Cognitive behavior therapy for adult eating disorders in routine clinical care: A systematic review and meta-analysis.

OBJECTIVE: Cognitive behavior therapy (CBT) is a recommended treatment for eating disorders (ED) in adults given its evidence, mainly based on efficacy studies. However, little is known about how CBT works in routine clinical care. The goal of the present meta-analysis is to investigate how CBT works for various ED when carried out in routine clinical settings. METHOD: Ovid MEDLINE, Embase OVID, and PsycINFO were systematically searched for articles published until June 2023. The outcome of CBT, methodological quality, risk of bias (RoB), and moderators of treatment outcome were examined and benchmarked by meta-analytically comparing with efficacy studies for ED. Fifty studies comprising 4299 participants who received CBT were included. RESULTS: Large within-group effect sizes (ES) were obtained for ED-psychopathology at post-treatment (1.12), and follow-up (1.22), on average 9.9 months post-treatment. Attrition rate was 25.5% and RoB was considerable in the majority of studies. The benchmarking analysis showed that effectiveness studies had very similar ESs as efficacy studies (1.20 at post-treatment and 1.28 at follow-up). CONCLUSION: CBT for ED is an effective treatment when delivered in routine clinical care, with ESs comparable to those found in efficacy studies. However, the evidence needs to be interpreted with caution due to the RoB in a high proportion of studies. PUBLIC SIGNIFICANCE: Eating disorders are common in the population and often lead to multiple negative consequences. CBT has been found effective for ED and is recommended in clinical guidelines. Since these recommendations are primarily based on university studies we wanted to investigate how CBT performs in routine clinical care. Our meta-analysis found that CBT worked as well in routine care as in university setting studies.

OBJETIVO: La terapia cognitivo-conductual (TCC) es un tratamiento recomendado para los trastornos de la conducta alimentaria (TCA) en adultos debido a su evidencia, basada principalmente en estudios de eficacia. Sin embargo, se sabe poco sobre cómo funciona la TCC en la atención clínica rutinaria. El objetivo de este meta-análisis es investigar cómo funciona la TCC para diversos TCA cuando se lleva a cabo en entornos clínicos habituales. MÉTODO: Se realizó una búsqueda sistemática en Ovid MEDLINE, Embase OVID y PsycINFO de artículos publicados hasta junio de 2023. Se examinaron el resultado de la TCC, la calidad metodológica, el riesgo de sesgo y los moderadores del resultado del tratamiento, y se compararon metaanalíticamente con estudios de eficacia para TCA. Se incluyeron cincuenta estudios que comprendían a 4299 participantes que recibieron TCC. RESULTADOS: Se obtuvieron tamaños del efecto (TE) grandes dentro del grupo para la patología de los TCA en el post-tratamiento (1.12) y en el seguimiento (1.22), en promedio 9.9 meses después del post-tratamiento. La tasa de abandono fue del 25.5% y el riesgo de sesgo fue considerable en la mayoría de los estudios. El análisis de comparación mostró que los estudios de efectividad tenían TE muy similares a los estudios de eficacia (1.20 en el post-tratamiento y 1.28 en el seguimiento). CONCLUSIÓN: La TCC para los TCA es un tratamiento efectivo cuando se administra en la atención clínica rutinaria, con TE comparables a los encontrados en estudios de eficacia. Sin embargo, la evidencia debe interpretarse con cautela debido al riesgo de sesgo en una alta proporción de los estudios.

Psychoeducation for adult ADHD: a scoping review about characteristics, patient involvement, and content.

