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  • 1.
    Anniko, Malin
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    Tillfors, Maria
    Örebro University, School of Law, Psychology and Social Work.
    Adolescent Stress Questionnaire: Evaluation of a Short Version in a Sample of Swedish Adolescents2016Conference paper (Refereed)
  • 2.
    Anniko, Malin
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    Tillfors, Maria
    Örebro University, School of Law, Psychology and Social Work.
    Investigating the mediating role of cognitive emotion regulation in the development of adolescent emotional problems2018In: Nordic Psychology, ISSN 1901-2276, E-ISSN 1904-0016, Vol. 70, no 1, p. 3-16Article in journal (Refereed)
    Abstract [en]

    Previous research has indicated that cognitive emotion regulation strategies contribute to the development and maintenance of emotional problems in adults and adolescents. However, there is a lack of longitudinal research with adolescent samples, hence knowledge of exactly how these strategies influence the development of emotional problems in adolescence is sparse. This study investigated maladaptive cognitive emotion regulation (cognitive avoidance and repetitive negative thinking) as a potential mediator in the development of anxiety and depressed mood over time in adolescence. Self-reported depressed mood, anxiety, and cognitive emotion regulation strategies were assessed during school hours in a sample of Swedish 10th graders (N=149; 53% girls), with follow-up assessments one and two years later. Repetitive negative thinking and cognitive avoidance formed a unidimensional factor of cognitive emotion regulation. Cognitive emotion regulation was found to mediate the development of both anxiety and depressed mood over time, lending support to the previous findings that cognitive emotion regulation strategies such as cognitive avoidance and repetitive negative thinking might act as transdiagnostic mechanisms in the development of emotional symptoms in adolescence. This suggests that maladaptive forms of cognitive emotion regulation could be important targets in prevention and treatment of emotional problems in adolescence.

  • 3.
    Anniko, Malin
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    Tillfors, Maria
    Örebro University, School of Law, Psychology and Social Work.
    Stress and Emotional Distress in Adolesence: The Role of Worry and Rumination2015Conference paper (Refereed)
    Abstract [en]

    Introduction: Adolescence is a time of profound changes in multiple contexts, giving rise to an increased amount of potential stressors. It is also a developmental period were emotional problems tend to have their onset and are common. We know from previous research that stressors are a risk factor for internalizing problems. However, we know less about how this relationship unfolds. There has been a lack of research into potential mechanisms affecting this relationship such as moderating and mediating variables. Concerning stressors in the form of daily hassles, a potent mechanism is how well adolescents regulate their emotions. Studies have shown that especially cognitive regulatory strategies, such as worry and rumination, tend to increase in early adolescence, an increase that precedes increases in emotional problems. However, with a few exceptions, many studies have been cross-sectional and we do not know exactly how these strategies affects or are affected by stressors and emotional problems. The aim of this study is therefore to investigate how cognitive emotion regulation strategies, more specifically worry and rumination, relate to the development of emotional problems in the face of stressors.

    Method: This is a prospective study following 3200 Swedish adolescents in 7th and 8th grade across one year. Participants completed questionnaires about amounts of stressors, levels och worry, rumination, anxiety and depressive symptoms during school hours in the spring of 2014 and again in 2015. Half-longitudinal mediational- and moderation analyses will be performed to investigate how worry and rumination relate to the development of emotional problems in the face of stressors.

    Results: The open paper will give an overview of the above-mentioned analyses and present a discussion of the results with respect to theory and clinical implications.

  • 4.
    Anniko, Malin
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    Tillfors, Maria
    Örebro University, School of Law, Psychology and Social Work.
    Stress-related Mental Health Problems in Adolescence: What are Adolescents Stressed About and Could Worry be a Potential Target in Prevention? A Longitudinal Investigation Manuscript (preprint) (Other academic)
  • 5.
    Anniko, Malin
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    van Wijk, Nikil Ph. L.
    Aquarius Analyses & Training (AA&T), Curaçao.
    Byrne, Don
    The Medical School, College of Medicine Biology and Environment, The Australian National University, Canberra, Australia.
    Tillfors, Maria
    Department of Social and Psychological Studies, Psychology, Karlstad University, Karlstad, Sweden.
    Development of a Shortened Version of the Adolescent Stress Questionnaire (ASQ-S): construct validity and sex invariance in a large sample of Swedish adolescents2018In: Scandinavian Journal of Child and Adolescent Psychiatry and Psychology, E-ISSN 2245-8875Article in journal (Other academic)
    Abstract [en]

    Background: Stressor experience is an important topic of research concerning adolescent health and ill-health. For this, valid and reliable measures of adolescent stress are needed. The Adolescent Stress Questionnaire 2 was developed to tap into stressor domains specific for adolescence. Psychometric evaluations in Australian and European samples have indicated adequate psychometric properties. However, the ASQ-2 is quite extensive, which may render its use in large cohort studies, where several aspects of adolescent health are investigated, inconvenient and problematic.

    Objective: To evaluate the psychometric properties of a short version of the ASQ-2 (ASQ-S) in terms of construct validity and factorial invariance across gender.

    Method: The ASQ-2 was translated into Swedish and items were retained from nine of the ten scales based on factor loadings. One scale (stress of emerging adult responsibilities) was removed entirely due to low internal consistency and variance explained. The remaining 27 items were piloted and then included in an ongoing 5-year longitudinal study involving the participation of all students in the 7th and 8th grade in public schools from three Swedish municipalities (N = 2768, 47.5 % girls, mean age 13.64 years). For this study data from the first and second wave was used.

