Insomnia is a common health complaint that often becomes a persistent problem. The theoretical frameworks for understanding and treating insomnia have mostly been behavioural, yet the importance of cognitive processes has received greater attention over the years. The overall aim of this dissertation was to expand the knowledge on the processes from the Cognitive Model of Insomnia by investigating them in novel contexts. Study I examined the outcomes from cognitive therapy for insomnia on adolescents. Study II explored the relationship between cognitive processes and the association with remission and persistence of insomnia in the general population. Lastly, Study III investigated if cognitive processes mediated between cognitive behavioural therapy for insomnia (CBT-I) and outcomes of insomnia and depressive severity in a sample of people with insomnia comorbid with depressive problems. The findings show that cognitive therapy for insomnia affected sleep for adolescents, thus this is a promising treatment option for this age group. Further, it was found that cognitive processes distinguished between adults with normal sleep and persistent insomnia. For people with insomnia, elevated sleep-related worry at baseline increased the risk of reporting persistent insomnia later on, whereas a lowering of selective attention and monitoring, and safety behaviours over time increased the likelihood of remission from insomnia. This has clinical implications for insomnia assessment and treatment, as well as theoretical implications, and warrants further research. CBT-I was associated with greater reductions in dysfunctional beliefs and sleep-related safety behaviours compared to control treatment. Dysfunctional beliefs mediated between CBT-I and insomnia severity and depressive severity respectively. This supports the importance of negative thought content in both insomnia and depression.

Despite the success of available medical and psychosocial treatments, a sizable subgroup of individuals with commonly co-occurring disorders, generalized anxiety disorder (GAD) and major depressive disorder (MDD), fail to make sufficient treatment gains thereby prolonging their deficits in life functioning and satisfaction. Clinically, these patients often display temperamental features reflecting heightened sensitivity to underlying motivational systems related to threat/safety and reward/loss (e.g., somatic anxiety) as well as inordinate negative self-referential processing (e.g., worry, rumination). This profile may reflect disruption in two important neural networks associated with emotional/motivational salience (e.g., salience network) and self-referentiality (e.g., default network, DN). Emotion Regulation Therapy (ERT) was developed to target this hypothesized profile and its neurobehavioral markers. In the present study, 22 GAD patients (with and without MDD) completed resting state MRI scans before receiving 16 sessions of ERT. To test study these hypotheses, we examined the associations between baseline patterns of intrinsic functional connectivity (iFC) of the insula and of hubs within the DN (anterior and dorsal medial prefrontal cortex [MPFC] and posterior cingulate cortex [PCC]) and treatment-related changes in worry, somatic anxiety symptoms and decentering. Results suggest that greater treatment linked reductions in worry were associated with iFC clusters in both the insular and parietal cortices. Greater treatment linked gains in decentering, a metacognitive process that involves the capacity to observe items that arise in the mind with healthy psychological distance that is targeted by ERT, was associated with iFC clusters in the anterior and posterior DN. The current study adds to the growing body of research implicating disruptions in the default and salience networks as promising targets of treatment for GAD with and without co-occurring MDD.

I dag föds färre barn med ryggmärgsbråck på grund av att skadan kan upptäckas med fosterdiagnostik. Kunskapen om ryggmärgbråck utanför specialistklinikerna är bristande och kommunikationsproblemen mellan vårdpersonal och föräldrar är inte ovanligt. Det symtom som mest påverkar vardagen hos den som har ryggmärgsbråck är blåsrubbning.Syftet är att beskriva upplevelser av vara förälder till ungdomar och unga vuxna födda med ryggmärgsbråck, och hur ungdomen och den unge vuxne själv upplever att leva med skadan.Vi har använt oss av en kvalitativ metod och resultatet bygger framförallt på vetenskapliga artiklar och avhandlingar. Materialet analyserades med hjälp av Evans (2003) analysmodell. Resultatet visar att föräldrarna upplever olika sorters oro under barnets uppväxt och att det ofta förekommer brister i samarbetet mellan föräldrar och vårdpersonal. I resultatet framkommer att ungdomarna inte upplever sig som annorlunda utan det är snarare omgivningen som påminner dem om deras funktionsnedsättning. Ryggmärgsbråcket kan dock påverka det dagliga livet i större eller mindre utsträckning. I diskussionen diskuteras först metodval. Vi valde att diskutera dagens fosterdiagnostik, och vilka signaler det sänder ut till samhället. Vi diskuterar om det bristande samarbetet mellan föräldrar och vårdpersonal. Vi tar upp föräldrarnas oro och ungdomars upplevelser av sin funktionsnedsättning och kopplar det till begreppet subjektiv kropp. / <p>Program: Sjuksköterskeutbildning</p><p>Uppsatsnivå: C</p>

