Jon Trygve Monsen

• Solbakken, Ole Andre; Frederiksen, Christina Kjær & Monsen, Jon Trygve (2025). Emotional Dysfunction: Difficulties in Emotion Regulation and Affect Integration. In Bach, Bo (Eds.), ICD-11 Personality Disorders: Assessment and Treatment. Oxford University Press. ISSN 9780191964343. Full text in Research Archive Show summary

  One central feature of the ICD-11 Personality Disorder classification system is the prominent role attributed to emotional dysfunction. As is undoubtedly well known to readers of this book, the ICD-11 Clinical Descriptions and Diagnostic Requirements for Personality Disorders and Related Traits (WHO, 2024) defines personality disorder as a marked disturbance in personality functioning characterized by impairments in the operation of core aspects of the self, such as sense of identity, self-worth, and capacity for self-direction, and/or problems in interpersonal functioning, such as developing and maintaining close and mutually satisfying relations, understanding the perspectives of others, and managing conflict in relationships. In turn, these impairments are manifested as maladaptive patterns of emotional experience and emotional expression, along with cognitive and behavioral manifestations (definitions reordered and italicized by the authors for emphasis), thereby placing emotional dysfunction at the very center of personality disorder nosology.

• Høstmælingen, Andreas Teisner; Monsen, Jon Trygve; Nissen-Lie, Helene, Amundsen & Solbakken, Ole Andre (2025). Kan bruk av antidepressiver påvirke nytten av psykologisk behandling? Tidsskrift for Norsk psykologforening (Psykologtidsskriftet). ISSN 0332-6470. doi: https:/www.psykologtidsskriftet.no/artikkel/2025as12ae-Kan-bruk-av-antidepressiver-p-virke-nytten-av-psykologisk-behandling-. Full text in Research Archive Show summary

  Pasienter med depresjon som brukte antidepressiver, trengte lengre tid i psykoterapi og hadde mindre symptomreduksjon

• Høstmælingen, Andreas Teisner; Nissen-Lie, Helene, Amundsen; Monsen, Jon Trygve; Heinonen, Erkki; Wampold, Bruce E. & Czajkowski, Nikolai Olavi [Show all 9 contributors for this article] (2025). Use of antidepressant medication is associated with slower response to open-ended psychotherapy for depressed patients. Frontiers in Psychiatry. 16. doi: 10.3389/fpsyt.2025.1503848. Full text in Research Archive Show summary

  Objective Depressed patients often experience both symptomatic distress and interpersonal problems. Comorbid personality disorder (PD) has been shown to attenuate the benefits of psychotherapy. Also, antidepressant medication (ADM) may affect the response to psychotherapy. The objective of this study was to investigate changes in depressive symptoms and interpersonal problems for ADM users and non-medicated depressed patients during psychotherapy and follow-up, controlling for comorbid PD. Method Depressive symptoms (SCL-90-R), and interpersonal problems (IIP-64) were assessed on 11 occasions for 166 depressed patients. ADM was used by 50.6% of the sample while 49.4% were unmedicated. Change during treatment and follow-up was assessed with multilevel modeling. We assessed whether ADM and PD predicted differences in symptom development. Results Depressive symptoms significantly reduced at a rate of.05 per month in treatment ( p <.001), corresponding to an effect size of 1.35. Interpersonal problems significantly reduced at a rate of.02 per month during treatment ( p <.001), corresponding to an effect size of.47. There was no significant difference between ADM users and nonmedicated patients at baseline. ADM users had nearly twice as long treatment duration than nonmedicated patients, and ADM users had lower rate of symptom reduction than nonmedicated patients for depressive symptoms and interpersonal problems. There were no differences in rates of change between patients with and without comorbid PD. Conclusion Medicated patients may experience less response to psychotherapy in terms of depressive symptoms and interpersonal problems compared to nonmedicated patients.

• Høstmælingen, Andreas Teisner; Nissen-Lie, Helene, Amundsen; Monsen, Jon Trygve & Solbakken, Ole Andre (2025). Interrelationships of symptomatic and relational distress: Improvements in interpersonal problems predict subsequent improvement in depressive symptoms during open-ended psychotherapy for adults with depression. Journal of Consulting and Clinical Psychology. ISSN 0022-006X. 93(6), p. 470–470. doi: 10.1037/ccp0000956. Full text in Research Archive Show summary

  Objective: Depressed patients often experience interpersonal distress. Understanding how interpersonal distress and depressive symptoms are associated may have implications for understanding the etiology and maintenance of depression, as well as for treatment. In this naturalistic psychotherapy study, we explored whether change in depressive symptoms predicted subsequent change in interpersonal distress or vice versa. Method: Depressive symptoms (depression scale of the Symptom Check List–90–Revised) and interpersonal problems (Inventory of Interpersonal Problems–64) were assessed on nine occasions, including before, during, and after treatment and at 1 and 2.5 years follow-up in a sample of 178 depressed patients receiving open-ended psychotherapy. We used latent curve modeling with structured residuals to assess possible reciprocal relations between interpersonal problems and depression, controlling for personality disorder. Results: The findings showed that interpersonal distress had a slower rate of change compared to depressive symptoms, but improvements in interpersonal distress predicted subsequent improvement in depressive symptoms during psychotherapy, and this effect was stable over time. Patients with comorbid personality disorder had higher initial levels of both depression and interpersonal distress, but there were no differences in rates of change for any of the outcomes. Conclusion: Our results indicate that improvements in interpersonal problems may play an important role in alleviating depressive symptoms during psychotherapy. We propose that reduction of interpersonal distress is associated with increased interpersonal flexibility, which may lead to more positive responses from others, thereby contributing to a reduction in depressive symptoms.

• Sønderland, Nils Martin; Solbakken, Ole Andre; Eilertsen, Dag Erik; Nordmo, Magnus & Monsen, Jon Trygve (2023). Emotional Changes and Outcomes in Psychotherapy: A Systematic Review and Meta-Analysis. Journal of Consulting and Clinical Psychology. ISSN 0022-006X. doi: 10.1037/ccp0000814. Full text in Research Archive
• Solbakken, Ole Andre; Ebrahimi, Omid Vakili; Hoffart, Asle; Monsen, Jon Trygve & Johnson, Sverre Urnes (2021). Emotion regulation difficulties and interpersonal problems during the COVID-19 Pandemic: Predicting anxiety and depression. Psychological Medicine. ISSN 0033-2917. doi: 10.1017/S0033291721001987. Full text in Research Archive
• Solbakken, Ole Andre & Monsen, Jon Trygve (2021). Validation of the Affect Integration Inventory Short Form (AII-SF-42). International Journal of Psychology and Psychological Therapy. ISSN 1889-1780. 21(1), p. 106–123. Full text in Research Archive
• Solbakken, Ole Andre & Monsen, Jon Trygve (2021). Validation of the Affect Integration InventoryShort Form (AII-SF-42). International Journal of Psychology and Psychological Therapy. ISSN 1889-1780. 21(1), p. 107–122. Full text in Research Archive
• Nordmo, Magnus; Sønderland, Nils Martin; Havik, Odd E.; Eilertsen, Dag-Erik; Monsen, Jon Trygve & Solbakken, Ole Andre (2020). Effectiveness of open-ended psychotherapy under clinically representative conditions. Frontiers in Psychiatry. 11:384, p. 1–13. doi: 10.3389/fpsyt.2020.00384. Full text in Research Archive Show summary

