Sverre Urnes Johnson

• Johnson, Miriam S.; Johnson, Sverre Urnes; Ko, Hayley; Memon, Amina; Milne, Rebecca & Baugerud, Gunn Astrid (2026). Frontline Practitioners Under Pressure: Secondary Traumatic Stress, Burnout, and Compassion Satisfaction Amongst Professionals Investigating Child Abuse. Journal of Police and Criminal Psychology. ISSN 0882-0783. doi: 10.1007/s11896-026-09831-4. Full text in Research Archive Show summary

  Frontline professionals involved in child abuse investigations face complex and demanding work environments. Repeated exposure to traumatic material places them at elevated risk of secondary traumatic stress (STS) and burnout. This cross-sectional study examined the prevalence of STS, burnout, compassion satisfaction, and associated psychosocial work factors, among 168 Norwegian police investigators and 31 health and social care professionals involved in child abuse investigations. The officers were recruited from specialized units investigating child sexual abuse and violence, whereas the health and social care workers were recruited from Children’s Advocacy Centers. A substantial proportion of the participants reported moderate levels of STS (35% of investigators; 45% of health/social care workers). Moderate levels of burnout were reported by an even higher proportion of participants (64% and 52%, respectively). Despite these indications of psychological strain, about 97% of participants in both groups reported moderate to high levels of compassion satisfaction, indicative of professional fulfillment co-existing with occupational stress. Burnout and job demands were strongly associated with higher STS and lower compassion satisfaction, while positive work challenges and supportive organizational environments were associated with higher compassion satisfaction and lower STS. After controlling for burnout, some differences in occupational stress profiles emerged, with health/social workers reporting lower burnout but higher STS. These findings highlight the complex interplay of STS, burnout, and compassion satisfaction, as well as the protective role of compassion satisfaction.

• Ulitzsch, Esther; Nestler, Steffen; Johnson, Sverre Urnes; Snuggerud, Therese Ruud & Lüdtke, Oliver (2026). Capturing Heterogeneity in Levels, Variability, and Couplings across Persons and Time with a Hierarchical Time-Varying Coefficient Formulation of the Multivariate Normal. Psychometrika. ISSN 0033-3123. doi: 10.1017/psy.2026.10125. Full text in Research Archive Show summary

  Time-varying coefficient modeling (TVCM), which represents regression coefficients as smooth functions of continuous time, provides a flexible framework for uncovering complex patterns of change in levels and associations in intensive longitudinal data. However, conventional TVCM remains limited to investigating directional effects across individuals. By introducing a TVCM formulation of the multivariate normal distribution, the present study extends TVCM to explore change in undirected associations (couplings) and variability, thereby broadening its utility for psychological research. We discuss three versions of this approach: an aggregate-level model and two hierarchical versions capturing interindividual differences in unfolding change, either via person-specific intercepts accounting for onset differences or through fully person-specific coefficient functions smoothed via partial pooling. To illustrate the proposed developments, we apply them to six weeks of intensive longitudinal data from 16 anxiety patients undergoing therapy and examine unfolding changes in the level and volatility of nervousness and threat monitoring, their coupling, as well as between-person heterogeneity in each of these. We further show how inspecting first-order derivatives of the coefficient functions supports identifying periods of stability and change. Finally, we discuss extensions incorporating person-level characteristics to explain heterogeneity in patterns of change and predict outcomes.

• Jørgensen, Hedda Friis; Helvig, Emma Karin; Schei, Hilde; Stormyren, Shirley; Steffensen, Elin & Johnson, Sverre Urnes (2026). Group metacognitive therapy for students with anxiety: an uncontrolled pre-post study of feasibility and associated outcomes. Frontiers in Psychiatry. 17. doi: 10.3389/fpsyt.2026.1766026. Full text in Research Archive
• Magnúsdóttir, Ingibjörg; Nygaard, Anders Benteson; Hoffart, Asle; Murphy, Gillian; Kõiv, Kadri & Barker, Mary M. [Show all 38 contributors for this article] (2026). Acute COVID-19 severity and impaired cognitive function up to 32 months after diagnosis: an observational study. BMC Medicine. 24(1). doi: 10.1186/s12916-026-04856-2. Full text in Research Archive Show summary

  Background Cognitive dysfunction (“brain fog”) is a commonly reported post-COVID-19 symptom. Leveraging data from five general population cohorts across four European countries (Estonia, Iceland, Norway, and Sweden), we assessed long-term prevalence of impaired subjective cognitive function among individuals diagnosed with COVID-19 by acute illness severity. Methods The included cohorts consisted of adult participants recruited from March 2020 and followed with self-report measures of cognitive function and past COVID-19 infection (except one cohort consisting of clinically confirmed COVID-19 cases) through February 2023. In a cross-sectional analysis we contrasted the prevalence of impaired cognitive function among individuals with and without a COVID-19 diagnosis, overall and by illness severity up to 32 months post-diagnosis. We adjusted for age, gender, education, relationship status, binge drinking, body mass index, previous psychiatric diagnosis, number of chronic medical conditions, and response period. In a longitudinal analysis, we assessed potential changes in cognitive function scores before and after COVID-19 diagnosis. Results The study population consisted of 153,841 participants (71% women), with 31,359 (20.4%) reporting a positive COVID-19 test. Overall, a COVID-19 diagnosis was not statistically significantly associated with increased prevalence ratio (PR) of impaired cognitive function (PR 1.30 [95% CI: 0.98–1.71]). Individuals bedridden due to COVID-19 for 1–6 days (PR 1.38 [95% CI 0.96–1.99]) or ≥ 7 days (2.59 [1.55–4.33]) had higher prevalence of impaired cognitive function compared to those never diagnosed, while individuals never bedridden had a lower prevalence to those never diagnosed with COVID-19 (0.89 [0.80–1.00]). These findings were corroborated in the longitudinal analysis where a pre- to post diagnosis decline in cognitive function was observed among individuals bedridden due to COVID-19 (p < 0.0001). Conclusions The data indicates that a severe COVID-19 acute illness course is associated with impaired cognitive function up to 18–32 months after COVID-19 diagnosis.

• Fasting, Agnes; Simensen, Maria Vikan; Sele, Peter; Frost, Karine; Hoffart, Asle & Johnson, Sverre Urnes (2026). Interpersonal problems as predictors of anxiety symptom trajectories in PTSD: A retrospective multilevel modeling study. Journal of Affective Disorders. ISSN 0165-0327. 405. doi: 10.1016/j.jad.2026.121457. Full text in Research Archive
• Snuggerud, Therese Ruud; Ulitzsch, Esther; Nordahl, Henrik; Vrabel, Kari-Anne; Hoffart, Asle & Ebrahimi, Omid V. [Show all 9 contributors for this article] (2026). Dynamic changes in metacognitive mechanisms and symptoms during the attention training technique: Insights from ecological momentary assessment. Journal of Anxiety Disorders. ISSN 0887-6185. 119, p. 103136–103136. doi: 10.1016/j.janxdis.2026.103136. Full text in Research Archive Show summary

  Background Anxiety disorders are prevalent and associated with substantial distress and impairment. Within the metacognitive model of emotional disorders, the cognitive attentional syndrome (CAS) and associated metacognitions maintain anxiety. The Attention Training Technique (ATT) targets the CAS and related metacognitions. However, less is known about how symptoms and metacognitive mechanisms evolve across treatment phases. Objective The study aimed to explore temporal dynamics in emotional symptoms and metacognitive mechanisms during group ATT by estimating mean levels, variability, and coupling across the pre-, during-, and post-treatment phases using ecological momentary assessment (EMA). Method Nineteen young adults with social anxiety disorder, panic disorder with agoraphobia, or generalized anxiety disorder participated. EMA was completed four times daily over six weeks: two weeks before treatment, two weeks during treatment, and two weeks after treatment. Each assessment included ten items measuring emotional symptoms (e.g., nervousness) and metacognitive mechanisms (e.g., worry, uncontrollability). Results Three patterns of change emerged: (1) reduced mean levels without change in variability (nervousness, self-consciousness, and worry); (2) reduced mean levels and reduced variability (threat monitoring); and (3) reduced mean levels and reduced variability during treatment, followed by an increase in variability after treatment (uncontrollability, difficulty collecting thoughts, and meta-worry). Conclusions The findings provide new insights into dynamic patterns of change in symptoms and metacognitive mechanisms before, during, and after ATT. Patterns of change in both intensity and stability may be relevant for understanding treatment response and vulnerability following treatment, suggesting the potential clinical relevance of monitoring these mechanisms.

• Pålerud, Kenneth M.; Helmich, Marieke A.; Hoffart, Asle; Ebrahimi, Omid Vakili; Snuggerud, Therese Ruud & Johnson, Sverre Urnes (2025). Sudden Gains in Cognitive Behavioural Therapy and Metacognitive Therapy for Complex Anxiety Disorders. Clinical Psychology and Psychotherapy. ISSN 1063-3995. 32(4). doi: 10.1002/cpp.70111. Full text in Research Archive
• Cloos, Leonie; Siepe, Björn S.; Piccirillo, Marilyn L.; Fried, Eiko; Wang, Shirley B. & Helmich, Marieke A. [Show all 9 contributors for this article] (2025). Accuracy and Consistency of Visual Analog Scales in Ecological Momentary Assessment and Digital Studies. Collabra: Psychology. ISSN 2474-7394. 11(1). doi: 10.1525/collabra.142735. Full text in Research Archive
• Skjerdingstad, Nora Paulsen; Johnson, Miriam Sinkerud; Johnson, Sverre Urnes; Hoffart, Asle & Ebrahimi, Omid Vakili (2025). Daily dynamics of parental mental health: Investigating depressive symptoms and negative parental experiences. Journal of Psychiatric Research. ISSN 0022-3956. 190, p. 341–346. doi: 10.1016/j.jpsychires.2025.08.007. Full text in Research Archive
• Rajesh, Sakshi; Johnson, Sverre Urnes; Hoffart, Asle; Leigh, Eleanor & Ebrahimi, Omid Vakili (2025). Differential Associations of Anticipatory and Consummatory Anhedonia With Depression and Social Anxiety Symptoms: A Network Analysis of University Students. Depression and Anxiety. ISSN 1091-4269. 2025(1), p. 1–11. doi: 10.1155/da/5674096. Full text in Research Archive
• Hoffart, Asle & Johnson, Sverre Urnes (2025). Nettverksperspektivet versus essensmodeller i behandling av emosjonelle lidelser – teori og kliniske implikasjoner. Tidsskrift for Norsk psykologforening (Psykologtidsskriftet). ISSN 0332-6470. 62(1), p. 33–33. doi: 10.52734/nqme5457. Full text in Research Archive Show summary

  Psykoterapimetoder har ulike teoretiske grunnlag, og de kan plasseres ulikt med hensyn til teoretisk forklaringstype. Mange psykoterapier bygger på essensteoretiske forklaringer der en antar at det ligger en felles rot-årsak til grunn for de fleste psykiske symptomer og lidelser. I nettverksforståelsen av psykiske lidelser antas det derimot at de observerbare trekkene, det vil si symptomene, samvirker gjennom kausale mekanismer. Målet med artikkelen er å sammenligne kliniske konsekvenser av terapi som bygger på forklaringstypene essens- og nettverksteori, i behandling av emosjonelle lidelser. Vi beskriver nettverksperspektivet, og illustrerer forskjellene mellom nettverksperspektivet og essensperspektivet i utredning og terapiforløp for et tenkt kasus (Live). Deretter drøfter vi kliniske konsekvenser for problemarbeidet og samarbeidet. Vår drøfting og analyse synliggjør at nettverksperspektivet, og ikke essensmodeller, fungerer induktivt og eksplorerende i valget av terapiteori. Dermed unngår en at terapeutens teori blir gjort til autoritet over pasientens opplevelse. Nettverksperspektivet medfører at klinikeren har et vedvarende søkelys på symptomene og pasientens egen opplevelse av tilstanden. Intervensjonene vil da være mer i samsvar med pasientens egne forklaringer, noe som vil fremme alliansen. Gjennom et eksempel viser vi at essensteorier kan omformuleres til nettverksteorier uten at teoriinnholdet forringes. På bakgrunn av vår analyse anbefaler vi at psykoterapifeltet samler seg om å utvikle nettverksperspektivet. Nøkkelord: psykoterapi, essenser, nettverk, kliniske konsekvenser