    Results: A nine factor Confirmatory Factor Analysis (CFA) showed a good fit to the data and invariance across sexes was supported. The nine scales correlated positively with depressive symptoms, anxiety and worry and negatively with self-esteem. Girls reported higher stress levels than boys in eight of the nine scales. Stressors related to peer pressure predicted reported levels of anxiety and worry one year later, whereas stressors related to romantic relationships predicted depressive symptoms.

    Conclusions: Overall this study suggests that the ASQ-S could be a valid measure of adolescent stressor experience and psychometrically equivalent to the full ASQ-2.

  • 6.
    Anniko, Malin
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Wurm, Matilda
    Örebro University, School of Law, Psychology and Social Work.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    Stressing Emotions: Emotion Focused Transdiagnostic Treatment for Work Stress2014Conference paper (Refereed)
    Abstract [en]

    Background: Work related stress usually involves a variety of difficulties within the realm of emotional disorders, while CBT treatments are often disorder specific. To effectively address work stress, more versatile and parsimonious interventions are needed. Transdiagnostic treatments, targeting common psychological processes in emotion related disorders are now available. One such treatment, the Unified Protocol (Barlow et al., 2011), has shown promising results. It focuses on inflexible and maladaptive use of emotion regulation strategies. Research implies that maladaptive strategies such as excessive worrying and avoidance may also be important for stress prolongation. Thus, the implementation of a transdiagnostic treatment protocol for work stress needs to be evaluated.

    Aim: To study whether treatment using the Unified Protocol, targeting generic emotional regulation, is feasible for patients who present with work stress. Furthermore, the aim is to investigate whether this treatment affects levels of stress as well as symptoms of anxiety and depression.

    Method: Using a single case experimental design, we recruited six patients seeking treatment for work stress at an occupational health care center. After baseline assessments, they took part in an eight-session treatment using the Unified Protocol. Levels of perceived stress, emotional symptoms and use of regulatory strategies were daily monitored. A six month follow-up was also completed. Results: All participants completed and reported that they were satisfied with treatment. Four out of six participants also improved on reported stress-levels and emotional symptoms. Improvements were sustained at follow-up.

    Discussion: Results showed that it is feasible to use a unified approach for emotional problems in patients with work stress. Treatment was also associated with symptom changes for most participants. Employing a unified CBT approach for stress would provide flexibility and parsimony for clinicians while retaining a strong theoretical framework and guiding principles. Although initial results were promising randomized controlled trials are needed. 

  • 7.
    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.

  • 8.
    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.
    When matching fails: Understanding the process of matching pain-disability treatment to risk profileManuscript (preprint) (Other academic)
    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.

  • 9.
    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.
    When matching fails: understanding the process of matching pain-disability treatment to risk profile2015In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 25, no 3, p. 518-526Article in journal (Refereed)
    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.

  • 10.
    Bergbom, Sofia
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    Overmeer, Thomas
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    Relationship Among Pain Catastrophizing, Depressed Mood, and Outcomes Across Physical Therapy Treatments2011In: Physical Therapy, ISSN 0031-9023, E-ISSN 1538-6724, Vol. 91, no 5, p. 754-764Article in journal (Refereed)
    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.

  • 11. Bergbom, Sofia
    et al.
    Flink, Ida K.
    Boersma, Katja
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    Are early improvements in psychological variables related to treatment outcome?2010Conference paper (Refereed)
  • 12.
    Bergbom, Sofia
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Flink, Ida K.
    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.
    Early psychologically informed interventions for workers at risk for pain-related disability: does matching treatment to profile improve outcome?2014In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 24, no 3, p. 446-457Article in journal (Refereed)
    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.

  • 13.
    Bergbom, Sofia
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Flink, Ida K.
    Örebro University, School of Law, Psychology and Social Work.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    Manual för KBT vid långvarig muskuloskeletal smärta2010Other (Other academic)
  • 14.
    Boersma, Katja
    Örebro University, Department of Behavioural, Social and Legal Sciences.
    Fear and avoidance in the development of a persistent musculoskeletal pain problem: implications for secondary prevention2005Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    This dissertation focused on the role of fear and avoidance in the development of a persistent back pain problem. The first aim of this dissertation was to study when and how cognitive, affective and behavioral factors influence one another in the development of persistent pain and disability. The moderating role of pain duration on the relationship between psychological risk factors and dysfunction was studied, as well as the interrelationships between psychological risk factors within individuals.

    The results suggest that pain duration may moderate the relationship between some of the psychological risk factors and function. In study two, depression and function were interrelated independent of stages of chronicity while the strength of the relationship between fear of movement and function increased across the stages. Further, the results suggest that there may be individual variability in the importance of psychological risk factors and in how these factors are interrelated within individuals. In study one and three profiles of psychological functioning emerged that were characterized by pain-related fear with and without depressed mood, by depressed mood only, and by low pain-related fear and no depressed mood. These profiles were meaningfully related to future disability.

    The second aim of this dissertation was to test a new treatment that is designed to match patients with high levels of fear and avoidance. The results of study four show that this exposure treatment can produce significant decreases in fear and increases in function.

    The results of the studies in this dissertation suggest that we need to assign a key role to psychological processes such as pain-related fear, depressed mood, and avoidance in our efforts to understand the development of persistent back pain disability. The results highlight that there may be several roads towards a persistent back pain problem and that the relationship between psychological factors and disability is not static but appears to change as a function of pain duration. This suggests that we need to know more about the process of development of persistent back pain disability and that future research should incorporate the role of time, as well as take into consideration that there may be individual variability in the importance of factors and their interactions. Lastly, the results suggest that secondary prevention of persistent back pain disability could be enhanced by addressing psychological processes at a much earlier time point than is currently practiced and by customizing interventions to the characteristics of the individual patient.

