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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, M
    Faculty of Arts and Social Sciences, Department of Social and Psychological Studies: Psychology, Karlstad University, Karlstad, Sweden.
    Sources of stress and worry in the development of stress-related mental health problems: A longitudinal investigation from early- to mid-adolescence2019In: Anxiety, Stress, and Coping, ISSN 1061-5806, E-ISSN 1477-2205, Vol. 32, no 2, p. 155-167Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND OBJECTIVES: Stress and stress-related mental health complaints are common and increasing among adolescents, especially girls. Identifying typical sources of stress as well as central intervention targets is an important effort in the development of effective prevention and treatment protocols. This study investigated worry as potential mediator in the development of mental health problems in response to common stressors in adolescence. We also examined to what sources adolescents ascribe their stress over the years from the 7th through the 9th grade.

    DESIGN: Prospective cohort study.

    METHODS: Self-reported subjective stressor load, worry, anxiety and depressive symptoms were assessed in a sample of Swedish 7th graders (N = 1137; 46% girls, mean age 13.2) with follow-up assessments one and two years later.

    RESULTS: School was the most common source of stress across all time-points, with girls reporting considerable more stress than boys. Worry mediated the relationship between overall stressor load and depressive symptoms and anxiety over time and was not moderated by gender.

    CONCLUSIONS: Worry may be an important target in stress prevention and efforts to prevent stress-related problems would benefit from focusing on early adolescence as especially school stress is already relatively common in grade 7.

  • 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.
    Adolescent Stress Questionnaire: Evaluation of a Short Version in a Sample of Swedish Adolescents2016Conference paper (Refereed)
  • 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.
    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.

  • 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 and Emotional Distress in Adolescence: 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.

  • 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.
    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)
  • 6.
    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 2245-8875, Vol. 6, no 1, p. 4-15Article in journal (Refereed)
    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.

    Download full text (pdf)
    Development of a Shortened Version of the Adolescent Stress Questionnaire (ASQ-S)
  • 7.
    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. 

  • 8.
    Bartels, Sara Laureen
    et al.
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Johnsson, Sophie I.
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    Flink, Ida
    Örebro University, School of Law, Psychology and Social Work.
    McCracken, Lance M.
    Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden.
    Petersson, Suzanne
    Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden.
    Christie, Hannah L.
    Department of Psychiatry and Neuropsychology and Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Maastricht University, Maastricht, Netherlands.
    Feldman, Inna
    Department of Public Health and Caring Science, Uppsala Universitet, Uppsala, Sweden.
    Simons, Laura E.
    Department of Anaesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA.
    Onghena, Patrick
    Research Group on Methods, Individual and Cultural Differences, Affect and Social Behavior, KU Leuven, Leuven, Belgium.
    Vlaeyen, Johan W. S.
    Research Group Health Psychology, KU Leuven, Leuven, Belgium; Research Group Experimental Health Psychology, Maastricht University, Maastricht, The Netherlands.
    Wicksell, Rikard K.
    Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden; Pain Clinic, Capio St. Göran Hospital, Stockholm, Sweden.
    Development, evaluation and implementation of a digital behavioural health treatment for chronic pain: study protocol of the multiphase DAHLIA project2022In: BMJ Open, E-ISSN 2044-6055, Vol. 12, no 4, article id e059152Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Chronic pain affects about 20%-40% of the population and is linked to mental health outcomes and impaired daily functioning. Pharmacological interventions are commonly insufficient for producing relief and recovery of functioning. Behavioural health treatment is key to generate lasting benefits across outcome domains. However, most people with chronic pain cannot easily access evidence-based behavioural interventions. The overall aim of the DAHLIA project is to develop, evaluate and implement a widely accessible digital behavioural health treatment to improve well-being in individuals with chronic pain.

