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Publications (10 of 13) Show all publications
Sairanen, E., Lappalainen, R., Lappalainen, P. & Hiltunen, A. (2020). Mediators of change in online acceptance and commitment therapy for psychological symptoms of parents of children with chronic conditions: An investigation of change processes. Journal of Contextual Behavioral Science, 15, 123-130
Open this publication in new window or tab >>Mediators of change in online acceptance and commitment therapy for psychological symptoms of parents of children with chronic conditions: An investigation of change processes
2020 (English)In: Journal of Contextual Behavioral Science, ISSN 2212-1447, Vol. 15, p. 123-130Article in journal (Refereed) Published
Place, publisher, year, edition, pages
Elsevier, 2020
Keywords
Psychology, Pliability, Psychological inflexibility
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:kau:diva-76619 (URN)10.1016/j.jcbs.2019.11.010 (DOI)000514809200014 ()2-s2.0-85076931266 (Scopus ID)
Funder
Region Värmland, c2015/327
Available from: 2020-01-30 Created: 2020-01-30 Last updated: 2020-05-08Bibliographically approved
Sairanen, E., Lappalainen, R., Lappalainen, P., Kaipainen, K., Carlstedt, F., Anclair, M. & Hiltunen, A. (2019). Effectiveness of a web-based acceptance and commitment therapy intervention for wellbeing of parents whose children have chronic conditions: A randomized controlled trial. Journal of Contextual Behavioral Science, 13, 94-102
Open this publication in new window or tab >>Effectiveness of a web-based acceptance and commitment therapy intervention for wellbeing of parents whose children have chronic conditions: A randomized controlled trial
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2019 (English)In: Journal of Contextual Behavioral Science, ISSN 2212-1447, Vol. 13, p. 94-102Article in journal (Refereed) Published
Place, publisher, year, edition, pages
Elsevier, 2019
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:kau:diva-75029 (URN)10.1016/j.jcbs.2019.07.004 (DOI)000483320600011 ()
Available from: 2019-10-02 Created: 2019-10-02 Last updated: 2019-11-14Bibliographically approved
Sairanen, E., Lappalainen, P. & Hiltunen, A. (2018). Psychological inflexibility explains distress in parents whose children have chronic conditions. PLoS ONE, 13(7), Article ID e0201155.
Open this publication in new window or tab >>Psychological inflexibility explains distress in parents whose children have chronic conditions
2018 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 7, article id e0201155Article in journal (Refereed) Published
Abstract [en]

Experiential avoidance, cognitive defusion, and mindfulness have all been associated with psychological disorders and well-being. This study investigates whether they predict psychological distress, i.e., symptoms of burnout, depression, stress and anxiety, in parents of children with chronic conditions. We hypothesized that these factors would exhibit a large degree of common variance, and that when compared to mindfulness and defusion, experiential avoidance on its own would predict a larger proportion of unique variance. 75 parents of children with chronic conditions having burnout symptoms who participated in an intervention study completed measures of burnout, stress, anxiety, depression, experiential avoidance, cognitive defusion, and mindfulness at the beginning of the intervention study (baseline). We ran several regression analyses to assess the predictive ability of these different constructs. Experiential avoidance on its own accounted for 28-48% of the variance in different psychological symptoms. Cognitive defusion and mindfulness did not make a significant contribution to explaining burnout, stress and anxiety, but cognitive defusion contributed to explaining depression. The results confirmed our hypothesis, supporting research on the importance of psychological flexibility as a central factor in understanding the occurrence of psychological distress.

Place, publisher, year, edition, pages
San Francisco: PUBLIC LIBRARY SCIENCE, 2018
Keywords
COMMITMENT THERAPY, MINDFULNESS QUESTIONNAIRE, INTELLECTUAL DISABILITIES, EXPERIENTIAL AVOIDANCE, CONSTRUCT-VALIDITY, ACCEPTANCE, BURNOUT
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:kau:diva-68794 (URN)10.1371/journal.pone.0201155 (DOI)000439942500085 ()30044852 (PubMedID)
Available from: 2018-08-17 Created: 2018-08-17 Last updated: 2018-09-06
Järvelä-Reijonen, E., Karhunen, L., Sairanen, E., Muotka, J., Lindroos, S., Laitinen, J., . . . Kolehmainen, M. (2018). The effects of acceptance and commitment therapy on eating behavior and diet delivered through face-to-face contact and a mobile app: A randomized controlled trial. International Journal of Behavioral Nutrition and Physical Activity, 15(22)
Open this publication in new window or tab >>The effects of acceptance and commitment therapy on eating behavior and diet delivered through face-to-face contact and a mobile app: A randomized controlled trial
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2018 (English)In: International Journal of Behavioral Nutrition and Physical Activity, ISSN 1479-5868, E-ISSN 1479-5868, Vol. 15, no 22, p. -14Article in journal (Refereed) Published
Abstract [en]

