Drawing on the tenets of family stress theory, the aim of this study is to examine parents' p... more Drawing on the tenets of family stress theory, the aim of this study is to examine parents' perceived stress, symptoms of anxiety, depression, and associated risk- and protective factors across demographic subgroups during in the first wave of the COVID-19 pandemic. Norwegian parents (N = 2,868; 79.5% mothers) with > 1 child under 18 years of age completed an online survey two weeks after the implementation of government-initiated distancing measures. The survey includes measures of COVID-related risk factors (parental stress, burnout, depression, anxiety, anger of parents toward children, difficulty working from home, and positive beliefs about worry) and protective factors (self-efficacy and social support). Mothers, parents living with more than one child, and parents with a psychiatric diagnosis reported greater levels of parental stress, more burnout, and more anger toward their children, as well as less social support. Almost 25% of the parents reported anxiety and depression that are clinically significant. Parents who followed distancing measures reported significantly higher distress. Anger of parents toward children explains 41% of the variation in parental stress. The findings indicate that parents have experienced symptoms of deteriorated mental health due to the COVID- 19 pandemic, including parental stress, anxiety, and depression. The study presents practical implications for meso- and macro-level policymaking and offers support to further the potential aims of public health and clinical interventions. Future studies to monitor long-term aversive mental health outcomes among parents are warranted. This article is protected by copyright. All rights reserved.
Background: The mitigation strategies employed against the COVID-19 pandemic have severe mental h... more Background: The mitigation strategies employed against the COVID-19 pandemic have severe mental health consequences. In particular, as a result of the social distancing protocols, loneliness is likely to increase. The aim of the present study was to investigate (a) the levels of loneliness in the Norwegian population during the strict social distancing non-pharmacological interventions (NPIs) implemented against the pandemic, (b) the risk and resilience factors for loneliness and (c) the associations between loneliness and psychopathology symptoms. Methods: A survey was disseminated online to the adult Norwegian population when strict social distancing measures had been implemented for two weeks. The resulting sample of 10084 respondents was proportionally biased in terms of gender and educational level and sensitivity analyses were conducted. The levels of loneliness were compared to those found in other studies during non-pandemic circumstances, loneliness levels were compared acr...
The use of treatment manuals in clinical practice is purported to increase internal validity by e... more The use of treatment manuals in clinical practice is purported to increase internal validity by ensuring specific, identifiable, and replicable treatments. In the present article, four factors in treatment manuals that should contribute to treatment integrity are singled out and addressed: (1) specification of model, (2) specification of relation between model and therapeutic practice, (3) circularity between model and actual practice, and (4) adoption of a natural attitude during therapy performance. Further, it is argued that theoretical contrast analyses and the accentuation of contrasting aspects in practice contribute to the differentiation of two or more treatments. A schema view of treatment manuals is developed and the implications for central issues in the field are inferred.
Metacognitive therapy (MCT) has shown promising outcomes across disorders, but, currently, little... more Metacognitive therapy (MCT) has shown promising outcomes across disorders, but, currently, little is known about the mechanisms of change in MCT as well as their specificity compared to those of cognitive behavioral therapy (CBT). The main purpose of this study was to examine the within-person relationships between features of the cognitive attentional syndrome (CAS)—the thinking style supposed to maintain clinical disorders according to the MCT model—and anxiety over the course of MCT and CBT for comorbid anxiety disorders. Seventy-four inpatients had been randomized to either MCT or CBT and actually started treatment. CAS features and anxiety were assessed weekly during treatment. These measures were disaggregated to their within- and between-person components and used as predictors in mixed models. All CAS features—coping activities, negative metacognitive beliefs, and positive metacognitive beliefs—decreased over the course of treatment. Negative and positive beliefs decreased m...
Process-outcome research in psychotherapy has mainly focused on between-person data (e.g., how di... more Process-outcome research in psychotherapy has mainly focused on between-person data (e.g., how differences in psychological process among patients are related to differences in outcome among the patients). However, this level of analysis is in danger of missing its target because psychotherapy models and therapists focus primarily on within-person relationships (e.g., whether change in a patient's cognitive process during the course of therapy may lead to a reduction of symptoms in that client). The study of within-person processes requires collection of repeated data and a disaggregation of the between- and within-person components of time-varying process predictors. The purpose of this study was to examine whether the results of a previously published longitudinal process-outcome study of cognitive and interpersonal therapy for social anxiety disorder (SAD) (Hoffart, Borge, Sexton, & Clark, 2009) were maintained when the process predictors were disaggregated. Eighty social pho...