BACKGROUND: Psychosocial interventions such as psychoeducation are increasingly being used to treat adult ADHD, both as an alternative and as a supplement to pharmacotherapy. A thorough overview of the literature on psychoeducation for adult ADHD is lacking. The objectives of this scoping review were therefore to identify the characteristics of psychoeducation interventions designed for adults with ADHD, examine how the patient experience or perspective is considered during the intervention's development and implementation, determine the typical themes covered, and explore how 'psychoeducation' is defined in these interventions. METHODS: A comprehensive search was performed to identify records in MEDLINE, Embase, PsycINFO, Web of Science, Cochrane CENTRAL, AMED, and ClinicalTrials.gov. Two or more reviewers were included in every step of the screening process and the final selection of included studies. The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist (Supplementary Material 1) was used to report the results, and the framework developed by Arksey and O'Malley was used as a guide throughout the scoping process. RESULTS: A total of 2121 records were identified through the literature search. After screening and full-text analysis, ten studies were included for final analysis. Most studies were conducted in Europe and followed a group format. Seven main themes were identified: Information about the diagnosis, treatment options, somatic health and ADHD, the insider perspective, ADHD and social life, coping and psychological skills, and ADHD and work. There was significant overlap in themes covered, but coverage of each theme varied. Themes deemed important by newer research, such as sexuality and gender-specific issues, were missing. Only one intervention involved patients in its development and implementation, and two interventions involved family members. There was variation in how psychoeducation was defined in the included studies, and the implications of this are discussed. CONCLUSION: The literature on psychoeducation for adult ADHD is not ready for any systematic effect estimation. Before such estimations are conducted, a shared understanding and definition of psychoeducation are needed. The involvement of end users in the development and delivery of interventions may aid reach this goal but results from this review indicate that such practices are rare.

Psychoeducational group interventions for adults diagnosed with attention-deficit/ hyperactivity disorder: a scoping review of feasibility, acceptability, and outcome measures.

INTRODUCTION: Although psychoeducational group interventions are increasingly used for adults diagnosed with attention-deficit/hyperactivity disorder (ADHD), a comprehensive review focused on the feasibility and acceptability indicators of these interventions remains lacking. Furthermore, although previous research has explored various aspects of psychoeducation for ADHD, such as its definition and approaches, limited research has focused on the synthesis for outcome measures and patients' experiences related to these interventions. Therefore, this scoping review aims to map the existing evidence reported on psychoeducational group interventions for adults diagnosed with ADHD. The objective is to provide a comprehensive overview of feasibility indicators, acceptability, and outcome measures used in psychoeducational group interventions. METHOD: A comprehensive structured literature search on the topic was performed in seven bibliographic databases, and the resulting records were independently screened, and their data extracted by two reviewers. We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-S) to ensure the transparency and rigor of this scoping review. RESULTS: The searches yielded 7510 records. Eight studies met the inclusion criteria. These included studies were conducted in European countries and the United States. Among these, six studies used a randomized control design, one an open feasibility trial, and one a pre-post intervention design. All the studies reported some feasibility and acceptability indicators. While all the studies reported on the severity of symptoms of ADHD as an outcome measure, some also reported on outcomes related to psychological or mental-health problems, quality of life, changes in knowledge regarding ADHD, or the level of self-esteem, functioning, and impairment. CONCLUSION: This scoping review revealed that psychoeducational group interventions are generally acceptable for patients in terms of patient satisfaction with the group intervention. All included studies reported some feasibility indicators, with some reporting good attendance and relatively low dropout rates. Most studies reported positive effects on ADHD and mental health symptoms, suggesting that these interventions are beneficial for adults with ADHD. However, several gaps exist regarding the reporting on the feasibility indicators, acceptability, and outcome measures employed across studies.

Metacognitive strategies mediate the association between metacognitive beliefs and perceived quality of life.

Quality of life may be understood as a multidimensional evaluation of life circumstances in relation to values, expectations, and perceived well-being. Quality of life is thus dependent on the subjective perception of the current life situation, not only objective circumstances. According to metacognitive theory, metacognition guides the appraisal of inner experiences (i.e., thoughts and feelings) and influences how one relates to external stressors. Hence, dysfunctional metacognitive beliefs and the cognitive attentional syndrome (CAS), which includes perseverative thinking, threat monitoring and ineffective coping strategies, may negatively influence subjective quality of life. Therefore, we aimed to investigate if metacognitive beliefs and CAS strategies were associated with quality of life. A sample of 503 participants (77.1% women, mean age 41.0, SD = 11.5) completed the metacognitions questionnaire 30 (MCQ-30), the CAS-1 and the quality of life scale (QOLS). We used structural equation modelling (SEM) to estimate associations between the variables founded in metacognitive theory. The results of the SEM showed a significant direct relationship between metacognitive beliefs and quality of life. CAS strategies mediated the effect of metacognitive beliefs on quality of life. Higher level of metacognitive beliefs was associated with greater use of CAS strategies, which in turn was associated with lower quality of life. Further, more CAS strategies were associated with lower quality of life. The results support the generic metacognitive model and suggest that stronger endorsement of dysfunctional metacognitive beliefs and corresponding CAS strategies are associated with lower quality of life. This observation held even when controlling for relevant covariates and suggests that modifying metacognitive beliefs may impact on subjective quality of life.