• Gjengedal, Ragne Gunnarsdatter Hole; Hannisdal, Marit; Osnes, Kåre; Reme, Silje Endresen; Wells, Adrian & Blonk, Roland [Show all 18 contributors for this article] (2025). Metacognitive therapy and work-focus for patients with depression, anxiety or comorbid depression and anxiety on sick leave: a single-centre, open-label randomised controlled trial. EClinicalMedicine. 89, p. 103613–103613. doi: 10.1016/j.eclinm.2025.103613. Full text in Research Archive
• Halsøy, Øyvind; Ebrahimi, Omid Vakili; Johnson, Sverre Urnes; Hoffart, Asle; Moreira, Hugo Cogo & Fjermestad, Krister Westlye (2025). Depressive Symptoms in Individuals With Chronic Conditions During the Covid-19 Pandemic: A 2-Year Longitudinal Study. Stress and Health. ISSN 1532-3005. 41(4). doi: 10.1002/smi.70082. Full text in Research Archive
• Lu, Li; Wang, Yue; Ebrahimi, Omid V.; Shen, Qing; Unnarsdóttir, Anna Bára & Hauksdóttir, Arna [Show all 18 contributors for this article] (2025). Long-term psychological effects of COVID-19-related quarantine: an observational study of three cohorts in Norway and Iceland. BMC Medicine. 23. doi: 10.1186/s12916-025-04349-8. Full text in Research Archive Show summary

  Abstract Background Longitudinal assessments of psychological effects related to length and recency of quarantine experience in general populations are of importance. We aim to investigate if recency and duration of quarantine exposures during the COVID-19 pandemic were associated with mental health, across subgroups. Methods We included three prospective cohorts from Iceland and Norway with data on quarantine and symptoms of depression and anxiety from March 2020 to March 2022. We calculated prevalence ratios (PR) of probable depression and anxiety in relation to quarantine exposure, and performed longitudinal analyses in a subpopulation with repeated assessments to test the potential change in mental health burden due to quarantine over time while controlling for current quarantine status and other covariates. Results In total, 105,344 and 94,435 individuals were included in the analysis of probable depression and anxiety, respectively, with 18.2% and 40.0% reporting quarantine exposure before the most recent assessment of corresponding mental health symptoms. Overall, quarantine exposure was associated with probable depression (PR 1.19 [95% CI: 0.99–1.42]) and anxiety (PR 1.21 [1.08–1.36]). Compared to individuals without quarantine, being exposed to quarantine for 0–2, 2–4, or > 4 weeks was associated with incrementally higher prevalence of probable depression (PR 1.15 [0.93–1.43]; 1.34 [1.06–1.68]; 1.72 [1.35–2.18], respectively) and probable anxiety (PR 1.12 [1.01–1.23]; 1.28 [1.14–1.45]; 1.76 [1.56–1.98]) in a step-wise manner; those who were quarantined within the last 2 weeks, last 2–4 weeks, or earlier showed a higher prevalence of probable depression in a dose–response manner (PR 1.62 [1.32–1.99], 1.32 [1.07–1.63], and 1.23 [1.06–1.43], respectively). The prevalence of probable anxiety did not appear to differ by the recency of quarantine. The longitudinal analyses (mean follow-up: 20.5 months) confirmed significantly higher prevalence of probable depression but only among those who were quarantined for > 4 weeks (PR 1.61 [1.30–2.00]), and of probable anxiety among those quarantined 2–4 weeks (PR 1.29 [1.14–1.45]) and > 4 weeks (PR 1.56 [1.34–1.82]). Conclusions This study underscores the importance of monitoring mental well-being of populations recently quarantined, particularly those quarantined for prolonged periods. Greater emphasis should be placed on the detrimental psychological effects in the risk-cost–benefit analysis of quarantine as a mitigation strategy in future pandemics.

• Du, Xinkai; Ebrahimi, Omid V.; Hoffart, Asle; Birkeland, Marianne Skogbrott; Skogen, Jens Christoffer & Smith, Otto Robert Frans [Show all 7 contributors for this article] (2025). The acceptability and usefulness of ambulatory assessment: A large-scale investigation of a daily diary study with 2,816 adults. Psychological Assessment. ISSN 1040-3590. 37(12), p. 719–719. doi: 10.1037/pas0001405. Full text in Research Archive Show summary

  Despite the popularity of ambulatory assessment (AA), few studies have investigated how participants experience and perceive their participation, including the burdensomeness and utility of AA. This is important, as participants’ experience in the measurement process can directly impact participants’ well-being and data quality. In a 40-day diary study involving 2,816 individuals, participants reported their experience of the measurement process (acceptability) with six self-report items. We further investigated the demographic difference in acceptability using seemingly unrelated regression and logistic regression. We explored how compliance was related to acceptability and participant demographics with Poisson regression. Most participants found daily diary assessments to be beneficial in general (74.7%), specifically, for their self-understanding (60.0%) and self-reflection and experience sharing (68.5%). Most participants expressed willingness to participate in similar research again (83.9%). A minority of participants (11.7%) reported they felt participation worsened their problems, while twice as many (21.7%) participants reported that participation helped alleviate their mental health problems. Demographic predictors were predominantly insignificant, reflecting that the high acceptability of daily diary assessments was relatively stable across different populations. Adults across different subgroups predominantly found their participation in daily diary research to be beneficial for their mental health, with the majority of adults expressing reparticipation interest. One in five participants experienced an improvement in their psychiatric symptoms related to participation, while a minority of individuals expressed mental deterioration, presenting a critical avenue for future research to identify the characteristics of individuals who are more or less likely to benefit from AA research.

• Snuggerud, Therese Ruud; Nordahl, Henrik; Vrabel, KariAnne; Hoffart, Asle & Johnson, Sverre Urnes (2025). The feasibility and preliminary outcomes of a two-week attention training technique intervention for young adults with mixed anxiety disorders. Cognitive Behaviour Therapy. ISSN 1650-6073. 55(3), p. 372–390. doi: 10.1080/16506073.2025.2509168. Full text in Research Archive
• Ebrahimi, Omid Vakili; Sandbakken, Ella Marie; Moss, Sigrun Marie; Johnson, Sverre Urnes; Hoffart, Asle & Bauermeister, Sarah [Show all 9 contributors for this article] (2025). Modifiable risk factors of vaccine hesitancy: insights from a mixed methods multiple population study combining machine learning and thematic analysis during the COVID-19 pandemic. BMC Medicine. 23(1). doi: 10.1186/s12916-025-03953-y. Full text in Research Archive Show summary

  Background Vaccine hesitancy, the delay in acceptance or reluctance to vaccinate, ranks among the top threats to global health. Identifying modifiable factors contributing to vaccine hesitancy is crucial for developing targeted interventions to increase vaccination uptake. Methods This mixed-methods multiple population study utilized gradient boosting machines and thematic analysis to identify modifiable predictors of vaccine hesitancy during the COVID-19 pandemic. Predictors of vaccine hesitancy were investigated in 2926 Norwegian adults (Mage = 37.91, 79.69% female), before the predictive utility of these variables was investigated in an independent sample of 734 adults in the UK (Mage = 40.34, 57.08% female). Two independent teams of authors conducted the machine learning and thematic analyses, blind to each other’s analytic procedures and results. Results The machine learning model performed well in discerning vaccine hesitant (n = 248, 8.48% and n = 109, 14.85%, Norway and UK, respectively) from vaccine uptaking individuals (n = 2678, 91.52% and n = 625, 85.15%), achieving an AUC of 0.94 (AUPRC: 0.72; balanced accuracy: 86%; sensitivity = 0.81; specificity = 0.98) in the Norwegian sample, and an AUC of 0.98 (AUPRC: 0.89; balanced accuracy: 89%; sensitivity = 0.83; specificity = 0.97) in the out-of-sample replication in the UK. The mixed methods investigation identified five categories of modifiable risk tied to vaccine hesitancy, including illusion of invulnerability, doubts about vaccine efficacy, mistrust in official entities, minimization of the societal impact of COVID-19, and health-related fears tied to vaccination. The portrayal of rare incidents across alternative media platforms as fear amplifiers, and the mainstream media’s stigmatizing presentation of unvaccinated individuals, were provided as additional motives underlying vaccine reluctance and polarization. The thematic analysis further revealed information overload, fear of needles, previous negative vaccination experiences, fear of not getting healthcare follow-up after vaccination if needed, and vaccine aversion due to underlying (psychiatric) illness (e.g., eating disorders) as motives underlying vaccine hesitance. Conclusions The identified influential predictors were consistent across two European samples, highlighting their generalizability across European populations. These predictors offer insights about modifiable factors that could be adapted by public health campaigns in mitigating misconceptions and fears related to vaccination toward increasing vaccine uptake. Moreover, the results highlight the media’s responsibility, as mediators of the public perception of vaccines, to minimize polarization and provide accurate portrayals of rare vaccine-related incidents, reducing the risk aggravating fear and reactance to vaccination.

• Tilden, Terje; Tilden, Solveig; Bæverfjord, Johanne Elise Bakke; Dammeyer, Jesper; Johnson, Sverre Urnes & Whittaker, Kristoffer James (2025). The Interplay Between Relationship Dissatisfaction and Individual Symptoms: Insights From Dyadic Analyses. Journal of Marital & Family Therapy. ISSN 0194-472X. 51(3). doi: 10.1111/jmft.70039. Full text in Research Archive
• Hoffart, Asle; Skjerdingstad, Nora Paulsen; Freichel, René; Johnson, Sverre Urnes; Epskamp, Sacha & Ebrahimi, Omid Vakili (2025). Mapping the Dynamics of Generalized Anxiety Symptoms and Actionable Transdiagnostic Mechanisms: A Panel Study. Depression and Anxiety. ISSN 1091-4269. 2025(1). doi: 10.1155/da/1885004. Full text in Research Archive
• Finnemann, Adam; Skjerdingstad, Nora; Speyer, Lydia G.; Zavlis, Orestis; Bartoš, František & Wiers, Reinout [Show all 12 contributors for this article] (2025). Urban-rural differences in anxiety and depression in the UK, New Zealand, and Norway. Journal of Affective Disorders. ISSN 0165-0327. 388. doi: 10.1016/j.jad.2025.119601. Full text in Research Archive
• Nordahl, Johanne; Nordahl, Henrik; Johnson, Sverre Urnes & Hjemdal, Odin (2025). Psychometric properties of the Metacognitions Questionnaire–30 in patients with posttraumatic stress disorder. Psychological Trauma. ISSN 1942-9681. doi: 10.1037/tra0001916. Full text in Research Archive
• Hoffart, Asle; Helmich, Marieke A.; Vrabel, KariAnne; Ebrahimi, Omid Vakili & Johnson, Sverre Urnes (2025). From a latent variable to a complex dynamic system conceptualization of the therapeutic alliance. Journal of psychotherapy integration. ISSN 1053-0479. doi: 10.1037/int0000357. Full text in Research Archive Show summary

  The aim of this study was to develop a complex dynamic system (CDS) model of the therapeutic alliance and compare it to the currently dominant latent state–trait (LST) model. A clinical example of a state of alliance rupture and repair is analyzed in terms of a LST model and a CDS model. Then, the implications of these two models in their application to clinical research and practice are compared. Adopting a CDS perspective offers significant advantages over the LST approach. Specifically, it provides stronger clinical face validity, aligns with Bordin’s (1979) conceptualization of the alliance, accounts for the interaction of state and trait alliance, and assures conceptual independence between causal entities. By examining the interactions among observable reactions, the coordination of these reactions into patterns that form alliance states, and how iterative state changes reshape the trait alliance landscape of attractor states, the CDS perspective offers actionable clinical recommendations across all three levels. However, CDS and LST hybrid theories are possible and may have merit. The CDS perspective provides a holistic approach that requires a specification of all influential components of the target system—the disorder addressed—and of the therapy system—the extended system of therapeutic components. It leads to a research program for developing models of therapeutic systems case by case using qualitative and quantitative methods. It also provides precise tests of complete models, including comparison of mathematically derived simulations to real-world data and empirical testing by newly developed network analytic methods.

