Theresa Wilberg

• Bremer, Kjetil; Pedersen, Geir; Ekberg, Daniel Gustav Andreas; Morken, Katharina Teresa Enehaug; Nissen-Lie, Helene Amundsen & Oftedal, Eileen [Show all 8 contributors for this article] (2026). Improvement of personality functioning in patients with personality disorders: a comparative study of mentalization-based treatment versus non-manualized treatments. Frontiers in Psychiatry. 17, p. 1–17. doi: 10.3389/fpsyt.2026.1831782. Full text in Research Archive
• 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
• Pedersen, Geir; Hummelen, Benjamin; Gulbrandsen, Sebastian; Leitemo, Kai; Oftedal, Eileen & Tenebroso, Alexandra [Show all 11 contributors for this article] (2026). Psychometric Evaluation of the Norwegian Difficulties in Emotion Regulation Scale in a Multi-Site Sample of Patients With Personality Disorders and Personality Problems. Journal of Clinical Psychology. ISSN 0021-9762. 82(9), p. 1388–1402. doi: 10.1002/jclp.70165. Full text in Research Archive Show summary

  Objective: The validity and psychometric qualities of the Difficulties in Emotion Regulation Scale (DERS) in populations with a broader range of personality disorders (PDs) are still unclear. The aim of the current study was to analyze the factor structure and validity of DERS and two of its short-forms (DERS-SF and DERS-18), their relation to PD features and personality functioning, gender differences, and the overlap between concepts of alexithymia and emotion regulation. Method: Data were extracted from a multi-site clinical sample of patients with PDs or personality related problems referred to specialist mental health services (n = 2093). Confirmatory factor analyses (CFA)—specifically first-order correlated and bifactor analysis, as well as analysis of measurement invariance—were applied. Linear associations and group differences were investigated by correlational analysis and independent samples t-tests. DERS and its shortforms were validated through associations with PD features (PD criteria), measures of personality functioning (LPFS-BF), and alexithymia (TAS-20). Results: CFA of the short forms revealed good model fit, while the full version of DERS showed poorer fit. None of the bifactor analyses supported a strong general factor. Gender differences were prominent, and substantial associations were found between DERS and PD criteria, LPFS-BF, and TAS-20. Conclusion: DERS and its short forms demonstrated acceptable reliability and validity in a sample of patients with PDs and personality related problems. Without support for a general factor, interpretation of the total scores of DERS should be conducted with care, especially if the subscales Awareness and Clarity are included. Given the advantages of the short forms, the selection of one version over another seems to be of limited consequence.

• Ulvestad, Dag Anders; Ekberg, Daniel Gustav Andreas; Bakali, Jan-Vegard; Eikenæs, Ingeborg Helene Ulltveit-Moe; Fjermestad-Noll, Jane & Hjermann, Eirik [Show all 14 contributors for this article] (2026). Improvement of emotional dysregulation, aggression, and self-harm among people treated within outpatient personality disorder mental health services. A large longitudinal, observational, multi-centre study. Psychotherapy Research. ISSN 1050-3307. doi: 10.1080/10503307.2026.2650154. Full text in Research Archive
• Torgersen, Kristin Stensland; Dammen, Toril; Klungsøyr, Ole; Wilberg, Theresa; Bringager, Christine Bull & Evensen, Julie Horgen [Show all 11 contributors for this article] (2026). Improvement and deterioration trajectories in psychotherapy for depression: results from an RCT with cognitive behavioural and psychodynamic therapy. Nordic Journal of Psychiatry. ISSN 0803-9488. doi: 10.1080/08039488.2026.2648291. Full text in Research Archive
• Kvarstein, Elfrida Hartveit; Bremer, Kjetil; Baltzersen, Åse-Line; Ekberg, Daniel Gustav Andreas; Normann, Eivind & Ulvestad, Dag Anders [Show all 8 contributors for this article] (2025). Sustainability of Mentalization‐Based Treatment Programs for Poorly Functioning Patients With Borderline Personality Disorder. Can We Really Keep It Up? Personality and Mental Health. ISSN 1932-8621. 19(4). doi: 10.1002/pmh.70036. Full text in Research Archive Show summary

  Though positive effects of mentalization-based treatment (MBT) for patients with severe borderline personality disorder (BPD) are increasingly documented, less is known about the sustainability of specialized treatment standards and the maintenance of positive outcomes over time. This study aimed to investigate the organizational and clinical sustainability of an outpatient MBT program across two successive treatment periods. The study compares outpatients referred to MBT in a tertiary-level, specialist mental health service in 2009–2011 (Period I: n = 96) versus 2011–2015 (Period II: n = 89). Organizational quality was based on the MBT quality manual (2019). By structured clinical interviews and repeated self-reports, comparisons included baseline characteristics of eligible patients, clinical outcomes during treatment, therapeutic alliance, therapist countertransferences, and treatment adherence. The MBT team, organization, and systems for quality assurance held satisfactory standards and stability across the two time periods largely compatible with manual recommendations. Patient selection to MBT was in accordance with the targeted patient group, admitting poorly functioning young adults with BPD in both periods. Period II included patients with more severe BPD and self-harming behaviors. Clinical improvement rendered effect sizes in the large range irrespective of time period, and overall 70% remission rates of self-harming. Patient-reported alliance to therapists and therapist-reported countertransference responses were stable with satisfactory levels in both periods. Both periods had low rates of drop-out, though higher in Period II. Results support positive effects and sustainability of MBT for poorly functioning BPD patients treated in a tertiary outpatient MBT-unit within a supportive and stable organizational environment.

• 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.

• Sayar, Hanna; Wilberg, Theresa; Eikenæs, Ingeborg Helene Ulltveit-Moe; Ekberg, Daniel Gustav Andreas; Leitemo, Kai & Morken, Katharina Teresa Enehaug [Show all 11 contributors for this article] (2025). Improvement of alexithymia in patients treated in mental health services for personality disorders: a longitudinal, observational study. Frontiers in Psychiatry. 16, p. 1–14. doi: 10.3389/fpsyt.2025.1558654. Full text in Research Archive Show summary

  Background The majority of mental health services include patients with personality disorder (PD) and comorbid conditions. Alexithymia, a psychological construct referring to difficulties in identifying and describing internal mental states, may represent a challenge to the psychotherapeutic treatment of patients with PD. This study aimed to investigate the prevalence of alexithymia among patients in specialized PD mental health services, differences according to PD severity and PD type, and the longitudinal course of alexithymia during treatment. Methods The study included 1,019 patients treated in specialized PD treatment units, with 70% of them with personality difficulties above the PD diagnostic threshold [borderline PD, 31%; avoidant PD, 39%; PD not otherwise specified (PD-NOS), 15%; other PDs, 15%; and more than one PD, 24%]. Alexithymia was measured repeatedly throughout treatment using the Toronto Alexithymia Scale (TAS-20) self-report questionnaire. Supplementary outcomes included global psychosocial function and health-related life quality. Linear mixed models were applied for data analysis. Results Alexithymia was highly prevalent in the sample: 53% of subjects reported high levels and 20% moderate levels. The TAS-20 subscale Difficulty Identifying Feelings was more strongly associated with borderline PD, while the subscale Difficulty Describing Feelings was more closely linked to avoidant PD. For all TAS subscales, poorer abilities were associated with more severe PD, higher levels of anxiety and depression, and poorer psychosocial functioning and life quality. Both alexithymia and measures of psychological functioning improved significantly during treatment with moderate effect sizes regardless of initial PD status. In total, 19% of the patients reported full remission of alexithymia. Conclusion Alexithymia is a common problem among patients with PDs and is associated with mental health difficulties and psychosocial dysfunction, with rates varying across PD type and severity. The study demonstrates moderate improvement of alexithymia during treatment in specialized PD mental health services. Further research should evaluate the effectiveness of different treatments and interventions in reducing alexithymia among PD patients.

• 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.

• Sveen, Carl-Aksel; Pedersen, Geir; Wilberg, Theresa & Kvarstein, Elfrida Hartveit (2025). The societal costs of avoidant personality disorder. Personality and Mental Health. ISSN 1932-8621. 19(1). doi: 10.1002/pmh.1644. Full text in Research Archive Show summary

  The study aims to estimate the societal costs of avoidant personality disorder (AvPD). Cross-sectional data on AvPD patients during 2017–2020 were retrieved from the quality register of the Norwegian Network for Personality Disorders. Cost estimations were based on a bottom-up approach, using a structured interview covering the 6-month period prior to initial assessment. Unit costs were retrieved from public records. The human capital approach was used to calculate productivity losses. Diagnoses were determined according to DSM-5 by semi-structured diagnostic interviews (SCID-5-PD). Mean societal costs were €19,378 for the total group (N = 410). The subgroup with a single diagnosis (n = 270) incurred €18,818, whereas the subgroup with at least one comorbid PD (n = 140) incurred €20,458. The difference between the two subgroups was not statistically significant. The largest cost component was productivity loss (69%), whereas health service costs constituted 31%. The main contributors to societal costs from the health service cost components were inpatient treatment (18%) and individual outpatient treatment (11%). In conclusion, societal costs for AvPD patients were high, on the same level as borderline PD, schizotypal PD, and schizophrenia, and higher than anxiety disorders, depression, and rheumatoid arthritis. In the future, development of effective AvPD treatment programs enhancing personality functioning and workforce participation is important in order reduce the cost of illness.

• Wichstrøm, Lars; Wilberg, Theresa; Kvarstein, Elfrida Hartveit & Steinsbekk, Silje (2024). Childhood predictors of avoidant personality disorder traits in adolescence: a seven-wave birth cohort study. Journal of Child Psychology and Psychiatry. ISSN 0021-9630. 66(3). doi: 10.1111/jcpp.14064. Full text in Research Archive Show summary

  Background: Although it is widely assumed that avoidant personality disorder (AvPD) originates in childhood, there is little prospective research to substantiate this claim. We therefore aimed to determine whether presumed childhood risk factors predict AvPD traits at 16 years. Methods: A population-based sample (n = 1,077; 50.9% female) from the 2003 and 2004 birth cohorts in Trondheim, Norway was examined biennially from 4 to 16 years. The number of AvPD traits at the age of 16 was assessed with the structured clinical interview for DSM-5 personality disorders and regressed on the intercept and growth in child risk and protective factors until the age of 14. Results: The prevalence of AvPD at the age of 16 was 3.2% (95% CI: 2.2–4.1). Higher levels and an increased number of social anxiety symptoms over time, as well as increased negative affectivity/neuroticism, predicted a higher number of AvPD traits. When the levels and changes in these factors were adjusted for, less and decreasing extraversion forecasted more AvPD traits, as did declining self-worth, higher levels of parental AvPD traits, and increased onlooking behavior. Conclusions: Neuroticism, low extraversion, social anxiety symptoms, passive onlooking behavior, and low self-worth predicted a higher number of AvPD traits in adolescence, as did more AvPD traits in parents. Efforts to enhance self-worth, reduce social anxiety, and promote peer interaction among onlooking children may reduce the development of AvPD traits in adolescence.

