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  • 51.
    Holländare, Fredrik
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Eriksson, Annsofi
    Örebro University, Örebro, Sweden.
    Lövgren, Lisa
    Örebro University, Örebro, Sweden.
    Humble, Mats B.
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Boersma, Katja
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Internet-Based Cognitive Behavioral Therapy for Residual Symptoms in Bipolar Disorder Type II: A Single-Subject Design Pilot Study2015Ingår i: JMIR Research Protocols, ISSN 1929-0748, E-ISSN 1929-0748, Vol. 4, nr 2, artikel-id e44Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

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

  • 52.
    Håkansson, Alexander
    et al.
    Cureum AB, Örebro, Sweden.
    Friberg, Manuela
    Örebro University, Örebro, Sweden.
    Lidén, Annika
    Örebro University, Örebro, Sweden.
    Svanberg, Mikael
    Unit for Psychosomatic Medicine, Västerås, Sweden.
    Rothman, Mats
    Unit for Psychosomatic Medicine, Västerås, Sweden.
    Boersma, Katja
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Compassion focused therapy: a transdiagnostic approach to counteract shame and self-criticism in the treatment of individuals with chronic pain and comorbid emotional problems2015Konferensbidrag (Refereegranskat)
    Abstract [en]

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

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

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

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

  • 53.
    Jansson-Fröjmark, Markus
    et al.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Boersma, Katja
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Bidirectionality between pain and insomnia symptoms: a prospective study2012Ingår i: British Journal of Health Psychology, ISSN 1359-107X, E-ISSN 2044-8287, Vol. 17, nr 2, s. 420-431Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

  • 54. Leeuw, Maaike
    et al.
    Goossens, Marielle E. J. B.
    van Breukelen, Gerard J. P.
    Boersma, Katja
    Örebro universitet, Institutionen för beteende-, social- och rättsvetenskap.
    Vlaeyen, Johan W. S.
    Measuring perceived harmfulness of physical activities in patients with chronic low back pain: The photograph series of daily activities-short electronic version2007Ingår i: Journal of Pain, ISSN 1526-5900, E-ISSN 1528-8447, Vol. 8, nr 11, s. 840-849Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

  • 55.
    Linton, Steven J.
    et al.
    Örebro universitet, Akademin för juridik, psykologi och socialt arbete.
    Boersma, Katja
    Örebro universitet, Akademin för juridik, psykologi och socialt arbete.
    Flink, Ida K.
    Örebro universitet, Akademin för juridik, psykologi och socialt arbete.
    Kognitiv beteendeterapi2010Ingår i: Smärta och smärtbehandling / [ed] Mads Werner, Ido Leden, Stockholm: Liber , 2010, 2, s. 482-487Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 56.
    Linton, Steven J.
    et al.
    Örebro universitet, Institutionen för beteende-, social- och rättsvetenskap.
    Boersma, Katja
    Örebro universitet, Institutionen för beteende-, social- och rättsvetenskap.
    Jansson, Markus
    Overmeer, Thomas
    Lindblom, Karin
    Vlaeyen, Johan W. S.
    A randomized controlled trial of exposure in vivo for patients with spinal pain reporting fear of work-related activities2008Ingår i: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 12, nr 6, s. 722-730Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

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

  • 57.
    Linton, Steven J
    et al.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Boersma, Katja
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Traczyk, Michal
    Department of Law, Psychology, and Social Work, Center for Health and Medical Psychology, Örebro University, Örebro, Sweden; Landstingshälsan, Occupational Health Services, Örebro, Sweden.
    Shaw, William
    Center for Disability Research, Liberty Mutual Research Institute for Safety, Boston MA, USA.
    Nicholas, Michael
    Pain Management Research Institute, Royal North Shore Hospital, University of Sydney, Sydney, Australia.
    Early Workplace Communication and Problem Solving to Prevent Back Disability: Results of a Randomized Controlled Trial Among High-Risk Workers and Their Supervisors2016Ingår i: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 26, nr 2, s. 150-159Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

  • 58.
    Linton, Steven J.
    et al.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Boersma, Katja
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Vangronsveld, K.
    Department of Experimental-Clinical and Health Psychology, Gent University, Gent, Belgium.
    Fruzzetti, A.
    Department of Psychology, University of Nevada, Reno NV, USA.
    Painfully reassuring?: The effects of validation on emotions and adherence in a pain test2012Ingår i: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 16, nr 4, s. 592-599Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

  • 59.
    Linton, Steven J.
    et al.
    Örebro universitet, Akademin för juridik, psykologi och socialt arbete.
    Flink, Ida K.
    Bergbom, Sofia
    Boersma, Katja
    Örebro universitet, Akademin för juridik, psykologi och socialt arbete.
    Manual för målbaserad aktivitetesträning vid långvarig muskuloskeletal smärta2010Övrigt (Övrigt vetenskapligt)
  • 60.
    Linton, Steven J.
    et al.
    Örebro universitet, Akademin för juridik, psykologi och socialt arbete.
    Nicholas, Michael K.
    MacDonald, Shane
    Örebro universitet, Akademin för juridik, psykologi och socialt arbete.
    Boersma, Katja
    Örebro universitet, Akademin för juridik, psykologi och socialt arbete.
    Bergbom, Sofia
    Örebro universitet, Akademin för juridik, psykologi och socialt arbete.
    Maher, Chris
    Refshauge, Kathy
    The role of depression and catastrophizing in musculoskeletal pain2011Ingår i: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 15, nr 4, s. 416-422Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Many patients with musculoskeletal pain also suffer from a depressed mood. Catastrophizing is one process that may link depression and pain since it is a key concept in models of both problems. Earlier research has suggested that catastrophizing measures something above and beyond depression. This study tests the idea that if depressed mood and catastrophizing are separate entities then when one is absent the other should still contribute to poor outcome, and, when both are present there should be an additional adverse effect. To this end, a prospective design, with a built-in replication from two clinical samples of patients with sub-acute pain (one from Sweden, N=373; one from Australasia, N=259), was employed. Participants were classified as to having high/low scores on measures of depression and catastrophizing. Subsequently, these classifications were studied in relation to outcome variables cross-sectionally and at follow-up. Results showed a small to moderate correlation between catastrophizing and depression and that there are individuals with one, but not the other problem. Further, having one or the other of the entities was associated with current pain problems and outcome, while having both increased the associations substantially. The replication showed very similar results Our data demonstrate that pain catastrophizing and heightened depressed mood have an additive and adverse effect on the impact of pain, relative to either alone. It suggests that each should be assessed in the clinic and that future research should focus on treatments specifically designed to tackle both depressed mood and catastrophizing.

