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Person-centred care requires improved documentation of nursing home resident wellbeing, e.g. by nursing staff proxy assessments. Previous studies mainly focused on proxy self-report agreement of quality of life of people with dementia, using lengthy questionnaires. This is the first study to investigate how well nursing staff assess residents’ wellbeing after training, using a single-question assessment method of happiness and engagement. We conducted a cross-sectional mixed-method study, including proxy assessments from 49 nursing staff, and self-reports from 49 nursing home residents without dementia (mean age 85). We explored agreement between colleagues, and between proxy assessments and self-reports, and potential nursing staff characteristics associated to this (age, experience, hours worked per week). Brief written motivations were evaluated on nursing staffs’ understanding of the happiness and engagement concepts. The results showed low agreement between colleagues, and low agreement between proxy assessments and self-reports. Nursing staff assessed happiness and engagement substantially higher than residents’ self-reports. Hours worked per week was related to happiness proxy assessments, but none of the included nursing staff characteristics were related to proxy self-report agreement. Nursing staff interpreted the concepts in diverse ways. Overestimating resident wellbeing when using this single-assessment method may undermine subsequent efforts to improve wellbeing. We could not identify which nursing staff could best provide wellbeing assessments. For now, proxy wellbeing assessments should always be combined with regular self-reports whenever possible.

Background The Life-Chart Method (LCM) is an effective self-management treatment option in bipolar disorder (BD). There is insufficient knowledge about the consumers’ needs and desires for an e-monitoring solution. The first step towards a new mood monitoring application is an extended inventory among consumers and professionals. Methods The aim of the current study was: to identify opinions about online mood monitoring of patients with BD and professionals and to identify preferences on design, technical features and options facilitating optimal use and implementation of online mood monitoring. This study used a qualitative design with focus-groups. Participants were recruited among patients and care providers. Three focus-groups were held with eight consumers and five professionals. Results The focus-group meetings reveal a shared consciousness of the importance of using the Life-Chart Method for online mood monitoring. There is a need for personalization, adjustability, a strict privacy concept, an adjustable graphic report, and a link to early intervention strategies in the design. Due to the fact that this is a qualitative study with a relative small number of participants, so it remains unclear whether the results are fully generalizable. We can’t rule out a selection bias. Conclusions This study demonstrates the importance of involving stakeholders in identifying a smartphone-based mood charting applications’ requirements. Personalization, adjustability, privacy, an adjustable graphic report, and a direct link to early intervention strategies are necessary requirements for a successful design. The results of this value specification are included in the follow-up of this project.

Purpose To evaluate the effectiveness of two versions (personal or automated feedback) of a psychological Web-based self-help intervention targeting partners of cancer patients. The intervention was based on acceptance and commitment therapy (ACT) and self-compassion training. Participants’ adherence and their satisfaction were also studied. Methods Two hundred three partners of patients with heterogeneous entities of cancer were randomized into three conditions: personal feedback (PF) (n = 67), automated feedback (AF) (n = 70), or waiting list (WL) control (n = 66). Participants completed measures at baseline (T0) and post-intervention (T1; 3 months after baseline) to assess psychological distress (HADS; primary outcome), positive mental health, caregiver strain, general health (secondary outcomes), posttraumatic growth, resilience, self-compassion, psychological flexibility, sense of mastery, and relational communication style (process measures). Participants in the two experimental conditions also completed these measures at follow-up (T2; 6 months after baseline). Results There was no significant difference in change in psychological distress, positive mental health, caregiver strain and general health from T0 to T1 for either of the experimental conditions compared with the WL-condition. However, when compared to a WL-condition, the PF-condition was effective in increasing psychological flexibility (effect size d = 0.49) and resilience (d = 0.12) and decreasing overprotection (d = 0.25), and the AF-condition was effective in reducing overprotection (d = 0.36) and improving protective buffering (d = 0.36). At follow-up, the PF-condition was more effective than the AF-condition for improving mental health (d = 0.36), psychological flexibility (d = 0.60), mastery (d = 0.48), and protective buffering (d = 0.24). Participants positively appreciated the intervention and 69% participants were adherent. Conclusion This study demonstrates that a Web-based intervention based on ACT and self-compassion training with automated or personal feedback does not seem to improve psychological distress; however, it may have the potential to support partners of cancer patients to cope with the difficult situation they are facing. The condition with personal feedback seemed to be more beneficial.

