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  • 1. Ahlborg, Tone
    et al.
    Rudeblad, Kristina
    Örebro universitet, Akademin för juridik, psykologi och socialt arbete.
    Linnér, Sarah
    Örebro universitet, Akademin för juridik, psykologi och socialt arbete.
    Linton, Steven J.
    Örebro universitet, Akademin för juridik, psykologi och socialt arbete.
    Sensual and sexual marital contentment in parents of small children: a follow-up study when the first child is four years old2008Ingår i: Journal of Sex Research, ISSN 0022-4499, E-ISSN 1559-8519, Vol. 45, nr 3, s. 295-304Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This follow-up study explored parents' (N=452) intimate relationships when their firstborn child was 6 months old and then 4 years later. The measurement used was a modified version of the Dyadic Adjustment Scale, DAS. The present results show that most parents responding were content sensually at 6 months postpartum in 2002 and 4 years later, in 2006. More parents had changed from being sensually content in 2002 to discontent in 2006, than the contrary, however, and the sexual contentment remained low. The average sexual frequency was low both at 6 months and at 4 years for both parents with and without additional children. Experiencing tiredness as a hindrance to having sex was perceived as a greater problem among those parents without additional children. Prospective regression analyses indicated that sexuality was significantly related to both sensual and sexual contentment 4 years later. Sexuality was also one of the most significant covariates in the cross-sectional regression analysis for sensual contentment. Since sexuality plays a central role in partner well-being, it may be an important target for helping parents with small children.

  • 2.
    Arnberg, Filip K.
    et al.
    Dept Neurosci, Uppsala Univ, Uppsala, Sweden.
    Linton, Steven J.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Hultcrantz, Monica
    Swedish Agency For Health Technology Assessment And Assessment Of Social Services (SBU), Stockholm, Sweden.
    Heintz, Emelie
    Swedish Agency For Health Technology Assessment And Assessment Of Social Services (SBU), Stockholm, Sweden; Dept Med & Hlth Sci, Ctr Med Technol Assessment CMT, Linköping Univ, Linköping, Sweden .
    Jonsson, Ulf
    Swedish Agency For Health Technology Assessment And Assessment Of Social Services, Stockholm, Sweden; Dept Clin Neurosci, Div Insurance Med, Karolinska Inst, Stockholm, Sweden .
    Internet-delivered psychological treatments for mood and anxiety disorders: a systematic review of their efficacy, safety, and cost-effectiveness2014Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, nr 5, s. e98118-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Greater access to evidence-based psychological treatments is needed. This review aimed to evaluate whether internet-delivered psychological treatments for mood and anxiety disorders are efficacious, noninferior to established treatments, safe, and cost-effective for children, adolescents and adults.

    Methods: We searched the literature for studies published until March 2013. Randomized controlled trials (RCTs) were considered for the assessment of short-term efficacy and safety and were pooled in meta-analyses. Other designs were also considered for long-term effect and cost-effectiveness. Comparisons against established treatments were evaluated for noninferiority. Two reviewers independently assessed the relevant studies for risk of bias. The quality of the evidence was graded using an international grading system.

    Results: A total of 52 relevant RCTs were identified whereof 12 were excluded due to high risk of bias. Five cost-effectiveness studies were identified and three were excluded due to high risk of bias. The included trials mainly evaluated internet-delivered cognitive behavioral therapy (I-CBT) against a waiting list in adult volunteers and 88% were conducted in Sweden or Australia. One trial involved children. For adults, the quality of evidence was graded as moderate for the short-term efficacy of I-CBT vs. waiting list for mild/moderate depression (d = 0.83; 95% CI 0.59, 1.07) and social phobia (d = 0.85; 95% CI 0.66, 1.05), and moderate for no efficacy of internet-delivered attention bias modification vs. sham treatment for social phobia (d = 20.04; 95% CI 20.24, 0.35). The quality of evidence was graded as low/very low for other disorders, interventions, children/adolescents, noninferiority, adverse events, and cost-effectiveness.

    Conclusions: I-CBT is a viable treatment option for adults with depression and some anxiety disorders who request this treatment modality. Important questions remain before broad implementation can be supported. Future research would benefit from prioritizing adapting treatments to children/adolescents and using noninferiority designs with established forms of treatment.

  • 3.
    Bauducco, Serena
    et al.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Flink, Ida
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Boersma, Katja
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Linton, Steven J.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Preventing sleep deficit in adolescents: Long-term effects of a quasi-experimental school-based intervention study2019Ingår i: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, artikel-id e12940Artikel i tidskrift (Refereegranskat)
    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.

  • 4.
    Bauducco, Serena
    et al.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Flink, Ida
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Jansson-Fröjmark, Markus
    Stockholm University, Stockholm, Sweden.
    Linton, Steven
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Sleep duration and patterns in adolescents: Correlates and the role of daily stressors2016Ingår i: Sleep Health, ISSN 2352-7218, E-ISSN 2352-7226, Vol. 2, nr 3, s. 211-218Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: The first aim of this study was to assess the prevalence of sleep deficit in a large sample of adolescents. Second, the study aimed to assess whether short sleep duration in the sample was associated with emotional and behavioral problems. Lastly, the study aimed to investigate the association between daily stressors-bedtime activities and sleep duration.

    Design: Cross-sectional survey.

    Setting: The questionnaires were completed during school hours in 17 municipal junior high schools in Sweden.

    Participants: A total of 2767 adolescents aged 12 to 16 years, 48% girls.

    Measurements and Results: Sleep measures included total sleep time (TST) for schooldays and weekends, obtained as combined measures of self-reported bed-time, wake-time, and sleep onset latency. We used the new National Sleep Foundation's guidelines to operationalize sleep duration. Overall 12% of younger adolescents (age 12-13 years) and 18% of older adolescents (14-16 years) slept less than recommended (TST < 7 hours). Adolescents reporting nonrecommended TST also reported more behavioral (ie, norm-breaking behaviors) and emotional problems (ie, depression, anxiety, and anger), with effects in the small-medium range. Finally, adolescents reporting bedtime arousal and use of information and communication technology in bed were more likely to report TST < 7 hours. Stress at home (for younger adolescents) and stress of school performance (for older adolescents) were also associated with TST less than 7 hours.

    Conclusions: The new National Sleep Foundation's recommendations were informative in this context. Future sleep interventions need to target barriers to good sleep practices, such as use of information and communication technology, stress, and worry that may contribute to arousal at bedtime.

  • 5.
    Bauducco, Serena
    et al.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Flink, Ida
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Linton, Steven J.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Making room for sleep: A classroom based prevention program for adolescents2016Konferensbidrag (Övrigt vetenskapligt)
  • 6.
    Bauducco, Serena
    et al.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Flink, Ida
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Linton, Steven J.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Prevalence, Incidence and Risk Factors for Sleep Deprivation in Adolescence: The Role of Technology and Stress2016Konferensbidrag (Övrigt vetenskapligt)
    Abstract [en]

    Aim: The first aim of this study was to describe the prevalence and incidence of poor sleep duration (<7 hours) over a one year period in a large sample of adolescents. The second aim was to inform prevention about the influence of adolescents´ social context on sleep duration. Therefore, we wanted to describe the longitudinal association between the use of Information and Communication Technology (ICT) at bedtime and daily stressors (e.g. school performance, family and peer issues) and poor sleep duration.

