1
|
Hedman-Lagerlöf M, Gasslander N, Ahnlund Hoffmann A, Bragesjö M, Etzell A, Ezra S, Frostell E, Hedman-Lagerlöf E, Ivert C, Liliequist B, Ljótsson B, Hoppe JM, Palmgren J, Spansk E, Sundström F, Särnholm J, Tzavara G, Buhrman M, Axelsson E. Effect of exposure-based vs traditional cognitive behavior therapy for fibromyalgia: a two-site single-blind randomized controlled trial. Pain 2024; 165:1278-1288. [PMID: 38131181 PMCID: PMC11090030 DOI: 10.1097/j.pain.0000000000003128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/13/2023] [Accepted: 10/13/2023] [Indexed: 12/23/2023]
Abstract
ABSTRACT Fibromyalgia is a debilitating pain condition for which treatment effects are typically modest. The most evaluated psychological treatment is traditional cognitive behavior therapy (T-CBT), but promising effects have recently been seen in exposure-based cognitive behavior therapy (Exp-CBT). We investigated whether Exp-CBT was superior to T-CBT in a randomized controlled trial. Self-referred participants with fibromyalgia (N = 274) were randomized (1:1) to 10 weeks of Exp-CBT or T-CBT. Treatments were delivered online and presented as "CBT for fibromyalgia." Participants were assessed at baseline, weekly during treatment, posttreatment, and at 6- and 12-month follow-up. Primary outcome was the difference in reduction in fibromyalgia severity as measured using the Fibromyalgia Impact Questionnaire (FIQ) over 11 assessment points from baseline to posttreatment, modelled within an intention-to-treat framework using linear mixed effects models fitted on multiple imputed data. Approximately 91% of weekly FIQ scores were collected over the main phase. There was no significant difference between Exp-CBT and T-CBT in the mean reduction of fibromyalgia severity from pretreatment to posttreatment (b = 1.3, 95% CI -3.0 to 5.7, P = 0.544, d = -0.10). Minimal clinically important improvement was seen 60% in Exp-CBT vs 59% in T-CBT. Effects were sustained up to 12 months posttreatment. This well-powered randomized trial indicated that Exp-CBT was not superior to T-CBT for fibromyalgia. Both treatments were associated with a marked reduction in fibromyalgia severity, and the online treatment format might be of high clinical utility. T-CBT can still be regarded a reference standard treatment that remains clinically relevant when compared to novel treatment approaches.
Collapse
Affiliation(s)
- Maria Hedman-Lagerlöf
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Nils Gasslander
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Alice Ahnlund Hoffmann
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Maria Bragesjö
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Amanda Etzell
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Simon Ezra
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Elsa Frostell
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Erik Hedman-Lagerlöf
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Gustavsberg Primary Health Care Center, Region Stockholm, Stockholm, Sweden
| | - Caroline Ivert
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Björn Liliequist
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Brjánn Ljótsson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Johanna M. Hoppe
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Josefin Palmgren
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Edward Spansk
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Felicia Sundström
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Josefin Särnholm
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Georgia Tzavara
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Monica Buhrman
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Erland Axelsson
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Liljeholmen Primary Health Care Center, Region Stockholm, Stockholm, Sweden
- Academic Primary Health Care Center, Region Stockholm, Stockholm, Sweden
| |
Collapse
|
2
|
Rozental A, Shafran R, Johansson F, Forsström D, Jovicic F, Gelberg O, Molin K, Carlbring P, Andersson G, Buhrman M. Treating perfectionism via the Internet: a randomized controlled trial comparing cognitive behavior therapy to unified protocol. Cogn Behav Ther 2024; 53:324-350. [PMID: 38483057 DOI: 10.1080/16506073.2024.2327339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/28/2024] [Indexed: 03/20/2024]
Abstract
Perfectionism can be problematic when your self-worth is dependent on achievements and leads to inflexible standards, cognitive biases, and rigid behaviors. Cognitive behavior therapy for perfectionism is shown to be effective, including for targeting psychiatric symptoms and when delivered via the Internet (iCBT-P). However, few studies have compared it to an active comparator. The current study randomly assigned 138 participants seeking help for perfectionism to iCBT-P or Internet-based Unified Protocol (iUP). Both treatments provided guidance on demand from a therapist and were eight weeks in duration. The results indicated large within-group effects of Cohen's d 2.03 (iCBT) and 2.51 (iUP) on the Clinical Perfectionism Questionnaire at post-treatment, and maintained effects at 6- and 12-month follow-up, but no between-group difference (β = 0.02, SE = 1.04, p = .98). Secondary outcomes of depression, anxiety, quality of life, self-compassion, procrastination, and stress ranged from small to large, with no differences between the conditions. Both treatments were deemed credible, relevant, of high quality, and well-adhered by the participants. Further research needs to be conducted, but the findings could indicate a lack of specificity, perhaps suggesting there is no need to differentiate between different treatments that are transdiagnostic in nature.
Collapse
Affiliation(s)
- Alexander Rozental
- Department of Psychology, Uppsala University, Uppsala, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
| | - Roz Shafran
- Great Ormond Street Hospital Institute of Child Health, UCL, London, UK
| | - Fred Johansson
- Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden
| | - David Forsström
- Department of Psychology, Uppsala University, Uppsala, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Filip Jovicic
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Olle Gelberg
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Katarina Molin
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Gerhard Andersson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Behavioural Sciences and Learning, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Monica Buhrman
- Department of Psychology, Uppsala University, Uppsala, Sweden
| |
Collapse
|
3
|
van de Leur JC, Johansson F, McCracken LM, Åhs F, Brodda Jansen G, Buhrman M. Mediators during a Multimodal intervention for stress-induced exhaustion disorder. Cogn Behav Ther 2024; 53:235-253. [PMID: 38130175 DOI: 10.1080/16506073.2023.2295217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023]
Abstract
Our understanding of the underlying psychological processes of development, maintenance, and treatments for stress-induced exhaustion disorder (ED) remains limited. Therefore, the current study aimed to explore whether sleep concerns, pathological worry, perfectionistic concerns, and psychological flexibility mediate change in exhaustion symptoms during a Multimodal intervention for ED based on Cognitive behavioral therapy principles. Participants (N = 913) were assessed at three time points, and mediation was explored using a two-criteria analytical model with linear mixed-effects models (criterion one) and random intercepts cross-lagged panel modeling (criterion 2). Criterion one for mediation was successfully met, as the findings indicated significant associations between time in treatment, with all suggested mediators, and exhaustion symptoms (significant ab-products). However, criterion two was not satisfied as changes in the mediators did not precede changes in exhaustion symptoms. Therefore, mediation could not be established. Instead, changes in the suggested mediators appeared to result from changes in exhaustion symptoms. Consequently, sleep concerns, pathological worry, perfectionistic concerns, and psychological flexibility appear to improve in conjunction with exhaustion symptoms during treatment, where improvement in exhaustion is indicated as the main driving factor, based on this exploratory analysis. The implications of these findings are contextualized within a broader framework of process-based therapy.
Collapse
Affiliation(s)
| | - Fred Johansson
- Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden
| | | | - Fredrik Åhs
- Department of Psychology and Social Work, Mid Sweden University, Östersund, Sweden
| | - Gunilla Brodda Jansen
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Karolinska Institutet Danderyds University Hospital, Stockholm, Sweden
| | - Monica Buhrman
- Department of Psychology, Uppsala University, Uppsala, Sweden
| |
Collapse
|
4
|
Hedman-Lagerlöf M, Buhrman M, Hedman-Lagerlöf E, Ljótsson B, Axelsson E. Shared and distinct effect mediators in exposure-based and traditional cognitive behavior therapy for fibromyalgia: Secondary analysis of a randomized controlled trial. Behav Res Ther 2024; 178:104546. [PMID: 38685153 DOI: 10.1016/j.brat.2024.104546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 04/19/2024] [Accepted: 04/19/2024] [Indexed: 05/02/2024]
Abstract
Fibromyalgia is a chronic pain condition associated with substantial suffering and societal costs. Traditional cognitive behavior therapy (T-CBT) is the most evaluated psychological treatment, but exposure therapy (Exp-CBT) has shown promise with a pronounced focus on the reduction of pain-related avoidance behaviors. In a recent randomized controlled trial (N = 274), we found that Exp-CBT was not superior to T-CBT (d = -0.10) in reducing overall fibromyalgia severity. This study investigated pain-related avoidance behaviors, pain catastrophizing, hypervigilance, pacing, overdoing and physical activity as potential mediators of the treatment effect. Mediation analyses were based on parallel process growth models fitted on 11 weekly measurement points, and week-by-week time-lagged effects were tested using random intercepts cross-lagged panel models. Results indicated that a reduction in avoidance behaviors, pain catastrophizing, and hypervigilance were significant mediators of change in both treatments. An increase in pacing and a reduction in overdoing were significant mediators in T-CBT only. Physical activity was not a mediator. In the time-lagged analyses, an unequivocal effect on subsequent fibromyalgia severity was seen of avoidance and catastrophizing in Exp-CBT, and of overdoing in T-CBT. Exposure-based and traditional CBT for fibromyalgia appear to share common treatment mediators, namely pain-related avoidance behavior, catastrophizing and hypervigilance.
Collapse
Affiliation(s)
- Maria Hedman-Lagerlöf
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Region Stockholm, Sweden.
| | - Monica Buhrman
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Erik Hedman-Lagerlöf
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Gustavsberg University Primary Health Care Center, Academic Primary Health Care Center, Stockholm, Region Stockholm, Sweden
| | - Brjánn Ljótsson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Erland Axelsson
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Liljeholmen University Primary Health Care Center, Academic Primary Health Care Center, Stockholm, Region Stockholm, Sweden
| |
Collapse
|
5
|
van de Leur JC, Jovicic F, Åhslund A, McCracken LM, Buhrman M. Psychological Treatment of Exhaustion Due to Persistent Non-Traumatic Stress: A Scoping Review. Int J Behav Med 2024; 31:175-191. [PMID: 37308772 PMCID: PMC11001660 DOI: 10.1007/s12529-023-10185-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Exhaustion due to persistent non-traumatic stress (ENTS) is a significant health problem with substantial personal, social, and economic impact. While there are increasing studies of ENTS, there is no international agreement on how it should be diagnosed and treated. This scoping review aimed to map definitions, diagnoses, treatments, outcome measures, and outcomes in psychological treatment studies of ENTS. A further aim was to assess the quality of the treatments and map what change processes are described within ENTS interventions. METHODS A PRISMA-guided scoping review of psychological treatment studies delivered in a clinical setting for ENTS was conducted using the databases of PubMed, PsycINFO, and CINAHL. RESULTS Of the 60 studies included, the majority (87%) stemmed from Europe. The most recurrent term for ENTS was burnout, and the diagnosis most often utilized was exhaustion disorder. Several treatments were reported, the most frequent being cognitive behavioral therapy (CBT) (68%). Statistically significant outcomes relevant to ENTS were reported in 65% (n = 39) of the studies, with effect sizes between 0.13 and 1.80. In addition, 28% of the treatments were rated as high quality. The most frequent change processes described were dysfunctional sleep, avoidance, behavioral activation, irrational thoughts and beliefs, worry, perceived competence/positive management, psychological flexibility, and recuperation. CONCLUSIONS While several treatments based on CBT show promising results for ENTS, there do not seem to be any uniformly established methods, theoretical models, or change processes. Instead of adopting a monocausal, syndromal, and potentially bio-reductionist perspective on ENTS, a process-based approach to treatment is encouraged.
