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In a Norwegian study of 73 couples attending a residential couple therapy program lasting between 6 and 12 weeks, weekly self-report data on therapy alliance and couple satisfaction were collected using routine outcome monitoring (ROM). The aim was to show how dyadic analyses could be applied to examine the predictive association between alliances and couple satisfaction. Results showed that improved alliance between dyad members and their couple therapist predicted their spouses' couple satisfaction. Furthermore, improved couple satisfaction predicted improvement in spouse's alliance. The clinical implication of these findings should heighten awareness to the importance of establishing and maintaining the alliance of male partners in couple therapy, something that predicts their spouses' couple satisfaction. These findings help nuance the already existing literature on the working alliance. Furthermore, we propose that dyadic analyses should be widely used in any psychotherapeutic research that aims to understand the reciprocal effects of dyads.

The aim of this naturalistic process study was to investigate the relationship between emotional clarity and tolerance of emotional distress and depressive symptoms over the course of short-term psychodynamic psychotherapy for chronically depressed patients.Weekly self-reports of emotional clarity, tolerance of emotional distress, and depressive symptoms (PHQ-9) were provided by 252 patients with chronic depression who were admitted to a 13-week inpatient treatment program. Latent curve modeling with structured residuals (LCM-SR) was applied to investigate the between- and within-person effects of week-to-week change in emotional clarity and tolerance of emotional distress as predictors of subsequent depression. The relationship between emotional clarity and tolerance of emotional distress was also investigated.At the within-person level, higher level of emotional clarity and tolerance of emotional distress predicted subsequent lower level of depression. A reciprocal relationship was found for tolerance of emotional distress (lower level of depression predicted subsequent level of tolerance emotional distress) but not for emotional clarity. No within-person effect between emotional clarity and tolerance of emotional distress was found.The results indicate that emotional clarity and tolerance of emotional distress may be mechanisms of change in short-term psychodynamic psychotherapy for chronic depression. The results are consistent with previous findings of the importance of emotional clarity and tolerance of emotional distress in psychotherapy. This study demonstrated the utility of LCM-SR as a method to identity mechanisms of change in psychotherapy. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

According to the literature, avoidant personality disorder (APD) is often overlooked in research on personality disorders. In the present study, patients with APD were compared to patients with borderline personality disorder (BPD) with respect to emotional dysfunction. Emotional dysfunction was operationalized through the Affect Integration Inventory. Sixty-one patients receiving treatment at specialized outpatient hospital facilities for either BPD (n = 25) or APD (n = 36) (Diagnostic and Statistical Manual of Mental Disorders, fifth edition) were included in a cross-sectional study. Supporting our expectations of no difference in the global capacity for affect integration between groups, the estimated difference was 0.00 (95% confidence interval [CI] [−0.53, 0.53]). On the other hand, the expected increased dysfunction in APD regarding Expression could not be confirmed. Furthermore, problems with specific affects distinguished the groups; integration of Interest was worse in APD (p = 0.01), whereas integration of Jealousy was worse in BPD (p = 0.04). In terms of prototypical modes of experiencing affects, APD was characterized by decreased access to the motivational properties of Interest (p

Background Norway has prioritized health services according to the principle of “severity of conditions”, where waiting time reflects patients’ medical urgency. We aim to investigate if the “severity-of-condition” principle performs well in the priority setting of waiting time, between and within groups of patients using community mental health services. We also aim to investigate the association between patients’ diagnoses and symptom severity at the start of treatment and the corresponding waiting time. Methods The study analyzed routine data from Lovisenberg electronic Patient-Reported Outcome Measurement (LOVePROM) at Lovisenberg Diaconal Hospital in Norway. We estimated patient-reported severity by using Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE-OM), together with patients’ diagnoses to identify patients’ needs in general. To assess the performance of current prioritization, we compared waiting times for patients with major depressive disorder and their maximum recommended waiting time. Multivariate regression models were used to assess the association between patient-reported severity, their diagnosis, and waiting times. Results Of the 6108 mental health disorder patients, patients with moderate to severe conditions waited seven weeks, while patients with mild conditions or below clinical cutoff waited 8 weeks. Included in the sample, 1583 were diagnosed with depression. Results indicated that patients with moderate and severe depression had a slightly shorter wait-time than patients with mild depression. However, 32.4% patients with moderate depression and 83.3% patients with severe depression, waited longer than their maximum recommended waiting time. CORE-OM identified depressive patients with risk-to-self harm, who had a 0.84 weeks shorter wait-time. These results were also applied to patients with other common mental health disorders. Conclusion Overall, patients waited in accordance with the “severity of condition” principle, but the trend was not strong. Therefore, we advocate that there is substantial room for quality improvements in priority setting on waiting time. We suggest further research should investigate if routine collection of PROM and assessment of referral letters, can better inform specialists when deciding on waiting time.

