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Avoidant personality disorder (AvPD) and social phobia (SP) are common disorders both in the community and in clinical settings. Whether the two disorders represent different severity levels of social anxiety disorder is currently in dispute. The relationship between AvPD and SP is probably more complex than previously assumed. Several environmental, temperamental, and constitutional factors may play a role in the etiology of AvPD and SP. Better knowledge about childhood experiences may shed light on similarities and differences between the two disorders. The aim of this study was to compare self-reported childhood experiences in AvPD and SP patients. This is a cross-sectional multi-site study of 91 adult patients with AvPD and/ or SP. We compared patients with AvPD with and without SP (AvPD group) to patients with SP without AvPD (SP group). The patients were examined using structured diagnostic interviews and self-report measures, including Child Trauma Questionnaire, Parental Bonding Instrument, and Adult Temperament Questionnaire. Both AvPD and SP were associated with negative childhood experiences. AvPD patients reported more severe childhood neglect than patients with SP, most pronounced for physical neglect. The difference between the disorders in neglect remained significant after controlling for temperamental factors and concurrent abuse. The study indicates that childhood neglect is a risk factor for AvPD and may be one contributing factor to phenomenological differences between AvPD and SP.

Patients in early phases of psychosis often struggle with depressive symptoms and low self-esteem. The main aims of the present study were to examine whether cognitive behavior therapy (CBT) compared to treatment as usual (TAU) would reduce depressive symptoms (primary outcome) and increase self-esteem (secondary outcome). Furthermore, we wanted to examine whether CBT reduces symptoms measured with the PANSS (positive, negative, cognitive, or excited symptoms) or increases general functioning compared to TAU. A total of 63 early psychosis patients were included and randomly assigned to receive either CBT (maximum 26 sessions) or TAU for a period of up to six months. A linear mixed model was used for longitudinal analysis, with a focus on whether patients in the CBT group or the TAU group changed differently to one another between the baseline and 15-month follow-up. There were no differences between the CBT group and TAU group regarding improvements in depressive symptoms measured with the Calgary Depression Scale for Schizophrenia (P = 0.188) or self-esteem measured with the Rosenberg Self-Esteem Scale (P = 0.580). However, patients in the CBT group improved significantly more on negative symptoms (P = 0.002) and social functioning (P = 0.001). We did not find CBT to be more effective than TAU in reducing depressive symptoms or increasing self-esteem in patients with early psychosis. However, CBT seems to improve negative symptoms and functioning. These results still need to be replicated in further studies as the present one was merely an exploratory analysis. ClinicalTrials.gov Identifier: NCT01511406. •CBT is no more effective than treatment as usual to reduce depressive symptoms.•CBT does not increase self-esteem compared to treatment as usual•Explorative findings shows that CBT improve negative symptoms/social functioning.

Background More studies with low risk of bias on the effectiveness of cognitive behavioral therapy (CBT) and short-term psychodynamic psychotherapy (STPP) for major depressive disorder (MDD) are needed. This study compares the outcome of CBT and STPP and examines the improvements in each treatment, focusing on effect sizes, reliable change, dropout rates, and remission rates, using broad inclusion criteria (e.g. participants using antidepressants or with strong suicidal ideation). Methods One hundred patients were randomly allocated to CBT or STPP. All patients were offered either 16 weekly sessions followed by 3 monthly booster sessions in CBT, or 28 weekly sessions in STPP. Primary outcome measures were Hamilton Depression Rating Scale (HDRS) and Beck’s Depression Inventory-II (BDI-II). Secondary outcome measures were Work and Social Adjustment Scale (WSAS), Generalized Anxiety Disorder-7 (GAD-7), Global Assessment of Functioning (GAF) and Short Form Health Survey-12 (SF-12). Results No significant differences in outcomes were found between the two treatment groups on any of the measures. The within-group effects were large (> 0.8) for the primary outcome measures and moderate to large for the secondary outcome measures. According to the reliable change index (RCI), 79% of patients reliably improved on HDRS and 76% improved on BDI-II, whereas respectively 6% and 10% reliably deteriorated. Conclusions These findings support the assumption that CBT and STPP are equally effective treatments for patients with depressive disorders in psychiatric outpatient clinics. Additionally, they strengthen the evidence for the effectiveness of both CBT and STPP in these settings, while also highlighting that not all depressed patients respond to short-term treatment. Clinical trial registration Clinical Trial gov. Identifier: NCT03022071. Date of registration: 2016-11-14.