    Method: Participants were high school students in the 7th and 8th grade (N = 2505; age range: 12-15 years, at baseline) from 17 public schools in three communities in middle Sweden. Students filled out questionnaires in school during the spring, 2014 and one year later (85% retention rate). Sleep measures included bed time (BT), wake up time (WUT), and sleep onset latency (SOL). Total sleep time was calculated as, BT + WUT - SOL.

    We calculated prevalence, incidence, and chronicity of poor sleep duration. Moreover, the effect of ICT and daily stressors on future sleep duration was estimated with odds ratios, controlling for gender.

    Results: Prevalence (18.6%), incidence (12.8%) and chronicity (50%) rates indicate that poor sleep duration was persistent and increased one year later. Moreover, adolescents who often used ICT at bedtime (OR = 1.21, p < .001) and reported more school stress (OR = 1.16, p = .02), were more likely to report poor sleep duration one year later.

    Conclusion: Because poor sleep duration is common and persists over time, it is crucial to intervene early to prevent chronic sleep deprivation. Sleep interventions with younger adolescence, before chronicity occurs, should focus on barriers to change, such as stress and use of technology. The results from this study have been used to develop an early school-based intervention.

  • 7.
    Bauducco, Serena V.
    et al.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Flink, Ida K.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Linton, Steven J.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Making room for sleep: The evaluation of a preventive school-based program to improve adolescents´ sleepManuskript (preprint) (Övrigt vetenskapligt)
  • 8.
    Bauducco, Serena V.
    et al.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Tillfors, Maria
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Özdemir, Metin
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Flink, Ida K.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Linton, Steven J.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Too tired for school?: the effects of insomnia on absenteeism in adolescence2015Ingår i: Sleep Health, ISSN 2352-7218, E-ISSN 2352-7226, Vol. 1, nr 3, s. 205-210Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: Sleep has important consequences for a person's daytime functioning. Numerous studies have shown that insomnia predicts work absenteeism and work disability in adults, but only a few studies have examined this association in adolescents. This study aims to explore whether symptoms of insomnia in adolescents predict school absenteeism 1 year later, over and above known psychological risk factors for absenteeism.

    Design: The study used a longitudinal design with 2 measurement points over 1 year.

    Setting: The students completed questionnaires during school hours at baseline and again at follow-up.

    Participants: Students in the 10th to 12th grades in a Swedish upper secondary school were followed prospectively for 1 year (age, 16-20 years; N = 353; 48.1% girls).

    Measurements and results: We used logistic regression analyses, controlling for the known effects of psychological factors, and arrived at a model elucidating the role of insomnia. That is, besides symptoms of insomnia, the model included previous absenteeism, alcohol intoxication, school-related social phobia, social anxiety, depressive symptoms, somatic symptoms, and bully victimization. Symptoms of insomnia predicted school absenteeism 1 year later, over and above known risk factors for absenteeism. Adolescents reporting severe symptoms of insomnia were almost 3 times more likely than adolescents reporting no or low symptoms to report problematic absenteeism 1 year later. We did not find any gender difference.

    Conclusions: Our findings underscore the importance of sleep problems on adolescents' daytime functioning as measured by school absenteeism. Therefore, sleep may be an important target for preventive interventions with adolescents.

  • 9.
    Beales, Darren
    et al.
    School of Physiotherapy and Exercise Science, Curtin Univ, Perth WA, Australia.
    Kyaw-Myint, SuMon
    Safe Work Australia, Canberra Australian Capital Territory, Australia.
    Smith, Anne
    School of Physiotherapy and Exercise Science, Curtin Univ, Perth WA, Australia.
    O'Sullivan, Peter
    School of Physiotherapy and Exercise Science, Curtin Univ, Perth WA, Australia.
    Pransky, Glenn
    Liberty Mutual Research Institute for Safety, Boston MA, USA.
    Linton, Steven
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Job, Jenny
    Safe Work Australia, Canberra Australian Capital Territory, Australia.
    Straker, Leon
    School of Physiotherapy and Exercise Science, Curtin Univ, Perth WA, Australia.
    Work Productivity Loss in Young Workers Is Substantial and Is Associated With Spinal Pain and Mental Ill-health Conditions2017Ingår i: Journal of Occupational and Environmental Medicine, ISSN 1076-2752, E-ISSN 1536-5948, Vol. 59, nr 3, s. 237-245Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: The aim of this study was to estimate the effect of spinal pain and mental ill-health conditions on work productivity in 22-year-old workers.

    Methods: A cross-sectional design using data from the Raine Study cohort (n = 867) including self-reported work productivity and self-report of health practitioner diagnosed medical conditions.

    Result: Mean (median, 25th-percentile, 75th-percentile) annualized cost of health-related absenteeism was $AUD1899 ($0, $0, $1738) per worker. Annualized cost of presenteeism was $AUD10,674 ($6573, $4003, $13,087) per worker. Spinal pain and mental ill-health conditions were associated with increased health-related absenteeism, but not presenteeism.

    Conclusion: Work productivity loss in young workers is a substantial problem needing priority attention. Addressing spinal pain and mental ill-health may improve productivity of this important sector of the workforce.

  • 10.
    Bergbom, Sofia
    et al.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Boersma, Katja
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Linton, Steven J.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Both early and late changes in psychological variables relate to treatment outcome for musculoskeletal pain patients at risk for disability2013Ingår i: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 50, nr 11, s. 726-734Artikel i tidskrift (Refereegranskat)
    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.

  • 11.
    Bergbom, Sofia
    et al.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Boersma, Katja
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Linton, Steven J.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    When matching fails: Understanding the process of matching pain-disability treatment to risk profileManuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    Purpose A previous study [1] 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 withprofiles 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.

  • 12.
    Bergbom, Sofia
    et al.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Boersma, Katja
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Linton, Steven J.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    When matching fails: understanding the process of matching pain-disability treatment to risk profile2015Ingår i: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 25, nr 3, s. 518-526Artikel i tidskrift (Refereegranskat)
    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.

  • 13.
    Bergbom, Sofia
    et al.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Boersma, Katja
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Overmeer, Thomas
    Linton, Steven J.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Relationship Among Pain Catastrophizing, Depressed Mood, and Outcomes Across Physical Therapy Treatments2011Ingår i: Physical Therapy, ISSN 0031-9023, E-ISSN 1538-6724, Vol. 91, nr 5, s. 754-764Artikel i tidskrift (Refereegranskat)
    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.

