Theoretischer Hintergrund: Die diagnostischen Kriterien der Generalisierten Angststörung (GAS) und ihr Status als eigenständige psychische Störung waren lange umstritten. Inzwischen liegen neuere epidemiologische Daten vor, die ein präziseres Bild dieser Störung und ihrer Besonderheiten ermöglichen. Methode: Es wird ein systematischer Überblick zu Prävalenz, Verlauf und Komorbidität, zur Beeinträchtigung und zum Inanspruchnahmeverhalten sowie zur Spezifität des Kernsymptoms (Sorgen) erstellt. Ergebnisse: GAS ist eine häufige Störung, die im jungen Erwachsenenalter einsetzt, jedoch auch – anders als andere Angststörungen – hohe Inzidenzraten im mittleren Lebensalter aufweist. Der Verlauf ist eher chronisch. Trotz hoher Komorbidität lässt sich die Störung valide abgrenzen. Klinisch relevante Sorgen erweisen sich als störungsspezifisch. Die Beeinträchtigungen sind auch bei GAS-Patienten ohne Komorbidität beträchtlich. Schlussfolgerung: Der Forschungsstand spricht für die Bedeutung und Eigenständigkeit der Diagnose sowie für die stärkere Beachtung offener Forschungsfragen. / Background: The diagnostic criteria for generalized anxiety disorder (GAD) and its status as an independent mental disorder have been controversial. More recent epidemiological data provide a more precise picture of this disorder and its specific features. Methods: A systematic overview is given in regard to prevalence, course and comorbidity, impairment, and help-seeking behavior as well as to specificity of the core symptom (worries). Results: GAD is a frequent disorder with high incidence rates in middle-age groups, which are not seen in other anxiety disorders. Despite the high comorbidity GAD can be validly distinguished. Clinically relevant worries have been proven as specific for the disorder. The impairments are also considerable for patients without comorbid disorders. Conclusions: Research supports the independent status of GAD and the importance of this diagnosis. Unsolved questions are to be analyzed in future research.

Bakgrund: Hälften av samtliga föräldrar upplever ångest inför att barnet ska genomgå anestesi. Preoperativ oro och ångest hos föräldrar kan exempelvis bero på att operationsmiljön upplevs skrämmande och att barnet kan tänkas uppleva smärta under vårdförloppet, men kan även relateras till anestesiinduktion och den separation från barnet som uppkommer härvid. Den ångest som föräldrar upplever kan överföras och inverka negativt på barnet. Syfte: Syftet var att undersöka tillgängliga interventioner samt deras effekt med avsikten att reducera preoperativ oro och ångest hos föräldrar till barn som ska genomgå kirurgi. Metod: En systematisk litteraturstudie genomfördes där 12 kvantitativa originalstudier söktes fram i databaserna Cinahl, Pubmed och PsycInfo, vilka kvalitetsgranskades och systematiskt analyserades. Relevanta resultat ur artiklarna extraherades i enlighet med Bettany-Saltikov och McSherry där avsikten var att via syntetisering generera föreliggande studies resultat. Resultat: Den systematiska litteraturstudien påvisar att preoperativa förberedelser i form av Undervisning via digitala hjälpmedel, Distraktion via lek, humor och musik, Förberedelser via preoperativ information samt Kombinerad preoperativ undervisning, medicinsk lek och rundvandring är interventioner som reducerar preoperativ oro och ångest hos föräldrar. Slutsats: Resultatet påvisade att flera interventioner hade en reducerande effekt avseende preoperativ oro och ångest hos föräldrar, men därtill att interventioner måste vara individuellt anpassade och i tillräckligt hög grad vara riktade till föräldrar för att erhålla önskvärd effekt. / Background: Half of all parents experience anxiety before the child undergoes anesthesia. Preoperative worry and anxiety in parents may, for example, be due to the fact that the surgical environment is experienced as frightening and that the child may experience pain during the course of care, but may also be related to anesthesia induction and the separation from the child that arises. The anxiety that parents experience can be transmitted to and cause negative effects on the child. Aim: The aim was to examine available interventions and their effects regarding intention of reducing preoperative worry and anxiety in parents of children undergoing surgery. Method: A systematic literature review was conducted where 12 quantitative original studies were applied from the databases Cinahl, Pubmed and PsycInfo, which were quality checked and systematically analyzed. Relevant results from the articles were extracted in accordance to Bettany-Saltikov and McSherry where the intention was to generate the results of this review by synthesization. Results: The systematic literature review demonstrates that preoperative preparations in terms of Teaching by digital aids, Distraction by play, humor and music, Preparation by preoperative information and Combined preoperative teaching, medical play and tour are interventions reducing preoperative worry and anxiety in parents. Conclusion: The results demonstrate that several interventions had a reducing effect regarding preoperative worry and anxiety in parents, but in addition that interventions must be individually customized and sufficiently directed at parents to obtain the desired effect.

