Search

To examine treatment fidelity in a randomized controlled trial of indicated school-based cognitive-behavioral therapy (CBT) delivered in groups to youth with anxiety. We investigated whether adherence and competence (a) differed across brief and standard-length CBT, and (b) if adherence and competence predicted change in anxiety symptoms and impairment. Method: Sessions were observationally coded with the "Competence and Adherence Scale for CBT for Anxiety Disorders in Youth." Coders (N = 7) rated 104 sessions from 52 groups delivered by 32 facilitators (M age = 43.2 years, SD = 8.1) to 295 youth (M age = 14.0 years, SD = 0.8). Outcomes were youth- and parent-reported anxiety symptoms and impairment at post-intervention and 1-year follow-up. Linear mixed effect models were used to analyze whether fidelity predicted clinical outcomes. Results: Levels of adherence and competence were adequate in both programs, but higher in brief compared to standard-length CBT p < 0.001 and p = 0.010, respectively). Neither adherence nor competence predicted clinical outcomes at any timepoints. Conclusion: Higher levels of adherence and competence in brief CBT suggest that it may be easier for novice CBT providers to achieve fidelity in simplified and less flexible interventions. Contrary to expectation, adherence and competence did not predict clinical outcomes.

The behavioral restrictions disrupting daily life during the COVID‐19 pandemic have profoundly impacted well‐being, and health behaviors have been advocated to prevent decline. To understand how processes related to fluctuation in well‐being unfold within individuals, analyses on the within‐person level are required. In this preregistered intensive longitudinal study, 1,709 individuals from the Norwegian adult population provided data daily over 40 consecutive days during the pandemic. The responses were modeled in a multilevel vector autoregressive model to estimate within‐person networks, across and within‐day, and a between‐person network. All three networks revealed productivity, relatedness, and optimism as positively associated. Social distancing was contemporaneously negatively associated with productivity and relatedness. Among behavioral factors, being physically active predicted lower relatedness across days but displayed positive associations with relatedness, productivity, and optimism contemporaneously. Alcohol consumption predicted lower productivity across and within‐day, although revealing a positive association with optimism within‐day. Being social online and feeling related to others displayed a temporal negative bidirectional relationship. In contrast, being social online was positively associated with optimism, productivity, and relatedness contemporaneously. Our study emphasizes the dynamic nature of well‐being and its complex associations with behavioral factors during the pandemic. The study shed light on opposing associations of behavioral factors at the within‐ and between‐person level. [ABSTRACT FROM AUTHOR]

Background: Recovery processes during residential treatment for eating disorders, especially in patients with a history of maltreatment, are insufficiently understood. This study aimed to explore the temporal relationships among comorbid factors, including depression, anxiety, and self‐compassion, with the influence of childhood maltreatment. Method: Using Dynamic Time Warp (DTW), weekly scores from the Symptom Checklist‐5, Eating Disorder Examination, and Self‐Compassion Scale were analysed over 12 weeks. The study generated undirected and directed networks to identify influential symptoms in a transdiagnostic sample, comparing patients with and without childhood maltreatment. Results: The study included 124 patients with eating disorders (ED) (97% women), mean age of 30.9 years (SD = 9.7, range 18–61 years). Diagnoses included anorexia nervosa (26%), bulimia nervosa (38%), and other specified feeding and eating disorders (36%). The directed DTW network showed that hopelessness, worrying, and restlessness had the highest out‐strength, predicting changes in self‐compassion and ED behaviour. In maltreatment cases, hopelessness and low acceptance predicted changes, while worry, restlessness, and nervousness were predictive in non‐maltreatment cases. Conclusion: Temporal network analyses suggest that a change in hopelessness, worrying, and restlessness drives symptom improvement in ED behaviour and the development of self‐compassion during residential treatment. These processes vary between patients with and without a history of childhood maltreatment separately, indicating the need for further analyses. Key points: Temporal network analysis can contribute to further advances in personalised medicine.Our study indicates that patients with eating disorders (ED) and a history of childhood maltreatment differ from patients without a history of childhood maltreatment in network dynamics, indicating different therapy processes.We find that a change in hopelessness and acceptance of disliked personality traits preceded and predicted change in ED behaviour and the ability to feel self‐compassionate in patients with ED and a history of childhood maltreatment.These findings point to a need to study patients with a history of maltreatment separately to further advance the field of personalised medicine in ED treatment. [ABSTRACT FROM AUTHOR]