    List of papers
    1. Screening to identify patients at risk: profiles of psychological risk factors for early intervention
    Open this publication in new window or tab >>Screening to identify patients at risk: profiles of psychological risk factors for early intervention
    2005 (English)In: The Clinical Journal of Pain, ISSN 0749-8047, E-ISSN 1536-5409, Vol. 21, no 1, p. 38-43Article in journal (Refereed) Published
    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.

    National Category
    Social Sciences Psychology
    Research subject
    Psychology
    Identifiers
    urn:nbn:se:oru:diva-2814 (URN)15599130 (PubMedID)
    Note
    Discussion p. 69-72Available from: 2005-04-29 Created: 2005-04-29 Last updated: 2017-12-14Bibliographically approved
    2. How does persistent pain develop?: An analysis of the relationship between psychological variables, pain and function across stages of chronicity
    Open this publication in new window or tab >>How does persistent pain develop?: An analysis of the relationship between psychological variables, pain and function across stages of chronicity
    2005 (English)In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 43, no 11, p. 1495-1507Article in journal (Refereed) Published
    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.

    Place, publisher, year, edition, pages
    Oxford: Pergamon, 2005
    National Category
    Social Sciences Psychology
    Research subject
    Psychology
    Identifiers
    urn:nbn:se:oru:diva-2815 (URN)10.1016/j.brat.2004.11.006 (DOI)16159591 (PubMedID)
    Available from: 2005-04-29 Created: 2005-04-29 Last updated: 2017-12-14Bibliographically approved
    3. 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 disability
    Open this publication in new window or tab >>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 disability
    2006 (English)In: The Clinical Journal of Pain, ISSN 0749-8047, E-ISSN 1536-5409, Vol. 22, no 2, p. 160-166Article in journal (Refereed) Published
    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.

    Place, publisher, year, edition, pages
    Lippincott Williams & Wilkins, 2006
    National Category
    Social Sciences Psychology
    Research subject
    Psychology
    Identifiers
    urn:nbn:se:oru:diva-2816 (URN)16428950 (PubMedID)
    Available from: 2005-04-29 Created: 2005-04-29 Last updated: 2018-02-20Bibliographically approved
    4. Lowering fear-avoidance and enhancing function through exposure in vivo: a multiple baseline study across six patients with back pain
    Open this publication in new window or tab >>Lowering fear-avoidance and enhancing function through exposure in vivo: a multiple baseline study across six patients with back pain
    Show others...
    2004 (English)In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 108, no 1-2, p. 8-16Article in journal (Refereed) Published
    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.

    National Category
    Social Sciences Psychology
    Research subject
    Psychology
    Identifiers
    urn:nbn:se:oru:diva-2817 (URN)10.1016/j.pain.2003.03.001 (DOI)
    Available from: 2005-04-29 Created: 2005-04-29 Last updated: 2017-12-14Bibliographically approved
  • 15.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    Is the search for a "pain personality" of added value to the Fear-Avoidance-Model (FAM) of chronic pain?2017In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 17, no October, p. 226-227Article in journal (Refereed)
  • 16.
    Boersma, Katja
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Carstens-Söderstrand, Johan
    Örebro University, School of Law, Psychology and Social Work.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    From acute pain to chronic disability: psychosocial processes in the development of chronic musculoskeletal pain and disability2014In: Handbook of musculoskeletal pain and disability disorders in the workplace / [ed] Gatchel, Robert J. & Schultz, Izabela Z., New York: Springer, 2014, p. 205-217Chapter in book (Refereed)
    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.

  • 17.
    Boersma, Katja
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Håkanson, Alexander
    Salomonsson, Elin
    Johansson, Ida
    Compassion focused therapy to counteract shame, self-criticism and isolation: a replicated single case experimental study for individuals with social anxiety2015In: Journal of Contemporary Psychotherapy, ISSN 0022-0116, E-ISSN 1573-3564, Vol. 45, no 2, p. 89-98Article in journal (Refereed)
    Abstract [en]

    Most forms of psychological distress encompass both the relation to the self in the form of shame and self-criticism, as well as the relation to others in the form of distance and isolation. These are often longstanding and pervasive problems that permeate a wide range of psychological disorders and are difficult to treat. This paper focuses on how problems with shame and self-criticism can be addressed using compassion focused therapy (CFT). In a pilot study we tested the effectiveness of CFT with a single case experimental design in six individuals suffering from social anxiety. The aim was to establish whether CFT lead to increases in self-compassion, and reductions in shame, self-criticism and social anxiety. Moreover, the aim was to investigate to what extent participants were satisfied and experienced CFT as helpful in coping with social anxiety and in increasing self-compassion. Taken together the preliminary results show that CFT is a promising approach. CFT was effective for 3 of 6 participants, probably effective for 1 of 6 and more questionably effective for 2 of 6 participants. These results add to the empirical evidence that CFT is a promising approach to address problems with self-compassion. This research body is as of yet small, and more studies are needed.

  • 18.
    Boersma, Katja
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Lindblom, Karin
    Örebro University, School of Law, Psychology and Social Work.
    Stability and change in burnout profiles over time: A prospective study in the working population2009In: Work & Stress, ISSN 0267-8373, E-ISSN 1464-5335, Vol. 23, no 3, p. 264-283Article in journal (Refereed)
    Abstract [en]

    This is a prospective study on the development of burnout in the general Swedish working population from a person-oriented perspective. A large random sample of the general working population (N=1118) was cluster analyzed, using scores on the subscales of the Maslach Burnout Inventory at baseline and at 1-year follow-up. The individual and structural stability of the configurations over time, as well as accompanying changes on work-related and mental health variables were investigated. The results show the occurrence of several different configurations of burnout variables. Scoring patterns with high exhaustion and cynicism reflected burnout; those with a high level of professional efficacy reflected engagement; there were also scoring patterns characterized by only one of the dimensions in the relative absence of others. These patterns show structural, as well as individual stability over time. The risk factors for development of burnout or engagement from clusters with only one burnout characteristic varied according to the cluster. These results give new insights, indicating that the road to burnout may be different for subgroups of different burnout profiles, and that these subgroups may potentially have different risk factors associated with the development of burnout. This is of importance for the development of early interventions.

