Psychotherapy & Psychopathology
A foundation in dimensional understanding of psychopathology governs psychopathological and psychosocial intervention studies in Region Zealand. Research within evidence-based treatment is supported by new research designs both within intervention studies and systematic reviews, through the development and testing of new recovery-oriented forms of psychotherapy and through a focus on building digital tools for investigation, treatment monitoring, e-therapy and supervision.
Research projects
The use of non-invasive brain stimulation has been proposed as a non-pharmacological treatment strategy for children and adolescents with ADHD. Trigeminal nerve stimulation (TNS) is an effective treatment method in children with ADHD.
Based on a recent randomized clinical trial by McGough et al (2019), which investigated TNS treatment on ADHD symptoms in children and adolescents, the U.S. Food and Drug Administration (FDA) approved the use of a specific TNS device in 2019 for symptom treatment in children and adolescence with ADHD. In this project, we will test the device in a larger randomized clinical trial - initially as a so-called "feasibility trial", with 30 children and young people, and if the project proves feasible, we will conduct the large trial, in which, in addition to including more participants will include a more in-depth study of the effectiveness of devices for treating ADHD in children and young people. The project will be conducted in collaboration with the child and adolescent psychiatry in the region of Southern Denmark.
I am working on a research project regarding the VideoVignet library that was created at Psykiatrien Vest, Slagelse. The VideoVignet library contains over 20 authentic patient video recordings; it was created with learning in mind, especially the mental status exam that is an analyzing tool in psychiatry.
The research project goal is to look into whether authentic patient videos makes medical students better at performing a mental status exam, as well as exploring if this type of learning makes a difference. This is done by dividing the students into two groups, the first gets access to a course room with the VideoVignet library, the latter gets access to a course room without the VideoVignet library. In both course rooms, there is additional learning material. The course rooms are found on the the intranet of the university.
The students have access to the course room for a limited time. Hereafter they are tested on three videovignets that no one has had access to, wherein they have to fill out a multiple-choice questioner based on the video.
Besides the multiple-choice questioner, the project also contains an analysis on their use of the course rooms and their evaluations of the course rooms.
A pragmatic randomized clinical trial (DAN-PACT) of paediatric autism communication therapy (PACT) combined with usual care, and compared to usual care alone in children aged 2-6 years with autism.
DIPNOT is a research project that aims to improve the therapeutic treatment for patients with depression in outpatient psychiatry. In this project, individual patient-centered add-on interventions will be developed and they will be offered to patients who are not on track during group therapy.
People with depression are often offered group-based Cognitive Behavioral Therapy (CBT) in Danish Mental Health Care Services. CBT is an evidence-based treatment and is recommended in the guidelines for the treatment of depression that is developed by the National Institute for Health and Care Excellence. Nevertheless, about 50% of patients with depression do not experience a positive change when having participated in CBT. Progress monitoring of therapy outcomes is a way to identify those patients that need other or additional treatment in order to gain improvement. In the present project, we will develop an intervention called DIPNOT. DIPNOT is a combination of progress monitoring, clinical support tools, and add-on interventions that are tailored to the individual patient. The development of DIPNOT will consist of two sub-studies. In the first study, we will follow patients with depression who participate in group CBT. We will conduct progress monitoring, and the therapists will receive warnings and clinical support tools in case a patient does not seem to improve. By including visual illustrations of patients' symptom progress in interviews with patients and therapists, we will explore their experiences and thoughts about what was and could have been helpful. Based on the results of study 1, study 2 focuses on those patients that are persistently not on track. We will implement a selection of add-on interventions, consisting of 3-5 individual sessions with different content. After the therapy course, we will conduct interviews with the patients and their therapists concerning their experiences of the new intervention where some of the patients participated in extra sessions.
The Copenhagen Child Cohort (CCC2000) is a longitudinal birth-cohort study with a unique data set that enables studies of developmental psychopathology, including the developmental pathways from subclinical psychotic experiences (PE) to manifest psychotic disorders.
In collaboration with PhD student Mikaela Tracy, University of Sydney (P.I. Louise Sharpe, PhD).
The project will investigate the effects and adverse effects of pharmacological treatment for patients with borderline personality disorder (BPD) by using a review of the literature on randomized clinical trials. The project is a follow-up to Stoffers 2010, which found 28 trials (n=1742) which investigated the effect of antipsychotic, antidepressant and mood stabilizing medication (including omega 3 fatty acids) for use in patients with BPD. The conclusion was that the effect sizes was very small and one should be careful in drawing conclusions based on these. The studies were also of poor scientific quality (high risk of bias).
Our updated review was published in the Cochrane Library in November 2022.
Although this review includes an additional 18 randomised clinical trials, the conclusions remain the same: There are probably no benefits and risks of pharmacological treatment of borderline personality disorder (BPD), but the evidence is inconclusive. There is a need for better and larger trials comparing the effect of medication with placebo. Such studies should focus on men, youth, and those with additional psychiatric diagnoses. A co-publication of this updated review is under development and will be completed in 2023.