  Objective: This study investigates the effectiveness of open-ended psychotherapy in a large, naturalistic, and diverse patient cohort using rigorous and multifaceted assessments. Method: Patients (N = 370) in open-ended psychotherapy completed an extensive set of self-report measures and diagnostic interviews, including long-term follow-up in order to assess stability of outcomes. About half of the patients qualified for a personality disorder at the onset of treatment. Treatments were open-ended, and on average therapists provided substantially larger treatment doses than common in the literature. Results: A substantial majority recovered from their respective Axis I (58%) and/or Axis II (55%) disorders during treatment. Patients also experienced large positive changes in self-report measures of overall psychiatric symptoms and moderate positive changes in self-reported interpersonal problems, while very few (< 3%) demonstrated negative development. The patients maintained their diagnostic and self-assessed changes at a two-and-a-half-year follow-up. In contrast, self-reported occupational functioning showed minimal improvement throughout the treatment and follow-up phase. Conclusion: A naturalistic patient cohort undergoing open-ended psychotherapy demonstrates substantial and stable improvements.

• Nordmo, Magnus; Monsen, Jon Trygve; Høglend, Per Andreas & Solbakken, Ole Andre (2020). Investigating the dose–response effect in open-ended psychotherapy. Psychotherapy Research. ISSN 1050-3307. doi: 10.1080/10503307.2020.1861359. Full text in Research Archive
• Nissen-Lie, Helene Amundsen; Solbakken, Ole Andre; Falkenström, Fredrik; Wampold, Bruce E.; Homqvist, Rolf & Ekeblad, Annika [Show all 7 contributors for this article] (2020). Does it make a difference to be more "on the same page"? Investigating the role of alliance convergence for outcomes in two different samples. Psychotherapy Research. ISSN 1050-3307. p. 1–17. doi: 10.1080/10503307.2020.1823030. Full text in Research Archive Show summary

  Objective: To better understand the complexity of dyadic processes, such as the mechanisms of the working alliance, researchers recommend taking advantage of innovations in data analytic procedures when studying the interactions between therapists and patients that are associated with favorable therapeutic outcomes. Inspired by a recent line of alliance research using dyadic multilevel modeling, the present study investigated the hypothesis that convergence in the patient-therapist working alliance (i.e., increased similarity in ratings of the alliance across treatment) would be associated with better outcomes. Method: Data were retrieved from two samples: 1. A randomized controlled trial for treatment resistant depression (N= 96 dyads), and 2. An archival dataset of naturalistic psychotherapies from public health care (N = 139 dyads). Multilevel growth curve analysis was employed to investigate the degree of change in session-to-session agreement of global WAI ratings between therapists and patients (i.e., alliance convergence) as a predictor of symptom reduction in the BDI-II and the SCL-90R. Results: Contrary to our expectations, alliance convergence did not predict outcome in either sample, but was negatively associated with symptom severity in Study 2. Implications for understanding the complexity of dyadic processes and alliance work in psychotherapy are discussed.

• Solbakken, Ole Andre; Rauk, Mari; Solem, Anders; Lødrup, William & Monsen, Jon Trygve (2017). Tell me how you feel and I will tell you who you are : first validation of the affect integration inventory. Scandinavian Psychologist. 2017(4:e2), p. 1–31. doi: 10.15714/scandpsychol.4.e2. Full text in Research Archive Show summary

  In this article, we present the first empirical validation of the Affect Integration Inventory (AII), a measure that assesses affect integration through a time-efficient self-report format, write Ole André Solbakken and colleagues.

• Taarvig, Eva; Solbakken, Ole Andre; Grova, Bjørg Kari & Monsen, Jon Trygve (2016). Vurdering av affektintegrasjon med Affektbevissthetsintervju for barn. Tidsskrift for Norsk psykologforening (Psykologtidsskriftet). ISSN 0332-6470. 53(4), p. 282–289. Full text in Research Archive
• Taarvig, Eva; Solbakken, Ole Andre; Grova, Bjørg Kari & Monsen, Jon Trygve (2016). Exploring Affect Integration in Children With Anxiety Disorders:A Pilot Study. Psychology of Consciousness. ISSN 2326-5523. 3(4), p. 338–356. doi: 10.1037/cns0000108. Full text in Research Archive
• Bjerke, Espen; Solbakken, Ole Andre; Friis, Svein & Monsen, Jon Trygve (2016). Self-Relatedness and Interpersonal Problems in a Large Psychiatric Outpatient Sample. PSYCHOLOGY. ISSN 2152-7180. 7, p. 864–876. doi: 10.4236/psych.2016.76088. Full text in Research Archive
• Nissen-Lie, Helene A; Rønnestad, Michael Helge; Høglend, Per Andreas; Havik, Odd E.; Solbakken, Ole Andre & Stiles, Tore C [Show all 7 contributors for this article] (2015). Love yourself as a person, doubt yourself as a therapist? Clinical Psychology and Psychotherapy. ISSN 1063-3995. 24(1), p. 48–60. doi: 10.1002/cpp.1977. Full text in Research Archive
• Nissen-Lie, Helene A; Havik, Odd E.; Høglend, Per Andreas; Rønnestad, Michael Helge & Monsen, Jon Trygve (2015). Patient and therapist perspectives on alliance development: Therapists' practice experiences as predictors. Clinical Psychology and Psychotherapy. ISSN 1063-3995. 22(4), p. 317–327. doi: 10.1002/cpp.1891. Full text in Research Archive
• Taarvig, Eva; Solbakken, Ole Andre; Grova, Bjørg & Monsen, Jon Trygve (2015). Affect Consciousness in children with internalizing problems: Assessment of affect integration. Clinical Child Psychology and Psychiatry. ISSN 1359-1045. 20(4), p. 591–610. doi: 10.1177/1359104514538434. Full text in Research Archive Show summary

  Affect integration was operationalized through the Affect Consciousness (AC) construct as degrees of awareness, tolerance, nonverbal expression and conceptual expression of 11 affects. These aspects are assessed through a semi-structured Affect Consciousness Interview (ACI) and separate rating scales (Affect Consciousness Scales (ACSs)) developed for use in research and clinical work with adults with psychopathological disorders. Age-adjusted changes were made in the interview and rating system. This study explored the applicability of the adjusted ACI to a sample of 11-year-old children with internalizing problems through examining inter-rater reliability of the adjusted ACI, along with relationships between the AC aspects and aspects of mental health as symptoms of depression, symptoms of anxiety, social competence, besides general intelligence. Satisfactory inter-rater reliability was found, as well as consistent relationships between the AC aspects and the various aspects of mental health, a finding which coincides with previous research. The finding indicates that the attainment of the capacity to deal adaptively with affect is probably an important contributor to the development of adequate social competence and maybe in the prevention of psychopathology in children. The results indicate that the adjusted ACI and rating scales are useful tools in treatment planning with children at least from the age of 11 years.

