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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?
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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
Flink, I., Smeets, E., Bergbom, S. & Peters, M. L. (2015). Happy despite pain: pilot study of a positive psychology intervention for patients with chronic pain. Scandinavian Journal of Pain, 7, 71-79
Open this publication in new window or tab >>Happy despite pain: pilot study of a positive psychology intervention for patients with chronic pain
2015 (English)In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 7, p. 71-79Article in journal (Refereed) Published
Abstract [en]

Background and purpose: Dealing with chronic pain is difficult and affects physiological as well as psy-chological well-being. Patients with chronic pain are often reporting concurrent emotional problems such as low mood and depressive symptoms. Considering this, treatments need to involve strategies for improving mood and promoting well-being in this group of patients. With the rise of the positive psy-chology movement, relatively simple intervention strategies to increase positive feelings, cognitions, and behaviours have become available. So far, the evidence for positive psychology techniques mainly comes from studies with healthy participants, and from studies with patients expressing emotional problems such as depression or anxiety as their main complaint. This study describes an initial attempt to explore the potential effects of a positive psychology intervention in a small sample of patients suffering from chronic pain.

Methods: A replicated single case design was employed with five participants. The participants started to fill out daily self-reports and weekly questionnaires two weeks before the intervention started, and continued throughout the intervention. In addition, they filled out a battery of questionnaires at pretest, posttest, and at a three months follow-up. The instruments for assessment were selected to cover areas and constructs which are important for pain problems in general (e.g. disability, life satisfaction, central psychological factors) as well as more specific constructs from positive psychology (e.g. compassion, savoring beliefs).

Results: The results on pre and post assessments showed an effect on some of the measures. However, according to a more objective measure of reliable change (Reliable Change Index, RCI), the effects were quite modest. On the weekly measures, there was a trend towards improvements for three of the par-ticipants, whereas the other two basically did not show any improvement. The daily ratings were rather difficult to interpret because of their large variability, both between and within individuals. For the group of participants as a whole, the largest improvements were on measures of disability and catastrophizing.

Conclusions: The results of this preliminary study indicate that a positive psychology intervention may have beneficial effects for some chronic pain patients. Although it is not to be expected that a limited positive psychology intervention on its own is sufficient to treat pain-related disability in chronic patients, our findings suggest that for some it may be an advantageous complement to enhance the effects of other interventions.

Keywords
Positive psychology; single case design; chronic pain
National Category
Social Sciences Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:oru:diva-45658 (URN)10.1016/j.sjpain.2015.01.005 (DOI)000217937200014 ()2-s2.0-84961291721 (Scopus ID)
Available from: 2015-08-27 Created: 2015-08-27 Last updated: 2018-07-01Bibliographically approved
Bergbom, S., Boersma, K. & Linton, S. J. (2015). When matching fails: understanding the process of matching pain-disability treatment to risk profile. Journal of occupational rehabilitation, 25(3), 518-526
Open this publication in new window or tab >>When matching fails: understanding the process of matching pain-disability treatment to risk profile
2015 (English)In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 25, no 3, p. 518-526Article in journal (Refereed) Published
Abstract [en]

Purpose: A previous study (Bergbom et al. in J Occup Rehabil, 2013) showed that matching people at risk for pain-related disability to an intervention aimed at targeting their psychological problem profile did not, as hypothesized, improve the effect of the intervention. Methodological issues were suggested to explain the lack of differential effect. It was questioned whether the profiles used to allocate people to treatment were adequate. The aim of this study was to investigate if the risk profiles used to determine matching were sufficiently stable and valid by comparing the original profiles with profiles constructed using other methods.

Methods: Ninety-five people suffering musculoskeletal problems were screened, profiled, and matched to workplace based early interventions according to profiles. We studied stability and validity of their psychological risk profiles by investigating their concordance at different time points. People were originally assigned to profiles at inclusion, using a brief screening questionnaire. Then, they were profiled just before treatment start, using the same items. Finally, they were profiled again at treatment start, using extensive questionnaires. Concordance among the three sets of profiles was investigated.

