Toril Dammen

• Getz, Vilde; Pleym, Karin; Dammen, Toril; Husebye, Einar; Sverre, Elise Christine Bjørkholen & Peersen, Kari [Show all 9 contributors for this article] (2026). Patient and healthcare system factors associated with participation in municipal smoking cessation programs after hospitalization for atherosclerotic vascular disease in Norway: A prespecified analysis of two randomized controlled trials. Tobacco Prevention & Cessation. 12(61), p. 1–13. doi: 10.18332/tpc/236282. Full text in Research Archive Show summary

  Introduction: Persistent smoking after hospitalization for an atherosclerotic vascular event remains common, and only a small proportion attend cardiac rehabilitation or community-based lifestyle support, including smoking cessation programs. This study aimed to identify patient and healthcare...

• Feng, Xin; Sigurdardottir, Fjola Dögg Hugberg; Arnardottir, Erna Sif; Dammen, Toril; Einvik, Gunnar & Korkalainen, Henri [Show all 15 contributors for this article] (2026). Association of major adverse cardiovascular events with the apnea-hypopnea index, desaturation severity parameters, and cardiac troponins in participants of the Akershus Sleep APnea cohort. Sleep. ISSN 0161-8105. 49(8). doi: 10.1093/sleep/zsag013. Full text in Research Archive Show summary

  Study Objectives: To examine the prognostic value of the apnea-hypopnea index (AHI), desaturation severity parameters, and cardiac troponins alone and combined for major cardiovascular events (MACEs). Methods: MACE data were retrieved in 2021 from the Norwegian Patient Registry for 518 participants in the Akershus Sleep APnea (ASAP) cohort. Baseline polysomnography and fasting blood samples were collected between June 2006 and January 2008. Desaturation duration (DesDur) and severity (DesSev) were calculated using Automatic Blood Oxygen Saturation Analysis software. Cox regression models estimated hazard ratios (HRs) for MACE. Predictive properties of combining troponins and obstructive sleep apnea severity were calculated by comparing established clinical thresholds for cardiac troponin I (cTnI) and T (cTnT) with AHI clinical thresholds of ≥15 and ≥30, respectively. Results: High AHI, DesDur, DesSev, cTnI, and cTnT were associated with increased MACE risk. However, only cTnI independently predicted MACE after adjustment (HR: 1.74, 95% CI: 1.32–2.29). The HR for MACE was 2.68 (95% CI: 1.03–6.97) in patients with both high cTnI and AHI ≥30 events/h. Conclusion: In this 15-year follow-up, cTnI was independently associated with risk of MACE, whereas the AHI, desaturation parameters, and cTnT were not independent predictors. cTnI, especially when combined with AHI, was a stronger MACE predictor than cTnT. Provided our findings are validated in clinical obstructive sleep apnea populations, the measurement of cTnI may be considered for cardiovascular risk stratification.

• 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
• Braanaas, Karoline Svensen; Dammen, Toril; Fagerland, Morten; Husebye, Einar; Leinaas, Amund & Schirmer, Henrik [Show all 10 contributors for this article] (2026). Individually tailored monitoring at home after hospitalization for HEART failure (IT-HEART): design and baseline characteristics of a randomized clinical trial. Heart Failure Reviews. ISSN 1382-4147. 31(1). doi: 10.1007/s10741-026-10635-1. Full text in Research Archive Show summary

  Telemonitoring has emerged as a promising alternative to conventional heart failure (HF) management, but randomized trials show conflicting results, and data from high-risk populations with frailty, is scarce. The Individually Tailored monitoring at home after HEART failure (IT-HEART) trial evaluates whether a non-invasive multi-component telemonitoring program improves outcomes in HF patients after HF-hospitalization. The aim of this study is to describe flow of patients and baseline characteristics of the IT-HEART trial population. This multicenter, open-label, blinded-endpoint trial randomized HF patients to either written information and a standardized self-treatment plan (Control) or HF education, a personalized self-treatment plan, and three months of home telemonitoring (Intervention). The primary endpoint is the total number of HF hospitalizations or cardiovascular death. Of 1016 consecutively screened patients, 200 (19.7%) were randomized. At baseline, median age was 78 (IQR 70–83) years, and 29.5% were women. Participants were multimorbid (median 6 diagnoses) with a median Clinical Frailty Scale score 4 (IQR 4–5). Median score of the European Heart Failure Self-care Behaviour Scale was 53 (IQR 35–67), and 75.5% had inadequate self-care. Self-rated knowledge on HF management was 3 (IQR 0–7) on a 0–10 Likert scale. Only 35.5% (n = 71) weighed themselves weekly whereas 1% (n = 2) reported having a self-care plan. In conclusion, patients enrolled after a recurrent HF hospitalization were multimorbid and frail, and scored low on self‑care and health literacy. The IT-HEART intervention is targeted to these factors and has the potential to improve clinical and patient‑reported outcomes, and costs.

• 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
• Getz, Vilde; Pleym, Karin; Dammen, Toril; Husebye, Einar; Sverre, Elise Christine Bjørkholen & Papageorgiou, Constantinos [Show all 8 contributors for this article] (2026). Clinical and psychosocial factors predicting persistent smoking in hospitalized patients with atherosclerotic vascular disease: A prespecified analysis of two randomized controlled trials. Tobacco Prevention & Cessation. 12. doi: 10.18332/tpc/217328. Full text in Research Archive
• Nyen, Johanne E; Kristensen, Anna Meta D; Dammen, Toril; Zwisler, Ann-Dorthe; Olsen, Michael Hecht & Maeng, Michael [Show all 14 contributors for this article] (2026). Beta-blockers, depression, and anxiety after myocardial infarction: the BETAMI-DANBLOCK trial. European Heart Journal. ISSN 0195-668X. doi: 10.1093/eurheartj/ehag200. Full text in Research Archive
• Getz, Vilde; Pleym, Karin; Dammen, Toril; Husebye, Einar; Sverre, Elise Christine Bjørkholen & Papageorgiou, Constantinos [Show all 8 contributors for this article] (2026). Clinical and psychosocial factors predicting persistent smoking in hospitalized patients with atherosclerotic vascular disease: A prespecified analysis of two randomized controlled trials. Tobacco Prevention & Cessation. 12(15). doi: https:/www.tobaccopreventioncessation.com/Clinical-and-psychosocial-factors-predicting-persistent-nsmoking-in-hospitalized,217328,0,2.html. Full text in Research Archive Show summary

  ABSTRACT Introduction: Smoking remains prevalent after hospitalization for atherosclerotic vascular disease, even with cessation programs. Understanding the clinical and psychosocial factors influencing long-term abstinence is essential for identifying patients who may benefit from tailored interventions. This study aimed to identify clinical and psychosocial factors associated with sustained smoking cessation in patients with atherosclerotic disease who were admitted to hospital for an elective or unplanned vascular event and enrolled in a cessation intervention study. Methods: This is a prespecified analysis of two randomized intervention trials that recruited participants from three secondary care hospitals in Norway between 2021 and 2023. Patients who smoked at least one cigarette daily before admission were randomized to: 1) motivational counselling and proactive referral to municipal cessation services (intervention); or 2) brief advice and contact information (control). Data were collected from medical records, a questionnaire, and telephone interviews. Logistic regression analyses were used to identify the prespecified factors associated with smoking status at 12 months. Results: In the total study population (n=262), 34% (n=88) reported 12-month sustained smoking abstinence. Anxiety diagnosis (adjusted odds ratio, AOR=4.2), shorter sleep duration per hour (AOR=1.3), living alone (AOR=2.2), somatic comorbidity per point on the Charlson score (AOR=1.5), and being in the precontemplation stage (AOR=2.9) were associated with persistent smoking. Increasing motivation per point on a 0–10 Likert scale (AOR=0.7), being in the preparation stage (AOR=0.4), and myocardial infarction or stroke as the index diagnosis (AOR=0.5) were associated with smoking abstinence. Results were generally consistent across intervention allocation groups. Conclusions: Motivation and readiness for smoking cessation were key predictors of abstinence. Living alone, anxiety disorders, and shorter sleep duration were associated with persistent smoking. These factors may help identify subgroups who could benefit from more targeted support.

• Pacheco, André Pekkola; Dammen, Toril; Munkhaugen, John; Papageorgiou, Constantinos; Kværner, Kari Jorunn & Støme, Linn Nathalie (2025). Potential benefits of group cognitive–behavioural therapy for insomnia in outpatients with coronary heart disease versus usual care: an early economic evaluation. BMJ Open. 15(12). doi: 10.1136/bmjopen-2024-092811. Full text in Research Archive Show summary

  Objective Insomnia afflicts about half of outpatients with coronary heart disease (CHD) and worsens prognosis. We aimed to simulate the potential socioeconomic savings of integrating group cognitive–behavioural therapy for insomnia (gCBT-I) into cardiac outpatient care for patients with CHD compared with usual care. Design Early health technology assessment using prospective and cross-sectional cohort data. Setting Secondary care for outpatients with CHD in Norway in a non-university hospital setting. Participants A hypothetical cohort of 100 outpatients with CHD and insomnia. Interventions Weekly sessions of gCBT-I over 5 weeks versus usual care. Primary and secondary outcome measures Potential savings related to possible effects on revascularisations and hospitalisations due to a recurrent CHD event, and reduced sick leave. Representative data on healthcare consumption and sick leave rates were collected from the NORwegian CORonary cohort study (n=528). Costs of productivity loss were drawn from public sources and calculated using a conservative human capital approach. Estimates of therapeutic effectiveness in conveying insomnia remission by gCBT-I were informed by results from randomised trials and meta-analyses. Results Rates of healthcare consumption and sick leave were higher in outpatients with CHD and insomnia compared with those without insomnia. Our model indicated that treating 100 patients with gCBT-I would cost €2406. If patients treated with gCBT-I show similar rates of revascularisations and hospitalisations as those without insomnia, there is a maximum potential saving of €117,221 per 100 patients tied to healthcare consumption. Similarly, the maximum potential savings related to reduced productivity loss from sick leave range from €53,244 to €692,172. Conclusion Treating insomnia among outpatients with CHD has the potential for substantial reduction of socioeconomic costs related to healthcare consumption and sick leave. Implementation into routine outpatient care seems relevant, but randomised controlled trials investigating the effects of gCBT-I in this population are warranted.

• 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.

• Hansen, Diana Dobran; Tinbod, Unn; Feng, Xin; Dammen, Toril; Hrubos-Strøm, Harald & Skirbekk, Helge (2025). Orofacial Myofunctional Therapy for Patients with Obstructive Sleep Apnea—A Mixed Methods Study of Facilitators and Barriers to Treatment Adherence. International Journal of Orofacial Myology and Myofunctional Therapy (IJOM). ISSN 0735-0120. 51(2). doi: 10.3390/ijom51020006. Full text in Research Archive Show summary

  Orofacial myofunctional therapy (OMT) for obstructive sleep apnea (OSA) is a promising, new treatment. We aimed to study patients’ experiences and adherence to OMT. Twelve patients with OSA were included in the study, and they engaged in OMT exercises three times daily for 12 weeks. Participants tracked their sleep and OMT exercise activities in an electronic diary. Exercise techniques were guided by a certified therapist. Patients’ experiences with OMT were assessed through semi-structured individual interviews conducted after a 12-week intervention, and the transcripts were analyzed using thematic analysis. The findings revealed an overarching theme that captured both facilitators of and barriers to OMT, organized into three subthemes: (1) motivation, (2) perceived support, and (3) perceived effects. Motivation was driven by a desire to improve general health and avoid continuous positive airway pressure treatment, and was supported by a sense of mastery and perceived effectiveness. Key facilitators included a trusting patient–therapist relationship, as well as developing routines and a sense of control. Barriers involved managing the comprehensive treatment protocol, insecurities around exercise execution and the potential impact of OMT, sickness burden, and previous negative healthcare experiences. These themes were supported by quantitative findings, which demonstrated high treatment adherence, while sleep data indicated modest individual improvements in subjective sleep quality and efficiency. By recognizing facilitators and barriers and addressing the individual differences among OSA patients, healthcare providers can better tailor their approach to meet diverse patient needs. This personalized approach, supported by emerging sleep improvements, may enhance patient engagement and improve adherence to OMT.

• Hummelen, Benjamin; Brovold, Filippa; Moen, Erna; Meland, Karete Jacobsen; Andersen, Anniken & Johsen, Diana Strand [Show all 9 contributors for this article] (2025). Psychometric properties of the action and acceptance questionnaire for trichotillomania in a clinical sample of patients with trichotillomania and skin picking disorder. Journal of Obsessive-Compulsive and Related Disorders. ISSN 2211-3649. 47. doi: 10.1016/j.jocrd.2025.100972. Full text in Research Archive
• Pleym, Karin; Sverre, Elise Christine Bjørkholen; Weedon-Fekjær, Harald; kahlon, Mohpal Singh; Stugaard, Marie & Husebye, Einar [Show all 9 contributors for this article] (2025). Motivational smoking cessation counselling and community‐based follow‐up after hospitalisation for vascular disease: A randomised controlled trial. Addiction. ISSN 0965-2140. p. 1–13. doi: 10.1111/add.70249. Full text in Research Archive Show summary

  Background and aims Evidence for motivational interviewing for smoking cessation is weak, with limited data on long-term abstinence rates. This trial aimed to evaluate the effect of in-hospital motivational interviewing-based smoking cessation counselling combined with proactive referral to community-based follow-up on 6- and 12-month continuous smoking abstinence in patients with atherosclerotic vascular disease. Design Multicentre, randomised, open-label, blinded-end-point trial with 1:1 randomisation. Setting Three secondary care hospitals in Norway, with recruitment from November 2021 to October 2023. Participants Hospitalised patients with established atherosclerotic vascular disease who smoked ≥1 cigarette daily prior to unplanned or elective hospitalisation. A total of 221 were randomised (40% women, mean age 65.2 years), of whom 213 were included in the primary analysis due to 7 deaths and 1 withdrawal. Intervention and comparator In the intervention group (n = 109), a trained nurse conducted a single 30-minute motivational interviewing-based counselling session, provided a leaflet explaining the local community-based cessation programme, sent discharge information to the general practitioner and arranged for a personal telephone invitation from the centre staff to the follow-up programme. In the control group (n = 111), a physician gave brief cessation advice and the nurse provided a leaflet about the cessation programme and sent discharge information to the general practitioner. Measurements The primary outcome was self-reported continuous smoking abstinence at 6 months. Secondary outcomes included biochemically validated abstinence (measurement of exhaled carbon monoxide) at 6 months and self-reported abstinence at 12 months. Exploratory outcomes included recurrent vascular events over a median 18-month follow-up. Findings Smoking abstinence at 6 months was 49.5% (53/107) and 24.5% (26/106) in the intervention and control groups, respectively [odds ratio (OR) = 3.08, 95% confidence interval (CI) = 1.70–5.55, P < 0.001]. The number needed to treat to achieve one additional abstinence was 4 (95% CI = 3–9). Biochemically validated abstinence was 44.9% (48/107) and 20.8% (22/106) in the intervention and control groups, respectively (OR = 3.28, 95% CI = 1.76–6.12). At 12 months, smoking abstinence was 45.7% (48/105) and 27.5% (28/102) in the intervention and control groups, respectively (OR = 2.31, 95% CI = 1.27–4.20). After a median of 18-month follow-up, a prespecified vascular event occurred in 24.8% (27/109) and 34.2% (38/111) of intervention and control participants, respectively. Conclusions In-hospital motivational counselling combined with proactive referral to follow-up in a community-based cessation programme approximately doubled long-term smoking abstinence rates in patients with atherosclerotic vascular disease and reduced occurrence of a new vascular event.

