Cognitive therapy is a fairly new form of psychotherapy. The article compares this form of therapy with the more common psychodynamic oriented psychotherapy on the one side and behavioural therapy on the other side. The authors define the... more
Cognitive therapy is a fairly new form of psychotherapy. The article compares this form of therapy with the more common psychodynamic oriented psychotherapy on the one side and behavioural therapy on the other side. The authors define the most common terms in cognitive therapy (basic beliefs and automatic thoughts), and describe the content of the therapy. Finally they outline the areas where cognitive therapy has been proven most beneficial (treatment of depression, anxiety states, chronic pain, psychosomatics and increase in patient compliance), and discuss the future use of cognitive therapy in Norway.
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Research Interests: Quality of life, Helicobacter pylori, Discriminant Analysis, Humans, Smoking, and 17 moreFemale, Male, Blood groups, Dyspepsia, Differential Diagnosis, Risk factors, Clinical Sciences, Psychological distress, Adult, Health Care System, Somatoform disorders, Age Factors, Functional Dyspepsia, Risk Factors, Boolean Satisfiability, Duodenal Ulcer, and attitude to health
Because non-ulcer dyspepsia is associated with stress and motility disturbances it is now called functional dyspepsia. Compared with healthy persons, patients with functional dyspepsia are characterized by poor vagal tone, wider gastric... more
Because non-ulcer dyspepsia is associated with stress and motility disturbances it is now called functional dyspepsia. Compared with healthy persons, patients with functional dyspepsia are characterized by poor vagal tone, wider gastric antrum both fasting and postprandially, lack of stress-related repression of antral motility and meal-induced dyspeptic symptoms. Postprandial discomfort is related to antral distension. Poor vagal tone may cause antral distension and dysmotility as well as symptoms in these patients. Treatment programmes or drugs which improve vagal tone may be beneficial.
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Research Interests: Anxiety Disorders, Life Style, Comorbidity, Psychosomatic Medicine, Norway, and 15 moreHumans, Female, Male, Data Collection, Depressive Disorder, Health Status, Aged, Prevalence, Middle Aged, Questionnaires, Adult, Sex Factors, Somatoform disorders, Age Factors, and Psychiatric Status Rating Scales
Patients with functional dyspepsia (FD) have more complaints than just the dyspepsia. One hundred FD patients were assessed with regard to psychologic, medical, and social factors, before randomization, in a study of cognitive therapy.... more
Patients with functional dyspepsia (FD) have more complaints than just the dyspepsia. One hundred FD patients were assessed with regard to psychologic, medical, and social factors, before randomization, in a study of cognitive therapy. They were asked to list their main problem areas or 'target complaints'. Dyspepsia was the third most frequent target complaint (26 patients), and anxiety was the most frequent one (65 patients). Patients identifying dyspepsia as a target complaint differed from the other FD patients in several aspects. They had significantly more dyspeptic symptoms (p < 0.05) and scored significantly higher on multiple somatic complaints (p = 0.001), depression (p = 0.025), general psychopathology (p = 0.043), the global assessment scale (p = 0.001), and the General Health Questionnaire (p = 0.040). However, they did not have more somatic predisposing factors like consumption of alcohol and coffee or infection with Helicobacter pylori than the patients with other target complaints. Anxiety and not dyspepsia was the most frequent target complaint, and patients who identified dyspepsia as a target complaint did not have more somatic predisposing factors.
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The aim of this study was to examine whether Helicobacter pylori status can identify a specific subset of patients with functional dyspepsia (FD) and erosive prepyloric changes (EPC). Anamnestic, somatic, and psychologic data were... more
The aim of this study was to examine whether Helicobacter pylori status can identify a specific subset of patients with functional dyspepsia (FD) and erosive prepyloric changes (EPC). Anamnestic, somatic, and psychologic data were collected from 87 patients with functional dyspepsia and 77 normal control persons. Presence of H. pylori infection was assessed by the 14C-urea breath test. H. pylori infection increased with age. Thirty-four per cent of the patients were H. pylori-positive, compared with 36% of the control persons. The patients had higher scores than the normal control persons on psychologic measures regardless of H. pylori status. Of 27 variables analyzed, age was the only factor that discriminated between H. pylori-positive and -negative patients. For most patients with FD and EPC the presence of H. pylori infection is probably a consequence of age, and it does not seem to help us in the search for factors that can identify a subset of patients within our group of FD patients.