    METHODS AND ANALYSIS: The project follows the four phases of the mHealth Agile Development and Evaluation Lifecycle: (1) development and pre-implementation surveillance using focus groups, stakeholder interviews and a business model; (2) iterative optimisation studies applying single case experimental design (SCED) method in 4-6 iterations with n=10 patients and their healthcare professionals per iteration; (3) a two-armed clinical randomised controlled trial enhanced with SCED (n=180 patients per arm) and (4) interview-based post-market surveillance. Data analyses include multilevel modelling, cost-utility and indicative analyses.In October 2021, inter-sectorial partners are engaged and funding is secured for four years. The treatment content is compiled and the first treatment prototype is in preparation. Clinical sites in three Swedish regions are informed and recruitment for phase 1 will start in autumn 2021. To facilitate long-term impact and accessibility, the treatment will be integrated into a Swedish health platform (www.1177.se), which is used on a national level as a hub for advice, information, guidance and e-services for health and healthcare.

    ETHICS AND DISSEMINATION: The study plan has been reviewed and approved by Swedish ethical review authorities. Findings will be actively disseminated through peer-reviewed journals, conference presentations, social media and outreach activities for the wider public.

    TRIAL REGISTRATION NUMBER: NCT05066087.

  • 9.
    Bartels, Sara Laureen
    et al.
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Taygar, Afra S.
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Institute of Social Sciences, Uskudar University, Istanbul, Turkey.
    Johnsson, Sophie I.
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Petersson, Suzanne
    Department of Medicine and Optometry, Linnaeus University, Kalmar, Region Kalmar County, Sweden.
    Flink, Ida
    Örebro University, School of Behavioural, Social and Legal Sciences.
    Boersma, Katja
    Örebro University, School of Behavioural, Social and Legal Sciences.
    McCracken, Lance M.
    Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden.
    Wicksell, Rikard K.
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Pain clinic, Capio St. Göran Hospital, Stockholm, Sweden.
    Using Personas in the development of eHealth interventions for chronic pain: A scoping review and narrative synthesis2023In: Internet Interventions, ISSN 2214-7829, Vol. 32, article id 100619Article, review/survey (Refereed)
    Abstract [en]

    OBJECTIVES: Behavioral eHealth interventions can enhance self-management and improve well-being in people with chronic pain. The development of these interventions calls for a user-centered approach to ensure that patient needs are appreciated. However, it may be challenging to involve patients; particularly during the early stages of the process. Fictional user profiles, known as Personas, can represent needs and guide designing eHealth interventions. This article provides a comprehensive overview of the use of Personas in the development of behavioral eHealth interventions for people with chronic pain with the aim to identify benefits and challenges.

    METHODS: Bibliographic databases (Medline, Web of Science Core Collection, PsycInfo, CINAHL) and registries (PubMed Central, medaRxiv) were systematically searched. In a double-reviewing process, n = 6830 hits and n = 351 full-texts were screened and read. Ten peer-reviewed studies published between 2017 and 2022 were included in the narrative synthesis.

    FINDINGS: Ten studies reported using "Pain Personas" in the development of eHealth interventions for such purposes as to gain a shared understanding of the user and to discuss solutions in team meetings, or for patients to identify with (if Personas are included in the intervention). Personas were based on qualitative and/or quantitative data. However, the procedure for creating Personas was only described in half of the included studies (n = 5). These five studies provided descriptive details of the Personas (i.e., picture, name, narrative of their pain behavior, technological skills, and motivation).

    CONCLUSIONS: Although Personas have been used by pain researchers in recent projects and were highlighted as an important ingredient in the development process, available design guidelines for the creation and use of Personas are not followed or communicated transparently. Benefits and challenges when using Personas in the development of eHealth interventions for people with chronic pain are discussed to support future eHealth efforts and to improve the quality of eHealth innovation in the field of pain.

  • 10.
    Bauducco, Serena
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Bayram Özdemir, Sevgi
    Örebro University, School of Law, Psychology and Social Work.
    Özdemir, Metin
    Örebro University, School of Law, Psychology and Social Work.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    Adolescents’ sleep trajectories over time: School stress as a potential risk factor for the development of chronic sleep problems2019Conference paper (Other academic)
  • 11.
    Bauducco, Serena
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Bayram Özdemir, Sevgi
    Örebro University, School of Law, Psychology and Social Work.
    Özdemir, Metin
    Örebro University, School of Law, Psychology and Social Work.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    Adolescents' sleep trajectories over time: school stress as a potential risk factor for the development of chronic sleep problems2019In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 64, no Suppl. 1, p. S27-S27Article in journal (Other academic)
    Abstract [en]

