Search

Background This study extends previous research by exploring whether changes in obsessive beliefs and metacognitions that were associated with changes in obsessive–compulsive disorder (OCD) symptom severity over the course of group behavioral treatment were maintained at long-term follow-up. Methods Forty patients with a primary diagnosis of OCD participated. The between- and within-person effects were investigated with multilevel longitudinal models. Predictor variables were obsessive beliefs and metacognitions. Results Across the study period, with a mean 8-year follow-up, obsessive and metacognitive beliefs significantly declined. There were significant between-person effects for metacognition and obsessive beliefs on OCD symptom severity. When the overlap between the obsessive belief factors was controlled for, only changes in metacognitions emerged as an independent predictor of OCD symptom severity. A further analysis revealed that metacognitive beliefs regarding the need to control thoughts made a separate contribution at both the between- and within-person levels. Conclusions The results indicate that decreases in metacognitive beliefs during OCD treatment can also have important long-term consequences.

This study aims to increase understanding of how social workers and therapists contribute to cooperation meetings within the individual placement and support intervention. The individual placement and support model of supported employment is expanding worldwide. Although several quantitative studies have shown this model`s effect, the need for qualitative studies on collaboration within this intervention is evident. The individual placement and support fidelity manual presents clear expectations to the social workers and therapist in the cooperation. Still, few previous studies investigate how these expectations are met in praxis. This study draws on sixteen collaboration meetings, recorded, transcribed, and analysed using reflexive thematic analyses. It shows that the social workers and therapists did, to a limited extent, adapting their support to the expectations of personalised work support inherent in the individual placement and support intervention. They underestimated their importance in collaboration meetings, and this limited the dialogue. Further qualitative studies are needed to understand how social workers and therapists experience their contribution to individual placement and support and their reasons underestimating their importance. Still, we suggest that more individualised work support from the social workers and therapists could help people who choose individual placement and support to succeed in work life.

Aim To provide increased understanding about how work applicants, employment specialists, social workers in the welfare service and clinicians in mental healthcare service experience participating in individual placement and support (IPS). Methods We searched in several databases and identified 17 studies published from 2007 to 2017 in Sweden, USA, Canada, UK, Australia and Denmark, and applied meta-ethnographic reinterpretation and synthesis. Results The employment specialists followed the core ideas of IPS, where work is seen as a way to recover. They saw the work applicants' preferences and needs as important for health and well-being, and crucial for successful work rehabilitation. In order to reach these goals, they offered a personal relationship to the work applicants. Work applicants clearly appreciated this personalised recovery-oriented mindset. Furthermore, work applicants needed the employment specialists as culture brokers between health-related questions and the expectations met in the labour market. Social workers lacked resources to such personalised support, and they were under demand of welfare regulations made for a 'train then place' model, which conflicts with the view that work leads to recovery as IPS sees it in their 'place then train' model. The scarce knowledge of the clinicians' experiences in the present study suggests that they are sceptical to work as a way to recover, which is in conflict with IPS. Conclusions The work applicants highlighted the significance of the individualised support they received. Social workers and some clinicians found it difficult to provide this important personalised support towards work. Conflicting mindsets between the traditional gradual work rehabilitation paradigm and the IPS approach as a way of recovering might explain these frustrations and distance. Recommendations for practice. An improvement of IPS may depend on more cooperation based on an acceptance of the recovery-oriented mindset, which for some will mean an acceptance of new knowledge.

Nearly half of patients with non-cardiac chest pain (NCCP) experience significant complaints after a negative cardiac evaluation, at considerable costs for society. Due to the lack of treatment capacity and low interest for psychological treatment among patients with somatic complaints, only a minority receive effective treatment. The aim of this study was to assess the feasibility and usefulness of internet-assisted cognitive behavioural therapy (I-CBT), including encouragement of physical activity for this condition. Ten patients with NCCP received a six-session I-CBT intervention with minimal support from a therapist. Questionnaires assessing cardiac anxiety, fear of bodily sensations, depression, interpretation of symptoms, frequency of chest pain and impact of chest pain symptoms were collected at baseline, post-treatment and at 3-month follow-up. Semi-structured interviews employing a phenomenological hermeneutic approach assessed the participants’ experience of the intervention. Quantitative results showed clear improvements in several measures both at end of treatment and at 3-month follow-up. The retention rate was 100% and client satisfaction was high. The intervention was feasible to implement in a cardiac setting. This setting made it easier for patients to accept a psychological approach. Qualitative interviews revealed that the participants felt respected and taken care of, and they obtained a better understanding of their chest pain and how to cope with it. This pilot study yielded promising results regarding feasibility, clinical effect and patient satisfaction from a brief I-CBT intervention for NCCP in a cardiac setting. These results indicate that a randomized controlled trial with a larger sample size is warranted. Key learning aims (1) Feasibility of internet-assisted cognitive behavioural therapy (I-CBT) for non-cardiac chest pain (NCCP). (2) How NCCP patients experience I-CBT. (3) Possible effects of I-CBT. (4) How I-CBT can be delivered at the Cardiac Department.

