oru.sePublications
Change search
Link to record
Permanent link

Direct link
BETA
Alternative names
Publications (10 of 57) Show all publications
Hedman-Lagerlöf, M., Hedman-Lagerlöf, E., Ljótsson, B., Wicksell, R. K., Flink, I. & Andersson, E. (2019). Cost-Effectiveness and Cost-Utility of Internet-Delivered Exposure Therapy for Fibromyalgia: Results From a Randomized, Controlled Trial. Journal of Pain, 20(1), 47-59
Open this publication in new window or tab >>Cost-Effectiveness and Cost-Utility of Internet-Delivered Exposure Therapy for Fibromyalgia: Results From a Randomized, Controlled Trial
Show others...
2019 (English)In: Journal of Pain, ISSN 1526-5900, E-ISSN 1528-8447, Vol. 20, no 1, p. 47-59Article in journal (Refereed) Published
Abstract [en]

Fibromyalgia (FM) is a prevalent and debilitating chronic pain disorder associated with a substantial economic burden. Although there are several studies investigating the effectiveness of psychological treatments such as cognitive-behavioral therapy for FM, studies on cost-effectiveness are scarce. The aim of the present study was to investigate the cost-effectiveness of Internet-delivered exposure therapy (iExp) for FM. We used health economic data from a recently conducted randomized, controlled trial, where 140 participants were randomized to either iExp or a waitlist control (WLC) condition. Economic data were collected at pre-treatment, post-treatment, and at the 1-year follow-up. Treatment effectiveness in relation to costs were analyzed using both a societal perspective (including all direct and indirect costs) and a health care unit perspective (including only the direct treatment costs). Bootstrapped net benefit regression analyses were also conducted, comparing the difference in costs and effects between iExp and WLC, within different willingness-to-pay scenarios. Results showed that the incremental cost-effectiveness ratio was -$15,295, indicating that iExp was highly cost-effective as each successfully treated case (treatment responder) was associated with a substantial net reduction in costs. The robustness of the results was tested in 2 different sensitivity analyses, where iExp remained cost-effective, even in a willingness-to-pay-scenario of $0. We conclude that iExp is a cost-effective treatment that generates large societal cost savings.

PERSPECTIVE: Health-economic evaluations of psychological interventions for FM are scarce. This study is a cost-effectiveness analysis of Internet-delivered exposure therapy for patients with FM. Results showed that iExp was highly cost-effective compared with no treatment, where each successfully treated case generated a substantial societal cost saving.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Fibromyalgia, cognitive-behavioral therapy, cost-effectiveness, health economic analysis
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Applied Psychology
Identifiers
urn:nbn:se:oru:diva-71213 (URN)10.1016/j.jpain.2018.07.012 (DOI)000455169700005 ()30107241 (PubMedID)2-s2.0-85058441258 (Scopus ID)
Note

Funding Agencies:

Söderström König Foundation  

Fredrik and Ingrid Thuring Foundation  

Stockholm County Council  

Karolinska Institutet 

Available from: 2019-01-08 Created: 2019-01-08 Last updated: 2019-01-23Bibliographically approved
Boersma, K., Södermark, M., Hesser, H., Flink, I., Gerdle, B. & Linton, S. J. (2019). Efficacy of a transdiagnostic emotion-focused exposure treatment for chronic pain patients with comorbid anxiety and depression: a randomized controlled trial. Pain, 160(8), 1708-1718
Open this publication in new window or tab >>Efficacy of a transdiagnostic emotion-focused exposure treatment for chronic pain patients with comorbid anxiety and depression: a randomized controlled trial
Show others...
2019 (English)In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 160, no 8, p. 1708-1718Article in journal (Refereed) Published
Abstract [en]

