Nutritional treatment is a cornerstone in treatment of anorexia nervosa (AN). However, the interplay between diet and appetite hormones in the gut-brain axis remains poorly understood in AN, particularly during treatment. This study assessed the effects of 12-week inpatient treatment on appetite-related biomarker profiles in patients with AN, compared these profiles with healthy controls (HCs), and explored associations between appetite-related biomarkers, clinical characteristics and diet. In this exploratory study, we included 42 patients with AN undergoing inpatient treatment and 42 age-matched HCs from the Norwegian Microbiota Study in AN (NORMA). Data was collected at baseline, after 6 and 12 weeks of treatment for patients with AN, and at baseline for HCs. Appetite-related biomarkers were measured in serum using Luminex technology and dietary intake was recorded via a 3-day digital food diary/interview. Statistical analyses included group comparisons, regression models, mixed-effects models, and correlation analyses. Compared to HCs, patients exhibited significantly lower levels of adipsin, leptin, insulin, and resistin, and higher levels of adiponectin and glucose-dependent insulinotropic polypeptide (GIP) at baseline, with a trend for ghrelin (p = 0.08). Group differences in glucagon-like-peptide-1 (GLP-1) and glucagon were higher in older patients. No baseline differences were observed for C-peptide, plasminogen activator inhibitor-1, or visfatin. After 12 weeks, mean BMI had increased significantly in patients with AN from 15.5 to 18.2 kg/m², adipsin, leptin, insulin, and C-peptide increased while ghrelin decreased and approached that of HCs. Glucagon, adiponectin, GIP, and GLP-1 were largely resistant to change. Notably, BMI alone did not fully account for biomarker differences; dietary composition, particularly fiber and fat, appeared important for hormone regulation in AN. Prior to treatment, appetite-related biomarkers differed markedly between patients with AN and HCs. Although inpatient treatment increased body weight and normalized several biomarkers, BMI for most patients with AN remained below the healthy range and several biomarkers displayed limited responsiveness to treatment, suggesting continued gut–brain axis dysregulation. Whether it is possible to target unresponsive hormones by nutritional and/or pharmacological therapies to improve treatment success of AN remains to be investigated. Trial registration clinicaltrials.gov, NCT06144905, registered Sep 22, 2023 Gaining weight through proper nutrition is a key part of treating anorexia nervosa (AN). However, we still do not fully understand how the body’s appetite signals change during recovery. Appetite is partly controlled by signals between the gut and the brain. These signals affect hunger, fullness, and how the body uses energy. In this study, we examined many appetite-related markers in 42 patients with AN and compared them with 42 healthy individuals. We looked at how the markers changed during 12 weeks of treatment and how they were related to diet and weight. Before treatment, people with AN had different levels of appetite markers compared to healthy individuals suggesting that the regulation of appetite is disrupted. During treatment, body mass index (BMI) increased and some appetite markers moved towards healthy levels. However, the BMI remained below the healthy range for most patients with AN and some appetite markers did not change much or diverged more from healthy individuals. It also mattered what people ate—not just the amount of food. The results indicate that patients with AN have a lasting disruption in the system controlling the body’s appetite which may be important to address through nutrition and/or medical therapies.

Survivors of childhood acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), and non-Hodgkin lymphoma (NHL) are at risk of developing long-term adverse effects after survival. This study examined observed proportions of perceived mental distress, fatigue, and executive function (EF) impairment in adult childhood cancer survivors (CCSs) of ALL, AML, and NHL. Secondly, it examined the association between perceived EF impairment and mental distress or fatigue. Participants (n = 132; 57% female) were recruited from two major Norwegian hospitals. Self-report questionnaires included the Behavior Rating Inventory of Executive Function, Adult Version, the Hopkins Symptom Checklist-25, and the Fatigue Severity Scale. Proportions exceeding established clinical thresholds were calculated, and groups were compared using Pearson’s chi-squared test and Newcombe confidence intervals. Overall, 49% and 41% of participants met the clinical thresholds for depression and anxiety; 43% for fatigue; and 28% for EF impairment. Perceived EF impairment was significantly associated with mental distress and fatigue. Mental distress, fatigue, and EF impairment are commonly reported and distressing late effects among CCSs of ALL, AML, and NHL. Follow-up care focusing on neurocognitive and psychological outcomes is important for the long-term functioning and well-being of this survivor group. Targeted neurocognitive rehabilitation may represent a key component of follow-up care.