Collapse
Affiliation(s)
- Jakob Clason van de Leur
- Department of Psychology, Uppsala University, Box 1225, 751 42, Uppsala, Sweden.
- PBM Globen Rehab, Arenavägen 27, 121 77, Johanneshov, Sweden.
| | - Filip Jovicic
- Department of Psychology, Uppsala University, Box 1225, 751 42, Uppsala, Sweden
- Capio Centrum För Smärta Och Utmattning, Krukmakargatan 37A, 118 51, Stockholm, Sweden
| | - Andreas Åhslund
- Capio Centrum För Smärta Och Utmattning, Krukmakargatan 37A, 118 51, Stockholm, Sweden
| | - Lance M McCracken
- Department of Psychology, Uppsala University, Box 1225, 751 42, Uppsala, Sweden
| | - Monica Buhrman
- Department of Psychology, Uppsala University, Box 1225, 751 42, Uppsala, Sweden
| |
Collapse
|
6
|
Lavefjord A, Sundström FTA, Buhrman M, McCracken LM. The role of stigma in health and functioning in chronic pain: Not just catastrophizing. Eur J Pain 2024; 28:620-632. [PMID: 37985939 DOI: 10.1002/ejp.2207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 10/16/2023] [Accepted: 11/01/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND People with chronic pain are frequently exposed to stigma, which is typically distressing and may lead to internal stigmatizing thoughts. The thought content associated with stigma has similarities to pain catastrophizing, although these concepts differ in that stigma is arguably more social in origin. Stigma can be measured by the Stigma Scale for Chronic Illness - 8-item version (SSCI-8). In this study, we first demonstrate the validity of this measure in Swedish. We then examine the role of stigma in the health and functioning of people with chronic pain, particularly beyond the role played by pain catastrophizing. METHODS Adult participants (N = 404) with chronic pain recruited online completed measures of pain, stigma, catastrophizing, pain interference, work and social adjustment and depression on two occasions. RESULTS A one-factor solution had an overall good model fit as long as residuals were allowed to covary, indicating some redundancy in the items. The SSCI-8 demonstrated good internal consistency and moderate temporal stability, and SSCI-8 scores demonstrated medium-to-large correlations with the measures of health and functioning. Furthermore, stigma was found to significantly contribute to explained variance in pain interference, work and social adjustment and depression, uniquely adding to the explained variance in these outcomes even after accounting for pain catastrophizing. CONCLUSIONS The SSCI-8 provides an adequate measure to capture stigma experiences. Stigma is uniquely associated with pain-related outcomes and should be further considered in pain research and clinical practice in the future. SIGNIFICANCE This study points to the importance of a social perspective on pain-related outcomes. We may need to more fully appreciate the way that people with chronic pain are treated by both health care providers and others can have an impact on their well-being. Potential negative impacts of stigmatizing responses to people with chronic pain are highlighted by the current results.
Collapse
Affiliation(s)
- Amani Lavefjord
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - F T A Sundström
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - M Buhrman
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - L M McCracken
- Department of Psychology, Uppsala University, Uppsala, Sweden
| |
Collapse
|
7
|
Buhrman M, Hällström H, Fridén A, Kettis Moden E, Grahn G, Carlfjord M, Hjo C, Gasslander N, Bohm-Starke N, McCracken LM. Guided internet-based acceptance and commitment therapy for provoked vestibulodynia: A randomized controlled trial. Eur J Pain 2024. [PMID: 38429870 DOI: 10.1002/ejp.2253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 01/31/2024] [Accepted: 02/13/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Provoked vestibulodynia (PVD) causes suffering in many women's lives due to its impact on relationships, sexual functioning and functioning in other key domains. OBJECTIVE Here, we report a randomized controlled trial conducted to examine whether Acceptance and Commitment Therapy (ACT) with a focus on values-based exposure, delivered online, benefits women with PVD. METHODS Participants (n = 88) were randomized to either guided online ACT for 10 weeks or a wait-list control group. Outcomes were assessed at baseline, post treatment and 1 year later. Analyses were based on intention to treat using linear mixed models. RESULTS There were significant group differences on the primary outcomes, Female Sexual Index and Female Sexual Distress Scale, in favour of online ACT with moderate effect sizes. Differences were also found on several secondary outcomes and therapeutic process measures, all in favour of ACT. No differences were found at post-treatment for depression or anxiety. At the 1-year follow-up, results were maintained and a difference between baseline and follow-up was also found for depression. CONCLUSION/SIGNIFICANCE In summary, a relatively brief, guided, online version of ACT appears to produce benefits for women with PVD and related impacts on daily functioning. 50% to 60% of the women who participated in the treatment reliably improved in sexual functioning and distress.
Collapse
Affiliation(s)
- Monica Buhrman
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Hanna Hällström
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Annika Fridén
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Emma Kettis Moden
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Gunnar Grahn
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Maja Carlfjord
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Camille Hjo
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Nils Gasslander
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Nina Bohm-Starke
- Division of Obstetrics and Gynecology, Department of Clinical Sciences, Karolinska Institute, Solna, Sweden
- Danderyd Hospital, Stockholm, Sweden
| | - Lance M McCracken
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| |
Collapse
|
8
|
Sundström FTA, Lavefjord A, Buhrman M, McCracken LM. Associations between psychological flexibility and daily functioning in endometriosis-related pain. Scand J Pain 2024; 24:sjpain-2022-0157. [PMID: 37867345 DOI: 10.1515/sjpain-2022-0157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 09/13/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVES Processes of psychological flexibility (PF) are positively associated with health and wellbeing in several chronic pain disorders. However, these processes have not been investigated in endometriosis, a chronic pain disorder affecting 5-10 % of women worldwide. This study is a preliminary investigation of the associations between PF or psychological inflexibility (PI) and daily functioning in people with a primary diagnosis of endometriosis. METHODS This study is based on a secondary analysis of survey data from Swedish-speaking adult participants with chronic pain recruited online. The current study included only those reporting a diagnosis of endometriosis and significant long-term pain. All participants completed the Multidimensional Psychological Flexibility Inventory (MPFI), a measure of PF and PI, as well as other measures of PF, and measures of pain and daily functioning. Correlation and multiple regression analyses were performed to examine relations of PF and PI with measures of pain and daily functioning. RESULTS In general, PF facet scores from the MPFI did not correlate with pain interference but did correlate with depression, with the exception of acceptance. The overall facets of PI appeared to perform better as correlates and in regression. Established measures of PF performed in correlation and regression analyses generally as has been observed in other chronic pain populations, with significant positive associations. CONCLUSIONS In this preliminary analysis of PF and PI in participants with endometriosis-related pain, these processes appear relevant, especially in understanding depression, but results varied along with the measures used. Specifically, when employing the MPFI, the PI facets emerged as stronger correlates. The findings underscore the potential benefit of incorporating assessments of PF and PI as process variables in endometriosis-research, but also that careful consideration should be given when selecting instruments.
Collapse
Affiliation(s)
| | - Amani Lavefjord
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Monica Buhrman
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | | |
Collapse
|
9
|
Buhrman M, Tillfors M, Holländare F, Lekström E, Håkansson A, Boersma K. Psychological Treatment Targeting Acceptance and Compassion in Patients With Chronic Pain: A Randomized Controlled, Internet-delivered, Treatment Trial. Clin J Pain 2023; 39:672-685. [PMID: 37712248 DOI: 10.1097/ajp.0000000000001157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 08/16/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVES Chronic pain is often associated with lower function. Self-criticism is associated with depressive symptoms. The purpose of this study was to explore if fusing Acceptance and Commitment Therapy and compassion-focused therapy could improve psychological well-being and disability in individuals with chronic pain with high levels of self-criticism in comparison to a wait-list control group. METHODS Individuals with chronic pain (n=71) were randomly assigned to an 8-week internet-based intervention focused on acceptance and compassion or a wait-list condition. Primary treatment outcomes were the Chronic Pain Acceptance Questionnaire, Self-Compassion Scale, and Pain Disability Index. Secondary outcomes were the Montgomery Åsberg Depression Rating Scale, Anxiety Sensitivity Index, Quality of Life Inventory, Multidimensional Pain Inventory, and Perseverative Thinking Questionnaire. RESULTS Missing data at postintervention were 22.5%. Intention-to-treat analyses were conducted using linear mixed models. The results revealed greater levels of acceptance and self-compassion for the treatment group, which were primary outcomes, with effect sizes ranging from small to large, and these results were maintained at 6-month follow-up. The rates of clinically significant improvements were also greater for the treatment group in comparison to the wait-list control group on acceptance and compassion. The treatment group also improved in the third primary outcome, pain disability. Significant differences were found in several of the secondary outcomes, in favor of the treatment group. DISCUSSION Internet-based Acceptance and Commitment Therapy with compassion-focused therapy components shows promise as a viable treatment option in the management of chronic pain.
Collapse
Affiliation(s)
| | - Maria Tillfors
- Department of Social and Psychological Studies, Section of Psychology, Karlstad University, Karlstad
| | | | | | | | - Katja Boersma
- School of Medical Sciences
- Center for Health and Medical Psychology, School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden
| |
Collapse
|
10
|
van de Leur JC, Buhrman M, Wallby K, Karlström A, Johansson F. Associations between improvements in psychological variables and subsequent sick leave among persons receiving a multimodal intervention for exhaustion disorder. BMC Public Health 2023; 23:1976. [PMID: 37821913 PMCID: PMC10568869 DOI: 10.1186/s12889-023-16799-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/20/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND The incidence of sick leave due to stress-related disorders such as exhaustion disorder (ED) is high in many economically developed countries. Meanwhile, knowledge about facilitating return to work during clinical interventions for ED patients is still limited. The current study aimed to investigate if improvements in exhaustion symptoms, insomnia, perfectionistic behaviors, psychological flexibility, and perceived work ability during treatment of ED were associated with subsequent sick leave in the year following treatment. METHODS Using a cohort of 880 ED patients who had participated in a multimodal intervention based on Cognitive Behavior Therapy, we estimated the association between one standard deviation (SD) improvement in treatment-related variables and the rate of net days of sick leave one-year following treatment. RESULTS Our results showed that improvements in all treatment-related variables were associated with lower sick leave rates one year following treatment. Improvements in exhaustion symptoms (rate ratio (RR): 0.70 [95% CI 0.66; 0.75]) and self-perceived work ability (RR 0.56 [95% CI 0.50; 0.63]) showed the strongest associations to subsequent sick leave. CONCLUSIONS These findings suggest that interventions focusing on exhaustion symptoms, insomnia, perfectionistic behaviors, psychological flexibility, and perceived work ability can have a meaningful impact on ED patients' subsequent sick leave. TRIAL REGISTRATION Clinicaltrials.gov (Identifier: NCT03360136).
