Patrick A Vogel - Academia.edu (original) (raw)

Papers by Patrick A Vogel

Research paper thumbnail of An apprenticeship model in the training of psychotherapy students. Study protocol for a randomized controlled trial and qualitative investigation

PLOS ONE

BackgroundOne approach towards advancing the quality of mental health care is to improve psychoth... more BackgroundOne approach towards advancing the quality of mental health care is to improve psychotherapists’ skills through education and training. Recently, psychotherapy training has benefitted from adapting training methods from other professions (e.g., deliberate practice). The apprenticeship model has a long history in skill trades and medicine, but has yet to be adopted in training mental health professionals. This study aims to investigate the impact of apprenticeship training on clinical psychology students’ skills.MethodsIn a pragmatic mixed-methods trial, 120 first year students in a Master’s degree clinical psychology program will be randomized to either training-as-usual or training-as-usual plus psychotherapy apprenticeship. In the intervention group, students will participate, over a period of 10 weeks, in weekly treatment sessions together with licensed therapists at outpatient mental health and substance use treatment clinics. Outcomes are assessed post-intervention an...

Research paper thumbnail of Correction to: Early maladaptive schemas impact on long-term outcome in patients treated with group behavioral therapy for obsessive-compulsive disorder

BMC Psychiatry

Reference 1. Sunde, et al. Early maladaptive schemas impact on long-term outcome in patients trea... more Reference 1. Sunde, et al. Early maladaptive schemas impact on long-term outcome in patients treated with group behavioral therapy for obsessive-compulsive disorder.

Research paper thumbnail of A Survey of Expert Opinions • 1

Research paper thumbnail of An International Comparison Between Different Theoretical Orientations of Psychotherapy : A Survey of Expert Opinions

Research paper thumbnail of TherapisT variabiliTy in The Task / goal dimension of The early working alliance predicTs ouTcome in exposure and response prevenTion TreaTmenT for obsessive-compulsive disorder

Objective: The importance of a strong working alliance is assumed to be important in exposure and... more Objective: The importance of a strong working alliance is assumed to be important in exposure and response prevention (ERP) treatment of obsessive-compulsive disorder (OCD). During the first sessions, the therapist aims to achieve agreement with the patient on the tasks and goals of therapy by formulating a treatment plan. The aims of the study were to explore the predictive role of therapistand patient variability in the early working alliance when using erp for ocd. Method: a total of 13 therapists gave individual erp treatment to 44 outpatients with ocd. The working alliance was measured after the second or third session with patient rated working alliance inventory-short (wai-s). we used two subscales from the wai-s (agreement on tasks/goals and therapeutic bond). Treatment outcome was measured using the yale-brown obsessive compulsive scale. Therapist variability in the working alliance was estimated by calculating each therapist’s mean wai-s scores and calculating how much eac...

Research paper thumbnail of Assessment of Cognitive Distortions and Cognitive Biases

The Wiley Handbook of Obsessive Compulsive Disorders, 2017

Research paper thumbnail of Where did my OCD come from? A qualitative exploratory study

Scandinavian Psychologist, 2019

Research paper thumbnail of Early maladaptive schemas impact on long-term outcome in patients treated with group behavioral therapy for obsessive-compulsive disorder

BMC Psychiatry, 2019

Background Some studies have previously found that certain elevated early maladaptive schemas (EM... more Background Some studies have previously found that certain elevated early maladaptive schemas (EMSs) are negative predictors for outcome for patients with obsessive-compulsive disorder (OCD) treated with Cognitive-Behavioral Therapy (CBT) or Exposure and Response Prevention (ERP). The current study explores whether EMS were related to reductions in OCD symptom severity at long-term follow-up (Mean = 8 years) after group ERP for patients with OCD. The central hypothesis was that patients with no response to treatment or patients who relapsed during the follow-up period were more likely to have elevated pre-treatment EMSs compared to those who responded to initial treatment and maintained gains over time. We also investigated whether there were any differences in change over time of overall EMS between patients who were recovered versus patients who were not recovered at extended follow-up. Methods Young Schema Questionnaire –Short Form (YSQ-SF), Yale-Brown Obsessive-Compulsive Scale ...

Research paper thumbnail of Explaining depression symptoms in patients with social anxiety disorder: Do maladaptive metacognitive beliefs play a role?

Clinical Psychology & Psychotherapy, 2018

Social anxiety disorder (SAD) is a major risk factor for developing symptoms of depression. Sever... more Social anxiety disorder (SAD) is a major risk factor for developing symptoms of depression. Severity of social anxiety has previously been identified as a risk factor, and cognitive models emphasise dysfunctional schemas and self-processing as the key vulnerability factors underlying general distress in SAD. However, in the metacognitive model, depressive and other symptoms are related to metacognitive beliefs. The aim of the current study was therefore to test the relative contribution of metacognitions when controlling for SAD severity and factors postulated in cognitive models. In a cross-sectional design, one-hundred and two patients diagnosed with primary SAD were included. We found that negative metacognitive beliefs concerning uncontrollability and danger and low confidence in memory emerged as the only factors explaining depressive symptoms in the regression model, suggesting that metacognitive beliefs are associated with increased depressive symptoms in SAD patients.