• Munkhaugen, John; Kristensen, Anna Meta D.; Halvorsen, Sigrun; Holmager, Therese; Olsen, Michael Hecht & Bakken, Arnhild [Show all 64 contributors for this article] (2025). Beta-Blockers after Myocardial Infarction in Patients without Heart Failure. New England Journal of Medicine. ISSN 0028-4793. 393(19), p. 1901–1911. doi: 10.1056/nejmoa2505985. Full text in Research Archive Show summary

  Background: The evidence supporting beta-blocker therapy after myocardial infarction was established before the introduction of modern coronary reperfusion therapy and secondary prevention strategies. Methods: In an open-label, randomized trial with blinded end-point evaluation, conducted in Denmark and Norway, we assigned patients who had had a myocardial infarction and who had a left ventricular ejection fraction of at least 40%, in a 1:1 ratio, to receive long-term beta-blocker therapy within 14 days after the event or no beta-blocker therapy. The primary end point was a composite of death from any cause or major adverse cardiovascular events (new myocardial infarction, unplanned coronary revascularization, ischemic stroke, heart failure, or malignant ventricular arrhythmias). Results: A total of 5574 patients underwent randomization and were included in the main analyses - 2783 in the beta-blocker group and 2791 in the no-beta-blocker group. After a median follow-up of 3.5 years (interquartile range, 2.2 to 4.6), a primary end-point event had occurred in 394 patients (14.2%) in the beta-blocker group and in 454 patients (16.3%) in the no-beta-blocker group (hazard ratio, 0.85; 95% confidence interval [CI], 0.75 to 0.98; P = 0.03). Death from any cause occurred in 4.2% of the patients in the beta-blocker group and in 4.4% of those in the no-beta-blocker group; myocardial infarction occurred in 5.0% and 6.7%, respectively (hazard ratio, 0.73; 95% CI, 0.59 to 0.92), unplanned coronary revascularization in 3.9% and 3.9%, ischemic stroke in 1.6% and 1.3%, heart failure in 1.5% and 1.9%, and malignant ventricular arrhythmias in 0.5% and 0.6%. No apparent differences in safety outcomes were observed between the groups. Conclusions: Among patients with a myocardial infarction and a left ventricular ejection fraction of at least 40%, beta-blocker therapy led to a lower risk of death or major adverse cardiovascular events than no beta-blocker therapy

• Holtrop, Joris; Gynnild, Mari Nordbø; Dammen, Toril; Dalen, Håvard; Saltvedt, Ingvild Tina & Ellekjær, Hanne [Show all 11 contributors for this article] (2025). Psychological factors beyond the SMART2 model for predicting recurrent events in atherosclerotic cardiovascular disease patients. European Journal of Preventive Cardiology (EJPC). ISSN 2047-4873. doi: 10.1093/eurjpc/zwaf526. Full text in Research Archive Show summary

  Aims Guidelines recommend using cardiovascular (CV) risk prediction models to support treatment decisions. Psychological factors such as depression, anxiety, and insomnia may affect CV risk. The aim is to evaluate the added value of these psychological factors on top of the SMART2 model for estimating 10-year risk of recurrent CV events in patients with atherosclerotic CV disease. Methods and results Patients aged 40–80 with atherosclerotic CV disease were included from the UCC-SMART, HUNT3, HUNT4, NORCOR, and Nor-COAST cohorts. Potential added value of (self-reported) symptoms, diagnoses, and treatment for depression, anxiety, and insomnia on top of the SMART2 was investigated using Fine and Gray models, with SMART2 coefficients as an offset. Added value was assessed by change (Δ) in C-statistic and calibration. A total of 20 050 patients were eligible, with 2987 experiencing recurrent CV events. Psychological factors were present in 3–9%, 3–45%, and 10–14% of patients for diagnosis, self-reported symptoms, and prescribed treatment, respectively. No psychological factors were significantly associated with recurrent CV events on top of SMART2 and performance in patients with psychological factors was adequate (C-statistics 0.61–0.70). Added value of psychological factors was minimal, with the ΔC-statistic ranging from −0.0003 [95% confidence interval: −0.0005–0.0001] for symptoms of depression, to 0.0011 [0.0011–0.0011] for prescribed treatment with anxiolytics. There was no relevant difference in calibration. Conclusion SMART2 model reliably estimates recurrent CV event risk in patients with psychological factors. Psychological factors have no added value to CV risk prediction when integrated on top of the SMART2 risk score.

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

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

• Flagstad, Ella; Hummelen, Benjamin; Moen, Erna; Dammen, Toril; Håland, Åshild Tellefsen & Sunde, Tor [Show all 10 contributors for this article] (2025). Early maladaptive schemas in trichotillomania and skin-picking disorder: their relationships with symptom severity and subtypes. BMC Psychology. 13. doi: 10.1186/s40359-025-03096-y. Full text in Research Archive Show summary

  Background: Higher levels of early maladaptive schemas (EMSs) have been associated with increased symptom severity and worse treatment outcomes in several mental disorders, but little is known about the role of EMSs in trichotillomania (TTM) and skin-picking disorder (SPD). The current study therefore aimed to explore the relationship of EMSs with symptom severity and subtypes in patients with TTM and SPD, as well as to compare their baseline EMS levels to those of a group of patients with obsessive‒compulsive disorder (OCD). Methods: The Young Schema Questionnaire–Short Form (YSQ-SF), along with measures of disorder-specific symptoms and subtypes, was administered to patients with TTM (n = 120), SPD (n = 75), and OCD (n = 88) prior to treatment. Potential between-group differences in EMSs were explored with ANCOVA, with age and illness duration as covariates. Disorder- and subtype-specific patterns were explored with correlational analysis. Results: No significant baseline differences in EMS severity were found between TTM, SPD, and OCD patients, thereby corroborating EMSs’ transdiagnostic function in mental disorders. Several EMSs were significantly positively associated with self-reported and clinician-rated symptoms and picking/pulling styles of TTM and SPD, with some indications of diagnosis-specific association patterns. Conclusion: These results suggest that EMSs are common among individuals with TTM and SPD and that assessment of these schemas may enhance clinicians’ understanding of TTM and SPD patients’ presenting problems.

• 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.

• Pivoriunas, Jonas; Engebretsen, Ingrid; Vethe, Nils Tore; Kristiansen, Oscar; Dammen, Toril & Husebye, Einar [Show all 9 contributors for this article] (2025). Statin adherence in coronary outpatients: The relationship between a novel blood test and pharmacy registry data. Atherosclerosis. ISSN 0021-9150. 403. doi: 10.1016/j.atherosclerosis.2025.119138. Full text in Research Archive
• Andersen, Silje Glenna; Sæterhagen, Henrik; Pacheco, André Pekkola; Pripp, Are Hugo; Hrubos-Strøm, Harald & Papageorgiou, Constantinos [Show all 8 contributors for this article] (2025). The effects of cognitive behavioral therapy for insomnia in patients with cardiovascular disease: a systematic review and meta-analysis. Journal of Clinical Sleep Medicine (JCSM). ISSN 1550-9389. 21(7), p. 1273–1284. doi: 10.5664/jcsm.11656. Full text in Research Archive
• Engebretsen, Ingrid; Bugge, Christoffer; Støvring, Henrik; Husebye, Einar; Sverre, Elise Christine Bjørkholen & Dammen, Toril [Show all 8 contributors for this article] (2024). Treatment patterns and adherence to lipid-lowering drugs during eight-year follow-up after a coronary heart disease event. Atherosclerosis. ISSN 0021-9150. 393. doi: 10.1016/j.atherosclerosis.2024.117550. Full text in Research Archive Show summary

  Background and aims Proper prescription and high adherence to intensive lipid lowering drugs (LLD) in patients with coronary heart disease (CHD) is crucial and strongly recommended. The aim of this study is to investigate long-term treatment patterns and adherence to LLD following hospitalization for a CHD event. Methods Patients admitted to two Norwegian hospitals with a CHD event from 2011-2014 (N=1094) attended clinical examination and completed a questionnaire, median 16 months later. Clinical data were linked to pharmacy dispensing data from 2010-2020. The proportions using high-intensity statin therapy (atorvastatin 40/80 mg or rosuvastatin 20/40 mg) and non-statin LLD after the CHD event were assessed. Adherence was evaluated by proportion of days covered (PDC) and gaps in treatment. Results Median age at hospitalization was 63 (IQR 12) years, 21% were female. Altogether, 1054 patients (96%) were discharged with a statin prescription, while treatment was dispensed in 85% within the following 90 days. During median 8 (SD 2.5) years follow-up, the proportion using high-intensity statin therapy ranged 62-68%, whereas the use of ezetimibe increased from 4-26 %. PDC <0.8 was found in 22% of statin users and 26% of ezetimibe users. The proportions with a treatment gap exceeding 180 days were 22% for statins and 28% for ezetimibe. Smoking at hospitalization and negative affectivity were significantly associated with reduced statin adherence, regardless of adherence measure. Conclusions In this long-term follow-up of patients with CHD, less than 70% used high-intensity statin therapy with only small changes over time, and only 25% used additional treatment with ezetimibe. We identified factors associated with reduced statin adherence that may be target for interventions.

• Thorisdottir, K.; Hrubos-Strøm, Harald; Karhu, T.; Nikkonen, S.; Dammen, Toril & Nordhus, Inger Hilde [Show all 9 contributors for this article] (2024). Verbal memory is linked to average oxygen saturation during sleep, not the apnea-hypopnea index nor novel hypoxic load variables. Sleep Medicine. ISSN 1389-9457. 123, p. 29–36. doi: 10.1016/j.sleep.2024.08.028. Full text in Research Archive Show summary

  Introduction: The apnea-hypopnea index (AHI) is the current diagnostic parameter for diagnosing and estimating the severity of obstructive sleep apnea (OSA). It is, however, poorly associated with the main clinical symptom of OSA, excessive daytime sleepiness, and with the often-seen cognitive decline among OSA patients. To better evaluate OSA severity, novel hypoxic load parameters have been introduced that consider the duration and depth of oxygen saturation drops associated with apneas or hypopneas. The aim of this paper was to compare novel hypoxic load parameters and traditional OSA parameters to verbal memory and executive function in OSA patients. Method: A total of 207 adults completed a one-night polysomnography at sleep laboratory and two neuropsychological assessments, the Rey Auditory Verbal Learning Test and Stroop test. Results: Simple linear regression analyses were used to evaluate independent associations between each OSA parameter and cognitive performance. Associations were found between immediate recall and arousal index, hypoxia <90 %, average SpO2 during sleep, and DesSev100+RevSev100. Total recall was associated with all OSA parameters, and no associations were found with the Stroop test. Subsequently, sex, age, and education were included as covariates in multiple linear regression analyses for each OSA parameter and cognitive performance. The main findings of the study were that average SpO2 during sleep was a significant predictor of total recall (p < .007, β = −.188) with the regression model explaining 21.2 % of performance variation. Average SpO2 during sleep was also a significant predictor of immediate recall (p < .022, β = −.171) with the regression model explaining 11.4 % of performance variation. Neither traditional OSA parameters nor novel hypoxic load parameters predicted cognitive performance after adjustment for sex, age, and education. Conclusion: The findings validate that the AHI is not an effective indicator of cognitive performance in OSA and suggest that average oxygen saturation during sleep may be the strongest PSG predictor of cognitive decline seen in OSA. The results also underline the importance of considering age when choosing neurocognitive tests, the importance of including more than one test for each cognitive domain as most tests are not pure measures of a single cognitive factor, and the importance of including tests that cover all cognitive domains as OSA is likely to have diffuse cognitive effects.

• Johnson, Sverre Urnes; Hagen, Roger; Dammen, Toril & Papageorgiou, Constantinos (2024). Videoconference-delivered metacognitive therapy for anxiety and depression in post-COVID-19 syndrome: A baseline-controlled single-arm pilot trial. General Hospital Psychiatry. ISSN 0163-8343. 88, p. 77–78. doi: 10.1016/j.genhosppsych.2024.02.003. Full text in Research Archive
• Strand, Elin Bolle; Nes, Lise Solberg; Børøsund, Elin; Pripp, Are Hugo; Malarkey, William & Dammen, Toril (2024). Psychometric properties of the REMAP resilience scale in a Norwegian sample of ME/CFS patients and healthy controls. Psychological Test Adaptation and Development (PTAD). 5(1), p. 163–174. doi: 10.1027/2698-1866/a000076. Full text in Research Archive Show summary

  Being able to increase and know how to strengthen resilience may be relevant for patients living with long-term symptoms such as chronic fatigue syndromes. The current study aimed to examine the psychometric properties of a Norwegian-translated version of the REMAP resilience measure in a sample of patients with myalgic encephalomyelitis/chronic fatigue syndrome and healthy controls. Factor analyses indicated poor fit for both the one- and five-factor solutions of the translated REMAP measure with best fit for a correlated five-factor model. Validity proved to be good, while reliability was poor for two of the subscales. Differences were revealed between gender, age groups, and between patients and healthy controls. The construct validity indicates that REMAP assesses adequate aspects of resilience. REMAP might be valuable to use to show that resilience resources could be developed in various life domains and aid in coping with chronic illness. However, REMAP should be further tested in other samples and cultures.

• Pleym, Karin; Dammen, Toril; Weedon-Fekjær, Harald; Husebye, Einar; Sverre, Elise Christine Bjørkholen & Tonstad, Serena [Show all 7 contributors for this article] (2024). A multi-component intervention increased access to smoking cessation treatment after hospitalization for atherosclerotic cardiovascular disease: A randomized trial. European Heart Journal Open (EHJ Open). 4(2). doi: 10.1093/ehjopen/oeae028. Full text in Research Archive Show summary

  Aims To evaluate the effects of a multi-component intervention for smokers hospitalized for atherosclerotic cardiovascular disease (ASCVD) on the participation rate in community-based cessation programmes and the use of cessation drugs. Additionally, to explore the impact on the cessation rates at 6 months. Methods and results A randomized parallel-group study was conducted at a Norwegian secondary care hospital in 2021. The intervention group was: (i) counselled using motivational interviewing techniques during hospitalization; (ii) given an information leaflet, detailing the cessation programme; and (iii) referred to the community-based smoking cessation treatment including a post-discharge pro-active telephone invitation. The control group received usual care and the same information leaflet containing clear contact details for initiating participation. Data were collected at baseline, 1, 3, and 6 months. Among 99 smokers hospitalized with ASCVD, 40 were excluded. Of 59 randomized patients, 4 were lost to follow-up and 55 completed the study. The mean age was 65.1 (standard deviation 9.3) years, 35% were female, and 88% had smoked >20 years. Co-morbidity was prevalent (mean Charlson score 4.8). The intervention group was more likely to participate in the smoking cessation treatment {48 vs. 7%, difference: 41% [95% confidence interval (CI): 14%, 63%]} and used cessation drugs more frequently [59 vs. 21%, difference: 38% (95% CI: 17%, 59%)]. At the 6 months point prevalence, we observed notable between-group differences in self-reported cessation rate (48 vs. 25%). Conclusion The intervention significantly increased the participation rate at community-based smoking cessation programmes and the use of cessation drugs among multi-morbid smokers hospitalized for ASCVD.

• 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.

