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  • 1.
    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.

  • 2.
    Edebol, Hanna
    Karlstad University, Karlstad, Sweden.
    Global Assessment of Attention Deficit Hyperactivity Disorder: Examining objective Measures of Hyperactivity, Impulsivity and Inattention in Adults2012Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The aim of this thesis is to examine objective laboratory measures of Attention Deficit Hyperactivity Disorder (ADHD) in adult persons and to develop measures for diagnosis and treatment using a psychometric instrument called the Quantified Behavior Test Plus. The instrument objectively quantifies cardinal symptom manifestations in adult ADHD using motion tracking devices and continuous performance testing.

    Paper I-IV suggest that ADHD predisposes adult persons to perform poorer on continuous performance tasks and to have higher levels of motor activity while performing these tasks as compared to other clinical as well as non-clinical groups. Performance by adults with ADHD is normalized following stimulant treatment which implicates therapeutic effects and measures of response to treatment and remission for ADHD is suggested.

    Paper I concludes that the psychometric instrument needs to be calibrated with regard to adult ADHD and emphasizes the importance of a composite measure for the disorder.

    Paper II generates two new measures, the Weighed Core Symptom scale (WCS) - a composite measure of adult ADHD ranging from 0 to 100, and Prediction of ADHD (PADHD) - a categorical variable of the diagnostic status with good predictive power. A majority of participants with ADHD has low points on WCS (indicating high levels of symptoms) and a majority of non-ADHD normative participants has high points on WCS (indicating low levels of symptoms).

    Paper III examines WCS and PADHD among complex clinical groups with shared symptoms vis-à-vis ADHD. Here, findings from Paper II are replicated since participants with ADHD present the highest level of global symptoms, followed by participants with bipolar II disorder and borderline personality disorder, participant with disconfirmed ADHD and finally, non-clinical participants has the lowest level of global symptoms.

    In Paper IV, the measures are proposed as indications of response to treatment and remission after titration with stimulant treatment and WCS indicates response to small changes in dose level.

    The major findings of the present thesis may be summarized as the construction of two new objective measures for ADHD in adult persons with practical implications for diagnosis and treatment. Hyperactivity is the most specific marker of ADHD in both men and women, followed by the cognitive markers of inattention and impulsivity. The composite measure, WCS, quantifies the global amount of ADHD symptoms and provides the most sensitive measure for the disorder. PADHD and WCS may not replace a thorough neuropsychiatric assessment and further studies promoting diagnostic subtype stratification is suggested. Future studies may want to consider these measures in outcome-based investigations of treatment efficacy as well as in the study of neuropsychological endophenotypes. Practical implications include clinical strategies to enhance objectivity during assessment as well as optimizing beneficial effects of treatment and attaining remission.

    List of papers
    1. In search for objective measures of hyperactivity, impulsivity and inattention in adult attention deficit hyperactivity disorder using the Quantified Behavior Test Plus
    Open this publication in new window or tab >>In search for objective measures of hyperactivity, impulsivity and inattention in adult attention deficit hyperactivity disorder using the Quantified Behavior Test Plus
    Show others...
    2011 (English)In: Europe's Journal of Psychology, ISSN 1841-0413, E-ISSN 1841-0413, Vol. 7, no 3, p. 443-457Article in journal (Refereed) Published
    Abstract [en]

    Clinical assessment tools for adult attention deficit hyperactivity disorder (ADHD) such as rating scales, interviews and behavior observations are often based on subjective judgments which enhance the risk of overlooking or misinterpreting symptoms. In search for objective measures of adult ADHD, the present study investigated levels of sensitivity and specificity for the Quantified Behavior Test Plus, QbTest-Plus, in adult patients (N = 19) awaiting clinical assessment for ADHD. QbTest-Plus report objective measures of ADHD core symptoms using an infrared motion tracking system and a continuous performance test. The measures were collected and evaluated previous to clinical assessment and compared regarding the diagnosis of ADHD. Sensitivity for detecting ADHD with QbTest-Plus was 83 % and specificity was 57 %. The results, possibly affected by confounding factors, suggest further examination of calibrated and objective measure for the QbTest-Plus with regard to ADHD in adults.

