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Bryde Christensen AB, Dyrloev K, Hoej M, Poulsen S, Reinholt N, Arnfred S. "The Depressed" and "People with Anxiety" therapists' discursive representations of patients with depression and anxiety in Danish Psychiatry. Health (London) 2024; 28:390-411. [PMID: 37191112 DOI: 10.1177/13634593231173802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Stigmatization within mental health care has previously been identified, and some diagnoses have been shown to be particularly exposed to negative attitudes and stigma. However, no previous studies have explored practitioners' discursive construction of patients with different diagnoses within a transdiagnostic group context. We performed discourse analysis on 12 interviews with Danish mental health practitioners, who had been conducting either transdiagnostic psychotherapy (The Unified Protocol) or standard group cognitive behavioral therapy (CBT) with patients treated for anxiety disorders or major depressive disorder. The purpose of this study was to identify how patients with anxiety and depression were represented by therapists. We identified a "training discourse," within which patients were evaluated through perceived motivation, responsibility, active participation, and progression. We argue that this training discourse can be related to a broader neoliberal order of discourse valuing efficiency and agency. The analysis indicated that patients with anxiety were sometimes "favorized" over patients with depression, and it is argued that the neoliberal order of discourse and pre-assumptions related to the diagnoses are contributing to this. The interviews indicate that multiple discourses were applied when describing patients, and ambivalence was often detectable. We discuss the findings of the analysis in relation to therapists' general critical attitudes toward the psychiatric system and in relation to broader societal tendencies.
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Affiliation(s)
- Anne Bryde Bryde Christensen
- Center for Eating and Feeding Disorders Research, Capital Region of Denmark & Mental Health Services Region Zealand, Denmark
| | | | - Michaela Hoej
- Capital Region of Denmark Mental Health Services, Denmark
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Randau M, Reinholt N, Pernet C, Oranje B, Rasmussen BS, Arnfred S. Robust single-trial event-related potentials differentiate between distress and fear disorders. Psychophysiology 2024; 61:e14500. [PMID: 38073133 DOI: 10.1111/psyp.14500] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/24/2023] [Accepted: 11/21/2023] [Indexed: 04/17/2024]
Abstract
Recent evidence indicates that measures of brain functioning as indexed by event-related potentials (ERPs) on the electroencephalogram align more closely to transdiagnostic measures of psychopathology than to categorical taxonomies. The Hierarchical Taxonomy of Psychopathology (HiTOP) is a transdiagnostic, dimensional framework aiming to solve issues of comorbidity, symptom heterogeneity, and arbitrary diagnostic boundaries. Based on shared features, the emotional disorders are allocated into subfactors Distress and Fear. Evidence indicates that disorders that are close in the HiTOP hierarchy share etiology, symptom profiles, and treatment outcomes. However, further studies testing the biological underpinnings of the HiTOP are called for. In this study, we assessed differences between Distress and Fear in a range of well-studied ERP components. In total, 50 patients with emotional disorders were divided into two groups (Distress, N = 25; Fear, N = 25) according to HiTOP criteria and compared against 37 healthy comparison (HC) subjects. Addressing issues in traditional ERP preprocessing and analysis methods, we applied robust single-trial analysis as implemented in the EEGLAB toolbox LIMO EEG. Several ERP components were found to differ between the groups. Surprisingly, we found no difference between Fear and HC for any of the ERPs. This suggests that some well-established results from the literature, e.g., increased error-related negativity in OCD, are not a shared neurobiological correlate of the Fear subfactor. Conversely, for Distress, we found reductions compared to Fear and HC in several ERP components across paradigms. Future studies could utilize HiTOP-validated psychopathology measures to more precisely define subfactor groups.
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Affiliation(s)
- Martin Randau
- Research Unit for Psychotherapy & Psychopathology, Mental Health Service West, Copenhagen University Hospital - Psychiatry Region Zealand, Slagelse, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Nina Reinholt
- Psychiatric Research Unit, Copenhagen University Hospital - Psychiatry Region Zealand, Slagelse, Denmark
| | - Cyril Pernet
- Neurobiology Research Unit, Copenhagen University Hospital, Copenhagen, Denmark
| | - Bob Oranje
- Center for Neuropsychiatric Schizophrenia Research (CNSR), Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Copenhagen University Hospital, Copenhagen, Denmark
| | - Belinda S Rasmussen
- Psychiatric Research Unit, Copenhagen University Hospital - Psychiatry Region Zealand, Slagelse, Denmark
| | - Sidse Arnfred
- Research Unit for Psychotherapy & Psychopathology, Mental Health Service West, Copenhagen University Hospital - Psychiatry Region Zealand, Slagelse, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Psychiatric Research Unit, Copenhagen University Hospital - Psychiatry Region Zealand, Slagelse, Denmark
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Randau M, Bach B, Reinholt N, Pernet C, Oranje B, Rasmussen BS, Arnfred S. Transdiagnostic psychopathology in the light of robust single-trial event-related potentials. Psychophysiology 2024:e14562. [PMID: 38459627 DOI: 10.1111/psyp.14562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/25/2024] [Accepted: 02/24/2024] [Indexed: 03/10/2024]
Abstract
Recent evidence indicates that event-related potentials (ERPs) as measured on the electroencephalogram (EEG) are more closely related to transdiagnostic, dimensional measures of psychopathology (TDP) than to diagnostic categories. A comprehensive examination of correlations between well-studied ERPs and measures of TDP is called for. In this study, we recruited 50 patients with emotional disorders undergoing 14 weeks of transdiagnostic group psychotherapy as well as 37 healthy comparison subjects (HC) matched in age and sex. HCs were assessed once and patients three times throughout treatment (N = 172 data sets) with a battery of well-studied ERPs and psychopathology measures consistent with the TDP framework The Hierarchical Taxonomy of Psychopathology (HiTOP). ERPs were quantified using robust single-trial analysis (RSTA) methods and TDP correlations with linear regression models as implemented in the EEGLAB toolbox LIMO EEG. We found correlations at several levels of the HiTOP hierarchy. Among these, a reduced P3b was associated with the general p-factor. A reduced error-related negativity correlated strongly with worse symptomatology across the Internalizing spectrum. Increases in the correct-related negativity correlated with symptoms loading unto the Distress subfactor in the HiTOP. The Flanker N2 was related to specific symptoms of Intrusive Cognitions and Traumatic Re-experiencing and the mismatch negativity to maladaptive personality traits at the lowest levels of the HiTOP hierarchy. Our study highlights the advantages of RSTA methods and of using validated TDP constructs within a consistent framework. Future studies could utilize machine learning methods to predict TDP from a set of ERP features at the subject level.