Clinically representative therapy for Nordic adult outpatients with common mental health problems: A systematic review and meta-analysis.

There is a knowledge gap regarding clinically representative therapy given in routine settings, that is treatment as usual (TAU), for patients with common mental health problems (CMHP). This review and meta-analysis aimed to investigate what characterizes clinically representative therapy in Nordic routine clinics and meta-analyze the outcome of such treatment. Databases (PubMed, EMBASE, PsychINFO, and SveMed+) were searched for TAU, CMHP, and Nordic countries, together with backward and forward search in Scopus (7 November 2022). Studies were either randomized controlled trials (RCT) or open trials, using prospective study designs, examining heterogeneous outpatient groups in routine treatment. Within- and between-group effect sizes (ES), using random effects model, and moderator analyses were calculated. Eleven studies (n = 1,413), demonstrated a small to moderate within-group ES with high heterogeneity (g = 0.49, I2 = 90%). ESs in RCTs were significantly smaller than in open trials. TAU had a marginally smaller ES (g = -0.21; adjusted for publication bias g = -0.06) compared to a broad set of clinical interventions. Clinically representative therapy in the Nordic countries demonstrated a wide variety of characteristics and also a marginally lower ES compared to other interventions. The ESs were smaller than other meta-analyses examining evidence-based treatments in routine treatment.

Sociodemographic factors and use of pain medication are associated with health-related quality of life: results from an adult community mental health service in Norway.

PURPOSE: Health-related quality of life (HRQoL) is an important aspect of mental health outcomes. There are few studies on HRQoL in heterogeneous patient populations seeking help at community mental health services. The aims of the study were to compare how HRQoL, measured by the EuroQol five dimensions with five levels (EQ-5D-5L), was distributed compared to other samples from national and international studies, and to explore what factors are associated with HRQoL. METHODS: In a cross-sectional study, 1379 Norwegian outpatients reported their HRQoL before starting treatment. Associations with demographic variables, job status, socio-economic status, and use of pain medication were examined using multiple regression analysis. RESULTS: Most of the sample, 70% to 90%, reported problems with usual activities, pain/discomfort, and anxiety/depression; 30% to 65% reported that these problems were of a moderate to extreme degree. Forty percent reported problems with mobility, and about 20% reported problems with self-care. The sample's HRQoL was considerably lower than the general population, and comparable to patient-groups from specialist mental health services. Originating from a developing country, lower level of education, lower yearly household income, being on sick leave or unemployed, and using pain medication were associated with lower HRQoL. Age, gender, and relationship status were not associated with HRQoL. This is the first study to simultaneously examine the unique contribution of these variables in one study. CONCLUSION: The most impacted domains of HRQoL were pain/discomfort, anxiety/depression, and usual activities. Lower HRQoL was associated with several socio-demographic factors and use of pain medication. These findings might have clinical implications and suggest that mental health professionals should routinely measure HRQoL in addition to symptom severity, to identify areas that should be targeted to improve HRQoL.

Measuring patient satisfaction with four items: validity of the client satisfaction questionnaire 4 in an outpatient population.

INTRODUCTION: Patient satisfaction with mental health services has for several decades been considered an important component when evaluating service quality. It is often assessed in the context of monitoring quality of care, developing or evaluating newly implemented interventions or changes in practice. Because of this, patient satisfaction questionnaires are often added to longer questionnaire batteries, and shorter questionnaires are preferred to prevent respondent fatigue and non-compliance and to secure easy implementation. However, most studies use unvalidated patient satisfaction measures, making comparisons between studies difficult. Validation studies of short patient satisfaction measures are therefore warranted. METHODS: The primary aim was to examine the construct validity and internal reliability of the Client Satisfaction Questionnaire-4 (CSQ-4) in a Norwegian outpatient mental health setting. A total of 467 patients were recruited from an outpatient psychiatric care clinic in Central Norway. The secondary aim was to examine an earlier proposed cutoff for classifying dissatisfied patients in this new population. A principal component analysis was conducted to evaluate factor structure, correlation analyses were conducted to test for predicted relationships, and Cronbach's alpha was calculated to examine internal reliability. RESULTS: The CSQ-4 showed a clear unidimensional structure with one factor explaining 80% of its variance. Its internal reliability was very high, with a Cronbach's alpha of 0.92. As hypothesised this study found no statistically significant sex differences in satisfaction and no statistically significant association between age and satisfaction. Positive changes in symptoms during treatment and higher post-treatment functional impairment were associated with higher patient-reported treatment satisfaction scores, which indicates good construct validity. CONCLUSION: This is the first study to evaluate the CSQ-4 in a psychiatric population. The CSQ-4 demonstrated good structural validity and internal reliability and was correlated with outcome variables in terms of symptom change and post-treatment functioning. In sum, this indicates that the CSQ-4 is a good short alternative for evaluating patient satisfaction in routine outpatient mental health care.