An in vivo cognitive treatment of panic attacks that combine active behavioral instructions and s... more An in vivo cognitive treatment of panic attacks that combine active behavioral instructions and standard cognitive procedures is described. A case example is presented that both illustrates the method and indicates the potential significance of this treatment component in a complete cognitive therapy package. It is argued that a reason for residual problems among panic/ agoraphobic patients after traditional cognitive therapy may be that the patients are still afraid of severe panic attacks and that in vivo treatment of such attacks may remediate this fear.
The present study explored the relationships among Early Maladaptive Schemas (EMS), beliefs about... more The present study explored the relationships among Early Maladaptive Schemas (EMS), beliefs about loss of control, a fear of bodily sensations, and avoidance in patients undergoing cognitive therapy. Fifty-nine patients (43 women and 16 men) being treated for panic disorder with agoraphobia (PDA) participated in the study. Two EMS that are seen as being central in PDA [vulnerability to harm (VH) and functional incompetence/dependency (DI)], beliefs about loss of control, a fear of bodily sensations, and avoidance were measured at treatment start and at six months follow-up. The data were analyzed using structural modeling techniques. The VH schema influenced beliefs about loss of control, a fear of bodily sensations, and avoidance. Beliefs about loss of control, in turn, predicted a fear of bodily sensations. DI was predicted by VH and did not influence other aspects of PDA. The results were largely in consort with the theoretical suppositions of schema theory and indicated that the...
Journal of Consulting and Clinical Psychology, 2016
OBJECTIVE The purpose of this study was to test 2 cognitive models of panic disorder with agoraph... more OBJECTIVE The purpose of this study was to test 2 cognitive models of panic disorder with agoraphobia (PDA)-a catastrophic cognitions model and a low self-efficacy model-by examining the within-person effects of model-derived cognitive variables on subsequent anxiety symptoms. METHOD Participants were 46 PDA patients with agoraphobic avoidance of moderate to severe degree who were randomly allocated to 6 weeks of either cognitive therapy, based on the catastrophic cognitions model of PDA, or guided mastery (guided exposure) therapy, based on the self-efficacy model of PDA. Cognitions and anxiety were measured weekly over the course of treatment. The data were analyzed with mixed models, using person-mean centering to disaggregate within- and between-person effects. RESULTS All of the studied variables changed in the expected way over the course of therapy. There was a within-person effect of physical fears, loss of control fears, social fears, and self-efficacy when alone on subsequent state anxiety. On the other hand, within-person changes in anxiety did not predict subsequent cognitions. Loss of control and social fears both predicted subsequent self-efficacy, whereas self-efficacy did not predict catastrophic cognitions. In a multipredictor analysis, within-person catastrophic cognitions still predicted subsequent anxiety, but self-efficacy when alone did not. CONCLUSIONS Overall, the findings indicate that anxiety in PDA, at least in severe and long-standing cases, is driven by catastrophic cognitions. Thus, these cognitions seem to be useful therapeutic targets. (PsycINFO Database Record
ABSTRACT FROM: Imai H, Tajika A, Chen P, et al . Psychological therapies versus pharmacological i... more ABSTRACT FROM: Imai H, Tajika A, Chen P, et al . Psychological therapies versus pharmacological interventions for panic disorder with or without agoraphobia in adults. Cochrane Database Syst Rev 2016;10:CD011170. The efficacy of psychological treatments for panic disorder — without or with agoraphobia — in comparison with waitlist, psychological placebo or pharmacological placebo controls is well established.1 Also pharmacotherapy has proved to be efficacious compared with placebo.2 However, meta-analyses directly comparing psychological and pharmacological treatments tend to be outdated.3 The aim of this paper was therefore to assess the relative efficacy and acceptability of psychological and pharmacological treatments for panic disorder in adults. The authors searched the Cochrane Common Mental Disorders Group Specialised Register on 11 September 2015. Among psychological treatments, the focus was on cognitive-behavioural, psychodynamic and supportive therapies. The main pharmacotherapies comprised tricyclic antidepressants, other antidepressants, …
Child and adolescent psychiatry and mental health, 2017
To examine associations between health-related quality of life (HRQoL) and anxiety symptoms acros... more To examine associations between health-related quality of life (HRQoL) and anxiety symptoms across anxiety domains (obsessions/compulsions, social anxiety, panic disorder, agoraphobia, separation anxiety, physical injury fears, generalised anxiety, and posttraumatic stress) in a general adolescent population. Expanded knowledge about these associations can provide valuable information for improving interventions and prevention strategies for adolescent anxiety. Cross-sectional data about anxiety were collected via a school survey from a community sample of Norwegian adolescents aged 12-17 (N = 1719). Based on scores from the Spence Children's Anxiety Scale (SCAS), each adolescent was categorized as reporting a low, medium, or high level of anxiety. Each adolescent's HRQoL was then measured using the Questionnaire for Measuring Health-Related Quality of Life in Children and Adolescents Revised Version (KINDL-R). Hierarchical regression analyses were performed to determine any...
