5. Treatment of stress disorders and complaints

An important aspect of stress research is treatment. Within SSC we have worked with innovative new approaches using psychological methods.

Subpackages

5.1 Psychological treatment of distress, and biological correlates to treatment success, when delivered in primary care settings or over the Internet

Several studies concern health anxiety, a complication of obvious importance for the subjective health perspective as individuals with health anxiety by definition perceive their subjective health to be low despite that medical data indicate absence of disease. These studies are now expanded to understanding mediators of change (i.e. understand the effective part in treatment), in comparison to stress management and comparisons with pure or guided self-help. With self-help bibliotherapy (with or without therapist guidance) for insomnia, we showed that a six-week treatment was as effective as individual therapy, also when co-morbid with e.g. inflammatory disease or pain. We are currently developing treatment manuals for Cognitive Behavioral Therapy (CBT) for insomnia in adolescents, a group where no clinical guidelines and virtually no studies exist. Following the logic of trans-diagnostic symptoms, we perform the studies both in child- and adolescent psychiatry and in a pain clinic. As in other studies, biological mechanisms are investigated in parallel with treatment outcome. Thereby, we aim to both develop effective treatments and to better understand our understanding of mechanisms coupled to subjective ill-health.

5.2 Mindfulness-based stress-related reduction training (MBSR)

In a randomized trial examining the effects of training in mindfulness stress techniques for patients newly diagnosed with cancer, we showed that such training in mindfulness led to normalization of cortisol levels in addition to decreased levels of stress, increased well-being and reduced post-traumatic avoidance symptoms. In a number of publications, the role of positive affect in the stress management process has been examined. These studies showed that positive affect seem to play an important role in moderating the influence of stress on health and well-being, as well as, facilitate health promotion behavior changes.

Planned research

5.1 Psychological treatment of distress, and biological correlates to treatment success, when delivered in primary care settings or over the Internet.

In a collaborative (P+S) we will further develop a behavioral treatment for insomnia in adolescents, and to test this treatment and its effects on co-morbid problems in child- and adolescent psychiatry as well as in young patients with chronic pain. We will further establish the effectiveness of cognitive behavioral therapy for common mental illness when implemented in primary care. Sleep and inflammation will be investigated as correlates of treatment success in above studies. In this set of studies, the best evidence based manual based treatments are chosen, to study how these can be implemented in primary care. In areas where evidence level is weak (stress disorders, exhaustion and return-to-work), the preliminary effective treatments developed at the Gustavsberg Primary Health Care Unit are investigated. The importance of this is underlined by the fact that of consecutive patients enrolled in the study, 74% of those on sick-leave suffer from maladaptive stress or exhaustion. One major effort will next be to develop a national program for evi- dence-based treatment for anxiety, depression, insomnia and stress/exhaustion, first implemented in Stockholm County and thereafter in other county councils. We are now intensively negotiating such steps with the Swedish Government and to do this in collaboration with the leader (David Clark, University of Oxford) of the successful IAPT program in the U.K. To develop a larger program (suggestion to Ministry of Social Affairs on 2500 patients/year in the first steps), an IT-interface will be developed, a process that has started. This platform builds on the national structure to register care, quality and patient-reported outcomes, while allowing a safe handling of research data within the system

5.2 Mindfulness and internet

We will extend our mindfulness-based stress-related reduction internet-based training (MBSR) studies: Our future research will focus on integrating our findings in the fields of stress-management techniques. In particular, we are currently planning two studies of the feasibility and effectiveness of internet-based psychosocial resilience training programs; one for cancer patients and one for depression prevention among adolescence and young adults. The planned training program builds on our earlier findings regarding mindfulness and positive affect, and could potentially have great impact on stress management, with implication for public health at a population level.