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Buhrman, Monica
Publications (10 of 22) Show all publications
Lin, J., Paganini, S., Sander, L., Lueking, M., Ebert, D. D., Buhrman, M., . . . Baumeister, H. (2017). An Internet-Based Intervention for Chronic Pain. Deutsches Ärzteblatt International, 141(41), 661-668
Open this publication in new window or tab >>An Internet-Based Intervention for Chronic Pain
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2017 (English)In: Deutsches Ärzteblatt International, ISSN 1866-0452, E-ISSN 1866-0452, Vol. 141, no 41, p. 661-668Article in journal (Refereed) Published
Abstract [en]

Background: Persons with chronic pain can be treated effectively with acceptance and commitment therapy (ACT). In this trial, we examined the effectiveness of guided and unguided ACT-based online treatment (ACTonPain) for chronic pain patients. Methods: 302 individuals were randomly assigned to ACTonPain with or without guidance (n = 100/101) or to a waiting-list control group (n= 101). The primary outcome was pain interference as measured by the Multidimensional Pain Inventory. The secondary outcomes were physical and emotional functioning, pain intensity, ACT process variables, quality of life, satisfaction with the intervention, adherence, and participants' rating of overall improvement. The online measurements were carried out before randomization (T0) and 9 weeks and 6 months after randomization (T1 and T2, respectively). Intention-to-treat (ITT) data analysis was supplemented with additional per-protocol analyses. Results: The guided ACTonPain group showed significantly less pain interference than the control group in the ITT analysis (p = 0.01), with a moderate effect size at T1 and T2 (d = 0.58 respectively), corresponding to a number needed to treat (NNT) of 3.14 for both time points. Participants in the guided ACTonPain group also indicated higher pain acceptance (T1: d = 0.59; T2: d = 0.76). The unguided ACTonPain group showed to be significantly less depressed in comparison to the control group at at time T2 (d = 0.50). No significant differences with respect to effectiveness were found between the two ACTonPain groups (p> 0.05). Conclusion: The online intervention ACTonPain is effective for persons with chronic pain when the program is guided. Further research in a variety of settings of health care is needed in order to determine whether and how ACTonPain can be implemented.

National Category
Applied Psychology
Identifiers
urn:nbn:se:uu:diva-340951 (URN)10.3238/arztebl.2017.0681 (DOI)000413846100001 ()
Available from: 2018-02-12 Created: 2018-02-12 Last updated: 2018-02-12Bibliographically approved
Peters, M. L., Smeets, E., Feijge, M., van Breukelen, G., Andersson, G., Buhrman, M. & Linton, S. J. (2017). Happy Despite Pain: A Randomized Controlled Trial of an 8-Week Internet-delivered Positive Psychology Intervention for Enhancing Well-being in Patients With Chronic Pain. The Clinical Journal of Pain, 33(11), 962-975
Open this publication in new window or tab >>Happy Despite Pain: A Randomized Controlled Trial of an 8-Week Internet-delivered Positive Psychology Intervention for Enhancing Well-being in Patients With Chronic Pain
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2017 (English)In: The Clinical Journal of Pain, ISSN 0749-8047, E-ISSN 1536-5409, Vol. 33, no 11, p. 962-975Article in journal (Refereed) Published
Abstract [en]

Objectives: There is preliminary evidence for the efficacy of positive psychology interventions for pain management. The current study examined the effects of an internet-based positive psychology self-help program for patients with chronic musculoskeletal pain and compared it with an internet-based cognitive-behavioral program.

Materials and Methods: A randomized controlled trial was carried out with 3 conditions: an internet-delivered positive psychology program, an internet-delivered cognitive-behavioral program and waitlist control. A total of 276 patients were randomized to 1 of the 3 conditions and posttreatment data were obtained from 206 patients. Primary outcomes were happiness, depression, and physical impairments at posttreatment and at 6-month follow-up. Intention-to-treat analyses were carried out using mixed regression analyses.

