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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.

Existing studies on cognitive impairments in chronic pain do not investigate peripheral neuropathic pain (PNP) or compare pain conditions in a satisfactory manner. Here we aimed to compare executive dysfunctions in PNP patients with fibromyalgia (FM) and healthy controls (HC). Patients who self-reported cognitive impairments were assessed according to criteria for PNP or FM. Seventy-three patients met criteria and completed testing on executive functioning and IQ measures. We also included twenty matched healthy controls. Regression models controlling for age, sex and IQ, tested associations between group category (PNP, FM or HC) and outcomes. If a substantial association was detected, we followed up with head-to-head comparisons between PNP and FM. Multivariate regression models then tested associations between executive functioning and pain type, controlling for significant confounders. Results from head-to-head comparison between pain conditions showed significant differences on years lived with pain (FM > PNP), the use of anticonvulsants (PNP > FM) and use of analgesics (PNP > FM). When controlled for all significant differences, PNP patients had significantly lower scores on an attention-demanding cued-recall task compared to FM. Poor performance on attention-demanding cued-recall task was associated with PNP, which translate into problems with retaining fast-pace or advanced information.

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.

Acceptance and commitment therapy (ACT) has never been tested for patients with chronic fatigue. We aimed to test if a 3.5-week ACT rehabilitation program for patients with chronic fatigue improved quality of life (QoL), fatigue, and psychological flexibility. Further, to test if improvements in QoL and fatigue were associated with improvement in psychological flexibility, and if psychological flexibility explained variance above and beyond maladaptive cognitions typically targeted in CBT for fatigue. Patients (n = 140) who had been on sick leave > 8 weeks due to chronic fatigue received a 3.5-week non-controlled inpatient rehabilitation program based on ACT. A physician and a psychologist examined the patients, assessing medication use and SCID-I diagnoses. Patients completed questionnaires about somatic complaints, psychological complaints, and maladaptive cognitions before and after treatment. At post-treatment, patients reported improved QoL (p < 0.001; g = 1.07) and less fatigue (p < 0.001; g = 1.08), but not increased psychological flexibility (p = 0.6). Changes in psychological flexibility was associated with improved QoL, but not fatigue, in hierarchical regression analyses. When adjusting for other cognitions, changes in fear-avoidance cognitions and all-or-nothing thoughts, but not psychological flexibility, were associated with improved QoL and fatigue. The ACT-based treatment improved QoL and reduced fatigue for patients with chronic fatigue with large effect sizes. Improvement was associated with a reduction in fear-avoidance cognitions and all-or-nothing thoughts, but not psychological flexibility.

Background Although several large-scale randomised controlled trials have shown the efficacy of digital cognitive behavioural therapy for insomnia (dCBT-I), there is a need to validate widespread dissemination of dCBT-I using recommended key outcomes for insomnia. We investigated the effect of a fully automated dCBT-I programme on insomnia severity, sleep–wake patterns, sleep medication use, and daytime impairment. Methods We did a parallel-group superiority randomised controlled trial comparing dCBT-I with online patient education about sleep. The interventions were available through a free-to-access website, publicised throughout Norway, which incorporated automated screening, informed consent, and randomisation procedures, as well as outcome assessments. Adults (age ≥18 years) who had regular internet access and scored 12 or higher on the Insomnia Severity Index (ISI) were eligible for inclusion, and were allocated (1:1) to receive dCBT-I (consisting of six core interactive sessions to be completed over 9 weeks) or patient education (control group). Participants were masked to group assignment and had no contact with researchers during the intervention period. The primary outcome was the change in ISI score from baseline to 9-week follow-up, assessed in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02558647) and is ongoing, with 2-year follow-up assessments planned. Findings Between Feb 26, 2016, and July 1, 2018, 5349 individuals commenced the online screening process, of which 1497 were ineligible or declined to participate, 2131 discontinued the screening process, and 1721 were randomly allocated (868 to receive dCBT-I and 853 to receive patient education). At 9-week follow-up, 584 (67%) participants in the dCBT-I group and 534 (63%) in the patient education group completed the ISI assessment. The latent growth model showed that participants in the dCBT-I group had a significantly greater reduction in ISI scores from baseline (mean score 19·2 [SD 3·9]) to 9-week follow-up (10·4 [6·2]) than those in the patient education group (from 19·6 [4·0] to 15·2 [5·3]; estimated mean difference −4·7 (95% CI −5·4 to −4·1; Cohen's d −1·21; p

Epidemiological studies have to a little extent addressed the potential fluctuations of chronic pain over time, and there is a lack of information about the long-term course of pain using repeated measurements. We wanted to identify different trajectories of pain during 8 waves of follow-up over 4 years among individuals in the general population reporting pain lasting at least 6 months at baseline. Secondarily, we wanted to investigate whether biopsychosocial factors at baseline were associated with the different pain trajectories. Longitudinal Latent Class Analysis was performed to classify a random sample of 1905 participants from a larger population-based study (HUNT3) into groups based on their longitudinal pain severity reporting. A five-class solution gave the best fit. The terms chosen to describe the pain trajectories were: “fluctuating” (n = 586 [31%]), “persistent mild” (n = 449 [24%]), “persistent moderate” (n = 414 [22%]), “persistent severe” (n = 251 [13%]), and “gradual improvement” (n = 205 [11%]). In a multinomial logistic regression model using “gradual improvement” as the reference category, the “persistent moderate”, “persistent severe”, and “fluctuating” pain groups were associated with chronic widespread pain, elevated levels of catastrophizing, and poorer mental health. The “persistent mild” group was associated with sleep difficulties only. This study finds that although most individuals have a stable pain course, individuals in the largest distinct trajectory reports pain that fluctuate between mild and moderate levels, thus fluctuating under and above the chronic pain definition using moderate pain or more as a criterion. Perspective When examining the long-term course of chronic pain in the general population, 5 trajectories emerge. Although most individuals have stable pain, the largest distinct trajectory fluctuated under and above the chronic pain cut-off, using moderate pain or more as a criterion. A dichotomous categorization of chronic pain may be overly simplistic.