• Thorshov, Thea Christine; Dammen, Toril; Moen, Anne; Einvik, Gunnar & Hrubos-Strøm, Harald (2024). Prevalence of insomnia and feasibility of a nurse-administered digital cognitive behavioural therapy two years after corona virus disease hospitalisation. Sleep Medicine. ISSN 1389-9457. 125, p. 108–113. doi: 10.1016/j.sleep.2024.11.028. Full text in Research Archive Show summary

  Background Disturbed sleep is prevalent after corona virus disease (COVID-19). However, little is known of post infectious prevalence, course, predictors and treatment of chronic insomnia. Aim To estimate the prevalence of chronic insomnia three and twelve months after hospitalisation for COVID-19, to identify predictors of chronic insomnia, and to evaluate the feasibility of a nurse-administered digital cognitive behavioural therapy for insomnia (dCBTi) protocol. Method Patients hospitalised at Akershus University Hospital (Norway) for COVID-19 between February–June 2020 were eligible. The 94 patients that consented to participate were contacted by phone and interviewed with a modified DUKE structured interview three- and twelve months after discharge. Participants with chronic insomnia after twelve months were offered a nurse-administered dCBTi treatment protocol. Outcome measurements were sleep efficiency (SE) calculated by standard formulas (0-100 %) and the Bergen Insomnia Scale (BIS) (0-42). Results At three-month follow-up, 22 persons (23 %) fulfilled the diagnostic criteria for chronic insomnia. At twelve-month follow-up, 23 fulfilled the diagnostic criteria. The odds ratios for chronic insomnia after twelve months were 0.857 (0.742–0.989) for body mass index (BMI), and 0.239 (0.069–0.821) for male sex. Ten participated in the dCBTi feasibility study. Five completed the treatment protocol. SE improved, but not significantly. The BIS score improved significantly from 24 to 12 (p-value = 0.036). Conclusion Chronic insomnia remained stable three- and twelve months post COVID-19 hospitalisation. Female sex and low BMI were independent predictors of chronic insomnia twelve months post infection, but only 50 % of participants completed the protocol. Completers significantly reduced insomnia symptoms.

• Getz, Vilde; Munkhaugen, John; Lie, Hanne Cathrine & Dammen, Toril (2023). Barriers and facilitators for smoking cessation in chronic smokers with atherosclerotic cardiovascular disease enrolled in a randomized intervention trial: A qualitative study. Frontiers in Psychology. 14. doi: 10.3389/fpsyg.2023.1060701. Full text in Research Archive Show summary

  Objectives: Smoking is common in patients with cardiovascular disease. Despite strong recommendations for cessation and the existence of efficacious pharmacological and behavioral interventions, cessation rates remain low. Therefore, in this study, we explore perceived facilitators and barriers to smoking cessation in patients with atherosclerotic cardiovascular disease who have participated in a cessation intervention study. Methods: Participants (N = 10) from the intervention arm of a randomized controlled study with access to free cessation support and pharmacological aids completed a semi-structured, in-depth telephone interview after a 6-monthfollow-up between October 2021 and July 2022. The interviews were audio recorded, transcribed, and analyzed according to principles of thematic analysis. Results: The mean age was 65.7 (range: 55–79) years, and three of the 10 participants were women. Among the participants, five had quit smoking, three had relapsed, and two were persistent smokers. The themes identified encompassed barriers and facilitators to cessation, both including individual and contextual factors. Barriers included the upsides of smoking, difficult life situations, addiction to smoking, smoking in social circles, perceived lack of support and understanding from health professionals. Facilitators included intrinsic motivation, concerns about the health condition, financial implications, specific behavioral strategies, positive influence from the social environment, and helpful components of the cessation intervention. Conclusion: Smokers with cardiovascular disease who have attended a cessation intervention study report several facilitators weighted against barriers, interacting with the intention to cease smoking. The most important potentially modifiable factors of significance for cessation identified may be addressed through motivational interviews and focus groups with other smokers.

• Torgersen, Kristin Stensland; Sverre, Elise Christine Bjørkholen; Weedon-Fekjær, Harald; Andreassen, Ole; Munkhaugen, John & Dammen, Toril (2023). Risk of recurrent cardiovascular events in coronary artery disease patients with Type D personality. Frontiers in Psychology. 14. doi: 10.3389/fpsyg.2023.1119146. Full text in Research Archive Show summary

  Introduction Data on the association between Type D personality, its traits negative affectivity (NA) and social inhibition (SI), and risk of major adverse cardiac events (MACE) in coronary outpatients is sparse. Furthermore, the associations between Type D subgroups and cardiovascular risk factors are largely unknown. Methods We investigated i) Type D personality, NA and SI and risk of recurrent MACE, and ii) the relationship between Type D subgroups and risk factors in a coronary population. This prospective cohort study included 1083 patients` median 16 months after a myocardial infarction and/or a revascularization procedure who were followed-up for 4.2 (SD 0.4) years. Type D personality was assessed by DS14. Anxiety and depression, statin adherence, and risk factors were assessed by patients’ self-report and a clinical examination with blood samples. MACE, defined as cardiovascular death, myocardial infarction, revascularization, stroke or heart failure, were obtained from hospital records from index event to end of study lasting 5.7 years. Data were analyzed by Cox proportional hazard regression. Results In all, 352 MACE occurred in 230 patients after average 4.2 years follow-up. Higher NA score was associated with MACE after adjustment for age, risk factors and comorbidity (HR 1.02 per unit increase, 95% CI 1.00-1.05), whereas we found a weaker, not statistically significant estimated effect of higher SI score. After additional adjustment for symptoms of anxiety and depression, we found a weaker, not statistically significant association between NA and MACE (HR 1.01 per unit increase, 95% CI 0.98-1.05). Low statin adherence and smoking were more prevalent in the Type D and high NA group. Discussion Our results indicate that the NA trait is related to worse prognosis in outpatients with coronary artery disease.

• Dammen, Toril; Munkhaugen, John; Sverre, Elise Christine Bjørkholen; Moum, Torbjørn & Papageorgiou, Constantinos (2023). Psychiatric disorders, rumination, and metacognitions in patients with type D personality and coronary heart disease. Nordic Journal of Psychiatry. ISSN 0803-9488. 77(6), p. 540–546. doi: 10.1080/08039488.2023.2182358. Full text in Research Archive Show summary

  Background: Little is known regarding the prevalence of psychiatric disorders in patients with both coronary heart disease (CHD) and type D personality, and whether these patients may benefit from psychotherapy that modifies metacognitive beliefs implicated in disorder maintenance. This study explored prevalence rates among these patients and associations between type D characteristics, rumination and metacognitions. Methods: Forty-seven consecutive patients with CHD who scored positive for type D personality were included in this pre-planned study. Participants underwent structured clinical interviews for mental and personality disorders and completed questionnaires assessing rumination and metacognitions. Results: Mean age was 53.8 (SD 8.1) years and 21.3% were female. At least one mood disorder or anxiety disorder was found in 70.2% and 61.7% of the patients. The most common disorders were major depressive disorder (59.6%), social phobia (40.4%), and generalized anxiety disorder (29.8%). At least one personality disorder was detected in 42.6%. Only 21% reported ongoing treatment with psychotropic medication whereas none had psychotherapy. Metacognitions and rumination were significantly associated with negative affectivity but not social inhibition. Conclusion: Mood and anxiety disorders were highly prevalent and relatively untreated among these patients. Future studies should test the metacognitive model for type D personality.

• Dammen, Toril; Papageorgiou, Constantinos; Lindstrøm, Jonas Christoffer & Einvik, Gunnar (2023). Metacognitions in patients with chronic obstructive pulmonary disease: a psychometric study of the metacognitions questionnaire-30. Frontiers in Psychology. 14. doi: 10.3389/fpsyg.2023.1265102. Full text in Research Archive Show summary

  The metacognitions questionnaire-30 (MCQ-30) was developed for the assessment of metacognitive beliefs and processes that are central components of the metacognitive model of emotional disorders. Anxiety and depression commonly occur in patients with chronic obstructive pulmonary disease (COPD). Testing such a model for anxiety and depression in patients with COPD is warranted. However, the psychometric properties of the MCQ-30 in COPD patients are unknown. Therefore, in this study we aimed to examine these properties in COPD patients. The MCQ-30 was administered to 203 COPD patients referred to a rehabilitation unit in respiratory medicine. Confirmatory factor analysis (CFA) was used to test the five-factor as well as the bi-factor models of MCQ-30. Exploratory factor analyses were also performed. Both models did not meet the criteria for an acceptable fit on Comparative Fit Index (CFI) of 0.810 and 0.858 vs. criterion of ≥0.9, but the Root Mean Square Error of Approximation (RMSEA) criterion ≤0.08 was acceptable for both models with RMSEA = 0.074 and 0.066, respectively. The factors were mostly moderately correlated (0.41–0.58) with acceptable reliability coefficients (0.73–0.87). The exploratory factor analysis identified three of the five factors originally described in the five-factor model of the MCQ-30. These data show that the factor structure of the MCQ-30 appears to differ from that of the original instrument in COPD patients and further studies are needed to confirm its validity and reliability in this patient group.

• Aastebøl, Lars Frøjd; Munkhaugen, John; Papageorgiou, Constantinos; Sverre, Elise Christine Bjørkholen; Moum, Torbjørn & Dammen, Toril (2023). Predictors of health-related quality of life in outpatients with coronary heart disease. Frontiers in Psychology. 14. doi: 10.3389/fpsyg.2023.1119093. Full text in Research Archive Show summary

  Health-related quality of life (HRQoL) is an important treatment target in patients with coronary heart disease (CHD) and is associated with poor outcomes. Therefore, it is of clinical importance to identify the key determinants of HRQoL among these patients. There is, however, limited knowledge of how a comprehensive set of psychosocial factors influence HRQoL. We aimed to determine the relative associations of clinical and psychosocial factors with mental and physical components of HRQoL in a sample of CHD outpatients. This cross-sectional study included 1042 patients 2-36 (mean 16) months after a CHD event recruited from two general Norwegian hospitals with a combined catchment area making up 7% of the Norwegian population, representative with regards to demographic and clinical factors. We collected data on HRQoL, demographics, comorbidities, coronary risk factors, and psychosocial factors. HRQoL was assessed using the Short Form 12 (SF12), which comprises a Mental Component Scale (MCS) and the Physical Component Scale (PCS). Crude and multi-adjusted linear regression analyses were used to investigate the association between covariates and MCS and PCS. Mean age was 61 (standard deviation [SD] 10) years, 20 % were females, 18% had type D personality, 20% significant depression symptoms, 14% significant symptoms of anxiety whereas 45% reported insomnia. The presence of type D personality (β:-.19), significant symptoms of depression (β:-.15), and the presence of insomnia (β:-.13) were negatively associated with MCS, but not PCS in multi-adjusted analyses. The presence of chronic kidney disease (β:-.11) was associated with reduced MCS, whereas the presence of chronic obstructive pulmonary disease (β:-.08) and low physical activity (β:-.14) were negatively associated with PCS. Younger age was associated with lower MCS, whereas older age was associated with lower PCS. We conclude that Type D personality, depressive symptoms, insomnia, and chronic kidney disease were the strongest determinants of the mental component of HRQoL. Assessing and managing these psychological factors among CHD outpatients may improve their mental HRQoL

• Thorshov, Thea Christine; Øverby, Caroline Tonje; Hansen, Diana Dobran; Bong, Way Kiat; Skifjeld, Knut & Hurlen, Petter [Show all 9 contributors for this article] (2023). Experience with the use of a digital sleep diary in symptom management by individuals with insomnia -a pilot mixed method study. Sleep Medicine: X. 6. doi: 10.1016/j.sleepx.2023.100093. Full text in Research Archive Show summary

  Background: Insomnia is the most common sleep disorder. The recommended treatment is cognitive behavioural therapy for insomnia (CBTi). A sleep diary is a core tool in CBTi. We have developed a digital sleep diary with a standardised feedback function. Aim: To study feasibility of the digital sleep diary in participants of the Akershus Sleep Apnea (ASAP) cohorts with difficulties falling asleep or maintaining sleep. To describe sleep diary engagement and explore experiences with the digital sleep diary with potential influences in insomnia symptom management. Material and methods: Twenty participants were recruited from the ASAP. All filled out a digital sleep diary up to 12 weeks. Treatment options provided were a self-help book (N = 11) or electroencephalography neurofeedback (N = 9) in addition to the sleep diary standardised feedback function. We collected quantitative data from the sleep diary reports and we sub-divided insomnia by sleep onset insomnia and non-sleep onset insomnia. Finally, we performed qualitative interviews. Results: The median number of entries to the sleep diary was 81 (25th quartile: 26, 75th quartile 84). In the qualitative analysis, we identified two main themes; “structure and overview” and “usability and digital features”. Conclusion: The sleep diary was found to be feasible when distributed in combination with a self-help book or electroencephalography neurofeedback. The qualitative results emphasised the importance of a timely graphical overview and visualisations of self-recorded sleep.

• Frøjd, Lars Aastebøl; Munkhaugen, John; Papageorgiou, Constantinos; Sverre, Elise Christine Bjørkholen; Moum, Torbjørn & Dammen, Toril (2023). Health-related quality of life in outpatients with coronary heart disease: impact of type D personality, depression, anxiety and insomnia. European Journal of Preventive Cardiology (EJPC). ISSN 2047-4873. 30. doi: 10.1093/eurjpc/zwad125.285. Full text in Research Archive
• Munkhaugen, John; Sverre, Elise Christine Bjørkholen; Dammen, Toril; Husebye, Einar; Gjertsen, Erik & Kristiansen, Oscar [Show all 7 contributors for this article] (2023). Skrøpelighet, helsekompetanse og egenomsorg hos pasienter som innlegges med akutt hjertesvikt. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 143(17). doi: 10.4045/tidsskr.23.0297. Full text in Research Archive Show summary

  BAKGRUNN Det er lite kunnskap fra Norge om kliniske karakteristika, egenomsorg og helsekompetanse hos sykehusinnlagte pasienter med akutt hjertesvikt. Formålet var å kartlegge disse faktorene i denne gruppen. MATERIALE OG METODE Vi inkluderte fortløpende innlagte pasienter med akutt hjertesvikt over seks måneder (2022/2023) ved Drammen sykehus og Sykehuset i Vestfold. Kardiologiske sykepleiere innhentet opplysninger fra pasientene, inkludert egenvurdert kunnskap på en ordinal skala fra 0 (lite) til 10 (mye). Klinisk skrøpelighetsskala ble beregnet, og data ble registrert fra sykehusjournalen. RESULTATER Av 136 pasienter med akutt hjertesvikt ble 81 inkludert. Median alder var 79 (spredning 35–95) år, 35 (43 %) var kvinner. 35 (43 %) hadde vært innlagt med hjertesviktforverring det siste året. Pasientene hadde median 5 (1–10) diagnoser, og median skår på klinisk skrøpelighetsskala var 4 (1–7), som tilsvarer «sårbar». 63 (78 %) var diagnostisert med hjertesvikt før den aktuelle innleggelsen. Blant disse var 13 (21 %) ikke klar over diagnosen, og egenvurdert kunnskap var median 3 (25- og 75-prosentiler, 0–5) for håndtering av hjertesvikt, 2 (25- og 75-prosentiler, 0–5) for livsstilstiltak og 0 (25- og 75-prosentiler, 0–2) for hjertemedisiner. 42 av 63 (67 %) veide seg ≥ 1 gang/uke, 13 (21 %) målte blodtrykk, mens 3 (5 %) hadde egenbehandlingsplan. Av 50 pasienter med venstre ventrikkel- ejeksjonsfraksjon ≤ 40 % ble 32 (64 %) utskrevet med betablokker og angiotensin II-hemmer eller kombinasjonspreparat med neprilysinhemmer, mens 11 (22 %) også fikk SGLT2-hemmer og mineralreseptorantagonist. FORTOLKNING De inkluderte pasientene var multimorbide og hadde lav grad av egenomsorg og helsekompetanse. Det foreligger et potensial for å optimalisere veldokumentert medikamentell behandling.

• Dammen, Toril; Tunheim, Kristoffer; Munkhaugen, John; Klungsøyr, Ole & Papageorgiou, Constantinos (2023). Attention training technique delivered in groups as treatment for anxiety and depression in patients with coronary heart disease: study protocol for a waiting-list randomized controlled trial. Frontiers in Psychology. 14. doi: 10.3389/fpsyg.2023.1226539. Full text in Research Archive
• 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.

