Stian Solem

The relationship between resilience and levels of anxiety, depression, and obsessive-compulsive symptoms in adolescents.

OBJECTIVE Mental health problems affect approximately 20% of adolescents. Traditionally, the principal focus has been on vulnerability and risk factors and less on protective factors. The study, therefore, explores the relation between frequent psychiatric symptoms and resilience factors among older adolescents. METHOD The Resilience Scale for Adolescents (READ) was completed by 307 Norwegian high school students (M = 16.4 years) along with the Depression Anxiety Stress Scales, and the Obsessive-Compulsive Inventory-Revised. RESULTS Higher resilience scores predicted lower scores on levels of depression, anxiety, stress and obsessive-compulsive symptoms after controlling for age and gender. CONCLUSION This study provides further evidence that it may be fruitful for clinicians and researchers to attend to resilience factors in relation to psychological symptoms among older adolescents.

Videoconference- and cell phone-based cognitive-behavioral therapy of obsessive-compulsive disorder: A case series

For most patients with obsessive-compulsive disorder (OCD) the availability of exposure-based therapy is limited. In our study six outpatients with obsessive-compulsive disorder (OCD) received 15 sessions of therapy delivered only over teleconference (six sessions) and cell phones (nine sessions) over a 3-month period of time. Five of the patients were women and the average age of the participants was 31.5 (SD=8.1). Patients presented a variety of OCD symptoms which were treated with standard exposure and response prevention exercises both during treatment sessions and as a part of homework exercises. All patients rated the treatment format as acceptable and rated the quality of the working alliance as high. At the end of therapy four of the six patients were highly improved and no longer met diagnostic criteria for OCD according to the Anxiety Disorders Interview Schedule for DSM-IV and the Yale-Brown Obsessive Compulsive Scale. The same was true at 3-month follow-up although some small increases in OCD symptoms had occurred. The innovative treatment format shows promise as a method of delivery that may make treatment accessible for patients with poor access to specialty clinics.

A Norwegian version of the Obsessive-Compulsive Inventory-Revised: psychometric properties.

The aims of this study were to test the psychometric properties of the Norwegian version of the Obsessive-Compulsive Inventory-Revised (OCI-R). The study included a student/community control sample (N = 1167) and a clinical sample (N = 72) with a diagnosis of obsessive-compulsive disorder (OCD). The results indicated a good fit for the six-factor structure of the OCI-R. The mean scores and standard deviations were similar to that of studies from other countries as was the internal consistency. The OCI-R scores were significantly higher in the OCD sample compared to the control sample. All the subscales, except hoarding, were significant predictors of obsessive-compulsive severity, and the OCI-R subscales seemed to be in agreement with the different subtypes of OCD according to DSM-IV. The OCI-R showed meaningful correlations with measures related to obsessive compulsive symptoms. As expected, it showed the strongest correlation with the Yale-Brown Obsessive Compulsive Scale, followed by measures of worry, anxiety, and depression. In summary, the Norwegian OCI-R showed adequate psychometric properties suggesting it could be a suitable measure of obsessive-compulsive symptoms.

Metacognitive Therapy for Depression in Adults: A Waiting List Randomized Controlled Trial with Six Months Follow-Up

This randomized controlled trial examines the efficacy of metacognitive therapy (MCT) for depression. Thirty-nine patients with depression were randomly assigned to immediate MCT (10 sessions) or a 10-week wait list period (WL). The WL-group received 10 sessions of MCT after the waiting period. Two participants dropped out from WL and none dropped out of immediate MCT treatment. Participants receiving MCT improved significantly more than the WL group. Large controlled effect sizes were observed for both depressive (d = 2.51) and anxious symptoms (d = 1.92). Approximately 70–80% could be classified as recovered at post-treatment and 6 months follow-up following immediate MCT, whilst 5% of the WL patients recovered during the waiting period. The results suggest that MCT is a promising treatment for depression. Future controlled studies should compare MCT with other active treatments.

Metacognitions and Mindful Attention Awareness in Depression: A Comparison Of Currently Depressed, Previously Depressed and Never Depressed Individuals

The primary aim of the study was to test (1) how metacognition relates to the concept of mindful attention awareness, and (2) whether metacognitions or mindful attention awareness best predicted symptoms of depression. Data was collected from three samples: currently depressed (n = 37), previously depressed (n = 81) and never depressed controls (n = 50). There was a moderate correlation between mindful attention awareness and three of five metacognitive subscales. Both mindful attention awareness and metacognition were significantly correlated with depression severity scores after controlling for anxiety. The depressed group had significantly more dysfunctional metacognitions and less mindful attention awareness than the never depressed group. Negative beliefs about worry and mindful attention awareness were also significantly different in the previously depressed group compared with the never depressed. This suggests that metacognitions and mindful attention awareness can be vulnerability factors for depression. The results also indicated that anxiety symptoms and negative beliefs about worry were the most important factors in predicting depression. In conclusion, the study shows that metacognitions and mindful attention awareness are two related but separate constructs and that metacognitions emerged as the best predictor of depression. These results provide support for the metacognitive model of emotional disorders. Copyright