Background Preoperative hypnosis has shown promising effects in controlling side effects from breast cancer surgery, but the feasibility and effects are largely unknown outside the US. Methods A mixed-methods approach was applied involving a large-scale population survey and a small-scale pilot study. The survey assessed attitudes toward hypnosis in a representative sample from the general population (n = 1049), while the pilot study involved interviews with 5 women who received hypnosis prior to mastectomy/lumpectomy. Results In the survey, 8% reported to have previous experience with hypnosis, and 67% reported willingness to accept hypnosis in a medical setting. Increasing age was associated with more skepticism, while previous experience was associated with less skepticism. In the pilot study, 4 themes were identified: (1) caretaking, (2) experiences related to hypnosis, (3) thoughts and feelings related to diagnosis, and (4) surgery. All participants reported positive experiences related to hypnosis, and none described unpleasant side effects or postoperative pain (pain intensity > 3) after surgery. Conclusions The results indicate that the general public is positive toward clinical hypnosis as a supplement to medical treatment and that preoperative hypnosis is feasible in Norwegian breast cancer patients. Trial Registration ClinicalTrials.gov Identifier: NCT04300283.

Conflict with parents is common among depressed adolescents, interferes with treatment, and may increase risk of recurrence. Parental depressive symptoms have been shown to predict conflict with adolescent children, but an important role for different kinds of parental interpersonal problems, as described by interpersonal circumplex, is also plausible. This study compared parental interpersonal problems to parental depressive symptoms as predictors of parent-adolescent conflict reported by a depressed adolescent child, using multilevel linear regression, leave-one-out cross-validation and model stacking (N = 100 parents, 57 mothers and 43 fathers, of 60 different adolescents). Cross-validation and model stacking showed that including parental interpersonal problems contributes to accurate predictions. Parents reporting more interpersonal problems related to excessive dominance or submissiveness was associated with increased or decreased conflict, respectively. Parental depressive symptoms were found to be negatively associated with parent-adolescent conflict only in father-adolescent relationships. Electronic supplementary material The online version of this article (doi:10.1007/s10578-020-00955-0) contains supplementary material, which is available to authorized users.

Kari Standal,1 Ole Andre Solbakken,2 Jorun Rugkåsa,3,4 Astrid Ringen Martinsen,1,2 Margrethe Seeger Halvorsen,2 Allan Abbass,5 Kristin Sverdvik Heiervang6,7 1District Psychiatric Center Nedre Romerike, Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway; 2Department of Psychology, University of Oslo, Oslo, Norway; 3Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway; 4Centre for Care Research, University of South-Eastern Norway, Porsgrunn, Norway; 5Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; 6Department of Research and Development, Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway; 7Centre of Medical Ethics, Faculty of Medicine, University of Oslo, Oslo, NorwayCorrespondence: Kari StandalDistrict Psychiatric Center Nedre Romerike, Division of Mental Health Services, Akershus University Hospital, Postboks 1000, Lørenskog, 1478, NorwayTel +47 679 60 155Email kari.standal@ahus.noPurpose: Medication has been a central part of treatment for severe mental disorders in Western medicine since the 1950s. In 2015, Norwegian Health Authorities decided that Norwegian health regions must have treatment units devoted to medication-free mental health treatment to enhance service users’ freedom of choice. The need for these units has been controversial. The aim of this study was to examine why service users choose medication-free services. This article examines what purpose these units serve in terms of the users’ reasons for choosing this service, what is important for them to receive during the treatment, and what factors lay behind their concerns in terms of medication-related views and experiences.Methods: Questionnaires were answered by 46 participants and 5 participants were interviewed in a mixed-method design integrated with a concurrent triangulation strategy applying thematic analysis and descriptive statistics.Results: Negative effects of medications and unavailable alternatives to medication in ordinary health care were important reasons for wanting medication-free treatment. Medication use may conflict with personal values, attitudes, and beliefs.Conclusion: This study broadens the understanding of why the demand for separate medication-free units has arisen. The findings may contribute to making medication-free treatment an option in mental health care in general. To this end, clinicians are advised to communicate all treatment alternatives to service users and to be mindful of the effect of power imbalances in their interactions with them.Keywords: mental health care, medication-free, choice, psychotropics