• Sagen, Ulrike; Finset, Arnstein; Moum, Torbjørn Åge; Vik, Tom Gunnar & Dammen, Toril (2022). The longitudinal course of anxiety, depression and apathy through two years after stroke. Journal of Psychosomatic Research. ISSN 0022-3999. 162. doi: 10.1016/j.jpsychores.2022.111016. Full text in Research Archive Show summary

  Objective: Estimate the prevalence of anxiety disorders, depressive disorders and apathy two years after stroke, examine their longitudinal course, describe the course of psychological distress through two years after stroke, and evaluate Hospital Anxiety and Depression Scale HADS-A and HADS-D cut-off scores of ≥4 and ≥ 8 for detection of anxiety and depressive disorders two years after stroke. Methods: In a longitudinal cohort study of 150 consecutive stroke patients in a stroke unit, 103 were assessed four months and 75 two years after stroke. Anxiety and depression disorders and symptoms were assessed by the Structured Clinical Interview for DSM-IV and HADS, apathy by the Apathy Evaluation Scale. Results: Prevalence of at least one anxiety disorder or one depressive disorder decreased from four months to two years (23% vs 9%, P = 0.026, 19% vs 10%, P = 0.17). Apathy remained stable at 48% vs 50%. After two years, 80%, 79% and 19% of those with anxiety, depression or apathy at four months had recovered. Recovery-rates among patients with anxiety were 83% for panic disorder, 60% for generalized anxiety disorder (GAD), and 50% for social phobia. Conclusions: In contrast to apathy, recovery from anxiety and depression was high. About half of the patients with GAD, social phobia or agoraphobia did not recover. Co-morbid depression and apathy at four months implied a high risk for not recovering at two years. HADS-A and HADS-D cut-off scores of ≥8 were feasible for detection of anxiety and depression disorders two years after stroke.

• Dammen, Toril; Tunheim, Kristoffer Joe; Munkhaugen, John & Papageorgiou, Constantinos (2022). The Attention Training Technique Reduces Anxiety and Depression in Patients With Coronary Heart Disease: A Pilot Feasibility Study. Frontiers in Psychology. 13. doi: 10.3389/fpsyg.2022.948081. Full text in Research Archive Show summary

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

• Frøyd, Lars; Dammen, Toril; Munkhaugen, John; Weedon-Fekjær, Harald; Nordhus, Inger Hilde & Papageorgiou, Constantinos [Show all 7 contributors for this article] (2022). Insomnia as a predictor of recurrent cardiovascular events in patients with coronary heart disease. SLEEP Advances. 3(1). doi: 10.1093/sleepadvances/zpac007. Full text in Research Archive Show summary

  Abstract Study Objectives Insomnia is highly prevalent in patients with coronary heart disease (CHD). However, the potential effect of insomnia on the risk of recurrent major adverse cardiovascular events (MACE) remains uncertain. Methods This prospective cohort study included 1082 consecutive patients 2–36 (mean 16) months after myocardial infarction and/or coronary revascularization. Data on clinical insomnia, coronary risk factors, and comorbidity were collected at baseline. Clinical insomnia was assessed using the Bergen Insomnia Scale (BIS). The primary composite endpoint of MACE (cardiovascular death, hospitalization due to myocardial infarction, revascularization, stroke, or heart failure) was assessed with an average follow-up of 4.2 (SD 0.3) years after baseline. Data were analyzed using Cox proportional hazard regression models stratified by prior coronary events before the index event. Results At baseline, mean age was 62 years, 21% were females, and 45% reported clinical insomnia. A total of 346 MACE occurred in 225 patients during the follow-up period. For clinical insomnia, the relative risk of recurrent MACE was 1.62 (95% confidence interval [CI]: 1.24–2.11, p

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

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

• Øverby, Caroline Tonje; Sutharshan, Prasanthy; Gulbrandsen, Pål; Dammen, Toril & Hrubos-Strøm, Harald (2022). Shared decision making: A novel approach to personalized treatment in obstructive sleep apnea. Sleep Medicine: X. 4. doi: 10.1016/j.sleepx.2022.100052. Full text in Research Archive Show summary

  Study objectives i) To describe a novel approach of phenotyping by shared decision making (SDM) in obstructive sleep apnea (OSA) discharge consultations ii) to describe correlation between patient and observer based evaluations of SDM and iii) to describe treatment adherence. Methods Consecutive patients referred to the otorhinolaryngology department at Akershus University Hospital with suspected OSA between 2015 and 2016 participated. Patients with body mass index >30 were oversampled. Four male communication-trained doctors aged from 30 to 60 years participated. SDM was evaluated by modified content analysis and by the CollaboRATE self-report questionnaire and the “Observer OPTION (Young et al., 2008) [5]” rating scale. Positive airway pressure (PAP) treatment adherence and weight reduction was assessed by interview at six year follow-up. Results Eighteen consultations were video filmed. The content analysis revealed that the patient perspectives only briefly were explored. PAP was chosen by 17 of 18 patients. Median CollaboRATE questionnaire score was 29 (26, 30). Mean OPTION (Young et al., 2008) [5] score was 65.6 (SD 6.6, range 55–80). The correlation between SDM assessed by CollaboRATE self-report and by the “Observer OPTION (Young et al., 2008) [5]” rating scale was low (Pearson's r = 0.09). At follow up, 11 patients (64.7%) were PAP adherent and no one achieved 10% weight loss. Conclusions Despite a high degree of SDM compared to studies of non-OSA populations, the sub-optimal exploration of the patient perspective by communication-trained doctors precluded identification of patients willing to cope actively. SDM assessed by self-report and by a rating scale may represent two different constructs. PAP adherence was good.

• Pleym, Karin; Sverre, Elise Christine Bjørkholen; Weedon-Fekjær, Harald; kahlon, Mohpal Singh; Husebye, Einar & Tonstad, Serena [Show all 8 contributors for this article] (2022). Effect of in-hospital nurse-led smoking cessation intervention for patients with atherosclerotic cardiovascular disease: a randomised pilot study. European Heart Journal. ISSN 0195-668X. 43. doi: 10.1093/eurheartj/ehac544.2329. Full text in Research Archive
• Sverre, Elise Christine Bjørkholen; Peersen, Kari; Kristiansen, Oscar; Fagerland, Morten; Perk, Joep & Husebye, Einar [Show all 9 contributors for this article] (2022). Tailored clinical management after blinded statin challenge improved the lipid control in coronary patients with self-perceived muscle side effects. Journal of Internal Medicine. ISSN 0954-6820. 291(6), p. 891–893. doi: 10.1111/joim.13454. Full text in Research Archive
• Sigurdardóttir, Fjóla Dögg; Øverby, Tonje Caroline; Nikkonen, Sami; Karhu, Tuomas; Dammen, Toril & Nordhus, Inger Hilde [Show all 14 contributors for this article] (2022). Novel oxygen desaturation parameters are associated with cardiac troponin I: Data from the Akershus Sleep Apnea Project. Journal of Sleep Research. ISSN 0962-1105. 31(5). doi: 10.1111/jsr.13581. Full text in Research Archive Show summary

  Novel diagnostic markers for obstructive sleep apnea beyond the apnea–hypopnea index (AHI) have been introduced. There are no studies on their association with markers of subclinical myocardial injury. We assessed the association between novel desaturation parameters and elevated cardiac troponin I and T. Participants with polysomnography (498) from the Akershus Sleep Apnea study were divided into normal and elevated biomarker groups based on sex-specific concentration thresholds (cardiac troponin I: ≥4 ng/L for women, ≥6 ng/L for men; and cardiac troponin T: ≥7 ng/L for women, ≥8 ng/L for men). Severity of obstructive sleep apnea was evaluated with the AHI, oxygen desaturation index, total sleep time with oxygen saturation below 90% (T90), lowest oxygen saturation (Min SpO2%), and novel oxygen desaturation parameters: desaturation duration and desaturation severity. How the AHI and novel desaturation parameters predicted elevated cardiac troponin I and cardiac troponin T levels was assessed by the area under the curve (AUC). Based on multivariable-adjusted linear regression, the AHI (β = 0.004, p = 0.012), desaturation duration (β = 0.007, p = 0.004), and desaturation severity (β = 0.147, p = 0.002) were associated with cardiac troponin I levels but not cardiac troponin T. T90 was associated with cardiac troponin I (β = 0.006, p = 0.009) and cardiac troponin T (β = 0.005, p = 0.007). The AUC for the AHI 0.592 (standard error 0.043) was not significantly different from the AUC of T90 (SD 0.640, p = 0.08), desaturation duration 0.609 (SD 0.044, p = 0.42) or desaturation severity 0.616 (SD 0.043, p = 0.26) in predicting myocardial injury as assessed by cardiac troponin I. Oxygen desaturation parameters and the AHI were associated with cardiac troponin I levels but not cardiac troponin T levels. Novel oxygen desaturation parameters did not improve the prediction of subclinical myocardial injury compared to the AHI.

• Torgersen, Kristin Stensland; Rahman, Zillur; Bahrami, Shahram; Hindley, Guy Frederick Lanyon; Parker, Nadine & Frei, Oleksandr [Show all 14 contributors for this article] (2022). Shared genetic loci between depression and cardiometabolic traits. PLoS Genetics. ISSN 1553-7390. 18(5). doi: 10.1371/journal.pgen.1010161. Full text in Research Archive Show summary

  Epidemiological and clinical studies have found associations between depression and cardiovascular disease risk factors, and coronary artery disease patients with depression have worse prognosis. The genetic relationship between depression and these cardiovascular phenotypes is not known. We here investigated overlap at the genome-wide level and in individual loci between depression, coronary artery disease and cardiovascular risk factors. We used the bivariate causal mixture model (MiXeR) to quantify genome-wide polygenic overlap and the conditional/conjunctional false discovery rate (pleioFDR) method to identify shared loci, based on genome-wide association study summary statistics on depression (n = 450,619), coronary artery disease (n = 502,713) and nine cardiovascular risk factors (n = 204,402–776,078). Genetic loci were functionally annotated using FUnctional Mapping and Annotation (FUMA). Of 13.9K variants influencing depression, 9.5K (SD 1.0K) were shared with body-mass index. Of 4.4K variants influencing systolic blood pressure, 2K were shared with depression. ConjFDR identified 79 unique loci associated with depression and coronary artery disease or cardiovascular risk factors. Six genomic loci were associated jointly with depression and coronary artery disease, 69 with blood pressure, 49 with lipids, 9 with type 2 diabetes and 8 with c-reactive protein at conjFDR < 0.05. Loci associated with increased risk for depression were also associated with increased risk of coronary artery disease and higher total cholesterol, low-density lipoprotein and c-reactive protein levels, while there was a mixed pattern of effect direction for the other risk factors. Functional analyses of the shared loci implicated metabolism of alpha-linolenic acid pathway for type 2 diabetes. Our results showed polygenic overlap between depression, coronary artery disease and several cardiovascular risk factors and suggest molecular mechanisms underlying the association between depression and increased cardiovascular disease risk.

• Stavem, Knut; Heir, Trond; Dammen, Toril; Brønstad, Eivind; Lerum, Tøri Vigeland & Durheim, Michael Thomas [Show all 9 contributors for this article] (2022). The course and determinants of post-traumatic stress over 12 months after hospitalization for COVID-19. Frontiers in Psychiatry. 13. doi: 10.3389/fpsyt.2022.931349. Full text in Research Archive Show summary

  Objective: To assess the trajectory of symptoms and symptom-defined post-traumatic stress disorder (PTSD) from 1.5 to 12 months after hospitalization for COVID-19 and determine risk factors for persistent symptoms and PTSD. Methods: This was a prospective cohort study of consecutive patients discharged after hospitalization for COVID-19 before 1 June 2020 in six hospitals in Southern Norway. Symptom-defined PTSD was assessed by the post-traumatic stress disorder (PTSD) checklist for DSM-5 (PCL-5) at 1.5, 3 and/or 12 months after hospitalization, using DSM-5 criteria. Changes in PCL-5 symptom score and the prevalence of PTSD were analyzed with multivariable mixed models. Results: In total, 388 patients were discharged alive, and 251 (65%) participated. Respondents had a mean (SD) age of 58.4 (14.2) years, and 142 (57%) were males. The prevalence of symptom-defined PTSD was 14, 8, and 9% at 1.5, 3, and 12 months, respectively. WHO disease severity for COVID-19 was not associated with PCL-5 scores. Female sex, lower age and non-Norwegian origin were associated with higher PCL-5 scores. The odds ratio (OR) (95%CI) for PTSD was 0.32 (0.12 to 0.83, p = 0.019) at 3 months and 0.38 (0.15 to 0.95, p = 0.039) at 12 months compared to 1.5 months. There was no association between PTSD and WHO severity rating. Conclusions: The level of PTSD symptoms decreased from 1.5 to 3 months after hospitalization, but did not decrease further to 12 months, and there was no association between PTSD symptoms and COVID-19 disease severity.

• 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.

• Torgersen, Kristin Stensland; Bahrami, Shahram; Frei, Oleksandr; Shadrin, Alexey; O'Connell, Kevin Sean & Smeland, Olav Bjerkehagen [Show all 10 contributors for this article] (2021). Shared genetic architecture between neuroticism, coronary artery disease and cardiovascular risk factors. Translational Psychiatry. 11(1), p. 1–13. doi: 10.1038/s41398-021-01466-9. Full text in Research Archive Show summary

  Neuroticism is associated with poor health, cardiovascular disease (CVD) risk factors and coronary artery disease (CAD). The conditional/conjunctional false discovery rate method (cond/conjFDR) was applied to genome wide association study (GWAS) summary statistics on neuroticism (n = 432,109), CAD (n = 184,305) and 12 CVD risk factors (n = 188,577–339,224) to investigate genetic overlap between neuroticism and CAD and CVD risk factors. CondFDR analyses identified 729 genomic loci associated with neuroticism after conditioning on CAD and CVD risk factors. The conjFDR analyses revealed 345 loci jointly associated with neuroticism and CAD (n = 30), body mass index (BMI) (n = 96) or another CVD risk factor (n = 1–60). Several loci were jointly associated with neuroticism and multiple CVD risk factors. Seventeen of the shared loci with CAD and 61 of the shared loci with BMI are novel for neuroticism. 21 of 30 (70%) neuroticism risk alleles were associated with higher CAD risk. Functional analyses of the genes mapped to the shared loci implicated cell division, nuclear receptor, elastic fiber formation as well as starch and sucrose metabolism pathways. Our results indicate polygenic overlap between neuroticism and CAD and CVD risk factors, suggesting that genetic factors may partly cause the comorbidity. This gives new insight into the shared molecular genetic basis of these conditions.

• Peersen, Kari; Munkhaugen, John; Sverre, Elise Christine Bjørkholen; Kristiansen, Oskar; Fagerland, Morten & Vethe, Nils Tore [Show all 9 contributors for this article] (2021). Clinical and psychological factors in coronary heart disease patients with statin associated muscle side-effects. BMC Cardiovascular Disorders. 21, p. 1–9. doi: 10.1186/s12872-021-02422-7. Full text in Research Archive Show summary

  Background: To compare clinical and psychological factors among patients with self-perceived statin-associated muscle symptoms (SAMS), confirmed SAMS, and refuted SAMS in coronary heart disease patients (CHD). Methods: Data were obtained from a cross-sectional study of 1100 CHD outpatients and a study of 71 CHD outpatients attending a randomized, double-blinded, placebo-controlled, crossover study to test effects of atorvastatin 40 mg/day on muscle symptom intensity. Clinical and psychosocial factors were compared between patients with and without SAMS in the cross-sectional study, and between patients with confirmed SAMS and refuted SAMS in the randomized study. Results: Bilateral, symmetric muscle symptoms in the lower extremities during statin treatment were more prevalent in patients with confirmed SAMS compared to patients with refuted SAMS (75% vs. 41%, p = 0.01) in the randomized study. No significant differences in psychological factors (anxiety, depression, worry, insomnia, type D personality characteristics) were detected between patients with and without self-perceived SAMS in the cross-sectional study, or between patients with confirmed SAMS and refuted SAMS, in the randomized study. Conclusions: Patients with confirmed SAMS more often present with bilateral lower muscle symptoms compared to those with refuted SAMS. Psychological factors were not associated with self-perceived SAMS or confirmed SAMS. A careful pain history and a search for alternative causes of muscle symptoms are likely to promote communication in patients with SAMS, and may reduce the risk for statin discontinuation.