Research paper thumbnail of Three-Week Inpatient Treatment of Obsessive-Compulsive Disorder: A 6-Month Follow-Up Study

Frontiers in psychology, 2018

Specialized inpatient or residential treatment might be an alternative treatment approach for pat... more Specialized inpatient or residential treatment might be an alternative treatment approach for patients with obsessive-compulsive disorder (OCD) that do not respond satisfactorily to the standard outpatient treatment formats. The aim of this open trial was to investigate the 6-month effectiveness of a 3-week inpatient treatment of OCD, where exposure with response prevention (ERP) was the main treatment intervention. The sample consisted of 187 adult patients with OCD, all with previous treatment attempts for OCD. The sample showed significant reductions in symptoms of OCD and depression. The effect sizes were large for obsessive-compulsive symptoms and moderate to large for depressive symptoms. At discharge, 79.7% of the intent-to-treat (ITT) group were classified as treatment responders (≥35% reduction in Y-BOCS scores). However, some participants experienced relapse, as 61.5% of the ITT group were classified as treatment responders at 6-month follow-up. Antidepressant use appeared...

Research paper thumbnail of Metacognitions in obsessive-compulsive disorder: A psychometric study of the Metacognitions Questionnaire-30

Journal of Obsessive-Compulsive and Related Disorders, 2016

Research paper thumbnail of The role of metacognitive beliefs about thoughts and rituals: A test of the metacognitive model of obsessive-compulsive disorder in a clinical sample

Journal of Obsessive-Compulsive and Related Disorders, 2017

The metacognitive model of obsessive-compulsive disorder (OCD; Wells, 1997) emphasises the role o... more The metacognitive model of obsessive-compulsive disorder (OCD; Wells, 1997) emphasises the role of metacognitive beliefs about both thoughts and rituals. The current study tested hypotheses that emerge from the model concerning three domains of these metacognitive beliefs: though fusion beliefs, beliefs about rituals, and stop signals, in an OCD sample (N =210). Results showed that each type of metacognitive belief significantly and positively correlated with two different measures of obsessive-compulsive symptoms. Additionally, in hierarchical regressions, with worry, and non-metacognitive beliefs linked to OCD in other theories controlled, each of the metacognitive domains, when entered in their hypothesised order of activation, incrementally predicted each obsessive-compulsive symptom measure. Results provide further support for the role of these three metacognitive belief domains as hypothesised in the metacognitive model.

Research paper thumbnail of ACT-enhanced behavior therapy in group format for Trichotillomania: An effectiveness study

Journal of Obsessive-Compulsive and Related Disorders, 2017

• The results showed significant decreases in TTM symptoms from pre-treatment to the one-year fol... more • The results showed significant decreases in TTM symptoms from pre-treatment to the one-year follow-up. • Nearly 90% of TTM patients scored below the diagnostic threshold at post-treatment on the CGI-TTM, and slightly more than 60% remained so at one-year follow-up. • Overall, patients improved equally well during treatment and it was not until the one-year follow-up that differences in treatment response came to the fore.

Research paper thumbnail of Metacognitive Therapy Applications in Social Anxiety Disorder: An Exploratory Study of the Individual and Combined Effects of the Attention Training Technique and Situational Attentional Refocusing

Journal of Experimental Psychopathology, 2016

Individuals with Social Anxiety Disorder have difficulty disengaging from self-processing in soci... more Individuals with Social Anxiety Disorder have difficulty disengaging from self-processing in social situations. Metacognitive therapy interventions for enhancing attentional control were administered to a convenience sample of 24 with a Social Anxiety Disorder diagnosis. Using a cross-over design, 11 participants were given four weekly sessions of Attention Training Technique (ATT), followed by four weekly sessions of Situational Attentional Refocusing (SAR). For the other 13 participants the two treatment components were given in the reverse order. All participants made significant reductions on interview rated and self-reported measures of social and general levels of anxiety by the end of the first intervention (either ATT or SAR). Following completion of the second treatment components, further reductions were observed and 46% (n = 11) of the total sample no longer met DSM-IV criteria for Social Anxiety Disorder diagnosis. Two large order effects were found favoring patients rec...