• Harpviken, Anna Naterstad; Jensen, Tine; Johnson, Sverre Urnes; Ormhaug, Silje Mørup & Birkeland, Marianne Skogbrott (2025). Assessing change and persistence of specific post-traumatic stress symptoms among youth in trauma treatment. European Journal of Psychotraumatology. doi: 10.1080/20008066.2025.2515683. Full text in Research Archive
• Barker, Mary M.; Kõiv, Kadri; Magnúsdóttir, Ingibjörg; Milbourn, Hannah; Wang, Bin & Du, Xinkai [Show all 35 contributors for this article] (2024). Mental illness and COVID-19 vaccination: a multinational investigation of observational & register-based data. Nature Communications. 15(1). doi: 10.1038/s41467-024-52342-1. Full text in Research Archive Show summary

  Individuals with mental illness are at higher risk of severe COVID-19 outcomes. However, previous studies on the uptake of COVID-19 vaccination in this population have reported conflicting results. Using data from seven cohort studies (N = 325,298) included in the multinational COVIDMENT consortium, and the Swedish registers (N = 8,080,234), this study investigates the association between mental illness (defined using self-report measures, clinical diagnosis and prescription data) and COVID-19 vaccination uptake. Results from the COVIDMENT cohort studies were pooled using meta-analyses, the majority of which showed no significant association between mental illness and vaccination uptake. In the Swedish register study population, we observed a very small reduction in the uptake of both the first and second dose of a COVID-19 vaccine among individuals with vs. without mental illness; the reduction was however greater among those not using psychiatric medication. Here we show that uptake of the COVID-19 vaccine is generally high among individuals both with and without mental illness, however the lower levels of vaccination uptake observed among subgroups of individuals with unmedicated mental illness warrants further attention.

• Nordahl, Johanne; Hjemdal, Odin; Johnson, Sverre Urnes & Nordahl, Hans Morten (2024). Metacognitive Therapy Versus Exposure-Based Treatments of Posttraumatic Stress Disorder: A Preliminary Comparative Trial in an Ordinary Clinical Practice. International Journal of Cognitive Therapy. ISSN 1937-1209. 17, p. 685–699. doi: 10.1007/s41811-024-00217-0. Full text in Research Archive Show summary

  Cognitive behavioral therapy, prolonged exposure, and eye movement desensitization and reprocessing are effective treatments for posttraumatic stress disorder (PTSD). They emphasize the processing of trauma-related memories and exposure as central components in treatment. In contrast, the metacognitive model emphasizes that PTSD is caused by a persistent negative thinking style, and the goal is to find alternative coping strategies and modify metacognitive beliefs without the use of exposure. In a quasi-experimental A-B design, patients diagnosed with PTSD received either MCT (n = 32) or TAU “treatment as usual” (n = 28) consisting of exposure-based treatments and were tested on different measures of symptoms. The results indicated that both treatments were effective and performed well on both trauma and anxiety symptoms. Recovery rates and clinical improvement were higher in the MCT condition at post-treatment. The study indicates that MCT could potentially be a viable alternative to trauma-focused treatment

• Nordahl, Johanne; Johnson, Sverre Urnes & Hjemdal, Odin (2024). Cognitions and Metacognitive Beliefs in Posttraumatic Stress Disorder. Clinical Psychology and Psychotherapy. ISSN 1063-3995. 31(4). doi: 10.1002/cpp.3031. Full text in Research Archive Show summary

  Objective - There has been an increasing interest in understanding what contributes to the development and what maintains posttraumatic stress disorder (PTSD). The cognitive model emphasizes that it is a disturbance of the autobiographical memory for the trauma, cognitive beliefs and maladaptive behaviour that maintain trauma symptoms. Interventions are based on cognitive restructuring and behaviour experiments to modify these beliefs. In contrast, the metacognitive model emphasizes that it is the metacognitive beliefs that give rise to the cognitive attentional syndrome (CAS) that maintain trauma symptoms. The focus of treatment is reducing CAS and working on metacognitive beliefs. The aim of this study was to explore the contribution of cognitions and metacognitive beliefs to trauma symptoms and investigate what predicts symptom burden in traumatized patients. Method - Participants (N = 290) diagnosed with PTSD were included, and hierarchical multiple regression analyses were performed to explore if cognitions and metacognitive beliefs explained additional and independent variance in trauma symptoms while controlling for age and gender. Results - Both cognitions and metacognitive beliefs contributed independently and significantly to predicting trauma symptoms. Conclusion - The results provide further support for investigating what maintains trauma symptoms and what to target in treatment. This may have clinical implications for our theoretical and practical understanding of PTSD.

• Kopland, Maren Gunnulfsen; Vrabel, KariAnne; Landt, Margarita Slof-Op 't; Hoffart, Asle; Johnson, Sverre Urnes & Giltay, Erik J. (2024). Network dynamics of self-compassion, anxiety, and depression during eating disorder therapy. European Eating Disorders Review. ISSN 1072-4133. p. 1–18. doi: 10.1002/erv.3121. Full text in Research Archive
• Bakali, Jan Vegard; Solbakken, Ole Andre; Hoffart, Asle; Brækhus, Hege; Kvarstein, Elfrida Hartveit & Johnson, Sverre Urnes (2024). Affect integration, metacognitions, and early maladaptive schemas as predictors of outcome in cognitive and metacognitive therapies for social anxiety disorder. Psychotherapy Research. ISSN 1050-3307. 35(7), p. 1149–1161. doi: 10.1080/10503307.2024.2443499. Full text in Research Archive Show summary

  Objective Few reliable patient characteristics have emerged as significant predictors of outcomes for Social Anxiety Disorder (SAD). This study aimed to explore whether affect integration, metacognitions, and maladaptive schemas could serve as predictors of therapeutic outcomes for patients with SAD. Relationships between these psychological constructs and baseline SAD symptomatology were also examined. Methods Eighty-eight patients across three sites participated in Cognitive Behavioral Therapy (CBT) or Metacognitive Therapy (MCT) for SAD in inpatient or outpatient clinics. Measures of predictors and SAD symptomatology were repeatedly assessed. Statistical analyses included longitudinal, multilevel modeling. Results Difficulties with affect integration, metacognitions and early maladaptive schemas clearly related to higher levels of SAD symptoms at baseline but were not generally predictive of changes in SAD symptoms during therapy. However, examining sub-domains revealed that difficulties with the integration of jealousy and tenderness, and the maladaptive schema of defectiveness/shame, predicted poorer outcomes. In contrast, initial difficulties with the integration of sadness, a greater lack of cognitive confidence, and the maladaptive schema of dependence/incompetence were associated with greater symptom improvement. Conclusion Identifying issues of affect integration and core self-other beliefs prior to therapy may enhance patient selection and allow for a more individualized treatment.

• Johnson, Sverre Urnes; Hagen, Roger; Dammen, Toril & Papageorgiou, Constantinos (2024). Videoconference-delivered metacognitive therapy for anxiety and depression in post-COVID-19 syndrome: A baseline-controlled single-arm pilot trial. General Hospital Psychiatry. ISSN 0163-8343. 88, p. 77–78. doi: 10.1016/j.genhosppsych.2024.02.003. Full text in Research Archive
• Ebrahimi, Omid V.; Freichel, René; Johnson, Sverre Urnes; Hoffart, Asle; Solbakken, Ole Andre & Bauer, Daniel J. (2024). Depressive Symptom Change Patterns during the COVID-19 Pandemic and Their Impact on Psychiatric Treatment Seeking: A 24-Month Observational Study of the Adult Population. Depression and Anxiety. ISSN 1091-4269. 2024. doi: 10.1155/2024/1272738. Full text in Research Archive
• Nordbø, Sara Ebling; Johnson, Sverre Urnes; Hoffart, Asle; Pallesen, Ståle & Ebrahimi, Omid Vakili (2024). The dynamic relationships between well-being, behavioral restrictions, and health behaviors during the COVID-19 pandemic: A large-scale intensive longitudinal network study. Applied Psychology: Health and Well-Being. ISSN 1758-0846. 16(4), p. 1801–1818. doi: 10.1111/aphw.12555. Full text in Research Archive Show summary

  The behavioral restrictions disrupting daily life during the COVID-19 pandemic have profoundly impacted well-being, and health behaviors have been advocated to prevent decline. To understand how processes related to fluctuation in well-being unfold within individuals, analyses on the within-person level are required. In this preregistered intensive longitudinal study, 1,709 individuals from the Norwegian adult population provided data daily over 40 consecutive days during the pandemic. The responses were modeled in a multilevel vector autoregressive model to estimate within-person networks, across and within-day, and a between-person network. All three networks revealed productivity, relatedness, and optimism as positively associated. Social distancing was contemporaneously negatively associated with productivity and relatedness. Among behavioral factors, being physically active predicted lower relatedness across days but displayed positive associations with relatedness, productivity, and optimism contemporaneously. Alcohol consumption predicted lower productivity across and within-day, although revealing a positive association with optimism within-day. Being social online and feeling related to others displayed a temporal negative bidirectional relationship. In contrast, being social online was positively associated with optimism, productivity, and relatedness contemporaneously. Our study emphasizes the dynamic nature of well-being and its complex associations with behavioral factors during the pandemic. The study shed light on opposing associations of behavioral factors at the within- and between-person level.

• Johnson, Miriam Sinkerud; Skjerdingstad, Nora Paulsen; Ebrahimi, Omid Vakili; Hoffart, Asle & Johnson, Sverre Urnes (2024). Fear of giving birth alone: Experiences of psychological distress, symptoms of anxiety and depression, and coping- strategies of childbearing women during COVID-19. Midwifery. ISSN 0266-6138. 131. doi: 10.1016/j.midw.2024.103951. Full text in Research Archive
• Hammersmark, Ane T; Hjemdal, Odin; Hannisdal, Marit; Lending, Hilde D.; Reme, Silje Endresen & Hodne, Kjetil [Show all 9 contributors for this article] (2023). Metacognitive therapy for generalized anxiety disorders in group: A case study. Journal of Clinical Psychology. ISSN 0021-9762. p. 1–16. doi: 10.1002/jclp.23615. Full text in Research Archive Show summary

  Objectives In Metacognitive therapy (MCT), homework is used, for example, to increase awareness of thoughts and thought processes, to challenge metacognitive beliefs in real-life situations, and to practice new ways of processing thoughts, feelings, and symptoms. All MCT treatment manuals include homework assignments to be given between each session. Method The following study provides a detailed description of the implementation of homework in a group-based MCT treatment for generalized anxiety disorder (GAD) at an outpatient clinic in Norway. The treatment described in this case consisted of 10 weekly group sessions (7 patients) lasting two hours. Results This case study demonstrates that group-based MCT can be used to treat GAD and describes how the use of homework can facilitate therapeutic change. Conclusion Overall, the effectiveness of MCT was found to be high. Homework gives patients the opportunity to take charge of their therapy and develop a sense of responsibility for their own progress, both during and after treatment.

• Memon, Amina; Hunt, Ashley; Thelwall, Ellamay; Hardwick, Nick & Johnson, Sverre Urnes (2023). The mental health of staff working in UK prisons during the Covid-19 pandemic. The Howard Journal of Crime and Justice. ISSN 2059-1098. doi: 10.1111/hojo.12522. Full text in Research Archive Show summary

  Abstract This article presents the results of an opportunistic, cross‐sectional, self‐report survey of the well‐being of staff working in prisons throughout the UK. The survey was completed by 594 participants in the early part of 2021 at the height of the Covid‐19 pandemic. Self‐report measures indicated concerning levels of burnout and 43.4% of participants were above the established cut‐offs on the Generalised Anxiety Disorder (GAD‐7) scale. Eighty‐one per cent reported that their mental and physical health had deteriorated and many said emotional support was lacking. Further research is required to establish how typical and persistent these concerns are.

• Vrabel, KariAnne; Johnson, Sverre Urnes; Ebrahimi, Omid Vakili & Hoffart, Asle (2023). Anxiety and depressive symptoms among migrants during the COVID-19 pandemic in Norway: A two-wave longitudinal study. Psychiatry Research Communications. 3(2), p. 1–9. doi: 10.1016/j.psycom.2023.100115. Full text in Research Archive Show summary

  This study was designed to examine the impact of the COVID-19 pandemic on the mental health of migrants living in Norway. We conducted a longitudinal two-waves survey among a sample of 574 migrants and multilevel modelling was used to analyse anxiety, health anxiety and depressive symptoms. Demographic and psychological predictors were investigated. The levels of anxiety, health anxiety and depressive symptoms among migrants decreased from the lockdown (strict social distancing protocols) to phaseout. Reductions in maladaptive coping strategies were related to parallel reductions in anxiety, health anxiety, and depression, and a reduction in loneliness was related to a reduction in depression. The results indicate that the elevated levels of anxiety, health anxiety and depressive symptoms among migrants in the first phase of the pandemic may be temporary.

