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Background: A burn event can elicit symptoms of posttraumatic stress disorder (PTSD) in survivors and their partners and may impact the way these couple members interact with each other. They may try to protect each other from further emotional distress by avoiding talking about the burn event, but they may also show concern towards each other. Objective: The aim of this study was to investigate bidirectional relationships between survivor’s and partner’s PTSD symptoms and two interpersonal processes: partner-oriented ‘self-regulation’, which is avoidance-oriented, and ‘expressed concern’, which is approach-oriented. Method: In this longitudinal multi-centre study, 119 burn survivors and their partners participated. Measures of PTSD symptoms, self-regulation, and expressed concern were administered in the acute phase following the burns, and follow-ups took place up to 18 months postburn. Intra- and interpersonal effects were examined in a random intercept cross-lagged panel model. Exploratory effects of burn severity were also investigated. Results: Within individuals, survivor’s expressed concern predicted later higher levels of survivor’s PTSD symptoms. In their partners, self-regulation and PTSD symptoms reinforced each other in the early phase postburn. Between the two couple members, partner’s expressed concern predicted later lower levels of survivor’s PTSD symptoms. Exploratory regression analyses showed that burn severity moderated the effect of survivor’s self-regulation on survivor’s PTSD symptoms, indicating that self-regulation was continuously related to higher levels of PTSD symptoms over time within more severely burned survivors, but not in less severely burned survivors. Conclusion: PTSD symptoms and self-regulation reinforced each other in partners and possibly also in more severely burned survivors. Partner’s expressed concern was related to lower levels of survivor’s PTSD symptoms, whereas survivor’s expressed concern was related to higher levels of survivor’s PTSD symptoms. These findings emphasize the importance of screening for and monitoring PTSD symptoms in burn survivors and their partner and of encouraging couple’s self-disclosure. PTSD symptoms in burn survivors and their partners are related to both avoidance- and approach-oriented interpersonal processes.In partners, higher levels of self-regulation were bidirectionally related to higher levels of posttraumatic stress symptoms.Concern expressed by partners may mitigate posttraumatic stress symptoms in burn survivors. PTSD symptoms in burn survivors and their partners are related to both avoidance- and approach-oriented interpersonal processes. In partners, higher levels of self-regulation were bidirectionally related to higher levels of posttraumatic stress symptoms. Concern expressed by partners may mitigate posttraumatic stress symptoms in burn survivors.

Objective Involuntary job loss can lead to symptoms of complicated grief (CG), depression, and anxiety. Information about the temporal linkage between these symptoms is limited and may have implications for the treatment of those suffering from mental health complaints after dismissal. The aim of this study was to explore the possible reciprocal relationships between symptoms of CG, depression, and anxiety following involuntary job loss. Method We recruited 128 Dutch workers who had lost their job within the past 12 months, including 72 males and 56 females with an average age of 49.8 (SD = 9.0) years. They completed questionnaires tapping CG, depression, and anxiety symptoms at baseline (Time 1) and a 6‐month follow‐up (Time 2). Several cross‐lagged panel models were compared. Results Our analyses indicated that CG symptom severity following job loss at Time 1 predicted depression at Time 2, but not vice versa. Similar results were found for job loss‐related CG and anxiety symptoms. Conclusions Symptom‐levels of CG following job loss predict later depression and anxiety symptoms more strongly than vice versa. This implies that screening and targeting job loss‐related CG symptoms with early interventions might protect individuals from developing depression or anxiety symptoms after their dismissal.

Purpose This study explored the individual trajectories of health-related quality of life (HRQL) compared to recalled pre-burn level of HRQL and investigated whether burn severity and post-traumatic stress disorder (PTSD) symptoms increase the risk of not returning to pre-burn level of HRQL. Methods Data were obtained from 309 adult patients with burns in a multicenter study. Patients completed the EQ-5D-3L questionnaire with a Cognition bolt-on shortly after hospital admission, which included a recalled pre-injury measure, and, again, at 3, 6, 12 and 18 months post-burn. Burn severity was indicated by the number of surgeries, and PTSD symptoms were assessed with the IES-R at three months post-burn. Pre- and post-injury HRQL were compared to norm populations. Results Recalled pre-injury HRQL was higher than population norms and HRQL at 18 months post-burn was comparable to population norms. Compared to the pre-injury level of functioning, four HRQL patterns of change over time were established: Stable, Recovery, Deterioration, and Growth. In each HRQL domain, a subset of patients did not return to their recalled pre-injury levels, especially with regard to Pain, Anxiety/Depression, and Cognition. Patients with more severe burns or PTSD symptoms were less likely to return to pre-injury level of functioning within 18 months post-burn. Conclusion This study identified four patterns of individual change. Patients with more severe injuries and PTSD symptoms were more at risk of not returning to their recalled pre-injury HRQL. This study supports the face validity of using a recalled pre-burn HRQL score as a reference point to monitor HRQL after burns.

Background Literature indicates that children from ethnic minorities are at increased risk of sustaining burns. Moreover, parents may experience more psychological distress but why this is the case is poorly investigated. Methods A prospective study including 120 mothers and 106 fathers of preschool children, of which 23 mothers and 24 fathers had an ethnic minority background, investigated levels of parental feelings of guilt, depressive and posttraumatic stress symptoms and compared Dutch parents with parents from different ethnic backgrounds on these outcomes. A qualitative study with 46 parents, 24 Dutch and 22 from different ethnic minority backgrounds, explored how they coped with the consequences of the burns. Results Results revealed more symptoms of posttraumatic stress and depression in ethnic minority parents. Ethnic minority fathers also had more guilt feelings. Lower social support, medical communication hampered by language barriers, lower health literacy and passive communication styles, (aspects of) religious coping and barriers to psychosocial care may partly explain the differences. Conclusions Parents with an ethnic minority background are at risk to experience increased distress after their child’s burn injury. By exploring the aforementioned factors, health care professionals may increase the family’s wellbeing. It may provide a starting point to offer tailored help.