Background Group-based transdiagnostic occupational rehabilitation programs including participants with mental and somatic disorders have emerged in clinical practice. Knowledge is sparse on subsequent participation in competitive work. This study aimed to investigate trajectories for (re)entry to work for predefined subgroups in a diagnostically heterogeneous sample of sick-listed participants after completing occupational rehabilitation. Methods A cohort of 212 participants aged 18–69 on long-term sick leave (> 8 weeks) with chronic pain, chronic fatigue and/or common mental disorders was followed for one year after completing a 3½-week rehabilitation intervention based on Acceptance and Commitment Therapy. Self-reported, clinical and registry data were used to study the associations between predefined biopsychosocial predictors and trajectories for (re)entry to competitive work (≥ 1 day per week on average over 8 weeks). Generalized estimating equations analysis was used to investigate trajectories. Results For all biopsychosocial subgroups (re)entry to work increased over time. Baseline employment, partial sick leave and higher expectation of return to work (RTW) predicted higher probability of having (re)entered work at any given time after discharge. The odds of increasing reentry over time (statistical interaction with time) was weaker for the group receiving the benefit work assessment allowance compared with those receiving sickness benefit (OR = 0.92, p = 0.048) or for those on partial sick leave compared with full sick leave (OR 0.77, p

BackgroundFollowing treatment, many depressed patients have significant residual symptoms. However, large randomised controlled trials (RCT) in this population are lacking. When Attention bias modification training (ABM) leads to more positive emotional biases, associated changes in clinical symptoms have been reported. A broader and more transparent picture of the true advantage of ABM based on larger and more stringent clinical trials have been requested.AimsTo evaluate the early effect of two weeks ABM training on blinded clinician-rated and self-reported residual symptoms, and whether changes towards more positive attentional biases (AB) would be associated with symptom reduction.MethodA total of 321 patients with a history of depression were included in a preregistered randomized controlled double-blinded trial. Patients were randomised to an emotional ABM paradigm over fourteen days or a closely matched control condition. Symptoms based on the Hamilton Rating Scale for Depression (HRSD) and Beck Depression Inventory II (BDI-II) were obtained at baseline and after ABM training.ResultsABM training led to significantly greater decrease in clinician-rated symptoms of depression as compared to the control condition. No differences between ABM and placebo were found for self-reported symptoms. ABM induced a change of AB towards relatively more positive stimuli associated with greater symptom reduction.ConclusionThe current study demonstrates that ABM produces early changes in both AB and blinded clinician-rated depressive symptoms. ABM may have practical potential in the treatment of residual depression.ClinicalTrials.govID:NCT02658682

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 most efficacious treatments for social anxiety disorder (SAD) are the SSRIs and cognitive therapy (CT). Combined treatment is advocated for SAD but has not been evaluated in randomized trials using CT and SSRI. Our aim was to evaluate whether one treatment is more effective than the other and whether combined treatment is more effective than the single treatments. Methods: A total of 102 patients were randomly assigned to paroxetine, CT, the combination of CT and paroxetine, or pill placebo. The medication treatment lasted 26 weeks. Of the 102 patients, 54% fulfilled the criteria for an additional diagnosis of avoidant personality disorder. Outcomes were measured at posttreatment and 12-month follow-up assessments. Results: CT was superior to paroxetine alone and to pill placebo at the end of treatment, but it was not superior to the combination treatment. At the 12-month follow-up, the CT group maintained benefits and was significantly better than placebo and paroxetine alone, whereas there were no significant differences among combination treatment, paroxetine alone, and placebo. Recovery rates at 12 months were much higher in the CT group (68%) compared to 40% in the combination group, 24% in the paroxetine group, and 4% in the pill placebo group. Conclusions: CT was the most effective treatment for SAD at both posttreatment and follow-up compared to paroxetine and better than combined treatment at the 12-month follow-up on the Liebowitz Social Anxiety Scale. Combined treatment provided no advantage over single treatments; rather there was less effect of the combined treatment compared to CT alone.

The present study was specifically designed to investigate the prevalence of auditory verbal hallucinations (AVH) in the general population, and sought to compare similarities and differences regarding socio-demographics, mental health and severe life events between individuals who have never experienced AVH with those who had. The study also aimed to compare those who sought professional help for their experience of AVH with those who had not sought help. Through a postal questionnaire, 2,533 participants ages 18 and over from a national survey completed the Launay-Slade Hallucinations Scale and other measures examining AVH characteristics and other areas related to AVH. In total, 7.3% of the sample reported a life-time prevalence of AVH. Those with AVH were more likely to be single and unemployed, reported higher levels of depression and anxiety, and experienced a higher number of severe life events compared with those without AVH. Only 16% of those who experienced AVH in the general population sought professional help for these experiences. Compared to those who did not seek professional help, participants that had were more likely to experience AVH with a negative content, experience them on a daily basis, undergo negative reactions when experiencing AVH, and resist AVH. In conclusion, the prevalence of AVH was found to be relatively high. The results also revealed higher levels of reduced mental health for individuals who sought professional help, followed by those who did not, compared with those who had never experienced AVH. © 2015 The Authors. Scandinavian Journal of Psychology published by Scandinavian Psychological Associations and John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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.

Background This project studies the effect of group-based Acceptance and Commitment Therapy (ACT) following Attention Bias Modification (ABM) on residual symptoms in recurrent depression. ACT is a cognitive-behavioral intervention combining acceptance and mindfulness processes with commitment and behavior-change processes. ACT enjoys modest empirical support in treating depression and has also shown promising results in secondary prevention of depression. The experimental cognitive bias modification (ABM) procedure has been shown to reduce surrogate markers of depression vulnerability in patients in remission from depression. The aim of the current project is to investigate if the effect of group-based ACT on reducing residual depressive symptoms can be enhanced by preceding it with ABM. Also, assessment of the relationship between conceptually relevant therapeutic processes and outcome will be investigated. Methods/design An invitation to participate in this project was extended to 120 individuals within a larger sample who had just completed a separate randomized, multisite, clinical trial (referred to hereafter as Phase 1) in which they received either ABM (n = 60) or a control condition without bias modification (n = 60). This larger Phase-1 sample consisted of 220 persons with a history of at least two episodes of major depression who were currently in remission or not fulfilling the criteria of major depression. After its inclusion, Phase-1 participants from the Sørlandet site (n = 120) were also recruited for this study in which they received an 8-week group-based ACT intervention. Measures will be taken immediately after Phase 1, 1 month, 2 months, 6 months, and 1 year after the conclusion of Phase 1. Discussion This study sequentially combines acceptable, nondrug interventions from neuropsychology and cognitive-behavioral psychology in treating residual symptoms in depression. The results will provide information about the effectiveness of treatment and on mechanisms and processes of change that may be valuable in understanding and further developing ABM and ACT, combined and alone. © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated.

