Hans M. Nordahl

The Structure of Maladaptive Schemas: A Confirmatory Factor Analysis and a Psychometric Evaluation of Factor-Derived Scales

One thousand and thirty-seven psychiatric patients and non-patients from six different sites completed the 205-item Young Schema Questionnaire or its shortended form, the 75-item Young Schema Questionnaire-S. Among 888 of the subjects, who all were patients, a confirmatory factor analysis (CFA) of the 75 items included in both forms of the questionnaire clearly yielded the 15 Early Maladaptive Schema (EMS) factors rationally developed by J. E. Young (1990). Confirmatory factor analyses, testing three models of the higher-order structure of the 15 EMSs, indicated that a four-factor model was the best alternative. The results slightly favored a correlated four second-order factor model over one also including a third-order global factor. The four factors or schema domains were Disconnection, Impaired Autonomy, Exaggerated Standards, and Impaired Limits. Scales derived from the four higher-order factors had good internal and test–retest reliabilities and were related to DSM-IV Cluster C personality traits, agoraphobic avoidance behavior, and depressive symptoms.

Functional impairment and occupational outcome in adults with ADHD.

Objective: ADHD is associated with poor functional outcomes. The objectives were to investigate the prevalence of functional impairment and occupational status in a clinically referred sample of adults with ADHD and explore factors predicting occupational outcome. Method: A sample of 149 adults with a confirmed diagnosis of ADHD participated in the present study. Cross-sectional data were collected from the participant’s medical records and from self-report questionnaires. A multiple regression model was applied to identify possible predictors of occupational outcome. Results: Only 22.2% had ordinary work as their source of income, compared with 72% in the general population. The most prevalent comorbid disorders were lifetime depression (37.8%), substance abuse (28.1%), and alcohol abuse (23.3%). Age at first treatment with central stimulants and inattentiveness negatively predicted occupational outcome. Conclusion: Adult ADHD was associated with lower educational attainment and lower level of employment. Later age of first central stimulant treatment and higher inattentiveness ratings were associated with lower level of employment.

Personality styles in patients with fibromyalgia, major depression and healthy controls

BackgroundThe fibromyalgia syndrome (FMS) is suggested to be a manifestation of depression or affective spectrum disorder. We measured the cognitive style of patients with FMS to assess personality styles in 44 patients with fibromyalgia syndrome (FMS) by comparing them with 43 patients with major depressive disorder (MDD) and 41 healthy controls (HC).MethodsPersonality styles were measured by the Sociotropy and Autonomy Scale (SAS) and the Dysfunctional Attitude Scale (DAS). The Structured Clinical interview for DSM Axis I was applied to Axis I disorders, while the Beck Depression Inventory was used to measure depression severity.ResultsPatients with FMS in general have a sociotropic personality style similar to patients with MDD, and different from HC, but FMS patients without a lifetime history of MDD had a cognitive personality style different from patients with MDD and similar to HC.ConclusionThese findings suggest that a depressotypic personality style is related to depressive disorder, but not to FMS.

Recollections of parent‐child relationships in OCD out‐patients compared to depressed out‐patients and healthy controls

The present study examined the relationship between parental bonding in 26 psychiatric out‐patients with obsessive‐compulsive disorder (OCD) compared to 34 out‐patients with major depressive disorder (MDD) and 41 healthy controls. The results indicated significantly lower levels of parental care and higher levels of maternal overprotection for the patients with a current principal diagnosis of depression, compared to healthy controls. In multiple regression analyses, the presence of depressive disorder was related to all Parental Bonding Inventory (PBI) subscales. When the presence of current depressive disorder was controlled for statistically, the diagnosis of OCD was not associated with abnormal patterns of parental bonding on the PBI.

Anxiety as a risk factor for school absenteeism: what differentiates anxious school attenders from non-attenders?