Research paper thumbnail of A long-term follow-up of group behavioral therapy for obsessive-compulsive disorder in a general outpatient clinic in Norway

Journal of Obsessive-Compulsive and Related Disorders, 2017

There is a lack of knowledge regarding the long-term effect of evidence-based CBT/ ERP treatment ... more There is a lack of knowledge regarding the long-term effect of evidence-based CBT/ ERP treatment for OCD that is delivered in routine clinical care. The aim of this study was to examine the long-term effectiveness of behavioral treatment for OCD in a Norwegian general outpatient clinic. In the current study, 62% (N = 40) of the original patients treated in a previously published study of group ERP for OCD were re-evaluated an average of eight years after completing the original treatment. This is the longest follow-up study that has been conducted for OCD patients treated with group ERP. There was a significant reduction in symptoms from pre-to posttreatment measured with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the Spielberger State Anxiety Inventory (STAI-S) and the Beck Depression Inventory (BDI). The gains were in average maintained from posttreatment through extended long-term follow-up. Fifty percent of the participants experienced either a clinically significant improvement (10%) or recovery (40%) in OCD symptoms at extended long-term follow-up. This suggests that many patients receiving general outpatient mental health clinic based group ERP for OCD maintain gains over the long-term.

Research paper thumbnail of Paroxetine, Cognitive Therapy or Their Combination in the Treatment of Social Anxiety Disorder with and without Avoidant Personality Disorder: A Randomized Clinical Trial

Psychotherapy and Psychosomatics, 2016

Background: The most efficacious treatments for social anxiety disorder (SAD) are the SSRIs and c... more Background: The most efficacious treatments for social anxiety disorder (SAD) are the SSRIs and cognitive therapy (CT). Combined treatment is advocated for SAD but has not been evaluated in randomized trials using CT and SSRI. Our aim was to evaluate whether one treatment is more effective than the other and whether combined treatment is more effective than the single treatments. Methods: A total of 102 patients were randomly assigned to paroxetine, CT, the combination of CT and paroxetine, or pill placebo. The medication treatment lasted 26 weeks. Of the 102 patients, 54% fulfilled the criteria for an additional diagnosis of avoidant personality disorder. Outcomes were measured at posttreatment and 12-month follow-up assessments. Results: CT was superior to paroxetine alone and to pill placebo at the end of treatment, but it was not superior to the combination treatment. At the 12-month follow-up, the CT group maintained benefits and was significantly better than placebo and paroxe...

Research paper thumbnail of The University of Rhode Island Change Assessment as Predictor of Treatment Outcome and Dropout in Outpatients with Obsessive-Compulsive Disorder Treated with Exposure and Response Prevention

Psychotherapy and Psychosomatics, 2016

tempts are unfortunately lacking in previous studies as well as in our study. In line with the li... more tempts are unfortunately lacking in previous studies as well as in our study. In line with the literature reviewed, we hypothesized that high scores on precontemplation should predict premature dropout, and that the readiness-to-change index is not predictive of treatment outcome with ERP. We included 121 outpatients with a diagnosis of OCD in the present study. The mean age was 33.8 years (SD = 12.0). Only 25.9% of the sample worked full time. Some had part-time work (12.1%) or were students (20.7%), while the remaining subjects were unemployed. Data were aggregated from two different OCD clinics: one specializing in group treatment, whilst the other did individual treatment. Sixty-five patients were treated with group ERP, while the other 56 were treated individually with ERP. The main inclusion criterion was a primary diagnosis of OCD according to the DSM-IV. Exclusion criteria were meeting criteria for psychotic disorders, alcohol or drug addiction, mental retardation, autism and suicidal behaviors. Patients who had been on a stable dosage of selective serotonin reuptake inhibitors (SSRIs) for the last month could be included. Their doses were kept stable throughout the treatment. A total of 56 participants used SSRIs (missing data for 5 patients). Different comorbid disorders were present in the sample. The most common comorbid disorder was depression (n = 34). All participants gave written informed consent. People treated in a group met once a week for 2.5 h over a 12week period. The behavioral group therapy was adapted from a manual developed by Krone et al. [7] . People treated individually received ERP based on a manual by Kozak and Foa [8] . Individual therapy consisted of 15 treatment sessions lasting 90 min. Pretreatment severity and treatment effects were similar to those of other studies on ERP for OCD, as Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) scores were reduced from 24.14 (4.03) to 12.80 (6.15) for completers and from 24.26 (4.14) to 13.60 (6.89) for the intent-to-treat sample. The 8 dropouts scored significantly lower than the 113 completers on the contemplation subscale, with t(119) = 2.98, p = 0.004, d = 1.05. There was no significant difference between the groups on any of the other URICA subscales. In order to determine predictors of treatment outcome (YBOCS after treatment) for treatment completers, we ran a multiple regression analysis entering pretreatment variables as independent variables. Y-BOCS, depression diagnosis and URICA subscales were entered into the equation, but the only significant predictor was Y-BOCS. Results from the regression are summarized in table 1 . The participants using SSRIs scored significantly higher on the change index than drug-free participants [t(114) = 2.37, p = 0.02], suggesting that patients on SSRIs could be more motivated to change their problem behavior. The study suggests that the degree to which OCD patients contemplate changing their behavior could be predictive of dropout. Approximately 25–30% of patients suitable for exposure and response prevention (ERP) for obsessive-compulsive disorder (OCD) do not want to start treatment, drop out early or show limited compliance [1] . Lack of motivation can be an important reason given the active participation required both during and between treatment sessions. A common way of assessing treatment motivation has been with the University of Rhode Island Change Assessment (URICA), which is a self-report measure including 4 subscales [2] . People who score high on ‘precontemplation’ have no plan to quit their problem behavior in the near future. ‘Contemplators’ are considering change but have not yet started acting on their intentions. People in the ‘action’ phase have begun their change, while people in the ‘maintenance’ phase are trying to maintain an already acquired change. These subscales can be combined into a readiness-to-change index. There are four empirical studies into the role of motivation in treating OCD. Vogel et al. [3] found that readiness to change showed no relation to treatment outcome for 37 outpatients treated with cognitive-behavioral therapy. A similar study conducted by Pinto et al. [4] found a negative association between precontemplation and change in OCD symptoms using a sample of 32 outpatients receiving pharmacotherapy. In another outpatient study (n = 28), Maher et al. [5] found no significant relationship between readiness to change and cognitive-behavioral treatment outcome. One large-scale study has been conducted. Monaghan et al. [6] found no evidence for readiness to change as predictive of cognitive-behavioral treatment outcome in 424 OCD inpatients. However, people with high scores on precontemplation were discharged earlier. The generalizability of these studies is questionable as they either have small sample sizes or use inpatient treatment. Also, none of the studies have controlled for both OCD severity and comorbid depression in their analyses. Another…

