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Acceptance and commitment group therapy for health anxiety--results from a pilot study.

https://arctichealth.org/en/permalink/ahliterature108574
Source
J Anxiety Disord. 2013 Jun;27(5):461-8
Publication Type
Article
Date
Jun-2013
Author
T. Eilenberg
L. Kronstrand
P. Fink
L. Frostholm
Author Affiliation
The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Barthsgade 5.1, 8200 Aarhus N, Denmark.
Source
J Anxiety Disord. 2013 Jun;27(5):461-8
Date
Jun-2013
Language
English
Publication Type
Article
Keywords
Adult
Analysis of Variance
Cognitive Therapy - methods
Denmark - epidemiology
Female
Humans
Hypochondriasis - epidemiology - psychology - therapy
Male
Middle Aged
Pilot Projects
Psychotherapy, Group - methods
Questionnaires
Abstract
Health anxiety (or hypochondriasis) is prevalent, may be persistent and disabling for the sufferers and associated with high societal costs. Acceptance and Commitment Therapy (ACT) is a new third-wave behavioral cognitive therapy that has not yet been tested in health anxiety. 34 consecutive Danish patients with severe health anxiety were referred from general practitioners or hospital departments and received a ten-session ACT group therapy. Patients were followed up by questionnaires for 6 months. There were significant reductions in health anxiety, somatic symptoms and emotional distress at 6 months compared to baseline: a 49% reduction in health anxiety (Whiteley-7 Index), a 47% decrease in emotional distress (SCL-8), and a 40% decrease in somatic symptoms (SCL-90R Somatization Subscale). The patients' emotional representations and perception of the consequences of their illness (IPQ) improved significantly, and 87% of the patients were very or extremely satisfied with the treatment.
PubMed ID
23871841 View in PubMed
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Adult attachment insecurity and narrative processes in psychotherapy: an exploratory study.

https://arctichealth.org/en/permalink/ahliterature139033
Source
Clin Psychol Psychother. 2011 Nov-Dec;18(6):498-511
Publication Type
Article
Author
Sarah I F Daniel
Author Affiliation
The University Clinic, Department of Psychology, University of Copenhagen, Denmark. sarah@selskabet.org
Source
Clin Psychol Psychother. 2011 Nov-Dec;18(6):498-511
Language
English
Publication Type
Article
Keywords
Adult
Bulimia Nervosa - psychology - therapy
Cognitive Therapy - methods
Female
Humans
Interview, Psychological - methods
Narration
Object Attachment
Observer Variation
Psychoanalytic Therapy - methods
Scandinavia
Abstract
Different types of client attachment insecurity may affect the psychotherapeutic process in distinct ways. This exploratory study compared the in-session discourse of clients with dismissing and preoccupied attachment states of mind on Adult Attachment Interviews conducted prior to therapy in the context of a randomized clinical trial of psychoanalytic and cognitive-behavioural psychotherapy for bulimia nervosa. In a subsample of six sessions from each of eight therapy dyads, preoccupied clients were found to talk more and have longer speaking turns than dismissing clients, who in turn generated more pauses. Using the Narrative Processes Coding System, preoccupied clients were found to show more narrative initiative; whereas, differences in terms of narrative process modes were not as clearly interpretable. Contrary to expectations, the two insecure states of mind were equally different in the relationship-focused psychoanalytic therapy and in the symptom-focused cognitive-behavioural therapy. Suggestions for further investigations of the in-session discourse of clients with different attachment states of mind are given.
PubMed ID
21110406 View in PubMed
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Affect school and script analysis versus basic body awareness therapy in the treatment of psychological symptoms in patients with diabetes and high HbA1c concentrations: two study protocols for two randomized controlled trials.

