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The purpose was to present a total description, distribution, and ranking of chronic pain conditions in the general population. This was based on structured clinical examinations of a random sample from a population-based survey (HUNT3) with a calculated oversampling of participants with chronic pain. Supplemented with access to hospital reports, the examination was performed by experienced physicians and psychologists using a consistent definition of chronic pain as well as ICD-10- and the new ICD-11-classification. The main findings were that a higher proportion of the 551 participants had chronic pain assessed by clinical examination (399) than by self-report in a survey the same day (337). Among those with examination-verified chronic pain estimated from HUNT3 to represent 27.9% of the general population, 63% had chronic primary pain, 81% musculoskeletal pain, and 77% more than one chronic pain condition. When separating chronic primary from chronic secondary pain according to ICD-11, the weighted prevalence was 17.7% for chronic pain conditions of unknown and 10.2% of known cause. When all the participants’ conditions were accounted for, the most prevalent were nonspecific low back (10.8%) and neck pain (7.6%). Participants with chronic primary pain did not have significantly more psychopathology than those with chronic secondary pain: 14.5% vs. 12.5%. Perspective: Since this study confirms the high prevalence in self-report surveys and indicates that two thirds of chronic pain conditions cannot be explained by underlying diseases, this huge health and societal problem should be solved primarily on a public health level directed towards prevention and rehabilitation.

Depression is associated with reduced executive functioning. Still, we lack a more detailed understanding of the factors explaining this association. Addressing several limitations in the previous literature, we examine whether poor executive functioning is associated with specific depression symptoms using a network approach. The sample consisted of currently depressed, previously depressed, and never-depressed individuals (n ​= ​289; 67% female; M age ​= ​37.4 years). Associations between poor executive functioning and nine depression symptoms were estimated using regularized Gaussian graphical modelling. Results showed associations between poor executive functioning and fatigue/energy loss, interest/pleasure loss, appetite changes, sleep problems, and concentration difficulties. Fatigue/energy loss was the most important symptom bridging depression with poor executive functioning. There were no direct associations between executive functions and core negative affect symptoms. Findings are discussed in the context of motivational impairments, and potential mechanisms such as immunological- and stress-related processes are considered.

That certain psychological factors are negatively associated with function in patients with chronic pain is well established. However, few studies have evaluated these factors in individuals with chronic pain from the general population. The aims of this study were to: 1) evaluate the unique associations between catastrophizing and perceived solicitous responses and psychological function, physical function, and insomnia severity in individuals with neuropathic pain, osteoarthritis, or spinal pain in the general population; and 2) determine if diagnosis moderates the associations found. Five hundred fifty-one individuals from the general population underwent examinations with a physician and physiotherapist, and a total of 334 individuals were diagnosed with either neuropathic pain (n = 34), osteoarthritis (n = 78), or spinal pain (n = 222). Results showed that catastrophizing was significantly associated with reduced psychological and physical function, explaining 24% and 2% of the variance respectively, whereas catastrophizing as well as perceived solicitous responding were significantly and uniquely associated with insomnia severity, explaining 8% of the variance. Perceived solicitous responding was significantly negatively associated with insomnia severity. Moderator analyses indicated that: 1) the association between catastrophizing and psychological function was greater among individuals with spinal pain and neuropathic pain than those with osteoarthritis, and 2) the association between catastrophizing and insomnia was greater among individuals with spinal pain and osteoarthritis than those with neuropathic pain. No statistically significant interactions including perceived solicitous responses were found. The findings support earlier findings of an association between catastrophizing and function among individuals with chronic pain in the general population, and suggest that diagnosis may serve a moderating role in some of these associations. Perspective When examining persons with pain in the general population, catastrophizing is associated with several aspects of function, and diagnosis serves as a moderator for these associations. The replication of these associations in the general population support their reliability and generalizability.