• Einvik, Gunnar; Dammen, Toril; Ghanima, Waleed Khalid; Heir, Trond & Stavem, Knut (2021). Prevalence and risk factors for post-traumatic stress in hospitalized and non-hospitalized COVID-19 patients. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 18(4), p. 1–12. doi: 10.3390/ijerph18042079. Full text in Research Archive Show summary

  This population-based study assessed the prevalence and determinants of symptom-defined post-traumatic stress disorder (PTSD) in a cohort of hospitalized and non-hospitalized patients about 1.5–6 months after their COVID-19 onset. The data were acquired from two mixed postal/web surveys in June–September 2020 from patients all aged ≥18 years with a positive polymerase chain reaction for severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2) until 1 June 2020, comprising both hospitalized and non-hospitalized subjects. The catchment areas of the two included hospitals covers about 17% of the population of Norway. In total, 211 hospitalized and 938 non-hospitalized subjects received invitation. The prevalence of symptom-defined PTSD was assessed using the PTSD checklist for DSM-5 (PCL-5). Determinants of symptom-defined PTSD and PTSD symptoms were analyzed using multivariable logistic and linear regression analysis. In total, 583 (51%) subjects responded at median 116 (range 41–200) days after COVID-19 onset. The prevalence of symptom-defined PTSD was 9.5% in hospitalized and 7.0% in non-hospitalized subjects (p = 0.80). Female sex, born outside of Norway, and dyspnea during COVID-19 were risk factors for persistent PTSD symptoms. In non-hospitalized subjects, previous depression and COVID-19 symptom load were also associated with persistent PTSD symptoms. In conclusion, COVID-19 symptom load, but not hospitalization, was associated with symptom-defined PTSD and PTSD symptom severity.

• Baklund, Ingrid H.; Dammen, Toril; Moum, Torbjørn Åge; Kristiansen, Wenche; Duarte, Sosa Daysi & Marrero, Jesus Castro [Show all 8 contributors for this article] (2021). Evaluating routine blood tests according to clinical symptoms and diagnostic criteria in individuals with myalgic encephalomyelitis/chronic fatigue syndrome. Journal of Clinical Medicine. 10(14), p. 1–14. doi: 10.3390/jcm10143105. Full text in Research Archive Show summary

  There is a lack of research regarding blood tests within individuals with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and between patients and healthy controls. We aimed to compare results of routine blood tests between patients and healthy controls. Data from 149 patients diagnosed with ME/CFS based on clinical and psychiatric evaluation as well as on the DePaul Symptom Questionnaire, and data from 264 healthy controls recruited from blood donors were compared. One-way ANCOVA was conducted to examine differences between ME/CFS patients and healthy controls, adjusting for age and gender. Patients had higher sedimentation rate (mean difference: 1.38, 95% CI: 0.045 to 2.714), leukocytes (mean difference: 0.59, 95% CI: 0.248 to 0.932), lymphocytes (mean difference: 0.27, 95% CI: 0.145 to 0.395), neutrophils (mean difference: 0.34, 95% CI: 0.0 89 to 0.591), monocytes (mean difference: 0.34, 95% CI: 0.309 to 0.371), ferritin (mean difference: 28.13, 95% CI: −1.41 to 57.672), vitamin B12 (mean difference: 83.43, 95% CI: 62.89 to 124.211), calcium (mean difference: 0.02, 95% CI: −0.02 to 0.06), alanine transaminase (mean difference: 3.30, 95% CI: −1.37 to -7.971), low-density lipoproteins (mean difference: 0.45, 95% CI: 0.104 to 0.796), and total proteins (mean difference: 1.53, 95% CI: −0.945 to 4.005) than control subjects. The patients had lower potassium levels (mean difference: 0.11, 95% CI: 0.056 to 0.164), creatinine (mean difference: 2.60, 95% CI: 0.126 to 5.074) and creatine kinase (CK) (mean difference: 37.57, 95% CI: −0.282 to 75.422) compared to the healthy controls. Lower CK and creatinine levels may suggest muscle damage and metabolic abnormalities in ME/CFS patients.

• Frøjd, Lars Aastebø; Papageorgiou, Constantinos; Munkhaugen, John; Moum, Torbjørn Åge; Sverre, Elise Christine Bjørkholen & Nordhus, Inger Hilde [Show all 7 contributors for this article] (2021). Worry and rumination predict insomnia in patients with coronary heart disease: a cross-sectional study with long-term follow-up. Journal of Clinical Sleep Medicine (JCSM). ISSN 1550-9389. doi: 10.5664/jcsm.9712. Full text in Research Archive
• Frøyd, Lars; Munkhaugen, John; Moum, Torbjørn Åge; Sverre, Elise Christine Bjørkholen; Nordhus, Inger Hilde & Papageorgiou, Constantinos [Show all 7 contributors for this article] (2021). Insomnia in patients with coronary heart disease: Prevalence and correlates. Journal of Clinical Sleep Medicine (JCSM). ISSN 1550-9389. 17(5). doi: 10.5664/jcsm.9082. Full text in Research Archive Show summary

  Study Objectives: The aim of this study was to determine the prevalence of insomnia and its association with clinical and psychosocial factors in a large sample of outpatients with coronary heart disease. Methods: The sample comprised 1,082 patients, mean age 62 years (21% female), who participated in the cross-sectional NORwegian CORonary Prevention Study. Patients who were hospitalized with myocardial infarction and/or a coronary revascularization procedure in 2011–2014 responded to a self-report questionnaire and participated in a clinical examination with blood samples 2–36 (mean, 16) months later. Insomnia was assessed using the Bergen Insomnia Scale, a questionnaire based on the criteria for the clinical diagnosis of insomnia as described in the Diagnostic and Statistical Manual of Mental Disorders, fourth version. We performed bivariate logistic regressions for crude analysis and backward stepwise logistic regressions for multiadjusted odds ratios (OR). Results: In total, 488 patients (45%) reported insomnia, and 24% of these patients had used sleep medication in the previous week. Anxiety symptoms (OR: 5.61) were the strongest determinants of insomnia, followed by female sex (OR: 1.88), diabetes (OR: 1.83), eating fish fewer than three times a week (OR: 1.69), type D personality (OR: 1.69), and C-reactive protein ≥ 2 mg/L (OR:1.58), in multiadjusted analyses. Conclusions: Insomnia was highly prevalent in coronary heart disease outpatients. Psychological factors, lifestyle factors, and subclinical inflammation were associated with insomnia. Our results emphasize the need to identify patients with insomnia and provide appropriate management of insomnia in outpatients with coronary heart disease.

• Kristiansen, Oskar; Sverre, Elise Christine Bjørkholen; Peersen, Kari; Fagerland, Morten; Gjertsen, Erik & Gullestad, Lars [Show all 11 contributors for this article] (2021). The relationship between directly measured statin adherence, self-reported adherence measures and cholesterol levels in patients with coronary heart disease. Atherosclerosis. ISSN 0021-9150. 336, p. 23–29. doi: 10.1016/j.atherosclerosis.2021.09.020. Full text in Research Archive Show summary

  Background and aims: We aimed to determine the relationship between statin adherence measured directly, and by self-report measures and serum cholesterol levels. Methods: Patients prescribed atorvastatin (N = 373) participated in a cross-sectional study 2–36 months after a coronary event. Self-reported adherence included statin adherence the past week, the 8-item Morisky medication adherence scale (MMAS-8), and the Gehi et al. adherence question. Atorvastatin was measured directly in spot blood plasma by a novel liquid chromatography tandem mass-spectrometry method discriminating adherence (0–1 doses omitted) and reduced adherence (≥2 doses omitted). Participants were unaware of the atorvastatin analyses at study participation. Results: Mean age was 63 (SD 9) years and 8% had reduced atorvastatin adherence according to the direct method. In patients classified with reduced adherence by the direct method, 40% reported reduced statin adherence, 32% reported reduced adherence with the MMAS-8 and 22% with the Gehi question. In those adherent by the direct method, 96% also reported high statin adherence, 95% reported high adherence on the MMAS-8 whereas 94% reported high adherence on the Gehi question. Cohen’s kappa agreement score with the direct method was 0.4 for self-reported statin adherence, 0.3 for the Gehi question and 0.2 for the MMAS-8. Adherence determined by the direct method, self-reported statin adherence last week, and the Gehi question was inversely related to LDL-cholesterol levels with a p-value of <0.001, 0.001 and 0.004, respectively. Conclusions: Plasma-statin measurements reveal reduced adherence with higher sensitivity than self-report measures, relate to cholesterol levels, and may prove to be a useful tool to improve lipid management.

• 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.

• 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.

• Sverre, Elise; Peersen, Kari; Weedon-Fekjær, Harald; Perk, J.; Gjertsen, Erik & Husebye, Einar [Show all 10 contributors for this article] (2020). Preventable clinical and psychosocial factors predicted two out of three recurrent cardiovascular events in a coronary population. BMC Cardiovascular Disorders. 20. doi: 10.1186/s12872-020-01368-6. Full text in Research Archive Show summary

  Background The relative importance of lifestyle, medical and psychosocial factors on the risk of recurrent major cardiovascular (CV) events (MACE) in coronary patients’ needs to be identified. The main objective of this study is to estimate the association between potentially preventable factors on MACE in an outpatient coronary population from routine clinical practice. Methods This prospective follow-up study of recurrent MACE, determine the predictive impact of risk factors and a wide range of relevant co-factors recorded at baseline. The baseline study included 1127 consecutive patients 2–36 months after myocardial infarction (MI) and/or revascularization procedure. The primary composite endpoint of recurrent MACE defined as CV death, hospitalization due to MI, revascularization, stroke/transitory ischemic attacks or heart failure was obtained from hospital records. Data were analysed using cox proportional hazard regression, stratified by prior coronary events before the index event. Results During a mean follow-up of 4.2 years from study inclusion (mean time from index event to end of study 5.7 years), 364 MACE occurred in 240 patients (21, 95% confidence interval: 19 to 24%), of which 39 were CV deaths. In multi-adjusted analyses, the strongest predictor of MACE was not taking statins (Relative risk [RR] 2.13), succeeded by physical inactivity (RR 1.73), peripheral artery disease (RR 1.73), chronic kidney failure (RR 1.52), former smoking (RR 1.46) and higher Hospital Anxiety and Depression Scale-Depression subscale score (RR 1.04 per unit increase). Preventable and potentially modifiable factors addressed accounted for 66% (95% confidence interval: 49 to 77%) of the risk for recurrent events. The major contributions were smoking, low physical activity, not taking statins, not participating in cardiac rehabilitation and diabetes. Conclusions Coronary patients were at high risk of recurrent MACE. Potentially preventable clinical and psychosocial factors predicted two out of three MACE, which is why these factors should be targeted in coronary populations. Trial registration Registered at ClinicalTrials.gov: NCT02309255. Registered at December 5th, 2014, registered retrospectively.

• Kristiansen, Oskar; Vethe, Nils Tore; Peersen, Kari; Fagerland, Morten; Sverre, Elise Christine Bjørkholen & Jensen, Elena Prunès [Show all 15 contributors for this article] (2020). Effect of Atorvastatin on Muscle Symptoms in Coronary Heart Disease Patients With Self-Perceived Statin Muscle Side-Effects: A Randomized, Double Blinded Crossover Trial. European Heart Journal (EHJ) - Cardiovascular Pharmacotherapy. ISSN 2055-6837. 7(6), p. 507–516. doi: 10.1093/ehjcvp/pvaa076. Full text in Research Archive Show summary

  Aims: To estimate the effect of atorvastatin on muscle symptom intensity in coronary heart disease (CHD) patients with self-perceived statin-associated muscle symptoms (SAMS) and to determine the relationship to blood levels of atorvastatin and/or metabolites. Methods and results: A randomized multi-center trial consecutively identified 982 patients with previous or ongoing atorvastatin treatment after a CHD event. Of these, 97 (9.9%) reported SAMS and 77 were randomized to 7-weeks double-blinded treatment with atorvastatin 40 mg/day and placebo in a crossover design. The primary outcome was the individual mean difference in muscle symptom intensity between the treatment periods, measured by visual-analogue scale (VAS) scores. Atorvastatin did not affect the intensity of muscle symptoms among 71 patients who completed the trial. Mean VAS difference [statin-placebo] was 0.31 (95% CI -0.24-0.86). The proportion with more muscle symptoms during placebo than atorvastatin was 17% (n = 12), 55% (n = 39) had the same muscle symptom intensity during both treatment periods whereas 28% (n = 20) had more symptoms during atorvastatin than placebo (confirmed SAMS). There were no differences in clinical or pharmacogenetic characteristics between these groups. The levels of atorvastatin and/or metabolites did not correlate to muscle symptom intensity among patients with confirmed SAMS (Spearmans rho ≤0.40, for all variables). Conclusion: Re-challenge with high-intensity atorvastatin did not affect the intensity of muscle symptoms in CHD patients with self-perceived SAMS during previous atorvastatin therapy. There was no relationship between muscle symptoms and the systemic exposure to atorvastatin and/or its metabolites. The findings encourage an informed discussion to elucidate other causes of muscle complaints and continued statin use.

• Peersen, Kari; Otterstad, Jan Erik; Sverre, Elise; Perk, Joep; Gullestad, Lars & Moum, Torbjørn Åge [Show all 8 contributors for this article] (2020). Medical and Psychosocial Factors Associated With Low Physical Activity and Increasing Exercise Level After a Coronary Event. Journal of Cardiopulmanory Rehabilitation and Prevention (JCRP). ISSN 1932-7501. 40(1), p. 35–40. doi: 10.1097/HCR.0000000000000399. Full text in Research Archive Show summary

  PURPOSE: The reasons why many coronary patients are inactive or have a low level of physical activity (PA) are not completely understood. We identified medical and psychosocial factors associated with PA status and increasing exercise level after a coronary event. METHODS: A cross-sectional study investigated the factors associated with PA in 1101 patients hospitalized with myocardial infarction (MI) and/or a revascularization procedure. Data were collected from hospital records, a self-report questionnaire, and a clinical examination. PA was categorized as inactivity, low activity, and adequate activity (≥ moderate intensity of 30 min ≥2-3 times/wk), an overall summary PA-index was measured as a continuous variable, and self-reported PA increase since the index event was measured on a 0- to 10-point Likert Scale. RESULTS: In all, 18% reported inactivity, 42% low, and 40% adequate activity at follow-up after median 16 mo. In multiadjusted linear regression analyses, low PA-index was significantly associated with smoking, obesity, unhealthy diet, depression, female, low education, MI as index diagnosis, and ≥1 previous coronary event. Motivation, risk and illness perceptions, and low reported need of help to increase PA were significantly associated with self-reported increasing PA level in adjusted continuous analyses. CONCLUSIONS: Daily smoking, obesity, unhealthy diet, and depression were the major potentially modifiable factors associated with insufficient PA, whereas high motivation and risk and illness perceptions were associated with increasing PA level. Further research on the effect of interventions tailored to the reported significant factors of failure is needed to improve PA level in CHD patients.