International collaborative project evaluating the reliability and validity of the LPFS-BF and PDS-ICD-11 scales across 34 countries and 19 languages (P.I. Adam Natoli, PhD, Sam Houston University).
Background: Schizotypal Disorder is a mental illness within the spectra of schizophrenia. The symptoms resembles those of schizophrenia, but are less pronounced. Due to lack of studies, it is not possible to make an evidence-based treatment for the group of patients.
Smaller studies have studied the effects of a more activity-focused approach (activity therapy, expressive arts therapy) for patients with schizophrenia, but not for schizotypal disorder.
Methods: In this pilot study, we offer a group of patients with schizotypal disorder group therapy with Expressive Art Therapy. We intend to test our hypothesis, higher daily well-being and less social anxiety. Seven patients (18-40 years old) participate in the study. After thorough diagnostic assessment to assure schizotypal disorder is present, a 26 session course with Expressive Art Therapy starts. The creation of art and a strong focus on engaging the senses will be in focus.
Results: We use frequent measures before, under and after the 26 weeks program (WHO-5 well-being) to test for changes in well-being. The participants answers on a mobile application. Furthermore, qualitative interviews with participants and therapist will be conducted, and analyzed with a thematic analysis approach.
The aim of my PhD-project is to identify potential predictors of mental health service use to explore windows of opportunities to change the trajectories for youths with mental health problems. The project will combine observational studies based on two different cohorts, Mind My Mind (MMM) and Copenhagen Child Cohort 2000 (CCC2000). The first study examines the utility of a stage-based stepped care approach in a municipal setting in Denmark by exploring register-based outcomes following the stage-based visitation process of the MMM study prior to randomization. The second study examines the predictors of later need for specialized psychiatric care among youths who were deemed eligible for indicated prevention in the MMM randomized controlled trial. We will explore a range of factors as potential predictors of poor long-term outcome, including both questionnaire data and research diagnoses of mental disorders using the Development and Well-Being Assessment (DAWBA). The third study will be a 10-year follow-up on CCC2000, a large, prospective cohort study where we will examine the predictive capacities of the DAWBA by examining clinically important outcomes through the Danish registers until the age of 21. The hope is to contribute with knowledge, which enables the formation base of a proportionate visitation process.
Evaluating of ICD-11 classification of personality disorder in prominent features of vulnerable versus grandiose narcissism (P.I. Ava Green, PhD, University of London).
The Neurocognitive Markers in Autism Project (neuroMAP) examines how neurobiological, sensory, verbal and social-communicate markers are associated with autistic traits, emotional problems and level of functioning in autistic children and their peers. Participants have undergone cognitive and psychiatric evaluation with standardized instruments, experimental testing of sensory, verbal and social-communicative vulnerabilities, brain activity with electroencephalography (EEG) and structure using magnetic resonance imaging (MRI).
A Cochrane systematic review investigating the effects of methylphenidate for children and adolescence with ADHD was published in 2015. The review was published in Cochrane Library, the BMJ and in JAMA. This review had been cited 250 times (Dimensions) and has been used in eight clinical guidelines. Furthermore, the review has had an essential role in the WHO decision not to place methylphenidate on the list of essential pharmaceuticals for ADHD. The debate on the use of methylphenidate as a treatment for ADHD has been put on both the national and international policy agenda due to our publication. The review has reached its fifth year and will be updated in 2023. The update of the review is of great importance since there is still disagreement internationally on the effect of methylphenidate despite the results.
We expect to find new trials that can be included in the pre-existing analyses and also more unpublished data due to the granting by the European Medicines agency of open access to the Clinical Study Reports database (CRS).
By using individual participant data meta-analyses, this project aims to investigate predictors of treatment effects on specialized psychotherapies compared to treatment as usual, other active treatments or waitlist/no intervention in people with borderline personality disorder. The IPD-BPD project investigates the effect of psychotherapy on three outcome sets: borderline symptom severity and interpersonal functioning, self-harm and suicide related outcomes, and quality of life and psychosocial functioning.
Psychotherapy is the recommended treatment for borderline personality disorder in guidelines worldwide and the beneficial effects of psychotherapy are undisputed. Diagnostic criteria however makes for a largely heterogenic patient group, and people with borderline personality disorder do not necessarily present clinically with the same symptomatic behaviors. Some people might have a better effect of some types of psychotherapy compared to others but information regarding predictors and moderators of treatment effects across psychotherapies is yet to be unfolded. The IPD-BPD project investigates whether characteristics such as age, gender, comorbidities and other personal and clinical variables can affect treatment outcomes in psychotherapy for people with borderline personality disorder. Identifying such variables is key in guiding the clinical treatment choice so it matches the individual optimally and exerts the best possible effect.
Currently, there is no treatment for PTSD in patients with psychosis in psychiatric services and there is extremely little evidence in this area. Based on a systematic review of the literature, an expert group with experience from psychosis and trauma therapy modified an evidenced based CBT manual for the treatment of PTSD so that it is could be suitable for people with psychosis.
