Purpose Research indicates that exam anxiety may decline with mindfulness-based interventions but there is a lack of research on adolescents’ accounts of the processes involved. We explored high-school students’ descriptions of how they perceived and applied mindfulness in managing anxiety-inducing thoughts related to academic performance following an 8-week Mindfulness-Based Stress Reduction (MBSR) course. Method Post-course individual semi-structured interviews with 22 high school students (2 males, mean age 17.8 years) were transcribed verbatim and analysed using reflexive thematic analysis. Results The analyses identified six themes: (1) Noticing and attending to the attention-binding “maelstrom” of anxious thoughts and feelings (2) Attending to the breath to cope with the maelstrom, (3) “removing” and “getting rid of” anxious thoughts (4) Being able to “think” (5) awareness of more helpful thoughts, and (6) Agency and control. The findings are discussed in light of the Buddhist notion of “unwholesome thoughts” and the distinction between thought suppression and the use of breathing as a benign distraction. We propose that mindfulness encompasses both a receptive, nonjudgmental awareness and an active, intentional redirection of attention. Conclusion Mindfulness training aided participants by enhancing their capacity to disengage from fear-engaging thoughts, thereby maintaining them within their window of tolerance and facilitating cognitive processing.

This study evaluates a mindful eating-based program for people with self-reported binge eating problems. The study was initiated by a non-governmental eating disorder interest organization. Participants met once a week over eight weeks. The Eating Disorder Questionnaire (EDE-Q) and three subscales of the Self-Compassion Scale (SCS) were used to measure eating pathology, self-compassion and mindfulness before, after, and six-months after the program. Results: Significant improvements in EDE-Q and SCS scores were found, and results remained stable at the six-month follow-up. The number of binge eating days decreased significantly during the study, both from before to after program participation, and from post-program participation to six-month follow-up. Conclusion: Future studies investigating the current program are clearly needed. These preliminary results are nonetheless encouraging and illustrate that mindful eating-based interventions as an interesting treatment avenue for individuals with binge eating pathology, a group which currently has few treatment options available to them.

This paper examines the existential context of physical and mental health. Hans Georg Gadamer and The World Health Organization's conceptualizations are discussed, and current medicalized and idealized views on health are critically examined. The existential dimension of health is explored in the light of theories of selfhood consisting of different parts, Irvin Yalom's approach to "ultimate concerns" and Martin Heidegger's conceptualization of "existentials." We often become aware of health as an existential concern during times of illness, and health and illness can co-exist. The paper discusses how existential suffering in Western culture is described, to an increasing degree, as disorders or psychological deficits, and perfectionistic health goals easily can become a problem. We seek to avoid suffering rather than relate to it, with all the tension that may create. The paper argues that suffering is an unavoidable aspect of people's experience of their lives, and actively relating to suffering must be regarded as a fundamental aspect of health. The need and usefulness of a concept of "existential health" is discussed.

This paper examines the psychology of existential guilt with Martin Heidegger and Rollo May's conceptualizations as the point of departure. The concept of existential guilt describes preconditions for responsibility and accountability in life choices and the relationship to the potential given in the life of a human. It might also be used as a starting point to examine an individual's relationship to the potential offered in their life and life context and, in this way, the hitherto unlived life of an individual. The following questions are discussed in contexts of identity development, perfectionism, and current cultural shifts in conceptualizations of selfhood: How can humans relate to the fact that only limited parts of who they might be can ever be actualized? Moreover, how can they relate to the fundamental ambiguity and "groundlessness" in the contexts of life where choices are made? There are striking parallels between the role of exploration in the Eriksonian approaches to healthy identity development and the ontological groundlessness that stands out as a premise for existential guilt. There are also parallels between identity fore-closure and normative identity styles and "falling" into das Man in the existential framework. Perfectionistic ideals easily become an objectivization - and closure - of possible alternatives and choices. In contemporary theories of constructions of selfhood, the dangers of alienation from the community on the one hand and escape into what might become totalitarian collectivism on the other is pointed out. The contextualization of personal responsibility offered through the concept of existential guilt might address both dangers. It provides a perspective on how personal responsibility is embedded in contexts of human relationships, relationships to nature, and the finitude, freedom, uncertainties, and suffering that is given through human existence. Existential guilt can wake sorrow and regret over opportunities overlooked and lost. However, most of all, it can be seen as a drive toward repair in the relationship toward both oneself and the other. It takes the form of receptivity, an openness to a life not yet lived, and creative use of imagination.