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Affiliation(s)
- Martin Randau
- Research Unit for Psychotherapy & Psychopathology, Mental Health Service West, Copenhagen University Hospital - Psychiatry Region Zealand, Slagelse, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Bo Bach
- Psychiatric Research Unit, Copenhagen University Hospital - Psychiatry Region Zealand, Slagelse, Denmark
| | - Nina Reinholt
- Psychiatric Research Unit, Copenhagen University Hospital - Psychiatry Region Zealand, Slagelse, Denmark
| | - Cyril Pernet
- Neurobiology Research Unit, Copenhagen University Hospital, Copenhagen, Denmark
| | - Bob Oranje
- Center for Neuropsychiatric Schizophrenia Research (CNSR), Copenhagen University Hospital, Copenhagen, Denmark
| | - Belinda S Rasmussen
- Psychiatric Research Unit, Copenhagen University Hospital - Psychiatry Region Zealand, Slagelse, Denmark
| | - Sidse Arnfred
- Research Unit for Psychotherapy & Psychopathology, Mental Health Service West, Copenhagen University Hospital - Psychiatry Region Zealand, Slagelse, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Psychiatric Research Unit, Copenhagen University Hospital - Psychiatry Region Zealand, Slagelse, Denmark
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Hovmand OR, Reinholt N, Bryde Christensen A, Bach B, Eskildsen A, Arendt M, Hvenegaard M, Poulsen S, Arnfred SM. Utility of the Work and Social Adjustment Scale (WSAS) in predicting long-term sick-leave in Danish patients with emotional disorders. Nord J Psychiatry 2024; 78:14-21. [PMID: 37988055 DOI: 10.1080/08039488.2023.2226123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/11/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND The Work and Social Adjustment Scale (WSAS) is a self-administered measure designed to assess the level of inability to function socially as a consequence of a defined problem or disorder. METHODS A total of 230 patients with emotional disorders completed the Danish translation of the WSAS, measures of anxiety and depression, the Level of Personality Functioning Brief Form, the Personality Inventory for DSM-5 Short Form, and the World Health Organization Five-Item Well-Being Index (WHO-5). We conducted a confirmatory factor analysis of the previously suggested factor structure of the instrument. We furthermore evaluated the construct validity of the WSAS by means of its relationship with depression, anxiety, personality functioning, and overall well-being. Finally, we evaluated the utility of the WSAS to identify those on long-term sick-leave by conducting receiver operating characteristic (ROC) curves. RESULTS The instrument had a poor to average fit with the previously reported single-factor structure, but a better fit to a modified single-factor structure. Cronbach's alpha and McDonald's omega showed good internal scale reliability (α = .79, ωtotal = .85). WSAS was positively correlated with measures of anxiety (r = .33), depression (r = .44), and personality functioning (r = .23 and r = .20), and negatively correlated with WHO-5 wellbeing (r = -.57). The optimal cut-off point in the ROC-analyses was 23, which yielded a sensitivity of 74% and a specificity of 55% in the prediction of sick-leave status. DISCUSSION The Danish WSAS shows promising psychometric properties, but has limited external validity insofar as predicting long-term sick leave in psychiatric patients with emotional disorders.
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Affiliation(s)
- Oliver Rumle Hovmand
- Psychiatric Research Unit, Region Zealand Mental Health Service, Slagelse, Faelledvej 6, Slagelse, Denmark
- Department of Clinical Medicine, Faculty of Health, University of Copenhagen, Denmark
- Psychiatry South, Region Zealand Mental Health Services, Denmark
| | - Nina Reinholt
- Psychiatric Research Unit, Region Zealand Mental Health Service, Slagelse, Faelledvej 6, Slagelse, Denmark
| | | | - Bo Bach
- Neurocentre, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Anita Eskildsen
- Department of Affective Disorders, Aarhus University Hospital, Denmark
| | - Mikkel Arendt
- Department of Affective Disorders, Aarhus University Hospital, Denmark
| | - Morten Hvenegaard
- Neurocentre, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Stig Poulsen
- Department of Psychology, University of Copenhagen, Denmark
| | - Sidse M Arnfred
- Psychiatric Research Unit, Region Zealand Mental Health Service, Slagelse, Faelledvej 6, Slagelse, Denmark
- Department of Clinical Medicine, Faculty of Health, University of Copenhagen, Denmark
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Hovmand OR, Reinholt N, Christensen AB, Eskildsen A, Bach B, Arendt M, Poulsen S, Hvenegaard M, Arnfred SM. Affectivity in danish patients with emotional disorders: assessing the validity of the Positive and Negative Affect Schedule (PANAS). BMC Psychiatry 2023; 23:943. [PMID: 38093282 PMCID: PMC10720164 DOI: 10.1186/s12888-023-05450-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 12/07/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND The Positive and Negative Affect Schedule (PANAS) was designed to measure trait positive affect (PA) and trait negative affect (NA). METHODS The Danish PANAS was administered to outpatients with depression and anxiety disorders. Internal consistency was assessed using Cronbach's alpha and McDonald's omega and factorial structure was evaluated using confirmatory factor analysis (CFA). Convergent validity was evaluated by means of correlations with the negative affectivity and the detachment domain of the Personality Inventory for DSM-5 Short Form (PID-5-SF), the Hamilton Anxiety Rating Scale 6 (HARS-6) and the Hamilton Depression Rating Scale 6 (HDRS-6). RESULTS PANAS Scores of 256 patients were analyzed. Cronbach's alpha and McDonald's omega showed good internal consistency for both the PA score (alpha = .84 and omega = .89) and the NA score (alpha = .86 and omega = .90). CFA analysis confirmed a structure with two factors corresponding to the PA and NA factors. PA was negatively correlated with the detachment domain of PID-5 (r = -.47), HARS-6 (r = -.15) and HDRS-6 (r = -.37). NA was positively correlated with PID-5-SF negative affectivity domain (r = .43), HARS-6 (r = .51) and HDRS-6 (r = .52). DISCUSSION The Danish PANAS has promising internal consistency and construct validity, which are comparable to other studies of the instrument.