Background: Digital CBT-I (dCBT-I) has demonstrated significant efficacy in reducing insomnia severity in self-referred and community samples. It is unknown, however, how dCBT-I compares to individual face-to-face (FtF) CBT-I for individuals referred to clinical secondary care services. Methods: Parallel-group non-inferiority randomized controlled trial of fully automated dCBT-I versus FtF CBT-I. Eligible participants were adults with insomnia referred to a sleep clinic via public mental health services in Norway. The primary outcome measure was the Insomnia Severity Index (ISI). The non-inferiority margin was defined a priori as 2-points on the ISI at week 33 post-randomization i.e. dCBT-I is non-inferior if the 95% Confidence Interval (CI) for the mean difference is between -2 and ∞, whilst individual FtF CBT-I is superior if the 95% CI is between -∞ and 0. Secondary outcomes were tested using superiority analyses. These were sleep-wake variables, psychological distress and fatigue. Findings: Between October 2014 and January 2016, 101 patients from 288 potential participants were recruited. Individuals were randomized to FtF CBT-I (n=52) or dCBT-I (n=49); mean baseline ISI scores were 18·4 (SD 3·7) and 19·4 (SD 4·1) respectively. At week 33, 48 (92%) in the FtF CBT-I group and 41 (85%) in the dCBT-I group completed the ISI; the mean scores were 8·9 (SD 6·0) and 12·3 (SD 6·9) respectively. There was a significant time effect for both interventions (p

Background: Although several large trials have demonstrated the efficacy of digital cognitive–behavioural therapy for insomnia (dCBT-I), there is a need to validate a far-reaching dissemination of dCBT-I on recommended key outcomes of insomnia. We aimed to investigate the effect of self-guided dCBT-I on insomnia severity, sleep-wake patterns, use of sleep medication, and daytime impairment. Methods: We did a parallel-group superiority randomised controlled trial (RCT) comparing digital CBT-I with online patient education about sleep (PE). Interventions were available from a free-to-access website with an online automated screening test. Primary outcome was ISI score at nine-week follow-up, and secondary outcomes included self-reported use of sleep medication, sleep diary measures, and measures of daytime impairment. Findings: A total of 1721 adults who scored ³12 on the Insomnia Severity Index (ISI) were randomized, 868 to dCBT-I and 853 to PE. At nine-week follow-up, 584 (67%) in the dCBT-I group and 534 (63%) in the PE group completed online self-report ratings. The dCBT-I group had a significantly greater reduction in the primary outcome of insomnia severity compared with the PE group (Cohen’s d = -1·21; 95% Confidence Interval [CI], -1·05 to -1·38; p < ·001). Compared with the PE intervention, the number needed to treat with dCBT-I was 2·7 (95% CI 2·4 to 3·2) for response and 3·2 (95% CI 2·8 to 3·8) for remission of insomnia. The dCBT-I group were significantly less likely to use sleep medication (secondary outcome) at follow-up, compared with the PE group (Odds ratio [OR] = 0·49; 95% CI, 0·23 to 0·74; p < ·001), and reported lower daytime impairment. Interpretation: A self-guided dCBT-I programme made widely accessible is effective in reducing both night-time and daytime impairments associated with the insomnia disorder, while also reducing the likelihood of using sleep medication. Trial Registration: This trial was registered with ClinicalTrials.gov, NCT02558647. Funding Statement: The Norwegian Research Council; grant number 239985 and the Liaison Committee for education, research and innovation in Central Norway; grant number 90061500. Declaration of Interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf. BS, HK, OV, ORFS, GM, SP, AGH, PG, KL, and TCS report no conflicts of interest. FPT and LMR report having a financial and/or business interest in BeHealth Solutions and Pear Therapeutics, two companies that develop and disseminate digital therapeutics, including by licensing the therapeutic developed, based in part, on early versions of the software utilized in research reported in the enclosed paper. These companies had no role in preparing this manuscript. LMR is also a consultant to Mahana Therapeutics, a separate digital therapeutic company not affiliated with this research. Some of the research in this paper was conducted while FPT was a faculty member at the University of Virginia. At that time for FPT, and ongoing for LMR, the terms of these arrangements have been reviewed and approved by the University of Virginia in accordance with its policies. Ethical Approval Statement: The trial protocol was approved by the Regional Committees for Medical and Health Research Ethics in South East Norway (2015/134).

