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Patients experience existential themes as pivotal in their lives, in order to be able to live with a severe, chronic illness; however, physicians report a hesitative approach to existential communication. The current study investigated Nordic patients' experiences of existential communication with their physicians related to the treatment of multiple sclerosis or chronic pain. Semi-structured interviews with 23 patients were analyzed following Interpretative Phenomenological Analysis. Physicians focusing on medical aspects at the expense of psychological and existential aspects of being ill was experienced by patients as challenging their treatment and well-being. For making a shared decision with the physician on their treatment, patients needed a transition from being dependent to being autonomous. A holding environment and existential communication about transitional objects such as relationships with something bigger than themselves, as nature or religion, supported this autonomy. The analysis showed that existential communication not only supported patients in developing and regaining autonomy but also functioned as a moderator for illness-related distress, as a prevention of withdrawal from treatment, and as significant for patients in relation to living with chronic illness. Further education in existential communication is desirable, to support physicians integrating existential dimensions in consultations and shared decision-making with patients suffering from a severe, chronic illness.

Background Internet-based cognitive behavioral therapy (iCBT) has been demonstrated to be cost- and clinically effective. There is a need, however, for increased therapist contact for some patient groups. Combining iCBT with traditional face-to-face (FtF) consultations in a blended format may produce a new treatment format (B-CBT) with multiple benefits from both traditional CBT and iCBT, such as individual adaptation, lower costs than traditional therapy, wide geographical and temporal availability, and possibly lower threshold to implementation. Objective The primary aim of this study is to compare directly the clinical effectiveness of B-CBT with FtF-CBT for adult major depressive disorder. Methods A 2-arm randomized controlled noninferiority trial compared B-CBT for adult depression with treatment as usual (TAU). The trial was researcher blinded (unblinded for participants and clinicians). B-CBT comprised 6 sessions of FtF-CBT alternated with 6-8 web-based CBT self-help modules. TAU comprised 12 sessions of FtF-CBT. All participants were aged 18 or older and met the diagnostic criteria for major depressive disorder and were recruited via a national iCBT clinic. The primary outcome was change in depression severity on the 9-item Patient Health Questionnaire (PHQ-9). Secondary analyses included client satisfaction (8-item Client Satisfaction Questionnaire [CSQ-8]), patient expectancy (Credibility and Expectancy Questionnaire [CEQ]), and working (Working Alliance Inventory [WAI] and Technical Alliance Inventory [TAI]). The primary outcome was analyzed by a mixed effects model including all available data from baseline, weekly measures, 3-, 6, and 12-month follow-up. Results A total of 76 individuals were randomized, with 38 allocated to each treatment group. Age ranged from 18 to 71 years (SD 13.96) with 56 (74%) females. Attrition rate was 20% (n=15), which was less in the FtF-CBT group (n=6, 16%) than in the B-CBT group (n=9, 24%). As many as 53 (70%) completed 9 or more sessions almost equally distributed between the groups (nFtF-CBT=27, 71%; nB-CBT=26, 68%). PHQ-9 reduced 11.38 points in the FtF-CBT group and 8.10 in the B-CBT group. At 6 months, the mean difference was a mere 0.17 points. The primary analyses confirmed large and significant within-group reductions in both groups (FtF-CBT: β=–.03; standard error [SE] 0.00; P Conclusions With large within-group effects in both treatment arms, the study demonstrated feasibility of B-CBT in Denmark. At 6 months’ follow-up, there appeared to be no difference between the 2 treatment formats, with a small but nonsignificant difference at 12 months. The study seems to demonstrate that B-CBT is capable of producing treatment effects that are close to FtF-CBT and that completion rates and satisfaction rates were comparable between groups. However, the study was limited by small sample size and should be interpreted with caution. Trial Registration ClinicalTrials.gov NCT02796573; https://clinicaltrials.gov/ct2/show/NCT02796573 International Registered Report Identifier (IRRID) RR2-10.1186/s12888-016-1140-y