Few have explored executive functioning in individuals born preterm into adulthood. We assessed whether challenges with executive functions in individuals born with very low birth weight (VLBW ≤ 1500g) persist into mid-adulthood. From two birth cohorts from Finland and Norway, 137 VLBW adults and 158 term-born controls were assessed with the Behavior Rating Inventory of Executive Function - Adult version (BRIEF-A) and the Trail Making Test (TMT) at mean age 35.9 (SD3.2) years. We also pooled data from both birth cohorts at young adulthood (23–26 years). Linear regression analyses were performed to assess mean differences between the VLBW and control group, and the interaction effect with age, adjusted for birth cohort and sex. In mid-adulthood, the Global Executive Composite score was 6.2 (95% CI: 1.3, 11.6) points higher in the VLBW group than in the control group, indicating poorer functioning. Group differences were also observed in metacognition and behavioral regulation. The VLBW group used 6.3 (95%CI: 3.9, 8.9) seconds more on TMT-2 and 22.8 (95%CI: 16.2, 29.6) seconds more on TMT-4 than the control group. Executive functioning generally improved from young to mid-adulthood in the control group, but not in the VLBW group. Our findings suggest that the gap between the groups in executive functioning becomes larger across adulthood.

Background/Objectives: Eating disorders (EDs) are associated with cognitive inefficiencies related to cognitive flexibility, central coherence, and inhibition. Transdiagnostic cognitive remediation therapy (TCRT) is a new adaption of cognitive remediation therapy aimed at addressing these difficulties across ED diagnoses. This study investigates the effects of TCRT as an adjunctive treatment for patients with EDs on cognitive and clinical outcomes. Methods: A randomized controlled trial compared the effect of 9 individual sessions of TCRT in conjunction with treatment as usual (TAU) compared to TAU only for patients with EDs and concurrent cognitive difficulties. Participants were assessed at baseline, post-treatment (12 weeks after baseline), and follow-up (6 months after post-treatment assessment). The outcome measures included neuropsychological tests and self-report questionnaires measuring cognitive difficulties and ED psychopathology. The analysis was in accordance with intention to treat principles. Results: Sixty patients with various ED diagnosis and concurrent cognitive difficulties were recruited. The TCRT group (n = 30) displayed significantly greater improvement in self-reported executive functioning, measured by the Behavior Rating Inventory of Executive Function—Adult version compared to the control group (n = 30). However, no superiority of TCRT was observed on performance-based measures of set shifting, central coherence, or inhibition. Moreover, there was no significant difference in improvement in self-reported ED psychopathology. Conclusions: TCRT may enhance compensatory mechanisms for cognitive inefficiencies rather than improve cognitive effectiveness or ED symptoms directly for patients with EDs and concurrent cognitive difficulties. Further investigation of how these impact everyday functioning may provide valuable insights into TCRT’s role in ED treatment.