Bakgrund Studier visar att det är vanligt att barn känner rädsla oro och ångest inför en operation. Att ha ont i magen och inte kunna sova några dagar innan operation är vanligt bland barn. Många sjuksköterskor möter dagligen barn i sitt yrke och ibland kan det vara en utmaning att tillgodose barns behov av trygghet. Syfte Syftet med denna litteraturöversikt var att kartlägga omvårdnadsåtgärder som kan utföras i det preoperativa skedet för att minska och motverka rädsla, oro och ångest hos barn som är mellan 2–14 år. Metod Examensarbetet har genomförts som en strukturerad litteraturöversikt med inslag av den metodologi som används vid systematiska översikter. Resultatet baserades på fyra kvalitativa och 13 kvantitativa artiklar. Artiklarnas fynd delades in i olika kategorier utifrån likheter och skillnader för att kunna sammanställa resultatet. Resultat I resultatet framkom tre huvudkategorier. Dessa är: Åldersanpassad information, distraktion och bemötande. Under huvudkategorier presenteras underkategorier: Skriftlig information, visuell information och spel, lek som distraktion, avledning som distraktion, sjuksköterskans förhållningssätt och föräldrars roll. Slutsats Sjuksköterskan kan utföra preoperativa omvårdnadsåtgärder för att minska och motverka rädsla, oro och ångest hos barn. Kommunikation är en viktig del i omvårdnaden. Barns rädsla, oro och ångest ökar om föräldrarna är oroliga. Att arbeta barncentrerat men även familjefokuserat är därför viktigt. / Background Studies show that it is common for children to feel fear, worry and anxiety before an operation. Having a stomach-ache and not being able to sleep a few days before surgery is common among children. Many nurses meet children daily in their profession and sometimes it can be a challenge to meet childrens need for security. Aim The purpose of this literature review was to chart nursing interventions that can be performed in the preoperative stage to reduce and counteract fear, worry and anxiety in children aged 2–14 years. Method A structure literature review with elements of the methodology used in systematic reviews. The result was based on 4 qualitative and 13 quantitative articles. The findings in the articles were then divided into different categories based on similarities and differences in order to compile the results. Results The results revealed three main categories. These are: Age-appropriate information, distraction and treatment. Under the main categories, subcategories are presented: Written information, visual information and games, play as a distraction, diversion as a distraction, the nurse's approach and the role of parents. Conclusions The nurse can perform preoperative nursing interventions to reduce and counteract fear, worry and anxiety in children. Communication is an important part of nursing. Childrens fear, worry and anxiety increase if the parents are worried. Working childcentred and also family-focused is therefore important.