Objective This prospective study examined the course and potential predictors of parents' posttraumatic stress symptoms (PTSS) after burn injury in their child (Age 8 to 18 years). Method One hundred eleven mothers and 91 fathers, representing 118 children, participated in the study. Within the first month after the burn event and subsequently at 3, 12, and 18 months postburn, both parents completed the Impact of Event Scale (IES). Parental emotions related to the burn event and appraisal of threat to the child's life were assessed, which were investigated in a multilevel regression model. Results Within the first month postburn, 48% of the mothers and 26% of the fathers reported clinically significant PTSS (IES ≥26), which decreased to, respectively, 19% and 4% 18 months postburn. Symptoms of intrusion were mainly individually experienced, whereas parents within a couple were more similar in terms of their avoidance symptoms. The perceived life threat and feelings of guilt and anger linked to the burn event were significantly related to parental PTSS, especially in mothers. Conclusions The results indicate that a burn event to a child has a severe (acute) psychological impact on parents and that clinical levels of PTSS may persist in a subgroup of parents. The findings underline the need to incorporate parent support in burn care, especially for mothers with a strong emotional response during the first months after the burn event. (PsycINFO Database Record

Background: Research on complicated grief (CG) symptoms following job loss is surprisingly rare. Involuntary job loss can turn someone’s world upside down and can result in loss of identity, social contacts, and self-worth. In this study, we drew on the literature on major life events in conceptualizing involuntary job loss as a significant and potentially devastating life event. Objectives: The aim of this study was to develop and evaluate an instrument that measures job loss-related CG symptoms, the Job Loss Grief Scale (JLGS). The purpose of the JLGS is to foster systematic research on CG symptoms following job loss. Design: A cross-sectional study Methods: We recruited Dutch workers who had lost their job, 130 men and 158 women with an average age of 49.6 years. To examine the psychometric properties of the JLGS and its associations with other concepts we conducted correlational and confirmatory factor analyses. Results: CFA revealed that the JLGS was a one-dimensional instrument, and that CG symptoms were distinguishable from depression and anxiety symptoms. Conclusion: The JLGS is a reliable and valid instrument to measure job loss-related CG symptoms. The availability of the JLGS could stimulate systematic research on the antecedents and consequences of involuntary job loss.

Pruritus is a frequently encountered symptom following burns. Higher intensity of itching has been associated with depth of the wounds and specific body locations but these differences are not well understood. Our aim was to investigate the intensity of post burn pruritus in grafted and non-grafted burns across anatomic areas and to report on itch-inducing factors and applied treatments. The study included 226 patients prospectively followed for 18 months. Results showed that grafted patients and non-grafted patients reported similar overall itch intensity in-hospital. At 3 months post burn, grafted patients had higher overall itch scores, a difference that was found robust across the study period. Grafted wounds were found to produce higher mean itch intensity at 3 months post burn but this difference disappeared at 12 months post burn. Differences in itch prevalence rates were found across anatomic areas, but only in non-grafted burns. The differences in itch intensity on patient level versus wound level suggest that on the longer run, peripheral mechanism do not explain the higher itch scores in grafted patients.

Een brandwondenongeval bij een kind treft niet alleen het kind, maar het hele gezin. Uit prospectief onderzoek in de drie Nederlandse en vier Belgische brandwondencentra bleken posttraumatische stressreacties vaak voor te komen bij moeders en vaders na een brandwondenongeval van hun jonge kind (0 tot 4 jaar). Emoties van ouders, zoals schuldgevoelens over het brandwondenongeval en vrees voor het leven van het kind, hadden een belangrijke voorspellende rol voor klachten op de langere termijn. Terwijl herbelevingen van het ongeval duidelijk individueel door ouders werden ervaren, bleken ouders binnen eenzelfde gezin vermijdingsreacties met elkaar te delen. Bij de kinderen werden door de ouders niet meer gedragsproblemen gezien dan in een normgroep van leeftijdgenootjes. Wel leefden er bij ouders zorgen over de ontwikkeling van de littekens en mogelijke (sociale) problemen in de toekomst. De stressreacties van ouders hingen samen met deze zorgen en met hun beoordeling van het gedrag van het kind. Deze studie laat zien dat zorgverleners oog moeten hebben voor het gehele gezin en de dynamieken tussen de gezinsleden om na het brandwondenongeval het kind en het gezin goed te ondersteunen.

Objective This study assessed the role of self-reported facial scar severity as a possible influencing factor on self-esteem and depressive symptoms in patients with facial burns. Method A prospective multicentre cohort study with a 6 months follow-up was conducted including 132 patients with facial burns. Patients completed the Patient and Observer Scar Assessment Scale, the Rosenberg Self-esteem Scale and the Hospital Anxiety and Depression Scale. Structural Equation Modeling was used to assess the relations between depressive symptoms, self-esteem and scar severity. Results The model showed that patient-rated facial scar severity was not predictive for self-esteem and depressive symptoms six months post-burn. There was, however, a significant relationship between early depressive symptoms and both patient-rated facial scar severity and subsequent self-esteem. The variables in the model accounted for 37% of the variance in depressive symptoms six months post-burn and the model provided a moderately well-fitting representation of the data. Conclusion The study suggests that self-esteem and depressive symptoms were not affected by self-reported facial scar severity but that earlier depressive symptoms were indicative for a more severe self-reported facial scar rating. Therefore, routine psychological screening during hospitalisation is recommended in order to identify patients at risk and to optimise their treatment.

Objective To examine whether GPs’ communication styles have changed since the introduction and implementation of clinical guidelines for psychosocial problems in Dutch general practice in the 1990s. Methods From a database of 5184 consultations videotaped between 1977 and 2008, 512 consultations assessed by GPs as ‘completely psychosocial’ were coded with RIAS (Roter Interaction Analysis System). The 121 consultations prior to and 391 consultations after implementation of guidelines were analyzed whether communication styles have changed over time. Results We found that GPs were more likely to consider consultations to be mainly (17%) or completely (12%) psychosocial after the implementation of guidelines. They gave more biomedical and psychosocial information and advice in the second period compared to the first period. We also found that empathy decreased over time (frequency of empathic statements by GPs changed from 2.9–3.2 to 1.4–1.6 between periods). Conclusion Communication in psychosocial consultations has changed; GPs have become more focused on task-oriented communication (asking questions, giving information and advice) and less on showing empathy. Practice implications GPs face the challenge of integrating an evidence-based approach of applying guidelines that promote active symptom exploration with understanding patients’ personal contexts and giving room to their emotions.

Background The face is central to our identity and provides our most expressive means of communication. Currently, the role of facial scarring in relation to self-esteem is unclear and the value of self-reported scar assessment is insufficiently understood. The aim of this study was twofold: (1) to assess the extent of agreement between patients’ ratings and observers’ ratings of facial scar characteristics; and (2) to examine if patients’ and observers’ scar characteristics ratings, or the differences, are associated with the patients’ self-esteem. Methods A prospective study was conducted including patients with facial burns. Patients completed the Patient and Observer Scar Assessment Scale (POSAS) and the Rosenberg Self-Esteem Scale 3 months post-burn. Results Ninety-four subjects were included, 76 (81%) men and mean percentage TBSA burned was 12.4 (SD 10.4; range 1–50). Subject's and observer's assessment were significantly positively correlated and were identical in 53% of the cases. Subjects’ assessments and discrepancy scores on the scar characteristic surface roughness were associated with self-esteem in multiple regression analysis. Conclusions The majority of the patients scored the quality of facial scars in a similar way as the professionals. Furthermore, facial scarring appeared only moderately associated with self-esteem. However, our study suggests that using both patients’ and professionals’ scar assessments provides more useful information regarding the patients’ well-being relative to focussing on the separate assessments only. In particular a discrepancy between the patients’ and professionals’ view on surface roughness might be an early indication of psychological difficulties and a call for further clinical attention.