https://arctichealth.org/en/permalink/ahliterature279373
Source
Trials. 2016 Apr 27;17(1):221
Publication Type
Article
Date
Apr-27-2016
Author
Eva O Melin
Ralph Svensson
Sven-Åke Gustavsson
Agneta Winberg
Ewa Denward-Olah
Mona Landin-Olsson
Hans O Thulesius
Source
Trials. 2016 Apr 27;17(1):221
Date
Apr-27-2016
Language
English
Publication Type
Article
Keywords
Biomarkers - blood
Body Image
Clinical Protocols
Cognitive Therapy - methods
Diabetes Mellitus, Type 1 - blood - diagnosis - psychology - therapy
Diabetes Mellitus, Type 2 - blood - diagnosis - psychology - therapy
Health Knowledge, Attitudes, Practice
Hemoglobin A, Glycosylated - analysis
Humans
Mind-Body Therapies - methods
Patient Education as Topic
Psychiatric Status Rating Scales
Research Design
Surveys and Questionnaires
Sweden
Time Factors
Treatment Outcome
Up-Regulation
Abstract
Depression is linked with alexithymia, anxiety, high HbA1c concentrations, disturbances of cortisol secretion, increased prevalence of diabetes complications and all-cause mortality. The psycho-educational method 'affect school with script analysis' and the mind-body therapy 'basic body awareness treatment' will be trialled in patients with diabetes, high HbA1c concentrations and psychological symptoms. The primary outcome measure is change in symptoms of depression. Secondary outcome measures are changes in HbA1c concentrations, midnight salivary cortisol concentration, symptoms of alexithymia, anxiety, self-image measures, use of antidepressants, incidence of diabetes complications and mortality.
Two studies will be performed. Study I is an open-labeled parallel-group study with a two-arm randomized controlled trial design. Patients are randomized to either affect school with script analysis or to basic body awareness treatment. According to power calculations, 64 persons are required in each intervention arm at the last follow-up session. Patients with type 1 or type 2 diabetes were recruited from one hospital diabetes outpatient clinic in 2009. The trial will be completed in 2016. Study II is a multicentre open-labeled parallel-group three-arm randomized controlled trial. Patients will be randomized to affect school with script analysis, to basic body awareness treatment, or to treatment as usual. Power calculations show that 70 persons are required in each arm at the last follow-up session. Patients with type 2 diabetes will be recruited from primary care. This study will start in 2016 and finish in 2023. For both studies, the inclusion criteria are: HbA1c concentration =62.5 mmol/mol; depression, alexithymia, anxiety or a negative self-image; age 18-59 years; and diabetes duration =1 year. The exclusion criteria are pregnancy, severe comorbidities, cognitive deficiencies or inadequate Swedish. Depression, anxiety, alexithymia and self-image are assessed using self-report instruments. HbA1c concentration, midnight salivary cortisol concentration, blood pressure, serum lipid concentrations and anthropometrics are measured. Data are collected from computerized medical records and the Swedish national diabetes and causes of death registers.
Whether the "affect school with script analysis" will reduce psychological symptoms, increase emotional awareness and improve diabetes related factors will be tried, and compared to "basic body awareness treatment" and treatment as usual.
ClinicalTrials.gov: NCT01714986.
Notes
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PubMed ID
27121185 View in PubMed
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An explorative outcome study of CBT-based multidisciplinary treatment in a diverse group of refugees from a Danish treatment centre for rehabilitation of traumatized refugees.

https://arctichealth.org/en/permalink/ahliterature146136
Source
Torture. 2009;19(3):248-70
Publication Type
Article
Date
2009
Author
Sabina Palic
Ask Elklit
Author Affiliation
Institute of Psychology, Aarhus University, Denmark.
Source
Torture. 2009;19(3):248-70
Date
2009
Language
English
Publication Type
Article
Keywords
Adult
Aged
Brain Injuries - therapy
Cognitive Therapy - methods
Denmark
Eye Movement Desensitization Reprocessing
Female
Humans
Language
Male
Middle Aged
Patient care team
Psychiatric Status Rating Scales
Refugees - psychology
Sex Factors
Stress Disorders, Post-Traumatic - psychology - therapy
Stress, Psychological - psychology - therapy
Treatment Outcome
Violence - psychology
Young Adult
Abstract
A group of highly traumatized refugees n = 26 with diverse cultural backgrounds in a Danish Clinic for Traumatized Refugees (CTR) was assessed for symptoms of post-traumatic stress disorder and other aspects of general functioning. Patients were assessed at intake, after the end of treatment and six months later. The results point to very high symptom levels and a large need for treatment in this population. Psychiatric symptoms and their correlates were assessed with the Harvard Trauma Questionnaire (HTQ), the Trauma Symptom Checklist-23 (TSC-23), the Global Assessment of Function (GAF), and the Crisis Support Scale (CSS). The Trail Making Test A & B (TMT) was used as a screening instrument for acquired brain damage, with promising results. Indications of effectiveness from 16-18 weeks of multidisciplinary treatment (physiotherapy, pharmacotherapy, psychotherapy, and social counseling) were supported with small to medium effect sizes on most outcome measures. The results are discussed in terms of clinical implications and future treatment, assessment, and research needs.
PubMed ID
20065543 View in PubMed
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An investigation of general predictors for cognitive-behavioural therapy outcome for anxiety disorders in a routine clinical setting.