  • 61.
    Mazzer, Kelly
    et al.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Bauducco, Serena
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Linton, Steven J.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Boersma, Katja
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Longitudinal associations between time spent using technology and sleep duration among adolescents2018Ingår i: Journal of Adolescence, ISSN 0140-1971, E-ISSN 1095-9254, Vol. 66, s. 112-119Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Technology use has been the focus of much concern for adolescents' sleep health. However, few studies have investigated the bidirectional association between sleep duration and time spent using technology. The aim of this study was to test whether time spent using technology predicted shorter sleep duration, and/or vice versa using cross-lagged analyses over one year. Participants were 1620 high school students in the 8th and 9th grade at baseline from 17 public schools in three middle Sweden communities. Students completed questionnaires at school during the spring of 2015 and 2016. Time spent using technology was self-reported and sleep duration was calculated from reported bed-times, wake-times and sleep onset latency. Time spent using technology significantly predicted shorter subsequent sleep duration and vice versa. Public health advocates educating others about the negative impacts of technology on sleep must also be mindful of the opposite, that many young people may turn to technological devices when experiencing difficulty sleeping.

  • 62.
    Mazzer, Kelly
    et al.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete. Centre for Health and Medical Psychology.
    Boersma, Katja
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete. Centre for Health and Medical Psychology.
    Linton, Steven J.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete. Centre for Health and Medical Psychology.
    A longitudinal view of rumination, poor sleep and psychological distress in adolescents2019Ingår i: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 245, s. 686-696Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Given the high prevalence and negative impact of psychological problems during adolescence, examining transdiagnostic factors that may have scope to positively influence a variety of psychological problems is imperative. The main purpose of this study was to investigate the longitudinal relationship between rumination and psychological distress and whether sleep mediated this relationship over a 2 year period.

    Methods: Participants were 1620 high school students in the 7th and 8th grade at baseline from 17 public schools in three middle Sweden communities. Students completed questionnaires at school during the spring of 2014, 2015 and 2016. Rumination and psychological distress were self-reported, and sleep duration was calculated from reported bed-times, wake-times and sleep onset latencies.

    Results: Sleep duration declined with age, whereas rumination and psychological distress increased. Rumination was predictive of future psychological distress and distress at a given time was predictive of concurrent rumination. Sleep duration did not consistently mediate the reciprocal relationships between rumination and psychological distress over time.

    Limitations: Stronger longitudinal associations may have been obtained by using smaller measurement intervals or further delineation of outcome constructs.

    Conclusions: Reducing rumination, rather than targeting sleep patterns, may work towards preventing the development of a number of psychological problems and is a strategy anticipated to function across disorders to improve young people's mental wellbeing.

  • 63.
    Olofsson, Malin Elisabeth
    et al.
    Modum Bad, Vikersund, Norway.
    Boersma, Katja
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Engh, Johannes
    School of Law, Psychology and Social Work, Örebro University, Sweden.
    Wurm, Matilda
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    A psychometric evaluation of the Swedish version of the Responses to Positive Affect questionnaire2014Ingår i: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 68, nr 8, s. 588-593Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Previous research mainly focused on responses to negative affect in relation to depression, and less on responses to positive affect. Cognitive responses to positive affect are interesting in the context of emotion regulation and emotion disorders: positive rumination is associated to hypomania risk and bipolar disorder. There is to date no questionnaire in Swedish that captures the phenomena of cognitive response styles.

    Aims: The aim of this study was to investigate the replicability of the Responses to Positive Affect questionnaire (RPA) in a newly translated Swedish versionand to test its psychometric properties.

    Methods: Swedish undergraduates (n 111) completed a set of self-report questionnaires in a fixed order.

    Results: The hypothesized three-factor model was largely replicated in the subscales Self-focused positive rumination, Emotion-focused positive rumination and Dampening. The two positive rumination subscales were strongly associated with each other and current positive affect. The subscales showed acceptable convergent and incremental validity with concurrent measures of depression, hypomania, anxiety, repetitive negative thinking, and positive and negative affect. The model explained 25% of the variance in hypomania, but fell short in the explanation of depression.

    Conclusions: The Swedish version of the RPA shows satisfactory reliability and initial fi ndings from a student sample indicate that it is a valid measure comparable with the original RPA questionnaire. Results give emphasis to the importance of further exploration of cognitive response styles in relation to psychopathology.

  • 64.
    Olofsson, Malin Elisabeth
    et al.
    Department of Psychology, Oslo University, Oslo, Norway; Modum Bad Psychiatric Center, Vikersund, Norway.
    Wurm, Matilda
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Boersma, Katja
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Do responses to positive affect influence mood reactivity?: exploring cognitive response styles through a mood induction procedure2016Ingår i: Nordic Psychology, ISSN 1901-2276, E-ISSN 1904-0016, Vol. 68, nr 4, s. 220-232Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Cognitive responses to positive affect (PA) are interesting in the context of emotion dysregulation and emotion disorders. Previous research mainly focused on ruminative responses to negative affect in relation to psychopathology. The aim of this study was to explore the interaction between cognitive response styles as measured with the Responses to Positive Affect questionnaire (RPA) and changes in emotional state during an experimental manipulation in a non-clinical sample. Using a pre-test post-test design, Swedish undergraduate students (n = 60) were randomized into either a mood induction procedure designed to evoke positive mood or a control condition. Results revealed that the two positive rumination subscales of the RPA were associated with each other and with PA. However, none of the RPA subscales interacted with participants’ mood reactivity, thus meaning that cognitive response styles did not predict changes in mood as the participants were exposed to a mood induction procedure. The results postulate new questions on the conceptualization and functioning of cognitive response styles, as their role concerning reactivity to elevated mood states remain unclear.

  • 65.
    Overmeer, Thomas
    et al.
    Physiotherapy Department, School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden; Center for Health and Medical Psychology, Örebro University, Örebro, Sweden.
    Boersma, Katja
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete. Center for Health and Medical Psychology, Örebro University, Örebro, Sweden.
    What messages do patients remember?: The relationship between patient perception of physical therapist’s messages, patient characteristics, satisfaction and outcome2016Ingår i: Physical Therapy, ISSN 0031-9023, E-ISSN 1538-6724, Vol. 96, nr 3, s. 275-283Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Based on a behavioral medicine perspective, modern recommendations for physical therapists treating patients with spinal pain include performing a trustworthy physical examination, conveying the message that back pain is benign, and stressing that activity is a key to recovery. However, little evidence is available on how patients perceive these biopsychosocial messages and how patients' perceptions of these messages relate to their recovery.

    Objectives: The aim of this study was to explore the relationships between perceptions of treatment delivery that are related to an evidence-based approach and psychological factors, treatment outcome, and treatment satisfaction.

    Design: A cohort study with 3 measurement points was conducted.

    Methods: Data on 281 participants were collected.

    Results: High catastrophizing and lower mood in the participants were correlated to "not perceiving the biopsychosocial message" measured at 6 weeks after treatment start. Participants who did not perceive the biopsychosocial message were at higher risk for disability and had lower treatment satisfaction 6 months after treatment start even when controlling for pretreatment pain intensity. "Not perceiving the biopsychosocial message" was not a mediator for treatment outcome and treatment satisfaction. Physical therapists' treatment orientations or attitudes were not related to the perception of the message by the patients.

