Geir Høstmark Nielsen

Mindfulness-based stress reduction for patients with anxiety disorders: evaluation in a randomized controlled trial.

The aim of this study was to investigate the effect of mindfulness-based stress reduction (MBSR) for patients with heterogeneous anxiety disorders. Seventy-six self-referred patients were randomized to MBSR or a waiting-list control condition. Eight participants did not complete the eight-week MBSR intervention. Treatment completers improved significantly on all outcome measures compared to controls. The completer sample showed medium to large effect sizes on measures of anxiety (Cohens d = 0.55-0.97), and a large effect size for symptoms of depression (Cohens d = 0.97). Intention-to-treat analyses yielded effect sizes in the small to moderate range (Cohens d = 0.32-0.76). Gains were maintained at six months follow-up. The percentage of participants reaching recovered status was highest for symptom measures of depression and anxiety, and lower for worry and trait anxiety. Mediation analyses indicated that mindfulness fully mediated changes in acute anxiety symptoms, and partially mediated changes in worry and trait anxiety. However, the present study did not find evidence of temporal precedence for the proposed mediator. In the absence of true mediation and an active control condition, it cannot be ruled out that results are due to non-specific aspects of treatment. Despite these and other limitations, we conclude that MBSR is an effective treatment for anxiety disorders and related symptomatology.

Behavioral treatment of insomnia in older adults: an open clinical trial comparing two interventions.

Fifty-five insomniacs, 60 years or above, participated in a behavioral treatment program, comparing two interventions (sleep hygiene+stimulus control vs sleep hygiene+relaxation tape). Half of the subjects were randomized to a waiting-list condition prior to treatment. No significant changes were observed during the waiting-list period. During the treatment period however, the subjects improved on several sleep parameters, and treatment gains were maintained at a 6-month follow-up. The effects of treatment were greater for nocturnal measures (e.g. sleep onset latency and total sleep time) as compared to daytime measures (e.g. life satisfaction, daytime alertness) and not-targeted behavior (medication use). There were no differences in treatment effects for the two interventions.

Why did I change when I went to therapy? A qualitative analysis of former patients' conceptions of successful psychotherapy

Abstract Aim: Much research has been undertaken to identify significant events and change processes in psychotherapy. Most of these studies use categories and concepts consonant with the researchers particular theoretical affiliation. But how do patients themselves, retrospectively, give meaning to what they felt most important for their realization of change? The present study sought to identify specific experiences and reflections of former psychotherapy patients who described their previous therapy as successful. Methods: Semi-structured, qualitative, in-depth interviews with ten former psychotherapy patients, recruited through an advertisement in a local newspaper. A descriptive and hermeneutically modified phenomenological approach was used to analyse interview transcripts, technically carried out with the assistance of Nvivo 8 software. Findings: The different ways the participants gave meaning to change processes and events clustered around the following themes: (i) Being in a relationship with a ...

Psychological characteristics of elderly insomniacs

Sixty insomniacs, aged 60 years or over, fulfilling the DSM-IV criteria for primary insomnia, completed a set of questionnaires measuring psychological distress. These included the Sleep Impairment Index (SIM), the Symptom Check List 90-Revised (SCL-90-R), the Penn State Worry Questionnaire (PSWQ), the Toronto Alexithymia Scale-20 (TAS-20) and the Elders Life Stress Inventory (ELSI). The insomniacs were compared on these measures with two contrast groups, one of elderly good sleepers and one an elderly community sample. As norms were developed for the SCL-90-R and PSWQ, insomniacs were also contrasted with the norm groups on these measures. In general, the results indicated a higher level of psychological distress among insomniacs than among the good sleepers, while there were negligible differences between insomniacs and the community sample on most measures. Overall, elderly insomniacs scored higher on measures of worry compared with the other groups, followed by measures of somatization, obsessive-compulsion and depression. It is concluded that excessive worrying was the most characteristic feature of elderly insomniacs.

Workplace Bullying and Suicidal Ideation: A 3-Wave Longitudinal Norwegian Study

OBJECTIVES We examined whether victimization from bullying is related to an increased risk of suicidal ideation over time and whether suicidal ideation is related to subsequent bullying. METHODS In a longitudinal study (2005-2010), we used well-established single-item measures to assess victimization from bullying and suicidal ideation. We used latent Markov models to determine forward and reverse relationships between variables at 3 time points with 2 or 3 years between the measurement points among a randomized nationwide sample of 1846 employees in Norway. RESULTS Victimization from bullying was associated with subsequent suicidal ideation (odds ratio = 2.05; 95% confidence interval = 1.08, 3.89). Suicidal ideation at baseline was not related to subsequent victimization from workplace bullying. CONCLUSIONS Workplace bullying may be a precursor to suicidal ideation, whereas suicidal ideation seems to have no impact on subsequent risk of being bullied. Regulations against bullying should be integrated into work-related legislation and public health policies.