Introduction Insomnia is a major public health concern. While cognitive behaviour therapy for insomnia (CBT-I) is acknowledged as the best available intervention, there are unanswered questions about its wider dissemination, socioeconomic benefits and its impact on health resource utilisation. The aim of this randomised controlled trial (RCT) is to investigate the effectiveness of a fully automated online version of CBT-I compared with online patient education about sleep (PE). Outcome measures comprise changes in symptoms of insomnia, time off work due to sick leave as well as medication and health resource utilisation. Also, we will examine (i) putative mediators of the effects of CBT-I on insomnia severity and (ii) selected potential psycho-bio-social moderators of the effects of the interventions. Methods and analysis A parallel-group RCT will be conducted in a target sample of about 1500 adults recruited across Norway. Participants will complete an online screening and consent process. Those who meet eligibility criteria will be randomised to receive direct access to fully automated online CBT-I or to an online PE programme. The primary outcome is change in insomnia severity immediately postintervention; secondary outcomes are change in daytime functioning and other sleep measures postintervention and at 6-month and 24-month follow-up. Objective data from national registries will be obtained at two time points (1 year and 2 years post-treatment), allowing a mirror image study of preintervention and postintervention rates of sick leave, and of medication and healthcare utilisation by condition. Ethics and dissemination The study protocol was approved by the Regional Committee for Medical and Health Research Ethics in South East Norway (2015/134). Findings from the RCT will be disseminated in peer-reviewed publications and conference presentations. Exploratory analyses of potential mediators and moderators will be reported separately. User-friendly outputs will be disseminated to patient advocacy and other relevant organisations. © Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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.

This study examined whether work-family conflict was associated with sleep deficiencies, both cross-sectionally and longitudinally. In this two-phase study, a workplace health survey was completed by a cohort of patient care workers ( n = 1,572). Additional data were collected 2 years later from a subsample of the original respondents (n = 102). Self-reported measures included work-family conflict, workplace factors, and sleep outcomes. The participants were 90% women, with a mean age of 41 ± 11.7 years. At baseline, after adjusting for covariates, higher levels of work-family conflict were significantly associated with sleep deficiency. Higher levels of work-family conflict also predicted sleep insufficiency nearly 2 years later. The first study to determine the predictive association between work-family conflict and sleep deficiency suggests that future sleep interventions should include a specific focus on work-family conflict.

This study examined the factor structure of the Achievement of Therapeutic Objectives Scale (ATOS; McCullough, Larsen, et al., 2003) in short-term dynamic psychotherapy (STDP) and cognitive therapy (CT). The ATOS is a process scale that has shown promise as a measure of patients' achievements of treatment objectives in STDP and CT and is conceptualized as comprising 7 subscales hypothesized to cluster according to 3 main treatment objectives (defense restructuring, affect restructuring, and restructuring of sense of self and others). However, the factor structure of the ATOS has not been examined empirically previously. Data were derived from ratings of videotaped therapy sessions from a randomized controlled trial, comparing STDP and CT for patients with Cluster C personality disorders. The model fit of a 2- and 3-factor solution was examined in the combined patient sample, as well as in each treatment separately, utilizing structural equation modeling. Both a 2- and 3-factor model provided acceptable fit to the data. The results add to the psychometric soundness of the ATOS as an innovative observer-based instrument for examining process in STDP and CT.

This article investigates whether patients' sense of self and therapists' interventions aimed at orienting patients toward affect produce an affective activation in the patient. Both the independent contribution of sense of self and therapist intervention, as well as sense of self's moderating effect on therapist interventions, were investigated. Fifty cluster C patients were analyzed using 2 psychotherapy process measures and multilevel modeling. The results indicate that patients' affect experience increases over time. Both the therapist orienting the patient toward affect and the patient's sense of self predicted affect activation for the within-person effect (i.e., the patient's or therapist's standing in any given session relative to his or her baseline), but only sense of self was significant for the between-person effect (i.e., the patient's standing relative to all other patients). The relationship between a therapist orienting the patient toward affect and the patient's affective response was moderated by the patient's sense of self. The results have implications for therapists who want their patients to experience affect in a session.

Background: Cognitive behavioural therapy for psychosis (CBTp) is currently a recommended form of psychosocial treatment for persons suffering from persistent psychotic symptoms. It has been argued that effect sizes from efficacy studies cannot be generalized to real clinical settings. Aims: Our aim was to evaluate whether the positive results from randomized controlled trials conducted by experts could be replicated in clinical setting with a heterogeneous sample of patients with psychotic disorder. Method: Patients referred to the study were either randomized to CBTp + TAU (the treatment group) or to a waiting-list group, only receiving TAU. The patients were assessed on different outcome measures such as the Brief Psychiatric Rating Scale (BPRS), the Scale for the Assessment of Negative Symptoms (SANS), and the Psychotic Symptom Rating Scales (PSYRATS), at pretreatment, at posttreatment (6 months), and at 12 months follow-up. In total, 45 patients participated in the study. Results: The results showed that 20 sessions of CBTp performed significantly better than the waiting list controls with respect to the global score on the BPRS, the delusional scale on the PSYRATS, and the GAF symptom score at posttreatment. At 12 months follow-up only the GAF symptom score remained significantly changed for the total sample. Conclusions: The study revealed that CBTp delivered by non-experts in routine clinical settings can produce improvements in positive psychotic symptoms, and also that some of these improvements can be maintained at one year follow-up.