• Bøe, Julianne Vike; Nissen-Lie, Helene, Amundsen & Wilberg, Theresa (2024). Finding a voice: A qualitative investigation of the therapeutic relationship with patients suffering from avoidant personality disorder. Counselling Psychology Quarterly. ISSN 0951-5070. doi: 10.1080/09515070.2024.2394766. Full text in Research Archive Show summary

  This study comprises in-depth qualitative analysis of transcribed audio recordings from therapy with Avoidant Personality Disorder (AvPD)-patients, with focus on the characteristics and challenges within the therapeutic relationship. The dataset comprises sixteen therapy sessions. The analysis employed Reflexive Thematic Analysisand yielded two themes: (1) Difficulties in conveying personal material and (2) How to get connected? The findings indicate that the patients struggled to share openly in sessions–often resulting in dialogues characterized by silence, lack of personal material, and a reduced sense of alliance. The silence seemed to represent a therapeutic challenge. Lack of observable ruptures made us hypothesize that the patients’ modus operandi was a detached mode. When the therapist made use of the “real relationship,” it seemed to affect the vitality and felt security of the patients. The findings indicate that these patients face difficulties expressing “a voice of their own,” posing a challenge in the relationship. To mitigate patients’ relational cautiousness and detachment, they may benefit from a therapist capable of scaffolding their efforts towards a strengthened agency and a sense of self. The risk of pseudo-alliance or subtle alliance ruptures, requires additional therapist attention and suggests that the relationship should be an explicit focus in therapy.

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

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

• Ulvestad, Dag Anders; Johansen, Merete Selsbakk; Kvarstein, Elfrida Hartveit; Pedersen, Geir & Wilberg, Theresa (2024). Minding mentalizing - convergent validity of the Mentalization Breakdown Interview. Frontiers in Psychiatry. 15. doi: 10.3389/fpsyt.2024.1380532. Full text in Research Archive Show summary

  Objectives: Mentalizing difficulties are central to borderline personality disorder (BPD), have severe consequences, and are an explicit focus in mentalization-based treatment. The significance of mentalizing capacity as a predictor or mediator of change is however still uncertain due to a scarcity of research. The Mentalization Breakdown Interview (MBI) was developed as a time saving tool for studying psychotherapy processes and outcome in borderline pathology. This study aimed to investigate the convergent validity of reflective functioning (RF) ratings based on the MBI (MBI-RF) by a comparison with the gold standard, i.e., RF assessments based on the Adult Attachment Interview (AAI-RF). A secondary aim was to investigate how MBI-RF relates to core symptoms of BPD, levels of functional impairment and symptom distress compared with AAI-RF. Method: Forty-five patients with BPD or significant BPD traits were included. MBI-RF and AAI-RF were rated using the Reflective Functioning Scale. Levels of MBI-RF and AAI-RF and the correlation between the measures were calculated, as well as their associations with the Difficulties in Emotion Regulation Scale, Levels of Personality Functioning-Brief Form 2.0, Work and Social Adjustment Scale, Patient Health Questionnaire, Depression, Generalized Anxiety Disorder-7, self-harm, suicide attempts, and PD diagnostics. Results: The correlation between MBI-RF and AAI-RF was 0.79 (p<0.01), indicating high convergent validity. There were few significant associations between MBI-RF and AAI-RF and clinical measures. Conclusions: The study provides support for the convergent validity of the MBI as a BPD-focused RF assessment method. The MBI has the potential as a time saving, reliable and valid method to be applied in treatment research on patients with borderline pathology. The results indicate that measures of MBI-RF and AAI-RF are different from clinical symptoms. Clinical trial registration: ClinicalTrials.gov ID NCT04157907.

• Sørensen, Kristine Dahl; Bremer, Kjetil & Wilberg, Theresa (2024). The significance of connectedness: avoidant personality disorder patients’ subjective experiences of change after attending a specialized treatment program. Frontiers in Psychology. 15. doi: 10.3389/fpsyg.2024.1412665. Full text in Research Archive Show summary

  Objectives: This study aimed to inquire into the subjective experiences and meaning-making of change of people diagnosed with avoidant personality disorder (AvPD) after attending a treatment program developed for AvPD. Methods: Eighteen AvPD patients were interviewed 1 year after completing their treatment using a semi-structured interview guide. The interviews were analyzed through reflexive thematic analysis. Results: Three main themes were found to capture the various subjective experiences of change. The first main theme “being more alive” included the subthemes “talking and listening together” and “opening up and grounding into myself.” The second main theme was “still longing for more,” and the third main theme “I cannot even manage therapy” included the subthemes “as if we were together” and “capitulation.” Conclusion: Although these findings may not be specific to AvPD, they shed light on the importance of attending to the dynamic interplay of intersubjectivity, social motivations, and agency in a therapeutic context. Discovering a sense of agency within an interpersonal context in which the patient feels connected may lead to them opening up for development in accordance with their social motivational intentions.

• 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.

• Sveen, Carl-Aksel; Pedersen, Geir Arild Feigum; Ulvestad, Dag Anders; Zahl, Kjell-Einar; Wilberg, Theresa & Kvarstein, Elfrida Hartveit (2023). Societal costs of personality disorders among treatment-seeking patients in Norway: the relative contribution of specific DSM-5 categories. European Archives of Psychiatry and Clinical Neuroscience. ISSN 0940-1334. doi: 10.1007/s00406-023-01655-1. Full text in Research Archive Show summary

  Personality disorders (PDs) are associated with high levels of societal costs, regardless of whether a single PD or a broad range of PDs have been studied. However, research on the relative contribution of specific PD-types on societal costs is limited. The aim of this study was to explore the possible contributions of the individual DSM-5 categories of PDs on the level of societal costs and its components (health service costs and productivity loss), while controlling for the impact of comorbid mental health and substance use disorders on these outcomes. Participants ( n  = 798) were retrieved from the quality register of the Norwegian Network for Personality Disorders—a collaboration of PD-treatment units within specialist mental health services. The patients were referred to treatment in the time-period 2017–2020. Costs were assessed using a structured interview covering the 6-month period prior to assessment. Diagnoses were determined by semi-structured diagnostic interviews (SCID-5-PD and M.I.N.I.). Statistics included multiple regression analyses. The main result was that no specific PD had a unique contribution to the high level of societal costs generally found among treatment-seeking patients with PDs. Borderline PD (BPD) was the only PD with significantly higher health service costs than the other PDs, while BPD, avoidant PD, and unspecified PD were independently associated with enhanced productivity loss. The differential cost-effects of specific PDs on the cost components were small. Several comorbid mental health and substance use disorders were significant contributors to costs, irrespective of PD status. The results underscore the importance of developing and implementing effective treatments for a broader range of PDs, to reduce the high levels of societal costs associated with all PDs.

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

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

• Sveen, Carl-Aksel; Pedersen, Geir Arild Feigum; Ulvestad, Dag Anders; Zahl, Kjell-Einar; Wilberg, Theresa & Kvarstein, Elfrida Hartveit (2023). Societal costs of personality disorders: A cross-sectional multicenter study of treatment-seeking patients in mental health services in Norway. Journal of Clinical Psychology. ISSN 0021-9762. 79(8), p. 1752–1769. doi: 10.1002/jclp.23504. Full text in Research Archive Show summary

  Abstract Objective There is a relatively small body of research on the cost‐of‐illness of personality disorders (PDs). Most studies only include borderline PD. The aim of this study was to investigate mean societal costs, including its components, (direct) health service costs and (indirect) productivity loss, among treatment‐seeking patients with the broad range of all PDs according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM‐5). Methods Cross‐sectional data from 911 patients diagnosed with at least 1 PD were retrieved from the quality register of the Norwegian Network for Personality Disorders—a collaboration of PD treatment units within specialist mental health services. The patients were referred in the time period 2017–2020. Estimation of costs was based on a bottom‐up approach, using information from a structured interview covering the 6‐month period before assessment, whereas unit costs were retrieved from public reports, public records, or public agencies. The human capital approach was used to calculate productivity loss. Diagnoses were determined by semi‐structured diagnostic interviews (Structured Clinical Interview for DSM‐5‐PD [SCID‐5‐PD]). Results The mean societal costs were €20.260 during the 6‐month period before specialized treatment. The largest cost component was productivity loss (65%), whereas health service costs constituted 35%. The main contributors to societal costs from the underlying health service cost components were inpatient treatment (20.5%) and individual outpatient treatment (10.5%). Conclusion Societal costs were substantial among treatment‐seeking patients with the broad range of DSM‐5 PDs, comparable to the societal costs of schizophrenia, and significantly higher than the societal costs of both depression and anxiety disorders. The cost estimates converged with recent, register‐based cost‐of‐illness studies of different PDs but exceeded previous findings from other bottom‐up studies. Furthermore, the results underscore the importance of implementing effective and specialized treatment for patients with a broad range of PDs, not only to alleviate individual suffering but also to reduce the level of societal costs. The emphasis on productivity loss as a main contributor to the overall societal costs is substantiated, hence underlining the relevance of interventions focusing on improving occupational functioning.

• Wilberg, Theresa; Pedersen, Geir Arild Feigum; Bremer, Kjetil; Johansen, Merete Selsbakk & Kvarstein, Elfrida Hartveit (2023). Combined group and individual therapy for patients with avoidant personality disorder—A pilot study. Frontiers in Psychiatry. 14. doi: 10.3389/fpsyt.2023.1181686. Full text in Research Archive Show summary

  Objective Avoidant personality disorder (AvPD) is a common disorder within mental health services, associated with significant psychosocial impairment. The disorder has been neglected in research. There are currently no evidence-based treatments for AvPD, and there is a need for treatment studies focusing particularly on this form of personality pathology. The present study was a pilot study of combined group and individual therapy for patients with AvPD, based on mentalization-based and metacognitive interpersonal therapy. The aim was to investigate the feasibility of the treatment program and the course of symptoms and personality functioning during treatment and 1-year follow-up. Methods The study included 28 patients. Clinical evaluation at baseline comprised structured diagnostic interviews and patients' self-report of symptoms, psychosocial function, interpersonal problems, personality functioning, alexithymia, self-esteem, attachment style, therapeutic alliance, and client satisfaction. Patients' self-report were repeated at the end of treatment and 1-year follow-up. Results The drop-out rate was 14%. Average treatment length among the 22 treatment completers was 17 months. Mean levels of therapeutic alliance and client satisfaction were satisfactory. Effect sizes were large for global symptom distress, depression, anxiety, and psychosocial adjustment, and in the moderate range for aspects of personality functioning. Yet, the results showed a wide range of outcomes among the patients. Conclusions This pilot study shows promising results for combined group- and individual therapy for AvPD patients with moderate to severe impairment. Larger scale studies should be conducted to increase empirically based knowledge to guide development of differentiated treatments adapted to patients' various levels of AvPD severity and profiles of personality dysfunction.

