Background An internal locus of control (LoC I) refers to the belief that the outcome of events in one’s life is contingent upon one’s actions, whereas an external locus of control (LoC E) describes the belief that chance and powerful others control one’s life. This study investigated whether LoC I and LoC E moderated the relationship between COVID-19 stress and general mental distress in the general population during the early months of the COVID-19 pandemic. Methods This cross-sectional survey study analysed data from a Norwegian (n = 1225) and a German-speaking sample (n = 1527). We measured LoC with the Locus of Control-4 Scale (IE-4), COVID-19 stress with a scale developed for this purpose, and mental distress with the Patient Health Questionnaire 4 (PHQ-4). Moderation analyses were conducted using the PROCESS macro for SPSS. Results The association between COVID-19 stress and general mental distress was strong (r = .61 and r = .55 for the Norwegian and the German-speaking sample, respectively). In both samples, LoC showed substantial moderation effects. LoC I served as a buffer (p < .001), and LoC E exacerbated (p < .001) the relation between COVID-19 stress and general mental distress. Conclusions The data suggest that the COVID-19 pandemic is easier to bear for people who, despite pandemic-related strains, feel that they generally have influence over their own lives. An external locus of control, conversely, is associated with symptoms of depression and anxiety. The prevention of mental distress may be supported by enabling a sense of control through citizen participation in policy decisions and transparent explanation in their implementation.

Existential suffering may contribute to treatment-resistant depression. The "VITA" treatment model was designed for such patients with long-standing depression accompanied by existential and/or religious concerns. This naturalistic effectiveness study compared the VITA model (n = 50) with a "treatment as usual" comparison group (TAU; n = 50) of patients with treatment-resistant depression and cluster c comorbidity. The TAU patients were matched on several characteristics with the VITA patients. The VITA model included existential, dynamic, narrative and affect-focused components. The VITA group had significantly greater improvement on symptom distress and relational problems during treatment and from pre-treatment to 1-year follow-up. Patients in the VITA, at follow-up, were more likely to be employed and less likely be using psychotropic medications.

This case study describes the treatment of "Olav," a divorced lawyer in his mid-30's, who, at the time of treatment, had been continuously hospitalized in closed, short-term psychiatric wards for more than seven years with severe treatment-resistant depression, transient psychotic episodes, self-destructive behavior, suicide attempts, and Axis II diagnoses of Borderline and Paranoid Personality Disorders, with narcissistic traits. He was about to be admitted to a long-term ward for chronic schizophrenics. A great deal of his psychopathology revolved around his feeling tortured from condemning inner voices of what he called "The Committee," which he believed were the sacred voices of God. Olav's treatment took place in our institution's "VITA" unit, a 12-week, group-based, residential day-treatment program that explicitly concentrates on existential and religious issues, and is based on principles drawn from existential, narrative, object relations, and affect theories. The VITA program includes diary-writing, affect consciousness exploration, individual therapy, and regular group sessions with such activities as mindfulness training; art therapy focusing on drawing or painting internal representations of self, father, mother, and God; reflection on existential issues; "here-and-now-oriented" psychodynamic group therapy; and physical exercise. An assessment battery of standardized, quantitative, clinical questionnaires documents Olav's dramatic improvement over the course of treatment and at one-year follow-up. CASE CONTEXT AND METHODHistorically, religious belief as a part of a patient's mental health treatment has not been given the attention it deserves, and the patient's relationship to God is often a neglected issue in psychotherapy (e.g., Rizzuto, 1979;Shafranske, 1992). Rizzuto's (1979) research 30 years ago demonstrated the psychological significance of the individual's representations of God for psychic health and sickness. Many patients state that religious belief is an important part of their life (Bergin, 1991). Recently a journal, Psychology of Religion and Spirituality, has been established by the American Psychological Association, and other developments in the field have shown a gradually increasing focus on religious issues in psychotherapy (e.g., Rizzuto, 1979;Meissner, 1984;Shafranske, 1992; Sperry & Shafranske, 2005;Silverstein, 2008). Nevertheless, there is a long way to go in learning how to address systematically religious belief and related affects in psychiatric treatment. The present case is intended as a contribution to this ongoing development. A. The Rationale for Selecting This Particular Patient for StudyA patient we will call "Olav" had a severe, long-standing, treatment-resistant depression linked to religious pathology, with psychotic episodes and suicidal behavior. This case was chosen to demonstrate how our institution's "VITA" model (Austad & Folleso, 2003; see below) could impact on severe pathology as well as personality structure, affect organization, and inner r...

The present study aimed to explore the relationship between changes in depressive symptoms and the capacity to mentalize over the course of a 3-month inpatient psychodynamic therapy in a sample of 56 patients with depression. Depressive symptoms and mentalizing were assessed weekly during treatment and at 1-year follow-up with the Beck Depression Inventory and the Reflective Functioning Questionnaire (RFQ). Data were analyzed using Latent Growth Curve (LGC) modeling with structured residuals. In the total sample, depressive symptoms improved on average from baseline to the end of treatment, while mentalizing skills did not. However, individual variations were observed in mentalizing skills, with some patients improving while others did not. Within-patient residual changes in mentalizing skills did not predict residual changes in depressive symptoms. Accordingly, the results did not support mentalizing as a mechanism of change at this level. Nonetheless, between-patient effects were found, showing that patients with higher levels of mentalizing at baseline and patients whose mentalizing skills improved over the course of therapy also had greater reductions in depressive symptoms. We suggest that the presence of relatively higher mentalizing skills might be a factor contributing to moderately depressed individuals' ability to benefit from treatment, while relatively poor or absent mentalizing capacity might be part of the dynamics underlying treatment resistance in individuals with severe depression. Public Significance StatementEmotional and relational changes related to psychodynamic therapy are likely to be followed by reductions in depressive symptoms over the course of therapy. Between-person improvements in mentalizing were related to reductions in depressive symptoms, but within-person change in mentalizing was not found to be a mechanism of change in depression. Further research is needed to examine the role of mentalizing skills as a factor contributing to the depressed individual's ability to profit from treatment.