Collapse
Affiliation(s)
| | - Monica Buhrman
- Department of Psychology, Uppsala University, Box 1225, Uppsala, 751 42, Sweden
| | - Kajsa Wallby
- Department of Psychology, Uppsala University, Box 1225, Uppsala, 751 42, Sweden
| | - Amanda Karlström
- Department of Psychology, Uppsala University, Box 1225, Uppsala, 751 42, Sweden
| | - Fred Johansson
- Department of Health Promotion Science, Sophiahemmet University, Valhallavägen 91, SE- 114 28, Stockholm, Sweden
| |
Collapse
|
11
|
Forsström D, Oscarsson M, Buhrman M, Rozental A. A study protocol of a randomized controlled study of internet-based cognitive behavioral therapy for adult attention deficit hyperactivity disorder. Internet Interv 2023; 33:100652. [PMID: 37529408 PMCID: PMC10388197 DOI: 10.1016/j.invent.2023.100652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 08/03/2023] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) is a disorder characterized by hyperactivity, impulsivity and lack of attention. It can have a major impact on everyday life and result in negative consequences for one's personal, academic, and work situation. For individuals with symptoms of ADHD, increased levels of anxiety and depression are common, and an overall reduction of quality of life is often present. This study protocol describes a clinical trial of internet-based cognitive behavioral therapy (iCBT), using a randomized controlled study design, with the primary aim to increase quality of life, as well as to reduce symptoms of ADHD, anxiety, depression, and stress. A second aim is to investigate, by qualitative means, what aspects of treatment were perceived as helpful and hindering when it comes to completing iCBT. Two hundred participants with symptoms of ADHD will be included and randomized to two conditions (treatment and wait-list control). The treatment period is comprised of a maximum of ten weeks, with two mandatory modules and ten modules from which the participants can choose freely. Self-report measures will be completed by the participants at baseline and end of treatment, as well as at a six-month follow-up. The treatment is guided by therapists and consists of weekly correspondence with the participants. The study will utilize an intention to treat design, with ANOVAs and Reliable Change Index to evaluate treatment effects. The qualitative part of the project will be interview-based and employ thematic analysis. Lastly, a psychometric evaluation of a common instrument for determining ADHD-symptoms will also be made. The results will hopefully contribute to the evidence base for iCBT for individuals with symptoms of ADHD and help disseminate potentially effective interventions.
Collapse
Affiliation(s)
- David Forsström
- Department of Psychology, Uppsala University, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Sweden
- Department of Psychology, Stockholm University, Sweden
| | | | | | - Alexander Rozental
- Department of Psychology, Uppsala University, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| |
Collapse
|
12
|
McCracken LM, Buhrman M, Brocki K. COVID-19 and processes of adjustment in people with persistent pain: the role of psychological flexibility. Scand J Pain 2023; 23:539-545. [PMID: 36779299 DOI: 10.1515/sjpain-2022-0138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 01/14/2023] [Indexed: 02/14/2023]
Abstract
OBJECTIVES The purpose of the current study was to investigate facets of Psychological Flexibility (PF) and Psychological Inflexibility (PI) and their relations with depression, anxiety, and insomnia in people with chronic pain during the COVID-19 pandemic. It was predicted that the full set of facets would significantly predict all three outcomes. The relative contributions of differing facets and dimensions was explored. METHODS Participants with pain were selected from a sample of 1,657 Swedish adults responding to an online survey of health and COVID-19. Persistent pain was defined as pain on most days, present for three months or more. A total of 560, 33.8% of the total sample, were included in the analyses. Standardized and validated measures were used to measure depression, anxiety, and insomnia, and the Multidimensional Psychological Flexibility Inventory (MPFI) was used to measure both PF and PI. RESULTS Significant rates of depression, anxiety, and insomnia, at 43.1, 26.4, and 64.2%, respectively, were found in this sample. These rates appear higher than those found in a general sample in Sweden. PF was negatively associated with these problems while PI was positively associated with them. Better prediction of outcome was obtained by PI compared to PF. CONCLUSIONS PF and especially PI appear to have played a role in relation to health outcomes in people with persistent pain during the COVID-19 pandemic. This group of people appears to have been especially vulnerable to the impacts of the pandemic. This study motivates further investigation and development of treatment approaches, possibly focusing on training PF, for people with persistent pain in the current pandemic context and in the future.
Collapse
Affiliation(s)
| | - Monica Buhrman
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Karin Brocki
- Department of Psychology, Uppsala University, Uppsala, Sweden
| |
Collapse
|
13
|
Maathz P, McCracken LM, Eriksson V, Säde F, Aneblom G, Rikner Å, Skalkidou A, Buhrman M. A feasibility trial of online Acceptance and Commitment Therapy for women with provoked vestibulodynia. Scand J Pain 2023; 23:476-482. [PMID: 37401654 DOI: 10.1515/sjpain-2022-0146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 05/26/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVES Acceptance and Commitment Therapy (ACT) is an established treatment for chronic pain. However, it is a form of treatment that have not yet been applied much in the treatment of persistent vulvar pain disorders. This study examines the feasibility and preliminary effects of online ACT for patients with provoked vestibulodynia. METHODS Women diagnosed with provoked vestibulodynia were assigned randomly either to online ACT or to a waitlist control group. Feasibility was assessed in terms of recruitment potential, treatment credibility, completions rates, retention in trial, and data quality. Participants completed measures of pain with sexual activity, sexual functioning, emotional and relational adjustment, and potential treatment processes before and after treatment. RESULTS Of the 111 women who were invited to participate in the study, 44 were included (39.6 % recruitment rate). Thirty seven participants (84.1 %) completed the pre-treatment assessment. Participants who received online ACT rated treatment credibility positively, and completed on average 4.31 (SD=1.60) of the six treatment modules. Of participants, 34 provided post treatment data, giving a trial retention rate of 77 %. Effects of online ACT, as compared to waitlist, were large for pain acceptance and quality of life, medium for anxiety and pain catastrophizing, and small for sexual satisfaction, pain with sexual activity, and relationship adjustment. CONCLUSIONS With some adjustments to recruitment procedures, a full scale randomized controlled trial of online ACT for provoked vestibulodynia appears feasible.
Collapse
Affiliation(s)
- Pernilla Maathz
- Department of Psychology, Division of Clinical Psychology, Uppsala University, Uppsala, Sweden
| | - Lance M McCracken
- Department of Psychology, Division of Clinical Psychology, Uppsala University, Uppsala, Sweden
| | - Viktor Eriksson
- Department of Psychology, Division of Clinical Psychology, Uppsala University, Uppsala, Sweden
| | - Fredrika Säde
- Department of Psychology, Division of Clinical Psychology, Uppsala University, Uppsala, Sweden
| | - Gunilla Aneblom
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Åsa Rikner
- Women's Health, University Hospital, Uppsala, Sweden
| | - Alkistis Skalkidou
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Monica Buhrman
- Department of Psychology, Division of Clinical Psychology, Uppsala University, Uppsala, Sweden
| |
Collapse
|
14
|
Hess Engström A, Bohm-Starke N, Buhrman M, Högberg U, Skalkidou A, Lagenskiöld S. Health economic evaluation of a randomized controlled trial (EMBLA study), an internet-based treatment for provoked vulvodynia. Sci Rep 2023; 13:6242. [PMID: 37069199 PMCID: PMC10110522 DOI: 10.1038/s41598-023-33406-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 04/12/2023] [Indexed: 04/19/2023] Open
Abstract
Internet-based treatment (IBT) for provoked vulvodynia (PVD) may reduce pain during intercourse and increases pain acceptance. However, a there is still a knowledge gap regarding the cost-effectiveness of IBT for PVD. The aim of this study was to perform a health economic evaluation of guided internet-based intervention for PVD as an addition to standard treatment. The sample consisted of 99 women with a PVD diagnosis. Healthcare related costs, health-related quality of life, and quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratio (ICER) were analyzed. After the IBT, the intervention group had fewer visits to a midwife than the control group (p = 0.03), but no between-group differences were found for visits to other professionals, treatment length, health-related quality of life, QALYs, and costs for treatment. It was estimated a cost of 260.77 € for a clinical meaningful change in pain acceptance. Internet-based treatment as add-on to clinical treatment may lower number of visits to a healthcare.
Collapse
Affiliation(s)
- A Hess Engström
- Department of Women's and Children's Health, Uppsala University, BOX 593, 751 24, Uppsala, Sweden.
- Centre for Clinical Research, Västmanland County Hospital, Uppsala University, Västerås, Sweden.
| | - N Bohm-Starke
- Division of Obstetrics and Gynecology, Department of Clinical Sciences, Karolinska Institute, Solna, Sweden
| | - M Buhrman
- Division Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - U Högberg
- Department of Women's and Children's Health, Uppsala University, BOX 593, 751 24, Uppsala, Sweden
| | - A Skalkidou
- Department of Women's and Children's Health, Uppsala University, BOX 593, 751 24, Uppsala, Sweden
| | - S Lagenskiöld
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| |
Collapse
|
15
|
Clason van de Leur J, Johansson F, McCracken LM, Åhs F, Brodda Jansen G, Buhrman M. Predictors and sub-groups in the treatment of stress-induced exhaustion disorder. Cogn Behav Ther 2023:1-22. [PMID: 37039046 DOI: 10.1080/16506073.2023.2197148] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
Little is known about psychological interventions for stress-induced Exhaustion disorder (ED), and there is a need for more research to improve the outcomes obtained in treatments. The present study examines predictors of improvement, including sub-group responses, in a large sample of ED patients receiving a Multimodal intervention (MMI) based on Cognitive Behavior Therapy (N = 915). In step one, available variables were explored separately as predictors of improvement in ED symptoms. In step two, sub-groups were explored through Latent Class Analysis to reduce the heterogeneity observed in the larger group and to investigate whether combining the variables from step one predicted symptom improvement. Younger age, no previous sick leave due to ED, and scoring high on anxiety, depression, insomnia, perfectionism, and treatment credibility emerged as separate predictors of improvement. In the sub-group analyses, a sub-group including participants who were single and had a lower income showed less improvement. Overall, people with ED participating in MMI report symptom improvement regardless of characteristics before treatment. However, the present findings do have the potential to inform future treatments for ED, as they highlight perfectionism as a predictor of improvement and the importance of assessing treatment credibility during treatment.