This paper explores the role of existential vulnerability in the experience of personal identity and how identity is found and created. Existential vulnerabilities mark a boundary between what humans can bring about willfully or manipulate to their advantage and what is resistant to such actions. These vulnerabilities have their origin, on an ontological level, in fundamental conditions of human existence. At the same time, they have implications on a psychological level when it comes to self-experience and identity formation. Narrative and value-based identity depend on how a person relates to finitude and the ambiguous side of lived experience. Relational identity depends on how a person relates to existential aloneness and the fact that the meaning and value of our actions are partly out of our control; they are always also dependent on other people's responses to us. Bodily identity makes us feel continuous and real, but at the same time vulnerable to death and the gaze and actions of others. Being 'thrown' into an arbitrary life context is also a form of existential vulnerability. Authentic psychological identities can develop by giving meaning to these circumstances and balancing acceptance of existential vulnerability with the courage to make choices and act.

BackgroundParents play a crucial role in the development, maintenance, and deterioration of child difficulties. Emotion focused skills training (EFST) targets parents’ capacity to provide their child with emotion-oriented skills in order to promote good child mental health. Few qualitative studies have specifically investigated parents’ experiences of receiving such programs.ObjectiveThis study aimed to explore how parents experience working with their own and their child’s emotions undergoing a short-term program in EFST; in particular, changes in their experience of being a parent and in everyday life are reported.MethodSemi-structured in-depth qualitative interviews were conducted with 14 parents who had completed a short-term EFST program (2-day group training and 6 h of supervision). Interview transcripts were analyzed using a reflexive thematic analysis approach.ResultsA total of 14 parents (40% men, four couples, Mage = 39.5, SD = 4.4) participated in the study. Our analysis resulted in the following three themes: (1) “Coming home” as a parent, with the following subthemes: (a) New ways of being with their child and (b) Parents’ painful inner world; (2) Reclaiming parenthood—applying new tools and learning in challenging situations; and (3) This is us—changing the heart of the story. The first theme was related to the descriptions of the changes that emerged in parents’ inner lives, the second revolved around the employment of their skills intuitively and creatively based on what was required by the challenging situations, and the third theme referred to new discoveries on family dynamics.ConclusionParents’ experiences of having wisdom and calmness inside them (being) and doing parenting differently, as well as the changed perspectives of the family (living), resonate with the theoretical ground of emotion-focused therapy (EFT). The findings also indicate that therapists should be aware of potential parental distress when working in view of changing unpleasant emotions in such skill-based programs.

Despite a seemingly higher need, refugees in Europe tend to underuse mental health (MH) services. To better understand this underuse, it is important to understand refugees' willingness and ability to seek help from their general practitioner (GP) when experiencing MH problems. We employed a combined vignette and survey design to explore how the GP fits into the larger context of help-seeking preferences among a sample of Syrian refugees in Norway (n = 92), and what barriers they perceive in accessing help from the GP. We also examined how indicators of integration relate to seeking help from the GP. We take an exploratory approach. Participants were presented a vignette of an individual with symptoms in line with ICD-10 and DSM-5 criteria for depression. Participants were somewhat likely to seek help from the GP; however, seeking help from one's relationship with Allah/God and one's partner was preferred. Furthermore, while the GP was rated a somewhat likely help-seeking source, most participants indicated an average of two barriers to seeking help from the GP. Finally, social ties to the majority population in the form of social integration and feelings of connectedness with the host country (psychological integration) were positively correlated with likelihood of seeking help from the GP. Taken together, these findings suggest that the GP is considered a viable source of help among Syrians with a refugee background in the current sample, but that this may be influenced by perceived barriers and social as well as psychological integration. Addressing these barriers and promoting psychosocial integration with the host country are key to facilitating access and usage amongst refugees in need of MH services.

