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Publications (10 of 34) Show all publications
Jansson-Fröjmark, M., Evander, J. & Alfonsson, S. (2019). Are sleep hygiene practices related to the incidence, persistence and remission of insomnia?: Findings from a prospective community study. Journal of behavioral medicine, 42(1), 128-138
Open this publication in new window or tab >>Are sleep hygiene practices related to the incidence, persistence and remission of insomnia?: Findings from a prospective community study
2019 (English)In: Journal of behavioral medicine, ISSN 0160-7715, E-ISSN 1573-3521, Vol. 42, no 1, p. 128-138Article in journal (Refereed) Published
Abstract [en]

The purpose was to examine whether sleep hygiene practices are associated with the course of insomnia (incidence, persistence and remission) over 1 year in the general population. This longitudinal study was carried out in the general population. After excluding anyone with other primary sleep disorder than insomnia, 1638 participants returned a baseline and a 1-year follow-up survey. Questions regarding sleep hygiene practices were administered at baseline, and the status of insomnia was assessed at baseline (T1) and at the 1-year follow-up (T2). Age, gender, mental ill-health, and pain were used as covariates in the analyses. Nicotine use, mental ill-health and pain were independently associated with an increased risk for concurrent insomnia at T1, while mental ill-health was the only risk factor for incident insomnia at T2. Relative to not reporting insomnia at the two time-points, nicotine use, light or noise disturbance, mental ill-health, and pain significantly increased the risk for persistent insomnia over 1 year. In comparison with those whose insomnia had remitted at the follow-up, reporting an irregular sleep schedule was a significant risk factor for persistent insomnia. Of the nine sleep hygiene practices examined in this study, only three were independently linked to concurrent and future insomnia, respectively; using nicotine late in the evening, light or noise disturbance, and having an irregular sleep schedule. This may have implications for the conceptualization and management of insomnia as well as for future research.

Keywords
Epidemiology, Insomnia, Longitudinal, Nicotine, Sleep hygiene, Sleep timing
National Category
Neurology
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-372837 (URN)10.1007/s10865-018-9949-0 (DOI)000460359900013 ()29995266 (PubMedID)
Funder
AFA Insurance
Available from: 2019-01-09 Created: 2019-01-09 Last updated: 2019-03-25Bibliographically approved
Toft, T., Alfonsson, S., Hovén, E. & Carlsson, T. (2019). Feeling excluded and not having anyone to talk to: Qualitative study of interpersonal relationships following a cancer diagnosis in a sibling. European Journal of Oncology Nursing, 42, 76-81
Open this publication in new window or tab >>Feeling excluded and not having anyone to talk to: Qualitative study of interpersonal relationships following a cancer diagnosis in a sibling
2019 (English)In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 42, p. 76-81Article in journal (Refereed) Published
Abstract [en]

Purpose: To explore experiences related to interpersonal relationships following a cancer diagnosis in a sibling.

Methods: Respondents (n = 7 females) were recruited by means of convenience sampling during a camp for children affected by childhood cancer and their siblings. Data from children and adolescents with a sibling diagnosed with cancer was collected through individual face-to-face interviews and analyzed using systematic text condensation.

Results: Two categories portrayed the experiences related to interpersonal relationships following a cancer diagnosis in a sibling. Feeling excluded while wanting to maintain a relationship with their ill sibling and be involved in the care portrayed that trying to be involved in the care of their ill sibling was a stressful and difficult experience, since they were simultaneously expected to also manage household chores and attend school. Feeling stigmatized and exposed in social contexts while needing an allowing space to talk about their experiences portrayed the emotional difficulties evoked by social situations and behaviors of others, which left respondents feeling exposed and mistreated. Having the possibility to talk about their experiences and receiving social support was described as essential in order to cope with the situation.

Conclusions: Health professionals need to take into consideration the emotional difficulties and vulnerable situation that children and adolescents who have a sibling diagnosed with cancer are at risk of experiencing. Stigmatization and social exposure present a risk of psychological distress. Having an allowing space to communicate feelings and experiences is desired. Interventions may be necessary to help these individuals psychologically cope.