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Research Interests: Epidemiology, Depression, Risk assessment, Community, Comorbidity, and 20 moreProbability, Anxiety, Norway, Humans, Female, Male, Depressive Disorder, Risk factors, Clinical Sciences, Scandinavian, Prevalence, Middle Aged, Questionnaires, Adult, Chi Square Distribution, Risk Factors, Risk Assessment, ANXIETY, General Population, and Gastrointestinal Diseases
The aim of this prospective, randomized trial was to assess whether short-term cognitive psychotherapy (10 sessions during 4 months) could reduce the 1-year recurrence rate of duodenal ulcer. One group received psychotherapy; one group... more
The aim of this prospective, randomized trial was to assess whether short-term cognitive psychotherapy (10 sessions during 4 months) could reduce the 1-year recurrence rate of duodenal ulcer. One group received psychotherapy; one group was a control group. One hundred patients, aged 17 to 64 years, with duodenal ulcer were selected from March 1989 to May 1991. The main outcome measure was relapse of duodenal ulcer, which was verified by endoscopy. When psychotherapy started after cessation of antiulcer medication, the relapse-free time was significantly shorter in the therapy group than in the controls. When the protocol was modified so that psychotherapy and antiulcer medication were given concomitantly, there was no significant difference in recurrence rate between the groups at 1-year follow-up (84% in the therapy group and 92% in the control group). Symptoms of upper abdominal discomfort/pain, measured every second month, decreased significantly in the therapy group compared to the control group. Psychotherapy led to less neuroticism (Eysenck Personality Questionnaire) and less trait anxiety (Spielberger Trait Anxiety Scale) compared to controls at 4 months. At the 12-month follow-up, most of this gain was lost, but the psychotherapy group had lower scores on "concern about disapproval" on the Sociotropy-Autonomy Scale than the control group. There is no beneficial effect of short-term cognitive psychotherapy on the 1-year recurrence rate of duodenal ulcer.
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Low vagal tone may represent a mediating mechanism for relationships between personality and symptoms of functional dyspepsia (FD) through a mechanism of antral hypomotility. Twenty-one patients with FD and seventeen healthy controls... more
Low vagal tone may represent a mediating mechanism for relationships between personality and symptoms of functional dyspepsia (FD) through a mechanism of antral hypomotility. Twenty-one patients with FD and seventeen healthy controls completed a series of personality tests before vagal and sympathetic activity, antral motility, and abdominal symptoms were assessed in response to a laboratory task. Functional dyspepsia patients had lower scores on vagal tone (p = .054) and motility index (p = .011) in addition to the expected higher scores on epigastric discomfort (p = .002). Psychological factors explained a substantial amount of the variance in vagal activity, antral motility, and reported symptoms. Symptoms were predicted by trait anxiety (STAI-TR), depression (BDI), and neuroticism (EPQ-N). Poor vagal tone was related to neuroticism (EPQ-N). Poor motility was best explained by task-related state dysphoria (SACL-STR).
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Research Interests: Bariatric Surgery, Obesity, Comorbidity, Counseling, Humans, and 14 moreWeight Loss, Subjective wellbeing, Female, Personality Disorder, Male, Mental Disorders, Obesity Surgery, Clinical Sciences, Prevalence, Social phobia, Middle Aged, Body mass index (BMI), Adult, and Public health systems and services research
ABSTRACT
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Research Interests: Demography, Anxiety Disorders, Personality, Depression, Personality Assessment, and 18 moreLife Style, Comparative Study, Social behavior, Humans, Female, Male, Dyspepsia, Depressive Disorder, Differential Diagnosis, Middle Aged, Psychosomatic, Adult, Patient Care Team, Somatoform disorders, Sick Role, Functional Dyspepsia, Social Behavior, and Duodenal Ulcer
Patients with functional dyspepsia were assigned at random to cognitive psychotherapy (10 sessions of 50 min duration, n = 50) or to a control group (no treatment, n = 50). Before treatment all patients were assessed on psychological,... more
Patients with functional dyspepsia were assigned at random to cognitive psychotherapy (10 sessions of 50 min duration, n = 50) or to a control group (no treatment, n = 50). Before treatment all patients were assessed on psychological, somatic and lifestyle factors. If allocated to the therapy group all patients were also asked to define the main problems they wanted to discuss in therapy ('target complaints'). The patients were evaluated at the end of therapy (after 4 months) and at 1 yr follow-up. Outcome measures were dyspeptic symptoms, scores on 'target complaints' and psychological parameters. Both groups showed improvement in dyspeptic and psychological parameters after 1 yr. The improvement in the control group was attributed to a non- specific effect of increased interest and attention. The therapy group showed greater reduction than the control group on dyspeptic symptoms [days of epigastric pain (p = 0.050), nausea (p = 0.024), heartburn (p = 0.021), diarrhoea (p = 0.002) and constipation (p = 0.047)]; and on scores on 'target complaints' (p = 0.001).