According to the Minority Stress Model, immigrants have an increased risk of mental health problems compared with the general population. Homosexual feelings can form an additional minority stress factor next to ethnic minority status, given the social disapproval of homosexuality within non-Western cultures, the open manifestations of homosexual behavior in the western society, and the influence of religion, such as the Islam. It is unknown whether Islamic homosexuals indeed have an increased risk of developing mental health problems as compared to the general population or indigenous homosexual people. The aim of this study is to obtain a first insight into mental health problems of Islamic men and women with homosexual feelings in order to tailor health care services to their possible needs. The Islamic sample consisted of 51 men and 6 women and was compared with the Dutch norm group (N=1009) and with a group of indigenous Dutch homosexuals (N=61). Indicators of mental health problems were the anxiety and depression subscales of the SCL-90. Both the Islamic and the indigenous homosexual group reported significantly more symptoms of anxiety and depression than the Dutch norm group. The Islamic homosexual group did not differ significantly from the indigenous homosexual group with regard to anxiety, but showed a trend for higher depression. Despite the limitations, this unique study has provided an important first insight into this complex to reach population, warranting more research. Potential consequences for prevention policy and clinical implications are discussed.

Background A longitudinal study was conducted in order to assess the impact of the Ghislenghien disaster (July 30th, 2004) on physical, mental and social health in the affected population. Objectives The present study explored the risk for the development of four types of mental health disturbances (MHD) due to exposure to different aspects of this technological disaster in comparison with data obtained from previous health surveys among the population of the same province. Methods/Design Surveys were conducted 5 months (T1) and 14 months (T2) after the disaster. Potential adult victims (≥ 15 years) were included (n=1027 and 579 at T1 and T2 respectively). The "Symptom Checklist-90-Revised" (SCL-90-R) has been used in order to compute actual prevalence rates of somatization-, depression-, anxiety- and sleeping disturbances for three defined exposure categories: direct witnesses who have seen human damage (SHD), direct witnesses who have not seen human damage (NSHD) and indirect witnesses (IW). Those prevalence rates were compared with overall rates using the inhabitants of the province of Hainaut (n=2308) as reference population. A mental health comorbidity index was computed. Relative risks were estimated using logistic regression models. Results Prevalence rates of the four MHD were much higher for the SHD than for the other exposure groups, at T1 and T2. Moreover, NSHD and IW had no increased risk to develop one of the 4 types of MHD compared to the reference population. The SHD had at T1 and T2 good 5-times a higher risk for somatization, about 4-times for depression and sleeping disorders, and 5- to 6-times for anxiety disorders respectively. Further, they suffered 13 times, respectively 17 times more from all mental disorders together. Conclusions The present study calls attention to the fact that mental health problems disturbances are significantly more prevalent and long-lasting among survivors who have directly been exposed to human damage.

Despite increased attention to the role of fathers within families, there is still a dearth of studies on the impact of trauma on father-involvement. This study investigates the quantity of father-involvement and the influence of posttraumatic stress on the quality of involvement in a refugee and asylum seeker population. Eighty refugees and asylum seekers and their young children (aged 18-42 months) were recruited. Measures included assessment of parental trauma (Harvard Trauma Questionnaire), quantity and quality of involvement (quantity of caregiving and Emotional Availability Scales), and perception of the father-child relationship (interview). The results show that fathers were less involved in caregiving tasks and play activities than mothers. No parental gender differences were found on each of the Emotional Availability Scales. Traumatic stress symptoms negatively affected the perception and the actual quality of parent-child interaction (sensitivity, structuring, nonhostility). Nevertheless, almost all fathers described their relationship with their child as good and their child as very important to them. As the quality of father-involvement is of importance to the development of the child, traumatized fathers are as much in need of clinical intervention as mothers. Despite the impact of posttraumatic stress, refugee fathers clearly are involved in the lives of their children. Mechanisms such as a deliberate withdrawal when stressed and compensation might enable affected fathers to step into the interaction when needed, raise the quality of involvement with their child, and diminish the negative impact of stress resulting from trauma and migration. Language: en

Aspects of the socio-economic costs of bereavement in Scotland were estimated using three sets of data. Spousal bereavement was associated with increased mortality and longer hospital stays, with additional annual cost of around £20 million. Cost of bereavement coded consultations in primary care was estimated at around £2.0 million annually. Additionally, bereaved people were significantly less likely to be employed in the year of and two years after bereavement than non-bereaved matched controls, but there were no significant differences in income between bereaved people and matched controls before and after bereavement.

Objective. The aim of the current study was to compare obese and nonobese type 2 diabetes patients at baseline and after participating in an existing self-management intervention (i.e., Beyond Good Intentions) on cognitive, self-care, and behavioral measures to examine whether both groups are equally prepared and able to adopt self-management approaches. Methods. A total of 94 type 2 diabetes patients were included, of whom 64 (59% male) completed the study. The final sample consisted of 27 obese (33% male) and 37 nonobese (78% male) patients. The intervention comprised one individual and four group sessions and aimed to improve self-management behavior by enhancing proactive coping skills (i.e., setting concrete goals, identifying barriers, coping with difficult situations, action planning, and progress evaluation). Cognitive (i.e., proactive coping, self-control, self-efficacy), self-care (i.e., adherence to lifestyle recommendations), and behavioral (i.e., diet, exercise) measures were assessed at baseline and after completing the intervention. Results. At baseline, obese patients reported to possess lower cognitive skills and lower adherence to lifestyle recommendations compared with nonobese patients. The intervention was effective in improving cognitive skills, self-care activities, as well as dietary and exercise behaviors. Improvements were equal for obese and nonobese patients. However, obese patients were more likely to drop out. Conclusions. Although obese type 2 diabetes patients were found to possess limited skills at baseline compared with nonobese patients, the self-management course proved to be equally effective for both groups.