Collapse
Affiliation(s)
| | - Fred Johansson
- Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden
| | | | - Fredrik Åhs
- Department of Psychology and Social Work, Mid Sweden University, Östersund, Sweden
| | - Gunilla Brodda Jansen
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Karolinska Institutet Danderyds University Hospital, Stockholm, Sweden
| | - Monica Buhrman
- Department of Psychology, Uppsala University, Uppsala, Sweden
| |
Collapse
|
16
|
Tabrizi FF, Larsson AB, Grönvall H, Söderstrand L, Hallén E, Champoux-Larsson MF, Lundgren T, Sundström F, Lavefjord A, Buhrman M, Sundin Ö, McCracken L, Åhs F, Jansson B. Psychometric evaluation of the Swedish Multidimensional Psychological Flexibility Inventory (MPFI). Cogn Behav Ther 2022:1-22. [PMID: 36562150 DOI: 10.1080/16506073.2022.2153077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Psychiatric disorders are common, and reliable measures are crucial for research and clinical practice. A cross-diagnostic construct that can be used to index treatment outcomes as well as prevalence of psychological ill health is psychological flexibility. The aim of this study was to validate a Swedish version of the Multidimensional Psychological Flexibility Inventory (MPFI). The MPFI has 12 subscales, six of which measure flexibility, and six that measure inflexibility. Using confirmatory factor analysis in a community sample of 670 participants, we found that a model with two higher order factors had satisfactory fit (CFI = .933) and a 12-factor model had the best fit to the data (CFI = .955). All 12 subscales showed adequate reliability (CRs = .803-.933) and the factor structure was similar across age groups and gender. Findings suggest that the Swedish version of the MPFI is a reliable instrument that can be used to index psychological flexibility. Potential areas for improvement of the instrument are discussed.
Collapse
Affiliation(s)
- Fara F Tabrizi
- Department of Psychology & Social Work, Mittuniversitetet, Östersund, Sweden
| | - Andreas B Larsson
- Department of Psychology & Social Work, Mittuniversitetet, Östersund, Sweden
| | - Hampus Grönvall
- Department of Psychology & Social Work, Mittuniversitetet, Östersund, Sweden
| | - Lux Söderstrand
- Department of Psychology & Social Work, Mittuniversitetet, Östersund, Sweden
| | - Ellen Hallén
- Department of Psychology & Social Work, Mittuniversitetet, Östersund, Sweden
| | | | - Tobias Lundgren
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm, Sweden
| | - Felicia Sundström
- Department of Psychology, Clinical Psychology, Uppsala Universitet, Uppsala, Sweden
| | - Amani Lavefjord
- Department of Psychology, Clinical Psychology, Uppsala Universitet, Uppsala, Sweden
| | - Monica Buhrman
- Department of Psychology, Clinical Psychology, Uppsala Universitet, Uppsala, Sweden
| | - Örjan Sundin
- Department of Psychology & Social Work, Mittuniversitetet, Östersund, Sweden
| | - Lance McCracken
- Department of Psychology, Clinical Psychology, Uppsala Universitet, Uppsala, Sweden
| | - Fredrik Åhs
- Department of Psychology & Social Work, Mittuniversitetet, Östersund, Sweden
| | - Billy Jansson
- Department of Psychology & Social Work, Mittuniversitetet, Östersund, Sweden
| |
Collapse
|
17
|
Sundström FTA, Lavefjord A, Buhrman M, McCracken LM. Assessing Psychological Flexibility and Inflexibility in Chronic Pain Using the Multidimensional Psychological Flexibility Inventory (MPFI). The Journal of Pain 2022; 24:770-781. [PMID: 36442815 DOI: 10.1016/j.jpain.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 11/11/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
Psychological flexibility (PF) is a model of well-being and daily functioning that is applied to chronic pain, and is the model behind Acceptance and Commitment Therapy (ACT). However, studies of PF in chronic pain are limited by the lack of a single measure capturing all facets. The Multidimensional Psychological Flexibility Inventory (MPFI) assesses all facets of PF and psychological inflexibility (PI) and could remedy this problem. The current study employs this measure. Adult participants with chronic pain (N = 404) were recruited online and completed the MPFI, other validated measures of PF/PI, and measures of pain, work and social adjustment, and depression, at two time points. The reliability, factor structure, and validity of the MPFI were assessed. Confirmatory factor analysis results demonstrated a good model fit for the proposed factor-and subscale structure. Correlations between MPFI and theoretically similar measures were moderate to strong, and correlations with pain intensity, pain interference, work-and social adjustment, and depression, were small to large. In this first examination of the potential utility of the MPFI within a chronic pain population, we found it to be valid and reliable. It should be noted that the MPFI was less predictive of outcomes compared with more established measures in most cases. Despite this, results from the wide range of variables available from the MPFI highlights the potential importance of aspects of PF and PI not previously emphasized, including the greater predictive utility of the inflexibility facets. Further use and study of the MPFI is recommended. ClinicalTrials.gov ID: NCT05050565 PERSPECTIVE: This article presents a comprehensive examination of a self-report measure assessing all facets of psychological flexibility and inflexibility, in a chronic pain sample. The results support the role of facets not previously emphasized. Comprehensive assessment of PF and PI appears possible and is recommended depending on research questions being asked.
Collapse
|
18
|
McCracken LM, Buhrman M, Badinlou F, Brocki KC. Health, well-being, and persisting symptoms in the pandemic: What is the role of psychological flexibility? J Contextual Behav Sci 2022; 26:187-192. [PMID: 36247216 PMCID: PMC9554036 DOI: 10.1016/j.jcbs.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 11/07/2022]
Abstract
Finding psychological factors that can reduce the substantial impact of COVID-19 on mental and physical health is important. Here we replicate and expand a previous study regarding the role of psychological flexibility (PF) in this context. We employed a comprehensive and well validated measure of PF and examined its role in relation to health outcomes and persistent post COVID-19 symptoms. 1174 participants completed standardized measures of depression, anxiety, insomnia and the Multidimensional Psychological Flexibility Inventory (MPFI), and reported the presence of persistent symptoms associated with "long COVID." All PF and psychological inflexibility (PI) facets, except for acceptance, correlated with the three mental health outcomes and with persistent symptoms. PF and PI accounted for significant variance in depression, anxiety, and insomnia after adjusting for background and health status variables. A notable finding was the particularly stronger correlations obtained for the PI facets. Our findings emphasize the potentially mitigating effects of PF on mental ill health, as well as the particularly aggravating effects of PI, in the pandemic context. A novel finding is the significant association of PI with persisting symptoms of COVID.
Collapse
Affiliation(s)
- Lance M. McCracken
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Monica Buhrman
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Farzaneh Badinlou
- Division of Emotion Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Karin C. Brocki
- Division of Emotion Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden,Corresponding author. Department of Psychology, Uppsala University, Box 1225, 751 42, Uppsala, Sweden
| |
Collapse
|
19
|
Hess Engström A, Bohm-Starke N, Kullinger M, Högberg U, Buhrman M, Skalkidou A, Widarsson M. Experiences of internet-based treatment for vulvodynia: A qualitative study. Sex Reprod Healthc 2022; 33:100756. [PMID: 35870352 DOI: 10.1016/j.srhc.2022.100756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 06/17/2022] [Accepted: 07/07/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE The aim of this study was to describe women's experiences before, under, and after a guided internet-based intervention for vulvodynia. METHODS The design was qualitative, based on content analysis. Participants were women who had undergone guided internet-based treatment for vulvodynia based on acceptance and commitment therapy principles (n = 13). Data were collected through in-depth interviews approximately-one month after participants completed treatment. RESULTS The analysis revealed the women's experiences of internet-based treatment for vulvodynia. Three themes emerged: "dealing with pain alone," which was related to experiences of living with vulvodynia before internet-based treatment; "finding new ways," which described the experiences of undergoing an internet-based treatment for vulvodynia and "feeling empowered to take control," referring to the experiences of living with vulvodynia after the internet-based treatment. The women described a long search for a diagnosis, revealing a negative experience of healthcare. The internet-based treatment helped them find new ways to manage vulvodynia, but difficulties with the treatment were also experienced. After the intervention, the women reported improvements in wellbeing and having better strategies to manage pain, but also stated that the treatment was insufficient to perceive changes in vulvar pain. CONCLUSIONS The guided internet-based treatment program for vulvodynia based on acceptance and commitment therapy principles was perceived as credible, helpful to manage vulvodynia, and could serve as a complement to regular care. Questions regarding the need for more support and optimal length of treatment need to be further evaluated.
Collapse
Affiliation(s)
- Andrea Hess Engström
- Uppsala University, Center for Clinical Research, Västmanland County Hospital, Västerås, Sweden; Uppsala University, Department of Women's and Children's Health, Uppsala, Sweden.
| | - Nina Bohm-Starke
- Karolinska Institute, Department of Clinical Sciences, Division of Obstetrics and Gynecology, Solna, Sweden; Danderyd Hospital, Stockholm, Sweden.
| | - Merit Kullinger
- Uppsala University, Center for Clinical Research, Västmanland County Hospital, Västerås, Sweden; Uppsala University, Department of Women's and Children's Health, Uppsala, Sweden.
| | - Ulf Högberg
- Uppsala University, Department of Women's and Children's Health, Uppsala, Sweden; Umeå University, Department of Epidemiology and Global Health, Umeå, Sweden.
| | - Monica Buhrman
- Uppsala University, Department of Psychology, Division of Clinical Psychology, Uppsala, Sweden.
| | - Alkistis Skalkidou
- Uppsala University, Department of Women's and Children's Health, Uppsala, Sweden.
| | - Margareta Widarsson
- Mälardalen University, School of Health, Care and Social Welfare, Division of Caring Sciences, Västerås, Sweden.
| |
Collapse
|
20
|
Gasslander N, Andersson G, Boström F, Brandelius L, Pelling L, Hamrin L, Gordh T, Buhrman M. Tailored internet-based cognitive behavioral therapy for individuals with chronic pain and comorbid psychological distress: a randomized controlled trial. Cogn Behav Ther 2022; 51:408-434. [PMID: 35533363 DOI: 10.1080/16506073.2022.2065528] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Comorbid psychological problems are commonly related to chronic pain but addressing heterogeneous comorbidities in traditional settings is often difficult. Delivering individually tailored treatment using the internet could be a viable alternative. The present study investigates whether a guided, individually tailored and internet-delivered cognitive behavioral therapy (ICBT) could improve mood and reduce disability in individuals suffering from chronic pain and comorbid psychological distress.Participants were recruited from a pain clinic and randomized to either ICBT or waiting list. The participants (n = 187) individually tailored treatments included 6-13 modules targeting different types of psychological distress. Modules were designed to be completed weekly, and feedback was provided by clinicians. Participants completed an average of 5.1 (49.7%) modules, with 22.9% completing all assigned modules. Intention-to-treat analyses showed significantly larger improvements in depression, disability, pain acceptance, catastrophizing, and quality of life in the ICBT-group compared to the control group. Between-group effect sizes were very small or small at post for the primary outcomes depression (d = 0.18) and pain interference (d = 0.22). Other effect sizes ranged from very small to small, with the largest effect being improvements in pain acceptance (d = 0.3). All significant changes were stable at 12-month follow up.