Background: Internal motivation and good psychological capabilities are important factors in successful eating-related behavior change. Thus, we investigated whether general acceptance and commitment therapy (ACT) affects reported eating behavior and diet quality and whether baseline perceived stress moderates the intervention effects. Methods: Secondary analysis of unblinded randomized controlled trial in three Finnish cities. Working-aged adults with psychological distress and overweight or obesity in three parallel groups: (1) ACT-based Face-to-face (n = 70; six group sessions led by a psychologist), (2) ACT-based Mobile (n = 78; one group session and mobile app), and (3) Control (n = 71; only the measurements). At baseline, the participants' (n = 219, 85% females) mean body mass index was 31.3 kg/m2 (SD = 2.9), and mean age was 49.5 years (SD = 7.4). The measurements conducted before the 8-week intervention period (baseline), 10 weeks after the baseline (post-intervention), and 36 weeks after the baseline (follow-up) included clinical measurements, questionnaires of eating behavior (IES-1, TFEQ-R18, HTAS, ecSI 2.0, REBS), diet quality (IDQ), alcohol consumption (AUDIT-C), perceived stress (PSS), and 48-h dietary recall. Hierarchical linear modeling (Wald test) was used to analyze the differences in changes between groups. Results: Group x time interactions showed that the subcomponent of intuitive eating (IES-1), i.e., Eating for physical rather than emotional reasons, increased in both ACT-based groups (p = .019); the subcomponent of TFEQ-R18, i.e., Uncontrolled eating, decreased in the Face-to-face group (p = .020); the subcomponent of health and taste attitudes (HTAS), i.e., Using food as a reward, decreased in the Mobile group (p = .048); and both subcomponent of eating competence (ecSI 2.0), i.e., Food acceptance (p = .048), and two subcomponents of regulation of eating behavior (REBS), i.e., Integrated and Identified regulation (p = .003, p = .023, respectively), increased in the Face-to-face group. Baseline perceived stress did not moderate effects on these particular features of eating behavior from baseline to follow-up. No statistically significant effects were found for dietary measures. Conclusions: ACT-based interventions, delivered in group sessions or by mobile app, showed beneficial effects on reported eating behavior. Beneficial effects on eating behavior were, however, not accompanied by parallel changes in diet, which suggests that ACT-based interventions should include nutritional counseling if changes in diet are targeted.

Place, publisher, year, edition, pages
BioMed Central Ltd., 2018
Keywords
ACT, Behavior change, Dietary intake, Intuitive eating, MHealth, Mindful eating, Mindfulness, Obesity, Overweight, Regulation of eating behavior
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:kau:diva-66665 (URN)10.1186/s12966-018-0654-8 (DOI)000426354100001 ()2-s2.0-85042546791 (Scopus ID)
Available from: 2018-03-13 Created: 2018-03-13 Last updated: 2020-01-07Bibliographically approved
Sairanen, E., Tolvanen, A., Karhunen, L., Kolehmainen, M., Järvelä-Reijonen, E., Lindroos, S., . . . Lappalainen, R. (2017). Psychological flexibility mediates change in intuitive eating regulation in acceptance and commitment therapy interventions. Public Health Nutrition, 20(9), 1681-1691
Open this publication in new window or tab >>Psychological flexibility mediates change in intuitive eating regulation in acceptance and commitment therapy interventions
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2017 (English)In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 20, no 9, p. 1681-1691Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Despite the promising results related to intuitive eating, few studies have attempted to explain the processes encouraging this adaptive eating behaviour. The focus of the present study was on exploring mechanisms of change in intuitive eating and weight in acceptance and commitment therapy (ACT) interventions. Mediation provides important information regarding the treatment processes and theoretical models related to specific treatment approaches. The study investigates whether psychological flexibility, mindfulness skills and sense of coherence mediated the interventions' effect on intuitive eating and weight.