Background Noncardiac chest pain has a high prevalence and is associated with reduced quality of life, anxiety, avoidance of physical activity, and high societal costs. There is a lack of an effective, low-cost, easy to distribute intervention to assist patients with noncardiac chest pain. Objective In this study, we aimed to investigate the effectiveness of internet-based cognitive behavioral therapy with telephone support for noncardiac chest pain. Methods We conducted a randomized controlled trial, with a 12-month follow-up period, to compare internet-based cognitive behavioral therapy to a control condition (treatment as usual). A total of 162 participants aged 18 to 70 years with a diagnosis of noncardiac chest pain were randomized to either internet-based cognitive behavioral therapy (n=81) or treatment as usual (n=81). The participants in the experimental condition received 6 weekly sessions of internet-based cognitive behavioral therapy. The sessions covered different topics related to coping with noncardiac chest pain (education about the heart, physical activity, interpretations/attention, physical reactions to stress, optional panic treatment, and maintaining change). Between sessions, the participants also engaged in individually tailored physical exercises with increasing intensity. In addition to internet-based cognitive behavioral therapy sessions, participants received a brief weekly call from a clinician to provide support, encourage adherence, and provide access to the next session. Participants in the treatment-as-usual group received standard care for their noncardiac chest pain without any restrictions. Primary outcomes were cardiac anxiety, measured with the Cardiac Anxiety Questionnaire, and fear of bodily sensations, measured with the Body Sensations Questionnaire. Secondary outcomes were depression, measured using the Patient Health Questionnaire; health-related quality of life, measured using the EuroQol visual analog scale; and level of physical activity, assessed with self-report question. Additionally, a subgroup analysis of participants with depressive symptoms at baseline (PHQ-9 score ≥5) was conducted. Assessments were conducted at baseline, posttreatment, and at 3- and 12-month follow-ups. Linear mixed models were used to evaluate treatment effects. Cohen d was used to calculate effect sizes. Results In the main intention-to-treat analysis at the 12-month follow-up time point, participants in the internet-based cognitive behavioral therapy group had significant improvements in cardiac anxiety (–3.4 points, 95% CI –5.7 to –1.1; P=.004, d=0.38) and a nonsignificant improvement in fear of bodily sensations (–2.7 points, 95% CI –5.6 to 0.3; P=.07) compared with the treatment-as-usual group. Health-related quality of life at the 12-month follow-up improved with statistical and clinical significance in the internet-based cognitive behavioral therapy group (8.8 points, 95% CI 2.8 to 14.8; P=.004, d=0.48) compared with the treatment-as-usual group. Physical activity had significantly (P Conclusions This study provides evidence that internet-based cognitive behavioral therapy with minimal therapist contact and a focus on physical activity is effective in reducing cardiac anxiety and increasing health related quality of life in patients with noncardiac chest pain. Trial Registration ClinicalTrials.gov NCT03096925; http://clinicaltrials.gov/ct2/show/NCT03096925

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 post-treatment 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 post-treatment 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.

There is need for more knowledge concerning couple relationships and obsessive-compulsive disorder. In this study, patients with obsessive-compulsive disorder were interviewed in focus groups concerning how their illness influences relationship with their partner. The interviews were analyzed phenomenological. The results show that obsessive-compulsive disorder can cause mental and physical distance, the patient can feel monitored and pathologized by the partner’s accommodation and support, and the patient can monitor that the partner follows the rituals. The disturbed power balance can last even in periods with low symptom level. Power-related aspects should be emphasized in couple therapy for patients with obsessive-compulsive disorder.

This focus group study explores the experiences of five partners of patients suffering from obsessive-compulsive disorder concerning how this disorder might influence couples’ relationships in the long-term. We find that the disorder might give rise to power struggles concerning “normality”, deprive couples of opportunities for rewarding fellowship during household chores and leisure time, and persistent analytic processes concerning predicaments of what to do. They also express a need for more help from the health services. The results might be of value to therapists in their daily work, and might have implications for future research on couple’s therapy involving this group.