Objectives Refugees in comparison with non-refugee patients may face higher unmet mental healthcare needs. The mechanisms underlying these disparities are still poorly understood. The general practitioner (GP) plays a vital role in refugees’ mental health (MH), managing complaints within primary care and acting as gatekeeper to specialist services. However, GPs have reported feeling uncertain about working with refugee patients. Somalis make up one of the largest refugee groups in Norway and use primary care services more than the majority population for physical health, although not for MH. The current study examines GPs’ management of MH complaints in Somali refugee versus Norwegian vignette characters and the role of GP clinical uncertainty. Design We distributed an online experimental survey to GPs in Norway (n=133), who were randomised to watch a simulated consultation with a female Norwegian, female Somali, male Norwegian or male Somali vignette character, presenting the same symptoms of depression. GPs indicated which diagnoses, assessments and treatments they would endorse for the patient and their level of certainty. Outcome measures We calculated Simpson indices to measure inter-rater reliability and 2×2 analysis of variances as well as Bayesian estimation to examine clinical certainty based on patient background and gender. Results GPs’ clinical decisions about Somali and Norwegian vignette characters were similar, with a few exceptions. There was less consensus regarding the first prioritised diagnosis for Somali characters (Simpson index=0.129) versus Norwegian characters (Simpson index=0.208), (p=0.011, one-tailed). Somalis more frequently received diagnoses of post-traumatic stress disorder (PTSD), while Norwegians received diagnoses of feeling depressed. GPs endorsed sick leave more often for Norwegian characters and medication for physical complaints for Somali characters. There were no substantial differences in GPs’ self-reported certainty. Conclusions We found few and relatively small effects of patient background and gender on GPs’ clinical decisions. Nevertheless, the validity of certain diagnoses and prescription of sick leave need to be considered by clinicians and in future research.

Background: Perfectionism is increasing over time and associated with various mental health problems. Recent research indicates adverse childhood experiences may play a role in the development of perfectionism. In addition, perfectionism is marked by interpersonal problems with implications for treatment outcome.Aim: This study aimed to fill an important gap in the predominantly quantitative literature field by exploring how individuals with perfectionism understand the relationship between painful experiences and how they relate to others.Method: Nine individuals with perfectionism were interviewed using McAdam's life-story interview. Thematic analysis was used to analyze the interviews.Results: Four themes emerged: “A childhood with big responsibilities,” “I am still the responsible one,” “Keeping others at a distance to protect the inner self,” and “Achieving physical distance to get a fresh start.” These themes are grouped into two overarching themes: “You can't always trust people” and “A distancing from others.”Conclusion: Findings highlight taking responsibility and social distancing serve an important function for perfectionistic individuals in response to painful relational events. We discuss how themes of control and agency impact individuals' relationship to mental health and turning toward others for help. The findings provide greater complexity to understanding perfectionism as a “barrier to treatment.”

Objective: Due to a rise in perfectionistic tendencies and growing concerns about the increase in mental health conditions among students this study aimed to examine the effects of a brief intervention in self-compassion on maladaptive perfectionism, anxiety, depression, and body image. Methods: The intervention consisted of four seminars and a silent half-day retreat with short lectures and relevant experiential practices from Mindful Self-Compassion (MSC) and Mindfulness Based Stress Reduction (MBSR). This randomized wait-list control trial was pre-registered at Clinicaltrials.gov (ID: NCT03453437, Unique Protocol ID: UiBMSC2018). University students were randomly assigned to the intervention group and wait-list control group and filled out surveys weekly. A repeated measures analysis of variance (ANOVA) was used to compare the groups pre- and post-treatment. Mixed level modeling was used to analyze changes in all outcome measures over time. Results: Eighty-nine participants completed the intervention. Results of the ANOVA showed significant post-intervention reductions in maladaptive perfectionistic tendencies and symptoms of depression and anxiety, in addition to increased self-compassion and improved body image in the intervention group as compared to the wait-list group. Mixed level modeling showed statistically significant changes in self-compassion, maladaptive perfectionism, adaptive perfectionism, anxiety, and depression but not body image. Only the mixed level modeling showed small but significant changes to adaptive perfectionism, also called strivings. Implications of different changes to maladaptive perfectionism than adaptive perfectionism are discussed.

