Odd E. Havik

Patterns of emotional reactions after a myocardial infarction.

In a prospective study of 283 myocardial infarction (MI) patients, state-dependent feelings of anxiety, depression, and irritability were assessed twice during hospital stay, and four times during a 3-5 yr follow-up. A K-mean cluster analysis identified six subgroups of MI patients with different pattern of emotional reactions. Two groups, containing nearly half of the sample, had low average levels of emotional upset at all assessments. Two groups showed an intermediate long-term outcome: one of these had a high level of initial emotional upset that subsided during the first six months after discharge, whereas the other group showed increasing levels of emotional distress long-term follow-up. Finally, two groups failed to achieve long-term emotional readjustment. For one of these, a high level of emotional upset was evident from the first in-hospital assessment, whereas the other one had a sharp increase in emotional distress after discharge. In a series of psychological, social and medical variables, the former pattern was associated with more pre-MI medical and psychosocial problems, whereas the delayed emotional reaction was related to lower levels of cardiac health knowledge. Furthermore, high levels of emotional upset preceded both failure in resuming work and increased long-term rehospitalization. The findings indicate that emotional reactions after a MI should be monitored during convalescence to identify patients at risk for a failure in emotional readjustment. Furthermore, effective treatment of initial emotional reactions could promote resumption of work and reduce long-term morbidity.

Quality of Early Working Alliance in Psychotherapy: Diagnoses, Relationship and Intrapsychic Variables as Predictors

Background: The aim of the study was the prediction of the quality of early working alliance, using possible predictors among patient pretreatment variables: diagnoses, current and past relationships and intrapsychic ones. Data arefrom the ongoing, naturalistic Norwegian Multisite Project on Process and Outcome of Psychotherapy (NMSPOP). Methods: The sample, n = 270, is recruited from 15 outpatient clinics; 61.1% of the patients have personality disorders. Alliance was assessed with the Working Alliance Inventory (WAI), and predictors include independent clinicians’ evaluations of diagnostic/interpersonal/intrapsychic characteristics and the patients’ self-reports on similar and additional variables. Results: Four of 6 hypotheses were supported: Quality of working alliance is difficult to predict, early alliance is better predicted than later, diagnostic variables do not predict quality of working alliance, but quality of both current and past relationships is associated with working alliance. In a hierarchical multiple-regression analysis, 7% variance of working alliance in the 3rd session was explained from current relationship variables, whereas alliance in the 12th session was not predicted by the same model. Intrapsychic variables predicted the therapists’ ratings of alliance, but not the patients’ ratings. Conclusion: The results are in line with previous research, and also with the theoretical model for working alliance.

Self-help treatment of anxiety disorders: a meta-analysis and meta-regression of effects and potential moderators.

Self-help treatments have the potential to increase the availability and affordability of evidence-based treatments for anxiety disorders. Although promising, previous research results are heterogeneous, indicating a need to identify factors that moderate treatment outcome. The present article reviews the literature on self-help treatment for anxiety disorders among adults, with a total sample of 56 articles with 82 comparisons. When self-help treatment was compared to wait-list or placebo, a meta-analysis indicated a moderate to large effect size (g=0.78). When self-help treatment was compared to face-to-face treatment, results indicated a small effect that favored the latter (g=-0.20). When self-help was compared to wait-list or placebo, subgroup analyses indicated that self-help treatment format, primary anxiety diagnosis and procedures for recruitment of subjects were related to treatment outcome in bivariate analyses, but only recruitment procedures remained significant in a multiple meta-regression analysis. When self-help was compared to face-to-face treatment, a multiple meta-regression indicated that the type of comparison group, treatment format and gender were significantly related to outcome. We conclude that self-help is effective in the treatment of anxiety disorders, and should be offered as part of stepped care treatment models in community services. Implications of the results and future directions are discussed.

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.

Mental disorders in foster children: a study of prevalence, comorbidity and risk factors

BackgroundThe aim of this study is to examine the prevalence of mental disorders in 6- to 12-year-old foster children and assess comorbidity and risk factors.MethodsInformation on mental health was collected from foster parents and from teachers using Developmental and Well-Being Assessment (DAWBA) Web-based diagnostic interview. Child welfare services provided information about care conditions prior to placement and about the child’s placement history.ResultsDiagnostic information was obtained about 279 (70.5%) of 396 eligible foster children. In total, 50.9% of the children met the criteria for one or more DSM-IV disorders. The most common disorders were grouped into 3 main diagnostic groups: Emotional disorders (24.0%), ADHD (19.0%), and Behavioural disorders (21.5%). The comorbidity rates among these 3 main groups were high: 30.4% had disorders in 2 of these 3 diagnostic groups, and 13.0% had disorders in all 3 groups. In addition, Reactive attachment disorder (RAD) was diagnosed in 19.4% of the children, of whom 58.5% had comorbid disorders in the main diagnostic groups. Exposure to violence, serious neglect, and the number of prior placements increased the risk for mental disorders.ConclusionsFoster children in Norway have a high prevalence of mental disorders, compared to the general child population in Norway and to other societies. The finding that 1 in 2 foster children presented with a mental disorder with high rates of comorbidity highlight the need for skilled assessment and qualified service provision for foster children and families.