    Place, publisher, year, edition, pages
    Trier, Germany: PsychOpen, 2011
    Keywords
    Adults, Attention deficit hyperactivity disorder, Clinical assessment, Objective measures, The quantified behavior test plus
    National Category
    Psychology
    Research subject
    Psychology
    Identifiers
    urn:nbn:se:oru:diva-39853 (URN)10.5964/ejop.v7i3.143 (DOI)2-s2.0-80051747290 (Scopus ID)
    Available from: 2014-12-17 Created: 2014-12-17 Last updated: 2018-05-06Bibliographically approved
    2. Measuring adult attention deficit hyperactivity disorder using the Quantified Behavior Test Plus
    Open this publication in new window or tab >>Measuring adult attention deficit hyperactivity disorder using the Quantified Behavior Test Plus
    2013 (English)In: PsyCh Journal, ISSN 2046-0252, E-ISSN 2046-0260, Vol. 2, no 1, p. 48-62Article in journal (Refereed) Published
    Abstract [en]

    Attention Deficit Hyperactivity Disorder (ADHD) occurs in approximately 5% of the adult population and includes cardinal symptoms of hyperactivity, inattention, and impulsivity that may be difficult to identify with clinical routine methods. Continuous performance tests are objective measures of inattention and impulsivity that, combined with objective measures of motor activity, facilitate identification of ADHD among adults. The aim of the present study was to examine the sensitivity, specificity, and a composite measure of ADHD using objective measures of the ADHD-cardinal symptoms in adult participants with ADHD and non-ADHD normative participants. Cardinal symptoms were measured in 55 participants having ADHD, 202 non-ADHD normative participants, as well as 84 ADHD normative participants using the Quantified Behavior Test Plus. This test measures inattention and impulsivity using a continuous performance test, and hyperactivity using a motion-tracking system. A predictive variable for the detection of ADHD called Prediction of ADHD yielded 86% sensitivity and 83% specificity. A composite measure of ADHD cardinal symptoms was developed using a Weighed Core Symptoms scale that indicated the total amount of ADHD symptoms on a numeric scale from 0 to 100. The total amount of ADHD symptoms was measured on a scale and predicted with the categorical variable in a majority of the cases in the present study. Further studies are needed in order to confirm the results with regard to additional clinical and normative samples. Careful consideration of potential sex and diagnostic subtype differences are noteworthy aspects for future examinations of the new instruments.

    Place, publisher, year, edition, pages
    John Wiley & Sons, 2013
    Keywords
    adults, Attention Deficit Hyperactivity Disorder, psychometrics, objective measures
    National Category
    Psychology
    Research subject
    Psychology
    Identifiers
    urn:nbn:se:oru:diva-39856 (URN)10.1002/pchj.17 (DOI)24294490 (PubMedID)
    Available from: 2014-12-17 Created: 2014-12-17 Last updated: 2018-05-22Bibliographically approved
    3. Objective measures of behavior manifestations in adult ADHD and differentiation from participants with Bipolar II disorder, Borderline personality disorder, participants with disconfirmed ADHD as well as Normative participants.
    Open this publication in new window or tab >>Objective measures of behavior manifestations in adult ADHD and differentiation from participants with Bipolar II disorder, Borderline personality disorder, participants with disconfirmed ADHD as well as Normative participants.
    2012 (English)In: Clinical Practice and Epidemiology in Mental Health, ISSN 1745-0179, E-ISSN 1745-0179, Vol. 8, p. 134-143Article in journal (Refereed) Published
    Abstract [en]

    Background:

    The present study evaluated two psychometric instruments derived from the objective measurement of adult ADHD using the Quantified Behavior Test Plus. The instruments were examined in ADHD versus a clinical group with overlapping symptoms including borderline personality disorder and bipolar II disorder, and another clinical group with participants assessed for but disconfirmed a diagnosis of ADHD as well as adult normative participants.

    Methods:

    The Quantified Behavior Test Plus includes Continuous Performance Testing and a Motion Tracking System with parameters related to attention and activity operationalized as the cardinal symptoms of ADHD and then summarized into a Weighed Core Symptoms scale with ten cut-points ranging from 0 to 100. A categorical predictor variable called Prediction of ADHD was used to examine the levels of sensitivity and specificity for the Quantified Behavior Test Plus with regard to ADHD.

    Results:

    The Weighed Core Symptoms scale separated ADHD and normative participants from each other as well as from the two clinical reference groups. The scale reported highest levels of core symptoms in the ADHD group and the lowest level of core symptoms in the normative group. Analyses with Prediction of ADHD yielded 85 % specificity for the normative group, 87 % sensitivity for the ADHD group, 36 % sensitivity for the bipolar II and borderline group and 41 % sensitivity for the group with a disconfirmed diagnosis of ADHD.