• Kvarstein, Elfrida Hartveit; Frøyhaug, Mathias; Skjeklesæther-Pettersen, Mona; Carlsen, Sara; Ekberg, Andreas & Fjermestad-Noll, Jane [Show all 16 contributors for this article] (2023). Improvement of personality functioning among people treated within personality disorder mental health services. A longitudinal, observational study. Frontiers in Psychiatry. 14. doi: 10.3389/fpsyt.2023.1163347. Full text in Research Archive Show summary

  Objective: Evidence-based personality disorder (PD) treatments are dominated by interventions targeting Borderline PD, although clinical populations characteristically include different PD features and severity. Personality functioning is a new concept intended to capture common features across PDs. This study aimed to investigate longitudinal improvement of personality functioning in a clinical sample assigned to PD treatment. Method: An observational, large, longitudinal study of patients in PD treatments on specialist mental health service levels (N = 1,051). DSM-5 PDs were systematically assessed on referral. Personality functioning was repeatedly assessed (LPFS-BF-2.0), supplemented by symptom distress (anxiety: PHQ-GAD-7, depression: PHQ-9), and social/occupational activity (WSAS, work/study activity). Statistics were linear mixed models. Results: Thirty per cent had personality difficulties below PD threshold. Among PDs, 31% had Borderline (BPD), 39% Avoidant (AvPD), 15% not otherwise specified, 15% other PDs, and 24% > one PD. More severe initial LPFS-BF was associated with younger age, presence of PD and increasing number of total PD criteria. Across PD conditions, LPFS-BF, PHQ-9 and GAD-7 improved significantly (overall effect size 0.9). Mean duration of PD treatment was 15 (SD 9) months. Drop-out rates were low (12%). LPFS-BF improvement-rates were higher for BPD. Younger age was moderately associated with slower PHQ-9 improvement. Work/study activity was initially poor, poorer levels associated with AvPD and younger age, and improvement was non-significant across PD conditions. AvPD was associated with slower WSAS improvement-rates. Conclusion: Personality functioning improved across PD conditions. The results highlight BPD improvements. The study points to challenges concerning AvPD treatment, poor occupational activity and age-related differences.

• 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.

• Pedersen, Geir Arild Feigum; Wilberg, Theresa; Hummelen, Benjamin & Kvarstein, Elfrida Hartveit (2022). The Norwegian network for personality disorders–development, contributions and challenges through 30 years. Nordic Journal of Psychiatry. ISSN 0803-9488. doi: 10.1080/08039488.2022.2147995. Full text in Research Archive Show summary

  Background Established in 1992, the Norwegian Network for Personality Disorders (The Network) is a clinical research collaboration of specialist mental health and addiction services in Norway. Its primary focus is to facilitate systematic and relevant clinical assessment for patients with personality disorder and evaluate progress in psychotherapeutic treatment. However, large-scale data registers for personality disorder are still unique. This article presents the circumstances that led to the establishment of the Network, and its development and challenges in many areas, and through various phases. Methods In the following, we will outline how this close interaction between researchers, clinicians, and well-adapted systems has facilitated cooperation and clinical research. We will highlight some key factors that have been decisive during the network’s development, and not least for further adaptation and existence. Results Through 30 years, the Network has succeeded in establishing a large and sustainable clinical research collaboration with a persistent focus on personality disorder and psychotherapeutic treatment. The collaboration has resulted in a broad range of scientific contributions to the understanding of personality disorder, assessment and measurement methods, treatment alliance, clinical outcomes, service utilization, and costs. In addition, The Network has also resulted in a number of synergy effects that have benefited clinicians, patients, and researchers. Conclusions The Norwegian Network for Personality Disorders has become an acknowledged institution in the field. Many aspects of its development, organization, maintenance, and solutions to challenges may be relevant to others who plan to establish, maintain, or further develop similar collaborations.

• Ulvestad, Dag Anders; Johansen, Merete Selsbakk; Kvarstein, Elfrida Hartveit; Pedersen, Geir Arild Feigum & Wilberg, Theresa (2022). A borderline focused Reflective Functioning measure–Interrater reliability of the Mentalization Breakdown Interview. Nordic Journal of Psychiatry. ISSN 0803-9488. doi: 10.1080/08039488.2022.2123040. Full text in Research Archive Show summary

  Objective Mentalizing difficulties can be considered the core psychopathology of borderline personality disorder (BPD). Typical failures of mentalizing are targets in therapy for BPD. They are related to severe distress, relational problems, self-destructive behaviors, violence, or substance misuse. A major obstacle in BPD treatment research is the lack of suitable and easily administrated methods to assess mentalizing ability during treatment. The Mentalization Breakdown Interview (MBI) is a new method for capturing episodic mentalizing difficulties occurring in close relationships. Interviews are videotaped and scored in accordance with the Reflective Functioning Scale (MBI-RF). In this way the patients’ ability to retrospectively reflect over such episodes are evaluated. This study investigates the interrater reliability of MBI-RF. Methods The study includes videotapes of MBIs from 32 patients with BPD in an outpatient clinic specialized on mentalization-based treatment (MBT). The MBIs were performed by MBT therapists. Three certified raters scored MBI-RF. Results The interrater reliability was good for MBI-RF. Conclusions The MBI is promising as a BPD-focused method for the assessment of Reflective Functioning.

• Zahl, Kjell-Einar; Pedersen, Geir Arild Feigum; Eikenæs, Ingeborg Helene Ulltveit-Moe; Stänicke, Line Indrevoll; Wilberg, Theresa & Baltzersen, Åse-Line [Show all 11 contributors for this article] (2022). Avoidant and borderline personality disorder patients during the first Covid-19 wave in Norway – a survey-based comparison of therapy changes and patients’ accommodations. Nordic Journal of Psychiatry. ISSN 0803-9488. doi: 10.1080/08039488.2022.2110614. Full text in Research Archive Show summary

  Background Patients with personality disorders (PDs) often have insecure attachment patterns and may be especially vulnerable to abrupt treatment changes. Patients with borderline PD (BPD) are often considered vulnerable to treatment interruption due to chronic fear of abandonment. Nonetheless, other PDs are poorly investigated. In the first Covid-19 wave in Norway, in-person treatment facilities and group treatments were strongly restricted from March 12th until May/June 2020. Objectives To examine and compare changes in outpatient treatment for patients with avoidant (AvPD) and BPD during the first Covid-19 wave in Norway, and patients’ reactions to these changes. Methods The study is based on a cross-sectional survey distributed to 1120 patients referred to 12 different PD treatment units on a specialist mental health service level within the Norwegian Network for Personality Disorders. The survey included questions on treatment situation, immediate reactions, and changes during the crisis. From 133 responders (response rate 12%), 40 patients reported BPD and 30 AvPD as diagnosis. Results All patients were followed up from their therapist after March 12th. Almost all patients in both groups expressed satisfaction under the new circumstances. Both groups experienced the same regularity as before, but more AvPD patients reported less than weekly consultations. AvPD patients reported more negative feelings about changes in therapy, and missed the therapy and group members more than the BPD group. Conclusion After the lockdown, BPD patients received a closer follow-up than AvPD patients, and the latter reported more negative feelings related to change in their treatment situation.

• Hummelen, Benjamin; Eikenæs, Ingeborg Helene Ulltveit-Moe & Wilberg, Theresa (2022). Is the Alternative Model for Personality Disorders Able to Capture Avoidant Personality Disorder According to Section II of the DSM–5? A Systematic Review. Personality Disorders: Theory, Research, and Treatment. ISSN 1949-2715. 13(4), p. 412–417. doi: 10.1037/per0000553. Full text in Research Archive
• Stänicke, Line Indrevoll; Arnevik, Espen Ajo; Pettersen, Mona Skjeklesæther; Baltzersen, Åse-Line; Zahl, Kjell-Einar & Eikenæs, Ingeborg Helene Ulltveit-Moe [Show all 9 contributors for this article] (2022). The importance of feeling remembered during the Covid-19 crisis–A qualitative study of experiences among patients with personality disorders. Nordic Psychology. ISSN 1901-2276. doi: 10.1080/19012276.2022.2062038. Full text in Research Archive
• 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.

• Pettersen, Mona Skjeklesæther; Moen, Anne; Børøsund, Elin & Wilberg, Theresa (2021). Therapists’ experiences with mentalization-based treatment for avoidant personality disorder. European Journal for Qualitative Research in Psychotherapy (EJQRP). 11, p. 143–159. Full text in Research Archive Show summary

  Recent research points to significant mentalizing difficulties in individuals with avoidant personality disorder (AvPD). A mentalization-based approach in psychotherapy with avoidant patients is emerging. The aim of this study is to contribute to an understanding of the therapeutic issues such work might entail with our research questions being: a) What are therapists’ experiences of using mentalization-based treatment (MBT) to treat patients with an AvPD diagnosis? and b) What do therapists perceive as therapeutic challenges when conducting MBT with avoidant patients? Semi-structured, in-depth interviews were conducted with six therapists from a MBT team treating patients with AvPD. The data were analyzed using thematic analysis. Two main themes emerged. The first ‘Scarcity of explicit personal narratives’ encompasses ‘Engaging the withdrawn patient’ and ‘Capitalizing on the treatment structure’. The second main theme – ‘On being a patient’ - incorporates ‘Stimulating but emotionally challenging work’ and ‘Making use of experience with other therapeutic approaches’. Participants’ responses about their experience suggests that MBT targets much of the AvPD core pathology. The use of some techniques, however, warrants active consideration, and there may be a need to adjust MBT treatment for use with AvPD patients. Our study reveals more nuances in therapists’ emotional reactions than earlier reported. Future studies should investigate the effect of MBT on AvPD patients and examine treatment processes and interventions that may facilitate change.

