Liv Hedley - Academia.edu (original) (raw)

Papers by Liv Hedley

Acta Psychiatrica Scandinavica, 2000

To investigate the relationship between panic attack intensity, catastrophic belief and cognition... more To investigate the relationship between panic attack intensity, catastrophic belief and cognitions. Data from 540 panic diaries were collected from 42 patients with panic disorder with agoraphobia. When we controlled for individual variation, effects of treatment and number of symptoms, catastrophic belief contributed significantly to more intense panic attacks (r2 change = 0.10, P<0.0001). There were no significant differences in panic attack intensity between primary and secondary cognitions. Our results indicate that catastrophic belief is a reliable predictor of panic attack intensity.

Psychiatry Research, 1995

Panic disorder patients with agoraphobia (n = 32) and agoraphobic patients without panic disorder... more Panic disorder patients with agoraphobia (n = 32) and agoraphobic patients without panic disorder (n = 18) who were participants in an inpatient behavioral-psychodynamic treatment program were assessed repeatedly from pretreatment to 2-year posttreatment follow-up. At pretreatment, there were statistical trends for more of the panic with agoraphobia patients to have obsessive-compulsive disorder and alcohol abuse/dependence, and for more of the agoraphobia without panic patients to have generalized anxiety disorder and avoidant personality disorder. There was also a trend for more of the panic with agoraphobia patients to have met criteria for major depression during the 2-year follow-up period.

Psychotherapy Research, 2001

ABSTRACT The authors investigated the relationship among catastrophic cognitions, fear of bodily ... more ABSTRACT The authors investigated the relationship among catastrophic cognitions, fear of bodily sensations, and avoidance in patients undergoing cognitive therapy for panic disorder with agoraphobia to determine which of three theoretical models was most consistent with their data, which were analyzed by structural modeling techniques. The final path model indicated a three-step change process. Beliefs about losing control predicted a fear of bodily sensations. A fear of bodily sensations, in turn, predicted both avoidance and a conviction of a looming physical catastrophe. The results, although preliminary, are consistent with an integrated behavioral and cognitive model for understanding the intratherapeutic relationship among these variables.

Journal of Psychosomatic Research, 2003

Objective: To compare sympathetic activity in agoraphobic patients with and without personality d... more Objective: To compare sympathetic activity in agoraphobic patients with and without personality disorders before and after 11 weeks inpatient treatment. Methods: Agoraphobic patients (n = 38), 84% with panic disorder and 47% with personality disorders underwent cold pressure test (CPT), mental stress test (MST), and a specific anxiety test (SAT). Psychological assessments were done by the Bodily Sensations Questionnaire (BSQ), the Agoraphobic Cognitions Questionnaire (ACQ), Spielberger STAI-1 and -2, and a Stress Test Anxiety (STA) questionnaire. Sympathetic activity was measured by blood pressure, heart rate, epinephrine, and norepinephrine. Results: The sympathetic activity did not differ significantly between patient groups, and the reactivity to stress was very low. The sympathetic reactivity remained unchanged after treatment, whereas psychiatric symptoms decreased. Correlations between sympathetic activity and psychological distress were not significant. Conclusion: Interpretation of bodily signals seems to be more important than the actual sympathetic activity in agoraphobic patients. D

Journal of Personality Disorders, 2004

The criteria for dependent personality disorder (DPD) in DSM-IV appear to fall into two categorie... more The criteria for dependent personality disorder (DPD) in DSM-IV appear to fall into two categories: dependent and attachment behaviors. The relevance of this division was evaluated in a sample of 182 patients admitted to a national Norwegian psychiatric hospital. Principal Components Analysis of all items belonging to the most frequent personality diagnoses revealed six components. The items for DPD formed two components, labeled attachment/abandonment and dependency/incompetence. Two criteria for borderline personality disorder also loaded on the attachment/abandonment component, while six criteria for avoidant personality disorder loaded on the dependency/incompetence component. Early Maladaptive Schemas of abandonment and failure correlated significantly higher with the attachment/abandonment component than with the dependency/incompetence component.