    Conclusions:

    The Weighed Core Symptoms scale facilitated objective assessment of adult ADHD insofar that the ADHD group presented more core symptoms than the other two clinical groups and the normative group. Sensitivity for the Quantified Behavior Test Plus was lower in complex clinical groups with Bipolar II disorder, Borderline disorder and in patients with a disconfirmed diagnosis of ADHD. The psychometric instruments may be further evaluated with regard to well-documented and effective treatment programs for ADHD core symptoms.

    Keywords
    Adults, Attention Deficit Hyperactivity Disorder, Behavior, Hyperactivity, Objective measures, Psychometrics, Quantified Behavior Test Plus
    National Category
    Psychology
    Research subject
    Psychology
    Identifiers
    urn:nbn:se:oru:diva-39855 (URN)10.2174/1745017901208010134 (DOI)23166565 (PubMedID)2-s2.0-84878121484 (Scopus ID)
    Available from: 2014-12-17 Created: 2014-12-17 Last updated: 2017-12-05Bibliographically approved
    4. The Weighed Core Symptom Scale and Prediction of ADHD in Adults: Objective Measures of Remission and Response to Treatment with Methylphenidate
    Open this publication in new window or tab >>The Weighed Core Symptom Scale and Prediction of ADHD in Adults: Objective Measures of Remission and Response to Treatment with Methylphenidate
    2013 (English)In: Clinical Practice and Epidemiology in Mental Health, ISSN 1745-0179, E-ISSN 1745-0179, Vol. 9, p. 171-179Article in journal (Refereed) Published
    Abstract [en]

    Objective: Two measures of the response rate and the optimal treatment response for adult ADHD were evaluated using methylphenidate. The hypotheses were that Prediction of ADHD (PADHD) defines remission, the Weighed Core Symptom (WCS) scale registers direct effects of medication and that WCS may indicate the optimal dose level during titration.

    Design: PADHD and WCS were analyzed at baseline and after intake of low doses of either short-acting or modified-release formulations of methylphenidate, MPH (Study I), during titration with modified-release formulations of MPH (18/27, 36, 54, 72 mg) and at three months follow-up (Study II).

    Patients: Study I consisted of 63 participants (32 females) and Study II consisted of 10 participants (6 females) diagnosed with ADHD and who was to start with treatment.

    Outcome Measures: Prediction of ADHD (PADHD) indicates the occurrence of ADHD (No, Yes) and the Weighed Core Symptom scale (WCS) quantifies ADHD from 0 to 100 (max-min).

    Results: The number of clinical cases of ADHD decreased after methylphenidate treatment according to PADHD. WCS increased (p < 0.001) from 9.75 (SD = 12.27) to 47.50 (SD = 29.75) with about 10 mg of methylphenidate (N = 63). During titration, symptoms improved after 18/27 mg and 36 mg of methylphenidate and baseline-follow up comparisons showed WCS increments (p = 0.005) from 31.00 (N = 10, SD = 26.85) to 69.00 (N = 10, SD = 22.34).

    Conclusions: PADHD defined remission and WCS measured therapeutic effects of methylphenidate in adult ADHD.

    Place, publisher, year, edition, pages
    Bentham Open, 2013
    Keywords
    Objective measures, Weighed Core Symptom scale, Prediction of ADHD, remission, ADHD
    National Category
    Psychology
    Research subject
    Psychology
    Identifiers
    urn:nbn:se:oru:diva-39858 (URN)10.2174/1745017901309010171 (DOI)24265648 (PubMedID)2-s2.0-84890673264 (Scopus ID)
    Available from: 2014-12-17 Created: 2014-12-17 Last updated: 2018-05-22Bibliographically approved
  • 3.
    Edebol, Hanna
    et al.
    Karlstad University, Karlstad, Sweden.
    Helldin, Lars
    NU health care in Sweden, Trollhättan, Sweden.
    Holmberg, Ebba
    NU health care in Sweden, Trollhättan, Sweden.
    Gustafsson, Stig-Arne
    NU health care in Sweden, Trollhättan, Sweden.
    Norlander, Torsten
    Karlstad University, Karlstad, Sweden.
    In search for objective measures of hyperactivity, impulsivity and inattention in adult attention deficit hyperactivity disorder using the Quantified Behavior Test Plus2011In: Europe's Journal of Psychology, ISSN 1841-0413, E-ISSN 1841-0413, Vol. 7, no 3, p. 443-457Article in journal (Refereed)
    Abstract [en]