• Paap, Muirne C. S.; Heltne, Aleksander; Pedersen, Geir Feigum; Selvik, Sara Germans; Frans, Niek & Wilberg, Theresa [Show all 7 contributors for this article] (2021). More Is More: Evidence for the Incremental Value of the SCID-II/SCID-5-PD Specific Factors Over and Above a General Personality Disorder Factor. Personality Disorders: Theory, Research, and Treatment. ISSN 1949-2715. 13(2), p. 108–118. doi: 10.1037/per0000426. Full text in Research Archive Show summary

  Currently, 3 competing conceptualizations of personality dysfunction can be distinguished: the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM–5) categorical model delineating 10 distinct types of personality disorders (PDs); the alternative model for PDs (DSM–5 Section III), which assesses personality functioning and traits separately; and the International Classification of Diseases, 11th Version conceptualization, which provides 1 single code for the presence of a PD (which is based on problems in functioning) as well as codes that specify the level of the disorder (mild/moderate/severe), and prominent trait domains or patterns (5 domains and 1 pattern). The current study aims to assess the incremental value of the DSM–5 PDs over and above a global personality dysfunction factor, using expert ratings obtained with the Structured Clinical Interview for DSM–IV PDs and the Structured Clinical Interview for DSM–5 PDs interview in a large sample of clinical patients (N = 3,851). All estimated bifactor models provided adequate fit to the data. We found a surprisingly low explained common variance for the g-factor (<40%), indicating that ignoring the specific PD factors would lead to a substantial loss of information. The strongest specific PDs in terms of explained common variance were the avoidant, schizotypal, and schizoid PD factors and the conduct disorder criteria set if included. Correlations between our factors and external variables were relatively low, except for the Severity Indices of Personality Problems, which aims to measure personality functioning. Our findings suggest that specific PDs still have an important role to play in the assessment of personality pathology.

• Pedersen, Geir Feigum; Kvarstein, Elfrida Hartveit; Wilberg, Theresa; Folmo, Espen; Burlingame, Gary M. & Lorentzen, Steinar (2021). The Group Questionnaire (GQ)—Psychometric Properties Among Outpatients With Personality Disorders. Group Dynamics. ISSN 1089-2699. doi: 10.1037/gdn0000176. Full text in Research Archive Show summary

  Objective: Relational and emotional vulnerability represent essential problems among patients with personality disorder (PD). Group psychotherapy is a central component of evidence-based PD treatments. Generally, patient and therapist interrelationships predict improvement in therapy. However, although treatment of patients with PD is a more complex process, group processes are poorly elaborated in PD research. Documentation of the psychometric quality of group process measures in PD samples is an important precursor of such research. The Group Questionnaire—GQ is based on concepts of group cohesion and climate, empathy, and alliance and aims to capture the quality of member–member, member–group, and member–leader relationships in group therapy. A three latent factor structure (positive bond, positive work, and negative relationship) has generally been supported. This study aimed to perform a psychometric analysis of GQ administered in a clinical population of patients with PD. Method: The study included 369 patients with PDs attending group psychotherapy in 14 outpatient treatment units on a specialist mental health service level within the Norwegian Network of Personality Disorders in the period 2017–2020. Psychometric analyses included three latent factors and eight subfacets. Results: The three latent factors, positive bond, positive work, and negative relationship, were replicated. Psychometric integrity of the tripartite relationship structure—member–member, member–group, and member–leader, with eight subfacets, was supported. Conclusion: The GQ with three latent factors and eight subfacets can be recommended for future research and clinical practice in patient populations with PD.

• 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.

• Kvarstein, Elfrida Hartveit; Zahl, Kjell_Einar; Stänicke, Line Indrevoll; Pettersen, MS; Baltzersen, Åse-Line & Johansen, Merete Selsbakk [Show all 11 contributors for this article] (2021). Vulnerability of personality disorder during COVID-19 crises: a multicenter survey of mental and social distress among patients referred to treatment. Nordic Journal of Psychiatry. ISSN 0803-9488. doi: 10.1080/08039488.2021.1942980. Full text in Research Archive Show summary

  Background Relational and emotional problems, dysregulation, self-harming or substance abuse often characterize personality disorders (PD). In Norway, COVID-19 restrictions led to an abrupt shutdown of services from 12 March 2020 also including specialized PD treatments. Aims The objective of this study was to investigate social and mental distress among patients with PDs during the first COVID-19 wave. Design A survey was distributed after the first COVID-19 wave (June–October 2020) among 1120 patients from 12 PD treatment units. Results The response rate was 12% (N = 133). The survey reflected impairment of occupational activity (53% <50% activity last 6 months), life quality (EQ-5D-VAS: 56, SD 19), and personality functioning (LPFS-BF ≥12: 81%, 35% avoidant PD, 44% borderline PD) and high levels of depression and anxiety (PHQ-9 ≥ 10: 84%, GAD-7 ≥ 10: 68%), 49% with health-related anxiety. Problem increase was reported for anxiety (28%), depression (24%), aggression (23%), substance use (14%), and 70% of parents had more child-care difficulties. Self-destructive behaviors (26%) did not increase. The majority (78%) reported increased or unchanged social isolation and loneliness. Occupational activity declined with negative effects on part-time jobs/rehabilitation. Therapist contact was mainly telephone-based (63% ≥ weekly contact). More severe personality problems, current depressive symptoms, and self-harming before 12 March were associated with more frequent consultations. Conclusion The survey confirms severe, enhanced levels of mental distress among patients receiving telephone-based consultations as the main alternative to specialized PD treatment during the COVID-19 shutdown. The most vulnerable patients received more frequent consultations and self-destructive actions did not increase.

• Kvarstein, Elfrida Hartveit; Antonsen, Bjørnar Torske; Klungsøyr, Ole; Pedersen, Geir Arild Feigum & Wilberg, Theresa (2021). A Longitudinal, Observational Study Investigating Predictors of Change in a Clinical Sample. Personality Disorders: Theory, Research, and Treatment. ISSN 1949-2715. doi: 10.1037/per0000471. Full text in Research Archive
• Pedersen, Geir Arild Feigum; Normann, Eivind; Eikenæs, Ingeborg Helene Ulltveit-Moe; Kvarstein, Elfrida Hartveit & Wilberg, Theresa (2021). Psychometric evaluation of the Norwegian Toronto Alexithymia Scale (TAS-20) in a multi-site clinical sample of patients with personality disorders and personality problems. Journal of Clinical Psychology. ISSN 0021-9762. doi: 10.1002/jclp.23270. Full text in Research Archive Show summary

  Objective Psychometric properties of 20-item Toronto Alexithymia Scale (TAS-20) have been widely analyzed, but the validity and psychometric qualities of the TAS-20 in populations with personality disorders are still poorly understood. The aim of the current study was to analyze the factor structure and validity of TAS-20. Method Data were extracted from a multisite clinical sample of patients with personality disorders or personality-related problems referred to specialist mental health services in Norway. Results With one exception, TAS-20 revealed acceptable psychometric properties. Variations of TAS-20 are associated with other clinical measures of distress and severity. Anxiety disorders, borderline, and avoidant personality disorders were all highly related to levels of TAS-20. The TAS-20 also revealed unique variance not accounted for by subjective distress, symptom disorders, or dysfunctional personality traits. Conclusion The TAS-20 is a relevant instrument for use in assessment of personality disorders, but one subscale should be improved.

• Kvarstein, Elfrida Hartveit; Zahl, Kjell_Einar; Stänicke, Line Indrevoll; Pettersen, Mona Skjeklesæther; Baltzersen, Åse-Line & Johansen, Merete Selsbakk [Show all 11 contributors for this article] (2021). Vulnerability of personality disorder during the Covid-19 crises – a multicenter survey of treatment experiences among patients referred to treatment. Nordic Journal of Psychiatry. ISSN 0803-9488. 76(1), p. 52–63. doi: 10.1080/08039488.2021.1934110. Full text in Research Archive Show summary

  <p>Background: The societal shutdown due to the Covid-19 pandemic involved mental health services for personality disorder (PD) and was introduced from 12 March 2020 in Norway. Rapid implementa- tion of treatment modifications was required for patients typically characterized by insecure attach- ment and vulnerability to separation. <p>Aim: To investigate immediate reactions to the shutdown of services; alternative treatment received; and differences related to age in a clinical sample of patients with PD. <p>Design: A survey performed from June to October 2020 (after the first Covid-19 wave) among 1120 patients from 12 units offering comprehensive group-based PD programs. <p>Results: The response-rate was 12% (N¼133). Negative feelings of anxiety, sadness, and helplessness were noteworthy immediate reactions, but the dominating attitude was accommodation. Younger patients (<26 years) reported more skepticism and less relief. Modified treatment was mainly tele- phone therapy. Digital therapy was less available, but was more frequent among younger patients. A minority received digital group therapy. Most patients rated the frequency and quality of modified treatments as satisfactory in the given situation, but also worried about own treatment progress, lack of group therapy, and 47% missed seeing the therapist when having telephone consultations. <p>Conclusion: The survey confirms a radical modification from comprehensive group-based PD pro- grams to telephone consultations, low availability of digital consultations and group treatments. Taking a short-term, first wave perspective, the survey indicates a noteworthy capacity among poorly functioning patients for accommodating to a clearly challenging situation, as well as considerable con- cern about treatment progress.

• 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.

• Kvarstein, Elfrida H; Folmo, Espen; Antonsen, Bjørnar Torske; Normann, Eivind; Pedersen, Geir & Wilberg, Theresa (2020). Social Cognition Capacities as Predictors of Outcome in Mentalization-Based Treatment (MBT). Frontiers in Psychiatry. 11, p. 1–12. doi: 10.3389/fpsyt.2020.00691. Full text in Research Archive Show summary

  Background: Mentalization-based treatment (MBT) is an evidence-based treatment for borderline personality disorder (BPD). Differences in treatment outcomes related to specific capacity of social cognition need further attention. This study aimed to investigate social cognition as a predictor of outcome. Method: The study included 31 BPD patients who completed a test of social cognition (Movie for the Assessment of Social Cognition, MASC) before outpatient MBT. The MASC-scores indicated a person’s theory of mind (ToM) and different error-types. During treatment repeated self-reports of alliance and clinical outcomes (symptoms, interpersonal problems, social functioning) were applied. Longitudinal analyses were based on Linear Mixed Models (n = 24). Results: The most frequent error-type was excessive ToM (hypermentalizing). Higher levels of excessive ToM were associated with greater improvement of alliance over time and good clinical outcomes. Insufficient ToM errors and low levels of accurate cognitive ToM responses were both associated with poorer improvement over time. The subgroup with frequent insufficient ToM errors had a larger total number of ToM errors. Insufficient ToM errors were associated with more childhood trauma, comorbid avoidant PD traits and/or PTSD, extensive prior treatment, and/or treatment irregularity. Conclusion: This study demonstrates considerable variation of social cognitive capacity among BPD patients and good outcomes for patients with mainly ToM errors of hypermentalizing. It also indicates that poorly responding patients may represent a cohort with more complex problems of social cognition and insufficient mentalizing.