Background Vocational rehabilitation programs (VRP) developing and improving work ability are used in Denmark to assist long-term unemployed citizens with complex problems. The aims of this study were to (1) describe VRP-participants in relation to general health, well-being, work ability and self-efficacy at baseline and one-year follow-up, (2) obtain an understanding of VRP-participants’ personal development towards improving work ability, and (3) explore VRP-participants’ hopes and thoughts about their future. Methods In a mixed methods approach, data from a longitudinal survey and semi-structured interviews were collected. In the quantitative longitudinal survey, all participants completed paper questionnaires at baseline and one-year follow-up. For the qualitative semi-structured interviews, VRP participants were recruited with a maximum variation sampling strategy through VRP coordinators and personal contact. Data were analysed by descriptive statistics and systematic text condensation. Following analysis, data were merged and presented in combination according to identified themes. Results At baseline and one-year follow-up 146 (response rate 34%) and 74 participants (response rate 52%) respectively, responded to the questionnaire. Seven participants were interviewed. The analysis revealed four themes: 1) Individual explanations of life situation and health; 2) Finding the path; 3) Work as giving meaning to life; 4) Hope for the future. Despite self-reported scores indicating poor general health, lack of well-being, low work ability and low self-efficacy, VRP-activities seemed to have assisted participants in finding meaning in life. VRP-components that may be drivers of successful recovery processes were identified. Conclusions VRP-participants experienced life situations that include multifactorial burdens, and low levels of general health, well-being, work ability, and self-efficacy at baseline and 1 year later. From the outset, most did not have a clear goal of employment, but over time, new goals were set as realistic opportunities for re-developing their work ability were explored. Successful core components of VRP were individually tailored programs and support, development of new relationships, and accommodated flexible internships and jobs. Trial registration ClinicalTrials.gov Identifier: NCT02641704, date of registration December 29, 2015.

Investigating therapeutic environments for young drug users is needed to avoid a high dropout rate due to a potential stigmatising effect of the structure of the space. In this article, we draw from three semi-structured interviews with young drug users. The interviews focused broadly on their experiences being on drug treatment and on how they experienced counselling and treatment in different spaces. The findings show that therapeutic spaces that were viewed as clinical and sterile were experienced as stigmatising, which discouraged young drug users from engaging in treatment and therapeutic processes. In contrast, therapeutic places with a homely atmosphere reduced the experience of stigmatisation, facilitated participation in treatment and helped users to relax and feel part of a community. In the analysis, we show how enabling therapeutic places with a homely atmosphere can be produced through materials, activities, and sensory processes.

(1) Background: Research has shown that patients with mental health diagnoses experience less anxiety and depressive symptoms and higher levels of ‘well-being’ when they spend time in natural environments as part of their treatment. It has been suggested that there is a relationship between the outdoor settings and the recovery of psychiatric patients. Recovery describes an individual process, which can vary from person to person. (2) Methods: This scoping review examined the relationship between the physical environment and the recovery of psychiatric patients. Systematic searches in three online databases, namely Medline, Embase, and PsycINFO, were performed using a selection of psychiatric, environmental, and recovery terms and included both quantitative and qualitative studies. In general, ‘well-being’ serves as an overarching indicator when it comes to research on how outdoor settings can affect mental health. Well-being was expressed in terms of mood, social relations, and autonomy. (3) Results: A total of 8138 records were screened, 85 studies were included for full-text reading, and five articles were included in the final analysis. The review showed in general that outdoor settings, more specifically gardening, contact with nature, and a safe environment can be related to the well-being of patients on psychiatric wards. (4) Conclusions: The five reviews allow us to conclude that outdoor settings can be seen as a comprehensive resource for mental health.

Rum, natur, relationer og stemninger er fænomener, som beskrives i en arkitekturpsykologisk tilgang, der i nærværende artikel spørger, om eller hvordan naturen kan understøtte menneskers helbred. Vi undersøger på grundlag af teoretiske præmisser, metodiske overvejelser og empiriske resultater, om og hvordan mennesker med sundhedsmæssige og psykiske udfordringer kan få gavn af ophold i og mødet med naturen. Selv om det er indlysende, at omgivelser kan berige mennesker, så er det ikke ofte, at forskere, kommuner og naturvejledere arbejder sammen i et forsknings- og praksisorienteret projekt. Artiklen beskriver erfaringer fra et pilotprojekt, der bruger naturen som med-behandler for stressramte mænd, og byder samtidig på en teoretisk tilnærmelse til emnet. Pilotprojektet blev gennemført i samarbejde mellem Svendborg kommune og museet Naturama og bestod af tre kursusforløb af otte ugers varighed med i alt 33 mænd. Projektets formål var at bruge naturen som med-behandler for en målgruppe, som ikke har gavn af kommunens øvrige rehabiliteringstilbud, og skal derved forankre et nyt rehabiliteringsforløb for mænd.

Self-perceived interpersonal problems are of central concern for researchers and individuals; they are at the basis of psychopathology and cause for subjective distress. In this study, we examine whether a group-based rehabilitation program in nature may reduce self-perceived interpersonal problems in a heterogeneous group of men declining participation in traditional rehabilitation offers. The intervention consisted of weekly meetings in nature, taking place over the course of nine weeks. Through a matched-control study including 114 participants in the intervention group and 39 in a treatment as usual group participating in traditional rehabilitation offers, we found that there was no statistically significant development in self-perceived interpersonal problems in the nature-based rehabilitation offer. Though promising with regards to a number of mental challenges, including relational challenges, nature-based group-rehabilitation may require a more elaborate and thoroughgoing intervention, including e.g., a therapist and more time to be an effective intervention against interpersonal problems. We conclude that perhaps due to the fundamental aspect of self-perceived interpersonal problems, exposure to nature, and being in a group of men in a similar situation for the duration that this intervention lasted, may not be enough to address such underlying perceptions of self.