In a time filled with concerns and threats of terrorism, Sweden faces a challenge that demands our full attention. In this critical situation, we have chosen to investigate how students perceive the threat of a potential terrorist attack. Previous research has shown that people's trust in authorities affects the extent to which they feel fear about the possibility of a terrorist attack. Prior research has further emphasized the importance of media consumption and gender in shaping the experience of fear. The purpose of this pilot study is to examine how the increased threat to Sweden influences the level of fear among students across the country regarding a potential terrorist attack in Sweden. Additionally, the aim is to investigate whether trust in the general public has any significance for fear, while controlling for the impact of media consumption and gender. The theoretical framework draws upon Beck's theory of the risk society, Giddens' concepts of ontological security, trust, and expert systems, and finally Misztal's definition of the concept of trust. Data collection involves a survey, with the sample consisting of individuals over 18 years of age residing in Sweden and studying at a university or college. Univariate analysis, as well as bivariate and multiple regression analysis, were used to analyze the collected data. The study revealed that students' experiences of fear varied, with trust in authorities and the general public having no impact on their fear levels. However, the degree of fear was significantly influenced by students' media consumption, which also affected the relationship between trust and fear. / I en tid fylld av oro och hot om terrordåd står Sverige inför en utmaning som kräver vår fulla uppmärksamhet. I detta kritiska läge har vi valt att undersöka hur studenter upplever hotet om ett eventuellt terrordåd. Tidigare forskning har visat på att människors tillit till myndigheter påverkar i vilken utsträckning de känner oro för att ett eventuellt terrordåd ska ske. Forskning har ytterligare understrukit mediekonsumtion och köns betydelse för upplevelsen av oro. Syftet med denna pilotstudie är att undersöka hur det ökade hotet mot Sverige påverkar i vilken utsträckning studenter runt om i landet känner oro för ett eventuellt terrordåd i Sverige. Vidare är syftet att undersöka om tilliten till allmänheten har någon betydelse för oron, samt kontrollera för mediekonsumtion och köns betydelse. Den teoretiska referensramen utgår ifrån Becks teori om risksamhället, Giddens begrepp ontologisk trygghet, tillit samt expertsystem och till sist Misztal definition av tillitssbegreppet. Datainsamlingen består av en enkätundersökning, där studiens urval består av personer över 18 år bosatta i Sverige som studerar på universitet eller högskola. Univariatanalys samt bivariat- och multipel regressionsanalys användes för att analysera studiens insamlade data. Studien visade att studenters upplevelser av oro är utspridd där tilliten till allmänheten inte har någon påverkan på deras oro. Graden av oro påverkas däremot till stor del av studenternas mediekonsumtion som även påverkar sambandet mellan tillit och oro.

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Insomni och depression är två  psykiatriska tillstånd med hög prevalens. Prevalensen för insomni är ca 11% hos den svenska befolkningen och motsvarande siffror för depression är ca 5-8%. Komorbiditet mellan dessa två tillstånd är vanligt förekommande. Dessa två tillstånd är ofta teoretiskt sammankopplade med de två kognitiva processerna oro och ruminering. En behandlingsmetod som visat sig vara effektiv mot respektive tillstånd är kognitiv beteendeterapi (KBT). I föreliggande studie har internetbaserad KBT (iKBT) där båda tillstånden behandlas simultant studerats. Studiens huvudsakliga syfte var att undersöka skillnaden i utfall mellan en behandlingsmetod och en kontrollbehandling samt dess långtidseffekter. Totalt inkluderades 124 deltagare som randomiserades till antingen kombinationsbehandling mot komorbid insomni och depression (n=63), eller kontrollbehandling mot depression med desensibilisering som placebo mot insomni (n=61). Resultatet visar att behandlingsgruppen har en statistiskt signifikant större sänkning av insomnisymtom mellan före- och eftermätning jämfört med kontrollbehandling. Statistiskt signifikanta samband förekom gällande förändring i insomnisymtom, depressionssymtom, oro och ruminering mellan två mättillfällen. Förändring i oro mellan före- och eftermätning kunde predicera utfall i förändringsvärde för insomnisymtom mellan föremätning och FU36. Förändring i oro mellan före- och eftermätning kunde predicera nivå av depressionssymtom vid FU36. Studiens resultat stärker hypotesen att insomni är ett tillstånd som kräver specifik behandling och att det finns ett samband mellan insomni och depression samt de kognitiva processerna oro och ruminering men att detta samband bör undersökas ytterligare. / Insomnia