Research paper thumbnail of Interpersonal style in obsessive compulsive disorder

The Cognitive Behaviour Therapist, 2015

According to interpersonal theory of personality, interpersonal behaviours can be causal and main... more According to interpersonal theory of personality, interpersonal behaviours can be causal and maintaining factors in emotional disorders. However, interpersonal styles have not yet been investigated in the treatment of obsessive compulsive disorder (OCD). The aim of the study was to investigate interpersonal style in OCD. The Inventory of Interpersonal Problems – Circumplex was used to assess the interpersonal styles of 101 outpatients with OCD treated with cognitive behavioural therapy (CBT). Patients with OCD had more interpersonal problems than the healthy control group. However, the OCD group presented with slightly fewer interpersonal problems than a further comparison group of psychiatric outpatients. Interpersonal style did not predict improvement in OCD symptoms. Following CBT for OCD, there were small to moderate improvements in interpersonal problems. These changes remained stable at 12-month follow-up. Although the OCD group reported reduced interpersonal problems post-tre...

Research paper thumbnail of Thought Content and Appraisals in Cognitive Behavioral Therapy for Obsessive-Compulsive Disorder

Journal of Cognitive Psychotherapy, 2015

A premise for cognitive behavioral therapy (CBT) for obsessive-compulsive disorder (OCD) is that ... more A premise for cognitive behavioral therapy (CBT) for obsessive-compulsive disorder (OCD) is that appraisal of obsessions maintains OCD symptoms whereas obsessive content is less important. The main aim of this study was therefore to explore this notion using the autogenous and reactive classification of obsessive content and by assessing changes in appraisals and symptoms following CBT for OCD. More specifically, the study investigates whether recovery from OCD is associated with changes in appraisal and explores how thought content relates to appraisal and symptoms both before and CBT. Data from 156 adults with OCD completing CBT for OCD were analyzed. Changes in appraisals were related to improvement in OCD symptoms. Slightly more participants reported reactive intrusions (47%) than autogenous (29%), but combinations of the two were common (24%). These classifications of thought content were not related to levels of appraisal or change in symptoms, with the exception of patients w...

Research paper thumbnail of Psychotic and schizotypal symptoms in non-psychotic patients with obsessive-compulsive disorder

BMC Psychiatry, 2015

Background: Research is scarce with regard to the role of psychotic and schizotypal symptoms in t... more Background: Research is scarce with regard to the role of psychotic and schizotypal symptoms in treatment of obsessive-compulsive disorder (OCD). The aim of the current study was to investigate the occurrence and specificity of psychotic and schizotypal symptoms among non-psychotic OCD patients, and to examine whether such symptoms was associated with response to exposure and response prevention (ERP), and whether ERP for OCD had an impact on psychotic and schizotypal symptoms. Methods: Non-psychotic OCD patients (n = 133) and a general non-psychotic psychiatric outpatient sample (n = 110) were assessed using self-report inventories before and after psychological treatment. Results: Non-psychotic OCD patients did not report greater degree of psychotic or schizotypal symptoms than the control group. Psychotic and schizotypal symptoms were not associated with OCD symptoms before or after ERP. Psychotic and schizotypal symptom were significantly reduced following ERP. Conclusions: Psychotic and schizotypal symptoms seem to be equally prevalent among non-psychotic OCD patients and non-psychotic psychiatric controls. These symptoms were more linked to depressive symptoms than OCD symptoms. In non-psychotic OCD patients, ERP seems sufficient in reducing OCD symptoms despite the presence of psychotic-and schizotypal symptoms, and reductions in psychotic-and schizotypal symptoms were observed following ERP.