• Simonsen, Sebastian; Eikenæs, Ingeborg Helene Ulltveit-Moe; Bach, Bo; Kvarstein, Elfrida H; Gondan, Matthias & Møller, Stine Bjerrum [Show all 7 contributors for this article] (2020). Level of alexithymia as a measure of personality dysfunction in avoidant personality disorder. Nordic Journal of Psychiatry. ISSN 0803-9488. doi: 10.1080/08039488.2020.1841290. Full text in Research Archive
• Sørensen, Kristine Dahl; Wilberg, Theresa; Berthelsen, Eivind & Råbu, Marit (2020). Subjective experience of the origin and development of avoidant personality disorder. Journal of Clinical Psychology. ISSN 0021-9762. doi: 10.1002/jclp.23013. Full text in Research Archive Show summary

  Objective To better understand how persons diagnosed with avoidant personality disorder (AVPD) make sense of the origin and development of their current everyday struggles. Methods Persons with AVPD (N = 15) were interviewed twice using semi‐structured qualitative interviews, which were analyzed through interpretative‐phenomenological analysis. Persons with the first‐hand experience of AVPD were included in the research. Results The superordinate theme, “a story of becoming forlorn,” encompassed three main themes: “it goes all the way back to when I was little,” “there was a distance between others and me,” and “transitions made it worse.” Conclusions Though the results are not necessarily specific to AVPD, the findings clarify how people with AVPD can make sense of their current struggles by constructing developmental life stories in the interplay between themselves as persons and the growing demands of their social world. Furthermore, childhood relational vulnerabilities may challenge the ongoing development of social cognition and skills.

• Kvarstein, Elfrida Hartveit; Folmo, Espen Jan; Antonsen, Bjørnar Torske; Norman-Eide, Eivind; Pedersen, Geir Arild Feigum & Wilberg, Theresa (2020). Social Cognition Capacities as Predictors of Outcome in Mentalization-Based Treatment (MBT). Frontiers in Psychiatry. doi: 10.3389/fpsyt.2020.00691. Full text in Research Archive
• Breivik, Randi; Wilberg, Theresa; Evensen, Julie Horgen; Røssberg, Jan Ivar; Dahl, Hanne-Sofie Johnsen & Pedersen, Geir Feigum (2020). Countertransference feelings and personality disorders: a psychometric evaluation of a brief version of the Feeling Word Checklist (FWC-BV). BMC Psychiatry. 20(1), p. 1–12. doi: 10.1186/s12888-020-02556-6. Full text in Research Archive Show summary

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

• Paap, Muirne C.S.; Hummelen, Benjamin; Braeken, Johan; Arnevik, Espen Kristian Ajo; Walderhaug, Espen & Wilberg, Theresa [Show all 9 contributors for this article] (2020). A multi-center psychometric evaluation of the Severity Indices of Personality Problems 118 (SIPP-118): Do we really need all those facets? Quality of Life Research. ISSN 0962-9343. 30(2), p. 567–575. doi: 10.1007/s11136-020-02654-8. Full text in Research Archive Show summary

  Abstract Purpose The Severity Indices of Personality Problems 118 (SIPP-118) is a self-report questionnaire that aims to measure core components of (mal)adaptive personality functioning that can change over time. In this study, we aimed to assess the facet strength of the 16 facets across three large clinical samples. Methods Data from Norwegian and Dutch psychiatric patients were analyzed in this international multi-center study (N 1 = 2814, N 2 = 4751, N 3 = 2217). Bi-factor modeling was used to assess to what degree the SIPP items tap into an overall general factor. The incremental value (distinctiveness) of the facets was studied using proportional reduction in mean squared error (PRMSE) based statistics. Results The estimated model showed adequate fit. The explained common variance (ECV) attributable to the general factor equaled 50% for all three samples. All but two facets (stable self-image and frustration tolerance) showed sufficient levels of distinctiveness. The findings were observed to be comparable across the three samples. Conclusion Our findings showed that the general factor was relatively weak, and the facets had a clear incremental value.

• Normann, Eivind; Antonsen, Bjørnar Torske; Kvarstein, Elfrida H; Pedersen, Geir Feigum; Vaskinn, Anja & Wilberg, Theresa (2019). Are impairments in theory of mind specific to borderline personality disorder? Journal of Personality Disorders. ISSN 0885-579X. 34(6), p. 827–841. doi: 10.1521/pedi_2019_33_417. Full text in Research Archive Show summary

  Impaired theory of mind (ToM) is an assumed feature of borderline personality disorder (BPD). Yet, no studies have compared ToM abilities in patients with BPD, other personality disorders, and healthy controls, or investigated the relationship between ToM and severity of psychopathology and interpersonal problems. In this study, ToM was investigated by the Movie for the Assessment of Social Cognition. No differences were found between the three groups in overall ToM abilities. The BPD group was, however, characterized by more excessive ToM (interpreted as hypermentalization). Yet, when differentiating between BPD and further severity indicators, excessive ToM was not specifically associated with a BPD diagnosis per se. Finally, there was a moderate association between hypermentalization and interpersonal problems in the BPD group. This study suggests that BPD patients tend to hypermentalize when they misinterpret social information, and that this tendency is related to the severity of their psychopathology.

• Arnevik, Espen Kristian Ajo; Pedersen, Geir Feigum; Walderhaug, Espen; Lien, Ingebjørg Aspeland; Wilberg, Theresa & Hummelen, Benjamin (2019). Measuring personality problems in patients with substance use disorders: A cross-sample validation. Journal of Dual Diagnosis (JDD). ISSN 1550-4263. 15(4), p. 324–332. doi: 10.1080/15504263.2019.1668583. Full text in Research Archive
• Kvarstein, Elfrida H; Pedersen, Geir Feigum; Folmo, Espen; Urnes, Øyvind; Hummelen, Benjamin & Wilberg, Theresa [Show all 8 contributors for this article] (2019). Mentalization-based treatment or psychodynamic treatment programs for patients with borderline personality disorder – the impact of clinical severity. Psychology and Psychotherapy: Theory, Research and Practice. ISSN 1476-0835. 92(1), p. 91–111. doi: 10.1111/papt.12179. Full text in Research Archive Show summary

  Objectives: Mentalization‐based treatment (MBT), originally designed for patients with borderline personality disorder (BPD), may be particularly indicated for severe conditions. However, there is limited documentation of how increasing severity of personality disorder (PD) effect outcomes of highly specialized treatments. This study aimed to investigate associations between clinical severity and outcomes for patients in MBT as compared to a psychodynamic group‐based treatment programme (PDT). Methods: The sample included 345 patients with BPD (PDTn = 281, MBTn = 64). The number of diagnosed PDs, PD criteria, and symptom disorders were chosen as baseline indicators of clinical severity. Clinical outcomes (global functioning, symptom distress, interpersonal problems) were repeatedly assessed over three years. Therapists’ fidelity to MBT was satisfactory. Linear mixed models were the applied statistics. Results: In PDT, greater clinical severity was associated with poorer improvement rates. Clinical severity was not associated with significant differences in outcomes for patients in MBT. Differences in outcomes for patients in MBT and PDT increased significantly with higher severity of disorder. Conclusions: Supporting previous research, this study indicates that clinical benefits associated with MBT also apply for BPD patients with severe conditions. The results also suggest that increasing severity was a challenge in PDT.

• Sørensen, Kristine Dahl; Wilberg, Theresa; Berthelsen, Eivind & Råbu, Marit (2019). Lived Experience of Treatment for Avoidant Personality Disorder: Searching for Courage to Be. Frontiers in Psychology. 10. doi: 10.3389/fpsyg.2019.02879. Full text in Research Archive Show summary

  Objective: To inquire into the subjective experience of treatment by persons diagnosed with avoidant personality disorder. Methods: Persons with avoidant personality disorder (n = 15) were interviewed twice, using semi-structured in-depth interviews, and the responses subject to interpretative-phenomenological analysis. Persons with first-hand experience of avoidant personality disorder were included in the research process. Results: The super ordinate theme emerging from the interviews, “searching for courage to be” encompassed three main themes: “seeking trust, strength, and freedom,” “being managed,” and “discovering the possibility for change and development.” The main theme, “being managed,” included the subthemes: “getting a diagnosis,” “receiving medication,” and “attending therapy.” Conclusion: Although this may not be specific to avoidant personality disorder, the findings highlight the importance of being met inter-subjectively as a person with intentionality and agency, even when one does not feel like one. The importance of establishing an emotional bond and emergent trust for open therapeutic collaboration, learning, and becoming able to build courage to begin to approach that which one fears is emphasized.

• Simonsen, Sebastian; Bateman, Anthony; Bohus, Martin; Dalewijk, Henk-Jan; Doering, Stephan. & Kaera, Andres [Show all 12 contributors for this article] (2019). European guidelines for personality disorders: past, present and future. Borderline Personality Disorder and Emotion Dysregulation. doi: 10.1186/s40479-019-0106-3. Full text in Research Archive Show summary

  Personality disorders (PD) are common and burdensome mental disorders. The treatment of individuals with PD represents one of the more challenging areas in the field of mental health and health care providers need evidence-based recommendations to best support patients with PDs. Clinical guidelines serve this purpose and are formulated by expert consensus and/or systematic reviews of the current evidence. In this review, European guidelines for the treatment of PDs are summarized and evaluated. To date, eight countries in Europe have developed and published guidelines that differ in quality with regard to recency and completeness, transparency of methods, combination of expert knowledge with empirical data, and patient/service user involvement. Five of the guidelines are about Borderline personality disorder (BPD), one is about antisocial personality disorder and three concern PD in general. After evaluating the methodological quality of the nine European guidelines from eight countries, results in the domains of diagnosis, psychotherapy and pharmacological treatment of PD are discussed. Our comparison of guidelines reveals important contradictions between recommendations in relation to diagnosis, length and setting of treatment, as well as the use of pharmacological treatment. All the guidelines recommend psychotherapy as the treatment of first choice. Future guidelines should rigorously follow internationally accepted methodology and should more systematically include the views of patients and users.