Journal of Behavior Therapy and Experimental Psychiatry, 2008

The purpose of this study was to test the predictions of an integrated cognitive and behavioral m... more The purpose of this study was to test the predictions of an integrated cognitive and behavioral model of agoraphobic avoidance in patients with chronic panic disorder and agoraphobia during the process of observed therapeutic change. Treatment was residential with the majority (n ¼ 165, 88%) receiving cognitive therapy, while the remaining 23 (12%) received guided mastery therapy. The results of latent variable path modeling of the changes occurring over the course of this treatment suggested that the anxiety elicited by bodily sensations influenced catastrophic beliefs, which, in turn, increased avoidance. Avoidance increased the anxiety elicited by bodily sensations. r

Journal of Anxiety Disorders, 1997

The first aim of this study was to examine the relationship between change

Cognitive Therapy and Research, 2005

One thousand and thirty-seven psychiatric patients and non-patients from six different sites comp... more One thousand and thirty-seven psychiatric patients and non-patients from six different sites completed the 205-item Young Schema Questionnaire or its shortended form, the 75-item Young Schema Questionnaire-S. Among 888 of the subjects, who all were patients, a confirmatory factor analysis (CFA) of the 75 items included in both forms of the questionnaire clearly yielded the 15 Early Maladaptive Schema (EMS) factors rationally developed by J. E. . Confirmatory factor analyses, testing three models of the higher-order structure of the 15 EMSs, indicated that a fourfactor model was the best alternative. The results slightly favored a correlated four second-order factor model over one also including a third-order global factor. The four factors or schema domains were Disconnection, Impaired Autonomy, Exaggerated Standards, and Impaired Limits. Scales derived from the four higher-order factors had good internal and test-retest reliabilities and were related to DSM-IV Cluster C personality traits, agoraphobic avoidance behavior, and depressive symptoms.

Cognitive Behaviour Therapy, 2006

The aims of this study were to examine whether therapists&amp... more The aims of this study were to examine whether therapists' emotional reactions to their patients mediate the effect of personality disorders and interpersonal problem behaviours on the outcome of treatment, focusing on an Axis I disorder; and whether therapists' reactions mediate the effect of personality disorders on the course of interpersonal problems. Therapists completed a checklist of emotional reactions to individual patients after the end of residential cognitive or guided mastery therapy for 46 inpatients with panic disorder with agoraphobia. The severity of DSM-III-R personality disorder was related to therapists' insecurity feelings, but not to interest and anger. A higher level of therapists' insecurity feelings was related to less reduction in self-reported agoraphobic avoidance during treatment, whereas therapists' emotions were unrelated to symptomatic course after treatment. Therapists' insecurity feelings appeared partly to mediate the relationship between patients' severity of personality disorder and persistence of patients' interpersonal dominance and nurturance problems.

Clinical Psychology & Psychotherapy, 2009

We examined changes in avoidant and dependent personality disorder dimensions, and pre-treatment ... more We examined changes in avoidant and dependent personality disorder dimensions, and pre-treatment and in-treatment factors associated with such changes in 77 patients, randomized to medication-free residential cognitive (CT) or residential interpersonal therapy for social phobia. Personality disorders and personality dimensions according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) were assessed at pre-treatment and at one-year post-treatment. Both treatments were associated with a decrease in avoidant and dependent personality dimensions; dependent dimension decreased more in CT. Changes in cognitive factors predicted changes in both personality dimensions, whereas changes in symptoms or interpersonal factors did not. Change in the cognitive factor estimated cost was the most powerful predictor in the avoidant dimension, as it was the only predictor that remained signifi cant in the forward regression analyses. Change in the cognitive factor estimated cost, and treatment were the most powerful predictors of change in the dependent dimension. Pre-treatment use of anxiolytics predicted larger changes in both PD dimensions.