Background: Central components of psychological functioning, such as difficulties in emotion regulation and interpersonal problems are likely to have been substantially impacted by COVID-19 and the amelioration measures of societal lock-down and social distancing. In turn, these factors are likely to predict mental health outcomes, such as symptoms of depression and anxiety throughout the pandemic and beyond. Methods: To investigate this issue, we conducted an internet-based survey with 10,061 responders at the height of lock-down (T1). After social distancing measures had been eased (T2), 4,936 responders (49.1%) completed the survey again. Results: Emotion regulation difficulties, interpersonal problems, and symptoms of depression and anxiety decreased from T1 to T2, but changes were minor. After controlling for age and gender, emotion regulation- and interpersonal difficulties were associated with anxiety and depression throughout the study period, and changes in all domains occurred in concert. More extensive problems with emotion regulation at T1 predicted greater reductions in both symptom domains as amelioration measures were eased, while the converse was true for interpersonal problems. Furthermore, the impact of initial emotion regulation difficulties on subsequent changes in both anxiety- and depressive symptoms was dependent on the level of interpersonal difficulties, so that high interpersonal problem load at T1 reversed the effect of emotion regulation difficulties on symptom development. Conclusions: The results suggest that emotion regulation- and interpersonal difficulties are highly central to mental health during the pandemic, and may be important targets for remediation to reduce mental health problems throughout the course of the pandemic and beyond.

Psychotherapy tends to produce meaningful and sustained positive changes for individuals suffering from a mental illness. A salient distinction can be made between patients with a Personality Disorder (PD) and those without. There is some evidence that patients with PD have poorer treatment outcomes, but the majority of these studies are from time-limited interventions that might be less suited for patients with PD. In contrast, the present study provided open-ended psychotherapy to a sample of patients (N = 370), half of which had at least one PD before treatment. The therapists received instruction to organize their treatments in cooperation with patients so that therapy was tailored to each patient’s individual needs and characteristics. The results revealed that patients with a PD demonstrated equal symptomatic improvement and greater interpersonal improvement compared to patients without a PD. Similarly, observer-rated diagnostic changes were equivalent across the two groups. Both groups demonstrated enduring improvements when assessed at a two-and-half-year follow-up. The degree of personality pathology was positively related to the magnitude of change, i.e. patients with more severe personality problems demonstrated greater gains in the open-ended treatment format.

Findings from previous psychotherapy research suggest that the majority of improvement takes place in the initial phase of treatment with the relative effectiveness dropping at a negatively accelerating rate. However, the evidence for this pattern of change comes from investigations of short-term treatments and it is unclear whether this also holds for more flexible and long-term psychotherapy. We provided open-ended treatments under routine-care conditions for a representative sample of 362 patients, including a large proportion characterized by severe psychopathology. Patients attended 52 sessions on average (

Findings from previous psychotherapy research suggest that the majority of improvement takes place in the initial phase of treatment with the relative effectiveness dropping at a negatively accelerating rate. However, the evidence for this pattern of change comes from investigations of short-term treatments and it is unclear whether this also holds for more flexible and long-term psychotherapy. We provided open-ended treatments under routine-care conditions for a representative sample of 370 patients, including a large proportion characterized by severe psychopathology. Patients attended 52 sessions on average (SD = 59, range = 1 - 364, Median = 36). Our results indicated that the degree of improvement was linearly associated with time spent in psychotherapy and contingent upon the severity of psychological problems at intake. The least severely afflicted received the shortest treatments, experienced the most rapid change but demonstrated smaller overall magnitudes of improvement. More severely suffering patients received longer treatments, had slower rates of change but received greater overall benefits. Among the patients who experienced clinically significant symptomatic improvement (47 %), a dose-response survival analysis indicated a median survival time of 57 sessions. We argue that previous suggestions of psychotherapy dosage have been inappropriate for patients suffering from moderate to severe psychopathology.