• Sverre, Elise Christine Bjørkholen; Peersen, Kari; Perk, Joep; Husebye, Einar; Gullestad, Lars & Dammen, Toril [Show all 8 contributors for this article] (2020). Challenges in coronary heart disease prevention - experiences from a long-term follow-up study in Norway. Scandinavian Cardiovascular Journal. ISSN 1401-7431. 55(2), p. 73–81. doi: 10.1080/14017431.2020.1852308. Full text in Research Archive Show summary

  Objective. To determine longitudinal changes in lifestyle behaviour and lipid management in a chronic coronary heart disease (CHD) population. Design. A multi-centre cohort study consecutively included 1127 patients at baseline in 2014–2015, on average 16 months after a CHD event. Data were collected from hospital records, a questionnaire and clinical examination. Seven hundred and seven of 1021 eligible patients participated in a questionnaire-based follow-up in 2019. Data were analysed with univariate statistics. Results. After a mean follow-up of 4.7 years (SD 0.4) from baseline, the percentage of current smokers (15% versus 16%), obesity (23% versus 25%) and clinically significant symptoms of anxiety (21% versus 17%) and depression (13% versus 14%) remained unchanged, whereas the proportion with low physical activity increased from 53% to 58% (p < .001). The proportions with reduced physical activity level were similar in patients over and under 70 years of age. Most patients were still taking statins (94% versus 92%) and more patients used high-intensity statin (49% versus 54%, p < .001) and ezetimibe (5% versus 15%, p < .001) at follow-up. 73% reported ≥1 primary-care consultation(s) for CHD during the last year while 27% reported no such follow-up. There were more smokers among participants not attending primary-care consultations compared to those attending (19% versus 14%, p = .026). No differences were found for other risk factors. Conclusions. We found persistent suboptimal risk factor control in coronary outpatients during long-term follow-up. Closer follow-up and intensified risk management including lifestyle and psychological health are needed to improved secondary prevention and outcome of CHD.

• Munkhaugen, John; Vethe, Nils Tore; Fagerland, Morten; Dammen, Toril; Perk, Joep & Gjertsen, Erik [Show all 10 contributors for this article] (2019). Statin-associated muscle symptoms in coronary patients: design of a randomized study. Scandinavian Cardiovascular Journal. ISSN 1401-7431. 53(3), p. 162–168. doi: 10.1080/14017431.2019.1612085. Full text in Research Archive Show summary

  Objectives. Estimate the effect of atorvastatin on muscular symptom intensity in coronary patients with subjective statin-associated muscle symptoms (SAMS) and to determine the association with blood levels of atorvastatin and its metabolites, to obtain an objective marker for true SAMS. Design. A randomized, double-blinded, cross-over study will include 80 coronary patients with subjectively reported SAMS during ongoing atorvastatin therapy or previous muscle symptoms that led to discontinuation of atorvastatin. Patients will be randomized to 7-weeks treatment with atorvastatin 40 mg/day in the first period and matched placebo in the second 7-weeks period, or placebo in the first period and atorvastatin in the second period. Each period is preceded by 1-week wash-out. A control group (n = 40) without muscle symptoms will have 7 weeks open treatment with atorvastatin 40 mg/day. Blood samples will be collected at baseline and at the end of each treatment period, and muscular symptoms will be rated by the patients weekly using a Visual Analogue Scale (VAS). The primary outcome is the difference in aggregated mean VAS scores between the last three weeks of atorvastatin treatment and of placebo treatment. The main purpose is to develop an objective marker for true SAMS, by comparing SAMS associated with blinded atorvastatin treatment with blood concentrations of atorvastatin and its metabolites. Diagnostic and discrimination performance will be determined. Conclusions. The study provides new knowledge on SAMS in coronary patients and may contribute to more personalized statin treatment and monitoring, fewer side-effects and consequently improved adherence and lipid management in future practice.

• Munkhaugen, John; Ruddox, Vidar; Halvorsen, Sigrun; Dammen, Toril; Fagerland, Morten & Hernæs, Kjersti Helene [Show all 23 contributors for this article] (2019). BEtablocker Treatment After acute Myocardial Infarction in revascularized patients without reduced left ventricular ejection fraction (BETAMI): Rationale and design of a prospective, randomized, open, blinded end-point study. American Heart Journal. ISSN 0002-8703. 208, p. 37–46. doi: 10.1016/j.ahj.2018.10.005. Full text in Research Archive Show summary

  Background - Current guidelines on the use of β-blockers in post–acute myocardial infarction (MI) patients without reduced left ventricular ejection fraction (LVEF) are based on studies before the implementation of modern reperfusion and secondary prevention therapies. It remains unknown whether β-blockers will reduce mortality and recurrent MI in contemporary revascularized post-MI patients without reduced LVEF. Design - BETAMI is a prospective, randomized, open, blinded end point multicenter study in 10,000 MI patients designed to test the superiority of oral β-blocker therapy compared to no β-blocker therapy. Patients with LVEF ≥40% following treatment with percutaneous coronary intervention or thrombolysis and/or no clinical signs of heart failure are eligible to participate. The primary end point is a composite of all-cause mortality or recurrent MI obtained from national registries over a mean follow-up period of 3 years. Safety end points include rates of nonfatal MI, all-cause mortality, ventricular arrhythmias, and hospitalizations for heart failure obtained from hospital medical records 30 days after randomization, and from national registries after 6 and 18 months. Key secondary end points include recurrent MI, heart failure, cardiovascular and all-cause mortality, and clinical outcomes linked to β-blocker therapy including drug adherence, adverse effects, cardiovascular risk factors, psychosocial factors, and health economy. Statistical analyses will be conducted according to the intention-to-treat principle. A prespecified per-protocol analysis (patients truly on β-blockers or not) will also be conducted. Conclusions - The results from the BETAMI trial may have the potential of changing current clinical practice for treatment with β-blockers following MI in patients without reduced LVEF. EudraCT number 2018-000590-75.

• Munkhaugen, John; Hjelmesæth, Jøran; Otterstad, Jan Erik; Helseth, Ragnhild; Sollid, Stina Therese & Gjertsen, Erik [Show all 11 contributors for this article] (2018). Managing patients with prediabetes and type 2 diabetes after coronary events: individual tailoring needed - a cross-sectional study. BMC Cardiovascular Disorders. 18(1). doi: 10.1186/s12872-018-0896-z. Full text in Research Archive Show summary

  Background Understanding the determinants associated with prediabetes and type 2 diabetes in coronary patients may help to individualize treatment and modelling interventions. We sought to identify sociodemographic, medical and psychosocial factors associated with normal blood glucose (HbA1c < 5.7%), prediabetes (HbA1c 5.7–6.4%), and type 2 diabetes. Methods A cross-sectional explorative study applied regression analyses to investigate the factors associated with glycaemic status and control (HbA1c level) in 1083 patients with myocardial infarction and/or a coronary revascularization procedure. Data were collected from hospital records at the index event and from a self-report questionnaire and clinical examination with blood samples at 2–36 months follow-up. Results In all, 23% had type 2 diabetes, 44% had prediabetes, and 33% had normal blood glucose at follow-up. In adjusted analyses, type 2 diabetes was associated with larger waist circumference (Odds Ratio 1.03 per 1.0 cm, p = 0.001), hypertension (Odds Ratio 2.7, p < 0.001), lower high-density lipoprotein cholesterol (Odds Ratio 0.3 per1.0 mmol/L, p = 0.002) and insomnia (Odds Ratio 2.0, p = 0.002). In adjusted analyses, prediabetes was associated with smoking (Odds Ratio 3.3, p = 0.001), hypertension (Odds Ratio 1.5, p = 0.03), and non-participation in cardiac rehabilitation (Odds Ratio 1.7, p = 0.003). In patients with type 2 diabetes, a higher HbA1c level was associated with ethnic minority background (standardized beta [β] 0.19, p = 0.005) and low drug adherence (β 0.17, p = 0.01). In patients with prediabetes or normal blood glucose, a higher HbA1c was associated with larger waist circumference (β 0.13, p < 0.001), smoking (β 0.18, p < 0.001), hypertension (β 0.08, p = 0.04), older age (β 0.16, p < 0.001), and non-participation in cardiac rehabilitation (β 0.11, p = 0.005). Conclusions Along with obesity and hypertension, insomnia and low drug adherence were the major modifiable factors associated with type 2 diabetes, whereas smoking and non-participation in cardiac rehabilitation were the factors associated with prediabetes. Further research on the effect of individual tailoring, addressing the reported significant predictors of failure, is needed to improve glycaemic control. Trial registration Retrospectively registered at ClinicalTrials.gov: NCT02309255, December 5th 2014.

• Munkhaugen, John; Otterstad, Jan Erik; Dammen, Toril; Gjertsen, Erik; Moum, Torbjørn Åge & Husebye, Einar [Show all 7 contributors for this article] (2018). The prevalence and predictors of elevated C-reactive protein after a coronary heart disease event. European Journal of Preventive Cardiology (EJPC). ISSN 2047-4873. 25(9), p. 923–931. doi: 10.1177/2047487318768940. Full text in Research Archive
• Irgens, Audun Campbell; Hoffart, Asle; Nysæter, Tor Erik; Haaland, Vegard Øksendal; Borge, Finn Magnus & Pripp, Are Hugo [Show all 8 contributors for this article] (2017). Thought field therapy compared to cognitive behavioral therapy and wait-list for agoraphobia: A randomized, controlled study with a 12-month follow-up. Frontiers in Psychology. 8. doi: 10.3389/fpsyg.2017.01027. Full text in Research Archive Show summary

  Background: Thought field therapy (TFT) is used for many psychiatric conditions, but its efficacy has not been sufficiently documented. Hence, there is a need for studies comparing TFT to well-established treatments. This study compares the efficacy of TFT and cognitive behavioral therapy (CBT) for patients with agoraphobia. Methods: Seventy-two patients were randomized to CBT (N = 24), TFT (N = 24) or a wait-list condition (WLC) (N = 24) after a diagnostic procedure including the MINI PLUS that was performed before treatment or WLC. Following a 3 months waiting period, the WL patients were randomized to CBT (n = 12) or TFT (n = 12), and all patients were reassessed after treatment or waiting period and at 12 months follow-up. At first we compared the three groups CBT, TFT, and WL. After the post WL randomization, we compared CBT (N = 12 + 24 = 36) to TFT (N = 12 + 24 = 36), applying the pre-treatment scores as baseline for all patients. The primary outcome measure was a symptom score from the Anxiety Disorders Interview Scale that was performed by an interviewer blinded to the treatment condition. For statistical comparisons, we used the independent sample’s t-test, the Fisher’s exact test and the ANOVA and ANCOVA tests. Results: Both CBT and TFT showed better results than the WLC (p < 0.001) at post-treatment. Post-treatment and at the 12-month follow-up, there were not significant differences between CBT and TFT (p = 0.33 and p = 0.90, respectively). Conclusion: This paper reports the first study comparing TFT to CBT for any disorder. The study indicated that TFT may be an efficient treatment for patients with agoraphobia. Trial Registration: https://clinicaltrials.gov/, identifier NCT00932919.

• Peersen, Kari; Munkhaugen, John; Gullestad, Lars; Dammen, Toril; Moum, Torbjørn Åge & Otterstad, Jan Erik (2017). Reproducibility of an extensive self-report questionnaire used in secondary coronary prevention. Scandinavian Journal of Public Health. ISSN 1403-4948. 45(3), p. 269–276. doi: 10.1177/1403494816688375. Full text in Research Archive
• Sverre, Elise; Otterstad, Jan Erik; Gjertsen, Erik; Gullestad, Lars; Husebye, Einar & Dammen, Toril [Show all 8 contributors for this article] (2017). Medical and sociodemographic factors predict persistent smoking after coronary events. BMC Cardiovascular Disorders. 17(1). doi: 10.1186/s12872-017-0676-1. Full text in Research Archive
• Sverre, Elise; Peersen, Kari; Husebye, Einar; Gjertsen, Erik; Gullestad, Lars & Moum, Torbjørn Åge [Show all 9 contributors for this article] (2017). Unfavourable risk factor control after coronary events in routine clinical practice. BMC Cardiovascular Disorders. 17(1). doi: 10.1186/s12872-016-0387-z. Full text in Research Archive Show summary

  Background Risk factor control after a coronary event in a recent European multi-centre study was inadequate. Patient selection from academic centres and low participation rate, however, may underscore failing risk factor control in routine clinical practice. Improved understanding of the patient factors that influence risk factor control is needed to improve secondary preventive strategies. The objective of the present paper was to determine control of the major risk factors in a coronary population from routine clinical practice, and how risk factor control was influenced by the study factors age, gender, number of coronary events, and time since the index event. Methods A cross-sectional study determined risk factor control and its association with study factors in 1127 patients (83% participated) aged 18-80 years with acute myocardial infarction and/or revascularization identified from medical records. Study data were collected from a self-report questionnaire, clinical examination, and blood samples after 2-36 months (median 16) follow-up. Results Twenty-one percent were current smokers at follow-up. Of those smoking at the index event 56% continued smoking. Obesity was found in 34%, and 60% were physically inactive. Although 93% were taking blood-pressure lowering agents and statins, 46% were still hypertensive and 57% had LDL cholesterol >1.8 mmol/L at follow-up. Suboptimal control of diabetes was found in 59%. The patients failed on average to control three of the six major risk factors, and patients with >1 coronary events (p < 0.001) showed the poorest overall control. A linear increase in smoking (p < 0.01) and obesity (p < 0.05) with increasing time since the event was observed. Conclusions The majority of coronary patients in a representative Norwegian population did not achieve risk factor control, and the poorest overall control was found in patients with several coronary events. New strategies for secondary prevention are clearly needed to improve risk factor control. Even modest advances will provide major health benefits. Trial registration Registered at ClinicalTrials.gov (ID NCT02309255).