Clinical Psychology & Psychotherapy, 2001

Agoraphobia without a history of panic attacks is a disorder lacking strong support. Data from th... more Agoraphobia without a history of panic attacks is a disorder lacking strong support. Data from the Australian National Survey were explored in respect to panic disorder with or without agoraphobia (PDA, PD), and agoraphobia without a history of panic disorder (AG). Panic disorder, agoraphobia, and panic disorder with agoraphobia occurred in 3.5% of the adult population. People with this group of disorders were more likely to be female and more likely to seek help than people with other anxiety disorders. Significant anxiety symptoms and unease about safety when out and about occur in all three disorders. People with the double disorder PDA report more comorbid disorders, are more disabled, and have higher neuroticism scores than people with PD or AG. People with AG are older and consult less than people with PD or PDA. Agoraphobia has been devalued as a cause of human suffering. This idea is wrong. Agoraphobia is as common, comorbid, and disabling as PD, but less disabling than the double disorder of PDA.

Acta Psychiatrica Scandinavica, 2000

To investigate the relationship between panic attack intensity, catastrophic belief and cognition... more To investigate the relationship between panic attack intensity, catastrophic belief and cognitions. Data from 540 panic diaries were collected from 42 patients with panic disorder with agoraphobia. When we controlled for individual variation, effects of treatment and number of symptoms, catastrophic belief contributed significantly to more intense panic attacks (r2 change = 0.10, P<0.0001). There were no significant differences in panic attack intensity between primary and secondary cognitions. Our results indicate that catastrophic belief is a reliable predictor of panic attack intensity.

Acta Psychiatrica Scandinavica, 1994

Patients attending an inpatient phobia treatment program were diagnosed for DSM-III-R Axis I and ... more Patients attending an inpatient phobia treatment program were diagnosed for DSM-III-R Axis I and II disorders, using the Structured Clinical Interview for DSM-III-R Disorders, and completed a set of self-report instruments. They were divided into 3 groups: (a) those who met the criteria for panic disorder with agoraphobia (n = 57), (b) those who met the criteria for agoraphobia without a history of panic disorder (n = 21), and (c) those who met criteria for other anxiety disorders, but not for panic/agoraphobia (n = 14). On Axis I, more of the panic with agoraphobia than of the agoraphobia without panic patients had obsessive-compulsive disorder. On Axis II, no significant differences between the agoraphobic patients with and without panic occurred. However, the number of hysterical traits was related to the presence of panic disorder among the agoraphobic patients. Avoidant and dependent traits were related to symptom severity.

Journal of Affective Disorders, 2015

Background: Little is currently known about predictors of follow-up outcome of psychological trea... more Background: Little is currently known about predictors of follow-up outcome of psychological treatment of agoraphobia. In this study, we wished to examine predictors of short-and long-term avoidance of inpatient group interventions for agoraphobia. Methods: Ninety-six (68%) of 141 agoraphobic patients (74% women) who had completed treatment in two open and one randomized controlled trial (RCT) were followed up 13 to 21 years after start of treatment. Results: Major depression at pre-treatment predicted less short-term (up to one year after end of treatment) improvement in agoraphobic avoidance. Working and being married/cohabiting at pretreatment predicted greater long-term (across one-year, two-year, and 13 to 21 year follow-up) improvement. In contrast, the duration of agoraphobia, amount of Axis I and II co-morbidity, being diagnosed with avoidant, dependent, and obsessive-compulsive personality disorder, and the use of antidepressants and benzodiazepines the month before intake to treatment, were unrelated to shortterm as well as long-term outcome. Limitations: As many as 31.9% of the included patients did not attend long-term follow-up and the power of the study was limited. The long time period between the two and 13-21 year follow-ups is a limitation, in which it is difficult to assess what actually happened. Although all the patients received some form of CBT, there was variability among the treatments. Conclusions: The only short-term predictor identified represented a clinical feature, whereas the longterm predictors represented features of the patients' life situation. The limited power of the study precludes the inference that non-significant predictors actually are unrelated to follow-up outcome. Abstract 1.The abstract reads well apart from the second sentence of the conclusion.