OBJECTIVE:Eating disorders (EDs) are associated with neuropsychological inefficiencies across diagnoses. A transdiagnostic approach may help clarify how neuropsychological factors contribute to ED psychopathology. This study aimed to investigate the neuropsychological profiles in patients with restrictive or binge/purge subtype of EDs. METHODS:Sixty-nine patients with restrictive or binge/purge subtype of EDs participated. Neuropsychological functioning was assessed using a comprehensive battery of tests. Neuropsychological outcomes were compared between the two groups, and with normative scores. Multiple linear regression was used to investigate potential predictors of neuropsychological inefficiencies. RESULTS:The subgroups displayed similar performance on most cognitive measures. Compared to normative scores inefficiencies related to central coherence, impulsivity, and self-reported executive functioning difficulties were observed in both groups. In addition, the restrictive subgroup demonstrated better set-shifting abilities, while the binge/purge subgroup excelled on a planning task. A significant association was found between depressive symptoms and self-reported executive function difficulties, but not with performance-based measures. CONCLUSION:The findings suggest similar cognitive inefficiencies across ED subtypes. However, each group demonstrated some distinct cognitive strengths compared to normative scores. Findings underscore discrepancies between performance-based and self-reported executive functioning assessment, raising questions about ecological validity, and the distinctiveness of cognitive measures in this population. TRAIL REGISTRATION:The current study utilises baseline data from a randomised controlled trail (ClinicalTrials.gov Id: NCT03808467).

There are mixed findings regarding executive functioning in individuals born small for gestational age (SGA) at term and associations between performance-based and self-reported executive functions have yet to be examined in adults. In a prospective cohort study, 56 SGA and 68 non-SGA control participants were assessed at 32 years using the performance-based Trail Making Test (TMT) and the self-report questionnaire Behavior Rating Inventory of Executive Function – Adult Version (BRIEF-A). The SGA group used 1.6 (95% confidence interval [CI] 0.1–3.1) to 3.9 (95% CI 1.2–6.5) seconds more on TMT conditions 1 and 3, indicating more difficulties with visual scanning and letter sequencing than controls. On BRIEF-A, the SGA group scored 1.5 (95% CI 0.2–2.8) points lower on the clinical scale Emotional Control. Correlation coefficients for the association between TMT and BRIEF-A scores ranged from -0.295 (p = 0.065) to 0.345 (p = 0.029) in the SGA group. In conclusion, we found that 32-year-old adults born SGA at term showed poorer performance on some executive function tasks than controls. However, they reported similar executive functioning in everyday life, except for emotional control. The associations between performance-based and self-report assessments of executive functions were weak.

Background Childhood traumatic events (CTE) are frequently described in patients with eating disorders. However, the understanding of how such events impact eating disorder treatment outcome is limited. The aim of this study was to examine the prevalence of childhood sexual abuse (CSA) or any CTE at baseline in a naturalistic transdiagnostic sample, and to evaluate how such events affect symptom change and rates of remission at follow-up. Methods The sample comprised 228 adult female former eating disorder inpatients (M age = 24.6 years), of which 61.4% ( n = 140) had been diagnosed with anorexia nervosa at baseline, 21.1% ( n = 48) with bulimia nervosa, and 17.5% ( n = 40) with other specified feeding or eating disorder including binge eating. Data on CSA/ CTE exposure were collected from the patients’ hospital records and were rated for degree of severity (severe, moderate to low, or no). Analyses of prevalence, group differences, and rates of remission at follow-up were performed. Results Findings showed high prevalence of high severity CSA and CTE at admission, respectively 33% ( n = 75) and 48.7% ( n = 111). Moreover, although all patients showed significant improvement in symptoms from baseline to follow-up, a significant association was found between severity of CTE exposure and remission group affiliation with 24% of those with severe CTE exposure and 40% of those with no CTE exposure being in remission. Conclusions Despite considerable heterogeneity in demographic characteristics, treatment and length of follow-up, severity of CTE exposure was associated with remission at follow-up. Thus, patients with the highest CTE severity showed the poorest prognoses. Findings from this study underline the importance of addressing trauma experiences in assessment and therapy and indicate that CTE severity level should be considered when assessing trauma experiences.