  • 14. Bergbom, Sofia
    et al.
    Flink, Ida K.
    Boersma, Katja
    Linton, Steven J.
    Örebro universitet, Akademin för juridik, psykologi och socialt arbete.
    Are early improvements in psychological variables related to treatment outcome?2010Konferensbidrag (Refereegranskat)
  • 15.
    Bergbom, Sofia
    et al.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Flink, Ida K.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Boersma, Katja
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Linton, Steven J.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Early psychologically informed interventions for workers at risk for pain-related disability: does matching treatment to profile improve outcome?2014Ingår i: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 24, nr 3, s. 446-457Artikel i tidskrift (Refereegranskat)
    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.

  • 16.
    Bergbom, Sofia
    et al.
    Örebro universitet, Akademin för juridik, psykologi och socialt arbete.
    Flink, Ida K.
    Örebro universitet, Akademin för juridik, psykologi och socialt arbete.
    Linton, Steven J.
    Örebro universitet, Akademin för juridik, psykologi och socialt arbete.
    Boersma, Katja
    Örebro universitet, Akademin för juridik, psykologi och socialt arbete.
    Manual för KBT vid långvarig muskuloskeletal smärta2010Övrigt (Övrigt vetenskapligt)
  • 17.
    Besen, Elyssa
    et al.
    Liberty Mutual Research Institute for Safety, Hopkinton MA, USA.
    Gaines, Brittany
    Liberty Mutual Research Institute for Safety, Hopkinton MA, USA; Department og Gerontology, University of Massachusetts, Boston MA, USA.
    Linton, Steven J.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Shaw, William S.
    Liberty Mutual Research Institute for Safety, Hopkinton MA, USA; University of Massachusetts Medical School, Worcester MA, USA.
    The role of pain catastrophizing as a mediator in the work disability process following acute low back pain2017Ingår i: Journal of applied biobehavioral research, ISSN 1071-2089, E-ISSN 1751-9861, Vol. 22, nr 1, artikel-id UNSP e12085Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The purpose of this study was to assess pain catastrophizing as a mediator in the relationships between pain and recovery expectations with work limitations and functional disability in a working population experiencing acute low back pain (LBP). Workers (n=241) with acute, work-related LBP completed measures of pain and injury at medical intake and then the Pain Catastrophizing Scale (PCS) shortly after the initial intake visit. At 3-months follow-up, measures of work limitations and functional disability were administered. Structural equation modeling was used to assess whether the PCS mediated longitudinal associations between pain and recovery expectations with perceived disability and work limitations. The PCS score completely mediated the relationship between initial pain intensity and 3-month perceptions of disability (40% explained) and work limitations (29% explained). The PCS also completely mediated the longitudinal relationship between pain recovery expectations and 3-month disability (50% explained) and work limitations (40% explained). Effective clinical management during this acute phase of LBP might be improved by incorporating early interventions to reduce catastrophizing in caseswhere pain catastrophizing may be especially problematic.

  • 18.
    Boersma, Katja
    et al.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Carstens-Söderstrand, Johan
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Linton, Steven J.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    From acute pain to chronic disability: psychosocial processes in the development of chronic musculoskeletal pain and disability2014Ingår i: Handbook of musculoskeletal pain and disability disorders in the workplace / [ed] Gatchel, Robert J. & Schultz, Izabela Z., New York: Springer, 2014, s. 205-217Kapitel i bok, del av antologi (Refereegranskat)
    Abstract [en]

    In the last decades, there has been a clear recognition of the importance of psychosocial factors in the explanation of chronic musculoskeletal pain. It is generally accepted that chronic musculoskeletal pain and disability has multiple causes, a view that is summarized in the so-called biopsychosocial models (Gatchel, Peng, Peters, Fuchs, & Turk, 2007). However, psychosocial factors have proven to be important predictors of chronic pain and disability already early on in acute and subacute stages of pain. A range of reviews conclude that factors, such as depression, anxiety, pain beliefs, catastrophizing, and coping behaviors, play a primary role in the transition from acute to chronic pain and disability (Linton, 2002; Main, Sullivan, & Watson, 2007; Nicholas, Linton, Watson, & Main, 2011). This supports the notion that psychosocial factors are preferably viewed as an integrated part of musculoskeletal pain, not only in the rehabilitation of chronic problems but also in prevention in the subacute stages.

  • 19.
    Boersma, Katja
    et al.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Flink, Ida
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Linton, Steven J.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Considering the interpersonal context of pain catastrophizing2019Ingår i: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, artikel-id /j/sjpain.ahead-of-print/sjpain-2019-2020/sjpain-2019-2020.xmlArtikel i tidskrift (Refereegranskat)
  • 20.
    Boersma, Katja
    et al.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Linton, Steven
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Editorial comment on Helen Richardson’s and Stephen Morley’s study on "Action identification and meaning in life in chronic pain"2015Ingår i: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 9, s. 64-65Artikel i tidskrift (Övrigt vetenskapligt)
  • 21.
    Boersma, Katja
    et al.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Linton, Steven J.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Editorial comment on Nina Kreddig's and Monika Hasenbring's study on pain anxiety and fear of (re) injury in patients with chronic back pain: Sex as a moderator2017Ingår i: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 16, s. 89-90, artikel-id S1877-8860(17)30050-2Artikel i tidskrift (Refereegranskat)
  • 22.
    Boersma, Katja
    et al.
    Örebro universitet, Institutionen för beteende-, social- och rättsvetenskap.
    Linton, Steven J.
    Örebro universitet, Institutionen för beteende-, social- och rättsvetenskap.
    How does persistent pain develop?: An analysis of the relationship between psychological variables, pain and function across stages of chronicity2005Ingår i: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 43, nr 11, s. 1495-1507Artikel i tidskrift (Refereegranskat)
    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.

  • 23.
    Boersma, Katja
    et al.
    Örebro universitet, Institutionen för beteende-, social- och rättsvetenskap.
    Linton, Steven J.
    Örebro universitet, Institutionen för beteende-, social- och rättsvetenskap.
    Psychological processes underlying the development of a chronic pain problem: a prospective study of the relationship between profiles of psychological variables in the fear-avoidance model and disability2006Ingår i: The Clinical Journal of Pain, ISSN 0749-8047, E-ISSN 1536-5409, Vol. 22, nr 2, s. 160-166Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: Understanding the psychological processes that underlie the development of a chronic pain problem is important to improve prevention and treatment. The aim of this study was to test whether distinct profiles of variables within the fear-avoidance model could be identified and could be related to disability in a meaningful way.

    Methods: In 81 persons with a musculoskeletal pain problem, cluster analysis was used to identify subgroups with similar patterns on fear and avoidance beliefs, catastrophizing, and depression. The clusters were examined cross-sectionally and prospectively on function, pain, health care usage, and sick leave.

