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At least 65 million people suffer from long COVID. Treatment guidelines are unclear, especially pertaining to recommendations of increased activity. This longitudinal study evaluated safety, changes in functional level and sick leave following a concentrated rehabilitation program for patients with long COVID. Seventy-eight patients (19–67 years) participated in a 3-day micro-choice based rehabilitation program with 7-day and 3-month follow-up. Fatigue, functional levels, sick leave, dyspnea and exercise capacity were assessed. No adverse events were reported and 97.4% completed the rehabilitation. Fatigue measured with Chalder Fatigue Questionnaire decreased at 7-days [mean difference (MD = − 4.5, 95% CI − 5.5 to − 3.4) and 3-month (MD = − 5.5, 95% CI − 6.7 to − 4.3). Sick leave rates and dyspnea were reduced (p < 0.001) and exercise capacity and functional level increased (p < 0.001) at 3-month follow-up regardless of severity of fatigue at baseline. Micro-choice based concentrated rehabilitation for patients with long COVID was safe, highly acceptable and showed rapid improvements in fatigue and functional levels, sustaining over time. Even though this is a quasi-experimental study, the findings are of importance addressing the tremendous challenges of disability due to long COVID. Our results are also highly relevant for patients, as they provide the base for an optimistic outlook and evidence supported reason for hope.

Background Several risk factors for anxious-depressive symptomatology during the COVID-19 pandemic have been established. However, few studies have examined the relationship between personality traits, hardiness , and such symptomatology during the pandemic. These constructs might serve as risk- and/or protective factors for such mental distress through the pandemic. Methods A sample of 5783 Norwegians responded to a survey at two time points within the first year of the pandemic. The first data collection was in April 2020 (T1) and the second in December 2020 (T2). Measures included the Ten-Item Personality-Inventory, the Revised Norwegian Dispositional Resilience Scale, and the Patient Health Questionnaire Anxiety and Depression Scale. Analyses were performed using Pearson’s correlations, multiple linear regression, and a moderation analysis. Results Anxious-depressive symptomatology in early phases (T1) of the pandemic was the strongest predictor for the presence of such symptomatology 9 months after the outbreak (T2). Personality and hardiness correlated significantly with mental distress at T1 and T2. Personality traits explained 5% variance in symptoms when controlling for age, gender, solitary living, negative economic impact, and mental distress at baseline. Higher neuroticism predicted higher mental distress, whereas higher conscientiousness and extraversion predicted less mental distress. Hardiness did not explain variance in outcome beyond personality traits. Hardiness did not significantly moderate the relationship between neuroticism and mental distress. Conclusion Individuals with high levels of neuroticism had greater difficulties adapting to the circumstances of the COVID-19 pandemic and were more prone to mental distress. Contrastingly, higher conscientiousness and extraversion may have served as protective factors for mental distress during the pandemic. The current findings might aid identification of vulnerable individuals and groups. Consequently, preventive interventions could be offered to those who need it the most.

Background This study investigated the associations among treatment motivation, patient adherence, and treatment outcomes in a group of outpatients with difficult-to-treat obsessive–compulsive disorder (OCD). Methods A total of 163 relapsed or nonresponding patients were treated with the Bergen 4-day treatment. Motivation was measured with a modified version of the Nijmegen Motivational List 2 (NML2) prior to the start of treatment. During treatment, patients rated their own adherence using the Patient Exposure and Response Prevention (EX/RP) Adherence Scale (PEAS). Treatment outcomes were assessed with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) at posttreatment and 3-month follow-up. Results The NML2 items related to commitment showed a weak but significant association with treatment outcomes but were not significant when patient adherence was controlled for. Higher adherence was strongly associated with better treatment outcomes. Discussion Self-reported motivation before the start of treatment had limited predictive validity, whereas in- and between-session patient adherence, which could reflect one aspect of the motivation construct (treatment engagement), was important for recovery. Trial registration ClinicalTrials.gov identifier: NCT02656342 (First registered: 2015–11–30).