DESIGN: Secondary analysis of a randomized control trial. Mediation analysis compared two ACT interventions - face-to-face (in a group) and mobile (individually) - with a control group using a latent difference score model. Settings Data were collected in three Finnish towns.

SUBJECTS: The participants were overweight or obese (n 219), reporting symptoms of perceived stress.

RESULTS: The effect of the interventions on participants' (i) BMI, (ii) intuitive eating and its subscales, (iii) eating for physical rather than emotional reasons and (iv) reliance on internal hunger and satiety cues was mediated by changes in weight-related psychological flexibility in both ACT groups.

CONCLUSIONS: These findings suggest that ACT interventions aiming for lifestyle changes mediate the intervention effects through the enhanced ability to continue with valued activities even when confronted with negative emotions and thoughts related to weight.

Place, publisher, year, edition, pages
Cambridge University Press, 2017
Keywords
Acceptance and commitment therapy Overweight, Intuitive eating, Psychological flexibility
National Category
Psychology (excluding Applied Psychology)
Research subject
Psychology
Identifiers
urn:nbn:se:kau:diva-63846 (URN)10.1017/S1368980017000441 (DOI)000435731200018 ()28414018 (PubMedID)
Available from: 2017-09-20 Created: 2017-09-20 Last updated: 2018-08-20Bibliographically approved
Järvelä-Reijonen, E., Karhunen, L., Sairanen, E., Rantala, S., Laitinen, J., Puttonen, S., . . . Kolehmainen, M. (2016). High perceived stress is associated with unfavorable eating behavior in overweight and obese Finns of working age.. Appetite, 103, 249-258, Article ID S0195-6663(16)30144-1.
Open this publication in new window or tab >>High perceived stress is associated with unfavorable eating behavior in overweight and obese Finns of working age.
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2016 (English)In: Appetite, ISSN 0195-6663, E-ISSN 1095-8304, Vol. 103, p. 249-258, article id S0195-6663(16)30144-1Article in journal (Refereed) Published
Abstract [en]

Stress-related eating may be a potential factor in the obesity epidemic. Rather little is known about how stress associates with eating behavior and food intake in overweight individuals in a free-living situation. Thus, the present study aims to investigate this question in psychologically distressed overweight and obese working-aged Finns. The study is a cross-sectional baseline analysis of a randomized controlled trial. Of the 339 study participants, those with all the needed data available (n = 297, 84% females) were included. The mean age was 48.9 y (SD = 7.6) and mean body mass index 31.3 kg/m(2) (SD = 3.0). Perceived stress and eating behavior were assessed by self-reported questionnaires Perceived Stress Scale (PSS), Intuitive Eating Scale, the Three-Factor Eating Questionnaire, Health and Taste Attitude Scales and ecSatter Inventory. Diet and alcohol consumption were assessed by 48-h dietary recall, Index of Diet Quality, and AUDIT-C. Individuals reporting most perceived stress (i.e. in the highest PSS tertile) had less intuitive eating, more uncontrolled eating, and more emotional eating compared to those reporting less perceived stress (p < 0.05). Moreover, individuals in the highest PSS tertile reported less cognitive restraint and less eating competence than those in the lowest tertile (p < 0.05). Intake of whole grain products was the lowest among those in the highest PSS tertile (p < 0.05). Otherwise the quality of diet and alcohol consumption did not differ among the PSS tertiles. In conclusion, high perceived stress was associated with the features of eating behavior that could in turn contribute to difficulties in weight management. Stress-related way of eating could thus form a potential risk factor for obesity. More research is needed to develop efficient methods for clinicians to assist in handling stress-related eating in the treatment of obese people.