Results: Both treatments led to significant increases in happiness and decreases in depression. Physical impairments did not significantly decrease compared with waitlist. Improvements in happiness and depression were maintained until 6-month follow-up. There were no overall differences in the efficacy of the 2 active interventions but effects seemed to be moderated by education. Patients with a higher level of education profited slightly more from the positive psychology intervention than from the cognitive-behavioral program.

Discussion: The results suggest that an internet-based positive psychology and cognitive-behavioral self-help interventions for the management of chronic pain are clinically useful. Because the self-help exercises as used in the current program do not require therapist involvement, dissemination potential is large. Further studies should examine whether it can best be used as stand-alone or add-on treatment combined with established pain treatment programs.

Place, publisher, year, edition, pages
LIPPINCOTT WILLIAMS & WILKINS, 2017
Keywords
positive psychology intervention, cognitive-behavior therapy, internet-based treatment, randomized controlled trial, chronic pain
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-337103 (URN)10.1097/AJP.0000000000000494 (DOI)000412425200002 ()28379873 (PubMedID)
Available from: 2017-12-22 Created: 2017-12-22 Last updated: 2017-12-22Bibliographically approved
Wurm, M., Strandberg, E. K., Lorenz, C., Tillfors, M., Buhrman, M., Hollandare, F. & Boersma, K. (2017). Internet delivered transdiagnostic treatment with telephone support for pain patients with emotional comorbidity: a replicated single case study. Internet Interventions, 10, 54-64
Open this publication in new window or tab >>Internet delivered transdiagnostic treatment with telephone support for pain patients with emotional comorbidity: a replicated single case study
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2017 (English)In: Internet Interventions, ISSN 2214-7829, Vol. 10, p. 54-64Article in journal (Refereed) Published
Abstract [en]

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

National Category
Applied Psychology
Identifiers
urn:nbn:se:uu:diva-389480 (URN)10.1016/j.invent.2017.10.004 (DOI)000457134100008 ()30135753 (PubMedID)
Available from: 2019-07-16 Created: 2019-07-16 Last updated: 2019-07-16Bibliographically approved
Buhrman, M., Gordh, T. & Andersson, G. (2016). Internet interventions for chronic pain including headache: A systematic review. Internet Interventions, 4, 17-34
Open this publication in new window or tab >>Internet interventions for chronic pain including headache: A systematic review
2016 (English)In: Internet Interventions, ISSN 2214-7829, Vol. 4, p. 17-34Article in journal (Refereed) Published
Abstract [en]

Chronic pain is a major health problem and behavioral based treatments have been shown to be effective. However, the availability of these kinds of treatments is scarce and internet-based treatments have been shown to be promising in this area. The objective of the present systematic review is to evaluate internet-based interventions for persons with chronic pain. The specific aims are to do an updated review with a broad inclusion of different chronic pain diagnoses and to assess disability and pain and also measures of catastrophizing, depression and anxiety. A systematic search identified 891 studies and 22 trials were selected as eligible for review. Two of the selected trials included children/youth and five included individuals with chronic headache and/or migraine. The most frequently measured domain reflected in the primary outcomes was interference/disability, followed by catastrophizing. Result across the studies showed a number of beneficial effects. Twelve trials reported significant effects on disability/interference outcomes and pain intensity. Positive effects were also found on psychological variable such as catastrophizing, depression and anxiety. Several studies (n = 12) were assessed to have an unclear level of risk bias. The attrition levels ranged from 4% to 54% where the headache trials had the highest drop-out levels. However, findings suggest that internet-based treatments based on cognitive behavioural therapy (CBT) are efficacious measured with different outcome variables. Results are in line with trials in clinical settings. Meta-analytic statistics were calculated for interference/disability, pain intensity, catastrophizing and mood ratings. Results showed that the effect size for interference/disability was Hedge's g = − 0.39, for pain intensity Hedge's g = − 0.33, for catastrophizing Hedge's g = − 0.49 and for mood variables (depression) Hedge's g = − 0.26.