    Results: Five distinct profiles were found: pain-related fear, pain-related fear + depressed mood, medium pain-related fear, depressed mood, and low risk. These subgroups were clearly related to outcome. In contrast to the clusters medium pain-related fear and low risk, the majority of those classified in the clusters pain-related fear, pain-related fear + depressed mood, and depressed mood reported long-term sick leave during follow-up. The subjects in the clusters with high scores on the depression measure reported the highest percentage of health care usage during follow-up (70% in the pain-related fear + depressed mood group and 42% in the depressed mood group reported >10 health care visits).

    Conclusions: Distinct profiles of psychological functioning could be extracted and meaningfully related to future disability. These profiles give support to the fear-avoidance model and underscore the need to address the psychological aspects of the pain experience early on.

  • 24.
    Boersma, Katja
    et al.
    Örebro universitet, Institutionen för beteende-, social- och rättsvetenskap.
    Linton, Steven J.
    Örebro universitet, Institutionen för beteende-, social- och rättsvetenskap.
    Screening to identify patients at risk: profiles of psychological risk factors for early intervention2005Ingår i: The Clinical Journal of Pain, ISSN 0749-8047, E-ISSN 1536-5409, Vol. 21, nr 1, s. 38-43Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    There is a serious need to provide effective early interventions that prevent the development of persistent pain and disability. Identifying patients at risk for this development is an important step. Our aim was to explore whether distinct subgroups of individuals with similar response patterns on a screening questionnaire exist. Moreover, the objective was to then relate these groups to future outcomes, for example, sick leave as an impetus for developing tailored interventions that might better prevent chronic problems. A total of 363 patients seeking primary care for acute or subacute spinal pain completed the Orebro Musculoskeletal Pain Screening Questionnaire and were then followed to determine outcome. Cluster analysis was used to identify subgroups. Validity was tested using 3 methods including the split-half technique. The subgroups were compared prospectively on outcome measures obtained 1 year later. Using pain intensity, fear-avoidance beliefs, function, and mood, we found 4 distinct profiles: Fear-Avoidant, Distressed Fear-Avoidant, Low Risk, and Low Risk-Depressed Mood. These 4 subgroups were also robust in all 3 of the validity procedures. The 4 subgroups were clearly related to outcome. Although the low risk profiles had virtually no one developing long-term sick leave, the Fear-Avoidant profile had 35% and the Distressed Fear-Avoidant profile 62% developing long-term sick leave. Our results suggest that fear-avoidance and distress are important factors in the development of pain-related disability and may serve as a key for early identification. Providing interventions specific to the factors isolated in the profiles should enhance the prevention of persistent pain and disability.

  • 25.
    Boersma, Katja
    et al.
    Örebro universitet, Institutionen för beteende-, social- och rättsvetenskap.
    Linton, Steven J.
    Örebro universitet, Institutionen för beteende-, social- och rättsvetenskap.
    Overmeer, Thomas
    Janson, Markus
    Vlaeyen, Johan
    de Jong, Jeroen
    Lowering fear-avoidance and enhancing function through exposure in vivo: a multiple baseline study across six patients with back pain2004Ingår i: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 108, nr 1-2, s. 8-16Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This study investigated the effects of an exposure in vivo treatment for chronic pain patients with high levels of fear and avoidance. The fear-avoidance model offers an enticing explanation of why some back pain patients develop persistent disability, stressing the role of catastrophic interpretations; largely fueled by beliefs and expectations that activity will cause injury and will worsen the pain problem. Recently, an exposure in vivo treatment was developed that aims to enhance function by directly addressing these fears and expectations. The purpose of this study was to describe the short-term, consequent effect of an exposure in vivo treatment. The study employed a multiple baseline design with six patients who were selected based on their high levels of fear and avoidance. The results demonstrated clear decreases in rated fear and avoidance beliefs while function increased substantially. These improvements were observed even though rated pain intensity actually decreased somewhat. Thus, the results replicate and extend the findings of previous studies to a new setting, with other therapists and a new research design. These results, together with the initial studies, provide a basis for pursuing and further developing the exposure technique and to test it in group designs with larger samples.

  • 26.
    Boersma, Katja
    et al.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Ljótsson, Brjánn
    Deptartment of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
    Edebol-Carlman, Hanna
    Schrooten, Martien
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Linton, Steven J.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Brummer, Robert Jan
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of gastroenterology, Örebro university hospital, Örebro, Sweden.
    Exposure-based cognitive behavioral therapy for irritable bowel syndrome: A single-case experimental design across 13 subjects2016Ingår i: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 45, nr 6, s. 415-430Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Irritable bowel syndrome (IBS) is a highly prevalent disorder with a significant impact on quality of life. The presence of psychological symptoms in IBS patients such as catastrophic worry and behavioral avoidance suggests the possible efficacy of cognitive behavioral interventions. Exposure-based cognitive behavioral therapy (CBT) has proven to be a promising approach but has only been investigated in a few studies and mainly via the Internet. Therefore, the aims of this study were to extend and replicate previous findings and to evaluate whether an individual, face-to-face, exposure-based CBT leads to improvement in gastrointestinal symptoms, pain catastrophizing, avoidance behavior and quality of life in IBS patients. Thirteen patients with IBS according to Rome III criteria participated in a single-case experimental study using a five-week baseline and a subsequent twelve-session intervention phase focusing on psycho-education, mindfulness and in vivo exposure. Standardized measurement of gastrointestinal symptoms, pain catastrophizing, avoidance behavior and quality of life was conducted weekly during baseline as well as intervention phase and at six-month follow-up. Results showed that over 70% of patients improved significantly on gastrointestinal symptoms, pain catastrophizing, and quality of life. Effects on avoidance behavior were modest. These results strengthen and extend earlier findings and provide further support for the efficacy of exposure-based strategies for IBS.

  • 27.
    Boersma, Katja
    et al.
    Örebro universitet, Akademin för juridik, psykologi och socialt arbete.
    MacDonald, Shane
    Örebro universitet, Akademin för juridik, psykologi och socialt arbete.
    Linton, Steven J.
    Örebro universitet, Akademin för juridik, psykologi och socialt arbete.
    Longitudinal relationships between pain and stress problems2010Konferensbidrag (Refereegranskat)
  • 28.
    Boersma, Katja
    et al.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    MacDonald, Shane
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Linton, Steven J.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Longitudinal relationships between pain and stress problems in the general population: predicting trajectories from cognitive behavioral variables2012Ingår i: Journal of applied biobehavioral research, ISSN 1071-2089, E-ISSN 1751-9861, Vol. 17, nr 4, s. 229-248Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Lately, cognitive behavioral models have put forth that the co-occurrence of pain and stress might be explained by mutually maintaining psychological mechanisms such as catastrophizing and avoidance. This study aimed to map the interrelationship between pain, stress, catastrophizing, cognitive, and behavioral avoidance across time. A general population sample (n = 551) was followed from baseline to 3-month and 1-year follow-up. The results revealed subgroups with stress and pain in combination as well as in isolation. The subgroups were highly stable across time, and catastrophizing, cognitive, and behavioral avoidance were related to the development of symptoms. The results support that shared, but also specific cognitive and behavioral, processes may maintain and drive the development of pain and stress problems.