Research paper thumbnail of An apprenticeship model in the training of psychotherapy students. Study protocol for a randomized controlled trial and qualitative investigation

PLOS ONE

BackgroundOne approach towards advancing the quality of mental health care is to improve psychoth... more BackgroundOne approach towards advancing the quality of mental health care is to improve psychotherapists’ skills through education and training. Recently, psychotherapy training has benefitted from adapting training methods from other professions (e.g., deliberate practice). The apprenticeship model has a long history in skill trades and medicine, but has yet to be adopted in training mental health professionals. This study aims to investigate the impact of apprenticeship training on clinical psychology students’ skills.MethodsIn a pragmatic mixed-methods trial, 120 first year students in a Master’s degree clinical psychology program will be randomized to either training-as-usual or training-as-usual plus psychotherapy apprenticeship. In the intervention group, students will participate, over a period of 10 weeks, in weekly treatment sessions together with licensed therapists at outpatient mental health and substance use treatment clinics. Outcomes are assessed post-intervention an...

Research paper thumbnail of Correction to: Early maladaptive schemas impact on long-term outcome in patients treated with group behavioral therapy for obsessive-compulsive disorder

BMC Psychiatry

Reference 1. Sunde, et al. Early maladaptive schemas impact on long-term outcome in patients trea... more Reference 1. Sunde, et al. Early maladaptive schemas impact on long-term outcome in patients treated with group behavioral therapy for obsessive-compulsive disorder.

Research paper thumbnail of A Survey of Expert Opinions • 1

Research paper thumbnail of An International Comparison Between Different Theoretical Orientations of Psychotherapy : A Survey of Expert Opinions

Research paper thumbnail of TherapisT variabiliTy in The Task / goal dimension of The early working alliance predicTs ouTcome in exposure and response prevenTion TreaTmenT for obsessive-compulsive disorder

Objective: The importance of a strong working alliance is assumed to be important in exposure and... more Objective: The importance of a strong working alliance is assumed to be important in exposure and response prevention (ERP) treatment of obsessive-compulsive disorder (OCD). During the first sessions, the therapist aims to achieve agreement with the patient on the tasks and goals of therapy by formulating a treatment plan. The aims of the study were to explore the predictive role of therapistand patient variability in the early working alliance when using erp for ocd. Method: a total of 13 therapists gave individual erp treatment to 44 outpatients with ocd. The working alliance was measured after the second or third session with patient rated working alliance inventory-short (wai-s). we used two subscales from the wai-s (agreement on tasks/goals and therapeutic bond). Treatment outcome was measured using the yale-brown obsessive compulsive scale. Therapist variability in the working alliance was estimated by calculating each therapist’s mean wai-s scores and calculating how much eac...

Research paper thumbnail of Assessment of Cognitive Distortions and Cognitive Biases

The Wiley Handbook of Obsessive Compulsive Disorders, 2017

Research paper thumbnail of Where did my OCD come from? A qualitative exploratory study

Scandinavian Psychologist, 2019

Research paper thumbnail of Early maladaptive schemas impact on long-term outcome in patients treated with group behavioral therapy for obsessive-compulsive disorder

BMC Psychiatry, 2019

Background Some studies have previously found that certain elevated early maladaptive schemas (EM... more Background Some studies have previously found that certain elevated early maladaptive schemas (EMSs) are negative predictors for outcome for patients with obsessive-compulsive disorder (OCD) treated with Cognitive-Behavioral Therapy (CBT) or Exposure and Response Prevention (ERP). The current study explores whether EMS were related to reductions in OCD symptom severity at long-term follow-up (Mean = 8 years) after group ERP for patients with OCD. The central hypothesis was that patients with no response to treatment or patients who relapsed during the follow-up period were more likely to have elevated pre-treatment EMSs compared to those who responded to initial treatment and maintained gains over time. We also investigated whether there were any differences in change over time of overall EMS between patients who were recovered versus patients who were not recovered at extended follow-up. Methods Young Schema Questionnaire –Short Form (YSQ-SF), Yale-Brown Obsessive-Compulsive Scale ...

Research paper thumbnail of Explaining depression symptoms in patients with social anxiety disorder: Do maladaptive metacognitive beliefs play a role?

Clinical Psychology & Psychotherapy, 2018

Social anxiety disorder (SAD) is a major risk factor for developing symptoms of depression. Sever... more Social anxiety disorder (SAD) is a major risk factor for developing symptoms of depression. Severity of social anxiety has previously been identified as a risk factor, and cognitive models emphasise dysfunctional schemas and self-processing as the key vulnerability factors underlying general distress in SAD. However, in the metacognitive model, depressive and other symptoms are related to metacognitive beliefs. The aim of the current study was therefore to test the relative contribution of metacognitions when controlling for SAD severity and factors postulated in cognitive models. In a cross-sectional design, one-hundred and two patients diagnosed with primary SAD were included. We found that negative metacognitive beliefs concerning uncontrollability and danger and low confidence in memory emerged as the only factors explaining depressive symptoms in the regression model, suggesting that metacognitive beliefs are associated with increased depressive symptoms in SAD patients.