Background Treatment readiness factors, such as treatment credibility and expectancy, are postulated to be predictors of outcomes within the context of cognitive behavioral therapy (CBT). Concentrated exposure therapy (cET) is a form of short-term, intensive, exposure-based CBT that has shown promising results. This study investigated whether treatment expectancy and credibility predict cET treatment outcomes in patients with difficult-to-treat (nonresponders and patients with relapse following CBT) obsessive-compulsive disorder (OCD). Methods A total of 163 patients underwent 4 days of cET treatment. Treatment credibility and expectancy were measured using the Credibility/Expectancy Questionnaire (CEQ) prior to the start of treatment. OCD symptom severity was measured using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) at pretreatment, posttreatment, 3-month follow-up, and 1-year follow-up. Work- and social functioning were measured before treatment and at the 1-year follow-up. Results Higher CEQ scores were significantly associated with lower Y-BOCS score at posttreatment and follow-up after controlling for age, sex, and pretreatment OCD, anxiety, and depression levels. The CEQ scores were also significantly associated with work- and social functioning at the 1-year follow-up. A receiver operating characteristic analysis suggested a mean item cutoff point of 92.5 (0-100 scale) for the CEQ, and 87% of the patients classified as having high expectancy had a positive treatment response. Conclusions This study confirmed that treatment expectancy and credibility are predictors of cET outcomes in patients with OCD. Higher scores on the CEQ were linked to better treatment results, both immediately and up to one year later. These insights highlight the need to consider patients’ attitudes toward treatment in the early treatment phase. Trial registration ClinicalTrials.gov identifier: NCT02656342 (First registered: 2015-11-30).

Background Bergen 4-day treatment (B4DT) is a concentrated exposure-based treatment (cET), where the patient receives concentrated, individually tailored cognitive behavioral therapy (CBT) during four consecutive days. Previous findings have indicated that B4DT could be a promising treatment for panic disorder (PD). Aim The aim of the present study was to evaluate the implementation of B4DT for panic disorder with- and without agoraphobia, at a new clinic. This is the first replication study for B4DT on panic disorder. Method Thirty consecutively recruited patients with PD were included in an open trial design. Assessment of symptoms of panic disorder were measured with Panic Disorder Severity Scale (PDSS), while symptoms of generalized anxiety were assessed by Generalized Anxiety Disorder-7 (GAD-7) and depressive symptoms by Patient Health Questionnaire (PHQ-9) pre-treatment, post-treatment and at 3-month follow-up. Treatment satisfaction was measured with Client Satisfaction Questionnaire (CSQ-8) post-treatment. Results The results showed a significant reduction in symptom severity from pre-treatment to post-treatment (d = 4.32), and at 3-month follow-up (d = 4.91). The proportion of patients classified as fulfilling the criteria for remission was 80.0% at post-treatment and 86.7% at follow up. There was a significant reduction in symptoms of depression and generalized anxiety. Treatment satisfaction was high and none of the patients dropped out. Conclusion The current study replicated the results from the original study and indicate that the treatment can be successfully implemented at new clinics. B4DT may be a promising treatment for panic disorder and comorbid symptoms of generalized anxiety and depression. Larger and more controlled studies are needed to establish the efficacy of B4DT for panic disorder.

Background The Bergen 4-day treatment (B4DT) is a concentrated exposure-based therapy that has been shown to be effective in the treatment of anxiety disorders. The current study sought to examine the effectiveness of B4DT for panic disorder (PD), when delivered with a combination of face-to-face sessions and videoconferencing. Methods Treatment was delivered to 50 patients from April 2020 to May 2021. Because of regulations during the pandemic, a significant portion of the treatment was conducted via videoconference. The primary outcome measure was the clinician-rated Panic Disorder Severity Scale (PDSS), and secondary measures included patient-rated symptoms of panic disorder, agoraphobia, generalized anxiety, depression, and treatment satisfaction. Changes in symptom levels over time were estimated using multilevel models. Results Patients showed a significant reduction in clinician-rated symptoms of panic disorder (Measured by PDSS) from before treatment to post treatment (d = 2.18) and 3-month follow-up (d = 2.01). At three months follow-up 62% of patients were classified as in remission, while 70% reported a clinically significant response. We also found a reduction in symptoms of depression and generalized anxiety, and the patients reported high satisfaction with the treatment. Conclusion The current study suggests that B4DT delivered in a combination of videoconference and face-to-face meetings may be a useful treatment approach. As the study is uncontrolled, future studies should also include more strictly designed investigations.