Purpose Investigate whether Life Review Therapy and Memory Specificity Training (LRT-MST) targeting incurably ill cancer patients may also have a beneficial effect on caregiving burden, symptoms of anxiety and depression, and posttraumatic growth of the informal caregivers. Methods Data was collected in the context of a randomized controlled trial (RCT) (secondary analyses) on the effect of LRT-MST among incurably cancer patients. Informal caregivers of participating patients were asked to complete outcome measures at baseline (T0), post-intervention (T1), and 1-month follow-up (T2): caregiver burden (caregivers reaction assessment scale (CRA)), symptoms of anxiety and depression (hospital anxiety and depression scale), and posttraumatic growth (posttraumatic growth inventory). Linear mixed models (intention to treat) were used to assess group differences in changes over time. Effect size and independent samples t tests were used to assess group differences at T1 and T2. Results In total, 64 caregivers participated. At baseline, 56% of the caregivers experienced anxiety and 30% depression. No significant effect was found on these symptoms nor on posttraumatic growth or most aspects of caregiver burden. There was a significant effect of LRT-MST on the course of self-esteem (subscale CRA) (p = 0.013). Effect size was moderate post-intervention (ES = − 0.38, p = 0.23) and at 3-month follow-up (ES = 0.53, p = 0.083). Conclusions Many caregivers of incurably ill cancer patients experience symptoms of anxiety and depression. LRT-MST does not improve symptoms of depression and anxiety, negative aspects of caregiver burden, or posttraumatic growth. LRT-MST may have a protective effect on self-esteem of informal caregivers (positive aspect of caregiver burden). Trial registration number Netherlands Trial Register (NTR 2256), registered on 23-3-2010.

Person-centered care (PCC) interventions have the potential to improve resident well-being in nursing homes, but can be difficult to implement. This study investigates perceived facilitators and barriers reported by nursing staff to using a PCC intervention consisting of three components: assessment of resident well-being, planning of well-being support, and behavioral changes in care to support resident well-being. Our explorative mixed method study combined interviews (n = 11) with a longitudinal survey (n = 132) to examine which determinants were most prevalent and predictive for intention to use the intervention and actual implementation 3 months later (n = 63). Results showed that perceived barriers and facilitators were dependent on the components of the intervention. Assessment of resident well-being required a stable nursing home context and a detailed implementation plan, while planning of well-being support was impeded by knowledge. Behavioral changes in nursing care required easy integration in daily caring tasks and social support. (C) 2020 The Author(s). Published by Elsevier Inc.

People with reduced levels of mental well-being might be at risk for developing future mental illness. Although several positive psychology interventions successfully improve mental well-being and psychological distress, less is known about their efficacy in a sample at risk for mental disorders. A Dutch sample of 289 participants with low or moderate levels of well-being were randomly assigned to other-focused kindness with reflection, other-focused kindness without reflection, self-focused kindness, or waitlist control (Trial register: NTR6786). Results of multilevel growth curve analyses revealed that other-focused kindness, but not self-focused kindness, led to improvements in the primary outcome mental well-being relative to waitlist control up to 6-week follow-up. By contrast, only other-focused kindness without reflection led to improvements in psychological distress. The three kindness conditions mainly did not differ from one another, and mainly no differences were found up to 6-months follow-up. An exception was that perceived stress was significantly more reduced up to 6-week and 6-months follow-up when people practiced other-focused kindness without reflection then when participants had practiced self-focused kindness. These findings point to the benefits of practicing kindness for others when people might be at risk for future mental illness. The study also indicates that reflecting about practicing kindness does not seem to have added value.

The job demands-resources (JD-R) model has hardly been studied in volunteer organizations and there is a scarcity of studies evaluating self-compassion as a personal resource within the JD-R model. The present study addresses these gaps in current knowledge, first by examining the applicability of the JD-R model in a crisis line volunteer organization. Second, self-compassion is examined, both in terms of its moderating role on the exhaustion process as well as its role on the motivation process. Structural equation modelling was used for the analyses. The influence on the organizational outcome ‘compassion towards others’ was examined using a multiple regression analysis. The results showed that the JD-R model has an acceptable fit on this sample and supports the central assumption that exhaustion and motivation are two independent but related processes. This study provides evidence that self-compassion is a valuable addition to the JD-R model, as it has an indirect effect on both processes, and increases the explained variance in compassion towards others by 7% through the exhaustion process and by 3% through the motivational process. These findings point to the importance of focusing on self-compassion in training and supervision in volunteer organizations.

