Jan Ivar Røssberg

• Klungsøyr, Ole; Røssberg, Jan Ivar; Papageorgiou, Constantinos; Evensen, Julie Horgen; Løvgren, André & Malkomsen, Anders [Show all 10 contributors for this article] (2026). Personalized and optimal treatment estimated by a value search method in a randomized clinical trial with psychodynamic versus cognitive behavioral therapy for depression. Psychotherapy Research. ISSN 1050-3307. doi: 10.1080/10503307.2026.2682995. Full text in Research Archive
• Hagen, Hallvard Solbø; Klonteig, Sandra; Røssberg, Jan Ivar; Jonassen, Rune; Landrø, Nils Inge & Bø, Ragnhild (2026). Fronto–Parietal EEG asymmetry interactions predict negative attention bias: A secondary data analysis. Cognitive, Affective, & Behavioral Neuroscience. ISSN 1530-7026. doi: 10.3758/s13415-026-01466-6. Full text in Research Archive Show summary

  Attention bias (AB), the excessive attentional selection of certain stimuli over others, is found in individuals suffering from depression. Similarly, alpha asymmetries, the lateralization of inhibitory cortical activity in the EEG alpha band (8–13 Hz) have been linked to depression and motivational direction. By contrasting novel and more reliable AB metrics against alpha asymmetries in an exploratory data analysis, we aimed to examine whether hemispheric differences are associated with AB scores, which could in turn refine the current model of AB metrics. Fifty nonclinical females, aged 18–30 years with minimal-to-moderate depressive symptoms were included. The participants performed two sessions of the dot-probe task, measuring AB, consisting of 160 trials each. Primary and ratio AB scores were calculated by using the novel response-based calculations. Furthermore, resting-state 32-channel EEG was measured for 2.5 min. Alpha asymmetry scores were calculated for frontal (F3/F4, F7/F8) and parietal electrode pairs (P3/P4, P7/P8). Correlations and interactions were analyzed. The primary AB scores were positively associated with frontal asymmetries, whereas parietal asymmetries showed negative associations. The ratio AB scores also showed regional differences. Parietal asymmetries interacted significantly with frontal asymmetries and AB. There was a moderate positive correlation between the BDI-II scores and the bias ratio. Our results suggest that alpha asymmetries contribute to individual differences in attention bias, with frontoparietal asymmetry interactions playing a notable role. These findings highlight hemispheric asymmetries as important to consider in future models of attention bias. Nonetheless, the associations are preliminary and call for replication.

• Norheim, Irene; Røssberg, Jan Ivar; Selle, Maria Lie; Woodberry, Kristen; O'Brien, Mary & Pedersen, Reidar [Show all 11 contributors for this article] (2026). Expressed emotions and caregiving appraisals among relatives of patients with psychotic disorders: a cross-sectional study. BMC Psychiatry. 26(1). doi: 10.1186/s12888-026-07868-7. Full text in Research Archive
• Torgersen, Kristin Stensland; Dammen, Toril; Klungsøyr, Ole; Wilberg, Theresa; Bringager, Christine Bull & Evensen, Julie Horgen [Show all 11 contributors for this article] (2026). Improvement and deterioration trajectories in psychotherapy for depression: results from an RCT with cognitive behavioural and psychodynamic therapy. Nordic Journal of Psychiatry. ISSN 0803-9488. doi: 10.1080/08039488.2026.2648291. Full text in Research Archive
• Hagen, Hallvard Solbø; Røssberg, Jan Ivar; Harmer, Catherine; Jonassen, Rune; Landrø, Nils Inge & Bø, Ragnhild (2025). Attention bias at baseline does not moderate the effect of attention bias modification for residual depressive symptoms. Journal of Behavior Therapy and Experimental Psychiatry. ISSN 0005-7916. 90, p. 1–8. doi: 10.1016/j.jbtep.2025.102073. Full text in Research Archive
• Baklund, Lise; Røssberg, Jan Ivar; Melbye, Sigurd; Pesonen, Eerikki Henri & Møller, Paul (2025). The influence of mood and social relationships on the intensity of basic self-disturbance: an experience sampling method investigation. Frontiers in Psychiatry. 16. doi: 10.3389/fpsyt.2025.1514351. Full text in Research Archive
• Bjåstad, Jon Fauskanger; Lillevoll, Kjersti; Hoffart, Asle; Nilsen, Toril Sørheim; Kjøterøe, Jane Katrine & Prescott, Peter [Show all 10 contributors for this article] (2025). Effekten av ferdighetstrening på utøvelse av kognitiv terapi for sosial angstlidelse: oppsummering av en randomisert kontrollert studie. Tidsskrift for kognitiv terapi. ISSN 1504-3142. Full text in Research Archive
• Norheim, Irene; Pedersen, Reidar; Selle, Maria Lie; Røssberg, Jan Ivar; Hestmark, Lars & Heiervang, Kristin Sverdvik [Show all 13 contributors for this article] (2025). Effectiveness of implementing family involvement on patient outcomes in individuals with psychotic disorders: a pragmatic cluster randomised controlled trial. BMC Psychiatry. 25(1). doi: 10.1186/s12888-025-07501-z. Full text in Research Archive Show summary

  Abstract Background The purpose of this sub-study, as part of the Implementation of guidelines on Family Involvement for persons with Psychotic disorders (IFIP) trial, was to examine the effectiveness of family interventions (FIs) implemented through an implementation support program (ISP) on patients’ outcomes. Methods The IFIP trial is a cluster randomised controlled trial where 15 Community Mental Health Centre units were randomly allocated either to the ISP, which included FIs as clinical interventions, implementation strategies, and implementation interventions, or to treatment as usual (TAU). In the control arm, patients could have access to FIs. Patients with psychotic disorders in both arms were asked to complete questionnaires at inclusion, 6- and 12 months. The primary outcome was patients’ difficulties in interpersonal relationships measured with the Relationships subscale of Behaviour and Symptom Identification scale. The secondary outcomes were patients’ mental health and functioning, perceived expressed emotions, recovery, and quality of life. Linear mixed-effects models were used to analyse differences in change over time between the two arms. Results We included 231 patients (135 from the intervention units; 96 from the control units). Except for the first 24% of the 6 months questionnaires, the 6- and 12-month data were collected during the COVID-19 pandemic. There were no significant differences in the primary outcome, difficulties in interpersonal relationships at 12 months, between the intervention and control arms (Cohen’s d = -0.19, p  = 0.2). The secondary outcomes showed less perceived criticism from the relatives (Perceived Criticism sub-score; d = − 0.4, p  = 0.01) and reduced difficulties in overall functioning (Health of the Nation Outcome Scale; d = − 0.29, p  = 0.01) in the intervention arm compared to the control arm at 12 months. Conclusion The FIs, implemented through the ISP, did not achieve significant decreases in patients’ difficulties with interpersonal relationships. However, this sub-study indicates that FIs in routine mental health practices can nurture a more positive family environment and enhance the patient’s process toward improved functioning. The complexity of the study design, and the restrictions due to COVID-19, may have diminished the implementation and effectiveness of the measured FIs for the patients. Trial registration ClinicalTrials.gov Identifier NCT03869177. Registered 2019-02-28.

• Liu, Siwei; Agartz, Ingrid; Allen, Paul; Amminger, G. Paul; Andreassen, Ole & Bachman, Peter [Show all 113 contributors for this article] (2025). Structural covariance network topology in individuals at clinical high risk for psychosis: the ENIGMA-CHR Study. Molecular Psychiatry. ISSN 1359-4184. doi: 10.1038/s41380-025-03304-6. Full text in Research Archive Show summary

  Brain network architecture is anticipated to influence future grey matter loss in individuals at Clinical High Risk (CHR) for psychosis. However, existing studies on grey matter structural network properties in CHR are scarce and constrained by small sample sizes. Here, we examined network topology differences comparing a) CHR versus healthy controls (HC); b) CHR who transitioned to psychosis (CHR-T) versus those who did not (CHR-NT); and c) different subsyndromes. We included structural scans from 1842 CHR individuals and 1417 HC individuals from 31 sites within the Enhancing NeuroImaging Genetics through Meta-Analysis (ENIGMA) consortium. At the global level, CHR individuals exhibited lower structural covariance (q < 0.001; Cohen’s d = 0.164) and less optimal structural network configuration than HC (lower global efficiency and clustering coefficient, d = 0.100,0.087, qs <= 0.027). Though no global difference between CHR-T and CHR-NT, network distinctiveness of the frontal and temporal surface area networks was higher in CHR-T than CHR-NT (d = 0.223,0.237) and HC (d = 0.208,0.219) (qs < 0.001). Network distinctiveness of the frontal cortical thickness network was lower in CHR-T (d = 0.218, q < 0.001) than CHR-NT and HC (d = 0.165, q < 0.001). Importantly, higher network distinctiveness was associated with worse positive symptoms in CHR-NT (frontal surface area, q = 0.008, R2 = 0.013) and at trend with worse negative symptoms in CHR-T (frontal thickness, q = 0.063, R2 = 0.049). Further, the brief intermittent psychotic syndrome subgroup showed more severe network alterations. Together, brain structural networks inform symptoms and the risk of transition to psychosis in CHR individuals.

• Malkomsen, Anders; Ulberg, Randi; Dammen, Toril; Evensen, Julie Horgen; Hummelen, Benjamin & Løvgren, André [Show all 9 contributors for this article] (2025). Childhood trauma and treatment outcomes in short-term psychodynamic and cognitive behavioral therapy for adult depression. Frontiers in Psychiatry. 16. doi: 10.3389/fpsyt.2025.1692277. Full text in Research Archive Show summary

  Childhood trauma (CT) is a known risk factor for major depressive disorder (MDD), yet its implications for treatment selection remain unclear. This exploratory randomized controlled trial (N = 100) compared short-term psychodynamic psychotherapy (STPP) and cognitive behavioral therapy (CBT) in adults with MDD treated in outpatient clinics. CT was assessed with the Childhood Trauma Questionnaire–Short Form (CTQ-SF), and depressive symptoms were measured using the Beck Depression Inventory-II (BDI-II) and the Hamilton Depression Rating Scale (HDRS) at baseline and after 28 weeks of therapy. Linear mixed-model analyses showed that CT was associated with higher depression severity at the start of treatment. No significant predictive effects of CT were found for treatment outcome or for moderation of the comparative effectiveness of CBT and STPP. Emotional abuse was initially associated with greater improvement in STPP compared to CBT on the HDRS, but the effect did not remain significant after correction for multiple testing. These findings suggest that both CBT and STPP are suitable options for patients with MDD and a history of CT.

• Kvam, Tor-Morten; Goksøyr, Ivar; Rog, Justyna; Vooren, Inger-Tove Jentoft van de; Stewart, Lowan H. & Autran, Ingrid [Show all 12 contributors for this article] (2025). MDMA-assisted therapy for major depressive disorder: A seven-month follow-up proof of principle trial. Journal of Psychiatric Research. ISSN 0022-3956. 193, p. 302–308. doi: 10.1016/j.jpsychires.2025.11.030. Full text in Research Archive Show summary

  Abstract Background: Major depressive disorder (MDD) is a leading cause of global disability, and current treatments often fail to provide sustained effectiveness. MDMA-assisted therapy (MDMA-AT) is a promising treatment for MDD. However, the long-term effects are not known. Objectives: To examine the long-term effects of MDMA-AT for MDD. Methods: Twelve participants with MDD and an ongoing moderate to severe depressive episode received MDMA-AT in two MDMA dosing sessions one month apart, integrated with nine psychotherapy sessions. Clinical assessments were done before MDMA-AT (baseline), after the final psychotherapy session (post-treatment), and at follow-up seven months after baseline. The primary and secondary outcome measures were the Montgomery-Asberg Depression Rating Scale (MADRS) and Sheehan Disability Scale (SDS), respectively. Suicidality was tracked with the Columbia-Suicide Severity Rating Scale. Exploratory outcomes included self-reported assessments of functional impairment, depression, generalized anxiety, insomnia, and PTSD symptoms. We used a mixed-effects model and multinomial logistic regression for analysis of repeated measures. Results: All twelve participants attended the follow-up visit. At follow-up, there was a significant reduction of MADRS (p < 0.001) and SDS (p = 0.001) scores compared with baseline, along with significant improvements in all exploratory outcome measures. There were no significant changes in any measures from the post-treatment visit. Neither the mean suicidal ideation (SI) score nor the SI intensity rating exceeded pre-study levels. Conclusion: This long-term follow-up study of MDMA-AT provides preliminary evidence supporting sustained treatment effects and long-term safety in MDD. However, further validation in larger, controlled trials is needed.

• Bjåstad, Jon Fauskanger; Lillevoll, Kjersti; Hoffart, Asle; Nilsen, Toril Sørheim; Kjøterøe, Jane Katrine & Prescott, Peter [Show all 11 contributors for this article] (2025). The effect of behavioral rehearsal in the training of clinical psychology students in cognitive therapy for social anxiety disorder: A randomized controlled trial. Behaviour Research and Therapy. ISSN 0005-7967. 193, p. 104849–104849. doi: 10.1016/j.brat.2025.104849. Full text in Research Archive Show summary

  Objective The present study investigated the effects of including behavioural rehearsal (i.e., expert demonstration followed by role-playing treatment components) in the training of clinical psychology students in cognitive therapy for social anxiety disorder. Method A randomized controlled design was used where fifth year clinical psychology students (N = 94, M age = 26.2 years, SD = 3.81) were randomized to behavioural rehearsal or a bona fide control training condition (expert demonstration and discussions), as part of a 16-h training course in cognitive therapy for social anxiety disorders. Videotapes (N = 94) of participants role-playing therapists after training were rated for therapist competence (primary outcome measured by three competence variables) by raters who were unaware of the training condition allocation. Secondary outcomes (therapists’ self-efficacy, therapist worry levels and satisfaction with training) were collected by self-report at post-training and at 6-month follow-up. Results Participants in the behavioural rehearsal condition achieved higher competence scores compared to the control condition. Differences between groups were found for all three competence variables, with large effect sizes (d = 1.23–1.40, 95 % CI [.78, 1.85]). Large between-group effect sizes were also found for all individual items of competence (d = .80–1.22, 95 % CI [.38, 1.66]). No effects were found for secondary outcomes. Conclusions The results suggest that inclusion of behavioural rehearsal in training leads to higher competence among clinical psychology students when delivering cognitive therapy for social anxiety disorder. Training providers should consider incorporating behavioural rehearsal in cognitive therapy training.

• Strandberg, Ragnhild Bjarkøy; Nilsen, Roy Miodini; Pouwer, Francois; Igland, Jannicke; Røssberg, Jan Ivar & Jenum, Anne Karen [Show all 8 contributors for this article] (2025). Pharmacologically treated depression, anxiety, and insomnia in individuals with type 2 diabetes: The role of diabetes duration, age, and age at diabetes onset. A Norwegian population-based registry study from the OMIT cohort. Journal of Psychosomatic Research. ISSN 0022-3999. 190, p. 1–8. doi: 10.1016/j.jpsychores.2025.112057. Full text in Research Archive Show summary

  Objective To examine whether type 2 diabetes (T2D) duration (‘0–4’; ‘≥5–9’; ≥10–19′; ‘≥20 years') was associated with use of medication for depression, anxiety, or insomnia, and if possible associations were modified by age, age at T2D onset, sex, and education. Methods We used data from 55,083 adults with T2D in the national registry-based cohort study Outcomes & Multi-morbidity In T2D (2006–2019). Adjusted associations and effect modifications were estimated using binary logistic regressions with generalized estimation equations in the subgroups age (<60, ≥60 years), age at diabetes onset (<40, ≥40 years), sex (men, women), and education (primary, high school, university). Results At initial registration, 12 % used medication for depression, 10 % for anxiety, and 16 % for insomnia. These prevalence estimates increased with diabetes duration in most subgroups. Individuals with early onset T2D had higher prevalence of depression than those with late onset, which increased with diabetes duration (per category change diabetes duration 0.7 % (95 % CI 0.2, 1.2), P for trend = 0.003). For anxiety and insomnia, a stronger association was found in those with early T2D onset compared to late onset (per category change 1.3 % (95 % CI 0.9, 1.8) and 1.9 (95 % CI 1.3, 2.4), P for interaction = 0.001; 0.01). Conclusion The prevalence of pharmacologically treated depression, anxiety, and insomnia increased with diabetes duration; this finding may imply that assessment of mental health disorders at the initial phase and along the diabetes trajectory are needed. As the prevalences advanced most prominently in people with early onset T2D, future studies should determine underlying mechanisms to test age-appropriate preventive interventions.

