Influence of co-morbid generalized anxiety disorder, panic disorder and personality disorders on the outcome of cognitive behavioural treatment of obsessive-compulsive disorder

This study examined co-morbid generalized anxiety disorder and/or panic disorder and personality disorders as predictors of treatment outcomes in adult outpatients with obsessive-compulsive disorder. The patients received exposure with response prevention (ERP) treatment with the addition of either elements of cognitive therapy (ERP+CT) or relaxation training (ERP+REL). It was hypothesized that the addition of cognitive interventions would yield better treatment outcomes for patients with co-morbid generalized anxiety disorder and/or panic disorder. It was also hypothesized that patients with any personality disorder would show less treatment gains in both conditions. Using intention-to-treat criteria, patients with generalized anxiety disorder and/or panic disorder co-morbidity showed less treatment gains at post-treatment across both treatment conditions. This group showed significantly more treatment gains in the ERP+CT condition at the post-treatment and the 12-month follow-up assessments compared with patients in the ERP+REL condition. However, this was not significant when comparing treatment completers. Patients with a co-morbid Cluster A or B personality disorder showed significantly less treatment gains in both treatment conditions at the 12-month follow-up assessment. Among treatment completers, patients with a Cluster C personality disorder showed significantly better outcomes at the post-treatment assessment in the ERP+REL treatment condition. These results, clinical implications, and the importance of further investigations are discussed.     

The Associations Between Intensive Residential Couple Therapy and Change in a Three-Year Follow-Up Period

This Norwegian couple therapy effectiveness therapy study explored the course and prediction of relationships between depressive symptoms, interpersonal problems, and dyadic adjustment during residential treatment and over a 3-year post-treatment period (N = 117). All measures indicated significant improvement (p < .001) between admission and discharge (effect sizes .25 to .67), and improvement was maintained at 3-year follow-up. The proportion of recovered patients during treatment was stable at follow-up. Finding that initial levels of the Inventory of Interpersonal Problems (IIP) predicted dyadic adjustment change in the follow-up period, we discuss how such interpersonal problems may influence the course of couple therapy.     

The role of self‐image as a predictor of psychotherapy outcome

The present study examined the relationship between self‐image and outcome in psychotherapy. Patients (n = 170) received treatment‐as‐usual at a university clinic, and met diagnostic criteria for mostly anxiety and depression related disorders. Self‐image was measured with the Structural Analysis of Social Behavior (SASB‐I) introject pre and post‐treatment. Using multiple regression analyses, higher levels of Self‐ignore and Self‐blame pre‐treatment predicted a poorer treatment outcome in terms of symptoms (SCL‐90‐R) and interpersonal problems (IIP‐64), respectively. Increase in Self‐love and decrease in Self‐blame (pre to post) predicted reduced symptoms at post‐treatment, whereas decrease in Self‐attack and Self‐control, as well as increase in Self‐affirm, predicted reduced interpersonal problems. The results suggest that self‐image improvement may be important in order to achieve a good outcome in psychotherapy.     

Factors Associated with Therapeutic Approaches Among Norwegian Occupational Therapists: An Exploratory Study

According to the Intentional Relationship Model, the use of therapeutic approaches tailored to individual clients’ needs is essential for building therapeutic relationships. This study investigated factors associated with occupational therapists’ preferred therapeutic approaches. One hundred eight occupational therapists were recruited as a convenience sample, and the data were analyzed with linear regressions. Mental health as the field of practice was associated with a stronger preference for use of empathy. More job satisfaction was associated with stronger preference for the instructing mode. Empathy appears to be more commonly used in mental health practice, whereas instructing may be linked with job satisfaction.     

