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Objective:The objective was to test the hypothesis that externalizing and internalizing helpfulness beliefs and learning styles at baseline moderate panic severity and overall mental illness as short-term and long-term outcomes of two panic-focused psychotherapies, Panic Control Treatment (PCT) and Panic-Focused Psychodynamic Psychotherapy (PFPP).Method:Participants were 108 adults with DSM-IV Panic Disorder with or without Agoraphobia (PD/A) who were randomized to treatment in a trial of PCT and PFPP. Piece-wise/segmented multilevel modeling was used to test three-way interactions (Treatments x Moderator x Time), with participants and therapists as random factors. Outcome variables were clinician-rated panic severity and self-rated mental illness post-treatment and during follow-up.Results:Patients' externalizing (but not internalizing) helpfulness beliefs moderated mental illness outcomes during follow-up (but not during treatment); low levels of Externalization were facilitative for PFPP but not PCT. Internalizing and externalizing helpfulness beliefs and learning style did not moderate clinician-rated panic severity, whether short- or long-term.Conclusions:These results suggest that helpfulness beliefs and learning style have limited use in assignment to either PCT or PFPP for PD/A. Although further research is needed, low levels of helpfulness beliefs about externalizing coping may play a role in mental illness outcomes for PFPP.

Objective: The effects of panic-specific psychotherapy on occupational functioning remain under-researched. This study tests whether two brief psychotherapies for Panic Disorder with or without Agoraphobia (PD/A) may generate improvement in work ability. Methods: Adults (N = 221) with a primary diagnosis of PD/A were randomised to wait-list, panic-focused psychodynamic psychotherapy (PFPP), panic control treatment (PCT), or to the choice between the two treatments. Participants completed the Work Ability Inventory (WAI) at baseline, post-treatment, and during 24-month follow-ups. Change in WAI scores were assessed using segmented multilevel linear growth models, and mediation was explored through path analysis. Results: WAI scores changed from the moderate to good range between baseline and post-treatment (SMD = 0.45; 95% CI [0.33, 0.57]) and continued to increase throughout the follow-up (SMD = 0.16; 95% CI [0.03, 0.28]) with no differences between treatments or allocation forms. In PFPP (but not in PCT) pre- to post-treatment change in WAI was mediated by reduction in panic symptoms and WAI predicted employment status and absences. Conclusions: Two brief panic specific psychotherapies, one cognitive behavioural and one psychodynamic, produced short and long-term increases in work ability.

ObjectivesCancer related pain (CRP) is among the most frequent collateral effects of cancer, with chronic CRP, lasting at least three months, affecting >40% of cancer survivors.Evidence based treatments, including pain-focused Cognitive Behavioral Therapy(CBT) are available, but it appears that cancer patients/survivors are often poorlyinformed about CRP or the potential benefits of CBT for such pain. The present studyexamines current experience of Swedish cancer patients/survivors in relation to CRP.MethodsParticipants (N= 276; 83% female; mean age = 55.5 years, SD=11.9) were recruited to an online survey via cancer websites in Sweden, and provided information about their history of chronic CRP, and whether they received information about or treatment for CRP from a healthcare professional.ResultsParticipants had a history of breast (36%), gynecological (12%), lung (10%), colon(8%) and other forms of cancer (36%). A majority (74%) reported a history of chronicCRP and being prescribed analgesic medications (70%). Less than half (47%)received information from their healthcare provider about the risk of CRP and only 13% with chronic CRP received psychological treatment, and of these only 33% received CBT. Among those receiving psychological treatment for chronic CRP, satisfaction rates were moderate, reported as an average of 6 on a 0-10 scale (SD 2.6).ConclusionsGreater efforts are needed to raise awareness among cancer patients/survivors, andhealthcare providers about the risk of CRP and evidence-based interventions,including CBT, the first-line intervention for chronic pain. These efforts will need to be matched with increases in treatment capacity, particularly pain-focused CBT.