Purpose To examine the prevalence and correlates of anxiety in a community sample of adolescents.... more Purpose To examine the prevalence and correlates of anxiety in a community sample of adolescents. Knowing the prevalence and characteristics of anxious adolescents is valuable to improve anxiety prevention strategies and interventions. Design Cross-sectional data about anxiety were collected via a school survey from a community sample of Norwegian adolescents aged 12–17 ( N = 1719). Methods Based on scores from the Spence Children’s Anxiety Scale, the adolescents were categorized as not anxious or anxious. Logistic regression analysis was performed to access the impact of each factor on the likelihood that participants would report an elevated level of anxiety. Results A total of 22% of the adolescents were categorized as anxious. Female gender, experienced negative life events, low social support, and low self-efficacy were associated with elevated level of anxiety. Conclusions The high prevalence of anxiety in adolescents demonstrates the importance of improved prevention interven...
Drawing on the tenets of family stress theory, the aim of this study is to examine parents' p... more Drawing on the tenets of family stress theory, the aim of this study is to examine parents' perceived stress, symptoms of anxiety, depression, and associated risk- and protective factors across demographic subgroups during in the first wave of the COVID-19 pandemic. Norwegian parents (N = 2,868; 79.5% mothers) with > 1 child under 18 years of age completed an online survey two weeks after the implementation of government-initiated distancing measures. The survey includes measures of COVID-related risk factors (parental stress, burnout, depression, anxiety, anger of parents toward children, difficulty working from home, and positive beliefs about worry) and protective factors (self-efficacy and social support). Mothers, parents living with more than one child, and parents with a psychiatric diagnosis reported greater levels of parental stress, more burnout, and more anger toward their children, as well as less social support. Almost 25% of the parents reported anxiety and depression that are clinically significant. Parents who followed distancing measures reported significantly higher distress. Anger of parents toward children explains 41% of the variation in parental stress. The findings indicate that parents have experienced symptoms of deteriorated mental health due to the COVID- 19 pandemic, including parental stress, anxiety, and depression. The study presents practical implications for meso- and macro-level policymaking and offers support to further the potential aims of public health and clinical interventions. Future studies to monitor long-term aversive mental health outcomes among parents are warranted. This article is protected by copyright. All rights reserved.
Background: The mitigation strategies employed against the COVID-19 pandemic have severe mental h... more Background: The mitigation strategies employed against the COVID-19 pandemic have severe mental health consequences. In particular, as a result of the social distancing protocols, loneliness is likely to increase. The aim of the present study was to investigate (a) the levels of loneliness in the Norwegian population during the strict social distancing non-pharmacological interventions (NPIs) implemented against the pandemic, (b) the risk and resilience factors for loneliness and (c) the associations between loneliness and psychopathology symptoms. Methods: A survey was disseminated online to the adult Norwegian population when strict social distancing measures had been implemented for two weeks. The resulting sample of 10084 respondents was proportionally biased in terms of gender and educational level and sensitivity analyses were conducted. The levels of loneliness were compared to those found in other studies during non-pandemic circumstances, loneliness levels were compared acr...