• Bjerke, Espen; Solbakken, Ole Andre & Monsen, Jon Trygve (2014). Are There Specific Relationships Between Symptom Patterns and Interpersonal Problems Among Psychiatric Outpatients? Journal of Personality Assessment. ISSN 0022-3891. 96(2), p. 237–244. doi: 10.1080/00223891.2013.834441. Full text in Research Archive Show summary

  Associations between symptoms and interpersonal problems, assessed with the Symptom Checklist–90 (SCL–90–R) and the Inventory of Interpersonal Problems–64-item version (IIP–64), are examined in a large psychiatric outpatient sample. On the basis of the IIP–64 scores, the sample was divided into 8 subgroups, made up of different types of predominant interpersonal problems. These octant groups were used as independent variables in analyses testing hypothesized associations with symptom subscales of the SCL–90–R. In general, strong associations between symptoms and interpersonal problems were found. In addition, hostile and paranoid ideation symptoms displayed significant differences among octant groups, and were associated with interpersonal problems of the vindictive/self-centered kind. Phobic anxiety was associated with interpersonal problems of the socially inhibited kind. Assessing specific combinations of symptoms and interpersonal problems might be useful in treatment planning and evaluation.

• Nissen-Lie, Helene A; Monsen, Jon Trygve; Ulleberg, Pål & Rønnestad, Michael Helge (2013). Psychotherapists' self-reports of their interpersonal functioning and difficulties in practice as predictors of patient outcome. Psychotherapy Research. ISSN 1050-3307. 23(1), p. 86–104. doi: 10.1080/10503307.2012.735775. Full text in Research Archive
• Monsen, Jon Trygve & Solbakken, Ole Andre (2013). Affektintegrasjon og nivåer av mental representasjon : fokus for terapeutisk intervensjon i Affektbevissthetsmodellen. Tidsskrift for Norsk psykologforening (Psykologtidsskriftet). ISSN 0332-6470. 50(8), p. 741–751. Full text in Research Archive
• Nissen-Lie, Helene A; Havik, Odd E.; Høglend, Per Andreas; Monsen, Jon Trygve & Rønnestad, Michael Helge (2013). The Contribution of the quality of therapists' personal lives to the development of the working alliance. Journal of Counseling Psychology. ISSN 0022-0167. 60(4), p. 483–495. doi: 10.1037/a0033643. Full text in Research Archive
• Stålsett, Gry; Gude, Tore; Rønnestad, Michael Helge & Monsen, Jon Trygve (2012). Existential dynamic therapy ("VITA") for treatment-resistant depression with Cluster C disorder: Matched comparison to treatment as usual. Psychotherapy Research. ISSN 1050-3307. 22(5), p. 579–591. doi: 10.1080/10503307.2012.692214. Full text in Research Archive
• Solbakken, Ole Andre; Hansen, Roger Sandvik; Havik, Odd E. & Monsen, Jon Trygve (2012). Affect integration as a predictor of change: Affect consciousness and treatment response in open-ended psychotherapy. Psychotherapy Research. ISSN 1050-3307. 22(6), p. 656–672. doi: 10.1080/10503307.2012.700871. Full text in Research Archive
• Bjerke, Espen; Hansen, Roger Sandvik; Solbakken, Ole Andre & Monsen, Jon Trygve (2011). Interpersonal problems among 988 Norwegian psychiatric outpatients. A study of pretreatment self-reports. Comprehensive Psychiatry. ISSN 0010-440X. 52(3), p. 273–279. doi: 10.1016/j.comppsych.2010.07.004. Full text in Research Archive
• Solbakken, Ole Andre; Hansen, Roger Sandvik & Monsen, Jon Trygve (2011). Affect integration and reflective function: Clarification of central conceptual issues. Psychotherapy Research. ISSN 1050-3307. 21(4), p. 482–496. doi: 10.1080/10503307.2011.583696. Full text in Research Archive Show summary

  The importance of affect regulation, modulation or integration for higher-order reflection and adequate functioning is increasingly emphasized across different therapeutic approaches and theories of change. These processes are probably central to any psychotherapeutic endeavor, whether explicitly conceptualized or not, and in recent years a number of therapeutic approaches have been developed that explicitly target them as a primary area of change. However, there still is important lack of clarity in the field regarding the understanding and operationalization of affect integration, particularly when it comes to specifying underlying mechanisms, the significance of different affect states, and the establishment of operational criteria for measurement. The conceptual relationship between affect integration and reflective function thus remains ambiguous. The present article addresses these topics, indicating ways in which a more complex and exhaustive understanding of integration of affect, cognition and behavior can be attained.

• Solbakken, Ole Andre; Hansen, Roger Sandvik; Havik, Odd E. & Monsen, Jon Trygve (2011). Assessment of Affect Integration: Validation of the Affect Consciousness Construct. Journal of Personality Assessment. ISSN 0022-3891. 93(3), p. 257–265. doi: 10.1080/00223891.2011.558874. Full text in Research Archive
• Nissen-Lie, Helene A; Monsen, Jon Trygve & Rønnestad, Michael Helge (2010). Therapist predictors of early patient-rated working alliance: A multilevel approach. Psychotherapy Research. ISSN 1050-3307. 20(6), p. 627–646. doi: 10.1080/10503307.2010.497633. Full text in Research Archive
• Arnevik, Espen Kristian; Wilberg, Theresa; Urnes, Øyvind; Johansen, Merete; Monsen, Jon Trygve & Karterud, Sigmund (2010). PSYCHOTHERAPY FOR PERSONALITY DISORDERS: 18 MONTHS' FOLLOW-UP OF THE ULLEVAL PERSONALITY PROJECT. Journal of Personality Disorders. ISSN 0885-579X. 24(2), p. 188–203. Full text in Research Archive
• Arnevik, Espen Kristian; Wilberg, Theresa; Urnes, Øyvind; Johansen, Merete Selsbakk; Monsen, Jon Trygve & Karterud, Sigmund (2010). Psychotherapy for persoality disorders: 18 months' follow-up of the Ullevål Personality Project. Journal of Personality Disorders. ISSN 0885-579X. 24, p. 188–203. doi: 10.1521/pedi.2010.24.2.188. Full text in Research Archive
• Hersoug, Anne Grete; Høglend, Per; Havik, Odd E. & Monsen, Jon T. (2010). Development of working alliance over the course of psychotherapy. Psychology and Psychotherapy: Theory, Research and Practice. ISSN 1476-0835. 83(2), p. 145–159. doi: 10.1348/147608309X471497. Full text in Research Archive
• Arnevik, Espen Kristian; Wilberg, Theresa; Urnes, Øyvind; Johansen, Merete; Monsen, Jon Trygve & Karterud, Sigmund (2009). Psychotherapy for personality disorders: Short-term day hospital psychotherapy versus outpatient individual therapy - a randomized controlled study. European psychiatry. ISSN 0924-9338. 24(2), p. 71–78. doi: 10.1016/j.eurpsy.2008.09.004. Full text in Research Archive
• Hersoug, Anne Grete; Høglend, Per Andreas; Havik, Odd E.; Lippe, Anna Louise von der & Monsen, Jon Trygve (2009). Pretreatment patient characteristics related to the level and development of working alliance in long-term psychotherapy. Psychotherapy Research. ISSN 1050-3307. 19(2), p. 172–180. Full text in Research Archive Show summary

