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Ryum T, Bennion M, Kazantzis N. Homework as a driver of change in psychotherapy. J Clin Psychol 2024; 80:733-743. [PMID: 38111148 DOI: 10.1002/jclp.23627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 11/22/2023] [Accepted: 11/27/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND AND OBJECTIVES The utilization of Between-Session Homework (BSH) holds a longstanding tradition in the field of psychotherapy. Significantly, it serves as a pivotal catalyst for change within behavioral and cognitive-behavioral therapies, and has also garnered endorsement within psychodynamic and humanistic-experiential therapies. While our current conceptualization of BSH is characterized by assimilation and integration, diversity prevails in how BSH is incorporated into the treatment plan, spanning various therapy stages, thus necessitating a customized therapist-client interpersonal dynamic. Far from being a panacea, the employment of BSH emerges as a highly sophisticated and intricate clinical methodology, demanding a high degree of therapist proficiency and competence to facilitate client engagement. METHODS In this introductory paper, we present an issue of the Journal of Clinical Psychology: In Session that exemplifies the diverse modalities through which BSH can be integrated into clinical practice across various client demographics and within distinct psychotherapeutic paradigms. We place specific emphasis on the pivotal role of BSH and its interplay with proposed mechanisms of change throughout the course of treatment. RESULTS Initially, we provide an overarching view of the subject and expound on empirical research substantiating the efficacy of BSH in psychotherapy. Subsequently, we delve into strategies for adeptly integrating and monitoring BSH within clinical practice. CONCLUSIONS Our primary objectives encompass affording readers a more lucid comprehension of (1) the content and nature of homework; (2) the influence of BSH on treatment outcomes; and (3) the ways through which therapists can foster client engagement with BSH. Finally, we introduce the six papers comprising this issue.
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Affiliation(s)
- Truls Ryum
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mia Bennion
- Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
| | - Nikolaos Kazantzis
- Cognitive Behavior Therapy Research Unit, Melbourne, Australia
- Beck Institute for Cognitive Behavior Therapy and Research, Philadelphia, Pennsylvania, USA
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Ryum T, Bennion M, Kazantzis N. Between-session homework and processes of change. J Clin Psychol 2024; 80:928-937. [PMID: 38111143 DOI: 10.1002/jclp.23628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 11/23/2023] [Accepted: 11/27/2023] [Indexed: 12/20/2023]
Affiliation(s)
- Truls Ryum
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mia Bennion
- Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
| | - Nikolaos Kazantzis
- Cognitive Behavior Therapy Research Unit, Melbourne, Australia
- Beck Institute for Cognitive Behavior Therapy and Research, Philapelphia, Pennsylvania, USA
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Gjestad E, Nerdal V, Saltvedt I, Lydersen S, Kliem E, Ryum T, Grambaite R. Delirium in acute stroke is associated with increased cognitive and psychiatric symptoms over time: The Nor-COAST study. J Stroke Cerebrovasc Dis 2024; 33:107667. [PMID: 38423153 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/21/2024] [Accepted: 02/26/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Delirium, an acute and fluctuating mental disturbance of attention, cognition, and consciousness, commonly occurs in acute stroke. Research on long-term outcomes of stroke patients experiencing delirium is limited, especially regarding cognitive and psychiatric symptoms. METHODS As part of the Nor-COAST study, 373 patients were screened for delirium using the Confusion Assessment Method (CAM) in the acute phase of stroke. Patients were included in the mixed-model linear regression analyses if they had available data from the follow-ups at three, 18 or 36 months, totaling 334 (44.6 % women, mean (SD) age: 72.1 (12.5) years, 17 (5.1 %) diagnosed with delirium). Global cognition was measured using the Montreal Cognitive Assessment (MoCA). Psychiatric symptoms were measured using the Hospital Anxiety and Depression Scale (HADS) and the Neuropsychiatric Inventory-Questionnaire (NPI-Q). RESULTS At three months, delirium was associated with a higher NPI-Q score (Mean (SD) 2.9 (3.6) vs 1.4 (2.2)). At 18 and 36 months, delirium was associated with a lower MoCA score (Mean (SD) 19.7 (6.6) vs 24.3 (5.0), and 20.6 (7.6) vs 24.6 (4.8)), higher HADS anxiety symptoms (5.0 (4.3) vs 3.3 (3.3), and 5.9 (4.1) vs 3.4 (3.6)), higher HADS depression symptoms (7.2 (4.7) vs 3.4 (3.3), and 6.6 (5.1) vs 3.7 (3.7)), and higher NPI-Q score (2.4 (4.4) vs 1.7 (2.3), 2.6 (4.5) vs 1.0 (1.9)). Delirium significantly predicted the psychiatric symptoms hallucinations and agitation. CONCLUSIONS Patients with delirium in the acute phase of stroke may be particularly vulnerable to developing cognitive and psychiatric symptoms in the chronic phase.