  • 29.
    Boersma, Katja
    et al.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete. Center for Health and Medical Psychology.
    Södermark, Martin
    Department of Medical and Health Sciences, Pain and Rehabilitation Centre, Linköping University, Linköping, Sweden.
    Hesser, Hugo
    Department of Behavioural Sciences and Learning, Division of Psychology, Linköping University, Linköping, Sweden.
    Flink, Ida
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Gerdle, Björn
    Department of Medical and Health Sciences, Pain and Rehabilitation Centre, Linköping University, Linköping, Sweden.
    Linton, Steven J.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete. Center for Health and Medical Psychology.
    Efficacy of a transdiagnostic emotion-focused exposure treatment for chronic pain patients with comorbid anxiety and depression: a randomized controlled trial2019Ingår i: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 160, nr 8, s. 1708-1718Artikel i tidskrift (Refereegranskat)
    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.

  • 30.
    Breivik, Harald
    et al.
    Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway.
    Reme, Silje Endresen
    Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway.
    Linton, Steven J.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    High risk of depression and suicide attempt among chronic pain patients: always explore catastrophizing and suicide thoughts when evaluating chronic pain patients2014Ingår i: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 5, nr 1, s. 1-3Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    A grave but important problem in the treatment of pain, is suicide. While many chronic pain problems are not life threatening, self-harming, e.g. suicide attempts are. Clinicians may ask whether suicide-risk is actually higher in a population of patients with chronic pain. In this issue of the Scandinavian Journal of Pain Elsebeth Stenager and her co-workers publish an important study in which they have combined the WHO research database in Odense on all suicide attempts in Southern Denmark with the database on patients referred to the multidisciplinary university pain clinic in Odense,Denmark. The WHO-database comprises only suicide attempts that resulted in hospitalization, i.e. they were all serious attempts. Suicide attempts of less serious character are not registered, so the research database is probably underestimating the real number of suicide attempts. The unique strength of the Stenager et al. study is that their data are strong, objective data fromc ombining the registry data on suicide attempts with their chronic pain patient-data. This enables the researchers to compare the pain–patient–population with the general population. We are not aware of any similar research on the real risk of suicide-attempts among the many who are burdened by chronic non-cancer pain.

  • 31.
    Buer, Nina
    et al.
    Neurotec Department, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden; Department of Health Promotion for Personnel, Örebro University Hospital, Örebro, Sweden .
    Linton, Steven J
    Department of Occupational and Environmental Medicine, Örebro University Hospital, Örebro, Sweden .
    Fear-avoidance beliefs and catastrophizing: occurrence and risk factor in back pain and ADL in the general population2002Ingår i: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 99, nr 3, s. 485-491Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Fear-avoidance beliefs and catastrophizing have been shown to be powerful cognitions in the process of developing chronic pain problems and there is a need for increased knowledge in early stages of pain.

    The objectives of this study were therefore, firstly, to examine the occurrence of fear-avoidance beliefs and catastrophizing in groups with different degrees of non-chronic spinal pain in a general population, and secondly to assess if fear-avoidance beliefs and catastrophizing were related to current ratings of pain and activities of daily living (ADL).

    The study was a part of a population based back pain project and the study sample consisted of 917 men and women, 35-45 years old, either pain-free or with non-chronic spinal pain. The results showed that fear-avoidance beliefs as well as catastrophizing occur in this general population of non-patients. The levels were moderate and in catastrophizing a 'dose-response' pattern was seen, such that more the catastrophizing was, the more was pain. The study showed two relationships, which were between fear-avoidance and ADL as well as between catastrophizing and pain intensity. Logistic regression analyses were performed with 95% confidence intervals and the odds ratio for fear-avoidance beliefs and ADL was 2.5 and for catastrophizing and pain 1.8, both with confidence interval above unity. The results suggest that fear-avoidance beliefs and catastrophizing may play an active part in the transition from acute to chronic pain and clinical implications include screening and early intervention. (C) 2002 International Association for the Study of Pain. Published by Elsevier Science B.V. All rights reserved.

  • 32.
    Buer, Nina
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Linton, Steven J.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Working despite pain: factors associated with work attendance versus dysfunction1995Ingår i: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 2, nr 3, s. 252-262Artikel i tidskrift (Refereegranskat)
  • 33.
    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 universitet, Institutionen för juridik, psykologi och socialt arbete.
    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 study2019Ingår i: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 117, s. 28-39Artikel i tidskrift (Refereegranskat)
    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.

  • 34.
    Carstens, Johan K. P.
    et al.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Boersma, Katja
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Linton, Steven J.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Lending an ear to pain: The impact of emotionally oriented communication on pain catastrophizingManuskript (preprint) (Övrigt vetenskapligt)
  • 35.
    Carstens, Johan K. P.
    et al.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Boersma, Katja
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Schrooten, Martien G. S.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Linton, Steven J.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Effects of validating communication on recall during a pain-task in healthy participants2017Ingår i: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 17, s. 118-125, artikel-id S1877-8860(17)30143-XArtikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Increasing recall of instructions and advice in a pain consultation is important, since it is a prerequisite for adherence to treatment recommendations. However, interference due to pain-related distress may result in poor recall. Whereas there are some indications that recall can be increased by empathic communication that reduces interference, this interesting possibility remains largely untested experimentally. The current experiment aimed at studying effects of empathic communication, and more specifically validation, on recall during a pain test and possible mediators and moderators of this effect.

    METHOD: Participants received either validating (N=25) or invalidating responses (N=25) from the experimenter during a pain provoking task, followed by self-report measures of interference (affect, situational pain catastrophizing) and recall (accurate and false memories of words).

    RESULTS: As expected, the validated group exhibited higher accurate recall and less false memories following the pain test as compared to the invalidated group. This was partly due to the effect of interference being counteracted by moderating the relationship between pain catastrophizing and recall.

    CONCLUSION: These novel results suggest that validating communication can counteract interference due to pain catastrophizing on recall, at least in a controlled experimental setting.

    IMPLICATIONS: Good communication by health professionals is of utmost importance for adherence to pain management. The current results expand our knowledge on the effects of pain communication by establishing and explaining a clear link between empathic communication and recall, highlighting the role of pain catastrophizing.

  • 36.
    Carstens-Söderstrand, Johan K. P.
    et al.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Shaw, W. S.
    Liberty Mutual Research institute for Safety, Hopkinton, USA; University of Massachusetts Medical School, Worcester, USA.
    Boersma, Katja
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Reme, S. E.
    Uni Research Health, Bergen, Norway; Harvard School of Public Health, Boston, USA.
    Pransky, G.
    Liberty Mutual Research institute for Safety, Hopkinton, USA; University of Massachusetts Medical School, Worcester, USA.
    Linton, Steven J.
    When the wind goes out of the sail - declining recovery expectations in the first weeks of back pain2014Ingår i: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 18, nr 2, s. 269-278Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Expectations for recovery are a known predictor for returning to work. Most studies seem to conclude that the higher the expectancy the better the outcome. However, the development of expectations over time is rarely researched and experimental studies show that realistic expectations rather than high expectancies are the most adaptive. This study aims to explore patterns of stability and change in expectations for recovery during the first weeks of a back-pain episode and how these patterns relate to other psychological variables and outcome.