    Introduction: Sleep is a complex behavior affected by biological, psychosocial and contextual factors typically present during adolescent development (Becker, Langberg, & Byars, 2015), including increasing autonomy from parents, increasing school demands, and socializing more with peers. However, these normative changes do not explain temporary vs chronic sleep disturbances. Who are the adolescents at risk for developing chronic sleep problems? Some risk factors have been identified as crucial, such as poor sleep hygiene and family stressors, others are not as clear, such as technology use (Bartel et al., 2015). The impact of another important stressor for youths other than family, the school context, has received less attention (Meldrum, 2018). The aim of this study was twofold; first, we explored sleep trajectories from early to mid-adolescence to be able to identify a risk group showing persistent sleep problems (including insomnia and short sleep duration); then, we investigated the role of school stressors (i.e., conflicts with teachers, performance, school-leisure conflict, attendance), controlling for well-established risk factors, in the development of chronic sleep problems in a large cohort of adolescents.

    Materials and methods: We used three longitudinal waves of questionnaire data collected annually from a sample of Swedish adolescents (n = 1457; Mage = 13.2 [range: 12- 15 years], SD = .43; 52.7% boys). We collected the data from all schools in three communities in central Sweden, during school hours. Using established measures, the students reported on their sleep duration (calculated from reported bedtime, wake-time, and sleep onset latency; SSHS [Wolfson & Carskadon, 1998]), insomnia symptoms (ISI; Morin, 1993), sleep hygiene (ASHS; LeBourgeois, Giannotti, Cortesi, Wolfson, & Harsh, 2005), technology use, and perceived stress (including school, home and peer related stress) (ASQ; Byrne, Davenport, & Mazanov, 2007).

    First we used latent class analysis (LCA) to identify adolescents' sleep trajectories, then we used regression analyses to predict the risk-group trajectory of chronic insomnia and short sleep duration, controlling for gender.

    Results: We found four trajectories for adolescents' insomnia; 1) low-stable (69%), 2) low-increasing (18%), 3) high-decreasing (8%), 4) high-increasing (5%; 'risk-group'). For sleep duration, we found two trajectories; 1) ∼8 h slightly decreasing (79%), 2) ∼7 h decreasing (21%; 'risk-group').

    School stressors including stress of fitting in with peers, stress of schoolwork leaving too little leisure time, a stressful home environment, poor sleep hygiene, and being female were risk factors for chronic insomnia symptoms. Conflicts with teachers, poor sleep hygiene, and being female were risk-factors for chronic insufficient sleep.

    Conclusions: Over and above well-known risk-factors for poor sleep, such as poor sleep hygiene, (Bartel et al., 2015), school-related stress was a significant predictor of persistent sleep problems in adolescents. Therefore, helping adolescents to handle school stress might be a promising strategy to improve sleep health in this population.

  • 12.
    Bauducco, Serena
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    Interventioner för att förebygga sömnbrist hos tonåringar: fokus på individ eller samhälle?2020In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 97, no 5-6, p. 866-877Article in journal (Refereed)
    Abstract [en]

    Adolescence is a sensitive time of development and sleep is important for optimal functioning. Sleep changes drastically during this time and many adolescents do not sleep enough. Although sleep deprivation may be temporary, even short-term consequences can be detrimental. Therefore, promoting sleep health in this age group is warranted. Sleep promotion may aim to change adolescents’ sleep behaviors directly or by postponing school start times to ensure sufficient sleep duration. School-based programs that aim to improve adolescents’ sleep habits have shown mixed results but have preliminarily shown long-term benefits. Delaying school-start times has shown clear increases in sleep. However, it is unclear whether the results can be generalized to Swedish schools, which already start at recommended times. Therefore, teaching adolescents how to achieve healthy sleep habits might be a better strategy.