Risk Perception, Worry and Satisfaction Related to Genetic Counseling for Hereditary Cancer

In this multi center study, genetic counseling for hereditary cancer was evaluated by assessing patients’ worry, perceived risk of developing cancer and satisfaction with genetic counseling. An overall aim was to identify characteristics of vulnerable patients in order to customize genetic counseling. In addition, agreement between patients’ and counselors’ scores was measured. A total of 275 Norwegian patients were consecutively recruited, and 213 completed questionnaires before and after genetic counseling. Patients’ perceived risk decreased after the genetic counseling session. There was incongruence between risk perception expressed as a percentage and in words. Patients were significantly less worried after counseling. Higher levels of worry were predicted by low instrumental satisfaction with counseling, high degree of perceived risk of developing cancer and younger age. In conclusion, counselors met the patients’ psychological needs to a satisfactory degree during counseling. However, patients did not fully understand their risk of developing cancer.

Self-assessment of health before and after a myocardial infarction

Self-evaluated health represents an important aspect of quality of life that may influence the rehabilitation process after a major illness. However, health is a multi-dimensional concept and relatively little is known about the determinants of, and the interrelationships between the separate aspects of health. In a prospective longitudinal study of myocaridal infarction (MI) patients, two indices of self-evaluated health, maximal physical ability (MPA) and perceived global health (PGH), were used. On the average, both ratings were clearly reduced compared with pre-MI levels even as long as 3-5 yr after the MI. Females and older patients indicated lower MPA before and after the MI, whereas PGH was not related to any sociodemographic variable. The severity of the MI appeared to be of relatively limited importance for self-evaluated health. Heart-related symptoms before and after the MI were more strongly related to lower MPA, whereas non-cardiac health problems and psychological distress more clearly influenced PGH. However, initial illness perceptions were of some importance for both health perceptions. The data suggest that to some extent self-evaluated health can be influenced by educational or psychological support in order to faccilitate readaption and recovery after a MI.

Verbal denial and outcome in myocardial infarction patients

In a prospective study of 367 myocardial infarction patients, in-hospital measures of three aspects of verbal denial were examined with regard to medical, social and psychological outcome during a 3-5 yr follow-up. A low level of Denial of Illness was associated with more problems related to work, sexual life, and physical activities; and with a higher mortality rate. Higher levels of Denial of Impact were related to better emotional outcome, but also weakly associated with increased mortality. In contrast, Suppression proved to be related only to self-reported emotional distress. The findings indicate that it is useful to distinguish among several forms of denial in medical patients according to what is being denied.

Circumplex structure and personality disorder correlates of the Interpersonal Problems model (IIP-C): construct validity and clinical implications.

This study assessed the construct validity of the circumplex model of the Inventory of Interpersonal Problems (IIP-C) in Norwegian clinical and nonclinical samples. Structure was examined by evaluating the fit of the circumplex model to data obtained by the IIP-C. Observer-rated personality disorder criteria (DSM-IV, Axis II) were used as external correlates. The reliability of the IIP-C scales was acceptable and in the same range as in the original version. A multisample analysis strategy did not support an invariant circumplex model across the 2 groups. However, the estimated structures reflected mostly the same circular pattern of a quasi-circumplex model in the 2 groups. Departures from the ideal model were of negligible practical significance. The validity results examining personality disorder correlates of the IIP-C generally conformed to predictions, providing direct evidence for agreement between self-report and expert judgments of interpersonal problems.

Outcome predictors in guided and unguided self-help for social anxiety disorder

Internet-based self-help with therapist guidance has shown promise as an effective treatment and may increase access to evidence-based psychological treatment for social anxiety disorder (SAD). Although unguided self-help has been suggested primarily as a population-based preventive intervention, some studies indicate that patients with SAD may profit from unguided self-help. Gaining knowledge about predictors of outcome in guided and unguided self-help for SAD is important to ensure that these interventions can be offered to those who are most likely to respond. Utilizing a sample of 245 patients who received either guided or unguided self-help for SAD, the present study examined pre-treatment symptoms and program factors as predictors of treatment adherence and outcome. The results were in line with previous findings from the face-to-face treatment literature: namely, the intensity of baseline SAD symptoms, but not depressive symptoms, predicted treatment outcomes in both unguided and guided self-help groups. Outcomes were unrelated to whether a participant has generalized versus specific SAD. Furthermore, for the unguided self-help group, higher credibility ratings of the treatment program were associated with increased treatment adherence. The findings suggest that guided and unguided self-help may increase access to SAD treatment in a population that is more heterogeneous than previously assumed.