    Methods The study included 496 volunteer patients seeking treatment for work-related, acute back pain. The participants were measured with self-report scales of depression, fear of pain, life impact of pain, catastrophizing and expectations for recovery at two time points. A follow-up focusing on recovery and return to work was conducted 3 months later. A cluster analysis was conducted, categorizing the data on the trajectories of recovery expectations.

    Results Cluster analysis revealed four clusters regarding the development of expectations for recovery during a 2-week period after pain onset. Three out of four clusters showed stability in their expectations as well as corresponding levels of proximal psychological factors. The fourth cluster showed increases in distress and a decrease in expectations for recovery. This cluster also has poor odds ratios for returning to work and recovery. Conclusion Decreases in expectancies for recovery seem as important as baseline values in terms of outcome, which has clinical and theoretical implications.

  • 37.
    Coenen, Pieter
    et al.
    School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia; Department of Public & Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands.
    Smith, Anne
    School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia.
    Kent, Peter
    School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia.
    Harris, Mark
    Curtin Business School, Curtin University, Perth, Australia.
    Linton, Steven J.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Pransky, Glenn
    University of Massachusetts Medical School, Worcester MA, United States.
    Beales, Darren
    School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia.
    O'Sullivan, Peter
    School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia.
    Straker, Leon
    School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia.
    The association of adolescent spinal-pain-related absenteeism with early adulthood work absenteeism: A six-year follow-up data from a population-based cohort2018Ingår i: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 44, nr 5, s. 521-529Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: Spinal (ie, back and neck) pain often develops as early as during adolescence and can set a trajectory for later life. However, whether early-life spinal-pain-related behavioral responses of missing school/work are predictive of future work absenteeism is yet unknown. We assessed the association of adolescent spinal-pain-related work or school absenteeism with early adulthood work absenteeism in a prospective population-based cohort.

    Methods: Six year follow-up data from the Western Australian Pregnancy Cohort (Raine) study were used (N=476; with a 54% response rate). At age 17, participants reported spinal pain (using the Nordic questionnaire) and adolescent spinal-pain-related work/school absenteeism (with a single item question). Annual total and health-related work absenteeism was assessed with the Health and Work Performance questionnaire distributed in four quarterly text messages during the 23rd year of age. We modelled the association of adolescent spinal-pain-related absenteeism with work absenteeism during early adulthood, using negative binomial regression adjusting for sex, occupation and comorbidities.

    Results: Participants with adolescent low-back or neck pain with work/school absenteeism reported higher total work absenteeism in early adulthood [148.7, standard deviation (SD) 243.4 hours/year], than those without pain [43.7 (SD 95.2) hours/year); incidence rate ratio 3.4 (95% CI 1.2-9.2)]. Comparable findings were found when considering low-back and neck separately, and when considering health-related absenteeism.

    Conclusions: We found a more than three-fold higher risk of work absenteeism in early adulthood among those with adolescent spinal-pain-related absenteeism, compared to those without. These findings suggest that, to keep a sustainable workforce, pain prevention and management should focus on pain-related behaviors as early as in adolescence.

  • 38.
    Danielsson, N. S.
    et al.
    Örebro universitet, Akademin för juridik, psykologi och socialt arbete.
    Jansson-Fröjmark, Markus
    Örebro universitet, Akademin för juridik, psykologi och socialt arbete.
    Linton, Steven J.
    Örebro universitet, Akademin för juridik, psykologi och socialt arbete.
    Harvey, A. G.
    Are sleep-onset problems stable over the course of development?2009Ingår i: Sleep, ISSN 0161-8105, E-ISSN 1550-9109, Vol. 32, s. A264-A264, artikel-id 0807Artikel i tidskrift (Refereegranskat)
  • 39. Danielsson, N. S.
    et al.
    MacDonald, S.
    Jansson-Fröjmark, Markus
    Örebro universitet, Akademin för juridik, psykologi och socialt arbete.
    Linton, Steven J.
    Örebro universitet, Akademin för juridik, psykologi och socialt arbete.
    Cognitive avoidance and catastrophizing characterize adolescent sleep and stress reports2010Konferensbidrag (Refereegranskat)
  • 40. Danielsson, N. S.
    et al.
    MacDonald, S.
    Jansson-Fröjmark, Markus
    Örebro universitet, Akademin för juridik, psykologi och socialt arbete.
    Linton, Steven J.
    Örebro universitet, Akademin för juridik, psykologi och socialt arbete.
    Mechanism behind adolescent sleep problems2010Konferensbidrag (Refereegranskat)
  • 41.
    Danielsson, Nanette S.
    et al.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Harvey, Allison G.
    Department of Psychology, University of California, Berkeley, Berkeley CA, United States.
    MacDonald, Shane
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Jansson-Fröjmark, Markus
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete. Department of Psychology, Stockholm University, Stockholm, Sweden.
    Linton, Steven J.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Sleep disturbance and depressive symptoms in adolescence: the role of catastrophic worry2013Ingår i: Journal of Youth and Adolescence, ISSN 0047-2891, E-ISSN 1573-6601, Vol. 42, nr 8, s. 1223-1233Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Depression is a common and debilitating disorder in adolescence. Sleep disturbances and depression often co-occur with sleep disturbances frequently preceding depression. The current study investigated whether catastrophic worry, a potential cognitive vulnerability, mediates the relationship between adolescent sleep disturbances and depressive symptoms, as well as whether there are gender differences in this relationship. High school students, ages 16–18, n = 1,760, 49 % girls, completed annual health surveys including reports of sleep disturbance, catastrophic worry, and depressive symptoms. Sleep disturbances predicted depressive symptoms 1-year later. Catastrophic worry partially mediated the relationship. Girls reported more sleep disturbances, depressive symptoms, and catastrophic worry relative to boys. The results, however, were similar regardless of gender. Sleep disturbances and catastrophic worry may provide school nurses, psychologists, teachers, and parents with non gender specific early indicators of risk for depression. Several potentially important practical implications, including suggestions for intervention and prevention programs, are highlighted. 