Acta Psychiatrica Scandinavica, 2000

To investigate the relationship between panic attack intensity, catastrophic belief and cognition... more To investigate the relationship between panic attack intensity, catastrophic belief and cognitions. Data from 540 panic diaries were collected from 42 patients with panic disorder with agoraphobia. When we controlled for individual variation, effects of treatment and number of symptoms, catastrophic belief contributed significantly to more intense panic attacks (r2 change = 0.10, P<0.0001). There were no significant differences in panic attack intensity between primary and secondary cognitions. Our results indicate that catastrophic belief is a reliable predictor of panic attack intensity.

Psychiatry Research, 1995

Panic disorder patients with agoraphobia (n = 32) and agoraphobic patients without panic disorder... more Panic disorder patients with agoraphobia (n = 32) and agoraphobic patients without panic disorder (n = 18) who were participants in an inpatient behavioral-psychodynamic treatment program were assessed repeatedly from pretreatment to 2-year posttreatment follow-up. At pretreatment, there were statistical trends for more of the panic with agoraphobia patients to have obsessive-compulsive disorder and alcohol abuse/dependence, and for more of the agoraphobia without panic patients to have generalized anxiety disorder and avoidant personality disorder. There was also a trend for more of the panic with agoraphobia patients to have met criteria for major depression during the 2-year follow-up period.

Psychotherapy Research, 2001

ABSTRACT The authors investigated the relationship among catastrophic cognitions, fear of bodily ... more ABSTRACT The authors investigated the relationship among catastrophic cognitions, fear of bodily sensations, and avoidance in patients undergoing cognitive therapy for panic disorder with agoraphobia to determine which of three theoretical models was most consistent with their data, which were analyzed by structural modeling techniques. The final path model indicated a three-step change process. Beliefs about losing control predicted a fear of bodily sensations. A fear of bodily sensations, in turn, predicted both avoidance and a conviction of a looming physical catastrophe. The results, although preliminary, are consistent with an integrated behavioral and cognitive model for understanding the intratherapeutic relationship among these variables.

Journal of Psychosomatic Research, 2003

Objective: To compare sympathetic activity in agoraphobic patients with and without personality d... more Objective: To compare sympathetic activity in agoraphobic patients with and without personality disorders before and after 11 weeks inpatient treatment. Methods: Agoraphobic patients (n = 38), 84% with panic disorder and 47% with personality disorders underwent cold pressure test (CPT), mental stress test (MST), and a specific anxiety test (SAT). Psychological assessments were done by the Bodily Sensations Questionnaire (BSQ), the Agoraphobic Cognitions Questionnaire (ACQ), Spielberger STAI-1 and -2, and a Stress Test Anxiety (STA) questionnaire. Sympathetic activity was measured by blood pressure, heart rate, epinephrine, and norepinephrine. Results: The sympathetic activity did not differ significantly between patient groups, and the reactivity to stress was very low. The sympathetic reactivity remained unchanged after treatment, whereas psychiatric symptoms decreased. Correlations between sympathetic activity and psychological distress were not significant. Conclusion: Interpretation of bodily signals seems to be more important than the actual sympathetic activity in agoraphobic patients. D

Journal of Personality Disorders, 2004

The criteria for dependent personality disorder (DPD) in DSM-IV appear to fall into two categorie... more The criteria for dependent personality disorder (DPD) in DSM-IV appear to fall into two categories: dependent and attachment behaviors. The relevance of this division was evaluated in a sample of 182 patients admitted to a national Norwegian psychiatric hospital. Principal Components Analysis of all items belonging to the most frequent personality diagnoses revealed six components. The items for DPD formed two components, labeled attachment/abandonment and dependency/incompetence. Two criteria for borderline personality disorder also loaded on the attachment/abandonment component, while six criteria for avoidant personality disorder loaded on the dependency/incompetence component. Early Maladaptive Schemas of abandonment and failure correlated significantly higher with the attachment/abandonment component than with the dependency/incompetence component.