• Lovik, Anikó; González-Hijón, Juan; Hoffart, Asle; Fawns-Ritchie, Chloe; Magnúsdóttir, Ingibjörg & Lu, Li [Show all 27 contributors for this article] (2023). Elevated symptoms of depression and anxiety among family members and friends of critically ill COVID-19 patients – an observational study of five cohorts across four countries. The Lancet Regional Health - Europe. 33. doi: 10.1016/j.lanepe.2023.100733. Full text in Research Archive Show summary

  Background Little is known regarding the mental health impact of having a significant person (family member and/or close friend) with COVID-19 of different severity. Methods The study included five prospective cohorts from four countries (Iceland, Norway, Sweden, and the UK) with self-reported data on COVID-19 and symptoms of depression and anxiety during March 2020–March 2022. We calculated prevalence ratios (PR) of depression and anxiety in relation to having a significant person with COVID-19 and performed a longitudinal analysis in the Swedish cohort to describe temporal patterns. Findings 162,237 and 168,783 individuals were included in the analysis of depression and anxiety, respectively, of whom 24,718 and 27,003 reported a significant person with COVID-19. Overall, the PR was 1.07 (95% CI: 1.05–1.10) for depression and 1.08 (95% CI: 1.03–1.13) for anxiety in relation to having a significant person with COVID-19. The respective PRs for depression and anxiety were 1.15 (95% CI: 1.08–1.23) and 1.24 (95% CI: 1.14–1.34) if the patient was hospitalized, 1.42 (95% CI: 1.27–1.57) and 1.45 (95% CI: 1.31–1.60) if the patient was ICU-admitted, and 1.34 (95% CI: 1.22–1.46) and 1.36 (95% CI: 1.22–1.51) if the patient died. Individuals with a significant person with hospitalized, ICU-admitted, or fatal COVID-19 showed elevated prevalence of depression and anxiety during the entire year after the COVID-19 diagnosis. Interpretation Family members and close friends of critically ill COVID-19 patients show persistently elevated prevalence of depressive and anxiety symptoms.

• Johnson, Miriam Sinkerud; Skjerdingstad, Nora Paulsen; Hoffart, Asle; Ebrahimi, Omid Vakili & Johnson, Sverre Urnes (2023). Triggered by worry: A dynamic network analysis of COVID-19 pandemic-related anxiety and parental stress. Journal of Affective Disorders. ISSN 0165-0327. 346, p. 329–337. doi: 10.1016/j.jad.2023.10.127. Full text in Research Archive Show summary

  Background: Major disruptions to daily life routines made families and parents particularly vulnerable to psy- chological distress during the COVID-19 lockdowns. However, the specific psychopathological processes related to within-person variation and maintenance of anxiety symptomatology and parental distress components in the parental population have been largely unexplored in the literature. Methods: In this preregistered intensive longitudinal study, a multilevel dynamic network was used to model within-person interactions between anxiety symptomatology, psychopathological processes, parental distress, and protective lifestyle components in a sample of 495 parents—each responding to daily assessments over a 40-day period. A total of 30,195 observa- tions were collected across the subjects. Results: Extensive worry, threat monitoring, and uncontrollability of worry were identified as overreaching psychopathological processes related to the aggravation of other symptoms of anxiety and parental distress. A strong association was found between parental stress and parental burnout. Anger toward one's child was associated with both parental stress and parental burnout. Protective factors showed the lowest strength cen- trality, with few and weak connections to other symptoms and processes in the network. Limitations: Associations may exist between the study variables on a different time scale; hence, different time lags should be used in future research. Conclusions: Accessible, low-cost interventions that address worry, threat monitoring, and the uncontrollability of worry could serve as potential targets for reducing the symptom burden of anxiety and distress in the parental population.

• Kopland, Maren Cecilie Gunnulfsen; Vrabel, KariAnne; Landt, Margarita Slof-Op ‘t; Hoffart, Asle; Johnson, Sverre Urnes & Giltay, Erik J. (2023). Breaking the cycle: Identifying key symptom pathways of eating disorders and the influence of childhood maltreatment. International Journal of Eating Disorders. ISSN 0276-3478. p. 1–11. doi: 10.1002/eat.24097. Full text in Research Archive Show summary

  Abstract Background Most network analyses on central symptoms in eating disorders (EDs) have been cross‐sectional. Longitudinal within‐person analyses of therapy processes are scarce. Our aim was to investigate central change processes in therapy in a transdiagnostic sample, considering the influence of childhood maltreatment. Method We employed dynamic time warping analyses to identify clusters of symptoms that tended to change similarly across therapy on a within‐person level. Symptoms were measured by a 28‐item Eating Disorder Examination Questionnaire (EDE‐Q). Furthermore, we examined the temporal direction of symptom change to identify symptoms that tended to precede and predict other symptoms. Finally, we estimated two directed, temporal networks in patients with and without a history of childhood maltreatment. Results Our analysis included 122 ED patients (mean age = 30.9, SD  = 9.7; illness duration = 14.2 years, SD  = 8.9; prior treatment = 5.6 years, SD  = 5.1). The initial network revealed three robust clusters of symptoms over time: (1) ED behavior, (2) inhibition, and (3) cognitions and feelings about body and weight. Overvaluation of shape had the highest out‐strength preceding and predicting other symptoms. Dissatisfaction with weight preceded and predicted other symptoms in the maltreatment network. The non‐maltreatment network showed a similar structure to the transdiagnostic network. Conclusion Targeting and monitoring feelings and cognitions related to shape may be crucial for achieving lasting symptom improvement in a transdiagnostic sample. Furthermore, our findings highlight the need for further investigation into the different processes driving EDs based on maltreatment status. Public significance There is limited understanding of the processes that occur for patients with eating disorders between admission and discharge in therapy, especially for patients with a history of childhood maltreatment. Our analyses suggest that changes in cognitions regarding shape precede and predict changes in cognitions about weight. Different processes may be driving the eating disorder according to maltreatment status, which might further illuminate the riddle of dropout and relapse in therapy for patients with a history of childhood maltreatment. These findings suggest the need for further investigation into the specific dynamics occurring during therapy for individuals with a history of childhood maltreatment.

• Shen, Qing; Joyce, Emily E.; Ebrahimi, Omid Vakili; Didriksen, Maria; Lovik, Anikó & Sævarsdóttir, Karen Sól [Show all 32 contributors for this article] (2023). COVID-19 illness severity and 2-year prevalence of physical symptoms: an observational study in Iceland, Sweden, Norway and Denmark. The Lancet Regional Health - Europe. 35. doi: 10.1016/j.lanepe.2023.100756. Full text in Research Archive Show summary

  Background Although the persistence of physical symptoms after SARS-CoV-2 infection is a major public health concern, evidence from large observational studies beyond one year post diagnosis remain scarce. We aimed to assess the prevalence of physical symptoms in relation to acute illness severity up to more than 2-years after diagnosis of COVID-19. Methods This multinational study included 64,880 adult participants from Iceland, Sweden, Denmark, and Norway with self-reported data on COVID-19 and physical symptoms from April 2020 to August 2022. We compared the prevalence of 15 physical symptoms, measured by the Patient Health Questionnaire (PHQ-15), among individuals with or without a confirmed COVID-19 diagnosis, by acute illness severity, and by time since diagnosis. We additionally assessed the change in symptoms in a subset of Swedish adults with repeated measures, before and after COVID-19 diagnosis. Findings During up to 27 months of follow-up, 34.5% participants (22,382/64,880) were diagnosed with COVID-19. Individuals who were diagnosed with COVID-19, compared to those not diagnosed, had an overall 37% higher prevalence of severe physical symptom burden (PHQ-15 score ≥15, adjusted prevalence ratio [PR] 1.37 [95% confidence interval [CI] 1.23–1.52]). The prevalence was associated with acute COVID-19 severity: individuals bedridden for seven days or longer presented with the highest prevalence (PR 2.25 [1.85–2.74]), while individuals never bedridden presented with similar prevalence as individuals not diagnosed with COVID-19 (PR 0.92 [0.68–1.24]). The prevalence was statistically significantly elevated among individuals diagnosed with COVID-19 for eight of the fifteen measured symptoms: shortness of breath, chest pain, dizziness, heart racing, headaches, low energy/fatigue, trouble sleeping, and back pain. The analysis of repeated measurements rendered similar results as the main analysis. Interpretation These data suggest an elevated prevalence of some, but not all, physical symptoms during up to more than 2 years after diagnosis of COVID-19, particularly among individuals suffering a severe acute illness, highlighting the importance of continued monitoring and alleviation of these targeted core symptoms.

• Hoffart, Asle; Skjerdingstad, Nora Paulsen; Freichel, René; Mansueto, Alessandra C.; Johnson, Sverre Urnes & Ebrahimi, Omid Vakili (2023). Depressive Symptoms and Their Mechanisms: An Investigation of Long-Term Patterns of Interaction Through a Panel-Network Approach. Clinical Psychological Science. ISSN 2167-7026. doi: 10.1177/21677026231208172. Full text in Research Archive
• Freichel, René; Skjerdingstad, Nora Paulsen; Mansueto, Alessandra C.; Epskamp, Sacha; Hoffart, Asle & Johnson, Sverre Urnes [Show all 7 contributors for this article] (2023). Use of Substances to Cope Predicts Posttraumatic Stress Disorder Symptom Persistence: Investigating Patterns of Interactions Between Symptoms and Its Maintaining Mechanisms. Psychological Trauma. ISSN 1942-9681. p. 1–10. doi: 10.1037/tra0001624. Full text in Research Archive
• Kopland, Maren C. G.; Vrabel, KariAnne; Melsom, Linne; Hoffart, Asle & Johnson, Sverre Urnes (2023). Self-compassion in eating disorders and childhood trauma: A study of within-person effects in a randomized controlled trial. Psychotherapy Research. ISSN 1050-3307. doi: 10.1080/10503307.2022.2149363. Full text in Research Archive Show summary

  Background Patients with eating disorders and childhood trauma have clinical presentations that make them less suitable for standard eating disorder treatment. This might be due to high levels of shame and self-criticism. Self-compassion can be a mechanism of change, especially for patients with eating disorders and childhood trauma. Method A total of 130 patients with or without childhood trauma were admitted to 13 weeks of inpatient treatment and randomized to either compassion-focused therapy or cognitive–behavioral therapy. Self-compassion and eating disorder symptoms were measured every week. The data were analyzed for within-person effects using multilevel modeling. Results We did not find a within-person effect of self-compassion on eating disorder symptoms. Rather, the analysis indicated that eating disorder symptoms predict self-compassion in the overall sample. However, we found a stronger within-person relationship between self-compassion and eating disorder symptoms in patients with trauma receiving compassion-focused therapy compared to the remaining patients in the study. Conclusion Overall, eating disorder symptoms predicted subsequent self-compassion at a within-person level. Patients with trauma in compassion-focused therapy demonstrated a stronger relationship between self-compassion and eating disorder symptoms. More studies with a cross-lagged design are needed to further illuminate self-compassion as a mechanism of change for these patients.

