Vegard Øksendal Haaland

Decision making as measured with the Iowa Gambling Task in patients with borderline personality disorder

Affective instability is a core dimension of borderline personality disorder. The somatic marker hypothesis suggests that emotions play a crucial role in decision making. In this preliminary study, decision making was assessed in individuals with borderline personality disorder. Patients with borderline personality disorder (n = 20) and healthy comparison subjects (n = 15) were tested with the Iowa Gambling Task (IGT). The patients showed less advantageous choices on the IGT than did the healthy comparison subjects. The results could not be explained by indicators of general cognitive function or by symptoms of depression. These findings demonstrate that deficits in decision making in borderline personality disorder may manifest themselves in an ecologically valid neuropsychological test. Future studies should address whether those deficits are related to the behavioral characteristics of affective dysregulation and/or impulsivity, to the proposed dysfunctions and reduced volume of the orbitofrontal cortex and/or the amygdala, and to other neuropsychological functions.

The MATRICS Consensus Cognitive Battery (MCCB): Performance and functional correlates

Neurocognitive impairment is a core feature in psychotic disorders and the MATRICS Consensus Cognitive Battery (MCCB) is now widely used to assess neurocognition in this group. The MATRICS has been translated into several languages, including Norwegian; although this version has yet to be investigated in an adult clinical population. Further, the relationship between the MATRICS and different measures of functioning needs examination. The purpose of this study was to describe neurocognition assessed with the Norwegian version of the MATRICS battery in a sample of patients with psychotic disorders compared to age and gender matched healthy controls and to examine the association with educational-, occupational- and social-functioning in the patient group. One hundred and thirty one patients and 137 healthy controls completed the battery. The Norwegian version of the MATRICS was sensitive to the magnitude of neurocognitive impairments in patients with psychotic disorders, with patients displaying significant impairments on all domains relative to healthy controls. Neurocognition was also related to both self-rated and objective functional measures such as social functioning, educational- and employment-history.

Cognitive remediation and occupational outcome in schizophrenia spectrum disorders: A 2 year follow-up study

Neurocognitive impairment is prominent in schizophrenia and a significant predictor of poor occupational outcomes. Vocational rehabilitation (VR) is frequently implemented to counteract high unemployment rates. Individuals with schizophrenia however face numerous challenges such as neurocognitive impairments and psychotic symptoms. Hence, augmenting VR to address illness-related factors may optimize occupational outcomes. The aim of this study was to examine the effects of Cognitive Remediation (CR) combined with VR(CR+VR) compared to techniques from Cognitive Behavioral Therapy (CBT) combined with VR(CBT+VR) on neurocognition and occupational functioning over a 2year period. A total of 131participants underwent assessment with the MATRICS Consensus Cognitive Battery (MCCB) at baseline, post treatment (after 10months) and follow-up (2years after randomization). Occupational status and number of hours worked were recorded at all assessment points. Both groups improved on several neurocognitive domains. All improvements were however in favor of the CR group. There was a significant increase in number of participants working and hours worked in both groups throughout the project period, with no between-group differences. Number of hours worked at follow-up was predicted by change in Working Memory and the Composite Score in the CR group. CR-augmented VR improved several domains, particularly Verbal Learning and Working Memory, which were central in the CR program. The combination of VR and CR or CBT thus enabled a significant proportion of participants to attain and maintain work.

Obsessive-Compulsive Disorder’s Impact on Partner Relationships: A Qualitative Study

ABSTRACT There is need for more knowledge concerning couple relationships and obsessive-compulsive disorder. In this study, patients with obsessive-compulsive disorder were interviewed in focus groups concerning how their illness influences relationship with their partner. The interviews were analyzed phenomenological. The results show that obsessive-compulsive disorder can cause mental and physical distance, the patient can feel monitored and pathologized by the partner’s accommodation and support, and the patient can monitor that the partner follows the rituals. The disturbed power balance can last even in periods with low symptom level. Power-related aspects should be emphasized in couple therapy for patients with obsessive-compulsive disorder.

Effects of Attentional Bias Modification on Residual Symptoms in depression. A Randomized Controlled Trial.

