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• 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.

• 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.

• Melsom, Linne; Ulvenes, Pål Gunnar; Solbakken, Ole Andre; Curran, Patrick J.; Eielsen, Karl Mikkel Veum & Wampold, Bruce E. (2023). Self-Compassion and Fear of Compassion in the Treatment of Chronic Depression: Mechanisms of Change? Journal of Consulting and Clinical Psychology. ISSN 0022-006X. doi: 10.1037/ccp0000822. Full text in Research Archive
• 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.

• Høstmælingen, Andreas; Ulvenes, Pål Gunnar; Nissen-Lie, Helene Amundsen; Eielsen, Karl Mikkel Veum & Wampold, Bruce E. (2021). Comparing outcomes in chronic depression following inpatient psychotherapy for patients continuing versus discontinuing antidepressant medication. Clinical Psychology and Psychotherapy. ISSN 1063-3995. 28, p. 1111–1127. doi: 10.1002/cpp.2561. Full text in Research Archive Show summary

  Research indicates that combination of psychotherapy and antidepressant medication (ADM) provides cumulative effects and thus outperforms monotherapy in treating chronic depression. In this quasi-experimental study, we explored symptom change for patients with chronic depression treated with ADM when presenting for a 12-week psychotherapeutic inpatient treatment programme. We compared outcomes through treatment and follow-up of patients who continued medication with those who discontinued. We also tested possible moderator effects of initial depression severity on change between the groups. Based on prior research, we hypothesized that combination treatment would yield better results (i.e., more reduction in depression). Patients (N = 112) were referred from general practitioners or local secondary health care. Outcome was measured by Beck Depression Inventory-II (BDI-II), and comparisons were carried out using multilevel modelling. Although 35 patients discontinued ADM during treatment, 77 continued. Both continuers and discontinuers had a significant treatment effect that was maintained at 1-year follow-up. There was no difference in outcome between continuers and discontinuers of ADM. Patients with severe depression had significantly more symptom improvement than patients with moderate depression, but depression severity did not affect outcomes across continuers and discontinuers of ADM differently. The results could indicate that patients had developed resistance and/or tolerance to the prophylactic effects of medication and that ADM did not contribute to the reduction of depressive symptoms. The findings may also indicate that psychotherapy alone in some instances can be a viable alternative to continued combined treatment. Clinicians should carefully assess benefits of patients' ongoing use of antidepressant medication when entering psychotherapy.

• Høstmælingen, Andreas; Ulvenes, Pål Gunnar; Nissen-Lie, Helene Amundsen; Eielsen, Karl Mikkel Veum & Wampold, Bruce E. (2021). Do self-criticism and somatic symptoms play a key role in chronic depression? Exploring the factor structure of Beck depression inventory-II in a sample of chronically depressed inpatients. Journal of Affective Disorders. ISSN 0165-0327. 283, p. 317–324. doi: 10.1016/j.jad.2021.01.066. Full text in Research Archive Show summary

  Background: The factor structure of depression differs for different sub-samples. The purpose of this study was to explore the factor structure of Beck Depression Inventory-II in patients with chronic depression presenting for inpatient treatment. Methods: Using exploratory structural equation modeling (ESEM), we explored whether a two-factor solution or a bifactor solution provided best model fit for a sample of 377 patients. For the best fitting model stability was assessed with tests for invariance across primary diagnosis (persistent depressive disorder v. recurrent major depressive disorder), and presence of comorbidity. Results: A bifactor solution with one general factor and two specific factors provided best model fit. Invariance analyses provided support for measurement invariance and stability of the factor solution. Limitations: The naturalistic study design implies some uncertainty regarding possible systematic differences between the patients on demographic and clinical characteristics. Conclusion: The factor structure in our sample was best explained by a general depression factor, one specific factor pertaining to self-criticism, and one consisting of the somatic items fatigue, disturbance of sleep, and appetite. Clinicians could benefit from paying special attention to the subfactors identified, as these findings may have implications for treatment choice for patients with chronic depression.

• Høstmælingen, Andreas; Ulvenes, Pål Gunnar; Nissen-Lie, Helene, Amundsen; Eielsen, Karl Mikkel Veum & Wampold, Bruce E. (2021). Trajectories of change in chronic depression: Differences in self-criticism and somatic symptoms between users of antidepressants and nonmedicated patients. Journal of Counseling Psychology. ISSN 0022-0167. 69, p. 85–99. doi: 10.1037/cou0000572. Full text in Research Archive

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• 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

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