In recent years, kindness-based meditation practices, including loving-kindness meditation (LKM), have gained empirical support for decreasing depression and anxiety symptoms. LKM is defined as the intentional transmission of unselfish kindness toward all beings. It is practiced by contemplating an object of meditation (e.g., self, difficult person) and offering goodwill by silently repeating phrases (e.g., “May you be happy”). Given LKM’s focus on cultivating positive emotional states, researchers have hypothesized that LKM may work by increasing positive affect (PA), promoting cognitive and behavioral flexibility, and reducing negative affect (NA). This study was the first to employ a multiple baseline, single-case design to evaluate the acceptability and clinical efficacy of a brief, individual LKM intervention for individuals (N = 9) with unipolar depressive disorders, social anxiety disorder, or generalized anxiety disorder and low PA. Participants were randomized to a 2-, 4-, or 6-week baseline and completed weekly assessments during baseline, 7 weeks of treatment, and at 1-, 2- and 4-week follow-up. LKM was hypothesized to be acceptable and effective for reducing depression and anxiety symptoms and increasing PA. Secondary hypotheses were that (1) improvements in PA would precede disorder symptom improvement and (2) LKM would lead to improvements in other treatment variables (e.g., NA, anger, mindfulness, affective regulation styles, quality of life, etc.) Results revealed that the study intervention had good feasibility and acceptability. Per visual inspection, LKM led to improvements in principal disorder symptoms for four participants during treatment and five participants at follow-up (three of whom showed clinically reliable change). Contrary to study hypotheses, only one participant demonstrated reliable improvements in PA during treatment. For this participant, increases in PA occurred simultaneously with reductions in depression. Across participants, LKM exerted moderate to large effects on disorder severity, depression and anxiety symptoms, quality of life, mindful nonreactivity, and tolerating affective style. Overall, individuals with principal unipolar depressive disorders showed the strongest response to the study intervention. In summary, this study provided preliminary evidence for the effectiveness of brief, individual LKM for reducing depression and anxiety in a transdiagnostic outpatient sample with low positive affect.

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Bakgrund: Felaktiga torrvikter är ett problem inom hemodialysvården. Det kan orsaka vårdskada i form av komplikationer och lidande, med symtom som trötthet, blodtrycksfall och sendrag för dialyspatienter. Det finns ett behov av implementering av evidensbaserade metoder som minskar risken för fel i torrviktsbestämning. Bioimpedansmätning beskrivs i litteraturen som ett lovande hjälpmedel för bestämning av torrvikt Syfte: Undersöka effekten av bioimpedansledd torrviktskorrigering, på symtom som hemodialyspatienter kan erfara under och efter dialysbehandling. Metod: Experimentell intervention, i form av veckovis korrigering av torrvikt med vägledning av bioimpedansspektroskopi, utförd med single-case-design och multiple base- line. Urvalet bestod av sex strategiskt utvalda hemodialyspatienter. Resultat: Interventionen hade ringa effekt på förekomst av intradialytiska symtom. Bland studiens deltagare förelåg sällan samvariation mellan förekomst av blodtrycksfall och/eller sendrag och felaktig torrvikt. Däremot förelåg positivt samband mellan symtombörda och differens mellan predialytisk vikt och torrvikt. Bioimpedansmätningarna avslöjade dessutom kliniskt relevant varians i torrvikt över tid. Slutsats: Även om interventionen inte hade bevisad effekt på de beroende variablerna, är det inte uteslutet att noga monitorering av vätskebalans med bioimpedansmätare och korrigering av torrvikt kan förebygga uppkomst av intradialytiska symtom. I vissa subgrupper kan bioimpedansmätning också bidra till förbättrad blodtryckskontroll. Dialyspatienters torrvikt visade sig kunna variera med flera kilogram per vecka, varför fixerad torrvikt kan vara ett dilemma för vissa individer. Bioimpedansmätning bland hemodialyspatienter kan underlätta identifiering av individuella riskfaktorer för intradialytiska symtom och vara ett verktyg som bidrar till utvecklingen mot personcentrerad vård med större patientdelaktighet och individualiserade mål. / Background: Inaccurate dry weight is a problem in hemodialysis care. It can cause health damage in the form of suffering and complications such as fatigue, intradialytic hypotension (IDH) and cramps for dialysis patients. There is a need for implementation of evidence-based practices that reduce the risk of error in dry weight assessment. Bioelectrical impedance is described in literature as a promising tool for assessment of dry weight.Objective: Examine the effect of bioimpedance guided dry weight correction on symptoms that hemodialysis patients may experience during and after dialysis. Method: Experimental intervention in the form of weekly assessment of dry weight with the guidance of bioimpedance spectroscopy, performed with single-case design and multiple baseline. The sample consisted of six strategically selected hemodialysis patients. Results: The intervention had little effect on the prevalence of intradialytic symptoms. Among the study participants, the occurrence of IDH and / or cramps and inaccurate dry weight rarely correlated. However, there was positive correlation between symptoms and the difference between predialytic weight and dry weight. Bioimpedance measurement also revealed clinically relevant variance in dry weight over time. Conclusion: Although the intervention had no proven effect on the dependent variables, it is possible that careful monitoring of fluid balance with bioimpedance measurement and correction of dry weight can help prevent intradialytic symptoms. In certain subgroups bioelectrical impedance may also contribute to improved blood pressure control. Dialysis patients' dry weight was found to vary several kilograms per week; fixated dry weight may therefore be a dilemma for some individuals. Bioelectrical impedance among hemodialysis patients may facilitate identification of individual risk factors for intradialytic symptoms and be a tool that contributes to the development of person-centered care with greater patient participation and individualized goals.

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SammanfattningLångvarig smärta orsakar stort lidande för individen och belastar samhället ekonomiskt. Syftet med denna uppsats var att undersöka om en exponering in vivo-behandling inspirerad av Dialektisk beteendeterapi (DBT) för människor med långvarig ländryggssmärta var görbar samt om behandlingen gav effekt på smärtrelaterad problematik. Designen var en single case experimental design vilket är en beprövad design för att testa nya terapimetoder. Studien bestod av sex deltagare, alla med hög grad av smärtrelaterade katastroftankar, något som litteraturen visat predicera sämre behandlingsutfall. Behandlingen var DBT-inspirerad och indelad i tre faser; en första valideringsfas, en andra färdighetsfas och en tredje exponeringsfas. Fem av sex deltagare fick förbättringar på alla de primära utfallsmått, tre av sex deltagare fick förbättringar på samtliga primära- och sekundära utfallsmått. Framtida replikationer är motiverade. / AbstractChronic pain causes great suffering for the individual and burden society economically. The aim of this study was to examine whether an exposure in vivo treatment inspired by Dialectical Behavior Therapy (DBT) for people with chronic low back pain was feasible and whether the treatment had effect on pain-related problems. The design was a single case experimental design, which is a widely used design to test new therapy methods. The study consisted of six participants, all with high levels of pain catastrophizing, something that in the literature been linked to poor treatment outcomes. The treatment was inspired by DBT and divided into three phases: an initial validation phase, a second phase for skills training and a third exposure phase. The results were promising: five out of six participants had improved in all primary outcome measures. Three out of six participants had improvements in all primary and secondary outcome measures. Future replications are warranted.