OBJECTIVE:An estimated 40% of patients experience cognitive impairment 3 months after a stroke. However, there is a lack of knowledge about cognitive improvement after stroke. This exploratory study aims to comprehend the prevalence and patterns of cognitive improvement within the initial 3 months poststroke. METHOD:At 1 week and 3 months poststroke, 85 patients aged 40-79 years with supratentorial ischemic stroke and a Mini-Mental State Examination score ≥23 underwent neuropsychological testing of learning, recall, recognition, working memory, verbal fluency, naming, executive function, attention, and processing speed. A hierarchical cluster analysis based on Ward's method and squared Euclidean distance was performed on changes in tests over 3 months to identify homogeneous groups. The within-cluster and between-cluster differences in change were presented descriptively for each cognitive domain. Potential predictors for cluster belonging were compared by independent samples t test or χ2 test. RESULTS:The cluster analysis identified two clusters. The improvement cluster (n = 22) progressed in learning, recall, recognition, executive function, and most measures of working memory, attention, and verbal fluency. In the stable cluster (n = 63), cognitive function remained stable across most domains, with an increase in a few working memory, verbal fluency and naming, and executive function measures. Notably, 67% of lacunar strokes and 93% of females were in the stable cluster, having less improvement. Age and education did not differentiate between the clusters. CONCLUSIONS:26% of patients showed overall cognitive improvement within 3 months. Knowing the prevalence and patterns of cognitive improvement after stroke lays the groundwork for future research and clinical practice. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

BACKGROUND:Transdiagnostic Cognitive Remediation Therapy (TCRT) is a new adaptation of cognitive remediation therapy for eating disorders (EDs) developed to address common cognitive difficulties across ED diagnoses (i.e., cognitive flexibility, central coherence, and impulsivity). This is the first evaluation of this novel treatment. The aim of this study was to explore acceptability and patients' experience of TCRT. METHODS:Thirteen patients diagnosed with restrictive or binge/purge subtypes of EDs and concurrent cognitive difficulties completed semi-structured qualitative interviews after receiving TCRT. Interview transcripts were analyzed using reflexive thematic analysis. RESULTS:The analysis resulted in four main themes: (1) Treatment fit (2), Treatment experience (3), Perceived outcomes, and (4) Future recommendations. Eleven of the thirteen patients evaluated the treatment positively, found the focus relevant and expressed how it contributed to new insights related to thinking style. Seven of the patients also described it as a starting point for making changes and using new strategies. Importantly, experiencing some challenges related to the cognitive difficulties addressed in the treatment seemed essential for engagement. CONCLUSION:Offering TCRT as an adjunctive treatment for patients with EDs and concurrent cognitive difficulties can be a way to engage patients in treatment, build therapeutic alliances and provide important awareness and strategies to handle challenges related to thinking style. TRIAL REGISTRATION:This study is part of a larger randomized controlled trial, ClinicalTrials.gov Id: NCT03808467.

The aim om this study was to explore the experiences of individuals who are admitted to inpatient treatment for anorexia nervosa (AN). We completed in-depth interviews with four patients diagnosed with AN who were currently admitted to inpatient treatment. We analyzed the transcripts using interpretative phenomenological analysis. The results indicate that inpatient treatment can reduce the emotional burden of recovery and provide necessary support for the motivational processes. For the participants, the restrictions inherent in the treatment regime are held accountable for change, relieving the patient from the guilt of this process, hence reducing shame and ambivalence. For the participants to entrust the personnel with the responsibility of taking over the control, they need to perceive the staff as AN experts, someone who understands them, and is worthy of their trust. Interaction with inpatient peers is both as a motivation to work against the AN and reduces negative emotions due to eating, as the perspectives shift from working with the AN to being there for their peers. The results support emphasizing the role of emotion regulation in the treatment of AN, the importance of specialized competence in eating disorders and the unique experience of individuals in inpatient treatment.