The comorbidity between chronic pain and emotional problems has proven difficult to address with current treatment options. This study addresses the efficacy of a transdiagnostic emotion-focused exposure treatment ("hybrid") for chronic pain patients with comorbid emotional problems. Adults (n = 115) with chronic musculoskeletal pain and functional and emotional problems were included in a 2-centre, parallel randomized controlled, open-label trial comparing this treatment to an active control condition receiving a guided Internet-delivered pain management treatment based on CBT principles (iCBT). The hybrid treatment (n = 58, 10-16 sessions) integrates exposure in vivo for chronic pain based on the fear-avoidance model with an emotion-regulation approach informed by procedures in Dialectical Behavior Therapy. The iCBT (n = 57; 8 treatment modules) addresses topics such as pain education, coping strategies, relaxation, problem solving, stress, and sleep management using standard CBT techniques. Patient-reported outcomes were assessed before and after treatment as well as at a 9-month primary end point. Across conditions, 78% participants completed post-treatment and 81% follow-up assessment. Intent-to-treat analyses showed that the hybrid had a significantly better post-treatment outcome on pain catastrophizing (d = 0.39) and pain interference (d = 0.63) and significantly better follow-up outcomes on depression (d = 0.43) and pain interference (d = 0.51). There were no differences on anxiety and pain intensity. Observed proportions of clinically significant improvement favoured the hybrid on all but one comparison, but no statistically significant differences were observed. We conclude that the hybrid emotion-focused treatment may be considered an acceptable, credible, and efficacious treatment option for chronic pain patients with comorbid emotional problems.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Chronic pain, Emotional problems, Transdiagnostic, Cognitive-behavioral therapy, Internet, Randomized clinical trial, Exposure
National Category
Applied Psychology
Identifiers
urn:nbn:se:oru:diva-75576 (URN)10.1097/j.pain.0000000000001575 (DOI)000480764500006 ()31335641 (PubMedID)2-s2.0-85066118471 (Scopus ID)
Funder
AFA Insurance, 140356Riksbankens Jubileumsfond, P14-0799: 1
Note

Funding Agency:

Region Östergötland  LIO-724821

Available from: 2019-08-09 Created: 2019-08-09 Last updated: 2019-09-04Bibliographically approved
Jansson-Fröjmark, M., Harvey, A. G. & Flink, I. (2019). Psychometric properties of the Insomnia Catastrophizing Scale (ICS) in a large community sample. Cognitive Behaviour Therapy
Open this publication in new window or tab >>Psychometric properties of the Insomnia Catastrophizing Scale (ICS) in a large community sample
2019 (English)In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316Article in journal (Refereed) Epub ahead of print
Abstract [en]

The purpose was to investigate the psychometric properties of the Insomnia Catastrophizing Scale (ICS) including factorial validity and internal consistency as well as discriminative and convergent validity. Associations with sleep parameters and daytime impairment are also examined. Drawn from a randomly selected sample of the general population, 1615 participants completed a survey on insomnia-related nighttime and daytime symptoms, health outcomes and psychological processes, including the ICS. A one-factor solution was supported for both the nighttime catastrophizing (11 items) and daytime catastrophizing (6 items) subscales. Both subscales displayed high internal consistencies (α > 0.90) and accounted for 59.1-70.1% of the variance. The insomnia disorder group had significantly higher scores than participants without insomnia on the two subscales and on the individual items. Cutoffs were established for both subscales with acceptable sensitivity and specificity. Both subscales displayed adequate convergent validity with measures indexing worry, cognitive pre-sleep arousal and anxiety. The two subscales were also significantly associated with nighttime and daytime insomnia symptoms. The ICS is a reliable and valid scale for the assessment of insomnia-related catastrophizing. Future research is needed to examine the test-retest reliability and treatment sensitivity of the ICS.