    Download full text (pdf)
    Interventioner för att förebygga sömnbrist hos tonåringar: fokus på individ eller samhälle?
  • 13.
    Bauducco, Serena
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Flink, Ida
    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.
    Preventing sleep deficit in adolescents: Long-term effects of a quasi-experimental school-based intervention study2020In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 29, no 1, article id e12940Article in journal (Refereed)
    Abstract [en]

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

  • 14.
    Bauducco, Serena
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Salihovic, Selma
    Örebro University, School of Law, Psychology and Social Work.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    Bidirectional associations between adolescents’ sleep problems and impulsive behavior over time2019In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 1, article id 100009Article in journal (Refereed)
    Abstract [en]

    Objective/Background: Adolescents who experience sleep problems are less able to resist impulses. Furthermore, youths who show more impulsive behaviors are, in turn, assumed to have more sleep problems, which sets the stage for a negative cycle over time. Empirical research has shown some evidence that sleep problems affect impulse control, but the bidirectional link has previously not been tested. Therefore, the aim of this study was to test this assumption.

    Methods: In this study, we used cross-lagged models to investigate the bidirectional association between sleep problems (ie, insomnia and sleep duration) and impulsive behaviors over two years in a cohort of young adolescents (n = 2767, mean age ∼13.7, 47.6% girls). We also investigated the moderating role of age and gender.

    Results: The results showed that the links between sleep duration/insomnia and impulsive behavior are bidirectional. Youths who experienced sleep problems also experienced increased difficulties with impulse control, and problems regulating impulses were also linked with increases in sleep problems, and these effects were systematic over two years. Moreover, age did not moderate these associations but impulsive behaviors had a larger impact on girls’ insomnia as compared to boys.

    Conclusions: By confirming the bi-directionality of this association, this study supports the importance of developing interventions to promote sleep health in adolescents but also the need to tailor such programs to adolescents’ development because adolescents might not be able to prioritize sleep if they cannot control their impulses.

  • 15.
    Bauducco, Serena
    et al.
    Örebro University, School of Law, Psychology and Social Work. Center for Health and Medical Psychology; Center for Lifespan Developmental Research.
    Özdemir, Metin
    Örebro University, School of Law, Psychology and Social Work. Center for Lifespan Developmental Research.
    Gradisar, Michael
    WINK Sleep, Adelaide, Australia; Sleep Cycle AB, Gothenburg, Sweden.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work. Center for Health and Medical Psychology.
    Bayram Özdemir, Sevgi
    Örebro University, School of Law, Psychology and Social Work. Center for Lifespan Developmental Research.
    Trajectories of insomnia symptoms and insufficient sleep duration in early adolescents: associations with school stress2022In: SLEEP Advances, E-ISSN 2632-5012, Vol. 3, no 1Article in journal (Refereed)
    Abstract [en]

    Study Objectives: We examined how adolescents’ sleep patterns (i.e. insomnia symptoms and sleep duration) change from early- to mid-adolescence and whether adolescents follow different trajectories. Furthermore, we also examined the characteristics of adolescents within different trajectories, with a specific focus on the role of school-related stress.

    Methods: We used three longitudinal waves of questionnaire data collected annually from a sample of Swedish adolescents (n = 1294; Mage = 13.2 [range: 12–15 years], SD = .42; 46.8% girls). Using established measures, the students reported on their sleep duration, insomnia symptoms, and perceived school-stress (including stress of school performance, peer and teacher relations, attendance, and school-leisure conflict). We used latent class growth analysis (LCGA) to identify adolescents’ sleep trajectories, and the BCH method to describe the characteristics of the adolescents in each trajectory.

    Results: We found four trajectories for adolescents’ insomnia symptoms; (1) low insomnia (69%), (2) low-increasing (17%, ‘emerging risk-group’), (3) high-decreasing (9%), (4) high-increasing (5%; ‘risk-group’). For sleep duration, we found two trajectories; (1) ~8 h sufficient-decreasing (85%), (2) ~7 h insufficient- decreasing (15%; ‘risk-group’). Adolescents in risk-trajectories were more likely to be girls and consistently reported higher levels of school stress, particularly regarding school performance and attending school.ConclusionsSchool stress was prominent among adolescents suffering from persistent sleep problems, especially insomnia, and deserves further attention.