    Limitations: There was no measure of actual practice behavior.

    Conclusions: Maladaptive cognitions and negative emotions appear to affect the way information provided during treatment is perceived by patients. The way information is perceived by patients influences treatment outcome and treatment satisfaction. Physical therapists are advised to check that patients with higher levels of catastrophizing and lower mood are correctly perceiving and interpreting a biopsychosocial message.

  • 66.
    Overmeer, Thomas
    et al.
    Örebro universitet, Hälsoakademin.
    Boersma, Katja
    Örebro universitet, Akademin för juridik, psykologi och socialt arbete.
    Denison, Eva
    Linton, Steven J.
    Örebro universitet, Akademin för juridik, psykologi och socialt arbete.
    Does teaching physical therapists to deliver a biopsychosocial treatment program result in better patient outcomes?: A randomized controlled trial2011Ingår i: Physical Therapy, ISSN 0031-9023, E-ISSN 1538-6724, Vol. 91, nr 5, s. 804-819Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Psychosocial risk factors are important in the development of chronic pain but treatment providers often lack knowledge and skills to assess and address these risk factors.

    Objectives: We examined the effects of a course on psychosocial factors for physical therapists on patient outcome in terms of pain and disability.

    Design: A randomised controlled trail.

    Participants: Forty-two primary care physical therapists attended an eight-day university course over eight weeks aimed at identifying and addressing psychosocial risk factors.

    Methods: They were randomised to either the course or a waiting list. The physical therapists collected consecutive acute and sub-acute patients with musculoskeletal pain both before and after the course.

    Results: There were no significant differences in outcome for pain or disability for all

    patients of physical therapists who had participated in the course or for risk patients with higher levels of catastrophizing or depression compared to patients of physical therapists who had not participated in the course. Outcome for low risk patients on pain and disability and for high risk patients on pain was not dependent on if their physical therapists changed their attitudes and beliefs during the course. Yet, outcome on disability for high risk patients may have been influenced if their physical therapists change their attitudes and beliefs.

    Limitations: no measure of actual practice behaviour.

    Conclusions: An eight-day university course for physiotherapists did not improve outcome for the group of patients as a whole or patients at risk of developing long term disability. Yet, risk patients with higher levels of catastrophizing or depression may have had a greater improvement in disability if their physical therapist changed attitudes and beliefs during the course.

  • 67.
    Overmeer, Thomas
    et al.
    Örebro universitet, Hälsoakademin.
    Boersma, Katja
    Örebro universitet, Akademin för juridik, psykologi och socialt arbete.
    Main, Chris J.
    Linton, Steven J.
    Örebro universitet, Akademin för juridik, psykologi och socialt arbete.
    Do physical therapists change their beliefs, attitudes,knowledge, skills and behaviour after a biopsychosocially orientated university course?2009Ingår i: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 15, nr 4, s. 724-732Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim The aim of this study is to examine the effects of an 8-day university-based training course, aimed at identifying and addressing psychosocial prognostic factors during physiotherapy treatment, in shifting therapists towards a more biopsychosocial orientation as measured by changes in beliefs/attitudes, knowledge, skills and behaviour.MethodWe combined a randomized controlled trail with a pre-post design. Forty-two physiotherapists applied for a university-accredited training course designed to enhance knowledge and management of psychosocial factors in their practice with patients suffering from musculoskeletal pain. The course participants were randomized either to receiving the course or to a waiting list for training. Attitudes and beliefs towards, and knowledge of psychosocial factors, patient vignettes and a video of an imaginary patient were tested before and after training. The patients of the course participants were asked to fill out a questionnaire with background questions at treatment start. The patients also received a questionnaire about the physical therapists' behaviour and patient satisfaction 6 weeks after treatment start.ResultsThe results show that physical therapists' attitudes and believes became more biopsychosocially and less biomedically orientated, they were less convinced that pain justifies disability and limitation of activities, and their knowledge and skills on psychosocial risk factors increased after a university-accredited training course. Yet despite these changes their patients perceived their practice behaviour before and after the course as similar and were equally satisfied with their treatment and treatment result.ConclusionA course, which enhanced biopsychosocial attitudes and beliefs, as well as increased such knowledge and skills did not change the way patients perceived their physical therapists. A future question is whether it improves patient outcome.

  • 68.
    Peters, Madelon L.
    et al.
    Dept Clin Psychol Sci, Maastricht Univ, Maastricht, Netherlands.
    Flink, Ida K.
    Örebro universitet, Akademin för juridik, psykologi och socialt arbete.
    Boersma, Katja
    Örebro universitet, Akademin för juridik, psykologi och socialt arbete.
    Linton, Steven J.
    Örebro universitet, Akademin för juridik, psykologi och socialt arbete.
    Manipulating optimism: Can imagining a best possible self be used to increase positive future expectancies?2010Ingår i: Journal of Positive Psychology, ISSN 1743-9760, E-ISSN 1743-9779, Vol. 5, nr 3, s. 204-211Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This study tested whether a brief manipulation consisting of positive future thinking can temporarily increase optimism. Participants in the positive future thinking condition (n = 44) wrote about their best possible self (BPS) for 15 min, followed by 5 min of mental imagery. Participants in the control condition (n = 38) wrote about and imagined a typical day in their life. Positive and negative future expectancies and positive and negative affect were measured before and after each manipulation. Compared to the control manipulation, the positive future thinking manipulation led to significantly larger increase in positive affect and positive future expectancies. The increase in positive expectancies was not dependent on the mood effect. The results indicate that imagining a positive future can indeed increase expectancies for a positive future.

  • 69.
    Quinn, Patrick D.
    et al.
    Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN, United States.
    Rickert, Martin E.
    Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, United States.
    Franck, Johan
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Sariaslan, Amir
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Boersma, Katja
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Lichtenstein, Paul
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Larsson, Henrik
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    DʼOnofrio, Brian M.
    Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, United States; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Associations of mental health and family background with opioid analgesic therapy: a nationwide Swedish register-based study2019Ingår i: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 160, nr 11, s. 2464-2472Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    There is evidence of greater opioid prescription to individuals in the United States with mental health conditions. Whether these associations generalize beyond the US prescription environment and to familial mental health and socioeconomic status (SES) has not been examined comprehensively. This study estimated associations of diverse preexisting mental health diagnoses, parental mental health history, and SES in childhood with opioid analgesic prescription patterns nationwide in Sweden. Using register-based data, we identified 5,071,193 (48.4% female) adolescents and adults who were naive to prescription opioid analgesics and followed them from 2007 to 2014. The cumulative incidence of any dispensed opioid analgesic within 3 years was 11.4% (95% CI, 11.3%-11.4%). Individuals with preexisting self-injurious behavior, as well as opioid and other substance use, attention-deficit/hyperactivity, depressive, anxiety, and bipolar disorders had greater opioid therapy initiation rates than did individuals without the respective conditions (hazard ratios from 1.24 [1.20-1.27] for bipolar disorder to 2.12 [2.04-2.21] for opioid use disorder). Among 1,298,083 opioid recipients, the cumulative incidence of long-term opioid therapy (LTOT) was 7.6% (7.6%-7.7%) within 3 years of initiation. All mental health conditions were associated with greater LTOT rates (hazard ratios from 1.66 [1.56-1.77] for bipolar disorder to 3.82 [3.51-4.15] for opioid use disorder) and were similarly associated with concurrent benzodiazepine-opioid therapy. Among 1,482,462 adolescents and young adults, initiation and LTOT rates were greater for those with parental mental health history or lower childhood SES. Efforts to understand and ameliorate potential adverse effects of opioid analgesics must account for these patterns.