Place, publisher, year, edition, pages
Routledge, 2019
Keywords
Insomnia, catastrophizing, scale, sleep
National Category
Psychology
Identifiers
urn:nbn:se:oru:diva-73276 (URN)10.1080/16506073.2019.1588362 (DOI)30896297 (PubMedID)
Available from: 2019-03-22 Created: 2019-03-22 Last updated: 2019-03-22Bibliographically approved
Flink, I., Boersma, K., Klein-Strandberg, E. & Linton, S. J. (2019). Responding to social cues: An experimental paradigm exploring the link between context sensitivity and pain. British Journal of Health Psychology, 24(2), 443-459
Open this publication in new window or tab >>Responding to social cues: An experimental paradigm exploring the link between context sensitivity and pain
2019 (English)In: British Journal of Health Psychology, ISSN 1359-107X, E-ISSN 2044-8287, Vol. 24, no 2, p. 443-459Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: The term context sensitivity refers to whether a response is in tune with the ever changing demands of the context, while insensitivity is the lack of responding to these cues. To date, we know little about how well patients with pain respond emotionally to changes in the cues provided by the social context, that is, how emotionally context (in)sensitive they are and if this is related to problem severity. The aim of this experimental study was to test a method for determining levels of context sensitivity in individuals with subacute and chronic pain and to explore the link between context (in)sensitivity and pain-related problems. We operationalized context (in)sensitivity as participants' emotional responses (observed facial expressions and self-reported affect) and pain bothersomeness in these contexts and explored the association between these context-(in)sensitive social-emotional responses and pain-related problems.

METHODS: Sixty-two participants with pain were cued to talk openly about three different topics consecutively in a counterbalanced order: (1) their pain, (2) a negative non-pain topic, and (3) a positive non-pain topic. We measured the participants' emotional responses (observed facial expressions and self-reported affect) and pain bothersomeness across these contexts and explored the effect of social-emotional responding on pain-related problems.

RESULTS: The results showed that, irrespective of individuals' baseline levels of pain bothersomeness, positive affect, and negative affect, those who reacted with more negative affect and pain bothersomeness when prompted to discuss a positive topic had higher levels of pain-related problems. Moreover, those who showed more negative facial expressions and pain bothersomeness when prompted to discuss a negative non-pain topic also had higher levels of pain-related problems.

CONCLUSIONS: These findings highlight a link between sensitivity to the social context and the severity of a pain problem. We showed that individuals with greater problem severity were less sensitive to social cues in their emotional responses, as compared to individuals with less pain-related problems. As predicted, context-insensitive responding appears to be most strongly associated with pain-related problems when dealing with negative emotions. Although the cross-sectional nature of the study prohibits causal conclusions, our findings demonstrate a link and future research is clearly needed to unravel the role of context sensitivity in the development of pain over time.

Statement of contributionWhat is already known on this subject?

  • Responding to social cues seems to be important for adaptation to pain. The term context sensitivity refers to whether a response is in tune with the provided social cue. To date, we know little about how well patients with persistent pain respond emotionally to changes in the social context, that is, how context (in)sensitive they are and if this is linked to problem severity.

What does this study add?

  • A test of a method for determining levels of context sensitivity in individuals with persistent pain.
  • Information about to what extent individuals with chronic pain respond context sensitively.
  • Knowledge on the link between social context sensitivity and level of pain problems.
Place, publisher, year, edition, pages
Wiley-Blackwell, 2019
Keywords
Chronic pain, context sensitivity, flexibility, social context
National Category
Psychology
Identifiers
urn:nbn:se:oru:diva-74213 (URN)10.1111/bjhp.12362 (DOI)000466379000012 ()30907044 (PubMedID)2-s2.0-85063340334 (Scopus ID)
Funder
Riksbankens Jubileumsfond, P14-0799:1
Available from: 2019-05-09 Created: 2019-05-09 Last updated: 2019-06-19Bibliographically approved
Engman, L., Flink, I., Ekdahl, J., Boersma, K. & Linton, S. J. (2018). Avoiding or enduring painful sex?: A prospective study of coping and psychosexual function in vulvovaginal pain. European Journal of Pain, 22(8), 1388-1398
Open this publication in new window or tab >>Avoiding or enduring painful sex?: A prospective study of coping and psychosexual function in vulvovaginal pain
Show others...
2018 (English)In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 22, no 8, p. 1388-1398Article in journal (Refereed) Published
Abstract [en]

Background: Recurring vulvovaginal pain is common, with evident effects on affected women's lives. Little is known about how affected women cope with painful sexual activities and how coping relates to pain intensity and psychosexual functioning over time. This prospective study explored the impact of avoidance and endurance on sexual function over time. Additionally, patterns of coping were studied on an individual level to increase knowledge about coping and its relation to psychosexual functioning.