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Research Interests: Mental Health, Depression, Gastroenterology, Life Style, Humans, and 13 moreDepressive Disorder, Risk factors, Hospital Anxiety and Depression Scale, Nausea, Clinical Sciences, Aged, Prevalence, Middle Aged, Adult, Somatoform disorders, Risk Factors, Anxiety Disorder, and General Hospital Psychiatry
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Research Interests: Quality of life, Helicobacter pylori, Discriminant Analysis, Humans, Smoking, and 17 moreFemale, Male, Blood groups, Dyspepsia, Differential Diagnosis, Risk factors, Clinical Sciences, Psychological distress, Adult, Health Care System, Somatoform disorders, Age Factors, Functional Dyspepsia, Risk Factors, Boolean Satisfiability, Duodenal Ulcer, and attitude to health
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The aim of this study was to assess the effectiveness of a cognitive behavioral therapy (CBT) stepped care model (psychoeducation, guided Internet treatment, and face-to-face CBT) compared with direct face-to-face (FtF) CBT. Patients with... more
The aim of this study was to assess the effectiveness of a cognitive behavioral therapy (CBT) stepped care model (psychoeducation, guided Internet treatment, and face-to-face CBT) compared with direct face-to-face (FtF) CBT. Patients with panic disorder or social anxiety disorder were randomized to either stepped care (n=85) or direct FtF CBT (n=88). Recovery was defined as meeting two of the following three criteria: loss of diagnosis, below cut-off for self-reported symptoms, and functional improvement. No significant differences in intention-to-treat recovery rates were identified between stepped care (40.0%) and direct FtF CBT (43.2%). The majority of the patients who recovered in the stepped care did so at the less therapist-demanding steps (26/34, 76.5%). Moderate to large within-groups effect sizes were identified at posttreatment and 1-year follow-up. The attrition rates were high: 41.2% in the stepped care condition and 27.3% in the direct FtF CBT condition. These findings indicate that the outcome of a stepped care model for anxiety disorders is comparable to that of direct FtF CBT. The rates of improvement at the two less therapist-demanding steps indicate that stepped care models might be useful for increasing patients' access to evidence-based psychological treatments for anxiety disorders. However, attrition in the stepped care condition was high, and research regarding the factors that can improve adherence should be prioritized.
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The research on the association between the working alliance and therapist competence/adherence and outcome from cognitive behavioral therapy (CBT) is limited and characterized by inconclusive findings. This study investigates the working... more
The research on the association between the working alliance and therapist competence/adherence and outcome from cognitive behavioral therapy (CBT) is limited and characterized by inconclusive findings. This study investigates the working alliance and competence/adherence as predictors of outcome of CBT for social anxiety disorder (SAD) and panic disorder (PD). Eighty-two clinically referred patients (58.5% female; age: M = 33.6 years, SD = 10.3) with PD (n = 31) or SAD (n = 51) were treated with 12 sessions of manualized CBT by 22 clinicians with limited CBT experience in a randomized controlled effectiveness trial. Independent assessors rated the CBT competence/adherence of the therapists using a revised version of the Cognitive Therapy Adherence and Competence Scale, and the patients rated the quality of the working alliance using the Working Alliance Inventory-short form in therapy sessions 3 and 8. The outcome was assessed by independent assessors as well as by patients self-report. A total of 20.7% of the patients (27.5% SAD, 9.7% PD) dropped out during treatment. The association between the alliance, competence/adherence, outcome and dropout was investigated using multiple regression analyses. Higher therapist' competence/adherence early in the therapy was associated with a better outcome among PD patients, lower competence/adherence was associated with dropout among SAD patients. Higher rating of the alliance late in the therapy was associated with a better outcome, whereas lower alliance rating late in the therapy was associated with dropout. The findings indicate that the therapist competence/adherence and the working alliance have independent contributions to the outcome from CBT for anxiety disorders, but in different phases of the treatment.