Symptoms and prevalence of common mental disorders in a heterogenous outpatient sample: an investigation of clinical characteristics and latent subgroups.

BACKGROUND: Patient-reported outcome measures (PROM) provide clinicians with information about patients' perceptions of distress. When linked with treatment and diagnostic registers, new information on common mental health disorders (CMHD) and service use, may be obtained, which might be useful clinically and for policy decision-making. This study reports the prevalence of CMHD and their association with PROM severity. Further, subgroups of self-reported symptoms of depression and anxiety were examined, and their association with clinician-assessed mental disorders, functional impairment, and service use. METHODS: In a cohort study of 2473 (63% female) outpatients, CMHD was examined with pre-treatment scores of self-reported depression and anxiety, and the number of assessments and psychotherapy appointments one year after treatment start. Factor mixture modelling (FMM) of anxiety and depression was used to examine latent subgroups. RESULTS: Overall, 22% of patients with a CMHD had an additional comorbid mood/anxiety disorder, making the prevalence lower than expected. This comorbid group reported higher symptoms of anxiety and depression compared to patients with non-comorbid disorders. FMM revealed three classes: "anxiety and somatic depression" (33%), "mixed depression and anxiety" (40%), and "cognitive depression" (27%). The anxiety and somatic depression class was associated with older age, being single and on sick leave, higher probability of depressive-, anxiety-, and comorbid disorders, having more appointments and higher functional impairment. Although the cognitive depression class had less somatic distress than the mixed depression and anxiety class, they reported more functional impairment and had higher service use. CONCLUSION: The results show that higher levels of somatic symptoms of depression could both indicate higher and lower levels of functional impairment and service use. A group of patients with high somatic depression and anxiety was identified, with severe impairment and high service needs. By gaining insights into CMHD factors' relation with clinical covariates, self-reported risk factors of depression and anxiety could be identified for groups with different levels of aggravating life circumstances, with corresponding service needs. These could be important symptom targets in different groups of patients.

Associations of adverse childhood experiences with caries and toothbrushing in adolescents. The Young-HUNT4 Survey.

BACKGROUND: Adverse childhood experiences (ACEs) are associated with poor oral health. Using a life course theoretical framework, this study explored the associations of specific and cumulative ACEs with caries and toothbrushing frequency in a Norwegian adolescent population. METHODS: Participants were adolescents (n = 6351) age 13-17 years from The Young-HUNT4 Survey. Clinical data were retrieved from dental health records. Oral health outcomes were toothbrushing frequency, dentine caries experience (Decayed, Missing, and Filled Teeth - DMFT), and enamel caries. ACE exposure variables were physical abuse, sexual abuse, witness to violence, parental separation/divorce, parental alcohol problems, and bully victimization. Negative binominal regression models (incident rate ratios, IRRs; 95% confidence intervals, CIs) were used to determine the associations of the various ACEs with caries; logistic regression analyses (odds ratios, ORs; 95% CIs) were used to estimate associations with toothbrushing frequency. Potential effect modification by age was assessed using likelihood ratio test. RESULTS: Adolescents exposed to physical abuse by others, sexual abuse by peers, parental separation/divorce, bullying, or who had witnessed violence, were more likely to report non-daily toothbrushing compared with those with no exposure to the given ACEs. Each cumulative increase in ACE exposure was associated with a 30% higher likelihood of non-daily toothbrushing (OR 1.30, 95% CI 1.19-1.42). Similarly, increasing number of adversities were associated with both higher dentine caries experience (IRR 1.06, 95% CI 1.02-1.09) and higher enamel caries (IRR 1.07, 95% CI 1.03-1.11). This effect was modified by age (13-15 vs. 16-17 years) for dentine caries experience. Furthermore, there was evidence of effect modification by age with bully victimization for both toothbrushing frequency (Pinteraction = 0.014) and dentine caries experience (Pinteraction < 0.001). Specifically, bully victimization was associated with a higher likelihood of non-daily toothbrushing (OR 2.59, 95% CI 1.80-3.72) and higher dentine caries experience (IRR 1.30, 95% CI 1.14-1.50) among 16-17-year-olds. CONCLUSIONS: Several specific ACEs were associated with non-daily toothbrushing and a higher caries experience among Norwegian adolescents in the Young-HUNT4 Survey.