  • 19.
    Boersma, Katja
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Linton, Steven
    Örebro University, School of Law, Psychology and Social Work.
    Editorial comment on Helen Richardson’s and Stephen Morley’s study on "Action identification and meaning in life in chronic pain"2015In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 9, p. 64-65Article in journal (Other academic)
  • 20.
    Boersma, Katja
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    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 moderator2017In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 16, p. 89-90, article id S1877-8860(17)30050-2Article in journal (Refereed)
  • 21.
    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.

  • 22.
    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.
    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 disability2006In: The Clinical Journal of Pain, ISSN 0749-8047, E-ISSN 1536-5409, Vol. 22, no 2, p. 160-166Article in journal (Refereed)
    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.

  • 23.
    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.
    Screening to identify patients at risk: profiles of psychological risk factors for early intervention2005In: The Clinical Journal of Pain, ISSN 0749-8047, E-ISSN 1536-5409, Vol. 21, no 1, p. 38-43Article in journal (Refereed)
    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.

  • 24.
    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.
    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 pain2004In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 108, no 1-2, p. 8-16Article in journal (Refereed)
    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.

  • 25.
    Boersma, Katja
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Ljótsson, Brjánn
    Deptartment of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
    Edebol-Carlman, Hanna
    Schrooten, Martien
    Örebro University, School of Law, Psychology and Social Work.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    Brummer, Robert Jan
    Örebro University, School of Medical Sciences. Department of gastroenterology, Örebro university hospital, Örebro, Sweden.
    Exposure-based cognitive behavioral therapy for irritable bowel syndrome: A single-case experimental design across 13 subjects2016In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 45, no 6, p. 415-430Article in journal (Refereed)
    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.

  • 26.
    Boersma, Katja
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    MacDonald, Shane
    Örebro University, School of Law, Psychology and Social Work.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    Longitudinal relationships between pain and stress problems2010Conference paper (Refereed)
  • 27.
    Boersma, Katja
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    MacDonald, Shane
    Örebro University, School of Law, Psychology and Social Work.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    Longitudinal relationships between pain and stress problems in the general population: predicting trajectories from cognitive behavioral variables2012In: Journal of applied biobehavioral research, ISSN 1071-2089, E-ISSN 1751-9861, Vol. 17, no 4, p. 229-248Article in journal (Refereed)
    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.

  • 28.
    Boersma, Katja
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Tillfors, Maria
    Örebro University, School of Law, Psychology and Social Work.
    Investigating a comorbid pattern of ill-health among late adolescents in relation to transdiagnostic processes: a prospective community study2013In: Health, ISSN 1949-4998, E-ISSN 1949-5005, Vol. 5, no 11, p. 1835-1847Article in journal (Refereed)
    Abstract [en]

    An increase in anxiety, depressed mood and sleep problems has been observed among adolescents. These symptoms have high rates of comorbidity and shared psychological processes have been proposed as maintaining factors. This study examined the occurrence and development of individual profiles of depressive symptoms, anxiety and sleeps problems and investigated them in relation to catastrophic thinking and cognitive avoidance. We used longitudinal data from a community sample of 379 senior high school students at two time points, one year apart. Five clusters were identified: a low scores cluster, a sleep problems cluster, a comorbidity cluster (high on all variables), a low mood cluster and a cluster with elevation on anxiety and depressed mood (“distress”). In general, the clusters showed stability across time. However, for the low mood and “distress” cluster, there was also an increased odds of developing sleep problems. The comorbidity and the “distress” cluster displayed the highest levels of catastrophic thinking. In conclusion, symptom patterns differed among adolescents and were stable over time. Anxiety and/or depressive symptoms were a risk factor for the development of sleep problems. Symptom constellations were related to differences in catastrophic thinking and cognitive avoidance and this may explain maintenance and exacerbation of problems over time.

  • 29.
    Carstens, Johan K. P.
    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.
    Lending an ear to pain: The impact of emotionally oriented communication on pain catastrophizingManuscript (preprint) (Other academic)
  • 30.
    Carstens, Johan K. P.
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    Schrooten, Martien G. S.
    Örebro University, School of Law, Psychology and Social Work.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    Effects of validating communication on recall during a pain-task in healthy participants2017In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 17, p. 118-125, article id S1877-8860(17)30143-XArticle in journal (Refereed)
    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.

  • 31.
    Carstens-Söderstrand, Johan K. P.
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Shaw, W. S.
    Liberty Mutual Research institute for Safety, Hopkinton, USA; University of Massachusetts Medical School, Worcester, USA.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    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 pain2014In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 18, no 2, p. 269-278Article in journal (Refereed)
    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.

  • 32.
    Edebol-Carlman, Hanna
    et al.
    Örebro University, School of Medical Sciences. Nutrition-Gut-Brain Interactions Research Centre.
    Ljotsson, Brjann
    Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    Boersma, Katja
    Schrooten, Martien
    Örebro University, School of Law, Psychology and Social Work.
    Repsilber, Dirk
    Örebro University, School of Medical Sciences. Nutrition-Gut-Brain Interactions Research Centre.
    Brummer, Robert J.
    Örebro University Hospital. Örebro University, School of Medical Sciences. Nutrition-Gut-Brain Interactions Research Centre.
    Face-to-Face Cognitive-Behavioral Therapy for Irritable Bowel Syndrome: The Effects on Gastrointestinal and Psychiatric Symptoms2017In: Gastroenterology Research and Practice, ISSN 1687-6121, E-ISSN 1687-630X, article id 8915872Article in journal (Refereed)
    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.