  • 70.
    Quinn, Patrick
    et al.
    Indiana University, Bloomington IN, USA.
    Rickert, Martin
    Indiana University, Bloomington IN, USA.
    Boersma, Katja
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Lichtenstein, Paul
    Karolinska Institutet, Stockholm, Sweden.
    Larsson, Henrik
    Örebro universitet, Institutionen för medicinska vetenskaper.
    D'Onofrio, Brian
    Indiana University, Bloomington IN, USA.
    Prescription opioid analgesic receipt among adolescents and young adults and subsequent substance abuse2019Ingår i: Behavior Genetics, ISSN 0001-8244, E-ISSN 1573-3297, Vol. 49, nr 6, s. 538-538Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Increases in opioid overdoses and related public health harms, particularly in North America, have led to great concerns about opioid pharmacotherapies for pain. However, the extent of the contribution of prescribed opioid analgesic use, as opposed to illicit opioid use or medication diversion, to the etiology of substance abuse among young people remains uncertain. This study used a co-twin-control design in data from a linkage of nationwide Swedish registers to examine risk of substance abuse. We identified a birth cohort of Swedish adolescents and young adults who were naïve to prescription opioid analgesics (aged 13–29 years; N = 1,541,862). Between 2007 and 2013, approximately 13% of these individuals initiated prescription opioid analgesic receipt (n = 193,922). Relative to non-recipients matched 1:1 on demographics, prescription opioid analgesic recipients had greater rates of subsequent substance abuse, as indexed by registered diagnoses, medication treatments, causes of death, and convictions for drug-or-alcohol-related crimes (HR, 2.29; 95% CI 2.21–2.36). This association was somewhat attenuated but persisted in comparisons of co-twins and other multiple births (HR, 1.47, 95% CI 1.15–1.87). That is, a family-based comparison could not rule out at least some causal role for prescription opioid analgesic receipt in risk of substance abuse among young people. Further research is needed to determine the extent to which within-family confounding explains the remaining association.

  • 71. Roelofs, J.
    et al.
    Sluiter, J. K.
    Frings-Dresen, M. H. W.
    Goossens, M.
    Thibault, P.
    Boersma, Katja
    Örebro universitet, Institutionen för beteende-, social- och rättsvetenskap.
    Vlaeyen, J. W. S.
    Fear of movement and (re)injury in chronic musculoskeletal pain: evidence for an invariant two-factor model of the Tampa Scale for Kinesiophobia across pain diagnoses and Dutch, Swedish, and Canadian samples2007Ingår i: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 131, nr 1-2, s. 181-190Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aims of the current study were twofold. First, the factor structure, reliability (i.e., internal consistency), and validity (i.e., concurrent criterion validity) of the Tampa Scale for Kinesiophobia (TSK), a measure of fear of movement and (re)injury, were investigated in a Dutch sample of patients with work-related upper extremity disorders (study 1). More specifically, examination of the factor structure involved a test of three competitive models: the one-factor model of all 17 TSK items, a one-factor model of the TSK (Woby SR, Roach NK, Urmston M, Watson P. Psychometric properties of the TSK-11: a shortened version of the Tampa Scale for Kinesiophobia. Pain 2005;117:137-44.), and a two-factor model of the TSK-11. Second, invariance of the aforementioned TSK models was examined in patients with chronic musculoskeletal pain conditions (i.e., work-related upper extremity disorders, chronic low back pain, fibromyalgia, osteoarthritis) from The Netherlands, Sweden, and Canada was assessed (study 2). Results from study 1 showed that the two-factor model of the TSK-11 consisting of 'somatic focus' (TSK-SF) and 'activity avoidance' (TSK-AA) had the best fit. The TSK factors showed reasonable internal consistency, and were modestly but significantly related to disability, supporting the concurrent criterion validity of the TSK scales. Results from study 2 showed that the two-factor model of the TSK-11 was invariant across pain diagnoses and Dutch, Swedish, and Canadian samples. Altogether, we consider the TSK-11 and its two subscales a psychometrically sound instrument of fear of movement and (re)injury and recommend to use this measure in future research as well as in clinical settings. © 2007 International Association for the Study of Pain.

  • 72. Roelofs, Jeffrey
    et al.
    van Breukelen, Gerard
    Sluiter, Judith
    Frings-Dresen, Monique H. W.
    Goossens, Marielle
    Thibault, Pascal
    Boersma, Katja
    Örebro universitet, Akademin för juridik, psykologi och socialt arbete.
    Vlaeyen, Johan W. S.
    Norming of the Tampa Scale for Kinesiophobia across pain diagnoses and various countries2011Ingår i: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 152, nr 5, s. 1090-1095Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The present study aimed to develop norms for the Tampa Scale for Kinesiophobia (TSK), a frequently used measure of fear of movement/(re) injury. Norms were assessed for the TSK total score as well as for scores on the previously proposed TSK activity avoidance and TSK somatic focus scales. Data from Dutch, Canadian, and Swedish pain samples were used (N = 3082). Norms were established using multiple regression to obtain more valid and reliable norms than can be obtained by subgroup analyses based on age or gender. In the Dutch samples (N = 2236), pain diagnosis was predictive of all TSK scales. More specifically, chronic low back pain displayed the highest scores on the TSK scores followed by upper extremity disorder, fibromyalgia, and osteoarthritis. Gender was predictive of TSK somatic focus scores and age of TSK activity avoidance scores, with male patients having somewhat higher scores than female patients and older patients having higher scores compared with younger patients. In the Canadian (N = 510) and Swedish (N = 336) samples, gender was predictive of all TSK scales, with male patients having somewhat higher scores than female patients. These norm data may assist the clinician and researcher in the process of decision making and treatment evaluation.