In this effectiveness trial we compared the long-term effects on hospitalizations of group psychoeducation (GP) versus individual psychoeducation (IP) for a heterogeneous sample of patients with BD recruited from general clinical settings.Eighty-five patients with BD were randomized to receive 10 weekly sessions of GP followed by 8 booster-sessions over the next two years, or three sessions of IP. Time to first admission over the course of GP was the primary outcome measure, with additional outcomes examining the use of psychiatric services over about 8 years.Patients allocated to GP had longer survival time compared to IP over 27 months (p0.05). There were also group differences in survival time over 8 years, but treatment allocation alone was no longer a significant predictor of survival time (p=0.07). There was an interaction between group (GP/IP) and harmful substance use (HSU), such that GP cases with comorbid HSU had the shortest survival time, whilst GP cases without HSU survived the longest (p=0.02). Also, GP cases had a small but significant reduction in hospital use compared with IP (p=0.04).We did not have a 'pure' treatment as usual group. Wide confidence intervals for some of the odds ratios suggest that the findings need to be treated with some caution. Insufficient sample size for more detailed subgroup analyses.GP is superior to IP in delaying hospitalizations in a clinically representative population. However, GP did not prevent or delay admissions in BD patients with HSU.

Depression is a common illness which tends to have a relapsing progression. Revealing vulnerability factors is an important step towards improved treatment and prevention. Previous studies of individuals in remission indicate that inhibitory control is more strongly impaired than other cognitive functions. Studies have mostly used Stroop tasks; it is unclear how this population performs on other measures of inhibition. Abnormal reactions to errors may also promote depression relapse, but this has rarely been studied in remitted depression. We used a Stop Signal task and Stroop inhibition task to investigate inhibitory function and post-error reaction time adjustments in 54 individuals with a history of depression and 185 never-depressed controls. Inhibitory processing was slower among the remitted depressed individuals on the Stop Signal task, but no difference was found in Stroop inhibition. The groups were not different on post-error adjustments. This finding extends the understanding of inhibitory deficiency in this population and offers insight into trait markers of depression.

Background The definition of Chronic Fatigue Syndrome (CFS) overlaps with definitions of insomnia, but there is limited knowledge about the role of insomnia in the treatment of chronic fatigue. Aims To test if improvement of insomnia during treatment of chronic fatigue was associated with improved outcomes on 1) fatigue and 2) cortisol recovery span during a standardized stress exposure. Methods Patients (n = 122) with chronic fatigue received a 3.5-week inpatient return-to-work rehabilitation program based on Acceptance and Commitment Therapy, and had been on paid sick leave > 8 weeks due their condition. A physician and a psychologist examined the patients, assessed medication use, and SCID-I diagnoses. Patients completed self-report questionnaires measuring fatigue, pain, depression, anxiety, and insomnia before and after treatment. A subgroup (n = 25) also completed the Trier Social Stress Test for Groups (TSST-G) before and after treatment. Seven cortisol samples were collected during each test and cortisol spans for the TSST-G were calculated. Results A hierarchical regression analysis in nine steps showed that insomnia improvement predicted improvement in fatigue, independently of age, gender, improvement in pain intensity, depression and anxiety. A second hierarchical regression analysis showed that improvement in insomnia significantly predicted the cortisol recovery span after the TSST-G independently of improvement in fatigue. Conclusion Improvement in insomnia severity had a significant impact on both improvement in fatigue and the ability to recover from a stressful situation. Insomnia severity may be a maintaining factor in chronic fatigue and specifically targeting this in treatment could increase treatment response.