Methods: One hundred and seventeen women, 18-35years old, with recurring vulvovaginal pain answered questionnaires at two measurement points, five months apart, assessing avoidance and endurance coping, pain intensity and psychosexual functioning. A multiple regression model explored the predictive value of avoidance and endurance on sexual function over time. Cluster analyses investigated patterns of coping and stability within the clusters. These subgroups were compared on psychosexual outcomes.

Results: Avoidance at baseline was the only significant predictor of sexual function five months later. Distinct and stable subgroups with different patterns of coping were identified, where avoidance and endurance coping were used both separately and combined. Women who both avoided and endured had the most unfavourable outcomes in terms of psychosexual functioning.

Conclusions: Avoidance of sexual activities was related to reduced sexual function over time, which calls for attention and clinical interventions targeting avoidance. Additionally, women who both avoid and endure sexual activities despite pain possibly need tailored interventions, as women with this coping pattern reported the lowest levels of psychosexual functioning.

Significance: In this prospective study, avoidance of sexual activities predicted sexual function over time, when controlling for pain intensity. Subgroups of women using distinct patterns of coping were identified. Those who both avoided and endured had the lowest levels of psychosexual functioning.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
National Category
Psychology Anesthesiology and Intensive Care Neurology
Identifiers
urn:nbn:se:oru:diva-66612 (URN)10.1002/ejp.1227 (DOI)000441435800002 ()29635880 (PubMedID)2-s2.0-85045933115 (Scopus ID)
Available from: 2018-04-17 Created: 2018-04-17 Last updated: 2018-08-27Bibliographically approved
Engman, L., Flink, I., Ter Kuile, M. & Linton, S. J. (2018). CBT group treatment for vulvovaginal pain with partner involvement: a single case experimental design pilot. In: : . Paper presented at IASR (International Academy of Sex Research) 44th annual meeting, Madrid, Spain, 2018.
Open this publication in new window or tab >>CBT group treatment for vulvovaginal pain with partner involvement: a single case experimental design pilot
2018 (English)Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

Background: Recurring pain in the vulvovaginal regional induced by touch or pressure is thought to be the most frequent cause of superficial dyspareunia in premenopausal women. Its prevalence is 7-15% in community samples and has a serious impact on couples sexual function, sexual satisfaction, general psychological well-being and overall quality of life.

The last decade of research suggests that psychological factors, such as fear of pain, catastrophizing, and avoidance behavior may contribute to the maintenance and exacerbation of dyspareunia. Conventional cognitive behavioral therapy (CBT) interventions aim at reducing pain, restoring sexual function and improving the romantic relationship by targeting the thoughts, emotions, behaviors and couple interactions associated with the experience of dyspareunia. Furthermore, given the interpersonal sexual context in which dyspareunia is most often triggered, relationship factors is an important area to address.

Research Questions: The primary purpose is to evaluate whether a CBT group program with partner involvement improves pain during penetration in women with superficial dyspareunia. Secondary objectives are to evaluate women’s (and their partner’s) sexuality (sexual function & satisfaction), psychological adjustment (negative and positive penetration beliefs, pain coping behaviour) and relationship factors (relationship satisfaction). 

Methods: The current study consists of a CBT group treatment program of 10 group sessions and 3 individual couple sessions distributed over a period of 6 months. The study will employ a single case experimental design with multiple baselines (N=6) where each individual represents a case and is randomized to a specific length of baseline. The primary and secondary outcomes will be measured weekly through both baseline and treatment phase to enable investigation of changes in outcome between the two phases. Additionally, secondary outcomes for both women and their partners are measured pre- and post-treatment. Single case experimental designs are recommended as a first step to investigate individual responses to psychological interventions as well as testing interventions as a pilot before implementing treatments in extensive RCT studies (Morley, 2017).

Results: Data collection is in progress and will be completed early June 2018. The results of the study will be presented at the conference.

