousal (PSAS), monitoring (SAMI), dysfunctional beliefs (DBAS) and safety behaviours (SRBQ) could predict development to insomnia and normal sleep respectively for people with poor sleep at baseline. The model was significant (p<.01) with increased safety behaviours as a unique predictor of movement to insomnia (p<.01) Decreased safety behaviours showed a tendency towards significance for development to normal sleep (p>.01).Conclusion: Complete remission was unusual once sleep problems had developed, although the severity varied over time. Safety behaviours seem to influence the development of insomnia for people with poor sleep. The role of psychological processes for insomnia needs to be explored further.
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| 11. |
- Tillfors, Maria, 1963-, et al.
(author)
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A randomized trial of Internet-delivered treatment for social anxiety disorder in high school students
- 2011
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In: Cognitive Behaviour Therapy. - 1650-6073 .- 1651-2316. ; 40:2, s. 147-157
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Journal article (peer-reviewed)abstract
- Internet-based cognitive behavior therapy (CBT) has proven to be effective for university students with social anxiety disorder (SAD) and public speaking fears. The aim of this study was to investigate if the promising results can be transferred to high school students suffering from this condition. A total of 19 speech-anxious high school students with SAD were randomized either into nine weeks of Internet-delivered CBT or to a waitlist control group. Significant improvements were found on measures of social anxiety, general anxiety, and depression. Effects were maintained at a 1-year follow-up. The average within and between-group effect sizes for the primary social anxiety scales at post-test were Cohen’s d = 0.98 and 1.38 respectively. However, the average number of completed modules in the CBT program was low. Although compliance can be improved, the results suggest that Internet-based guided self-help is effective in the treatment of high school students with SAD.
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| 12. |
- Tillfors, Maria, 1963-, et al.
(author)
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Inhibited and impulsive subgroups of socially anxious young adults : Their depressive symptoms and life satisfaction
- 2013
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In: Open Journal of Psychiatry. - Irvine : Scientific Research Publishing. - 2161-7325 .- 2161-7333. ; 3:1A, s. 195-201
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Journal article (peer-reviewed)abstract
- Purpose: Socially anxious people are typically thought of as being behaviorally inhibited; however, an atypical subgroup, which is impulsive rather than inhibited, has recently been identified. Theoretically, inhibition and impulsivity could be viewed as different strategies for coping with anxiety that have the same goal—escape from negative emotions—but they seem to have different implications. Previous studies have found that the socially anxious-impulsive subgroup was higher on risk-prone behavior, as for example drug use, compared with a socially anxious-inhibited subgroup. In this study, we aimed to identify these subgroups in a general population, and asked whether they also experience various levels of depressive symptoms and life satisfaction, as well as moderating effects of gender. Methods: Cluster analysis was used to identify subgroups of young adults (20 - 24 years old; N = 772) characterized by different profiles of social anxiety and impulsivity. These subgroups were compared on levels of internal adjustment, and the moderating effects of gender were also tested. Results: We identified five clusters, including an Anxious-Inhibited and an Anxious-Impulsive cluster. In the interaction between gender and cluster membership, gender showed evidence of moderation regarding both depressive symptoms and life satisfaction, with the young women in the Anxious-Inhibited and the Anxious-Impulsive clusters faring worst. Conclusions: We replicated previous findings demonstrating the existence of a socially anxious-impulsive subgroup, thus solidifying current knowledge that may be important when it comes to diagnostics and treatment. This may prove particularly important for young women regarding internalizing symptoms.
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| 14. |
- Tillfors, Maria, 1963-, et al.
(author)
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Underlying factors of social anxiety and pain : Aspects of self-focused attention – private and public self-consciousness
- 2012
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In: 14th World Congress on Pain.
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Conference paper (peer-reviewed)abstract
- A high degree of co-morbidity has been observed in general between chronic pain and various anxiety disorders and specifically between chronic pain and social anxiety disorder (or social phobia) both in clinical pain populations and in general populations. What is the etiology behind this co-morbidity? One clue may come from the concept of self-focused attention. A personality trait that refers to people’s individual differences in the degree of self-focused attention is self-consciousness, which has been observed to consist of two separate aspects. One is a private aspect addressing a person’s inner experiences as thoughts, feelings and somatic symptoms. The other aspect is a public aspect addressing a person’s attention to the self as a social object. Social anxiety disorder is characterized by a marked fear of scrutiny in a variety of social situations which implies a high degree of public self-consciousness. High degree of public self- consciousness has been associated both with higher degree of sensitivity to being socially rejected, and with physical (sexual) pain. However, research related to public self-consciousness and pain is very limited. Interesting to note is that from a neurobiological perspective the same area in the brain is activated both in physical pain and in social exclusion. In line with this, it has also been observed that sensitivity to physical pain and sensitivity to social rejection are mutually reinforcing. In Western societies we build much of our identity from what we achieve. For people who develop chronic pain and the often accompanying labor reduction should the social environment be experienced more invalidating if the person at the same time worries a lot for how others will perceive him/her (i.e., being high on public self-consciousness). This in turn may reinforce the impulse to avoid not only situations involving activities of a physical nature but also social activities. Overall, it should be of interest to examine public self-consciousness in relation to both pain and social anxiety. It has to our knowledge not been done before.Aim: The aim of the present study was to examine and identify possible patterns (by cluster analysis) of self-consciousness (public and private), social anxiety and pain in a non-clinical population. These profiles were examined in relation to disabling social anxiety respectively disabling pain.Methods: In this study, cluster analysis was used to identify subgroups of people characterized by different profiles of social anxiety, self-consciousness (public and private) and pain. University students (19-46 years old; N = 302) participated in a cross-sectional study.Results: We identified six clusters, including one group scoring high on all variables (the co-morbidity cluster). Further, we found a significant relation between the cluster solution and both disabling pain and disabling social anxiety where people belonging to the co-morbidity cluster were overrepresented.Conclusions: This suggests that public self-consciousness may be important to consider in terms of co-morbidity between pain and social anxiety. A next step is to try to replicate this result and thereby increase the external validity. Finally, if a person has a pattern in which he/she scores high on pain, social anxiety and public and private self-consciousness this may point to an enhanced risk for that person to developing both social anxiety disorder and chronic pain.
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