Place, publisher, year, edition, pages
Elsevier, 2016
Keywords
Dietary intake, Eating behavior, Emotional eating, Intuitive eating, Obesity, Perceived stress
National Category
Psychology (excluding Applied Psychology)
Research subject
Psychology
Identifiers
urn:nbn:se:kau:diva-63847 (URN)10.1016/j.appet.2016.04.023 (DOI)000378666500031 ()27108837 (PubMedID)
Available from: 2017-09-20 Created: 2017-09-20 Last updated: 2020-05-25Bibliographically approved
Mattila, E., Lappalainen, R., Välkkynen, P., Sairanen, E., Lappalainen, P., Karhunen, L., . . . Ermes, M. (2016). Usage and Dose-Response of a Mobile Acceptance and Commitment Therapy App: Secondary Analysis from the Intervention Arm of a Randomized Controlled Trial. JMIR mhealth and uhealth, 4(3)
Open this publication in new window or tab >>Usage and Dose-Response of a Mobile Acceptance and Commitment Therapy App: Secondary Analysis from the Intervention Arm of a Randomized Controlled Trial
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2016 (English)In: JMIR mhealth and uhealth, E-ISSN 2291-5222, Vol. 4, no 3Article in journal (Refereed) Published
Place, publisher, year, edition, pages
JMIR Publications Inc., 2016
National Category
Applied Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:kau:diva-63854 (URN)10.2196/mhealth.5241 (DOI)000381184200009 ()
Available from: 2017-09-20 Created: 2017-09-20 Last updated: 2019-12-18Bibliographically approved
Sairanen, E., Tolvanen, A., Karhunen, L., Kolehmainen, M., Järvelä, E., Rantala, S., . . . Lappalainen, R. (2015). Psychological flexibility and mindfulness explain intuitive eating in overweight adults. Behavior modification, 39(4), 557-79
Open this publication in new window or tab >>Psychological flexibility and mindfulness explain intuitive eating in overweight adults
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2015 (English)In: Behavior modification, ISSN 0145-4455, E-ISSN 1552-4167, Vol. 39, no 4, p. 557-79Article in journal (Refereed) Published
Abstract [en]

The current study investigated whether mindfulness and psychological flexibility, independently and together, explain intuitive eating. The participants were overweight or obese persons (N = 306) reporting symptoms of perceived stress and enrolled in a psychological lifestyle intervention study. Participants completed self-report measures of psychological flexibility; mindfulness including the subscales observe, describe, act with awareness, non-react, and non-judgment; and intuitive eating including the subscales unconditional permission to eat, eating for physical reasons, and reliance on hunger/satiety cues. Psychological flexibility and mindfulness were positively associated with intuitive eating factors. The results suggest that mindfulness and psychological flexibility are related constructs that not only account for some of the same variance in intuitive eating, but they also account for significant unique variances in intuitive eating. The present results indicate that non-judgment can explain the relationship between general psychological flexibility and unconditional permission to eat as well as eating for physical reasons. However, mindfulness skills-acting with awareness, observing, and non-reacting-explained reliance on hunger/satiety cues independently from general psychological flexibility. These findings suggest that mindfulness and psychological flexibility are interrelated but not redundant constructs and that both may be important for understanding regulation processes underlying eating behavior.

Place, publisher, year, edition, pages
Beverly Hills: Sage Publications, 2015
Keywords
intuitive eating, mindfulness, obesity, overweight, psychological flexibility
National Category
Psychology (excluding Applied Psychology)
Research subject
Psychology
Identifiers
urn:nbn:se:kau:diva-63849 (URN)10.1177/0145445515576402 (DOI)000354992900005 ()25810381 (PubMedID)
Available from: 2017-09-20 Created: 2017-09-20 Last updated: 2020-05-25Bibliographically approved
Sairanen, E., Lappalainen, R., Lapveteläinen, A., Tolvanen, A. & Karhunen, L. (2014). Flexibility in weight management.. Eating Behaviors, 15(2), 218-24, Article ID S1471-0153(14)00022-1.
Open this publication in new window or tab >>Flexibility in weight management.
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2014 (English)In: Eating Behaviors, ISSN 1471-0153, E-ISSN 1873-7358, ISSN 1471-0153, Vol. 15, no 2, p. 218-24, article id S1471-0153(14)00022-1Article in journal (Refereed) Published
Abstract [en]

The purpose of the study was to investigate the relationships between changes in flexible vs. rigid restraints of eating during weight management, as well as how changes in the cognitive restraint of eating were related to psychological well-being and flexibility. The data includes information on 49 overweight persons who participated in a weight loss and maintenance (WLM) intervention and a follow-up assessment after 8-9 months. An increase in flexible cognitive restraint during the weight loss intervention was related to better weight loss maintenance and well-being. The more flexible restraint increased during the WLM intervention, the more psychological distress decreased. Moreover, larger reduction of rigid restraint during the follow-up period (between the WLM intervention and the follow-up assessment) was related to a better maintenance of improved psychological well-being at the follow-up endpoint. These results suggest that increasing flexible control while reducing rigid control of eating after an active weight loss phase improves success in weight management and the psychological well-being of weight losers.