    Clinical assessment tools for adult attention deficit hyperactivity disorder (ADHD) such as rating scales, interviews and behavior observations are often based on subjective judgments which enhance the risk of overlooking or misinterpreting symptoms. In search for objective measures of adult ADHD, the present study investigated levels of sensitivity and specificity for the Quantified Behavior Test Plus, QbTest-Plus, in adult patients (N = 19) awaiting clinical assessment for ADHD. QbTest-Plus report objective measures of ADHD core symptoms using an infrared motion tracking system and a continuous performance test. The measures were collected and evaluated previous to clinical assessment and compared regarding the diagnosis of ADHD. Sensitivity for detecting ADHD with QbTest-Plus was 83 % and specificity was 57 %. The results, possibly affected by confounding factors, suggest further examination of calibrated and objective measure for the QbTest-Plus with regard to ADHD in adults.

  • 4.
    Edebol, Hanna
    et al.
    Department of Psychology, Karlstad University, Karlstad, Sweden.
    Helldin, Lars
    Department of Psychiatry, NU-Health Care, Trollhättan, Sweden.
    Norlander, Torsten
    Evidens Research and Development Center, Göteborg, Sweden; Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden.
    Measuring adult attention deficit hyperactivity disorder using the Quantified Behavior Test Plus2013In: PsyCh Journal, ISSN 2046-0252, E-ISSN 2046-0260, Vol. 2, no 1, p. 48-62Article in journal (Refereed)
    Abstract [en]

    Attention Deficit Hyperactivity Disorder (ADHD) occurs in approximately 5% of the adult population and includes cardinal symptoms of hyperactivity, inattention, and impulsivity that may be difficult to identify with clinical routine methods. Continuous performance tests are objective measures of inattention and impulsivity that, combined with objective measures of motor activity, facilitate identification of ADHD among adults. The aim of the present study was to examine the sensitivity, specificity, and a composite measure of ADHD using objective measures of the ADHD-cardinal symptoms in adult participants with ADHD and non-ADHD normative participants. Cardinal symptoms were measured in 55 participants having ADHD, 202 non-ADHD normative participants, as well as 84 ADHD normative participants using the Quantified Behavior Test Plus. This test measures inattention and impulsivity using a continuous performance test, and hyperactivity using a motion-tracking system. A predictive variable for the detection of ADHD called Prediction of ADHD yielded 86% sensitivity and 83% specificity. A composite measure of ADHD cardinal symptoms was developed using a Weighed Core Symptoms scale that indicated the total amount of ADHD symptoms on a numeric scale from 0 to 100. The total amount of ADHD symptoms was measured on a scale and predicted with the categorical variable in a majority of the cases in the present study. Further studies are needed in order to confirm the results with regard to additional clinical and normative samples. Careful consideration of potential sex and diagnostic subtype differences are noteworthy aspects for future examinations of the new instruments.

  • 5.
    Edebol, Hanna
    et al.
    Karlstad University, Karlstad, Sweden.
    Helldin, Lars
    NU health Care, Trollhättan, Sweden.
    Norlander, Torsten
    Evidens Research and Development Center, Göteborg, Sweden; Karolinska Institutet, Solna, Sweden .
    Objective measures of behavior manifestations in adult ADHD and differentiation from participants with Bipolar II disorder, Borderline personality disorder, participants with disconfirmed ADHD as well as Normative participants.2012In: Clinical Practice and Epidemiology in Mental Health, ISSN 1745-0179, E-ISSN 1745-0179, Vol. 8, p. 134-143Article in journal (Refereed)
    Abstract [en]

    Background:

    The present study evaluated two psychometric instruments derived from the objective measurement of adult ADHD using the Quantified Behavior Test Plus. The instruments were examined in ADHD versus a clinical group with overlapping symptoms including borderline personality disorder and bipolar II disorder, and another clinical group with participants assessed for but disconfirmed a diagnosis of ADHD as well as adult normative participants.

    Methods:

    The Quantified Behavior Test Plus includes Continuous Performance Testing and a Motion Tracking System with parameters related to attention and activity operationalized as the cardinal symptoms of ADHD and then summarized into a Weighed Core Symptoms scale with ten cut-points ranging from 0 to 100. A categorical predictor variable called Prediction of ADHD was used to examine the levels of sensitivity and specificity for the Quantified Behavior Test Plus with regard to ADHD.

    Results:

    The Weighed Core Symptoms scale separated ADHD and normative participants from each other as well as from the two clinical reference groups. The scale reported highest levels of core symptoms in the ADHD group and the lowest level of core symptoms in the normative group. Analyses with Prediction of ADHD yielded 85 % specificity for the normative group, 87 % sensitivity for the ADHD group, 36 % sensitivity for the bipolar II and borderline group and 41 % sensitivity for the group with a disconfirmed diagnosis of ADHD.

