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  • 1.
    Bergbom, Sofia
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    Both early and late changes in psychological variables relate to treatment outcome for musculoskeletal pain patients at risk for disability2013In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 50, no 11, p. 726-734Article in journal (Refereed)
    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.

  • 2.
    Boersma, Katja
    et al.
    Örebro University, Department of Behavioural, Social and Legal Sciences.
    Linton, Steven J.
    Örebro University, Department of Behavioural, Social and Legal Sciences.
    How does persistent pain develop?: An analysis of the relationship between psychological variables, pain and function across stages of chronicity2005In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 43, no 11, p. 1495-1507Article in journal (Refereed)
    Abstract [en]

    The fear-avoidance model is an attempt to underscore the importance of cognitive and behavioral factors, in a chain of events linking pain to disability. However, it is not clear at what time point the psychological variables within the model begin to be prominent. The aim of this study was to investigate the role of these psychological variables in the development of a chronic musculoskeletal pain problem. Three stages of chronicity, defined by duration of pain, provided a proxy for the developmental process: <1 year (N=48), 1–3 years (N=47) and >3 years (N=89). Subjects completed questionnaires on fear of movement, catastrophizing, depression, pain and function. The results indicate that the relationship between fear of movement and function is moderated by the stage of chronicity. Regression analyses showed that fear of movement did not explain any variance in the group with pain duration <1 year. Fear of movement did explain variance in the groups with pain duration of 1–3 years and >3 years. This suggests that the time point in the development of a musculoskeletal pain problem might be an essential aspect of the importance of the relationship between psychological components and function.

  • 3.
    Caneiro, J. P.
    et al.
    Curtin University, School of Physiotherapy and Exercise Science, GPO, Perth, WA, Australia; Body Logic Physiotherapy, Shenton Park, WA, Australia.
    Smith, Anne
    Curtin University, School of Physiotherapy and Exercise Science, GPO, Perth, WA, Australia.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    Moseley, G. Lorimer
    University of South Australia, GPO, Adelaide SA, Australia.
    O'Sullivan, Peter
    Curtin University, School of Physiotherapy and Exercise Science, GPO Box U1987, Perth, WA 6845, Australia; Body Logic Physiotherapy, Shenton Park, WA, Australia.
    How does change unfold? an evaluation of the process of change in four people with chronic low back pain and high pain-related fear managed with Cognitive Functional Therapy: A replicated single-case experimental design study2019In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 117, p. 28-39Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To understand the process of change at an individual level, this study used a single-case experimental design to evaluate how change in potential mediators related to change in disability over time, during an exposure-based behavioural intervention in four people with chronic low back pain and high pain-related fear. A second aim was to evaluate whether the change (sequential or simultaneous) in mediators and disability occurred at the same timepoint for all individuals.

    RESULTS: For all participants, visual and statistical analyses indicated that changes in disability and proposed mediators were clearly related to the commencement of Cognitive Functional Therapy. This was supported by standard outcome assessments at pre-post timepoints. Cross-lag correlation analysis determined that, for all participants, most of the proposed mediators (pain intensity, pain controllability, and fear) were most strongly associated with disability at lag zero, suggesting that mediators changed concomitantly and not before disability. Importantly, these changes occurred at different rates and patterns for different individuals, highlighting the individual temporal variability of change.

    CONCLUSION: This study demonstrated the interplay of factors associated with treatment response, highlighting 'how change unfolded' uniquely for each individual. The findings that factors underpinning treatment response and the outcome changed simultaneously, challenge the traditional understanding of therapeutic change.