Journal of Behavior Therapy and Experimental Psychiatry, 2008

The purpose of this study was to test the predictions of an integrated cognitive and behavioral m... more The purpose of this study was to test the predictions of an integrated cognitive and behavioral model of agoraphobic avoidance in patients with chronic panic disorder and agoraphobia during the process of observed therapeutic change. Treatment was residential with the majority (n ¼ 165, 88%) receiving cognitive therapy, while the remaining 23 (12%) received guided mastery therapy. The results of latent variable path modeling of the changes occurring over the course of this treatment suggested that the anxiety elicited by bodily sensations influenced catastrophic beliefs, which, in turn, increased avoidance. Avoidance increased the anxiety elicited by bodily sensations. r

Journal of Anxiety Disorders, 1997

The first aim of this study was to examine the relationship between change

Cognitive Therapy and Research, 2005

One thousand and thirty-seven psychiatric patients and non-patients from six different sites comp... more One thousand and thirty-seven psychiatric patients and non-patients from six different sites completed the 205-item Young Schema Questionnaire or its shortended form, the 75-item Young Schema Questionnaire-S. Among 888 of the subjects, who all were patients, a confirmatory factor analysis (CFA) of the 75 items included in both forms of the questionnaire clearly yielded the 15 Early Maladaptive Schema (EMS) factors rationally developed by J. E. . Confirmatory factor analyses, testing three models of the higher-order structure of the 15 EMSs, indicated that a fourfactor model was the best alternative. The results slightly favored a correlated four second-order factor model over one also including a third-order global factor. The four factors or schema domains were Disconnection, Impaired Autonomy, Exaggerated Standards, and Impaired Limits. Scales derived from the four higher-order factors had good internal and test-retest reliabilities and were related to DSM-IV Cluster C personality traits, agoraphobic avoidance behavior, and depressive symptoms.

Cognitive Behaviour Therapy, 2006

The aims of this study were to examine whether therapists&amp... more The aims of this study were to examine whether therapists' emotional reactions to their patients mediate the effect of personality disorders and interpersonal problem behaviours on the outcome of treatment, focusing on an Axis I disorder; and whether therapists' reactions mediate the effect of personality disorders on the course of interpersonal problems. Therapists completed a checklist of emotional reactions to individual patients after the end of residential cognitive or guided mastery therapy for 46 inpatients with panic disorder with agoraphobia. The severity of DSM-III-R personality disorder was related to therapists' insecurity feelings, but not to interest and anger. A higher level of therapists' insecurity feelings was related to less reduction in self-reported agoraphobic avoidance during treatment, whereas therapists' emotions were unrelated to symptomatic course after treatment. Therapists' insecurity feelings appeared partly to mediate the relationship between patients' severity of personality disorder and persistence of patients' interpersonal dominance and nurturance problems.

Clinical Psychology & Psychotherapy, 2009

We examined changes in avoidant and dependent personality disorder dimensions, and pre-treatment ... more We examined changes in avoidant and dependent personality disorder dimensions, and pre-treatment and in-treatment factors associated with such changes in 77 patients, randomized to medication-free residential cognitive (CT) or residential interpersonal therapy for social phobia. Personality disorders and personality dimensions according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) were assessed at pre-treatment and at one-year post-treatment. Both treatments were associated with a decrease in avoidant and dependent personality dimensions; dependent dimension decreased more in CT. Changes in cognitive factors predicted changes in both personality dimensions, whereas changes in symptoms or interpersonal factors did not. Change in the cognitive factor estimated cost was the most powerful predictor in the avoidant dimension, as it was the only predictor that remained signifi cant in the forward regression analyses. Change in the cognitive factor estimated cost, and treatment were the most powerful predictors of change in the dependent dimension. Pre-treatment use of anxiolytics predicted larger changes in both PD dimensions.