Background The health care is likely to break down unless we are able to increase the level of functioning for the growing number of patients with complex, chronic illnesses. Hence, novel high-capacity and cost-effective treatments with trans-diagnostic effects are warranted. In accordance with the protocol paper, we aimed to examine the acceptability, satisfaction, and effectiveness of an interdisciplinary micro-choice based concentrated group rehabilitation for patients with chronic low back pain, long COVID, and type 2 diabetes. Methods Patients with low back pain > 4 months sick-leave, long COVID, or type 2 diabetes were included in this clinical trial with pre-post design and 3-month follow-up. The treatment consisted of three phases: (1) preparing for change, (2) the concentrated intervention for 3–4 days, and (3) integrating change into everyday life. Patients were taught and practiced how to monitor and target seemingly insignificant everyday micro-choices, in order to break the patterns where symptoms or habits contributed to decreased levels of functioning or increased health problems. The treatment was delivered to groups (max 10 people) with similar illnesses. Client Satisfaction Questionnaire (CSQ-8)) (1 week), Work and Social Adjustment Scale (WSAS), Brief Illness Perception Questionnaire (BIPQ), and self-rated health status (EQ-5D-5L) were registered at baseline and 3-month follow-up. Results Of the 241 included participants (57% women, mean age 48 years, range 19–84), 99% completed the concentrated treatment. Treatment satisfaction was high with a 28.9 (3.2) mean CSQ-8-score. WSAS improved significantly from baseline to follow-up across diagnoses 20.59 (0.56) to 15.76 (0.56). BIPQ improved from: 22.30 (0.43) to 14.88 (0.47) and EQ-5D-5L: 0.715 (0.01) to 0.779 (0.01)), all P <0.001. Conclusions Across disorders, the novel approach was associated with high acceptability and clinically important improvements in functional levels, illness perception, and health status. As the concentrated micro-choice based treatment format might have the potential to change the way we deliver rehabilitation across diagnoses, we suggest to proceed with a controlled trial. Trial registration ClinicalTrials.gov NCT05234281

Background A concentrated transdiagnostic and micro choice-based group treatment for patients with depression and anxiety has previously shown to yield significant reduction in symptoms and increased level of functioning from pre to 3-month follow-up. In the present study, we report the results after 12 months follow-up. Methods This was a non-randomized clinical intervention pilot study, conducted in line with a published protocol. Sixty-seven consecutively referred patients, aged 19–47 (mean age 32.5, SD  = 8.0) were included and completed treatment. All had a severity of their problems that entitled them to care in the specialist public mental health care. Self-reported age at onset of symptoms was 17.6 ( SD  = 7.9) years. Mean number of prior treatment courses was 3.5 ( SD =  3.3; range 0–20). The main objective was to assess the treatment effectiveness by questionnaires measuring relevant symptoms at pre-treatment, 7 days-, 3 months-, 6 months- and at 12-months follow-up. Results Validated measures of functional impairment (WSAS), depression (PHQ9), anxiety (GAD7), worry (PSWQ), fatigue (CFQ), insomnia (BIS) and illness perception (BIPQ) improved significantly ( p  < .0005) from before treatment to 12 months follow-up, yielding mostly large to extremely large effect sizes (0.89–3.68), whereas some moderate (0.60–0.76). After 12 months, 74% report an overall improvement in problems related to anxiety and depression. Utilization of specialist, public and private mental health care was reported as nonexistent or had decreased for 70% of the patients at 12-month follow up. Conclusions The concentrated, micro-choice based group treatment approach yielded a highly clinically significant reduction in a wide range of symptoms already one week after treatment, and the positive results persisted at 12-month follow-up. Trial registration ClinicalTrials.gov Identifier: NCT05234281, first posted date 10/02/2022.