  This study explored pretreatment patient characteristics associated with the working alliance in therapies lasting up to 120 therapy sessions. The quality of working alliance was rated by both patients (N=201) and therapists (N=61) at session 3, 12, 20 and then every 20th successive session. Patients’ reported experience of good maternal care up to adolescence and better current interpersonal relationships were associated with positive ratings of working alliance throughout therapy. Higher global functioning was associated with growth of alliance over time. Higher levels of interpersonal problems of the cold/detached kind were associated with poorer early working alliance. On the other hand, this type of interpersonal problem was also associated with improvement of working alliance over time. Therapists’ ratings of alliance were associated with patients’ intrapsychic functioning. Implications for treatment and research are discussed.

• Arnevik, Espen Kristian; Wilberg, Theresa; Monsen, Jon Trygve; Andrea, Helene & Karterud, Sigmund (2009). A cross-national validity study of the Severity Indices of Personality Problems (SIPP-118). Personality and Mental Health. ISSN 1932-8621. 3(1), p. 41–55. doi: 10.1002/pmh.60. Full text in Research Archive
• Hersoug, Anne Grete; Høglend, Per; Havik, Odd E.; Lippe, Anna Louise von der & Monsen, Jon (2009). Therapist characteristics influencing the quality of alliance in long-term psychotherapy. Clinical Psychology and Psychotherapy. ISSN 1063-3995. 16(2), p. 100–110. doi: 10.1002/cpp.605. Full text in Research Archive
• Lippe, Anna Louise von der; Monsen, Jon Trygve; Rønnestad, Michael Helge & Eilertsen, Dag-Erik (2008). Treatment failure in psychotherapy: The pull of hostility. Psychotherapy Research. ISSN 1050-3307. 18(4), p. 420–432. doi: 10.1080/10503300701810793. Full text in Research Archive
• Monsen, Jon Trygve (2007). Følelser-fra grunnen av. In Biong, Trine Line & Bu, Kari (Ed.), Kunsten å bruke følelser. Flux. ISSN 9788292773116. p. 23–33. Full text in Research Archive
• Monsen, Jon T.; Lippe, Anna Louise von der; Lippe, Anna Louise von der; Havik, Odd E.; Halvorsen, Margrethe S. & Eilertsen, Dag E. (2007). Validation of the SASB introject surface in a Norwegian clinical and nonclinical sample. Journal of Personality Assessment. ISSN 0022-3891. 88(2), p. 235–245. Full text in Research Archive
• Halvorsen, Margrethe Seeger & Monsen, Jon Trygve (2007). Self-image as a moderator of change in psychotherapy. Psychotherapy Research. ISSN 1050-3307. 17(2), p. 205–217. doi: 10.1080/10503300600608363. Full text in Research Archive
• Monsen, Jon Trygve; Hagtvet, Knut Arne; Havik, Odd E. & Eilertsen, Dag-Erik (2006). Circumplex Structure and Personality Disorders Correlates of the Interpersonal Problems Model (IIP-C): Construct validity and clinical implications. Psychological Assessment. ISSN 1040-3590. 18(2), p. 165–173. doi: 10.1037/1040-3590.18.2.165. Full text in Research Archive Show summary

  This study assessed the construct validity of the circumplex model of the Inventory of Interpersonal Problems (IIP-C) in Norwegian clinical and non-clinical samples. Structure was examined by evaluating the fit of the circumplex model to data obtained by the IIP-C. Observer-rated personality disorder criteria (DSM-IV, axis II) were used as external correlates. The reliability of the IIP-C scales were acceptable and in the same range as in the original version. A multi-sample analysis strategy did not support an invariant circumplex model across the two groups. However, the estimated structures reflected mostly the same circular pattern of a quasi-circumplex model in the two groups. Departures from the ideal model were of negligible practical significance. The validity results examining personality disorder correlates of the IIP-C generally conformed to predictions, providing direct evidence for agreement between self-report and expert judgments of interpersonal problems.

• Halvorsen, Margrethe Seeger; Hagtvet, Knut Arne & Monsen, Jon Trygve (2006). The reliability of self-image change scores in psychotherapy research: An application of generalizability theory. Psychotherapy. ISSN 0033-3204. 43, p. 308–321. Full text in Research Archive
• Monsen, Jon T.; Hagtvet, Knut Arne; Havik, Odd E. & Eilertsen, Dag E. (2006). Circumplex structure and personality disorder correlates of the interpersonal problems model (IIP-C): Construct validity and clinical implications. Psychological Assessment. ISSN 1040-3590. 18(2). doi: 10.1037/1040-3590.18.2.165. Full text in Research Archive
• Monsen, Kirsti; Monsen, Jon Trygve; Svartberg, Martin & Havik, Odd E. (2002). Chronic pain patients: Patterns of change in interpersonal problems, pain intensity, and depression-anxiety. Psychotherapy Research. ISSN 1050-3307. 12(3), p. 339–354. Full text in Research Archive
• Hersoug, Anne Grete; Monsen, Jon Trygve; Havik, Odd E. & Høglend, Per Andreas (2002). Quality of working alliance in psychotherapy: Diagnoses, relationships, and intrapsychic variables as predictors. Psychotherapy and Psychosomatics. ISSN 0033-3190. 71, p. 18–27. Full text in Research Archive Show summary

  Background: The aim of the study was the prediction of the quality of early working alliance, from possible predictors among patient pretreatment variables: Diagnoses, current and past relationships, and intrapsychic. Data are from an ongoing, naturalistic Norwegian Multisite Project on Process and Outome of Psychotherapy (NMSPOP). Methods: The sample, N=270, is recruited from 15 outpatient clinics, and 61.1 % of the patients have personality disorders. Alliance was assessed with the Working Alliance Inventory (WAI), and predictors include independent clinicians' evaluations of diagnostic/interpersonal/intrapsychic characteristics, and patients' self-reports on similar and additional variables. Results: Four of six hypotheses were supported: Quality of working alliance is difficult to predict, early alliance is better predicted than later, diagnostic variables do not predict quality of working alliance, but quality of both current and past relationships are associated with working alliance. In a hierarchical multiple regression analysis, 12% variance of working alliance in the 3rd session was explained from current and past relationship variables, whereas alliance in the 12th session was not predicted by the same model. Intrapsychic variables predicted therapists' ratings of alliance, but not patients' ratings. Conclusion: The results are in line with previous research, and also with the theoretical model for working alliance.