Place, publisher, year, edition, pages
ELSEVIER SCI LTD, 2019
Keywords
Interpersonal relations, Life change events, Pediatric cancer, Siblings, Sibling relations
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-397779 (URN)10.1016/j.ejon.2019.07.010 (DOI)000494886500011 ()31450042 (PubMedID)
Available from: 2019-11-26 Created: 2019-11-26 Last updated: 2019-11-26Bibliographically approved
Alfonsson, S., Englund, J. & Parling, T. (2019). Tailored Text Message Prompts to Increase Therapy Homework Adherence: A Single-Case Randomised Controlled Study. Behaviour change, 36(3), 180-191
Open this publication in new window or tab >>Tailored Text Message Prompts to Increase Therapy Homework Adherence: A Single-Case Randomised Controlled Study
2019 (English)In: Behaviour change, ISSN 0813-4839, E-ISSN 2049-7768, Vol. 36, no 3, p. 180-191Article in journal (Refereed) Published
Abstract [en]

Background: Psychotherapy homework completion is associated with positive treatment outcomes, but many patients show low adherence to prescribed assignments. Whether text-message prompts are effective in increasing adherence to assignments is unknown. Aims: To evaluate whether tailored daily text-message prompts can increase homework adherence in a stress/anxiety treatment. Method: This study used a randomised controlled single-case alternating treatment design with parallel replication in seven participants. Participants received a five-week relaxation program for stress and anxiety with daily exercises. The intervention consisted of daily text messages tailored for each participant. Phases with or without text messages were randomly alternated over the study course. Randomisation tests were used to statistically analyse differences in mean number of completed relaxation exercises between phases. Results: There was a significant (combined p = .018) effect of daily text messages on homework adherence across participants with weak to medium effect size improvements. No negative effects of daily text messages were identified. Conclusions: Tailored text messages can marginally improve adherence to assignments for patients in CBT. Further studies may investigate how text messages can be made relevant for more patients and whether text messages can be used to increase homework quality rather than quantity.

Keywords
Homework assignments, treatment adherence, prompts, mobile phone, cognitive behaviour therapy
National Category
Psychiatry
Research subject
Psychiatry
Identifiers
urn:nbn:se:uu:diva-393948 (URN)10.1017/bec.2019.10 (DOI)
Available from: 2019-09-30 Created: 2019-09-30 Last updated: 2019-09-30
Alfonsson, S., Parling, T., Spännargård, Å., Andersson, G. & Lundgren, T. (2018). The effects of clinical supervision on supervisees and patients in cognitive behavioral therapy: a systematic review. Cognitive Behaviour Therapy, 47(3), 206-228
Open this publication in new window or tab >>The effects of clinical supervision on supervisees and patients in cognitive behavioral therapy: a systematic review
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2018 (English)In: Cognitive Behaviour Therapy, ISSN 1650-6073, E-ISSN 1651-2316, Vol. 47, no 3, p. 206-228Article, review/survey (Refereed) Published
Abstract [en]

Clinical supervision is a central part of psychotherapist training but the empirical support for specific supervision theories or features is unclear. The aims of this study were to systematically review the empirical research literature regarding the effects of clinical supervision on therapists’ competences and clinical outcomes within Cognitive Behavior Therapy (CBT). A comprehensive database search resulted in 4103 identified publications. Of these, 133 were scrutinized and in the end 5 studies were included in the review for data synthesis. The five studies were heterogeneous in scope and quality and only one provided firm empirical support for the positive effects of clinical supervision on therapists’ competence. The remaining four studies suffered from methodological weaknesses, but provided some preliminary support that clinical supervision may be beneficiary for novice therapists. No study could show benefits from supervision for patients. The research literature suggests that clinical supervision may have some potential effects on novice therapists’ competence compared to no supervision but the effects on clinical outcomes are still unclear. While bug-in-the-eye live supervision may be more effective than standard delayed supervision, the effects of specific supervision models or features are also unclear. There is a continued need for high-quality empirical studies on the effects of clinical supervision in psychotherapy.

Keywords
Clinical supervision, training, Cognitive Behavior Therapy, review, empirical research
National Category
Applied Psychology
Identifiers
urn:nbn:se:uu:diva-345100 (URN)10.1080/16506073.2017.1369559 (DOI)000428807200002 ()28929863 (PubMedID)
Available from: 2018-03-08 Created: 2018-03-08 Last updated: 2018-08-17Bibliographically approved
Abrahamsson, N., Ahlund, L., Ahrin, E. & Alfonsson, S. (2018). Video-based CBT-E improves eating patterns in obese patients with eating disorder: A single case multiple baseline study. Journal of Behavior Therapy and Experimental Psychiatry, 61, 104-112
Open this publication in new window or tab >>Video-based CBT-E improves eating patterns in obese patients with eating disorder: A single case multiple baseline study
2018 (English)In: Journal of Behavior Therapy and Experimental Psychiatry, ISSN 0005-7916, E-ISSN 1873-7943, Vol. 61, p. 104-112Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND OBJECTIVES:

Cognitive Behavioral Therapy (CBT) is effective for treating eating disorders but it may be difficult to reach patients living far from urban centers. Mobile video-based psychotherapy may potentially improve service reach but has not yet been evaluated. The purpose of this study was to investigate the effects of mobile video-based CBT for eating disorder and to explore the feasibility to use this technology in clinical care.

METHODS:

A controlled single case multiple baseline design was used which allowed for statistical analyses with randomization tests and non-overlap of all pairs (NAP). Five patients in the first stage of eating disorder treatment were included and the main outcome variable was daily meal frequency. Secondary outcome variables included eating disorder symptoms, psychological distress and treatment satisfaction.

RESULTS:

The treatment resulted in a significant (p < .01) increase in daily meal frequency with medium to large effect sizes (combined NAP = .89). Four participants reported reliable improvements in eating disorder symptoms and three reported improvements in mood. The participants reported high satisfaction with the treatment and with the mobile video-application despite some technical problems.

LIMITATIONS:

Self-reported data on eating behavior is prone to be biased and the results of single case studies may have limited generalizability.

CONCLUSION:

CBT can be delivered effectively via a mobile video application and, despite some technological issues, can be well received by patients. All participants in this study had previous low access to mental health services and reported high satisfaction with the treatment format.

Keywords
Cognitive behavioral therapy; Eating disorders; Telemedicine; Video-based psychotherapy
National Category
Psychology Health Sciences
Identifiers
urn:nbn:se:uu:diva-356514 (URN)10.1016/j.jbtep.2018.06.010 (DOI)000444065700015 ()29990679 (PubMedID)
Funder
VINNOVA
Available from: 2018-08-31 Created: 2018-08-31 Last updated: 2018-11-07Bibliographically approved
Alfonsson, S., Johansson, K., Uddling, J. & Hursti, T. (2017). Differences in motivation and adherence to a prescribed assignment after face-to-face and online psychoeducation: A randomized experiment. BMC Psychology, 5(1), Article ID 3.
Open this publication in new window or tab >>Differences in motivation and adherence to a prescribed assignment after face-to-face and online psychoeducation: A randomized experiment
2017 (English)In: BMC Psychology, E-ISSN 2050-7283, Vol. 5, no 1, article id 3Article in journal (Refereed) Published
Abstract [en]

Background: Adherence to treatment homework is associated with positive outcomes in behavioral psychotherapy but compliance to assignments is still often moderate. Whether adherence can be predicted by different types of motivation for the task and whether motivation plays different roles in face-to-face compared to online psychotherapy is unknown. If models of motivation, such as Self-determination theory, can be used to predict patients’ behavior, it may facilitate further research into homework promotion. The aims of this study were, therefore, to investigate whether motivation variables could predict adherence to a prescribed assignment in face-to-face and online interventions using a psychotherapy analog model. Methods: A total of 100 participants were included in this study and randomized to either a face-to-face or online intervention. Participants in both groups received a psychoeducation session and were given an assignment for the subsequent week. The main outcome measurements were self-reported motivation and adherence to the assignment. Results: Participant in the face-to-face condition reported significantly higher levels of motivation and showed higher levels of adherence compared to participants in the online condition. Adherence to the assignment was positively associated with intrinsic motivation and intervention credibility in the whole sample and especially in the online group. Conclusions: This study shows that intrinsic motivation and intervention credibility are strong predictors of adherence to assignments, especially in online interventions. The results indicate that intrinsic motivation may be partly substituted with face-to-face contact with a therapist. It may also be possible to identify patients with low motivation in online interventions who are at risk of dropping out. Methods for making online interventions more intrinsically motivating without increasing external pressure are needed.