Background and purpose: In Denmark attractive rehabilitation offers for men are lacking. Consequently, more men than women say no to participate in and more often drop out of rehabilitation programs. Therefore, a nature-based rehabilitation program called the ‘Wildman Programme’ has been designed to men. The ‘Wildman Programme’ combines nature experiences, body awareness training, mind relaxation, and supporting community spirit. The method is called Nature-Body-Mind-Community (NBMC). The aim of this study was to assess the implementability and effect of the ‘Wildman Programme’ on the participants' quality of life and symptoms of stress. Materials and methods: The ‘Wildman Programme’ was explored as a quasi-experimental study. The study included 20 men with psychological stress and diminished quality of life due to mental health challenges and chronic illnesses. The primary outcome was quality of life and the secondary outcome was stress level. All outcomes were measured at baseline (T1) and at the end of the ‘Wildman Programme’ (T2). Results: The study showed the ‘Wildman Programme’ has potential to reduce stress symptoms (15.40%) and enhance quality of life (10.07%) among the male participants. Furthermore, physical health (13.92%) and psychological health (16.88%) in relation to quality of life increased during the program. Conclusion: The study showed that the ‘Wildman Programme’ is implementable in a Danish healthcare center. It was well received by the health professionals and the method was in demand by the target group of men. However, a larger study should be conducted to further investigate the findings of this study.

BaggrundDet kan have alvorlige konsekvenser for unge pårørendes udvikling at leve med alvorligt syge forældre, men langt fra alle får optimal støtte. Sundhedsstyrelsen anbefaler i overensstemmelse hermed ”at styrke inddragelsen af patienternes pårørende […] med særligt fokus på børn, der som pårørende er en sårbar – men ofte tavs – gruppe”. På Plastikkirurgisk og Brystkirurgisk Afdeling, SUH, har vi etableret Netværk for Unge Pårørende (NUP) – en netværksgruppe for unge i alderen 12-18 år – og undersøgt de unges behov for inddragelse ogstøtte.Undersøgelsens forskningsspørgsmål lød:- Hvilke behov oplever unge pårørende under deres mors brystkræftforløb?- Hvordan kan unge pårørende bedst inddrages og støttes tidligt i deres mors sygdomsforløb?Teoretisk referencerammeVi anvendte John S. Rollands psykosociale systemiske sygdomsmodel, som tydeliggør forholdet mellem kronisk sygdom og familien. Rolland inddeler sygdomsforløbet i en krise-, kronisk- og terminalfase. Faserne kan opfattes som udviklingsmæssige tidsperioder, der hver stiller en række krav og udfordringer til familiemedlemmerne og ændrer deres livsvilkår. De psykosociale krav, de unge stilles over for, afhænger af den aktuelle sygdomsfase sammenholdt med familiens evne til kommunikation, problemløsning og fleksibilitet. Rollandfremhæver forældrenes egen tilpasning samt åbenhed og inddragelse af de unge i sygdomsforløbet som særligt prædikativt for de unges tilpasning.MetodeUndersøgelsen bestod af otte individuelle interviews med unge pårørende om oplevelsen af at leve med en brystkræftramt mor samt et gruppeinterview med syv unge om deres oplevelse af deltagelse i NUP. Alle interviews blev optaget, transskriberet og analyseret med en induktiv tilgang ud fra et fænomenologisk udgangspunkt. Med tematisk analyse blev fælles temaer på tværs af interviewene afdækket.ResultaterDe unge pårørende havde svært ved at italesætte egne behov. De efterspurgte viden om brystkræft og behandling og ønskede inddragelse på hospitalet, men var tilbageholdende med at opsøge den. Forældrenes opbakning havde generelt stor betydning for de unges motivation og udbytte af NUP, og særligt psykosocialt belastede unge havde gavn af at deltage. Svar på spørgsmål fra sundhedsfagligt personale mindskede de unges oplevelse af utryghed, og defølte sig lettede og mindre alene af at dele oplevelser med hinanden. Konklusion og perspektiveringSundhedspersonale kan med fordel inddrage unge pårørende i samtaler om alvorlig sygdom hos forældre og aktivt støtte forældre i at motivere de unge til deltagelse i en erfaringsudvekslingsgruppe med særligt fokus på psykosocialt belastede unge. Vi anbefaler etablering af støttetilbud, som giver unge pårørende mulighed for at udveksle erfaringer med hinanden og at tiltag som NUP afprøves i yngre og ældre aldersgrupper og andre relevante somatiske specialer.

