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Norell-Clarke, AnnikaORCID iD iconorcid.org/0000-0003-2008-0784
Publications (10 of 23) Show all publications
Norell-Clarke, A. & Hagquist, C. (2018). Child and adolescent sleep duration recommendations in relation to psychological and somatic complaints based on data between 1985 and 2013 from 11 to 15 year-olds. Journal of Adolescence, 68, 12-21
Open this publication in new window or tab >>Child and adolescent sleep duration recommendations in relation to psychological and somatic complaints based on data between 1985 and 2013 from 11 to 15 year-olds
2018 (English)In: Journal of Adolescence, ISSN 0140-1971, E-ISSN 1095-9254, Vol. 68, p. 12-21Article in journal (Refereed) Published
Abstract [en]

Purpose: To investigate the association between sleep duration, sleep initiation difficulties and psychological and somatic complaints. Methods: We used three cohorts of cross-sectional Swedish questionnaire data, from the Health Behaviours of School aged Children (1985/1986, 2005/2006, 2013/2014, n=>18 000, aged 11–15). Specific complaints (e.g. pain) and total complaint load were used as outcomes of sleep duration, sleep initiation difficulties and the combination of them both. Results: Sleeping less than recommended and sleep initiation difficulties were associated with increased odds of specific complaints and belonging to the group with the greatest complaint load. The combination of short sleep duration and sleep initiation difficulties were associated with higher odds than either sleep issue alone. No interaction effects between time and sleep variables were found regarding complaints. Conclusions: The findings support recent sleep duration recommendations. Further, sleep issues warrant a broad health assessment as they indicate a high likelihood of other complaints.

Place, publisher, year, edition, pages
Academic Press, 2018
Keywords
Adolescents, Bedtime, Mood, Pain, Sleep duration, Sleep onset difficulties, adolescent, Article, backache, child, cohort analysis, controlled study, cross-sectional study, dizziness, female, headache, human, male, mental irritation, nervousness, pediatrics, psychosomatic disorder, sadness, sleep disorder, sleep time, stomach pain, Swedish citizen
National Category
Psychology
Research subject
Public Health Science; Psychology
Identifiers
urn:nbn:se:kau:diva-69047 (URN)10.1016/j.adolescence.2018.07.006 (DOI)000447105200002 ()2-s2.0-85049740893 (Scopus ID)
Available from: 2018-09-05 Created: 2018-09-05 Last updated: 2018-11-22Bibliographically approved
Norell-Clarke, A., Tillfors, M., Jansson-Froejmark, M., Hollaendare, F. & Engstroem, I. (2018). Does Mid-Treatment Insomnia Severity Mediate between Cognitive Behavioural Therapy for Insomnia and Post-Treatment Depression?: An Investigation in a Sample with Comorbid Insomnia and Depressive Symptomatology. Behavioural and Cognitive Psychotherapy, 46(6), 726-737
Open this publication in new window or tab >>Does Mid-Treatment Insomnia Severity Mediate between Cognitive Behavioural Therapy for Insomnia and Post-Treatment Depression?: An Investigation in a Sample with Comorbid Insomnia and Depressive Symptomatology
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2018 (English)In: Behavioural and Cognitive Psychotherapy, ISSN 1352-4658, E-ISSN 1469-1833, Vol. 46, no 6, p. 726-737Article in journal (Refereed) Published
Abstract [en]

Background: Recent treatment studies with cognitive behavioural therapy for insomnia (CBT-I) have demonstrated effects on both sleep problems and depression. Two previous studies have indicated that the beneficial effect from CBT-I on depression may come through improved sleep, although insomnia severity during treatment had not previously been investigated as a mediator. Aims: Our aim was to investigate if insomnia severity during treatment mediated between CBT-I and depression severity after treatment, in a sample with co-morbid insomnia and depressive symptomology. We also examined whether depressive severity during treatment mediated between CBT-I and insomnia after treatment. Method: The participants were recruited from advertisements and fulfilled criteria for insomnia diagnosis, and had depressive symptomatology (Beck Depression Inventory-second edition: BDI-II > 13). Two-thirds of the participants were diagnosed with major depressive disorder. The participants received four biweekly group sessions of CBT-I or relaxation training (active control). Insomnia severity (Insomnia Severity Index) and depressive severity (BDI-II) were measured at baseline, mid-treatment, post-treatment and 6-month follow-up. The mid-treatment measures were used as mediators. Results: Mediational analyses demonstrated a significant reciprocal relationship between insomnia severity and depressive severity throughout CBT-I, although mid-treatment insomnia had a stronger effect on depression than mid-treatment depression had on insomnia. The results were similar for both post-treatment and follow-up. Discussion: Some improvement in depressive severity after CBT-I is explained by improved sleep. The findings emphasize the importance of making comorbid insomnia a treatment focus in its own right.