    Download full text (pdf)
    Trajectories of insomnia symptoms and insufficient sleep duration in early adolescents: associations with school stress
  • 16.
    Bayram Özdemir, Sevgi
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Özdemir, Metin
    Örebro University, School of Law, Psychology and Social Work.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    How Does Adolescents' Openness to Diversity Change Over Time? The Role of Majority-Minority Friendship, Friends' Views, and Classroom Social Context2021In: Journal of Youth and Adolescence, ISSN 0047-2891, E-ISSN 1573-6601, Vol. 50, no 1, p. 75-88Article in journal (Refereed)
    Abstract [en]

    Young people are growing up in increasingly “super-diverse” societies, and show variations in how they approach diversity and embrace differences. Developing a good understanding of why some youth appreciate and value diversity whereas others do not is crucial in identifying ways to promote social interactions among different groups in broader society. The current study examined whether adolescents follow different trajectories in their views on diversity, and identified possible factors behind how they change over time. The sample included 1362 adolescents residing in Sweden (Mage = 13.18, SD = 0.43, 48% girls). Adolescents reported on their openness to diversity and classroom social climate. The peer nominations method was used to measure majority-minority friendship, and friends’ views on diversity. Latent growth analysis showed that adolescents, on average, became more open to diversity over time, but with clear heterogeneity. Three distinct trajectories were identified as: high-increasing, average-increasing, and average-declining. Relative to the high-increasing group, the other two were more likely to be male and immigrant. Relative to the high-increasing group, adolescents on the average-increasing trajectory perceived their classroom climate as less cooperative, while the adolescents on the average-declining trajectory were less likely to have friends with positive views on diversity. The findings suggest that schools may serve as a shared ground for promoting openness to diversity.

  • 17.
    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.

  • 18.
    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.

  • 19.
    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.

  • 20.
    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.

  • 21. 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)
  • 22.
    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.

  • 23.
    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)
  • 24.
    Bergbom, Sofia
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    Flink, Ida
    Örebro University, School of Law, Psychology and Social Work.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    Åkerlund, Daniel
    Örebro University, Örebro, Sweden.
    Psykologer i primärvården - en förbisedd möjlighet2017In: Nerikes Allehanda, ISSN 1103-971X, no 9 aprilArticle in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Psykologer har den expertkunskap som krävs för att behandla dagens ohälsa, och regionen riskerar skapa en närsjukvård som tillhör B-laget genom att inte ta vara på psykologers kompetens. Evidensen pekar tydligt ut psykologisk behandling som förstahandsval vid behandling av sömnsvårigheter, depression, ångest och stressproblematik – ändå ignoreras psykologers kunskap i den arbetsgrupp som tillsatts för att tackla nutidens problematik i primärvården.

  • 25.
    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)10.1097/00002508-200501000-00005 (DOI)000225958300005 ()15599130 (PubMedID)2-s2.0-10944266361 (Scopus ID)
    Note

    Discussion p. 69-72

    Available from: 2005-04-29 Created: 2005-04-29 Last updated: 2023-12-08Bibliographically 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)000235698100007 ()16159591 (PubMedID)2-s2.0-24644522000 (Scopus ID)
    Available from: 2005-04-29 Created: 2005-04-29 Last updated: 2023-12-08Bibliographically 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)10.1097/01.ajp.0000159582.37750.39 (DOI)000234968400007 ()16428950 (PubMedID)2-s2.0-33644921768 (Scopus ID)
    Available from: 2005-04-29 Created: 2005-04-29 Last updated: 2023-12-08Bibliographically 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.

    Place, publisher, year, edition, pages
    Elsevier, 2004
    Keywords
    cognitive behavioral treatment, back pain, fear-avoidance model, function, multiple baseline design
    National Category
    Psychology
    Research subject
    Psychology
    Identifiers
    urn:nbn:se:oru:diva-2817 (URN)10.1016/j.pain.2003.03.001 (DOI)000220312400003 ()15109502 (PubMedID)2-s2.0-1342321736 (Scopus ID)
    Available from: 2005-04-29 Created: 2005-04-29 Last updated: 2020-12-14Bibliographically approved
  • 26.
    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)
  • 27.
    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.

