http://hdl.handle.net/1956/991 Search the Channel search http://bora.uib.no/simple-search http://hdl.handle.net/1956/1941 Title: Insomnia in older adults : consequences, assessment and treatment <br/> <br/>Authors: Sivertsen, Børge <br/> <br/>Abstract: Objective: Insomnia is one of the most common conditions in older adults, affecting almost one third of adults aged 55 years or older. Insomnia has been linked to a number of individual adverse medical and psychological consequences, in addition to having large socioeconomic consequences in terms of lost productivity and risk of accidents. Still, only ten percent of chronic insomniacs receive treatment for their condition, of which the vast majority is treated pharmacologically. Psychological treatment options have previously been successfully applied in younger adults, but only a few studies have focused on nonpharmacological treatment in the elderly. In the first paper of this thesis, we investigated empirically the contribution of insomnia to the award of disability pensions. The aim of the study was to estimate the independent effect of insomnia on permanent work disability by statistically controlling for a range of possible confounders. In the second paper we examined both the short- and long-term treatment effect of cognitivebehavior therapy (CBT) and pharmacological treatment in older adults suffering from insomnia. In the third paper, we compared both the psychometric properties and clinical utility of two objective measures of sleep (polysomnography and actigraphy) in the same study sample as in paper II. Methods: In the first paper we used a historical cohort design to estimate the effect of DSM-IV defined insomnia on permanent work disability. Baseline data comprised 37 308 working age people from a large population based Norwegian health study. The outcome was subsequent award of a disability pension 18 to 48 months after baseline assessment, as registered in the National Insurance Administration. In order to estimate the independent contribution of insomnia, we statistically controlled for a range of possible confounders. These included both physical and mental symptoms and diagnoses, as well as lifestyle behaviors, shift work and other potential socio-demographic factors. The two papers from the treatment study are based on a double-blinded randomized controlled trial of 46 patients with chronic primary insomnia who received either cognitivebehavior therapy (CBT, n=18), sleep medication (7.5 mg zopiclone daily, n=16), or placebo (n=12). All active treatments lasted 6 weeks with follow-ups conducted at 6 months. Ambulant clinical polysomnography (PSG), actigraphy and sleep diaries were used on all three assessment points. In paper II we primarily focused on the treatment effect of the two active interventions, while we in paper III explored the ability of actigraphy to correctly classify sleep/wake patterns. Results: From the first paper it is concluded that insomnia is a robust and independent predictor of subsequent permanent work disability. Socio-demographic and shift work characteristics barely affected the association, which also remained significant after adjusting for both psychiatric and physical morbidity and health-related behaviors. In the treatment study (paper II) we found that CBT produced significantly better short- andlong-term treatment effect than zopiclone. We found no significant outcome differences between zopiclone and placebo. Patients receiving CBT spent significantly less time awake and had higher sleep efficiency than patients treated pharmacologically. Patients in the CBT condition spent significantly more time in slow wave sleep (stages 3/4) than either of the two other conditions. In paper III we found that actigraphy performed poorly in detecting wakefulness, and consequently overestimated the patients’ total sleep time and sleep efficiency. Compared with PSG, actigraphy captured only part of the treatment effects on total wake time and sleep onset latency, and failed to detect significant changes in sleep efficiency. Conclusions: Even though a diagnosis of insomnia is legally insufficient for the award of a disability pension, we found that insomnia is an independent predictor of subsequent work disability. Considering the direct costs of disability expenditures, in addition to the indirect costs from lost productivity, sleep medications and sleep-related accidents, we believe that early detection and interventions for insomnia should receive increased focus. Based on the findings from the treatment study we conclude that interventions based on CBT are superior to zopiclone treatment, both in terms of short- and long-term management of insomnia in older adults. We also