Research Interests: Psychology, Forecasting, Treatment Outcome, Humans, Business and Management, and 13 moreFemale, Cognitive Therapy, Male, Panic Disorder, Patient Compliance, Social phobia, Middle Aged, Adult, Professional Competence, Self report, Health Personnel, Behaviour Therapy, and professional patient relations
During recent years attention has been drawn to the importance of psychosocial support to victims of accidents and disasters. Post-traumatic stress disorder seems to be more frequent than earlier believed, and early psychosocial... more
During recent years attention has been drawn to the importance of psychosocial support to victims of accidents and disasters. Post-traumatic stress disorder seems to be more frequent than earlier believed, and early psychosocial assistance is thought to reduce the psychological effects of the traumatic experience. The authors describe the psychosocial work, as it was organized at Haukeland Hospital, after a shipwreck. Experiences with mobile medical teams with stress competence are also discussed.
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To investigate predictors and moderators of treatment outcome by comparing immediate face-to-face cognitive behavioral therapy (FtF-CBT) to a Stepped Care treatment model comprising three steps: Psychoeducation, Internet-delivered CBT,... more
To investigate predictors and moderators of treatment outcome by comparing immediate face-to-face cognitive behavioral therapy (FtF-CBT) to a Stepped Care treatment model comprising three steps: Psychoeducation, Internet-delivered CBT, and FtF-CBT for panic disorder (PD) and social anxiety disorder (SAD). Patients (N = 173) were recruited from nine public mental health out-patient clinics and randomized to immediate FtF-CBT or Stepped Care treatment. Characteristics related to social functioning, impairment from the anxiety disorder, and comorbidity was investigated as predictors and moderators by treatment format and diagnosis in multiple regression analyses. Lower social functioning, higher impairment from the anxiety disorder, and a comorbid cluster C personality disorder were associated with significantly less improvement, particularly among patients with PD. Furthermore, having a comorbid anxiety disorder was associated with a better treatment outcome among patients with PD but not patients with SAD. Patients with a comorbid depression had similar outcomes from the different treatments, but patients without comorbid depression had better outcomes from immediate FtF-CBT compared to guided self-help. In general, the same patient characteristics appear to be associated with the treatment outcome for CBT provided in low- and high-intensity formats when treated in public mental health care clinics. The findings suggest that patients with lower social functioning and higher impairment from their anxiety disorder benefit less from these treatments and may require more adapted and extensive treatment. CLINICALTRIALS.GOV: Identifier: NCT00619138.
Research Interests: Psychology, Anxiety Disorders, Depression, Personality Disorders, Treatment Outcome, and 15 moreSocial behavior, Humans, Business and Management, Female, Cognitive Therapy, Male, Panic Disorder, Young Adult, Patient Compliance, Adult, Social Behavior, Professional Competence, Self report, Internet, and Behaviour Therapy
Musculoskeletal pain is associated with comorbidity, extensive use of health services, long-term disability and reduced quality of life. The scientific literature on effects of treatment for musculoskeletal pain is inconclusive. The... more
Musculoskeletal pain is associated with comorbidity, extensive use of health services, long-term disability and reduced quality of life. The scientific literature on effects of treatment for musculoskeletal pain is inconclusive. The purpose of this study is to compare a multidisciplinary intervention (MI), including use of the novel Interdisciplinary Structured Interview with a Visual Educational Tool (ISIVET), with a brief intervention (BI), on effects on mental and physical symptoms, functioning ability, use of health services and coping in patients sick-listed due to musculoskeletal pain. Two hundred eighty-four adults aged 18-60, referred to a specialist clinic in physical rehabilitation, were randomized to MI or BI. Patients received a medical examination at baseline and completed a comprehensive questionnaire at baseline, 3 months and 12 months. Both groups reported improvements in mental and physical symptoms, including pain, and improved functioning ability at 3 and 12 month...