Research paper thumbnail of Three-Week Inpatient Treatment of Obsessive-Compulsive Disorder: A 6-Month Follow-Up Study

Frontiers in psychology, 2018

Specialized inpatient or residential treatment might be an alternative treatment approach for pat... more Specialized inpatient or residential treatment might be an alternative treatment approach for patients with obsessive-compulsive disorder (OCD) that do not respond satisfactorily to the standard outpatient treatment formats. The aim of this open trial was to investigate the 6-month effectiveness of a 3-week inpatient treatment of OCD, where exposure with response prevention (ERP) was the main treatment intervention. The sample consisted of 187 adult patients with OCD, all with previous treatment attempts for OCD. The sample showed significant reductions in symptoms of OCD and depression. The effect sizes were large for obsessive-compulsive symptoms and moderate to large for depressive symptoms. At discharge, 79.7% of the intent-to-treat (ITT) group were classified as treatment responders (≥35% reduction in Y-BOCS scores). However, some participants experienced relapse, as 61.5% of the ITT group were classified as treatment responders at 6-month follow-up. Antidepressant use appeared...

Research paper thumbnail of Metacognitions in obsessive-compulsive disorder: A psychometric study of the Metacognitions Questionnaire-30

Journal of Obsessive-Compulsive and Related Disorders, 2016

Research paper thumbnail of The role of metacognitive beliefs about thoughts and rituals: A test of the metacognitive model of obsessive-compulsive disorder in a clinical sample

Journal of Obsessive-Compulsive and Related Disorders, 2017

The metacognitive model of obsessive-compulsive disorder (OCD; Wells, 1997) emphasises the role o... more The metacognitive model of obsessive-compulsive disorder (OCD; Wells, 1997) emphasises the role of metacognitive beliefs about both thoughts and rituals. The current study tested hypotheses that emerge from the model concerning three domains of these metacognitive beliefs: though fusion beliefs, beliefs about rituals, and stop signals, in an OCD sample (N =210). Results showed that each type of metacognitive belief significantly and positively correlated with two different measures of obsessive-compulsive symptoms. Additionally, in hierarchical regressions, with worry, and non-metacognitive beliefs linked to OCD in other theories controlled, each of the metacognitive domains, when entered in their hypothesised order of activation, incrementally predicted each obsessive-compulsive symptom measure. Results provide further support for the role of these three metacognitive belief domains as hypothesised in the metacognitive model.

Research paper thumbnail of ACT-enhanced behavior therapy in group format for Trichotillomania: An effectiveness study

Journal of Obsessive-Compulsive and Related Disorders, 2017

• The results showed significant decreases in TTM symptoms from pre-treatment to the one-year fol... more • The results showed significant decreases in TTM symptoms from pre-treatment to the one-year follow-up. • Nearly 90% of TTM patients scored below the diagnostic threshold at post-treatment on the CGI-TTM, and slightly more than 60% remained so at one-year follow-up. • Overall, patients improved equally well during treatment and it was not until the one-year follow-up that differences in treatment response came to the fore.

Research paper thumbnail of Metacognitive Therapy Applications in Social Anxiety Disorder: An Exploratory Study of the Individual and Combined Effects of the Attention Training Technique and Situational Attentional Refocusing

Journal of Experimental Psychopathology, 2016

Individuals with Social Anxiety Disorder have difficulty disengaging from self-processing in soci... more Individuals with Social Anxiety Disorder have difficulty disengaging from self-processing in social situations. Metacognitive therapy interventions for enhancing attentional control were administered to a convenience sample of 24 with a Social Anxiety Disorder diagnosis. Using a cross-over design, 11 participants were given four weekly sessions of Attention Training Technique (ATT), followed by four weekly sessions of Situational Attentional Refocusing (SAR). For the other 13 participants the two treatment components were given in the reverse order. All participants made significant reductions on interview rated and self-reported measures of social and general levels of anxiety by the end of the first intervention (either ATT or SAR). Following completion of the second treatment components, further reductions were observed and 46% (n = 11) of the total sample no longer met DSM-IV criteria for Social Anxiety Disorder diagnosis. Two large order effects were found favoring patients rec...