• Malkomsen, Anders; Wilberg, Theresa; Bull-Hansen, Bente; Dammen, Toril; Evensen, Julie Horgen & Hummelen, Benjamin [Show all 10 contributors for this article] (2025). Comparative effectiveness of short-term psychodynamic psychotherapy and cognitive behavioral therapy for major depression in psychiatric outpatient clinics: a randomized controlled trial. BMC Psychiatry. 25. doi: 10.1186/s12888-025-06544-6. Full text in Research Archive Show summary

  Background More studies with low risk of bias on the effectiveness of cognitive behavioral therapy (CBT) and short-term psychodynamic psychotherapy (STPP) for major depressive disorder (MDD) are needed. This study compares the outcome of CBT and STPP and examines the improvements in each treatment, focusing on effect sizes, reliable change, dropout rates, and remission rates, using broad inclusion criteria (e.g. participants using antidepressants or with strong suicidal ideation). Methods One hundred patients were randomly allocated to CBT or STPP. All patients were offered either 16 weekly sessions followed by 3 monthly booster sessions in CBT, or 28 weekly sessions in STPP. Primary outcome measures were Hamilton Depression Rating Scale (HDRS) and Beck’s Depression Inventory-II (BDI-II). Secondary outcome measures were Work and Social Adjustment Scale (WSAS), Generalized Anxiety Disorder-7 (GAD-7), Global Assessment of Functioning (GAF) and Short Form Health Survey-12 (SF-12). Results No significant differences in outcomes were found between the two treatment groups on any of the measures. The within-group effects were large (> 0.8) for the primary outcome measures and moderate to large for the secondary outcome measures. According to the reliable change index (RCI), 79% of patients reliably improved on HDRS and 76% improved on BDI-II, whereas respectively 6% and 10% reliably deteriorated. Conclusions These findings support the assumption that CBT and STPP are equally effective treatments for patients with depressive disorders in psychiatric outpatient clinics. Additionally, they strengthen the evidence for the effectiveness of both CBT and STPP in these settings, while also highlighting that not all depressed patients respond to short-term treatment.

• Gjerdalen, Oda Skancke; Zucknick, Manuela; Westlie, Ingvild Tvedt; Bull, Helen; Evensen, Stig & Falkum, Erik [Show all 17 contributors for this article] (2025). An exploratory study of the relevance of therapy format and therapist’ training in individual cognitive behavioral therapy for psychosis. Frontiers in Psychiatry. 16. doi: 10.3389/fpsyt.2025.1527549. Full text in Research Archive Show summary

  Introduction: Cognitive Behavioral Therapy for psychosis (CBTp) is an evidence-based intervention that can be delivered in various formats, including as part of vocational rehabilitation. However, due to scarcity of resources, CBTp is currently accessible to only a minority of individuals with psychosis. This secondary analysis aims to explore potential differences in clinical outcomes between distinct CBTp formats and to examine whether therapist training influences treatment effect. Exploring these aspects is of importance, as they may influence the scalability and accessibility of CBTp in routine care. Material and methods: Data in this study is sourced from two independent projects; KATOslo and JUMP, comprising a total of 200 participants with broad schizophrenia-spectrum disorders. The current study compares CBTp delivered as either symptom-focused individual therapy (KATOslo) or as an add-on to a vocational rehabilitation (VR) program (JUMP), with two reference groups; VR combined with cognitive remediation (JUMP) and treatment as usual (KATOslo). Using a series of mixed effects models for repeated measurements, we examined differences between the groups in terms of general functioning and psychiatric symptom severity. Emphasis was placed on potential differences between the two groups receiving CBTp, considering both average differences across assessment points and trajectories over time. Results: In line with expectations, all groups demonstrated overall improvements in functioning and symptom levels. After adjusting for relevant confounders, no statistically significant differences were found between the two groups receiving CBTp following treatment initiation. Conclusions: These findings suggest that CBTp may be effective across different delivery formats and levels of therapist training in terms of similar, positive clinical outcomes for this patient group. This has potential implications for service design and broader implementation of CBTp in real-world settings.

• Eielsen, Karl Mikkel Veum; Ulvenes, Pål Gunnar; Melsom, Linne; Wampold, Bruce E.; Røssberg, Jan Ivar & Myhre, Filip [Show all 9 contributors for this article] (2025). Development and psychometric evaluation of a screening instrument for cognitive perceptual disruption (Copeds) in psychotherapy patients. Psychotherapy Research. ISSN 1050-3307. doi: 10.1080/10503307.2025.2495773. Full text in Research Archive Show summary

  Objective Cognitive perceptual disruption (CPD) is an emotion regulation mechanism described in intensive short-term dynamic psychotherapy (ISTDP) that distinguishes fragile patients from resistant ones. CPD functions as an involuntary avoidance-based mechanism that prevents engagement with distressing emotions, making its identification crucial for guiding treatment. Currently, CPD assessment relies solely on clinical psychodiagnostic evaluation, with no available psychometric instruments. This study introduces a cognitive perceptual disruption screening instrument (Copeds), a self-report measure designed to identify CPD and assist in treatment planning for emotion-focused therapies. Method A cross-sectional study was conducted to develop Copeds, evaluate its ability to distinguish between fragile and resistant patients, and examine its preliminary psychometric properties. 112 outpatients underwent clinical psychodiagnostic evaluation and completed Copeds. Regularized regression techniques, receiver operating characteristic (ROC) analysis, and analyses of internal consistency and sensitivity/specificity were performed. Results The final instrument contained 19 psychometric items that strongly discriminated between fragile and resistant patients. ROC analysis yielded an area under the curve (AUC) value of 0.88. Sensitivity was 91.4%, and specificity was 76.4%. Conclusion The study provides promising initial evidence for Copeds as a reliable instrument with strong classification accuracy, supporting its potential use in clinical assessment and treatment planning for emotion-focused therapies.

• Hagen, Hallvard Solbø; Røssberg, Jan Ivar; Harmer, Catherine; Jonassen, Rune; Landrø, Nils Inge & Bø, Ragnhild (2024). Does rumination moderate the effect of attention bias modification for depressive symptoms? Journal of Affective Disorders Reports. 17. doi: 10.1016/j.jadr.2024.100824. Full text in Research Archive Show summary

  Background: Current treatment of major depressive disorders still leave many patients with modest improvement. Attention Bias Modification (ABM) is an approach that may serve as an adjuvant therapy for subgroups of pa- tients. We examined whether rumination, often found to be associated with a negative attentional bias, acts as a moderating variable in a computerized ABM procedure in participants with recurrent depression. Methods: A total of 301 patients were randomized to receive either active - or sham ABM twice daily for 14 days. A regression-based moderator analysis was applied to evaluate whether baseline brooding, from the Rumination Response Scale (RRS-B), moderated the effect of ABM on Hamilton Depression Rating Scale (HDRS) and Beck Depression Inventory II (BDI-II). Results: There was no significant interaction effect of ABM and RRS-B on HDRS or BDI-II at post-intervention or at 1 month follow-up. In addition, no correlation was found for pre-training attention bias and RRS-B. Limitations: : Generalizability is limited to individuals with non-clinical symptom scores. Conclusions: There was no moderator effect of brooding rumination on clinical depression scales in the largest clinical study on ABM to date.

• Baklund, Lise; Røssberg, Jan Ivar; Melbye, Sigurd & Møller, Paul (2024). Basic self-disturbance in adolescents at risk of psychosis: temporal stability investigated by the experience sampling method in a mixed method study. BMJ Mental Health. 27(1). doi: 10.1136/bmjment-2024-301209. Full text in Research Archive Show summary

  Background Basic self-disturbance (BSD), also called anomalous self-experiences (ASEs), are core phenotypic markers for schizophrenia spectrum disorders and a prepsychotic vulnerability marker considered to be temporally stable (trait-phenomenon). Studies of BSD in children and adolescents are lacking. Objective To be clinically useful, we need to know more about the characteristics and temporal development of BSD in prepsychotic phases. Method This study used a smartphone application measuring the occurrence and subjective intensity of ASEs in the daily life of 27 help-seeking adolescents (12–18 years) repeatedly over a period of 6 months. A total of 5223 unique application-reports based on individually selected and verbatim descriptions of personal core ASEs were analysed by mixed methods. Findings The intensity of ASEs, within subjects and between subjects and irrespective of time intervals or baseline scores obtained by the Examination of Anomalous Self-Experience (EASE) were relatively stable with a mean variability of 1.25 (0.4) SD. Participants with low EASE total scores at baseline had a significantly lower score on ASE intensity than those with high baseline EASE total scores at baseline (mean 2.42 vs 3.42, p=0.046). Conclusion and clinical implications In this study, ASEs were not reported as essentially fluctuating experiences but as almost constantly present, demonstrating BSD as a mainly trait phenomenon in prepsychotic phases in persons under the age of 18. Considering the continuous experience of BSD and its predictive value for psychosis development, ASEs should be targeted and monitored to the same extent as other prepsychotic features.

• Gjerstad, Christer Lunde; Schjøtt-Pedersen, Olivia; Seierstad, Andreas; Røssberg, Jan Ivar; Bull, Helen & Berentzen, Lars-Christian [Show all 7 contributors for this article] (2024). Virtuell virkelighet, virkelig mestring: Virtual Reality som verktøy i behandling av psykoselidelser. Tidsskrift for Norsk psykologforening (Psykologtidsskriftet). ISSN 0332-6470. 61(9), p. 578–586. doi: 10.52734/MXMI5408. Full text in Research Archive Show summary

  Nasjonale og internasjonale føringer oppfordrer til økt bruk av digitale teknologier og e-helse-tiltak i behandling av psykiske lidelser (Meld. St. 7 (2019–2020); World Health Organization, 2022). Virtual Reality (VR) er en av flere teknologier som har vist seg lovende i denne sammenheng, men som foreløpig har begrenset utbredelse (Ose et al., 2019; Stige et al., 2023). Selv om VR-teknologi tradisjonelt har vært forbundet med spill og underholdning, har man i løpet av de siste tiårene virkelig oppdaget dens potensial i psykoterapi (Birckhead et al., 2019). En annen teknologi med stort potensial er kunstig intelligens (KI; Kellogg & Sadeh-Sharvit, 2022). Siden lanseringen av OpenAIs generative språkmodell ChatGPT høsten 2022 har bruken av KI i helsesektoren økt betraktelig, både i somatikk (Berntsen, 2023) og psykisk helsevern (Günther, 2024). Her presenterer vi forskningsgrunnlaget for VR som psykoterapeutisk verktøy, med vekt på behandling av psykoselidelser. Ved hjelp av et fiktivt kasus basert på reelle behandlingsforløp fra psykoseenheter ved Oslo universitetssykehus (OUS) viser vi hvordan VR muliggjør realistisk eksponering for angstutløsende situasjoner og trening i å mestre dem. Videre belyser vi hvordan VR i kombinasjon med KI kan brukes for å utvikle og tilby skreddersydde behandlingsprogrammer for norske psykosepasienter. Artikkelen er skrevet av et tverrfaglig team av klinikere og forskere innen psykoseog angstfeltet. Forfattergruppens brede sammensetning, bestående av psykologer, psykiatere, psykiatriske sykepleiere og ergoterapeuter, bidrar til å belyse temaet fra ulike kliniske og praktiske vinklinger. Alle forfatterne er tilknyttet RecoVRy-prosjektet – et samarbeid mellom OUS, Universitetet i Oslo, OsloMet, University of Oxford og Fornix (les mer på https://www.recovry.no/).

• Norheim, Irene; Pedersen, Reidar; Selle, Maria; Røssberg, Jan Ivar; Hestmark, Lars & Heiervang, Kristin Sverdvik [Show all 12 contributors for this article] (2024). Implementation of guidelines on Family Involvement for persons with Psychotic disorders: a pragmatic cluster randomized trial. Effect on relatives’ outcomes and family interventions received. Frontiers in Psychiatry. 15. doi: 10.3389/fpsyt.2024.1381007. Full text in Research Archive Show summary

  Background: Family interventions (FI) are recommended as part of the treatment for psychotic disorders, but the implementation in mental health services is generally poor. Recently, The Implementation of guidelines on Family Involvement for persons with Psychotic disorders (IFIP) trial, demonstrated significant improvements in implementation outcomes at cluster-level. This sub-study aims to examine the effectiveness of the IFIP intervention on relatives’ outcomes and received FI. Methods: A cluster randomized controlled trial, was conducted in 15 Norwegian Community Mental Health Center (CMHC) units that were randomized to either the IFIP intervention, including implementation interventions and clinical interventions, or treatment as usual (TAU). The clinical interventions consisted of FI: basic family involvement and support (BFIS) to all patients and family psychoeducation (FPE) to as many as possible. Patients with psychotic disorders and their closest relative were invited to fill in questionnaires at inclusion and 6 months and 12 months follow-up. Received FI was reported by both relatives and clinicians. The relatives’ primary outcome was satisfaction with health service support, measured by the Carer well-being and support questionnaire part B (CWS-B). The relatives’ secondary outcomes were caregiver experiences, expressed emotions and quality of life. Patients’ outcomes will be reported elsewhere. Results: In total 231 patient/relative pairs from the CMHC units were included (135 intervention; 96 control).The relatives in the intervention arm received an increased level of BFIS (p=.007) and FPE (p < 0.05) compared to the relatives in the control arm, including involvement in crisis planning. The primary outcome for relatives’ satisfaction with health service support, showed a non-significant improvement (Cohen’s d = 0.22, p = 0.08). Relatives experienced a significant reduced level of patient dependency (Cohen’s d = -0.23, p = 0.03). Conclusion: The increased support from clinicians throughout FI reduced the relatives’ perceived level of patient dependency, and may have relieved the experience of responsibility and caregiver burden. The COVID-19 pandemic and the complex and pioneering study design have weakened the effectiveness of the IFIP intervention, underscoring possible potentials for further improvement in relatives’ outcomes. Clinical Trial Registration: ClinicalTrials.gov, identifier NCT03869177.