Disorders of Extreme Stress Not Otherwise Specified (DESNOS), also known as Complex posttraumatic stress disorder, was assessed in a sample (N = 472) of adult psychiatric patients with confirmed diagnoses of Borderline Personality Disorder (BPD), Somatoform Disorders (SoD), comorbid BPD + SoD, or Affective or Anxiety Disorders (Psychiatric Controls, PC). BPD + SoD patients had the most extensive childhood trauma histories and were most likely (38%) to meet DESNOS criteria, followed by BPD (26%), PC (17%), and SoD (10%), The BPD + SoD and BPD-only groups reported significantly higher levels of DESNOS symptoms than the SoD or PC groups, and did not differ from each other except for greater severity of DESNOS somatic symptoms by the BPD + SoD group. DESNOS warrants further investigation with psychiatrically impaired adults as a potential independent syndrome or as a marker identifying a subgroups of affectively or both affectively and somatically dysregulated patients diagnosed with BPD who have childhood trauma histories. (PsycINFO Database Record (c) 2012 APA, all rights reserved) Complex Posttraumatic Stress Disorder in Patients With Borderline Personality Disorder and Somatoform Disorders (PDF Download Available). Available from: http://www.researchgate.net/publication/232491929_Complex_Posttraumatic_Stress_Disorder_in_Patients_With_Borderline_Personality_Disorder_and_Somatoform_Disorders [accessed Oct 29, 2015].

Background and objectives Safety behaviours are widely held to impede the beneficial effects of exposure, certainly in OCD. Recently, Rachman, Radomsky, Shafran, and Zysk (2011) challenged this view. Healthy volunteers repeatedly touched a contaminant in two sessions. Half of the participants did not engage in safety behaviours after touching (exposure + response prevention), while the other half did (exposure + safety behaviours, i.e., cleaning hands with a hygienic wipe). Scores of contamination, fear, danger, and disgust decreased in both sessions and the effects were not impeded by safety behaviours. Three potential artefacts were identified in the Rachman et al. study: a no-treatment control group was lacking, the stop rules for ending exposure differed between conditions, and positive expectations may have been induced in the safety behaviours group. We tried to critically replicate the main findings. Method The Rachman et al. (2011) study was replicated, with 44 volunteers but stop rules and expectations were similar between treatments, and effects were also assessed in a no-intervention control group. Results Relative to the control condition, both exposure interventions induced reliable decreases in feelings of contamination, fear, danger, and disgust. The decline followed an exponential curve with the largest gains at the first trials of each session. Limitations Findings were obtained from a non-clinical sample. Conclusion The findings attest to the robustness of the Rachman et al. findings, and challenge the notion that safety behaviours should be dismissed categorically in exposure treatments.

Samenvatting Eye Movement and Desensitisation Reprocessing (EMDR) is een effectieve behandeling van traumasymptomen en de positieve effecten worden teruggevonden in het laboratorium, onder goed gecontroleerde omstandigheden. Dat biedt de mogelijkheid om na te gaan hoe EMDR werkt. Er wordt verslag gedaan naar de bevindingen uit een lange reeks experimenten. De hypothese dat oogbewegingen (of andere taken die worden uitgevoerd tijdens het ophalen van herinneringen) overbodig zijn en dat de exposure aan aversieve herinneringen tijdens EMDR de effecten verklaart, is niet houdbaar. Het idee dat ‘bilaterale stimulatie’ noodzakelijk is, snijdt evenmin hout. Je kunt net zo goed de ogen van boven naar beneden laten bewegen of taken laten doen waarbij helemaal geen oogbewegingen worden gemaakt. Belangrijk is dat de taak het werkgeheugen belast. Uit de werkgeheugenverklaring van EMDR is een lange reeks voorspellingen af te leiden. Die blijken wonderwel bestand tegen kritische experimentele tests en er tekent zich een solide verklaring af van hoe EMDR werkt. Die theorie en de empirische bevindingen hebben allerhande implicaties voor de techniek van EMDR. Abstract Eye Movement and Desensitization Reprocessing (EMDR) is an effective treatment of trauma symptoms, while beneficial effects can be reproduced under controlled laboratory conditions. This opens the door for testing how EMDR works. The paper reports data from a long series of experiments. The hypothesis that eye movements (or other dual tasks) are superfluous and that EMDR effects are explained by exposure is untenable. The idea that ‘bilateral stimulation’ is crucial, does not match the data either. One can just as well move the eyes vertically, or carry out tasks that do not involve eye movements. The crucial factor seems to be that the dual task is taxing working memory. From the working memory account of EMDR a long series of predictions can be derived. The predictions survived critical experimental tests. The theory and empirical data have a range of technical implications for carrying out EMDR. These implications are discussed.

The Dual Process Model of Coping with Bereavement (DPM; Stroebe & Schut, 1999) is described in this article. The rationale is given as to why this model was deemed necessary and how it was designed to overcome limitations of earlier models of adaptive coping with loss. Although building on earlier theoretical formulations, it contrasts with other models along a number of dimensions which are outlined. In addition to describing the basic parameters of the DPM, theoretical and empirical developments that have taken place since the original publication of the model are summarized. Guidelines for future research are given focusing on principles that should be followed to put the model to stringent empirical test.

Little evidence is available on the extent, course and influencing factors of pain in young children with burns. At present, reliable and valid measurement instruments to assess pain behavior in these children are available, implying that valuable insight into these questions can now be obtained. The aim of this study is to document the extent and course of pain behavior with the COMFORT-B, and to assess factors that may influence procedural pain. First, cutpoints for COMFORT-B scores were established by Rasch analysis to assess clinically relevant changes. Second, the extent of background and procedural pain behavior was assessed by descriptive statistics. Third, the course and factors that may influence procedural pain behavior were investigated by latent growth modeling. Trained nurses collected pain behavior data in 168 children (mean age 20 months, mean TBSA 6%, mean length of stay 10 days). Cutpoints of COMFORT-B scores were as follows: 6-13 (mild pain), 14-20 (moderate pain) and 21-30 (severe pain). This study suggests that background pain is more adequately treated than procedural pain. Factors that influenced baseline pain scores and/or the course over 8 days included TBSA, the number of surgical procedures, acetaminophen administration by the referring hospital, and the application of hydrofiber dressings. The implications of these findings are discussed.