Serotoninergic transmission is reliably implicated in inhibitory control processes. The aim of this study was to test the hypothesis if serotonin transporter polymorphisms mediate inhibitory control in healthy people. 141 healthy subjects, carefully screened for previous and current psychopathology, were genotyped for the 5-HTTLPR and rs25531 polymorphisms. Inhibitory control was ascertained with the Stop Signal Task (SST) from the Cambridge Neuropsychological Test Automated Battery (CANTAB). The triallelic gene model, reclassified and presented in a biallelic functional model, revealed a dose-dependent gene effect on SST performance with Individuals carrying the low expressive allele had inferior inhibitory control compared to high expressive carriers. This directly implicates serotonin transporter polymorphisms (5-HTTLPR plus rs25531) in response inhibition in healthy subjects.

Therapist competence in assigning homework was used to predict mid- and posttreatment outcome for patients with Cluster C personality disorders in cognitive therapy (CT). Twenty-five patients that underwent 40 sessions of CT were taken from a randomized controlled trial (Svartberg, Stiles, & Seltzer, 2004). Therapist competence in assigning homework was rated by 2 independent raters assessing a session early in treatment (mostly Session 6) using the Cognitive Therapy Scale (CTS; Young & Beck, 1980). Higher ratings of therapist competence in assigning homework predicted a positive outcome at both mid- and posttreatment, even when controlling for initial symptom improvement. The results indicated that therapist competence in assigning homework is important for both symptom reduction and personality change in CT in the treatment of patients with Cluster C personality disorders.

Although previous studies have examined the factor structure of the SPAI-C, adequate factor analytic methodology has not been employed. This study explored the psychometric properties of the Social Phobia and Anxiety Inventory for Children (SPAI-C), using a non-American population-based sample of older children and young adolescents 11-14 years of age. Initially an exploratory factor analysis was conducted followed 1 year later by a confirmatory factor analysis. Five factors labeled Assertiveness, Public Performance, Physical/Cognitive Symptoms, Social Encounter, and Avoidance were retained and confirmed. The Public Performance and Assertiveness factors were the most stable and consistent factors or traits of social anxiety over a 1-year period. Results revealed adequate concurrent validity, internal consistency and moderate 12-month test-retest reliability of the SPAI-C total scale. The SPAI-C was found to assess levels of both social anxiety and social anxiety disorder according to DSM-IV criteria. Findings suggest that the SPAI-C is applicable in clinical treatment studies designed to assess sensitivity to change in various aspects of social anxiety disorder.

The present study investigated the relationship between personality traits, depression, hopelessness, and suicide ideation. The participants were university students (N = 219) who completed, among other instruments, the NEO Personality Inventory Revised (NEO-PI-R), the Beck Hopelessness Scale (BHS), and the Hopkin's Symptom Checklist-25. The results of the factor-level multiple regression analyses revealed that depressive symptoms were positively predicted by Neuroticism and Openness, and negatively predicted by Extraversion. Hopelessness was positively predicted by Neuroticism and negatively predicted by Extraversion. Finally, suicide ideation was positively predicted by Neuroticism. More detailed results were obtained from facet-level multiple regression analyses. Accordingly, depressive symptoms were positively predicted by the Neuroticism facets, angry hostility and depression, and negatively predicted by the Extraversion facet, positive emotions, and by the Openness facet, actions. Hopelessness was positively predicted by the Neuroticism facet, depression, and negatively predicted by the Extraversion facets, assertiveness and positive emotions. Among the Neuroticism facets, depression positively predicted suicide ideation, while self-consciousness negatively predicted suicide ideation.

The relationships between personality and psychiatric symptoms and long-lasting physical symptoms were assessed in 88 neck sprain patients injured in car accidents. The Millon Clinical Multiaxial Inventory (MCMI-I) was completed at time of occurrence (intake) and 6 months after the injury. The neck sprain patients were divided into three subgroups according to symptoms 6 months after the accident. In addition, the total neck sprain group was compared with three other subject groups. The results indicated that the three neck sprain subgroups did not differ on the MCMI-I neither at intake nor 6 months later. The total neck sprain patients group was significantly different from patients with major depression on all scales of the MCMI-I, but not significantly different compared to patients with localized musculoskeletal pain. Compared to a group of health personnel, there were only a few significant differences. The study does not support the view that premorbid personality traits can predict outcome for neck sprain patients.