Objectives: To examine if elevated symptoms of insomnia affects neuropsychological functioning in patients with concurrent symptoms of pain, fatigue, and mood disorders. Methods and results: A total of seventy-six subjects participated in this (cross-sectional) study. Based on the cut-off score guidelines from The Insomnia Severity Index subjects were assigned to either a clinical insomnia group (N = 35) or a comparison group (N = 41). Factors such as age, general cognitive functioning, and symptoms of pain, fatigue, depression, and anxiety did not differ between the groups. Both groups completed a questionnaire which assessed subjective memory functioning. In addition they completed a set of neuropsychological tests measuring general cognitive functioning, spatial and verbal working memory, and inhibitory control. Although the subjects with clinical insomnia did not report more memory problems than the comparison group, they presented significant deficiencies on the tests assessing spatial and verbal working memory. There was no difference between the groups in inhibitory control. Conclusions: This study shows that as the symptom severity of insomnia increases and become clinically significant, it has substantial effect on both spatial and verbal-numeric working memory functioning. By differentiating and testing different domains of working memory, this study provides a more detailed and nuanced characterization of working memory deficiencies than the previous studies within this field. The results need to be transferred to clinical practice so that neuropsychologists include assessments of sleep as part of their routine screenings. © The Author 2017. Published by Oxford University Press. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/)

Inattention in people with schizophrenia is common. However, there has been little research on the association between inattention and auditory hallucinations. The aim of the study was to investigate how inattention is affected by beliefs about voices as benevolent and malevolent and perceived control of voices. A total of 31 patients who experienced auditory hallucinations and who met the criteria for schizophrenia or other psychosis completed the attention subscale of the Scale for the Assessment of Negative Symptoms (SANS) and the Connors’ Continuous Performance Test II (CCPT-II). The revised Beliefs About Voices Questionnaire (BAVQ-R) was used to assess malevolent and benevolent beliefs about voices, and severity of auditory hallucinations (the Psychotic Symptom Rating Scales; PSYRATS) was used to assess perceived control of voices and frequency of voices. Levels of depression (the Beck Depression Inventory; BDI), anxiety (the Beck Anxiety Inventory; BAI), severity of overall psychiatric symptoms (the Brief Psychiatric Rating Scale; BPRS), and severity of negative symptoms (SANS) were assessed to control for their potential confounding effects. The relations between the variables were explored with correlations and multiple hierarchical regression analyses. The results indicated that more malevolent, but not more benevolent, beliefs about voices predicted lower levels of attention, independently of general psychiatric symptoms and various other psychotic symptoms such as frequency of and perceived control of voices. These findings suggest an important relationship between malevolent beliefs about voices and levels of inattention. The possible impact of changing beliefs about voices to improve attentional functioning is discussed.

In the short-term dynamic psychotherapy model termed "Affect Phobia Treatment," it is assumed that increase in patients' defense recognition, decrease in inhibitory affects (e.g., anxiety, shame, guilt), and increase in the experience of activating affects (e.g., sadness, anger, closeness) are related to enhanced self-compassion across therapeutic approaches. The present study aimed to test this assumption on the basis of data from a randomized controlled trial, which compared a 40-session short-term dynamic psychotherapy (N = 25) with 40-session cognitive treatment (N = 25) for outpatients with Cluster C personality disorders. Patients' defense recognition, inhibitory affects, activating affects, and self-compassion were rated with the Achievement of Therapeutic Objectives Scale (McCullough et al., 2003b) in Sessions 6 and 36. Results showed that increase in self-compassion from early to late in therapy significantly predicted pre- to post-decrease in psychiatric symptoms, interpersonal problems, and personality pathology. Decrease in levels of inhibitory affects and increase in levels of activating affects during therapy were significantly associated with higher self-compassion toward the end of treatment. Increased levels of defense recognition did not predict higher self-compassion when changes in inhibitory and activating affects were statistically controlled for. There were no significant interaction effects with type of treatment. These findings support self-compassion as an important goal of psychotherapy and indicate that increase in the experience of activating affects and decrease in inhibitory affects seem to be worthwhile therapeutic targets when working to enhance self-compassion in patients with Cluster C personality disorders.

The aim of this study was to examine both executive control of verbal working memory and verbal learning as well as long-term storage function in outpatients with major depressive disorder (n = 61) compared to healthy controls (n = 92). A total of 37 patients had no co-morbid anxiety disorder, whereas 24 had a co-morbid anxiety disorder. Both patient groups showed impaired working memory test performance compared to healthy controls. Patients with co-morbid depression and anxiety disorder performed significantly below the depression group. Only patients with depression and co-morbid anxiety displayed deficient long-term memory function compared to healthy controls. The present results show impairments in various memory functions in patients presenting depression and depression with co-morbid anxiety disorder.

This study examined interrater reliability and sensitivity to change of the Achievement of Therapeutic Objectives Scale (ATOS; McCullough, Larsen, et al., 2003) in short-term dynamic psychotherapy (STDP) and cognitive therapy (CT). The ATOS is a process scale originally developed to assess patients' achievements of treatment objectives in STDP, but further operational definitions have led to a theoretically neutral assessment device, making it applicable to other treatment modalities as well. Videotapes from a randomized controlled trial comparing the effectiveness of STDP and CT for patients with Cluster C personality disorders were rated by independent raters, typically at Sessions 6 and 36. The results indicated good to excellent interrater reliability, as well as adequate sensitivity to change in theoretically expected ways, in both STDP and CT. The results lend further support to the psychometric soundness of the ATOS and show promise for its use when comparing STDP and CT.