Dysregulation of the immune system may play a role in chronic pain, although study findings are inconsistent. This cross-sectional study examined whether basal inflammatory markers and the innate immune response are associated with the presence and severity of chronic multisite musculoskeletal pain. Data were used on 1632 subjects of the Netherlands Study of Depression and Anxiety. The Chronic Pain Grade questionnaire was used to determine the presence and severity of chronic multisite musculoskeletal pain. Subjects were categorized in a chronic multisite musculoskeletal pain group (n = 754) and a control group (n = 878). Blood levels of the basal inflammatory markers C-reactive protein, interleukin-6, and tumor necrosis factor-alpha were determined. To obtain a measure of the innate immune response, 13 inflammatory markers were assessed after lipopolysaccharide (LPS) stimulation in a subsample (n = 707). Subjects with chronic multisite musculoskeletal pain showed elevated levels of basal inflammatory markers compared with controls, but statistical significance was lost after adjustment for lifestyle and disease variables. For some LPS-stimulated inflammatory markers, we did find elevated levels in subjects with chronic multisite musculoskeletal pain both before and after adjustment for covariates. Pain severity was not associated with inflammation within chronic pain subjects. An enhanced innate immune response in chronic multisite musculoskeletal pain may be examined as a potential biomarker for the onset or perpetuation of chronic pain. © 2014 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Objective Quality of life (QOL) is one of the leading outcomes in burn care research. This study classifies subscales of common QOL measures within the International Classification of Functioning disability and health (ICF) framework to determine to which extent the measures are complementary or overlapping and to investigate whether the instruments are able to describe the full spectrum of patients’ functioning. Methods A literature search was performed to determine the most frequently used questionnaires in burn research. The subscales of the three mostly used questionnaires were classified within the ICF framework. Results Two generic measures, the Short Form-36 items (SF-36) and the European Quality of Life 5 Dimensions (EQ-5D), and a disease specific measure, the Burn Specific Health Scale-Brief (BSHS-B), were analyzed. The BSHS-B covered most domains and was the only scale that included personal factors. The SF-36 included only one domain in the activity limitations and similar to the EQ-5D no contextual factors were included. Environmental factors were not addressed in the questionnaires, even though these may have an impact on the quality of life in patients with burns. Conclusion To capture the full spectrum of dysfunctioning a combination of the BSHS-B with a generic questionnaire seems obligatory. However still some domains of functioning remain uncovered.

Using data of 56 bereaved individuals, this study examined associations of various manifestations of continuing bonds, assessed at 7–12 months post-loss, with concurrent and prospective (9 months later) symptoms of grief and depression. Among other things it was found that, independent of initial symptom levels, manifestations of continuing bonds differed in their associations with subsequent grief and depression. That is, continuing bonds through recovering memories was a strong predictor of grief but not depression, whereas continuing bonds through the use of the deceased's possessions was a weak predictor of both grief and depression. In part, these findings contradict earlier prospective findings.

Typically, it is believed that palatable, high caloric foods signal reward and trigger indulgent responses. However, Counteractive Control Theory suggests that, to the extent that people are concerned about their weight, a confrontation with palatable foods should also trigger ‘alarm bell responses’ which promote successful self-control. Our study is the first to investigate such counteractive control processes in the brain employing functional magnetic resonance imaging (fMRI) in a sample of successful self-regulators. Indeed, besides the traditional finding that foods elicit heightened attention as witnessed by greater activation of primary visual cortex, we found that viewing palatable foods elicited brain activation in areas associated with self-regulation. Crucially, brain activation in self-regulation areas was related to diet importance. Thus, our results are the first to show that food cues not only evoke hedonic brain responses; in successful self-regulators they also trigger alarm bell responses, which may reflect the neural processes underlying successful self-control.

Sustaining burns is considered a stressful life event that has the power to elicit depressive symptoms. This study aimed to identify predictors of depressive symptoms by investigating the role of demographic variables, the number of operations (burn severity), neuroticism, and cognitive emotion regulation styles as possible influencing factors. Data from 242 patients with burns were analyzed employing latent growth modeling. The level of depressive symptoms across the 2-year interval was associated with burn severity, higher levels of neuroticism and rumination, and lower levels of positive refocusing. Notably, rumination partly mediated the effect of neuroticism on the course of depressive symptoms. Correlational analysis suggested a specific effect of burn severity on rumination. The results indicate that screening for symptoms of depression, rumination, and neuroticism in burn patients is useful. Early interventions focusing on cognitive restructuring could assist in improving the cognitive emotional adaptation process following a burn event.

Background : The analysis of small data sets in longitudinal studies can lead to power issues and often suffers from biased parameter values. These issues can be solved by using Bayesian estimation in conjunction with informative prior distributions. By means of a simulation study and an empirical example concerning posttraumatic stress symptoms (PTSS) following mechanical ventilation in burn survivors, we demonstrate the advantages and potential pitfalls of using Bayesian estimation. Methods : First, we show how to specify prior distributions and by means of a sensitivity analysis we demonstrate how to check the exact influence of the prior (mis-) specification. Thereafter, we show by means of a simulation the situations in which the Bayesian approach outperforms the default, maximum likelihood and approach. Finally, we re-analyze empirical data on burn survivors which provided preliminary evidence of an aversive influence of a period of mechanical ventilation on the course of PTSS following burns. Results : Not suprisingly, maximum likelihood estimation showed insufficient coverage as well as power with very small samples. Only when Bayesian analysis, in conjunction with informative priors, was used power increased to acceptable levels. As expected, we showed that the smaller the sample size the more the results rely on the prior specification. Conclusion : We show that two issues often encountered during analysis of small samples, power and biased parameters, can be solved by including prior information into Bayesian analysis. We argue that the use of informative priors should always be reported together with a sensitivity analysis. Keywords: Bayesian estimation; maximum likelihood; prior specification; power; repeated measures analyses; small samples; burn survivors; mechanical ventilation; PTSS Responsible Editor: Cherie Armour, University of Ulster, United Kingdom. For the abstract or full text in other languages, please see Supplementary files in the column to the right (under ‘Article Tools’). (Published: 11 March 2015) Citation: European Journal of Psychotraumatology 2015, 6 : 25216 - http://dx.doi.org/10.3402/ejpt.v6.25216

Contains fulltext : 76692.pdf (Publisher’s version ) (Closed access) Objective: Not all morbidly obese patients attain sufficient weight loss after laparoscopic adjustable gastric banding (LAGB). We examined patients' explanations for unsuccessful weight loss and self-awareness regarding food intake. Methods: Interviews with 11 patients (10 female/1 male; mean age 46 years) with unsuccessful weight loss were transcribed and analyzed with the MAXqda2 program. Results: Interviewees were disappointed with the postoperative outcome. Some showed no awareness of their own role, while others were inefficacious to continue the actions needed to maintain weight loss, especially during times of stress. Typical statements that distinguished interviewees were: 'It didn’t work out', 'I don’t care anymore', 'I know I have to do it', 'I know I can do it'. Conclusion: Some patients with unsuccessful weight loss after LAGB are insufficiently aware that their own effort is needed to maintain weight loss. Others have self-awareness, but find it difficult to turn awareness into action. Practice implications: This group could perhaps be helped by tailoring postoperative guidance to the stage of change of an individual patient. Counseling could include increasing awareness of the need to self-control eating and offering assistance to turn intentions into action and to deal with stress, emotions and physical problems. 6 p.