• Øvstebø, Randi Breivik; Pedersen, Geir; Wilberg, Theresa; Røssberg, Jan Ivar; Dahl, Hanne-Sofie Johnsen & Kvarstein, Elfrida Hartveit (2024). Countertransference, alliance, and outcome in the treatment of patients with personality disorder: a longitudinal naturalistic study. Frontiers in Psychiatry. 15. doi: 10.3389/fpsyt.2024.1490056. Full text in Research Archive Show summary

  Objective: Relational dynamics, including countertransference responses and the therapeutic alliance, are crucial in the treatment of patients with personality disorders (PD). However, few studies on PD treatment focus on the dyadic process of therapy. The present study aims to investigate associations between therapist emotional response/countertransference (CT) and patients’ experience of treatment alliance, and CT developments in therapies with treatment completion as outcome. Method: A longitudinal, observational study of patients (N = 365) treated at PD treatment units within specialist mental health services. CT was assessed repeatedly during therapy by the Feeling Word Checklist – Brief Version with three subscales—Inadequate, Confident, and Idealized. Early alliance was assessed after 6 months of treatment (Working Alliance Inventory, WAI). Treatment completion was defined as completing treatment according to schedule versus not completing treatment. Statistical analyses included Linear Mixed Models. Results: In the early phase of therapy, lower WAI predicted lower levels of Confident, Idealized, and higher Inadequate CT. The relation between early WAI and CT levels during treatment remained stable. The development of CT during treatment differed according to treatment completion with significant trends of increasing Inadequate CT and decreasing Idealized CT in not completed treatments. WAI and treatment completion had strong and independent effects. Further moderator analysis did not yield additional information. Conclusion: The study demonstrates significant associations between negative CTs and lower patient-rated WAI in the early phase of therapy, and a development of increasingly more negative CTs during therapy in treatments which were not completed according to schedule. The results indicate high clinical relevance of monitoring therapeutic relationships in PD treatments. Further research on the emotional and relational quality of psychotherapeutic relationships in PD treatments is needed.

• Igland, Jannicke; Forster, Rachel Bedenis; Jenum, Anne Karen; Strandberg, Ragnhild Bjarkøy; Berg, Tore Julsrud & Røssberg, Jan Ivar [Show all 8 contributors for this article] (2024). How valid is a prescription-based multimorbidity index (Rx-risk) in predicting mortality in the Outcomes and Multimorbidity In Type 2 diabetes (OMIT) study? A nation-wide registry-based cohort study from Norway. BMJ Open. 14(3). doi: 10.1136/bmjopen-2023-077027. Full text in Research Archive Show summary

  Objective: The prescription-based Rx-risk index has previously been developed to measure multimorbidity. We aimed to adapt and evaluate the validity of the Rx-risk index in prediction of mortality among persons with type 2 diabetes. Design: Registry-based study. Setting: Adults with type 2 diabetes in Norway identified within the ‘Outcomes and Multimorbidity In Type 2 diabetes’ cohort, with linkage to prescriptions from the Norwegian Prescription Database and mortality from the Population Registry. Participants: We defined a calibration sample of 42 290 adults diagnosed with type 2 diabetes 1950–2013, and a temporal validation sample of 7085 adults diagnosed 2014–2016 to evaluate the index validity over time Primary outcome measure: All-cause mortality Methods: For the calibration sample, dispensed drug prescriptions in 2013 were used to define 44 morbidity categories. Weights were estimated using regression coefficients from a Cox regression model with 5 year mortality as the outcome and all morbidity categories, age and sex included as covariates. The Rx-risk index was computed as a weighted sum of morbidities. The validity of the index was evaluated using C-statistic and calibration plots. Results: In the calibration sample, mean (SD) age at start of follow-up and duration of diabetes was 63.8 (12.4) and 10.1 (7.0) years, respectively. The overall C-statistic was 0.82 and varied from 0.74 to 0.85 when stratifying on age groups, sex, level of education and country of origin. In the validation sample, mean (SD) age and duration of diabetes was 59.7 (13.0) and 2.0 (0.8) years, respectively. Despite younger age, shorter duration of diabetes and later time period, the C-index was high both in the total sample (0.84) and separately for men (0.83) and women (0.84). Conclusions: The Rx-risk index showed good discrimination and calibration in predicting mortality and thus presents a valid tool to assess multimorbidity among persons with type 2 diabetes.

• Zhu, Yinghan; Maikusa, Norihide; Radua, Joaquim; Sämann, Philipp G.; Fusar-Poli, Paolo & Agartz, Ingrid [Show all 82 contributors for this article] (2024). Using brain structural neuroimaging measures to predict psychosis onset for individuals at clinical high-risk. Molecular Psychiatry. ISSN 1359-4184. 29, p. 1465–1477. doi: 10.1038/s41380-024-02426-7. Full text in Research Archive Show summary

  Machine learning approaches using structural magnetic resonance imaging (sMRI) can be informative for disease classification, although their ability to predict psychosis is largely unknown. We created a model with individuals at CHR who developed psychosis later (CHR-PS+) from healthy controls (HCs) that can differentiate each other. We also evaluated whether we could distinguish CHR-PS+ individuals from those who did not develop psychosis later (CHR-PS-) and those with uncertain follow-up status (CHR-UNK). T1-weighted structural brain MRI scans from 1165 individuals at CHR (CHR-PS+, n = 144; CHR-PS-, n = 793; and CHR-UNK, n = 228), and 1029 HCs, were obtained from 21 sites. We used ComBat to harmonize measures of subcortical volume, cortical thickness and surface area data and corrected for non-linear effects of age and sex using a general additive model. CHR-PS+ (n = 120) and HC (n = 799) data from 20 sites served as a training dataset, which we used to build a classifier. The remaining samples were used external validation datasets to evaluate classifier performance (test, independent confirmatory, and independent group [CHR-PS- and CHR-UNK] datasets). The accuracy of the classifier on the training and independent confirmatory datasets was 85% and 73% respectively. Regional cortical surface area measures-including those from the right superior frontal, right superior temporal, and bilateral insular cortices strongly contributed to classifying CHR-PS+ from HC. CHR-PS- and CHR-UNK individuals were more likely to be classified as HC compared to CHR-PS+ (classification rate to HC: CHR-PS+, 30%; CHR-PS-, 73%; CHR-UNK, 80%). We used multisite sMRI to train a classifier to predict psychosis onset in CHR individuals, and it showed promise predicting CHR-PS+ in an independent sample. The results suggest that when considering adolescent brain development, baseline MRI scans for CHR individuals may be helpful to identify their prognosis. Future prospective studies are required about whether the classifier could be actually helpful in the clinical settings.

• Protić, Sonja; Wittmann, Lutz; Taubner, Svenja; Conejo-Cerón, Sonia; Ioannou, Yianna & Heinonen, Erkki [Show all 22 contributors for this article] (2024). Mediators of Outcome in Trauma-Focused Psychotherapy with Youth: A Systematic Review. Trauma, Violence, & Abuse. ISSN 1524-8380. doi: 10.1177/15248380231223264. Full text in Research Archive
• Malkomsen, Anders; Røssberg, Jan Ivar; Dammen, Toril; Wilberg, Theresa; Løvgren, André & Ulberg, Randi [Show all 7 contributors for this article] (2024). “It takes time to see the whole picture”: patients’ views on improvement in cognitive behavioral therapy and psychodynamic therapy after three years. Frontiers in Psychiatry. 15. doi: 10.3389/fpsyt.2024.1342950. Full text in Research Archive Show summary

  Introduction: There is a lack of qualitative research that retrospectively explores how patients with major depressive disorder view their improvement in psychotherapy. Methods: Fifteen patients who received short-term cognitive behavioral therapy and psychodynamic therapy were individually interviewed approximately three years after completing therapy. Results: Some patients had altered their views on therapy, especially those who initially were uncertain of how helpful therapy had been. They said they did not realize the extent and importance of their improvement in therapy before some time had passed, which can be explained by the surprising cumulative effects of seemingly small changes. Discussion: This should make retrospective qualitative research an important part of future psychotherapy research.

• for, . ENIGMA Clinical High Risk; Haas, Shalaila S.; Ge, Ruiyang; Agartz, Ingrid; Amminger, G. Paul & Andreassen, Ole [Show all 51 contributors for this article] (2023). Normative Modeling of Brain Morphometry in Clinical High Risk for Psychosis. JAMA psychiatry. ISSN 2168-6238. 81(1), p. 77–88. doi: 10.1001/jamapsychiatry.2023.3850. Full text in Research Archive
• Eielsen, Karl Mikkel Veum; Ulvenes, Pål Gunnar; Wampold, Bruce E.; Røssberg, Jan Ivar & Abbass, Allan (2023). A naturalistic pilot study exploring the differences between fragile and resistant patients in ISTDP. Journal of Affective Disorders Reports. 14. doi: 10.1016/j.jadr.2023.100639. Full text in Research Archive Show summary

  Introduction Intensive Short-Term Dynamic Psychotherapy (ISTDP) defines two spectra of patients based on the patients’ capacity to tolerate anxiety and complex emotions. Resistant patients have a better capacity to tolerate affective stimulus compared to fragile patients. There is, however, little empirical evidence that supports this categorization. This exploratory study seeks to identify reliable differences between 330 resistant and 88 fragile patients. Methods To assess which category patients belong to, therapists conducted a specific psychodiagnostic assessment of patients when entering psychotherapy. Patients selfreported on the Brief Symptom Inventory (BSI) and the Inventory of Interpersonal Problems (IIP). Independent samples t-tests estimated differences between psychodiagnostic categories on self-reported measurements. Results Fragile patients scored significantly higher on five IIP subscales and all BSI subscales, barring “Paranoid Ideation”. As symptom distress might mask underlying pathological processes, we used a matching procedure to compare resistant and fragile patients with the same level of symptom distress, before repeating estimation of differences between the categories. Fragile patients scored significantly higher only on the BSI somatization subscale as well as on three items from the BSI somatization subscale, and one item from each of three other BSI subscales (i.e., “Phobic anxiety”, “Anxiety”, “Psychoticism”). Limitations The study used generic psychometric instruments. A specific psychometric instrument developed according to ISTDP theory would likely be more suited to capture group differences. Conclusions The results provide support for the notion that fragile patients in general experience more psychological distress and specifically suffer from more somatization and additionally anxiety, phobic anxiety and psychoticism symptoms.

• Øvstebø, Randi Breivik; Pedersen, Geir Arild Feigum; Wilberg, Theresa; Røssberg, Jan Ivar; Dahl, Hanne-Sofie Johnsen & Kvarstein, Elfrida Hartveit (2023). Countertransference in the treatment of patients with personality disorders: A longitudinal study. Psychotherapy Research. ISSN 1050-3307. doi: 10.1080/10503307.2023.2279645. Full text in Research Archive Show summary

  Objective This study examines how therapist emotional response/countertransference (CT) develops during treatment for patients with personality disorders (PDs) and how pre-treatment patient factors (severity of personality pathology, PD category, level of symptom distress) predict CT responses. Secondly, we explored associations between patient clinical outcome and CT. Method A longitudinal, observational study including 1956 patients with personality pathology treated at psychotherapy units within specialist mental health services. Therapists’ emotional response was repeatedly assessed by the Feeling Word Checklist—Brief Version (FWC-BV) with three subscales—Inadequate, Confident, and Idealized. Results Levels of Inadequate CT were lowest and stable over time while Confident and Idealized increased over time. Greater severity of personality pathology and borderline PD predicted higher initial Inadequate, lower initial Confident and decreasing Inadequate over time. Antisocial PD predicted decreasing Confident. Number of PD criteria had higher impact on therapist CT than level of symptom distress. Clinical improvement was associated with decreasing Inadequate. Conclusion Therapists reported predominantly Confident CT when working with PD patients. More severe personality pathology, and borderline PD, specifically, predicted more negative CT initially, but the negative CT decreased over time. Patients who did not improve were associated with increasing Inadequate.

• Dysthe, Kim Kristoffer; Røssberg, Jan Ivar; Brandtzæg, Petter Bae; skjuve, Marita; Haavet, Ole Rikard & Følstad, Asbjørn [Show all 7 contributors for this article] (2023). Analyzing User-Generated Web-Based Posts of Adolescents' Emotional, Behavioral, and Symptom Responses to Beliefs About Depression: Qualitative Thematic Analysis. Journal of Medical Internet Research (JMIR). ISSN 1439-4456. 25. doi: 10.2196/37289. Full text in Research Archive Show summary

  Background: Depression is common during adolescence. Early intervention can prevent it from developing into more progressive mental disorders. Combining information technology and clinical psychoeducation is a promising way to intervene at an earlier stage. However, data-driven research on the cognitive response to health information targeting adolescents with symptoms of depression is lacking. Objective: This study aimed to fill this knowledge gap through a new understanding of adolescents’ cognitive response to health information about depression. This knowledge can help to develop population-specific information technology, such as chatbots, in addition to clinical therapeutic tools for use in general practice. Methods: The data set consists of 1870 depression-related questions posted by adolescents on a public web-based information service. Most of the posts contain descriptions of events that lead to depression. On a sample of 100 posts, we conducted a qualitative thematic analysis based on cognitive behavioral theory investigating behavioral, emotional, and symptom responses to beliefs associated with depression. Results: Results were organized into four themes. (1) Hopelessness, appearing as a set of negative beliefs about the future, possibly results from erroneous beliefs about the causal link between risk factors and the course of depression. We found beliefs about establishing a sturdy therapy alliance as a responsibility resting on the patient. (2) Therapy hesitancy seemed to be associated with negative beliefs about therapy prognosis and doubts about confidentiality. (3) Social shame appeared as a consequence of impaired daily function when the cause is not acknowledged. (4) Failing to attain social interaction appeared to be associated with a negative symptom response. In contrast, actively obtaining social support reduces symptoms and suicidal thoughts. Conclusions: These results could be used to meet the clinical aims stated by earlier psychoeducation development, such as instilling hope through direct reattribution of beliefs about the future; challenging causal attributions, thereby lowering therapy hesitancy; reducing shame through the mechanisms of externalization by providing a tentative diagnosis despite the risk of stigmatizing; and providing initial symptom relief by giving advice on how to open up and reveal themselves to friends and family and balance the message of self-management to fit coping capabilities. An active counseling style advises the patient to approach the social environment, demonstrating an attitude toward self-action.

• Gohar, Sherif Mostafa Mohamed Ahmed; Hegelstad, Wenche; Auestad, Bjørn Henrik; Haahr, Ulrik Helt; Joa, Inge & Johannessen, Jan Olav [Show all 13 contributors for this article] (2023). Association between early suicidal trajectories in first-episode psychosis and 10-year follow-up: TIPS registry-linked study. The Lancet Psychiatry. ISSN 2215-0374. 10(7), p. 528–536. doi: 10.1016/S2215-0366(23)00156-6. Full text in Research Archive
• Dysthe, Kim Kristoffer; Røssberg, Jan Ivar; Brandtzæg, Petter Bae; skjuve, Marita; Følstad, Asbjørn & Haavet, Ole Rikard [Show all 7 contributors for this article] (2023). The Depressed Teenage Brain: Chatbot Psychoeducation. Mayo Clinic proceedings. ISSN 0025-6196. 1(3), p. 334–342. doi: 10.1016/j.mcpdig.2023.03.008. Full text in Research Archive Show summary

  Objective To gain the knowledge needed to develop a cognitive behavioral intervention and reliable psychoeducation applicable for conversational artificial intelligence models, we investigated the underlying constructs of thoughts common to cognitive distortions found in online questions written by adolescents with symptoms of depression. Methods From June 30, 2020, to October 30, 2020, we analyzed a sample of 100 written questions from adolescents about depression posted on an online information service using a qualitative analysis guided by cognitive behavioral theory and informed by the neuroscience of adolescence. Results Four types of cognitive distortions (CDs) were found: (1) emotional reasoning, (2) mind reading, (3) catastrophizing, and (4) labeling. Our analysis suggested 3 underlying constructs common to the different CDs: (1) emotional states appearing as reality, (2) experiencing this emotional reality as something others think, and (3) generalizing such beliefs to every relation and the future. These constructs may signify events leading to a ruminative state that seems hard to escape. Conclusion The 4 different CDs originate from 3 underlying constructs possibly associated with adolescent neurodevelopment. This study indicates a potential to reveal the underlying constructs of thought common to different CDs, thus making CDs more useful as a target point in artificial intelligence–based technological information and intervention tools.