https://arctichealth.org/en/permalink/ahliterature278097
Source
BMJ Open. 2016 Mar 25;6(3):e010898
Publication Type
Article
Date
Mar-25-2016
Author
Sara Kerstine Kaya Nielsen
Signe Vangkilde
Kate B Wolitzky-Taylor
Sarah Ingrid Franksdatter Daniel
Ida Hageman
Source
BMJ Open. 2016 Mar 25;6(3):e010898
Date
Mar-25-2016
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Anxiety Disorders - therapy
Cognition
Cognitive Therapy - methods
Denmark
Emotions
Female
Humans
Logistic Models
Male
Middle Aged
Prospective Studies
Psychiatric Status Rating Scales
Research Design
Self Report
Severity of Illness Index
Treatment Outcome
Young Adult
Abstract
Cognitive-behavioural therapy (CBT) is effective for treating anxiety disorders and is offered in most mental health services around the world. However, a relatively large number of patients with anxiety disorders do not benefit from CBT, experience relapses or drop out. Reliable predictors of treatment effects are lacking. The aim of this study is to investigate the predictive value of emotion regulation and attentional control for CBT outcome in a routine setting.
In this prospective and practice-based study, 112 patients with anxiety disorders referred for manual-based group CBT at two psychiatric outpatient clinics will be recruited. Emotion regulation, severity of anxiety and attentional control will be assessed with self-report measures and with an experimental computer-based attentional control task at baseline, post-treatment and at a 6-month follow-up. Emotion regulation will be measured with Difficulties in Emotion Regulation Questionnaire, severity of anxiety will be assessed with Beck Anxiety Inventory and attentional control will be measured with the self-report questionnaire, Attention Control Scale, and with an experimental computer-based attentional control task based on theory of visual attention. Data will be analysed using multilevel mixed-effects modelling.
The study is approved by the Danish National Ethical Board, the Department of Psychology Ethical Board, University of Copenhagen and by the Danish Data Protection Agency. Study findings will be disseminated through peer-reviewed journal publications and conference presentations. The Danish Committee System on Health Research Ethics has been notified about the project.
NCT02638363.
Notes
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PubMed ID
27016248 View in PubMed
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An open trial of group metacognitive therapy for depression in Norway.

https://arctichealth.org/en/permalink/ahliterature263582
Source
Nord J Psychiatry. 2015 Feb;69(2):126-31
Publication Type
Article
Date
Feb-2015
Author
Toril Dammen
Costas Papageorgiou
Adrian Wells
Source
Nord J Psychiatry. 2015 Feb;69(2):126-31
Date
Feb-2015
Language
English
Publication Type
Article
Keywords
Adult
Anxiety Disorders - psychology
Cognitive Therapy - methods
Comorbidity
Depressive Disorder, Major - therapy
Diagnostic and Statistical Manual of Mental Disorders
Feasibility Studies
Female
Humans
Middle Aged
Norway
Psychotherapy, Group - methods
Young Adult
Abstract
Preliminary data support the implementation of individual metacognitive therapy (MCT) for depression. Given the focus of MCT on transpersonal processes, we hypothesized that this treatment should translate well to a group format. In this study, the effects and feasibility associated with group MCT for depression are reported.
Eleven patients who were consecutively referred by general practitioners to a specialist psychiatric practice in Norway participated in an open trial of the effects and feasibility associated with group MCT for depression. All of the patients met the DSM-IV criteria for major depressive disorder (MDD) and were monitored in a baseline period before attending 90-min weekly treatment sessions of group MCT for 10 weeks. The primary symptom outcome measure was severity of depression whilst secondary outcome measures included levels of anxiety, rumination and metacognitive beliefs. We also assessed recovery rates and changes in comorbid Axis I and Axis II diagnoses.
Large clinically significant improvements across all measures were detected at post-treatment and these were maintained at follow-up. Based on objectively defined recovery criteria, all patients were classified as recovered at post-treatment and 91% at 6 months follow-up. The intervention was also associated with significant reductions in comorbid diagnoses.
These preliminary data indicate that group MCT in the treatment of depression is effective, well accepted and it extends clinical application of MCT for depression to group formats as a potential cost-effective intervention.
PubMed ID
25124119 View in PubMed
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Antidepressant monotherapy vs sequential pharmacotherapy and mindfulness-based cognitive therapy, or placebo, for relapse prophylaxis in recurrent depression.