Collapse
Affiliation(s)
- Nils Gasslander
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Frida Boström
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Lisa Brandelius
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Lotta Pelling
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Lovisa Hamrin
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Torsten Gordh
- Department of Surgical Sciences, Pain Research, Uppsala University, Uppsala, Sweden
| | - Monica Buhrman
- Department of Psychology, Uppsala University, Uppsala, Sweden
| |
Collapse
|
21
|
Hess Engström A, Bohm-Starke N, Kullinger M, Hesselman S, Högberg U, Buhrman M, Skalkidou A. Internet-based Treatment for Vulvodynia (EMBLA) - A Randomized Controlled Study. J Sex Med 2022; 19:319-330. [PMID: 34972640 DOI: 10.1016/j.jsxm.2021.11.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 11/22/2021] [Accepted: 11/29/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Internet-based ACT (Acceptance and commitment therapy) treatment may improve accessibility and reduce stigma related to seeking health care, but there are a lack of studies investigating internet-based treatment using ACT principles for women with vulvodynia. AIM The aim of this study was to investigate the effects of an internet-based treatment of pain during intercourse for women with provoked vulvodynia compared with no intervention during the waiting period before clinical treatment. METHODS A multicenter randomized controlled trial was conducted during 2016 to 2020, in which 99 participants were included. Participants were randomized to either a 6 week guided internet-based treatment using ACT principles or usual care. Data were collected at baseline, 6 weeks after baseline, and approximately 10 months after baseline. OUTCOMES Pain-related (pain during intercourse, tampon test, impact of pain on sexual function) and pain behavior-related outcomes (attempts at intercourse, sexual activities besides intercourse, willingness to perform the tampon test, chronic pain acceptance questionnaire) were used as outcomes. RESULTS Treatment was efficacious in what concerns pain during intercourse and pain acceptance. Less pain during intercourse among women in the intervention group was observed at both post-treatment (primary endpoint, P = .01, Cohen's d = 1.4, 95% CI = 0.33, 2.4), and follow-up (P = .04). Absolut mean difference between groups for pain during intercourse at post-treatment was -2.84, (95 % CI = -4.91, -0.78), and -1.58 at follow-up, (95 % CI = -3.17, 0.02), where the intervention group rated less pain than controls. No differences between groups over time were found for tampon test measures or impact of pain on sexual function. There was a significant difference between groups at all timepoints indicating fewer attempts at intercourse among participants in the intervention group. At post-treatment, women who underwent internet-based treatment reported higher pain acceptance and a rise in activity engagement compared with the control group. CLINICAL IMPLICATIONS There is an indication that internet-based treatment could be incorporated into clinical practice as a complement to clinical treatment. STRENGTHS & LIMITATIONS Study strengths included using several forms of recruitment and an intervention built by different professions with long experience of treating patients with vulvodynia. High dropout rate was a limitation of this study. CONCLUSION Internet-based treatment may have an impact on pain during intercourse and positive effects on pain acceptance. However, conclusions must be drawn with caution due to the small sample size. Engström AH, Bohm-Starke N, Kullinger M, et al. Internet-based Treatment for Vulvodynia (EMBLA) - A Randomized Controlled Study. J Sex Med 2022;19:319-330.
Collapse
Affiliation(s)
- Andrea Hess Engström
- Uppsala University, Center for Clinical Research, Västmanland County Hospital, Västerås, Sweden; Uppsala University, Department of Women's and Children's Health, Uppsala, Sweden.
| | - Nina Bohm-Starke
- Karolinska Institute, Department of Clinical Sciences, Division of Obstetrics and Gynecology, Solna, Sweden; Danderyd Hospital, Stockholm, Sweden
| | - Merit Kullinger
- Uppsala University, Center for Clinical Research, Västmanland County Hospital, Västerås, Sweden; Uppsala University, Department of Women's and Children's Health, Uppsala, Sweden
| | - Susanne Hesselman
- Uppsala University, Department of Women's and Children's Health, Uppsala, Sweden; Uppsala University, Center for Clinical Research, Falun, Sweden
| | - Ulf Högberg
- Uppsala University, Department of Women's and Children's Health, Uppsala, Sweden; Umeå University, Department of Epidemiology and Global Health, Umeå, Sweden
| | - Monica Buhrman
- Uppsala University, Department of Psychology, Division of Clinical Psychology, Uppsala, Sweden
| | - Alkistis Skalkidou
- Uppsala University, Department of Women's and Children's Health, Uppsala, Sweden. https://twitter.com/ASkalkidou
| |
Collapse
|
22
|
Gasslander N, Alfonsson S, Jackalin A, Tengberg C, Håkansson J, Huotari L, Buhrman M. Predictors of adherence to an internet-based cognitive behavioral therapy program for individuals with chronic pain and comorbid psychological distress. BMC Psychol 2021; 9:156. [PMID: 34641946 PMCID: PMC8507117 DOI: 10.1186/s40359-021-00663-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/22/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The burden caused by chronic pain is significant, affecting at least 10 percent of the world´s population. While internet-based treatments based on cognitive behavioral therapy (CBT) have been shown to be promising in this area, attrition levels vary significantly. The purpose of this study was to investigate predictor variables for participants' adherence to an internet-based CBT treatment for individuals with chronic pain as well as to investigate associations between adherence and treatment outcome. METHODS Data for this study was retrieved from a randomized controlled trial including 95 individuals with chronic pain who received internet-based CBT. Treatment adherence was studied through three outcome variables: treatment progress, treatment completion and exercise completion. The predictor variables were grouped into four clusters: background variables (age, gender, marital status, level of education, and typical computer usage); the second cluster included health status variables (sick leave, current psychiatric diagnosis, previous psychotherapy for pain, current pharmacological treatment, previous depression, current depression, and current depressive symptoms); the third cluster included pain-related variables (opioid medication, history of pain, and pain symptoms) and the fourth cluster included motivation variables (measured with treatment preference, treatment credibility, compliance to the treatment schedule and contact with the therapists). RESULTS Findings showed that treatment progress was predicted by higher treatment credibility at baseline, whereas participants who were behind schedule in the second week of the program finished fewer treatment modules. When analyzing each cluster of predictor variables separately, current depressive symptoms also predicted fewer completed treatment modules. Among the pain-related variables, higher pain acceptance was the only predictor for completing more treatment modules. Treatment completion (which in this study was defined as having completed at least 75% of treatment modules) was predicted by higher treatment credibility and fewer depressive symptoms at baseline, and was thus similar to the results regarding treatment progress. Finally, all adherence variables predicted the treatment outcome pain interference. CONCLUSIONS Low treatment credibility, depressive symptoms and falling behind the treatment schedule early on were the most important predictor variables for low treatment adherence, while a number of demographical and pain-related variables were not related to adherence. The results from this study may help clinicians identify patients who are less likely to complete, and thus benefit from, their pain treatment. Trial registration ClinicalTrials.gov NTC03316846.
Collapse
Affiliation(s)
- Nils Gasslander
- Department of Psychology, Uppsala University, P.O. Box 1225, 751 42, Uppsala, Sweden.
| | - Sven Alfonsson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Amanda Jackalin
- Department of Psychology, Uppsala University, P.O. Box 1225, 751 42, Uppsala, Sweden
| | - Cecilia Tengberg
- Department of Psychology, Uppsala University, P.O. Box 1225, 751 42, Uppsala, Sweden
| | - Johanna Håkansson
- Department of Psychology, Uppsala University, P.O. Box 1225, 751 42, Uppsala, Sweden
| | - Linda Huotari
- Department of Psychology, Uppsala University, P.O. Box 1225, 751 42, Uppsala, Sweden
| | - Monica Buhrman
- Department of Psychology, Uppsala University, P.O. Box 1225, 751 42, Uppsala, Sweden
| |
Collapse
|
23
|
Lavefjord A, Sundström FT, Buhrman M, McCracken LM. Assessment methods in single case design studies of psychological treatments for chronic pain: A scoping review. Journal of Contextual Behavioral Science 2021. [DOI: 10.1016/j.jcbs.2021.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
24
|
Hess Engström AH, Kullinger M, Jawad I, Hesselman S, Buhrman M, Högberg U, Skalkidou A. Internet-based treatment for vulvodynia (EMBLA) - Study protocol for a randomised controlled study. Internet Interv 2021; 25:100396. [PMID: 33996511 PMCID: PMC8091887 DOI: 10.1016/j.invent.2021.100396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 04/10/2021] [Accepted: 04/12/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Vulvodynia is defined as vulvar pain for at least 3 months without a clear cause. To the best of our knowledge, there are no trials investigating the effects of internet treatment using CBT (Cognitive behavioural therapy) treatment with Acceptance and Commitment Therapy (ACT) components for women with vulvodynia. The aim of this study is to examine the effects of such a guided internet-based intervention on provoked vulvar pain during the waiting period before clinical treatment. METHODS We will randomise 52 patients to either guided internet-based intervention with CBT with (ACT) components or no intervention during the waiting period for treatment as usual. Online assessments are conducted at baseline, posttreatment, and at follow-up after 9 months. The primary outcome measure is provoked vulvar pain. Secondary outcomes are depression, anxiety, sexual function, and quality of life. Linear-mixed effect models will be used to assess the effect of the internet-based intervention on vulvar pain, pain acceptance, depression, anxiety, sexual function, and quality of life over time, by applying the intention-to-treat approach. Continuous data will be analysed with general linear models using intention-to-treat and also per protocol approaches to assess the effects of the intervention at different time points. Ordinal and binary data will be analysed with Mann Whitney's test, Fischer's exact test and multivariate logistic regression, respectively. DISCUSSION As a randomised controlled trial with short- and long-term follow-up points, the EMBLA study intends to provide a novel and better understanding regarding the treatment of vulvodynia and the role of internet-based treatment as a complement to standard care for women suffering from vulvodynia. The effects of vulvodynia on pain, sexual function, quality of life, depression, and anxiety are investigated. The study's results are expected to be of value in the planning of clinical care in the medical area. High dropout rates and technical difficulties associated with using the platform are common in similar studies. TRIAL REGISTRATION NUMBER NCT02809612.
