Modum Bad – Gordon Johnsens stiftelse

Personality disorders (PD) are highly prevalent among patients with eating disorders (ED) and are often associated with unfavorable treatment outcomes. This may be due to poor engagement in therapy, interpersonal difficulties hampering the treatment alliance, and emotional instability overshadowing the ED symptoms. However, the patients' perspectives on these processes are understudied. To illustrate the potential of addressing personality vulnerabilities and relational issues in ED treatment, we present the case of Jade, a 29-year-old female with longstanding bulimia nervosa, major depressive disorder, and posttraumatic stress disorder following childhood maltreatment. Jade had been diagnosed with multiple PD such as paranoid, borderline, and avoidant PD, and at the time of treatment, she fulfilled the diagnostic criteria for the latter. Jade participated in a 12-week Cognitive Behavioral Therapy (CBT) inpatient program in a specialized ED unit. The treatment focused on the complex symptom interplay, specifically connecting early memories to current reactions, coping strategies, and relationship patterns. Jade normalized her eating patterns and trauma symptoms decreased. She highlighted being able to trust the staff and the treatment program as a prerequisite for ED improvement. Her narrative was triangulated with real-time self-report data examining ED symptoms (EDE-Q), interpersonal patterns (IIP-64), and trauma symptoms (PSS-SR) at assessment, admission, discharge, and 1-year follow-up. Jade was fully recovered from the ED at 1-year follow-up, however, the avoidant PD persisted. Considering the frequent ED-PD co-occurrence, the patient perspective may provide valuable insight to reduce long-term suffering by guiding tailored treatment approaches to improve outcomes for these difficult-to-treat patients. Trial Registration: NCT02649114.

BackgroundThe network approach in the eating disorder (ED) field has confirmed important links between EDs and posttraumatic stress disorder (PTSD) symptoms. However, studies including comorbid symptoms are scarce, which limits our understanding of potentially important connections. We hypothesised that anxiety, depression and poor quality of life (QOL) would provide a more complete picture of central, maintaining factors.MethodsNetwork analysis using R was performed in 2178 adult ED patients (91% female) admitted to residential treatment. Assessments included the ED Examination Questionnaire (EDEQ), the Eating Disorders Inventory (EDI‐2), the PTSD Checklist for DSM‐5 (PTSD clusters (PCL‐5)), the Patient Health Questionnaire (PHQ‐9), the Spielberger State‐Trait Anxiety Scale (STAI), and the ED QOL Scale (EDQOL), which measure symptoms of EDs, PTSD, major depression, state‐trait anxiety, and QOL, respectively.ResultsEDI‐2 ineffectiveness showed the highest centrality (expected influence) followed by EDI‐2 interoceptive awareness, STAI state anxiety, EDEQ shape concern, EDQOL psychological subscale, and PTSD cluster D (hyperarousal) symptoms. Eating Disorder Quality of Life psychological and physical‐cognitive subscales and PHQ‐9 major depressive, STAI state anxiety and PCL‐5 PTSD cluster E (negative alterations in mood and cognition) symptoms showed the highest bridge expected influence, suggesting their interactive role in maintaining ED‐PTSD comorbidity.ConclusionsThis is the first network analysis of the interaction between ED and PTSD symptoms to include the comorbid measures of depression, anxiety, and QOL in a large clinical sample of ED patients. Our results indicate that several symptom clusters are likely to maintain ED‐PTSD comorbidity and may be important targets of integrated treatment.

ObjectiveThis study aimed to explore the experience and impact of participating in psychoeducative group therapy based on an explanatory model for dissociative symptoms. We further explored the potential significance this may have for the participants healing process. MethodsA total of 26 participants with Complex Dissociative Disorder (CDD) were interviewed 6 months after finishing a 20-week psychoeducative group therapy that included skills training. The research team analyzed the data with an interpretative interview-based qualitative research method. ResultsThe analysis resulted in two main categories with 12 subcategories. The first main category was “Developing a more coherent self”, describing an initial change in the participants' self-experience from confused and fragmented to increased coherency. The second main category “Increased sense of agency” represented a new way of relating to and helping oneself. The results are presented in a model which points towards some possible connections between the categories. ConclusionsOur results suggest that the psychoeducative group therapy contributed to a movement towards increased self-awareness which permits a sense of coherence among various parts of the self and an increased sense of agency. The model resulting from this work identifies crucial elements of change that can be applied to improving treatment.