https://arctichealth.org/en/permalink/ahliterature138809
Source
Arch Gen Psychiatry. 2010 Dec;67(12):1256-64
Publication Type
Article
Date
Dec-2010
Author
Zindel V Segal
Peter Bieling
Trevor Young
Glenda MacQueen
Robert Cooke
Lawrence Martin
Richard Bloch
Robert D Levitan
Author Affiliation
Centre for Addiction and Mental Health, Toronto, ON, Canada. zindel_segal@camh.net
Source
Arch Gen Psychiatry. 2010 Dec;67(12):1256-64
Date
Dec-2010
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Antidepressive Agents - administration & dosage - therapeutic use
Attention
Cognitive Therapy - methods
Combined Modality Therapy - methods
Depressive Disorder, Major - drug therapy - prevention & control - psychology
Diagnostic and Statistical Manual of Mental Disorders
Drug Administration Schedule
Female
Follow-Up Studies
Humans
Male
Middle Aged
Ontario
Outpatients - psychology
Psychiatric Status Rating Scales
Psychotherapy, Group - methods
Recurrence - prevention & control
Treatment Outcome
Young Adult
Abstract
Mindfulness-based cognitive therapy (MBCT) is a group-based psychosocial intervention designed to enhance self-management of prodromal symptoms associated with depressive relapse.
To compare rates of relapse in depressed patients in remission receiving MBCT against maintenance antidepressant pharmacotherapy, the current standard of care.
Patients who met remission criteria after 8 months of algorithm-informed antidepressant treatment were randomized to receive maintenance antidepressant medication, MBCT, or placebo and were followed up for 18 months.
Outpatient clinics at the Centre for Addiction and Mental Health, Toronto, Ontario, Canada, and St Joseph's Healthcare, Hamilton, Ontario.
One hundred sixty patients aged 18 to 65 years meeting DSM-IV criteria for major depressive disorder with a minimum of 2 past episodes. Of these, 84 achieved remission (52.5%) and were assigned to 1 of the 3 study conditions.
Patients in remission discontinued their antidepressants and attended 8 weekly group sessions of MBCT, continued taking their therapeutic dose of antidepressant medication, or discontinued active medication and were switched to placebo.
Relapse was defined as a return, for at least 2 weeks, of symptoms sufficient to meet the criteria for major depression on module A of the Structured Clinical Interview for DSM-IV.
Intention-to-treat analyses showed a significant interaction between the quality of acute-phase remission and subsequent prevention of relapse in randomized patients (P = .03). Among unstable remitters (1 or more Hamilton Rating Scale for Depression score >7 during remission), patients in both MBCT and maintenance treatment showed a 73% decrease in hazard compared with placebo (P = .03), whereas for stable remitters (all Hamilton Rating Scale for Depression scores =7 during remission) there were no group differences in survival.
For depressed patients achieving stable or unstable clinical remission, MBCT offers protection against relapse/recurrence on a par with that of maintenance antidepressant pharmacotherapy. Our data also highlight the importance of maintaining at least 1 long-term active treatment in unstable remitters.
Notes
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PubMed ID
21135325 View in PubMed
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Anxiety in children: remote area sensitivities and considered changes in structuring a Cool Kids approach.

https://arctichealth.org/en/permalink/ahliterature131551
Source
Australas Psychiatry. 2011 Jul;19 Suppl 1:S23-5
Publication Type
Article
Date
Jul-2011
Author
Michael Davies
Author Affiliation
Remote Area Child and Youth Mental Health Service, Queensland Health, Cairns, QLD, Australia. Michael_davies@health.qld.gov.au
Source
Australas Psychiatry. 2011 Jul;19 Suppl 1:S23-5
Date
Jul-2011
Language
English
Publication Type
Article
Keywords
Anxiety - psychology - therapy
Child
Cognitive Therapy - methods
Feasibility Studies
Health Services, Indigenous
Humans
Oceanic ancestry group - psychology
Program Development - methods
Rural Population
Abstract
To explore the feasibility of utilizing Cool Kids, a mainstream resource based on cognitive behavioural principles, to address acute and chronic anxiety with Aboriginal children in a remote setting.
Evidence from the literature suggests some symptomatic differences and learning challenges which demand consideration prior to implementation in this population. In particular, cultural sensitivities in many areas need to be respected, as does the sense of interconnectedness in terms of self and thinking.
Given sufficient knowledge, appropriate cultural protocol, and concentration on engagement it should be possible to use an adapted Cool Kids program to decrease the high levels of anxiety in a remote Indigenous population. Being aware of the differences in western and Indigenous thinking and learning will help direct adaptation.
PubMed ID
21878011 View in PubMed
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Anxious Children and Adolescents Non-responding to CBT: Clinical Predictors and Families' Experiences of Therapy.