Factor structure, measurement invariance, and concurrent validity of the Patient Health Questionnaire-9 and the Generalized Anxiety Disorder scale-7 in a Norwegian psychiatric outpatient sample.

OBJECTIVE: The aim of this study was to test factor structure, measurement invariance, and concurrent validity of the nine item Patient Health Questionnaire-9 (PHQ-9) and the seven item Generalized Anxiety Disorder scale-7 (GAD-7) in a heterogeneous outpatient sample. METHOD: Outpatients completed the PHQ-9, GAD-7, and the Working Social Adjustment Scale (WSAS) before starting treatment. Study design was cross-sectional, with convenience sampling. The total sample consisted of 831 participants (61% women). RESULTS: Both PHQ-9 and GAD-7 demonstrated better fit statistics with two-factor and bifactor solutions consisting of a cognitive and somatic factor. Omega hierarchical was .78 for PHQ-9 and .81 for GAD-7. Both instruments achieved scalar invariance across gender, diagnosis, and comorbidity. However, the somatic factors demonstrated poor discriminant validity. These factors are not well separatable and risks being too similar if used together. The general factors of both instruments were most associated with functional impairment, although PHQ-9 demonstrated a stronger association with WSAS (γ = .74, r2 = .62) than GAD-7 (γ = .54, r2 = .32). Using latent mean difference, women and patients with comorbidity had significantly higher scores of both depression and anxiety. CONCLUSION: This study shows that the PHQ-9 and GAD-7 may be used as one-dimensional instruments in clinical settings. Tests for measurement invariance supported that both measures are understood and interpreted comparably across gender and diagnostic subgroups.

A digital Norwegian version of the client satisfaction questionnaire 8: factor validity and internal reliability in outpatient mental health care.

BACKGROUND: Validated measures of patient-reported experiences are essential for assessing and improving the quality of mental health services and interventions. In Norwegian mental healthcare settings, the Client Satisfaction Questionnaire (CSQ-8) is increasingly being used for this purpose, but the validity and reliability of the Norwegian translation have not been investigated. METHODS: We examined the factor structure and internal consistency of a digitally administrated Norwegian translation of the CSQ-8 in a sample of 338 patients recruited from outpatient treatment. The relationship between satisfaction scores and the change in symptom severity during treatment, measured by the Patient Health Questionnaire-4, was also investigated. RESULTS: The Norwegian CSQ-8 showed a clear unidimensional structure with one factor explaining 74% of the variance. Internal consistency was very high, with a Cronbach's alpha of 0.95. Satisfaction showed a small-to-moderate negative relationship with change in symptom severity. Satisfaction scores were negatively skewed, and the presence of ceiling effects is discussed. CONCLUSION: Our results support the use of the Norwegian CSQ-8 as a valid and reliable measure of satisfaction with mental healthcare services. Further studies are needed to determine the test-retest reliability of the questionnaire, its sensitivity to change, and to assess its propensity to ceiling effects.

Change in personality traits and facets (Revised NEO Personality Inventory) following metacognitive therapy or cognitive behaviour therapy for generalized anxiety disorder: Results from a randomized controlled trial.

OBJECTIVE: We aimed to discover whether psychological treatment for generalized anxiety disorder (GAD) was associated with changes in the big five personality traits and their facets. METHOD: Patients with GAD were randomized either to receive cognitive behaviour therapy (CBT, n = 28) or metacognitive therapy (MCT, n = 32). Before and after 12 sessions of treatment, 55 of the patients completed the full Revised NEO Personality Inventory (NEO-PI-R) (240 items). RESULTS: Patients with GAD showed a personality profile with high Neuroticism and lower Extraversion and Openness. Treatment across conditions was associated with significant reduction in Neuroticism and increased Extraversion and Openness. There were no significant changes in Agreeableness and Conscientiousness. However, their facets of Actions and Trust increased. Post-treatment levels of neuroticism were associated with symptoms of worry before and after therapy, whereas post-treatment extraversion was related to depressive symptoms after treatment. MCT was associated with greater reduction of Neuroticism than CBT. CONCLUSIONS: This is the first study to show that efficient treatment for a specific disorder resulted in changes across NEO-PI-R factors and facets and that more efficient treatment results in greater change. If this reflects a reduced trait vulnerability for mental disorder, this might provide evidence of relapse prevention.