  • 73.
    Rusu, Adina C.
    et al.
    Department of Medical Psychology and Medical Sociology, Faculty of Medicine, Ruhr-University, Bochum, Germany; Department of Psychology, Royal Holloway University, London, UK.
    Boersma, Katja
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Turk, Dennis C.
    Department of Anesthesiology, University of Washington, Seattle WA, USA.
    Reviewing the concept of subgroups in subacute and chronic pain and the potential of customizing treatments2012Ingår i: From acute to chronic back pain: risk factors, mechanisms, and clinical implications / [ed] Monika I. Hasenbring, Adina C. Rusu, Dennis C. Turk, Oxford: Oxford University Press, 2012, 1, s. 485-512Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 74.
    Svanberg, Mikael
    et al.
    Pychosomatic Medicine Clinic, Region of Västmanland, Västerås, Sweden.
    Johansson, Ann-Christin
    School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.
    Boersma, Katja
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Does validation and alliance during the multimodal investigation affect patients' acceptance of chronic pain?: An experimental single case study2019Ingår i: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 19, nr 1, s. 73-82Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background and aims: Among chronic pain patients who are referred to participation in a multimodal rehabilitation program (MMRP), pain catastrophizing and dysfunctional pain coping is common. In many cases it may have driven the patient to a range of unsuccessful searches for biomedical explanations and pain relief. Often these efforts have left patients feeling disappointed, hopeless and misunderstood. The MMRP process can be preceded by a multimodal investigation (MMI) where an important effort is to validate the patient to create a good alliance and begin a process of change towards acceptance of the pain. However, whether the MMI has such therapeutic effect is unclear. Using a repeated single case experimental design, the purpose of this study was to investigate the therapeutic effect of MMI by studying changes in patients' experience of validation, alliance, acceptance of pain, coping, catastrophizing, and depression before and during the MMI process.

    Methods: Participants were six chronic pain patients with high levels of pain catastrophizing (>25 on the Pain Catastrophizing Scale) and risk for long term disability (>105 on the Örebro Musculoskeletal Pain Screening Questionnaire) who were subjected to MMI before planned MMRP. For each patient, weekly self-report measures of validation, alliance and acceptance of pain were obtained during a 5-10-weeks baseline, before the MMI started. Subsequently, these measures were also obtained during a 6-8 weeks MMI process in order to enable comparative analyses. Additionally, pain coping, depression and pain catastrophizing were measured using standardized questionnaires before and after the MMI.

    Results: Irrespective of experiences of validation and alliance before MMI, all six patients felt validated and experienced a good alliance during MMI. Acceptance of pain improved only in one patient during MMI. None of the patients showed clinically relevant improvement in pain coping, depression or catastrophizing after the MMI.

    Conclusions: The patients did not change their acceptance and pain coping strategies despite of good alliance and experience of validation during the MMI process. Even if the design of this study precludes generalization to chronic pain patients in general, the results suggest that MMI may not have a therapeutic effect.

  • 75.
    Svanberg, Mikael
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper. Psychosomatic Medicine Clinic, Västerås County Council, Västerås, Sweden.
    Stålnacke, Britt-Marie
    Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden; Department of Clinical Sciences, Division of Rehabilitation Medicine, Danderyd Hospital, Stockholm, Sweden.
    Enthoven, Paul
    Department of Medical and Health Sciences, Physiotherapy, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden; Pain and Rehabilitation Centre, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Brodda-Jansen, Gunilla
    Department of Clinical Sciences, Division of Rehabilitation Medicine, Danderyd Hospital, Stockholm, Sweden; Institute for Psychophysiological Behavioral Medicine, Stockholm, Sweden.
    Gerdle, Björn
    Pain and Rehabilitation Centre, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Boersma, Katja
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Impact of emotional distress and pain-related fear on patients with chronic pain: Subgroup analysis of patients referred to multimodal rehabilitation2017Ingår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 49, nr 4, s. 354-361Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: Multimodal rehabilitation programmes (MMRP) for chronic pain could be improved by determining which patients do not benefit fully. General distress and pain-related fear may explain variations in the treatment effects of MMRP.

    Design: Cohort study with a cross-sectional, prospective part.

    Patients: Chronic musculoskeletal pain patients referred to 2 hospital-based pain rehabilitation clinics.

    Methods: The cross-sectional part of this study cluster analyses patients (n = 1,218) with regard to distress and pain-related fear at first consultation in clinical pain rehabilitation and describes differences in external variables between clusters. The prospective part follows the subsample of patients (n = 260) participating in MMRP and describes outcome post-treatment.

    Results: Four distinct subgroups were found: (i) those with low levels of distress and pain-related fear; (ii) those with high levels of pain-related fear; (iii) those with high levels of distress; and (iv) those with high levels of distress and pain-related fear. These subgroups showed differences in demographics, pain characteristics, quality of life, and acceptance, as well as the degree of MMRP participation and MMRP outcome.

    Conclusion: Among patients with chronic pain referred to MMRP there are subgroups with different profiles of distress and pain-related fear, which are relevant to understanding the adaptation to pain and MMRP outcome. This knowledge may help us to select patients and tailor treatment for better results.

  • 76.
    Thomtén, Johanna
    et al.
    Department of psychology, Mid Sweden University, Östersund, Sweden .
    Boersma, Katja
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Flink, Ida
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Tillfors, Maria
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Social Anxiety, Pain Catastrophizing and Return-To-Work Self-Efficacy in chronic pain: a cross-sectional study2016Ingår i: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 11, s. 98-103Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background and aims: Returning to work after periods of sick-leave due to chronic pain problems, involve a number of situations of interpersonal nature (e.g. meeting supervisors/insurance companies to adapt work setting to present functional level, receive help from colleagues, express pain, etc.). Since chronic pain has shown co-morbidity with social anxiety, it is of interest to investigate restraining factors in return to work among chronic pain sufferers from a social perspective. Catastrophizing is identified in both pain and social anxiety as a mechanism that might fuel a continuous bias in how situations are perceived (threat) and by hindering the development of functional behavior strategies. The presence of social anxiety in chronic pain patients might be seen as a stressor that limits the individuals' ability to effectively communicate pain-related needs to colleagues, and/or employers and therefore act as a hindering factor in return-to-work. Hence, the overall aim of this study was to examine the relationship between social anxiety, pain catastrophizing, and perceived ability to communicate pain-related needs to the work environment in a clinical pain population.

    Methods: The study employed a cross-sectional design and involved 247 individuals with chronic pain (82.3% women; M-age = 44 years). Measures included the Pain catastrophizing Scale, the Social Phobia Screening Questionnaire and the communication of pain-related needs-subscale of the Return-To-Work Self-efficacy Questionnaire. Analyzes were run to examine whether social anxiety moderated the relation between pain catastrophizing, and perceived ability to communicate pain-related needs while controlling for pain severity/interference and sick leave.

    Results: Social anxiety and pain catastrophizing correlated positively with each other and negatively with perceived ability to communicate pain-related needs. No support was obtained for a moderating effect of social anxiety. However, social anxiety and pain interference were each significant predictors of the individual's confidence in being able to communicate pain-related needs to the work environment.

    Conclusions: In the context of pain and work-related communication, symptoms of social anxiety was identified as being of similar importance to the outcome as pain interference, while pain severity was not associated with the individual's confidence in communicating one's pain-related needs.