There is a lack of empirical studies investigating patients’ understanding of why they developed obsessive-compulsive disorder (OCD). In this article, we explore patients’ conceptualization of why they developed OCD and their understanding of the significance of having a theory about why they developed OCD. We utilized a hermeneutical-phenomenological approach to analyze and interpret the data. Focus group interviews were conducted with 15 individuals who had undergone group behavioral treatment for OCD for an average of 8.5 years ago. Four core categories were drawn from our analysis: (1) OCD as a coping strategy; (2) OCD as a result of family heritage; (3) comfort in understanding where one’s OCD comes from; and (4) ambivalence about focusing on causes in treatment of OCD. In conclusion, participants noted a range of potential psychosocial contributors to the development of their OCD symptoms. Of particular note were beliefs that OCD initially developed as a coping strategy for handling difficult life situations. Potential clinical and research-related implications of these findings are discussed. This article is an open access article. DOI:https://doi.org/10.15714/scandpsychol.6.e12

Background Power in doctor–patient relationships is asymmetrically distributed. The doctor holds resources the patient needs and has a mandate to promote healthy living. Power may benefit or harm the patients9 health, and the doctor–patient relationship. Aim To identify aspects of power and powerlessness in GPs9 narratives about lifestyle counselling. Design and setting A qualitative study using focus groups from peer-group meetings of Norwegian GPs attending continuing medical education. Method GPs discussed case stories about lifestyle counselling in focus groups. The discussions were transcribed and the text analysed using systematic text condensation. Results Aspects of power concerning the framework of the consultation and the GPs9 professional role were found. Also identified were: power expressed by opportunistic approaches to change patients9 lifestyle; rhetoric communication; paternalism; and disclosure. GPs reported powerlessness in complex communication, when there were difficulties reaching goals, and when patients resisted or ignored their proposals. Conclusion Case-study discussions in peer groups disclose several aspects of power and powerlessness that occur in consultations. Consciousness about aspects of power may facilitate counselling that benefits the patient and the doctor–patient relationship.

The ideal of dialogue is at stake in professional conversations. The aim of this study is to develop an instrument that makes it possible to compare principles of deliberation with what actually takes place in professional conversations. The developed instrument is tested on one patient's conversation with his doctor about lifestyle changes, and meetings where pupils with learning disabilities and their parents discuss further schooling with school representatives. Although in need of refinement, the conclusion is that the instrument provides meaningful insight into how much each participant 'contributes' to the decision-making process and 'behaves' during the conversation.

BACKGROUND GPs consider individual lifestyle counselling as part of their obligation. There is a lack of knowledge about how such counselling is done. OBJECTIVE To investigate what tools GPs utilize in individual consultations concerning lifestyle change. METHODS Qualitative analysis of six focus groups with 50 GPs sharing and commenting each other's case stories. RESULTS To enhance change of lifestyle, GPs adjusted the organization of their practice and utilized visualization tools. They established doctor-patient relationships based on shared decision making and trust, and gave their patients advice and tips to accomplish change, but also used paternalistic approaches and rhetoric manipulation. CONCLUSIONS GPs use a variety of tools in consultations about lifestyle change. A patient-centred approach is shown, but GPs also deliberately use distressing communication tools.

Background, aims and objectives: When research investigates how patients obsessive compulsive disorder (OCD) are doing after therapy they usually report a symptom level at single points in time. The goal of the present study was to reveal a more multidimensional description of what OCD patients who have received treatment might find valuable when dealing with OCD symptoms in the long term. Methods: Fifteen patients with OCD who had received group exposure and prevention response therapy (ERP) between 6 and 11 years ago were recruited to attend focus groups. Eleven of the patients had received various other treatments in addition. The present symptom-level varied from none to severe OCD symptoms. The patients were asked open-ended questions concerning what they had learned from the group ERP, which they all had as denominator and how they dealt with the OCD symptom variations over time. The interviews were audiotaped, transcribed and analysed phenomenologically. Results: The overall finding was that the patients had achieved a foundation for a relaxed solution-oriented attitude regarding their OCD, regardless of their Yale-Brown Obsessive Compulsive Scale (Y-BOCS) level. The foundation for the attitude consisted of a new self-understanding, a higher evaluation of themselves, externalization and devaluation of OCD, where the OCD was seen in terms of symptoms and not as behaviour crucial to their identity, seeing OCD as possible to influence and maintaining several self-management strategies. Concretely, patients used parts of ERP such as: reminding themselves that bad emotions will eventually subside, comparing their behaviour to normal standards, recalling specific exposure exercises they undertook in therapy and using less formal exposures than in therapy. Furthermore, the patients made efforts to reduce their general stress level and took breaks from routines. One patient even avoided everyday habits to prevent the occurrence of new rituals. Surprisingly, none of the participants used formal ERP as they were taught. Conclusion: The present study provides valuable experience-based knowledge which might serve as input to future the development of a multidimensional assessment tool which can evaluate whether OCD patients have attitudes and strategies that make them able to cope with symptom variations. The results also indicate ways in which future improvements in OCD treatment can be achieved. Finally, the study points to the need to develop strategies to increase engagement in formal ERP after therapy. We advance our study as an important contribution to the literature on person-centered OCD management.

