Metacognitive Therapy Versus Cognitive Behavioral Therapy:A Network Approach

A network perspective on mental problems represents a new alternative to the latent variable perspective. Diagnoses are assumed to refer to a causal network of observable mental problems or symptoms (observables). The observable symptoms that traditionally have been considered indicators of latent traits (disorders) are taken to be directly related causal entities. Few studies have investigated how different therapies affect a network-structure of symptoms and processes. In this study, three anxiety symptoms, three depression symptoms and mechanisms in the form of cognitions, metacognitions, worry and threat monitoring were selected. The network structure over the course of therapy for metacognitive therapy (MCT) and Cognitive behavioral therapy (CBT) was investigated. It was hypothesized that worry, attention, and metacognition would be important nodes in MCT and that cognitions would be important in CBT. The data used in the analysis are from a RCT where 74 patients with comorbid anxiety disorders were randomized to either transdiagnostic MCT or disorder-specific CBT. Symptoms and mechanisms were measured every week. The data was analyzed using the multilevel vector autoregressive (mlVAR) model, which is currently the most developed method to analyze multivariate time series in multiple subjects and construct networks. The results indicate that there were different networks of symptoms and mechanisms in MCT and CBT. Central nodes in both treatments are worry and attention, however, the node of negative metacognitive beliefs about uncontrollability was more central in the MCT treatment. The results are consistent with predictions from the S-REF model

Within- and across-day patterns of interplay between depressive symptoms and related psychopathological processes:a dynamic network approach during the COVID-19 pandemic

Background In order to understand the intricate patterns of interplay connected to the formation and maintenance of depressive symptomatology, repeated measures investigations focusing on within-person relationships between psychopathological mechanisms and depressive components are required. Methods This large-scale preregistered intensive longitudinal study conducted 68,240 observations of 1706 individuals in the general adult population across a 40-day period during the COVID-19 pandemic to identify the detrimental processes involved in depressive states. Daily responses were modeled using multi-level dynamic network analysis to investigate the temporal associations across days, in addition to contemporaneous relationships between depressive components within a daily window. Results Among the investigated psychopathological mechanisms, helplessness predicted the strongest across-day influence on depressive symptoms, while emotion regulation difficulties displayed more proximal interactions with symptomatology. Helplessness was further involved in the amplification of other theorized psychopathological mechanisms including rumination, the latter of which to a greater extent was susceptible toward being influenced rather than temporally influencing other components of depressive states. Distinctive symptoms of depression behaved differently, with depressed mood and anhedonia most prone to being impacted, while lethargy and worthlessness were more strongly associated with outgoing activity in the network. Conclusions The main mechanism predicting the amplifications of detrimental symptomatology was helplessness. Lethargy and worthlessness revealed greater within-person carry-over effects across days, providing preliminary indications that these symptoms may be more strongly associated with pushing individuals toward prolonged depressive state experiences. The psychopathological processes of rumination, helplessness, and emotion regulation only exhibited interactions with the depressed mood and worthlessness component of depression, being unrelated to lethargy and anhedonia. The findings have implications for the impediment of depressive symptomatology during and beyond the pandemic period. They further outline the gaps in the literature concerning the identification of psychopathological processes intertwined with lethargy and anhedonia on the within-person level

Pandemic Information Dissemination and Its Associations With the Symptoms of Mental Distress During the COVID-19 Pandemic: Cross-sectional Study