    Implications: The results implicate that fears relating to pain-related social situations at work might be central in the process of return-to-work and rehabilitation in chronic pain.

  • 77.
    Tillfors, Maria
    et al.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Ekbäck, Kristofer
    Linton, Steven J.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Boersma, Katja
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Underlying factors of social anxiety and pain: Aspects of self-focused attention – private and public self-consciousness2012Ingår i: 14th World Congress on Pain, 2012Konferensbidrag (Refereegranskat)
    Abstract [en]

    A high degree of co-morbidity has been observed in general between chronic pain and various anxiety disorders and specifically between chronic pain and social anxiety disorder (or social phobia) both in clinical pain populations and in general populations. What is the etiology behind this co-morbidity? One clue may come from the concept of self-focused attention. A personality trait that refers to people’s individual differences in the degree of self-focused attention is self-consciousness, which has been observed to consist of two separate aspects. One is a private aspect addressing a person’s inner experiences as thoughts, feelings and somatic symptoms. The other aspect is a public aspect addressing a person’s attention to the self as a social object. Social anxiety disorder is characterized by a marked fear of scrutiny in a variety of social situations which implies a high degree of public self-consciousness. High degree of public self- consciousness has been associated both with higher degree of sensitivity to being socially rejected, and with physical (sexual) pain. However, research related to public self-consciousness and pain is very limited. Interesting to note is that from a neurobiological perspective the same area in the brain is activated both in physical pain and in social exclusion. In line with this, it has also been observed that sensitivity to physical pain and sensitivity to social rejection are mutually reinforcing. In Western societies we build much of our identity from what we achieve. For people who develop chronic pain and the often accompanying labor reduction should the social environment be experienced more invalidating if the person at the same time worries a lot for how others will perceive him/her (i.e., being high on public self-consciousness). This in turn may reinforce the impulse to avoid not only situations involving activities of a physical nature but also social activities. Overall, it should be of interest to examine public self-consciousness in relation to both pain and social anxiety. It has to our knowledge not been done before.

    Aim: The aim of the present study was to examine and identify possible patterns (by cluster analysis) of self-consciousness (public and private), social anxiety and pain in a non-clinical population. These profiles were examined in relation to disabling social anxiety respectively disabling pain.

    Methods: In this study, cluster analysis was used to identify subgroups of people characterized by different profiles of social anxiety, self-consciousness (public and private) and pain. University students (19-46 years old; N = 302) participated in a cross-sectional study.

    Results: We identified six clusters, including one group scoring high on all variables (the co-morbidity cluster). Further, we found a significant relation between the cluster solution and both disabling pain and disabling social anxiety where people belonging to the co-morbidity cluster were overrepresented.

    Conclusions: This suggests that public self-consciousness may be important to consider in terms of co-morbidity between pain and social anxiety. A next step is to try to replicate this result and thereby increase the external validity. Finally, if a person has a pattern in which he/she scores high on pain, social anxiety and public and private self-consciousness this may point to an enhanced risk for that person to developing both social anxiety disorder and chronic pain.

  • 78.
    Tillfors, Maria
    et al.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete. Center for Health and Medical Psychology.
    Toll, Christina
    Center for Health and Medical Psychology.
    Branting, Mattias
    Center for Health and Medical Psychology.
    Boersma, Katja
    Jansson-Fröjmark, Markus
    Department of Psychology, Stockholm University, Stockholm, Sweden.
    Allowing or fighting social anxiety: The role of psychological flexibility in a non-clinical population2015Ingår i: Journal for Person-Oriented Research, ISSN 2002-0244, Vol. 1, nr 3, s. 151-161Artikel i tidskrift (Refereegranskat)
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  • 79.
    Tseli, Elena
    et al.
    Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden.
    Boersma, Katja
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Stålnacke, Britt-Marie
    Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå; Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stokholm, Sweden.
    Enthoven, Paul
    Department of Medical and Health Sciences.
    Gerdle, Björn
    Department of Medical and Health Sciences, Pain and Rehabilitation Centre, Linköping University, Linköping.
    Äng, Björn O.
    Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden; School of Education, Health and Social Studies, Dalarna University, Sweden; Center for Clinical Research Dalarna,Uppsala University, Falun, Sweden.
    Grooten, Wilhelmus J. A.
    Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden; Functional Area Occupational Therapy & Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden.
    Prognostic Factors for Physical Functioning After Multidisciplinary Rehabilitation in Patients With Chronic Musculoskeletal Pain: A Systematic Review and Meta-Analysis2019Ingår i: The Clinical Journal of Pain, ISSN 0749-8047, E-ISSN 1536-5409, Vol. 35, nr 2, s. 148-173Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    OBJECTIVES: This systematic review aimed to identify and evaluate prognostic factors for long-term (≥6 mo) physical functioning in patients with chronic musculoskeletal pain following multidisciplinary rehabilitation (MDR).

    MATERIALS AND METHODS: Electronic searches conducted in MEDLINE, PsycINFO, EMBASE, CINAHL, Web of Science, and Cochrane CENTRAL revealed 25 original research reports, published 1983-2016, (n=9436). Potential prognostic factors relating to initial pain and physical and psychological functioning were synthesized qualitatively and quantitatively in random effects meta-analyses. The level of evidence (LoE) was evaluated with Grading of Recommendations Assessment, Development and Evaluation (GRADE).

    RESULTS: Pain-related factors (intensity and chronicity) were not associated with function/disability at long-term follow-up, odds ratio (OR)=0.84; 95% confidence interval (CI), 0.65-1.07 and OR=0.97; 95% CI, 0.93-1.00, respectively (moderate LoE). A better function at follow-up was predicted by Physical factors; higher levels of initial self-reported functioning, OR=1.07; 95% CI, 1.02-1.13 (low LoE), and Psychological factors; low initial levels of emotional distress, OR=0.77; 95% CI, 0.65-0.92, low levels of cognitive and behavioral risk factors, OR=0.85; 95% CI, 0.77-0.93 and high levels of protective cognitive and behavioral factors, OR=1.49; 95% CI, 1.17-1.90 (moderate LoE).

    DISCUSSION: While pain intensity and long-term chronicity did not predict physical functioning in chronic pain patients after MDR, poor pretreatment physical and psychological functioning influenced the prognosis negatively. Thus, treatment should further target and optimize these modifiable factors and an increased focus on positive, psychological protective factors may perhaps provide an opening for yet untapped clinical gains.

  • 80.
    Tseli, Elena
    et al.
    Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden.
    Grooten, Wilhelmus Johannes Andreas
    Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden; Functional Area Occupational Therapy and Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden.
    Stålnacke, Britt-Marie
    Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden; Department of Clinical Sciences, Department of Rehabilitation Medicine, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
    Boersma, Katja
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Enthoven, Paul
    Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Gerdle, Björn
    Pain and Rehabilitation Centre, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Äng, Björn Olov
    Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden; Functional Area Occupational Therapy and Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden; School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    Predictors of multidisciplinary rehabilitation outcomes in patients with chronic musculoskeletal pain: protocol for a systematic review and meta-analysis2017Ingår i: Systematic Reviews, E-ISSN 2046-4053, Vol. 6, nr 1, artikel-id 199Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Chronic musculoskeletal pain is a major public health problem. Early prediction for optimal treatment results has received growing attention, but there is presently a lack of evidence regarding what information such proactive management should be based on. This study protocol, therefore, presents our planned systematic review and meta-analysis on important predictive factors for health and work-related outcomes following multidisciplinary rehabilitation (MDR) in patients with chronic musculoskeletal pain.