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Affiliation(s)
- Elise Gjestad
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Vilde Nerdal
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ingvild Saltvedt
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway; Department of Geriatrics, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Stian Lydersen
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Elisabeth Kliem
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway; Health Services Research Unit (HØKH), Akershus University Hospital, Lørenskog, Norway
| | - Truls Ryum
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ramune Grambaite
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; Health Services Research Unit (HØKH), Akershus University Hospital, Lørenskog, Norway.
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Ryum T, Bennion M, Kazantzis N. Integrating between-session homework in psychotherapy: A systematic review of immediate in-session and intermediate outcomes. Psychotherapy (Chic) 2023; 60:306-319. [PMID: 37104804 DOI: 10.1037/pst0000488] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
[Correction Notice: An Erratum for this article was reported in Vol 60(3) of Psychotherapy (see record 2023-99100-002). In the article (https://doi.org/10.1037/ pst0000488), the number of included studies in Figure 2 omitted two studies that were added to the literature synthesis. Therefore, the following has been added to the Reports excluded box in Figure 2: A further two studies were added to the research synthesis by author knowledge. All versions of this article have been corrected.] This article reviews the evidence for between-session homework (BSH) in individual psychotherapy. Whereas previous reviews have demonstrated a positive association between-client compliance with BSH and distal treatment outcomes; here, we pay particular attention to therapist behaviors that may promote client engagement with BSH assessed as immediate (in-session) and intermediate (session-to-session) outcomes, and moderators of these effects. For our systematic review, we identified 25 studies with 1,304 clients and 118 therapists, mostly on cognitive behavioral therapy such as exposure-based treatments with depression and anxiety disorders. A box score approach was utilized to summarize findings. Results for immediate outcomes were mixed but neutral. Results for intermediate outcomes were positive. Presenting a convincing rationale, being flexible in collaboratively designing, planning, and reviewing homework tasks in accordance with the clients' goals, aligning BSH with the clients' takeaways from the session and providing a written summary of homework and rationale, are some therapist behaviors that can promote client engagement with BSH. We conclude with research limitations, training implications, and therapeutic practices. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Truls Ryum
- Department of Psychology, Norwegian University of Science and Technology
| | - Mia Bennion
- Division of Nursing, Midwifery and Social Work, University of Manchester
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Ryum T, Stiles TC. Changes in pain catastrophizing, fear-avoidance beliefs, and pain self-efficacy mediate changes in pain intensity on disability in the treatment of chronic low back pain. Pain Rep 2023; 8:e1092. [PMID: 37719924 PMCID: PMC10501475 DOI: 10.1097/pr9.0000000000001092] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 05/19/2023] [Accepted: 06/10/2023] [Indexed: 09/19/2023] Open
Abstract
Introduction Treatment of chronic low back pain (CLBP) based on the fear-avoidance model (FAM) has received support in randomized controlled trials, but few studies have examined treatment processes associated with treatment outcome. This study examined changes in pain catastrophizing, fear-avoidance beliefs, and pain self-efficacy as mediators of the relation between changes in pain intensity and disability in exposure-based treatment of CLBP. Methods Data from a randomized controlled trial with 2 treatment arms (exposure treatment based on the FAM with/without in-session exposure) was pooled, including only participants with complete data (N = 69). Change scores (pre to booster session) were computed for all variables, and the indirect effect of change in pain intensity on change in 3 measures of disability, through change in the proposed mediators, was tested in parallel mediation analyses. Results Decreases in pain catastrophizing and fear-avoidance beliefs, as well as increases in pain self-efficacy, mediated a unique proportion of the relation between changes in pain intensity and disability, depending on the outcome measure. The direct relation between changes in pain intensity and disability was absent when indirect effects were controlled. Conclusions The results suggest that the way pain is interpreted (pain catastrophizing, fear-avoidance beliefs), as well as pain self-efficacy, are all more critical for reducing disability in exposure-based treatment of CLBP than symptom relief per se.