Addiction programs are plagued with high dropout and relapse rates. A large proportion of patients suffering from addiction also suffer from personality disorders. A 30-day inpatient program based on intensive short-term dynamic psychotherapy was developed to address features of personality disorders such as anxiety regulation, emotion recognition, and handling of fear responses and projective processes. The hypothesis was that addressing comorbid symptoms of personality disorder might improve recovery from drug addiction. We used a pilot randomized controlled trial design with six-month follow-up of both cases and controls. Rates of remission, relapse and drop out were recorded at each time point. N-1 chi-squared (

Objective: This study investigates the effectiveness of open-ended psychotherapy in a large, naturalistic, and diverse patient cohort using rigorous and multifaceted assessments. Method: Patients (N = 370) in open-ended psychotherapy completed an extensive set of self-report measures and diagnostic interviews, including long-term follow-up in order to assess stability of outcomes. About half of the patients qualified for a personality disorder at the onset of treatment. Treatments were open-ended, and on average therapists provided substantially larger treatment doses than common in the literature. Results: A substantial majority recovered from their respective Axis I (58%) and/or Axis II (55%) disorders during treatment. Patients also experienced large positive changes in self-report measures of overall psychiatric symptoms and moderate positive changes in self-reported interpersonal problems, while very few (< 3%) demonstrated negative development. The patients maintained their diagnostic and self-assessed changes at a two-and-a-half-year follow-up. In contrast, self-reported occupational functioning showed minimal improvement throughout the treatment and follow-up phase. Conclusion: A naturalistic patient cohort undergoing open-ended psychotherapy demonstrates substantial and stable improvements. publishedVersion

Interpersonal- and self-relatedness problems are strongly correlated on a global level. However, few studies have examined associations between distinct forms of interpersonal problems and specific types of problems in self-relatedness. We hypothesized that patients with domineering interpersonal problems would exhibit a more positive self-image than patients with submissive interpersonal features. We also wanted to examine if the self-hostile and self-accepting aspects of patients’ self-relatedness were differentially associated with their interpersonal problems. A large clinical outpatient sample (N = 958) was divided into eight subgroups (Octant Groups) of patients with different predominant interpersonal problems, as measured with the 64 item version of the Inventory of Interpersonal Problems—IIP-64. Self-relatedness was measured with the Introject surface of the Structural Analysis of Social Behavior—SASB Introject. ANCOVA analyses showed that patients with more positive and self-accepting self-images displayed domineering, but also warmer forms of interpersonal problems than peers with more negative self-images. Dividing the self-relatedness variable into Self-Hostile and Self-Accepting components yielded a new finding: patients within different interpersonal Octant Groups differed significantly with regard to Self- Acceptance, but not with respect to Self-Hostility. The former component may be reflective of a more stable personality feature than Self-Hostility, thereby rendering it less susceptible to change.

Objective 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, 1996), relate to patient (n = 255) outcome in public outpatient care. Method 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. Results 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. Conclusion A tentative take-home message from this study could be: ‘Love yourself as a person, doubt yourself as a therapist’. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Messages 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.

Aims: Concepts of mentalization, affect consciousness, and mindfulness have been increasingly emphasized as crucial in psychotherapy of diverse orientations. Different measures have been developed ...

