A selection from Stockholm University publication database

• Beliefs and Experiences of Fear of Hypoglycemia and Use of Uncooked Cornstarch before Bedtime in Persons with Type 1-Diabetes

  2018. Therese Anderbro (et al.). Open Journal of Nursing 8 (11)

  Article

  Among persons living with type 1-diabetes hypoglycemia and fear of hypoglycemia remain limiting barriers for achieving optimal glucose control and a good quality of life. Fear of hypoglycemia has been found stable over time if not treated. Uncooked cornstarch has been found to reduce the risk of hypoglycemia but has not been studied in relation to fear of hypoglycemia. The aims of this study were to through clinical data, self-reported measures and clinical interviews explore subjects’ experience of using uncooked cornstarch before bedtime and their beliefs and experiences of fear of hypoglycemia. Methods: Mixed methods with both quantitative and qualitative data were used. Self-reported measures of hypoglycemia and fear of hypoglycemia were compared to subjects’ responses during a clinical interview. The interviews were analyzed with a functional behavior analytical approach. Results: A total of five subjects took part in the study. One subject perceived the uncooked cornstarch helpful in reducing hypoglycemia. Several subjects could recall frightening hypoglycemic episodes triggering their fear. Three out of the five subjects reported avoidance behaviors such as excessive self-monitoring of blood glucose or overeating related to fear of hypoglycemia. Conclusions: The uncooked cornstarch was found appetizing but was not perceived as having an effect on BG or hypoglycemia frequency. The clinical interviews confirmed previous research regarding experience of hypoglycemia and fear of hypoglycemia.

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• Acceptance and commitment therapy (ACT) for adult type 1 diabetes management

  2018. Susanne Amsberg (et al.). BMJ Open 8 (11)

  Article

  Introduction Integrating diabetes self-management into daily life involves a range of complex challenges for affected individuals. Environmental, social, behavioural and emotional psychological factors influence the lives of those with diabetes. The aim of this study is to evaluate the impact of a stress management group intervention based on acceptance and commitment therapy (ACT) among adults living with poorly controlled type 1 diabetes.

  Methods and analysis This study will use a randomised controlled trial design evaluating treatment as usual (TAU) and ACT versus TAU. The stress management group intervention will be based on ACT and comprises a programme divided into seven 2-hour sessions conducted over 14 weeks. A total of 70 patients who meet inclusion criteria will be recruited over a 2-year period with follow-up after 1, 2 and 5 years. The primary outcome measure will be HbA1c. The secondary outcome measures will be the Depression Anxiety Stress Scales, the Swedish version of the Hypoglycemia Fear Survey, the Swedish version of the Problem Areas in Diabetes Scale, The Summary of Self-Care Activities, Acceptance Action Diabetes Questionnaire, Swedish Acceptance and Action Questionnaire and the Manchester Short Assessment of Quality of Life. The questionnaires will be administered via the internet at baseline, after sessions 4 (study week 7) and 7 (study week 14), and 6, 12 and 24 months later, then finally after 5 years. HbA1c will be measured at the same time points. Assessment of intervention effect will be performed through the analysis of covariance. An intention-to-treat approach will be used. Mixed-model repeated measures will be applied to explore effect of intervention across all time points.

  Ethics and dissemination The study has received ethical approval (Dnr: 2016/14-31/1). The study findings will be disseminated through peer-reviewed publications, conferences and reports to key stakeholders.

  Trial registration number NCT02914496; Pre-results.

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• A longitudinal study of fear of hypoglycaemia in adults with type 1 diabetes

  2018. Therese Carin Anderbro (et al.).

  Article

  Aims: To investigate fear of hypoglycaemia (FoH) longitudinally in a cross‐sectional study of adult patients with type 1 diabetes. Specifically, we investigated two subgroups of patients who over 4 years either showed a substantial increase or decrease in level of FoH to identify factors associated with changes in FoH.

  Methods: The Swedish version of the Hypoglycaemia Fear Survey (HFS) along with a questionnaire to assess hypoglycaemia history was sent by mail to 764 patients in 2010. The responders in 2010 (n = 469) received another set of the same two questionnaires in 2014. HbA1c, insulin regimen, weight and creatinine from 2010 and 2014 were obtained from medical records. Those with an absolute difference in HFS scores ≥ 75th percentile were included in the subgroup analyses. Statistical analyses included one‐sample t tests, chi‐square and McNemar's test.

  Results: The absolute difference in the HFS total score (n = 347) between 2010 and 2014 was m = ±7.6, SD ± 6. In the increased FoH group, more patients reported a high level of moderate hypoglycaemic episodes as well as impaired awareness of hypoglycaemia in 2014 compared with the decreased FoH group. There were more subjects in the increased FoH group with insulin pumps in 2014 and in 2010. In the decreased FoH group, more patients had a high frequency of daily self‐monitoring of blood glucose (SMBG) in 2010 and in 2014.

  Conclusions: Fear of hypoglycaemia is stable across time for most patients. Changes in fear level are associated with changes in hypoglycaemia frequency. Thus, asking patients about changes in hypoglycaemia experiences is of great importance.