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Affiliation(s)
- Truls Ryum
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tore C. Stiles
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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Brattland H, Holgersen KH, Vogel PA, Anderson T, Ryum T. An apprenticeship model in the training of psychotherapy students. Study protocol for a randomized controlled trial and qualitative investigation. PLoS One 2022; 17:e0272164. [PMID: 35998132 PMCID: PMC9397867 DOI: 10.1371/journal.pone.0272164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/13/2022] [Indexed: 12/01/2022] Open
Abstract
Background One 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. Methods In 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 and at two-year follow-up. The main outcome measure is the Facilitative Interpersonal Skills (FIS) performance test. Additional self-report measures tap self-efficacy, self-compassion, worry, rumination, and stress. Weekly reflection log entries written by the students will be qualitatively analyzed in order to gain an in-depth understanding of the learning process. Students’ and therapists’ experiences with the intervention will be explored in focus group interviews. Discussion To the best of our knowledge, this is the first controlled study to investigate the impact of apprenticeship as an isolated training component in the education of clinical psychologists. The study is designed so as to yield a comprehensive understanding of an approach which could prove to be a valuable supplement to the existing educational methods in this field and ultimately, contribute to improve the quality of mental health care.
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Affiliation(s)
- Heidi Brattland
- Nidelv Community Mental Health Center, St. Olav’s University Hospital, Trondheim, Norway
- * E-mail:
| | - Katrine Høyer Holgersen
- Nidelv Community Mental Health Center, St. Olav’s University Hospital, Trondheim, Norway
- Department of Psychology, the Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Patrick A. Vogel
- Department of Psychology, the Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Timothy Anderson
- Department of Psychology, Ohio University, Athens, Ohio, United States of America
| | - Truls Ryum
- Department of Psychology, the Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Nerdal V, Gjestad E, Saltvedt I, Munthe-Kaas R, Ihle-Hansen H, Ryum T, Lydersen S, Grambaite R. The relationship of acute delirium with cognitive and psychiatric symptoms after stroke: a longitudinal study. BMC Neurol 2022; 22:234. [PMID: 35761180 PMCID: PMC9235162 DOI: 10.1186/s12883-022-02756-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 06/14/2022] [Indexed: 12/03/2022] Open
Abstract
Objective Delirium, a common complication after stroke, is often overlooked, and long-term consequences are poorly understood. This study aims to explore whether delirium in the acute phase of stroke predicts cognitive and psychiatric symptoms three, 18 and 36 months later. Method As part of the Norwegian Cognitive Impairment After Stroke Study (Nor-COAST), 139 hospitalized stroke patients (49% women, mean (SD) age: 71.4 (13.4) years; mean (SD) National Institutes of Health Stroke Scale (NIHSS) 3.0 (4.0)) were screened for delirium with the Confusion Assessment Method (CAM). Global cognition was measured with the Montreal Cognitive Assessment (MoCA), while psychiatric symptoms were measured using the Hospital Anxiety and Depression Scale (HADS) and the Neuropsychiatric Inventory-Questionnaire (NPI-Q). Data was analyzed using mixed-model linear regression, adjusting for age, gender, education, NIHSS score at baseline and premorbid dementia. Results Thirteen patients met the criteria for delirium. Patients with delirium had lower MoCA scores compared to non-delirious patients, with the largest between-group difference found at 18 months (Mean (SE): 20.8 (1.4) versus (25.1 (0.4)). Delirium was associated with higher NPI-Q scores at 3 months (Mean (SE): 2.4 (0.6) versus 0.8 (0.1)), and higher HADS anxiety scores at 18 and 36 months, with the largest difference found at 36 months (Mean (SE): 6.2 (1.3) versus 2.2 (0.3)). Conclusions Suffering a delirium in the acute phase of stroke predicted more cognitive and psychiatric symptoms at follow-up, compared to non-delirious patients. Preventing and treating delirium may be important for decreasing the burden of post-stroke disability. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-022-02756-5.