    Conclusions:

    The Weighed Core Symptoms scale facilitated objective assessment of adult ADHD insofar that the ADHD group presented more core symptoms than the other two clinical groups and the normative group. Sensitivity for the Quantified Behavior Test Plus was lower in complex clinical groups with Bipolar II disorder, Borderline disorder and in patients with a disconfirmed diagnosis of ADHD. The psychometric instruments may be further evaluated with regard to well-documented and effective treatment programs for ADHD core symptoms.

  • 6.
    Edebol, Hanna
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Nutrition Gut Brain Interactions Research Centre, Örebro University, Örebro, Sweden .
    Helldin, Lars
    Department of Psychiatry, NU-Health Care, Trollhättan, Sweden .
    Norlander, Torsten
    Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden; Evidens Research and Development Center, Göteborg, Sweden.
    The Weighed Core Symptom Scale and Prediction of ADHD in Adults: Objective Measures of Remission and Response to Treatment with Methylphenidate2013In: Clinical Practice and Epidemiology in Mental Health, ISSN 1745-0179, E-ISSN 1745-0179, Vol. 9, p. 171-179Article in journal (Refereed)
    Abstract [en]

    Objective: Two measures of the response rate and the optimal treatment response for adult ADHD were evaluated using methylphenidate. The hypotheses were that Prediction of ADHD (PADHD) defines remission, the Weighed Core Symptom (WCS) scale registers direct effects of medication and that WCS may indicate the optimal dose level during titration.

    Design: PADHD and WCS were analyzed at baseline and after intake of low doses of either short-acting or modified-release formulations of methylphenidate, MPH (Study I), during titration with modified-release formulations of MPH (18/27, 36, 54, 72 mg) and at three months follow-up (Study II).

    Patients: Study I consisted of 63 participants (32 females) and Study II consisted of 10 participants (6 females) diagnosed with ADHD and who was to start with treatment.

    Outcome Measures: Prediction of ADHD (PADHD) indicates the occurrence of ADHD (No, Yes) and the Weighed Core Symptom scale (WCS) quantifies ADHD from 0 to 100 (max-min).

    Results: The number of clinical cases of ADHD decreased after methylphenidate treatment according to PADHD. WCS increased (p < 0.001) from 9.75 (SD = 12.27) to 47.50 (SD = 29.75) with about 10 mg of methylphenidate (N = 63). During titration, symptoms improved after 18/27 mg and 36 mg of methylphenidate and baseline-follow up comparisons showed WCS increments (p = 0.005) from 31.00 (N = 10, SD = 26.85) to 69.00 (N = 10, SD = 22.34).

    Conclusions: PADHD defined remission and WCS measured therapeutic effects of methylphenidate in adult ADHD.

  • 7.
    Edebol-Carlman, Hanna
    et al.
    Karlstad University, Karlstad, Sweden.
    Bood, Sven-Åke
    Karlstad University, Karlstad, Sweden.
    Norlander, Torsten
    Karlstad University, Karlstad, Sweden.
    Chronic Whiplash-Associated Disorders and Their Treatment Using Flotation-REST (Restricted Environmental Stimulation Technique).2008In: Qualitative Health Research, ISSN 1049-7323, Vol. 18, no 4, p. 480-488Article in journal (Refereed)
    Abstract [en]

    In this study, we investigated for the first time whether flotation-REST might be used for treating chronic whiplash-associated disorders (WAD). Six women and one man, all diagnosed by licensed physicians as having chronic whiplash-associated disorder, participated. Two of the participants were beginners with regard to flotation-REST (2 or 3 treatments), and five of them had experienced between 7 and 15 treatments. The method for data collection was the semistructured qualitative interview. The empirical phenomenological psychological method devised by Karlsson was used for the analyses. Two qualitative models explaining the participants' experiences of flotation-REST emerged. The models describe the participants' experiences of flotation-REST, as well as the short-term effects of the treatment in terms of five phases: (a) intensification, (b) vitalization, (c) transcendation, (d) defocusation, and (e) reorientation. Results indicated that flotation-REST is a meaningful alternative for treating chronic whiplash-associated disorder.