Objectives Cancer-related pain (CRP) is among the most frequent collateral effects of cancer, with chronic CRP, lasting at least 3 months, affecting >40% of cancer survivors. Evidence-based treatments, including pain-focused cognitive behavioral therapy (CBT), are available, but it appears that cancer patients/survivors are often poorly informed about CRP or the potential benefits of CBT for such pain. This study examined current experience of Swedish cancer patients/survivors in relation to CRP. Methods Participants (N = 276; 83% female; mean age = 55.5 years, SD = 11.9) were recruited to an online survey via cancer websites in Sweden, and they provided information about their history of chronic CRP and whether they received information about or treatment for CRP from a healthcare professional. Results Participants had a history of breast (36%), gynecological (12%), lung (10%), colon (8%), and other forms of cancer (36%). A majority (74%) reported a history of chronic CRP and being prescribed analgesic medications (70%). Less than half (47%) received information from their healthcare provider about the risk of CRP and only 13% with chronic CRP received psychological treatment, and of these, only 33% received CBT. Among those receiving psychological treatment for chronic CRP, satisfaction rates were moderate, reported as an average of 6 on a 0-10 scale (standard deviation 2.6). Conclusions Greater efforts are needed to raise awareness among cancer patients/survivors and healthcare providers about the risk of CRP and evidence-based interventions, including CBT, the first-line intervention for chronic pain. These efforts will need to be matched with increases in treatment capacity, particularly pain-focused CBT.

BackgroundStudies of individuals with non-cancer-related chronic pain find that higher levels of psychological flexibility (PF) are associated with less distress, better functioning, and a better response to treatment. People diagnosed with cancer are at a significantly increased risk of developing chronic cancer-related pain, the presence of which is associated with poorer health outcomes. Little is known about whether PF is applicable to cancer pain. The current study investigates the relationship between chronic cancer-related pain, distress and functioning, and three theoretical processes proposed by the PF model: pain acceptance, present-moment focus, and committed action. MethodsAdults (n = 246) with a cancer diagnosis (current or previous), and living in Sweden, completed an online survey involving standardized measures of cancer-related pain (intensity and impairment), depression, fatigue, PF and social stigma. ResultsModerate to strong correlations were found between PF and all variables. In regression analyses, PF, and particularly pain acceptance, accounted for a large and significant proportion of the observed variance in depression, pain-related and overall functioning, after controlling for cancer status, pain intensity and social stigma. ConclusionConsistent with studies of non-cancer-related pain, higher levels of PF were strongly associated with lower levels of distress and better functioning in individuals with cancer-related pain. Further studies are needed to further explore these relationships and to determine whether psychosocial treatments targeting PF may be of benefit to people with chronic cancer-related pain. SignificanceThis study explores the relationship between cancer-related pain (intensity and impairment), depression, fatigue, overall functioning, social stigma and PF. The findings suggest that higher levels of PF are associated with lower levels of distress and improved functioning in chronic cancer-related pain, after controlling f