Keywords
Vulvovaginal pain, CBT group treatment, Partner participation, Single case experimental design
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:oru:diva-70480 (URN)
Conference
IASR (International Academy of Sex Research) 44th annual meeting, Madrid, Spain, 2018
Available from: 2018-12-04 Created: 2018-12-04 Last updated: 2018-12-04Bibliographically approved
Flink, I., Peters, M., Bergbom, S., Bergman, M., Ekstrand, K., Carstens-Söderstrand, J. & Tillfors, M. (2018). Dwelling on a successful task: Does how or why influence affect?. Journal of Experimental Psychopathology, 9(3), Article ID UNSP 047915.
Open this publication in new window or tab >>Dwelling on a successful task: Does how or why influence affect?
Show others...
2018 (English)In: Journal of Experimental Psychopathology, ISSN 2043-8087, E-ISSN 2043-8087, Vol. 9, no 3, article id UNSP 047915Article in journal (Refereed) Published
Abstract [en]

Repetitive negative thinking (RNT) has been identified as a key maintaining process of emotional difficulties. However, the consequences of repetitive thinking may depend on whether negative thoughts or feelings are processed in an abstract, evaluative mode, or in a concrete, process-focused mode. In recent years an increasing number of studies has also explored the effect of processing mode in relation to positive events, yielding inconsistent results. So far, the studies using positive material have not examined the interaction between trait rumination and processing mode. Consequently, the purpose of this study was to further explore the effects of abstract vs. concrete mode of processing on positive affect and negative affect in the context of a success task in a sample scoring high on trait rumination. 62 participants were randomly assigned to abstract vs. concrete processing training prior to a success task. The results showed that positive affect increased whereas negative affect and state RNT decreased after the success task in both groups. However, abstract vs. concrete processing did not have an effect on outcome. The findings indicate that processing mode does not influence outcome in the context of a success task.

Place, publisher, year, edition, pages
Sage Publications, 2018
Keywords
Processing mode, Repetitive negative thinking, Positive affect, Negative affect
National Category
Psychology (excluding Applied Psychology) Psychiatry
Identifiers
urn:nbn:se:oru:diva-53988 (URN)10.5127/jep.047915 (DOI)000446859400007 ()2-s2.0-85054848903 (Scopus ID)
Available from: 2016-12-15 Created: 2016-12-15 Last updated: 2018-10-22Bibliographically approved
Hedman-Lagerlöf, M., Hedman-Lagerlöf, E., Axelsson, E., Ljótsson, B., Engelbrektsson, J., Hultkranz, S., . . . Andersson, E. (2018). Internet-Delivered Exposure Therapy for Fibromyalgia: A Randomized Controlled Trial. The Clinical Journal of Pain, 34(6), 532-542
Open this publication in new window or tab >>Internet-Delivered Exposure Therapy for Fibromyalgia: A Randomized Controlled Trial
Show others...
2018 (English)In: The Clinical Journal of Pain, ISSN 0749-8047, E-ISSN 1536-5409, Vol. 34, no 6, p. 532-542Article in journal (Refereed) Published
Abstract [en]

Background: Fibromyalgia (FM) is a common and disabling chronic pain disorder, for which existing pharmacological and psychological treatments have yet yielded insufficient effects. Previous literature has shown that exposure therapy may be an effective treatment for chronic pain. This study constitutes the first randomized controlled trial evaluating exposure therapy for FM.

Methods: A total of 140 participants with diagnosed FM were randomized to a 10-week Internet-delivered exposure treatment (iExp; n=70) or a waitlist control condition (WLC; n=70). Primary outcome measure were FM symptoms and impact, and secondary outcome measures were fatigue, disability, quality of life, pain-related distress and avoidance behaviors, insomnia, depression, and anxiety.

Results: Data retention was high (100% data completion at posttreatment for primary outcome, 96% at 6-month follow-up and 94% at 12-month follow-up). Results showed that participants in the iExp group made large and superior improvements compared with WLC on FM symptoms and impact (B, ?1.93; z, ?10.14; P<0.001, betweengroup Cohen d=0.90), as well as all secondary outcomes (betweengroup Cohen d ranging from 0.44 to 1.38) with sustained results.