• Yang, Lisbeth Xin-Yi; Vrabel, KariAnne; Rø, Øyvind & Johnson, Sverre Urnes (2023). Kognitiv atferdsterapi for spiseforstyrrelser (CBT-E) – en poliklinisk behandlingsstudie. Tidsskrift for Norsk psykologforening (Psykologtidsskriftet). ISSN 0332-6470. 60(11), p. 696–696. doi: 10.52734/TDCK5656. Full text in Research Archive Show summary

  Background: Few studies have evaluated the effectiveness of enhanced cognitive behaviour therapy (CBT-E) in clinical settings with a transdiagnostic patient population. The current study aimed to evaluate the effectiveness of CBT-E in a specialised outpatient eating disorder clinic in southeastern Norway. Method: The study involved a transdiagnostic sample of 96 patients (age 30.7 (SD = 9.4), 92.7% women) with longstanding eating disorders and previous failed treatment attempts. We used multilevel modelling to examine change in eating disorder pathology from pre-treatment (T1) to post-treatment (T2) and follow-up 25 weeks later (T3). A total of 57 patients had sufficient data at T2 and 35 patients at T3. Results: We found statistically significant reductions in eating disorder pathology from pre- to post-treatment. Of those who completed treatment, 49.1% met criteria for remission at post-treatment. These changes were stable at follow-up. Implications: CBT-E may lead to reductions in eating disorder pathology and should be considered an acceptable form of treatment for adult patients with eating disorders. Keywords: anorexia nervosa, binge eating disorder, bulimia nervosa, cognitive behaviour therapy, eating disorders, effectiveness

• Hoffart, Asle; Burger, Julian; Johnson, Sverre Urnes & Ebrahimi, Omid Vakili (2022). Daily dynamics and mechanisms of anxious symptomatology in the general population: A network study during the COVID-19 pandemic. Journal of Anxiety Disorders. ISSN 0887-6185. doi: 10.1016/j.janxdis.2022.102658. Full text in Research Archive
• Nordbø, Sara Ebling; Ebrahimi, Omid Vakili; Johnson, Sverre Urnes; Skjerdingstad, Nora & Hoffart, Asle (2022). Psychological well-being in times of COVID-19: Associated factors and levels in the general population. Frontiers in Public Health. 10:86086, p. 1–12. doi: 10.3389/fpubh.2022.860863. Full text in Research Archive Show summary

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

• Nordahl, Henrik; Ebrahimi, Omid V.; Hoffart, Asle & Johnson, Sverre Urnes (2022). Trait Versus State Predictors of Emotional Distress Symptoms: The Role of the Big-5 Personality Traits, Metacognitive Beliefs, and Strategies. Journal of Nervous and Mental Disease. ISSN 0022-3018. 210(12), p. 943–950. doi: 10.1097/NMD.0000000000001557. Full text in Research Archive Show summary

  To enhance formulation and interventions for emotional distress symptoms, research should aim to identify factors that contribute to distress and disorder. One way to formulate emotional distress symptoms is to view them as state manifestations of underlying personality traits. However, the metacognitive model suggests that emotional distress is maintained by metacognitive strategies directed by underlying metacognitive beliefs. The aim of the present study was therefore to evaluate the role of these factors as predictors of anxiety and depression symptoms in a cross-sectional sample of 4936 participants collected during the COVID-19 pandemic. Personality traits (especially neuroticism) were linked to anxiety and depression, but metacognitive beliefs and strategies accounted for additional variance. Among the predictors, metacognitive strategies accounted for the most variance in symptoms. Furthermore, we evaluated two statistical models based on personality traits versus metacognitions and found that the latter provided the best fit. Thus, these findings indicate that emotional distress symptoms are maintained by metacognitive strategies that are better accounted for by metacognitions compared with personality traits. Theoretical and clinical implications of these findings are discussed.

• Whittaker, Kristoffer; Stänicke, Erik; Johnson, Sverre Urnes; Solbakken, Ole Andre & Tilden, Terje (2022). Troubled Relationships: A Retrospective Study of How Couples with Histories of Trauma Experience Therapy. Journal of Couple & Relationship Therapy. ISSN 1533-2691. p. 1–24. doi: 10.1080/15332691.2022.2053262. Full text in Research Archive Show summary

  In the present study we aim to increase our knowledge of the relationship between childhood trauma and outcome in couple therapy. We samples participants based on their sub-optimal responses to treatment as well as one member of the dyad having reported experiences of childhood trauma. Six participants constituting three couples were included. All data was analyzed using thematic analysis. Our main finding was that when couples are not able to agree ont he goal of their therapy and this is not handled adequately by the therapist, the alliance tends to split. The therapy thus becomes more individually focused at the expense of the couple relationship. Generally, participants did not themselves assess their past traumas as having negatively impacted therapy giving instead credence as to how it has impacted their self-knowledge. In the future, longitudinal studies should be conducted to explore if there is an association across treatment between trauma and the therapeutic relationship, and the influence it might have on outcome. The findings of this study further support the already existing literature on the importance of alliance and elaborates upon how split alliances occur, develops, and constrains therapy.

• Johnson, Sverre Urnes; Amundsen, Ole Myklebust; Johnson, Miriam S.; Hoffart, Asle; Halsøy, Øyvind & Skjerdingstad, Nora [Show all 8 contributors for this article] (2022). Psychiatric symptoms in COVID-19-positive individuals in the general population: Trajectories of depression, anxiety, and insomnia. Psychiatry Research. ISSN 0165-1781. 317. doi: 10.1016/j.psychres.2022.114806. Full text in Research Archive Show summary

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

• Ebrahimi, Omid Vakili; Hoffart, Asle & Johnson, Sverre Urnes (2022). Mechanisms associated with the trajectory of depressive and anxiety symptoms: A linear mixed-effects model during the COVID-19 Pandemic. Current Psychology. ISSN 1046-1310. doi: 10.1007/s12144-022-02732-9. Full text in Research Archive Show summary

  Abstract With the fluctuations in anxious and depressive symptomatology accompanied by the pandemic crises, studies on the trajectories of these symptom domains are warranted to monitor the development of mental health problems in the population. This pre-registered longitudinal study examines stable factors and mechanistic processes covarying with the trajectory of anxiety and depressive symptoms using linear-mixed effects models in 4936 adults from the pandemic’s onset to four months into the COVID-19 pandemic in Norway. Prevalence estimates of moderate to severe levels of clinically impairing symptoms of anxiety and depression revealed high but reduced occurrence four months into the pandemic where social distancing protocols were substantially lightened in severity, revealing associations between symptoms and viral mitigation protocols after stringent control of plausible confounders. Subgroups at risk at the onset of the pandemic sustained their relative position compared to their counterparts four months into the pandemic, indicating prolonged suffering of these subgroups. Among mechanistic processes, key differences were identified regarding the trajectory of anxiety and depressive symptoms. Physical exercise was associated with long-term but not momentaneous alleviations in anxiety. In contrast, reductions in depressive symptoms were associated with both the simultaneous exertion as well as dose-increases in exercise over time. Increased knowledge about how to best cope with pandemic challenges was associated with greater improvement in depressive but not anxiety symptoms. Reductions in maladaptive coping strategies and negative metacognitive beliefs was substantially associated with greater improvement of both anxious and depressive symptomatology. Mechanistic processes divergently relate to the trajectory of depressive and anxious symptomatology, yielding domain-specific information of utility for preventive and interventive efforts aimed at impeding deleterious symptom levels.

• Hoffart, Asle; Johnson, Sverre Urnes & Ebrahimi, Omid Vakili (2022). Metacognitive beliefs, maladaptive coping strategies, and depressive symptoms: A two-wave network study of the COVID-19 lockdown and reopening. Journal of Psychiatric Research. ISSN 0022-3956. 152, p. 70–78. doi: 10.1016/j.jpsychires.2022.06.008. Full text in Research Archive
• Whittaker, Kristoffer; Johnson, Sverre Urnes; Solbakken, Ole Andre & Tilden, Terje (2022). Treated together–changed together: The application of dyadic analyses to understand the reciprocal nature of alliances and couple satisfaction over time. Journal of Marital & Family Therapy. ISSN 0194-472X. doi: 10.1111/jmft.12595. Full text in Research Archive Show summary

  In a Norwegian study of 73 couples attending a residential couple therapy program lasting between 6 and 12 weeks, weekly self-report data on therapy alliance and couple satisfaction were collected using routine outcome monitoring (ROM). The aim was to show how dyadic analyses could be applied to examine the predictive association between alliances and couple satisfaction. Results showed that improved alliance between dyad members and their couple therapist predicted their spouses' alliance. The clinical implication of these findings should heighten awareness to the importance of male partners in couple therapy, something that predicts their spouses' couple satisfaction. These findings help nuance the already existing literature on the working alliance. Futhermore, we propose that dyadic analyses should be widely used in any psycho-therapeutic research that aims to understand the reciprocal effects of dyads.

• Ebrahimi, Omid Vakili; Hoffart, Asle; Bauer, Daniel J. & Johnson, Sverre Urnes (2022). A Critical Period for Pandemic Adaptation: The Evolution of Depressive Symptomatology in a Representative Sample of Adults Across a 17-Month Period During COVID-19. Journal of Psychopathology and Clinical Science. ISSN 2769-7541. doi: 10.1037/abn0000786. Full text in Research Archive
• Hoffart, Asle; Bauer, Daniel J.; Johnson, Sverre Urnes & Ebrahimi, Omid Vakili (2022). Anxiety in the adult population from the onset to termination of social distancing protocols during the COVID-19: a 20-month longitudinal study. Scientific Reports. 12(1), p. 1–13. doi: 10.1038/s41598-022-22686-z. Full text in Research Archive Show summary

  The social distancing protocols (SDPs) implemented as a response to the COVID-19 pandemic may seriously influence people's mental health. We used a sample of 4361 Norwegian adults recruited online and stratified to be nationally representative to investigate the evolution of anxiety following each modification in national SDPs across a 20-month period from the onset of the pandemic to the reopening of society and discontinuation of SDPs. The mean anxiety level fluctuated throughout the observation period and these fluctuations were related to the stringency of the modified SDPs. Those with a high initial level almost in unison showed a substantial and lasting decrease of anxiety after the first lifting of SDPs. A sub-group of 9% had developed a persistent anxiety state during the first 3 months. Younger age, pre-existing psychiatric diagnosis, and use of unverified information platforms proved to predict marked higher anxiety in the long run. In conclusion, individuals with a high level of anxiety at the outbreak of the pandemic improved when the social distancing protocols were lifted. By contrast, a sizeable subgroup developed lasting clinical levels of anxiety during hte first 3 months of the pandemic and is vulnerable to prolonged anxiety beyond the pandemic period.

• Gjengedal, Ragne Gunnarsdatter Hole; Osnes, Kåre; Reme, Silje Endresen; Lagerveld, Suzanne E.; Johnson, Sverre Urnes & Lending, Hilde Dallavara [Show all 9 contributors for this article] (2022). Changes in depression domains as predictors of return to work in common mental disorders. Journal of Affective Disorders. ISSN 0165-0327. 308, p. 520–527. doi: 10.1016/j.jad.2022.04.080. Full text in Research Archive Show summary

  Background Depression highly impairs function and reduces quality of life. Therefore, both symptomatic and functional recovery are important treatment goals. Depression consists of several cognitive, somatic, and affective symptom factors that differently affect function. However, it is unclear whether changes in these domains predict return to work (RTW) after treatment. Methods Data were collected during treatment from patients on full or partial sick leave reporting depression symptoms (N = 300) at an out-patient clinic. Information on work status was assessed pre- and post-treatment and at 6 months follow-up. Multiple logistic regression was used to investigate if residualized changes in symptom factors predicted full RTW, controlling for gender, education level, and age. Results Changes (as symptom improvement) in the cognitive, somatic, and affective factor scores each significantly predicted full RTW post-treatment and at follow-up for patients on full and partial sick leave, even after controlling for gender, education level, and age. The change in the somatic factor explained the largest proportion of variance for full work post-treatment in patients on full sick-leave, while change in the cognitive factor explained most unique variance for patients on graded sick leave. Limitations The sample consisted of a majority of women with a relatively high level of education. This study should be replicated in more heterogeneous samples. Conclusion Changes in depression symptom domains are significant predictors for RTW work post-treatment. The change in the somatic factor explained the largest proportion of variance in patients on full sick leave and thus may particularly influence RTW after treatment.