• Sverre, Elise; Peersen, Kari; Otterstad, Jan Erik; Gullestad, Lars; Perk, Joep & Gjertsen, Erik [Show all 10 contributors for this article] (2017). Optimal blood pressure control after coronary events: the challenge remains. Journal of the American Society of Hypertension : JASH. ISSN 1933-1711. 11(12), p. 823–830. doi: 10.1016/j.jash.2017.10.007. Full text in Research Archive
• Munkhaugen, John; Sverre, Elise; Otterstad, Jan Erik; Peersen, Kari; Gjertsen, Erik & Perk, Joep [Show all 10 contributors for this article] (2017). Medical and psychosocial factors and unfavourable low-density lipoprotein cholesterol control in coronary patients. European Journal of Preventive Cardiology (EJPC). ISSN 2047-4873. 24(9), p. 981–989. doi: 10.1177/2047487317693134. Full text in Research Archive
• Peersen, Kari; Munkhaugen, John; Gullestad, Lars; Liodden, Toril; Moum, Torbjørn Åge & Dammen, Toril [Show all 8 contributors for this article] (2017). The role of cardiac rehabilitation in secondary prevention after coronary events. European Journal of Preventive Cardiology (EJPC). ISSN 2047-4873. 24(13), p. 1360–1368. doi: 10.1177/2047487317719355. Full text in Research Archive
• Strand, Elin Bolle; Lillestøl, Kristine; Jason, Leonard A; Tveito, Kari; Diep, Lien My & Valla, Simen Strand [Show all 10 contributors for this article] (2016). Comparing the DePaul Symptom Questionnaire with physician assessments: a preliminary study. Fatigue: Biomedicine, Health & Behavior. ISSN 2164-1846. 4(1), p. 52–62. doi: 10.1080/21641846.2015.1126026. Full text in Research Archive
• Dammen, Toril; Papageorgiou, Costas & Wells, Adrian (2016). A Two Year Follow up Study of Group Metacognitive Therapy for Depression in Norway. Journal of Depression and Anxiety. ISSN 2167-1044. 5(2). doi: 10.4172/2167-1044.1000227. Full text in Research Archive
• Munkhaugen, John; Sverre, Elise; Peersen, Kari; Gjertsen, Erik; Gullestad, Lars & Moum, Torbjørn Åge [Show all 10 contributors for this article] (2016). The role of medical and psychosocial factors for unfavourable coronary risk factor control. Scandinavian Cardiovascular Journal. ISSN 1401-7431. 50(1), p. 1–8. doi: 10.3109/14017431.2015.1111408. Full text in Research Archive
• Munkhaugen, John; Sverre, Elise; Peersen, Kari; Egge, Oystein; Gjertsen, Caroline Eikeseth & Gjertsen, Erik [Show all 10 contributors for this article] (2016). Patient characteristics and risk factors of participants and non-participants in the NOR-COR Study. Scandinavian Cardiovascular Journal. ISSN 1401-7431. 50(5-6), p. 317–322. doi: 10.1080/14017431.2016.1202445. Full text in Research Archive

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• Getz, Vilde; Pleym, Karin; Dammen, Toril; Husebye, Einar; Sverre, Elise Christine Bjørkholen & Peersen, Kari [Show all 9 contributors for this article] (2026). Patient- and healthcare system predictors of participation in a municipal smoking cessation programme after hospitalisation for atherosclerotic cardiovascular disease. European Journal of Preventive Cardiology (EJPC). ISSN 2047-4873. 33(Supplement_2). doi: 10.1093/eurjpc/zwag249.268. Full text in Research Archive Show summary

  Abstract Introduction Few patients with atherosclerotic vascular disease attend hospital-based cardiac rehabilitation, and alternative models have been called for (1). Municipal Healthy Life Centres (HLCs) in Norway provide evidence-based lifestyle support, including smoking cessation programmes. We have recently demonstrated that a single in-hospital motivational counselling session with proactive referral to a HLC programme resulted in a higher programme uptake and doubled long-term cessation rates (25% to 50%) (2,3). Purpose To identify patient- and healthcare system factors associated with participation in a municipal cessation programme among patients hospitalised with atherosclerotic vascular disease included in a smoking cessation trial. Methods A pre-specified analysis of two smoking cessation intervention trials conducted from 2021 to 2024. Patients who smoked daily at hospital admission for an atherosclerotic vascular event were randomised 1:1 to in-hospital motivational counselling session combined with proactive referral to the HLC cessation programme (intervention) or to brief advice and written information about the HLC programme (control). Study data were collected from medical records at hospitals and HLCs and from self-report questionnaires. Associations between patient- and healthcare system factors and programme participation were estimated with logistic regression. Results Among 280 randomised patients, mean age was 65 years (SD 10), and 39% were women. Myocardial infarction was the most prevalent cause of hospitalisation (36%) followed by peripheral artery disease (18%) and cerebrovascular disease (14%). At six months 268 patients were available for analysis, excluding two who withdrew consent and ten who had died. Participation in the municipal smoking cessation programme was 42% (56/134) in the intervention group versus 9% (12/134) in the control group. In adjusted analyses of the total population, living with a smoking partner was positively associated with participation at the HLC (odds ratio 2.6) (Table 1). Factors inversely associated with HLC participation were older age (OR 0.7 per 10 years), living alone (OR 0.3), and low education (OR 0.4). Readiness for cessation and psychological distress were not significantly associated with participation. No healthcare system factor reached statistical significance, although inclusion during the summer holiday period appeared to reduce participation. Analysis of the intervention group (N=134) showed comparable results (Table 2). Conclusions Participation in a municipal smoking cessation programme among hospitalised patients with atherosclerotic vascular disease included in the trial was suboptimal, despite proactive referral. Older patients, those living alone, and those with lower education were less likely to participate, highlighting groups that need targeted referral strategies and tailored support to improve the participation rate.For image description, please refer to the figure legend and surrounding text.  For image description, please refer to the figure legend and surrounding text.

• Braanaas, Karoline Svensen; Dammen, Toril; Fagerland, Morten; Husebye, Einar; Leinaas, A & Schirmer, Henrik [Show all 10 contributors for this article] (2026). Individually Tailored monitoring at home after hospitalization for HEART failure (IT-HEART): Design and baseline characteristics of a randomized clinical trial. European Journal of Preventive Cardiology (EJPC). ISSN 2047-4873. 33(2). doi: 10.1093/eurjpc/zwag249.461. Full text in Research Archive Show summary

  Abstract Background Telemonitoring has emerged as a promising alternative to conventional heart failure (HF) management. Despite its potential, evidence from randomized controlled trials remains inconclusive, and data from high-risk populations with frailty, is scarce. The Individually Tailored remote monitoring at home after HEART failure (IT-HEART) trial evaluates whether a non-invasive telemonitoring program improves clinical, patient reported, and health economic outcomes in HF patients after a recurrent hospitalization. Purpose To describe flow of patients and baseline characteristics of the IT-HEART study population. Methods This multicentre, open-label, blinded-endpoint trial randomized HF patients to either written information and a self-management plan (Control) or HF education, a personalized self-management plan, and three months of home telemonitoring (Intervention). The primary endpoint is the total number of HF hospitalizations or cardiovascular death. Secondary endpoints include hospitalizations and outpatient visits, adherence the intervention, patient reported outcomes, and health economic measures. End of follow-up will be in October 2026. Results Of 1027 consecutively screened patients, 200 (19.5%) were randomized. Median age was 78 (IQR (70-83) years, and 29.5% were women. At baseline, participants had substantial multimorbidity with median Clinical Frailty Scale score 4, median Charlson Comorbidity Index score 6, and symptom burden was high (Table). Median self-rated HF management knowledge was 3 (IQR 0-7) on a 0-10 Likert scale. Only 35.5% weighed themselves weekly whereas 1 % (n=2) reported having a formal self-care plan at baseline. In the intervention arm (N=100), 64 participants used a digital telemonitoring platform and 36 received telephone-based monitoring. Conclusion Patients enrolled after a recurrent HF hospitalization were older, multimorbid, and frail, with high symptom burden, and low self-care and health literacy. The IT-HEART telemonitoring intervention is targeted to these modifiable deficits and has the potential to improve clinical and patient-reported outcomes.For image description, please refer to the figure legend and surrounding text.

• Nyen, J; Kristensen, A M D; Fagerland, Morten; Dammen, Toril; Zwisler, A D & Olsen, M H [Show all 14 contributors for this article] (2026). Beta-blocker therapy and sleep disturbances after myocardial infarction: a prespecified sub-study of the BETAMI-DANBLOCK trial. European Journal of Preventive Cardiology (EJPC). ISSN 2047-4873. 33(Issue Supplement_2). doi: 10.1093/eurjpc/zwag249.074. Full text in Research Archive Show summary

  Abstract Introduction Sleep disturbances have been proposed as a side effect of beta-blocker therapy, but evidence from large, randomised controlled trials are lacking. Purpose To evaluate the effects of beta-blockers on insomnia and nightmare frequency in patients with myocardial infarction (MI) and preserved or mildly reduced left ventricular ejection fraction (LVEF≥40%) enrolled in the BETAMI-DANBLOCK trial. Methods BETAMI-DANBLOCK was an open-label trial in Norway and Denmark in which MI-patients were randomised to receive long-term beta-blocker therapy or no such therapy. For this prespecified analysis, patients completed the Bergen Insomnia Scale (BIS) (all patients) and the Nightmare Frequency Questionnaire (NFQ) (Norwegian patients only) at baseline, 1-6, 12 and 18-24-months follow-up. BIS provides a continuous score (0-42) increasing with symptoms severity. BIS can also be used as a diagnostic tool (insomnia vs. no insomnia) based on self-reported diagnostic criteria scores. NFQ measures the number of nights with nightmares per week/month/year. The main endpoint was the incidence of insomnia during the first 12 months of follow-up in the two groups, estimated with logistic regression. Additional endpoints included between-group changes in BIS scores and nightmare frequency from baseline to 12 months, estimated by linear mixed models. Results Of 5574 randomised patients, 4728 (85% of all patients) completed BIS and 2031 (71% of the Norwegian patients) completed NFQ during the trial period. Median age was 62 (IQR: 55-70) years, 21% were women, and median metoprolol dose was 50 mg/day. At baseline, median self-reported sleep duration was 7 hours/night (IQR: 6-7.5) in both groups, median BIS score was 10 (IQR: 4-19) in both groups, and 40% fulfilled diagnostic criteria for insomnia. Beta-blocker therapy was associated with a negligible increase of 0.63 (95% CI: 0.03 to 1.24) in continuous BIS score. We found no statistically significant effect of beta-blockers on the incidence of insomnia during follow-up (Table 1). At baseline, the proportion of patients reporting nightmares at least monthly was 16% in the beta-blocker group and 15% in the no-beta-blocker group. A higher proportion of patients on beta-blockers reported at least monthly nightmares at 6 (25% vs 18%) and 12 (23% vs. 18%) months follow-up (6 months OR 2.12, 95% CI 1.02 to 4.40; 12 months OR 1.08, 95% CI 0.51 to 2.25). No significant change in the number of monthly nightmares was observed at 12 months (0.21, 95% CI: -0.15 to 0.57). Conclusions We found no clear and substantial effects of beta-blocker therapy on the incidence of insomnia or nightmare frequency among post-MI patients with LVEF ≥40%; however, a small effect cannot be ruled out.For image description, please refer to the figure legend and surrounding text.

• Pleym, Karin; Engebretsen, Ingrid; Sverre, Elise Christine Bjørkholen; Dammen, Toril; Husebye, Einar & kahlon, Mohpal Singh [Show all 10 contributors for this article] (2026). Cost-effectiveness of in-hospital motivational smoking cessation counselling and proactive referral to community-based follow-up. European Journal of Preventive Cardiology (EJPC). ISSN 2047-4873. 33(Supplement_2). doi: 10.1093/eurjpc/zwag249.265. Full text in Research Archive Show summary

  Abstract Background Hospital-based smoking cessation interventions are generally cost-effective, but most economic evaluations among inpatients with atherosclerotic cardiovascular disease (ASCVD) rely on modelled data only rather than patient-level data (1). Moreover, cost-effectiveness evidence for motivational interviewing in smoking cessation is limited and is primarily derived from non-hospitalised populations (2,3). Purpose To evaluate the cost-effectiveness of an in-hospital smoking cessation intervention with proactive referral to community-based follow-up among patients with ASCVD. Methods We performed an economic evaluation alongside a randomised controlled trial using a hospital perspective. The analysis included the cost of training, materials, and personnel. We recorded survival over sixteen months. Hospital costs during this period were monetised using Diagnosis Related Group cost weights. Survival beyond follow-up was projected using national mortality data adjusted for age, sex, and ASCVD. Remaining lifetime costs were estimated from mean costs in the final six months of follow-up. Costs and life-years were discounted at four percent. Uncertainty was assessed with 2000 bootstrap replicates. The primary outcome was net monetary benefit using a willingness-to-pay threshold of €38,346 per life-year. Results Mean baseline age was 65.2 years. During the sixteen-month follow-up, five participants in the intervention group and nine in the control group died. The intervention group had lower per-patient hospital costs during follow-up (€9,114 versus €13,973; difference: €4,859; 95% confidence interval [CI]: –€1,514 to €11,232). Lifetime costs were higher in the intervention group due to longer projected survival (€114,170 versus €110,522; difference: €3,648; uncertainty estimates [UE]: -€19,816 to €27,718). Undiscounted remaining life expectancy was 20.5 years in the intervention group and 18.7 years in the control group, (difference: 1.7 years, 95% UE: –1.9 to 6.1). The estimated net monetary benefit was €37,475 (95% CI: -15,868 to 107,797) and the probability that the intervention was cost-effective at the €38,346 per life-year threshold was 90.5% (Figure). Conclusion An in-hospital, motivational smoking cessation intervention with proactive referral to community-based support is likely to be cost-effective from a hospital perspective for patients with atherosclerotic vascular disease.FigureFor image description, please refer to the figure legend and surrounding text.

• Getz, Vilde; Pleym, Karin; Dammen, Toril; Husebye, Einar; Sverre, Elise Christine Bjørkholen & Peersen, Kari [Show all 9 contributors for this article] (2026). Patient- and healthcare system predictors of participation in a municipal smoking cessation programme after hospitalisation for atherosclerotic cardiovascular disease. doi: https:/esc365.escardio.org/preventive-cardiology/sessions/18511-prognostic-factors-in-populations. Full text in Research Archive
• Pleym, Karin; Engebretsen, Ingrid; Sverre, Elise Christine Bjørkholen; Dammen, Toril; Husebye, Einar & kahlon, Mohpal Singh [Show all 10 contributors for this article] (2026). Cost-effectiveness of in-hospital motivational smoking cessation counselling and proactive referral to community-based follow-up. doi: https:/esc365.escardio.org/preventive-cardiology/sessions/18493-feasibility-and-outcomes-of-lifestyle-and-behavioural-interventions. Full text in Research Archive
• Nyen, Johanne; Kristensen, Anna Meta; Fagerland, Morten; Dammen, Toril; Zwisler, Ann-Dorthe & Olsen, Michael Hecht [Show all 14 contributors for this article] (2026). Beta-blocker therapy and sleep disturbances after myocardial infarction: a prespecified sub-study of the BETAMI-DANBLOCK trial. doi: https:/esc365.escardio.org/preventive-cardiology/sessions/18499-risk-management-in-acute-coronary-syndrome. Full text in Research Archive
• 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.

• Hrubos-Strøm, Harald; Hansen, Diana Dobran; Feng, Xin; Mäkinen, Hanna; Tinbod, Unn & Köster, Andres [Show all 12 contributors for this article] (2025). Effect of Orofacial Myofunctional Therapy with Auto-Monitoring on the Apnea–Hypopnea Index and Secondary Outcomes in Treatment-Naïve Patients with Mild to Moderate Obstructive Sleep Apnea (OMTaOSA): A Multicenter Randomized Controlled Trial Protocol. doi: 10.3390/ijom51020008. Full text in Research Archive Show summary

  Background: The aim of this article is to describe the protocol of a large, multicenter randomized controlled trial evaluating the effects of orofacial myofunctional therapy with auto-monitoring (OMTa) versus auto-monitoring alone on obstructive sleep apnea (OSA) assessed by the apnea–hypopnea index and other pre-specified outcomes. Method: The OMTaOSA study protocol was registered at ClinicalTrials.gov (NCT06079073) in August 2023, and data collection ended in January 2025. One hundred and four participants with mild and moderate OSA were included. Randomization was conducted in a 1:1 ratio, using sex-stratified blocks. The intervention was a standardized protocol of OMT exercises previously shown to be effective, auto-monitoring with a Withings scan watch, and feedback from self-reports. Controls received watches and access to the same application without the exercise module. Sleep was measured over three nights at baseline and after three months. The sleep scorer and researchers evaluating other outcomes were blinded to the treatment allocation. Change in the apnea–hypopnea index was defined as the primary outcome. Secondary outcomes are published on Clinicaltrials.gov. Results: The results of the trial are still in preparation. Conclusions: By addressing the limitations of previous OMT studies, this trial may clarify the effectiveness of digitally delivered OMT for patients with mild to moderate OSA.