Objective: Mental health problems affect approximately 20% of adolescents. Traditionally, the principal focus has been on vulnerability and risk factors and less on protective factors. The study, therefore, explores the relation between frequent psychiatric symptoms and resilience factors among older adolescents. Method: The Resilience Scale for Adolescents (READ) was completed by 307 Norwegian high school students (M = 16.4 years) along with the Depression Anxiety Stress Scales, and the Obsessive–Compulsive Inventory-Revised. Results: Higher resilience scores predicted lower scores on levels of depression, anxiety, stress and obsessive–compulsive symptoms after controlling for age and gender. Conclusion: This study provides further evidence that it may be fruitful for clinicians and researchers to attend to resilience factors in relation to psychological symptoms among older adolescents. Copyright © 2010 John Wiley & Sons, Ltd. Key Practitioner Message: • Resilience is significantly related to psychological symptoms in older adolescents after controlling for age and gender. • Resilience factors are differently expressed by female and male youths, but overall resilience is equally distributed among the sexes. • Assessment of resilience factors may provide appropriate targets for interventions among youths.

Palliative Medicine Unit,Department of Oncology, St Olav University Hospital, Trondheim, NorwayBackground: Brief treatments for chronic non-malignantpain patients with problematicopioidusearewarranted.The aims of the present study were to investigate (1)whether it is possible to withdraw codeine use in suchpatients with a brief cognitive-behavioural therapy (CBT),(2) whether this could be done without pain escalation andreduction in quality of life and (3) to explore the effects ofcodeine reduction on neurocognitive functioning.Methods: Eleven patients using codeine daily correspond-ing to 40–100mg morphine were included. Two specificallytrained physicians treated the patients with six CBT ses-sions, tapering codeine gradually within 8 weeks. Codeineuse, pain intensity, quality of life and neuropsychologicalfunctioning were assessed at pre-treatment to the 3-monthfollow-up.Results: Codeine use was significantly reduced from mean237mg [standard deviation (SD) 65] pre-treatment to 45mg(SD 66) post-treatment and to 48mg (SD 65) at follow-upwithout significant pain escalation or reductions in qualityof life. Moreover, neuropsychological functioning im-proved significantly on some tests, while others remainedunchanged.Conclusion: The promising findings of codeine reductionin this weaning therapy programme for pain patients withproblematic opioid use should be further evaluated in alarger randomized control trial comparing this brief CBTwith both another brief treatment and attention placebocondition.

Empirical research has established that both individual and group psychotherapy is effective for a broad range of psychiatric disorders, but less is known about the processes associated with positive treatment outcomes. The aim of the present thesis was to examine the individual and combined contribution of two essential aspects of the Generic Model of Psychotherapy to outcome, namely the therapeutic bond (therapeutic alliance; group climate) and therapist interventions (homework assignments; transference work). Data was taken from two previously published randomized controlled trials. The first trial examined the effectiveness of cognitive behavioral group therapy (CBGT) for patients with comorbid disorders, whereas the second trial examined the effectiveness of short-term dynamic psychotherapy (STDP) and cognitive therapy (CT) for patients with cluster C personality disorders. Paper I found support for the use of a trans-theoretical measure of group climate as a predictor of long-term followup outcome in CBGT for comorbid disorders, particularly the dimension of engagement. In paper II, early ratings of therapist competence in assigning homework was found to predict both mid- and post treatment outcomes in CT with cluster C personality disorders. The use of homework assignments was not observable in STDP. This finding emphasizes the quality of homework assignments as an important and measurable therapist skill essential for treatment outcome, at least in CT. Paper III reported that a stronger emphasis on transference work, especially in the context of a weak therapeutic alliance, was associated with a smaller reduction in interpersonal problems at treatment termination in STDP and CT with cluster C personality disorders. The findings demonstrate the “risks” involved in having a stronger emphasis on transference work, especially in the context of a weak therapeutic alliance early in treatment. The results add to the importance of examining the contribution of the therapeutic bond, therapist interventions and their interaction to outcome in psychotherapy, and have noteworthy clinical implications for practicing therapists.

This study assessed age and sex differences in the prevalence and incidence rates of syndromal social anxiety (SSA), as well as the predictive role of depressive symptoms and stressful life events on the development and persistence of SSA. A sample of 1,439 young people, between 11 and 14 years of age, was assessed twice within a 12-month interval. No age differences were found. Girls had a significantly higher prevalence of SSA than boys, but there was no sex difference for incidence rate. Depressive symptoms did not play a significant role in either the development or the persistence of SSA, whereas SSA predicted the development of depression. Stressful life events played a significant role in SSA's development but not in its persistence.

This article reports results from a universal preventive program aimed at (a) reducing social anxiety and (b) preventing the development of syndromal social anxiety among a population-based sample of older children and young adolescents during a 1-year period. Pupils (N = 1,748) from 2 counties were cluster randomized to either an intervention or a control condition. In the intervention condition, the Norwegian Universal Preventive Program for Social Anxiety (NUPP―SA)―which educates pupils, parents/ guardians, teachers/school staff, and county health workers―was administered. The results indicate that NUPP-SA had a significant specific intervention effect for reducing social anxiety in the total sample as well as among the syndromal subjects. Further, significantly fewer subjects from the intervention county developed syndromal social anxiety during the 1-year period, thus showing a prevention effect. The results demonstrate the value of an intervention specifically aimed at reducing social anxiety and preventing the development of syndromal social anxiety among young people.

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.

Objective: To examine the predictive validity of the Parental Bonding Instrument (PBI) for outcome in individual and group psychotherapy. Method: Data from four different clinical trials were combined, yielding a total of 105 patients. After controlling for gender, age and initial symptomatic distress, the predictive validity of the PBI subscales was investigated using the symptom checklist-90-revised (SCL-90-R) and inventory of interpersonal problems-64 (IIP-64) at termination as dependent measures in each treatment condition using separate hierarchical multiple regression analyses. Results: Using the SCL-90-R at termination as dependent measure, reports of higher paternal and maternal care were related to a worse outcome in the Pesso–Boyden System Psychomotor condition, whereas reports of higher paternal care were related to a better outcome in the Cognitive–Behavioural Therapy condition. Also, higher maternal protection was related to a better outcome in the Cognitive-Behavioral Group condition. Using the IIP-64 at termination as dependent measure, reports of higher paternal protection were related to a better outcome in the Treatment As Usual condition. Discussion: The study shows that the PBI may function as a clinical predictor for treatment response, although the results were somewhat contrary to previous reportings. Future studies should contrast and investigate possible differences between individual and group treatments further, as well as more clearly defined diagnostic groups. Clinical implications are presented. Copyright © 2008 John Wiley & Sons, Ltd.