Research paper thumbnail of A long-term follow-up of group behavioral therapy for obsessive-compulsive disorder in a general outpatient clinic in Norway

Journal of Obsessive-Compulsive and Related Disorders, 2017

There is a lack of knowledge regarding the long-term effect of evidence-based CBT/ ERP treatment ... more There is a lack of knowledge regarding the long-term effect of evidence-based CBT/ ERP treatment for OCD that is delivered in routine clinical care. The aim of this study was to examine the long-term effectiveness of behavioral treatment for OCD in a Norwegian general outpatient clinic. In the current study, 62% (N = 40) of the original patients treated in a previously published study of group ERP for OCD were re-evaluated an average of eight years after completing the original treatment. This is the longest follow-up study that has been conducted for OCD patients treated with group ERP. There was a significant reduction in symptoms from pre-to posttreatment measured with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the Spielberger State Anxiety Inventory (STAI-S) and the Beck Depression Inventory (BDI). The gains were in average maintained from posttreatment through extended long-term follow-up. Fifty percent of the participants experienced either a clinically significant improvement (10%) or recovery (40%) in OCD symptoms at extended long-term follow-up. This suggests that many patients receiving general outpatient mental health clinic based group ERP for OCD maintain gains over the long-term.

Research paper thumbnail of Paroxetine, Cognitive Therapy or Their Combination in the Treatment of Social Anxiety Disorder with and without Avoidant Personality Disorder: A Randomized Clinical Trial

Psychotherapy and Psychosomatics, 2016

Background: The most efficacious treatments for social anxiety disorder (SAD) are the SSRIs and c... more Background: The most efficacious treatments for social anxiety disorder (SAD) are the SSRIs and cognitive therapy (CT). Combined treatment is advocated for SAD but has not been evaluated in randomized trials using CT and SSRI. Our aim was to evaluate whether one treatment is more effective than the other and whether combined treatment is more effective than the single treatments. Methods: A total of 102 patients were randomly assigned to paroxetine, CT, the combination of CT and paroxetine, or pill placebo. The medication treatment lasted 26 weeks. Of the 102 patients, 54% fulfilled the criteria for an additional diagnosis of avoidant personality disorder. Outcomes were measured at posttreatment and 12-month follow-up assessments. Results: CT was superior to paroxetine alone and to pill placebo at the end of treatment, but it was not superior to the combination treatment. At the 12-month follow-up, the CT group maintained benefits and was significantly better than placebo and paroxe...

Research paper thumbnail of The University of Rhode Island Change Assessment as Predictor of Treatment Outcome and Dropout in Outpatients with Obsessive-Compulsive Disorder Treated with Exposure and Response Prevention

Psychotherapy and Psychosomatics, 2016

tempts are unfortunately lacking in previous studies as well as in our study. In line with the li... more tempts are unfortunately lacking in previous studies as well as in our study. In line with the literature reviewed, we hypothesized that high scores on precontemplation should predict premature dropout, and that the readiness-to-change index is not predictive of treatment outcome with ERP. We included 121 outpatients with a diagnosis of OCD in the present study. The mean age was 33.8 years (SD = 12.0). Only 25.9% of the sample worked full time. Some had part-time work (12.1%) or were students (20.7%), while the remaining subjects were unemployed. Data were aggregated from two different OCD clinics: one specializing in group treatment, whilst the other did individual treatment. Sixty-five patients were treated with group ERP, while the other 56 were treated individually with ERP. The main inclusion criterion was a primary diagnosis of OCD according to the DSM-IV. Exclusion criteria were meeting criteria for psychotic disorders, alcohol or drug addiction, mental retardation, autism and suicidal behaviors. Patients who had been on a stable dosage of selective serotonin reuptake inhibitors (SSRIs) for the last month could be included. Their doses were kept stable throughout the treatment. A total of 56 participants used SSRIs (missing data for 5 patients). Different comorbid disorders were present in the sample. The most common comorbid disorder was depression (n = 34). All participants gave written informed consent. People treated in a group met once a week for 2.5 h over a 12week period. The behavioral group therapy was adapted from a manual developed by Krone et al. [7] . People treated individually received ERP based on a manual by Kozak and Foa [8] . Individual therapy consisted of 15 treatment sessions lasting 90 min. Pretreatment severity and treatment effects were similar to those of other studies on ERP for OCD, as Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) scores were reduced from 24.14 (4.03) to 12.80 (6.15) for completers and from 24.26 (4.14) to 13.60 (6.89) for the intent-to-treat sample. The 8 dropouts scored significantly lower than the 113 completers on the contemplation subscale, with t(119) = 2.98, p = 0.004, d = 1.05. There was no significant difference between the groups on any of the other URICA subscales. In order to determine predictors of treatment outcome (YBOCS after treatment) for treatment completers, we ran a multiple regression analysis entering pretreatment variables as independent variables. Y-BOCS, depression diagnosis and URICA subscales were entered into the equation, but the only significant predictor was Y-BOCS. Results from the regression are summarized in table 1 . The participants using SSRIs scored significantly higher on the change index than drug-free participants [t(114) = 2.37, p = 0.02], suggesting that patients on SSRIs could be more motivated to change their problem behavior. The study suggests that the degree to which OCD patients contemplate changing their behavior could be predictive of dropout. Approximately 25–30% of patients suitable for exposure and response prevention (ERP) for obsessive-compulsive disorder (OCD) do not want to start treatment, drop out early or show limited compliance [1] . Lack of motivation can be an important reason given the active participation required both during and between treatment sessions. A common way of assessing treatment motivation has been with the University of Rhode Island Change Assessment (URICA), which is a self-report measure including 4 subscales [2] . People who score high on ‘precontemplation’ have no plan to quit their problem behavior in the near future. ‘Contemplators’ are considering change but have not yet started acting on their intentions. People in the ‘action’ phase have begun their change, while people in the ‘maintenance’ phase are trying to maintain an already acquired change. These subscales can be combined into a readiness-to-change index. There are four empirical studies into the role of motivation in treating OCD. Vogel et al. [3] found that readiness to change showed no relation to treatment outcome for 37 outpatients treated with cognitive-behavioral therapy. A similar study conducted by Pinto et al. [4] found a negative association between precontemplation and change in OCD symptoms using a sample of 32 outpatients receiving pharmacotherapy. In another outpatient study (n = 28), Maher et al. [5] found no significant relationship between readiness to change and cognitive-behavioral treatment outcome. One large-scale study has been conducted. Monaghan et al. [6] found no evidence for readiness to change as predictive of cognitive-behavioral treatment outcome in 424 OCD inpatients. However, people with high scores on precontemplation were discharged earlier. The generalizability of these studies is questionable as they either have small sample sizes or use inpatient treatment. Also, none of the studies have controlled for both OCD severity and comorbid depression in their analyses. Another…

