Susanna Jernelöv

Changes in immune regulation in response to examination stress in atopic and healthy individuals

Background Stress can aggravate the allergic inflammation, but determinants of disturbed immune regulation are largely unknown.

Internet-Delivered Acceptance and Values-Based Exposure Treatment for Fibromyalgia: A Pilot Study

Background: Acceptance and commitment therapy (ACT) is a promising treatment option for fibromyalgia (FM). Studies have shown that many cognitive behavioral protocols can be transferred to the Internet with sustained efficacy. However, no study has investigated the effect on an Internet-delivered ACT-based protocol for FM. This study evaluated the efficacy, acceptability, and the health economic effects of an Internet-delivered acceptance and values-based exposure treatment for FM. Methods: This open pilot trial included 41 self-referred women with a FM diagnosis. The 10-week Internet-delivered treatment included acceptance, mindfulness, work with life-values, and systematic exposure to FM symptoms and FM-related situations. Participants also had regular contact with an assigned online therapist. Assessments were made at pretreatment, post-treatment, and 6-month follow-up. Results: The treatment was completed by 70% of the participants. Attrition rates were low, with 98% completing the post-treatment assessment and 90% completing the 6-month follow-up assessment. Multiple imputations were used to replace missing values. Pre- to post-treatment within-group effect sizes were in the moderate to large range (Cohens d = 0.62–1.56) on measures of FM symptoms and impact, disability, quality of life, depression, anxiety, fatigue, and psychological flexibility. All improvements were maintained at follow-up. Economical analyses revealed significant societal cost reductions that offset the treatment costs within 2 months of treatment completion. Conclusions: An Internet-delivered psychological treatment based on acceptance and exposure principles seems to be an efficacious, acceptable, and cost-effective treatment for FM. Randomized controlled trials are needed to confirm these results.

Effects of Examination Stress on Psychological Responses, Sleep and Allergic Symptoms in Atopic and Non-Atopic Students

BackgroundRecent findings indicate that atopics may be more vulnerable to stress than non-atopics. However, the roles of psychological well-being and sleep in this presumed increased sensitivity are not known.PurposeTo investigate the effects of a brief naturalistic stressor on psychological responses, sleep, and allergic symptoms and to compare those responses between atopic and non-atopic individuals.MethodsWe assessed atopic and non-atopic students during a period without and during a period with examinations.ResultsFor both atopic and non-atopic students, tension, anxiety, and depression deteriorated in response to examination, as did sleep latency and sleep quality. Overall, atopics were more tense, had more anxiety, longer sleep latencies, and were less well rested than non-atopics. Non-atopic students rose from bed later during the examination period. In response to examination, atopic students reported increased frequency of stress behaviors (e.g., eating fast), while decreased stress behaviors were reported by non-atopic students. Allergic symptoms were not affected.ConclusionAtopic students were worse off in aspects of psychological well-being and sleep, but displayed only partly stronger responses to a stressor compared to non-atopic students. In spite of a broad negative response to examination, allergic symptoms were not affected.

Three-Year Follow-Up Comparing Cognitive Behavioral Therapy for Depression to Cognitive Behavioral Therapy for Insomnia, for Patients With Both Diagnoses

Abstract This 3‐year follow‐up compared insomnia treatment to depression treatment for patients with both diagnoses. Forty‐three participants were randomized to either treatment, in the form of Internet‐delivered therapist‐guided cognitive behavior therapy (CBT), and 37 (86%) participants provided primary outcome data at the 3‐year follow‐up. After 3 years, reductions on depression severity were similar in both groups (between‐group effect size, d = 0.33, p = .45), while the insomnia treatment had superior effects on insomnia severity (d = 0.66, p < .05). Overall, insomnia treatment was thus more beneficial than depression treatment. The implication for practitioners, supported by previous research, is that patients with co‐occurring depression and insomnia should be offered CBT for insomnia, in addition to medication or psychological treatment for depression.

Facilitating and hindering factors in Internet-delivered treatment for insomnia and depression

Insomnia and depression is a common and debilitating comorbidity, and treatment is usually given mainly for depression. Guided Internet-based cognitive behavioral therapy for insomnia (ICBT-i) was, in a recent study on which this report is based, found superior to a treatment for depression (ICBT-d) for this patient group, but many patients did not reach remission. Aims To identify facilitating and hindering factors for patients in ICBT-i and ICBT-d and formulate hypotheses for future research. Method Qualitative telephone interviews at the time of the 6-month follow-up. Thirty-five interviews were done and analyzed with a grounded theory approach. Based on the qualitative results, an iterative method-triangulation including quantitative and semi-qualitative was performed. Results The interviews were coded into 738 sentences, condensed into 47 categories and finally 11 themes. Four areas were investigated further with method triangulation: Opinions about treatment, adherence, hindering symptoms and acceptance. Patients in ICBT-i were more positive regarding the treatment than patients in ICBT-d. Using treatment components was positively associated with outcome in both groups. Symptoms of insomnia, depression and other comorbidities were perceived as more hindering for ICBT-d than for ICBT-i. Acceptance of diagnose-related problems as well as negative emotions and cognitions was positively associated with outcome for ICBT-i. Proposed future research hypotheses 1) A combination of CBT for insomnia and CBT for depression is more effective than only one of the treatments. 2) Additional therapist support increases outcomes for patients with more comorbidities. 3) Acceptance is a mechanism of change in CBT-i.