Overall, few studies reported in the literature have focused specifically on non-respond ers to psychotherapy. Even fewer have specifically selected patients based on previous non-response to treatment and attempted systematic, customized psychological interventions to address their needs. Such studies could yield important information about strategies for overcoming the unfortunate fact that so many do not benefit from psychological treatments. The current study, and the treatment program it examines, was designed and implemented as an attempt to remedy this state of affairs. With the aim of relieving the suffering of patients with repeated non-response to treatment, an intensive, time-limited, residential treatment program was devised. Using criteria for clinically signifi cant change in symptoms, 1 the average recovery rate for formal psychotherapeutic treatments delivered in welldesigned trials is approximately 50%. 2 Accordingly, approximately half the patients leave treatment with significant clinical symptoms or deteriorate during or after the intervention. In routine care (treatment as delivered outside of organized psychotherapy trials), the rates of recovery are substantially smaller. 3 Thus, a large percentage of patients in mental health care can be classified as “treatment-resistant” to psychotherapy. Given this, the development of new approaches specifically designed to aid these patients is of prime importance. Due to lack of research, it remains unknown whether modifications in treatment format, setting, dose, or con

Associations between symptoms and interpersonal problems, assessed with the Symptom Checklist-90 (SCL-90-R) and the Inventory of Interpersonal Problems-64-item version (IIP-64), are examined in a large psychiatric outpatient sample. On the basis of the IIP-64 scores, the sample was divided into 8 subgroups, made up of different types of predominant interpersonal problems. These octant groups were used as independent variables in analyses testing hypothesized associations with symptom subscales of the SCL-90-R. In general, strong associations between symptoms and interpersonal problems were found. In addition, hostile and paranoid ideation symptoms displayed significant differences among octant groups, and were associated with interpersonal problems of the vindictive/self-centered kind. Phobic anxiety was associated with interpersonal problems of the socially inhibited kind. Assessing specific combinations of symptoms and interpersonal problems might be useful in treatment planning and evaluation.

Affect integration, or the capacity to utilize affects for personal adjustment, is an essential aspect of psychological functioning. Affect integration has been operationalized through the affect consciousness construct as degrees of awareness, tolerance, nonverbal expression, and conceptual expression of nine discrete affects. It is measured by the Affect Consciousness Interview (ACI). The ACI, however, is time-consuming and demands extensive training. It is therefore a priority to develop a self-rated measure of affect integration that is more readily accessible. This study explored the validity of the Affect Integration Inventory (AII), a self-rated operationalization of affect integration, through estimates of internal consistency and internal structure. External validity was addressed by examining relationships between AII scores and emotion regulation, alexithymia, psychiatric symptoms, and interpersonal problems. We found satisfactory reliability, sound internal structure, and associations with external criteria, indicating good convergent and discriminant validity. Such findings included distinct relationships between AII ratings and specific types of interpersonal problems.

The present study investigated the relationship between baseline levels of affect integration and the magnitude of change during and after open-ended psychotherapy. Affect integration reflects the capacity for accessing and utilizing the adaptive properties of affects for personal adjustment, along with the more general capability of tolerating and regulating affective activation. It is thus a capacity with relevance for the postulated mechanisms of change in various treatment modalities. Overall, the results indicated that patients with more severe problems in affect integration had larger improvements in symptoms, interpersonal and personality problems in open-ended treatment than those with less severe problems. This was also the case when examining the predictive effects of the integration of specific affects on changes in interpersonal relatedness. It was indicated that increasing problems with the integration of discrete affects were associated with distinct patterns of change in different interpersonal problem domains.

The importance of affect regulation, modulation or integration for higher-order reflection and adequate functioning is increasingly emphasized across different therapeutic approaches and theories of change. These processes are probably central to any psychotherapeutic endeavor, whether explicitly conceptualized or not, and in recent years a number of therapeutic approaches have been developed that explicitly target them as a primary area of change. However, there still is important lack of clarity in the field regarding the understanding and operationalization of affect integration, particularly when it comes to specifying underlying mechanisms, the significance of different affect states, and the establishment of operational criteria for measurement. The conceptual relationship between affect integration and reflective function thus remains ambiguous. The present article addresses these topics, indicating ways in which a more complex and exhaustive understanding of integration of affect, cognition and behavior can be attained.