conclude that the clinical utility of actigraphy is still suboptimal in older insomniacs, and should hence not be used in a clinical setting without parallel use of additional assessment tools. http://hdl.handle.net/1956/1794 Title: Det gløymde objekt : om psykodynamisk tilnærming til religiøse tema i terapi <br/> <br/>Authors: Krøvel-Velle, Anita; Aasen, Cecilie <br/> <br/>Abstract: Til grunn for dette arbeidet ligg antakinga om at religiøsitet er ein viktig dimensjon i menneskeleg psykologi, og det vert hevda at denne dimensjonen ikkje må utelukkast frå terapi. Vi argumenterer for at viktige endringar i psykodynamisk teori og praksis har hatt betydning for psykologidisiplinen si forståing og handsaming av religion og religiøs tru. Nyare psykodynamisk tilnærming til religiøs tru vert presentert; det vert her fokusert på Gud som objektrepresentasjon, og på forståing av gudsrepresentasjonen si utviklingshistorie og funksjon for individet. På grunnlag av dette vert det hevda at religiøsitet kan utgjere ein viktig utviklingsmessig dimensjon for individet, og at utforsking av religiøst materiale difor kan vere viktig å inkludere i terapi. Tankar kring psykologen si rolle i møte med religiøse tema i terapi vert drøfta, samt om arbeid med religiøst materiale representerer særlege terapeutiske utfordringar. Med utgangspunkt i dette vert det så drøfta og illustrert korleis ei psykodynamisk tilnærming til religiøsitet kan nyttast som teoretisk forståingsramme og terapeutisk verktøy i terapiprosessen. Endeleg vert det gjennom arbeidet argumentert for at teoretisk kunnskap, samt medvit om terapeuten sine verdiar, er viktig i møte med religiøse tema i terapi.; This paper is built upon the assumption that religiosity is an important dimension in human mental life, and that this dimension shouldn‘t be excluded from therapy. It is maintained that recent changes in psychodynamic theory and practice have implications for the discipline’s attitudes toward, understanding of, and treatment of religion and religiosity. A contemporary psychodynamic approach to religiosity is presented. A main characteristic of this approach is that it focuses on God as an object representation, and that it seeks to understand the developmental history and the function of an individual‘s representation of God. From this basis, it is argued that religiosity can represent an important developmental dimension for an individual, and it is proposed that active exploration of religious material can become a positive force in the therapeutic process. Thoughts concerning the role of the psychologist when confronted with religious themes in therapy, are presented, and whether work with religious material may represent a particular therapeutic challenge. Finally we discuss how psychodynamic theories can be used as a theoretical frame of reference and as a therapeutic tool in the therapeutic processs. The importance of theoretical knowledge in therapeutic work with religious themes is underscored. http://hdl.handle.net/1956/1777 Title: Parent Management Training - en foreldreveiledningsmetodefor behandling av barn med atferdsproblemer : teori, behandlingsprogram og implementering i Norge <br/> <br/>Authors: Apelseth, Eva Fohlin; Amlie, Christine <br/> <br/>Abstract: Antisocial behavior is arguably one of the most comprehensive and expensive diseases in child psychiatry. Parent Management Training-Oregon (PMT-O), a treatment and prevention program for families with children with antisocial behavior, is currently being introduced in Norway. PMT-O is based on the ”social interaction learning theory”, developed by Patterson and coworkers at Oregon Social Learning Center. PMT-O is a detailed program designed to improve parenting practices, and indirectly reduce antisocial behavior in the children. This paper describes and discusses the theoretical foundation for PMT-O, and gives a detailed description of the treatment program, as well as the implementation of PMT-O in Norway. A questionnaire survey was conducted among the 33 therapists currently undergoing training in the use of PMT-O in Norway, evaluating their satisfaction with the training.; Antisosial atferd blant barn og ungdom er et stort og økende helsemessig og økonomisk problem. Parent Management Training – Oregon (PMT-O), et behandlings- og forebyggingsprogram for familier med barn som fremviser antisosial adferd, blir for tiden implementert i Norge som ledd i satsingen på psykisk helsevern. PMT-O er basert på ”social learning interaction theory”, utviklet av Patterson og medarbeidere ved Oregon Social Learning Center. PMT-O er et detaljert program for styrking av foreldrenes foreldreferdigheter, og derved indirekte redusere adferdsproblemer hos barna. Denne