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Kennair LEO, Hagen R, Hjemdal O, Havnen A, Ryum T, Solem S. Depression, Anxiety, Insomnia, and Quality of Life in a Representative Community Sample of Older Adults Living at Home. Front Psychol 2022; 13:811082. [PMID: 35432108 PMCID: PMC9010942 DOI: 10.3389/fpsyg.2022.811082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/11/2022] [Indexed: 12/02/2022] Open
Abstract
Background The aim of the study was to explore symptoms of anxiety and depression, insomnia, and quality of life in a Norwegian community sample of older adults. Methods A representative sample (N = 1069) was drawn from home-dwelling people of 60 years and above, living in a large municipality in Norway (Trondheim). Results Based on established cut-off scores, 83.7% of the participants showed no symptoms of anxiety/depression, 12% had mild symptoms, 2.7% moderate symptoms, 1.5% showed severe symptoms of anxiety/depression. A total of 18.4% reported insomnia symptoms. Regarding health-related quality of life, few participants reported problems with self-care, but pain and discomfort were common (59%). Depression/anxiety, insomnia, and health-related quality of life showed moderate to strong associations. Discussion The results suggest a close interplay between anxiety/depression, insomnia, and health-related quality of life in older adults.
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Affiliation(s)
| | - Roger Hagen
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
- Modum Bad, Research Institute, Vikersund, Norway
| | - Odin Hjemdal
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Audun Havnen
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
- St. Olavs Hospital, Trondheim, Norway
| | - Truls Ryum
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Stian Solem
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
- *Correspondence: Stian Solem,
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Ryum T, Svartberg M, Stiles TC. Homework Assignments, Agenda Setting and the Therapeutic Alliance in Cognitive Therapy with Cluster C Personality Disorders: Synergetic or Antagonistic Ingredients? Cogn Ther Res 2021. [DOI: 10.1007/s10608-021-10268-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ryum T, Hartmann H, Borchgrevink P, de Ridder K, Stiles TC. The effect of in-session exposure in Fear-Avoidance treatment of chronic low back pain: A randomized controlled trial. Eur J Pain 2020; 25:171-188. [PMID: 32964624 DOI: 10.1002/ejp.1659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 08/18/2020] [Accepted: 09/13/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Treatment based on the Fear-Avoidance (FA) model has been found to be effective with chronic low back pain (CLBP), and in-vivo exposure of fear evoking movements is proposed as a key change mechanism. Exposure tasks may be conducted in the session (in-session exposure; ISE), in other real-life situations (between sessions exposure) as part of homework assignments, or both. Utilising a randomized, controlled dismantling study design, the aim of this study was to examine the unique effects of ISE in FA-treatment of CLBP. METHODS Patients (N = 90) with CLBP as primary medical complaints were randomized to receive six sessions of either (a) FA-treatment with ISE (FA-ISE) or (b) FA-treatment without ISE (FA), allowing for between sessions exposure in both treatment groups. Patients were assessed with a large battery of outcome measures at four time-points (pre-treatment, post-treatment, after a booster-session and at 1-year follow-up) including pain intensity, pain catastrophising, self-efficacy, physical performance and quality of life. RESULTS Both treatment groups (FA-ISE, FA) demonstrated statistically significant improvements on primary and most secondary outcomes, with mostly non-significant between-group differences. CONCLUSIONS No added benefit was found for the inclusion of ISE of feared movements in FA-treatment for CLBP, delivered in a group format to participants with moderately elevated levels of fear-avoidance beliefs. Clinical trials: NCT01158339. SIGNIFICANCE This study adds to the existing research literature demonstrating FA-treatment to be effective with CLBP, but further experimental studies are needed in order to examine under what circumstances ISE of feared movements may add to positive treatment outcomes.