Mindfulness has become an integrated element in many psychotherapy approaches. It has also been embraced by media, the self-help industry, and popular culture. This paper will address the question: Is the explosive growth in mindfulness approaches a success-story? We will address some concerns on both a clinical and sociopolitical level. The authors have both been, and still are, enthusiastic about the potential of mindfulness-based approaches. Mindfulness-meditation has proven its value as a mental health intervention for a relatively broad range of clinical symptoms and disorders. However, they do not seem to work for all. There are reasons to be concerned about meditation's potential for having harmful as well as helpful effects. When mindfulness is decontextualized from its Buddhist roots, this often leaves the meditator alone, without both a community and a conceptual framework to give meaning to their experiences. Mindfulness is often presented as a panacea for all types of stress-related problems in society. It might join forces with an individualistic do-it-yourself culture. Decontextualization of stress - and its solutions - might mask real social problems that require political solutions. However, suffering occurs in even the very best of societies; it arises both from social structures and the conditions of human existence. At all times, individuals have sought ways to improve their lives, and mindfulness offers a broad range of valuable practices. An in between is needed, combining the healthy energy of enthusiasm with critical inquiry and awareness of the limitations of mindfulness-based approaches to psychotherapy.

Refugees suffer from higher rates of certain mental health problems than non-refugee migrants and the native population of their host country. General practitioners (GPs) in Norway and many other European countries are the first contact person for settled refugees in need of non-emergency medical support. This includes psychiatric support, although GPs are not typically specialists in psychiatry. The aim of this study is to investigate how GPs experience working with refugees suffering from mental health problems, with a specific focus on perceived challenges and facilitators. We conducted semi-structured interviews with 15 GPs working in Norway (7 females). Participants ages ranged from 29 to 67 (M = 41.7 years, SD = 11.1) with work experience ranging from 2 to 39 years (M = 13.6 years, SD = 12.1). Interviews were analysed thematically using the qualitative data analysis computer software package NVivo 12. The main challenges presented by GPs relate to language barriers, mismatched expectations, different understandings of health and illness, and the GP feeling unprepared to work with this patient group. The main facilitating themes related to establishing trust and finding the work meaningful. The themes presented in this study highlight areas of interest for future research, and should inform training programmes to improve health care for both clinicians and refugee patients.

Comprehending professionals' emotional challenges when addressing child abuse can help to improve identification, protection, and care for exposed children. This study presents an interpretive description analysis of qualitative interviews with ten child protective services workers and nine child mental health services psychologists in Norway. The participants described intense negative reactions due to addressing child abuse during assessments and investigations. We identified five main themes: (a) facing children's suffering caused by adults, (b) feeling mean, (c) doubting one's ability and skills, (d) feeling that one is betraying children, and (e) being obstructed by heavy workload and dysfunctional structure. To improve professionals' capacity to help exposed children, it is necessary to change the organizational structure and culture. In addition, professionals would benefit from systematic training in handling complexity and in efficient emotion regulation. Finally, we strongly suggest that institutions responsible for investigating child abuse facilitate and prioritize deliberate practice for their staff.

Objective: The aim of this study was to study how participants used a mindfulness-based program—Mindfulness Based Relapse Prevention to reduce use of habit-forming prescription drugs after long-term use. We explored participants' descriptions of their post-intervention strategies for controlling medication intake. Method: Eighteen participants provided semi-structured qualitative interviews shortly after completion of the program and 13 participants were also interviewed 1 year after completion. Participants were asked about the conditions that originally led to use of medication, how they had attempted prior to the course to cope with problems associated with these conditions and their prescription drug-use, and whether and how their coping strategies had changed after participation in the program. Thematic analysis was performed within the framework of a realist epistemology, with an emphasis on researcher reflexivity. Results: The following themes were identified in the material: Increased present-moment sensory awareness, Observing without controlling, Self-acceptance, Making conscious choices, Non-judgmental self-guidance, Sense of control, and Challenges of learning and using mindfulness. Although these findings are closely related to the specific needs of our sample—mainly coping with tapering use of prescription drugs—they are largely in line with existing research on mindfulness interventions. An exception is the theme “Non-judgmental self-guidance,” which encompasses change in individuals' inner dialogue and practical self-care. Conclusions: Analyses suggested that mindfulness might increase individuals' control over medication intake by shifting individuals' attention toward present-moment sensory awareness of concrete stimuli, thereby facilitating other kinds of control, such as non-judgmental inner self-guidance and more adaptive ways of reducing distress. We suggest that it is the moment-to-moment sensory awareness and non-controlling observation of distress, together with inner self-guidance, that differentiates mindful control from dysfunctional attempts at direct, top down control of medication-use.