and depression are two psychiatric conditions with high prevalence in the general population. Insomnia occurs among around 11% of the Swedish population and the equivalence for depression is around 5-8%. These conditions frequently appear comorbidly. There has found to be a theoretical link between these two conditions and the cognitive processes labeled anxious worry and rumination. One treatment method which has shown itself to be effective in treating these respective conditions is cognitive behavioral therapy (CBT). In the present study, internet-delivered CBT aiming to treat both conditions simultaneously have been studied with the purpose of evaluating two different methods and the long term effects of these methods. A total of 124 participants were included and randomized to either a combined treatment for insomnia or depression (n=63) or a control treatment consisting of treatment for depression and desensibilisation as placebo for insomnia (n=61). The results of the present study indicates a statistically significant effect on symptoms of insomnia between pre- and post measurements depending on treatment group. There was a statistically significant correlation between change in all the four domains, depression, insomnia, rumination and anxious worry between two separate measurements. A change in anxious worry between pre and post measurements was also found to predict the level of change in insomnia symptoms between pre and 36 month follow-up measurements. Change in anxious worry between pre and post measurements could also predict the level of depression observed at the measurement at the 36 month follow-up. The findings in this study corroborates the hypotheses that insomnia is a condition which require a specific treatment and that there is a relation between insomnia and depression and the cognitive processes anxious worry and rumination but that this relation needs to be further examined. / ClinicalTrials.gov Identifier: NCT01663844 New Clinical Applications for Internet-based Cognitive Behavior Therapy for Insomnia and Depression

Background: Worry exposure (WE) is a core element of cognitive-behavioral treatment for generalized anxiety disorder (GAD). Its efficacy as a stand-alone treatment method (without further cognitive-behavioral therapy interventions) has never been tested.We aimed to examine whether WE alone is as efficacious as the empirically supported stand-alone treatment for GAD, applied relaxation (AR). Methods: In a randomized controlled study, 73 outpatients meeting DSM-IV criteria for GAD as primary diagnosis were allocated to either WE or AR or a waiting list control group; in a 2nd randomization procedure the waiting list subjects were reallocated to WE or AR. The treatment was manualized (15 sessions with WE or AR), included 6-month and 1-year follow-ups, as well as last observation carried forward and completer analyses, and was controlled for allegiance effects.The Hamilton Anxiety Rating Scale and the State-Trait Anxiety Scale were used as primary outcome measures. Self-report scales of anxiety, worrying and depression including negative metacognition about worrying and thought suppression served as secondary outcome measures. Results: The dropout rate was moderate. The pre-/posttreatment effects were high for the Hamilton Anxiety Rating Scale (standardized mean difference >1) and for the State-Trait Anxiety Inventory (standardized mean difference >0.87). The proportion of patients reaching high end state functioning was 48% (WE) and 56% (AR). WE and AR did not differ with regard to dropout rate or treatment effects. The treatment effects were stable at 6 month and 1 year follow-up. Conclusion: This is the first study to show that a stand-alone exposure in sensu technique – WE – is efficacious in the treatment of GAD. Both AR and WE seem to represent effective principles of change in GAD. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Emotions are an integral part of the human experience and their interpretation can provide valuable but also misleading clues about oneself and other people’s state of mind. Negative emotional states can be perceived as uncomfortable and – when experienced chronically – can develop into anxiety and mood disorders. The more pervasive these disorders the more severely they affect and disable a person’s everyday functioning and often their sleep as well. According to Lang and colleagues (1998), emotions may be expressed verbally, behaviorally, and physiologically, i.e., emotions can be reported, observed, and objectively measured. Each measurement approach provides important, unique, and often conflicting information that can be used in the assessment and treatment evaluation of psychological disorders affecting the emotions. Autonomic measures have been used to indicate the physiological components of emotions, such as those along the worry-anxiety-fear-panic spectrum. Worry has been shown to suppress cardiac responses to