• Magnúsdóttir, Ingibjörg; Lovik, Anikó; Unnarsdóttir, Anna Bára; McCartney, Daniel L.; Ask, Helga & Kõiv, Kadri [Show all 23 contributors for this article] (2022). Acute COVID-19 severity and mental health morbidity trajectories in patient populations of six nations: an observational study. The Lancet Public Health. ISSN 2468-2667. 7(5), p. 406–416. doi: 10.1016/S2468-2667(22)00042-1. Full text in Research Archive Show summary

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

• Tilden, Terje; Ulvenes, Pål Gunnar; Zahl-Olsen, Rune; Hoffart, Asle; Johnson, Sverre Urnes & Wampold, Bruce E. [Show all 7 contributors for this article] (2021). Predicting change through individual symptoms and relationship distress: A study of within- and between-person processes in couple therapy. Clinical Psychology and Psychotherapy. ISSN 1063-3995. 28, p. 1275–1284. doi: 10.1002/cpp.2575. Full text in Research Archive
• Ebrahimi, Omid Vakili; Hoffart, Asle & Johnson, Sverre Urnes (2021). Viral mitigation and the COVID-19 pandemic: factors associated with adherence to social distancing protocols and hygienic behaviour. Psychology and Health. ISSN 0887-0446. doi: 10.1080/08870446.2021.1960987. Full text in Research Archive Show summary

  Objective To investigate the factors associated with adherence to viral mitigation protocols during the COVID-19 pandemic. Design This epidemiological cross-sectional study examines adherence to behaviour in 4158 adults and its relationship with sources of information. Main outcome measures Adherence to social distancing protocols (SDPs) and adherence to hygienic behaviour (HB) recommendations. Results Individuals aged 18–30 reported lowest adherence to SDPs and HB. Alcohol consumption was associated with lower adherence. Increased risk perception, fear of infection and altruistic attitude were associated with greater adherence. Males, single and childless individuals reported lower adherence. Extroverts and urban residents reported lower adherence to SDPs, but not HB. In contrast to earlier stages of the pandemic, voluntary social distancing was associated with greater adherence to SDPs as opposed to rule-enforced social distancing. Regarding information obtainment, increased time spent acquiring information from recognised newspapers had the strongest favourable association with adherence. Relying on information from friends and family was associated with decreased adherence to SDPs. Sensitivity analyses replicated the findings, supporting the stability and robustness of the proposed models. Conclusion This study identifies factors associated with favourable and detrimental adherence behaviour along with substantial dissemination routes, presenting strategies that may be of utility towards fostering adherence to contemporaneously implemented mitigation protocols.

• Hoffart, Asle; Johnson, Sverre Urnes & Ebrahimi, Omid Vakili (2021). Loneliness during the COVID-19 pandemic: change and predictors of change from strict to discontinued social distancing protocols. Anxiety, Stress, & Coping. ISSN 1061-5806. doi: 10.1080/10615806.2021.1958790. Full text in Research Archive
• Sunde, Tor; Johnson, Sverre Urnes; Himle, Joseph A.; Bertelsen, Thomas Bjerregaard; Haaland, Vegard Øksendal & Vogel, Patrick A. [Show all 8 contributors for this article] (2021). Metacognitions and obsessive beliefs in obsessive-compulsive disorder: A study of within- and between-person effects on long-term outcome. Cognitive Therapy and Research. ISSN 0147-5916. 45, p. 1105–1119. doi: 10.1007/s10608-021-10210-y. Full text in Research Archive Show summary

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

• 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
• Johnson, Miriam Sinkerud; Skjerdingstad, Nora; Ebrahimi, Omid Vakili; Hoffart, Asle & Johnson, Sverre Urnes (2021). Parenting in a Pandemic: Parental Stress, Anxiety and Depression Among Parents During the Government-Initiated Physical Distancing Measures Following the First Wave of COVID-19. Stress and Health. ISSN 1532-3005. p. 1–16. doi: 10.1002/smi.3120. Full text in Research Archive Show summary

  Drawing on the tenets of family stress theory, the aim of this study is to examine parents' perceived stress, symptoms of anxiety, depression, and associated risk- and protective factors across demographic subgroups during in the first wave of the COVID-19 pandemic. Norwegian parents (N = 2868; 79.5% mothers) with >1 child under 18 years of age completed an online survey two weeks after the implementation of government-initiated distancing measures. The survey includes measures of COVID-related risk factors (parental stress, burnout, depression, anxiety, anger of parents towards children, difficulty working from home, and positive beliefs about worry) and protective factors (self-efficacy and social support). Mothers, parents living with more than one child, and parents with a psychiatric diagnosis reported greater levels of parental stress, more burnout, and more anger towards their children, as well as less social support. Almost 25% of the parents reported anxiety and depression that are clinically significant. Parents who followed distancing measures reported significantly higher distress. Anger of parents towards children explains 41% of the variation in parental stress. These findings indicate that parents have experienced symptoms of deteriorated mental health due to the COVID- 19 pandemic, including parental stress, anxiety, and depression. The study presents practical implications for meso- and macro-level policymaking and offers support to further the potential aims of public health and clinical interventions. Future studies to monitor long-term aversive mental health outcomes among parents are warranted.

• Halsøy, Øyvind; Johnson, Sverre Urnes; Hoffart, Asle & Ebrahimi, Omid Vakili (2021). Insomnia Symptoms in the General Population During the COVID-19 Pandemic. Frontiers in Psychiatry. 12. doi: 10.3389/fpsyt.2021.762799. Full text in Research Archive Show summary

  This empirical study aims to investigate factors associated with insomnia symptoms during the COVID-19 pandemic in 4,921 Norwegian adults. Participants were queried across two time-points, between March 31 st and April the 7th 2020, and between June 22nd and July 13th, 2020. Relevant risk factors and psychological correlates at the first time-point and insomnia symptoms were measured 3 months later, allowing for the investigation of concurrent associations as well as associations across time. Insomnia symptoms were measured with the Bergen Insomnia Scale. The results revealed that individuals reported higher mean levels of insomnia symptoms during the COVID-19 lockdown, compared to pre-pandemic surveys from 2008 ( p &amp;lt; 0.0001, Cohen's d = 0.29). Individuals who predominantly socially distanced reported higher mean levels of insomnia symptoms than those who did not predominantly distance. Females, individuals with lower education levels, individuals who had lost their job, and individuals who declared having been diagnosed with an unspecified pre-existing psychiatric disorder reported the most symptoms. The regression model (R 2 = 0.44) showed that physical exercise, was associated with less symptoms of insomnia. Symptoms of health Anxiety, symptoms of depression, unhelpful coping strategies, worry about job and economy, and older age were all associated with higher levels of insomnia symptoms. These findings highlight particularly vulnerable subgroups, as well as providing clinicians with key areas of intervention to help individuals suffering from insomnia symptoms.

• Ebrahimi, Omid Vakili; Hoffart, Asle & Johnson, Sverre Urnes (2021). Physical Distancing and Mental Health During the COVID-19 Pandemic: Factors Associated With Psychological Symptoms and Adherence to Pandemic Mitigation Strategies. Clinical Psychological Science. ISSN 2167-7026. 9(3), p. 489–506. doi: 10.1177/2167702621994545. Full text in Research Archive Show summary

  In this epidemiological investigation, we assessed the prevalence of depression and anxiety symptoms during the COVID-19 pandemic. A total of 10,061 adults participated in the study. Symptoms of depression and anxiety were 2 to 3 times higher compared with prepandemic samples. Participants who predominantly socially distanced themselves revealed substantially higher symptoms than their counterparts. Females, ethnic and sexual-orientation minorities, younger adults, unemployed individuals, and participants with a psychiatric diagnosis reported higher prevalence of psychological symptoms. Worry about prolonged duration of physical-distancing protocols and frustration of autonomy was associated with elevation in symptoms of depression and anxiety. Increased competence to deal with the pandemic crisis was associated with fewer adverse symptoms. Physical exercise, experiencing nature, and distraction with activities were associated with reduced depressive symptoms but not anxiety. The extent of information access about the pandemic was associated with reduced anxiety symptoms. Furthermore, adherence to mitigation protocols was investigated. Younger adults and males reported lowest adherence. Altruistic attitudes, in addition to mandatory as opposed to voluntary adherence, were associated with higher adherence rates. Worrying about the health of significant others was associated with higher adherence rates, whereas worry about duration of pandemic protocols was associated with lower adherence rates.

• Whittaker, Kristoffer; Johnson, Sverre Urnes; Solbakken, Ole Andre; Wampold, Bruce E. & Tilden, Terje (2021). Childhood trauma as a predictor of change in couple and family therapy: A study of treatment response. Couple and Family Psychology: Research and Practice (CFP). ISSN 2160-4096. doi: 10.1037/cfp0000181. Full text in Research Archive
• Tilden, Terje; Johnson, Sverre Urnes; Hoffart, Asle; Zahl-Olsen, Rune; Wampold, Bruce E. & Ulvenes, Pål [Show all 7 contributors for this article] (2021). Alliance Predicting Progress in Couple Therapy. Psychotherapy. ISSN 0033-3204. 58(3), p. 391–400. doi: 10.1037/pst0000355. Full text in Research Archive
• Skjerdingstad, Nora; Johnson, Miriam Sinkerud; Johnson, Sverre Urnes; Hoffart, Asle & Ebrahimi, Omid Vakili (2021). Parental burnout during the COVID-19 pandemic. Family Process. ISSN 0014-7370. p. 1–15. doi: 10.1111/famp.12740. Full text in Research Archive Show summary

  Increased and long-term parental stress related to one's parental role can lead to parental burnout. In the early phase of the COVID-19 pandemic, families experienced intensified pressure due to the government-initiated contact restrictions applied to prevent the spread of the virus in the population. This study investigates the risk factors and predictors of parental burnout in a large sample of parents (N = 1488) during the COVID-19 pandemic in Norway. Demographic and psychosocial factors were assessed at two timepoints: at the beginning of the pandemic outbreak in March 2020 (T1) and at 3 months follow-up (T2). A hierarchical regression analysis was applied to identify the factors that contribute to parental burnout at T2. Parental burnout was additionally explored across subgroups. Findings revealed that younger age was associated with more parental burnout. Concurrent (T2) use of unhelpful coping strategies, insomnia symptoms, parental stress, and less parental satisfaction was significantly associated with the presence of greater parental burnout (T2). Additionally, parental stress and satisfaction measured in the earliest phase of the pandemic (T1) were associated with parental burnout 3 months later (T2) over and above concurrent parental stress/satisfaction. Unemployed parents and individuals with a mental health condition were identified as subgroups with substantially heightened levels of parental burnout.

• Skjerdingstad, Nora; Johnson, Miriam Sinkerud; Johnson, Sverre Urnes; Hoffart, Asle & Ebrahimi, Omid Vakili (2021). Feelings of Worthlessness Links Depressive Symptoms and Parental Stress: A Network Analysis during the COVID-19 Pandemic. European psychiatry. ISSN 0924-9338. 64(1), p. 1–10. doi: 10.1192/j.eurpsy.2021.2223. Full text in Research Archive Show summary

  Background. The prevalent co-occurrence between parental stress and depression has been established prior to and during the COVID-19 pandemic outbreak. However, no studies to date have identified the connections through which these symptom domains interact with each other to emerge into a complex and detrimental mental health state, along with the plausible mechanistic variables that may play key roles in maintaining parental stress and depression. The aim of this research is to uncover these interactions in a period where parents experience heightened demands and stress because of the strict social distancing protocols. Methods: Network analysis is utilized to examine parental stress and depressive symptoms during the COVID-19 pandemic in a large cross-sectional study (N = 2,868) of parents. Two graphical Gaussian graphical network models were estimated, one in which only parental stress and depression symptoms were included, and another in which several mechanistic variables were added. Results: Expected influence and bridge expected influence revealed that feeling worthless was the most influential node in the symptoms network and bridged the two psychological states. Among the mechanistic variables, worry and rumination was specifically relevant in the depressive cluster of symptoms, and self-criticism was connected to both constructs. Conclusion: The study displays that the co-occurrence of parental stress and depression has specific pathways, was manifested through feelings of worthlessness, and has specific patterns of connection to important mechanisms of psychopathology. The results are of utility when aiming to avoid the constellation of co-occurring parental stress and depressive symptoms during the pandemic.