Objective No studies, to our knowledge, have examined what specific kinds of interpersonal problems characterize a general psychiatric outpatient population. Do they differ from the normal population in any specific way, apart from the expected “more of everything”? The aim of this study was to map and categorize a large psychiatric outpatient sample with regard to self-reported interpersonal problems. Method First-admission psychiatric patients completed the 64-item version of the Inventory of Interpersonal Problems (Horowitz et al, Inventory of Interpersonal Problems Manual . San Antonio, TX: The Psychological Corporation 2000) before treatment. Scores were compared with Norwegian reference data. Profile characteristics of 8 subgroups (octant groups), corresponding to 8 different forms of predominant interpersonal problem, were calculated according to the structural summary method (Gurtman and Balakrishnan, Circular measurement redux: the analysis and interpretation of interpersonal circle profiles. Clin Psychol Sci Pract . 1998;5[3]:344-360). Results The clinical sample had considerably more interpersonal problems than the normal reference sample. Among the 8 octant groups with different predominant interpersonal problems, the 3 most prevalent in the sample, characterized by a low degree of assertiveness (low agency), were also the most distressed with regard to interpersonal problems. Conclusions Psychiatric outpatients seem to have the most severe interpersonal problems along the agency dimension; that is, they have problems being assertive. Patients within different octant groups of the 64-item version of the Inventory of Interpersonal Problems system, corresponding to different kinds of specific, predominant interpersonal problems, have characteristic ways of relating to others, which ought to be identified and addressed in therapy.

Affect integration, or the capacity to utilize the motivational and signal properties of affect for personal adjustment, is assumed to be an important aspect of psychological health and functioning. Affect integration has been operationalized through the affect consciousness (AC) construct as degrees of awareness, tolerance, nonverbal expression, and conceptual expression of nine discrete affects. A semistructured Affect Consciousness Interview (ACI) and separate Affect Consciousness Scales (ACSs) have been developed to specifically assess these aspects of affect integration. This study explored the construct validity of AC in a Norwegian clinical sample including estimates of reliability and assessment of structure by factor analyses. External validity issues were addressed by examining the relationships between scores on the ACSs and self-rated symptom- and interpersonal problem measures as well as independent, observer-based ratings of personality disorder criteria and the Global Assessment of Functioning (GAF) scale from the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994).

ObjectiveThe study investigated the effectiveness of an 8-week intensive residential treatment programme based on principles from intensive short-term dynamic psychotherapy for patients with known treatment-resistant anxiety- and/or depressive disorders (mainly with comorbid personality disorders).MethodsPatients (N=95) with prior repeated treatment failure were included. Changes in self-reported target complaints, symptom severity, and overall interpersonal problems have been presented for these patients in two previous articles. We now expand upon the existing knowledge by presenting novel data from a number of important observer-based and self-reported outcome domains (diagnostic changes on Axis I and II, changes in overall personality dysfunction, disorder complexity, medication use, health care utilisation, and occupational activity).ResultsThere were pervasive and significant improvements on all measures during treatment, which were maintained or further improved during follow-up. Fourteen months after the end of treatment, 46.26% of patients had recovered in terms of Axis I pathology, 63.79% had recovered in terms of Axis II pathology, 71.18% had returned to work, and there was a 28.62% reduction in regular use of psychotropic medications. Health care utilisation was reduced by 65.55%, and there were large improvements in disorder complexity and levels of personality dysfunction.ConclusionThe treatment programme was highly effective for patients with common and complex treatment-resistant mental disorders. Results are encouraging for the relatively large number of patients who tend not to benefit from standard formats of treatment for debilitating psychological problems.