Introduction With similar estimates at 3 and 12 months after stroke, 4 out of 10 individuals have cognitive impairment that does not match the criteria for dementia. Cognitive impairment contributes significantly to disability in these patients and has been the subject of numerous studies. However, few studies have focused on improvement of cognition after stroke. Therefore, this study aimed to determine the prevalence and trend of cognitive improvement within three months after stroke. Methods A total of 85 stroke patients with supratentorial ischemic stroke, aged between 40 and 79 years, with an MMSE score ≥23 were included in this study. All participants underwent neuropsychological testing at 1 week and 3 months post-stroke in order to assess learning, recall, recognition, working memory, verbal fluency, naming, executive function, attention and processing speed. A hierarchical cluster analysis based on Ward's method and squared Euclidean distance was performed on changes in neuropsychological tests over three months in order to identify homogeneous groups of patients. The within- and between-group differences were presented descriptively with respect to changes in each cognitive domain. Results The cluster analysis identified 2 groups of patients, where 22 patients improved overall cognitively and 63 declined or remained stable from 1 week to 3 months after stroke. Within the improvement group, learning, recall, recognition, working memory and verbal fluency improved significantly. However, there was a significant decline in 8 out of 10 measures of attention and executive function. Within the decline/stable group, cognitive function remained stable for almost all domains, aside from significant decline in 1 out of 5 measures of executive function, and significant improvement in verbal fluency and 2 out of 3 measures of working memory. In 13 out of 20 measures, the changes were significantly different between the 2 groups. Discussion About 25% of patients showed overall cognitive improvement within three months after stroke. Knowing the prevalence and trend of cognitive improvement after stroke, can serve as a foundation for future research focused on cognitive improvement and its predictors.

Objective: This study examines the reciprocal relationship between self-compassion and eating disorder (ED) and trauma symptoms for patients receiving compassion- focused therapy for eating disorders (CFT-E). Method: A total of thirty-six patients with EDs and childhood trauma received inpatient treatment over 13 weeks. Levels of self-compassion and symptoms were assessed using repeated measures. A multilevel growth model was applied, and the effects of self-compassion and symptoms were separated into between- and within-patient effects. Results: The results show that ED symptoms did decrease significantly during treatment. Furthermore, the analyses demonstrated a reciprocal between-patient relationship between self-compassion and ED symptoms, and between self-compassion and trauma symptoms. However, regarding within-patient effects, only self-compassion predicted trauma symptoms. Discussion: The outcome of the current study demonstrates a favourable course for patients with EDs and childhood trauma receiving CFT-E in an inpatient facility. While there is a reciprocal relationship between the variables, the within-patient analyses imply the role of self-compassion in the therapy process for trauma symptoms.

There is considerable interest in cognitive and behavioural interventions to manage and improve neurocognitive (dys)functions in childhood cancer survivors and the literature is rapidly growing. This systematic review aimed to examine the literature of such interventions and their impact on executive functions (EFs) and attention. A search of relevant manuscripts was performed in PubMed, PsycINFO, and Web of Science in March 2023 in accordance with the PRISMA statement. After screening 3737 records, 17 unique studies published between 2002 and 2022 were charted and summarized. Participants (N = 718) were mostly children (M = 12.2 years), who were long-term survivors (M = 5.0 years post treatment) of brain or CNS tumours (48%). Identified interventions included computerized cognitive training, physical activity, and cognitive interventions with compensatory strategy training. The highest quality RCT studies included computerized training (i.e., Cogmed), neurofeedback, and exergaming. Evidence suggests that Cogmed may improve the performance of certain working memory tasks (near transfer) and possibly improve visual attention tasks for individuals with working memory impairments. However, the evidence did not support far transfer of effects to real life. No significant effects (near or far-transfer) were found following neurofeedback and exergaming interventions. Finally, a knowledge gap was identified for interventions directed at long-term survivors in adulthood.