• Taubner, Svenja; Ioannou, Yianna; Saliba, Andrea; Sales, Célia M. D.; Volkert, Jana & Protić, Sonja [Show all 21 contributors for this article] (2023). Mediators of outcome in adolescent psychotherapy and their implications for theories and mechanisms of change: a systematic review. European Child and Adolescent Psychiatry. ISSN 1018-8827. doi: 10.1007/s00787-023-02186-9. Full text in Research Archive Show summary

  Abstract Psychotherapeutic treatment of adolescents requires age-specific approaches and thus plausibly also involves different change mechanisms than adult psychotherapy. To guide further research and improve therapeutic outcomes for adolescents, we reviewed all RCTs investigating mechanisms of change in the psychological treatment of adolescents to identify the most promising age-, disorder- or treatment-specific mediators. Following the preferred reporting items for systematic reviews (PRISMA), 106 studies were included that reported 252 statistical mediation tests assessed with 181 different measures. Most often studied and significant mediators were cognitive, followed by family-related, and behavioral variables. Several mediators were identified to be promising for future investigations: changes in negative thoughts, dysfunctional beliefs and metacognitive skills; family functioning and parenting skills; as well as successful engagement in therapy activities and increased impulse control. Symptom change during therapy was least often a mediator for other therapeutic changes. Relational and emotional mediators were largely understudied, whereas peer-influence appeared a promising mediator for intervention outcomes. Adolescence-specific mediators were most commonly investigated. Majority of studied mediators were not disorder-specific. There was a tendency to mainly test change mechanisms of specific theoretical models without considering other possible change theories. Further, virtually no studies fulfilled all criteria for rigorously investigating mediation and only nine were classified with an overall good study quality. While bearing in mind the current limitations in study designs, methodological rigor and reporting, there appears to be substantial evidence for transdiagnostic age-specific change models in the psychological treatment of adolescents. For future research, need for consensus on a core set of transdiagnostic and transtheoretical mediators and measures is highlighted. These should address likely core mechanisms of change, as well as take into account age-relevant developmental challenges and biological markers.

• Malkomsen, Anders; Røssberg, Jan Ivar; Dammen, Toril; Wilberg, Theresa; Løvgren, André & Ulberg, Randi [Show all 7 contributors for this article] (2022). How therapists in cognitive behavioral and psychodynamic therapy reflect upon the use of metaphors in therapy: a qualitative study. BMC Psychiatry. 22(1). doi: 10.1186/s12888-022-04083-y. Full text in Research Archive Show summary

  Background Research suggests that metaphors are integral to psychotherapeutic practice. We wanted to explore how 10 therapists reflect upon the use of metaphors in therapy, and how they react to some metaphors expressed by patients treated for of major depressive disorder (MDD). Methods Five therapists practicing psychodynamic therapy (PDT) and five practicing cognitive behavioral therapy (CBT) were interviewed with a semi-structured qualitative interview. Transcripts were analyzed using a thematic analysis approach. Results Our analysis resulted in two main themes: the therapeutic use of metaphors, and conflicting feelings towards metaphors used by depressed patients. Most therapists said that they do not actively listen for metaphors in therapy and many said that they seldom use metaphors deliberately. While PDT-therapists appeared more attentive to patient-generated metaphors, CBT-therapists seemed more focused on therapist-generated metaphors. Most therapists did not try to alter the patient-generated metaphors they evaluated as unhelpful or harmful. Some therapists expressed strong negative feelings towards some of the metaphors used by patients. PDT-therapists were the most critical towards the metaphor of tools and the metaphor of depression as an opponent. CBT-therapists were the most critical towards the metaphor of surface-and-depth. Conclusions These results remind us of the complexity of using metaphors in therapy, and can hopefully be an inspiration for therapists to reflect upon their own use of metaphors. Open therapeutic dialogue on the metaphor of tools, surface-depth and depression as an opponent may be necessary to avoid patient-therapist-conflicts. Trial registration Clinical Trial gov. Identifier: NCT03022071. Date of registration: 16/01/2017.

• Baldwin, Helen; Radua, Joaquim; Antoniades, Mathilde; Haas, Shalaila S.; Frangou, Sophia & Agartz, Ingrid [Show all 111 contributors for this article] (2022). Neuroanatomical heterogeneity and homogeneity in individuals at clinical high risk for psychosis. Translational Psychiatry. 12(297). doi: 10.1038/s41398-022-02057-y. Full text in Research Archive Show summary

  Individuals at Clinical High Risk for Psychosis (CHR-P) demonstrate heterogeneity in clinical profiles and outcome features. However, the extent of neuroanatomical heterogeneity in the CHR-P state is largely undetermined. We aimed to quantify the neuroanatomical heterogeneity in structural magnetic resonance imaging measures of cortical surface area (SA), cortical thickness (CT), subcortical volume (SV), and intracranial volume (ICV) in CHR-P individuals compared with healthy controls (HC), and in relation to subsequent transition to a first episode of psychosis. The ENIGMA CHR-P consortium applied a harmonised analysis to neuroimaging data across 29 international sites, including 1579 CHR-P individuals and 1243 HC, offering the largest pooled CHR-P neuroimaging dataset to date. Regional heterogeneity was indexed with the Variability Ratio (VR) and Coefficient of Variation (CV) ratio applied at the group level. Personalised estimates of heterogeneity of SA, CT and SV brain profiles were indexed with the novel Person-Based Similarity Index (PBSI), with two complementary applications. First, to assess the extent of within-diagnosis similarity or divergence of neuroanatomical profiles between individuals. Second, using a normative modelling approach, to assess the ‘normativeness’ of neuroanatomical profiles in individuals at CHR-P. CHR-P individuals demonstrated no greater regional heterogeneity after applying FDR corrections. However, PBSI scores indicated significantly greater neuroanatomical divergence in global SA, CT and SV profiles in CHR-P individuals compared with HC. Normative PBSI analysis identified 11 CHR-P individuals (0.70%) with marked deviation (>1.5 SD) in SA, 118 (7.47%) in CT and 161 (10.20%) in SV. Psychosis transition was not significantly associated with any measure of heterogeneity. Overall, our examination of neuroanatomical heterogeneity within the CHR-P state indicated greater divergence in neuroanatomical profiles at an individual level, irrespective of psychosis conversion. Further large-scale investigations are required of those who demonstrate marked deviation.

• Gjerdalen, Oda Skancke; Lystad, June Ullevoldsæter; Bull, Helen; Ringen, Petter Andreas; Røssberg, Jan Ivar & Martinsen, Egil Wilhelm [Show all 9 contributors for this article] (2022). Vocational rehabilitation augmented with cognitive behavioral therapy or cognitive remediation for individuals with schizophrenia: a 5-year follow-up study. Nordic Journal of Psychiatry. ISSN 0803-9488. 77(1), p. 23–30. doi: 10.1080/08039488.2022.2042598. Full text in Research Archive Show summary

  Introduction: Although employment is an important part of recovery for individuals with schizophrenia spectrum disorders, the employment rate for this group remains low. Increasing evidence supports the use of augmented vocational rehabilitation (VR) programs to improve occupational outcome. The aim of this study is to explore 5-year follow-up registry data from the JUMP study, a VR program for individuals with schizophrenia spectrum disorders, specifically with regard to competitive employment outcome and predictors of competitive employment. The VR was augmented with either cognitive remediation (CR) or elements from cognitive behavior therapy (CBT). Methods: One hundred and forty eight participants with schizophrenia spectrum disorders from six Norwegian counties received 10 months VR augmented with either CR (n ¼ 64) or CBT (n ¼ 84). Both competitive and sheltered workplaces were used. Assessments were conducted at baseline, at post intervention and at 2-year follow-up. Data on employment status at 5-year follow-up was obtained by registry. Results: At 5-year follow-up 55.4% were engaged in working activity, of which 22.3% had obtained competitive employment. A further 18.2% had work placements in competitive workplaces. Number of received intervention hours and competitive employment at 2-year follow-up emerged as significant predictors of competitive employment. IQ and intervention type in marginal favor of CBT were predictors on trend level. Conclusion: To the best of our knowledge, this is the first study investigating competitive employment at 5-year follow-up for individuals with schizophrenia spectrum disorders. The results add to existing evidence that competitive employment is attainable for this group.

• Baklund, Lise; Røssberg, Jan Ivar & Møller, Paul (2022). Linguistic markers and basic self-disturbances among adolescents at risk of psychosis. A qualitative study. EClinicalMedicine. 55. doi: 10.1016/j.eclinm.2022.101733. Full text in Research Archive Show summary

  Background Language impairments are key features of schizophrenia spectrum disorders, and have also been suggested to signal enhanced psychosis risk. Incoherence, derailment, and monotonous speaking are however closely related to psychosis onset, and thus not very early markers. Recent phenomenologic-psychiatric studies claim that basic self-disturbance (BSD) may represent more useful early markers. Methods We searched for distinctive irregular linguistics of 30 CHR outpatient adolescents, aged 12–18 years. Standard instruments established psychosis risk and BSD. Participants chose three personal and well manifested BSD phenomena. Ninety verbatim statements were analyzed and grouped into higher order clusters of linguistic irregularities. Findings We identified five clusters of irregular language features: distinctive words, describing an atmosphere of unreality; irregular use of prepositions, indicating experiential detachment; shifts of personal pronouns, indicating identity confusion; near-literal use of metaphors and conjunctions indicating existential insecurity, and idiosyncratic use of adjectives indicating perceptual transcendence. Interpretation The adolescents provided naturalistic descriptions of experiences that were markedly twisted and almost ineffable. This unique irregular “BSD -language” was highly meaningful in its proper context, expressing informative characteristics of first-personal experiential alterations, essential for early detection. The features may additionally represent precursors of psychosis transition, useful for clinical decision-making.

• Hoy, Angelika Van; Rzeszutek, Marcin; Pięta, Małgorzata; Mestre, Jose M.; Rodríguez-Mora, Álvaro & Midgley, Nick [Show all 22 contributors for this article] (2022). Subjective well-being among psychotherapists during the coronavirus disease pandemic: A cross-cultural survey from 12 european countries. Journal of Psychiatric Research. ISSN 0022-3956. 154, p. 315–323. doi: 10.1016/j.jpsychires.2022.07.065. Full text in Research Archive Show summary

  Objective The aim of this study is to examine the amount of the total variance of the subjective well-being (SWB) of psychotherapists from 12 European countries explained by between-country vs. between-person differences regarding its cognitive (life satisfaction) and affective components (positive affect [PA] and negative affect [NA]). Second, we explored a link between the SWB and their personal (self-efficacy) and social resources (social support) after controlling for sociodemographics, work characteristics, and COVID-19-related distress. Methods In total, 2915 psychotherapists from 12 countries (Austria, Bulgaria, Cyprus, Finland, Great Britain, Serbia, Spain, Norway, Poland, Romania, Sweden, and Switzerland) participated in this study. The participants completed the Satisfaction with Life Scale (SWLS), the International Positive and Negative Affect Schedule Short Form (I-PANAS-SF), the General Self-Efficacy Scale, and the Multidimensional Scale of Perceived Social Support. Results Cognitive well-being (CWB; satisfaction with life) was a more country-dependent component of SWB than affective well-being (AWB). Consequently, at the individual level, significant correlates were found only for AWB but not for CWB. Higher AWB was linked to being female, older age, higher weekly workload, and lower COVID-19-related distress. Self-efficacy and social support explained AWB only, including their main effects and the moderating effect of self-efficacy. Conclusions The results highlight more individual characteristics of AWB compared to CWB, with a more critical role of low self-efficacy for the link between social support and PA rather than NA. This finding suggests the need for greater self-care among psychotherapists regarding their AWB and the more complex conditions underlying their CWB.

• Hoy, Angelika Van; Rzeszutek, Marcin; Pięta, Małgorzata; Mestre, Jose M.; Rodríguez-Mora, Álvaro & Midgley, Nick [Show all 22 contributors for this article] (2022). Burnout among psychotherapists: a cross-cultural value survey among 12 European countries during the coronavirus disease pandemic. Scientific Reports. 12(1). doi: 10.1038/s41598-022-17669-z. Full text in Research Archive Show summary

  Abstract The aim of this study was to examine cross-cultural differences, as operationalized by Schwartz's refined theory of basic values, in burnout levels among psychotherapists from 12 European countries during the coronavirus disease (COVID-19) pandemic. We focused on the multilevel approach to investigate if individual- and country-aggregated level values could explain differences in burnout intensity after controlling for sociodemographic, work-related characteristics and COVID-19-related distress among participants. 2915 psychotherapists from 12 countries (Austria, Bulgaria, Cyprus, Finland, Great Britain, Serbia, Spain, Norway, Poland, Romania, Sweden, and Switzerland) participated in this study. The participants completed the Maslach Burnout Inventory-Human Service Survey, the revised version of the Portrait Values Questionnaire, and a survey questionnaire on sociodemographic, work-related factors and the COVID-19 related distress. In general, the lowest mean level of burnout was noted for Romania, whereas the highest mean burnout intensity was reported for Cyprus. Multilevel analysis revealed that burnout at the individual level was negatively related to self-transcendence and openness-to-change but positively related to self-enhancement and conservation values. However, no significant effects on any values were observed at the country level. Male sex, younger age, being single, and reporting higher COVID-19-related distress were significant burnout correlates. Burnout among psychotherapists may be a transcultural phenomenon, where individual differences among psychotherapists are likely to be more important than differences between the countries of their practice. This finding enriches the discussion on training in psychotherapy in an international context and draws attention to the neglected issue of mental health among psychotherapists in the context of their professional functioning.

• Eielsen, Karl Mikkel Veum; Ulvenes, Pål Gunnar; Røssberg, Jan Ivar; Høstmælingen, Andreas Teisner; Soma, Christina S. & Wampold, Bruce E. (2022). The Effectiveness of an Intensive Inpatient Psychotherapy Program for Chronic Depression: A naturalistic comparison with wait list. BMC Psychiatry. 22(1). doi: 10.1186/s12888-022-04381-5. Full text in Research Archive Show summary

  Background Patients with chronic depression (CD) typically have an early symptom onset, more psychiatric comorbidities, more treatment attempts, and more frequent and longer inpatient hospitalizations than patients with major depressive disorders. The main purpose of this study was to investigate the effectiveness of an intensive inpatient psychotherapy program for patients with chronic depression (CD). The primary research question was whether two intensive psychodynamic inpatient treatments, affect phobia therapy (APT) and VITA, were superior to an outpatient wait list condition, receiving treatment as usual (TAU), at completion of treatment. To investigate if a potential difference between the intensive treatment and the wait list control group was dependent on a specific psychotherapeutic model, the study contrasted two therapies with similar intensity, but different theoretical rationales. Methods Two hundred eighty patients with CD were included in a naturalistic study. Patients were assessed at four time points; assessment, start of therapy, end of therapy and 1-year follow-up. Three comparisons were performed with patients matched across groups; Intensive inpatient treatment program (APT + VITA) vs wait list during treatment, APT vs VITA during treatment and APT vs VITA during follow-up. The outcome measure was the BDI-II. Results Intensive inpatient treatment program vs. wait list showed a significant difference in favor of the intensive treatment. No significant differences were found between APT and VITA during therapy or follow-up; but both groups had large effect sizes during treatment, which were maintained during follow-up. Conclusions The intensive inpatient psychotherapy program showed superior effect on chronic depression over an outpatient wait list condition receiving treatment as usual (TAU), but no significant differences were found between the two intensive inpatient psychodynamic treatments. The results provide support for the effectiveness of an intensive inpatient psychotherapy program in treatment of chronic and severe disorders, such as CD, which could be of benefit for policymakers and the health care sector as they are allocating recourses efficiently. Trial registration This study has been retrospectively registered on ClinicalTrials.gov (NCT05221567) on February 3rd, 2022.