BACKGROUND Internet-based cognitive behavioral therapy (iCBT) is a promising new treatment method for depression and anxiety. However, it is important to determine whether its results can be replicated in routine care before its implementation on a large scale. Although many studies have demonstrated the efficacy of iCBT under controlled conditions, only a few studies have investigated its effectiveness in routine care. Furthermore, several effects of iCBT such as treatment effects in routine care are unclear. OBJECTIVE This study aimed to evaluate the clinical effectiveness of iCBT for depression and anxiety in routine secondary care. METHODS n a retrospective cohort study, we analysed patients treated for depression or anxiety in a dedicated iCBT clinic in secondary care in Denmark. Patients were examined before treatment and weekly thereafter by using the Patient Health Questionnaire-9 and the Generalized Anxiety Disorder-7 scales for the diagnoses of depression and anxiety, respectively. Primary analyses were conducted using a linear mixed-effects model with random slope and intercept. Secondary analyses were conducted using baseline characteristics as predictors (gender, age, highest level of education, occupational status, marital status, psychotropic medication use, consumption of alcohol, and leisure drugs). Additionally, logistic regression analyses were used to predict noncompletion of treatment. RESULTS A total of 203 (depression, N=60; anxiety, N=143) patients were included. Participants were mainly female (78.3% with depression and 65.7% with anxiety), with a mean age of 36.03 (SD 10.97) years (range, 19-67 years) for patients with depression and 36.80 (SD 13.55) years (range, 19-69 years) for patients with anxiety. The completion rates were 62% (37) and 40% (57) for depression and anxiety treatments, respectively. The primary analyses revealed large and significant reductions in the symptom levels of depression (beta=-6.27, SE 0.83, P CONCLUSIONS iCBT can be clinically effective in routine care. Since depression and anxiety are costly and debilitating disorders that are vastly undertreated, this finding is important. Additionally, iCBT may help bridge the gap between the need for treatment and its provision. Our results are comparable to the within-group results of efficacy and effectiveness studies. Our noncompletion rates are similar to those observed in psychotherapy but are higher than those reported in similar clinics. Multiple factors predicted outcome and noncompletion. However, all predictor effects were statistically weak.

Surgical treatment of obesity has led to a large group of patients with massive weight loss. The massive weight loss results in excessive skin, which leads to pain, skin problems, cosmetic discomfort and psychosocial issues. The impact on quality of life of bariatric and body contouring surgery can be measured by patient-specific, well-constructed psychometrically validated patient-reported outcome measures. A new patient-reported outcome measure, the Body-Q, has been translated for use in Danish patients

Background and aimAlcohol use disorder is a widespread problem in Denmark and has severe impacts on health and quality of life of each individual. The clinical treatment of alcohol use disorder involves evidence-based knowledge on medical treatment, physical training, and psychological management. The aim of this study is to investigate the effect of physical exercise on alcohol intake, cardio-respiratory fitness and socio-psychological outcomes.Methods and designThe study is a randomized controlled trial with three arms: (A) Standard treatment alone, (B) Standard treatment and physical exercise in groups, or (C) Standard treatment and physical exercise on an individual basis. The patients will fill a questionnaire and they will be tested at baseline, and after 6 and 12 months.ResultsAt the end of March 2014 we expect to analyse the first baseline data and follow up data. Here, we will present the study and inform about the first preliminary results. PerspectivesIf this study detects a positive relationship between exercise as a supplement to alcohol treatment and patients’ alcohol intake, quality of life, fitness, well-being, anxiety, depression and interpersonal problems, it will be recommended to implement exercise as an offer to users of the outpatient clinic in the future.

INTRODUCTION: Body contouring surgery is associated with changes in body image and identity. The primary aim of the study was to investigate a multidisciplinary assessment of potential psychological challenges before and after body contouring surgery.METHODS: Eight pre- and post-operative patients undergo- ing plastic surgery, two surgeons and two nurses were in- vestigated using semi-structured and focus group inter- views to capture the perspectives of both the healthcare professionals and the patients. Data were analysed using an interpretive descriptive approach and coded line-by-line until all relevant codes had been extracted.RESULTS: A total of seven psychological themes were iden- tified, indicating that surgery alone cannot improve the pa- tients’ psychological difficulties and that psychological care and management of the expected discomfort and body im- age is of considerable importance in providing continuity of care.CONCLUSIONS: The reported quality of life is of consider- able importance to patients undergoing body contouring surgery after massive weight loss. Our findings may provide useful information for surgeons and healthcare profes- sionals allowing them to develop patient education pro- grammes, reduce discrepancies in patient expectations and improve patient satisfaction.