The use of treatment manuals in clinical practice is purported to increase internal validity by e... more The use of treatment manuals in clinical practice is purported to increase internal validity by ensuring specific, identifiable, and replicable treatments. In the present article, four factors in treatment manuals that should contribute to treatment integrity are singled out and addressed: (1) specification of model, (2) specification of relation between model and therapeutic practice, (3) circularity between model and actual practice, and (4) adoption of a natural attitude during therapy performance. Further, it is argued that theoretical contrast analyses and the accentuation of contrasting aspects in practice contribute to the differentiation of two or more treatments. A schema view of treatment manuals is developed and the implications for central issues in the field are inferred.
Metacognitive therapy (MCT) has shown promising outcomes across disorders, but, currently, little... more Metacognitive therapy (MCT) has shown promising outcomes across disorders, but, currently, little is known about the mechanisms of change in MCT as well as their specificity compared to those of cognitive behavioral therapy (CBT). The main purpose of this study was to examine the within-person relationships between features of the cognitive attentional syndrome (CAS)—the thinking style supposed to maintain clinical disorders according to the MCT model—and anxiety over the course of MCT and CBT for comorbid anxiety disorders. Seventy-four inpatients had been randomized to either MCT or CBT and actually started treatment. CAS features and anxiety were assessed weekly during treatment. These measures were disaggregated to their within- and between-person components and used as predictors in mixed models. All CAS features—coping activities, negative metacognitive beliefs, and positive metacognitive beliefs—decreased over the course of treatment. Negative and positive beliefs decreased m...
Process-outcome research in psychotherapy has mainly focused on between-person data (e.g., how di... more Process-outcome research in psychotherapy has mainly focused on between-person data (e.g., how differences in psychological process among patients are related to differences in outcome among the patients). However, this level of analysis is in danger of missing its target because psychotherapy models and therapists focus primarily on within-person relationships (e.g., whether change in a patient's cognitive process during the course of therapy may lead to a reduction of symptoms in that client). The study of within-person processes requires collection of repeated data and a disaggregation of the between- and within-person components of time-varying process predictors. The purpose of this study was to examine whether the results of a previously published longitudinal process-outcome study of cognitive and interpersonal therapy for social anxiety disorder (SAD) (Hoffart, Borge, Sexton, & Clark, 2009) were maintained when the process predictors were disaggregated. Eighty social pho...
An in vivo cognitive treatment of panic attacks that combine active behavioral instructions and s... more An in vivo cognitive treatment of panic attacks that combine active behavioral instructions and standard cognitive procedures is described. A case example is presented that both illustrates the method and indicates the potential significance of this treatment component in a complete cognitive therapy package. It is argued that a reason for residual problems among panic/ agoraphobic patients after traditional cognitive therapy may be that the patients are still afraid of severe panic attacks and that in vivo treatment of such attacks may remediate this fear.
The present study explored the relationships among Early Maladaptive Schemas (EMS), beliefs about... more The present study explored the relationships among Early Maladaptive Schemas (EMS), beliefs about loss of control, a fear of bodily sensations, and avoidance in patients undergoing cognitive therapy. Fifty-nine patients (43 women and 16 men) being treated for panic disorder with agoraphobia (PDA) participated in the study. Two EMS that are seen as being central in PDA [vulnerability to harm (VH) and functional incompetence/dependency (DI)], beliefs about loss of control, a fear of bodily sensations, and avoidance were measured at treatment start and at six months follow-up. The data were analyzed using structural modeling techniques. The VH schema influenced beliefs about loss of control, a fear of bodily sensations, and avoidance. Beliefs about loss of control, in turn, predicted a fear of bodily sensations. DI was predicted by VH and did not influence other aspects of PDA. The results were largely in consort with the theoretical suppositions of schema theory and indicated that the...