Research Interests: Psychology, Quality of life, Treatment Outcome, Behavioral Medicine, Interdisciplinary Studies, and 13 moreActivities of Daily Living, Humans, Female, Male, Musculoskeletal pain, Middle Aged, Adult, Patient Care Team, Public health systems and services research, Time Factors, Disease Management, Disability Evaluation, and Surveys and Questionnaires
Dysregulation of hypothalamus-pituitary-adrenal-activity has been associated with low back pain (LBP). The underlying mechanisms are not fully explained, but psychological mechanisms are considered important. In this study we examine the... more
Dysregulation of hypothalamus-pituitary-adrenal-activity has been associated with low back pain (LBP). The underlying mechanisms are not fully explained, but psychological mechanisms are considered important. In this study we examine the association between psychiatric disorders/symptoms measured with different instruments, and cortisol in a population with LBP. Participants (n=305) sick-listed 2-10 months due to non-specific LBP were included in the study. The screening instruments were the MINI-interview, HADS and HSCL-25. Saliva cortisol were measured on 2 consecutive days; at awakening, 30min later, at 15:00h and 22:00h. Results showed no associations between any of the main diagnostic categories from the MINI-interview, or anxiety/depression measured with HADS or HSCL-25 and cortisol. However, significant associations were found between low cortisol awakening response, low cortisol slope during the day and the somatization scale from HSCL-25 (dizziness or lack of energy, lack of sexual interest, the feeling that everything requires substantial efforts, difficulties to fall asleep, headache). The results indicate that cortisol, may not be directly associated with psychopathology, such as anxiety and depression, but instead are associated with one dimension of the psychopathology, namely lack of energy. This could help explain the inconsistency in the literature, and it should be explored further.
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There is an increasing interest in the psychosocial impact of a disease, but few instruments available to measure it. The internal consistency and construct validity of the Norwegian translation of the Psychosocial Adjustment to Illness... more
There is an increasing interest in the psychosocial impact of a disease, but few instruments available to measure it. The internal consistency and construct validity of the Norwegian translation of the Psychosocial Adjustment to Illness Scale (PAIS-SR) was examined in a total of 557 patients. The seven dimensions of the psychosocial adjustment to medical illness from the original test were represented in the Norwegian translation. Psychologic distress, social environment, and vocational environment explained most of the variance. The instrument had high internal consistency with Cronbach's alpha coefficients of > 0.75 on six of seven subscales. The PAIS-SR differentiated between groups of patients with urologic and upper gastrointestinal disease and seemed to give meaningful and useful clinical data. Patients with functional dyspepsia (n = 97) had higher score on psychologic distress than the other groups, whereas patients with duodenal ulcer (n = 97) were significantly less affected in their social life than the other patients. The Norwegian translation of the PAIS-SR had high internal consistency, acceptable construct validity, and good discriminating validity.
Research Interests: Family, Quality of life, Adolescent, Schools, Norway, and 18 moreSocial behavior, Humans, Work, Female, Male, Sexual Behavior, Dyspepsia, Social Adjustment, Clinical Sciences, Aged, Middle Aged, Psychological Tests, Adult, Functional Dyspepsia, Social Behavior, Psychosocial Adjustment, Urinary Bladder, and Duodenal Ulcer
Effects of acute mental stress on gastric antral motility were investigated in 23 healthy persons and 25 patients with functional dyspepsia (FD). Real-time ultrasonography of gastric antrum was recorded, after ingestion of 500 ml meat... more
Effects of acute mental stress on gastric antral motility were investigated in 23 healthy persons and 25 patients with functional dyspepsia (FD). Real-time ultrasonography of gastric antrum was recorded, after ingestion of 500 ml meat soup, during a 4-min resting period, 2.5 min of mental stress, and a 4-min recovery period. Amplitude of antral contractions was scored as a fraction of relaxed area. Motility-index was calculated as the amplitude multiplied by frequency. Measurement of skin conductance reflected sympathetic tone, and respiratory sinus arrhythmia (RSA) was calculated to index vagal tone. Antral motility was reduced by mental stress in the healthy persons, but not in FD patients. Group differences were significant for amplitude (p < 0.002) and motility-index scores (p < 0.02). Sympathetic tone increased during stress in both groups. Vagal tone was lower in the FD patients than in the healthy controls (p < 0.001). The lack of stress-related reduction of motility among patients with FD may, therefore, be a consequence of poor vagal tone.