• Malkomsen, Anders; Røssberg, Jan Ivar; Dammen, Toril; Wilberg, Theresa; Løvgren, André & Evensen, Julie Horgen (2021). The synergistic process of improvement in cognitive behavioral therapy for major depression. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 18(5), p. 1–17. doi: 10.3390/ijerph18052292. Full text in Research Archive Show summary

  Background: There is a substantial lack of qualitative research concerning individual cognitive behavioral therapy (CBT) for patients with major depressive disorder (MDD). In the present study, we wanted to explore how patients suffering from MDD experience improvement in CBT. Method: Patients with MDD (N = 10) were interviewed at therapy termination with semi-structured qualitative interviews. The transcripts were analyzed using a thematic analysis approach. Results: We identified three elements that were relevant to the process of improvement for all patients: the therapeutic relationship, the therapeutic interventions and increased insight. There is a dynamic interrelationship and synergy between these elements that may explain why patients considered the same elements as helpful, but often in different ways and at different stages of therapy. Conclusions: Highlighting the synergies and interrelationship between the elements that patients experience as helpful, may help therapists to learn from and utilize these experiences. This is a reminder of the importance of always being attentive to the individual processes of patients.

• Bahrami, Shahram; Shadrin, Alexey A.; Frei, Oleksandr; O`Connell, Kevin; Bettella, Francesco & Krull, Florian [Show all 15 contributors for this article] (2021). Genetic loci shared between major depression and intelligence with mixed directions of effect. Nature Human Behaviour. p. 1–9. doi: 10.1038/s41562-020-01031-2. Full text in Research Archive
• Mestre, Jose M.; Taubner, Svenja; Mota, Catarina Pinheiro; Henriques, Margarida Rangel; Saliba, Andrea & Heinonen, Erkki [Show all 21 contributors for this article] (2021). Theories of Change and Mediators of Psychotherapy Effectiveness in Adolescents With Externalising Behaviours: A Systematic Review. Frontiers in Psychiatry. 12. doi: 10.3389/fpsyt.2021.730921. Full text in Research Archive Show summary

  Background Externalising behaviours are becoming a remarkably prevalent problem during adolescence, often precipitating both externalising and internalising disorders in later adulthood. Psychological treatments aim to increase the social functioning of adolescents in order for them to live a more balanced life and prevent these negative trajectories. However, little is known of the intervening variables and mediators involved in these treatments' change mechanisms. We conducted a systematic review, exploring the available evidence on mediators of psychological treatments for externalising behaviours and symptoms amongst adolescents (10 to 19 years old). Methods A systematic search was performed on Medline and PsycINFO databases, which identified studies from inception to February 23, 2020. Eligible studies included randomised controlled trials that enrolled adolescents with externalising symptoms and behaviours as, at least, one of the primary outcomes. A group of 20 reviewers from the COST-Action TREATme (CA16102) were divided into 10 pairs. Each pair independently screened studies for inclusion, extracted information from the included studies, and assessed the methodological quality of the included studies and the requirements for mediators, following Kazdin's criteria. Risk of bias of RCTs was assessed by the Mixed Methods Appraisal Tool. Extracted data from the included studies were reported using a narrative synthesis. Results Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA), after removing duplicates, 3,660 articles were screened. Disagreements were resolved by consensus. In a second stage, 965 full-text articles were assessed for eligibility. A total of 14 studies fulfilled all inclusion criteria. The majority were related to systemic psychological treatment approaches. Two types of mediators were identified as potentially being involved in the mechanisms of change for better social improvements of adolescents: to increase healthier parent–adolescent relationships and parental discipline. However, there were significant and non-significant results amongst the same mediators, which led to discussing the results tentatively. Conclusions Family variables were found to be the largest group of investigated mediators, followed by relational, behavioural, and emotional variables. No cognitive or treatment-specific mediators were identified. Both adequate behavioural control of adolescents' peer behaviour and a better positive balance in their relationships with their parents seemed to buffer the effects of externalising behaviours in adolescents. Several methodological limitations concerning mediation testing design, outcome measures, and mediator selection have been identified. Ethics and Dissemination Ethical approval was not required. PROSPERO registration number: CRD42021231835.

• Volkert, Jana; Taubner, Svenja; Barkauskiene, Rasa; Mestre, Jose M.; Sales, Célia M. D. & Thiele, Vanessa [Show all 22 contributors for this article] (2021). Mediators and Theories of Change in Psychotherapy for Young People With Personality Disorders: A Systematic Review Protocol. Frontiers in Psychology. 12, p. 1–7. doi: 10.3389/fpsyg.2021.703095. Full text in Research Archive Show summary

  Background: Personality disorders (PDs) are a severe health issue already prevalent among adolescents and young adults. Early detection and intervention offer the opportunity to reduce disease burden and chronicity of symptoms and to enhance long-term functional outcomes. While psychological treatments for PDs have been shown to be effective for young people, the mediators and specific change mechanisms of treatment are still unclear. Aim: As part of the “European Network of Individualized Psychotherapy Treatment of Young People with Mental Disorders” (TREATme), funded by the European Cooperation in Science and Technology (COST), we will conduct a systematic review to summarize the existing knowledge on mediators of treatment outcome and theories of change in psychotherapy for young people with personality disorders. In particular, we will evaluate whether mediators appear to be common or specific to particular age groups, treatment models, or outcome domains (e.g., psychosocial functioning, life quality, and adverse treatment effects). Method: We will follow the reporting guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement recommendations. Electronic databases (PubMed and PsycINFO) have been systematically searched for prospective, longitudinal, and case–control designs of psychological treatment studies, which examine mediators published in English. Participants will be young people between 10 and 30years of age who suffer from subclinical personality symptoms or have a personality disorder diagnosis and receive an intervention that aims at preventing, ameliorating, and/or treating psychological problems. Results: The results will be published in a peer-reviewed journal and at conference presentations and will be shared with relevant stakeholder groups. The data set will be made available to other research groups following recommendations of the open science initiative. Databases with the systematic search will be made openly available following open science initiatives. The review has been registered in PROSPERO (evaluation is pending, registration number ID 248959). Implications: This review will deliver a comprehensive overview on the empirical basis to contribute to the further development of psychological treatments for young people with personality disorders.

• Dysthe, Kim Kristoffer; Haavet, Ole Rikard; Røssberg, Jan Ivar; Brandtzæg, Petter Bae; Følstad, Asbjørn & Klovning, Atle (2021). Finding relevant psychoeducation content for adolescents experiencing symptoms of depression: Content analysis of user-generated online texts. Journal of Medical Internet Research (JMIR). ISSN 1439-4456. 23(9), p. 1–15. doi: 10.2196/28765. Full text in Research Archive Show summary

  Background: Symptoms of depression are frequent in youth and may develop into more severe mood disorders, suggesting interventions should take place during adolescence. However, young people tend not to share mental problems with friends, family, caregivers, or professionals. Many receive misleading information when searching the internet. Among several attempts to create mental health services for adolescents, technological information platforms based on psychoeducation show promising results. Such development rests on established theories and therapeutic models. To fulfill the therapeutic potential of psychoeducation in health technologies, we lack data-driven research on young peoples’ demand for information about depression. Objective: Our objective is to gain knowledge about what information is relevant to adolescents with symptoms of depression. From this knowledge, we can develop a population-specific psychoeducation for use in different technology platforms. Methods: We conducted a qualitative, constructivist-oriented content analysis of questions submitted by adolescents aged 16-20 years to an online public information service. A sample of 100 posts containing questions on depression were randomly selected from a total of 870. For analysis, we developed an a priori codebook from the main information topics of existing psychoeducational programs on youth depression. The distribution of topic prevalence in the total volume of posts containing questions on depression was calculated. Results: With a 95% confidence level and a ±9.2% margin of error, the distribution analysis revealed the following categories to be the most prevalent among adolescents seeking advice about depression: self-management (33%, 61/180), etiology (20%, 36/180), and therapy (20%, 36/180). Self-management concerned subcategories on coping in general and how to open to friends, family, and caregivers. The therapy topic concerned therapy options, prognosis, where to seek help, and how to open up to a professional. We also found young people dichotomizing therapy and self-management as opposite entities. The etiology topic concerned stressors and risk factors. The diagnosis category was less frequently referred to (9%, 17/180). Conclusions: Self-management, etiology, and therapy are the most prevalent categories among adolescents seeking advice about depression. Young people also dichotomize therapy and self-management as opposite entities. Future research should focus on measures to promote self-management, measures to stimulate expectations of self-efficacy, information about etiology, and information about diagnosis to improve self-monitoring skills, enhancing relapse prevention.

• Taubner, Svenja; Saliba, Andrea; Heinonen, Erkki; Protić, Sonja; Volkert, Jana & Adler, Asta [Show all 21 contributors for this article] (2021). Mediators and theories of change in psychotherapy with adolescents: a systematic review protocol. BMJ Open. 11(3). doi: 10.1136/bmjopen-2020-042411. Full text in Research Archive Show summary

  Introduction Approximately 75% of mental disorders emerge before the age of 25 years but less than half receive appropriate treatment. Little is known about the mechanisms underlying the therapeutic change of adolescents in psychotherapy. The ‘European Network of Individualised Psychotherapy Treatment of Young People with Mental Disorders’, funded by the European Cooperation in Science and Technology, will conduct the first systematic review to summarise the existing knowledge on mediators and theories of change in psychotherapy for adolescents. Method A systematic review will be conducted, conforming to the reporting guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement recommendations. Electronic databases (PubMed and PsycINFO) have been systematically searched on 23 February 2020, for prospective, longitudinal and case-control designs which examine mediators of change. Participants will be adolescents between 10 and 19 years of age who suffer from a mental disorder or psychological difficulties and receive an intervention that aims at preventing, ameliorating and/or treating psychological problems. Ethics and dissemination Ethical approval is not required for this systematic review as no primary data will be collected. The results will be published in a peer-reviewed journals and at conference presentations and will be shared with stakeholder groups. The whole data set will be offered to other research groups following recommendations of the open science initiative. Databases with the systematic search will be made openly available following open science initiatives. PROSPERO registration number CRD42020177535.

• Lockertsen, Veronica; Holm, Lill Ann Wellhaven; Nilsen, Liv; Rø, Øyvind; Burger, Linn May & Røssberg, Jan Ivar (2021). The transition process between child and adolescent mental services and adult mental health services for patients with anorexia nervosa: a qualitative study of the parents’ experiences. Journal of Eating Disorders. 9. doi: 10.1186/s40337-021-00404-w. Full text in Research Archive Show summary

  Background Patients with Anorexia Nervosa (AN) often experience the transition between Child and Adolescent Mental Health Services (CAMHS) and Adult Mental Health Services (AMHS) as challenging. This period tends to have a negative influence on the continuity of care for the adolescents and represents a demanding and difficult period for the parents. To our knowledge, no previous study has explored the parents’ experience with the transition from CAMHS to AMHS. Therefore, this qualitative study examines how parents experience the transition process from CAMHS to AMHS. Methods In collaboration with a service user with carer experience, qualitative interviews were conducted with 10 parents who had experienced the transition from CAMHS to AMHS, some from outpatient care and others from both in- and outpatient mental care units in Norway. All had some experience with specialized eating disorder units. The interviews were analyzed with a Systematic Text Condensation (STC) approach. Service users’ perspectives were involved in all steps of the research process. Results Six categories represent the parents’ experiences of the transition: (1) the discharge when the child turns 18 years old is sudden; (2) the lack of continuity is often followed by deterioration and relapses in the patient; (3) the lack of involvement and information causes distress; (4) knowledge – an important factor for developing a trusting relationship between parents` and clinicians`; (5) parents have overwhelming multifaceted responsibilities; and (6) parents need professional support. Conclusion Improving the transition by including parents and adolescents and preparing them for the transition period could ease parental caregiving distress and improve adolescents’ compliance with treatment. Clinicians should increase their focus on the important role of parents in the transition process. The system should implement routines and guidelines to offer caregivers support and guidance during the transition process.

• Værnes, Tor Gunnar; Røssberg, Jan Ivar; Melle, Ingrid; Nelson, Barnaby; Romm, Kristin Lie & Møller, Paul (2021). Basic self-disturbance in subjects at clinical high risk for psychosis: Relationship with clinical and functional outcomes at one year follow-up. Psychiatry Research. ISSN 0165-1781. 300. doi: 10.1016/j.psychres.2021.113942. Full text in Research Archive Show summary

  Basic self-disturbance (BSD) is assumed to drive symptom development in schizophrenia spectrum disorders and in clinical high-risk (CHR) for psychosis. We investigated the relationship between BSD at baseline, assessed with the Examination of Anomalous Self-Experience (EASE), and symptoms and functional outcome after one year in 32 patients, including 26 CHR and six with non-progressive attenuated psychotic symptoms. Correlations between baseline BSD levels and positive, negative and disorganization symptoms, and global functioning level at follow-up were significant. Hierarchical regression analyses revealed that higher levels of baseline BSD predicted more severe positive symptoms and lower global functioning at follow-up, after adjusting for baseline positive symptoms and functioning. Subjects who were not in symptomatic and functional remission after one year had higher levels of BSD and negative symptoms, and lower functioning level, at baseline. Baseline BSD in participants with schizophrenia spectrum diagnoses at follow-up (9 of 12 were schizotypal personality disorder) were at the levels seen in schizotypal disorders in previous studies, but not significantly different from the other participants. Early identification and assessment of BSD may constitute a useful prognostic tool and a signal for therapeutic targets in CHR conditions. Further CHR studies investigating these relationships with larger samples are recommended.

• Værnes, Tor Gunnar; Røssberg, Jan Ivar; Melle, Ingrid; Nelson, Barnaby; Romm, Kristin Lie & Møller, Paul (2021). Basic self-disturbance trajectories in clinical high risk for psychosis: a one-year follow-up study. European Archives of Psychiatry and Clinical Neuroscience. ISSN 0940-1334. p. 1–13. doi: 10.1007/s00406-021-01349-6. Full text in Research Archive Show summary

  Abstract Basic self-disturbance (BSD) has been proposed as a driver of symptom development in schizophrenia spectrum disorders (SSDs). In a one-year follow-up of 32 patients (15–30 years) at putative risk for psychosis, we investigated trajectories of BSD levels from baseline to follow-up, and associations between clinical characteristics at baseline and follow-up, including follow-up levels of BSD (assessed with the EASE). Clinical high risk (CHR) for psychosis status and symptom severity were assessed with the SIPS/SOPS scales and also according to the cognitive basic symptoms high-risk criteria (COGDIS). DSM-IV diagnoses, functioning and other clinical characteristics were assessed with standard clinical instruments. Higher severity of negative symptoms and meeting COGDIS criteria at baseline were associated with higher BSD levels at follow-up. All measured at follow-up, higher BSD levels correlated with higher severity of positive, negative, disorganization and general symptoms, and with a lower level of global functioning. We found higher BSD levels at follow-up in subjects with schizotypal personality disorder (SPD) at baseline ( n  = 5) and in SSDs at follow-up ( n  = 12, including nine with SPD). Mean BSD levels decreased significantly from baseline to follow-up, but individual trajectories varied considerably. Increased BSD levels were associated with higher baseline BSD levels, non-remission of positive symptoms and functional decline. Overall, the current study indicates that subgroups in the CHR population with a higher risk of non-remission or deterioration may be identified by supplementing CHR criteria with assessment of BSD and negative symptoms.