The loss of a marital partner results in substantial increases in morbidity and mortality among both men and women, but the effects are relatively greater for widowers than for widows in the acute grieving period. Evidence is reviewed, and explanations of the pattern are examined. An interpretation in terms of gender differences in social support (cf. M. Stroebe & W. Stroebe, 1983 ), although plausible, has not yet been empirically confirmed. Likewise, with respect to gender differences in coping styles, women are more confrontive and expressive of their emotions than men, but there has been little validation of the generally accepted grief work hypothesis (working through grief by women brings about their better recovery). Cognitive processes underlying effective coping with bereavement are analyzed, and a stressor-specific framework, the dual-process model of coping with loss, is suggested to help explain gender differences in health outcomes.

A new theory of eating regulation is presented to account for the over-responsiveness of restrained eaters to external food-relevant cues. According to this theory, the food intake of restrained eaters is characterized by a conflict between two chronically accessible incentives or goals: eating enjoyment and weight control. Their difficulty in weight control is due to their behavioral sensitivity to eating enjoyment and its incompatibility with the eating control goal. Accordingly, exposure to food-relevant stimuli primes the goal of eating enjoyment in restrained (but not unrestrained) eaters, resulting in an inhibition of weight control thoughts. Three studies are reported that support these assumptions. Study 1 demonstrates a substantial relation between Eating Restraint and measures of ambivalence towards eating. Studies 2 and 3 show that priming eating enjoyment decreases the accessibility of eating control concepts. The results are discussed in the context of current research on the psychology of obesity and restrained eating.

OBJECTIVE: This study examines traumatic stress reactions in couples that were followed prospectively for 18 months after a burn event to their child. METHOD: The participants included 186 mothers and 159 fathers of 198 preschool children. Parents' self-reported traumatic stress reactions were measured with the Impact of Event Scale (IES). Predictors included parental emotions and the perceived life-threatening character of the child's injury. RESULTS: Rates for clinically significant symptoms (IES ≥26) decreased from 50% within the first month to 18% at 18 months postburn for mothers and from 27% to 6% for fathers. The decline in symptoms was not entirely linear. Mothers had higher scores than fathers, but the discrepancy in intrusion symptoms among couples diminished over the course of time. Early appraisal of life threat and emotions about the burn event were significant predictors. CONCLUSIONS: Both mothers and fathers are seriously affected by a burn event of their young child. Despite a general decrease over time, a subgroup of parents is at risk for chronic symptoms. The results call for the integration of prolonged parent support in family centered pediatric burn aftercare programs. (PsycINFO Database Record (c) 2013 APA, all rights reserved). Language: en

Objective This multicenter study examines acute stress reactions in couples following a burn event to their preschool child. Methods Participants were 182 mothers and 154 fathers, including 143 couples, of 193 children (0–4 years) with acute burns. Parents’ self-reported acute stress reactions and emotions regarding the burn event were measured within the first month postburn. Results More mothers than fathers reported clinically significant acute stress reactions. Multilevel analysis revealed that individual parent reactions were associated with parent gender and negative emotions about the burn event. Interestingly, avoidance symptoms overlapped to an important extent within couples, whereas intrusion symptoms were mainly intra-individual. Burn characteristics, such as burn size, contributed to acute stress within couples. Conclusions Mothers and fathers are seriously affected by their child’s burn trauma and share a part of their acute stress reactions. These results emphasize the importance of a family-based approach to support adjustment after pediatric medical trauma.

Implementation intentions specifying the replacement of a habitual response with an alternative response in a critical situation can overrule habits. In three experiments the cognitive effects of such counterhabitual implementation intentions were investigated. Results showed that implementation intentions eliminated the cognitive advantage of the habitual means in the “horse race” with the alternative response. That is, in the control condition, the habitual means was more accessible than the alternative means on encountering the critical situation, but this was no longer the case when implementation intentions were formulated. However, the cognitive advantage of the habitual means was not immediately replaced by an automatic activation of the alternative means. This suggests that formulating counterhabitual implementation intentions increases individuals’ flexibility to choose which behavior to perform in the critical situation but that actual behavior will depart from their habits only to the extent that individuals have strong alternative goal intentions.

In this Review, we look at the relation between bereavement and physical and mental health. Although grief is not a disease and most people adjust without professional psychological intervention, bereavement is associated with excess risk of mortality, particularly in the early weeks and months after loss. It is related to decrements in physical health, indicated by presence of symptoms and illnesses, and use of medical services. Furthermore, bereaved individuals report diverse psychological reactions. For a few people, mental disorders or complications in the grieving process ensue. We summarise research on risk factors that increase vulnerability of some bereaved individuals. Diverse factors (circumstances of death, intrapersonal and interpersonal variables, ways of coping) are likely to co-determine excesses in ill-health. We also assess the eff ectiveness of psychological intervention programmes. Intervention should be targeted at high-risk people and those with complicated grief or bereavement-related depression and stress disorders.

Affect regulation is often compromised as a result of early life interpersonal traumatization and disruption in caregiving relationships like in situations where the caretaker is emotionally, sexually or physically abusing the child. Prior studies suggest a clear relationship between early childhood attachment-related psychological trauma and affect dysregulation. We evaluated the relationship of retrospectively recalled childhood traumatization by primary caretaker(s) (TPC) and affect dysregulation in 472 adult psychiatric patients diagnosed with borderline personality disorder (BPD), somatoform disorder (SoD), both BPD and SoD, or disorders other than BPD or SoD, using the Bermond-Vorst Alexithymia Questionnaire, the self-report version of the Structured Interview for Disorders of Extreme Stress, the Self-Rating Inventory for Posttraumatic Stress Disorder (SRIP) and the Traumatic Experiences Checklist. Almost two-thirds of participants reported having experienced childhood TPC, ranging from approximately 50% of patients with SoD or other psychiatric disorders to more than 75% of patients with comorbid BPD+SoD. Underregulation of affect was associated with emotional TPC and TPC occurring in developmental epoch 0-6 years. Over-regulation of affect was associated with physical TPC. Childhood trauma by a primary caretaker is prevalent among psychiatric patients, particularly those with BPD, and differentially associated with underand over-regulation of affect depending on the type of traumatic exposure. Keywords: Borderline personality disorder; somatoform disorders; child abuse; affect dysregulation (Published: 28 March 2011) Citation: European Journal of Psychotraumatology 2011, 2: 5628 - DOI: 10.3402/ejpt.v2i0.5628 For the abstract or full text in other languages, please see Supplementary files in the column to the right (under Reading Tools).