  • 33.
    Edebol-Carlman, Hanna
    et al.
    Örebro University, School of Medical Sciences. Nutrition-Gut-Brain Interactions Research Centre.
    Schrooten, Martien G. S.
    Örebro University, School of Law, Psychology and Social Work.
    Ljóttson, Brjánn
    Department of Clinical Neuroscience, Division of Psychology and Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    Brummer, Robert Jan
    Örebro University, School of Medical Sciences. 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 trial2018In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 18, p. 81-91Article in journal (Refereed)
    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.

  • 34.
    Engman, Linnea
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Flink, Ida
    Örebro University, School of Law, Psychology and Social Work.
    Ekdahl, J
    Department of Psychology, Mid Sweden University, Östersund, Sweden.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work. Center for Health and Medical Psychology (CHAMP).
    Avoiding or enduring painful sex?2018In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149Article in journal (Refereed)
    Abstract [en]

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

    METHODS: 117 women, 18-35 years old, with recurring vulvovaginal pain answered questionnaires at two measurement points, five months apart, assessing avoidance and endurance coping, pain intensity, and psychosexual functioning. A multiple regression model explored the predictive value of avoidance and endurance on sexual function over time. Cluster analyses investigated patterns of coping and stability within the clusters. These subgroups were compared on psychosexual outcomes.

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

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

  • 35.
    Flink, Ida K.
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Bergbom, Sofia
    Örebro University, School of Law, Psychology and Social Work.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    Manual för exponering in vivo för rörelserädsla vid långvarig muskuloskeletal smärta2010Other (Other academic)
  • 36.
    Flink, Ida K.
    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.
    Catastrophizing moderates the effect of exposure in vivo for back pain patients with pain-related fear2010In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 14, no 8, p. 887-892Article in journal (Refereed)
    Abstract [en]

    This investigation was an initial attempt to explore psychological factors that might help or hinder the effect of exposure in vivo for patients with musculoskeletal pain and pain-related fear. The study was based on data from a randomized-controlled trial for patients with non-specific spinal pain (Linton et al., 2008).

    First, catastrophizing, anxiety, and depression were studied as possible treatment moderators. We found evidence that catastrophizing was a moderator of treatment outcome in exposure. When further exploring the nature of the relationship between catastrophizing and outcome, the results showed that the exposure was effective only for patients with low or moderate levels of catastrophizing. High catastrophizers did not improve from the treatment. On the other hand, anxiety was a general predictor of poor outcome, and not a specific moderator of outcome in exposure. In contrast, depression was not significantly related to outcome.

    Next, patients were divided into high change participants and low change participants based on their improvement in disability after treatment in order to investigate the change in psychological variables during treatment. Descriptive data indicated that high change participants had large improvements across treatment on depression, anxiety, catastrophizing, and fear-avoidance beliefs whereas low change participants virtually did not change at all on these variables across treatment.

    These findings denote that catastrophizing is a moderator of treatment outcome in exposure whereas several psychological variables might be important for the treatment process

  • 37.
    Flink, Ida K.
    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.
    Changes in catastrophizing and depressed mood during and after early cognitive behaviorally oriented interventions for pain2014In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 43, no 4, p. 332-341Article in journal (Refereed)
    Abstract [en]

    Catastrophizing and depressed mood are risk factors for poor outcome in treatments for pain and appear to act as mediators for favorable outcome. However, little is known about how catastrophizing and depressed mood co-occur within individuals and how these patterns change during treatment, which is the focus of the current study. The study uses data from a randomized controlled trial about early cognitive behaviorally oriented interventions for patients with nonspecific spinal pain (N = 84). Cluster analyses were used to extract subgroups of individuals with similar scoring patterns on catastrophizing and depressed mood at pretreatment, mid-treatment, posttreatment, and at 6 months' follow-up. To track individual progress, the clusters were linked over time. The analyses revealed four clusters: "low depression and catastrophizing", "high depression and catastrophizing", "high depression", and "high catastrophizing". There was little individual transition from one scoring pattern to another across time, not at least for those scoring high on both depressed mood and catastrophizing. Moreover, high stability within this cluster was related to low levels of psychological flexibility at baseline. It is concluded that catastrophizing and depressed mood at the start of treatment were likely to remain high despite a cognitive behavioral intervention and that a lack of psychological flexibility may have a role.

  • 38.
    Flink, Ida K.
    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.
    Pain catastrophizing as repetitive negative thinking: a development of the conceptualization2013In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 42, no 3, p. 215-223Article in journal (Refereed)
    Abstract [en]

    Pain catastrophizing is a well-known concept in the pain literature and has been recognized as one of the most powerful psychological determinants of negative outcomes for pain problems. However, relatively little effort has been put into developing its theoretical underpinnings. More specifically, the intrinsic function of catastrophizing is not explicitly dealt with in contemporary theoretical models. The aim of this article is to add to existing models by proposing a development of the conceptualization of catastrophizing that stresses its function as an emotion regulator. We argue that catastrophizing can be conceptualized as a form of negative repetitive thinking, which is abstract, intrusive, and difficult to disengage from. It has been argued that repetitive negative thinking is a form of ineffective problem solving that functions to downregulate negative affect and that it can be regarded as an avoidant coping strategy because it impedes processing of emotional and somatic responses. Thus, in our conceptualization, catastrophizing is proposed to be a form of problem-solving behavior that functions to reduce negative emotion triggered by pain, and other related stimuli. Furthermore, we argue that catastrophizing is preferably regarded as a process where cognitions, emotions, and overt behavior are intertwined and not viewed as separate entities. To underscore the latter, we suggest the term catastrophic worry. Our intention with this development of the conceptualization is to give rise to new ideas for research and clinical practice and to revitalize discussions about the theoretical framework around pain-related catastrophizing.