Purpose: Childhood acute lymphoblastic leukemia (ALL) is associated with executive dysfunction in long-term survivorship. This is evidenced by subjective and objective measures of executive functions (EFs). However, the two measures do not always align, and the EF discrepancy in this population is understudied. This cross-sectional study aimed to examine the association between global measures of subjective and objective EF in young adult (YA) survivors of childhood ALL. Second, we aimed to explore how psychological distress, fatigue, self-efficacy, and estimated IQ relate to the discrepancy between these measures. Methods: A total of 53 subjects (age 18-34) participated in a clinical trial baseline assessment (clinicaltrials.gov NCT04541056). The Behavior Rating Inventory of Executive Function for Adults assessed subjective EFs. Results from six neurocognitive tests were combined to represent objective EFs. Discrepancy scores were calculated by subtracting the objective EF composite score from the subjective EF score. Spearman's correlations and simple and multiple linear regression analyses were performed to explore associations and predictors for the global EF discrepancy. Results: Subjective and objective measures of EF were moderately correlated (r(s) = 0.407). The regression analyses showed that psychological distress (R-2 = 0.44), fatigue (R-2 = 0.29), and self-efficacy (R-2 = 0.24) significantly predicted the global EF discrepancy (p < .001). Only psychological distress explained unique variation (B = -0.46). Conclusion: Neurocognitive tests and self-reports offer valuable insights into EF assessment for YA survivors. Psychological distress emerged as the most central contributor to the overall EF discrepancy. Consequently, screening for anxiety and depression alongside subjective EF complaints will be of significance.

Objective: There is limited research on neurocognitive outcome and associated risk factors in long-term, adult survivors of childhood acute lymphoblastic leukemia (ALL), without treatment of cranial radiation therapy. Moreover, the impact of fatigue severity and pain interference on neurocognition has received little attention. In this cross-sectional study, we examined neurocognitive outcome and associated factors in this population. Method: Intellectual abilities, verbal learning/memory, processing speed, attention, and executive functions were compared to normative means/medians with one sample t tests or Wilcoxon signed-rank tests. Associations with risk factors, fatigue severity, and pain interference were analyzed with linear regressions. Results: Long-term, adult survivors of childhood ALL (N = 53, 51% females, mean age = 24.4 years, SD = 4.4, mean = 14.7 years post-diagnosis, SD = 3.4) demonstrated above average intellectual abilities, but performed below average in attention, inhibition, processing speed, and shifting (p < 0.001). Executive functioning complaints were significantly higher than normative means, and positively associated with fatigue (p < 0.001). There was no interaction between sex and fatigue and no neurocognitive impairments were associated with pain interference, risk group, age at diagnosis, or sex. Conclusions: Long-term, adult survivors of ALL treated without cranial radiation therapy, demonstrate domain-specific performance-based neurocognitive impairments. However, continued research on the neurocognitive outcome in this population as they age will be important in the coming years. Executive functioning complaints were frequently in the clinical range, and often accompanied by fatigue. This suggests a need for cognitive rehabilitation programs.

Anorexia nervosa (AN) is associated with food restriction and significantly low body weight, but the neurobiology of food avoidance in AN is unknown. Animal research suggests that food avoidance can be triggered by conditioned fear that engages the anterior cingulate and nucleus accumbens. We hypothesized that the neural activation during food avoidance in AN could be modeled based on aversive goal value processing. Nineteen females with AN and thirty healthy controls matched for age underwent functional magnetic resonance brain imaging while conducting a food avoidance task. During active control free-bid and computer-generated forced-bid trials, participants bid money to avoid eating food items. Brain activation was parametrically modulated with the trial-by-trial placed bids. During free-bid trials, the AN group engaged the caudate nucleus, nucleus accumbens, ventral anterior cingulate, and inferior and medial orbitofrontal cortex more than the control group. High- versus low-bid trials in the AN group were associated with higher caudate nucleus response. Emotion dysregulation and intolerance of uncertainty scores were inversely associated with nucleus accumbens free-bid trial brain response in AN. This study supports the idea that food avoidance behavior in AN involves aversive goal value computation in the nucleus accumbens, caudate nucleus, anterior cingulate, and orbitofrontal cortex.