The efficacy of teaching psychology students exposure and response prevention for obsessive-compulsive disorder

The aim of the study was to investigate whether inexperienced student therapists could successfully learn exposure and response prevention for obsessive-compulsive disorder. Twenty out of 21 outpatients completed treatment as delivered by ten psychology students. A total of 60 hours group supervision and approximately 30 hours with individual supervision was given to the students over the course of three semesters. Large effect sizes were observed for measures of symptoms and depression. Sixty-two percent (N= 13) of the intent to treat group achieved clinical significant change and 81% no longer met the diagnosis criteria (N= 17). The treatment effects observed at the 6 month follow-up period were promising. The results are encouraging for training students in evidence based treatment for specific disorders.

Metacognitive Therapy Applications in Social Phobia: An Exploratory Study of the Individual and Combined Effects of the Attention Training Technique and Situational Attentional Refocusing

Individuals with Social Anxiety Disorder have difficulty disengaging from self-processing in social situations. Metacognitive therapy interventions for enhancing attentional control were administered to a convenience sample of 24 with a Social Anxiety Disorder diagnosis. Using a cross-over design, 11 participants were given four weekly sessions of Attention Training Technique (ATT), followed by four weekly sessions of Situational Attentional Refocusing (SAR). For the other 13 participants the two treatment components were given in the reverse order. All participants made significant reductions on interview rated and self-reported measures of social and general levels of anxiety by the end of the first intervention (either ATT or SAR). Following completion of the second treatment components, further reductions were observed and 46% (n = 11) of the total sample no longer met DSM-IV criteria for Social Anxiety Disorder diagnosis. Two large order effects were found favoring patients receiving SAR interventions first. Overall these brief techniques aimed at increasing attentional flexibility were associated with large and clinically significant changes in Social Anxiety Disorder symptoms.

Cognitive behavioural therapy for obsessive-compulsive disorder with comorbid schizophrenia: a case report with repetitive measurements.

BACKGROUND Obsessive-compulsive disorder (OCD) has been observed in a substantial proportion of patients with schizophrenia. Although cognitive-behavioural therapy (CBT) is well documented for OCD, few case studies are available regarding CBT for comorbid OCD in schizophrenia. AIMS The study aims to present a case study to augment the limited knowledge concerning CBT treatment for OCD in patients with schizophrenia. METHOD The research adopted a case study approach, with a baseline condition and repeated assessments during the 3-week treatment and 6-month follow-up period. RESULTS The treatment was successful and the patient achieved clinical significant change in OCD symptoms. The patient had a reduction on the Y-BOCS from 24 to 5 (79%) and from 38 to 10 (73%) on the OCI-R from before treatment to 6 months follow-up. He did not fulfil the criteria for an OCD diagnosis at the end of the 3-week treatment period, or the follow-up at 3- and 6 months. CONCLUSIONS The results strengthen the impressions given by previous case studies suggesting that CBT may be a promising treatment for OCD in patients with schizophrenia.

The metacognitive model of depression: An empirical test in a large Norwegian sample

The aim of the current study was to test the metacognitive model of depression in a large Norwegian sample. We hypothesized that metacognitions and rumination would explain variance in depressive symptoms as suggested by the metacognitive model. A total of 1433 participants were included using a cross-sectional study design. Participants answered scales assessing positive beliefs about rumination, rumination, negative beliefs about rumination, and symptoms of depression. Metacognitive beliefs and rumination in their hypothesized order explained significant variance in depressive symptoms. The results replicate previous studies and provide further support for a metacognitive model of depression.

The Bergen 4-Day OCD Treatment Delivered in a Group Setting: 12-Month Follow-Up

The Bergen 4-day concentrated exposure treatment (cET) for obsessive-compulsive disorder (OCD) has proven highly acceptable; with practically no drop-out and a 6 month remission rate of nearly 70%. The aim of the present study was to evaluate long term gains of the approach, and to compare the results to findings from our recent meta-analysis. Sixty-nine of 95 patients consecutively referred to an outpatient clinic in the specialist health care, were offered the Bergen 4-day treatment. Among the 65 who initiated treatment, 60.0% were classified with “severe” to “extreme” OCD. None of the patients dropped-out during treatment. Independent Yale-Brown Obsessive-Compulsive Scale interviews were conducted post-treatment, and at 3- and 12-month follow-up. Using the international consensus criteria, 83.1% responded to treatment at 12-month follow-up, and 67.7% of patients were classified as recovered. Significant changes were also seen in depression, as measured by Patient Health Questionnaire-9, and in generalized anxiety, as measured by Generalized Anxiety Disorder-7 scale. A total of 89% of the patients rated the treatment as very good and 100% would recommend the treatment to a friend. Compared to results in a recent meta-analysis, the Bergen 4-day treatment is favorable in respect to attrition, response and 12-month recovery. In sum the Bergen 4-day treatment is a feasible way to deliver treatment for OCD, and the effects are stable at 12-month follow-up. Implications for dissemination are discussed.