Background Depressed patients have an increased incidence of pain. A pathophysiological connection between depression and pain is still not revealed. Immunological activation has been found in both depression and pain. There are few studies of pain and immune activation in patients with depression, without inflammatory and autoimmune disorders. Methods This is a naturalistic follow-up study of 50 patients with a major depressive disorder (MDD) depressive episode, without any inflammatory or autoimmune conditions. We have previously reported on the relationship between depression and cytokine levels. In this study, we obtained data of depression, pain and cytokine levels before and after 12 weeks of depression treatment. All patients were medication-free at inclusion. Results At inclusion three out of four patients experienced pain, and the pain scores correlated with the depression scores. After treatment, as depression was relieved, the pain scores dropped significantly and were no longer correlated to the depression scores. There were no correlations between pain scores and cytokine levels. Pain level at inclusion did not correlate with depression treatment outcome. Conclusion Our findings indicate that pain is a feature of depression. Pain levels and cytokine values didn’t correlate. Pain at inclusion did not predict depression treatment outcome.

Despite the presence of individual differences in the depressive response patterns of adults during the COVID-19 pandemic, most studies have investigated overall population-level changes in depressive symptoms during the first year of the pandemic. This longitudinal repeated-measurement observational study obtained 39,259 observations from 4,361 adults assessed nine times over a 24-month period, spanning from the onset of the pandemic to its proclaimed termination. Using a Latent Change Score Mixture Model to investigate differential change patterns in depressive symptoms over time, five profiles were identified. Most adults revealed a consistently resilient (42.52%) or predominantly resilient pattern differentiated by an initial shock in symptomatology (13.17%). Another group exhibited consistently high depressive adversities (8.5%). One group showed mild deterioration with small increases in depressive symptomatology compared to onset levels (29.04%), and a second strong deterioration group exhibited substantial and clinically severe levels of gained symptoms over time during the pandemic (6.77%). Both deteriorating depressive response patterns predicted the presence of a psychiatric diagnosis and treatment-seeking behavior at the end of the pandemic. Together, the absence of a preexisting psychiatric diagnosis at the onset of the pandemic, severe symptom increases during, combined with reports of psychiatric treatment-seeking and diagnosis at its termination, indicated that the strongly deteriorating subgroup represents an additional group of adults struggling with depressive problems. Factors related to general adverse change (lower education levels, lone residence), initial shocks prior to recovery (frequent information seeking, and financial and occupational concerns at the onset of the pandemic), and resilience and recovery (older age, being in a relationship, physical activity) were identified. Binge drinking and belonging to an ethnic minority were influential predictors of the strongly deteriorating group. Major changes in response patterns occurred during the first three months of the pandemic, suggesting this period represents a window of sensitivity for the development long-lasting depressive states versus patterns of recovery and resilience. These findings call for increased vigilance of psychiatric symptoms during the initial phases of infectious disease outbreaks and highlight a specific target period for the implementation of preventive measures.

Maintaining good mental health is important during a crisis. However, little attention has been given to how people achieve this, or how they evaluate emotions associated with stressors, such as the COVID-19 pandemic. This study aims to (1) investigate whether emotion regulation, in particular cognitive reappraisal and suppression, moderates the relationship between COVID-19 stress and general mental distress and (2) examine gender differences in the interrelations between COVID-19 stress, emotion regulation, and mental distress. Data from a population in Norway (n = 1.225) were collected using a cross-sectional survey during the early months of the COVID-19 pandemic. Emotion regulation was measured using the Emotion Regulation Questionnaire Scale (ERQ), COVID-19 stress with the COVID-19 Stress Scale, and mental distress with the Patient Health Questionnaire 4 (PHQ-4). Moderation analyses were conducted using the PROCESS macro for SPSS. There was a strong association between COVID-19 stress and general mental distress (r = 0.61). The moderation analyses showed substantial moderation effects of cognitive reappraisal and suppression on the relationship between COVID-19 stress and mental distress. Cognitive reappraisal served as a buffer (p = 0.001) and suppression (p = 0.002) exacerbated the relation between COVID-19 stress and mental distress. Men had higher scores of suppression (p < 0.001), and women had higher scores of cognitive reappraisal (p = 0.025). The buffering effect of cognitive reappraisal presented itself only in women (p < 0.001), while the exacerbation effect of suppression appeared only in men (p < 0.001). The current study suggests that COVID-19 pandemic-related stress is easier to deal with for those who have the tendency to cognitively reappraise. In contrast, suppression is associated with symptoms of depression and anxiety. The prevention of mental distress can be supported by guiding people about the importance of using healthy emotion regulation strategies, as well as helping them to become more aware of the way they interpret and regulate their emotions. Gender differences in emotion regulation suggest gender awareness, e.g., tailored programs for men and women.