Background: The 2020-2021 COVID-19 pandemic has added to the mental health strain on individuals and groups across the world in a variety of ways. Viral mitigation protocols and viral spread affect people on all continents every day, but at widely different degrees. To understand more about the mental health consequences of the pandemic, it is important to investigate whether or how people gather pandemic-related information and how obtaining this information differentially affects individuals. Objective: This study aimed to investigate whether and to what extent higher levels of COVID-19–related media consumption across information sources are associated with the symptoms of anxiety, health anxiety, and depression, and whether and to what extent using social media and online interactive platforms versus traditional media platforms is associated with the symptoms of anxiety, health anxiety, and depression. Additionally, we aimed to investigate whether and to what extent avoidance of COVID-19–related information is associated with the aforementioned symptoms. Methods: In a cross-sectional preregistered survey, 4936 participants responded between June 22 and July 13, 2020. Eligible participants were adults currently residing in Norway and were thus subjected to identical viral mitigation protocols. This sample was representative of the Norwegian population after utilizing an iterative raking algorithm to conduct poststratification. As 2 subgroups (transgender and intersex individuals) were too small to be analyzed, the final sample for descriptive statistics and regressions included 4921 participants. Multiple regressions were used to investigate associations between the symptoms of psychopathology and COVID-19–related information dissemination. Part correlations were calculated as measures of the effect size for each predictor variable. Due to the large anticipated sample size, the preregistered criterion for significance was set at P<.01. Results: The symptoms of anxiety and health anxiety were significantly associated with obtaining information from newspapers (P<.001), social media (P<.001), and the broader categories of online interactive (P<.001) and traditional media (P<.001). The symptoms of depression were significantly associated with obtaining information from newspapers (P=.003), social media (P=.009), and the broader category of online interactive media (P<.001). Additionally, avoidance of COVID-19–related information showed a significant association in all 3 domains of psychopathological symptoms (anxiety and depression, P<.001; health anxiety, P=.007). Conclusions: This study found significant associations between the symptoms of psychopathology and the use of media for obtaining information related to the COVID-19 pandemic. Significant findings for obtaining information through newspapers, social media, and online interactive media were seen across all 3 measures of psychopathology. Avoidance of COVID-19–related information and associations with the symptoms of psychopathology emerged as core findings, with generally higher effect sizes compared with information attainment.publishedVersio

Exploring the temporal associations between avoidance behavior and cognitions during the course of cognitive behavioral therapy for clients with symptoms of social anxiety disorder

Objectives In cognitive behavioral therapy (CBT) for social anxiety disorder (SAD), avoidance behavior (AB) and cognitions (COG) are two important targets of intervention, but so far no studies have directly examined their relative importance. By means of cross-lagged panel models (CLPM), we examined their temporal associations and impacts on outcome in clients with symptoms of SAD while addressing typical methodological challenges. Method We used data from the first six therapy sessions in a sample of 428 primary care clients (mean [SD] age = 34.6 [12.2], 34.3% men), participating in the Prompt Mental Health Care trial. Session-by-session data was collected on AB, COG, depression and general anxiety. Competing multiple indicator CLPMs were tested. Results The Random Intercept-CLPM provided best fit, and indicated that AB predicted COG at subsequent time points (.39 ≤ β  ≤ .42 for T2–T5, p  < .05), but not vice versa. In addition, AB, but not COG, predicted clients’ general anxiety score at subsequent time points. Results were both robust to the inclusion of depressive symptoms as a within-level covariate, and sensitivity tests for stationarity and missing data assumptions. Conclusion Targeting avoidance behavior for primary care clients with symptoms of SAD may be more vital for the optimal effect of CBT than targeting cognitions. Methodological considerations and limitations of the study are discussed.publishedVersio

Psychological well-being in times of COVID-19: Associated factors and levels in the general population

The COVID-19 pandemic and living under social distancing restrictions have been hypothesized to impact well-being and mental health in the general population. This study investigated the general Norwegian adult population's well-being after implementing and lifting strict social distancing restrictions. The study was conducted through digital surveys; during the implementation of strict social distancing restrictions in March 2020 (T1) and 3 months later, when the preponderance of strict distancing restrictions was discontinued (T2). Well-being was measured at T2. Four thousand nine hundred twenty-one individuals participated, and a sensitivity analysis was conducted to ensure that the sample reflects the true Norwegian adult population. Hierarchical regression analyses show that contemporaneous employment status and positive metacognitions at T2 were associated with higher well-being. Negative metacognitions and the use of unhelpful coping strategies at T2 had a contemporaneous association with lower mental well-being. Negative metacognitions at T1 were associated with lower well-being scores, while positive metacognitions at T1 were positively associated with higher well-being. An indirect association between social distancing and lower well-being was found through heightened depressive symptoms. These results contribute to understanding how social distancing restrictions relate to general well-being, which may further contribute to designing proper strategies to strengthen mental health and well-being during challenging and unavoidable societal conditions.publishedVersio

Childhood trauma and outcome trajectories in patients with longstanding eating disorders across 17 years

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

Psychiatric symptoms in COVID-19-positive individuals in the general population: Trajectories of depression, anxiety, and insomnia