This study examined co-morbid generalized anxiety disorder and/or panic disorder and personality disorders as predictors of treatment outcomes in adult outpatients with obsessive-compulsive disorder. The patients received exposure with response prevention (ERP) treatment with the addition of either elements of cognitive therapy (ERP+CT) or relaxation training (ERP+REL). It was hypothesized that the addition of cognitive interventions would yield better treatment outcomes for patients with co-morbid generalized anxiety disorder and/or panic disorder. It was also hypothesized that patients with any personality disorder would show less treatment gains in both conditions. Using intention-to-treat criteria, patients with generalized anxiety disorder and/or panic disorder co-morbidity showed less treatment gains at post-treatment across both treatment conditions. This group showed significantly more treatment gains in the ERP+CT condition at the post-treatment and the 12-month follow-up assessments compared with patients in the ERP+REL condition. However, this was not significant when comparing treatment completers. Patients with a co-morbid Cluster A or B personality disorder showed significantly less treatment gains in both treatment conditions at the 12-month follow-up assessment. Among treatment completers, patients with a Cluster C personality disorder showed significantly better outcomes at the post-treatment assessment in the ERP+REL treatment condition. These results, clinical implications, and the importance of further investigations are discussed.

The aims of this study were to identify cognitive vulnerabilities and to examine the protective role of active engagement in sport in the development of (1) suicide ideation and (2) hopelessness. In Study 1,102 male military recruits were the participants. Scores on the Automatic Thoughts Questionnaire (ATQ-30), but not on the Dysfunctional Attitude Scale (DAS-A), predicted presence of suicide ideation three months later. The results of Study 2 with 84 university students showed that scores on the ATQ-30, but not on the DAS-A were significantly associated with hopelessness. Moreover, students actively engaged in sports exhibited less hopelessness. The findings suggest that active engagement in sports is strongly associated with negative automatic thoughts, suicidal thoughts, and hopelessness.

There are reasons to suggest that the therapist effect lies at the intersection between psychotherapists' professional and personal functioning. The current study investigated if and how the interplay between therapists' (n = 70) professional self-reports (e.g., of their difficulties in practice in the form of 'professional self-doubt' and coping strategies when faced with difficulties) and presumably more global, personal self-concepts, not restricted to the professional treatment setting (i.e., the level of self-affiliation measured by the Structural Analysis of Social Behaviour (SASB) Intrex, Benjamin, ), relate to patient (n = 255) outcome in public outpatient care.Multilevel growth curve analyses were performed on patient interpersonal and symptomatic distress rated at pre-, post- and three times during follow-up to examine whether change in patient outcome was influenced by the interaction between their therapists' level of 'professional self-doubt' and self-affiliation as well as between their therapists' use of coping when faced with difficulties, and the interaction between type of coping strategies and self-affiliation.A significant interaction between therapist 'professional self-doubt' (PSD) and self-affiliation on change in interpersonal distress was observed. Therapists who reported higher PSD seemed to evoke more change if they also had a self-affiliative introject. Therapists' use of coping strategies also affected therapeutic outcome, but therapists' self-affiliation was not a moderator in the interplay between therapist coping and patient outcome.A tentative take-home message from this study could be: 'Love yourself as a person, doubt yourself as a therapist'. Copyright © 2015 John WileySons, Ltd.The findings of this study suggest that the nature of therapists' self-concepts as a person and as a therapist influences their patients' change in psychotherapy. These self-concept states are presumably communicated through the therapists' in-session behaviour. The study noted that a combination of self-doubt as a therapist with a high degree of self-affiliation as a person is particularly fruitful, while the combination of little professional self-doubt and much positive self-affiliation is not. This finding, reflected in the study title, 'Love yourself as a person, doubt yourself as a therapist', indicates that exaggerated self-confidence does not create a healthy therapeutic attitude. Therapist way of coping with difficulties in practice seems to influence patient outcome. Constructive coping characterized by dealing actively with a clinical problem, in terms of exercising reflexive control, seeking consultation and problem-solving together with the patient seems to help patients while coping by avoiding the problem, withdrawing from therapeutic engagement or acting out one's frustrations in the therapeutic relationship is associated with less patient change.

This study presents the psychometric properties of the Norwegian language version of the Beck Scale for Suicide Ideation (BSI). The participants were 314 university students (71 males and 243 females) enrolled in one of the introductory courses in psychology or sociology at the Norwegian University of Science and Technology, Norway. The results revealed satisfactory internal consistency and good temporal stability. Moderately high correlations with other measures of suicide ideation suggested satisfactory concurrent validity. Similarly, the construct validity was evidenced by moderate correlations among the BSI, the Hopkins Symptom Check List (HSCL-25) depressive scale, and the Beck Hopelessness Scale (BHS). In general, the findings suggest that the BSI is a reliable and valid instrument to assess severity of suicide ideation in college students.

The aim of the study was to assess suicide risk in psychiatric outpatients with specific cluster C personality disorders (avoidant, dependent, and obsessive-compulsive). A sample of 142 psychiatric outpatients was used for the study. The sample was composed of 87 outpatients meeting diagnostic criteria for a personality disorder and 53 psychiatric outpatients meeting criteria for an axis I disorder only. The results showed that dependent, but not avoidant or obsessive-compulsive, personality disorders, as well as the clusters A and B personality disorders, were significantly associated with suicide attempts. This association remained significant after controlling for both a lifetime depressive disorder and severity of depression for the cluster A and the cluster B personality disorders, but not for dependent personality disorder. The results underline the importance of assessing suicide risk in patients with cluster A and cluster B personality disorders, while the assessment of suicide risk in patients with cluster C personality disorders seems to be irrelevant as long as assessment of a comorbid depressive disorder is appropriately conducted.