Journal of Consulting and Clinical Psychology, 2016
OBJECTIVE The purpose of this study was to test 2 cognitive models of panic disorder with agoraph... more OBJECTIVE The purpose of this study was to test 2 cognitive models of panic disorder with agoraphobia (PDA)-a catastrophic cognitions model and a low self-efficacy model-by examining the within-person effects of model-derived cognitive variables on subsequent anxiety symptoms. METHOD Participants were 46 PDA patients with agoraphobic avoidance of moderate to severe degree who were randomly allocated to 6 weeks of either cognitive therapy, based on the catastrophic cognitions model of PDA, or guided mastery (guided exposure) therapy, based on the self-efficacy model of PDA. Cognitions and anxiety were measured weekly over the course of treatment. The data were analyzed with mixed models, using person-mean centering to disaggregate within- and between-person effects. RESULTS All of the studied variables changed in the expected way over the course of therapy. There was a within-person effect of physical fears, loss of control fears, social fears, and self-efficacy when alone on subsequent state anxiety. On the other hand, within-person changes in anxiety did not predict subsequent cognitions. Loss of control and social fears both predicted subsequent self-efficacy, whereas self-efficacy did not predict catastrophic cognitions. In a multipredictor analysis, within-person catastrophic cognitions still predicted subsequent anxiety, but self-efficacy when alone did not. CONCLUSIONS Overall, the findings indicate that anxiety in PDA, at least in severe and long-standing cases, is driven by catastrophic cognitions. Thus, these cognitions seem to be useful therapeutic targets. (PsycINFO Database Record
ABSTRACT FROM: Imai H, Tajika A, Chen P, et al . Psychological therapies versus pharmacological i... more ABSTRACT FROM: Imai H, Tajika A, Chen P, et al . Psychological therapies versus pharmacological interventions for panic disorder with or without agoraphobia in adults. Cochrane Database Syst Rev 2016;10:CD011170. The efficacy of psychological treatments for panic disorder — without or with agoraphobia — in comparison with waitlist, psychological placebo or pharmacological placebo controls is well established.1 Also pharmacotherapy has proved to be efficacious compared with placebo.2 However, meta-analyses directly comparing psychological and pharmacological treatments tend to be outdated.3 The aim of this paper was therefore to assess the relative efficacy and acceptability of psychological and pharmacological treatments for panic disorder in adults. The authors searched the Cochrane Common Mental Disorders Group Specialised Register on 11 September 2015. Among psychological treatments, the focus was on cognitive-behavioural, psychodynamic and supportive therapies. The main pharmacotherapies comprised tricyclic antidepressants, other antidepressants, …
Child and adolescent psychiatry and mental health, 2017
To examine associations between health-related quality of life (HRQoL) and anxiety symptoms acros... more To examine associations between health-related quality of life (HRQoL) and anxiety symptoms across anxiety domains (obsessions/compulsions, social anxiety, panic disorder, agoraphobia, separation anxiety, physical injury fears, generalised anxiety, and posttraumatic stress) in a general adolescent population. Expanded knowledge about these associations can provide valuable information for improving interventions and prevention strategies for adolescent anxiety. Cross-sectional data about anxiety were collected via a school survey from a community sample of Norwegian adolescents aged 12-17 (N = 1719). Based on scores from the Spence Children's Anxiety Scale (SCAS), each adolescent was categorized as reporting a low, medium, or high level of anxiety. Each adolescent's HRQoL was then measured using the Questionnaire for Measuring Health-Related Quality of Life in Children and Adolescents Revised Version (KINDL-R). Hierarchical regression analyses were performed to determine any...
Purpose To examine the prevalence and correlates of anxiety in a community sample of adolescents.... more Purpose To examine the prevalence and correlates of anxiety in a community sample of adolescents. Knowing the prevalence and characteristics of anxious adolescents is valuable to improve anxiety prevention strategies and interventions. Design Cross-sectional data about anxiety were collected via a school survey from a community sample of Norwegian adolescents aged 12–17 ( N = 1719). Methods Based on scores from the Spence Children’s Anxiety Scale, the adolescents were categorized as not anxious or anxious. Logistic regression analysis was performed to access the impact of each factor on the likelihood that participants would report an elevated level of anxiety. Results A total of 22% of the adolescents were categorized as anxious. Female gender, experienced negative life events, low social support, and low self-efficacy were associated with elevated level of anxiety. Conclusions The high prevalence of anxiety in adolescents demonstrates the importance of improved prevention interven...
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