• Sørensen, Kristine Dahl; Råbu, Marit; Wilberg, Theresa & Berthelsen, Eivind (2018). Struggling to be a person: Lived experience of avoidant personality disorder. Journal of Clinical Psychology. ISSN 0021-9762. 1(17), p. 1–17. doi: 10.1002/jclp.22740. Full text in Research Archive
• Mehlum, Lars; Bateman, Anthony; Dalewijk, Henk-Jan; Doering, Stephan.; Kaera, Andres & Moran, Paul [Show all 11 contributors for this article] (2018). Building a strong European alliance for personality disorder research and intervention. Borderline Personality Disorder and Emotion Dysregulation. doi: 10.1186/s40479-018-0082-z. Full text in Research Archive
• Pedersen, Geir Feigum; Urnes, Øyvind; Hummelen, Benjamin; Wilberg, Theresa & Kvarstein, Elfrida H (2018). Revised manual for the Global Assessment of Functioning scale. European psychiatry. ISSN 0924-9338. 51, p. 16–19. doi: 10.1016/j.eurpsy.2017.12.028. Full text in Research Archive
• Simonsen, Sebastian; Eikenæs, Ingeborg Helene; Nørgaard, Nana Lund; Normann, Eivind; Juul, Sophie & Wilberg, Theresa (2018). Specialized Treatment for Patients with Severe Avoidant Personality Disorder: Experiences from Scandinavia. Journal of Contemporary Psychotherapy. ISSN 0022-0116. p. 1–12. doi: 10.1007/s10879-018-9395-x. Full text in Research Archive
• Johansen, Merete Selsbakk; Karterud, Sigmund; Normann, Eivind; Rø, Frida Gullestad; Kvarstein, Elfrida H & Wilberg, Theresa (2018). The relationship between reflective functioning and affect consciousness in patients with avoidant and borderline personality disorders. Psychoanalytic psychology. ISSN 0736-9735. 35(4), p. 382–393. doi: 10.1037/pap0000169. Full text in Research Archive
• Wilberg, Theresa (2018). The neurobiological basis of avoidant personality disorder. In Schmahl, Christian; Phan, K. Luan & Friedel, Robert O. (Ed.), Neurobiology of personality disorders. Oxford University Press. ISSN 9780199362318. doi: 10.1093/med/9780199362318.003.0015. Full text in Research Archive
• Paap, Muirne C. S.; Braeken, Johan; Pedersen, Geir Feigum; Urnes, Øyvind; Karterud, Sigmund & Wilberg, Theresa [Show all 7 contributors for this article] (2017). A Psychometric Evaluation of the DSM-IV Criteria for Antisocial Personality Disorder: Dimensionality, Local Reliability, and Differential Item Functioning Across Gender. Assessment (ASM). ISSN 1073-1911. doi: 10.1177/1073191117745126. Full text in Research Archive Show summary

  This study aims at evaluating the psychometric properties of the antisocial personality disorder (ASPD) criteria in a large sample of patients, most of whom had one or more personality disorders (PD). PD diagnoses were assessed by experienced clinicians using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Axis II PDs. Analyses were performed within an item response theory framework. Results of the analyses indicated that ASPD is a unidimensional construct that can be measured reliably at the upper range of the latent trait scale. Differential item functioning across gender was restricted to two criteria and had little impact on the latent ASPD trait level. Patients fulfilling both the adult ASPD criteria and the conduct disorder criteria had similar latent trait distributions as patients fulfilling only the adult ASPD criteria. Overall, the ASPD items fit the purpose of a diagnostic instrument well, that is, distinguishing patients with moderate from those with high antisocial personality scores.

• Klungsøyr, Ole; Antonsen, Bjørnar Torske & Wilberg, Theresa (2017). Contours of a causal feedback mechanism between adaptive personality and psychosocial function in patients with personality disorders: A secondary analysis from a randomized clinical trial. BMC Psychiatry. 17:210, p. 1–13. doi: 10.1186/s12888-017-1365-4. Full text in Research Archive Show summary

  Background Patients with personality disorders commonly exhibit impairment in psychosocial function that persists over time even with diagnostic remission. Further causal knowledge may help to identify and assess factors with a potential to alleviate this impairment. Psychosocial function is associated with personality functioning which describes personality disorder severity in DSM-5 (section III) and which can reportedly be improved by therapy. Methods The reciprocal association between personality functioning and psychosocial function was assessed, in 113 patients with different personality disorders, in a secondary longitudinal analysis of data from a randomized clinical trial, over six years. Personality functioning was represented by three domains of the Severity Indices of Personality Problems: Relational Capacity, Identity Integration, and Self-control. Psychosocial function was measured by Global Assessment of Functioning. The marginal structural model was used for estimation of causal effects of the three personality functioning domains on psychosocial function, and vice versa. The attractiveness of this model lies in the ability to assess an effect of a time – varying exposure on an outcome, while adjusting for time – varying confounding. Results Strong causal effects were found. A hypothetical intervention to increase Relational Capacity by one standard deviation, both at one and two time-points prior to assessment of psychosocial function, would increase psychosocial function by 3.5 standard deviations (95% CI: 2.0, 4.96). Significant effects of Identity Integration and Self-control on psychosocial function, and from psychosocial function on all three domains of personality functioning, although weaker, were also found. Conclusion This study indicates that persistent impairment in psychosocial function can be addressed through a causal pathway of personality functioning, with interventions of at least 18 months duration.

• Pedersen, Geir Feigum; Arnevik, Espen Kristian; Hummelen, Benjamin; Walderhaug, Espen & Wilberg, Theresa (2017). Psychometric properties of the severity indices of personality problems (sipp) in two samples a norwegian community sample and clinical samples of patients with and without personality disorders. European Journal of Psychological Assessment. ISSN 1015-5759. 35(5), p. 698–711. doi: 10.1027/1015-5759/a000436. Full text in Research Archive Show summary

  This study investigated psychometric properties of a dimensional measure of maladaptive core pathology for personality disorders, the Severity Indices of Personality Problems (SIPP). The study analyzed data from 941 respondents in a community sample, 949 psychiatric patients with Personality Disorders (PD), and 413 psychiatric patients without PD in Norway. The facets of SIPP had acceptable internal consistency, but the construct validity of some facets had potentials for improvement. The original SIPP domains (the factor structures of the facets) were not supported, and factor analysis gave different results across the three current study samples. All facets of SIPP have good discriminative properties with respect to differentiating between a nonclinical sample, a clinical sample without PD, and a clinical PD sample. Further research and improvements in SIPP are suggested.

• Pedersen, Geir Feigum; Kvarstein, Elfrida H & Wilberg, Theresa (2017). The Work and Social Adjustment Scale: Psychometric properties and validity among males and females, and outpatients with and without personality disorders. Personality and Mental Health. ISSN 1932-8621. 11(4), p. 215–228. doi: 10.1002/pmh.1382. Full text in Research Archive
• Antonsen, Bjørnar Torske; Kvarstein, Elfrida H; Urnes, Øyvind; Hummelen, Benjamin; Karterud, Sigmund & Wilberg, Theresa (2017). Favourable outcome of long-term combined psychotherapy for patients with borderline personality disorder: Six-year follow-up of a randomized study. Psychotherapy Research. ISSN 1050-3307. 27(1), p. 51–63. doi: 10.1080/10503307.2015.1072283. Full text in Research Archive Show summary

  Objective: This study reports the six-year follow-up data of patients with borderline personality disorder (BPD) who participated in the Ullevål Personality Project (UPP), a randomized clinical study comparing outpatient individual psychotherapy (OIP) with a long-term combination programme (CP) comprising short-term day-hospital treatment followed by outpatient combined group and individual psychotherapy. Methods: For 52 patients, outcomes were evaluated after 8 months, 18 months, 3 years, and 6 years based on a wide range of clinical measures, such as symptom severity, psychosocial functioning, personality functioning, and Axis-I and II diagnoses. Results: At the six-year follow-up, patients in the CP condition reported significantly greater reduction of symptom distress and improvements in the personality functioning domains Identity Integration and Self-control compared with patients allocated to OIP. Patients in the CP also had a more favourable long-term course of psychosocial functioning. There were no differences between treatment conditions in outcomes of interpersonal functioning and self-esteem. Conclusions: Long-term psychotherapy in a combination programme seems favourable for BPD patients. In this study, patients who received combined treatment fared better on crucial parameters than patients who received individual therapy. Of particular importance are the positive effects on fundamental borderline problem areas like Identity Integration and Self-control.

• Kvarstein, Elfrida H; Nordviste, Ola; Dragland, Lone Irene & Wilberg, Theresa (2016). Outpatient psychodynamic group psychotherapy – outcomes related to personality disorder, severity, age and gender. Personality and Mental Health. ISSN 1932-8621. 11(1), p. 37–50. doi: 10.1002/pmh.1352. Full text in Research Archive
• Karterud, Sigmund; Pedersen, Geir Feigum; Johansen, Merete; Wilberg, Theresa; Davis, Ken & Pankseep, Jaak (2016). Primary emotional traits in patients with personality disorders. Personality and Mental Health. ISSN 1932-8621. 10(10), p. 261–273. doi: 10.1002/pmh.1345. Full text in Research Archive
• Antonsen, Bjørnar Torske; Johansen, Merete Selsbakk; Rø, Frida Gullestad; Kvarstein, Elfrida H & Wilberg, Theresa (2016). Is reflective functioning associated with clinical symptoms and long-term course in patients with personality disorders? Comprehensive Psychiatry. ISSN 0010-440X. 64, p. 46–58. doi: 10.1016/j.comppsych.2015.05.016. Full text in Research Archive Show summary

  Objective Mentalization is the capacity to understand behavior as the expression of various mental states and is assumed to be important in a range of psychopathologies, especially personality disorders (PDs). The first aim of the present study was to investigate the relationship between mentalization capacity, operationalized as reflective functioning (RF), and clinical manifestations before entering study treatment. The second aim was to investigate the relationship between baseline RF and long-term clinical outcome both independent of treatment (predictor analyses) and dependent on treatment (moderator analyses). Methods Seventy-nine patients from a randomized clinical trial (Ullevål Personality Project) who had borderline and/or avoidant PD were randomly assigned to either a step-down treatment program, comprising short-term day-hospital treatment followed by outpatient combined group and individual psychotherapy, or to outpatient individual psychotherapy. Patients were evaluated on variables including symptomatic distress, psychosocial functioning, personality functioning, and self-esteem at baseline, 8 and 18 months, and 3 and 6 years. Results RF was significantly associated with a wide range of variables at baseline. In longitudinal analyses RF was not found to be a predictor of long-term clinical outcome. However, when considering treatment type, there were significant moderator effects of RF. Patients with low RF had better outcomes in outpatient individual therapy compared to the step-down program. In contrast, patients in the medium RF group achieved better results in the step-down program. Conclusion These findings indicate that RF is associated with core aspects of personality pathology and capture clinically relevant phenomena in adult patients with PDs. Moreover, patients with different capacities for mentalization may need different kinds of therapeutic approaches.