  • 39.
    Flink, Ida K.
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    MacDonald, Shane
    Örebro University, School of Law, Psychology and Social Work.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    Understanding catastrophizing from a misdirected problem-solving perspective2012In: British Journal of Health Psychology, ISSN 1359-107X, E-ISSN 2044-8287, Vol. 17, no 2, p. 408-419Article in journal (Refereed)
    Abstract [en]

    Objectives.  The aim is to explore pain catastrophizing from a problem-solving perspective. The links between catastrophizing, problem framing, and problem-solving behaviour are examined through two possible models of mediation as inferred by two contemporary and complementary theoretical models, the misdirected problem solving model (Eccleston & Crombez, 2007) and the fear-anxiety-avoidance model (Asmundson, Norton, & Vlaeyen, 2004).

    Design.  In this prospective study, a general population sample (n= 173) with perceived problems with spinal pain filled out questionnaires twice; catastrophizing and problem framing were assessed on the first occasion and health care seeking (as a proxy for medically oriented problem solving) was assessed 7 months later.

    Methods.  Two different approaches were used to explore whether the data supported any of the proposed models of mediation. First, multiple regressions were used according to traditional recommendations for mediation analyses. Second, a bootstrapping method (n= 1000 bootstrap resamples) was used to explore the significance of the indirect effects in both possible models of mediation.

    Results.  The results verified the concepts included in the misdirected problem solving model. However, the direction of the relations was more in line with the fear-anxiety-avoidance model. More specifically, the mediation analyses provided support for viewing catastrophizing as a mediator of the relation between biomedical problem framing and medically oriented problem-solving behaviour.

    Conclusion.  These findings provide support for viewing catastrophizing from a problem-solving perspective and imply a need to examine and address problem framing and catastrophizing in back pain patients.

  • 40.
    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.

  • 41.
    Holländare, Fredrik
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Eriksson, Annsofi
    Örebro University, Örebro, Sweden.
    Lövgren, Lisa
    Örebro University, Örebro, Sweden.
    Humble, Mats B.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    Internet-Based Cognitive Behavioral Therapy for Residual Symptoms in Bipolar Disorder Type II: A Single-Subject Design Pilot Study2015In: JMIR Research Protocols, ISSN 1929-0748, E-ISSN 1929-0748, Vol. 4, no 2, article id e44Article in journal (Refereed)
    Abstract [en]

    Background: Bipolar disorder is a chronic condition with recurring episodes that often lead to suffering, decreased functioning, and sick leave. Pharmacotherapy in the form of mood stabilizers is widely available, but does not eliminate the risk of a new depressive or (hypo) manic episode. One way to reduce the risk of future episodes is to combine pharmacological treatment with individual or group psychological interventions. However, access to such interventions is often limited due to a shortage of trained therapists. In unipolar depression there is now robust evidence of the effectiveness of Internet-based psychological interventions, usually comprising psychoeducation and cognitive behavioral therapy (CBT). Internet-based interventions for persons suffering from bipolar disorder could increase access to psychological treatment.

    Objective: The aim of this study was to investigate the feasibility of an Internet-based intervention, as well as its effect on residual depressive symptoms in persons diagnosed with bipolar disorder type II (BP-II). The most important outcomes were depressive symptoms, treatment adherence, and whether the patient perceived the intervention as helpful.

    Methods: A total of 7 patients diagnosed with bipolar disorder type II at a Swedish psychiatric outpatient clinic were offered the opportunity to participate. Of the 7 patients, 3 (43%) dropped out before treatment began, and 4 (57%) were treated by means of an online, Internet-based intervention based on CBT (iCBT). The intervention was primarily aimed at psychoeducation, treatment of residual depressive symptoms, emotion regulation, and improved sleep. All patients had ongoing pharmacological treatment at recruitment and established contact with a psychiatrist. The duration of BP-II among the treated patients was between 6 and 31 years. A single-subject design was used and the results of the 4 participating patients were presented individually.

    Results: Initiating treatment was perceived as too demanding under current life circumstances for 3 patients who consequently dropped out during baseline assessment. Self-ratings using the Montgomery-sberg Depression Rating Scale-Self-rated (MADRS-S) showed symptom reduction in 3 (75%) of the 4 treated cases during iCBT. In the evaluation of the treatment, 2 patients reported that they perceived that the treatment had reduced symptoms a little, 1 that it had reduced symptoms very much, and 1 not at all. Treatment adherence (ie, module completion) was fairly high in 3 cases. In general, the modules were perceived as fairly helpful or very helpful by the patients. In one case, there was a reliable change-according to the Reliable Change Index-in self-rated symptoms of depression and perseverative thinking.

    Conclusions: The treatment seemed to have acceptable feasibility. The iCBT intervention could be an effective way to treat residual symptoms in some patients with bipolar disorder type II. This should be investigated in a larger study.