  • 42.
    Danielsson, Nanette S.
    et al.
    Örebro universitet, Akademin för juridik, psykologi och socialt arbete.
    Jansson-Fröjmark, Markus
    Örebro universitet, Akademin för juridik, psykologi och socialt arbete.
    Linton, Steven J.
    Örebro universitet, Akademin för juridik, psykologi och socialt arbete.
    Jutengren, Göran
    Örebro universitet, Akademin för juridik, psykologi och socialt arbete.
    Stattin, Håkan
    Örebro universitet, Akademin för juridik, psykologi och socialt arbete.
    Neuroticism and sleep-onset: what is the long-term connection?2010Ingår i: Personality and Individual Differences, ISSN 0191-8869, E-ISSN 1873-3549, Vol. 48, nr 4, s. 463-468Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    People with sleep-onset problems often experience neuroticism. To what extent the one problem leads to the other is unknown. We used self-reported data from a Swedish longitudinal project to examine developmental links between neuroticism and sleep-onset problems. A sample of 212 people, followed from birth to midlife, was part of a cohort study spanning 37 years. Adolescent neuroticism was measured at age 16 with the High School Personality Questionnaire (HSPQ, Form A) and in midlife at age 37 with the Eysenck Personality Questionnaire (EPQ). Sleep-onset problems were measured at ages 15 to 17, 25, and 37 with items developed for the Solna Project. Adolescent neuroticism failed to predict sleep-onset problems. Instead, sleep-onset problems in adolescence and young adulthood predicted midlife neuroticism. We found that sleep-onset problems during adolescence were a direct risk for midlife neuroticism, as well as, an indirect risk through continuance of sleep-onset problems into adulthood. This study provides longitudinal support for adolescent sleep-onset problems as a potent risk factor for heightened neuroticism in midlife.

  • 43.
    Danielsson, Nanette S.
    et al.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Linton, Steven J.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Jansson-Fröjmark, Markus
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Effects of partial sleep deprivation on subjectice emotion experience and implicit emotion regulationManuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    Background: Neurophysiological research implicates sleep deprivation in emotion dysregulation. Less is known about the effects of partial sleep deprivation on the emotions and on emotion regulation of otherwise healthy people. An experimental, randomized pretest-posttest study design was used to examine the differential effects of partial sleep deprivation on emotion experience and implicit emotion regulation following emotion elicitation.

    Methods: We randomized 81 healthy adults (44 females) into a sleep deprivation or rested condition. Sleep deprivation was defined as 3-nights with 5-hours total time in bed. Scores on positive and negative emotion markers measured emotions. Mixed between-within subjects analyses of variance were used to examine group differences in emotion following the sleep condition and after the emotion elicitation procedures and test.

    Results: Sleep deprived people reported significantly less positive emotions, and more fatigue, irritability, and hostility compared to people who were rested following the sleep condition. There were negligible differences between groups in implicit emotion regulation following emotion elicitation.

    Conclusions: These findings suggest that partial sleep deprivation is a potent stressor in emotion dysregulation through reductions in positive emotions. It also appears that implicit emotion regulation works equally well following strong negative emotional events, regardless of sleep condition. From a clinical perspective, sleep deprivation and ensuing reductions in positive affect and emotion may provide clinicians with viable targets in depression treatment. Keywords: Experimental, sleep deprivation, affect, emotions, emotion regulation, emotion elicitation.

  • 44.
    Edebol-Carlman, Hanna
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Nutrition-Gut-Brain Interactions Research Centre.
    Ljotsson, Brjann
    Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
    Linton, Steven J.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Boersma, Katja
    Schrooten, Martien
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Repsilber, Dirk
    Örebro universitet, Institutionen för medicinska vetenskaper. Nutrition-Gut-Brain Interactions Research Centre.
    Brummer, Robert J.
    Region Örebro län. Örebro universitet, Institutionen för medicinska vetenskaper. Nutrition-Gut-Brain Interactions Research Centre.
    Face-to-Face Cognitive-Behavioral Therapy for Irritable Bowel Syndrome: The Effects on Gastrointestinal and Psychiatric Symptoms2017Ingår i: Gastroenterology Research and Practice, ISSN 1687-6121, E-ISSN 1687-630X, artikel-id 8915872Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Irritable bowel syndrome (IBS) is a gastrointestinal disorder linked to disturbances in the gut-brain axis. Visceral hypersensitivity and pain are hallmarks of IBS and linked to the physiological and psychological burden and to the nonadaptive coping with stress. Cognitive-behavioral therapy (CBT) for IBS has proven effective in reducing gastrointestinal and psychiatric symptoms in IBS by means of coping with stress. The present pilot study evaluated for the first time whether CBT for IBS affected visceral sensitivity and pain. Individual CBT was performed for 12 weeks in 18 subjects with IBS and evaluated in terms of visceral sensitivity and pain during rectal distensions using the barostat method and self-rated visceral sensitivity and gastrointestinal and psychiatric symptoms. Visceral discomfort, urge, and pain induced by the barostat were not affected by CBT but were stable across the study. However, the level of self-rated visceral sensitivity and gastrointestinal and psychiatric symptoms decreased after the intervention. Central working mechanisms and increased ability to cope with IBS-symptoms are suggested to play a key role in the alleviation of IBS symptoms produced by CBT.

  • 45.
    Edebol-Carlman, Hanna
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Nutrition-Gut-Brain Interactions Research Centre.
    Schrooten, Martien G. S.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Ljóttson, Brjánn
    Department of Clinical Neuroscience, Division of Psychology and Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
    Boersma, Katja
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Linton, Steven J.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Brummer, Robert Jan
    Örebro universitet, Institutionen för medicinska vetenskaper. Nutrition-Gut-Brain Interactions Research Centre.
    Cognitive behavioral therapy for irritable bowel syndrome: the effects on state and trait anxiety and the autonomic nervous system during induced rectal distensions - An uncontrolled trial2018Ingår i: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 18, s. 81-91Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background and aims: Irritable bowel syndrome (IBS), is a common multifactorial gastrointestinal disorder linked to disturbances in the microbe gut-brain axis. Cognitive behavioral therapy (CBT), in face-to-face format has showed promising results on IBS and its associated psychological symptoms. The present study explored for the first time if CBT for IBS affects the autonomic nervous system (ANS) during experimentally induced visceral pain and cognitive stress, respectively. The levels of state and trait anxiety, current and perceived stress were also evaluated.

    Methods: In this uncontrolled trial, individual CBT was performed in face-to-face format for 12 weeks in 18 subjects with IBS. Heart rate variability and skin conductance were measured during experimentally induced visceral pain and during a cognitive task (Stroop color-word test), before and after intervention. The levels of state and trait anxiety as well as self-rated current and perceived stress were also measured before and after the intervention.

    Results: CBT did not affect ANS activity during experimentally induced visceral pain and cognitive stress. The sympathetic activity was high, typical for IBS and triggered during both visceral pain and cognitive stress. The levels of state and trait anxiety significantly decreased after the intervention. No significant changes in self-rated current or perceived stress were found.

    Conclusions: Results suggest that face-to-face CBT for IBS improved anxiety- a key psychological mechanism for the IBS pathophysiology, rather than the autonomic stress response to experimentally induced visceral pain and cognitive stress, respectively.