Results: Profiles at inclusion were unstable until treatment start. People moved from profiles with more severe elevations in psychological variables, to a profile with moderate elevations. Concordance between the two means of profiling at treatment start was better; the brief screening and the extensive questionnaires assigned people to similar profiles.

Conclusions: Risk level may be determined with brief instruments at an early stage of problem development. However, profiles and targets for interventions should be determined immediately prior to treatment start, preferably using full questionnaires.

Keywords
Musculoskeletal pain, Occupational Health Services, Disability leave, Risk Assessment, Process Assessment (Health Care)
National Category
Occupational Therapy Psychology
Research subject
Occupational therapy; Psychology
Identifiers
urn:nbn:se:oru:diva-45802 (URN)10.1007/s10926-014-9558-x (DOI)000359948000006 ()25503587 (PubMedID)
Note

Funding Agency:

Swedish Council for Working Life and Social Research

Available from: 2015-09-16 Created: 2015-09-15 Last updated: 2017-12-04Bibliographically approved
Bergbom, S., Flink, I. K., Boersma, K. & Linton, S. J. (2014). Early psychologically informed interventions for workers at risk for pain-related disability: does matching treatment to profile improve outcome?. Journal of occupational rehabilitation, 24(3), 446-457
Open this publication in new window or tab >>Early psychologically informed interventions for workers at risk for pain-related disability: does matching treatment to profile improve outcome?
2014 (English)In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 24, no 3, p. 446-457Article in journal (Refereed) Published
Abstract [en]

Purpose: This randomized controlled trial had two main aims. The first aim was to investigate the effect of early preventive, psychologically informed, interventions for pain-related disability. The second aim was explore whether people who are matched to an intervention specifically targeting their psychological risk profile had better outcomes than people who were not matched to interventions.

Methods: A total of 105 participants were recruited from their workplace, screened for psychological risk factors and classified as being at risk for long-term pain-related disability. They were subgrouped into one of three groups based on their psychological profile. Three behaviorally oriented psychological interventions were developed to target each of the three risk profiles. Half of the participants were assigned a matched intervention developed to target their specific profile, and half were assigned an unmatched intervention. After treatment, repeated measure ANOVAs and χ2 tests were used to determine if treatments had an effect on primary and secondary outcomes including perceived disability, sick leave, fear and avoidance, pain catastrophizing and distress, and if matched participants had better outcomes than did unmatched.

Results: Treatments had effects on all outcome variables (effect sizes d ranging between 0.23 and 0.66), but matched participants did not have better outcomes than unmatched.

Conclusions: Early, preventive interventions have an impact on a number of outcome variables but it is difficult to realize a matching procedure. More in-depth research of the process of matching is needed.

Place, publisher, year, edition, pages
Springer, 2014
Keywords
Musculoskeletal pain, Occupational health services, Disability leave, Return-to-work, Pain management, Randomized controlled trial
National Category
Psychology Medical and Health Sciences
Research subject
Psychology
Identifiers
urn:nbn:se:oru:diva-34090 (URN)10.1007/s10926-013-9478-1 (DOI)000340487900008 ()2-s2.0-84905444201 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare
Available from: 2014-03-06 Created: 2014-03-06 Last updated: 2017-12-05Bibliographically approved
Bergbom, S. (2014). Matchmaking in pain practice: challenges and possibilities. (Doctoral dissertation). Örebro: Örebro universitet
Open this publication in new window or tab >>Matchmaking in pain practice: challenges and possibilities
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

All people experience pain and for some people, acute pain may over time develop into long-term disabling problems. Already at an early stage, it is possible to identify people at risk for long-term problems and psychologically oriented interventions have been shown to successfully prevent future disability. However, not all people are helped by treatment and there is room for improvement. Moreover, subgroups of people suffering from pain, with different profiles of psychological factors have been identified, indicating that people with pain problems differ. The first aim of this dissertation was to improve the understanding of how people differ. The second aim was to use these individual differences and to match people to psychological treatment based on their psychological profile. The third aim was to explore what happens during treatment that might be important for treatment outcome.