The purpose of this study is to investigate the feasibility of treating PTSD in 10 patients with psychosis. Evaluation consists of three parts:
- Case study with measurement of the effect of treatment on psychopathology and functioning
- Qualitative interviews with staff about the implementation of treatment in clinical practice
- Qualitative interviews with patients about their experience of participating in treatment
Information from the case study will provide insight into the implementation of the intervention as well as the patients' response to treatment. Qualitative interviews with patients and staff can provide some detailed information about their experiences throughout the treatment process. Information from this study will be used to identify positive and negative aspects of treatment in terms of further developing and adapting the therapy for PTSD for people with psychosis.
I am currently working on three different but overlapping projects. The first project goes by the name Patient-Report Outcome Measurement – Personality Anxiety Depression (PROM-PAD), where multidimensional self-report data have been collected from the general population, which can provide a normative foundation for a trustworthy interpretation of these outcomes in clinical settings (e.g., personality, anxiety, and depression scales). My particular focus is on scales that measure the severity of personality dysfunction as well as individual personality traits cf. new ICD-11 classification (P.I. Bo Bach, PhD).
PROM-PAD II består af data fra personer som aktuelt står registreret i Sundhedsdatastyrelsens landspatientregister (LPR) med en ICD-10 diagnose for relevante psykiske lidelser (bl.a. personlighedsforstyrrelse, angst og depression). Disse data skal danne grundlag for estimering af forventede scores og grænseværdier hos forskellige psykiatriske populationer. Der er særlig fokus på skalaer, der måler sværhedsgrad af personlighedsdysfunktion samt individuelle personlighedstræk jf. ny ICD-11 klassifikation (P.I. er Bo Bach, PhD).
Recent evidence indicates that measures of brain functioning as recorded on the electroencephalogram (EEG) are more closely associated with transdiagnostic measures of psychopathology (TDP) than with diagnostic categories. In this project we apply cutting-edge single-trial analysis methods to evaluate the associations between several classic event-related potentials (ERPs) on the EEG and measures of TDP at the group and symptom levels. We aim to recruit 45 patients with emotional disorders (agoraphobia, depression, generalized anxiety disorder, obsessive-compulsive disorder, social phobia and panic disorder) undergoing 14 weeks of transdiagnostic Unified Protocol group psychotherapy as well as 45 healthy controls matched in age and sex. In the first study, we examine differences in ERPs at baseline between groups based on the ‘Distress’ and ‘Fear’ subfactors in the transdiagnostic framework the Hierarchical Taxonomy of Psychopathology. In the second, we look for correlations between ERPs and measures of TDP assessed before, during and after psychotherapy. In the third, we examine whether ERPs at baseline can predict psychotherapy outcome. To find associations between measures of brain functioning and symptoms and treatment outcome would be an important step toward non-invasive biomarkers in psychiatry.
"The Borderline Conditions" project examines how maladaptive personality traits and functioning in adults with borderline personality disorder and schizotypal personality disorder are associated with sensory vulnerability, emotion recognition, semantic cognition and verbal communication.
The PDS-ICD-11 scale has now also been employed in clinical settings and in other research projects across several WHO member countries. Currently, the scale is being adapted to a clinician-rating format, named PDS-ICD-11 Clinician-Rating Form, which first of all is being evaluated internationally (P.I. Bo Bach, PhD).
Most children and adolescents with autism show a sensory vulnerability, and despite sensory sensitivity is a diagnostic criterion for autism, we still lack objective methods to screen for sensory sensitivity. Studies suggest that children with autism have an imbalance in the way sensory input is processed, which appears to entail a vulnerability to perceptual complexity and sensory noise.
The project group seeks to up-qualify early detection of autism and to promote mental health in children and adolescents with autism and, have therefore developed two user-friendly digital test paradigms that measure how visual sensory noise and perceptual complexity affect the child's attentional control and working memory. The tests are designed to be carried out on a touch-screen-tablet and can be implemented in clinical practice at low cost if the tests meet scientific standards for proof-of-concept.
The PhD-project aims to investigate whether the attention of children with autism is vulnerable to perceptual complexity and visual noise, and how perceptual sensitivity is associated with autistic traits, functional levels, and variations in brain structure. Sixty children with autism aged 7-14 years and 86 matched controls underwent autism screening, cognitive examinations, clinical observations, parent- and teacher reports, and were scanned with magnetic resonance imaging (MRI).
The visual search paradigm from the projects 1st phase. The paradigm is possible to operate independently on a tablet after very short instructions. The trial starts when the individual pushes the green button, a target is then presented in the upper field, where after the visual search field presents the identical target hidden amongst distractors. The visual search time is sampled from presentation of the search field until the target is identified and represent the child's visual sensitivity and attentional control.
Adresse
Psykiatrien Region Sjælland
Psykiatrisk Forskningsenhed
Bygning 3
Fælledvej 6, 4. sal
4200 Slagelse
Ring til os
Tlf. 58 53 60 70
Tlf. 58 53 60 70Opdateret fredag den 25. aug. 2023