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Affiliation(s)
- Oliver Rumle Hovmand
- Psychiatric Research Unit, Region Zealand Mental Health Service, Faelledvej 6, 4200, Slagelse, Denmark.
- Department of Clinical Medicine, Faculty of Health, University of Copenhagen, Copenhagen, Denmark.
- Psychiatry South, Region Zealand Mental Health Services, Copenhagen, Denmark.
| | - Nina Reinholt
- Psychiatric Research Unit, Region Zealand Mental Health Service, Faelledvej 6, 4200, Slagelse, Denmark
| | | | - Anita Eskildsen
- Department of Affective Disorders, Aarhus University Hospital, Aarhus, Denmark
| | - Bo Bach
- Psychiatric Research Unit, Region Zealand Mental Health Services, Copenhagen, Denmark
| | - Mikkel Arendt
- Department of Affective Disorders, Aarhus University Hospital, Aarhus, Denmark
| | - Stig Poulsen
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Morten Hvenegaard
- Neurocentre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sidse M Arnfred
- Psychiatric Research Unit, Region Zealand Mental Health Service, Faelledvej 6, 4200, Slagelse, Denmark
- Department of Clinical Medicine, Faculty of Health, University of Copenhagen, Copenhagen, Denmark
- Psychiatric Research Unit, Region Zealand Mental Health Services, Copenhagen, Denmark
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Niemeijer M, Reinholt N, Poulsen S, Bach B, Christensen AB, Eskildsen A, Hvenegaard M, Arendt M, Arnfred S. Trait and symptom change in group cognitive behaviour therapy for anxiety and depression. Clin Psychol Psychother 2023; 30:1058-1070. [PMID: 37106559 DOI: 10.1002/cpp.2857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 04/08/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023]
Abstract
Personality traits underlying both anxiety disorders and depression are more malleable than previously presumed. This study examined associations between changes in personality traits (i.e. negative affectivity and detachment) and alleviation of anxiety and depression symptoms following cognitive behaviour therapy (CBT). We hypothesized that decreases in negative affectivity would predict alleviation of depression and anxiety symptoms and decreases in detachment would predict decreases in depression and, to a lesser degree, anxiety symptoms. Data (N = 156) were collected in a randomized controlled trial comparing transdiagnostic and diagnosis-specific group CBT for patients with major depressive disorder, social anxiety disorder, panic disorder or agoraphobia. We assessed personality traits using the Personality Inventory for DSM-5 (PID-5) and symptoms with the Hopkins Symptom Checklist 25-item scale (SCL). Prediction was based on regression analyses. We found that decreases in negative affectivity predicted lower levels of depression and anxiety symptoms while decreases in detachment only predicted lower levels of depression symptoms. The findings substantiate current efforts to explicate the dynamic interplay between personality traits and symptoms and support the existing focus on targeting negative affectivity and detachment in therapy for anxiety disorders and depression. The trial is registered at clinicaltrials.gov (ID NCT02954731).