• Malkomsen, Anders; Røssberg, J.I.; Dammen, T.; Wilberg, T.; Løvgren, A. & Ulberg, R. [Show all 7 contributors for this article] (2021). Digging down or scratching the surface: how patients use metaphors to describe their experiences of psychotherapy. BMC Psychiatry. 21(1), p. 1–12. doi: 10.1186/s12888-021-03551-1. Full text in Research Archive Show summary

  Background In the present study, we wanted to explore which metaphors patients suffering from major depressive disorder (MDD) use to explain their experience of being in therapy and their improvement from depression. Methods Patients with MDD (N = 22) received either psychodynamic therapy (PDT) or cognitive behavioral therapy (CBT). They were interviewed with semi-structured qualitative interviews after ending therapy. The transcripts were analyzed using a method based on metaphor-led discourse analysis. Results Metaphors were organized into three different categories concerning the process of therapy, the therapeutic relationship and of improvement from depression. Most frequent were the metaphorical concepts of surface and depth, being open and closed, chemistry, tools, improvement as a journey from darkness to light and depression as a disease or opponent. Conclusions Patient metaphors concerning the therapeutic experience may provide clinicians and researchers valuable information about the process of therapy. Metaphors offer an opportunity for patients to communicate nuances about their therapeutic experience that are difficult to express in literal language. However, if not sufficiently explored and understood, metaphors may be misinterpreted and become a barrier for therapeutic change. Trial registration Clinical Trial gov. Identifier: NCT03022071. Date of registration: 16/01/2017.

• Ottesen, Akiah; Hegelstad, Wenche; Joa, Inge; Opjordsmoen, Stein E.; Rund, Bjørn Rishovd & Røssberg, Jan Ivar [Show all 13 contributors for this article] (2021). Childhood trauma, antipsychotic medication, and symptom remission in first-episode psychosis. Psychological Medicine. ISSN 0033-2917. p. 1–10. doi: 10.1017/S003329172100427X. Full text in Research Archive Show summary

  Background: To what extent psychotic symptoms in first-episode psychosis (FEP) with a history of childhood interpersonal trauma (CIT) are less responsive to antipsychotic medication is not known. In this longitudinal study, we compare symptom trajectories and remission over the first 2 years of treatment in FEP with and without CIT and examine if differences are linked to the use of antipsychotics. Methods: FEP (N = 191) were recruited from in- and outpatient services 1997–2000, and assessed at baseline, 3 months, 1 and 2 years. Inclusion criteria were 15–65 years, actively psychotic with a DSM-IV diagnosis of psychotic disorder and no previous adequate treatment for psychosis. Antipsychotic medication is reported as defined daily dosage (DDD). CIT (<18) was assessed with the Brief Betrayal Trauma Survey, and symptomatic remission based on scores from the Positive and Negative Syndrome Scale. Results: CIT (n = 63, 33%) was not associated with symptomatic remission at 2 years follow-up (71% in remission, 14% in relapse), or time to first remission (CIT 12/ no-CIT 9 weeks, p = 0.51). Those with CIT had significantly more severe positive, depressive, and excited symptoms. FEP with physical (N = 39, 20%) or emotional abuse (N = 22, 14, 7%) had higher DDD at 1 year (p < 0.05). Mean DDD did not excerpt a significant between-group effect on symptom trajectories of positive symptoms. Conclusion: Results indicate that antipsychotic medication is equally beneficial in the achievement of symptomatic remission in FEP after 2 years independent of CIT. Still, FEP patients with CIT had more severe positive, depressive, and excited symptoms throughout.

• Jalbrzikowski, Maria; Hayes, Rebecca A.; Wood, Stephen J.; Dorte, Nordholm; Zhou, Juan H & Fusar-Poli, Paolo [Show all 51 contributors for this article] (2021). Association of Structural Magnetic Resonance Imaging Measures With Psychosis Onset in Individuals at Clinical High Risk for Developing Psychosis: An ENIGMA Working Group Mega-analysis. JAMA psychiatry. ISSN 2168-6238. 78(7), p. 753–766. doi: 10.1001/jamapsychiatry.2021.0638. Full text in Research Archive
• Røssberg, Jan Ivar; Evensen, Julie Horgen; Dammen, Toril; Wilberg, Theresa; Klungsøyr, Ole & Jones, Maria-Helene [Show all 11 contributors for this article] (2021). Mechanisms of change and heterogeneous treatment effects in psychodynamic and cognitive behavioural therapy for patients with depressive disorder: a randomized controlled trial. BMC Psychology. 9, p. 1–14. doi: 10.1186/s40359-021-00517-6. Full text in Research Archive Show summary

  Background Major depressive disorder (MDD) is a prevalent psychiatric condition associated with significant disability, mortality and economic burden. Cognitive behavioral therapy (CBT) and psychodynamic psychotherapy (PDT) are found to be equally effective for patients with depression. However, many patients do not respond sufficiently to either treatment. To offer individualized treatment, we need to know if some patients benefit more from one of the two therapies. At present little is known about what patient characteristics (moderators) may be associated with differential outcomes of CBT and PDT, and through what therapeutic processes and mechanisms (mediators) improvements occur in each therapy mode. Presently only theoretical assumptions, sparsely supported by research findings, describe what potentially moderates and mediates the treatment effects of CBT and PDT. The overall aim of this study is to examine theoretically derived putative moderators and mediators in CBT and PDT and strengthen the evidence base about for whom and how these treatments works in a representative sample of patients with MDD. Methods One hundred patients with a diagnosis of MDD will be randomized to either CBT or PDT. Patients will be treated over 28 weeks with either CBT (one weekly session over 16 weeks and three monthly booster sessions) or PDT (one weekly session over 28 weeks). The patients will be evaluated at baseline, during the course of therapy, at the end of therapy, and at follow-up investigations 1 and 3 years post treatment. A large range of patient and observer rated questionnaires (specific preselected putative moderators and mediators) are included. Discussion The clinical outcome of this study may better guide clinicians when deciding what kind of treatment any individual patient should be offered. Moreover, the study aims to further our knowledge of what mechanisms lead to symptom improvement and increased psychosocial functioning. Trial registration ClinicalTrials.gov Identifier: NCT03022071.

• Løvgren, André; Røssberg, Jan Ivar; Engebretsen, Eivind & Ulberg, Randi (2020). Improvement in Psychodynamic Psychotherapy for Depression: A Qualitative Study of the Patients’ Perspective. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 17(18). doi: 10.3390/ijerph17186843. Full text in Research Archive
• Jones, Maria-Helene; Råbu, Marit; Røssberg, Jan Ivar & Ulberg, Randi (2020). Therapists’ experiences of psychodynamic therapy with and without transference interventions for adolescents with depression. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 17(13), p. 1–18. doi: 10.3390/ijerph17134628. Full text in Research Archive Show summary

  Psychodynamic therapy is an effective treatment for depression. However, a large number of adolescent patients with depression do not respond and/or drop out of therapy and little is known about what therapists actually do in therapy with adolescents. Thus, more research is needed to explore the various actions that therapists do in therapy, so that therapists can tailor their therapy more specifically to each individual adolescent. The present study aimed to investigate how the experience of psychotherapists differs between two treatment modes for adolescents with depression: psychodynamic psychotherapy with and without transference interventions. In-depth interviews were conducted with six therapists. The data, which were analyzed using thematic analysis, generated three key themes: (1) The therapists experienced that transference interventions are often useful in therapies with adolescents with depression, (2) therapies without transference interventions can be challenging for therapists, but still helpful for patients, and (3) the experience contributed to the deepening recognition of therapists that they always need to adapt their techniques to the particular patient. The results enhance our knowledge of the significance of therapists’ actions in therapy with adolescents. The therapists highlighted issues that are important for identifying barriers to incorporating new knowledge into clinical practice.

• Lockertsen, Veronica; Nilsen, Liv; Holm, Lill Ann Wellhaven; Rø, Øyvind; Burger, Linn May & Røssberg, Jan Ivar (2020). Experiences of patients with anorexia nervosa during the transition from child and adolescent mental health services to adult mental health services. Journal of Eating Disorders. 8(1). doi: 10.1186/s40337-020-00313-4. Full text in Research Archive Show summary

  Background The transition between the Child and Adolescent Mental Health Services (CAMHS) and the Adult Mental Health Services (AMHS) is identified as an especially critical time for the continuity of care for patients with anorexia nervosa (AN). However, research on this topic is scarce. In the present study, we explore the patients’ experiences of the transition between CAMHS and AMHS. Methods A qualitative explorative study was carried out based on recorded interviews from one multi-step focus group and six individual interviews with patients who experienced the transition from CAMHS to AHMS in Norway. This study is service user-initiated, meaning service users were involved in all steps of the research process. Results The adolescents’ experiences are characterized by four overall themes regarding the transition process between CAMHS and AMHS: (1) “Being unprepared and alone in the transition process” describes how a lack of preparation for the transition between CAMHS and AMHS makes them feel alone and increases stress. (2) “It takes time to create a trusting relationship” describes how time influences patients’ trust in therapists and motivation for treatment. (3) “We are not all the same” describes how adolescents develop differently but are not treated differently despite their diverse ability to be self-sufficient. (4) “How they see me and treat me affects my hope for the future” describes the interaction between adolescents and therapists. Conclusions Acknowledging the patients’ needs during the transition period and considering their readiness for the transition is important. Taking into account the four dimensions described in the present study might improve the transition process and enhance the patients’ self-sufficiency and maturity.

• Løvgren, André; Røssberg, Jan Ivar; Engebretsen, Eivind & Ulberg, Randi (2020). Multiple Mutuality. Positions and Storylines in Adolescent Psychodynamic Psychotherapy. Journal of Infant, Child, and Adolescent Psychotherapy (JICAP). ISSN 1528-9168. doi: 10.1080/15289168.2020.1771530. Full text in Research Archive Show summary

  In the psychodynamic psychotherapy of adolescents, a mutual relationship is a central and often reoccurring theme. However, what this mutuality consists of and how adolescents experience this seems to have been the subject of scant investigation or conceptualization. Thus, the aim of the present study was to obtain a more comprehensive insight into mutuality by innovatively applying interdisciplinary positioning theory to the analysis of adolescents’ experiences of psychotherapy. Qualitative, post-treatment interviews with nine female adolescents receiving psychodynamic psychotherapy for depression in the Norwegian First Experimental Study of Transference Work – In Teenagers were conducted. Drawing on positioning theory, unique characteristics of mutuality with a focus on storylines and positions were identified within the patients’ descriptions of their therapy. Adolescents in psychodynamic psychotherapy experience multifarious forms of mutuality and partake in the co-creation of shifting positions. They also constantly evaluate and negotiate what to say and disclose in therapy. These negotiations offer both desired and unattractive positions, dependent on each individual adolescent’s norms and moral perceptions. From the study, it was found that adolescents pass through different forms of mutuality. These are discussed, illuminating how the power of positions and storylines may be used by therapists to promote therapeutic, mutual relationships.

• Lockertsen, Veronica; Nilsen, Liv; Holm, Lill Ann Wellhaven; Rø, Øyvind; Burger, Linn May & Røssberg, Jan Ivar (2020). Mental health professionals' experiences transitioning patients with anorexia nervosa from child/adolescent to adult mental health services: a qualitative study. BMC Health Services Research. 20:891(1), p. 1–9. doi: 10.1186/s12913-020-05740-2. Full text in Research Archive Show summary

  Background The transition period between child and adolescent mental health services (CAMHS) and adult mental health services (AMHS) has been identified as an especially critical time for patients with anorexia nervosa. In the present study, to better facilitate patients’ recovery process, we explored the experiences of professionals concerning the transition from CAMHS to AMHS. Method A qualitative explorative study was carried out based on recorded interviews from one multi-step focus group and two individual interviews with eight experienced health care professionals. Together they had experience with treating patients with AN and the transition from CAMHS to AMHS, both from specialized eating disorder units, specialized mental health care units, and from a school nurse context. Service users with parents` perspectives and patients’ perspectives were involved in all steps of the research process. Results Barriers experienced during the transition process were classified into four categories: (1) different treatment cultures that describe differences in how parents are included in CAMHS and AMHS; (2) mistrust between CAMHS and AMHS that can create a lack of collaboration and predictability for the patients’ transition; (3) Clinicians` factors such as lack of professional self-confidence can influence continuity of care for patients; and (4) lack of trust between services and not enough focus on building a new alliance in AMHS negatively influences the transition. Conclusions The present study revealed four important categories that professionals needs to consider when participating in the transition for patients with AN from CAMHS to AMHS. Awareness of these challenges might improve the transition process for patients with AN.

• Breivik, Randi; Wilberg, Theresa; Evensen, Julie Horgen; Røssberg, Jan Ivar; Dahl, Hanne-Sofie Johnsen & Pedersen, Geir Feigum (2020). Countertransference feelings and personality disorders: a psychometric evaluation of a brief version of the Feeling Word Checklist (FWC-BV). BMC Psychiatry. 20(1), p. 1–12. doi: 10.1186/s12888-020-02556-6. Full text in Research Archive Show summary

  Background The Feeling Word Checklist (FWC) is a self-report questionnaire designed to assess therapists’ countertransference (CT) feelings. The primary aim of the study was to evaluate the psychometric properties of a brief, 12-item version of the Feeling Word Checklist (FWC-BV). The second aim was to validate the factor structure by examining the associations between the FWC-BV factors, patients’ personality pathology and therapeutic alliance (TA). Methods Therapists at 13 different outpatient units within the Norwegian Network of Personality Disorders participated, and the study includes therapies for a large sample of patients (N = 2425) with personality pathology. Over a period of 2.5 years, therapists completed the FWC-BV for each patient in therapy every 6 months. Statistical methods included exploratory (EFA) and confirmatory (CFA) factor analysis. Internal consistency was estimated using Mc Donald’s coefficient Omega (ωt). The Structured Clinical Interview for DSM-IV – Axis II (SCID II) and Mini International Neuropsychiatric Interview (MINI) were used as diagnostic instruments, and patient-rated TA was assessed using the Working Alliance Inventory (WAI-SR). Results Factor analyses revealed three clinically meaningful factors: Inadequate, Idealised and Confident. These factors had acceptable psychometric properties. Most notably, a number of borderline PD criteria correlated positively with the factors Inadequate and Idealised, and negatively with the factor Confident. All the factors correlated significantly with at least one of the WAI-SR subscales. Conclusions The FWC-BV measures three clinically meaningful aspects of therapists’ CT feelings. This brief version of the FWC seems satisfactory for use in further research and in clinical contexts.

• Løvgren, André; Røssberg, Jan Ivar; Nilsen, Liv; Engebretsen, Eivind & Ulberg, Randi (2019). How do adolescents with depression experience improvement in psychodynamic psychotherapy? A qualitative study. BMC Psychiatry. 19. doi: 10.1186/s12888-019-2080-0. Full text in Research Archive Show summary

  Background There is emerging evidence for the effectiveness of psychodynamic psychotherapy for depressive disorders. However, we know less of how this relation-focused therapy mode is experienced and what the patients themselves identify as helpful. Hence, the purpose of this study is to explore adolescents’ experiences of factors promoting improvement in psychodynamic therapy. Methods Eight female patients participating in a Norwegian study on psychodynamic therapy, the First Experimental Study of Transference Work – In Teenagers (FEST-IT), were included. The participants were offered a total number of 28 sessions. Semi-structured qualitative interviews about experiences with therapy were then conducted and analysed with systematic text condensation and hermeneutic interpretation. Results The analysis revealed four main themes. ‘Exploring oneself’ comprises autonomy and acknowledgment, openness, insight and acceptance of oneself. ‘Therapist relation and characteristics’ includes confidence and trust in and support from the therapist as well as having a trustworthy and experienced therapist. ‘Focusing on everyday life’ includes learning and practical orientation. ‘Time factors’ refers to duration and frequency. Conclusions Together with a supportive and listening therapist, the adolescents improve by exploring themselves within the frames of a time-limited treatment period. Improvement seems to be experienced through better relations to oneself and to others and by finding one’s place in the family, or at school. Adolescents value problem solving and help with concrete challenges. Hence, therapy should be tailored to the needs of adolescents with depression and incorporate the challenges they face in their everyday life.