<p>Hovedmålet med avhandlingen var å undersøke risikopersepsjon i den norske befolkningen. I tillegg ble relaterte prioriteringer av sikkerhet og krav om risikoreduserende tiltak undersøkt. Avhandlingen består av en introduksjonsdel og tre artikler. Alle er basert på to spørreskjemaundersøkelser gjennomført i 2004 (n= 1730 og 510).</p><p>Den første artikkelen hadde som hovedmål å undersøke risikopersepsjon. Resultatene viser at transportrisiko er delt i to hovedkategorier: offentlig og privat transport. Bekymring ble funnet å være den viktigste predikatoren på risikopersepsjon. Ved nærmere undersøkelse ble det funnet kjønnsforskjeller hvor kvinner la størst vekt på bekymring relatert til både offentlig og privat transport. For menn derimot var sannsynlighetsvurderinger (dvs. kognitive evalueringer) viktigst for privat transport, mens bekymring var viktigst for offentlig transport. Dette impliserer en forskjell i hvordan risikoen blir oppfattet, og dermed er det ansett som hensiktsmessig å differensiere hvordan risiko blir kommunisert til de ulike gruppene.</p><p>Den andre artikkelen foreslår en modell for potensielle faktorer som kan predikere prioritering av sikkerhet. Effekten av personlighetstrekkene angst, sensasjonssøking og tillit ble undersøkt. I tillegg var føreroptimisme, bekymring relatert til transportrisiko, betalingsvillighet for å redusere risiko og negative holdninger mot regler inkludert i modellen. Bekymring var den viktigste predikatoren for prioritering av sikkerhet. Den foreslåtte modellen forklarte 44% av variansen i sikkerhetsprioriteringer. Denne kunnskapen kan øke suksessen relater til intervensjoner fordi det kan øke sjansen for å treffe de som prioriterer sikkerhet lavt og dermed veilede dem til å forandre sin atferd.</p><p>Den tredje artikkelen undersøker hvorvidt det teorietiske rammeverket til ’risk-as-feelings’ hypotesen kunne brukes til å forklare krav om risikoreduserende tiltak. Modelltilpasningen til den teoretiske modellen var tilfredsstillende og resultatene viste at 30% av variasjonen til krav om risikoreduserende tiltak kunne forklares av denne modellen. Den viktigste predikatoren var atferdsmessige intensjoner om å prioritere sikkerhet. Sannsynlighetsvurdering og evaluering av konsekvenser ble funnet å være viktige for både kognitiv vurdering og følelser.</p> / <p>The aims of the PhD-thesis were to examine perceived risk in the Norwegian public as well as related priorities of safety and demands for risk mitigation. The thesis consists of a theoretical introduction and three papers. They are all based on two questionnaire surveys conducted in 2004 (n=1730 and 510 respectively).</p><p>The first paper aims to explore risk perception. The results showed that transport risks consisted of two main categories: public and private means of transportation. Related to risk perception, worry was found to be the most important predictor. On further scrutiny, a gender difference was found. Females were found to emphasize worry related to both public and private transportation as highest. For men, probability assessments (i.e. cognitive evaluations) were found to be most important to private means of transportation whereas worry was found to be most important for public transportation. This implies a difference in perceived risk, and hence how risk is communicated to the public should dependent on the target group.</p><p>The second paper proposed a model for potential predictors of priorities of safety. Several factors were investigated. First, the personality traits anxiety, excitement-seeking, and trust were included. Further factors were driver optimism, worry related to transport risks, willingness to pay to increase safety, and negative attitudes towards traffic rules. Worry was found to be the most important predictor of safety priorities, and the proposed model explained 44% of the variance in priority of safety. This knowledge gives additional information to improve the success of interventions because it can help targeting those who consider safety a low priority and guide them to modify their behaviour.</p><p>The third paper investigated the applicability of the risk-as-feeling framework to explain demand for risk mitigation. The fit of the data to the theoretical model was found to be satisfactory. The results showed that the risk-as-feelings framework explained 30 per cent of the variance of demand for risk mitigation. Behavioural intentions as priorities were found to be an important predictor of mitigation demands. Probability assessment and consequence evaluation were found to be important to cognitive risk assessment and feelings.</p>