OBJECTIVE. (1) To elucidate the relevance of Habermas's theory as a practical deliberation procedure in lifestyle counselling in general practice, using a patient perspective. (2) To search for topics which patients consider of significance in such consultations. DESIGN. Qualitative observation and interview study. SETTING. General practice. Subjects. A total of 12 patients were interviewed after lifestyle consultations with their GPs. MAIN OUTCOME MEASURES. How the patients perceived the counselling, how it affected them, and what they wanted from their GP in follow-up consultations. RESULTS. The GP should be a source of medical knowledge and a caretaker, but also actively discuss contextual reasons for lifestyle choices, and be a reflective partner exploring values and norms. The patients wanted their GP to acknowledge emotions and to direct the dialogue towards common ground where advice was adjusted to the concrete life situation. A good, personal doctor-patient relationship created motivation and obligation to change, and allowed counselling to be interpreted as care. CONCLUSION. The findings underscore the necessity of a patient-centred approach in lifestyle counselling and support the relevance of Habermas's theory as practical guidance for deliberation. IMPLICATIONS. The findings suggest that GPs should trust the long-term effects of investing in a good relationship and personalized care in lifestyle consultations. The study should incite the GP to act as an encouraging informer, an explorer of everyday life and reasons for behaviour, a reflective partner, and a caretaker, adjusting medical advice to patients' identity, context, and values.

Adjustments of everyday life in order to prevent disease or treat illness afflict partly unconscious preferences and cultural expectations that are often difficult to change. How should one, in medical contexts, talk with patients about everyday life in ways that might penetrate this blurred complexity, and help people find goals and make decisions that are both compatible with a good life and possible to accomplish? In this article we pursue the question by discussing how Habermas’ theory of communicative action can be implemented in decision-making processes in general practice. The theory of deliberative decision-making offers practical guidelines for what to talk about and how to do it. For a decision to be rooted in patients’ everyday life it has to take into consideration the patient’s practical circumstances, emotions and preferences, and what he or she perceives as ethically right behaviour towards other people. The aim is a balanced conversation, demonstrating respect, consistency and sincerity, as well as offering information and clarifying reasons. Verbalising reasons for one’s preferences may increase awareness of values and norms, which can then be reflected upon, producing decisions rooted in what the patient perceives as good and right behaviour. The asymmetry of medical encounters is both a resource and a challenge, demanding patient-centred medical leadership, characterised by empathy and ability to take the patient’s perspective. The implementation and adjustments of Habermas’ theory in general practice is illustrated by a case story. Finally, applications of the theory are discussed.

Objective To present theory that illustrates the relevance of ethics for lifestyle counselling in patient-centred general practice, and to illustrate the theory by a qualitative study exploring how doctors may obstruct or enhance the possibilities for ethical dialogue. Methods The theoretical part is based on theory of common morality and Habermas’ communication theory. The empirical study consists of 12 consultations concerning lifestyle changes, followed by interviews of doctors and patients. Analysis: Identification of two contrasting consultations holding much and little ethical dialogue, “translation” into speech acts, and interpretation of speech acts and interviews guided by theory. Results General advice obstructed possibilities for ethical clarification and patient-centredness. Ethical clarification was asked for, and was enhanced by the doctor using communication techniques such as interpretation, summarization, and exploration of the objective, subjective and social dimensions of the patients’ lifeworlds. However, to produce concrete good decisions an additional reflection over possibilities and obstacles in the patient's lifeworld is necessary. Conclusion Consultations concerning lifestyle changes hold opportunities for ethical clarification and reflection which may create decisions rooted in the patient's everyday life. Practice implications The study suggests that GPs should encourage active reflection and deliberation on values and norms in consultations concerning lifestyle changes.