The findings show that people who belonged to subgroups with elevated levels of psychological factors had less favorable outcomes over time, despite treatment, than people with no elevations. Moreover, people with elevations in several psychological factors had even less favorable outcomes. Psychological treatments aimed at preventing future disability performed well, but using profiles to match people to treatment did not improve outcomes further; people who were matched to a treatment and people who were unmatched had similar outcomes. However, the profiles used for matching were unstable over time and there is need to improve the identification of psychological variables used for treatment matching. Finally, a number of psychological factors were shown to be valuable targets for treatment; if the treatments successfully produced change in people’s thoughts and emotions related to pain the treatment outcomes were better. The findings were summarized in a flow chart showing the recommended clinical approach to people seekinghealth care for acute pain problems.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2014. p. 91
Series
Örebro Studies in Psychology, ISSN 1651-1328 ; 29
Keywords
pain, psychological profiles; psychological treatment; early intervention; secondary prevention; treatment matching
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:oru:diva-33751 (URN)978-91-7529-006-5 (ISBN)
Public defence
2014-03-28, Hörsal L3, Långhuset, Örebro universitet, Fakultetsgatan 1, Örebro, 10:15 (English)
Opponent
Supervisors
Available from: 2014-02-14 Created: 2014-02-14 Last updated: 2018-04-17Bibliographically approved
Linton, S. J., Flink, I. K. & Bergbom, S. (2013). Beteendeanalys steg för steg: grunden till en effektiv KBT-behandling (1ed.). Stockholm: Natur och kultur
Open this publication in new window or tab >>Beteendeanalys steg för steg: grunden till en effektiv KBT-behandling
2013 (Swedish)Book (Other academic)
Place, publisher, year, edition, pages
Stockholm: Natur och kultur, 2013. p. 216 Edition: 1
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:oru:diva-28964 (URN)9789127132146 (ISBN)
Available from: 2013-05-06 Created: 2013-05-06 Last updated: 2017-10-17Bibliographically approved
Bergbom, S., Boersma, K. & Linton, S. J. (2013). Both early and late changes in psychological variables relate to treatment outcome for musculoskeletal pain patients at risk for disability. Behaviour Research and Therapy, 50(11), 726-734
Open this publication in new window or tab >>Both early and late changes in psychological variables relate to treatment outcome for musculoskeletal pain patients at risk for disability
2013 (English)In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 50, no 11, p. 726-734Article in journal (Refereed) Published
Abstract [en]

We know little about why some people get better after psychological treatments for pain disability, whereas other people do not. In order to understand differences in treatment response, we need to explore processes of change during treatment. It has been suggested that people with pain complaints who change early in treatment have better outcomes. Therefore, we aimed to investigate whether changes in psychological variables at different time points are related to outcome, and whether early or late changes are better predictors of outcome. We used the fear avoidance model as a theoretical framework. We followed 64 patients weekly over 6–7 weeks and then determined outcome. Our findings indicate that people who decrease in catastrophizing and function early in treatment as well as in depressive symptoms, worry, fear avoidance beliefs and function late in treatment have better outcomes. Early decreases in function, and late decreases in depressive symptoms and worry uniquely predict improvements in disability. While early and late changes covaried concurrently, there were no significant sequential relationships between early and late changes. Changes in the proposed process variables in the fear avoidance model, early as well as late in treatment, thus add valuable information to the explanation of outcome.