Research paper thumbnail of Interpersonal style in obsessive compulsive disorder

The Cognitive Behaviour Therapist, 2015

According to interpersonal theory of personality, interpersonal behaviours can be causal and main... more According to interpersonal theory of personality, interpersonal behaviours can be causal and maintaining factors in emotional disorders. However, interpersonal styles have not yet been investigated in the treatment of obsessive compulsive disorder (OCD). The aim of the study was to investigate interpersonal style in OCD. The Inventory of Interpersonal Problems – Circumplex was used to assess the interpersonal styles of 101 outpatients with OCD treated with cognitive behavioural therapy (CBT). Patients with OCD had more interpersonal problems than the healthy control group. However, the OCD group presented with slightly fewer interpersonal problems than a further comparison group of psychiatric outpatients. Interpersonal style did not predict improvement in OCD symptoms. Following CBT for OCD, there were small to moderate improvements in interpersonal problems. These changes remained stable at 12-month follow-up. Although the OCD group reported reduced interpersonal problems post-tre...

Research paper thumbnail of Thought Content and Appraisals in Cognitive Behavioral Therapy for Obsessive-Compulsive Disorder

Journal of Cognitive Psychotherapy, 2015

A premise for cognitive behavioral therapy (CBT) for obsessive-compulsive disorder (OCD) is that ... more A premise for cognitive behavioral therapy (CBT) for obsessive-compulsive disorder (OCD) is that appraisal of obsessions maintains OCD symptoms whereas obsessive content is less important. The main aim of this study was therefore to explore this notion using the autogenous and reactive classification of obsessive content and by assessing changes in appraisals and symptoms following CBT for OCD. More specifically, the study investigates whether recovery from OCD is associated with changes in appraisal and explores how thought content relates to appraisal and symptoms both before and CBT. Data from 156 adults with OCD completing CBT for OCD were analyzed. Changes in appraisals were related to improvement in OCD symptoms. Slightly more participants reported reactive intrusions (47%) than autogenous (29%), but combinations of the two were common (24%). These classifications of thought content were not related to levels of appraisal or change in symptoms, with the exception of patients w...

Research paper thumbnail of Psychotic and schizotypal symptoms in non-psychotic patients with obsessive-compulsive disorder

BMC Psychiatry, 2015

Background: Research is scarce with regard to the role of psychotic and schizotypal symptoms in t... more Background: Research is scarce with regard to the role of psychotic and schizotypal symptoms in treatment of obsessive-compulsive disorder (OCD). The aim of the current study was to investigate the occurrence and specificity of psychotic and schizotypal symptoms among non-psychotic OCD patients, and to examine whether such symptoms was associated with response to exposure and response prevention (ERP), and whether ERP for OCD had an impact on psychotic and schizotypal symptoms. Methods: Non-psychotic OCD patients (n = 133) and a general non-psychotic psychiatric outpatient sample (n = 110) were assessed using self-report inventories before and after psychological treatment. Results: Non-psychotic OCD patients did not report greater degree of psychotic or schizotypal symptoms than the control group. Psychotic and schizotypal symptoms were not associated with OCD symptoms before or after ERP. Psychotic and schizotypal symptom were significantly reduced following ERP. Conclusions: Psychotic and schizotypal symptoms seem to be equally prevalent among non-psychotic OCD patients and non-psychotic psychiatric controls. These symptoms were more linked to depressive symptoms than OCD symptoms. In non-psychotic OCD patients, ERP seems sufficient in reducing OCD symptoms despite the presence of psychotic-and schizotypal symptoms, and reductions in psychotic-and schizotypal symptoms were observed following ERP.