Collapse
Key Words
- ACT, Acceptance and commitment therapy
- Acceptance and commitment therapy
- BAI, Beck Anxiety Inventory
- CBT, Cognitive Behavioural therapy
- CPAQ, Chronic Pain Acceptance questionnaire
- EQ5-D, EuroQol-5-dimension questionnaire
- ESSI, ENRICHD Social Support Instrument
- FSDS-R, Female Sexual Distress Scale – Revised
- FSFI, Female Sexual Function Index
- Internet-based
- LOCF, last observation carried forward
- MADRS-S, Montgomery-Åsberg Depression Rating Scale
- Randomised controlled trial
- SWLS, Satisfaction with Life Scale
- Vulvodynia
- rDAS, Revised Dyadic Adjustment Scale
Collapse
Affiliation(s)
- Andrea Hess Hess Engström
- Centre for Clinical Research, Västmanland County Hospital, Västerås, Sweden,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden,Corresponding author at: Centre for Clinical Research, Västmanland County Hospital, Västerås, Sweden.
| | - Merit Kullinger
- Centre for Clinical Research, Västmanland County Hospital, Västerås, Sweden,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Izabella Jawad
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Susanne Hesselman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden,Center for clinical research, Uppsala University, Falun, Sweden
| | - Monica Buhrman
- Department of Psychology, Division of Clinical Psychology, Uppsala University, Uppsala, Sweden
| | - Ulf Högberg
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Alkistis Skalkidou
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| |
Collapse
|
25
|
van de Leur JC, Buhrman M, Åhs F, Rozental A, Jansen GB. Standardized multimodal intervention for stress-induced exhaustion disorder: an open trial in a clinical setting. BMC Psychiatry 2020; 20:526. [PMID: 33153461 PMCID: PMC7643309 DOI: 10.1186/s12888-020-02907-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 09/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Long-term sick-leave due to stress-related ill-health is increasing in several economically developed countries. Even though different forms of interventions are administered in regular care for stress-related disorders, such as Stress-induced Exhaustion disorder (SED), the scientific evidence for the effectiveness of such treatments is sparse. The objective of this study was to explore changes in SED-symptoms and return-to-work-rates in a large group of SED-patients participating in a standardized Multimodal intervention (MMI) in a clinical setting. METHOD This open clinical trial tracked 390 patients who fulfilled the criteria for SED undergoing a 24-week MMI, including return-to-work-strategies. Before inclusion, all patients underwent a multi-professional assessment by a team of licensed physicians, licensed psychologists, and licensed physiotherapists. Self-rated questionnaires were administered before treatment, at treatment-start, mid-treatment, post-treatment, and at 12-month follow-up. Within-group change was evaluated over time with mixed-effects models. Beyond different symptoms, working time, sick-leave compensation, and adverse effects were also measured. RESULTS There were significant improvements in symptoms of SED, burnout, anxiety, depression, and insomnia, with large within-group effect sizes (d = 0.91-1.76), improvements that were maintained at 12-month follow-up. Furthermore, there was a significant increase in quality of life and large improvements in average working time and sick-leave compensation. Some adverse effects were reported, mainly concerning an increase in stress, anxiety, and worry. CONCLUSION SED-patients participating in this standardized MMI reported large symptom alleviation, increased working time and reduced sick-leave compensation, indicating a beneficial treatment. There were some adverse effects, but no more so than other psychological treatments. This study confirms previous findings that high levels of depression and anxiety decrease to sub-clinical levels during treatment, while symptoms of SED also decline, yet still persists above sub-clinical levels at 12-month follow-up. On the whole, this open clinical trial suggests that a standardized MMI, administered in a clinical setting, improves symptoms and return-to-work rates in a clinically representative SED-population. TRIAL REGISTRATION This study was registered on Clinicaltrials.gov 2017.12.02 (Identifier: NCT03360136 ).
Collapse
Affiliation(s)
| | - Monica Buhrman
- grid.8993.b0000 0004 1936 9457Department of Psychology, Uppsala University, Von Kraemers allé 1A, SE-752 37 Uppsala, Sweden
| | - Fredrik Åhs
- grid.29050.3e0000 0001 1530 0805Department of Psychology and Social Work, Mid Sweden University, Kunskapens väg 1, SE- 831 40 Östersund, Sweden
| | - Alexander Rozental
- grid.4714.60000 0004 1937 0626Department of Clinical Neuroscience, Karolinska Institute, Tomtebodavägen 18A, SE-171 76 Stockholm, Sweden
| | - Gunilla Brodda Jansen
- grid.4714.60000 0004 1937 0626Division of Rehabilitation Medicine, Department of Clinical Sciences, Karolinska Institute Danderyds University Hospital, SE-182 57 Stockholm, Sweden
| |
Collapse
|
26
|
Buhrman M, Gelberg O, Jovicic F, Molin K, Forsström D, Andersson G, Carlbring P, Shafran R, Rozental A. Treating perfectionism using internet-based cognitive behavior therapy: A study protocol for a randomized controlled trial comparing two types of treatment. Internet Interv 2020; 21:100338. [PMID: 32944504 PMCID: PMC7481556 DOI: 10.1016/j.invent.2020.100338] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/14/2020] [Accepted: 08/18/2020] [Indexed: 12/13/2022] Open
Abstract
Perfectionism is characterized by setting high standards and striving for achievement, sometimes at the expense of social relationships and wellbeing. Despite sometimes being viewed as a positive feature by others, people with perfectionism tend to be overly concerned about their performance and how they are being perceived by people around them. This tends to create inflexible standards, cognitive biases, and performance-related behaviors that maintain a belief that self-worth is linked to accomplishments. Cognitive behavior therapy has been shown to be a viable treatment for perfectionism, both in terms of reducing levels of perfectionism and improving psychiatric symptoms. Furthermore, a number of recent studies indicate that it can be successfully delivered via the Internet, both with regular support and guidance on demand from a therapist. In the present study protocol, a clinical trial for perfectionism is described and outlined. In total, 128 participants will be recruited and randomized to either a treatment that has already been demonstrated to have many benefits, Internet-based Cognitive Behavior Therapy for perfectionism (iCBT-P), or an active comparison condition, Internet-based Unified Protocol (iUP), targeting the emotions underlying depression and anxiety disorders. The results will be investigated with regard to self-reported outcomes of perfectionism, psychiatric symptoms, self-compassion, and quality of life, at post-treatment and at six- and 12-month follow-up. Both iCBT-P and iUP are expected to have a positive impact, but the difference between the two conditions in terms of their specific effects and adherence are currently unknown and will be explored. The clinical trial is believed to lead to a better understanding of how perfectionism can be treated and the specificity of different treatments.
Collapse
Affiliation(s)
| | - Olle Gelberg
- Department of Psychology, Uppsala University, Sweden
| | - Filip Jovicic
- Department of Psychology, Uppsala University, Sweden
| | | | - David Forsström
- Department of Clinical Neuroscience, Karolinska Institutet, Sweden
- Department of Psychology, Stockholm University, Sweden
| | - Gerhard Andersson
- Department of Clinical Neuroscience, Karolinska Institutet, Sweden
- Department of Behavioural Sciences and Learning, Linköping University, Sweden
| | - Per Carlbring
- Department of Psychology, Stockholm University, Sweden
| | - Roz Shafran
- UCL Great Ormond Street Institute of Child Health, University College London, UK
| | - Alexander Rozental
- Department of Clinical Neuroscience, Karolinska Institutet, Sweden
- UCL Great Ormond Street Institute of Child Health, University College London, UK
| |
Collapse
|
27
|
McCracken LM, Badinlou F, Buhrman M, Brocki KC. Psychological impact of COVID-19 in the Swedish population: Depression, anxiety, and insomnia and their associations to risk and vulnerability factors. Eur Psychiatry 2020; 63:e81. [PMID: 32843115 PMCID: PMC7503043 DOI: 10.1192/j.eurpsy.2020.81#] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The 2019 coronavirus disease (COVID-19) pandemic, with its associated restrictions on daily life, is like a perfect storm for poor mental health and wellbeing. The purpose of this study was therefore to examine the impacts of COVID-19 on mental health and wellbeing during the ongoing pandemic in Sweden. METHOD Standardized measures of depression, anxiety, and insomnia as well as measures of risk and vulnerability factors known to be associated with poor mental health outcomes were administered through a national, online, cross-sectional survey (n = 1,212; mean age 36.1 years; 73% women). RESULT Our findings show significant levels of depression, anxiety, and insomnia in Sweden, at rates of 30%, 24.2%, and 38%, respectively. The strongest predictors of these outcomes included poor self-rated overall health and a history of mental health problems. The presence of COVID-19 symptoms and specific health and financial worries related to the pandemic also appeared important. CONCLUSIONS The impacts of COVID-19 on mental health in Sweden are comparable to impacts shown in previous studies in Italy and China. Importantly, the pandemic seems to impose most on the mental health of those already burdened with the impacts of mental health problems. These results provide a basis for providing more support for vulnerable groups, and for developing psychological interventions suited to the ongoing pandemic and for similar events in the future.
Collapse
Affiliation(s)
- Lance M. McCracken
- Division for Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Farzaneh Badinlou
- Division for Emotion Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Monica Buhrman
- Division for Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Karin C. Brocki
- Division for Emotion Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden.,Karin C. Brocki, E-mail:
| |
Collapse
|
28
|
McCracken LM, Badinlou F, Buhrman M, Brocki KC. Psychological impact of COVID-19 in the Swedish population: Depression, anxiety, and insomnia and their associations to risk and vulnerability factors. Eur Psychiatry 2020; 63:e81. [PMID: 32843115 PMCID: PMC7503043 DOI: 10.1192/j.eurpsy.2020.81] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/23/2020] [Accepted: 08/23/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The 2019 coronavirus disease (COVID-19) pandemic, with its associated restrictions on daily life, is like a perfect storm for poor mental health and wellbeing. The purpose of this study was therefore to examine the impacts of COVID-19 on mental health and wellbeing during the ongoing pandemic in Sweden. METHOD Standardized measures of depression, anxiety, and insomnia as well as measures of risk and vulnerability factors known to be associated with poor mental health outcomes were administered through a national, online, cross-sectional survey (n = 1,212; mean age 36.1 years; 73% women). RESULT Our findings show significant levels of depression, anxiety, and insomnia in Sweden, at rates of 30%, 24.2%, and 38%, respectively. The strongest predictors of these outcomes included poor self-rated overall health and a history of mental health problems. The presence of COVID-19 symptoms and specific health and financial worries related to the pandemic also appeared important. CONCLUSIONS The impacts of COVID-19 on mental health in Sweden are comparable to impacts shown in previous studies in Italy and China. Importantly, the pandemic seems to impose most on the mental health of those already burdened with the impacts of mental health problems. These results provide a basis for providing more support for vulnerable groups, and for developing psychological interventions suited to the ongoing pandemic and for similar events in the future.
Collapse
Affiliation(s)
- Lance M. McCracken
- Division for Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Farzaneh Badinlou
- Division for Emotion Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Monica Buhrman
- Division for Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Karin C. Brocki
- Division for Emotion Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| |
Collapse
|
29
|
Bendelin N, Björkdahl P, Risell M, Nelson KZ, Gerdle B, Andersson G, Buhrman M. Patients' experiences of internet-based Acceptance and commitment therapy for chronic pain: a qualitative study. BMC Musculoskelet Disord 2020; 21:212. [PMID: 32252707 PMCID: PMC7137329 DOI: 10.1186/s12891-020-03198-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 03/10/2020] [Indexed: 12/22/2022] Open
Abstract
Background Chronic pain is a globally widespread condition with complex clusters of symptoms within a heterogeneous patient group. Internet-delivered Acceptance and Commitment Therapy (IACT) has shown promising results in the treatment of chronic pain. How IACT is experienced by patients is less well known. Qualitative studies of patients’ experiences are needed to further understand factors behind both engagement and negative effects. The aim of this study was to explore how IACT was experienced by chronic pain patients who had participated in a controlled trial. Methods Through an open and exploratory approach this study aimed to investigate how IACT was experienced when delivered as a guided self-help program to persons with chronic pain. Eleven participants were interviewed over telephone after completing IACT. Results Qualitative analysis based on grounded theory resulted in 2 core categories and 8 subcategories. In treatment: Physical and cognitive restraints, Time and deadline, Therapist contact, and Self-confrontation. After treatment: Attitude to pain, Image of pain, Control or Command, and Acting with pain. Individual differences as well as specific conditions of the treatment may explain variations in how the treatment was approached, experienced and what consequences it led to. Therapist guidance and deadlines for homework play complex roles in relation to autonomy and change. Conclusions Adjusting treatment content and format based on participants’ characteristics, such as expectations, motivation and restraints, might positively affect engagement, autonomy and change. Further research on attrition and negative effects of treatment might clarify what enables chronic pain patients to benefit from IACT. Trial registration clinicaltrials.gov (NCT01603797). Registered 22 May 2012. Retrospectively registered.