Keywords
Adherence, Motivation, Psychoeducation, Internet, Homework assignments
National Category
Applied Psychology
Identifiers
urn:nbn:se:uu:diva-280799 (URN)10.1186/s40359-017-0172-5 (DOI)28126022 (PubMedID)
Available from: 2016-03-15 Created: 2016-03-15 Last updated: 2018-05-08Bibliographically approved
Alfonsson, S., Wallin, E. & Maathz, P. (2017). Factor structure and validity of the Depression Anxiety and Stress Scale-21 in Swedish translation. Journal of Psychiatric and Mental Health Nursing, 24(2-3), 154-162
Open this publication in new window or tab >>Factor structure and validity of the Depression Anxiety and Stress Scale-21 in Swedish translation
2017 (English)In: Journal of Psychiatric and Mental Health Nursing, ISSN 1351-0126, E-ISSN 1365-2850, Vol. 24, no 2-3, p. 154-162Article in journal (Refereed) Published
Abstract [en]

Introduction There is a constant need for theoretically sound and valid self-report instruments for measuring psychological distress. Previous studies have shown that the Depression, Anxiety and Stress Scale-21 (DASS-21) is theoretically sound, but there have been some inconsistent results regarding its factor structure. Aims The aim of the present study was to investigate and elucidate the factor structure and convergent validity of the DASS-21. Methods A total of 624 participants recruited from student, primary care and psychotherapy populations. The factor structure of the DASS-21 was assessed by confirmatory factor analyses and the convergent validity by investigating its unique correlations with other psychiatric instruments. Results A bifactor structure with depression, anxiety, stress and a general factor provided the best fit indices for the DASS-21. The convergent validity was adequate for the Depression and Anxiety subscales but more ambiguous for the Stress subscale. Discussion The present study overall supports the validity and factor structure of the DASS-21. Implications for practice The DASS-21 can be used to measure symptoms of depression and anxiety as well as overall distress. It can be useful for mental health nurses, and other first-line psychiatric professionals, in need of a short, feasible and valid instrument in everyday care

Keywords
screening, anxiety, depression, stress, distress, psychometric
National Category
Psychology
Identifiers
urn:nbn:se:uu:diva-306697 (URN)10.1111/jpm.12363 (DOI)000395714100008 ()28124410 (PubMedID)
Available from: 2016-11-02 Created: 2016-11-02 Last updated: 2017-12-19Bibliographically approved
Alfonsson, S., Weineland-Strandskov, S. & Sundbom, M. (2017). Self-Reported Hedonism Predicts 12-Month Weight Loss After Roux-en-Y Gastric Bypass. Obesity Surgery, 27(8), 2073-2078
Open this publication in new window or tab >>Self-Reported Hedonism Predicts 12-Month Weight Loss After Roux-en-Y Gastric Bypass
2017 (English)In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 27, no 8, p. 2073-2078Article in journal (Refereed) Published
Abstract [en]

Introduction Research regarding psychological risk factors for reduced weight loss after bariatric surgery has yielded mixed results, especially for variables measured prior to surgery. More profound personality factors have shown better promise and one such factor that may be relevant in this context is time perspective, i.e., the tendency to focus on present or future consequences. The aim of this study was to investigate the predictive value of time perspective for 12-month weight loss after Roux-en-Y gastric bypass surgery.

Methods A total of 158 patients were included and completed self-report instruments prior to surgery. Weight loss was measured after 12 months by medical staff. Background variables as well as self-reported disordered eating, psychological distress, and time perspective were analyzed with regression analysis to identify significant predictors for 12-month weight loss.

Results The mean BMI loss at 12 months was 14 units, from 45 to 30 kg/m(2). Age, sex, and time perspective could significantly predict weight loss but only male sex and self-reported hedonism were independent risk factors for reduced weight loss in the final regression model.

Conclusion In this study, self-reported hedonistic time perspective proved to be a better predictor for 12-month weight loss than symptoms of disordered eating and psychological distress. It is possible that a hedonistic tendency of focusing on immediate consequences and rewards is analogous to the impaired delay discounting seen in previous studies of bariatric surgery candidates. Further studies are needed to identify whether these patients may benefit from extended care and support after surgery.