Keywords
chronic pain, internet, cognitive behavioral therapy
National Category
Psychology
Identifiers
urn:nbn:se:uu:diva-284152 (URN)10.1016/j.invent.2015.12.001 (DOI)
Available from: 2016-04-15 Created: 2016-04-15 Last updated: 2017-11-30Bibliographically approved
Lin, J., Lüking, M., Ebert, D. D., Buhrman, M., Andersson, G. & Baumeister, H. (2015). Effectiveness and cost-effectiveness of a guided and unguided internet-based Acceptance and Commitment Therapy for chronic pain: Study protocol for a three-armed randomised controlled trial. Internet Interventions, 2(1), 7-16
Open this publication in new window or tab >>Effectiveness and cost-effectiveness of a guided and unguided internet-based Acceptance and Commitment Therapy for chronic pain: Study protocol for a three-armed randomised controlled trial
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2015 (English)In: Internet Interventions, Vol. 2, no 1, p. 7-16Article in journal (Refereed) Published
National Category
Psychology
Identifiers
urn:nbn:se:uu:diva-284156 (URN)10.1016/j.invent.2014.11.005 (DOI)
Available from: 2016-04-15 Created: 2016-04-15 Last updated: 2016-04-28
Buhrman, M., Syk, M., Burvall, O., Hartig, T., Gordh, T. & Andersson, G. (2015). Individualized Guided Internet-delivered Cognitive Behaviour Therapy for Chronic Pain Patients with Comorbid Depression and Anxiety: A Randomized Controlled Trial. The Clinical Journal of Pain, 31(6), 504-516
Open this publication in new window or tab >>Individualized Guided Internet-delivered Cognitive Behaviour Therapy for Chronic Pain Patients with Comorbid Depression and Anxiety: A Randomized Controlled Trial
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2015 (English)In: The Clinical Journal of Pain, ISSN 0749-8047, E-ISSN 1536-5409, Vol. 31, no 6, p. 504-516Article in journal (Refereed) Published
Abstract [en]

Depression and anxiety are commonly seen in patients with chronic pain which affects the patient´s daily life functioning. Although considerable attention has been devoted to explain why depression and anxiety are frequent comorbid with chronic pain, little empirical work has been conducted on interventions that target depression and anxiety and chronic pain. The present study was designed to test an individualized cognitive-behavioral treatment delivered through the internet for persons with chronic pain and emotional distress. A total of 52 patients with chronic pain and depression were included and randomized to either treatment for 8 weeks or to a control group that participated in a moderated online discussion forum. Intent-to-treat analyses showed significant decreases regarding depressive symptoms and pain disability in the treatment group. Results on the primary outcomes of depression and anxiety were in favour of the treatment group. Reductions were also found on pain catastrophizing. One year follow-up showed maintenance of improvements. We conclude that an individualized guided internet-delivered treatment based on cognitive behaviour therapy can be effective for persons with chronic pain comorbid emotional distress.

National Category
Medical and Health Sciences Applied Psychology
Identifiers
urn:nbn:se:uu:diva-238808 (URN)10.1097/AJP.0000000000000176 (DOI)000354103300004 ()25380222 (PubMedID)
Available from: 2014-12-16 Created: 2014-12-16 Last updated: 2017-12-05Bibliographically approved
Buhrman, M. (2015). Internet-delivered psychologic treatment for chronic pain. In: : . Paper presented at Pain in the Baltics 2015. Monica Buhrman
Open this publication in new window or tab >>Internet-delivered psychologic treatment for chronic pain
2015 (English)Conference paper, Oral presentation with published abstract (Refereed)
Place, publisher, year, edition, pages
Monica Buhrman, 2015
Series
Monica Buhrman
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:uu:diva-289117 (URN)
Conference
Pain in the Baltics 2015
Available from: 2016-04-28 Created: 2016-04-28 Last updated: 2016-04-28
Andersson, G., Bergman Nordgren, L., Buhrman, M. & Carlbring, P. (2014). Psychological treatments for depression delivered via the Internet and supported by a clinician: an update. Spanish Journal of Clinical Psychology, 19, 217-225
Open this publication in new window or tab >>Psychological treatments for depression delivered via the Internet and supported by a clinician: an update
2014 (English)In: Spanish Journal of Clinical Psychology, Vol. 19, p. 217-225Article in journal (Refereed) Published
National Category
Psychology
Identifiers
urn:nbn:se:uu:diva-284172 (URN)
Available from: 2016-04-15 Created: 2016-04-15 Last updated: 2016-04-28
Buhrman, M., Skoglund, A., Husell, J., Bergström, K., Gordh, T., Hursti, T., . . . Andersson, G. (2013). Guided Internet-delivered acceptance and commitment therapy for chronic pain patients: a randomized controlled trial. Behaviour Research and Therapy, 51(6), 307-315
Open this publication in new window or tab >>Guided Internet-delivered acceptance and commitment therapy for chronic pain patients: a randomized controlled trial
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2013 (English)In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 51, no 6, p. 307-315Article in journal (Refereed) Published
Abstract [en]

