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Boersma, K., Flink, I. & Linton, S. J. (2020). Interpersonal problems as a predictor of pain catastrophizing in patients with chronic pain: Editorial comment on: Ryum, T., Börsting Jacobsen, H., Borchgrevink, P.C., Landrö, N.I. & Stiles, T.C.. Scandinavian Journal of Pain
Open this publication in new window or tab >>Interpersonal problems as a predictor of pain catastrophizing in patients with chronic pain: Editorial comment on: Ryum, T., Börsting Jacobsen, H., Borchgrevink, P.C., Landrö, N.I. & Stiles, T.C.
2020 (English)In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879Article in journal (Refereed) Accepted
Place, publisher, year, edition, pages
Walter de Gruyter, 2020
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:oru:diva-78835 (URN)
Available from: 2019-12-27 Created: 2019-12-27 Last updated: 2020-01-07Bibliographically approved
Bauducco, S., Flink, I., Boersma, K. & Linton, S. J. (2020). Preventing sleep deficit in adolescents: Long-term effects of a quasi-experimental school-based intervention study. Journal of Sleep Research (1), Article ID e12940.
Open this publication in new window or tab >>Preventing sleep deficit in adolescents: Long-term effects of a quasi-experimental school-based intervention study
2020 (English)In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, no 1, article id e12940Article in journal (Refereed) Published
Abstract [en]

Adolescents are at risk of sleep deficit, which has serious consequences for their daytime functioning. However, school-based interventions to improve sleep have shown limited success. This might be due to the content of the programmes (e.g., not targeting central factors such as daytime stress and technology use) or because changes have not been captured due to a lack of long-term follow-ups. Hence, the aim of this study was to evaluate the long-term effects of a school-based sleep education curriculum including time-management training. The study used a quasi-experimental design. Participants were 3,622 adolescents (mean age 13.7, 48% girls); 286 were in the intervention group and 3,336 were followed as a natural control group. Data were collected before the intervention and at a 1-year follow-up. We divided participants into three groups according to baseline sleep duration (calculated from self-reported bed- and wake times, minus sleep onset latency): insufficient (<7 hr), borderline (7-8 hr) and adequate (>8 hr). Adolescents in the intervention group were ~2 times less likely to report insufficient sleep at follow-up as compared to controls. Sleep knowledge improved significantly in the intervention group but there were no changes in emotional sleep hygiene (e.g., bedtime worry) and perceived stress. Surprisingly, technology use increased and behavioural sleep hygiene worsened in the intervention group. Although the mechanisms of change need further investigation, the results of this study point to potential long-term benefits of school-based sleep programmes.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2020
Keywords
Information and communication technology, prevention, sleep health, youths
National Category
Applied Psychology
Identifiers
urn:nbn:se:oru:diva-77882 (URN)10.1111/jsr.12940 (DOI)000494302700001 ()31691408 (PubMedID)2-s2.0-85074845721 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2012-65Vinnova, 2012-65Swedish Research Council Formas, 2012-65
Available from: 2019-11-14 Created: 2019-11-14 Last updated: 2020-02-14Bibliographically approved
Hedman-Lagerlöf, M., Andersson, E., Hedman-Lagerlöf, E., Wicksell, R. K., Flink, I. & Ljótsson, B. (2019). Approach as a key for success: Reduced avoidance behaviour mediates the effect of exposure therapy for fibromyalgia. Behaviour Research and Therapy, 122, Article ID UNSP 103478.
Open this publication in new window or tab >>Approach as a key for success: Reduced avoidance behaviour mediates the effect of exposure therapy for fibromyalgia
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2019 (English)In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 122, article id UNSP 103478Article in journal (Refereed) Published
Abstract [en]

Fibromyalgia (FM) is a prevalent chronic pain disorder associated with large suffering and substantial societal costs. Pain-related avoidance behaviour and hypervigilance to bodily symptoms are common in FM and contribute in maintaining and exacerbating the disorder. Exposure therapy targeting avoidance behaviours and hypervigilance has shown promise in the treatment of FM. The present study investigated mediators of treatment outcome in exposure therapy for FM. We used data from a randomised trial, where 140 participants were allocated to 10-week Internet-delivered exposure therapy or to a waiting-list control condition. The main outcome variable (FM symptoms) and the hypothesized mediators (FM-related avoidance behaviour, mindful non-reactivity and FM-related worry) were measured weekly throughout treatment. Mediation analyses were conducted using linear mixed effects models with bootstrap replication and time-lagged analysis. Results indicated that all three process variables were significant mediators of FM severity. However, in the time-lagged analyses, only FM-related avoidance behaviour displayed a unidirectional relationship over time with FM symptoms, suggesting a causal effect. Thus, results illustrate that changes in avoidance behaviour mediate the outcome of exposure on FM symptoms, which implies that avoidance behaviour is an important treatment target in exposure therapy.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Mediation analysis, Exposure-based therapy, Fibromyalgia, Avoidance behaviour, Cognitive behaviour therapy
National Category
Psychology
Identifiers
urn:nbn:se:oru:diva-77751 (URN)10.1016/j.brat.2019.103478 (DOI)000491674300004 ()31585343 (PubMedID)2-s2.0-85072727352 (Scopus ID)
Funder
Stockholm County CouncilThe Karolinska Institutet's Research Foundation
Note

Funding Agencies:

Söderstrom Wittig Foundation  

Fredrik and Ingrid Thuring Foundation

Available from: 2019-11-05 Created: 2019-11-05 Last updated: 2019-11-05Bibliographically approved
Boersma, K., Flink, I. & Linton, S. J. (2019). Considering the interpersonal context of pain catastrophizing. Scandinavian Journal of Pain, 20(1), 9-10
Open this publication in new window or tab >>Considering the interpersonal context of pain catastrophizing
2019 (English)In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 20, no 1, p. 9-10Article in journal, Editorial material (Refereed) Published
Place, publisher, year, edition, pages
Walter de Gruyter, 2019
National Category
Physiology
Identifiers
urn:nbn:se:oru:diva-78556 (URN)10.1515/sjpain-2019-2020 (DOI)000504845500003 ()31785197 (PubMedID)
Available from: 2019-12-13 Created: 2019-12-13 Last updated: 2020-01-10Bibliographically approved
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
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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
Flink, I. & Linton, S. J. (2019). Du, jag och sex: Om lust och närhet i parrelationer. Stockholm: Natur och kultur
Open this publication in new window or tab >>Du, jag och sex: Om lust och närhet i parrelationer
2019 (Swedish)Book (Other (popular science, discussion, etc.))
Place, publisher, year, edition, pages
Stockholm: Natur och kultur, 2019. p. 118
National Category
Psychology
Identifiers
urn:nbn:se:oru:diva-78836 (URN)9789127824577 (ISBN)9789127824591 (ISBN)
Available from: 2019-12-27 Created: 2019-12-27 Last updated: 2020-01-07Bibliographically 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
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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: 2020-01-08Bibliographically 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
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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
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ORCID iD: ORCID iD iconorcid.org/0000-0003-2718-7402

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