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Affiliation(s)
- Truls Ryum
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Helge Hartmann
- Department of Physical Medicine and Rehabilitation, Levanger Hospital, Levanger, Norway
| | - Petter Borchgrevink
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Karin de Ridder
- Department of Public Health and Surveillance, Scientific Institute of Public Health, Brussels, Belgium
| | - Tore C Stiles
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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Hagen R, Havnen A, Hjemdal O, Kennair LEO, Ryum T, Solem S. Protective and Vulnerability Factors in Self-Esteem: The Role of Metacognitions, Brooding, and Resilience. Front Psychol 2020; 11:1447. [PMID: 32719640 PMCID: PMC7351531 DOI: 10.3389/fpsyg.2020.01447] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 05/29/2020] [Indexed: 11/13/2022] Open
Abstract
The aim of the current study was to explore protective (resilience) and vulnerability factors (dysfunctional metacognitions and brooding) for self-esteem. A total of 725 participants were included in a cross-sectional study. A path analysis revealed five paths to self-esteem. The three main paths were as follows: (1) symptoms −> metacognitions −> brooding −> self-esteem, (2) symptoms −> resilience −> self-esteem, and (3) a direct path from symptoms. The first path corresponds with the metacognitive model of psychopathology and suggests that triggers in the form of anxiety and depression symptoms lead to the activation of metacognitive beliefs, which in turn activates brooding in response to these triggers. When a person engages in brooding, this makes the person vulnerable to experiencing low self-esteem. The second path suggests a protective role of resilience factors. The overall model explained 55% of the variance in self-esteem. Regression analysis found that unique predictors of self-esteem were female sex, symptoms of anxiety and depression, brooding, and resilience. These findings have possible clinical implications, as treatment may benefit from addressing both protective and vulnerability factors in individuals suffering from low self-esteem.
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Affiliation(s)
- Roger Hagen
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Audun Havnen
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Odin Hjemdal
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Truls Ryum
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Stian Solem
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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Ryum T, Jacobsen HB, Borchgrevink PC, Landrø NI, Stiles TC. Interpersonal problems as a predictor of pain catastrophizing in patients with chronic pain. Scand J Pain 2019; 20:51-59. [PMID: 31560651 DOI: 10.1515/sjpain-2019-0064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 07/30/2019] [Indexed: 11/15/2022]
Abstract
Background and aims Pain catastrophizing has consistently been related to a variety of negative outcomes within chronic pain conditions, but competing models exist explaining the role of catastrophizing. According to the fear-avoidance model (FAM), catastrophizing is primarily related to the appraisal of pain (i.e. "intrapersonal"), whereas the communal coping model (CCM) suggests that catastrophizing is a strategy to elicit support (i.e. "interpersonal"). In order to examine the interpersonal nature of catastrophizing, this cross-sectional study examined interpersonal problems as a predictor of pain catastrophizing in a sample of patients (n = 97) with chronic pain. Methods Self-report data was taken from patients entering a multidisciplinary, inpatient rehabilitation program. The four quadrants of the Inventory of Interpersonal Problems circumplex model (Hostile-Dominant, Hostile-Submissive, Friendly-Submissive, Friendly-Dominant) were used as predictors of pain catastrophizing in a series of separate, hierarchical regression analyses. Results After controlling for relevant confounding variables such as demographics (gender, age), pain severity, psychiatric symptoms (anxiety/depression, fatigue, insomnia), adverse life experiences and perceived social support, higher levels of Hostile-Dominant interpersonal problems predicted higher levels of pain catastrophizing (p ≤ 0.01, d = 0.56). Conclusions The results add support to the notion that pain catastrophizing may serve a communicative functioning, as predicted by the CCM, with cold, dominant and controlling behaviors as a maladaptive interpersonal strategy to elicit support. It may thus be useful to consider the broader interpersonal context of the individual, and not only the patient's appraisal of pain, when conceptualizing the role of pain catastrophizing in patients with chronic pain. Implications Future psychosocial research and treatment of chronic pain could be informed by including interpersonal theory as a useful theoretical framework, which may help shed more light on how interpersonal problems relates to pain catastrophizing.