  • 42.
    Holländare, Fredrik
    et al.
    Örebro University, School of Science and Technology.
    Eriksson, Ann-sofi
    Lövgren, Lisa
    Humble, Mats
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    Internet-Based Cognitive Behavior Therapy for Residual Symptoms in Bipolar II: A Single Subject Design PilotIn: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871Article in journal (Refereed)
  • 43.
    Håkansson, Alexander
    et al.
    Cureum AB, Örebro, Sweden.
    Friberg, Manuela
    Örebro University, Örebro, Sweden.
    Lidén, Annika
    Örebro University, Örebro, Sweden.
    Svanberg, Mikael
    Unit for Psychosomatic Medicine, Västerås, Sweden.
    Rothman, Mats
    Unit for Psychosomatic Medicine, Västerås, Sweden.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    Compassion focused therapy: a transdiagnostic approach to counteract shame and self-criticism in the treatment of individuals with chronic pain and comorbid emotional problems2015Conference paper (Refereed)
    Abstract [en]

    Introduction: Chronic pain affects people worldwide. Depression and anxiety are common comorbid problems and are many times associated with pervasive problems with self-image, shame and self-criticism. Recently, Compassion Focused Therapy (CFT) has received increasing clinical and scientific interest as a means to counteract shame, self-criticism and isolation. CFT integrates influences from affective neuroscience, Buddhism, attachment theory, evolution theory and cognitive behavioral theories. The focus in CFT is on increasing individuals' ability to experience warmth, acceptance and community in relation to themselves as well as to and from others. Therefore, CFT may be a promising approach to address self-criticism and shame in chronic patients with comorbid emotional problems.

    Method: This study employs a Single Case Experimental Design (N=6) to examine whether a 7 week, Internet delivered, CFT can lead to increased self-compassion, reduced shame, self-criticism, depression and anxiety symptoms in patients with chronic pain and comorbid anxiety and depression.

    Results: The results showed treatments effects on all variables of varying magnitude.

    Discussion: The results add to the growing body of research that CFT affects several problem areas, and can be delivered via the Internet. While the results are encouraging, variations in treatment results and methodological restrictions indicate need for further research.

  • 44.
    Jansson-Fröjmark, Markus
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    Bidirectionality between pain and insomnia symptoms: a prospective study2012In: British Journal of Health Psychology, ISSN 1359-107X, E-ISSN 2044-8287, Vol. 17, no 2, p. 420-431Article in journal (Refereed)
    Abstract [en]

    Objectives: The purpose of this study was to investigate whether there is a bidirectional relationship between pain and insomnia symptoms over the course of a year.

    Design: A longitudinal design with a 1-year follow-up was used. Methods. From a randomly selected sample of the adult general population (N = 3,000), 1,746 individuals filled out a baseline and 1-year follow-up survey on pain, insomnia symptoms, anxiety symptoms, and depressive symptoms.

    Results: Pain (OR = 1.64) and anxiety symptoms increased the risk for the incidence of insomnia symptoms (R-2 =.125) and pain (OR = 1.98), anxiety symptoms and depressive symptoms were related to the persistence of insomnia symptoms (R-2 =.212). Gender and anxiety symptoms increased the risk for the incidence of pain (R-2 =. 073); and age, insomnia symptoms (OR= 1.49), anxiety symptoms, and depressive symptoms were associated with the persistence of pain (R-2 =.187).

    Conclusion: While pain was linked to future insomnia symptoms and insomnia symptoms to the persistence of pain over the course of a year, insomnia symptoms was not associated with the incidence of pain. The results, thus, partly argue against bidirectionality between pain and insomnia symptoms.

  • 45. Leeuw, Maaike
    et al.
    Goossens, Marielle E. J. B.
    van Breukelen, Gerard J. P.
    Boersma, Katja
    Örebro University, Department of Behavioural, Social and Legal Sciences.
    Vlaeyen, Johan W. S.
    Measuring perceived harmfulness of physical activities in patients with chronic low back pain: The photograph series of daily activities-short electronic version2007In: Journal of Pain, ISSN 1526-5900, E-ISSN 1528-8447, Vol. 8, no 11, p. 840-849Article in journal (Refereed)
    Abstract [en]

    Cognitive-behavioral models of chronic low back pain (CLBP) predict that dysfunctional assumptions about the harmfulness of activities may maintain pain-related fear and disability levels. The Photograph Series of Daily Activities (PHODA) is an instrument to determine the perceived harmfulness of daily activities in patients with CLBP. This study examined the psychometric properties of a short electronic version of the PHODA (PHODA-SeV). The results show that the PHODA-SeV measures a single factor and has a high internal consistency. The test-retest reliability and stability of the PHODA-SeV over a 2-week time interval are good, with discrepancies between 2 measurements over 20 points suggesting true change. The construct validity is supported by the finding that both self-reported pain severity and fear of movement/(re)injury were uniquely related to the PHODA-SeV. Validity is further corroborated by the finding that patients who have received exposure in vivo, that aimed to systematically reduce the perceived harmfulness of activities, had significantly lower PHODA-SeV scores after treatment than patients receiving graded activity that did not address these assumptions. The findings support the PHODA-SeV as a valid and reliable measure of the perceived harmfulness of activities in patients with CLBP. Preliminary normative data of the PHODA-SeV are presented. Perspective: This article describes a pictorial measurement too/(PHODA-SeV) for the assessment of the perceived harmfulness of activities in patients with chronic low back pain. The PHODA-SeV has good psychometric properties and can be used to elaborate on the contribution of beliefs about harmful consequences of activities to pain and disability. (c) 2007 by the American Pain Society.