• Hoffart, Asle; Johnson, Sverre Urnes & Ebrahimi, Omid Vakili (2021). The network of stress-related states and depression and anxiety symptoms during the COVID-19 lockdown. Journal of Affective Disorders. ISSN 0165-0327. doi: 10.1016/j.jad.2021.07.019. Full text in Research Archive
• Amundsen, Ole Myklebust; Hoffart, Asle; Johnson, Sverre Urnes & Ebrahimi, Omid V. (2021). Pandemic Information Dissemination and Its Associations With the Symptoms of Mental Distress During the COVID-19 Pandemic: Cross-sectional Study. JMIR Formative Research. 5(12). doi: 10.2196/28239. Full text in Research Archive Show summary

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

• Ebrahimi, Omid Vakili; Burger, Julian; Hoffart, Asle & Johnson, Sverre Urnes (2021). Within- and across-day patterns of interplay between depressive symptoms and related psychopathological processes: a dynamic network approach during the COVID-19 pandemic. BMC Medicine. 19(1), p. 1–17. doi: 10.1186/s12916-021-02179-y. Full text in Research Archive Show summary

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

• Wisting, Line Norøm; Johnson, Sverre Urnes; Bulik, Cynthia M.; Andreassen, Ole Andreas; Rø, Øyvind & Bang, Lasse (2021). Psychometric properties of the Norwegian version of the Patient Health Questionnaire-9 (PHQ-9) in a large female sample of adults with and without eating disorders. BMC Psychiatry. 21:6, p. 1–11. doi: 10.1186/s12888-020-03013-0. Full text in Research Archive Show summary

  Background Internationally, the Patient Health Questionnaire-9 (PHQ-9) is commonly used to assess the frequency and severity of depressive symptoms. However, psychometric properties of the Norwegian version of the PHQ-9 have only been assessed in adolescents. We present normative data for women and an evaluation of the psychometric properties (internal consistency, convergent validity, and factor structure) of the Norwegian PHQ-9 among women with and without eating disorders (ED). Methods In this case-control study, a total of 793 females aged 18–78 years (mean 30.39; SD 9.83) completed an online self-report assessment. Measures included the ED100K and Eating Disorder Examination Questionnaire (EDE-Q) to assess ED psychopathology, and the Generalized Anxiety Disorder (GAD) scale and Difficulties in Emotion Regulation Scale Short Form (DERS-SF) to assess symptoms of anxiety and emotion regulation deficits. Participants were categorized into three groups, i.e., previous ED (19.7%, n = 148), current ED (36.3%, n = 272), and no history of ED (44.0%, n = 330), based on self-reported scores on the ED 100 K and the EDE-Q. Results Mean PHQ-9 total score for those with a previous history of ED was 10.67 (SD 6.33), for those with a current ED 16.61 (SD 5.84), and for those with no lifetime history of ED 6.83 (SD 5.58). Excellent internal consistency was demonstrated by Cronbach’s alpha’s for individuals with a previous ED (.88), for individuals with a current ED (.86), and for individuals with no history of ED (.88). Acceptable convergent validity was indicated based on significant correlations between the PHQ-9 and GAD-7 and DERS-SF. Confirmatory Factor Analyses revealed a mediocre fit for a one-factor structure of the PHQ-9, regardless of diagnostic status. Conclusions The psychometric properties of the Norwegian version of the PHQ-9 are acceptable across females with and without ED, and the PHQ-9 can be recommended for use in clinical ED settings and for people without mental disorders.

• Johnson, Miriam Sinkerud; Skjerdingstad, Nora; Ebrahimi, Omid V.; Hoffart, Asle & Johnson, Sverre Urnes (2021). Mechanisms of parental distress during and after the first COVID-19 lockdown phase: A two-wave longitudinal study. PLOS ONE. 16(6), p. 1–17. doi: 10.1371/journal.pone.0253087. Full text in Research Archive Show summary

  Background: In these unpredictable times of the global coronavirus disease 2019 (COVID-19) pandemic, parents worldwide are affected by the stress and strain caused by the physical distancing protocols that have been put in place. Objective: In a two-wave longitudinal survey, we investigated the levels of parental stress and symptoms of anxiety and depression in a sample of parents at two time points; during the implementation of the strictest physical distancing protocols following the onset of the COVID-19 pandemic (T1, N = 2,868) and three months after the discontinuation of the protocols (T2, N = 1,489). Further, we investigated the relationships between parental stress and anxiety and depression relative to relationship quality and anger toward their children at the two aforementioned time points, including subgroups based on age, parental role, cultural background, relationship status, education level, number of children, employment status and pre-existing psychiatric diagnosis. Methods and findings: Parents were asked to fill out a set of validated questionnaires on the two measurement points. Parental stress significantly decreased from T1 to T2, indicating that the cumulative stress that parents experienced during the implementation of the distancing protocols declined when the protocols were phased out. The decrease of perceived parental stress was accompanied by a significant decrease in the symptoms of both depression and anxiety among the participating parents. Symptoms meeting the clinical cut-offs for depression (23.0%) and generalized anxiety disorder (23.3%) were reported among participating parents at T1, compared to 16.8% and 13.8% at T2, respectively. The reduction in depression and anger toward their child(ren) from T1 to T2 was associated with a reduction of parental stress. Relationship quality and anger toward their child(ren) at T1 further predicted a change in the level of parental stress from T1 to T2. Conclusions: The study underlines the negative psychological impacts of the implementation of the distancing protocols on parents’ health and well-being. Uncovering the nature of how these constructs are associated with parents and families facing a social crisis such as the ongoing pandemic may contribute to the design of relevant interventions to reduce parental distress and strengthen parental coping and resilience.

• Ebrahimi, Omid Vakili; Johnson, Miriam Sinkerud; Ebling, Sara; Amundsen, Ole Myklebust; Halsøy, Øyvind & Hoffart, Asle [Show all 8 contributors for this article] (2021). Risk, Trust, and Flawed Assumptions: Vaccine Hesitancy During the COVID-19 Pandemic. Frontiers in Public Health. 9. doi: 10.3389/fpubh.2021.700213. Full text in Research Archive Show summary

  Background: The pace at which the present pandemic and future public health crises involving viral infections are eradicated heavily depends on the availability and routine implementation of vaccines. This process is further affected by a willingness to vaccinate, embedded in the phenomenon of vaccine hesitancy. The World Health Organization has listed vaccine hesitancy among the greatest threats to global health, calling for research to identify the factors associated with this phenomenon. Methods: The present cross-sectional study seeks to investigate the psychological, contextual, and sociodemographic factors associated with vaccination hesitancy in a large sample of the adult population. 4,571 Norwegian adults were recruited through an online survey between January 23 to February 2, 2021. Subgroup analyzes and multiple logistic regression was utilized to identify the covariates of vaccine hesitancy. Results: Several subgroups hesitant toward vaccination were identified, including males, rural residents, and parents with children below 18 years of age. No differences were found between natives and non-natives, across education or age groups. Individuals preferring unmonitored media platforms (e.g., information from peers, social media, online forums, and blogs) more frequently reported hesitance toward vaccination than those relying on information obtainment from source-verified platforms. Perceived risk of vaccination, belief in the superiority of natural immunity, fear concerning significant others being infected by the virus, and trust in health officials' dissemination of vaccine-related information were identified as key variables related to vaccine hesitancy. Conclusion: Given the heterogeneous range of variables associated with vaccine hesitancy, additional strategies to eradicate vaccination fears are called for aside from campaigns targeting the spread of false information. Responding to affective reactions in addition to involving other community leaders besides government and health officials present promising approaches that may aid in combating vaccination hesitation.

• Halstensen, Kari; Gjestad, Rolf; Luyten, Patrick; Wampold, Bruce; Granqvist, Pehr & Stålsett, Gry [Show all 7 contributors for this article] (2021). Depression and Mentalizing: A Psychodynamic Therapy Process Study. Journal of Counseling Psychology. ISSN 0022-0167. 68(6), p. 705–718. doi: 10.1037/cou0000544. Full text in Research Archive
• Hoffart, Asle; Johnson, Sverre Urnes & Ebrahimi, Omid V. (2020). Loneliness and social distancing during the COVID-19 pandemic: Risk factors and associations with psychopathology. Frontiers in Psychiatry. 11:589127, p. 1–9. doi: 10.3389/fpsyt.2020.589127. Full text in Research Archive Show summary

  Background: The mitigation strategies employed against the COVID-19 pandemic have severe mental health consequences. In particular, as a result of the social distancing protocols, loneliness is likely to increase. This study investigates (a) potential risk and resilience factors for loneliness in the Norwegian population during the strict social distancing non-pharmacological interventions (NPIs) implemented against the pandemic and (b) the associations between loneliness and psychopathology symptoms. Methods: A survey was disseminated online to the adult Norwegian population when strict social distancing measures had been implemented for 2 weeks. The resulting sample of 10,061 respondents was unproportionate in terms of gender and educational level and thus sensitivity analyses were conducted. The levels of loneliness were compared across demographic sub-groups, and regression analyses were conducted to identify potential risk and resilience factors for loneliness and associations between loneliness and psychopathology symptoms. Results: Among the stable factors, being single and having a psychiatric diagnosis were related to more loneliness with small effect sizes. Among the state risk factors, more rumination and worry in general were associated with stronger loneliness, showing a medium effect size. Among the coping behaviors examined, doing new things at home not done otherwise was negatively related to loneliness, with a small effect size. Loneliness was associated with both depression and anxiety with small effect sizes when all potential confounders and psychiatric diagnosis were controlled for. The relationship to depression was more marked than the relationship to anxiety. Conclusions: The findings suggest that singles and those with a psychiatric diagnosis were most affected by loneliness during the implementation of social distancing measures to impede the coronavirus. The results support the link between loneliness and depression and anxiety symptoms. The results of the analysis of potential risk and resilience factors point to intervention targets for reducing loneliness during pandemic crises.

• Johnson, Sverre Urnes; Ebrahimi, Omid V. & Hoffart, Asle (2020). PTSD symptoms among health workers and public service providers during the COVID-19 outbreak. PLOS ONE. doi: 10.1371/journal.pone.0241032. Full text in Research Archive Show summary

  In the frontline of the pandemic stand healthcare workers and public service providers, occupations which have proven to be associated with increased mental health problems during pandemic crises. This cross-sectional, survey-based study collected data from 1773 healthcare workers and public service providers throughout Norway between March 31, 2020 and April 7, 2020, which encompasses a timeframe where all non-pharmacological interventions (NPIs) were held constant. Post-traumatic stress disorder (PTSD), anxiety and depression were assessed by the Norwegian version of the PTSD checklist (PCL-5), General Anxiety Disorder –7, and Patient Health Questionnaire-9 (PHQ-9), respectively. Health anxiety and specific predictors were assessed with specific items. Multiple regression analysis was used for predictor analysis. A total of 28.9% of the sample had clinical or subclinical symptoms of PTSD, and 21.2% and 20.5% were above the established cut-offs for anxiety and depression. Those working directly in contrast to indirectly with COVID-19 patients had significantly higher PTSD symptoms. Worries about job and economy, negative metacognitions, burnout, health anxiety and emotional support were significantly associated with PTSD symptoms, after controlling for demographic variables and psychological symptoms. Health workers and public service providers are experiencing high levels of PTSD symptoms, anxiety and depression during the COVID-19 pandemic. Health workers working directly with COVID-19 patients have significantly higher levels of PTSD symptoms and depression compared to those working indirectly. Appropriate action to monitor and reduce PTSD, anxiety, and depression among these groups of individuals working in the frontline of pandemic with crucial societal roles should be taken immediately.

• Hoffart, Asle & Johnson, Sverre Urnes (2020). Latent trait, latent-trait state, and a network approach to mental problems and their mechanisms of change. Clinical Psychological Science. ISSN 2167-7026. 8(4), p. 595–613. doi: 10.1177/2167702620901744. Full text in Research Archive
• Tilden, Terje; Theisen, Marie; Wampold, Bruce E.; Johnson, Sverre Urnes & Hoffart, Asle (2020). Individual distress and dyadic adjustment over the course of couple therapy and three-year follow-up: A replication study. Psychotherapy Research. ISSN 1050-3307. 30(3), p. 375–386. doi: 10.1080/10503307.2019.1645369. Full text in Research Archive
• Johnson, Sverre Urnes; Hoffart, Asle; Tilden, Terje; Toft, Helge Prytz; Neupane, Sudan & Lien, Lars [Show all 7 contributors for this article] (2020). Circulating cytokine levels in the treatment of comorbid anxiety disorders. Acta Neuropsychiatrica. ISSN 0924-2708. p. 1–7. doi: 10.1017/neu.2020.38. Full text in Research Archive Show summary

  Psychotherapy research aims to investigate predictors and moderators of treatment outcome, but there are few consistent findings. This study aimed to investigate cytokines in patients undergoing treatment for anxiety disorders and whether the level of cytokines moderated the treatment outcome. Thirty-seven patients with comorbid and treatment-resistant anxiety disorders were investigated using multilevel modelling. Serum cytokine levels were measured three times: pretreatment, in the middle of treatment, and at the end of treatment. Anxiety and metacognitions were measured weekly throughout treatment by self-report. The levels of monocyte chemoattractant protein-1, tumour necrosis factor-alpha, and interleukin-1 receptor antagonist did not change during therapy or were not related to the level of anxiety. Metacognitive beliefs predicted anxiety, but the relationship between metacognitions and anxiety was not moderated by cytokines. Limitations of the study include that the patients were not fasting at blood sampling, and we did not assess body mass index, which may affect cytokine levels. The lack of significance for cytokines as a predictor or moderator may be due to a lack of power for testing moderation hypotheses, a problem associated with many psychotherapy studies. Cytokines did not predict the outcome in the treatment of comorbid anxiety disorders in our sample. Furthermore, cytokines did not moderate the relationship between metacognitions and anxiety. Keywords: anxiety; comorbidity; cytokines; metacognition; psychotherapy.