• Pacheco, André Pekkola; Dammen, Toril; Munkhaugen, John; Papageorgiou, Constantinos; Kvaerner, Kari Jorunn & Støme, Linn Nathalie (2025). Potential benefits of group cognitive-behavioural therapy for insomnia in patients with coronary heart disease versus usual care: an early economic evaluation. Full text in Research Archive Show summary

  Purpose To simulate the potential socioeconomic savings of integrating group cognitive-behavioural therapy for insomnia (gCBT-I) into cardiac outpatient care for patients with CHD compared with usual care, focusing on potential savings related to possible effects on (1) revascularizations and hospitalizations due to a recurrent CHD event; and (2) effects on sick leave. Methods Representative data on healthcare consumption and sick leave rates collected from the NORwegian CORonary (NORCOR) cohort study (n=1127). Costs of productivity loss were drawn from public sources and calculated using a conservative human capital approach. Estimates of therapeutic effectiveness in conveying insomnia remission by CBT-I were informed by results from randomized trials and meta-analyses. The comparator conditions in this early health technology assessment were weekly sessions of group cognitive-behavioural therapy for insomnia over five weeks versus usual care in 100 hypothetical outpatients with coronary heart disease and insomnia. Results Rates of healthcare consumption and sick leave were higher in outpatients with CHD and insomnia compared to those without insomnia. Our model indicated that treating 100 patients with gCBT-I would cost €2,406. If patients treated with gCBT-I show similar rates of recurrent revascularizations and hospitalizations as those without insomnia, there is a maximum potential saving of €117,221 per 100 patients tied to healthcare consumption. Similarly, the maximum potential savings related to reduced productivity loss from sick leave range from €53,244 to €692,172. Conclusions Treating insomnia among outpatients with CHD has the potential for substantial reduction of socioeconomic costs related to healthcare consumption and sick leave. Implementation into routine outpatient care seems relevant but randomized controlled trials investigating the effects of gCBT-I in this population are warranted.

• Pleym, Karin; Sverre, Elise Christine Bjørkholen; Weedon-Fekjaer, Harald; kahlon, Mohpal Singh; Stugaard, Marie & Husebye, Einar [Show all 9 contributors for this article] (2025). Motivational smoking cessation counselling with proactive referral to community-based follow-up after hospitalisation for vascular disease: a pragmatic, randomised trial. Full text in Research Archive Show summary

  Purpose: To evaluate the effect of an intervention consisting of one session of in-hospital motivational interviewing smoking cessation counselling combined with proactive referral to follow-up in a community-based cessation program on continuous smoking abstinence rates at six and twelve months. Methods: We conducted a multi-centre pragmatic, randomised, open, blinded endpoint (PROBE) intervention trial at three secondary care hospitals. We included patients with established atherosclerotic vascular disease smoking ≥ 1 cigarette daily prior to unplanned or elective hospitalisation. Participants were randomised 1:1 to (i) brief advice, a leaflet with contact information for a community-based cessation program, and discharge information to their general practitioner (control), or (ii) identical interventions as (i), plus a single in-hospital motivational counselling session that included referral to the cessation program, and a proactive telephone invitation from the community-based centre staff within two weeks post-discharge (intervention). Results: Among 332 screened patients, 110 were excluded, and 221 (67%) were randomised. The mean age was 65 years (SD 10, range of 37 to 85 years), with 40% being women. In intention-to-treat analyses (excluding 7 deaths and one consent withdrawal), 50% (53/107) in the intervention group and 25% (26/106) in the control group reported smoking abstinence at six months (adjusted odds ratio [OR] 3.1, 95% confidence interval [CI] 1.7-5.6, p<0.001), biochemically confirmed in 89% (70/79) with carbon monoxide measurements. The number needed to treat to achieve abstinence in one additional patient who smoke was 4 (95% CI 3 to 8). The intervention increased participation in the cessation programme (41% vs. 11%) and increased the number of participants that obtained coupons for free cessation medications (36% vs. 11%). At 12 months, abstinence was reported by 46% of the intervention group and 28% of the control group (Figure 1). After a median follow-up of 18 months (range 12–24), recurrent vascular events occurred in 26% (28/109) of the intervention group and 34% (38/111) of the control group. Conclusions: One session of in-hospital motivational counselling combined with proactive referral to follow-up in a community-based cessation program nearly doubled long-term smoking abstinence rates in patients with atherosclerotic vascular disease. Moreover, early data suggests that the intervention might translate into a numeric reduction in recurrent cardiovascular events and death during a follow-up period of 1-2 years.

• Getz, Vilde; Pleym, Karin; Dammen, Toril; Tonstad, Serena; Husebye, Einar & Sverre, Elise Christine Bjørkholen [Show all 9 contributors for this article] (2025). Clinical and psychosocial predictors of long-term smoking cessation in patients with atherosclerotic vascular disease: a pre-specified analysis of two randomised trials. Full text in Research Archive Show summary

  Purpose: To identify clinical and psychosocial factors associated with long-term smoking cessation in patients admitted for cardiovascular disease enrolled in a smoking cessation intervention study. Methods: A pre-specified analysis of two randomised intervention trials conducted at three secondary care hospitals. Patients with atherosclerotic vascular disease who smoked ≥1 cigarette daily before admission for an elective or unplanned event were randomised 1:1 to i.) motivational counselling and proactive referral to a municipal cessation program (intervention) or ii.) brief advice and a leaflet with contact information to the cessation program (control). Data were collected from hospital medical records, a questionnaire, and telephone interviews. Logistic regression analyses were applied to explore associations between clinical and psychosocial factors at the time of randomisation and smoking status at the 12 months follow-up. Results: Among 280 randomised participants, two withdrew consent, 16 died, and 262 completed the 12-month follow-up. Mean age was 65 (SD 10) years, 39% were women, 78% had low education, 37% were hospitalised due to coronary artery disease, 17% due to peripheral artery disease, and 14% due to cerebrovascular disease. At 12 months, 88 out of 262 participants reported sustained smoking cessation. In analyses adjusted for age and site, increasing motivation (OR 1.35/1 point on a 0 to 10 Likert scale) and being in the preparation stage (OR 2.46) were significantly associated with a higher likelihood of sustained smoking cessation. Comorbidity (odds ratio (OR) 0.64/1.0 point on the Charlson score), living alone (OR 0.48) and shorter sleep duration (OR 0.76/hour) were significantly inversely associated with smoking cessation (Table, model 1). Further adjustment for group allocation (intervention vs. control) had only minor impact on the effect estimates (Table, model 2). Conclusions: Higher motivation and readiness for smoking cessation increased the likelihood of abstinence in patients with atherosclerotic vascular disease who attended a cessation intervention, whereas living alone, comorbidity and shorter sleep duration were inversely associated with smoking cessation. These factors may be targets for future interventions tailored to vulnerable subgroups of patients in need of a more tailored approach.

• Holtrop, Joris; Gynnild, Mari Nordbø; Dammen, Toril; Dalen, Håvard; Hageman, Steven HJ & Visseren, Frank [Show all 9 contributors for this article] (2025). Integration of psychological risk modifiers on-top the SMART2-risk score for estimation of recurrent cardiovascular events in patients with atherosclerotic cardiovascular disease. European Journal of Preventive Cardiology (EJPC). ISSN 2047-4873. doi: 10.1093/eurjpc/zwaf236.210. Full text in Research Archive
• Holtrop, Joris; Gynnild, Mari Nordbø; Dalen, Håvard; Dammen, Toril; McEvoy, John William & Hageman, Steven H. J. [Show all 9 contributors for this article] (2025). Integration of guideline-recommended psychosocial risk modifiers on-top the SMART2-risk score for estimation of recurrent cardiovascular events in patients with established cardiovascular disease. Full text in Research Archive
• Pacheco, André Pekkola; Munkhaugen, John; Hrubos-Strøm, Harald; Klungsøyr, Ole; Kværner, Kari Jorunn & Støme, Linn Nathalie [Show all 8 contributors for this article] (2024). Cognitive behavioural therapy for insomnia (CBT-I) in patients with coronary heart disease: a protocol for a randomized controlled trial with six months follow-up. European Journal of Preventive Cardiology (EJPC). ISSN 2047-4873. 31(Supplement_1). doi: 10.1093/eurjpc/zwae175.434. Full text in Research Archive
• Pivoriunas, Jonas; Engebretsen, Ingrid; Vethe, Nils Tore; Kristiansen, Oscar; Dammen, Toril & Fagerland, Morten Wang [Show all 9 contributors for this article] (2024). Statin adherence in coronary outpatients: a novel direct method compared with pharmacy registry data. European Journal of Preventive Cardiology (EJPC). ISSN 2047-4873. 31(Supplement_1). doi: 10.1093/eurjpc/zwae175.063. Full text in Research Archive
• Grøtte, Torun; Hummelen, Benjamin; Moen, Erna & Dammen, Toril (2024). ACT-enhanced behavior therapy in group format for skin-picking disorder: An effectiveness study. Full text in Research Archive
• Pivoriunas, Jonas; Engebretsen, Ingrid; Vethe, Nils Tore; Kristiansen, Oscar; Dammen, Toril & Husebye, Einar [Show all 9 contributors for this article] (2024). Statin adherence in coronary outpatients: the relationship between a novel direct method and pharmacy registry data. Full text in Research Archive Show summary

  Introduction An optimal method to assess adherence to statin therapy is needed. We developed a novel blood test to determine adherence to atorvastatin and simvastatin therapy. The relationship between statin adherence measured in blood and long-term adherence is yet to be defined. Purpose To compare statin adherence measured by single blood test with pharmacy registry data: i. the three months period prior to the blood test, and ii. from six months before until six months after the blood test. Methods In a cross-sectional study including 451 patients using either atorvastatin or simvastatin, a spot blood sample was collected median 18 months after a coronary heart disease event. Participants were unaware of the forthcoming statin analyses. Adherence (0 or 1 omitted dose) and reduced adherence, defined as ≥2 consecutively omitted doses of atorvastatin and simvastatin was determined by drug concentration measurements using liquid chromatography - tandem mass spectrometry. Study data was linked to the pharmacy registry. Indirect reduced adherence was defined as statin treatment gap exceeding 90 days. Results Thirty-nine (9%) out of 412 patients had reduced adherence to statins, determined by the novel blood test. Among patients classified as adherent by the blood test, only three (0.7%) had a treatment gap exceeding 90 days during the preceding three months. Correspondingly, of 39 patients with reduced adherence by the blood test, 11 (28%) had treatment gaps exceeding 90 days. The positive agreement between the methods was 96% and the negative agreement 42%. Among patients classified as adherent by the blood test, 21 (5%) had treatment gaps exceeding 90 days from six months before until six months after the blood test. Correspondingly, of 39 patients with reduced adherence by the blood test, 15 (39%) had at least one treatment gap exceeding 90 days. The positive agreement between measurements was 95% and the negative agreement 40%. Conclusions Among coronary patients classified as adherent by the statin blood test, registry data only identified three patients (0.7%) with a treatment gap exceeding 90 days in the three months prior to the blood test. The novel blood test emerges as a promising tool to identify patients adherent to statins, and thus may improve lipid management in clinical practice.

• Frøjd, Lars Aastebøl; Munkhaugen, John; Papageorgiou, Constantinos; Torbjørn, Moum; Dammen, Toril & Sverre, Elise Christine Bjørkholen (2023). Insomnia was associated with increased risk of recurrent cardiovascular events in coronary heart disease patients. Full text in Research Archive
• Munkhaugen, John; Papageorgiou, Constantinos; Hagen, Roger; Johnson, Sverre Urnes; Einvik, Gunnar & Dammen, Toril (2023). Editorial: Progress in understanding and treating distress, sleep, and personality in heart and lung disease. Frontiers in Psychology. 14. doi: 10.3389/fpsyg.2023.1323677. Full text in Research Archive
• Pleym, Karin; Sverre, Elise Bjerkholen; Weedon-Fekjaer, H; Kahlon, Mohpal Singh; Husebye, Einar & Tonstad, Serena [Show all 8 contributors for this article] (2022). Effect of in-hospital nurse-led smoking cessation intervention for patients with atherosclerotic cardiovascular disease: a randomised pilot study. Full text in Research Archive
• Peersen, Kari; Sverre, Elise Christine Bjørkholen; Kristiansen, Oscar; Fagerland, Morten; Gullestad, Lars & Otterstad, Jan Erik [Show all 8 contributors for this article] (2020). Clinical factors, psychological factors and beliefs about statin use in patients with coronary heart disease and self-perceived muscle side-effects. European Heart Journal. ISSN 0195-668X. 41(Supplement_2). doi: 10.1093/ehjci/ehaa946.3337. Full text in Research Archive Show summary

  Abstract Background Statin associated muscle symptoms (SAMS) are commonly reported and constitute the principal reason for statin non-adherence and/or discontinuation. Understanding the determinants of SAMS may enhance the clinical management and form the basis of interventions. The association between psychological distress and the beliefs about statin treatment and SAMS have previously not been investigated under randomized, controlled conditions. Purpose To compare clinical and psychological factors among coronary patients with confirmed SAMS and non-SAMS. Methods This pre-planned exploratory study included 71 consecutively recruited patients with self-perceived SAMS enrolled in the MUscle Side-Effect of atorvastatin in coronary patients (MUSE) randomized double-blinded crossover trial. Muscle symptom (pain, weakness, tenderness, stiffness and/or cramps) intensity was registered weekly in a patient diary using a 0 (no symptoms) to 10 (worst imaginable) cm visual-analogue scale (VAS). Confirmed SAMS was predefined as a 25% higher individual mean VAS-scores during 7-weeks treatment with atorvastatin 40 mg/day versus 7-weeks treatment with placebo, and ≥1cm absolute difference. Clinical factors (10 variables), psychological factors (5 variables) and beliefs about medicine (3 variables) were obtained from a questionnaire and a clinical examination at study start. Results Mean age was 63 (SD 9.5) years, 32% were women, and each participant had tried average 1.3 (SD 0.6, range 1 to 3) statins prior to study start. In all, 28% (n=20) had confirmed SAMS and 72% (n=51) had non-SAMS. There were no differences in mean VAS score at study start between the groups (mean VAS score 4.5 vs. 4.7, p=0.20). More patients with confirmed SAMS than non-SAMS (25% vs. 6%, p&lt;0.001) did not use statin treatment at study start, and mean LDL-cholesterol level was borderline higher (2.8 vs. 2.3 mmol/L, p=0.06). Patients with confirmed SAMS had a weaker belief in their statin use compared to patients with non-SAMS (3.1 vs. 3.6, p&lt;0.001) using a 5-category scale from 1 (weak belief) to 5 (strongest belief). There were no differences in the sociodemographic, clinical (pre-existing muscle skeletal disorders, somatic comorbidity, cardiovascular risk factors) or psychological (symptoms of anxiety or depression, type D personality, worry, insomnia) factors explored between patients with confirmed SAMS or with non-SAMS. There were no associations between these factors and increasing VAS scores in continuous analyses among patients with confirmed SAMS and non-SAMS. Conclusions Patients with statin dependent muscle side-effects reported a weaker belief on the necessity to take statins than patients with muscle complaints not caused by the statin. Otherwise, we found no differences in clinical or psychological factors between these populations. The results indicate that these factors do not distinguish patients with and without associated muscle symptoms in clinical practice. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Vestfold Hospital Trust, research grant

• Sverre, Elise; Peersen, Kari; Weedon-Fekjær, Harald; Perk, J.; Gjertsen, Erik & Husebye, E [Show all 10 contributors for this article] (2019). Potentially modifiable clinical and psychosocial factors associated with recurrent cardiovascular events in an outpatient coronary population. European Heart Journal. ISSN 0195-668X. 40, p. 2631–2631. doi: 10.1093/eurheartj/ehz745.0803. Full text in Research Archive
• Munkhaugen, John; Peersen, Kari; Sverre, Elise; Gjertsen, Erik; Gullestad, Lars & Dammen, Toril [Show all 8 contributors for this article] (2018). Oppfølging etter hjerteinfarkt - er den god nok? 138(5), p. 434–437. doi: 10.4045/tidsskr.17.1050. Full text in Research Archive

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