National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:kau:diva-69470 (URN)10.1017/S1352465818000395 (DOI)000444683800006 ()29898793 (PubMedID)
Available from: 2018-10-04 Created: 2018-10-04 Last updated: 2018-12-10Bibliographically approved
Jansson-Fröjmark, M. & Norell-Clarke, A. (2018). The cognitive treatment components and therapies of cognitive behavioral therapy for insomnia: A systematic review. Sleep Medicine Reviews, 42, 19-36
Open this publication in new window or tab >>The cognitive treatment components and therapies of cognitive behavioral therapy for insomnia: A systematic review
2018 (English)In: Sleep Medicine Reviews, ISSN 1087-0792, E-ISSN 1532-2955, Vol. 42, p. 19-36Article in journal (Refereed) Published
Abstract [en]

Since the beginning of the twenty-first century, there has been an increased focus on developing and testing cognitive components and therapies for insomnia disorder. The aim of the current review was thus to describe and review the efficacy of cognitive components and therapies for insomnia. A systematic review was conducted on 32 studies (N = 1455 subjects) identified through database searches. Criteria for inclusion required that each study constituted a report of outcome from a cognitive component or therapy, that the study had a group protocol, adult participants with diagnosed insomnia or undiagnosed insomnia symptoms or reported poor sleep, and that the study was published until and including 2016 in English. Each study was systematically reviewed with a standard coding sheet. Several cognitive components, a multi-component cognitive program, and cognitive therapy were identified. It is concluded that there is support for paradoxical intention and cognitive therapy. There are also other cognitive interventions that appears promising, such as cognitive refocusing and behavioral experiments. For most interventions, the study quality was rated as low to moderate. We conclude that several cognitive treatment components and therapies can be viewed as efficacious or promising interventions for patients with insomnia disorder. Methodologically stronger studies are, however, warranted.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
CBT, Cognitive therapy, Efficacy, Insomnia, Systematic review
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:kau:diva-68079 (URN)10.1016/j.smrv.2018.05.001 (DOI)000449095300004 ()2-s2.0-85048127016 (Scopus ID)
Available from: 2018-06-26 Created: 2018-06-26 Last updated: 2019-04-04Bibliographically approved
Norell-Clarke, A. & Hagquist, C. (2017). Changes in sleep habits between 1985 and 2013 among children and adolescents in Sweden. Scandinavian Journal of Public Health, 45(8), 869-877
Open this publication in new window or tab >>Changes in sleep habits between 1985 and 2013 among children and adolescents in Sweden
2017 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 45, no 8, p. 869-877Article in journal (Refereed) Published
Abstract [en]