Personer med flyktingbakgrund löper betydligt högre risk för att utveckla psykisk ohälsa, däribland posttraumatiskt stressyndrom (PTSD). Det finns mycket stöd i forskningen som visar att traumafokuserade psykologiska behandlingar för PTSD är effektiva. Majoriteten av forskningen inkluderar dock inte flyktingar, vilket innebär att vi vet mindre om hur behandling av PTSD fungerar i gruppen. Den här rapporten utforskar det rådande forskningsläget om psykologiska interventioner för PTSD hos vuxna flyktingar. En kartläggande litteratursökning genomfördes i två steg för att identifiera: 1) nyligen publicerade metaanalyser om randomiserade kontrollerade studier (RCT-studier) och 2) RCT-studier publicerade efter metaanalyserna, som bemöter de kunskapsluckor som identifierats i dem. Det aktuella forskningsläget summerades utifrån dessa källor. Sammantaget inkluderades fyra metaanalyser, som alla gav stöd för psykologiska interventioner för PTSD, med mest stöd för traumafokuserad kognitiv beteendeterapi (TF-KBT). Alla fyra metaanalyserna indikerade att majoriteten av studierna varken involverade jämförelser med aktiv behandling eller långsiktig uppföljning, samt var av varierande metodologisk kvalitet. I den andra litteratursökningen identifierades 12 RCT-studier. Endasten av dessa involverade både en aktiv kontrollgrupp och långtidsuppföljning. I de inkluderade studierna var TF-KBT, Eye Movement Desensitization and Reprocessing (EMDR) and Narrativ Exponeringsterapi (NET) de oftast utvärderade psykologiska interventionerna för PTSD hos flyktingar. Den tillgängliga evidensen tyder på att dessa interventioner ger måttliga till stora effektstorlekar vid behandlingsavslut jämfört med ingen behandling hos flyktingar, vilket liknar funna effektstorlekar i RCT-studier i generell befolkning. För att dra säkra slutsatser krävs dock mer omfattande RCT-studier med aktiva jämförelser och långtidsuppföljning. Det vetenskapliga underlaget tyder tills vidare på att behandling med TF-KBT, EM, People with a refugee background are at significantly increased risk of mental health difficulties, including Post-Traumatic Stress Disorder (PTSD). There is a large evidence base showing that traumafocused psychological treatments for PTSD are effective. However, the majority of trials do not include refugees and less is known about how refugees respond to treatment. The present report explores the current state of the literature about psychological interventions for PTSD in adult refugees. A scoping review was conducted in two stages to identify: 1) recent meta-analyses of randomized controlled trials (RCTs) of psychological interventions for PTSD in adult refugees; and 2) RCTs published after the meta-analyses that address knowledge gaps identified in the meta-analyses. The status of the evidence base is summarized from these sources. A total off our meta-analyses were included, all yielding support for trauma-focused psychological interventions, primarily trauma-focused cognitive behavioural therapy (TF-CBT). Included meta-analyses indicated that the majority of RCTs involved inactive comparisons and short follow-ups. In the secondary search, 12 recent RCTs were identified. However, only one involved active treatment comparison and long-term follow-up, and the majority of trials are of varying methodological quality. Across included studies, the most frequently evaluated interventions are TF-CBT, Eye Movement Desensitizationand Reprocessing Therapy (EMDR) and Narrative Exposure Therapy (NET). The available evidence suggests that these interventions yield moderate to large effect sizes for PTSD at post-treatment relative to no-treatment in refugee populations, which is similar to effect sizes found in RCTs with non-refugee populations. However, firm conclusions await more rigorous RCTs involving active comparisons and long-term follow-ups. In the interim, the available evidence suggests that TF-CBT, EMDR and NET interventions should be made available to refugees

Background: Studies of individuals with non-cancer-related chronic pain, find that higher levels of psychological flexibility (PF) are associated with less distress, better functioning, and a better response to treatment. People diagnosed with cancer are at significantly increased risk of developing chronic cancer-related pain, the presence of which is associated with poorer health outcomes. Little is known about whether PF is applicable to cancer pain. The current study investigates the relationship between chronic cancer-related pain, distress and functioning, and three theoretical processes proposed by the PF model: pain acceptance, present-moment focus, and committed action. Methods: Adults (n = 246) with a cancer diagnosis (current or previous), and living in Sweden, completed an online survey involving standardized measures of cancer relatedpain (intensity and impairment), depression, fatigue, PF and social stigma. Results: Moderate to strong correlations were found between PF and all variables. In regression analyses, PF, and particularly pain acceptance, accounted for a large and significant proportion of the observed variance in depression, pain-related and overall functioning, after controlling for cancer status, pain intensity and social stigma.Conclusion: Consistent with studies of non-cancer-related pain, higher levels of PF were strongly associated with lower levels of distress and better functioning in individuals with cancer-related pain. Further studies are needed to further explore these relationships and to determine whether psychosocial treatments targeting PF may be of benefit to people with chronic cancer-related pain.