Validity of a Norwegian version of the Desire Thinking Questionnaire (DTQ): Associations with problem drinking, nicotine dependence and problematic social media use.

The aim of the current study was to test the validity of the Norwegian version of the Desire Thinking Questionnaire (DTQ). Three cross-sectional surveys were conducted investigating the psychometric properties of the DTQ in alcohol use (N = 588), nicotine use (N = 446) and social media use (N = 359). Principal components and confirmatory factor analyses supported the original two-factor solution consisting of verbal perseveration (VP) and imaginal prefiguration (IP); however, one item was removed to obtain good fit. Internal consistency was acceptable. Both IP and VP showed significant correlations with problem drinking, nicotine dependence and problematic social media use. Regression analyses, controlling for demographics and negative affect, found IP and VP to be significantly associated with all dependent variables. The results confirm that desire thinking is an important construct across different addictive behaviours.

The Bergen 4-day treatment for OCD: four years follow-up of concentrated ERP in a clinical mental health setting.

There are few long-term follow-up studies on psychological treatment of anxiety disorders carried out in clinical mental health settings, so called effectiveness studies. The present paper presents a four year follow-up of patients with obsessive-compulsive disorder treated by the Bergen 4-day treatment (B4DT), a concentrated form of exposure and response prevention (ERP). A total of 77 obsessive-compulsive disorder (OCD) patients received treatment during four consecutive days and were assessed with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) pre, post, and at follow-ups after 3 and 6 months, and 4 years post-treatment. The Y-BOCS mean score changed from 25.9 at pre- to 10.0 post-treatment and 9.9 at long-term follow-up. The proportion fulfilling the strict international consensus criteria for remission was 73% at post-treatment and 69% at follow-up. When taking declining rate, attrition rate, remission, relapse, and further improvement during the follow-up period into account, 72% were recovered on a long-term basis. A comparison with previously published effectiveness studies of ERP indicated that the 4-day treatment yielded significantly higher proportions of remission at post-treatment and recovery at follow-up, as well as within-group effect size on the Y-BOCS. The implications of these results are discussed.

Sleep disturbances in treatment-seeking OCD-patients: Changes after concentrated exposure treatment.

Research indicates that patients with Obsessive Compulsive Disorder (OCD) frequently suffer from comorbid sleep difficulties, and that these difficulties often are not clinically recognized and diagnosed. There has been limited research investigating if comorbid sleep difficulties impair treatment outcome for OCD and if the sleep difficulties change following OCD-treatment. Thirty-six patients with obsessive compulsive disorder underwent concentrated exposure treatment delivered in a group over four consecutive days and were assessed with measures of OCD, depressive symptoms and sleep disturbance at three different time points (pre, post and 6 months follow-up). The sample was characterized by a high degree of comorbidity with other psychiatric disorders. At pre-treatment nearly 70% of the patients reported sleep difficulties indicative of primary insomnia. The results showed that patients had large reductions of OCD-symptoms as well as significant improvements in sleep disturbance assessed after treatment, and that these improvements were maintained at follow-up. Sleep disturbance did not impair treatment outcome, on the contrary patients with higher degree of sleep disturbance at pre-treatment had better outcome on OCD-symptoms after treatment. The results indicated that the majority of the OCD sample suffered from sleep disturbances and that these sleep disturbances were significantly reduced following adequate treatment of OCD without specific sleep interventions. However, a proportion of the patients suffered from residual symptoms of insomnia after treatment.

Concentrated ERP Delivered in a Group Setting: A Replication Study.