• Eikenæs, Ingeborg Helene; Pedersen, Geir Feigum & Wilberg, Theresa (2016). Attachment styles in patients with avoidant personality disorder compared with social phobia. Psychology and Psychotherapy: Theory, Research and Practice. ISSN 1476-0835. 89(3), p. 245–260. doi: 10.1111/papt.12075. Full text in Research Archive
• Johansen, Merete Selsbakk; Normann, Eivind; Normann-Eide, Tone; Klungsøyr, Ole; Kvarstein, Elfrida Hartveit & Wilberg, Theresa (2016). Relationship Between Affect Consciousness and Personality Functioning in Patients With Personality Disorders: A Prospective Study. Journal of Personality Disorders. ISSN 0885-579X. 30(5), p. 633–652. doi: 10.1521/pedi_2015_29_220. Full text in Research Archive
• Vaskinn, Anja; Antonsen, Bjørnar Torske; Fretland, Ragnhild Avdem; Dziobek, Isabel; Sundet, Kjetil Søren & Wilberg, Theresa (2015). Theory of mind in women with borderline personality disorder or schizophrenia: differences in overall ability and error patterns. Frontiers in Psychology. doi: 10.3389/fpsyg.2015.01239. Full text in Research Archive Show summary

  Although borderline personality disorder (BPD) and schizophrenia (SZ) are notably different mental disorders, they share problems in social cognition—or understanding the feelings, intentions and thoughts of other people. To date no studies have directly compared the social cognitive abilities of individuals with these two disorders. In this study, the social cognitive subdomain theory of mind was investigated in women with BPD (n = 25), women with SZ (n = 25) and healthy women (n = 25). An ecologically valid video-based measure (Movie for the Assessment of Social Cognition) was used. For the overall score, women with SZ performed markedly below both healthy women and women with BPD, whereas women with BPD did not perform significantly different compared to the healthy control group. A statistically significant error type × group interaction effect indicated that the groups differed with respect to kind of errors. Whereas women with BPD made mostly overmentalizing errors, women with SZ in addition committed undermentalizing errors. Our study suggests different magnitude and pattern of social cognitive problems in BPD and SZ.

• Normann, Eivind; Johansen, Merete Selsbakk; Normann-Eide, Tone; Egeland, Jens & Wilberg, Theresa (2015). Personality Disorder and Changes in Affect Consciousness: A 3-Year Follow-Up Study of Patients with Avoidant and Borderline Personality Disorder. PLOS ONE. 10(12). doi: 10.1371/journal.pone.0145625. Full text in Research Archive
• Pedersen, Geir Feigum; Eikenæs, Ingeborg Helene; Urnes, Øyvind; Skulberg, Guro Mikaelsen & Wilberg, Theresa (2015). Experiences in Close Relationships - Psychometric properties among patients with personality disorders. Personality and Mental Health. ISSN 1932-8621. 9(3), p. 208–219. doi: 10.1002/pmh.1298. Full text in Research Archive Show summary

  Patients with personality disorders represent maladaptive attachment strategies, influencing the quality of their interpersonal relationships. Within these patient populations, it is important to have a measure, easily applied, to assess such strategies. A widely used instrument is Experiences in Close Relationships (ECR), assessing two constructs called avoidance and anxiety. Lately, two short forms of ECR have been proposed, called ECR-S and ECR-N12. The aim of this study is to investigate the psychometric properties of the Norwegian @version of ECR and its two short forms in a sample of patients with mainly personality disorders. An internal consistency and confirmatory factor analysis of ECR, ECR-S and ECR-N12 from 495 patients was conducted, as well as an exploratory factor analysis of ECR. The internal consistency of ECR was found questionable. Confirmatory factor analysis revealed a poor model fit based on ECR and ECR-S. The ECR-N12 revealed a mediocre fit, indicating a potential for improvement. Exploratory factor analysis indicated two different aspects of avoidance and three aspects of anxiety. This five-factor solution was called ECR-FF. Inferences from scores based on ECR should be derived with care. A revision of ECR and ECR-N12 is warranted, and further studies are needed to investigate the validity of ECR-FF.

• Eikenæs, Ingeborg Helene; Egeland, Jens; Hummelen, Benjamin & Wilberg, Theresa (2015). Avoidant personality disorder versus social phobia: The significance of childhood neglect. PLOS ONE. 10(3). doi: 10.1371/journal.pone.0122846. Full text in Research Archive
• Kvarstein, Elfrida Hartveit; Pedersen, Geir Feigum; Urnes, Øyvind; Hummelen, Benjamin; Wilberg, Theresa & Karterud, Sigmund (2015). Changing from a traditional psychodynamic treatment programme to mentalization-based treatment for patients with borderline personality disorder - Does it make a difference? Psychology and Psychotherapy: Theory, Research and Practice. ISSN 1476-0835. 88(1), p. 71–86. doi: 10.1111/papt.12036. Full text in Research Archive
• Lorentzen, Steinar; Wilberg, Theresa & Martinsen, Egil Wilhelm (2015). Group psychotherapy in Norway. International journal of group psychotherapy. ISSN 0020-7284. 65(4), p. 543–551. doi: 10.1521/ijgp.2015.65.4.543. Full text in Research Archive
• Hummelen, Benjamin; Pedersen, Geir Feigum; Wilberg, Theresa & Karterud, Sigmund (2015). Poor validity of the DSM IV schizoid personality disorder construct as a diagnostic category. Journal of Personality Disorders. ISSN 0885-579X. 29(3), p. 334–346. doi: 10.1521/pedi_2014_28_159. Full text in Research Archive
• Antonsen, Bjørnar Torske; Klungsøyr, Ole; Kamps, Anne; Hummelen, Benjamin; Johansen, Merete Selsbakk & Pedersen, Geir Feigum [Show all 10 contributors for this article] (2014). Step-down versus outpatient psychotherapeutic treatment for personality disorders: 6-year follow-up of the Ullevål personality project. BMC Psychiatry. 14(119). doi: 10.1186/1471-244X-14-119. Full text in Research Archive Show summary

  Background Although psychotherapy is considered the treatment of choice for patients with personality disorders (PDs), there is no consensus about the optimal level of care for this group of patients. This study reports the results from the 6-year follow-up of the Ullevål Personality Project (UPP), a randomized clinical trial comparing outpatient individual psychotherapy with a long-term step-down treatment program that included a short-term day hospital treatment followed by combined group and individual psychotherapy. Methods The UPP included 113 patients with PDs. Outcome was evaluated after 8 months, 18 months, 3 years and 6 years and was based on a wide range of clinical measures, such as psychosocial functioning, interpersonal problems, symptom severity, and axis I and II diagnoses. Results At the 6-year follow-up, there were no statistically significant differences in outcome between the treatment groups. Effect sizes ranged from medium to large for all outcome variables in both treatment arms. However, patients in the outpatient group had a marked decline in psychosocial functioning during the period between the 3- and 6-year follow-ups; while psychosocial functioning continued to improve in the step-down group during the same period. This difference between groups was statistically significant. Conclusions The findings suggest that both hospital-based long-term step-down treatment and long-term outpatient individual psychotherapy may improve symptoms and psychosocial functioning in poorly functioning PD patients. Social and interpersonal functioning continued to improve in the step-down group during the post-treatment phase, indicating that longer-term changes were stimulated during treatment. Trial registration NCT00378248 .

• Wilberg, Theresa; Kvarstein, Elfrida Hartveit & Røvik, Jan Ole (2014). Pasienter med personlighetsforstyrrelse i avtalepraksis. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 134(23/24), p. 2267–2271. doi: 10.4045/tidsskr.13.1581. Full text in Research Archive
• Pedersen, Geir Feigum; Johansen, Merete Selsbakk; Wilberg, Theresa & Karterud, Sigmund (2014). Testing different versions of the affective neuroscience personality scales in a clinical sample. PLOS ONE. 9(10). doi: 10.1371/journal.pone.0109394. Full text in Research Archive
• Gullestad, Frida Slagstad; Johansen, Merete Selsbakk; Høglend, Per Andreas; Karterud, Sigmund & Wilberg, Theresa (2013). Mentalization as a moderator of treatment effects: Findings from a randomized clinical trial for personality disorders. Psychotherapy Research. ISSN 1050-3307. 23(6), p. 674–689. doi: 10.1080/10503307.2012.684103. Full text in Research Archive
• Pedersen, Geir Feigum; Karterud, Sigmund; Hummelen, Benjamin & Wilberg, Theresa (2013). The impact of extended longitudinal observation for assessment of personality disorders. Personality and Mental Health. ISSN 1932-8621. 7(4), p. 277–287. doi: 10.1002/pmh.1234. Full text in Research Archive
• Johansen, Merete Selsbakk; Normann, Eivind; Normann-Eide, Tone & Wilberg, Theresa (2013). Emotional dysfunction in avoidant compared to borderline personality disorder: A study of affect consciousness. Scandinavian Journal of Psychology. ISSN 0036-5564. 54(6), p. 515–521. doi: 10.1111/sjop.12076. Full text in Research Archive
• Kvarstein, Elfrida Hartveit; Arnevik, Espen Kristian; Halsteinli, Vidar; Rø, Frida Gullestad; Karterud, Sigmund & Wilberg, Theresa (2013). Health service costs and clinical gains of psychotherapy for personality disorders: a randomized controlled trial of day-hospital-based step-down treatment versus outpatient treatment at a specialist practice. BMC Psychiatry. 13(315). doi: 10.1186/1471-244X-13-315. Full text in Research Archive Show summary

  Background: Day-hospital-based treatment programmes have been recommended for poorly functioning patients with personality disorders (PD). However, more research is needed to confirm the cost-effectiveness of such extensive programmes over other, presumably simpler, treatment formats. Methods: This study compared health service costs and psychosocial functioning for PD patients randomly allocated to either a day-hospital-based treatment programme combining individual and group psychotherapy in a step-down format, or outpatient individual psychotherapy at a specialist practice. It included 107 PD patients, 46% of whom had borderline PD, and 40% of whom had avoidant PD. Costs included the two treatment conditions and additional primary and secondary in- and outpatient services. Psychosocial functioning was assessed using measures of global (observer-rated GAF) and occupational (self-report) functioning. Repeated assessments over three years were analysed using mixed models. Results: The costs of step-down treatment were higher than those of outpatient treatment, but these high costs were compensated by considerably lower costs of other health services. However, costs and clinical gains depended on the type of PD. For borderline PD patients, cost-effectiveness did not differ by treatment condition. Health service costs declined during the trial, and functioning improved to mild impairment levels (GAF > 60). For avoidant PD patients, considerable adjuvant health services expanded the outpatient format. Clinical improvements were nevertheless superior to the step-down condition. Conclusion: Our results indicate that decisions on treatment format should differentiate between PD types. For borderline PD patients, the costs and gains of step-down and outpatient treatment conditions did not differ. For avoidant PD patients, the outpatient format was a better alternative, leaning, however, on costly additional health services in the early phase of treatment.