This dissertation is about health-related sense of humor measurement and associations between a sense of humor and health. Two sense of humor measures were developed, the QOHC and the HCL. The QOHC measures four humorous coping styles, aimed at acquiring positive affective states: antecedent-focused (AFHC), response-focused (RFHC), affiliative and aggressive-manipulative. AFHC is defined as the preventive use of humor to decrease negative affect, whereas RFHC is aimed at the reduction of negative affect already present. AFHC is expected to be more favorable to health than RFHC. Although the QOHC showed good validity and adequate divergent validity, the differences between positive and negative forms of humorous coping was not clear-cut. In an additional study, the QOHC and six other currently available humorous coping questionnaires were compared with regard to their fit with a stress-coping model. A mapping sentence was formed, which included external demands, humorous coping responses and coping aims. Five raters judged 81 humorous coping items from the questionnaires, using this “mapping sentence” as a template. External demands and humorous responses were sometimes underrepresented, whereas the coping aims facet was covered by only a few of them. Raters had difficulty to distinguish between antecedent-focused and response-focused humorous coping aims. Also, the 24-item HCL was developed and validated. Its intention is to measure six types of humorous behaviors validly and consistently: humor appreciation, positive humorous coping, mirth, positive humor climate at work, negative humor production and humor reproduction. Internal consistency and validity varied depending on the time window of the HCL used. Two studies were then conducted to test the associations of the new instruments with health. In the first study an occupational health model predicting the frequency of upper respiratory tract infections (URTI) by job demands, job resources (including humorous coping styles) and job-related affect was tested. Most humorous coping styles were unrelated to URTI frequency, except for response-focused humorous coping, which was positively related to it. Response-focused humorous coping was also positively related to negative job-related affect, which was positively associated with URTI frequency. The model including antecedent-focused humorous coping showed that this style was positively associated with positive job-related affect and negatively related to negative job-related affect. However, job control and negative job-related affect were more powerful predictors of URTI frequency than humorous coping styles. In the second study burnout was considered to influence humorous behaviors in a negative way, compared to healthy subjects. Also, burnout subjects were supposed to differ with regard to their humor styles. Burnout and healthy subjects were compared with regard to humorous traits (generic humorous coping and humor styles) and humorous behaviors during the past two weeks. The burnout group had lower generic humorous coping and lower positive humor styles than the control group, whereas no differences with respect to negative humor styles were found. The burnout group reported lower mirth, humor appreciation and humor reproduction than the control group, but the groups showed no differences with regard to more active humor use like negative humor production and positive humorous coping.

Aim & background The aim of this PhD research was to explore care for anxiety and depressive disorders that is in keeping with evidence-based general practice guidelines on the one hand, and care that is according to patients’ own perceived needs on the other hand. Since recommendations in clinical guidelines for anxiety and depression may be in contrast with patients’ own ideas and preferences, some tension might exist between evidence-based care and patient-centred care for these common mental disorders. In addition to measuring patients’ perceived need for care and patient related factors with guideline adherence, we evaluated the clinical outcomes and costs for society in cases where guideline-concordant care was delivered in comparison with non-guideline concordant care, and the clinical outcomes and costs in cases where patients’ self-perceived needs were fulfilled or not. Methods Data from the Netherlands Study of Depression and Anxiety (NESDA) were used in most of the studies. NESDA is a naturalistic longitudinal cohort study that has included 2981 adult participants for the baseline assessment between 2004 and 2006, recruited from three different settings. We have used the ‘primary care sample’ which included 743 participants with a current (6-month recency) anxiety or depressive disorder. Data were assessed at baseline and one year later. Perceived need for care was measured by the Perceived Need for Care Questionnaire (PNCQ) during the baseline assessment of NESDA. Adherence to evidence-based general practice guidelines for anxiety and depression was defined and measured in an earlier study, based on electronic medical record data from general practices and questionnaire data. Results In general, patients prefer psychological treatment over medication. Patients’ perceived needs for information, counseling or psychotherapy are often not (fully) met while medication needs are more frequently met. Of 721 patients with anxiety and depressive disorders 39% had received guideline-concordant care. On average these patients had more severe symptoms compared to those who did not receive care according to the evidence-based guidelines. However, education level, accessibility of care and patients’ perceived needs for care were more strongly related to the delivery of guideline-concordant care than clinical need factors. After one year, both treatment groups had improved significantly, but the guideline-concordant care group had generated €1035 more costs than the non-guideline concordant care group. There were no significant differences in costs for society between patients who had their perceived needs fully met or not. Conclusions In general, patients with anxiety and depressive disorders prefer psychological treatment but this study shows that this need is not always met in general practice. A possible solution could be found in task delegation. Mental health nurse practitioners, for example, could be valuable partners of GPs to manage mental disorders within general practice. Cooperation within primary care with primary care psychologists or social work might be another option. Because of the naturalistic design, no definite conclusions can be drawn about effectiveness. So, more research is needed to draw any valid conclusions about the costs and effects of guideline-concordant care and care that has fulfilled patients needs.

Having strong goal intentions is generally not sufficient to ensure actual goal-directed behavior. However, when goal intentions are furnished with a specific type of planning, called ‘implementation intentions’, the likelihood of successful goal-striving substantially increases. Implementation intentions are simple action plans that specify the where, when, and how of goal-striving (“If I am in situation X, then I will perform goal-directed behavior Y!”), unlike intentions which merely specify a desired end-state (“I intend to achieve Z!”). Although many studies have shown that implementation intentions help to promote the initiation of new, wanted behaviors (e.g., eating more fruits), there was little empirical evidence for the efficacy of implementation intentions in diminishing existing unwanted habits (e.g., eating less junk food). The main objective of this dissertation was therefore to investigate whether implementation intentions can also be effective in endorsing this more difficult, but important, type of behavior change. This question was investigated in the domain of eating, and specifically for unhealthy snacking behavior. Two types of implementation intentions were tested for their efficacy: implementation intentions that specify not to eat an unhealthy snack in a critical situation (negation implementation intentions), and implementation intentions that specify the replacement of unhealthy snacks with healthy snacks in a critical situation (replacement implementation intentions). In addition to investigating their efficacy, the underlying mechanisms making these different types of implementation intentions (in)effective were also investigated. Moreover, it was tested whether, by fostering the identification of critical situations, the self-regulation strategy ‘mental contrasting’ could augment the efficacy of implementation intentions. Findings showed that replacement implementation intentions are effective in diminishing unwanted habits. The underlying mechanism making these implementation intentions effective involve a simultaneous facilitation of the ‘situation-healthy snack association’ and an inhibition of the ‘situation-unhealthy snack association’. Together, these two processes increase the chance that one is able to choose the healthy snack upon encountering the critical situation. Some important boundary conditions were also identified. First of all, it was found that implementation intentions should specify the replacement of unhealthy snacks by healthy snacks in order to be effective, rather than specifying not to consume the unhealthy snack. When negation implementation intentions are formulated, unhealthy snack intake ironically actually increases. Second, the if-part of the implementation intention needs to capture the actual critical situation that triggers the unwanted behavior for the implementation intention to be successful in diminishing the unwanted behavior. Related, it was found that mental contrasting is a promising strategy for identifying these critical situations and thus for increasing the effectiveness of the implementation intentions. In conclusion, while making a specific action plan may help to break unwanted habits, there are some important boundary conditions. Only when implementation intentions with the right format (replacement), that specify truly critical situations are formulated, they are effective in breaking habits. Since the plans people make without any help generally do not adhere to these conditions, formulating effective plans may require additional self-regulation strategies, such as mental contrasting.