• Gude, Tore; Monsen, Jon Trygve & Hoffart, Asle (2001). Schemas, affect consciuosness, and Cluster C personality pathology: A prospective one-year follow-up study of patients in a schema-focused short-term treatment program. Psychotherapy Research. ISSN 1050-3307. 11(1), p. 85–98. Full text in Research Archive Show summary

  In this prospective study the aim was to investigate the relationship between affect consciousness and Cluster C personality pathology (DSM-IV, Axis-II). Forty-four patients with panic disorder and/or agoraphobia and Cluster C personality traits were treated in a schema-focused program comprising a first panic/agoraphobia-focused phase and a second personality-focused phase, being finally assessed at a one-year follow-up. According to the treatment strategy, affect consciousness was expected to change during the second phase, independent of change in agoraphobic avoidance being focused in the first phase. Pretreatment level of affect consciousness during treatment was related to a reduction in avoidant personality pathology (not dependent or obsessive-compulsive) from pretreatment to follow-up, while increase in affect consciousness did not contribute in the same way. These results indicate that affect consciousness is important as a selection criterion, as a parameter in treatment with focus on schemas and schema-avoidance, and as a predictor for outcome in agoraphobic patients with avoidant personality pathology.

• Hersoug, Anne Grete; Høglend, Per Andreas; Monsen, Jon Trygve & Havik, Odd E. (2001). Quality of working alliance in psychotherapy: Therapist variables and patient/therapist similarity as predictors. Journal of Psychotherapy Practice and Research (JPPR). ISSN 1055-050X. 10, p. 205–216. Full text in Research Archive Show summary

  Therapist characteristics were explored as possible predictors of working alliance, rated early and later in therapy by both therapists (N=59) and patients (N=270) in an ongoing multisite project on process and outcome of psychotherapy. Patients and therapists had divergent perspectives on the working alliance. Therapists' experience, training, skill and progress did not have any significant impact on alliance as rated by patients, whereas training and skill were positively related to alliance as rated by therapists. Interpersonal relationships (IIP, PBI) on the cold-warm dimension had a moderate impact for both patients' and therapists' alliance ratings. Some implications for therapist training are discussed.

• Monsen, Kirsti & Monsen, Jon Trygve (2000). Chronic pain and psychodynamic body therapy. A controlled outcome study. Psychotherapy. ISSN 0033-3204. 37(3), p. 257–270. Full text in Research Archive Show summary

  Forty patients with pain disorders participated in a controlled study. Half of the patients were treated with psychodynamic body therapy (PBT) for 33 sessions, and the other half received treatment as usual (TAU) or no treatment (NTAU). All patients were evaluated before therapy (T1), at the end of therapy (T2) and at one year follow-up (T3) with a VAS-pain scale (subjective experience of pain), SCL-90-R, IIP-C, MMPI and the affect consciousness interview (ACI). Results: The study demonstrated that at T2 the pain was significantly reduced in the PBT group compared to the controls, and 50% of the PBT patients reported no pain. The findings further showed a significant and substantial change on level of somatization, depression, anxiety, denial, assertiveness, social withdrawal and increased affect consciousness. The results remained stable at T3, and the PBT patients even continued their improvement on some scales during follow-up.

• Monsen, Jon Trygve & Monsen, Kirsti (2000). Affekter og affektbevissthet: Et bidrag til integrerende psykoterapimodell, Psykoterapi og psykoterapiveiledning: Teori, empiri, praksis. Gyldendal Akademisk. ISSN 9788241711978. p. 71–91. Full text in Research Archive
• Monsen, Jon Trygve & Monsen, Kirsti (1999). Affects and affect consciousness - a psychotherapy model integrating Silvan Tomkins' affect and script theory within the framework of self psychology. In Goldberg, Arnold (Eds.), Pluralisms in self psychology. Progress in self psychology. The analytic press, Hillsdale, NJ. ISSN 9780881633122. p. 287–307. Full text in Research Archive
• Monsen, Jon Trygve (1999). A szelfpszichológia és a modern affektuselmélet. In Karterud, Sigmund & Monsen, Jon Trygve (Ed.), Szelfpszichologia a Kohut utani fejlódés. Animula, Ungarn. ISSN 9789634081227. p. 75–109. Full text in Research Archive
• Monsen, Jon Trygve (1997). Selvpsykologi og nyere affektteori. In Karterud, Sigmund & Monsen, Jon Trygve (Ed.), Selvpsykologi. Utviklingen etter Kohut. Gyldendal Akademisk. ISSN 9788241707667. p. 90–137. Full text in Research Archive Show summary

  Kapittelet innledes med en teoretisk drøfting av forholdet mellom selvutvikling og integrering av følelser, samt noen implikasjoner for psykoterapi. Deretter presenteres sentrale utdrag fra Tomkins' affekt- og script teori. Senere presenteres affekt-teoretiske bidrag fra kjente selvpsykologer som Basch, Lichtenberg et al., Stolorow et al.hvor det trekkes implikasjoner i forhold til sentrale psykoanalytiske begreper.

• Monsen, Jon Trygve (1997). Affekternas roll i psykoterapeutisk teori och teknik. Del 2: Om självutveckling och bristfällig integration av känslor - nogra konsekvenser för psykoterapi. Insikten. ISSN 1400-0938. p. 40–48. Full text in Research Archive
• Monsen, Jon Trygve (1996). Affektenes rolle i psykoterapeutisk teori og teknikk I: Hvordan har en fokusert på følelser innen atferdsterapi, kognitiv, humanistisk/eksistensiell og psykodynamisk psykoterapi? Tidsskrift for Norsk psykologforening (Psykologtidsskriftet). ISSN 0332-6470. 33, p. 867–877. Full text in Research Archive Show summary

  The article discusses how four of the major therapeutic perspectives have tended to emphasize different aspects of affects in psychotherapy. Behavioral and cognitive theories have traditionally focused on elimination of maladaptive affective responses, and the therapeutic strategies have centered around preventing avoidance behavior and faulty cognitions. Within the humanistic/existential and psychodynamic approaches affects were to a greater extent viewed as an adaptive system providing the individual with valuable orienting information. Empathic validation of affect experiences were seen as a central therapeutic agent in order to facilitate integration of affects with symbolic representations of self and others. Improved affect theory may promote the development of integrative psychotherapy models centering around the identification of discrete affect experiences, how they are represented mentally and organized at a structural level of personality functioning.