• Eikenæs, Ingeborg Helene; Hummelen, Benjamin; Abrahamsen, Gun; Andrea, Helene & Wilberg, Theresa (2013). Personality functioning in patients with avoidant personality disorder and social phobia. Journal of Personality Disorders. ISSN 0885-579X. 27(6), p. 746–763. doi: 10.1521/pedi_2013_27_109. Full text in Research Archive
• Normann, Eivind; Johansen, Merete Selsbakk; Normann-Eide, Tone; Egeland, Jens & Wilberg, Theresa (2013). Is low affect consciousness related to the severity of psychopathology? A cross-sectional study of patients with avoidant and borderline personality disorder. Comprehensive Psychiatry. ISSN 0010-440X. 54(2), p. 149–157. doi: 10.1016/j.comppsych.2012.07.003. Full text in Research Archive
• Bakali, Jan Vegard; Wilberg, Theresa; Klungsøyr, Ole & Lorentzen, Steinar (2013). Development of Group Climate in Short- and Long-Term Psychodynamic Group Psychotherapy. International journal of group psychotherapy. ISSN 0020-7284. 63(3), p. 366–393. doi: 10.1521/ijgp.2013.63.3.366. Full text in Research Archive
• Karterud, Sigmund; Pedersen, Pedersen Feigum; Engen, Magnus Johan; Johansen, Merete Selsbakk; Johansson, Paul Niklas & Schlüther, Christian [Show all 9 contributors for this article] (2013). The MBT Adherence and Competence Scale (MBT-ACS): Development, structure and reliability. Psychotherapy Research. ISSN 1050-3307. 23(6), p. 705–717. doi: 10.1080/10503307.2012.708795. Full text in Research Archive
• Gullestad, Frida Slagstad; Wilberg, Theresa; Klungsøyr, Ole; Johansen, Merete Selsbakk; Urnes, Øyvind & Karterud, Sigmund (2012). Is treatment in a day hospital step-down program superior to outpatient individual psychotherapy for patients with personality disorders? 36 months follow-up of a randomized clinical trial comparing different treatment modalities. Psychotherapy Research. ISSN 1050-3307. 22(4), p. 426–441. doi: 10.1080/10503307.2012.662608. Full text in Research Archive
• Wilberg, Theresa (2012). Avoidant personality, cluster A traits and Taijin kyofusho: Deconstructing a treatment resistant socially fearful young man: A commentary on a case by Maruta et al. Personality and Mental Health. ISSN 1932-8621. 6(3), p. 276–278. doi: 10.1002/pmh.1209. Full text in Research Archive
• Gullestad, Frida Slagstad & Wilberg, Theresa (2011). Change in reflective functioning during psychotherapy-A single-case study. Psychotherapy Research. ISSN 1050-3307. 21(1), p. 97–111. doi: 10.1080/10503307.2010.525759. Full text in Research Archive
• Bakali, Jan-Vegard; Wilberg, Theresa; Hagtvet, Knut Arne & Lorentzen, Steinar (2010). Sources accounting for alliance and cohesion at three stages in group psychotherapy: Variance component analyses. Group Dynamics. ISSN 1089-2699. 14(4), p. 368–383. doi: 10.1037/a0019170. Full text in Research Archive
• Arnevik, Espen Kristian; Wilberg, Theresa; Urnes, Øyvind; Johansen, Merete; Monsen, Jon Trygve & Karterud, Sigmund (2010). PSYCHOTHERAPY FOR PERSONALITY DISORDERS: 18 MONTHS' FOLLOW-UP OF THE ULLEVAL PERSONALITY PROJECT. Journal of Personality Disorders. ISSN 0885-579X. 24(2), p. 188–203. Full text in Research Archive
• Arnevik, Espen Kristian; Wilberg, Theresa; Urnes, Øyvind; Johansen, Merete Selsbakk; Monsen, Jon Trygve & Karterud, Sigmund (2010). Psychotherapy for persoality disorders: 18 months' follow-up of the Ullevål Personality Project. Journal of Personality Disorders. ISSN 0885-579X. 24, p. 188–203. doi: 10.1521/pedi.2010.24.2.188. Full text in Research Archive
• Wilberg, Theresa; Karterud, Sigmund; Pedersen, Geir & Urnes, Øyvind (2009). The impact of avoidant personality disorder on psychosocial impairment is substantial. Nordic Journal of Psychiatry. ISSN 0803-9488. 63(5), p. 390–396. doi: 10.1080/08039480902831322. Full text in Research Archive
• Arnevik, Espen Kristian; Wilberg, Theresa; Urnes, Øyvind; Johansen, Merete; Monsen, Jon Trygve & Karterud, Sigmund (2009). Psychotherapy for personality disorders: Short-term day hospital psychotherapy versus outpatient individual therapy - a randomized controlled study. European psychiatry. ISSN 0924-9338. 24(2), p. 71–78. doi: 10.1016/j.eurpsy.2008.09.004. Full text in Research Archive
• Wilberg, Theresa; Karterud, Sigmund; Pedersen, Geir; Urnes, Øyvind & Costa, PT (2009). Nineteen-Month Stability of Revised NEO Personality Inventory Domain and Facet Scores in Patients With Personality Disorders. Journal of Nervous and Mental Disease. ISSN 0022-3018. 197(3), p. 187–195. doi: 10.1097/NMD.0b013e3181923fa0. Full text in Research Archive

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• Wilberg, Theresa & Eikenæs, Ingeborg Helene Ulltveit-Moe (2022). Å ønske, men ikke våge Om engstelig unnvikende personlighetsproblemer. Gyldendal Norsk Forlag A/S. ISBN 9788205554641. 264 p. Full text in Research Archive
• Karterud, Sigmund; Urnes, Øyvind & Wilberg, Theresa (2017). Personlighetspsykiatri. Gyldendal Norsk Forlag A/S. ISBN 9788205494626. 533 p. Full text in Research Archive
• Karterud, Sigmund; Wilberg, Theresa & Urnes, Øyvind (2010). Personlighetspsykiatri. Gyldendal Akademisk. ISBN 9788205392106. 538 p. Full text in Research Archive

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

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

• Sørensen, Kristine Dahl; Wilberg, Theresa & Bremer, Kjetil (2021). Subjective experiences of change after attending a treatment program for avoidant personality disorder. Full text in Research Archive
• Homqvist, Rolf; Nissen-Lie, Helene A; Jørgensen, Carsten René; Broberg, Anders; Gustavsson, Per & Hau, Stephan [Show all 17 contributors for this article] (2017). Enfäldiga riktlinjer för behandling av depression. Full text in Research Archive
• Eikenæs, Ingeborg Helene & Wilberg, Theresa (2011). Essential Differences between Social Phobia and Avoidant Personality Disorder. Journal of Personality Disorders. ISSN 0885-579X. 25, p. 38–38. doi: 10.1521/pedi.2011.25Supplement37. Full text in Research Archive Show summary

  Aims: Avoidant Personality Disorder (APD) is one of the most prevalent personality disorders in clinical settings as well as in the general population. Despite evidence that APD is associated with significant psychosocial impairment and poor treatment progress, there is still little research that focus directly on APD. A main hypothesis is that APD is a more severe form of Social Phobia (SP); the so called “severity continuum hypotheses”, and it is disputed whether APD should be classified as a PD or belong to SP and axis I. However, results from later research does not uniformly support this hypothesis and more studies are needed. This study aims to provide more knowledge about the core pathology of APD and the relationship between APD and SP. Method: It is a cross-sectional multi-site study of 91 patients with SP and/or APD, recruited from units treating PDs or anxiety disorder clinics. They are assessed by diagnostic interviews and self report questionnaires. We will test hypotheses of similarities and differences between APD and SP regarding extent of psychosocial dysfunction, symptoms, and personality functioning. Results: Preliminary results points to substantial differences in self-pathology, in line with the proposal for DSM-V. Conclusions: The final results will be presented and discussed.

• Eikenæs, Ingeborg Helene; Urnes, Øyvind & Wilberg, Theresa (2011). Attachment patterns in patients with Avoidant Personality Disorder. AAI of two cases coded according to the manuals of Mary Main and Patricia McKinsey Crittenden. Full text in Research Archive Show summary

  Aims: To investigate attachment patterns in Avoidant Personality Disorder (APD). APD is one of the most prevalent personality disorders in clinical settings as well as in the general population. Despite evidence that APD is associated with significant psychosocial impairment and poor treatment progress, there is still little research that focuses directly on APD. We assume that Unsecure Attachment and adverse childhood experiences will be predictors of APD. Method: This is a part of a cross-sectional multi-site study of 91 patients with Social Phobia and/or APD, recruited from units treating PDs or anxiety disorder clinics. They are assessed by diagnostic interviews, AAI and self report questionnaires, incl. ECR (Experiences in close relationships). We will use two cases with APD to compare attachment pattern coded according to the manual of Mary Main vs. Patricia M Crittenden Results: Analyses of the Attachment data are in progress. Conclusions: The results will be presented and discussed.

• Eikenæs, Ingeborg Helene; Wilberg, Theresa & Urnes, Øyvind (2011). Experiences in close relationships in patients with Avoidant Personality Disorder and Social Phobia. Full text in Research Archive Show summary

  Aims: Avoidant Personality Disorder (APD) is one of the most prevalent personality disorders in clinical settings as well as in the general population. Despite evidence that APD is associated with significant psychosocial impairment and poor treatment progress, there is still little research that focuses directly on APD. A main hypothesis is that APD is a more severe form of Social Phobia (SP); the so called “severity continuum hypotheses”. However, results from later research do not uniformly support this hypothesis and more studies are needed. This study is part of a project which aims to provide more knowledge about the core pathology of APD and the relationship between APD and SP. We assume that attachment and adverse childhood experiences will be predictors of APD vs SP. The present study focus on experiences in close relationships. Method: A cross-sectional multi-site study of 91 patients with SP and/or APD, recruited from units treating PDs or anxiety disorders. The patients are assessed by diagnostic interviews, AAI and self report questionnaires, incl. ECR. We will test hypotheses of similarities and differences between APD and SP regarding attachment by use of the ECR, a self-report measure of experiences in close relationships. Results: Preliminary results points to substantial differences in self-pathology and interpersonal functioning, in line with the proposal for DSM-5. Analyzes of the Attachment data are in progress. Conclusions: The results will be presented and discussed.

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