Background Little is known about the influence on outcome of exploration of the patient-therapist relationship (that is, transference work) in psychoanalytic psychotherapy. We hypothesized that depressed adolescents would have better long-term effects from psychoanalytic psychotherapy with than without transference work. Methods Depressed adolescent (16 to 18 years) were recruited in health authority funded out-patient clinics in Oslo and Vestfold County, Norway. They were randomized to 28 weeks of treatment with psychoanalytic psychotherapy with or without transference work. Change was assessed using linear-mixed models. The primary outcome measure was the Psychodynamic Functioning Scale (pre- post-, and 1-year post-treatment). Level of depression was measured at the same time points and during therapy (week 12, and 20). Results 69 adolescents were treated with ( N  = 39) or without ( N  = 31) transference work. The mean number of sessions was 18.6 (SD = 8,6) in the transference work group and 18.0 (SD = 10.9) in the non-transference work group. Both groups showed large and significant improvement on Psychodynamic Functioning Scale during the whole study period. The difference between the two groups was not significant during the treatment period (95% CI −.79 to 1.2, p  = .674, F = .18), or from post-treatment to one-year follow-up (95% CI −.13 to .96; p  = .134; F = 2.3). For the secondary outcome measures the transference work group had significantly better outcomes from 12 weeks in treatment to one-year follow-up (Beck Depression Inventory, 95% CI − 1.7 to −.14, p  = .022; Montgomery and Åsberg Depression Rating Scale, 95% CI − 1.6 to −.23, p  = .009). Conclusion The findings suggest that exploration of the adolescents’ relations to the therapist amplify the effects of short-term psychoanalytic psychotherapy on their depressive symptoms for adolescents with a Major Depressive Disorder. Trial registration ClinicalTrials.gov . Id: NCT01531101 . Registered 8 February 2012.

Purpose The Severity Indices of Personality Problems 118 (SIPP-118) is a self-report questionnaire that aims to measure core components of (mal)adaptive personality functioning that can change over time. In this study, we aimed to assess the facet strength of the 16 facets across three large clinical samples. Methods Data from Norwegian and Dutch psychiatric patients were analyzed in this international multi-center study (N 1 = 2814, N 2 = 4751, N 3 = 2217). Bi-factor modeling was used to assess to what degree the SIPP items tap into an overall general factor. The incremental value (distinctiveness) of the facets was studied using proportional reduction in mean squared error (PRMSE) based statistics. Results The estimated model showed adequate fit. The explained common variance (ECV) attributable to the general factor equaled 50% for all three samples. All but two facets (stable self-image and frustration tolerance) showed sufficient levels of distinctiveness. The findings were observed to be comparable across the three samples. Conclusion Our findings showed that the general factor was relatively weak, and the facets had a clear incremental value.