Keywords
Bariatric surgery, Weight loss, Risk factors, Time perspective, Personality, Hedonism
National Category
Psychology Gastroenterology and Hepatology
Identifiers
urn:nbn:se:uu:diva-316575 (URN)10.1007/s11695-017-2603-z (DOI)000405712400025 ()28229317 (PubMedID)
Available from: 2017-03-03 Created: 2017-03-03 Last updated: 2017-12-19Bibliographically approved
Hauffman, A., Alfonsson, S., Mattson, S., Forslund, M., Bill-Axelson, A., Nygren, P. & Johansson, B. (2017). The development of a Nurse-led Internet-based Learning and Self-care program for cancer patients with symptoms of anxiety and depression: a part of U-CARE. Cancer Nursing, 40(5), E9-E16
Open this publication in new window or tab >>The development of a Nurse-led Internet-based Learning and Self-care program for cancer patients with symptoms of anxiety and depression: a part of U-CARE
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2017 (English)In: Cancer Nursing, ISSN 0162-220X, E-ISSN 1538-9804, ISSN 0162-220X, Vol. 40, no 5, p. E9-E16Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Having access to information about the disease and being encouraged to participate in self-care activities may reduce anxiety and depression symptoms in cancer patients. Internet-based interventions may be one way to support effective self-care strategies to improve emotional well-being and health-related quality of life.

OBJECTIVE:

The aim of this study was to describe the development and acceptance of an Internet-based program intended to support cancer patients with anxiety and depression symptoms.

METHODS:

A structured collaboration between patients, clinicians, and researchers was used to develop a theory- and evidence-based interactive health communication application (IHCA) based on Orem's self-care deficit nursing theory with influences from Bandura's social learning theory and psychoeducation.

RESULTS:

The result is an IHCA described as a Nurse-led, Internet-based Learning and Self-care program that helps patients to perform self-care using different types of material in interaction with patients and healthcare staff. The acceptance of the program is consistent with the results of similar studies.

CONCLUSIONS:

Collaboration between patients, clinicians, and researchers seems to be a fruitful approach in the development of an IHCA aiming to support cancer patients' self-care strategies. Well-designed intervention studies are needed to evaluate the effects of the IHCA.

IMPLICATIONS FOR PRACTICE:

This article suggests a theoretical foundation for an IHCA and allows researchers and healthcare providers to take part in the discussion regarding format and content of IHCAs.

National Category
Nursing
Research subject
Caring Sciences
Identifiers
urn:nbn:se:uu:diva-283650 (URN)10.1097/NCC.0000000000000402 (DOI)000414798700002 ()27223884 (PubMedID)
Funder
U‐Care: Better Psychosocial Care at Lower Cost? Evidence-based assessment and Psychosocial Care via Internet, a Swedish Example
Available from: 2016-04-14 Created: 2016-04-14 Last updated: 2019-04-05Bibliographically approved
Alfonsson, S., Spännargård, Å., Parling, T., Andersson, G. & Lundgren, T. (2017). The effects of clinical supervision on supervisees and patients in cognitive-behavioral therapy: a study protocol for a systematic review. Systematic Reviews, 6(94), 1-6
Open this publication in new window or tab >>The effects of clinical supervision on supervisees and patients in cognitive-behavioral therapy: a study protocol for a systematic review
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2017 (English)In: Systematic Reviews, E-ISSN 2046-4053, Vol. 6, no 94, p. 1-6Article, review/survey (Refereed) Published
Abstract [en]

Background: Clinical supervision by a senior therapist is a very common practice in psychotherapist training and psychiatric care settings. Though clinical supervision is advocated by most educational and governing institutions, the effects of clinical supervision on the supervisees ’ competence, e.g., attitudes, behaviors, and skills, as well as on treatment outcomes and other patient variables are debated and largely unknown. Evidence-based practice is advocated in clinical settings but has not yet been fully implemented in educational or clinical training settings. The aim of this systematic review is to synthesize and present the empirical literature regarding effects of clinical supervision in cognitive-behavioral therapy. Methods: This study will include a systematic review of the literature to identify studies that have empirically investigated the effects of supervision on supervised psychotherapists and/or the supervisees ’ patients. A comprehensive search strategy will be conducted to identify published controlled studies indexed in the MEDLINE, EMBASE, PsycINFO, and Cochrane Library databases. Data on supervision outcomes in both psychotherapists and their patients will be extracted, synthesized, and reported. Risk of bias and quality of the included studies will be assessed systematically. Discussion: This systematic review will rigorously follow established guidelines for systematic reviews in order to summarize and present the evidence base for clinical supervision in cognitive-behavioral therapy and may aid further research and discussion in this area.

Keywords
Systematic review, Clinical supervision, psychotherapy, Training
National Category
Psychology
Identifiers
urn:nbn:se:uu:diva-324208 (URN)10.1186/s13643-017-0486-7 (DOI)000453154500094 ()28490376 (PubMedID)
Available from: 2017-06-13 Created: 2017-06-13 Last updated: 2019-01-16Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-4570-5891

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