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Affiliation(s)
- Miriam Niemeijer
- Department of Psychology, University of Copenhagen, Copenhagen K, Denmark
| | - Nina Reinholt
- Research Unit for Psychotherapy & Psychopathology, Copenhagen University Hospital-Psychiatry Region Zealand, Slagelse, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
- Psychotherapeutical Clinic, Psychiatric Center Copenhagen, Copenhagen Ø, Denmark
| | - Stig Poulsen
- Department of Psychology, University of Copenhagen, Copenhagen K, Denmark
| | - Bo Bach
- Research Unit for Psychotherapy & Psychopathology, Copenhagen University Hospital-Psychiatry Region Zealand, Slagelse, Denmark
- Center for Personality Disorder Research, Psychiatric Research Unit, Copenhagen University Hospital-Psychiatry Region Zealand, Slagelse, Denmark
| | - Anne Bryde Christensen
- Research Unit for Psychotherapy & Psychopathology, Copenhagen University Hospital-Psychiatry Region Zealand, Slagelse, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| | - Anita Eskildsen
- Department of Affective Disorders, Aarhus University Hospital, Aarhus, Denmark
| | - Morten Hvenegaard
- Research Unit for Psychotherapy & Psychopathology, Copenhagen University Hospital-Psychiatry Region Zealand, Slagelse, Denmark
| | - Mikkel Arendt
- Department of Affective Disorders, Aarhus University Hospital, Aarhus, Denmark
| | - Sidse Arnfred
- Research Unit for Psychotherapy & Psychopathology, Copenhagen University Hospital-Psychiatry Region Zealand, Slagelse, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
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Hovmand OR, Reinholt N, Dichmann K, Borisov R, Arnfred S. Social phobia and evasiveness: trial protocol for a randomized controlled feasibility and superiority trial of the effect of Modified Collaborative Assessment vs. standard assessment on patients' readiness for psychotherapy (CO-ASSM-RCT). Pilot Feasibility Stud 2023; 9:102. [PMID: 37340450 DOI: 10.1186/s40814-023-01332-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 05/26/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Evasive personality disorder (AvPD) and social phobia (SP) have substantial costs for patients and their families and great economic costs to the society. While psychotherapy can be an efficacious treatment, many patients drop out during treatment. Increased knowledge on how to decrease dropout from psychotherapy is warranted, including how to increase a patient's readiness for psychotherapy. METHODS We describe a randomized controlled feasibility and superiority trial of 42 individuals with a clinical diagnosis of either SP or AvPD, who are to initiate psychotherapeutic treatment in Danish outpatient mental health services. They will be randomized in a 1:1 ratio to either assessment-as-usual and receive no further assessment or to a Modified Collaborative Assessment (MCA) provided as a pre-treatment intervention before psychotherapy initiation. MCA will include a battery of psychological tests designed to thoroughly assess the patients' psychopathology. The tests are administered in collaboration with the patient, including detailed oral and written feedback. We hypothesize that the intervention is feasible regarding patient's acceptance and adherence. We further hypothesize that patients randomized to MCA will reach higher levels of readiness for psychotherapy as assessed with the University of Rhode Island Change Assessment Scale (URICA). DISCUSSION This protocol assesses the feasibility, efficacy, acceptability, and safety of an intervention aimed at changing the readiness for participation in psychotherapy of patients with SP and AvPD. Results from this feasibility study could guide the development of future large-scale trials of MCA and procedures for MCA treatment fidelity assessment. TRIAL REGISTRATION NCT2021001.
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Affiliation(s)
- Oliver Rumle Hovmand
- Department of Clinical Medicine, Faculty of Health, University of Copenhagen, Copenhagen, Denmark.
- Psychiatric Research Unit, Region Zealand Mental Health Service, Fælledvej 6, 4200, Slagelse, Denmark.
| | - Nina Reinholt
- Psychiatric Research Unit, Region Zealand Mental Health Service, Fælledvej 6, 4200, Slagelse, Denmark
| | - Kirstine Dichmann
- Department of Clinical Medicine, Faculty of Health, University of Copenhagen, Copenhagen, Denmark
- Research Unit for Psychotherapy and Psychopathology, Region Zealand Mental Health Service, Fælledvej 6, 4200, Slagelse, Denmark
- Department of Forensic Psychiatry, Region Zealand Mental Health Service, Slagelse, Denmark
| | - Radoslav Borisov
- Psychiatry South, Region Zealand Mental Health Service, Ramsherred 1, 1. Sal, 4700, Naestved, Denmark
| | - Sidse Arnfred
- Department of Clinical Medicine, Faculty of Health, University of Copenhagen, Copenhagen, Denmark
- Psychiatric Research Unit, Region Zealand Mental Health Service, Fælledvej 6, 4200, Slagelse, Denmark
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Á Steig DH, Reinholt N, Christensen AB, Hvenegaard Pedersen M, Arnfred SM. Patient-reported outcome measures in depression. Nord J Psychiatry 2023; 77:212-219. [PMID: 35848935 DOI: 10.1080/08039488.2022.2074136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
AIM Patient-reported outcome measures (PROMs) are increasingly important as a mean for quality assurance. Feasible estimates of recovery can be achieved through the application of Jacobson plots, which is a simple demonstration of the outcome of each case, recommended for clinical use. We applied this approach with PROMs collected regarding group psychotherapy in a mental health service (MHS) setting. We hypothesized a recovery rate of above 50% of all cases, expecting a lower recovery rate amongst patients with severe depression. METHODS We made a secondary sub-sample analysis of data from patients with unipolar depression (N = 171) within a pragmatic, non-inferiority, randomized controlled clinical trial comparing two cognitive behavior therapy (CBT) group interventions. The treatment consisted of 14 2-hours weekly group CBT sessions. We collected depression PROMs with the Becks Depression Inventory-II and functional levels PROMs with the Work and Social Adjustment Scale at baseline, end-of-treatment, and at a 6-months follow-up. RESULTS At follow-up, 35% (N = 43/123) of cases with moderate or severe depression (BDI > 19) at baseline reached scores below the cut-off for moderate depression. Recovery rates in severe cases were significantly lower (26.5 vs 52.5%; p = 0.0004). We observed severe functional impairment in 36% of the patients at baseline (52/144) and observed no changes or worsening in scores at a 6-months follow-up in 44% of the patients (64/144). CONCLUSION We achieved satisfactory remission rates for patients with moderate depression. Patients with severe depression and patients with functional impairment reached recovery rates below the standard of comparable MHSs. Improved MHSs for these patients are needed.