Despite the presence of individual differences in the depressive symptom change in adults during the COVID‐19 pandemic, most studies have investigated population‐level changes in depression during the first year of the pandemic. This longitudinal repeated‐measurement study obtained 39,259 observations from 4,361 adults assessed nine times over a 24‐month period in Norway (March 2020 to March 2022). Using a Latent Change Score Mixture Model to investigate differential change patterns in depressive symptoms, five profiles were identified. Most adults revealed a consistently resilient (42.52%) or predominantly resilient pattern differentiated by an initial shock in symptomatology (13.17%). Another group exhibited consistently high depressive adversities (8.5%). One group showed mild deterioration with small increases in depressive symptomatology compared to onset levels (29.04%), and a second strong deterioration group exhibited clinically severe levels of gained symptoms over time (6.77%). Both deteriorating depressive symptom change patterns predicted the presence of a psychiatric diagnosis and treatment seeking at the end of the study period. Together, the absence of a preexisting psychiatric diagnosis at the onset of the pandemic and severe symptom increases during, combined with reports of psychiatric treatment seeking and diagnosis at the end of the study period, indicated that the strongly deteriorating subgroup represents an additional and newly emerged group of adults struggling with depressive problems. Factors related to general adverse change (lower education levels, lone residence), initial shocks prior to recovery (frequent information seeking, financial and occupational concerns), and resilience and recovery (older age, being in a relationship, physical activity) were identified. Binge drinking and belonging to an ethnic minority were influential predictors of the strongly deteriorating group. All major change patterns in depressive symptoms occurred during the first 3 months of the pandemic, suggesting this period represents a window of sensitivity for the development of long‐lasting depressive states versus patterns of recovery and resilience. These findings call for increased vigilance of psychiatric symptoms during the initial phases of infectious disease outbreaks and highlight a specific target period for the implementation of preventive measures. [ABSTRACT FROM AUTHOR]

Background: Most network analyses on central symptoms in eating disorders (EDs) have been cross‐sectional. Longitudinal within‐person analyses of therapy processes are scarce. Our aim was to investigate central change processes in therapy in a transdiagnostic sample, considering the influence of childhood maltreatment. Method: We employed dynamic time warping analyses to identify clusters of symptoms that tended to change similarly across therapy on a within‐person level. Symptoms were measured by a 28‐item Eating Disorder Examination Questionnaire (EDE‐Q). Furthermore, we examined the temporal direction of symptom change to identify symptoms that tended to precede and predict other symptoms. Finally, we estimated two directed, temporal networks in patients with and without a history of childhood maltreatment. Results: Our analysis included 122 ED patients (mean age = 30.9, SD = 9.7; illness duration = 14.2 years, SD = 8.9; prior treatment = 5.6 years, SD = 5.1). The initial network revealed three robust clusters of symptoms over time: (1) ED behavior, (2) inhibition, and (3) cognitions and feelings about body and weight. Overvaluation of shape had the highest out‐strength preceding and predicting other symptoms. Dissatisfaction with weight preceded and predicted other symptoms in the maltreatment network. The non‐maltreatment network showed a similar structure to the transdiagnostic network. Conclusion: Targeting and monitoring feelings and cognitions related to shape may be crucial for achieving lasting symptom improvement in a transdiagnostic sample. Furthermore, our findings highlight the need for further investigation into the different processes driving EDs based on maltreatment status. Public significance: There is limited understanding of the processes that occur for patients with eating disorders between admission and discharge in therapy, especially for patients with a history of childhood maltreatment. Our analyses suggest that changes in cognitions regarding shape precede and predict changes in cognitions about weight. Different processes may be driving the eating disorder according to maltreatment status, which might further illuminate the riddle of dropout and relapse in therapy for patients with a history of childhood maltreatment. These findings suggest the need for further investigation into the specific dynamics occurring during therapy for individuals with a history of childhood maltreatment. [ABSTRACT FROM AUTHOR]

Background: A large proportion of patients with eating disorders (ED) report experiences of childhood trauma. Latent trajectory analysis in ED samples reveals the complexities in course and outcome and can explore the long‐term impact of adverse experiences in childhood. Method: A total of 84 patients with longstanding ED were included. ED symptoms were assessed by the Eating Disorder Examination interview at discharge from inpatient treatment, and at 1‐, 2‐, 5‐, and 17‐year follow‐up, respectively. Change over time was examined using growth mixture modeling, allowing the number of trajectories to emerge through the data. Prevalence of childhood trauma was assessed, and its relation to class membership was tested. Results: We identified four distinct classes: patients with (a) a continuous improvement in the entire follow‐up period, and scores within normal range at the end, "continuous improvement" (54.8%); (b) a high symptom level at baseline and moderate decrease over time, "high and declining" (22.6%); (c) initial ED scores below clinical cut‐off and stable symptoms throughout the course, "consistently low" (14.3%); and (d) with high scores initially, and a significant increase in symptoms over time, "high and increasing" (8.3%). A history of childhood sexual abuse (CSA) was overrepresented in classes with persistently high symptom levels and poor long‐term outcome Discussion: Patients with longstanding ED displayed considerable diversity in trajectories of symptom change across 17 years. To improve long‐term outcome, enhanced treatment of sequelae from CSA seems essential. Public Significance: Patients with longstanding eating disorders displayed four different trajectories of change in a 17‐year follow‐up study. Although there were significant changes over time, the majority of patients remained within similar symptom levels as they presented with at discharge from inpatient treatment. Exposure to childhood maltreatment was common within the sample. Childhood sexual abuse predicted poor long‐term outcome, which highlights the importance of trauma informed care. [ABSTRACT FROM AUTHOR]