Background: Trauma-related symptoms are common and there is a need for treatment interventions targeting underlying core vulnerabilities regardless of the client’s diagnosis. Mindfulness and Compassion interventions have shown promising results in trauma treatment. However, little is known of how clients experience such interventions. Objective: This study describes clients’ experiences of change after participating in a transdiagnostic group intervention, Trauma-sensitive Mindfulness and Compassion Group (TMC). Method: All 17 participants from two TMC groups were interviewed within one month of completing treatment. Transcripts were analysed using reflexive thematic analysis with a focus on how the participants experienced change and change mechanisms. Results: Three main themes of experienced change were developed: Becoming empowered; A new relationship to oneself and one’s body; and Gaining more freedom in relationships and life. Four main themes were developed to capture clients’ experiences of change mechanisms: New perspectives give understanding and hope; Accessing tools facilitates agency; Significant moments of awareness open up to new possibilities, and Circumstances in life that facilitate change. Conclusion: We discuss and reflect upon participants’ experiences of the effects of participating in a TMC group and the mental and emotional costs of doing the work and present a broader perspective on change processes overall.

Within-person network dynamics on a monthly or yearly level have been difficult to study due to the lack of suitable analytic methods. In this study, a new method for estimating networks from panel data was used to investigate how symptoms of depression, mechanisms proposed in the meta-cognitive therapy (MCT) model, and loneliness interact across a nine-month period. Four data waves were delivered by a representative population sample of 4,361 participants during the COVID-19 pandemic in Norway. Networks were estimated using the panel graphical vector-autoregression (panelgvar) method. In the temporal network, use of substance to cope with negative feelings positively predicted threat monitoring and depressed mood. In turn, threat monitoring positively predicted suicidal ideation. Meta-cognitive beliefs that thoughts and feelings are dangerous positively predicted anhedonia. Suicidal ideation positively predicted sleep problems and worthlessness. Loneliness was positively predicted by depressed mood. In turn, more loneliness predicted more control of emotions. In the contemporaneous network, worry/rumination was positively related to depressed mood, worthlessness, and sleep problems. In conclusion, the findings indicate the importance of the theory-derived variables threat monitoring, beliefs that thoughts and feelings are dangerous, and substance use as potential targets for intervention to alleviate long-term depressive symptoms. Suicidal ideation may have a detrimental long-term effect on worthlessness. The results also suggest that depressed mood leads to loneliness in the long run but does not support that loneliness leads to depressive symptoms.

ABSTRACT Background Patients with eating disorders and childhood trauma have clinical presentations that make them less suitable for standard eating disorder treatment. This might be due to high levels of shame and self-criticism. Self-compassion can be a mechanism of change, especially for patients with eating disorders and childhood trauma. Method A total of 130 patients with or without childhood trauma were admitted to 13 weeks of inpatient treatment and randomized to either compassion-focused therapy or cognitive–behavioral therapy. Self-compassion and eating disorder symptoms were measured every week. The data were analyzed for within-person effects using multilevel modeling. Results We did not find a within-person effect of self-compassion on eating disorder symptoms. Rather, the analysis indicated that eating disorder symptoms predict self-compassion in the overall sample. However, we found a stronger within-person relationship between self-compassion and eating disorder symptoms in patients with trauma receiving compassion-focused therapy compared to the remaining patients in the study. Conclusion Overall, eating disorder symptoms predicted subsequent self-compassion at a within-person level. Patients with trauma in compassion-focused therapy demonstrated a stronger relationship between self-compassion and eating disorder symptoms. More studies with a cross-lagged design are needed to further illuminate self-compassion as a mechanism of change for these patients. Trial registration: ClinicalTrials.gov identifier: NCT02649114.

In the present study we aim to increase our knowledge of the relationship between childhood trauma and outcome in couple therapy. We sampled participants based on their suboptimal responses to treatment as well as one member of the dyad having reported experiences of childhood trauma. Six participants constituting three couples were included. All data was analyzed using thematic analysis. Our main finding was that when couples are not able to agree on the goal of their therapy and this is not handled adequately by the therapist, the alliance tends to split. The therapy thus becomes more individually focused at the expense of the couple relationship. Generally, participants did not themselves assess their past traumas as having negatively impacted therapy giving instead credence as to how it has impacted their self-knowledge. In the future, longitudinal studies should be conducted to explore if there is an association across treatment between trauma and the therapeutic relationship, and the influence it might have on outcome. The findings of this study further support the already existing literature on the importance of alliance and elaborates upon how split alliances occur, develops, and constrains therapy. Supplemental data for this article is available online at http://dx.doi.org/10.1080/15332691.2022.2053262