Aims: The aim was to investigate changes in child and adolescent sleep habits in Sweden over time. This had not been done previously. Methods: Cross-sectional questionnaire data over three decades of investigations of the Health Behaviours of School Children study (1985/1986, 2005/2006 and 2013/2014) were used. The sample included 18,682 children and adolescents, aged 11, 13 and 15. Empirically based age-specific sleep duration recommendations were used to operationalise sleep duration. Results: The results showed that, over time, fewer go to bed early and more go to bed late. Regarding sleep duration, there have been decreases in the proportion of children and adolescents that sleep as much as is recommended for their age. Sleep onset difficulties have increased for all ages and increase the odds of sleeping less than recommended as well as having late bedtimes. Boys were more likely than girls to have later bedtimes and to sleep less than recommended. A vocational educational track, not planning to study further or being unsure of which track to choose increased the odds for 15 year olds to have late bedtimes and to sleep less than recommended compared with a college preparatory track. Conclusions: The results indicate that over time, fewer children and adolescents attain sufficient sleep duration. This may have implications for study results, mental health and cognitive abilities.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public Health Science
Identifiers
urn:nbn:se:kau:diva-65949 (URN)10.1177/1403494817732269 (DOI)000418185200019 ()28992746 (PubMedID)
Available from: 2018-01-25 Created: 2018-01-25 Last updated: 2018-06-29Bibliographically approved
Norell-Clarke, A., Tillfors, M., Jansson-Fröjmark, M., Holländare, F. & Engstrom, I. (2017). How does cognitive behavioral therapy for insomnia work?: An investigation of cognitive processes and time in bed as outcomes and mediators in a sample with insomnia and depressive symptomatology. International Journal of Cognitive Therapy, 10(4), 304-329
Open this publication in new window or tab >>How does cognitive behavioral therapy for insomnia work?: An investigation of cognitive processes and time in bed as outcomes and mediators in a sample with insomnia and depressive symptomatology
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2017 (English)In: International Journal of Cognitive Therapy, ISSN 1937-1209, E-ISSN 1937-1217, Vol. 10, no 4, p. 304-329Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to gain a greater understanding of the five cognitive processes from the cognitive model of insomnia, negative automatic thoughts, and time in bed as outcomes and potential mediators of cognitive behavioral therapy for insomnia (CBT-I), in a sample with insomnia and depressive symptomatology. Sixty-four participants were randomized to receive either CBT-I or an active control (relaxation training: RT) in groups during four biweekly sessions. Insomnia, depressive severity, and the potential processes of change were measured pre-, mid-, and post-treatment. CBT-I was associated with greater reductions of dysfunctional beliefs about sleep, sleep-related safety behaviors, and time in bed compared to RT. Mid-treatment dysfunctional beliefs about sleep was the only process that mediated between CBT-I and outcomes on insomnia and depressive severity, respectively. The relationships were reciprocal. Dysfunctional beliefs about sleep may be a transdiagnostic process of both insomnia and depression.

Place, publisher, year, edition, pages
Guilford Publications, 2017
Keywords
cognitive behavioral therapy, depression, dysfunctional beliefs, insomnia, mediation
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:kau:diva-66189 (URN)10.1521/ijct.2017.10.4.304 (DOI)000423606400003 ()
Available from: 2018-02-09 Created: 2018-02-09 Last updated: 2019-01-15Bibliographically approved
Norell-Clarke, A. & Hagquist, C. (2016). Adolescent sleep duration in relation to psychosomatic complaints: development between 1985 and 2013 in Sweden. Paper presented at 23rd Congress of the European-Sleep-Research-Society, SEP 13-16, 2016, Bologna, ITALY. Journal of Sleep Research, 25(SI), 139-139
Open this publication in new window or tab >>Adolescent sleep duration in relation to psychosomatic complaints: development between 1985 and 2013 in Sweden
2016 (English)In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 25, no SI, p. 139-139Article in journal, Meeting abstract (Refereed) Published
Place, publisher, year, edition, pages
John Wiley & Sons, 2016
National Category
Health Sciences
Research subject
Public Health Science
Identifiers
urn:nbn:se:kau:diva-47683 (URN)000383445200341 ()
Conference
23rd Congress of the European-Sleep-Research-Society, SEP 13-16, 2016, Bologna, ITALY
Available from: 2017-01-19 Created: 2017-01-19 Last updated: 2018-11-13Bibliographically approved
Danielsson, N., Norell-Clarke, A. & Hagquist, C. (2016). Associations between adolescent sleep disturbance and different worry themes: findings from a repeated cross-sectional study from 1988 to 2011. Sleep Health, 2(3), 194-197
Open this publication in new window or tab >>Associations between adolescent sleep disturbance and different worry themes: findings from a repeated cross-sectional study from 1988 to 2011
2016 (English)In: Sleep Health, ISSN 2352-7218, E-ISSN 2352-7226, Vol. 2, no 3, p. 194-197Article in journal (Refereed) Published
Abstract [en]

Objective

The objective was to investigate relationships between adolescent sleep disturbance and various worry themes.

Methods

Questionnaire data from 8 cross-sectional collections between 1988 and 2011 were used. The sample included more than 20,000 adolescents aged 15-16. Binary logistic regressions were used for the analyses.