In the investigation of a criminal event, the police may encounter witnesses or victims experiencing symptoms of being traumatized (e.g. anxiety, intrusive thoughts or avoidance of trauma-related stimuli). This may pose a challenge in investigative interviews where police interviewers aim to obtain reliable and detailed accounts. Based on previous theory and research, this theoretical paper aims to outline recommendations for police interviewers for approaching traumatized adult witnesses to facilitate communication, attend to the well-being of the individual and reach investigative aims. First, factors considered important for preparing for the interview and building rapport are presented. Then, different aspects of how to facilitate the interviewee's account will be described with an emphasis on how police interviewers can approach emotional reactions to maintain rapport.

I boken «Generasjon prestasjon – hva er det som feiler oss?» undersøker Ole Jacob Madsen hvordan det terapeutiske og diagnostiserende språket psykologprofesjonen tilbyr ungdommen, reduserer deres selverkjennelse. Det begrenser både samfunnets forståelse av en ungdomsgenerasjon, og deres forståelse av seg selv. Livet som sådan er tidvis smertefullt. I tråd med Hackings imitasjons- og internaliseringsmodell og teori om selvfortolkninger påpeker Madsen at det diagnostiske ikke bare suggererer frem lidelse – det blir også et språk og et uttrykk for lidelse. Språk og lidelsesfortolkninger kan være både lukkende og frigjørende. For «generasjon prestasjon» kan terapi og diagnosespråket bli låsende. For alle de unge som ikke er spesielt prestasjonsorienterte, og som oftest er dem som virkelig strever med psykisk uhelse, så etterlater generasjonsdiagnosen et stort tomrom.

Therapist self-disclosure is one of the most controversial topics in the history of psychotherapy. The controversies reflect some basic discussions regarding the nature of psychotherapy practice. In psychotherapy practice, a particular concern is the interaction between the psychotherapist and the patient. The expert-patient interaction has been addressed in a novel framework for clinical practice called shared-decision making. In this paper, we discuss the relationship between self-disclosure and shared-decision making. The chief aim is to illustrate some of the principles and practical problems with shared-decision making by using therapist self-disclosure as an example.

This qualitative study investigated ways in which student participants in a three-session self-compassion course became more compassionate toward themselves and challenges related to this change. Ninety-four participants completed an online survey and 12 participants were interviewed face-to-face. First, a thematic analysis of the responses from the online survey was conducted, and then sorted by frequency, indicating their representativeness in the written responses. The following themes were identified: (1) being more supportive and friendlier toward self, (2) being more aware of being too hard on oneself, (3) feeling less alone when having painful feelings, (4) having more acceptance of painful feelings, and (5) feeling more stable and peaceful. These five most frequent themes served as a basis for a structured phenomenological analysis in the next analytic stage. They were used as a template for a content analysis of the interview material. Subsequently, a phenomenological analysis was conducted on the interview transcripts covering the five thematic areas.

Background Extensive research documents that child abuse is widespread and that it has detrimental effects on victims’ physical, psychological and social well-being. Efforts to help abused children by removing stressors and administering restorative care can reverse these negative effects, but the evidence suggests that professionals often fail to expose child abuse. This study aims to generate insight into professionals’ experiences with facilitators in handling the challenges of addressing abuse in child interviews. We expect that this knowledge can improve interventions that qualify professionals in the identification, protection and care of abused children. Methods Within the qualitative approach and an Interpretive Description framework, we performed in-depth interviews with nineteen participants from southern Norway, specifically ten social workers from child protective services and nine psychologists from child mental health services. Then, Interpretive Description analysis was performed by using constant comparison, reflexive and critical examinations, and contextualized theoretical interpretations. Results The participants’ accounts revealed that various facilitators relative to the stages of the skill development and intrinsic motivation of the practitioner enhance the explorative work of the professional. We identified the following five main themes: (a) alleviating personal choice ; (b) collective accountability ; (c) sharing vulnerability ; (d) finding your own way ; and (e) doing it for the right reasons . Conclusions To facilitate explorative work, our findings suggest that competence development should apply goal-directed reflective practice combined with positive feedback on performance. Furthermore, our results indicate that developing personal competence is contingent on supporting individual choice and volition while decreasing demands towards following rules and guidelines. To promote the relatedness and the emotion regulation of professionals, we suggest endorsing shared vulnerability with colleagues and promoting an organizational culture that supports openness and allows professionals to discuss their emotions when addressing difficult and complex issues. It is also advisable to promote autonomy by helping professionals to find meaning in their work that is compatible with their personal values.