Objectives To evaluate the psychometric properties of the Responses to Positive Affect (RPA) questionnaire in a sample of persons with bipolar disorder (BD). Method Cross‐sectional survey study with 107 persons with BD. The original 3‐factor model of the RPA was compared with a 2‐factor model. Construct validity was determined with measures of well‐being, personal recovery, social role participation, and psychopathology and incremental validity was evaluated. Results The fit of the 3‐factor model was acceptable for most fit indices. Subscores of the RPA revealed a significant relationship with aspects of well‐being, personal recovery, and psychopathology. Dampening and self‐focused positive rumination explained additional variance in personal recovery above and beyond well‐being. Conclusions The RPA is an internally consistent and valid tool to assess positive emotion regulation processes in persons with BD. Specifically, the processes of dampening and emotion‐focused positive rumination seem to play an important role in BD.

The relevance of personal recovery receives increasing attention in mental health care and is also important for people with bipolar disorder (BD). There is a need for reliable and valid instruments measuring personal recovery. Therefore, the current study evaluated the psychometric properties of a Dutch translation of the Questionnaire about the Process of Recovery (QPR) in a sample of people with BD and explored the relationship with constructs of well-being, social role participation and psychopathology. A cross-sectional survey study was conducted, in which 102 people diagnosed with BD completed the QPR. Factor structure of the QPR was evaluated by conducting confirmatory factor analyses (CFA) and internal consistency was assessed by calculating reliability coefficients. Convergent validation measures assessed well-being, social role participation and symptomatology. Incremental validity was determined by evaluating the ability of the QPR to explain variance in symptomatology above and beyond measures of well-being and social role participation. Findings of the CFA supported a unidimensional factor structure and internal consistency estimates were excellent. Scores of the QPR showed strong correlations with convergent measures, but were only weakly associated with manic symptomatology. Moreover, personal recovery explained additional variance in symptoms of depression and anxiety above and beyond well-being, indicating incremental validity. The QPR appears to be a reliable and valid tool to assess personal recovery in people with BD. Our findings underline the importance of personal recovery in the context of treatment of BD. Personal recovery demonstrates a substantial overlap with well-being.

Background: Personal recovery is increasingly recognized as important outcome for people with bipolar disorder (BD), but research addressing associated factors of personal recovery in this group remains scarce. This study aimed to explore the association of sociodemographic variables, social participation, psychopathology, and positive emotion regulation with personal recovery in BD. Methods: Baseline data from a randomized controlled trial and survey data were combined (N = 209) and split into a training (n = 149) and test sample (n = 60). Block-wise regression analyses and model training were used to determine the most relevant predictors. The final parsimonious model was cross-validated in the test sample. Results: In the final parsimonious model, satisfaction with social roles (β =.442, p 2 =.561) and performed well in predicting personal recovery in the independent test sample (adjusted R2 =.491). Conclusions: Our findings suggest that especially social participation, anxiety and positive rumination might be relevant treatment targets when aiming to improve personal recovery. Practitioner points: Personal recovery is considered an increasingly important outcome for people with chronic mental health conditions, including bipolar disorder. We found that anxiety and manic symptoms as well as positive rumination and social participation were independently associated with personal recovery in bipolar disorder. Therefore, these outcomes might be relevant treatment targets when aiming to improve personal recovery in bipolar disorder. Possible interventions to improve these outcomes are discussed, including supported employment and vocational rehabilitation for social participation and exercising with savoring strategies to increase positive rumination.

There is growing evidence that positive psychology interventions (PPIs) are effective in enhancing mental well-being and reducing depressive symptoms. However, there is a knowledge gap regarding the motives of people to seek such PPIs. This study qualitatively identifies help-seeking motives and quantitatively examines which motives relate to client satisfaction, adherence and an impact on mental well-being, anxiety and depressive symptoms. We analyzed 123 introductory emails of people with suboptimal levels of mental well-being who assigned to a comprehensive 9-week PPI with email support, of which its efficacy was investigated in a randomized controlled trial. Results showed that 49% mentioned mainly suffering-related motives (i.e. distress and stressful events/circumstances) and 51% mentioned mainly growth-related motives (i.e. mental well-being and developing resources). Hardly any motive was significantly related to beneficial outcomes, albeit developing resources and suffering were positively—though weak—correlated with adherence. The present study indicates that this PPI was effective for a broad audience, namely for those with suffering-related and with growth-related motives. This finding underscores the great relevance of PPIs to reach people who might be at risk for future mental disorders who otherwise do not seek help.