imaginal feared material (see Borkovec, Alcaine, & Behar, 2004) and reduce autonomic variability (Hoehn-Saric, McLeod, Funderburk, & Kowalski, 2004; Hoehn-Saric, McLeod, & Zimmerli, 1989). Results for panic and anticipatory anxiety are less conclusive but theoretically these states should go along with increased autonomic arousal. Abnormal autonomic arousal might also be present during sleep as both panic disorder and worrying have been associated with sleeping difficulties. However, most empirical research has been confined to the laboratory where high internal validity is achieved at the cost of poor ecological validity. Thus, the purpose of this doctoral dissertation is to extend and validate laboratory findings on worry, anticipatory anxiety, and panic using ambulatory monitoring. Twenty-four hour monitoring not only can give valuable insights into a person’s daytime emotional experience but also allows observing how these emotions might affect their sleep in their natural environment. In the following chapter, the reader will be introduced to a conceptual framework that ties together worry, anxiety, fear, and panic, and related anxiety disorders (section 2.1), to autonomic arousal and electrodermal and cardiac arousal in particular (section 2.2), to sleep and its relation to autonomic arousal and anxiety disorders (section 2.3), and to ambulatory monitoring (section 2.4). After illustrating the aims of this thesis (chapter 3), chapters 4 to 6 present the results of three empirical studies conducted as part of this doctoral research. The first study deals solely with electrodermal monitoring and how it is affected by confounding variables in an ambulatory context (chapter 4). The next study then seeks to investigate the relationship between electrodermal arousal and anticipatory anxiety and panic in a sample of panic disorder patients and healthy controls. The last study focuses primarily on the effect of trait and state worry on subjective and objective sleep and electrodermal and cardiac arousal in a group of high and low worriers. Chapters 7 to 9 summarize and integrate the findings from these three empirical studies, discuss methodological limitations, and provide an outlook into future research.

Kognitiv beteendeterapi för primär insomni är inte lika effektivt som KBT för annan problematik. Behandlingen har mest fokuserat på förändring av sömn och bortsett från andra faktorer som kan bidraga till problematiken. Denna studie syftade till att utvärdera effekten av att addera en intervention mot en ytterligare faktor, nämligen oro, till behandling. Studien hade en single subject-design med två betingelser, med och utan oroshantering, för- och eftermätning och sju deltagare. Resultaten tyder på att metoden konstruktiv oro tillförde bättre utfall på sömn, oro och daglig funktion. Slutsatsen är att fokus på fler faktorer än sömn, som oro och dagtidsfunktion, kan effektivisera KBT för primär insomni. / Cognitive behavioral therapy for primary insomnia is not as effective as CBT for other problems. The treatment has primary focused on change of sleep and neglected other factors which can contribute to the problem. The purpose of this study was to investigate the effect of adding an intervention aimed at an additional factor, namely worry, to treatment. The study had a single subject design with two conditions, with and without constructive worry, pre- and posttest and seven participants. The results indicated that the intervention constructive worry added better outcomes on sleep, worry and daytime function.  The conclusion that can be drawn is that a focus on more factors than sleep, such as worry and daytime function, can render CBT for primary insomnia more effective.

Meta-cognitive models have been utilized to explore the relations between worry and generalized anxiety disorder, as well as, the associations between rumination and depression. However, relatively few studies have focused on the role of meta-cognitive variables and social phobia symptoms. It is possible that individuals with social phobia follow a pattern of thinking similar to that of those who experience depressive rumination and worry. Specifically, it may be that individuals with social phobia hold positive beliefs about their highly negative prolonged post-event evaluations of social interactions. The primary goal of this study was the development and assessment of the Positive Beliefs about Post-Event Processing Questionnaire (PB-PEPQ). Further, it was predicted that post-event processing would mediate the relationship between positive beliefs about post-event processing and social phobia symptoms. The findings from this study suggested that the PB-PEPQ is a valid and reliable construct. Additionally, the findings provide initial evidence for a cognitive model in which individuals who tend to hold positive beliefs about post-event processing, tend to engage in post-event processing which may increase social phobia symptoms.