Results

Sleep disturbance and female sex increased the odds of worrying about all themes. Sleep disturbance shared stronger associations with worry about financial security, accidents/illness, being bullied, and terrorist attacks (odds ratios, 2.65-3.35) compared with worry about environmental destruction or nuclear war (odds ratios, 1.73-2.11). No interactions between sleep and year of investigation were found.

Conclusions

Little is known about the association between adolescent worry and sleep, and about sleep disturbance and specific worry content. This study shows that the strength in the relationship between adolescent worry and sleep varies with worry themes. Knowledge of the worry content related to sleep may aid in targeting preventions and interventions.

Keywords
Sleep disturbance, Adolescence, Worry, Time trends, Sex
National Category
Health Sciences
Research subject
Public Health Science
Identifiers
urn:nbn:se:kau:diva-45804 (URN)10.1016/j.sleh.2016.05.005 (DOI)000437210000008 ()
Projects
Ung i Värmland
Available from: 2016-09-08 Created: 2016-09-08 Last updated: 2019-06-10Bibliographically approved
Jansson-Fröjmark, M. & Norell-Clarke, A. (2016). Cognitive Behavioural Therapy for Insomnia in Psychiatric Disorders.. Current sleep medicine reports, 2(4)
Open this publication in new window or tab >>Cognitive Behavioural Therapy for Insomnia in Psychiatric Disorders.
2016 (English)In: Current sleep medicine reports, ISSN 2198-6401, Vol. 2, no 4Article in journal (Refereed) Published
Abstract [en]

Insomnia means difficulties in initiating or maintaining sleep and is commonly comorbid with psychiatric disorders. From being considered secondary to primary psychiatric disorders, comorbid insomnia is now considered an independent health issue that warrants treatment in its own right. Cognitive behavioural therapy for insomnia (CBT-I) is an evidence-based treatment for insomnia. The effects from CBT-I on comorbid psychiatric conditions have received increasing interest as insomnia comorbid with psychiatric disorders has been associated with more severe psychiatric symptomologies, and there are studies that indicate effects from CBT-I on both insomnia and psychiatric symptomology. During recent years, the literature on CBT-I for comorbid psychiatric groups has expanded and has advanced methodologically. This article reviews recent studies on the effects from CBT-I on sleep, daytime symptoms and function and psychiatric comorbidities for people with anxiety, depression, bipolar disorder, psychotic disorders and post-traumatic stress disorder. Future strategies for research are suggested.

Keywords
Insomnia, Sleep, Arousal, Scale
National Category
Psychology
Identifiers
urn:nbn:se:kau:diva-47572 (URN)10.1007/s40675-016-0055-y (DOI)28003955 (PubMedID)
Available from: 2017-01-04 Created: 2017-01-04 Last updated: 2019-05-27Bibliographically approved
Norell-Clarke, A., Tillfors, M., Wilmenius, L., Jansson Fröjmark, M., Holländare, F. & Engström, I. (2016). Insomnia severity mediates between cognitive behavioural therapy for insomnia and depression in a sample with insomnia and depression: New possibilities for treatments of comorbid patients. In: EABCT 2016 Abstract Book: Total Awareness. Paper presented at 46th European Association of Behavioural and Cognitive Therapies congress, August 31 - September 3, Stockholm, Sweden. (pp. 544-544). The European Association for Behavioural and Cognitive Therapies
Open this publication in new window or tab >>Insomnia severity mediates between cognitive behavioural therapy for insomnia and depression in a sample with insomnia and depression: New possibilities for treatments of comorbid patients
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2016 (English)In: EABCT 2016 Abstract Book: Total Awareness, The European Association for Behavioural and Cognitive Therapies , 2016, p. 544-544Conference paper, Oral presentation with published abstract (Other (popular science, discussion, etc.))
Abstract [en]