  • 4.
    Flink, Ida K.
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Nicholas, Michael K.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    Linton, Steven J.
    Örebro University, School of Health and Medical Sciences.
    Reducing the threat value of chronic pain: A preliminary replicated single-case study of interoceptive exposure versus distraction in six individuals with chronic back pain2009In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 47, no 8, p. 721-728Article in journal (Refereed)
    Abstract [en]

    This paper describes a preliminary experimental evaluation of a technique intended to help people suffering from chronic back pain and low pain acceptance to alter the aversiveness or threat value of their persisting pain. Using a multiple baseline cross-over design six individuals with chronic back pain were taught to use a form of interoceptive exposure as well as a relaxation/distraction breathing-based technique in the presence of their pain. Half the participants used one method for three weeks, and then crossed over to the other method for a further three weeks. The other half did the reverse. Assessments were conducted at pre/post treatment and at a three month follow-up. Daily monitoring of pain-related distress was also completed. The results indicated moderately high improvements in pain acceptance across most participants and corresponding declines in pain-related distress. No clear differences occurred between conditions, but the changes on disability and catastrophising scales for most cases were consistent with those reported after more substantial interventions. The study raises some important clinical and methodological issues that could inform future research in this area.

  • 5.
    Hedman-Lagerlöf, Maria
    et al.
    Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.
    Andersson, Erik
    Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.
    Hedman-Lagerlöf, Erik
    Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.
    Wicksell, Rikard K.
    Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden; Functional Area Medical Psychology, Karolinska University Hospital Solna, Stockholm, Sweden.
    Flink, Ida
    Örebro University, School of Law, Psychology and Social Work.
    Ljótsson, Brjánn
    Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Approach as a key for success: Reduced avoidance behaviour mediates the effect of exposure therapy for fibromyalgia2019In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 122, article id UNSP 103478Article in journal (Refereed)
    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.

  • 6.
    Holländare, Fredrik
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Psychiatric Research Center, Örebro University Hospital, Region Örebro County, Örebro, Sweden.
    Anthony, Susanne A.
    School of Law, Psychology & Social Work, Örebro University, Örebro, Sweden.
    Randestad, Mia
    School of Law, Psychology & Social Work, Örebro University, Örebro, Sweden.
    Tillfors, Maria
    Örebro University, School of Law, Psychology and Social Work.
    Carlbring, Per
    Stockholm Univ, Dept Psychology, Stockholm, Sweden.
    Andersson, Gerhard
    Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
    Engström, Ingemar
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Two-year outcome of internet-based relapse prevention for partially remitted depression2013In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 51, no 11, p. 719-722Article in journal (Refereed)
    Abstract [en]

    The objective of the study was to investigate the long-term effects of internet-based relapse prevention for sufferers of partially remitted depression. Eighty-four individuals with partially remitted unipolar depression were randomized to either internet-based CBT (iCBT) or to a control group. After the ten week intervention period the participants were followed for 24 months and diagnostic interviews conducted to detect relapse. The intervention and monthly self-ratings of depressive symptoms were administered via an internet-based platform that ensured secure communication with all participants. Significantly fewer participants in the iCBT group had experienced a relapse compared with those in the control group two years after the internet-based intervention. The relapse rate in the iCBT group was 13.7% (CI 95% = 2.5-24.9) and in the control group it was 60.9% (CI 95% = 44.8-77). Furthermore, a significantly larger proportion of the iCBT group experienced remission two years after the intervention compared with the control group. Internet-based CBT seems promising for preventing relapse in sufferers of partially remitted depression. (C) 2013 Elsevier Ltd. All rights reserved.

  • 7.
    Jansson, Markus
    et al.
    Örebro University, Department of Behavioural, Social and Legal Sciences.
    Linton, Steven J.
    Örebro University, Department of Behavioural, Social and Legal Sciences.
    Psychological mechanisms in the maintenance of insomnia: Arousal, distress, and sleep-related beliefs2007In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 45, no 3, p. 511-521Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to examine whether arousal, distress, and sleep-related beliefs are related to the maintenance of insomnia. From a randomly selected sample from the general population (N = 3,600), 1,936 participants filled out a baseline and 1-year follow-up survey. Logistic regressions were used to investigate whether arousal, distress, and beliefs were related to sleep status (insomnia: n = 116; poor sleep: n = 222; normal sleep: n = 529; good sleep: n = 234) over one year. Cluster analysis was employed to assess whether it was possible to classify the participants based on their profiles of psychological functioning. The results showed that beliefs in the long-term negative consequences of insomnia, anxiety, depression, and arousal were significantly related to the maintenance of insomnia (18-72% of the variance). Of the individuals with persistent insomnia, 91% belonged to a cluster characterized by high scores on sleep-related beliefs, anxiety, depression, and arousal, and 9% to a cluster defined by low scores on the mechanisms. This study shows that sleep-related beliefs, anxiety, depression, and arousal are related to the maintenance of persistent insomnia, but also that these mechanisms often co-occur in individuals with insomnia.