Background Some studies have previously found that certain elevated early maladaptive schemas (EMSs) are negative predictors for outcome for patients with obsessive-compulsive disorder (OCD) treated with Cognitive-Behavioral Therapy (CBT) or Exposure and Response Prevention (ERP). The current study explores whether EMS were related to reductions in OCD symptom severity at long-term follow-up ( Mean  = 8 years) after group ERP for patients with OCD. The central hypothesis was that patients with no response to treatment or patients who relapsed during the follow-up period were more likely to have elevated pre-treatment EMSs compared to those who responded to initial treatment and maintained gains over time. We also investigated whether there were any differences in change over time of overall EMS between patients who were recovered versus patients who were not recovered at extended follow-up. Methods Young Schema Questionnaire –Short Form (YSQ-SF), Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Beck Depression Inventory (BDI) were measured in 40 OCD patients in a general outpatient clinic before and after group ERP, after 12-months and at extended follow-up. To analyze the predictors, a multiple regression analyses was conducted. Changes in overall EMS was analyzed by mixed models procedures. Results The major finding is that patients with high pre-treatment YSQ-SF total scores were less likely to respond to initial treatment or were more likely to relapse between post-treatment and the extended follow-up. The YSQ-SF total score at pre-treatment explained 10.5% of the variance of extended long-term follow-up outcome. The entire sample experienced a significant reduction in overall EMS over time with largest reduction from pre- to post-test. There were no statistically significant differences in total EMS change trajectories between the patients who were recovered at the extended follow-up compared to those who were not. Conclusion The results from the present study suggest that patients with higher pre-treatment EMSs score are less likely to recover in the long-term after receiving group ERP for OCD. A combined treatment that also targets early maladaptive schemas may be a more effective approach for OCD patients with elevated EMS who don’t respond to standard ERP.

Background Higher levels of early maladaptive schemas (EMSs) have been associated with increased symptom severity and worse treatment outcomes in several mental disorders, but little is known about the role of EMSs in trichotillomania (TTM) and skin-picking disorder (SPD). The current study therefore aimed to explore the relationship of EMSs with symptom severity and subtypes in patients with TTM and SPD, as well as to compare their baseline EMS levels to those of a group of patients with obsessive‒compulsive disorder (OCD). Methods The Young Schema Questionnaire–Short Form (YSQ-SF), along with measures of disorder-specific symptoms and subtypes, was administered to patients with TTM ( n  = 120), SPD ( n  = 75), and OCD ( n  = 88) prior to treatment. Potential between-group differences in EMSs were explored with ANCOVA, with age and illness duration as covariates. Disorder- and subtype-specific patterns were explored with correlational analysis. Results No significant baseline differences in EMS severity were found between TTM, SPD, and OCD patients, thereby corroborating EMSs’ transdiagnostic function in mental disorders. Several EMSs were significantly positively associated with self-reported and clinician-rated symptoms and picking/pulling styles of TTM and SPD, with some indications of diagnosis-specific association patterns. Conclusion These results suggest that EMSs are common among individuals with TTM and SPD and that assessment of these schemas may enhance clinicians’ understanding of TTM and SPD patients’ presenting problems.

Animal and human studies have suggested that hippocampal subfields are differentially vulnerable to stress, but subfield volume has not been investigated in patients with borderline personality disorder (BPD). Based on the putative role of stressful life events as vulnerability factors for BPD, we hypothesized that patients with BPD would exhibit reduced volumes for the stress-sensitive dentate gyrus (DG) and the cornu ammonis (CA) 3 subfields volumes, and that these volumes would be associated with traumatic childhood experiences. All participants underwent 3 T magnetic resonance imaging. Hippocampal subfield volumes were estimated using an automated and validated segmentation algorithm implemented in FreeSurfer. Age and total subcortical grey matter volume were covariates. We assessed traumatic childhood experiences using the Childhood Trauma Questionnaire (CTQ). A total of 18 women with BPD and 21 healthy control women were included in the study. Only 1 patient had comorbid posttraumatic stress disorder (PTSD). The volumes of the left (p = 0.005) and right (p = 0.011) DG-CA4 and left (p = 0.007) and right (p = 0.005) CA2–3 subfields were significantly reduced in patients compared with controls. We also found significant group differences for the left (p = 0.032) and right (p = 0.028) CA1, but not for other hippocampal subfields. No associations were found between CTQ scores and subfield volumes. The self-reported CTQ might be inferior to more comprehensive assessments of traumatic experiences. The sample size was moderate. The volumes of stress-sensitive hippocampal subfields are reduced in women with BPD without PTSD. However, the degree to which childhood trauma is responsible for these changes is unclear.