Acceptance and commitment therapy (ACT) interventions for persons with chronic pain have recently received empirical support. ACT focuses on reducing the disabling influences of pain through targeting ineffective control strategies and teaches people to stay in contact with unpleasant emotions, sensations, and thoughts. The aim of the present study was to investigate the effect of a guided internet-delivered ACT intervention for persons with chronic pain. A total of 76 patients with chronic pain were included in the study and randomized to either treatment for 7 weeks or to a control group that participated in a moderated online discussion forum. Intent-to-treat analyses showed significant increases regarding activity engagement and pain willingness. Measurements were provided with the primary outcome variable Chronic Pain Acceptance Questionnaire which was in favour of the treatment group. Reductions were found on other measures of pain-related distress, anxiety and depressive symptoms. A six month follow-up showed maintenance of improvements. We conclude that an acceptance based internet-delivered treatment can be effective for persons with chronic pain.

Keywords
Internet-delivered CBT, Chronic pain, Acceptance and commitment therapy, Mindfulness, Guided self-help
National Category
Psychology (excluding Applied Psychology)
Identifiers
urn:nbn:se:uu:diva-183341 (URN)10.1016/j.brat.2013.02.010 (DOI)000319175400010 ()23548250 (PubMedID)
Available from: 2012-10-24 Created: 2012-10-24 Last updated: 2017-12-07
Buhrman, M., Fredriksson, A., Edström, G., Shafiei, D., Tärnqvist, C., Ljóttson, B., . . . Andersson, G. (2013). Guided Internet-delivered cognitive behavioural therapy for chronic pain patients who have residual symptoms after rehabilitation: Randomized controlled trial. European Journal of Pain, 17(5), 753-765
Open this publication in new window or tab >>Guided Internet-delivered cognitive behavioural therapy for chronic pain patients who have residual symptoms after rehabilitation: Randomized controlled trial
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2013 (English)In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 17, no 5, p. 753-765Article in journal (Refereed) Published
Abstract [en]

Background Chronic pain can be treated with cognitive behavioural therapy delivered in multidisciplinary settings. However, relapse is likely, and there is a need for cost-effective secondary interventions for persons with residual problems after rehabilitation. The aim of the present study was to investigate the effects of a guided Internet-delivered cognitive behavioural intervention for patients who had completed multidisciplinary treatment at a pain management unit. Methods A total of 72 persons with residual pain problems were included in the study and were randomized to either treatment for 8 weeks or to a control group who were invited to participate in a moderated online discussion forum. The participants had different chronic pain conditions, and a majority were women (72%). Twenty-two percent of the participants dropped out of the study before the post-treatment assessment. Results Intent-to-treat analyses demonstrated differences on the catastrophizing subscale of the Coping Strategies Questionnaire (Cohen's d=0.70), in favour of the treatment group but a small within-group effect. Differences were also found on other measures of pain-related distress, anxiety and depressive symptoms. A 6-month follow-up exhibited maintenance of improvements. Conclusions We conclude that Internet-delivered treatment can be partly effective for persons with residual problems after completed pain rehabilitation.

National Category
Psychology (excluding Applied Psychology)
Identifiers
urn:nbn:se:uu:diva-183338 (URN)10.1002/j.1532-2149.2012.00244.x (DOI)000316810000013 ()23139021 (PubMedID)
Available from: 2012-10-24 Created: 2012-10-24 Last updated: 2017-12-07Bibliographically approved
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