  • 46.
    Edlund, Sara M.
    et al.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Carlsson, Maria L.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Linton, Steven J.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Fruzzetti, Alan E.
    Tillfors, Maria
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    I see you're in pain: the effects of partner validation on emotions in people with chronic pain2013Konferensbidrag (Övrigt vetenskapligt)
  • 47.
    Edlund, Sara M.
    et al.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Carlsson, Maria L.
    School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden.
    Linton, Steven J.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Fruzzetti, Alan E.
    Department of Psychology 298, University of Nevada, Reno, USA.
    Tillfors, Maria
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    I see you're in pain: the effects of partner validation on emotions in people with chronic pain2015Ingår i: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 6, s. 16-21Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Background and aims

    Chronic pain not only affects the person in pain, but can also have a negative impact on relationships with loved ones. Research shows that chronic pain is associated with difficulties in marital relationships, which in turn is related to a variety of negative outcomes such as psychological distress and conflict within the family. This suggests that couples where chronic physical pain is present also struggle with emotional pain and relationship problems, and thus targeting relationship skills and interpersonal functioning might be helpful for these couples. Although studies in this area are promising, their numbers are few. In the present study, validation as a way of communicating is suggested for handling emotional expression in interpersonal interactions. Validation communicates understanding and acceptance of the other person's experience, and it has been shown to have a down-regulating effect on negative emotions. It has previously been demonstrated to be important for these couples. However, the feasibility and effects of increasing partner validation in these couples are unknown. Therefore, the aim of the present study was to investigate if a brief training session in validation for spouses would result in more validating and fewer invalidating responses towards their partners with pain, and to investigate if changes in these behavioural responses were associated with changes in emotion and pain level in the partner with pain.

    Methods

    Participants were 20 couples where at least one partner reported chronic pain. The study employed a within-groups design in which spouses of people with pain received validation training (without their partner's knowledge), and their validating and invalidating responses were rated pre- and post-intervention using a reliable observational scale. Also, positive and negative affect and subjective pain level in the persons with pain were rated pre- and post-intervention.

    Results

    Results showed that the validation training was associated with increased validating and decreased invalidating responses in the partners. Their spouses with chronic pain reported a decrease in negative affect from pre- to post-training.

    Conclusions

    Our results indicate that the partner or closest family member, after brief validation training, increased validating responses and decreased invalidating responses towards the person with pain, which had an immediate positive impact on emotions in the other person.

    Implications

    This study suggests that using validation in interpersonal interactions is a promising tool for couples where chronic pain is present.

  • 48.
    Edlund, Sara M.
    et al.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Fruzzetti, Alan E
    McLean Hospital & Department of Psychiatry, Harvard Medical School, Boston, USA.
    Holländare, Fredrik
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Psychiatry.
    Linton, Steven J.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Tillfors, Maria
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Dialectical behavior therapy to augment stand-ard cognitive behavioral therapy for treatment-resistant anxi-ety disorders: A replicated single-subject pilot studyManuskript (preprint) (Övrigt vetenskapligt)
  • 49.
    Edlund, Sara
    et al.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Wurm, Matilda
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Holländare, Fredrik
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Psychiatry, Örebro University Hospital, Örebro, Sweden.
    Linton, Steven J.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Fruzzetti, Alan E.
    McLean Hospital & Department of Psychiatry, Harvard Medical School, Boston, USA.
    Tillfors, Maria
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Pain patients´ experiences of validation and invalidation from physicians before and after multimodal pain rehabilitation: Associations with pain, negative affectivity and treatment outcome2017Ingår i: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 17, s. 77-86Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background and aims: Validating and invalidating responses play an important role in communication with pain patients, for example regarding emotion regulation and adherence to treatment. However, it is unclear how patients’ perceptions of validation and invalidation relate to patient characteristics and treatment outcome. The aim of this study was to investigate the occurrence of subgroups based on pain patients’ perceptions of validation and invalidation from their physicians. The stability of these perceptions and differences between subgroups regarding pain, pain interference, negative affectivity and treatment outcome were also explored.

    Methods: A total of 108 pain patients answered questionnaires regarding perceived validation and invalidation, pain severity, pain interference, and negative affectivity before and after pain rehabilitation treatment. Two cluster analyses using perceived validation and invalidation were performed, one on pre-scores and one on post-scores. The stability of patient perceptions from pre- to post-treatment was investigated, and clusters were compared on pain severity, pain interference, and negative affectivity. Finally, the connection between perceived validation and invalidation and treatment outcome was explored.

    Results: Three clusters emerged both before and after treatment: (1) low validation and heightened invalidation, (2) moderate validation and invalidation, and (3) high validation and low invalidation. Perceptions of validation and invalidation were generally stable over time, although there were individuals whose perceptions changed. When compared to the other two clusters, the low validation/heightened invalidation cluster displayed significantly higher levels of pain interference and negative affectivity post-treatment but not pre-treatment. The whole sample significantly improved on pain interference and depression, but treatment outcome was independent of cluster. Unexpectedly, differences between clusters on pain interference and negative affectivity were only found post-treatment. This appeared to be due to the pre- and post-heightened invalidation clusters not containing the same individuals. Therefore, additional analyses were conducted to investigate the individuals who changed clusters. Results showed that patients scoring high on negative affectivity ended up in the heightened invalidation cluster post-treatment.

    Conclusions: Taken together, most patients felt understood when communicating with their rehabilitation physician. However, a smaller group of patients experienced the opposite: low levels of validation and heightened levels of invalidation. This group stood out as more problematic, reporting greater pain interference and negative affectivity when compared to the other groups after treatment. Patient perceptions were typically stable over time, but some individuals changed cluster, and these movements seemed to be related to negative affectivity and pain interference. These results do not support a connection between perceived validation and invalidation from physicians (meeting the patients pre- and post-treatment) and treatment outcome. Overall, our results suggest that there is a connection between negative affectivity and pain interference in the patients, and perceived validation and invalidation from the physicians. Implications In clinical practice, it is important to pay attention to comorbid psychological problems and level of pain interference, since these factors may negatively influence effective communication. A focus on decreasing invalidating responses and/or increasing validating responses might be particularly important for patients with high levels of psychological problems and pain interference.

  • 50.
    Ekdahl, Johanna
    et al.
    Department of Psychology, Mid Sweden University, Östersund, Sweden.
    Flink, Ida
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Engman, Linnea
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Linton, Steven J.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Vulvovaginal pain from a fear-avoidance perspective: a prospective study among female university students in Sweden2018Ingår i: International Journal of Sexual Health, ISSN 1931-7611, E-ISSN 1931-762X, Vol. 30, nr 1, s. 49-59Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: To examine how fear-avoidance influences vulvovaginal pain and sexual function over time.

    Method: At baseline and at 10-month follow-up, self-report measures for sexual- and fear avoidance factors were obtained from 483 female university students with and without self-reported vulvovaginal pain.

    Results: Individuals with pain at both times reported lower sexual function, and higher levels of fear-avoidance compared to the pain-free group. Fear-avoidance beliefs predicted the occurrence of vulvovaginal pain at follow up and the level of pain intensity.

    Conclusion: The results points to the relevance of the components of the fear-avoidance model in vulvovaginal pain over time.

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