• Monsen, Jon Trygve (1996). Affektenes rolle i psykoterapeutisk teori og teknikk II: Om selvutvikling og mangelfull integrasjon av følelser - noen implikasjoner for psykoterapi. Tidsskrift for Norsk psykologforening (Psykologtidsskriftet). ISSN 0332-6470. 33, p. 952–960. Full text in Research Archive Show summary

  The aim of the article is to elucidate the relationship between formation of the representational self, the capacity to integrate affect experiences and some required steps in psychotherapy leading to the change of affect structures. According to theories of psychodynamic self psychology, psychic structure formation has a social and interactional basis. Invariant relationship patterns, including affect information, are represented mentally and organized as images, scenes and scripts. At the onset of language development and the capacity for symbolic representations, this stored knowledge and unconscious ordering principles normally become decontextualized and generalized. Deficient validating responsiveness is believed to create maladaptive scripts and a socially, linguisticly and symbolicly constructed form of self representation which devaluates or excludes the informative value of the affect system. The implications of psychotherapy are discussed and some necessary conditions for achieving structural change are suggested.

• Monsen, Jon Trygve (1996). Affects and affect consciousness: Initial experiences from the assessment of affect integration. Journal of Psychotherapy Practice and Research (JPPR). ISSN 1055-050X. 5, p. 238–249. Full text in Research Archive Show summary

  The concept of affect consciousness (AC) was operationalized as degrees of awareness, tolerance, nonverbal expression and conceptual expression of nine specific affects. A semistructured interview (ACI) and separate scales (ACS) were developed to assess these aspects of affect integration. The measure's psychometric properties were preliminarily explored in a study in which 20 subjects (former psychiatric outpatients) completed the interview. Concurrent validity was assessed using DSM-III-R diagnoses, axes I and II, the Health Sickness Rating Scale, SCL-90-R and several indexes from the Minnesota Multiphasic Personality Inventory (MMPI). The results showed satisfactory interrater reliability and high levels of internal consistency, and support the construct validity of the measure. The psychometric properties suggests that the most meaningful use of this instrument is at the level of each specific affect and at the overall measure of AC. Clinically, the ACI has so far demonstrated its usefulness by providing qualitative data that are highly specific and relevant for planning of psychotherapeutic interventions.

• Monsen, Jon Trygve; Eilertsen, Dag-Erik; Melgård, Trond & Ødegård, Pål (1996). Affects and affect consciousness: Initial experiences from the assessment of affect integration. The Journal of Psychotherapy Practice and Research. 5, p. 238–249. Full text in Research Archive
• Monsen, Jon Trygve (1996). Affekternas roll i psykoterapeutisk teori och teknik. Del I: Hur har man fokuserat på känslor innom beteendeterapi,kognitiv, humanistisk/eksistensiell och psykodynamisk psykoterapi? Insikten. ISSN 1400-0938. 5, p. 22–29. Full text in Research Archive
• Monsen, Jon Trygve; Odland, Torleiv; Faugli, Anne; Daae, Elisabeth & Eilertsen, Dag-Erik (1995). Personality disorders: Changes and stability after intensive psychotherapy focussing on affect consciousness. Psychotherapy Research. ISSN 1050-3307. 5(1), p. 33–48. Full text in Research Archive
• Monsen, Jon Trygve; Odland, Torleiv; Faugli, Anne; Daae, Elisabeth & Eilertsen, Dag-Erik (1995). Personality disorders and psychosocial changes after intensive psychotherapy: A prospective follow-up study of an outpatient psychotherapy project, 5 years after end of treatment. Scandinavian Journal of Psychology. ISSN 0036-5564. 36, p. 256–268. Full text in Research Archive
• Monsen, Jon Trygve (1993). Knut O: En gutt med mangelfull og forstyrret selvutvikling, Psykoterapi med voksne. Tano, Oslo. ISSN 9788251831659. p. 291–306. Full text in Research Archive
• Melgård, Trond; Monsen, Jon Trygve & Ødegård, Pål (1991). Psykososiale forandringer etter inngående psykoterapi. Tidsskrift for Norsk psykologforening (Psykologtidsskriftet). ISSN 0332-6470. 28, p. 379–386. Full text in Research Archive
• Monsen, Jon Trygve; Ødegård, Pål & Melgård, Trond (1989). Major psychological disorders and changes after intensive psychotherapy: Findings from the Tøyen project, Oslo. Psychoanalysis and psychotherapy. 7, p. 171–180. Full text in Research Archive
• Monsen, Jon Trygve (1989). Inngående psykoterapi. En psykologisk behandlingsform tilpasset personer med alvorlige former for psykiske forstyrrelser. Tidsskrift for Norsk psykologforening (Psykologtidsskriftet). ISSN 0332-6470. 26, p. 523–534. Full text in Research Archive
• Monsen, Jon Trygve; Ødegård, Pål & Melgård, Trond (1989). Alvorlige psykiske forstyrrelser og forandringer etter inngående psykoterapi. Tidsskrift for Norsk psykologforening (Psykologtidsskriftet). ISSN 0332-6470. 26, p. 523–534. Full text in Research Archive
• Ødegård, Pål; Melgård, Trond & Monsen, Jon Trygve (1986). Myter om psykoterapibehov? En registrering av behovet for inngående psykoterapi i sosialdistriktene 2 og 8 i Oslo. Tidsskrift for Norsk psykologforening (Psykologtidsskriftet). ISSN 0332-6470. 23, p. 525–530. Full text in Research Archive
• Monsen, Jon Trygve; Melgård, Trond & Ødegård, Pål (1986). Vitalitet og psykiske forstyrrelser belyst ved begrepene opplevelsesevne og ekspressivitet. Tidsskrift for Norsk psykologforening (Psykologtidsskriftet). ISSN 0332-6470. 23, p. 285–294. Full text in Research Archive
• Melgård, Trond; Monsen, Jon Trygve & Ødegård, Pål (1984). Alvorlige psykiske forstyrrelser og inngående psykoterapi. Tidsskrift for Norsk psykologforening (Psykologtidsskriftet). ISSN 0332-6470. 10, p. 515–520. Full text in Research Archive
• Monsen, Jon Trygve (1978). Smerte og kroppsopplevelser sett i et psykologisk perspektiv. Artikkelsamling for medarbeidere ved Dikemark sykehus. 11(1). Full text in Research Archive

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• Karterud, Sigmund & Monsen, Jon Trygve (1999). Szelfpszichologia a Kohut utani fejlódés. Animula, Ungarn. ISBN 9789634081227. -1 p. Full text in Research Archive
• Karterud, Sigmund & Monsen, Jon Trygve (1997). Selvpsykologi. Utviklingen etter Kohut. Gyldendal Akademisk. ISBN 9788241707667. -1 p. Full text in Research Archive
• Karterud, Sigmund & Monsen, Jon Trygve (1997). Selvpsykologi. Utvikling etter Kohut. Gyldendal Akademisk. -1 p. Full text in Research Archive
• Monsen, Jon Trygve (1991). Klinisk psykologi. Om personlighetsutveckling och terapi. Runa Förlag. ISBN 9789188298072. 303 p. Full text in Research Archive
• Monsen, Jon Trygve (1990). Vitalitet, psykiske forstyrrelser og psykoterapi. Utdrag fra klinisk psykologi. Tano a.s.. ISBN 9788251826303. 304 p. Full text in Research Archive