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Affiliation(s)
| | - Nina Reinholt
- Research Unit for Psychotherapy & Psychopathology, Mental Health Service West, Copenhagen University Hospital - Psychiatry Region Zealand, Slagelse, Denmark
| | - Anne Bryde Christensen
- Research Unit for Psychotherapy & Psychopathology, Mental Health Service West, Copenhagen University Hospital - Psychiatry Region Zealand, Slagelse, Denmark
| | - Morten Hvenegaard Pedersen
- Mental Health Centre, Ballerup, Mental Health Service Capital Region, Copenhagen University Hospital, Ballerup, Denmark
| | - Sidse Marie Arnfred
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Research Unit for Psychotherapy & Psychopathology, Mental Health Service West, Copenhagen University Hospital - Psychiatry Region Zealand, Slagelse, Denmark
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Hovmand OR, Storebø OJ, Reinholt N, Gryesten JR, Arnfred SM. What is the effect of using collaborative assessment on symptomatology as an intervention in the treatment of mental illness? A systematic review and meta-analysis protocol. Syst Rev 2022; 11:244. [PMID: 36397127 PMCID: PMC9673370 DOI: 10.1186/s13643-022-02124-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 11/08/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Clinicians usually conduct diagnostic assessments in order to establish a diagnosis or to evaluate the effect of treatment. Two meta-analyses suggest that diagnostic assessment administered in collaboration with the patient and personalized feedback might have a therapeutic effect. METHODS We aim to conduct a systematic review and meta-analysis of the effect on symptomatology when using assessment as a therapeutic intervention for patients with psychiatric illnesses. We will search in five relevant electronic databases. Two reviewers will independently select papers following pre-defined eligibility criteria, extract data, and assess the quality of included studies. Randomized controlled trials comparing the effect of psychological assessment with other psychotherapeutic interventions in populations of patients will be included in the meta-analysis. We will extract data on symptom-related outcomes, quality of life, dropout, and re-diagnosis and use meta-analysis techniques to compute the effect size of interventions using assessment as a psychotherapeutic intervention. The review will be conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Risk of bias will be assessed by using the Risk of Bias tool RoB 2.0 of the Cochrane Collaboration, and the certainty of the body of evidence will be assessed with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. DISCUSSION THE RESULTS WILL BE ABLE TO INFORM CLINICIANS AND POLICYMAKERS ON THE EFFECT OF ASSESSMENT AND, DEPENDING ON THE RESULTS, COULD LEAD TO A RECOMMENDATION FOR MODIFIED ASSESSMENT PROCEDURES AND APPROACHES IN MENTAL HEALTH SERVICES. ULTIMATELY, IT MIGHT IMPROVE THE TREATMENT OUTCOME IN MENTAL HEALTH SERVICES.: SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42021270567.
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Affiliation(s)
- Oliver Rumle Hovmand
- Region Zealand Mental Health Service, Research Unit for Psychotherapy and Psychopathology & Psychiatry South, Slagelse, Faelledvej 6, 4200, Slagelse, Denmark. .,Department of Clinical Medicine, Faculty of Health, University of Copenhagen, Copenhagen, Denmark.
| | - Ole Jakob Storebø
- Region Zealand Mental Health Services, Psychiatric Research Unit, Center for Evidence-Based Psychiatry, Slagelse, Denmark.,Department of Psychology, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Nina Reinholt
- Region Zealand Mental Health Service, Research Unit for Psychotherapy and Psychopathology & Psychiatry South, Slagelse, Faelledvej 6, 4200, Slagelse, Denmark
| | - Jasmin Rejaye Gryesten
- Region Zealand Mental Health Service, Research Unit for Psychotherapy and Psychopathology & Psychiatry South, Slagelse, Faelledvej 6, 4200, Slagelse, Denmark.,Department of Clinical Medicine, Faculty of Health, University of Copenhagen, Copenhagen, Denmark
| | - Sidse M Arnfred
- Region Zealand Mental Health Service, Research Unit for Psychotherapy and Psychopathology & Psychiatry South, Slagelse, Faelledvej 6, 4200, Slagelse, Denmark.,Department of Clinical Medicine, Faculty of Health, University of Copenhagen, Copenhagen, Denmark
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Christensen AB, Rejaye Gryesten J, Kokholm J, Vislie K, Reinholt N, Dichmann K, Poulsen S, Arnfred S. The unified protocol: patient and therapist perspectives on the utility of the group manual. CLIN PSYCHOL-UK 2022. [DOI: 10.1080/13284207.2022.2061340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Anne Bryde Christensen
- Research Unit for Psychotherapy & Psychopathology, Mental Health Service West, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jasmin Rejaye Gryesten
- Research Unit for Psychotherapy & Psychopathology, Mental Health Service West, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Julie Kokholm
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Kitty Vislie
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Nina Reinholt
- Research Unit for Psychotherapy & Psychopathology, Mental Health Service West, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kirstine Dichmann
- Research Unit for Psychotherapy & Psychopathology, Mental Health Service West, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Stig Poulsen
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Sidse Arnfred
- Research Unit for Psychotherapy & Psychopathology, Mental Health Service West, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Bryde Christensen A, Pavlo AJ, Davidson L, Poulsen S, Reinholt N, Hvenegaard M, Simonsen E, Arnfred S. Does one treatment benefit all? Patients’ experiences of standardized group CBT for anxiety and depression. Curr Psychol 2022. [DOI: 10.1007/s12144-022-02820-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Arnfred SM, Reinholt N. [Transdiagnostic cognitive behaviour therapy for anxiety disorders]. Ugeskr Laeger 2022; 184:V09210684. [PMID: 35179114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Evidence-based diagnosis specific cognitive behaviour therapy (CBT) protocols for anxiety disorders, currently recommended in national clinical guidelines, have shortcomings in relation to the application of group therapy in the mental health service. Transdiagnostic CBT is theory-driven, targeting common personality traits and emotion-driven behaviour observed in all of the anxiety disorders. This review recapitulates the theory and the evidence base. More head-to-head comparison studies are needed, in particular concerning group therapy. The current evidence is, however, very promising.