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Affiliation(s)
- Truls Ryum
- Department of Psychology, Norwegian University of Science and Technology, Faculty of Social and Educational Sciences, Trondheim, Norway
- Hysnes Rehabilitation Center, St. Olav's University Hospital, Trondheim, Norway, Phone: (+47)41 60 87 35
| | - Henrik Børsting Jacobsen
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
- Hysnes Rehabilitation Center, St. Olav's University Hospital, Trondheim, Norway
| | - Petter Christian Borchgrevink
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Pain and Complex Symptom Disorders, Clinic of Anaesthesia and Intensive Care, St. Olavs University Hospital, Trondheim, Norway
| | | | - Tore Charles Stiles
- Department of Psychology, Norwegian University of Science and Technology, Faculty of Social and Educational Sciences, Trondheim, Norway
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Brattland H, Koksvik JM, Burkeland O, Gråwe RW, Klöckner C, Linaker OM, Ryum T, Wampold B, Lara-Cabrera ML, Iversen VC. The effects of routine outcome monitoring (ROM) on therapy outcomes in the course of an implementation process: A randomized clinical trial. J Couns Psychol 2018; 65:641-652. [DOI: 10.1037/cou0000286] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Hjemdal O, Hagen R, Solem S, Nordahl H, Kennair LEO, Ryum T, Nordahl HM, Wells A. Metacognitive Therapy in Major Depression: An Open Trial of Comorbid Cases. Cognitive and Behavioral Practice 2017. [DOI: 10.1016/j.cbpra.2016.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ryum T, Kennair LEO, Hjemdal O, Hagen R, Halvorsen JØ, Solem S. Worry and Metacognitions as Predictors of Anxiety Symptoms: A Prospective Study. Front Psychol 2017; 8:924. [PMID: 28620338 PMCID: PMC5450809 DOI: 10.3389/fpsyg.2017.00924] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 05/19/2017] [Indexed: 01/23/2023] Open
Abstract
Both worry and metacognitive beliefs have been found to be related to the development of anxiety, but metacognitive theory (Wells and Matthews, 1994; Wells, 2009) suggest that metacognitive beliefs may play a more prominent role. The aim of the present prospective study was to examine whether worry, metacognitive beliefs or the interaction between worry and metacognitive beliefs, were the best predictor of anxiety over time, utilizing a longitudinal, prospective study design. An undergraduate student sample (N = 190) was assessed on measures of worry (PSWQ), metacognitive beliefs (MCQ-30) and anxiety (BAI) at three points in time over a 7-month period. A mixed-model analysis revealed that both worry and metacognitive beliefs predicted development of anxiety, independently of each other, with no indication of an interaction-effect (PSWQ * MCQ-30). Further, analyses of the MCQ-30 subscales indicated that negative metacognitive beliefs may be particularly important in the development of anxiety. While gender was correlated with worry, gender predicted anxiety beyond the effect of worry. Taken together, the results imply that both worry and metacognitive beliefs play a prominent role for the development of anxiety.