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• Høstmælingen, Andreas Teisner; Nissen-Lie, Helene, Amundsen; Monsen, Jon Trygve; Heinonen, Erkki; Wampold, Bruce E. & Czajkowski, Nikolai Olavi [Show all 8 contributors for this article] (2026). The Potential Impact of Antidepressant Medication on Psychotherapy Outcome for Depressed Patients. Full text in Research Archive Show summary

  Aim: Many depressed patients are already being treated with antidepressant medication (ADM) when presenting for psychotherapy. However, the potential impact of ADM on psychotherapy processes and outcome remains an unresolved issue. A large body of research indicates a combination of ADM and psychotherapy is superior to either monotherapy, but there are also indications that especially long-term use of ADM may be associated with negative consequences such as tolerance, negative side effects and iatrogenic comorbidity. The aim of this study was to investigate changes in depressive symptoms and interpersonal problems for ADM users and non-medicated depressed patients during psychotherapy and follow-up. Methods: Depressive symptoms (SCL-90-R) were assessed on 11 occasions for 166 depressed patients. ADM was used by 50.6% of the sample while 49.4% were unmedicated. Change during treatment and follow-up was assessed with multilevel modeling. We assessed whether ADM predicted differences in symptom development. Results: Depressive symptoms significantly reduced at a rate of .05 per month in treatment (p <.001), corresponding to an effect size of 1.35. There was no significant difference between ADM users and nonmedicated patients at baseline. ADM users had nearly twice as long treatment duration than nonmedicated patients, and ADM users had lower rate of symptom reduction than nonmedicated patients for depressive symptoms. Conclusions: Our results indicate medicated patients experience less response to psychotherapy than non medicated. Patients on ADM may believe that depression is primarily a biochemical condition and thus have less confidence in the potential for psychotherapy to treat depression. Also, it is possible that patients not using ADM have better access to emotions that need to be accessed and processed in psychotherapy. Iatrogenic comorbidity may thus have contributed to slower improvement for ADM users.

• Høstmælingen, Andreas Teisner; Nissen-Lie, Helene, Amundsen; Monsen, Jon Trygve & Solbakken, Ole Andre (2025). Practice oriented research in Norway: Improvements in interpersonal problems predict subsequent improvement in depressive symptoms during open-ended psychotherapy for adults with depression. doi: https:/cdn.ymaws.com/www.psychotherapyresearch.org/resource/resmgr/spr2025/spr_meeting_program_2025.pdf. Full text in Research Archive Show summary

  Objective: Depressed patients often experience interpersonal distress. Understanding how interpersonal distress and depressive symptoms are associated may have implications for understanding the aetiology and maintenance of depression, as well as for treatment. In this practice-oriented research program, we explored whether change in depressive symptoms predicted subsequent change in interpersonal distress or vice versa. Method: Depressive symptoms (depression scale of the SCL-90-R), and interpersonal problems (IIP-64) were assessed on 9 occasions including before, during, and after treatment, and at 1 and 2.5-years’ follow-up in a sample of 178 depressed patients receiving open-ended psychotherapy. We used latent curve modelling with structured residuals (LCM-SR) to assess possible reciprocal relations between interpersonal problems and depression, controlling for personality disorder (PD). Results: The findings showed that interpersonal distress had a slower rate of change compared to depressive symptoms, but improvements in interpersonal distress predicted subsequent improvement in depressive symptoms during psychotherapy and this effect was stable over time. Patients with comorbid PD had higher initial levels of both depression and interpersonal distress, but there were no differences in rates of change for any of the outcomes. Conclusion: Our results indicate that improvements in interpersonal problems may play an important role in alleviating depressive symptoms during psychotherapy. We propose that reduction of interpersonal distress is associated with increased interpersonal flexibility, which may lead to more positive responses from others, thereby contributing to a reduction in depressive symptom

• Steimoen, Teodor Melker Nytrøen; Høstmælingen, Andreas Teisner; Nissen-Lie, Helene Amundsen; Monsen, Jon Trygve & Solbakken, Ole Andre (2022). Toward a more nuanced understanding of the role of the working alliance in producing therapeutic benefits. Full text in Research Archive
• Nordmo, Magnus; Monsen, Jon Trygve; Høglend, Per Andreas & Solbakken, Ole Andre (2021). Comparing the magnitude of improvement for patients with and without personality disorders in open-ended psychotherapy. Personality Disorders: Theory, Research, and Treatment. ISSN 1949-2715. doi: 10.1037/per0000474. Full text in Research Archive
• Nissen-Lie, Helene A; Solbakken, Ole Andre & Monsen, Jon Trygve (2018). Are we on the same page? Alliance convergence and its impact on therapy outcomes. Full text in Research Archive
• Axelsen, Eva Dalsgaard; Benum, Kirsten; Bernhardt, Ida S.; Gullestad, Siri Erika; Halvorsen, Margrethe Seeger & Hartmann, Ellen Johanne [Show all 24 contributors for this article] (2017). Historien Psykologtidsskriftet ikke forteller. 54(12), p. 1197–1199. Full text in Research Archive
• Nissen-Lie, Helene A; Garås, Anna & Monsen, Jon Trygve (2017). Agreement about goals in psychotherapy: Patients’ and therapists’ perspectives, therapist effects and predictors, and relation to outcome. Full text in Research Archive
• Solbakken, Ole Andre; Sønderland, Nils Martin; Sundal, Martin Seem & Monsen, Jon Trygve (2014). Affect Representation and Intervention Focus(ARIF): A coding system for modeling micro processes in therapeutic dialogues. Full text in Research Archive
• Nissen-Lie, Helene A; Rønnestad, Michael Helge & Monsen, Jon Trygve (2014). The therapist as a person and as a professional: How does this interplay affect patient outcome of psychotherapy? Full text in Research Archive
• Nissen-Lie, Helene A; Høglend, Per Andreas; Monsen, Jon Trygve; Havik, Odd E.; Rønnestad, Michael Helge & Solbakken, Ole Andre [Show all 7 contributors for this article] (2013). Therapists' experiences of difficulties inpractice and their self-images (introjects). Does the interplay between thesefactors affect patient outcome from psychotherapy? Full text in Research Archive
• Nissen-Lie, Helene A; Havik, Odd. E.; Monsen, Jon Trygve; Høglend, Per Andreas & Rønnestad, Michael Helge (2012). Therapists' personal lives and alliance development. Full text in Research Archive
• Nissen-Lie, Helene A; Ulleberg, Pål; Monsen, Jon Trygve & Rønnestad, Michael Helge (2011). The influence of therapists' self-perceptions on patient outcome. Full text in Research Archive
• Nissen-Lie, Helene A; Monsen, Jon Trygve & Rønnestad, Michael Helge (2010). The influence of therapists' self-reported characteristics on patient outcome from therapy. Full text in Research Archive
• Hansen, Roger Sandvik; Solbakken, Ole Andre; Havik, Odd E. & Monsen, Jon Trygve (2008). Interpersonal problems and personality disorders. Some findings from the Norwegian Multicenter Project for the Study of Process and Outcome of Psychotherapy. Full text in Research Archive
• Solbakken, Ole Andre; Hansen, Roger Sandvik; Havik, Odd E. & Monsen, Jon Trygve (2008). Affect consciousness and mental health; measurement issues, validity and prediction of change. Some findings from the Norwegian Multicenter Project for the Study of Process and Outcome of Psychotherapy. Full text in Research Archive
• Nissen-Lie, Helene A; Rønnestad, Michael Helge & Monsen, Jon Trygve (2008). Therapist effects in the Norwegian Multicenter Project for the study of process and outcome of psychotherapy. Full text in Research Archive
• Hersoug, Anne Grete; Høglend, Per Andreas; Havik, Odd E.; Lippe, Anna von der & Monsen, Jon Trygve (2008). Therapist characteristics influencing the quality of working alliance. Full text in Research Archive
• Herzoug, Anne; Monsen, Jon & Havik, Odd E. (2000). Development of working alliance predicted from patient and therapist variables. Full text in Research Archive
• Herzoug, Anne; Monsen, Jon & Havik, Odd E. (2000). Development of working alliance related early change in dynamic psychotherapy. Full text in Research Archive
• Sønderland, Nils Martin; Monsen, Jon Trygve & Solbakken, Ole Andre (2026). Exploring the role of affect integration in the processes and outcomes of psychotherapy. Universitetet i Oslo. Full text in Research Archive Show summary