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Affiliation(s)
- Sidse Marie Arnfred
- Forskningsenhed for Psykoterapi og Psykopatologi, Psykiatrien Vest, Slagelse, Københavns Universitetshospital - Psykiatrien Region Sjælland
- Institut for Klinisk Medicin, Københavns Universitet
| | - Nina Reinholt
- Forskningsenhed for Psykoterapi og Psykopatologi, Psykiatrien Vest, Slagelse, Københavns Universitetshospital - Psykiatrien Region Sjælland
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Reinholt N, Hvenegaard M, Christensen AB, Eskildsen A, Hjorthøj C, Poulsen S, Arendt MB, Rosenberg NK, Gryesten JR, Aharoni RN, Alrø AJ, Christensen CW, Arnfred SM. Transdiagnostic versus Diagnosis-Specific Group Cognitive Behavioral Therapy for Anxiety Disorders and Depression: A Randomized Controlled Trial. Psychother Psychosom 2022; 91:36-49. [PMID: 34111874 DOI: 10.1159/000516380] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 04/07/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) delivered in a group format could facilitate the implementation of evidence-based psychological treatments. OBJECTIVE This study compared the efficacy of group UP and diagnosis-specific cognitive behavioral therapy (dCBT) for anxiety and depression in outpatient mental health services. METHODS In this pragmatic, multi-center, single-blinded, non-inferiority, randomized controlled trial (RCT), we assigned 291 patients with major depressive disorder, social anxiety disorder, panic disorder, or agoraphobia to 14 weekly sessions in mixed-diagnosis UP or single-diagnosis dCBT groups. The primary test was non-inferiority, using a priori criteria, on the World Health Organisation 5 Well-Being Index (WHO-5) at the end of the treatment. Secondary outcomes were functioning and symptoms. We assessed outcomes at baseline, end-of-treatment, and at a 6-month follow-up. A modified per-protocol analysis was performed. RESULTS At end-of-treatment, WHO-5 mean scores for patients in UP (n = 148) were non-inferior to those of patients in dCBT (n = 143; mean difference -2.94; 95% CI -8.10 to 2.21). Results were inconclusive for the WHO-5 at the 6-month follow-up. Results for secondary outcomes were non-inferior at end-of-treatment and the 6-month follow-up. Client satisfaction and rates of attrition, response, remission, and deterioration were similar across conditions. CONCLUSIONS This RCT demonstrated non-inferior acute-phase outcomes of group-delivered UP compared with dCBT for major depressive disorder, social anxiety disorder, panic disorder, and agoraphobia in outpatient mental health services. The long-term effects of UP on well-being need further investigation. If study findings are replicated, UP should be considered a viable alternative to dCBT for common anxiety disorders and depression in outpatient mental health services.
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Affiliation(s)
- Nina Reinholt
- Research Unit for Psychotherapy and Psychopathology, Mental Health Service West, Copenhagen University Hospital, Psychiatry Region Zealand, Slagelse, Denmark.,Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Morten Hvenegaard
- Competency Center for Rehabilitation and Recovery, Mental Health Center Ballerup, Ballerup, Denmark
| | - Anne Bryde Christensen
- Research Unit for Psychotherapy and Psychopathology, Mental Health Service West, Copenhagen University Hospital, Psychiatry Region Zealand, Slagelse, Denmark
| | - Anita Eskildsen
- Department of Affective Disorders, Aarhus University Hospital, Aarhus, Denmark
| | - Carsten Hjorthøj
- Copenhagen Research Center for Mental Health, CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - Stig Poulsen
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Berg Arendt
- Department of Affective Disorders, Aarhus University Hospital, Aarhus, Denmark
| | | | - Jasmin Rejaye Gryesten
- Research Unit for Psychotherapy and Psychopathology, Mental Health Service West, Copenhagen University Hospital, Psychiatry Region Zealand, Slagelse, Denmark
| | - Ruth Nielsen Aharoni
- Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anja Johnsen Alrø
- Department of Affective Disorders, Aarhus University Hospital, Aarhus, Denmark
| | | | - Sidse Marie Arnfred
- Research Unit for Psychotherapy and Psychopathology, Mental Health Service West, Copenhagen University Hospital, Psychiatry Region Zealand, Slagelse, Denmark.,Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Bryde Christensen A, Wahrén S, Reinholt N, Poulsen S, Hvenegaard M, Simonsen E, Arnfred S. "Despite the Differences, We Were All the Same". Group Cohesion in Diagnosis-Specific and Transdiagnostic CBT Groups for Anxiety and Depression: A Qualitative Study. Int J Environ Res Public Health 2021; 18:5324. [PMID: 34067758 PMCID: PMC8157163 DOI: 10.3390/ijerph18105324] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/11/2021] [Accepted: 05/13/2021] [Indexed: 11/16/2022]
Abstract
Group cohesion refers to a sense of belonging, mutual support and identification with other group members. Group cohesion has been associated with better outcomes, lower drop-out rates, more interpersonal support and better participation in psychotherapy. Nevertheless, the role of group cohesion in CBT has not yet received much attention. The rationale for delivering CBT in groups is that patients can model themselves through each other due to their similarities in symptoms. However, there has recently been a shift towards transdiagnostic CBT protocols, in which patients with varied diagnoses participate in the same groups. This shift challenges the rationale of delivering CBT in groups, and it is therefore highly important to understand if and how group cohesion develops in mixed diagnoses CBT groups. The current study used a qualitative comparative framework to investigate the patients' experiences of group cohesion in diagnosis-specific versus transdiagnostic CBT groups. Twenty-three patients were interviewed with semi-structured interviews upon completion of the treatment. Participants had a primary diagnosis of MDD, panic disorder, agoraphobia or social anxiety disorder. A comparative thematic analysis was carried out. Three themes were found: the move from differences to similarities, the role of group cohesion in group CBT and factors helpful and hindering to group cohesion. Group cohesion developed across groups and was considered highly important in both diagnosis-specific and transdiagnostic CBT groups.