In this dissertation some of the major facets associated with the psychological effects of bereavement were the subject of investigation: risk factors, mediating processes and intervention. Previous research on risk factors is limited because of a number of methodological shortcomings: a focus on only one or a few factors (which increases the chances of reporting spurious results) and reliance on use of a single measure of bereavement outcome. We avoided these pitfalls by simultaneously examining the impact of a large set of potential risk factors on multiple outcome measures (grief, depressive symptoms, emotional loneliness, and positive mood). We found that (un)expectedness of the death, type of loss, gender, attachment style, neuroticism, spirituality, social support, and aspects having to do with the financial situation of the bereaved person uniquely predicted bereavement outcome. Risk factors were differentially related to different outcome measures. Although knowledge about risk factors is valuable, it does not inform one about pathways through which these predictors become impactful. In a subsequent study we therefore examined the degree to which three potentially critical processes (rumination, threatening grief interpretations and deliberate grief avoidance) mediated the relationship between the risk factors and outcome measures identified earlier. Results showed that rumination and – to a somewhat lesser extent - threatening grief interpretations played an important role in mediating the effects of various risk factors on outcomes. However, the contribution of these two mediators was dependent on the specific risk factor and outcome measure under consideration. An effective paradigm for relieving the impact of stressful events is the disclosure technique developed by Pennebaker and colleagues. However, there is little evidence that written disclosure facilitates recovery from bereavement. We assumed that written disclosure may only benefit those bereaved who are at risk for developing problems or who are experiencing significant psychological problems as a result of their loss, and only when appropriate writing instructions are used. We developed a new writing intervention to test these assumptions. Bereaved individuals were randomly assigned to the intervention condition (n=460) or a waiting list control condition (n=297). Both groups filled in questionnaires online at baseline, and 3 and 6 months later. The intervention was administered via e-mail immediately after baseline measurement. Results showed that writing decreased feelings of emotional loneliness and increased positive mood, in part through its effect on rumination. However, writing did not affect grief or depressive symptoms. Contrary to expectations, effects did not depend on participants’ risk profile or baseline distress level. Another type of intervention - that appears to be growing - is online mutual bereavement support. We designed a study to increase our understanding of the people who use this type of support and of its effect. Our findings showed that people who draw on this type of support are more likely to be female, younger, to have lost a child, and are less likely to be part of a religious community. Using this type of support did not predict changes in mental health over time.

The goal of this dissertation is to increase understanding of individual differences in vulnerability for and resilience to trauma in military personnel. Specifically, the studies in this dissertation examined clinical symptoms and personality profiles of Dutch peacekeepers and sought to elucidate how personality may moderate risk and resilience to posttraumatic stress disorder (PTSD) in soldiers and veterans. Personality affects the development of trauma-related psychopathology at different stages. It may play a role in the development of PTSD by affecting the risk of exposure to trauma and / or by influencing the individual’s potential to effectively deal with stress and trauma. Although the cross-sectional studies in this dissertation foreclose inferences on causality, we demonstrated that healthy soldiers who report more childhood trauma display personality traits that were previously associated with interpersonal problems and mental disorders. Furthermore, the data demonstrated that personality may affect coping resources and behaviour. Hardiness facilitates coping by increasing social support and the use of problem oriented coping behaviour whereas increased neuroticism has opposite effects. Personality may also affect the course of PTSD: personality traits neuroticism and optimism are directly related (in opposite directions) to concurrent symptom severity. Personality vulnerability and resilience factors are closely related. The absence of the former can imply the presence of the latter. However, in some instances it is difficult to disentangle risks from resilience. This dissertation demonstrated that the personality trait of neuroticism is closely (inversely) related to optimism and hardiness, and that both adaptive and maladaptive personality traits can be related to similar underlying biological systems. That is, both harm avoidance and self-directedness are related to hypothalamic-pituitary-adrenal (HPA) axis functioning as measured by the increase in salivary cortisol after awakening. Finally, the need for effective prevention and treatment programs for stress-related disorders in peacekeeping veterans is illustrated by two studies that showed that Dutch veterans with (chronic) PTSD symptoms report diffuse psychiatric symptoms and personality problems, not too dissimilar from what was previously observed in Vietnam veterans, and that their symptoms are difficult to treat. In conclusion, this dissertation demonstrates that personality is an important determinant of post-traumatic morbidity and functioning. Therefore, personality assessment can aid in improving screening programs and may prove useful to optimize military training and treatment programs. However, a number of issues need to be resolved before personality psychology can fulfil its full potential. These include addressing the need for more sophisticated and ‘fine-grained’ assessment procedures on the one hand, and providing more insight into the dynamic relationship between trauma and personality on the other.

In the Western rich food environment, people are constantly confronted with palatable but unhealthy food products. For those who would like to watch their weight, the appeal of immediate satisfaction is in conflict with their long-term weight watching goal, constituting a classic self-control dilemma. The current studies were designed to test the effect of food temptations on self-regulation mechanisms. Hypotheses were based on counteractive control theory stating that temptations trigger goal-directed behavior, thereby forming an adaptive self-regulation mechanism. Two experimental studies showed that exposure to food temptations, compared to a control condition, yielded enhanced goal importance (Study 1), goal intentions, and goal-directed behavior (i.e., healthy eating; Study 2). It is concluded that confrontation with temptations is not always undermining self-control and may even be beneficial for long-term goal pursuit.

BACKGROUND: Medically unexplained symptoms (MUS) are a common reason to seek medical care. When presented to the general practitioner (GP), more than three-quarters of symptoms such as stomach ache, headache, and pain in bones and muscles cannot be explained by a medical disorder. OBJECTIVE: The authors examined the course of MUS presented to the GP in the 1 year before the disaster and in the 4 years after a disaster in order to study the risk factors for MUS. METHOD: Data were extracted from the electronic medical records of survivors and from a questionnaire (N=1,216). RESULTS: Although the mean number of MUS was significantly increased statistically in the first 2 years post-disaster, the increase was not clinically significant. CONCLUSION: The authors identified several important risk factors, such as immigrant status and psychological problems, that are easy for GPs to recognize. Despite this, the sensitivity of the regression model was relatively low.