  • 28.
    Boersma, Katja
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Flink, Ida
    Örebro University, School of Law, Psychology and Social Work.
    Investigating the Role of Emotion Regulation in Relation to Co-Occurring Pain: Emotional and Interpersonal Problems in Adolescents2015Conference paper (Other academic)
  • 29.
    Boersma, Katja
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Flink, Ida
    Örebro University, School of Law, Psychology and Social Work.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    Considering the interpersonal context of pain catastrophizing2019In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 20, no 1, p. 9-10Article in journal (Refereed)
  • 30.
    Boersma, Katja
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Flink, Ida
    Örebro University, School of Law, Psychology and Social Work.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    Södermark, Martin
    Linköping University, Linköping, Sweden.
    Emotion regulation in chronic pain patients with emotional difficulties: A DBT-inspired exposure treatment2016Conference paper (Other academic)
    Abstract [en]

    Co-occuring pain and emotional difficulties are strikingly common and a true challenge in the clinic. Nearly all pain patients suffer from some kind of emotional distress. Difficulties with emotion regulation has been pointed out as one core process, which may explain the high co-occurrence of pain and emotional distress. Current treatments have not succeeded in helping pain patients with high levels of emotional distress, and therefore a new treatment approach has been developed, based on emotion regulation theory, DBT and exposure techniques. This presentation will describe the theory behind this new intervention and present preliminary data from a randomized controlled trial in patients with chronic pain and emotional distress. This trial compares the effectiveness of a DBT inspired exposure treatment with internet-based CBT for chronic pain.

  • 31.
    Boersma, Katja
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Håkanson, Alexander
    Department of Law, Psychology and Social Work, Örebro University, Örebro, Sweden.
    Salomonsson, Elin
    Department of Law, Psychology and Social Work, Örebro University, Örebro, Sweden.
    Johansson, Ida
    Department of Law, Psychology and Social Work, Örebro University, Örebro, Sweden.
    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.

  • 32.
    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.

  • 33.
    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)
  • 34.
    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. Department of Occupational and Environmental Medicine, Orebro University Hospital, Orebro, Sweden.
    Early assessment of psychological factors: the Örebro screening questionnaire for pain2002In: New avenues for the prevention of chronic musculoskeletal pain and disability / [ed] Steven J. Linton, Amsterdam: Elsevier, 2002, p. 205-214Chapter in book (Refereed)
  • 35.
    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)
  • 36.
    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.
    Expectancy, fear and pain in the prediction of chronic pain and disability: A prospective analysis2006In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 10, no 6, p. 551-557Article in journal (Refereed)
    Abstract [en]

    Studies with (sub) acute back pain patients show that negative expectancies predict pain and disability at a one-year follow up. Yet, it is not clear how expectations relate to other factors in the development of chronic disability such as pain and fear. This study investigates the relationship between expectations, pain-related fear and pain and studies how these variables are related to the development of chronic pain and disability. Subjects (N = 141) with back and/or neck pain (duration <1 year) were recruited via primary care. They completed measures on pain, expectancy, pain-related fear (pain-related negative affect and fear avoidance beliefs) and function. A one-year follow up was conducted with regard to pain and function. It was found that pain, expectancy, pain-related fear and function were strongly interrelated. In the cross-sectional analyses negative expectancies were best explained by frequent pain and a belief in an underlying and serious medical problem. Prospectively, negative expectancy, negative affect and a belief that activity may result in (re) injury or increased pain, explained unique variance in both pain and function at one-year follow up. In conclusion, expectancy, negative affect and fear avoidance beliefs are interrelated constructs that have predictive value for future pain and disability. Clinically, it can be helpful to inquire about beliefs, expectancy and distress as an indication of risk as well as to guide intervention. However, the strong interrelations between the variables call for precaution in treating them as if they were separate entities existing in reality. 

  • 37.
    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.

  • 38.
    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.

  • 39.
    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.

  • 40.
    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
    Department of Occupational and Environmental Medicine, Örebro University Hospital, Örebro, Sweden.
    Jansson, Markus
    Department of Occupational and Environmental Medicine, Örebro University Hospital, Örebro, Sweden; Department of Social Sciences—Psychology, Örebro University, Örebro, Sweden.
    Vlaeyen, Johan
    Department of Medical, Clinical and Experimental Psychology, Maastricht University, Maastricht, The Netherlands.
    de Jong, Jeroen
    Department of Medical, Clinical and Experimental Psychology, Maastricht University, Maastricht, The Netherlands.
    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.