Place, publisher, year, edition, pages
Elsevier, 2013
Keywords
Pain-related disability, Psychological treatment, CBT, Process of change, Treatment response
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:oru:diva-28927 (URN)10.1016/j.brat.2012.08.008 (DOI)000311178800010 ()23000845 (PubMedID)2-s2.0-84866305805 (Scopus ID)
Available from: 2013-05-03 Created: 2013-05-03 Last updated: 2017-12-06Bibliographically approved
Bergbom, S., Boersma, K., Overmeer, T. & Linton, S. J. (2011). Relationship Among Pain Catastrophizing, Depressed Mood, and Outcomes Across Physical Therapy Treatments. Physical Therapy, 91(5), 754-764
Open this publication in new window or tab >>Relationship Among Pain Catastrophizing, Depressed Mood, and Outcomes Across Physical Therapy Treatments
2011 (English)In: Physical Therapy, ISSN 0031-9023, E-ISSN 1538-6724, Vol. 91, no 5, p. 754-764Article in journal (Refereed) Published
Abstract [en]

Background: Pain catastrophizing and emotional distress can act as prognosticfactors for pain and disability. Research on how these variables interact withinindividuals and over time is in an early stage. Understanding various patterns ofprognostic factors and how these factors change during treatment is important fordeveloping treatments targeting important factors.

Objective: The primary aim of this study was to investigate relationships betweenpain catastrophizing and depressed mood in people seeking primary care for mus-culoskeletal pain. An additional aim was to relate these patterns of prognostic factorsto outcomes during a 6-month period.

Design: The design was prospective; data were obtained at baseline and atfollow-up.

Methods: Forty-two physical therapists taking part in an educational programrecruited, from their clinical practices in primary care, consecutive patients whowere currently experiencing a pain problem. Patients received various physicaltherapy interventions between baseline and follow-up.

Results: On the basis of patterns of scoring for pain catastrophizing and depressedmood, 4 subgroups of participants were found. Belonging to a subgroup withelevated levels of either pain catastrophizing or depressed mood at baseline wasrelated to the absence of improvement and elevated levels of disability after physicaltherapy interventions. Furthermore, elevated levels of both variables were related tothe highest levels of disability.

Limitations: The analyses relied on self-report. Neither treatment content norpain-related fear was measured. The sample was a mixture of participants reportingacute pain and subacute pain.

Conclusions: The results stress the importance of assessing and targeting prog-nostic factors. Moreover, the results suggest the need to tailor treatments to matchpatterns of prognostic factors and the need to target depressed mood and paincatastrophizing in physical therapy interventions.

Place, publisher, year, edition, pages
Oxford University Press, 2011
National Category
Psychology Medical and Health Sciences
Research subject
Psychology
Identifiers
urn:nbn:se:oru:diva-34088 (URN)10.2522/ptj.20100136 (DOI)000289961000016 ()21451092 (PubMedID)2-s2.0-79960940349 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare
Available from: 2014-03-06 Created: 2014-03-06 Last updated: 2017-12-05Bibliographically approved
Linton, S. J., Nicholas, M. K., MacDonald, S., Boersma, K., Bergbom, S., Maher, C. & Refshauge, K. (2011). The role of depression and catastrophizing in musculoskeletal pain. European Journal of Pain, 15(4), 416-422
Open this publication in new window or tab >>The role of depression and catastrophizing in musculoskeletal pain
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2011 (English)In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 15, no 4, p. 416-422Article in journal (Refereed) Published
Abstract [en]

Many patients with musculoskeletal pain also suffer from a depressed mood. Catastrophizing is one process that may link depression and pain since it is a key concept in models of both problems. Earlier research has suggested that catastrophizing measures something above and beyond depression. This study tests the idea that if depressed mood and catastrophizing are separate entities then when one is absent the other should still contribute to poor outcome, and, when both are present there should be an additional adverse effect. To this end, a prospective design, with a built-in replication from two clinical samples of patients with sub-acute pain (one from Sweden, N=373; one from Australasia, N=259), was employed. Participants were classified as to having high/low scores on measures of depression and catastrophizing. Subsequently, these classifications were studied in relation to outcome variables cross-sectionally and at follow-up. Results showed a small to moderate correlation between catastrophizing and depression and that there are individuals with one, but not the other problem. Further, having one or the other of the entities was associated with current pain problems and outcome, while having both increased the associations substantially. The replication showed very similar results Our data demonstrate that pain catastrophizing and heightened depressed mood have an additive and adverse effect on the impact of pain, relative to either alone. It suggests that each should be assessed in the clinic and that future research should focus on treatments specifically designed to tackle both depressed mood and catastrophizing.