https://arctichealth.org/en/permalink/ahliterature282704
Source
Clin Psychol Psychother. 2017 Jan;24(1):82-93
Publication Type
Article
Date
Jan-2017
Author
Irene Lundkvist-Houndoumadi
Mikael Thastum
Source
Clin Psychol Psychother. 2017 Jan;24(1):82-93
Date
Jan-2017
Language
English
Publication Type
Article
Keywords
Adolescent
Anxiety Disorders - diagnosis - psychology - therapy
Attitude
Caregivers - psychology
Child
Cognitive Therapy - methods
Comorbidity
Denmark
Female
Humans
Individuality
Male
Mood Disorders - diagnosis - psychology - therapy
Motivation
Phobia, Social - diagnosis - psychology - therapy
Professional-Patient Relations
Psychotherapy, Group - methods
Treatment Failure
Abstract
The purpose of the study was to examine clinical predictors of non-response to manualized cognitive behaviour therapy (CBT) among youths (children and adolescents) with anxiety disorders, and to explore families' perspective on therapy, using a mixed methods approach. Non-response to manualized group CBT was determined among 106 youths of Danish ethnicity (7-17?years old) with a primary anxiety disorder, identified with the Clinical Global Impression of Improvement Scale at the 3-month follow-up. Twenty-four youths (22.6 %) had not responded to treatment, and a logistic regression analysis revealed that youths with a primary diagnosis of social phobia were seven times more likely not to respond, whereas youths with a comorbid mood disorder were almost four times more likely. Families of non-responding youths with primary social phobia and/or a comorbid mood disorder (n?=?15) were interviewed, and data were analysed through interpretative phenomenological analysis. Two superordinate themes emerged: youths were not involved in therapy work, and manualized group format posed challenges to families. The mixed methods approach provided new perspectives on the difficulties that may be encountered by families of non-responding youths with a primary social phobia diagnosis and youths with a comorbid mood disorder during manualized group CBT. Clinical implications related to youths' clinical characteristics, and families' experience and suggestions are drawn. Copyright © 2015 John Wiley & Sons, Ltd.
Youths with an anxiety disorder, who had a primary social phobia diagnosis and those, who had a comorbid mood disorder, were more likely not to respond to manualized group CBT. Parents of those non-responding youths often considered them as motivated to overcome their difficulties, but due to their symptomatology, they were unreceptive, reluctant and ambivalent and therefore not actively involved in therapy. The non-responding youths with social phobia felt evaluated and nervous of what others thought of them in the group. The parents of the non-responding youths with a comorbid mood disorder felt the group format placed restraints on therapists' ability to focus on their individual needs.
PubMed ID
26514088 View in PubMed
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BDNF Val66Met and childhood adversity on response to physical exercise and internet-based cognitive behavioural therapy in depressed Swedish adults.

https://arctichealth.org/en/permalink/ahliterature290870
Source
J Psychiatr Res. 2017 Oct; 93:50-58
Publication Type
Journal Article
Randomized Controlled Trial
Date
Oct-2017
Author
Md Shafiqur Rahman
Vincent Millischer
Zangin Zeebari
Yvonne Forsell
Catharina Lavebratt
Author Affiliation
Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
Source
J Psychiatr Res. 2017 Oct; 93:50-58
Date
Oct-2017
Language
English
Publication Type
Journal Article
Randomized Controlled Trial
Keywords
Adolescent
Adult
Brain-Derived Neurotrophic Factor - genetics
Child Abuse - psychology
Cognitive Therapy - methods
Cohort Studies
Depression - genetics - psychology - rehabilitation
Exercise - physiology
Female
Genotype
Humans
Internet
Logistic Models
Male
Methionine - genetics
Middle Aged
Polymorphism, Genetic - genetics
Statistics, nonparametric
Sweden - epidemiology
Valine - metabolism
Abstract
The genetic effect of Brain-derived neurotrophic factor (BDNF) on treatment response in depression is not consistent in the literature. Childhood adversity is a known risk factor for depression which has been reported to increase depression susceptibility by interacting with BDNF genetic variation. We aimed to explore whether the BDNF variation Val66Met and childhood adversity (CA) predicted the treatment response to a 12-week intervention with physical exercise (PE) or internet-based cognitive behavioural therapy (ICBT) when compared with treatment as usual (TAU). A prospective cohort study nested within a randomised control trial was conducted using data from 547 participants with mild to moderate depression. Depression severity at baseline and follow-up was measured using the Montgomery-Åsberg Depression Rating Scale. Met allele carriers without exposure to CA and current antidepressant use showed higher treatment response to PE than Val homozygotes. There was no evidence to support that BDNF Val66Met or CA alone predicted treatment response to PE and ICBT. The Met carriers had higher serum mature BDNF level. These data suggest that Met allele carriers benefit more from PE treatment but only if they are not exposed to early adversity.
PubMed ID
28578208 View in PubMed
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