Conclusions: We conclude that iExp seems to be an efficacious treatment for FM compared with no treatment, and the results also highlight the potential increase of accessibility by using the Internet format to deliver psychological treatments for these patients. Future trials with active control conditions are warranted.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2018
Keywords
Fibromyalgia, exposure therapy, cognitive behavior therapy, randomized controlled trial, clinical trial, chronic pain
National Category
Applied Psychology Anesthesiology and Intensive Care Neurology
Identifiers
urn:nbn:se:oru:diva-63394 (URN)10.1097/AJP.0000000000000566 (DOI)000432189500006 ()29077623 (PubMedID)2-s2.0-85046896272 (Scopus ID)
Note

Funding Agencies:

Fredrik and Ingrid Thuring Foundation, Stockholm, Sweden  

Söderström-König Foundation, Stockholm, Sweden 

Stockholm County Council, Stockholm, Sweden  

Karolinska Institutet, Stockholm, Sweden 

Available from: 2017-12-18 Created: 2017-12-18 Last updated: 2018-09-16Bibliographically approved
Wurm, M., Anniko, M., Tillfors, M., Flink, I. & Boersma, K. (2018). Musculoskeletal pain in early adolescence: A longitudinal examination of pain prevalence and the role of peer-related stress, worry, and gender. Journal of Psychosomatic Research, 111, 76-82
Open this publication in new window or tab >>Musculoskeletal pain in early adolescence: A longitudinal examination of pain prevalence and the role of peer-related stress, worry, and gender
Show others...
2018 (English)In: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 111, p. 76-82Article in journal (Refereed) Published
Abstract [en]

Objective: Adolescence is a time of change during which several health problems, such as pain problems, increase. Psychosocial mechanisms involved in this development, such as interpersonal stressors and worry, are still understudied, especially longitudinally. The first aim of this study was to investigate the prevalence of musculoskeletal pain in Swedish adolescents between the ages 13 and 15 using pain grades. The second aim was to study the role of peer-related stress, worry, and gender in the development of musculoskeletal pain problems over time.

Methods: Adolescents in 18 public schools were followed from 7th to 9th grade (N=1181) and answered selfreport questionnaires at three time points. Prevalence was assessed at all three time points and a moderated mediation analysis investigated if peer-related stress in 7th grade predicted musculoskeletal pain two years later and if this relationship was mediated by worry in 8th grade. Gender was entered as a moderator.

Results: In 7th grade, 8.4% of adolescents reported musculoskeletal pain with some functional impairment. In 8th and 9th grade around 10% of adolescents reported musculoskeletal pain problems, with girls reporting a higher prevalence than boys. Peer-related stress in 7th grade predicted musculoskeletal pain problems in 9th grade, mediated by worry in 8th grade. The mediation was moderated by gender: peer-related stress predicted worry for girls, but not for boys.

Conclusion: Peer-related stress and worry seem to be involved in the development of pain over time. These factors should therefore be targeted in preventative interventions and during treatment.

Place, publisher, year, edition, pages
Elsevier, 2018
National Category
Psychology (excluding Applied Psychology) Psychiatry
Research subject
Psychology
Identifiers
urn:nbn:se:oru:diva-67289 (URN)10.1016/j.jpsychores.2018.05.016 (DOI)000437386600012 ()29935758 (PubMedID)2-s2.0-85048472319 (Scopus ID)
Funder
Swedish Research Council FormasSwedish Research CouncilVINNOVA, 2012-65Forte, Swedish Research Council for Health, Working Life and Welfare
Available from: 2018-06-17 Created: 2018-06-17 Last updated: 2018-07-25Bibliographically approved
Linton, S. J. & Flink, I. (2018). Sömn, dröm, mardröm: kunskap och verktyg för god sömn. Stockholm: Natur och kultur
Open this publication in new window or tab >>Sömn, dröm, mardröm: kunskap och verktyg för god sömn
2018 (Swedish)Book (Other (popular science, discussion, etc.))
Place, publisher, year, edition, pages
Stockholm: Natur och kultur, 2018. p. 170
National Category
Psychology
Identifiers
urn:nbn:se:oru:diva-71831 (URN)9789127818095 (ISBN)
Available from: 2019-01-25 Created: 2019-01-25 Last updated: 2019-01-25Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-2718-7402

Search in DiVA

Show all publications