  • 46.
    Linton, Steven J.
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    Flink, Ida K.
    Örebro University, School of Law, Psychology and Social Work.
    Kognitiv beteendeterapi2010In: Smärta och smärtbehandling / [ed] Mads Werner, Ido Leden, Stockholm: Liber , 2010, 2, p. 482-487Chapter in book (Other academic)
  • 47.
    Linton, Steven J.
    et al.
    Örebro University, Department of Behavioural, Social and Legal Sciences.
    Boersma, Katja
    Örebro University, Department of Behavioural, Social and Legal Sciences.
    Jansson, Markus
    Overmeer, Thomas
    Lindblom, Karin
    Vlaeyen, Johan W. S.
    A randomized controlled trial of exposure in vivo for patients with spinal pain reporting fear of work-related activities2008In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 12, no 6, p. 722-730Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Pain-related fear is related to disability in persistent pain conditions. Exposure treatment has been reported to be of great benefit in replicated single case experiments.

    AIM: To evaluate the effects of exposure in vivo on fear and function in patients with persistent pain and work disability.

    METHOD: We recruited 46 patients suffering from long-term back pain and reduced function, who also were deemed fearful according to standardized measures. Participants were randomized into either an exposure plus usual treatment or waiting list control plus usual treatment group. After the waiting period the control group crossed over and received the exposure treatment.

    RESULTS: Between group comparisons showed a significantly better result for the exposure group on function, but not for fear or pain and effect sizes were modest (function=.6; fear=.4; pain=.1). When the control group crossed over to treatment significant treatment effects were noted for fear and function. For all patients treated, the pre to post-treatment effect sizes were large (function=.7; fear=1.1; pain=.9). There were 12 dropouts (8 in exposure and 4 in the control) during the first treatment phase and an additional 4 when the control group crossed over to exposure.

    CONCLUSIONS: Compared to a group receiving usual treatment and waiting for exposure, the exposure in vivo group demonstrated a significantly larger improvement on function. Overall exposure had moderate effects on function, fear and pain intensity. We conclude that exposure may be important in treatment, but is not recommended as a "stand alone" adjunct to usual treatment.

  • 48.
    Linton, Steven J
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    Traczyk, Michal
    Department of Law, Psychology, and Social Work, Center for Health and Medical Psychology, Örebro University, Örebro, Sweden; Landstingshälsan, Occupational Health Services, Örebro, Sweden.
    Shaw, William
    Center for Disability Research, Liberty Mutual Research Institute for Safety, Boston MA, USA.
    Nicholas, Michael
    Pain Management Research Institute, Royal North Shore Hospital, University of Sydney, Sydney, Australia.
    Early Workplace Communication and Problem Solving to Prevent Back Disability: Results of a Randomized Controlled Trial Among High-Risk Workers and Their Supervisors2016In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 26, no 2, p. 150-159Article in journal (Refereed)
    Abstract [en]

    Purpose: There is a clear need for interventions that successfully prevent the development of disability due to back pain. We hypothesized that an intervention aimed at both the worker and the workplace could be effective. Hence, we tested the effects of a new early intervention, based on the misdirected problem solving model, aimed at both workers at risk of long-term impairments and their workplace.

    Methods: Supervisors of volunteers with back pain, no red flags, and a high score on a screen (Örebro Musculoskeletal Screening Questionnaire) were randomized to either an evidence based treatment as usual (TAU) or to a worker and workplace package (WWP). The WWP intervention included communication and problem solving skills for the patient and their immediate supervisor. The key outcome variables of work absence due to pain, health-care utilization, perceived health, and pain intensity were collected before, after and at a 6 month follow up.

    Results: The WWP showed significantly larger improvements relative to the TAU for work absence due to pain, perceived health, and health-care utilization. Both groups improved on pain ratings but there was no significant difference between the groups. The WWP not only had significantly fewer participants utilizing health care and work absence due to pain, but the number of health care visits and days absent were also significantly lower than the TAU.

    Conclusions: The WWP with problem solving and communication skills resulted in fewer days off work, fewer health care visits and better perceived health. This supports the misdirected problem solving model and indicates that screening combined with an active intervention to enhance skills is quite successful and likely cost-effective. Future research should replicate and extend these findings with health-economic analyses.

  • 49.
    Linton, Steven J.
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    Vangronsveld, K.
    Department of Experimental-Clinical and Health Psychology, Gent University, Gent, Belgium.
    Fruzzetti, A.
    Department of Psychology, University of Nevada, Reno NV, USA.
    Painfully reassuring?: The effects of validation on emotions and adherence in a pain test2012In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 16, no 4, p. 592-599Article in journal (Refereed)
    Abstract [en]

    Communicating reassurance to patients with musculoskeletal pain complaints, but no red flags, presents a dilemma of dampening worry while refraining from reinforcing undue pain behaviors. Previous research shows that reassurance does not decrease negative affect and may be perceived as not taking the symptoms seriously. Validation offers an alternative where the patient's experiences and feelings are acknowledged and has demonstrated, for other problems, a decrease in arousal which may set the stage for behavioral change. The purpose of this study was to investigate experimentally whether validation, as compared to invalidation, impacts on emotions and adherence during repeated pain tests.

    To this end, 50 participants were randomized to either a validation or invalidation condition. Each participant was told they would undergo four pain trials involving holding a bucket at arm's length to tolerance. During the inter-trial interval, the experimenter provided validating or invalidating responses according to the randomization. As a proxy measure of adherence subjects were asked to engage in an additional pain test.

    Results indicated that validation relative to invalidation resulted in significantly more positive affect and significantly less worry. Both groups had reductions in negative affect over the trials, but there were no difference between the groups on negative affect or pain. However, adherence was more than twice as high in the validation group as compared to invalidation.

    These results show that a relatively simple validation procedure had significant and positive effects on emotion and increased adherence. Further research should extend these findings and explore their clinical application.

  • 50.
    Linton, Steven J.
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Flink, Ida K.
    Bergbom, Sofia
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    Manual för målbaserad aktivitetesträning vid långvarig muskuloskeletal smärta2010Other (Other academic)
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