hovedoppgaven beskriver og diskuterer det teoretiske grunnlaget for PMT-O, i tillegg til å gi en detaljert beskrivelse av selve behandlingsprogrammet, og dets implementering i Norge. En spørreskjema undersøkelse ble gjennomført blant de 33 terapeutene som har gjennomgått opplæring i PMT-O i Norge, for å evaluere i hvilken grad deltakerne var fornøyd med opplæringen. http://hdl.handle.net/1956/1776 Title: Beck Anxiety Inventory : translation and validation of a Norwegian version <br/> <br/>Authors: Nordhagen, Thomas <br/> <br/>Abstract: This study investigated the psychometric properties of the Norwegian version of the Beck Anxiety Inventory (BAI) in a community sample of 879 respondents and two student samples of a total of 408 respondents. Scores on the BAI were compared to the State-trait Anxiety Inventory, the Beck Depression Inventory-II, three subscales of the SCL-90, the White Bear Suppression Inventory, the Penn State Worry Questionnaire, and the Fear Questionnaire. The BAI demonstrated good psychometric properties with high levels of internal consistency reliability. A moderate test-retest correlation provides support for the BAI as a state measure. All results obtained on the Norwegian version corresponded to those reported on the original version. The study supported the use of the Norwegian version of the BAI. Subsequent confirmatory factor analyses slightly favored a four-factor model initially reported by Beck and Steer (1990). A post hoc analysis supported loading item 16 ?fear of dying? on the Subjective factor and pointed to some difficulties with the wording of two items in the Norwegian version. http://hdl.handle.net/1956/1667 Title: Cognitive activity in insomnia <br/> <br/>Authors: Omvik, Siri <br/> <br/>Abstract: The study investigated the causal relationship between worry and insomnia. A 2 x 2 design (Worry x Induced sleeplessness) with repeated measures was employed. In all 96 female undergraduate students who scored high or low on a measure of worry (Penn State Worry Questionnaire) completed the study. The induced sleeplessness variable consisted of two levels defined by a double-blind distribution of 300 mg caffeine and placebo. The repeated measures were nocturnal cognitive activity, as measured by the Night-Time Thoughts Questionnaire, and sleep parameters derived from a sleep diary and an actigraph. The data were obtained from two consecutive nights. Worry was found to be associated with nocturnal cognitive activity on both nights and with subjective sleep parameters on the first night. The findings indicate that nocturnal cognitive activity occurs as an epiphenomenon of wakefulness. The results are discussed in terms of their relationship to various categories of cognitive activity and models of insomnia. A core implication of the findings is that cognitive activity caused by induced sleeplessness may be conceived of as rumination. There is a need for the development of an instrument that can distinguish between types of nighttime rumination, under which worry is one subgroup.; Studien undersøkte årsakssammenhenger mellom bekymring og søvnløshet. Det ble brukt et 2 x 2 design (Bekymring x Indusert søvnløshet) med repeterte målinger. I alt fullførte 96 kvinnelige lavere grads studenter som skåret høyt eller lavt på et mål for bekymring (Penn State Worry Questionnaire) studien. Indusert søvnløshet hadde to nivåer. Disse var 300 mg koffein og placebo som ble distribuert i en dobbelblind prosedyre. De repeterte målene var nattlig kognitiv aktivitet, målt med et spørreskjema om nattlige tanker (Night-Time Thoughts Questionnaire), og subjektive og objektive søvnmål, målt med søvndagbok og aktigraf. Dataene ble samlet inn fra to påfølgende netter. Resultatene viser at det er en sammenheng mellom grad av bekymring og grad av nattlig kognitiv aktivitet på begge nettene, og mellom grad av bekymring og skåren på de subjektive søvnparametrene på den første natten. Nattlige tanker forekommer som et epifenomen av våkenhet. Resultatene diskuteres i forhold til modeller for søvnløshet og i forhold til hvordan kognitiv aktivitet forårsaket av søvnløshet kan kategoriseres. En sentral konklusjon fra studien er at tankene som oppstod kan karakteriseres som grubling (”rumination”). Det er et behov for å utvikle måleinstrumenter som kan skille mellom former for nattlig grubling, hvorav bekymring er en type. http://hdl.handle.net/1956/1538 Title: Ambivalens - hemmende eller fremmende i terapi? : en teoretisk undersøkelse av ambivalensbegrepet i motiverende intervju <br/> <br/>Authors: Formo, Tomas H. http://hdl.handle.net/1956/1327 Title: Evidensbaserte relasjoner : en litteraturgjennomgang av temaet pasient og terapimatching <br/> <br/>Authors: Hausken, Bjørn Tore