BACKGROUND: In a previous effectiveness study (Havnen et al., 2014), 35 obsessive compulsive disorder (OCD) patients underwent Concentrated Exposure Treatment (cET), which is a newly developed group treatment format delivered over four consecutive days. AIMS: The primary aims of the present study were to evaluate the treatment results for a new sample of OCD patients receiving the cET treatment approach and to replicate the effectiveness study described in Havnen et al. (2014). METHOD: Forty-two OCD patients underwent cET treatment. Treatment was delivered by different therapists than in Havnen et al. (2014), except for two groups led by the developers of the treatment. Assessments of OCD symptom severity, treatment satisfaction, and occupational impairment were included. RESULTS: The results showed a significant reduction in Yale-Brown Obsessive Compulsive Scale scores from pre-treatment to post-treatment, which was maintained at 6-month follow-up. At post-treatment, 74% of the sample was remitted; at 6-month follow-up, 60% were recovered. The sample showed a very high degree of overall treatment satisfaction. The results from the present study were statistically compared with those obtained in the previous study. The analyses showed that the study samples had comparable demographic data and equal application of treatment. The outcome of the present and original study did not differ significantly on primary and secondary outcome measures. CONCLUSIONS: This study shows that cET was successfully replicated in a new patient sample treated by different therapists than the original study. The results indicate that cET is well accepted by the patients, and the potential for dissemination is discussed.

An empirical investigation of the associations between metacognition, mindfulness experiential avoidance, depression, and anxiety.

BACKGROUND: The aims of this study were to explore the possible relation between metacognition, mindfulness, and experiential avoidance, as well as their association with symptoms of anxiety and depression. METHODS: Cross-sectional data was collected from a community sample (N = 364) who completed the Metacognitions Questionnaire-30 (MCQ-30), the Five Facet Mindfulness Questionnaire-24 (FFMQ-24), the Acceptance and Action Questionnaire-II (AAQ-II), the Generalized Anxiety Disorder 7-item (GAD-7), and the Patient Health Questionnaire-9 (PHQ-9). RESULTS: There were moderate-strong associations between mindfulness (FFMQ-24), metacognition (MCQ-30), and experiential avoidance (AAQ-II) (0.62 - 0.67), and they showed similar relations with symptoms of depression (PHQ-9) and anxiety (GAD-7) (0.57 - 0.71). Mindfulness, experiential avoidance, and the non-judging subscale of FFMQ-24 constituted a latent factor of flexibility in cognition and emotional experience, while three FFMQ-24 subscales (describing, acting with awareness, and observing) constituted a present-centered attention and awareness factor. Regression analyses indicated that flexibility explained more of the variance in symptoms of anxiety and depression than present-centered attention and awareness. CONCLUSIONS: The results suggest that flexibility in cognitive and emotional regulation skills could be important in explaining symptoms of anxiety and depression.

Cardiorespiratory fitness and incident use of anxiolytics and antidepressants in adults. A linkage study between HUNT and the Norwegian Prescription Database.

BACKGROUND: We investigated the association between cardiorespiratory fitness (CRF) and incident use of antidepressants or anxiolytics in the general adult population. METHODS: A non-exercise prediction model was used to estimate CRF in 32,603 participants in the third wave of the Trøndelag Health Study (HUNT3; 2006-08). Data on first purchase of antidepressants and anxiolytics were obtained from the Norwegian Prescription Database. Cox regression was used to estimate hazard ratios (HRs). RESULTS: Each 1- metabolic equivalent of task (MET) increase in CRF was associated with 4 % reduced risk of purchasing antidepressant or anxiolytic medication during follow-up (HR 0.96, 95 % Confidence interval [CI] 0.94-0.98). Compared to the low CRF tertile, participants in intermediate (HR 0.93, 95 % CI 0.87-0.98) and high (HR 0.92, 95 % CI 0.86-0.98) CRF tertiles had reduced risk of medication purchase. Men in intermediate and high CRF tertile had lower risk of medication purchase (intermediate HR 0.87, 95 % CI 0.79-0.96; high HR 0.87, 95 % CI 0.78-0.96). Intermediate and high CRF tertiles were associated with reduced risk of medication use for younger adults (20 to <30 years old; intermediate HR 0.74, 95 % CI 0.61-0.91, high HR 0.78, 95 % CI 0.64-0.95) and middle-aged adults (30 to <65 years old; intermediate HR 0.90, 95 % CI 0.83-0.97, high HR 0.90, 95 % CI 0.84-0.98), but not in older adults (≥65 years old). LIMITATIONS: Only information about medication purchase and not actual use was available. CONCLUSION: Increased CRF is associated with reduced risk of anxiolytics and antidepressants purchase, with stronger effects for men and younger adults.