National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:oru:diva-13716 (URN)10.1016/j.ejpain.2010.08.009 (DOI)000289280200012 ()20884261 (PubMedID)2-s2.0-79953893930 (Scopus ID)
Available from: 2011-01-13 Created: 2011-01-13 Last updated: 2017-12-11Bibliographically approved
Linton, S. J. & Bergbom, S. (2011). Understanding the link between depression and pain. Scandinavian Journal of Pain, 2(2), 47-54
Open this publication in new window or tab >>Understanding the link between depression and pain
2011 (English)In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 2, no 2, p. 47-54Article in journal (Refereed) Published
Abstract [en]

Background and aims

Patients seeking care for a pain problem very often also report symptoms of depression. In fact, depression is associated with the development of chronic pain as well as poor treatment results. Yet, the mechanisms by which depression and pain impact upon one another are not clear. This paper provides a critical review of the literature with the aim of shedding light on the relationship between pain and depression. Further, we introduce the Örebro Behavioral Emotion Regulation Model which may stimulate understanding in addition to research.

Method

Data bases (MedLine and PsychINFO) were searched as well as reference lists to locate relevant articles, especially previous reviews, published since 2000. We located 244 articles including 6 reviews.

Results

We found that while depression is strongly linked to pain, there is little understanding of how this link works or how it might be utilized in clinical settings. It is not clear whether one of the symptoms precedes the other, but when both are present prognosis is significantly affected. Clinicians often fail to assess both depression and pain resulting in probable “under” treatment of one or both problems. There is little evidence that treating the pain will result in the disappearance of the depression. Indeed, early improvements in depression are associated with overall treatment gains for patients with musculoskeletal pain. Therefore, treatment outcomes might be substantially enhanced by addressing both the pain and the depression. Moreover, directly addressing the depression early in treatment may be especially valuable. While pharmacological treatments of depression are often pursued for pain patients, the results for depression, pain and function are not impressive. Although there are effective cognitive-behavioral techniques for depression, these have not been properly evaluated in patients with co-morbid pain and depression.

We found two likely mechanisms that can help to explain the link between depression and pain. First, catastrophizing plays a central role in models of both pain and depression and hence might form an important link between them. Second, emotion regulation is important in both depression and pain since they both can be viewed as significant emotional stressors. We offer a model which focuses on the recurrent nature of pain and depression. It hypothesizes that flare-ups trigger catastrophic worry which in turn strains the individual's emotion regulation system. Successful behavioral emotion regulation is said to result in coping while negative behavioral emotion regulation results in spiraling negative affect, pain and mood related disability and, in the long term, a consequent relapse.

Implications

Since both pain and depression are closely linked and are both involved in the development of long-term problems, it is important for clinicians to assess them as early as possible. Moreover, both symptoms should be monitored and addressed in treatment to maximize outcome results. Because pharmacological treatment has limited effects, cognitive-behavioral therapy is an alternative. Behavioral emotion regulation may be an important mechanism linking depression and pain.

Conclusions

It is concluded that pain and depression impact on each other and play an important role in the development and maintenance of chronic problems. Future studies of treatments for co-morbid depression and pain are urgently required. The purposed Örebro Behavioral Emotion Regulation Model provides much needed guidance for investigating the psychological mechanisms involved.

National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:oru:diva-13705 (URN)10.1016/j.sjpain.2011.01.005 (DOI)
Available from: 2011-01-12 Created: 2011-01-12 Last updated: 2018-04-24Bibliographically approved
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