Clinical trials have shown that cognitive behavioural therapy for insomnia (CBT-I) may have an effect on both insomnia and depression in comorbid samples, but there is a gap in the knowledge on why CBT-I has an impact on depression. Neuropsychological theories suggest that disturbed sleep may work as a transdiagnostic process that maintains psychopathology. The aim was to test whether CBT-I impacts depressive symptoms through improved sleep, in a sample with insomnia comorbid with major depression and subthreshold depressive symptoms. 64 participants were recruited through advertisements and randomised to receive either CBT-I or an active control (relaxation training: RT) in groups during four bi-weekly sessions. Insomnia (ISI) and depressive severity (BDI-II) were measured pre-, mid- and post-treatment. Mediational analyses were conducted. Insomnia and depressive severity lowered over the course of treatments. CBT-I was superior in reducing insomnia. The main treatment outcomes have been published elsewhere (Norell-Clarke et al, 2015). The relationship between CBT-I and post-treatment depressive severity was mediated by mid-treatment insomnia severity, which indicates that the effect of CBT-I on depression goes through improved sleep (b = -4.87, BCa CI = -9.21, -1.97). The results were maintained when pre-treatment insomnia and depressive severity were controlled for (b = -3.36, BCa CI = -8.86, -0.45). Testing for reciprocity, we found that mid-treatment depressive severity did not mediate between CBT-I and post-treatment insomnia severity. The results support the perpetuating role of insomnia in depression. This may have implications for other psychiatric patient groups with comorbid insomnia. Also, the results indicate that CBT for comorbid patient groups may need to target sleep specifically.

Place, publisher, year, edition, pages
The European Association for Behavioural and Cognitive Therapies, 2016
Keywords
insomnia, depression, cbt
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:kau:diva-64510 (URN)
Conference
46th European Association of Behavioural and Cognitive Therapies congress, August 31 - September 3, Stockholm, Sweden.
Available from: 2016-10-17 Created: 2017-10-03 Last updated: 2019-07-11Bibliographically approved
Norell-Clarke, A. & Hagquist, C. (2016). Psychosomatic problems in relation to alcohol use and physical exercise: A study between 1988 and 2011 among adolescents in Sweden. Journal of Public Health, 24(4), 325-333
Open this publication in new window or tab >>Psychosomatic problems in relation to alcohol use and physical exercise: A study between 1988 and 2011 among adolescents in Sweden
2016 (English)In: Journal of Public Health, ISSN 2198-1833, E-ISSN 1613-2238, Vol. 24, no 4, p. 325-333Article in journal (Refereed) Published
Abstract [en]

Aim: The aim was to investigate the association between psychosomatic problems and lifestyle patterns of alcohol use and physical exercise in adolescence. Subject and Methods: Cross-sectional questionnaire data from 8 years of investigations (1988–2011) were used. The sample included over 20,000 adolescents (50 % girls), aged 15–16. Adolescents were divided into three groups depending on psychosomatic problem load: 10th, 11th–89th and 90th percentiles on the psychosomatic problems scale (PSP). A composite measure of alcohol use (frequent/rarely/never) and physical exercise (regular/little/never) was created, resulting in nine combinations of health-related behaviours, and used as dependent variable. Results: Multinomial regression analysis showed that those over the 90th percentile of the PSP had nearly 12 times higher odds of regular alcohol use combined with no exercise compared with those who had the least symptoms. The former subgroup also had higher odds of belonging to all suboptimal lifestyle categories. Those in the 11th–89th percentiles had increased, albeit smaller, odds of belonging to all lifestyle categories. Descriptive data analysis indicated gender differences and changes over time in the strength of the association between psychosomatic problems and health-related behaviours but the regression analysis did not show any statistically significant interactions. The proportion of adolescents engaging in the unhealthiest lifestyle had decreased over time while reports of psychosomatic problems had increased. Conclusion: Adolescents with the greatest psychosomatic symptom load were the most likely to engage in unhealthy lifestyles. This may mean multiplied risks of future psychopathology and warrants longitudinal investigations

Place, publisher, year, edition, pages
Springer, 2016
Keywords
AdolescenceAlcoholPhysical exerciseGenderPsychosomatic health
National Category
Public Health, Global Health, Social Medicine and Epidemiology Psychology (excluding Applied Psychology)
Research subject
Public Health Science
Identifiers
urn:nbn:se:kau:diva-41999 (URN)10.1007/s10389-016-0729-4 (DOI)000382204900008 ()
Available from: 2016-05-12 Created: 2016-05-12 Last updated: 2017-11-30Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-2008-0784

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