• Hoffart, Asle & Johnson, Sverre Urnes (2020). Within-person networks of clinical features of social anxiety disorder during cognitive and interpersonal therapy. Journal of Anxiety Disorders. ISSN 0887-6185. 76. doi: 10.1016/j.janxdis.2020.102312. Full text in Research Archive
• Johnson, Sverre Urnes; Ulvenes, Pål; Øktedalen, Tuva & Hoffart, Asle (2019). Psychometric Properties of the General Anxiety Disorder 7-item (GAD-7) Scale in a Heterogeneous Psychiatric Sample. Frontiers in Psychology. 10(1713). doi: 10.3389/fpsyg.2019.01713. Full text in Research Archive Show summary

  The GAD-7 is commonly used as a measure of general anxiety symptoms across various settings and populations. However, there has been disagreement regarding the factor structure of the GAD-7, and there is a need for larger studies investigating the psychometric properties of the measure. Patients undergoing treatment (N = 1201), both inpatient and outpatient patients, completed the GAD-7 at pre- and post-treatment. Measures of depression, well-being, and other anxiety measures were also completed, making it possible to investigate convergent and divergent validity. Internal consistency and convergent validity were excellent for the total sample, and there was acceptable variation related to treatment groups. We conducted an exploratory factor analysis (EFA) on a random sample (50%) of the patients at intake and then conducted a confirmatory factor analysis (CFA) to confirm the factor structure in the other part of the sample at intake. The EFA indicated a clear one-factor solution, but the one-factor solution with CFA provided a poor fit to the data. Correlating the residuals among items assessing somatic symptoms led to a good fit in a respecified CFA solution. The GAD-7 has excellent internal consistency, and the one-factor structure in a heterogeneous clinical population was supported.

• Hoffart, Asle; Langkaas, Tomas Formo; Øktedalen, Tuva & Johnson, Sverre Urnes (2019). The temporal dynamics of symptoms during exposure therapies of PTSD: a network approach. European Journal of Psychotraumatology. 10:1618134, p. 1–11. doi: 10.1080/20008198.2019.1618134. Full text in Research Archive Show summary

  Background: Analysis of dynamic (temporal) networks allows an identification of important targets of treatment. Objective: This study examined the dynamic network of symptoms in patients diagnosed with post-traumatic stress disorder (PTSD) during exposure therapy. Method: Patients (n = 65) were randomized to either standard prolonged exposure, which includes imaginal exposure to the traumatic memory, or modified prolonged exposure, where imagery re-scripting of the memory replaced imaginal exposure, in a 10-week residential program. They completed a measure of DSM-IV PTSD symptoms weekly. The multilevel vector autoregressive (mlVAR) model was used to analyse the data, producing a temporal (dynamic), contemporaneous, and between-person network. Results: Physiological reactivity to reminders in a given week was positively related to distress reactivity and to flashbacks the subsequent week. Hypervigilance one week was positively related to startle response and external avoidance the subsequent week. In addition, sleep problems were positively predicted by previous week internal avoidance and negatively predicted by previous week flashbacks. Hypervigilance and physiological reactivation had the highest out-strength, indicating that they were the most predictive of other symptoms. Conclusions: The present within-person results make a preliminaryrect basis for the recommendation to monitor and facilitate change in physiological reactivation and hypervigilance in the treatment of PTSD. Future studies should examine the replicability of our temporal PTSD network and also include causal variables beyond symptoms.

• Johnson, Sverre Urnes; Johnson, Miriam S.; Sele, Peter & Hoffart, Asle (2019). Kompleks post-traumatisk stresslidelse: fra latent konstrukt til nettverksforståelse. Tidsskrift for Norsk psykologforening (Psykologtidsskriftet). ISSN 0332-6470. 56(6), p. 404–415. Full text in Research Archive
• Johnson, Sverre Urnes & Hoffart, Asle (2019). Moderators and predictors of outcome in metacognitive and cognitive behavioural therapy for co-morbid anxiety disorders. Clinical Psychology and Psychotherapy. ISSN 1063-3995. 26(4), p. 399–408. doi: 10.1002/cpp.2361. Full text in Research Archive
• Johnson, Sverre Urnes (2018). Oppsumert. Tidsskrift for Norsk psykologforening (Psykologtidsskriftet). ISSN 0332-6470. Full text in Research Archive
• Hoffart, Asle; Johnson, Sverre Urnes; Nordahl, Hans Morten & Wells, Adrian (2018). Mechanisms of change in metacognitive and cognitive behavioral therapy for treatment-resistant anxiety: The role of metacognitive beliefs and coping strategies. Journal of Experimental Psychopathology. 9(3), p. 1–10. doi: 10.1177/2043808718787414. Full text in Research Archive Show summary

  Metacognitive therapy (MCT) has shown promising outcomes across disorders, but, currently, little is known about the mechanisms of change in MCT as well as their specificity compared to those of cognitive behavioral therapy (CBT). The main purpose of this study was to examine the within-person relationships between features of the cognitive attentional syndrome (CAS)—the thinking style supposed to maintain clinical disorders according to the MCT model—and anxiety over the course of MCT and CBT for comorbid anxiety disorders. Seventy-four inpatients had been randomized to either MCT or CBT and actually started treatment. CAS features and anxiety were assessed weekly during treatment. These measures were disaggregated to their within- and between-person components and used as predictors in mixed models. All CAS features—coping activities, negative metacognitive beliefs, and positive metacognitive beliefs—decreased over the course of treatment. Negative and positive beliefs decreased more in MCT than in CBT. Time-specific changes in positive metacognitive beliefs predicted variations in subsequent anxiety across the two treatments (within-person effect). The finding of a within-person relationship between positive metacognitive beliefs and subsequent anxiety has the clinical implication that reduction in these beliefs may be important for treatment response.

• Johnson, Sverre Urnes & Hoffart, Asle (2018). Metacognitive therapy versus cognitive behavioral therapy: A network approach. Frontiers in Psychology. 9:2382, p. 1–10. doi: 10.3389/fpsyg.2018.02382. Full text in Research Archive
• Johnson, Sverre Urnes (2018). Transdiagnostisk behandling av angstlidelser. Tidsskrift for Norsk psykologforening (Psykologtidsskriftet). ISSN 0332-6470. 55(4), p. 271–273. Full text in Research Archive
• Hoffart, Asle; Øktedalen, Tuva; Ulvenes, Pål & Johnson, Sverre Urnes (2018). The Mobility Inventory for Agoraphobia Avoidance Alone Scale: Factor Structure and Psychometric Properties of Subscales. Assessment (ASM). ISSN 1073-1911. 25(6), p. 769–776. doi: 10.1177/1073191116659739. Full text in Research Archive
• Johnson, Sverre Urnes; Hoffart, Asle; Nordahl, Hans Morten & Wampold, Bruce E. (2017). Metacognitive therapy versus disorder-Specific CBT for comorbid anxiety disorders: A randomized controlled trial. Journal of Anxiety Disorders. ISSN 0887-6185. 50, p. 103–112. doi: 10.1016/j.janxdis.2017.06.004. Full text in Research Archive
• Sunde, Tor; Walseth, Liv Tveit; Himle, Joe; Vogel, Patrick A.; Launes, Gunvor & Haaland, Vegard Øksendal [Show all 9 contributors for this article] (2017). A long-term follow-up of group behavioral therapy for obsessive-compulsive disorder in a general outpatient clinic in Norway. Journal of Obsessive-Compulsive and Related Disorders. ISSN 2211-3649. 14, p. 59–64. doi: 10.1016/j.jocrd.2017.06.002. Full text in Research Archive Show summary

  There is a lack of knowledge regarding the long-term effect of evidence-based CBT/ ERP treatment for OCD that is delivered in routine clinical care. The aim of this study was to examine the long-term effectiveness of behavioral treatment for OCD in a Norwegian general outpatient clinic. In the current study, 62% (N = 40) of the original patients treated in a previously published study of group ERP for OCD were re-evaluated an average of eight years after completing the original treatment. This is the longest follow-up study that has been conducted for OCD patients treated with group ERP. There was a significant reduction in symptoms from pre- to post-treatment measured with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the Spielberger State Anxiety Inventory (STAI-S) and the Beck Depression Inventory (BDI). The gains were in average maintained from post-treatment through extended long-term follow-up. Fifty percent of the participants experienced either a clinically significant improvement (10%) or recovery (40%) in OCD symptoms at extended long-term follow-up. This suggests that many patients receiving general outpatient mental health clinic based group ERP for OCD maintain gains over the long-term.

• Johnson, Sverre Urnes; Hoffart, Asle; Nordahl, Hans Morten; Ulvenes, Pål; Vrabel, Kari-Anne & Wampold, Bruce E. (2017). Metacognition and cognition in inpatient mct and cbt for comorbid anxiety disorders: A study of within-person effects. Journal of Counseling Psychology. ISSN 0022-0167. 65(1), p. 86–97. doi: 10.1037/cou0000226. Full text in Research Archive
• Langkaas, Tomas Formo; Johnson, Sverre Urnes; Stenshorne, Kjersti; Collin-Tiller, Cecilie & Vrabel, Kari-Anne (2017). Klinisk signifikans i praksis. Tidsskrift for Norsk psykologforening (Psykologtidsskriftet). ISSN 0332-6470. 54(12), p. 1160–1167. Full text in Research Archive

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• Hoffart, Asle; Helmich, Marieke A.; Ebrahimi, Omid V. & Johnson, Sverre Urnes (2024). Changes in Emotional Disorders. In Taku, Kanako & Shackelford, Todd K. (Ed.), The Routledge International Handbook of Changes in Human Perceptions and Behaviors. Routledge. ISSN 9781003316602. doi: 10.4324/9781003316602-21. Full text in Research Archive
• Nordahl, Henrik; Hjemdal, Odin; Johnson, Sverre Urnes & Nordahl, Hans Morten (2023). Metakognitiv terapi. Tidsskrift for Norsk psykologforening (Psykologtidsskriftet). ISSN 0332-6470. 60(12), p. 781–791. doi: 10.52734/CHIQ3716. Full text in Research Archive Show summary

  Metacognitive therapy (MCT) was developed by Adrian Wells and is founded on the self-regulatory executive function (S-REF) model, often referred to as the metacognitive model of psychological disorder. The metacognitive model assumes that symptoms of psychological disorder will naturally subside through a process of reflexive self-regulation. However, this process can be blocked by a cognitive attentional syndrome (CAS), consisting of worry, rumination, threat monitoring and maladaptive coping behaviours, and lead to prolonged emotional distress. The CAS is under the influence of a metacognitive control system, and biases in metacognitive knowledge held by this system are assumed to constitute the central mechanisms underlying the CAS and therefore psychological disorders in general. MCT was specially developed to achieve metacognitive change and enhance self-regulation using a set of transdiagnostic treatment techniques and procedures. In the current paper we present MCT, its conceptual foundation and central features. We briefly present some of the empirical evidence supporting the metacognitive model and therapy and how MCT can be applied to a case named Nadine.

• Munkhaugen, John; Papageorgiou, Constantinos; Hagen, Roger; Johnson, Sverre Urnes; Einvik, Gunnar & Dammen, Toril (2023). Editorial: Progress in understanding and treating distress, sleep, and personality in heart and lung disease. Frontiers in Psychology. 14. doi: 10.3389/fpsyg.2023.1323677. Full text in Research Archive
• Hoffart, Asle & Johnson, Sverre Urnes (2019). Psykiske lidelser: Fra rot-årsaker til problemer i samspill. Tidsskrift for kognitiv terapi. ISSN 1504-3142. Full text in Research Archive
• Johnson, Sverre Urnes (2017). "Psyktnormalt - prosjektet". [Radio]. NRK Buskerud. Full text in Research Archive
• Johnson, Sverre Urnes (2017). Slik får du brukt med negative tanker. [Internet]. NRK.no. Full text in Research Archive
• Johnson, Sverre Urnes (2017). "Grubling". [Radio]. NRK P2 Ytring. Full text in Research Archive

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