Clinical Psychology & Psychotherapy, 2001

Agoraphobia without a history of panic attacks is a disorder lacking strong support. Data from th... more Agoraphobia without a history of panic attacks is a disorder lacking strong support. Data from the Australian National Survey were explored in respect to panic disorder with or without agoraphobia (PDA, PD), and agoraphobia without a history of panic disorder (AG). Panic disorder, agoraphobia, and panic disorder with agoraphobia occurred in 3.5% of the adult population. People with this group of disorders were more likely to be female and more likely to seek help than people with other anxiety disorders. Significant anxiety symptoms and unease about safety when out and about occur in all three disorders. People with the double disorder PDA report more comorbid disorders, are more disabled, and have higher neuroticism scores than people with PD or AG. People with AG are older and consult less than people with PD or PDA. Agoraphobia has been devalued as a cause of human suffering. This idea is wrong. Agoraphobia is as common, comorbid, and disabling as PD, but less disabling than the double disorder of PDA.

Acta Psychiatrica Scandinavica, 2000

To investigate the relationship between panic attack intensity, catastrophic belief and cognition... more To investigate the relationship between panic attack intensity, catastrophic belief and cognitions. Data from 540 panic diaries were collected from 42 patients with panic disorder with agoraphobia. When we controlled for individual variation, effects of treatment and number of symptoms, catastrophic belief contributed significantly to more intense panic attacks (r2 change = 0.10, P<0.0001). There were no significant differences in panic attack intensity between primary and secondary cognitions. Our results indicate that catastrophic belief is a reliable predictor of panic attack intensity.

Acta Psychiatrica Scandinavica, 1994

Patients attending an inpatient phobia treatment program were diagnosed for DSM-III-R Axis I and ... more Patients attending an inpatient phobia treatment program were diagnosed for DSM-III-R Axis I and II disorders, using the Structured Clinical Interview for DSM-III-R Disorders, and completed a set of self-report instruments. They were divided into 3 groups: (a) those who met the criteria for panic disorder with agoraphobia (n = 57), (b) those who met the criteria for agoraphobia without a history of panic disorder (n = 21), and (c) those who met criteria for other anxiety disorders, but not for panic/agoraphobia (n = 14). On Axis I, more of the panic with agoraphobia than of the agoraphobia without panic patients had obsessive-compulsive disorder. On Axis II, no significant differences between the agoraphobic patients with and without panic occurred. However, the number of hysterical traits was related to the presence of panic disorder among the agoraphobic patients. Avoidant and dependent traits were related to symptom severity.

Journal of Affective Disorders, 2015

Background: Little is currently known about predictors of follow-up outcome of psychological trea... more Background: Little is currently known about predictors of follow-up outcome of psychological treatment of agoraphobia. In this study, we wished to examine predictors of short-and long-term avoidance of inpatient group interventions for agoraphobia. Methods: Ninety-six (68%) of 141 agoraphobic patients (74% women) who had completed treatment in two open and one randomized controlled trial (RCT) were followed up 13 to 21 years after start of treatment. Results: Major depression at pre-treatment predicted less short-term (up to one year after end of treatment) improvement in agoraphobic avoidance. Working and being married/cohabiting at pretreatment predicted greater long-term (across one-year, two-year, and 13 to 21 year follow-up) improvement. In contrast, the duration of agoraphobia, amount of Axis I and II co-morbidity, being diagnosed with avoidant, dependent, and obsessive-compulsive personality disorder, and the use of antidepressants and benzodiazepines the month before intake to treatment, were unrelated to shortterm as well as long-term outcome. Limitations: As many as 31.9% of the included patients did not attend long-term follow-up and the power of the study was limited. The long time period between the two and 13-21 year follow-ups is a limitation, in which it is difficult to assess what actually happened. Although all the patients received some form of CBT, there was variability among the treatments. Conclusions: The only short-term predictor identified represented a clinical feature, whereas the longterm predictors represented features of the patients' life situation. The limited power of the study precludes the inference that non-significant predictors actually are unrelated to follow-up outcome. Abstract 1.The abstract reads well apart from the second sentence of the conclusion.