TEMPERAMENTAL ADAPTABILITY,PERSISTENCE, AND REGULARITY: PARENTAL RATINGS OF NORWEGIAN INFANTS AGED 6 TO 12 MONTHS,WITH SOME IMPLICATIONS FOR PREVENTIVE PRACTICE

There is a need for standardized measures of infant temperament to strengthen current practices in prevention and early intervention. The present study provides Norwegian data on the Cameron‐Rice Infant Temperament Questionnaire (CRITQ; J.R. Cameron & D.C. Rice, 1986a), which comprises 46 items and is used within a U.S. health maintenance organization. The CRITQ was filled out by mothers and fathers at 6 and again at 12 months as part of a longitudinal study of mental health during the first years of life (the “Little in Norway” study, N = 1,041 families enrolled; V. Moe & L. Smith, 2010). Results showed that internal consistencies were comparable with U.S. data. The temperament dimensions of persistence, adaptability, and regularity had acceptable or close‐to‐acceptable reliabilities in the U.S. study as well as in this study, and also were unifactorial in confirmatory factor analysis. These dimensions are the focus in this article. Findings concerning parents’ differential ratings of their infants on the three dimensions are reported, as is the stability of parents’ ratings of temperament from 6 to 12 months. In addition, results on the relation between temperament and parenting stress are presented. The study suggests that temperamental adaptability, persistence, and regularity may be relevant when assessing infant behavior, and may be applied in systematic prevention trials for families with infants. The inclusion of concepts related to individual differences in response tendencies and regulatory efforts may broaden the understanding of parent—infant transactions, and thus enrich prevention and sensitizing interventions with the aim of assisting infants’ development.     

COGNITIVE AND SOCIOEMOTIONAL FUNCTIONING AT 4½ YEARS IN CHILDREN BORN TO MOTHERS WHO HAVE RECEIVED TREATMENT FOR SUBSTANCE‐ABUSE PROBLEMS WHILE PREGNANT

Cognitive and socioemotional functioning at 4½ years of age were examined in children born to mothers with substance‐abuse problems (n = 22) recruited from residential treatment institutions while pregnant, and then compared to children born to mothers with mental health problems (n = 18) and children from a low‐risk group (n = 26). No significant group differences in cognitive functioning were found, but the children born to mothers with substance‐abuse problems showed more caregiver‐reported socioemotional problems than did the low‐risk children, like the children born to mothers with mental health problems. Birth weight had an effect on internalizing problems at 4½ years and mediated the relation between group and socioemotional problems, although not when controlling for caregiver education, single parenthood, and anxiety and depression. At 4½ years, 7 children born to mothers with substance‐abuse problems were placed in foster care. These children had lower birth weight and higher caregiver‐rated internalizing problems. In addition to emphasizing the importance of the quality of the prenatal environment, this study suggests that families with previous substance abuse are in need of long‐term follow‐up to address socioemotional problems and enhance further positive child cognitive development. The foster‐placed children may be in particular need of long‐term follow‐up.     

Resilience is a good predictor of hopelessness even after accounting for stressful life events, mood and personality (NEO-PI-R)

A better understanding of the relation between protection and vulnerability may advance our understanding of mental health. Therefore the purpose of this study was to examine the incremental validity of the Resilience Scale for Adults (RSA) as a predictor for level of hopelessness. A healthy sample (N = 532) completed the Beck Hopelessness Scale, a list of Stressful Life Events (SLE), the Hopkins Symptom Checklist-25 (HSCL-25), NEO-PI-R (NEO Personality Inventory Revised) and the RSA. The relations between the variables were explored with correlations and multiple hierarchical regression analyses. The results indicated that the RSA measures important protective factors that significantly predict lower levels of hopelessness even when accounting for age, gender, SLE, HSCL-25 and NEO-PI-R. This study supports the notion that the protective resilience factors in the RSA have unique contributions over and above established constructs of stressful life events, depressive and anxiety symptoms and personality in predicting hopelessness, supporting the incremental validity of the RSA.     

Factors associated with self-efficacy in persons with chronic illness

Change of lifestyle may be necessary for persons with chronic illnesses in order to manage their health situation and reduce symptom distress. Success in changing lifestyle partly depends on a person's self-efficacy beliefs. This cross-sectional study explores social support, physical activity, and illness perceptions in relation to self-efficacy in a sample with morbid obesity and in a sample with chronic obstructive pulmonary disease (COPD). The linear regression analyses showed that higher physical activity and less emotional response to illness were directly associated with higher self-efficacy among persons with obesity, while more social support; fewer perceived consequences from illness; and more understanding of the illness were directly associated with higher self-efficacy among persons with COPD. The results indicate that obese persons are likely to benefit from increasing physical activity and from receiving emotional support. Persons with COPD may be empowered by being able to utilize cognitive coping strategies and by receiving social support.