  • 41.
    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.

  • 42.
    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)
  • 43.
    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.

  • 44.
    Boersma, Katja
    et al.
    Örebro University, School of Law, Psychology and Social Work. Center for Health and Medical Psychology.
    Södermark, Martin
    Department of Medical and Health Sciences, Pain and Rehabilitation Centre, Linköping University, Linköping, Sweden.
    Hesser, Hugo
    Department of Behavioural Sciences and Learning, Division of Psychology, Linköping University, Linköping, Sweden.
    Flink, Ida
    Örebro University, School of Law, Psychology and Social Work.
    Gerdle, Björn
    Department of Medical and Health Sciences, Pain and Rehabilitation Centre, Linköping University, Linköping, Sweden.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work. Center for Health and Medical Psychology.
    Efficacy of a transdiagnostic emotion-focused exposure treatment for chronic pain patients with comorbid anxiety and depression: a randomized controlled trial2019In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 160, no 8, p. 1708-1718Article in journal (Refereed)
    Abstract [en]

    The comorbidity between chronic pain and emotional problems has proven difficult to address with current treatment options. This study addresses the efficacy of a transdiagnostic emotion-focused exposure treatment ("hybrid") for chronic pain patients with comorbid emotional problems. Adults (n = 115) with chronic musculoskeletal pain and functional and emotional problems were included in a 2-centre, parallel randomized controlled, open-label trial comparing this treatment to an active control condition receiving a guided Internet-delivered pain management treatment based on CBT principles (iCBT). The hybrid treatment (n = 58, 10-16 sessions) integrates exposure in vivo for chronic pain based on the fear-avoidance model with an emotion-regulation approach informed by procedures in Dialectical Behavior Therapy. The iCBT (n = 57; 8 treatment modules) addresses topics such as pain education, coping strategies, relaxation, problem solving, stress, and sleep management using standard CBT techniques. Patient-reported outcomes were assessed before and after treatment as well as at a 9-month primary end point. Across conditions, 78% participants completed post-treatment and 81% follow-up assessment. Intent-to-treat analyses showed that the hybrid had a significantly better post-treatment outcome on pain catastrophizing (d = 0.39) and pain interference (d = 0.63) and significantly better follow-up outcomes on depression (d = 0.43) and pain interference (d = 0.51). There were no differences on anxiety and pain intensity. Observed proportions of clinically significant improvement favoured the hybrid on all but one comparison, but no statistically significant differences were observed. We conclude that the hybrid emotion-focused treatment may be considered an acceptable, credible, and efficacious treatment option for chronic pain patients with comorbid emotional problems.

  • 45.
    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.

  • 46.
    Boersma, Katja
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Wicksell, Rikard
    Karolinska University Hospital/Karolinska Institutet, Stockholm, Sweden.
    Bothelius, Kristoffer
    Uppsala University, Uppsala, Sweden.
    Flink, Ida
    Örebro University, School of Law, Psychology and Social Work.
    Thomtén, Johanna
    Mid University, Östersund, Sweden.
    Symposium: Pain and emotion – biological processes, emotion regulation and implications for treatment2016In: EABCT 2016 Abstract Book: Total Awareness, 2016, p. 162-162Conference paper (Other academic)
    Abstract [en]

    Co-occurring pain and emotional difficulties are strikingly common and a true challenge in the clinic. Nearly all pain patients suffer from some kind of emotional distress. In the last decade, research in the field has started to focus on the role of underlying processes in concurrent problems with pain and emotional distress. This symposium is therefore focused on the link between pain and emotion and will highlight new perspectives on processes, theoretical as well as clinical. Talks will address the role of biological mechanisms, interpersonal contexts and the development of the new treatment approaches.

    Poor emotion regulation has been pointed out as one core process, which may explain the high co-occurrence of pain and emotional distress. Current treatments have not succeeded in helping paon patients with high levels of emotional distress, and therefore a new treatment approach has been developed, based on emotion regulation theory and exposure techniques. Dr. Katja Boersma will describe the theory beind this new intervention and present preliminary data from an RCT in patients with chronic pain and emotional distress.