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Affiliation(s)
- Anne Bryde Christensen
- Research Unit for Psychotherapy & Psychopathology, Psychiatry West, Region Zealand, 4200 Slagelse, Denmark; (N.R.); (S.A.)
| | - Signe Wahrén
- Department of Psychology, University of Copenhagen, 1353 København K, Denmark; (S.W.); (S.P.)
| | - Nina Reinholt
- Research Unit for Psychotherapy & Psychopathology, Psychiatry West, Region Zealand, 4200 Slagelse, Denmark; (N.R.); (S.A.)
| | - Stig Poulsen
- Department of Psychology, University of Copenhagen, 1353 København K, Denmark; (S.W.); (S.P.)
| | - Morten Hvenegaard
- Mental Health Services, Capital Region of Denmark, 2200 København N, Denmark;
| | - Erik Simonsen
- Psychiatric Research Unit, Region Zealand, 4200 Slagelse, Denmark;
- Department of Clinical Medicine, University of Copenhagen, 2200 København N, Denmark
| | - Sidse Arnfred
- Research Unit for Psychotherapy & Psychopathology, Psychiatry West, Region Zealand, 4200 Slagelse, Denmark; (N.R.); (S.A.)
- Department of Clinical Medicine, University of Copenhagen, 2200 København N, Denmark
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Bryde Christensen A, Svart N, Bokelund H, Reinholt N, Eskildsen A, Poulsen S, Hvenegaard M, Simonsen E, Arnfred S. Therapists' Perceptions of Individual Patient Characteristics that May Be Hindering to Group CBT for Anxiety and Depression. Psychiatry 2020; 83:344-357. [PMID: 33064967 DOI: 10.1080/00332747.2020.1800292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objective: Individual patient characteristics are important in trying to understand why people respond differently to group CBT. Only a few studies have explored therapists' perceptions of within-patient attributes that may be hindering in group CBT in a mental health setting. Method: We explored the perception of individual patient characteristics and related obstacles in 12 psychotherapists in Danish Mental Health Services through semi-structured interviews. The interviews were analyzed using a descriptive qualitative framework. Results: The results revealed four distinct themes that the therapists pointed to as important for the outcome of a 14-week group CBT intervention for social phobia, panic disorder, agoraphobia and major depressive disorder. The four themes were Complexity & severity, External circumstances, Attitudes & coping and Cognitive ability & reflection level. The therapists explained how they perceived higher complexity and severity in the patients as an obstacle, they highlighted that a calm and stable outside environment aided therapeutic change, whilst stressors were hindering. They perceived active coping mechanisms, positive attitudes and high readiness to change as positive factors, whilst dependent and hostile coping mechanisms and negative attitudes were seen as obstacles. Finally, the therapists pointed to cognitive abilities and reflection level, explaining how it could be difficult to obtain good outcomes for patients who's cognitive abilities were debilitated due to psychopathological factors or for patients with a generally low reflection level. Conclusions: The results indicated that the therapists experience group CBT as an intervention that requires certain prerequisites of the patients, and that the four themes should be considered when deciding on treatment options for any given patient. The clinical utility and theoretical implications of the results are discussed.
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Arnfred SM, Aharoni R, Hvenegaard M, Poulsen S, Bach B, Arendt M, Rosenberg NK, Reinholt N. Transdiagnostic group CBT vs. standard group CBT for depression, social anxiety disorder and agoraphobia/panic disorder: Study protocol for a pragmatic, multicenter non-inferiority randomized controlled trial. BMC Psychiatry 2017; 17:37. [PMID: 28114915 PMCID: PMC5260024 DOI: 10.1186/s12888-016-1175-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 12/23/2016] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Transdiagnostic Cognitive Behavior Therapy (TCBT) manuals delivered in individual format have been reported to be just as effective as traditional diagnosis specific CBT manuals. We have translated and modified the "The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders" (UP-CBT) for group delivery in Mental Health Service (MHS), and shown effects comparable to traditional CBT in a naturalistic study. As the use of one manual instead of several diagnosis-specific manuals could simplify logistics, reduce waiting time, and increase therapist expertise compared to diagnosis specific CBT, we aim to test the relative efficacy of group UP-CBT and diagnosis specific group CBT. METHODS/DESIGN The study is a partially blinded, pragmatic, non-inferiority, parallel, multi-center randomized controlled trial (RCT) of UP-CBT vs diagnosis specific CBT for Unipolar Depression, Social Anxiety Disorder and Agoraphobia/Panic Disorder. In total, 248 patients are recruited from three regional MHS centers across Denmark and included in two intervention arms. The primary outcome is patient-ratings of well-being (WHO Well-being Index, WHO-5), secondary outcomes include level of depressive and anxious symptoms, personality variables, emotion regulation, reflective functioning, and social adjustment. Assessments are conducted before and after therapy and at 6 months follow-up. Weekly patient-rated outcomes and group evaluations are collected for every session. Outcome assessors, blind to treatment allocation, will perform the observer-based symptom ratings, and fidelity assessors will monitor manual adherence. DISCUSSION The current study will be the first RCT investigating the dissemination of the UP in a MHS setting, the UP delivered in groups, and with depressive patients included. Hence the results are expected to add substantially to the evidence base for rational group psychotherapy in MHS. The planned moderator and mediator analyses could spur new hypotheses about mechanisms of change in psychotherapy and the association between patient characteristics and treatment effect. TRIAL REGISTRATION Clinicaltrials.gov NCT02954731 . Registered 25 October 2016.