Objectives:To assess neurocognitive function in adults born with low birthweight compared with controls and to explore associations between neurocognitive function and psychopathology in these groups. Methods:In this prospective cohort study, one group born preterm with very low birthweight (VLBW: birthweight <1,500 g, n = 53), one group born small for gestational age at term (SGA: birthweight <10th percentile, n = 63) and one term-born control group (birthweight ≥10th percentile, n = 81) were assessed with neurocognitive tests, diagnostic interviews, and self-report questionnaires at 26 years of age. Results:The VLBW group scored significantly below the control group on several neurocognitive measures, including IQ measures, psychomotor speed, verbal fluency, aspects of visual learning and memory, attention, social cognition, working memory and fine motor speed. The SGA group consistently scored at an intermediate level between the VLBW and the control group and had significantly lower scores than controls on Performance IQ and psychomotor speed, including switching. In the VLBW group, associations were found between lower spatial working memory and the presence of anxiety disorders, internalizing and attention problems, and autistic traits. Furthermore, lower Full scale IQ was associated with attention problems when adjusting for sex and parental socioeconomic status. Conclusion:Adults born preterm with VLBW or born term SGA displayed neurocognitive difficulties. Spatial working memory was associated with difficulties with attention, anxiety, and social function of VLBW adults. The finding and its clinical applicability should be further explored.

The comorbidity between recurrent pain, anxiety, and depression among children is frequent and well documented. However, only a few studies of the predictive effect of anxiety and depression on pain have adjusted for symptoms of the other disorder when examining the respective relations to different pain locations, rendering the unique contribution from anxiety and depression undetermined. In the current investigation we explore the strength of associations between pain at different locations with symptoms of anxiety and depression in a community sample of 10-year-old children (n = 703). The children were interviewed about the frequency of pain during the last 3 months. Parents and children were interviewed separately about symptoms of anxiety and depression using a semi-structured diagnostic interview. Results of three multivariate regression models for each of headache, abdominal and musculoskeletal pain revealed that depression was associated with musculoskeletal pain and headache, whereas anxiety was not. The associations for depression were not significantly stronger compared to anxiety. Gender-specific models found that depression was related to headache only among girls, but the association was not statistically different compared to boys. These results may, in turn, influence our interpretation of different forms of pain in children, with less weight given to abdominal symptoms viewed as a strong correlate with psychological problems, compared to for instance headache. The results provided no clear support for neither a differential relationship between anxiety and pain and depression and pain nor gender differences.

Introduction:Substance use disorder (SUD) is characterized by cognitive impairment, especially executive dysfunction. Executive function is recognized as an important determinant of treatment outcome as it is associated with dropout rate, attendance to therapy and potential relapse after treatment termination. Physical activity can have beneficial effects on cognitive function, but there is still a lack of knowledge regarding potential benefits of aerobic exercise for executive function in SUD treatment. The aim of this study is to examine the effect of aerobic high-intensity interval training (HIIT) on cognitive function and the subsequent effect on treatment outcome in patients with SUD.Methods and analysis:This study is a randomized controlled trial, including men and women ≥18 years with diagnosed SUD by ICD-10. The patients will be recruited from the department for inpatient treatment at Blue Cross - Lade Addiction Treatment Center, Trondheim, Norway. Participants will be randomized 1:1 into either HIIT (3x/week) + treatment as usual (TAU), or TAU alone. Study outcomes will be assessed at baseline, after eight weeks of intervention, and at 3- and 12-months follow-up. The primary outcome is to compare the change in executive function (via altered BRIEF-A score, Behavior Rating Inventory of Executive Function-Adult) measured between the two study groups after eight weeks. Secondary outcomes include mapping of cognitive function in different subgroups (e.g. type of substance, age, fitness level), collecting self-reported information about quality of life, craving, sleep quality, etc., as well as assessing compliance to TAU and long-term treatment outcome.Ethics and dissemination:The project was approved by the Regional Ethical Committee and will be performed in accordance with this protocol and the Declaration of Helsinki. Written informed consent will be obtained from all participants prior to inclusion. This project will explore a novel approach to how exercise can be applied in SUD treatment, beyond the well-known effects on physical health. We expect to achieve new knowledge in regard to what extent HIIT can improve cognitive abilities and subsequent treatment outcome in SUD.Trial registration number:https://www.clinicaltrials.gov/NCT05324085.