• Sønmez, Nasrettin; Romm, Kristin Lie; Østefjells, Tiril; Grande, Marit; Jensen, Lene Hunnicke & Hummelen, Benjamin [Show all 9 contributors for this article] (2019). Cognitive behavior therapy in early psychosis with a focus on depression and low self-esteem: A randomized controlled trial. Comprehensive Psychiatry. ISSN 0010-440X. 97. doi: 10.1016/j.comppsych.2019.152157. Full text in Research Archive Show summary

  Background Patients in early phases of psychosis often struggle with depressive symptoms and low self-esteem. The main aims of the present study were to examine whether cognitive behavior therapy (CBT) compared to treatment as usual (TAU) would reduce depressive symptoms (primary outcome) and increase self-esteem (secondary outcome). Furthermore, we wanted to examine whether CBT reduces symptoms measured with the PANSS (positive, negative, cognitive, or excited symptoms) or increases general functioning compared to TAU. Methods A total of 63 early psychosis patients were included and randomly assigned to receive either CBT (maximum 26 sessions) or TAU for a period of up to six months. A linear mixed model was used for longitudinal analysis, with a focus on whether patients in the CBT group or the TAU group changed differently to one another between the baseline and 15-month follow-up. Results There were no differences between the CBT group and TAU group regarding improvements in depressive symptoms measured with the Calgary Depression Scale for Schizophrenia (P = 0.188) or self-esteem measured with the Rosenberg Self-Esteem Scale (P = 0.580). However, patients in the CBT group improved significantly more on negative symptoms (P = 0.002) and social functioning (P = 0.001). Conclusions We did not find CBT to be more effective than TAU in reducing depressive symptoms or increasing self-esteem in patients with early psychosis. However, CBT seems to improve negative symptoms and functioning. These results still need to be replicated in further studies as the present one was merely an exploratory analysis.

• Weibell, Melissa Anne E; Johannessen, Jan Olav; Auestad, Bjørn Henrik; Bramness, Jørgen Gustav; Brønnick, Kolbjørn Kallesten & Haahr, Ulrik [Show all 17 contributors for this article] (2019). Early substance use cessation improves cognition-10 years outcome in first-episode psychosis patients. Frontiers in Psychiatry. 10. doi: 10.3389/fpsyt.2019.00495. Full text in Research Archive Show summary

  Background: Cognitive impairment may be a risk factor for, as well as a consequence of, psychosis. Non-remitting symptoms, premorbid functioning, level of education, and socioeconomic background are known correlates. A possible confounder of these associations is substance use, which is common among patients with psychosis and linked to worse clinical outcomes. Studies however show mixed results for the effect of substance use on cognitive outcomes. In this study, the long-term associations of substance use with cognition in a representative sample of first-episode psychosis patients were examined. Methods: The sample consisted of 195 patients. They were assessed for symptom levels, function, and neurocognition at 1, 2, 5, and 10 years after first treatment. Test scores were grouped into factor analysis-based indices: motor speed, verbal learning, visuomotor processing, verbal fluency, and executive functioning. A standardized composite score of all tests was also used. Patients were divided into four groups based on substance-use patterns during the first 2 years of treatment: persistent users, episodic users, stop-users, and nonusers. Data were analyzed using linear mixed effects modeling. Results: Gender, premorbid academic functioning, and previous education were the strongest predictors of cognitive trajectories. However, on motor speed and verbal learning indices, patients who stopped using substances within the first 2 years of follow-up improved over time, whereas the other groups did not. For verbal fluency, the longitudinal course was parallel for all four groups, while patients who stopped using substances demonstrated superior performances compared with nonusers. Persistent users demonstrated impaired visuomotor processing speed compared with nonusers. Within the stop- and episodic use groups, patients with narrow schizophrenia diagnoses performed worse compared with patients with other diagnoses on verbal learning and on the overall composite neurocognitive index. Discussion: This study is one of very few long-term studies on cognitive impairments in first-episode psychosis focusing explicitly on substance use. Early cessation of substance use was associated with less cognitive impairment and some improvement over time on some cognitive measures, indicating a milder illness course and superior cognitive reserves to draw from in recovering from psychosis.

• Værnes, Tor Gunnar; Røssberg, Jan Ivar & Møller, Paul (2019). Anomalous self-experiences are strongly associated with negative symptoms in a clinical high-risk for psychosis sample. Comprehensive Psychiatry. ISSN 0010-440X. 93, p. 65–72. doi: 10.1016/j.comppsych.2019.07.003. Full text in Research Archive Show summary

  Objective Anomalous self-experiences (ASE) are considered as central features of the schizophrenia spectrum disorders and prodromal schizophrenia. We investigated total and single-item prevalence of these phenomena in a clinical high-risk (CHR) for psychosis sample, and associations with conventional psychosis-risk symptoms, present and childhood global/psychosocial functioning, and childhood trauma. Methods The sample (n = 38) included 31 CHR, according to ultra-high risk or cognitive basic symptoms (COGDIS) criteria, and seven with non-progressive attenuated positive symptoms. Psychopathological evaluations included the Examination of Anomalous Self-Experience (EASE), Structured Clinical Interview for Prodromal Syndromes (SIPS), Schizophrenia Proneness Instrument – Adult (SPI-A) (only the COGDIS-criteria), a diagnostic interview (SCID-I), Global Assessment of Functioning – Split version (S-GAF), Premorbid Adjustment Scale (PAS) and Childhood Trauma Questionnaire (CTQ). Results The mean total EASE score was in line with reports from other CHR samples, and was particularly enhanced in schizotypal personality disorder and in subjects fulfilling COGDIS-criteria. The four most frequent EASE-items were present in two-thirds or more of the participants. EASE total was significantly associated with negative and disorganization symptoms. A multiple regression analysis revealed that the level of negative symptoms explained most of the variance in EASE total. Conclusions These results corroborates other findings that anomalous self-experiences are frequent and important features in CHR conditions and in the schizophrenia spectrum. The strong associations with negative symptoms and cognitive disturbances (COGDIS) should be investigated in longitudinal studies to address causality, psychopathological pathways and schizophrenia spectrum specificity. The weaker correlation between EASE total and positive symptoms may partly be related to a restricted range of positive symptoms.

• Værnes, Tor Gunnar; Røssberg, Jan Ivar & Møller, Paul (2018). Anomalous self-experiences: markers of schizophrenia vulnerability or symptoms of depersonalization disorder? A phenomenological investigation of two cases. Psychopathology. ISSN 0254-4962. 51(3), p. 198–209. doi: 10.1159/000488462. Full text in Research Archive Show summary

  Background: Basic self-disturbance (BSD) is proposed to constitute the clinical core of schizophrenia spectrum disorders, including prodromal states and schizotypy. Anomalous self-experiences (ASEs) are suggested as phenotypic variants of BSD, representing markers of schizophrenia vulnerability. However, ASEs are not restricted to the schizophrenia spectrum, but may also occur in non-psychotic states like depersonalization disorder (DPD). It is unclear to what extent the prevalence and nature of ASEs are differing between the two conditions. The main aim of this paper is to assess and compare ASEs in both conditions, based on literature and two illustrating cases. This might expand the understanding of these phenomena, and strengthen the basis for clinical differentiation. Methods: One patient with schizotypal personality disorder (SPD) and one with DPD were selected from an ongoing clinical high-risk (CHR) for psychosis study. ASEs were assessed with the Examination of Anomalous Self-Experience (EASE) and analyzed according to the two central dimensions of BSD: diminished self-affection and hyperreflexivity, as well as according to prototypical aspects of depersonalization. The cases were also analyzed and compared with respect to chronology, other symptomatology, and psychopathological pathways. Results: Both cases revealed ASEs reflecting the central dimensions of BSD as well as prototypical aspects of depersonalization. Only the SPD case however, linked ASEs to psychotic-like ideas of external influence and control. The symptoms had an insidious early childhood onset with no obvious triggers in the SPD case, and an abrupt adolescence onset triggered by second-time cannabis use and panic anxiety in the DPD case. Conclusions: The similarities and differences in ASEs, symptomatology and developmental pathways of the two cases might be accounted for by an updated model of self-disorders. The model proposes that schizophrenia manifests as a result of a combination of early “primary”-onset ASEs, reflecting dis­turbances in early neurodevelopment, and later occurring, “secondary” ASEs of a more defensive-protective character. In line with this, the DPD case may be characterized only by secondary ASEs and thus better protected against psychotic decompensation than the SPD case, tentatively affected by a combination of primary and secondary ASEs.

• Gardsjord, Erlend Strand; Romm, Kristin Lie; Røssberg, Jan Ivar; Friis, Svein; Barder, Helene & Evensen, Julie Horgen [Show all 17 contributors for this article] (2018). Depression and functioning are important to subjective quality of life after a first episode psychosis. Comprehensive Psychiatry. ISSN 0010-440X. 86, p. 107–114. doi: 10.1016/j.comppsych.2018.07.014. Full text in Research Archive
• Røberg, Liv; Nilsen, Liv & Røssberg, Jan Ivar (2018). How do men with severe sexual and physical childhood traumatization experience trauma-stabilizing group treatment? A qualitative study. European Journal of Psychotraumatology. 13(9). doi: 10.1080/20008198.2018.1541697. Full text in Research Archive Show summary

  Background: Exposure to potentially traumatizing events, defined as events involving actual or threatened death or serious injury, is associated with an elevated risk of developing enduring physical, psychological and social problems. Complex post-traumatic stress disorder (PTSD) is a disorder that can occur after prolonged and repeated trauma. At least 30% of the sexually abused population is male, but in spite of this fact, treatment research focusing on male victims is virtually non-existent in comparison to research on female victims. Objective: Trauma-stabilizing group treatment is an increasingly used treatment method for patients with complex PTSD. The aim of the present study was to explore how men participating in a gender-specific trauma-stabilizing intervention experience this treatment approach. Methods: Five men who participated in a trauma-stabilizing group treatment were interviewed with a semi-structured qualitative interview. The data were analysed using interpretative phenomenological analysis. Results: The analysis revealed five main themes. The themes highlight the experiences of the participants and describe positive and negative experiences: (1) Group atmosphere, comprising safety, community, emotional openness, anxiety and pressure; (2) Learning, categorized into knowledge and self-understanding; (3) Motivation, which describes both inner and outer motivation; (4) Structure, comprising structure of the meetings, group size and duration of the meetings; and (5) Gender, defined as the experiences of being in an all-male group with female group leaders. Conclusions: There seem to be a lot of advantages to inviting men to attend gender-specific groups for trauma-stabilizing treatment. The men emphasized the support they received and that participating in a mixed-gender group would have been more difficult. In the future, it may be important to arrange all-male stabilization groups with more focus on male-specific topics.

• Gardsjord, Erlend Strand; Romm, Kristin Lie; Røssberg, Jan Ivar; Friis, Svein; Barder, Helene & Evensen, Julie Horgen [Show all 18 contributors for this article] (2017). Is going into stable symptomatic remission associated with a more positive development of life satisfaction? A 10-year follow-up study of first episode psychosis. Schizophrenia Research. ISSN 0920-9964. 193, p. 364–369. doi: 10.1016/j.schres.2017.07.006. Full text in Research Archive
• Østefjells, Tiril; Lystad, June Ullevoldsæter; Berg, Akiah Ottesen; Hagen, Roger; Loewy, R & Sandvik, Leiv [Show all 8 contributors for this article] (2017). Metacognitive beliefs mediate the effect of emotional abuse on depressive and psychotic symptoms in severe mental disorders. Psychological Medicine. ISSN 0033-2917. 47(13), p. 2323–2333. doi: 10.1017/S0033291717000848. Full text in Research Archive
• Østefjells, Tiril; Melle, Ingrid; Aminoff, Sofie Ragnhild; Hellvin, Tone; Hagen, Roger & Lagerberg, Trine Vik [Show all 8 contributors for this article] (2017). An exploration of metacognitive beliefs and thought control strategies in bipolar disorder. Comprehensive Psychiatry. ISSN 0010-440X. 73, p. 84–92. doi: 10.1016/j.comppsych.2016.11.008. Full text in Research Archive Show summary

  Background: Previous studies have shown that individuals with schizophrenia exhibit higher levels of unhelpful metacognitive beliefs than healthy controls, but no studies have explored metacognitive beliefs in early psychosis. Aims: We examined i) differences in levels of unhelpful metacognitive beliefs between psychosis spectrum disorders, and healthy controls, and ii) to what extent demographic and clinical characteristics predicted levels of metacognitive beliefs in the early treated phases of psychotic disorders. Method: Patients were included within two years of first treatment for a psychotic disorder (N=92). They were assessed on premorbid adjustment, psychotic symptoms, anxiety/depression, and self-reported metacognitive beliefs (MCQ-30). Ninety-seven controls also completed MCQ-30. Predictors of metacognitive beliefs were explored with multiple linear regression analyses. Results: Patients scored significantly higher than controls on all metacognitive subscales except positive beliefs about worry. The regression model explained 14—38% of the variance on each metacognitive subscale. Current affective symptoms explained a significant amount of variance on all subscales, except positive beliefs about worry. Childhood (premorbid) social adjustment predicted a significant amount of the variance on all subscales, except cognitive confidence. Duration of untreated psychosis contributed significantly to more unhelpful beliefs about cognitive confidence. Negative symptoms predicted lower scores on cognitive self-consciousness. Conclusion: Affective symptoms and childhood social adjustment could be important predictors of unhelpful metacognitive beliefs in the early treated phases of psychosis, indicating potential psychopathological relationships that warrant further investigation for clinical relevance.

• Dahl, Hanne-Sofie Johnsen; Ulberg, Randi; Marble, Alice Ruth; Gabbard, Glen O.; Røssberg, Jan Ivar & Høglend, Per Andreas (2017). Beyond the Statistics: A Case Comparison Study of Victor and Tim. Psychoanalytic psychology. ISSN 0736-9735. 34(4), p. 461–477. doi: 10.1037/pap0000085. Full text in Research Archive
• Melle, Ingrid; Johannessen, Jan Olav; Haahr, Ulrik H.; Hegelstad, Wenche; Joa, Inge & Langeveld, Johannes H. [Show all 15 contributors for this article] (2017). Causes and predictors of premature death in first-episode schizophrenia spectrum disorders. World Psychiatry. ISSN 1723-8617. 16(2), p. 217–218. doi: 10.1002/wps.20431. Full text in Research Archive
• Langeveld, Johannes H.; Bjørkly, Stål; Evensen, Julie Horgen; Joa, Inge; Johannessen, Jan Olav & Larsen, Tor Ketil [Show all 15 contributors for this article] (2017). A 10-year follow-up study of violent victimization in first episode psychosis : risk and protective factors. Psychiatry Research. ISSN 0165-1781. 259(January), p. 545–549. doi: 10.1016/j.psychres.2017.11.013. Full text in Research Archive Show summary

  Violent victimization in persons with severe mental illness has long-term adverse consequences. Little is known about the long-term prevalence of victimization in first episode psychosis, or about factors affecting victimization throughout the course of illness. To assess the prevalence of violent victimization during a 10-year follow-up period in a group of first episode psychosis (FEP) patients, and to identify early predictors and risk factors for victimization. A prospective design was used with comprehensive assessments of violent victimization, treatment variables and functioning at baseline and during 10-year follow-up. A clinical epidemiological sample of FEP patients (n= 298) was studied. FEP patients in our study were at a 3.5 times greater risk of victimization as compared to the normal population. During the 10-year follow-up period, 23% of subjects fell victim to one or more violent assaults. Victimized patients were younger and reported less occupational activity. At 10-year follow-up, victimization was associated with more concomitant drug use, alcohol misuse and violent behavior, but not with a worse clinical or functional outcome. Treatment programs should focus on risk factors for victimization and develop behavioral alternatives to mitigate risk in FEP patients.