Associations Between Leptin and Self-Rated Health in Men and Women

BACKGROUND As an important mediator by which the brain receives information about the bodys energy state, leptin may be associated with subjectively perceived health. OBJECTIVE The main aim of the present study was to investigate concurrent and prospective associations between leptin and self-rated health (SRH), a strong predictor of morbidity and mortality, in a random population sample. An additional aim was to examine whether sick leave was associated with leptin and poor SRH. METHODS In a prospective, population-based cohort study in Sweden, men and women underwent a medical examination in 1998, at which time blood was drawn and participants were asked to respond to a questionnaire concerning demographics, health behavior, and psychosocial factors. In 2000, the participants responded to a second questionnaire sent by postal mail. Spearman rank correlations were used to investigate the relationships between leptin, SRH, sick leave, and background variables. Partial Spearman coefficients were then calculated to investigate the patterns of association between leptin, SRH, and sick leave independent of age, body mass index (BMI), presence of diagnosis, and testosterone or estradiol. RESULTS A total of 98 men and 104 women, aged 23 to 76 years, and 91 men and 96 women at follow-up, participated in the study. In men, relatively higher levels of leptin were prospectively associated with relatively worse SRH (rho = 0.20; P = 0.05), but the relationship was not significant in the cross-sectional analysis (rho = 0.18; P = 0.07). This association was not found in women. When controlling for age, BMI, presence of diagnosis, and testosterone, higher levels of leptin were associated with poor SRH in men in cross-sectional analysis (rho = 0.27; P < 0.01) but not prospectively. In women, leptin was not associated with SRH in cross-sectional analysis, but relatively higher levels were prospectively associated with better SRH when adjusted for background factors and estradiol (rho = -0.26; P < 0.05). SRH was independently associated with future sick leave in both men (rho = 0.34; P < 0.01) and women (rho = 0.30; P < 0.05), whereas no association between leptin and future sick leave was found. CONCLUSIONS Contrasting associations were found between men and women in the relationship between leptin and SRH. Based on the finding that higher leptin levels were associated with better SRH in women than in men, along with corroboration from recent studies, we propose that leptin may serve different psychobiological functions in men than in women.

BDNF expression in response to academic stress in asthmatic and healthy subjects

381 BDNF expression in response to academic stress in asthmatic and healthy subjects C. Kemi , M. Lekander , J. Grunewald , J. Axén , S. Jernelöv , C. Müller-Suur , Y. Smith , R. Grönneberg , A. Eklund , P. Stierna , C. Olgart Höglund a,e,f,g a Dept. of Medicine Solna, Karolinska Institutet, Stockholm, Sweden b Dept. of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden c Stress Research Institute, Stockholm University, Stockholm, Sweden d Dept. of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden e Dept. of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden f Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden g Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden Stress may modulate immune responses and has been shown to regulate allergic inflammation in an unfavourable way. The neurotrophin brain-derived neurotrophic factor (BDNF) was originally discovered as a neuronal growth factor, but is today also recognized as a critical mediator of allergic inflammation and asthma. Recent studies have suggested a role for BDNF as a survival factor for eosinophils and inducer of bronchial hyperreactivity in asthma. Stress has been shown to regulate neurotrophins in brain and blood. However, if stress can regulate BDNF release from immune cells and if this regulation differs between asthmatic and healthy subjects is unknown. The aim of the study was to determine the regulation of BDNF secretion from white blood cells in asthmatic and healthy subjects, in parallel to studies of inflammatory parameters and bronchial hyperreactivity, in response to stress. Thirtyfive medical students were examined during a low-stress and stressful (academic exams) study period. ELISA analysis of white blood cells revealed generally higher secreted levels of BDNF in asthmatic compared to healthy subjects. At the stress period, BDNF secretion increased in healthy subjects only and correlated positively to IL-5 and CD4+ T-cells in asthmatics. A possible role for BDNF in the pathogenesis of asthma and stress-mediated neuroimmune regulation is therefore suggested. doi:10.1016/j.bbi.2010.07.135

116. Sex-specific relations between leptin and self-rated health

adults. We also hypothesized that associations would be patterned by age and gender. Data were from the second wave of the Survey of Midlife in the United States (MIDUS). Participants (N = 507) completed questionnaires focused on lifetime instances of unfair treatment in multiple life domains. Fasting blood samples were obtained during an overnight stay at a General Clinical Research Center (GCRC), and serum levels of fibrinogen were assessed using a semiautomated modification of the Clauss method. Almost half the sample (43%) reported at least one instance of perceived discrimination. Participants under 65 years old reported significantly more instances than those over 65, and women reported more instances than men (P < 0.01 for both). Analyses of variance (ANOVA) that included interaction terms for age and gender showed that perceived discrimination predicted higher serum levels of fibrinogen in young men (P < 0.05), but not in other groups. This association remained statistically significant after adjustment for potential demographic, socioeconomic, health, and health behavior confounds. These results suggest that circulating levels of fibrinogen may be sensitive to perceived discrimination and may play a role in its health consequences. They also suggest that young men may be particularly vulnerable to the adverse impact of perceived discrimination.