This study aimed to describe the somatic, social, psychological, and work-related factors that characterize participants with a duration of sick leave over and under one year.During 2012, 181 patients on long-term sick leave were consecutively recruited and asked to answer an extensive survey. Several outcomes were reported, addressing work-related factors and somatic, psychological, and social symptoms. In cross-sectional analyses, sick leave duration was dichotomized asorone year, based on Norwegian legislation. Linear and logistic regressions were used to estimate population probabilities and means.The estimated prevalence of pain, fatigue, anxiety, and depression was overall high. There was a tendency towards a higher prevalence of fatigue, anxiety, and depression in those with sick leave duration less than one year, with the exception of sleep problems, which was more frequent in the population with longer duration. Relationship with friends, family, co-workers, and the last workplace were worse in the population with longer duration.Cross-sectional analyses indicated that social and work-related problems are more adverse in patients with longer duration of sick leave, while psychological and somatic symptoms appear less adverse. This is one of the first studies quantitatively demonstrating these differences through comprehensive, simultaneously measured self-report questionnaires.

The present study aimed to investigate the relationship between self-image and outcome of psychotherapy. Self-image was measured with Benjamin’s Structural Analysis of Social Behavior (SASB) introject construct. The sample consisted of 170 outpatients with heterogenous disorders, who completed treatment at a university clinic. Using multiple regression analyses, we found that pre-treatment self-image was not significantly related to post-treatment symptom level, but it weakly related to post-treatment interpersonal problems. Self-image improvement from pre-treatment to post-treatment was significantly related to treatment outcome, both in terms of symptom level and level of interpersonal problems. In a comparison between the patients with depression and patients with an anxiety disorder, the depression group showed a poorer pre-treatment self-image compared to the anxiety group, but there was no difference at the end of treatment. Self-image improvement showed a non-significant trend towards being more closely related to symptom outcome in the depression group compared to the anxiety group, but not to interpersonal problems outcome. The results suggest that self-image improvement is important to achieve a good outcome in psychotherapy, and that further research on this subject is needed.

This study attempted to identify the necessary and sufficient change factors in short-term anxiety-provoking psychotherapy (STAPP). Twenty patients were randomly assigned to either STAPP or a form of nondirective therapy almost devoid of psychodynamic elements but with common factors of psychotherapy intact. Both treatments were 20 sessions long, were manualized, and therapists in both conditions were experienced clinicians receiving manual-guided supervision. Most patients had a diagnosis of anxiety. Results showed that patients in both treatments improved greatly symptomatically and that no further gains were made after termination. Treatments were equally effective. The therapeutic alliance was a strong predictor of symptom improvement. The findings underscore the importance of common factors pertaining to the therapeutic relationship, and they may open to question, to some degree, the therapeutic effectiveness of psychodynamic technique factors in STAPP. The way in which specific and common factors can be brought together under the umbrella of the concept of affect attunement is discussed.

STUDY DESIGN: A single-blinded, randomized treatment study with a follow-up period of 6 months. OBJECTIVE: To study the long-term consequences of whiplash neck sprain injuries in patients treated with two different regimes during the first 14 days after the car accident. Patients in the first group were encouraged to act as usual, i.e., continue to engage in their normal, pre-injury activities; that group was compared with another group of patients who were given time off from work and who were immobilized using a soft neck collar. The end point of the comparison was the evaluation of subjective symptoms 6 months after the accident. SUMMARY OF BACKGROUND DATA: Few randomized treatment studies have been performed to evaluate the clinical outcome for patients with neck sprain. METHOD: Patients who participated in the study were recruited from the Emergency Clinic at the University Hospital in Trondheim, Norway. The study group included 201 patients (47% of the study group) with neck sprain that resulted from a car accident. Neck and shoulder movements and subjective symptoms, which were assessed using several different measurements, were assessed during the follow-up period. RESULTS: There was a significant reduction of symptoms from the time of intake to 24 weeks after the treatment period in both groups. There was a significantly better outcome for the act-as-usual group in terms of subjective symptoms, including pain localization, pain during daily activities, neck stiffness, memory, and concentration, and in terms of visual analog scale measurements of neck pain and headache. CONCLUSIONS: The outcome was better for patients who were encouraged to continue engaging in their normal, pre-injury activities as usual than for patients who took sick leave from work and who were immobilized during the first 14 days after the neck sprain injury. Language: en

The aims of the present study was (a) to examine the relationship between parental bonding and various personality disorders, when the effect of a lifetime depressive disorder was statistically controlled for, and (b) to examine the relationship between parental bonding and a lifetime depressive disorder when the effects of various personality disorders were accounted for. The study included 135 psychiatric outpatients and 41 healthy controls. The patients were diagnosed according to DSM-III-R axis I and axis II. Results indicated that obsessive-compulsive personality disorder was associated with reports of lower levels of paternal care and higher levels of paternal overprotection, while cluster B personality disorder was associated with reports of high parental overprotection. Avoidant, dependent, and cluster A personality disorders were not associated with abnormal parental bonding. Lifetime depressive disorders were associated with reports of low maternal care and high maternal overprotection when the effect of a personality disorder was accounted for.

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.

Therapeutic bond, as a component of the alliance, is considered a common factor in psychotherapy; however, it may operate differently in various treatments. This article investigates therapist actions, particularly affect focus, in the formation of the bond and on reduction of symptoms in short-term dynamic psychotherapy (STDP) and cognitive therapy (CT) for cluster C patients. Forty-six cases (23 STDP and 23 CT) were assessed using the Psychotherapy Process Q-Sort, the Helping Alliance Questionnaire, and the Symptom Checklist 90. These scores were used to determine (a) therapist actions that predict formation of the bond, (b) the relation of the bond to symptom reduction, and (c) how therapist actions and bond interacted to reduce symptoms. Multiple regressions were applied to the total sample and to the STDP and CT cases. Psychotherapy Process Q-Sort items describing avoidance of affects were positively related to the bond in the total sample, STDP and CT. However, the relation between therapist actions, bond, and symptom reduction differed for the two treatments. For STDP, avoidance of affect suppressed the relation of bond to symptom reduction and also negatively influenced symptom reduction. On the other hand, in CT, avoidance of affect was positively related to both the formation of the bond and to symptom reduction. Although the bond is a common factor and important component of the alliance, it appears to operate differently in STDP and CT. A focus on affect is important to the benefits of STDP but interferes with the benefits of CT.