Background Exposure and response prevention (ERP) is considered the first-line psychotherapy for obsessive-compulsive disorder (OCD). Substantial research supports the effectiveness of ERP, yet a notable portion of patients do not fully respond while others experience relapse. Understanding poor outcomes such as these necessitates further research. This study investigated the role of patient adherence to ERP tasks in concentrated exposure treatment (cET) in a sample who had previously not responded to treatment or relapsed. Method The present study included 163 adults with difficult-to-treat OCD. All patients received cET delivered during four consecutive days. Patients’ treatment adherence was assessed using the Patient EX/RP Adherence Scale (PEAS-P) after the second and third day of treatment. OCD severity was evaluated at post-treatment, 3-month follow-up, and 1-year follow-up by independent evaluators. Results PEAS-P scores during concentrated treatment were associated with OCD-severity at post-treatment, 3-month follow-up, and 1-year follow-up. Moreover, PEAS-P scores predicted 12-month OCD severity adjusting for relevant covariates. Adherence also predicted work- and social functioning at 1-year follow-up. Conclusions These results indicate that ERP adherence during the brief period of cET robustly relates to improvement in OCD symptoms and functioning in both the short and long term. Assessing adherence might identify patients at risk of poor outcomes, while improving adherence may enhance ERP for treatment resistant patients. Trial Registration ClinicalTrials.gov identifier: NCT02656342.

Introduction Bergen 4-Day treatment (B4DT) is a form of concentrated exposure-based cognitive behavioral therapy (CBT) in which patients receive treatment over four consecutive days. Previous studies have shown B4DT to be a promising treatment format for panic disorder (PD), although the long-term stability of treatment gains requires additional study. Aim The aim of the current study was to evaluate the longer-term effectiveness of B4DT for patients with panic disorder with or without agoraphobia. This study extends a previously published study by providing a long-term follow-up of the same cohort ( n  = 30), initially assessed at three months post-treatment. Method Thirty patients with panic disorder were consecutively included in a retrospect open trial. The primary outcome measure was the Panic Disorder Severity Scale. The secondary outcome measures were the Generalized Anxiety Disorder-7 and the Patient Health Questionnaire-9. Outcomes were assessed at pretreatment, posttreatment, 3-month follow-up, and longer-term follow-up (with a mean time of 18 months). Results There was a significant reduction in panic disorder symptoms from pretreatment to longer-term follow-up (d = 5.03, 95% CI [18.55, 21.12] to [1.33, 3.87]). The Panic Disorder Severity Scale (PDSS) mean decreased from 19.83 (SD = 0.64, 95% CI [18.55, 21.12]) before treatment, to 4.37 (SD = 0.64, 95% CI [2.98, 5.76]) post-treatment, followed by further decreases at the 3-month follow-up to a mean of 2.84 (SD = 0.64, 95% CI [1.45, 4.22]), and at the longer-term follow-up to 2.60 (SD = 0.64, 95% CI [1.33, 3.87]). There was no significant difference in symptom severity between the 3-month and 18-month assessments, indicating a sustained improvement ( p  <.001). At the 18-month follow-up, 90% of the patients were classified as being in remission. There were also significant reductions in symptoms of depression ( d =  1.44) and generalized anxiety ( d =  1.62) that were maintained at the longer-term follow-up assessment. Conclusion The results from the current study indicated that the treatment effects of B4DT are stable over time and that the treatment format appears to be promising for PD. Confirming these preliminary results in rigorous study designs is needed. Trial registration The study was approved by the Regional Committee for Medical and Health Research Ethics of Northern Norway (REK Nord-2021/209619).