Background: The study investigated the effectiveness of an Intensive Short-Term Dynamic (ISTDP) residential treatment program for patients with treatment resistant anxiety- and/or depressive disorders, with and without comorbid personality disorders. Method: A non-randomized controlled trial examined the effects of an eight week intensive residential treatment program based on principles from ISTDP. Patients (N ¼60), who had repeated prior treatment failure for current mental disorder, sufficient dysfunction to warrant hospitalization, and evidencing capacity to take an intrapsychic perspective on own problems, were included. Outcome variables included measures of target complaints (depression/anxiety, social role dysfunction, and interpersonal distress), general symptom distress, and interpersonal functioning. Measures were administered throughout and after treatment. Change was assessed by multilevel growth curve modeling. Changes during and after treatment were compared to those reported by a sub-sample of wait-list controls taking treatment as usual (N ¼30). Results: The treatment group evidenced significant improvements on all measures. By contrast, receiving treatment as usual while on the wait-list did not yield significant changes. Effect sizes in the treatment group were consistently large at both termination and follow-up. Fourteen months after treatment 50.0% of patients had recovered in terms of target complaints. Approximately 53.3% and 48.3%, respectively, had recovered in terms of general symptom distress and interpersonal functioning. Limitations: Limitations included a relatively small sample size, inability to discern the effectiveness of separate components of the treatment program, and lack of randomization of patients to wait-list and treatment. Conclusion: ISTDP-based residential treatment with an eight-week time-limit appears to be effective for alleviating common and severe, treatment resistant mental disorders. The treatment program was superior to receiving treatment as usual while on the wait-list. Participation in the program quickly reduced target complaints, symptoms and interpersonal problems for patients who, based on previous treatment experiences, were expected to fare poorly in treatment. Gains were consistently maintained or improved further at follow-up. Results are promising for patients with chronic debilitating problems who often do not profit from traditional psychiatric treatment.

Affect integration was operationalized through the Affect Consciousness (AC) construct as degrees of awareness, tolerance, nonverbal expression and conceptual expression of 11 affects. These aspects are assessed through a semi-structured Affect Consciousness Interview (ACI) and separate rating scales (Affect Consciousness Scales (ACSs)) developed for use in research and clinical work with adults with psychopathological disorders. Age-adjusted changes were made in the interview and rating system. This study explored the applicability of the adjusted ACI to a sample of 11-year-old children with internalizing problems through examining inter-rater reliability of the adjusted ACI, along with relationships between the AC aspects and aspects of mental health as symptoms of depression, symptoms of anxiety, social competence, besides general intelligence. Satisfactory inter-rater reliability was found, as well as consistent relationships between the AC aspects and the various aspects of mental health, a finding which coincides with previous research. The finding indicates that the attainment of the capacity to deal adaptively with affect is probably an important contributor to the development of adequate social competence and maybe in the prevention of psychopathology in children. The results indicate that the adjusted ACI and rating scales are useful tools in treatment planning with children at least from the age of 11 years.

Monitoring of ongoing psychotherapy is of crucial importance in improving the quality of mental health care by detecting therapies being off track, which requires that the instrument used is psychometrically sound. This study investigates the psychometric properties of the Norwegian version of the Outcome Questionnaire 45.2 (OQ-45) and situates the results in an international context.Data from one non-clinical sample (N = 338) and one clinical sample (N = 560) were compared to international samples investigating reliability, cut-offs, and factor structure.The results show adequate reliability and concurrent validity.The means, clinical cut-offs, and the reliable change index vary across countries. However, the means of the OQ-45 for nonclinical samples correlate highly with external values of national well-being, indicating that the OQ-45 is a valid instrument internationally. The factor analyses in the present study do not confirm the hypothesized factor structure of the OQ-45, but are similar to the results internationally.

Background This protocol presents a systematic residential treatment- and research program aimed at patients who have not responded adequately to previous treatment attempts. Patients included in the program primarily suffer from anxiety and/or depressive disorders and usually from one or more comorbid personality disorders. The treatment program is time-limited (eight weeks) and has its basis in treatment principles specified in intensive short-term dynamic psychotherapy (ISTDP). This treatment modality is theoretically well-suited for the handling of various forms of treatment resistance presumably central to these patients’ previous non-response to psychological and psychiatric interventions. Methods/Design The research component of the project entails a naturalistic longitudinal research design which aims at systematic evaluation of the effectiveness of the program. To our knowledge, this is one of the first treatment programs and corresponding research projects that systematically select patients with previous non- or negative response to treatment and subjects them to a broad and comprehensive, but theoretically unified and consistent treatment system. Discussion The present paper introduces the project, describes its theoretical and methodological underpinnings, and discusses possible future implications and contributions of the project. It thereby serves as a comprehensive background reference to future publications from the project.