• Haahr, Ulrik Helt; Larsen, Tor Ketil; Simonsen, Erik; Rund, Bjørn Rishovd; Joa, Inge & Røssberg, Jan Ivar [Show all 16 contributors for this article] (2016). Relation between premorbid adjustment, duration of untreated psychosis and close interpersonal trauma in first-episode psychosis. Early Intervention in Psychiatry. ISSN 1751-7885. 12(3), p. 316–323. doi: 10.1111/eip.12315. Full text in Research Archive

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• Ulberg, Randi; Wilberg, Theresa; Dammen, Toril; Evensen, Julie Horgen; Osnes, Kåre & Røssberg, Jan Ivar (2026). Psykoterapi må ha en sentral plass i psykiatrien. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 146. Full text in Research Archive Show summary

  For at pasientene skal få persontilpasset behandling, er det viktig at psykiatere er oppdaterte innen nevrobiologi og medisinering, men også har psykoterapeutisk kompetanse. Derfor må spesialisthelsetjenesten ha organisatoriske rammer for å legge til rette for videreutdannelse, i de evidensbaserte og velutviklede psykoterapeutiske metodene som inngår i spesialistutdanningene i BUP og VOP.

• Bø, Ragnhild; Røssberg, Jan Ivar; Klovning, Atle; Landrø, Nils Inge; Hagen, Hallvard Solbø & Andreassen, Ole [Show all 7 contributors for this article] (2026). Forskning i allmennpraksis er nødvendig og etterspurt – men har mange utfordringer. Dagens medisin. ISSN 1501-4290. Full text in Research Archive Show summary

  Det trekkes ofte frem at forskning i allmennpraksis er viktig for bedre behandling av vanlige helseplager. Vår erfaring er at entusiasmen for forskningsløft i fastlegetjenesten er langt større enn det rammene tillater i dag.

• Johnsen, Erik; Andreassen, Ole; Melle, Ingrid; Røssberg, Jan Ivar; Weibell, Melissa Anne Elin Authen & Kroken, Rune Andreas (2025). Antipsykotika har god effekt ved psykoselidelser. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 145(8). doi: 10.4045/tidsskr.25.0271. Full text in Research Archive
• Strandberg, Ragnhild Bjarkøy; Nilsen, Roy Miodini; Pouwer, Francois; Igland, Jannicke; Røssberg, Jan Ivar & Jenum, Anne Karen [Show all 8 contributors for this article] (2025). Associations of diabetes duration with depression, anxiety and insomnia in people with type 2 diabetes mellitus. Full text in Research Archive
• Lien, Lars; Halvorsen, Niclas; Larsson, Anna Ulrika; Røssberg, Jan Ivar; Shaygani, Shahram & Weibell, Melissa Anne Elin Authen [Show all 9 contributors for this article] (2025). Antipsykotika virker. 145(7). doi: 10.4045/tidsskr.25.0273. Full text in Research Archive
• Sollund, Adrian; Røssberg, Jan Ivar & Valeur, Jørgen (2025). Antidepressiva: Nye sjokkfunn. [Internet]. Dagbladet.no. Full text in Research Archive
• Strandberg, Ragnhild Bjarkøy; Nilsen, Roy Miodini; Pouwer, Francois; Igland, Jannicke; Røssberg, Jan Ivar & Jenum, Anne Karen [Show all 8 contributors for this article] (2024). Associations of diabetes duration with anxiety, depression, and insomnia in people with type 2 diabetes. Full text in Research Archive
• Røssberg, Jan Ivar & Bjåstad, Jon Fauskanger (2024). Frekvensen av kognitiv atferdsterapi i behandlingen av depressive lidelser. Er hyppigere bedre? Tidsskrift for kognitiv terapi. ISSN 1504-3142. Full text in Research Archive
• Tørmoen, Anita Johanna; Røssberg, Jan Ivar; Aasland, Line & Mehlum, Lars (2024). SINCERITY WITH A CATCH: YOUNG ADULTS EARLIER TREATED FOR SELF-HARM LOOKING BACK AT THEIR SOCIAL MEDIA EXPERIENCES. Full text in Research Archive
• Buhl, Esben Selmer; Igland, Jannicke; Forster, Rachel Bedenis; Jenum, Anne Karen; Strandberg, Ragnhild Bjarkøy & Berg, Tore Julsrud [Show all 8 contributors for this article] (2023). Prediction of mortality and validation of the ATC-code based Rx-risk comorbidity index in the “Outcomes & Multi-Morbidity In Type 2 diabetes” (OMIT) cohort. Full text in Research Archive
• Landrø, Nils Inge; Harmer, Catherine; Blackwell, Simon E.; Bø, Ragnhild; Dawson, Gerry & Goodwin, Guy [Show all 16 contributors for this article] (2023). Combining antidepressants and attention bias modification in primary health care (DEPTREAT): Protocol for a pragmatic randomized controlled trial. Contemporary Clinical Trials. ISSN 1551-7144. 133. doi: 10.1016/j.cct.2023.107326. Full text in Research Archive Show summary

  Background Major depressive disorder (MDD) is a highly prevalent psychiatric condition associated with significant disability, mortality and economic burden. A large proportion of MDD patients are treated in primary health care in the local community. Attentional Bias Modification (ABM) training in combination with antidepressants could be an effective treatment. Here we test the hypothesis that adding an ABM procedure to regular treatment with antidepressants in primary health care will result in further improvement of symptoms compared to treatment with antidepressants alone (treatment as usual, TAU) and as compared to an active comparison condition. Methods A total of 246 patients with a diagnosis of MDD will be included in this study. The study is a three-armed pragmatic randomized controlled trial comparing the efficacy of ABM as add-on to treatment with antidepressants in primary care (ABM condition) compared to standard antidepressant treatment (TAU condition). In a third group participants will complete the same schedule of intermediate assessments as the ABM condition in addition to TAU, but no ABM, thus controlling for the non-training-specific aspects of the ABM condition (Antidepressant active comparison group). Discussion The clinical outcome of this study may help develop easily accessible, low-cost treatment of depression in primary health care. Moreover, the study aims to broaden our knowledge of optimal treatment for patients with a MDD by providing adjunct treatment to facilitate recovery and long-term gain.

• Oddli, Hanne Berit Weie; Nissen-Lie, Helene, Amundsen; Røssberg, Jan Ivar; Schanche, Elisabeth & Karlsson, Bengt Eirik (2023). Runderbordssamtale om endring. Full text in Research Archive
• Igland, Jannicke; Forster, Rachel Bedenis; Jenum, Anne Karen; Strandberg, Ragnhild Bjarkøy; Berg, Tore Julsrud & Røssberg, Jan Ivar [Show all 8 contributors for this article] (2022). The validity of the Rx-risk comorbidity index among adults in the Outcomes & Multimorbidity in Type 2 diabetes cohort (OMIT). Full text in Research Archive
• Kvam, Tor-Morten; Goksøyr, Ivar; Stewart, Lowan H.; Repantis, Dimitris; Røssberg, Jan Ivar & Andreassen, Ole (2022). Study protocol for “MDMA-assisted therapy as a treatment for major depressive disorder: A proof of principle study”. Frontiers in Psychiatry. 13. doi: 10.3389/fpsyt.2022.954388. Full text in Research Archive Show summary

  Background: Major depressive disorder (MDD) is a world-leading cause of disability. The available treatments are not effective in all patients, and there is a significant need for more effective treatment options. Here we present the protocol for an investigator-initiated and publicly funded trial of MDMA-assisted therapy (MDMA-AT) for MDD. This single-site, open-label study investigates the proof of principle and safety of MDMA-AT in participants with MDD and provides an initial impression of treatment effectiveness. Methods: A total of 12 participants [>18 years] with DSM-5 diagnosis of MDD will receive a flexible dose of MDMA in a therapeutic setting on two dosing days over a 4 week period preceded by three preparatory sessions. Each MDMA dosing session will be followed by three integration sessions. The primary outcome is change in MDD symptom severity, as measured by the mean change in MADRS scores from Baseline to 8 weeks after the second MDMA session. The secondary outcome is change in functional impairment, as evaluated by the mean change in Sheehan Disability Scale scores from Baseline to 8 weeks after the second MDMA session. Safety measures include vital signs, the incidence of Adverse Events and suicidality as measured by the Colombia-Suicide Severity Rating Scale. Discussion: This proof of principle trial will inform the development of fully powered clinical trials, optimize the protocol for the administration of MDMA-AT in participants with MDD and explore uncertainties including barriers to recruitment, retention and acceptability of MDMA-AT as a treatment for MDD. Clinical trial identification: EudraCT number 2021-000805-26

• Conejo-Cerón, Sonia; Taubner, Svenja; Heinonen, Erkki; Adler, Asta; Barkauskiene, Rasa & Giacomo, Dina Di [Show all 21 contributors for this article] (2021). Mediators in Psychological Treatments for Anxiety and Depression in Adolescents and Young People: A Protocol of a Systematic Review. Frontiers in Psychology. 12, p. 1–7. doi: 10.3389/fpsyg.2021.708436. Full text in Research Archive Show summary

  Introduction Anxiety and depressive disorders are a significant problem that starts in childhood or adolescence and should be addressed early to avoid chronic mental conditions. There is strong evidence to demonstrate that psychological treatments are effective for these disorders, however, little is known on mediators and mechanisms of change of psychological treatment in adolescents and young adults. Understanding the pathways through which psychological treatments operate will facilitate more effective treatments. Aim We aim to conduct a systematic review, exploring the available evidence on mediators of psychological treatments for anxiety and depression in adolescents and young adults. Methods A systematic search has been performed on PubMed and PsycINFO databases to identify studies from inception to 23rd February 2020. Eligible studies include randomized controlled trials and trials (quasi-experimental) designs that have enrolled adolescents and young adults presenting with depression and/or anxiety and that have examined mediators of psychological treatments. A group of 20 reviewers from the COST-Action TREATme (CA16102) divided into 10 pairs independently screen studies for inclusion, extract information from the included studies, and assess the methodological quality of the included studies and the requirements for mediators. The methodological quality will be assessed by The Mixed Methods Appraisal Tool. Extracted data from the included studies will be collected and presented using a narrative approach. Discussion This systematic review will summarize and provide a comprehensive overview of the current evidence on mediators of psychological treatments for anxiety and depression for adolescents and young adults. Results will allow the identification of strategies to optimize intervention to enhance clinical outcomes. Ethics and dissemination Ethics approval is not required. Findings from this systematic review will be published in a peer-reviewed journal and disseminated at conferences and meetings. PROSPERO registration number: CRD42021234641.

• Røssberg, Jan Ivar & Halvorsen, Joar Øveraas (2020). Å satse på psykisk helse koster mer enn bare tomme ord. Aftenposten (morgenutg. : trykt utg.). ISSN 0804-3116. Full text in Research Archive
• Lillenes, Ola; Ankersen, Roald & Røssberg, Jan Ivar (2019). Professor i psykiatri om regninger på 750.000: -Jeg har ikke ord! [Journal]. Fædrelandsvennen. Full text in Research Archive Show summary

  Professor i psykiatri er meget betenkt over behandlingen den norske kvinnen har fått av sin terapeut, og er målløs over at hun har fått regninger på 750.000 kroner.

• Østefjells, Tiril; Melle, Ingrid; Romm, Kristin Lie; Sønmez, Nasrettin & Røssberg, Jan Ivar (2019). Metacognitive Beliefs in Psychosis: A 15-Month Follow Up Study. Full text in Research Archive
• Lillenes, Ola & Røssberg, Jan Ivar (2019). Alvorlige psykiske lidelser – og alternativ behandling. 13/14-2019. Full text in Research Archive Show summary

  Det er grunn til å se nærmere på vilkårene til behandlere som oppsøkes av pasienter med psykiske lidelser. Av hensyn til sikkerheten bør myndighetene gjennomgå tittelbruken i det alternative markedet.

• Halvorsen, Joar Øveraas & Røssberg, Jan Ivar (2018). Dokumentasjonen for medisinsk behandling holder ikke. Stavanger Aftenblad. ISSN 0804-8991. p. 32–32. Full text in Research Archive
• Halvorsen, Joar Øveraas & Røssberg, Jan Ivar (2018). Miljøterapi og medisiner bør ikke være et enten eller. Stavanger Aftenblad. ISSN 0804-8991. p. 38–38. Full text in Research Archive
• Eielsen, Mikkel; Høstmælingen, Andreas Teisner; Nissen-Lie, Helene Amundsen; Wampold, Bruce E.; Røssberg, Jan Ivar & Ulvenes, Pål Gunnar (2018). Effect and effectiveness of Affect Phobia Therapy in treating persistent depressive disorder. Full text in Research Archive
• Høstmælingen, Andreas Teisner; Eielsen, Mikkel; Nissen-Lie, Helene Amundsen; Wampold, Bruce E.; Røssberg, Jan Ivar & Ulvenes, Pål Gunnar (2018). Short and long term effects of combination treatment compared to psychotherapy alone in the treatment of persistent depressive disorder. Full text in Research Archive
• Ulvenes, Pål Gunnar; Eielsen, Mikkel; Høstmælingen, Andreas Teisner; Nissen-Lie, Helene Amundsen; Røssberg, Jan Ivar & Wampold, Bruce E. (2018). Trajectories of change in persistent depressive disorders across two psychotherapeutic modalities. Full text in Research Archive
• Røssberg, Jan Ivar & Bramness, Jørgen Gustav (2018). Antipsychotic drugs for more than two years? Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. doi: 10.4045/tidsskr.18.0844. Full text in Research Archive
• Røssberg, Jan Ivar; Andreassen, Ole Andreas & Ilner, Stein E. Opjordsmoen (2017). Re: Psykiatriens indre konflikter eksponert. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 137(9), p. 594–595. doi: 10.4045/tidsskr.17.0288. Full text in Research Archive
• Røssberg, Jan Ivar; Andreassen, Ole Andreas & Ilner, Stein E. Opjordsmoen (2017). Medisinfrie sykehusposter – et kunnskapsløst tiltak. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 137(6), p. 426–427. doi: 10.4045/tidsskr.17.0091. Full text in Research Archive
• Løvgren, André; Nilsen, Liv; Engebretsen, Eivind; Røssberg, Jan Ivar & Ulberg, Randi (2017). Adolescents’ experience of change in psychodynamic therapy; a qualitative study. Full text in Research Archive Show summary

  Aim: There is an emerging empirical support for the effect of psychodynamic psychotherapy in adolescents. However, there is lack of knowledge in how psychodynamic therapy works for depressed adolescents, how they experience the therapy process and the factors contributing to positive change. Little is known when it comes to adolescent patients’ own experiences of what they found helpful and leading to less symptoms and better interpersonal relationships. The aim of this study was to explore what adolescents themselves recognised as helpful during therapy. Method: An interview guide was developed, focusing on the experiences of the therapy process from the adolescents’ point of view, and what they after treatment identified as helpful factors. Main topics were on how therapy was experienced, what within therapy was helpful – or not so helpful, and how therapy affected important relations and areas in the adolescents’ everyday life. Explorative, semi-structured interviews were conducted with nine, female adolescents. The interviews lasted for approximately one hour, was audio recorded and transcribed verbatim. The transcripts were analysed with thematic content analysis, looking for similarities and differences among the adolescents’ utterances. Results: During the analysis of the transcribed interviews, thematic areas emerged. They were categorised in three main groups with several sub themes. The main areas were Exploring of self, Relational work, and Time. Discussion: Categories and themes will be presented and discussed. Keywords: Psychotherapy change, adolescent depression, patients’ perspective.

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