  • 8.
    Edebol-Carlman, Hanna
    et al.
    Department of Psychology, Karlstad University, Karlstad, Sweden.
    Kjellgren, Anette
    Department of Psychology, Karlstad University, Karlstad, Sweden.
    Bood, Sven-Åke
    Department of Psychology, Karlstad University, Karlstad, Sweden.
    Norlander, Torsten
    Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden; Evidens Research and Development Center, Göteborg, Sweden.
    Enhanced independence and quality of life through treatment with Flotation-Restricted Environmental Stimulation Technique of a patient with both Attention Deficit Hyperactivity Disorder and Asperger’s Syndrome: A case report2009In: Cases Journal, Vol. 2, article id 6979Article in journal (Refereed)
    Abstract [en]

    Introduction

    The objective of this qualitative case report was to describe experiences of flotation-Restricted Environmental Stimulation Technique from the perspective of a woman with Attention Deficit Hyperactivity Disorder, Aspergers syndrome and experiences of depression and distress.

    Case presentation

    The respondent is a 36-year-old woman from Sweden, assessed and diagnosed by a neuropsychological multi-professional team in 2006. The 19-session flotation series prolonged during almost one year.

    Conclusion

    The positive development of arousal control, activity regulation, sensory integration and interpretation, cognitive functioning and emotional maturity created experiences of personal independence and quality of life. Flotation-restrictive environmental stimulation technique was experienced as a meaningful treatment. Additional studies of treatment for Attention Deficit Hyperactivity Disorder and comorbid disorders in adults using the flotation-restrictive environmental stimulation technique are strongly encouraged.

  • 9.
    Edebol-Carlman, Hanna
    et al.
    Örebro University, School of Medical Sciences. Nutrition-Gut-Brain Interactions Research Centre.
    Ljotsson, Brjann
    Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    Boersma, Katja
    Schrooten, Martien
    Örebro University, School of Law, Psychology and Social Work.
    Repsilber, Dirk
    Örebro University, School of Medical Sciences. Nutrition-Gut-Brain Interactions Research Centre.
    Brummer, Robert J.
    Örebro University Hospital. Örebro University, School of Medical Sciences. Nutrition-Gut-Brain Interactions Research Centre.
    Face-to-Face Cognitive-Behavioral Therapy for Irritable Bowel Syndrome: The Effects on Gastrointestinal and Psychiatric Symptoms2017In: Gastroenterology Research and Practice, ISSN 1687-6121, E-ISSN 1687-630X, article id 8915872Article in journal (Refereed)
    Abstract [en]

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

  • 10.
    Edebol-Carlman, Hanna
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Nordén, Tommy
    Evidens University College, Gothenburg, Sweden.
    Norlander, Torsten
    Evidens University College, Gothenburg, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden .
    Behavior change and pain relief in chronic whiplash associated disorder Grade IV using flotation restricted environmental stimulation technique: A case report2013In: Psychology and Behavioral Sciences, ISSN 2328-7837, E-ISSN 2328-7845, Vol. 2, p. 202-216Article in journal (Refereed)
    Abstract [en]

    Pain is a major public health problem and the needs for more differentiated and flexible treatment options are obvious. The purpose of the present study was to examine, for the first time, experiences from long-term flotation Restricted Environmental Stimulation Technique (REST) made by a patient with chronic Whiplash Associated Disorder (WAD), grade IV. The patient of the present study was a middle aged native-born Caucasian male from Sweden who had been diagnosed with chronic WAD IV by a licensed physician. The patient performed regular flotation during one and a half year and wrote about his experiences in a diary. A semi-structured interview was conducted at the end of therapy. Both the diary and the interviews were analyzed with help of the empirical phenomenological psychological method and results describe experiences of relaxation, pain relief, sleep and deep rest, mental coping, increased energy, wellbeing and behavioral changes as a result of flotation. A model describes the rehabilitative circuit of chronic whiplash during flotation and is in line with the potential role of a stress response system for development and management of chronic whiplash. The study provides qualitative insights into the experiences of flotation as a pain- and stress- management system for chronic whiplash. Results are encouraging for future research and even suggest that interested clinics may use flotation-REST in order to relieve chronic pain and enhance the quality of life for a more comprehensive group of patients with whiplash associated disorders.