    Another treatment approach with well documented effects in this area is ACT. However, large variability in treatment effects can be seen consistently across studies and predictors of outcome remain unclear. Few studies have yet investigated the role of biological processes in ACT. Dr. Rikard Wicksell will briefly describe ACT for patients with chronic pain, bring up recent findings on ACT and neuroscience, and discuss implications for future research and clinical development.

    Pain-related fear is a salient emotion in many pain patients, which tend to lead to avoidance of movements or activities. Avoidance behaviors are negatively reinfrced as they lead to less pain for the moment; in the long run, however, it often results in inactivity and disuse. Furthermore, a change in neural response profile, so called cortical reorganization, occurs in cortical sensory and motor areas. Targeting immobilisation and cortical reorganisation, using cognitive behavioral, sensory, and motor strategies, may improve function in individuals with chronic pain. Dr. Kristoffer Bothelius will present findings in this area and discuss possible treatment implications.

    One way of regulating pain and negative emotions is to share personal experiences with others. However, it is important to know where, when and with whom to share; in other terms, to be context sensitive. The opposite, context insensitivity, has been related to prolonged and exaggerated emotional distress. The theory, importance and potential clinical implications of context sensitivity in the area pf pain and emotional distress will serve the basis for the presentation by Dr. Ida Flink, and data from an ongoing project will be presented.

    The link between pain and emotional distress may become extra salient when the pain occurs in an intimate interpersonal context. Vulvovaginal pain in women has been neglected in pain research, but is closely linked to emotional reactions such as fear and anxiety. Dr. Johanna Thomtén will describe the link between pain and emotional distress among women suffering from vulvovaginal pain, presenting data from an ongoing longitudinal project.

  • 47.
    Buhrman, Monica
    et al.
    Uppsala universitet, Uppsala, Sweden.
    Tillfors, Maria
    Department of Social and Psychological Studies, Section of Psychology, Karlstad University, Karlstad.
    Holländare, Fredrik
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Lekström, Emily
    Uppsala universitet, Uppsala, Sweden.
    Håkansson, Alexander
    Örebro University, School of Behavioural, Social and Legal Sciences.
    Boersma, Katja
    Örebro University, School of Behavioural, Social and Legal Sciences.
    Psychological treatment targeting acceptance and compassion in chronic pain patients: a randomized controlled, internet delivered, treatment trial2023In: The Clinical Journal of Pain, ISSN 0749-8047, E-ISSN 1536-5409, Vol. 39, no 12, p. 672-685Article in journal (Other academic)
    Abstract [en]

    Objectives: Chronic pain is often associated with suffering. Self-criticism is associated with depressive symptoms. The purpose of this study was to explore if fusing acceptance and commitment therapy (ACT) and compassion focused therapy (CFT), could improve psychological wellbeing and disability in chronic pain patients with high levels of self-criticism in comparison to a wait-list control group. 

    Methods: Individuals with chronic pain (n=71) were randomly assigned to an 8-week internet-based intervention focused on acceptance and compassion or a wait-list condition. Primary treatments outcomes were Chronic Pain Acceptance Questionnaire, Self-Compassion Scale, and Pain Disability index. Secondary outcomes were Montgomery Åsberg Depression Rating Scale, Anxiety sensitivity index, Quality of Life Inventor, Multidimensional Pain Inventory and Perseverative Thinking Questionnaire. 

    Results: Missing data at post-intervention was 22.5%. ITT-analyses were conducted using linear mixed-models. Results revealed significantly greater levels of acceptance and self-compassion for the treatment group, which were primary outcomes, with effect sizes ranging from small to large and these results were maintained at six-month follow-up. Rates of clinical significant improvements were also greater for the treatment group in comparison to the wait-list control group on acceptance and compassion. Results in the third primary outcome showed also improvements in disability levels. Significant differences were also found in several of the secondary outcomes, in favour for the treatment group.

    Discussion: Internet-based ACT with CFT components shows promise as a viable treatment option in the management of chronic pain.

  • 48.
    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)
  • 49.
    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.

  • 50.
    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.

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