Hovedmålet med avhandlingen var å undersøke risikopersepsjon i den norske befolkningen. I tillegg ble relaterte prioriteringer av sikkerhet og krav om risikoreduserende tiltak undersøkt. Avhandlingen består av en introduksjonsdel og tre artikler. Alle er basert på to spørreskjemaundersøkelser gjennomført i 2004 (n= 1730 og 510). Den første artikkelen hadde som hovedmål å undersøke risikopersepsjon. Resultatene viser at transportrisiko er delt i to hovedkategorier: offentlig og privat transport. Bekymring ble funnet å være den viktigste predikatoren på risikopersepsjon. Ved nærmere undersøkelse ble det funnet kjønnsforskjeller hvor kvinner la størst vekt på bekymring relatert til både offentlig og privat transport. For menn derimot var sannsynlighetsvurderinger (dvs. kognitive evalueringer) viktigst for privat transport, mens bekymring var viktigst for offentlig transport. Dette impliserer en forskjell i hvordan risikoen blir oppfattet, og dermed er det ansett som hensiktsmessig å differensiere hvordan risiko blir kommunisert til de ulike gruppene. Den andre artikkelen foreslår en modell for potensielle faktorer som kan predikere prioritering av sikkerhet. Effekten av personlighetstrekkene angst, sensasjonssøking og tillit ble undersøkt. I tillegg var føreroptimisme, bekymring relatert til transportrisiko, betalingsvillighet for å redusere risiko og negative holdninger mot regler inkludert i modellen. Bekymring var den viktigste predikatoren for prioritering av sikkerhet. Den foreslåtte modellen forklarte 44% av variansen i sikkerhetsprioriteringer. Denne kunnskapen kan øke suksessen relater til intervensjoner fordi det kan øke sjansen for å treffe de som prioriterer sikkerhet lavt og dermed veilede dem til å forandre sin atferd. Den tredje artikkelen undersøker hvorvidt det teorietiske rammeverket til ’risk-as-feelings’ hypotesen kunne brukes til å forklare krav om risikoreduserende tiltak. Modelltilpasningen til den teoretiske modellen var tilfredsstillende og resultatene viste at 30% av variasjonen til krav om risikoreduserende tiltak kunne forklares av denne modellen. Den viktigste predikatoren var atferdsmessige intensjoner om å prioritere sikkerhet. Sannsynlighetsvurdering og evaluering av konsekvenser ble funnet å være viktige for både kognitiv vurdering og følelser. / The aims of the PhD-thesis were to examine perceived risk in the Norwegian public as well as related priorities of safety and demands for risk mitigation. The thesis consists of a theoretical introduction and three papers. They are all based on two questionnaire surveys conducted in 2004 (n=1730 and 510 respectively). The first paper aims to explore risk perception. The results showed that transport risks consisted of two main categories: public and private means of transportation. Related to risk perception, worry was found to be the most important predictor. On further scrutiny, a gender difference was found. Females were found to emphasize worry related to both public and private transportation as highest. For men, probability assessments (i.e. cognitive evaluations) were found to be most important to private means of transportation whereas worry was found to be most important for public transportation. This implies a difference in perceived risk, and hence how risk is communicated to the public should dependent on the target group. The second paper proposed a model for potential predictors of priorities of safety. Several factors were investigated. First, the personality traits anxiety, excitement-seeking, and trust were included. Further factors were driver optimism, worry related to transport risks, willingness to pay to increase safety, and negative attitudes towards traffic rules. Worry was found to be the most important predictor of safety priorities, and the proposed model explained 44% of the variance in priority of safety. This knowledge gives additional information to improve the success of interventions because it can help targeting those who consider safety a low priority and guide them to modify their behaviour. The third paper investigated the applicability of the risk-as-feeling framework to explain demand for risk mitigation. The fit of the data to the theoretical model was found to be satisfactory. The results showed that the risk-as-feelings framework explained 30 per cent of the variance of demand for risk mitigation. Behavioural intentions as priorities were found to be an important predictor of mitigation demands. Probability assessment and consequence evaluation were found to be important to cognitive risk assessment and feelings.

The main aims were to: explore whether there is a relation between doctors’ ability to identify patients’ worry and wish for information and self-efficacy with regard to communicating with patients about difficult matters; describe which cues doctors consider when estimating patients’ worry and wish for information, and investigate whether there is a relation between patients’ satisfaction with doctors’ care and patients’ psychosocial function. Eleven doctors and 69 patients (of which 36 patients participated in the longitudinal study) with carcinoid tumours participated. Doctors’ self-efficacy, and ability to identify patients’ worry/wish for information were investigated at patients’ first admission. Doctors were interviewed about which cues they considered when estimating patients worry/wish for information. Patients’ satisfaction with care (CASC SF 4.0) and psychosocial function (EORTC QLQ-C30, HADS) were measured longitudinally, during the first year after diagnosis. Doctors reported higher self-efficacy when showing good ability to identify patients’ wish for information, than when showing less good ability, overestimated patients’ worry and underestimated patients’ wish for information. Doctors considered patients’ verbal behaviour and body language together with knowledge and experience when estimating patients worry and wish for information. Patients who met doctors showing good ability to identify their wish for information, reported a higher cognitive function than patients who met doctors showing less good ability. At all assessments patients expressed high satisfaction with doctor’ care and patients’ satisfaction did not change over time. Patients’ satisfaction with doctors’ care were related to their psychosocial function shortly after the first three admissions to specialist care. Patients with carcinoid tumours in some respects reported a worse HRQoL than the general Swedish population. Fatigue, diarrhoea, limited possibilities to work/pursue daily activities, and worry that the illness will get worse were among the most prevalent, and worst, aspects of disease- and treatment related distress.