  • 8.
    Norell-Clarke, Annika
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Jansson-Fröjmark, Markus
    Örebro University, School of Law, Psychology and Social Work. Dept Psychol, Stockholm Univ, Stockholm, Sweden.
    Tillfors, Maria
    Örebro University, School of Law, Psychology and Social Work.
    Harvey, Allison G.
    Dept Psychol, Univ Calif Berkeley, Berkeley, USA.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    Cognitive processes and their association with persistence and remission of insomnia: Findings from a longitudinal study in the general population2014In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 54, p. 38-48Article in journal (Refereed)
    Abstract [en]

    Aim: Insomnia is a common health problem that affects about 10% of the population. The purpose of this investigation was to examine the association between cognitive processes and the persistence and remission from insomnia in the general population.

    Methods: In a longitudinal design, 2333 participants completed a survey on night time and daytime symptoms, and cognitive processes. Follow-up surveys were sent out six months and 18 months after the first assessment. Participants were categorised as having persistent insomnia, being in remission from insomnia or being a normal sleeper.

    Results: Cognitive processes distinguished between people with persistent insomnia and normal sleepers. Specifically, worry, dysfunctional beliefs, somatic arousal, selective attention and monitoring, and safety behaviours increased the likelihood of reporting persistent insomnia rather than normal sleep. For people with insomnia, more worry about sleep at baseline predicted persistent insomnia but not remission later on. Lower selective attention and monitoring, and use of safety behaviours over time increased the likelihood of remission from insomnia. In general, these results remained, when psychiatric symptoms and medical complaints were added to the models.

    Conclusions: The findings support that certain cognitive processes may be associated with persistence and remission of insomnia. Clinical implications are discussed.

  • 9.
    Norell-Clarke, Annika
    et al.
    Centre for Research on Child and Adolescent Mental Health, Karlstad University, Karlstad, Sweden.
    Jansson-Fröjmark, Markus
    Örebro University, School of Law, Psychology and Social Work. Department of Psychology, Stockholm University, Stockholm, Sweden.
    Tillfors, Maria
    Örebro University, School of Law, Psychology and Social Work.
    Holländare, Fredrik
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. University Health Care Research Centre, Örebro, Sweden.
    Engström, Ingemar
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. University Health Care Research Centre, Örebro, Sweden.
    Group cognitive behavioural therapy for insomnia: Effects on sleep and depressive symptomatology in a sample with comorbidity2015In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 74, p. 80-93Article in journal (Refereed)
    Abstract [en]

    Aim: To investigate the effects of group CBT for insomnia (CBT-I) on insomnia and depressive symptomatology in a comorbid sample through a randomised controlled trial with a 6 month follow-up.

    Methods: 64 participants were recruited through advertisements and randomised to receive CBT-I or an active control (relaxation training: RT) during four group sessions. Insomnia Severity Index and BDI-II were the primary outcome measures, assessed pre-treatment, post-treatment and at 6 month follow-up. Insomnia and depressive diagnoses, and functional impairment were assessed before and after treatment, whereas sleep diary data was gathered continuously from one week before treatment until after treatment.

    Results: CBT-I was more efficient than RT in reducing insomnia severity and equally effective in reducing depressive symptoms, although CBT-I was associated with a higher proportion of remitted persons than RT, regarding both insomnia and depression diagnoses. Also, CBT-I was associated with less functional impairment, shorter sleep onset latency and wake after sleep onset but both treatments had equal improvements of sleep quality, early morning awakenings and total sleep time.

    Conclusion: Group CBT-I is an efficient form of insomnia-treatment for people with insomnia comorbid with depressive symptomatology. The mixed results regarding depression outcomes warrants replication and further studies into treatment mechanisms. (C) 2015 Elsevier Ltd. All rights reserved.

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