Collapse
Affiliation(s)
- Nina Bendelin
- Pain and Rehabilitation Center, and Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 85, Linköping, Sweden.
| | - Pär Björkdahl
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Mimmi Risell
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | | | - Björn Gerdle
- Pain and Rehabilitation Center, and Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 85, Linköping, Sweden
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.,Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Monica Buhrman
- Department of Psychology, Uppsala University, Uppsala, Sweden
| |
Collapse
|
30
|
Wurm M, Klein Strandberg E, Lorenz C, Tillfors M, Buhrman M, Holländare F, Boersma K. Internet delivered transdiagnostic treatment with telephone support for pain patients with emotional comorbidity: a replicated single case study. Internet Interv 2017; 10:54-64. [PMID: 30135753 PMCID: PMC6084869 DOI: 10.1016/j.invent.2017.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 10/06/2017] [Accepted: 10/24/2017] [Indexed: 11/24/2022] Open
Abstract
In pain patients, comorbid emotional problems have been linked to negative outcomes, including suboptimal treatment gains. Developing parsimonious and accessible treatment options is therefore important. The overarching aim of this study was to test an internet delivered therapist guided transdiagnostic treatment with telephone support. An adapted version of the Unified Protocol for Transdiagnostic Treatments of Emotional Disorders was used as an intervention for pain patients with residual pain problems and comorbid emotional problems after having received a multimodal pain rehabilitation. The study used a replicated AB single case experimental design (N = 5; 3 females). Outcome measures were depressive and general anxiety symptoms, pain intensity, pain coping problems, and diagnostic status. Feasibility measures (completion and compliance) and patient satisfaction were also assessed. Scores on Nonoverlap of All Pairs (NAP) indicate a decrease of anxiety for three participants and a decrease of depression for four participants. Decreases were small and did not always reach statistical significance. Also, Tau-U scores could only confirm a reliable trend for one participant. Two out of four patients who were diagnosed with psychiatric disorders before treatment did no longer fulfill diagnostic criteria posttreatment. No improvements could be seen on pain problems. The treatment was feasible and patient satisfaction was high. Hence, while an internet delivered transdiagnostic treatment with telephone support may be a feasible and accepted secondary intervention for pain patients with comorbid emotional problems, the effects are unclear. The gap between high patient satisfaction and small changes in symptomatology should be explored further.
Collapse
Affiliation(s)
- Matilda Wurm
- Center for Health and Medical Psychology (CHAMP), Örebro University, Sweden
| | | | - Caroline Lorenz
- Center for Health and Medical Psychology (CHAMP), Örebro University, Sweden
| | - Maria Tillfors
- Center for Health and Medical Psychology (CHAMP), Örebro University, Sweden
| | | | - Fredrik Holländare
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Sweden
| | - Katja Boersma
- Center for Health and Medical Psychology (CHAMP), Örebro University, Sweden
| |
Collapse
|
31
|
Lin J, Paganini S, Sander L, Lüking M, Daniel Ebert D, Buhrman M, Andersson G, Baumeister H. An Internet-Based Intervention for Chronic Pain. Dtsch Arztebl Int 2017; 114:681-688. [PMID: 29082858 PMCID: PMC5672594 DOI: 10.3238/arztebl.2017.0681] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 12/07/2016] [Accepted: 06/14/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Persons with chronic pain can be treated effectively with acceptance and commitment therapy (ACT). In this trial, we examined the effectiveness of guided and unguided ACT-based online treatment (ACTonPain) for chronic pain patients. METHODS 302 individuals were randomly assigned to ACTonPain with or without guidance (n = 100/101) or to a waiting-list control group (n=101). The primary outcome was pain interference as measured by the Multidimensional Pain Inventory. The secondary outcomes were physical and emotional functioning, pain intensity, ACT process variables, quality of life, satisfaction with the intervention, adherence, and participants' rating of overall improvement. The online measurements were carried out before randomization (T0) and 9 weeks and 6 months after randomization (T1 and T2, respectively). Intention-to-treat (ITT) data analysis was supplemented with additional per-protocol analyses. RESULTS The guided ACTonPain group showed significantly less pain interference than the control group in the ITT analysis (p = 0.01), with a moderate effect size at T1 and T2 (d = 0.58 respectively), corresponding to a number needed to treat (NNT) of 3.14 for both time points. Participants in the guided ACTonPain group also indicated higher pain acceptance (T1: d = 0.59; T2: d = 0.76). The unguided ACTonPain group showed to be significantly less depressed in comparison to the control group at at time T2 (d = 0.50). No significant differences with respect to effectiveness were found between the two ACTonPain groups (p>0.05). CONCLUSION The online intervention ACTonPain is effective for persons with chronic pain when the program is guided. Further research in a variety of settings of health care is needed in order to determine whether and how ACTonPain can be implemented.
Collapse
Affiliation(s)
- Jiaxi Lin
- Department of Rehabilitational Psychology and Psychotherapy, Institute of Psychology, University of Freiburg
- Psychology Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Sarah Paganini
- Department of Rehabilitational Psychology and Psychotherapy, Institute of Psychology, University of Freiburg
| | - Lasse Sander
- Department of Rehabilitational Psychology and Psychotherapy, Institute of Psychology, University of Freiburg
| | | | - David Daniel Ebert
- Clinical Psychology and Psychotherapy, Institute of Psychology, University of Erlangen-Nürnberg
| | | | - Gerhard Andersson
- Linnaeus Centre HEAD, Swedish Institute for Disability Research, Department of Behavioural Sciences and Learning, Linköping University, and Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education Science, University of Ulm
| |
Collapse
|
32
|
Buhrman M, Gordh T, Andersson G. Internet interventions for chronic pain including headache: A systematic review. Internet Interv 2016; 4:17-34. [PMID: 30135787 PMCID: PMC6096254 DOI: 10.1016/j.invent.2015.12.001] [Citation(s) in RCA: 131] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 12/17/2015] [Accepted: 12/18/2015] [Indexed: 12/15/2022] Open
Abstract
Chronic pain is a major health problem and behavioral based treatments have been shown to be effective. However, the availability of these kinds of treatments is scarce and internet-based treatments have been shown to be promising in this area. The objective of the present systematic review is to evaluate internet-based interventions for persons with chronic pain. The specific aims are to do an updated review with a broad inclusion of different chronic pain diagnoses and to assess disability and pain and also measures of catastrophizing, depression and anxiety. A systematic search identified 891 studies and 22 trials were selected as eligible for review. Two of the selected trials included children/youth and five included individuals with chronic headache and/or migraine. The most frequently measured domain reflected in the primary outcomes was interference/disability, followed by catastrophizing. Result across the studies showed a number of beneficial effects. Twelve trials reported significant effects on disability/interference outcomes and pain intensity. Positive effects were also found on psychological variable such as catastrophizing, depression and anxiety. Several studies (n = 12) were assessed to have an unclear level of risk bias. The attrition levels ranged from 4% to 54% where the headache trials had the highest drop-out levels. However, findings suggest that internet-based treatments based on cognitive behavioural therapy (CBT) are efficacious measured with different outcome variables. Results are in line with trials in clinical settings. Meta-analytic statistics were calculated for interference/disability, pain intensity, catastrophizing and mood ratings. Results showed that the effect size for interference/disability was Hedge's g = - 0.39, for pain intensity Hedge's g = - 0.33, for catastrophizing Hedge's g = - 0.49 and for mood variables (depression) Hedge's g = - 0.26.
Collapse
Affiliation(s)
- Monica Buhrman
- Department of Psychology, Uppsala University, Uppsala, Sweden
- Corresponding author at: Department of Psychology, Uppsala University, Box 1225, 751 42 Uppsala, Sweden.
| | - Torsten Gordh
- Department of Surgical Sciences, Pain Research, Uppsala University, Sweden
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Swedish Institute for Disability Research, Linköping University, SE-581 83 Linköping, Sweden
- Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
33
|
Buhrman M, Skoglund A, Husell J, Bergström K, Gordh T, Hursti T, Bendelin N, Furmark T, Andersson G. Guided internet-delivered acceptance and commitment therapy for chronic pain patients: A randomized controlled trial. Behav Res Ther 2013; 51:307-15. [DOI: 10.1016/j.brat.2013.02.010] [Citation(s) in RCA: 180] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 02/02/2013] [Accepted: 02/12/2013] [Indexed: 11/26/2022]
|
34
|
Kaldo V, Haak T, Buhrman M, Alfonsson S, Larsen HC, Andersson G. Internet-based cognitive behaviour therapy for tinnitus patients delivered in a regular clinical setting: outcome and analysis of treatment dropout. Cogn Behav Ther 2013; 42:146-58. [PMID: 23432207 DOI: 10.1080/16506073.2013.769622] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Cognitive behaviour therapy (CBT) can reduce tinnitus distress but is not available for most patients. Therapist guided, internet-based CBT (ICBT) increase availability and has been shown to be effective. However, the initial positive results need to be replicated in larger samples, and treatment dropout has not been thoroughly studied. Moreover, it has not been evaluated if a low-intensity version of ICBT without therapist contact could be an alternative for patients who do not need or are able to manage the full ICBT-program. This study evaluated two parallel interventions delivered in regular care: ICBT for tinnitus distress (n = 293) and a low-intensity version of ICBT (n = 81) for patients with lower levels of tinnitus distress. We also explored predictors of dropout from ICBT and if dropout influences outcome. Tinnitus Reaction Questionnaire (Wilson, Henry, Bowen, & Haralambous, 1991) was used as the primary outcome. Secondary outcomes were measures of depression, anxiety, sleep, and sound sensitivity. Significant reductions following ICBT were found on all measures after treatment and also at a three-month follow-up. Patients receiving low-intensity ICBT showed a significant reduction in distress, even when they had low levels of distress initially. Treatment dropout was preceded by an increase in days spent at each treatment step but not by an increased distress. Early dropout was related to worse outcome. ICBT can be used in a regular clinical setting to reduce tinnitus distress. Early dropouts may need additional management. For help-seeking patients with lower distress, a low-intensity version of ICBT can be used.