    METHODS: We aim to perform a synthesis of the available evidence together with a meta-analysis of published peer-reviewed original research that includes predictive factors preceding MDR. Included are prospective studies of adults with benign, chronic (> 3 months) musculoskeletal pain diagnoses who have taken part in MDR. In the studies, associations between personal and rehabilitation-based factors and the outcomes of interest are reported. Outcome domains are pain, physical functioning including health-related quality of life, and work ability with follow-ups of 6 months or more. We will use a broad, explorative approach to any presented predictive factors (demographic, symptoms-related, physical, psychosocial, work-related, and MDR-related) and these will be analyzed through (a) narrative synthesis for each outcome domain and (b) if sufficient studies are available, a quantitative synthesis in which variance-weighted pooled proportions will be computed using a random effects model for each outcome domain. The strength of the evidence will be evaluated using the Grading of Recommendations, Assessment, Development and Evaluation.

    DISCUSSION: The strength of this systematic review is that it aims for a meta-analysis of prospective cohort or randomized controlled studies by performing an extensive search of multiple databases, using an explorative study approach to predictive factors, rather than building on single predictor impact on the outcome or on predefined hypotheses. In this way, an overview of factors central to MDR outcome can be made and will help strengthen the evidence base and inform a wide readership including health care practitioners and policymakers.

    SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42016025339.

  • 81. Vlaeyen, Johan
    et al.
    Morley, Stephen
    Linton, Steven J.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Boersma, Katja
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    de Jong, Jeroen
    Pain-related fear: exposure based treatment for chronic pain2012 (uppl. 1)Bok (Övrigt vetenskapligt)
    Abstract [en]

    This book identifies fear of movement and injury as a primary issue in chronic pain management. It provides a detailed treatment manual on exposure-based techniques for the reduction of pain-related fear and disability in chronic pain. Includes a disc with therapist and patient materials and videos.

  • 82.
    Westman, Anders E.
    et al.
    Örebro universitet, Hälsoakademin.
    Boersma, Katja
    Örebro universitet, Akademin för juridik, psykologi och socialt arbete.
    Leppert, Jerzy
    Centre for Clinical Research, Uppsala University, Uppsala, Sweden; Central Hospital, Västerås, Sweden.
    Linton, Steven J.
    Örebro universitet, Akademin för juridik, psykologi och socialt arbete.
    Fear-avoidance beliefs, catastrophizing, and distress: a longitudinal subgroup analysis on patients with musculoskeletal pain2011Ingår i: The Clinical Journal of Pain, ISSN 0749-8047, E-ISSN 1536-5409, Vol. 27, nr 7, s. 567-577Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: The aim of the present study was to describe fear-avoidance beliefs, catastrophizing, and emotional distress among musculoskeletal pain patients in primary healthcare and to explore the relationship of psychological risk profiles for pain, function, and sick leave from baseline through 1-year and 3-year follow-ups.

    Methods: Ratings from 110 musculoskeletal pain patients were collected and cluster analysis was used to identify subgroups with similar patterns on fear-avoidance beliefs, catastrophizing, and emotional distress. The clusters were examined cross-sectionally and prospectively on sick leave, function, and pain.

    Results: Five distinct profiles were found: “low scores cluster,” “high score cluster,” “fear-avoidance beliefs and catastrophizing cluster,” “distress only cluster,” and “medium catastrophizing cluster.” The “low scores cluster” and “distress only cluster” had the most favorable scores on outcome variables. The analysis of common developmental pathways showed considerable stability over time. Reorganization of clusters in a psychological “high risk cluster” and a “low risk cluster” showed significant differences at 1-year and 3-year follow-ups in functional ability as well as in decreased sick leave. There were no significant differences between the groups on average pain ratings at the 2 measure points.

    Conclusions: Distinct profiles of catastrophizing, fear-avoidance beliefs, and emotional distress were extracted and meaningfully related to future sick leave and dysfunction outcomes. The structures of the profiles were essentially stable and became more accentuated across a 3-year period. The results underscore the need to address psychological aspects as fear-avoidance beliefs, catastrophizing, and emotional distress in the management of patients with musculoskeletal pain and may open the path for a better tailored treatment approach for this patient group.

  • 83.
    Wurm, Matilda
    et al.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Anniko, Malin
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Tillfors, Maria
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Flink, Ida
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Boersma, Katja
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Musculoskeletal pain in early adolescence: A longitudinal examination of pain prevalence and the role of peer-related stress, worry, and gender2018Ingår i: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 111, s. 76-82Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: Adolescence is a time of change during which several health problems, such as pain problems, increase. Psychosocial mechanisms involved in this development, such as interpersonal stressors and worry, are still understudied, especially longitudinally. The first aim of this study was to investigate the prevalence of musculoskeletal pain in Swedish adolescents between the ages 13 and 15 using pain grades. The second aim was to study the role of peer-related stress, worry, and gender in the development of musculoskeletal pain problems over time.

    Methods: Adolescents in 18 public schools were followed from 7th to 9th grade (N=1181) and answered selfreport questionnaires at three time points. Prevalence was assessed at all three time points and a moderated mediation analysis investigated if peer-related stress in 7th grade predicted musculoskeletal pain two years later and if this relationship was mediated by worry in 8th grade. Gender was entered as a moderator.

    Results: In 7th grade, 8.4% of adolescents reported musculoskeletal pain with some functional impairment. In 8th and 9th grade around 10% of adolescents reported musculoskeletal pain problems, with girls reporting a higher prevalence than boys. Peer-related stress in 7th grade predicted musculoskeletal pain problems in 9th grade, mediated by worry in 8th grade. The mediation was moderated by gender: peer-related stress predicted worry for girls, but not for boys.

    Conclusion: Peer-related stress and worry seem to be involved in the development of pain over time. These factors should therefore be targeted in preventative interventions and during treatment.

