Kristoffer Joe Tunheim

• Tunheim, Kristoffer Joe; Papageorgiou, Constantinos; Lie, Hanne Cathrine; Munkhaugen, John & Dammen, Toril (2025). Experiences of the attention training technique delivered in groups as treatment for anxiety and depression in patients with coronary heart disease: a qualitative study. BMC Psychiatry. 25. doi: 10.1186/s12888-025-07027-4. Full text in Research Archive Show summary

  Background Clinically significant anxiety and depression symptoms are common in patients with coronary heart disease (CHD) and associated with a range of negative outcomes. Preliminary evidence suggests that the attention training technique (ATT), a component of metacognitive therapy (MCT), delivered in a group format, is feasible and potentially effective in reducing symptoms of anxiety and depression in these patients. Patients’ experiences of treatment including facilitators and barriers are useful in order to further develop effective intervention. We are not aware of any previous qualitative studies conducted on ATT in patients with CHD. Our study aimed to assess the treatment experiences in these patients. Methods Patients (N = 10) with CHD and significant symptoms of anxiety and/or depression, who participated in a randomized controlled trial of the effectiveness of ATT delivered in a group format, were recruited to in-depth, individual interviews three months after treatment completion. The interviews were recorded, transcribed and analysed according to the principles of thematic analysis. Results Nine males and one female participated, with a mean age of 54.3 (range 45–63) years. Mean time since cardiac event was 54.2 months. We identified two main themes; non-specific ATT treatment factors and group ATT-specific treatment factors. Furthermore, non-specific ATT treatment factors included subthemes relating to individual and group factors. These subthemes encompassed the (relational aspects such as the) interaction between the group patients, interaction between the patients and the therapist, and the therapist’s delivery of the group ATT. Second, specific ATT treatment factors included subthemes concerning understanding and making sense of the technique and treatment, changes in relation to thoughts and thinking, and group format as a facilitator of ATT treatment. Conclusions Group ATT was perceived as helpful among outpatients with CHD in terms of symptom relief. Both general and ATT specific factors were regarded important, and the patients seemed to understand ATT in a way that is consistent with the rationale of ATT treatment. All patients emphasized the importance of the group format.

• Dammen, Toril; Tunheim, Kristoffer; Munkhaugen, John; Klungsøyr, Ole & Papageorgiou, Constantinos (2023). Attention training technique delivered in groups as treatment for anxiety and depression in patients with coronary heart disease: study protocol for a waiting-list randomized controlled trial. Frontiers in Psychology. 14. doi: 10.3389/fpsyg.2023.1226539. Full text in Research Archive
• Dammen, Toril; Tunheim, Kristoffer Joe; Munkhaugen, John & Papageorgiou, Constantinos (2022). The Attention Training Technique Reduces Anxiety and Depression in Patients With Coronary Heart Disease: A Pilot Feasibility Study. Frontiers in Psychology. 13. doi: 10.3389/fpsyg.2022.948081. Full text in Research Archive Show summary

  Background and Objectives: Depression and anxiety symptoms are highly prevalent in coronary heart disease (CHD) patients and associated with poor outcome. Most psychological treatments have shown limited effectiveness on anxiety and depression in these patients. This study evaluates the feasibility of the attention training technique (ATT) in CHD patients with symptoms of anxiety and/or depression. Methods: Five consecutive CHD patients with significant depression and anxiety symptoms with Hospital Anxiety and Depression rating scale (HADS) -anxiety or -depression subscale score > 8 received 6 weekly group-sessions of ATT in an open trial. Outcomes included feasibility and symptoms measured by HADS, at baseline, post-treatment and at 6 months follow-up. We also assessed psychiatric diagnoses, type D personality, insomnia, worry, and rumination. Results: The sample comprised five men with a mean age of 59.9 (SD 4.4) years. Four of the patients attended all six sessions, and one patient attended all but one session. Mean HADS-A scores at baseline, post-treatment, and follow-up were 9.4 (SD 3.0), 4.2 (SD 3.0), and 4.0 (SD 2.5), and for HADS-D 8.6 (SD 3.3), 3.0 (SD 3.7), and 1.6 (SD 1.5), respectively. The results showed clinically significant changes in anxiety, depression, psychiatric disorders, insomnia, worry, and rumination. Statistically significant changes were found from pre- to post-treatment scores for HADS-A and worry, which were maintained at follow-up, and HADS-D scores significantly decreased from pre-treatment to 6-months follow-up. Conclusions: ATT in a group format appears to be a feasible stand-alone metacognitive treatment for CHD patients. An adequately powered randomized controlled trial is warranted.

• Tunheim, Kristoffer Joe; Dammen, Toril; Bårdstu, Silje Kvam; Moum, Torbjørn Åge; Munkhaugen, John & Papageorgiou, Constantinos (2022). Relationships between depression, anxiety, type D personality, and worry and rumination in patients with coronary heart disease. Frontiers in Psychology. 13. doi: 10.3389/fpsyg.2022.929410. Full text in Research Archive Show summary

  Psychological distress, including depression and anxiety, and Type-D personality are prevalent in patients with coronary heart disease (CHD) and associated with poor cardiovascular outcomes. Worry and rumination may be among the core features responsible for driving psychological distress in these patients. However, the nature of associations between these constructs remains to be delineated, yet they may have implications for the assessment and treatment of CHD patients. This study aimed to (1) explore the factorial structure and po-tential overlap between measures of depression, anxiety and the Type-D personality factors known as nega-tive affectivity and social inhibition, and (2) examine how these constructs relate to worry and rumination in a sample of 1042 CHD outpatients who participated in the in the cross-sectional NORwegian CORonary Pre-vention study. We conducted confirmatory factor analyses (n=1042) and regression analyses (n=904) within a structural equation modelling framework. Results showed all constructs to have acceptable factor structure and indicated an overlap between the constructs of depression and negative affectivity. Worry was most strongly associated with anxiety, whereas rumination was most strongly associated with depression and neg-ative affectivity. The results suggest conceptual similarities across the measures of depression and negative affectivity. They further suggest that intervention efforts could benefit from targeting worry and/or rumina-tion in the treatment of CHD outpatients presenting with symptoms of psychological distress Keywords: Anxiety, Depression, Type D personality, worry, rumination, metacognition, Metacognitive Therapy, coronary heart disease Received: 26 Apr 2022; Accepted: 24 Aug 2022.

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