Collapse
Affiliation(s)
- Viktor Kaldo
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | | | | | | | | | | |
Collapse
|
35
|
Buhrman M, Fredriksson A, Edström G, Shafiei D, Tärnqvist C, Ljótsson B, Hursti T, Gordh T, Andersson G. Guided Internet-delivered cognitive behavioural therapy for chronic pain patients who have residual symptoms after rehabilitation treatment: randomized controlled trial. Eur J Pain 2012; 17:753-65. [PMID: 23139021 DOI: 10.1002/j.1532-2149.2012.00244.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2012] [Indexed: 01/30/2023]
Abstract
BACKGROUND Chronic pain can be treated with cognitive behavioural therapy delivered in multidisciplinary settings. However, relapse is likely, and there is a need for cost-effective secondary interventions for persons with residual problems after rehabilitation. The aim of the present study was to investigate the effects of a guided Internet-delivered cognitive behavioural intervention for patients who had completed multidisciplinary treatment at a pain management unit. METHODS A total of 72 persons with residual pain problems were included in the study and were randomized to either treatment for 8 weeks or to a control group who were invited to participate in a moderated online discussion forum. The participants had different chronic pain conditions, and a majority were women (72%). Twenty-two percent of the participants dropped out of the study before the post-treatment assessment. RESULTS Intent-to-treat analyses demonstrated differences on the catastrophizing subscale of the Coping Strategies Questionnaire (Cohen's d = 0.70), in favour of the treatment group but a small within-group effect. Differences were also found on other measures of pain-related distress, anxiety and depressive symptoms. A 6-month follow-up exhibited maintenance of improvements. CONCLUSIONS We conclude that Internet-delivered treatment can be partly effective for persons with residual problems after completed pain rehabilitation.
Collapse
Affiliation(s)
- M Buhrman
- Department of Psychology, Uppsala University, Uppsala, Sweden.
| | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Buhrman M, Nilsson-Ihrfeldt E, Jannert M, Ström L, Andersson G. Guided internet-based cognitive behavioural treatment for chronic back pain reduces pain catastrophizing: a randomized controlled trial. J Rehabil Med 2011; 43:500-5. [PMID: 21533329 DOI: 10.2340/16501977-0805] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate whether an Internet-based cognitive behavioural intervention would have an effect on the symptoms of chronic back pain. DESIGN Experimental design with a treatment group and a control group measured before and after a treatment period. SUBJECTS Participants who met the criteria for chronic back pain (n = 54). METHODS All participants were screened in a live, structured interview before inclusion. The study period was 12 weeks and the treatment consisted of education, cognitive skills acquisition, behavioural rehearsal, generalization and maintenance. The main outcome of interest was the catastrophizing subscale of the Coping Strategies Questionnaire. RESULTS There were statistically significant reductions from pre- to post-treatment in catastrophizing in the treatment group, and an improvement in quality of life for the treatment group. However, most outcome measures did not indicate a positive treatment outcome. On a scale measuring pain catastrophizing, 58% (15/26) of the treated participants showed reliable improvement, compared with 18% (5/28) of the control group. CONCLUSION Internet-based cognitive behavioural therapy can serve as a complement for individuals with chronic pain who prefer this treatment and have difficulties accessing specialist treatment facilities.
Collapse
|
37
|
Kaldo V, Levin S, Widarsson J, Buhrman M, Larsen HC, Andersson G. Internet versus group cognitive-behavioral treatment of distress associated with tinnitus: a randomized controlled trial. Behav Ther 2008; 39:348-59. [PMID: 19027431 DOI: 10.1016/j.beth.2007.10.003] [Citation(s) in RCA: 121] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2007] [Revised: 10/16/2007] [Accepted: 10/21/2007] [Indexed: 11/15/2022]
Abstract
Tinnitus distress can be reduced by means of cognitive-behavior therapy (CBT), and the treatment can be delivered in different ways. The most recent format is Internet-based self-help. The aim of this study was to compare this treatment (n= 26) with standard group-based CBT (n=25) in a randomized controlled trial. Outcomes on self-report inventories measuring tinnitus distress were evaluated immediately after and 1 year after treatment. Results showed that both groups had improved, and there were few differences between them. The effect size for the Internet treatment was d=0.73 (95% CI=0.16-1.30) and for the group treatment was d=0.64 (95% CI=0.07-1.21). The Internet treatment consumed less therapist time and was 1.7 times as cost-effective as the group treatment. At pretreatment patients rated the Internet treatment as less credible than the group treatment. In conclusion, Internet treatment for tinnitus distress merits further investigation, as the outcomes achieved are promising.
Collapse
Affiliation(s)
- Viktor Kaldo
- Department of Psychology, Uppsala University, Uppsala, Sweden.
| | | | | | | | | | | |
Collapse
|
38
|
Carlbring P, Bohman S, Brunt S, Buhrman M, Westling BE, Ekselius L, Andersson G. Remote treatment of panic disorder: a randomized trial of internet-based cognitive behavior therapy supplemented with telephone calls. Am J Psychiatry 2006; 163:2119-25. [PMID: 17151163 DOI: 10.1176/ajp.2006.163.12.2119] [Citation(s) in RCA: 141] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study evaluated a 10-week Internet-based bibliotherapy self-help program with short weekly telephone calls for people suffering from panic disorder with or without agoraphobia. METHOD After the authors confirmed the diagnosis by administering the Structured Clinical Interview for DSM-IV by telephone, 60 participants were randomly assigned to either a wait-listed control group or a multimodal treatment package based on cognitive behavior therapy plus minimal therapist contact via e-mail. A 10-minute telephone call was made each week to support each participant. Total mean time spent on each participant during the 10 weeks was 3.9 hours. The participants were required to send in homework assignments before receiving the next treatment module. RESULTS Analyses were conducted on an intention-to-treat basis, which included all randomly assigned participants. From pretreatment to posttreatment, all treated participants improved significantly on all measured dimensions (bodily interpretations, maladaptive cognitions, avoidance, general anxiety and depression levels, and quality of life). Treatment gains on self-report measures were maintained at the 9-month follow-up. A blind telephone interview after the end of treatment revealed that 77% of the treated patients no longer fulfilled the criteria for panic disorder, whereas all of the wait-listed subjects still suffered from it. CONCLUSIONS This study provides evidence to support the use of treatment distributed via the Internet with the addition of short weekly telephone calls to treat panic disorder. Replication should be made to compare self-help and telephone treatment based on cognitive behavior methods with nonspecific interventions.
Collapse
Affiliation(s)
- Per Carlbring
- Department of Behavioural Sciences, Linkoping University, SE-581 83 Linkoping, Sweden.
| | | | | | | | | | | | | |
Collapse
|
39
|
Andersson G, Carlbring P, Holmström A, Sparthan E, Furmark T, Nilsson-Ihrfelt E, Buhrman M, Ekselius L. Internet-based self-help with therapist feedback and in vivo group exposure for social phobia: A randomized controlled trial. J Consult Clin Psychol 2006; 74:677-86. [PMID: 16881775 DOI: 10.1037/0022-006x.74.4.677] [Citation(s) in RCA: 262] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Sixty-four individuals with social phobia (social anxiety disorder) were assigned to a multimodal cognitive-behavioral treatment package or to a waiting list control group. Treatment consisted of a 9-week, Internet-delivered, self-help program that was combined with 2 group exposure sessions in real life and minimal therapist contact via e-mail. Results were analyzed on an intention-to-treat basis, including all randomized participants. From pre- to posttest, treated participants in contrast to controls showed significant improvement on most measured dimensions (social anxiety scales, general anxiety and depression levels, quality of life). The overall within- and between-groups effect sizes were Cohen's d = 0.87 and 0.70, respectively. Treatment gains were maintained at 1-year follow-up. The results from this study support the continued use and development of Internet-distributed, self-help programs for people diagnosed with social phobia.
Collapse
Affiliation(s)
- Gerhard Andersson
- Department of Behavioural Sciences, Linköping University, Linköping, Sweden.
| | | | | | | | | | | | | | | |
Collapse
|
40
|
Carlbring P, Nilsson-Ihrfelt E, Waara J, Kollenstam C, Buhrman M, Kaldo V, Söderberg M, Ekselius L, Andersson G. Treatment of panic disorder: live therapy vs. self-help via the Internet. Behav Res Ther 2005; 43:1321-33. [PMID: 16086983 DOI: 10.1016/j.brat.2004.10.002] [Citation(s) in RCA: 194] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2004] [Revised: 10/04/2004] [Accepted: 10/06/2004] [Indexed: 11/20/2022]
Abstract
A randomized trial was conducted comparing 10 individual weekly sessions of cognitive behaviour therapy for panic disorder (PD) with or without agoraphobia with a 10-module self-help program on the Internet. After confirming the PD diagnosis with an in-person structured clinical interview (SCID) 49 participants were randomized. Overall, the results suggest that Internet-administered self-help plus minimal therapist contact via e-mail can be equally effective as traditional individual cognitive behaviour therapy. Composite within-group effect sizes were high in both groups, while the between-group effect size was small (Cohen's d=16). One-year follow-up confirmed the results, with a within-group effect size of Cohen's d=0.80 for the Internet group and d=0.93 for the live group. The results from this study generally provide evidence to support the continued use and development of Internet-distributed self-help programs.
Collapse
Affiliation(s)
- Per Carlbring
- Department of Psychology, Uppsala University, Box 1225, 751 42 Uppsala, Sweden.
| | | | | | | | | | | | | | | | | |
Collapse
|
41
|
|
42
|
Buhrman M, Fältenhag S, Ström L, Andersson G. Controlled trial of Internet-based treatment with telephone support for chronic back pain. Pain 2004; 111:368-377. [PMID: 15363881 DOI: 10.1016/j.pain.2004.07.021] [Citation(s) in RCA: 148] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2003] [Revised: 07/09/2004] [Accepted: 07/16/2004] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to investigate the effects of an Internet-based cognitive-behavioral intervention with telephone support for chronic back pain. Participants who met the criteria for chronic back pain (N=56) were randomly assigned to either an Internet-based cognitive behavioral self-help treatment or to a waiting-list control condition. The study period lasted 8 weeks and consisted of 1 week of self-monitoring prior to the intervention, 6 weeks of intervention, and 1 week of post-intervention assessment. Treatment consisted of education, cognitive skill acquisition, behavioral rehearsal, generalization and maintenance. The dropout rate was 9% (N=5). Results showed statistically significant improvements in catastrophizing, control over pain and ability to decrease pain. Some improvement was found in both the control group and the treatment group. A follow-up of 3 months after treatment termination was completed in 92% (N=47) of the participants who completed the treatment intervention. Follow-up results showed that some improvement was maintained. Findings indicate that Internet-based self-help with telephone support, based on established psychological treatment methods, holds promise as an effective approach for treating disability in association with pain.
Collapse
Affiliation(s)
- Monica Buhrman
- Department of Psychology, Uppsala University, Box 12 25, SE-751 42 Uppsala, Sweden Department of Behavioural Sciences, Linköping University, SE-581 83 Linköping, Sweden
| | | | | | | |
Collapse
|