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Affiliation(s)
- Sidse M. Arnfred
- Psychiatric Hospital Slagelse & Psychiatric Research Unit, Region Zealand Psychiatry, Faelledvej 6, Building 3, Level 4., DK-4200 Slagelse, Denmark
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ruth Aharoni
- Psychotherapeutic Clinic Nannasgade, Mental Health Centre Copenhagen, Capital Region Mental Health Services, Copenhagen University Hospital, Copenhagen, Denmark
| | - Morten Hvenegaard
- Psychiatric Hospital Slagelse & Psychiatric Research Unit, Region Zealand Psychiatry, Faelledvej 6, Building 3, Level 4., DK-4200 Slagelse, Denmark
| | - Stig Poulsen
- Department of Psychology, Faculty of Social Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Bo Bach
- Psychiatric Hospital Slagelse & Psychiatric Research Unit, Region Zealand Psychiatry, Faelledvej 6, Building 3, Level 4., DK-4200 Slagelse, Denmark
| | - Mikkel Arendt
- Unit for Anxiety and Compulsive Disorders, Psychiatric Hospital Risskov, Aarhus University Hospital, Aarhus, Denmark
| | - Nicole K. Rosenberg
- Psychotherapeutic Clinic Nannasgade, Mental Health Centre Copenhagen, Capital Region Mental Health Services, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nina Reinholt
- Psychotherapeutic Clinic Nannasgade, Mental Health Centre Copenhagen, Capital Region Mental Health Services, Copenhagen University Hospital, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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Reinholt N, Aharoni R, Winding C, Rosenberg N, Rosenbaum B, Arnfred S. Transdiagnostic group CBT for anxiety disorders: the unified protocol in mental health services. Cogn Behav Ther 2016; 46:29-43. [PMID: 27705086 DOI: 10.1080/16506073.2016.1227360] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Comorbidity among the anxiety disorders is common and may negatively impact treatment outcome. Potentially, transdiagnostic cognitive-behavioral treatments (CBT) deal more effectively with comorbidity than standard CBT. The present study tested the effectiveness of The Unified Protocol (UP) applied to Mental Health Services. Pre-post-treatment effects were examined for psychiatric outpatients with anxiety disorders receiving UP treatment in groups. Forty-seven patients (mean-age = 34.1 (SD = 9.92), 77% females) with a principal diagnosis of anxiety were included. We found significant and clinically meaningful changes in the primary outcomes Clinical Global Impression Severity Scale (CGI-S; d = 1.36), Hamilton Anxiety Scale (HARS; d = .71), and WHO-5 Well-being Index (WHO-5; d = .54). Also, comorbid depressive symptoms and levels of positive and negative affect changed significantly after treatment. Patients with high levels of comorbidity profited as much as patients with less comorbidity; however, these patients had higher scores after treatment due to higher symptom burden at onset. Patients with comorbid depression profited more from treatment than patients without comorbid depression. The treatment effects found in the present study correspond to treatment effects of other TCBT studies, other UP group studies, and effectiveness studies on standard CBT for outpatients. The results indicate that the UP can be successfully applied to a MHS group setting, demonstrating positive effects on anxiety and depressive symptoms for even highly comorbid cases.
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Affiliation(s)
- Nina Reinholt
- a Faculty of Health Sciences, Mental Health Centre Copenhagen , University of Copenhagen , Copenhagen , Denmark
| | - Ruth Aharoni
- b Mental Health Centre of Copenhagen , Mental Health Services Capital Region of Denmark , Copenhagen , Denmark
| | - Clas Winding
- b Mental Health Centre of Copenhagen , Mental Health Services Capital Region of Denmark , Copenhagen , Denmark
| | - Nicole Rosenberg
- b Mental Health Centre of Copenhagen , Mental Health Services Capital Region of Denmark , Copenhagen , Denmark
| | - Bent Rosenbaum
- c Department of Psychology , University of Copenhagen , Copenhagen , Denmark
| | - Sidse Arnfred
- d Faculty of Health and Medical Science , University of Copenhagen , Copenhagen , Denmark
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Reinholt N, Krogh J. Efficacy of transdiagnostic cognitive behaviour therapy for anxiety disorders: a systematic review and meta-analysis of published outcome studies. Cogn Behav Ther 2014; 43:171-84. [PMID: 24646219 DOI: 10.1080/16506073.2014.897367] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Transdiagnostic approaches to cognitive behaviour therapy (TCBT) of anxiety disorders have drawn increasing interest and empirical testing over the past decade. In this paper, we review evidence of the overall efficacy of TCBT for anxiety disorders, as well as TCBT efficacy compared with wait-list, treatment-as-usual, and diagnosis-specific cognitive behaviour therapy (CBT) controls. A total of 11 studies reporting 12 trials (n = 1933) were included in the systematic review. Results from the meta-analysis of 11 trials suggest that TCBT was generally associated with positive outcome; TCBT patients did better than wait-list and treatment-as-usual patients, and treatment gains were maintained through follow-up. The pooled estimate showed a moderate treatment effect, however with large heterogeneity suggesting differences in treatment effects between the studies. Also, all the included trials, apart from one, were judged to be associated with a high risk of bias. Only one study compared TCBT with diagnosis-specific CBT suggesting treatment effect of TCBT to be as strong as diagnosis-specific CBT. This study not only cautiously supports evidence for the efficacy of TCBT, but also suggests the need for more high-quality, large-scaled studies in this area. Transdiagnostic treatments offer great clinical promise as an affordable and pragmatic treatment for anxiety disorders and as a specialized treatment for co-morbid and other-specified anxiety disorders.
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Affiliation(s)
- Nina Reinholt
- a Mental Health Centre Copenhagen, Faculty of Health Sciences , University of Copenhagen , Copenhagen , Denmark
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Abstract
The aim of this study was to assess post-traumatic stress disorder (PTSD) and predictors of PTSD in individuals who experienced the loss of a close relative to cancer. A total of 251 bereaved relatives ages 14 to 76 (M = 41.3, SD = 16.8) were recruited at a counseling service for cancer patients and their relatives. The prevalence of current probable PTSD was 40% in the bereaved sample. A hierarchical logistic regression analysis indicated that full-time employment, perceived control, and a secure attachment style moderated the risk for PTSD. Moreover, a long period of caretaking, high levels of somatization, and dissociation were all associated with an increased risk of PTSD.
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Affiliation(s)
- Ask Elklit
- National Center for Psychotraumatology, SDU, Odense, Denmark.
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