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Affiliation(s)
- Truls Ryum
- Department of Psychology, Norwegian University of Science and TechnologyTrondheim, Norway
| | | | - Odin Hjemdal
- Department of Psychology, Norwegian University of Science and TechnologyTrondheim, Norway
| | - Roger Hagen
- Department of Psychology, Norwegian University of Science and TechnologyTrondheim, Norway
| | | | - Stian Solem
- Department of Psychology, Norwegian University of Science and TechnologyTrondheim, Norway
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Støre-Valen J, Ryum T, Pedersen GAF, Pripp AH, Jose PE, Karterud S. Does a web-based feedback training program result in improved reliability in clinicians’ ratings of the Global Assessment of Functioning (GAF) Scale? Psychol Assess 2015; 27:865-73. [DOI: 10.1037/pas0000086] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ryum T, Vogel PA, Walderhaug EP, Stiles TC. The role of self-image as a predictor of psychotherapy outcome. Scand J Psychol 2014; 56:62-8. [PMID: 25352222 DOI: 10.1111/sjop.12167] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 08/24/2014] [Indexed: 11/27/2022]
Abstract
The present study examined the relationship between self-image and outcome in psychotherapy. Patients (n = 170) received treatment-as-usual at a university clinic, and met diagnostic criteria for mostly anxiety and depression related disorders. Self-image was measured with the Structural Analysis of Social Behavior (SASB-I) introject pre and post-treatment. Using multiple regression analyses, higher levels of Self-ignore and Self-blame pre-treatment predicted a poorer treatment outcome in terms of symptoms (SCL-90-R) and interpersonal problems (IIP-64), respectively. Increase in Self-love and decrease in Self-blame (pre to post) predicted reduced symptoms at post-treatment, whereas decrease in Self-attack and Self-control, as well as increase in Self-affirm, predicted reduced interpersonal problems. The results suggest that self-image improvement may be important in order to achieve a good outcome in psychotherapy.
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Affiliation(s)
- Truls Ryum
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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Ryum T, Støre-Valen J, Svartberg M, Stiles TC, McCullough L. Factor analysis of the Achievement of Therapeutic Objectives Scale (ATOS) in short-term dynamic psychotherapy and cognitive therapy. Psychol Assess 2014; 26:925-34. [PMID: 24749750 DOI: 10.1037/a0036570] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study examined the factor structure of the Achievement of Therapeutic Objectives Scale (ATOS; McCullough, Larsen, et al., 2003) in short-term dynamic psychotherapy (STDP) and cognitive therapy (CT). The ATOS is a process scale that has shown promise as a measure of patients' achievements of treatment objectives in STDP and CT and is conceptualized as comprising 7 subscales hypothesized to cluster according to 3 main treatment objectives (defense restructuring, affect restructuring, and restructuring of sense of self and others). However, the factor structure of the ATOS has not been examined empirically previously. Data were derived from ratings of videotaped therapy sessions from a randomized controlled trial, comparing STDP and CT for patients with Cluster C personality disorders. The model fit of a 2- and 3-factor solution was examined in the combined patient sample, as well as in each treatment separately, utilizing structural equation modeling. Both a 2- and 3-factor model provided acceptable fit to the data. The results add to the psychometric soundness of the ATOS as an innovative observer-based instrument for examining process in STDP and CT.
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Affiliation(s)
- Truls Ryum
- Department of Psychology, Norwegian University of Science and Technology
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Valen J, Ryum T, Svartberg M, Stiles TC, McCullough L. The Achievement of Therapeutic Objectives Scale: Interrater reliability and sensitivity to change in short-term dynamic psychotherapy and cognitive therapy. Psychol Assess 2011; 23:848-55. [PMID: 21517190 DOI: 10.1037/a0023649] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Jakob Valen
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway.
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Ryum T, Stiles TC, Svartberg M, McCullough L. The Effects of Therapist Competence in Assigning Homework in Cognitive Therapy With Cluster C Personality Disorders: Results From a Randomized Controlled Trial. Cognitive and Behavioral Practice 2010. [DOI: 10.1016/j.cbpra.2009.10.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ryum T, Stiles TC, Svartberg M, McCullough L. The role of transference work, the therapeutic alliance, and their interaction in reducing interpersonal problems among psychotherapy patients with Cluster C personality disorders. ACTA ACUST UNITED AC 2010; 47:442-53. [DOI: 10.1037/a0021183] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ryum T, Vogel PA, Hagen R, Stiles TC. Memories of early attachment: the use of PBI as a predictor of outcome in Pesso-Boyden System Psychomotor (PBSP) group therapy, Cognitive-Behavioural Group Therapy (CBGT), Individual Cognitive-Behavioural Therapy (CBT) and Individual Treatment As Usual (TAU) with adult out-patients. Clin Psychol Psychother 2008; 15:276-85. [DOI: 10.1002/cpp.576] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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