Background In clinical practice, sleep disturbance is often regarded as an epiphenomenon of the primary mental disorder. The aim of this study was to test if sleep disturbance, independently of primary mental disorders, is associated with current clinical state and benefit from treatment in a sample representative of public mental health care clinics. Method 2246 patients receiving treatment for mental disorders in eight public mental health care centers in Norway were evaluated in a cross-sectional study using patient and clinician reported measures. Patients reported quality of life, symptom severity, and benefit from treatment. Clinicians reported disorder severity, level of functioning, symptom severity and benefit from treatment. The hypothesis was tested using multiple hierarchical regression analyses. Results Sleep disturbance was, adjusted for age, gender, time in treatment, type of care, and the presence of any primary mental disorder, associated with lower quality of life, higher symptom severity, higher disorder severity, lower levels of functioning, and less benefit from treatment. Conclusion Sleep disturbance ought to be considered a stand-alone therapeutic entity rather than an epiphenomenon of existing diagnoses for patients receiving treatment in mental health care.

A better understanding of the relation between protection and vulnerability may advance our understanding of mental health. Therefore the purpose of this study was to examine the incremental validity of the Resilience Scale for Adults (RSA) as a predictor for level of hopelessness. A healthy sample (N = 532) completed the Beck Hopelessness Scale, a list of Stressful Life Events (SLE), the Hopkins Symptom Checklist-25 (HSCL-25), NEO-PI-R (NEO Personality Inventory Revised) and the RSA. The relations between the variables were explored with correlations and multiple hierarchical regression analyses. The results indicated that the RSA measures important protective factors that significantly predict lower levels of hopelessness even when accounting for age, gender, SLE, HSCL-25 and NEO-PI-R. This study supports the notion that the protective resilience factors in the RSA have unique contributions over and above established constructs of stressful life events, depressive and anxiety symptoms and personality in predicting hopelessness, supporting the incremental validity of the RSA.

This study examined whether 49 patients from a randomized controlled trial developed insight during therapy and whether insight predicted long-term outcome in short-term dynamic psychotherapy (STDP) and cognitive therapy (CT) for Cluster C personality disorders. Videotaped sessions early and late in treatment were analyzed using the Achievement of Therapeutic Objectives Scale. Patients' level of insight increased significantly during STDP but not CT. After controlling for early symptom change and early insight, insight near the end of therapy predicted improvement of symptom severity and interpersonal functioning during a 2-year follow-up period. These results support the theoretical assumption that insight may be a factor in the change process, central to STDP. Within CT, gain of insight did not predict long-term improvement.

The aims of this study were to test the psychometric properties of the Norwegian version of the Obsessive-Compulsive Inventory-Revised (OCI-R). The study included a student/community control sample (N = 1167) and a clinical sample (N = 72) with a diagnosis of obsessive-compulsive disorder (OCD). The results indicated a good fit for the six-factor structure of the OCI-R. The mean scores and standard deviations were similar to that of studies from other countries as was the internal consistency. The OCI-R scores were significantly higher in the OCD sample compared to the control sample. All the subscales, except hoarding, were significant predictors of obsessive-compulsive severity, and the OCI-R subscales seemed to be in agreement with the different subtypes of OCD according to DSM-IV. The OCI-R showed meaningful correlations with measures related to obsessive compulsive symptoms. As expected, it showed the strongest correlation with the Yale-Brown Obsessive Compulsive Scale, followed by measures of worry, anxiety, and depression. In summary, the Norwegian OCI-R showed adequate psychometric properties suggesting it could be a suitable measure of obsessive-compulsive symptoms.

The relationship between presleep worry and insomnia has been investigated in previous studies, but less attention has been given to the role of daytime worry and symptoms of insomnia. The aims of the current study were (a) to assess the psychometric properties of a novel scale measuring insomnia-specific worry during daytime and (b) to examine whether levels of daytime worry predict severity of insomnia symptoms. Participants (N = 353) completed the Insomnia Daytime Worry Scale (IDWS) and the Insomnia Severity Index. An explorative principal-axis factor analysis extracted two factors from the IDWS, accounting for 70.5% of the variance. The IDWS demonstrated good reliability. The total score of IDWS and both factors predicted levels of insomnia severity in two separate hierarchical regression analyses. This preliminary evidence suggests that the IDWS is a valid and reliable scale to measure daytime worry in insomnia.

Background: Research on group therapy indicates that various dimensions of the helpful relationship qualities (cohesion, climate, empathy, alliance) are associated with outcome. However, the use of a wide variety of empirical scales makes comparisons between studies as well as generalizations somewhat difficult. Although a generic, trans-theoretical measure such as the Group Climate Questionnaire-Short Form (GCQ-S; MacKenzie, 1983) is available and applicable to most treatment conditions, it has never been tested with cognitive-behavioural group therapy. Aims: To investigate perceived dimensions of group climate (engagement, avoidance and conflict) as predictors of long-term (1 year) follow-up in a manualized, structured time-limited cognitive-behavioural group therapy (CBGT) for out-patients with comorbid psychiatric disorders. Methods: Data from 27 patients were analysed using hierarchical multiple regression analyses. Outcome measures used were general symptomatic complaints (SCL-90-R), interpersonal problems (IIP-64), specific mood- and anxiety symptoms (BDI; BAI) and early maladaptive schemas (YSQ). After controlling for scores on the relevant dependent variables at both intake and treatment termination, dimensions of group climate measured close to termination were entered as predictors in separate analyses. Results: Higher ratings of engagement were associated with reduced scores on all outcome measures at follow-up, except for anxiety symptoms (BAI). Higher ratings of avoidance were associated with lower anxiety symptoms at follow up, whereas ratings of conflict were unrelated to all follow-up scores. Conclusions: The results provide partial support for the use of the GCQ-S as a predictor of long-term follow-up in CBGT, and highlights perceived engagement as the most important dimension. Clinical implications are discussed.