Nondisclosure in psychotherapy group supervision: The supervisee perspective

The aim of this study was to investigate aspects of nondisclosure in a sample of 55 student therapists, working within a group format of supervision. The study constituted one part of a larger study, with the other, parallel part addressing nondisclosure in supervisors. The participants were recruited from seven university-based training clinics in Norway and Denmark. The supervisees answered a questionnaire comprising 11 items about nondisclosure in supervision. The items were answered in a yes/no format, and the respondents were invited to provide examples and justifications for their answers to each item. The examples and justifications provided were analysed in accordance with Hill’s guidelines for consensual qualitative research. The study confirmed significant nondisclosure by supervisees in a number of important areas. A high percentage found it difficult to talk about topics related to the supervisory relationship, fearing that they would hurt their supervisor or be met with criticism or interpretation. They were also reluctant to talk to their supervisors about professional matters, particularly related to the perceived incompetence of their supervisors and their expectancy of non-constructive criticism. They felt that their supervisors withheld feedback on their work, as well as advise on what to do, and would like more of this. Several of them thought of the lack of feedback as a conscious strategy helping the students to find out for themselves. A rather striking finding was that a high number of students experienced that the groups became more closed throughout the supervision, and blamed their supervisors for inadequate handling of the group process. This is an issue that needs further exploration.Supervisee non-disclosure in psychotherapy group supervision: The supervisee perspective

Re-establishing contact: A qualitative exploration of how therapists work with alliance ruptures in adolescent psychotherapy

Abstract What challenges do therapists face when they experience ruptures in the working alliance in psychotherapy with adolescent clients; and what are their most typical strategies when they try to re-establish contact? These issues were explored through qualitative interviews with nine psychotherapists from outpatient child and adolescent psychiatric clinics in Bergen, Norway. A descriptive and hermeneutically informed phenomenological approach was used to analyse the interview transcripts. Most therapists/participants described that they would explore the reason for the rupture from the adolescents point of view, and all participants often understood ruptures in light of the adolescents’ need for autonomy. However, the participants differed strongly in how much they would focus on the relationship per se, on intrapsychic factors, or on the adolescents life outside therapy. For the therapists who regarded the relationship as something to be explored, client ambivalence to treatment was seen as someth...

Brief dynamic psychotherapy with older adults

In this article, we present an outline of brief dynamic psychotherapy guiding our case formulation, and contrast the perspective of cyclical maladaptive patterns with the traditional conception of a normative model of therapeutic change in old age. A case illustration of a 68-year-old married woman is introduced to demonstrate how presenting complaints are translated into cyclical maladaptive patterns, a formulation used as a heuristic to help the therapist generate, recognize, and organize relevant psychotherapeutic information. The goal of therapy is to help the client change her maladaptive interpersonal patterns, focusing on new experiences and new understandings that emanate from the therapeutic relationship.

Training graduate students as raters in psychotherapy process research

The aim of this study was to conduct a further investigation of the reliability of an innovative new measure for examining processes within psychotherapy sessions, the Achievement of Therapeutic Objectives Scale (ATOS). The ATOS assesses seven common factors in psychotherapy: insight, motivation, activating affects, inhibitory affects, new learning (appropriate expression of feeling), sense of self, and sense of others. Through the use of ATOS, a patient’s degree of ‘assimilation’ or ‘achievement’ of the objectives of psychotherapy can be captured throughout the therapy process. A previous reliability study with graduate students demonstrated poor to fair reliability with 8 hours of training. This study sought to improve reliability by providing 15 hours of training in using the ATOS, in five classes of three hours, and with more focused rating. When all subscales were rated simultaneously, students (N = 32) attained ICCs in the fair to good range of.42–.71. When students were allowed to focus on two subscales at a time (rather than the full scale) during 20 hours of additional practice, ICC values increased to the range of .76–.95. The study suggests that an investment in solid training of clinically inexperienced raters may pay dividends in terms of higher quality ATOS data, and would allow individual rating of tapes.

Self-esteem and interpersonal functioning in psychiatric outpatients

This study explored associations between self-esteem and interpersonal functioning in a one-year clinic cohort of psychiatric outpatients (n= 338). At intake, patients completed questionnaires measuring self-esteem, interpersonal problems, interpersonal style, and general symptomatic distress. They were also diagnosed according to the ICD-10. Interpersonal behaviour was measured along the agency and communion dimensions of the Inventory of Interpersonal Problems-Circumplex [IIP-C]. The results show that lower self-esteem was associated with higher levels of interpersonal problems in general. Further, lower self-esteem was first and foremost linked to frustrated agentic motives, as measured by the IIP-C. Hence, the study concludes that fostering patient agency should be considered as an important goal in psychotherapy. Furthermore, the analyses revealed an interaction effect of agency and communion on self-esteem, indicating a need for balancing the two motive dimensions. Finally, some questions are raised concerning the interpretation of the IIP-C subscales in general.