  • 84.
    Wurm, Matilda
    et al.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Boersma, Katja
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Det senaste inom psykoterapi och smärta: Aktuellt från CHAMP: Unified Protocol online och Compassion Focused Therapy för smärtpatienter2016Konferensbidrag (Övrigt vetenskapligt)
  • 85.
    Wurm, Matilda
    et al.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Edlund, Sara
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Boersma, Katja
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Tillfors, Maria
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Comorbi social anxiety and pain: Relationship with transdiagnostic psychological processes2013Konferensbidrag (Övrigt vetenskapligt)
  • 86.
    Wurm, Matilda
    et al.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Edlund, Sara
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Tillfors, Maria
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Boersma, Katja
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Characteristics and consequences of the co-occurence between social anxiety and pain-related fear in chronic pain patients receiving multimodal pain rehabilitation treatment2016Ingår i: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 12, s. 45-52Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background and aims: Chronic pain problems are related to specific pain related fears and maladaptive pain-coping but also commonly co-occur with other anxiety problems. Shared emotional vulnerabil-ity factors may explain this comorbidity and may influence treatment outcome. Indeed, pain patients going through multimodal pain treatment are a heterogeneous group and treatment results vary. One understudied anxiety disorder co-occurring with pain is social anxiety. This may be relevant as many pain-related challenges are situated in social contexts. The aim of this study is to investigate the occur-rence of subgroups with differential patterns of social anxiety and pain related fear in a sample of chronic pain patients who receive multimodal pain treatment. The aim is also to study the characteristics of these potential subgroups and the consequences of different patterns of social anxiety and pain related fear.

    Methods: 180 patients with chronic musculoskeletal pain answered questionnaires before and after a multimodal pain treatment in a hospital rehabilitation setting in middle Sweden. A cluster analysis using pre-treatment scores on the Social Phobia Screening Questionnaire and the Tampa Scale of Kinesiophobia was performed. Subgroups were thereafter validated and compared on impairment due to social anxi-ety, pain catastrophizing, anxiety, and depression. Moreover, subgroups were described and compared on vulnerability factors (anxiety sensitivity, negative affect) and outcome factors (pain intensity, pain interference, and return to work self-efficacy).

    Results: Four distinct clusters emerged: (1) low scores, (2) pain-related fear only, (3) social concern only, and (4) high social anxiety and pain-related fear. Patients high on social anxiety and pain-related fear had significantly higher levels of anxiety sensitivity, negative affect, and higher general emotional symptomatology. They also had remaining problems posttreatment.

    Conclusions: A subgroup of patients with clinical levels of social anxiety has suboptimal rehabilitation results, with residual emotional problems and high levels of emotional vulnerability.

    Implications: These patients may be in need of additional treatment efforts that are not being met today. To prevent insufficient treatment results and prolonged work disability, these patients need to be detected during screening and may benefit from pain treatment that takes their emotional problems into account.

  • 87.
    Wurm, Matilda
    et al.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Flink, Ida
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Anniko, Malin
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Tillfors, Maria
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Boersma, Katja
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Musculoskeletal pain in adolescents: Prevalence, and the role of peer-related stress, worry, and gender in the development of pain problems over timeManuskript (preprint) (Övrigt vetenskapligt)
  • 88.
    Wurm, Matilda
    et al.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Flink, Ida
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Tillfors, Maria
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Boersma, Katja
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    External and internal social factors as risk factors for the development of back/neck pain in Swedish adolescents2017Ingår i: : Pain in Europe, 2017Konferensbidrag (Övrigt vetenskapligt)
    Abstract [en]

    Background and aim: Back/neck pain is common in adolescents. Studies show correlations with social factors, such as bully victimization and individual social functioning (social anxiety). In adult pain populations, comorbid social anxiety has been correlated with higher symptomatology and worse treatment outcome. The aim of this study was to describe the prevalence of back/neck pain and to analyze the influence of bullying and social anxiety on back/neck pain over time in a general population sample of Swedish adolescents.

    Method: Data consisted at baseline of all pupils in 7’th grade attending public schools in three Swedish municipalities (N= 1453, Mage= 13.19, sd= .43, 52.6 % boys), followed up yearly. Pupils were categorized as having a pain-problem based on self-reported pain frequency, pain intensity, and functional limitation. A multivariate logistic regression was conducted with bullying victimization, social anxiety, back/neck pain and gender at time 1 as predictors for back/neck pain at time 3.

    Results: The prevalence of problematic back/neck pain was 8.4% (N= 122) at time 1, 10.5% (N=144) at time 2 and 9.9% (N=117) at time 3. The regression model was statistically significant (X² (4, N= 1181) = 84.46, p=.000). Gender, back/neck pain and bully victimization at time 1, but not social anxiety, significantly predicted pain problem at time 3.

    Conclusions: External social factors rather than individual social function predicted back/neck pain. Since studies have found correlations between bully victimization and social anxiety and social anxiety may be prevalent and influence treatment outcomes in adult pain populations, this relationship should be studied further.

  • 89.
    Wurm, Matilda
    et al.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Klein Strandberg, Ester
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Lorenz, Caroline
    Buhrman, Monica
    Uppsala University, Uppsala, Sweden.
    Holländare, Fredrik
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Tillfors, Maria
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Boersma, Katja
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Chronic pain and emotional problems: A replicated single case study of an internet based therapist guided treatment based on CBT principles and the Unified Protocol of transdiagnostic treatments2016Konferensbidrag (Övrigt vetenskapligt)
  • 90.
    Wurm, Matilda
    et al.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Klein Strandberg, Ester
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Lorenz, Caroline
    Private person.
    Tillfors, Maria
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Buhrman, Monica
    Department of Psychology, Uppsala University, Uppsala, Sweden.
    Holländare, Fredrik
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. University Health Care Research Centre, Region Örebro County, Örebro, Sweden.
    Boersma, Katja
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Internet delivered transdiagnostic treatment with telephone support for pain patients with emotional comorbidity: a replicated single case study2017Ingår i: Internet Interventions, ISSN 2214-7829, Vol. 10, s. 54-64Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In pain patients, comorbid emotional problems have been linked to negative outcomes, including suboptimaltreatment gains. Developing parsimonious and accessible treatment options is therefore important. The overarchingaim of this study was to test an internet delivered therapist guided transdiagnostic treatment withtelephone support. An adapted version of the Unified Protocol for Transdiagnostic Treatments of EmotionalDisorders was used as an intervention for pain patients with residual pain problems and comorbid emotionalproblems after having received a multimodal pain rehabilitation. The study used a replicated AB single caseexperimental design (N =5; 3 females). Outcome measures were depressive and general anxiety symptoms, painintensity, pain coping problems, and diagnostic status. Feasibility measures (completion and compliance) andpatient satisfaction were also assessed. Scores on Nonoverlap of All Pairs (NAP) indicate a decrease of anxiety forthree participants and a decrease of depression for four participants. Decreases were small and did not alwaysreach statistical significance. Also, Tau-U scores could only confirm a reliable trend for one participant. Two outof four patients who were diagnosed with psychiatric disorders before treatment did no longer fulfill diagnosticcriteria posttreatment. No improvements could be seen on pain problems. The treatment was feasible and patientsatisfaction was high. Hence, while an internet delivered transdiagnostic treatment with telephone support maybe a feasible and accepted secondary intervention for pain patients with comorbid emotional problems, theeffects are unclear. The gap between high patient satisfaction and small changes in symptomatology should beexplored further.

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