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• A longitudinal study of fear of hypoglycemia in type 1 diabetes

  2015. Therese Anderbro (et al.).

  Conference

  Aim

  The aim of this study was to investigate fear of hypoglycemia (FoH) longitudinally in adult patients with type 1 diabetes. Specifically, we investigated two subgroups of patients who over four years either showed a significantly higher or significantly lower level of FoH in order to identify factors associated with changes in FoH.

  Method

  The Swedish version of the Hypoglycemia Fear Survey (HFS) along with a questionnaire to assess hypoglycemia history (mild, moderate, nocturnal and severe hypoglycaemia (SH), unawareness, and daytime/nocturnal self-monitoring of blood glucose (SMBG)) were sent by mail to 764 patients in 2010. The responders in 2010 (n=469) received another set of the same two questionnaires in 2014. A1c, insulin regimen, weight and creatinine from 2010 and 2014 were obtained from medical records. Those with an absolute difference in HFS scores ≥ 75th percentile were included in the subgroup analyses. Statistical analyses included one-sample t-tests and chi-square.

  Results

  The absolute difference in the HFS total score (n=359) between 2010 and 2014 was m=±7.6, SD ±6 (range -29 - +35). In the subgroup with increased FoH 2014 (n=45), more patients reported unawareness (76% vs 58%, Χ²= 5.05, p= 0.025) and a higher frequency of moderate hypoglycemia (52% v s 38%, Χ²= 3.93, p= 0.047) compared to 2010. In the group with decreased FoH (n=43), fewer patients reported going to the emergency department due to hypoglycemia in 2014 compared to 2010 (2% vs 14%, Χ²= 4.84, p= 0.028). There were no differences in the remaining hypoglycemia history variables or medical variables between 2010 and 2014. Between group analyzes show that in the decreased FoH group more patients have a high frequency of daily SMBG compared to the increased FoH group in 2010 (35% vs 17%, Χ²= 12.23, p= 0.00) and in 2014 (33% vs 13%, Χ²= 13.75, p= 0.00). In the increased FoH group more patients report a high level of mild (67% vs 49%,Χ²= 6.4, p= 0.011) and moderate (52% vs 23%,Χ²= 14.00, p= 0.00) hypoglycemic episodes as well as unawareness (76% vs 54%,Χ²= 11.37, p= 0.001) in 2014 compared with the decreased FoH group.

  Discussion

  To our knowledge, this is the first longitudinal study of FoH in patients with type 1 diabetes. Our study shows that FoH is stable across time for most patients although a number of patients show increased or decreased levels of FoH. The patients whose level of FoH increased experienced a higher frequency of moderate hypoglycemic episodes and more hypoglycemic unawareness in 2014.

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• Fear of hypoglycemia

  2015. Therese Anderbro (et al.). Acta Diabetologica 52 (3), 581-589

  Article

  The major aims of this study were to examine (1) the association between fear of hypoglycemia (FOH) in adults with type 1 diabetes with demographic, psychological (anxiety and depression), and disease-specific clinical factors (hypoglycemia history and unawareness, A(1c)), including severe hypoglycemia (SH), and (2) differences in patient subgroups categorized by level of FOH and risk of SH. Questionnaires were mailed to 764 patients with type 1 diabetes including the Swedish translation of the Hypoglycemia Fear Survey (HFS) and other psychological measures including the Perceived Stress Scale, Hospital Anxiety and Depression Scale, Anxiety Sensitivity Index, Social Phobia Scale, and Fear of Complications Scale. A questionnaire to assess hypoglycemia history was also included and A(1c) measures were obtained from medical records. Statistical analyses included univariate approaches, multiple stepwise linear regressions, Chi-square t tests, and ANOVAs. Regressions showed that several clinical factors (SH history, frequency of nocturnal hypoglycemia, self-monitoring) were significantly associated with FOH but R (2) increased from 16.25 to 39.2 % when anxiety measures were added to the model. When patients were categorized by level of FOH (low, high) and SH risk (low, high), subgroups showed significant differences in non-diabetes-related anxiety, hypoglycemia history, self-monitoring, and glycemic control. There is a strong link between FOH and non-diabetes-related anxiety, as well as hypoglycemia history. Comparison of patient subgroups categorized according to level of FOH and SH risk demonstrated the complexity of FOH and identified important differences in psychological and clinical variables, which have implications for clinical interventions.

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• Par i beteendeterapi

  2014. Therese Anderbro, Liv Svirsky.

  Book

  Att arbeta med par ställer psykoterapeuten inför helt nya utmaningar. Den här boken ger teoretisk kunskap och praktiska instruktioner för att hjälpa par med relationssvårigheter. Metoden som presenteras utgår från den så kallade tredje vågens beteendeterapi och betonar vikten av acceptans. Boken visar hur bedömningen går till och hur behandlingen genomförs. Den ger också fylliga beskrivningar av acceptans- och förändringsstrategier och arbetets olika faser illustreras med hjälp av fallbeskrivningar och dialoger. Par i beteendeterapi är den första boken som presenterar metoden IBCT (Integrative Behavioural Couples Therapy) på svenska. Den vänder sig till KBT-behandlare som vill börja arbeta med par och till behandlare som redan arbetar med parterapi och vill öka sin kunskap om hur man kan göra det ur ett inlärningsteoretiskt perspektiv. Boken är även lämplig som kurslitteratur under utbildning.

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Show all publications by Therese Anderbro at Stockholm University