  • 11.
    Edebol-Carlman, Hanna
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Norlander, Torsten
    Evidens FoU och Institutionen för klinisk neurovetenskap, Karolinska Institute, Solna, Sweden.
    Perspektiv på utredning och diagnos vid ADHD2013In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 90, no 3, p. 319-327Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Attention Deficit Hyperactivity Disorder, ADHD, är en erkänd och väl etablerad klinisk diagnos som används inom psykiatrin för att beteckna en samling beteenden som återfinns hos både barn och vuxna och som orsakar problem i vardagen. Diagnosen har hög klinisk validitet vilket innebär att ADHD hänger ihop rent statistiskt, uppvisas av barn och vuxna som har funktionsnedsättning och behöver hjälp, svarar på behandling samt korrelerar med andra meningsfulla markörer på grupp-nivå t ex olika biologiska och genetiska markörer samt via långtidsuppföljningar. I likhet med de flesta andra psykiatriska diagnoser (förutom vissa typer av mental retardation) har diagnosen inte uppnått etiologisk validitet eftersom vi då skulle behöva förklara orsakerna till ADHD i varje enskilt fall. Mycket forskning är idag inriktad på orsaksmekanismer inom ramen för multifaktoriella teorier.

    De sociala och medicinska konsekvenserna av ADHD är många och allvarliga och hänger samman med att ADHD hos de flesta, i synnerhet vuxna, idag är en odiagnostiserad funktionsnedsättning. Långsiktig behandling och positiva resultat är ofta avhängig kvaliteten på utredningarna, och här ser vi att vetenskapligt utprovade och tillförlitliga metoder är nödvändiga och utslagsgivande. Vi valde att med utgångspunkt från ett befintligt test (Quantified Behavior Test Plus) utveckla två mått som kan användas vid klinisk utredning av ADHD hos vuxna personer. PADHD är ett kategoriskt mått (ja/nej) som predicerar sannolikheten för ADHD med goda testresultat i avseende på sensitivitet och specificitet. WCS är ett mått på graden av ADHD från 0 till 100 som visat sig i stor utsträckning kunna skilja personer med ADHD från personer utan psykiatriska diagnoser samt skilja ADHD från andra liknande psykiatriska diagnoser. En studie antyder också att WCS kan indikera respons och remission vid behandling med centralstimulerande läkemedel.

    ADHD diagnosen innebär en rad metodologiska utmaningar samt medför särskilt i obehandlad form allvarliga socialmedicinska konsekvenser för individen och samhället. Diagnosens exakta utformning kommer sannolikt att förändras en del under den närmaste tiden vilket kan påverka utredningsarbetet. Målet är dock detsamma, att på ett systematiskt, empirinära och konstruktivt sätt undersöka, beskriva och göra allt som det enskilda fallet kräver för att uppnå och bibehålla remission samt förmedla att det finns god behandling och hopp att få.

  • 12.
    Edebol-Carlman, Hanna
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Norlander, Torsten
    Evidens FoU och Institutionen för klinisk neurovetenskap, Karolinska Institutet, Solna, Sweden.
    Robust mätmetod för ADHD hos vuxna.2013In: Best Practice, ISSN 1329-1874, Vol. 4, no 14, p. 18-21Article in journal (Other (popular science, discussion, etc.))
  • 13.
    Edebol-Carlman, Hanna
    et al.
    Örebro University, School of Medical Sciences.
    Rode, Julia
    Örebro University, School of Medical Sciences.
    König, Julia
    Örebro University, School of Medical Sciences.
    Hutchinson, Ashley
    Örebro University, School of Medical Sciences.
    Repsilber, Dirk
    Örebro University, School of Medical Sciences.
    Kiselev, Andrey
    Örebro University, School of Science and Technology.
    Thunberg, Per
    Örebro University, School of Medical Sciences.
    Lathrop Stern, Lori
    Labus, Jennifer
    Brummer, Robert Jan
    Örebro University, School of Medical Sciences.
    Evaluating the effects of probiotic intake on brain activity during an emotional attention task and blood markers related to stress in healthy subjects2019Conference paper (Refereed)
  • 14.
    Edebol-Carlman, Hanna
    et al.
    Örebro University, School of Medical Sciences. Nutrition-Gut-Brain Interactions Research Centre.
    Schrooten, Martien G. S.
    Örebro University, School of Law, Psychology and Social Work.
    Ljóttson, Brjánn
    Department of Clinical Neuroscience, Division of Psychology and Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    Brummer, Robert Jan
    Örebro University, School of Medical Sciences. Nutrition-Gut-Brain Interactions Research Centre.
    Cognitive behavioral therapy for irritable bowel syndrome: the effects on state and trait anxiety and the autonomic nervous system during induced rectal distensions - An uncontrolled trial2018In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 18, p. 81-91Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 15.
    Kjellgren, Anette
    et al.
    Department of Psychology, Karlstad University, Karlstad, Sweden.
    Edebol-Carlman, Hanna
    Nutrition Gut Brain Interactions Research Centre, Örebro University, Örebro, Sweden.
    Nordén, Tommy
    Evidens Research and Development Center, Göteborg, Sweden.
    Norlander, Torsten
    Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden; Evidens Research and Development Center, Göteborg, Sweden.
    Quality of Life with Flotation Therapy for a Person diagnosed with Attention Deficit Disorder, Atypical autism, PTSD, Anxiety and Depression2013In: Open Journal of Medical Psychology, ISSN 2165-9370, Vol. 2, p. 134-138Article in journal (Refereed)
    Abstract [en]