BackgroundAnxiety is a major risk factor for problematic school absenteeism. However, most anxious students attend school. What differentiates anxious attenders from non-attenders?MethodHigh school students (N = 865) were assigned to groups based on anxiety and absenteeism scores. These groups were then tested for differences in risk factor profiles using discriminant analysis.ResultsAnxious school attenders were less affected by negative personality traits, total number of risk factors, social anxiety, panic, and behavioural and family problems. They also displayed greater resilience.ConclusionsThis study indicates that the risk for problematic school absenteeism increases as the number of risk factors aggregate and that treatment for anxious school refusal should be based on a profile of the individuals risk factors.

Perceived Group Climate as a Predictor of Long-Term Outcome in a Randomized Controlled Trial of Cognitive-Behavioural Group Therapy for Patients with Comorbid Psychiatric Disorders

BACKGROUND Research on group therapy indicates that various dimensions of the helpful relationship qualities (cohesion, climate, empathy, alliance) are associated with outcome. However, the use of a wide variety of empirical scales makes comparisons between studies as well as generalizations somewhat difficult. Although a generic, trans-theoretical measure such as the Group Climate Questionnaire-Short Form (GCQ-S; MacKenzie, 1983) is available and applicable to most treatment conditions, it has never been tested with cognitive-behavioural group therapy. AIMS To investigate perceived dimensions of group climate (engagement, avoidance and conflict) as predictors of long-term (1 year) follow-up in a manualized, structured time-limited cognitive-behavioural group therapy (CBGT) for out-patients with comorbid psychiatric disorders. METHODS Data from 27 patients were analysed using hierarchical multiple regression analyses. Outcome measures used were general symptomatic complaints (SCL-90-R), interpersonal problems (IIP-64), specific mood- and anxiety symptoms (BDI; BAI) and early maladaptive schemas (YSQ). After controlling for scores on the relevant dependent variables at both intake and treatment termination, dimensions of group climate measured close to termination were entered as predictors in separate analyses. RESULTS Higher ratings of engagement were associated with reduced scores on all outcome measures at follow-up, except for anxiety symptoms (BAI). Higher ratings of avoidance were associated with lower anxiety symptoms at follow up, whereas ratings of conflict were unrelated to all follow-up scores. CONCLUSIONS The results provide partial support for the use of the GCQ-S as a predictor of long-term follow-up in CBGT, and highlights perceived engagement as the most important dimension. Clinical implications are discussed.

Does dissociation moderate treatment outcomes of narrative exposure therapy for PTSD? A secondary analysis from a randomized controlled clinical trial.

UNLABELLED Dissociative symptoms, especially depersonalisation and derealisation, are often perceived as a contraindication for exposure-based treatments of posttraumatic stress disorder (PTSD) despite limited empirical evidence. The present paper examines whether derealisation and depersonalisation influence the treatment outcomes of narrative exposure therapy (NET) and treatment as usual (TaU) among severely traumatised asylum seekers and refugees. We performed a secondary analysis of a recently published randomized controlled multicentre trial comparing NET and TaU for the treatment of PTSD in asylum seekers and refugees. In order to investigate whether depersonalisation and derealisation moderate treatment outcomes, a number of moderated multiple, blockwise regression analyses were conducted. Missing data were handled with multiple imputation. The main finding from intention-to-treat analyses is that derealisation and depersonalisation overall do not moderate the treatment outcomes of either NET or TaU. The treatment condition was the most stable predictor of residual gain scores across outcome measures, with NET being associated with lower residual gain scores indicating better treatment outcomes. The present study substantiates and extends previous research indicating that dissociative symptoms such as derealisation and depersonalisation do not moderate the treatment outcome of exposure-based treatments for PTSD. CLINICALTRIALSGOV IDENTIFIER NCT00218959.