Place, publisher, year, edition, pages
Amsterdam: Elsevier, 2014
Keywords
Flexible vs. rigid eating restraint, Overweight, Psychological flexibility, Psychological well-being, Weight maintenance
National Category
Psychology (excluding Applied Psychology)
Research subject
Psychology
Identifiers
urn:nbn:se:kau:diva-63851 (URN)10.1016/j.eatbeh.2014.01.008 (DOI)000337875100008 ()24854807 (PubMedID)
Available from: 2017-09-20 Created: 2017-09-20 Last updated: 2019-06-10Bibliographically approved
Lappalainen, R., Sairanen, E., Järvelä, E., Rantala, S., Korpela, R., Puttonen, S., . . . Kolehmainen, M. (2014). The effectiveness and applicability of different lifestyle interventions for enhancing wellbeing: the study design for a randomized controlled trial for persons with metabolic syndrome risk factors and psychological distress.. BMC Public Health, 14, Article ID 310.
Open this publication in new window or tab >>The effectiveness and applicability of different lifestyle interventions for enhancing wellbeing: the study design for a randomized controlled trial for persons with metabolic syndrome risk factors and psychological distress.
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2014 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, E-ISSN 1471-2458, Vol. 14, article id 310Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Obesity and stress are among the most common lifestyle-related health problems. Most of the current disease prevention and management models are not satisfactorily cost-effective and hardly reach those who need them the most. Therefore, novel evidence-based controlled interventions are necessary to evaluate models for prevention and treatment based on self-management. This randomized controlled trial examines the effectiveness, applicability, and acceptability of different lifestyle interventions with individuals having symptoms of metabolic syndrome and psychological distress. The offered interventions are based on cognitive behavioral approaches, and are designed for enhancing general well-being and supporting personalized lifestyle changes.

METHODS/DESIGN: 339 obese individuals reporting stress symptoms were recruited and randomized to either (1) a minimal contact web-guided Cognitive Behavioral Therapy-based (CBT) intervention including an approach of health assessment and coaching methods, (2) a mobile-guided intervention comprising of mindfulness, acceptance and value-based exercises, (3) a face-to-face group intervention using mindfulness, acceptance and value-based approach, or (4) a control group. The participants were measured three times during the study (pre = week 0, post = week 10, and follow-up = week 36). Psychological well-being, lifestyles and habits, eating behaviors, and user experiences were measured using online surveys. Laboratory measurements for physical well-being and general health were performed including e.g. liver function, thyroid glands, kidney function, blood lipids and glucose levels and body composition analysis. In addition, a 3-day ambulatory heart rate and 7-day movement data were collected for analyzing stress, recovery, physical activity, and sleep patterns. Food intake data were collected with a 48 -hour diet recall interview via telephone. Differences in the effects of the interventions would be examined using multiple-group modeling techniques, and effect-size calculations.

DISCUSSION: This study will provide additional knowledge about the effects of three low intensity interventions for improving general well-being among individuals with obesity and stress symptoms. The study will show effects of two technology guided self-help interventions as well as effect of an acceptance and value-based brief group intervention. Those who might benefit from the aforesaid interventions will increase knowledge base to better understand what mechanisms facilitate effects of the interventions.

TRIAL REGISTRATION: Current Clinical Trials NCT01738256, Registered 17 August, 2012.

Place, publisher, year, edition, pages
BioMed Central, 2014
National Category
Psychology (excluding Applied Psychology)
Research subject
Psychology
Identifiers
urn:nbn:se:kau:diva-63850 (URN)10.1186/1471-2458-14-310 (DOI)000335465900001 ()24708617 (PubMedID)
Available from: 2017-09-20 Created: 2017-09-20 Last updated: 2019-12-19Bibliographically approved
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Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-4499-644x

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