    The aim of this single-subject study was to report experiences from one and a half years of regular floating as described by a person with neuropsychiatric and mental health disorders. Floating, or Flotation Restricted Environmental Stimulation Technique, involves relaxation and sensory deprivation by means of resting in a tank with highly salted and body-tempered water. The subject, a 24-year-old woman diagnosed with attention deficit hyperactivity disorder, atypical autism, posttraumatic stress disorder, anxiety and depression floated regularly for one and a half years. Interviews regarding her experiences were analyzed and the main findings involved a subjective sense of improved quality of life, wellbeing and healthy behavior. There were no negative effects from treatment. Results suggest that floating may have beneficial therapeutic effects on mental health. Further studies that evaluate the efficacy and possible effects of floating with regard to mental health are needed.

  • 16.
    König, Julia
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Ganda-Mall, John-Peter
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Rangel, Ignacio
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Edebol-Carlman, Hanna
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Brummer, Robert Jan
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    The Role of the Gut Microbiota in Brain Function2015In: Probiotics and Prebiotics: Current Research and Future Trends / [ed] Koen Venema & Ana Paula do Carmo, Poole, UK: Caister Academic Press, 2015Chapter in book (Refereed)
  • 17.
    Wall, Rebecca
    et al.
    Örebro University, School of Medical Sciences.
    Marques, Tatiana
    Örebro University, School of Medical Sciences.
    Edebol-Carlman, Hanna
    Örebro University, School of Medical Sciences.
    Sundin, J.
    University of Gothenburg, Gothenburg, Sweden.
    Vumma, R.
    Linnaeus University, Kalmar, Sweden.
    Rangel, Ignacio
    Örebro University, School of Medical Sciences.
    Brummer, Robert Jan
    Örebro University, School of Medical Sciences.
    Altered expression of membrane transporters in colonic mucosa of patients with Irritable Bowel Syndrome (IBS) and Post-infectious (PI)-IBS compared to healthy subjects2017In: Neurogastroenterology and Motility, ISSN 1350-1925, E-ISSN 1365-2982, Vol. 29, no Suppl. 2, p. 107-108Article in journal (Other academic)
    Abstract [en]

    Background: Irritable bowel syndrome (IBS) affects 5%- 15% of adults in the general population, and is characterized by chronic recurrent abdominal pain and discomfort and associated with altered bowel habits. The pathophysiology of IBS is complex and not fully under-stood. Hence, treatment is often based on symptomatology rather than underlying physiological aberrancies.

    Objective: To compare the expression of membrane transporters in mucosal biopsies of healthy subjects, IBS patients and post- infectious (PI)- IBS patients.

    Methods: Mucosal biopsies were obtained from the unprepared sigmoid colon in 18 IBS patients, 9 PI- IBS patients and 10 healthy subjects. Total RNA was isolated and prepared for gene expression analyses using quantitative reverse- transcription polymerase chain reaction (qRT- PCR). We compared the expression of genes encoding membrane- spanning transporters, using GAPDH as a reference gene, and by using the comparative 2- ΔΔCt method.

    Results: Colonic expression of SCL7A5 and SLC3A2 (together com-prising the amino acid transporter LAT1+4F2hc) was significantly lower in IBS patients, but not in PI- IBS patients, compared to healthy controls (P<.001). The expression of SLC7A8 (LAT2) tended to be lower in IBS patients compared to controls (P=.06). Mucosal gene ex-pression of the short chain fatty acid transporter SMCT1 (SLC5A8) was lower in both IBS- patients and PI- IBS patients compared to healthy subjects (P<.01).

    Conclusions: The amino acid transporters LAT1 and LAT2 appeared to be affected in IBS patients, but not in PI- IBS patients, compared to healthy subjects, suggesting a possible alteration in amino acids transport in this patient group. Furthermore, our results suggest a lower uptake of short chain fatty acids in both IBS- and PI- IBS pa-tients. Altered expression of these transporters may be involved in the pathophysiology of IBS as well as being a potential biomarker of this aberration, and therefore deserves further study in IBS.

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