Objective Following treatment, many depressed patients have significant residual symptoms. However, large randomised controlled trials (RCT) in this population are lacking. Attention bias modification training (ABM) can modify biases in emotion processing and may lead to symptom relief. We hypothesized that two weeks of ABM training would reduce clinician rated and self-reported residual symptoms and that change towards more positive attentional biases (AB) would be associated with symptom reduction. Method A total of 322 patients with a history of depression were included in a preregistered randomized controlled double-blinded trial. Patients were randomised to an emotional ABM paradigm over fourteen days or a closely matched control condition. Symptoms based on the Hamilton Rating Scale for Depression (HRSD) and Beck Depression Inventory II (BDI-II) were obtained at baseline and after ABM training. The primary outcome was change in HRSD and BDI-II. Participants were assessed for AB before and after the intervention. Results ABM training led to significantly greater decrease in clinician rated symptoms of depression as compared to the control condition. No differences between ABM and placebo were found for self-reported symptoms. ABM induced a change of AB towards more positive versus neutral stimuli with a more positive bias being associated with greater symptom reduction. Conclusion The current study demonstrates that ABM produces early changes in both AB and residual depressive symptoms. ABM may have practical potential in the treatment of residual depression. Trial Registration clinicaltrials.gov Identifier: NCT02658682.

Acceptance and Commitment Therapy preceded by an experimental Attention Bias Modification procedure in recurrent depression: study protocol for a randomized controlled trial

BackgroundThis project studies the effect of group-based Acceptance and Commitment Therapy (ACT) following Attention Bias Modification (ABM) on residual symptoms in recurrent depression. ACT is a cognitive-behavioral intervention combining acceptance and mindfulness processes with commitment and behavior-change processes. ACT enjoys modest empirical support in treating depression and has also shown promising results in secondary prevention of depression. The experimental cognitive bias modification (ABM) procedure has been shown to reduce surrogate markers of depression vulnerability in patients in remission from depression. The aim of the current project is to investigate if the effect of group-based ACT on reducing residual depressive symptoms can be enhanced by preceding it with ABM. Also, assessment of the relationship between conceptually relevant therapeutic processes and outcome will be investigated.Methods/designAn invitation to participate in this project was extended to 120 individuals within a larger sample who had just completed a separate randomized, multisite, clinical trial (referred to hereafter as Phase 1) in which they received either ABM (n = 60) or a control condition without bias modification (n = 60). This larger Phase-1 sample consisted of 220 persons with a history of at least two episodes of major depression who were currently in remission or not fulfilling the criteria of major depression. After its inclusion, Phase-1 participants from the Sørlandet site (n = 120) were also recruited for this study in which they received an 8-week group-based ACT intervention. Measures will be taken immediately after Phase 1, 1 month, 2 months, 6 months, and 1 year after the conclusion of Phase 1.DiscussionThis study sequentially combines acceptable, nondrug interventions from neuropsychology and cognitive-behavioral psychology in treating residual symptoms in depression. The results will provide information about the effectiveness of treatment and on mechanisms and processes of change that may be valuable in understanding and further developing ABM and ACT, combined and alone.Trial registrationClinicalTrials.gov, Identifier: NCT02648165. Registered on 6 January 2016.

Thought Field Therapy Compared to Cognitive Behavioral Therapy and Wait-List for Agoraphobia: A Randomized, Controlled Study with a 12-Month Follow-up

Background: Thought field therapy (TFT) is used for many psychiatric conditions, but its efficacy has not been sufficiently documented. Hence, there is a need for studies comparing TFT to well-established treatments. This study compares the efficacy of TFT and cognitive behavioral therapy (CBT) for patients with agoraphobia. Methods: Seventy-two patients were randomized to CBT (N = 24), TFT (N = 24) or a wait-list condition (WLC) (N = 24) after a diagnostic procedure including the MINI PLUS that was performed before treatment or WLC. Following a 3 months waiting period, the WL patients were randomized to CBT (n = 12) or TFT (n = 12), and all patients were reassessed after treatment or waiting period and at 12 months follow-up. At first we compared the three groups CBT, TFT, and WL. After the post WL randomization, we compared CBT (N = 12 + 24 = 36) to TFT (N = 12 + 24 = 36), applying the pre-treatment scores as baseline for all patients. The primary outcome measure was a symptom score from the Anxiety Disorders Interview Scale that was performed by an interviewer blinded to the treatment condition. For statistical comparisons, we used the independent sample’s t-test, the Fisher’s exact test and the ANOVA and ANCOVA tests. Results: Both CBT and TFT showed better results than the WLC (p < 0.001) at post-treatment. Post-treatment and at the 12-month follow-up, there were not significant differences between CBT and TFT (p = 0.33 and p = 0.90, respectively). Conclusion: This paper reports the first study comparing TFT to CBT for any disorder. The study indicated that TFT may be an efficient treatment for patients with agoraphobia. Trial Registration: https://clinicaltrials.gov/, identifier NCT00932919.