  In recent years, increasing attention has been directed toward understanding the processes and mechanisms that underlie the effectiveness of psychotherapeutic interventions (Crits-Christoph et al., 2013; Elliott, 2010; Kazdin, 2009). Among these, emotional change processes and mechanisms have been highlighted as particularly promising (Gross, 2013; Whelton, 2004), given their central role in both adaptive psychological functioning and the development and maintenance of psychopathology (Aldao et al., 2010; Power & Dalgleish, 2015). The overarching aim of this research project was to advance a broader and more nuanced understanding of emotional change in psychotherapy by conducting an extensive review of the relevant literature and by examining the validity of a specific theoretical framework: Affect Integration. The thesis consisted of three studies. In Paper I, we aimed to summarize the current state of knowledge on emotional change processes and mechanisms, and their associations with psychotherapy outcomes. To this end, we conducted a systematic review and meta analysis of the primary change processes and mechanisms identified in the literature. A total of 121 studies, representing 92 unique samples, met the inclusion criteria. The emotional change processes and mechanisms most robustly associated with positive outcomes were fear habituation across sessions in exposure-based treatments for anxiety disorders (r = .38), experiencing in psychotherapy for depression (r = .44), and emotion regulation in psychotherapies for various anxiety disorders (r = .37). Despite differences in emphasis and theoretical lineage, these processes appear to converge on a shared underlying function: the reorganization of maladaptive emotional perception. In Paper II, we examined affect integration as a potential mechanism of change in the treatment of social anxiety disorder (SAD). Affect integration refers to the functional and fluent integration of affect with cognition and behavior (Solbakken et al., 2011) and is operationalized in terms of the individual’s capacity for awareness, tolerance, and both nonverbal and verbal expression of nine discrete emotions (Solbakken et al., 2017). Research has shown that individuals with SAD often struggle to accurately perceive and adaptively utilize their emotions (Rozen & Aderka, 2023). Accordingly, we hypothesized that improvements in affect integration would be associated with reductions in social anxiety symptoms and interpersonal difficulties. The sample consisted of 88 clients who provided self-reports on affect integration, social anxiety, and interpersonal functioning at five time points during treatment and follow-up. We disaggregated the within- and between-person components of these variables and examined the lagged effects of affect integration on subsequent symptoms. As hypothesized, time-specific increases in affect integration predicted reductions in both social anxiety symptoms and interpersonal problems. In Paper III, we aimed to evaluate the utility of Affect Integration Theory (AIT; Monsen & Solbakken 2013; Solbakken et al., 2011) in describing core psychotherapeutic change processes through a theory-building case study. Both qualitative and quantitative methods were employed to examine a successful course of affect-consciousness focused therapy (ACT, Monsen & Monsen, 1999) with a client suffering from depression. The client’s nuclear script—representing a central affective conflict—was identified prior to treatment. Drawing on AIT, the Affect Representation and Intervention Focus (ARIF; Monsen & Solbakken, 2013) coding system was applied to track therapist and client change processes across sessions. Affect consciousness and depressive symptoms were assessed on a session by-session basis. The qualitative analysis involved an in-depth review of session transcripts and video recordings. The nuclear script indicated that several uncomfortable feelings tended to merge and were encoded as a generalized diffuse and mixed state of discomfort and anxiety. Three main therapeutic phases were identified: (1) increased differentiation and integration of affects (shame, sadness, contempt, and anxiety) embedded in the nuclear script; (2) enhanced capacity to express discrete emotions in relational contexts; and (3) development of more nuanced and realistic representations of self and others. A notable finding was that early integration of aversive affects (i.e., contempt and disgust) appeared to facilitate access to sadness and grief related to past injustices. Contempt and disgust initially emerged as taboo feelings, but were relatively early on better integrated, with a clear signaling function in the form of a strong distancing from some of his father’s ways of behaving. After these (for him) unacceptable feelings became more integrated, they were also less fused with other emotional states such as shame, fear, and sadness. Increased affect integration and differentiation involved a clearer conceptualization of his own feelings, a clearer sense of self and self boundaries, a greater capacity to grieve and accept loss, and a more undisturbed access to joy and other positive feelings. The initially paralyzing feelings of shame and self-criticism were, by the end of the therapy process, transformed into greater humility and openness. Cross lagged regression analyses further showed that improvements in affect consciousness systematically predicted subsequent reductions in depressive symptoms, while the converse was not true. Collectively, the three studies contribute to a more nuanced understanding of emotional change in psychotherapy. Meta-analytic findings indicate that several emotional change processes—such as fear habituation, emotional experiencing, and emotion regulation—are robustly associated with therapeutic improvement. These processes appear to converge on a shared underlying function: the reorganization of maladaptive emotional perception. Affect integration emerged as a plausible mechanism of change in the treatment of social anxiety disorder, and findings from the theory-building case study highlighted its role in the treatment of depression.

• Monsen, Jon Trygve (1994). Personality disorders and intensive psychotherapy focusing on affect consciousness: A prospective follow-up study. Publications from the Institute of Psychology. ISSN 9788256913732. Full text in Research Archive

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