Connection between patient and therapist and therapist's competence in schema-focused therapy of personality problems

Abstract The aim of this study was to examine whether the connection between patient and therapist, therapist competence, and the interaction between connection and competence, measured in the early process of schema-focused therapy of personality problems, influenced treatment outcome. Connection is a rater-observed measure of the intimacy and mutual engagement between patient and therapist that appears to represent an easily observable aspect of the therapeutic alliance. The sample consisted of 35 patients with panic disorder and/or agoraphobia and DSM–IV Cluster C personality traits who participated in an 11-week inpatient program. Patients and an expert observer rated the schema-focused individual therapy sessions. Better observer-rated connection in the first session predicted greater across-session reduction in the strength of belief in the particular schemas addressed in the individual therapies. Connection was unrelated to across-session symptomatic improvement and to overall change. Competence predicted a reduction in maladaptive schemas during the schema-focused treatment and in the number of Cluster C personality traits from pretreatment to the follow-up period but was unrelated to across-session change. There was no interaction between connection and competence, indicating that they influenced treatment independently of each other.

Children in remission from acute lymphoblastic leukaemia: mental health, psychosocial adjustment and parental functioning

Children in remission from acute lymphoblastic leukaemia: mental health, psychosocial adjustment and parental functioningThe objective of this study is to assess the mental health and psychosocial adjustment of children in remission from acute lymphoblastic leukaemia (ALL), and parental functioning compared to healthy controls. A cross-sectional study of 40 children treated for ALL (mean age 11.8 years, range 8.5-15.4) and healthy controls (n = 42) (mean age 11.8 years, range 8.11-15.0) were assessed by the Child Behaviour Checklist (CBCL), the Youth Self-Report (YSR) and the Strength and Difficulties Questionnaire (SDQ). The parents own mental health was assessed by the General Health Questionnaire (GHQ-30). Children treated for ALL showed on average significantly more symptoms as measured by the CBCL Total Behaviour Score for mothers report (P = 0.005), and for fathers report (P = 0.004) compared with healthy children. Fathers reported more anxiety (P = 0.03) and depression (P = 0.02) as measured by the GHQ-30 compared with healthy controls. Children in remission from ALL showed on average significantly more problems regarding mental health and psychosocial adjustment, as reported by their parents, compared with healthy controls. Adequate rehabilitation and follow-up programmes should be implemented for children in remission from ALL. The results indicate the need to pay attention to the mental health of fathers during the rehabilitation phase.

A 4-year follow-up study of syndromal and sub-syndromal anxiety and depression symptoms in the general population

BackgroundOur aims were to examine the stability of self-rated anxiety and depression symptoms and the predictors for change in case-level status after 4 years in a general population sample.MethodsProspective cohort study. Based on the total score on the Hospital Anxiety and Depression rating scale (HADS-T) in HUNT 2 (1995–1997), three groups were identified: Level 3 (n = 654, score ≥ 25 points), Level 2 (n = 654, score 19–24 points), and Level 1 (n = 1,308, score < 19 points). The groups were followed up with a mailed questionnaire after 4 years.ResultsAmong the 1,326 (53% response rate) who participated in the follow-up, 816 (62%) had not changed symptom level. The number of participants that had crossed the HADS-T caseness level (19 points) was the same in both directions. In non-cases at baseline (Level 1), lack of friends (OR 2.34, 95% CI 1.28–4.27, P = 0.006) and previous episodes of depression (OR 2.90, 95% CI 1.76–4.78, P < 0.001) predicted HADS-T caseness at follow-up, while higher educational level (OR 0.66, 95% CI 0.46–0.96, P = 0.028) protected from developing caseness level of anxiety and depression. In HADS-T cases (Levels 2 and 3) at baseline, previous episode(s) of depression (OR 0.36, 95% CI 0.19–0.68, P = 0.002) and being unemployed (OR 0.58, 95% CI 0.34–1.00, P = 0.050) predicted HADS-T caseness at follow-up, whereas a higher educational level (OR 1.83, 95% CI 1.24–2.70, P = 0.002) was associated with remission from HADS-T caseness after 4 years.ConclusionsThough symptom fluctuation was considerable, conventional HADS-T caseness (≥19 points) was a reliable and valid predictor for high long-term symptom stability of anxiety and depression in our general population sample.