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.

Thesis (Ph. D.)--University of Missouri-Columbia, 2001. / Typescript. Vita. Includes bibliographical references (leaves 76-85). Also available on the Internet.

Thesis (Ph. D.)--University of Missouri-Columbia, 2001. / Typescript. Vita. Includes bibliographical references (leaves 76-85). Also available on the Internet.

Syftet med studien har varit att få klarhet i vilka faktorer som påverkar personalens handlande i mötet med äldres upplevelser av ensamhet, oro och ångest inom äldreomsorgen. Studien är kvantitativ och en enkätundersökning har genomförts på omsorgsavdelningar med personal som arbetar på särskilt boende. Jag har varit intresserad av att studera hur personalen möter de äldres upplevelser samt om brister kan identifieras som påverkar personalens handlande gentemot äldres behov. Den här studien har sin utgångspunkt i Socialstyrelsens nationella enkätundersökning 2012. Socialstyrelsens undersökning visade höga siffror vad gäller äldres upplevelser av ensamhet, oro och ångest på särskilt boende, vilket jag valt att studera vidare kring. Urvalet i min studie har bestått av 50 omsorgspersonal varav 31 svarade på enkäten vilket gav en svarsfrekvens på 62 procent. Den teoretiska utgångspunkten för studien har varit analysmodell med faktorer som utgår från individuella och organisatoriska områden. Studien påvisar utifrån personalens perspektiv att äldre upplever oro och ångest i hög grad vilket personalen anser orsakas av känslor av ensamhet. Resultaten utifrån analysmodellen visar huvudsakligen brister inom organisatoriska områden som brist på tid, arbetssätt, resurser, mål och arbetsledning. Personalens individuella resurser såsom empati, engagemang och värderingar visar tillfredsställande resultat. Däremot personalens kompetens vad gäller bemötande och arbetsmetoder visar genomgående brister. Detta påvisas genom avsaknad av utveckling och mål på det personliga, arbetsmässiga samt utbildningsmässiga planet. De äldres sociala tillfredsställelse har i studien gett paradoxala svar angående deras behov av samtal, stöd och gemenskap. Å ena sidan anses de äldres sociala behov vara tillfredsställda. Å andra sidan anses de äldre inte kunna påverka sina känslor av ensamhet, oro och ångest då personalen hänvisar till brist på tid och kompetens. / The purpose of this study was to ascertain the factors affecting employee behavior when meeting older people's experiences of loneliness, worry and anxiety in elderly care. The study is quantitative and a questionnaire survey has been conducted with staff working in elderly care. My scope has been based on the staff´s perspective to find out the situation of the elderly and needs from social satisfaction and the older people´s opportunities for meaningful conversations in retirement home. The study is based on the 2012 national survey, performed by the Swedish National Board of Health and Welfare (Socialstyrelsen). The survey is showing high numbers of older people`s experience of loneliness, worry and anxiety in retirement home, which I have chosen to study futher about. The sample of the study consisted of 50 care staff employees, 31 of which responded to the questionnaire giving a response rate of 62 percent. The theoretical starting point for the study is an analysis model with prepared factors. Factors based on individual and organizational areas acquired from the theory of the elderly care. The study demonstrates from the perspective of the staff members, that the elderly are experiencing a high grade of worry and anxiety, which is considered to be caused by feelings of loneliness. The results based on the analysis model shows mainly deficiencies in organizational areas such as lack of time, work methods, resources, goals and management. The employees individual resources such as empathy, commitment and values show satisfactory results. However the staff's competence in treatment and working consistently show deficiencies. This is demonstrated by the lack of development and aims at the personal, labor, and educational level. Older people's social satisfaction has in the study yielded paradoxical response regarding older people's need foriiconversation, support and fellowship. On the one hand the social needs of the elderly is considered to be satisfied. On the other hand, the elderly are considered not to be able to influence their feelings of loneliness, worry and anxiety as the staff refer to the lack of time and expertise.