The present study investigates differences in the trajectories of anxiety, depression, and sleep problems among infected versus non-infected case-controlled individuals. Patients who tested positive for COVID-19 were selected from a representative sample in Norway (N > 10,000). In total, 126 of these individuals were infected during the project period, and this group was analyzed at T5 (May 2021). Of these positive cases, those who had completed both PHQ-9 and GAD-7 at all three measurement points were selected for longitudinal analysis using multilevel modeling. There was a significant difference at T5 between those who had tested positive for COVID-19 and matched controls. Anxiety and depression were reduced among those who tested positive, but there were no differences in trajectory when compared to matched controls. Limitations include the use of self-report measures and the assessment of symptoms at a time when strict virus mitigation protocols were in place. The present findings indicate that individuals who test positive for COVID-19 exhibit higher levels of depressive symptoms after restrictions are lifted. However, comparison of anxiety and depression symptom trajectories with matched controls reveals that both groups exhibited stable or slightly decreased symptoms.publishedVersio

Predictors of school-based cognitive behavior therapy outcome for youth with anxiety

Meta-analyses of school-based CBT have shown that prevention for anxiety symptoms typically report small but significant effects. There is limited knowledge regarding which youths may benefit most and least from such programs, and characteristics of youth who respond differentially to interventions of different intensity. The present study examined predictors of school-based CBT outcomes among 302 youths (mean age 14.0 years, SD 0.8, 84% female) who participated in a randomized waitlist-controlled trial comparing a 10-session and a 5-session group intervention. Potential predictors included youth and parental factors, and credibility and expectancy of the interventions. Pre-intervention anxiety and depression levels, and clinician rated severity were examined as moderators of intervention effects. Outcomes were youth-, and parent-reported youth anxiety and depressive symptoms at post-intervention and 1-year follow-up. Higher parent-reported impairment from youth anxiety predicted larger parent-reported anxiety and depressive symptom change, whereas higher caregiver strain was associated with less symptom change. Higher parent rated credibility and expectancy was associated with improved outcomes at post-intervention. At 1-year follow-up, no predictors of outcome were identified. No moderators were identified. Families with high levels of caregiver strain associated with youth anxiety may need extra support regardless of length of intervention program. Parents’ credibility and expectancy of interventions should be targeted to optimize school-based CBT.publishedVersio

Acute COVID-19 severity and mental health morbidity trajectories in patient populations of six nations: an observational study

Background Long-term mental and physical health consequences of COVID-19 (long COVID) are a persistent public health concern. Little is still known about the long-term mental health of non-hospitalised patients with COVID-19 with varying illness severities. Our aim was to assess the prevalence of adverse mental health symptoms among individuals diagnosed with COVID-19 in the general population by acute infection severity up to 16 months after diagnosis. Methods This observational follow-up study included seven prospectively planned cohorts across six countries (Denmark, Estonia, Iceland, Norway, Sweden, and the UK). Participants were recruited from March 27, 2020, to Aug 13, 2021. Individuals aged 18 years or older were eligible to participate. In a cross-sectional analysis, we contrasted symptom prevalence of depression, anxiety, COVID-19-related distress, and poor sleep quality (screened with validated mental health instruments) among individuals with and without a diagnosis of COVID-19 at entry, 0–16 months from diagnosis. In a cohort analysis, we further used repeated measures to estimate the change in mental health symptoms before and after COVID-19 diagnosis. Findings The analytical cohort consisted of 247 249 individuals, 9979 (4·0%) of whom were diagnosed with COVID-19 during the study period. Mean follow-up was 5·65 months (SD 4·26). Participants diagnosed with COVID-19 presented overall with a higher prevalence of symptoms of depression (prevalence ratio [PR] 1·18 [95% CI 1·03–1·36]) and poorer sleep quality (1·13 [1·03–1·24]) but not symptoms of anxiety (0·97 [0·91–1·03]) or COVID-19-related distress (1·05 [0·93–1·20]) compared with individuals without a COVID-19 diagnosis. Although the prevalence of depression and COVID-19-related distress attenuated with time, individuals diagnosed with COVID-19 but never bedridden due to their illness were consistently at lower risk of depression (PR 0·83 [95% CI 0·75–0·91]) and anxiety (0·77 [0·63–0·94]) than those not diagnosed with COVID-19, whereas patients who were bedridden for more than 7 days were persistently at higher risk of symptoms of depression (PR 1·61 [95% CI 1·27–2·05]) and anxiety (1·43 [1·26–1·63]) than those not diagnosed throughout the study period. Interpretation Severe acute COVID-19 illness—indicated by extended time bedridden—is associated with long-term mental morbidity among recovering individuals in the general population. These findings call for increased vigilance of adverse mental health development among patients with a severe acute disease phase of COVID-19.Funding Nordforsk, Horizon2020, Wellcome Trust, and Estonian Research Council