This article presents findings from a meta-analysis which sought to determine the effectiveness of interventions adopting a whole school approach to enhancing children and young people’s social and emotional development. Whole school interventions were included if they involved a coordinated set of activities across curriculum teaching, school ethos and environment, and family and community partnerships. A total of 45 studies (30 interventions) involving 496,299 participants were included in the analysis. Post-intervention outcomes demonstrated significant but small improvements in participants’ social and emotional adjustment (d = 0.220), behavioural adjustment (d = 0.134), and internalising symptoms (d = 0.109). Interventions were not shown to impact on academic achievement. Origin of study and the inclusion of a community component as part of a whole school approach were found to be significant moderators for social and emotional outcomes. Further research is required to determine the active ingredients of whole school interventions that we can better understand the components necessary to achieve successful outcomes.

Objective The growing evidence for the dual continua model of psychopathology and well‐being has important implications for measuring outcomes in mental health care. The aim of the current study is to validate a measure of well‐being as well as the dual continua model in adults with mood, anxiety, personality, and developmental disorders. Methods 472 adult psychiatric outpatients filled out the Mental Health Continuum‐Short Form (MHC‐SF) and the Outcome Questionnaire before start of treatment. Results Confirmatory factor analyses (CFA) confirmed the three‐factor structure of emotional, psychological, and social well‐being of the MHC‐SF. The dual continua model had the best fit in the complete sample and the different diagnostic groups. Conclusion The MHC‐SF is a reliable and valid instrument to measure well‐being in the psychiatric population. Although relatively high correlations between psychopathology and well‐being exist, the results underline the importance to measure well‐being in addition to psychopathology in mental health care.

Objectives: Solution-focused support (SFS) is an upcoming approach to support people with intellectual disabilities (ID). However, while research shows that clients appreciate this approach, insight into professionals’ experiences and their application of SFS is lacking. This article describes a qualitative study aimed at understanding how professionals make sense of learning and applying SFS, specifically, Cauffman’s Solution Cube. Methods: Logbook files in which professionals reported their experiences with SFS for a full year were qualitatively analyzed in two steps: (1) identification of how professionals assigned successful and unsuccessful applications of SFS, and reflected on what worked and dilemmas arising during this application process, (2) identification of patterns over time in how professionals learned how to deal with the encountered dilemmas. Results: The main dilemma experienced by professionals concerns ‘doing what works’ in conjunction with other dimensions of the Solution Cube. Three overall patterns were identified to address how professionals made sense of learning how to apply SFS over time and deal with ambiguities of ‘doing what works’ in practice: (1) a focus on caring, (2) a focus on empowering, and (3) a focus on balancing between the two. Conclusions: Understanding how professionals deal with SFS over time enables researchers to identify different ways professionals learn SFS, along with the ambiguities they experience about the approach and unintended applications. Implications for implementing SFS and learning facilitators that might help promote a balance between caring and empowerment, specifically for people with ID, are provided.

Unemployment is associated with a diminished mental health. Interventions to improve mental health for the unemployed exist. However, there is no clear overview with respect to the content and effectiveness of these interventions. A systematic search was conducted and, included studies that targeted unemployed adults, described an intervention and reported mental health as an outcome measure. After screening, 24 studies remained, which contained 21 different interventions. These interventions could be classified into three categories: occupational skills training interventions, psychological interventions and combined interventions. The majority of the studies reported significant short-term effects on mental health, but in most cases evidence of sustained effects was lacking or not assessed. There is promising evidence that interventions combining occupational skills and resilience training are effective in promoting mental health. However, there is a need for high-quality research on the intervention effects on the mental health of the (long-term) unemployed.

We examined whether sustained vs. transient spatial attention differentially affect the processing of electrical nociceptive stimuli. Cued nociceptive stimuli of a relevant intensity (low or high) on the left or right forearm required a foot pedal press. The cued side varied trial wise in the transient attention condition, while it remained constant during a series of trials in the sustained attention condition. The orienting phase preceding the nociceptive stimuli was examined by focusing on lateralized EEG activity. ERPs were computed to examine the influence of spatial attention on the processing of the nociceptive stimuli. Results for the orienting phase showed increased ipsilateral alpha and beta power above somatosensory areas in both the transient and the sustained attention conditions, which may reflect inhibition of ipsilateral and/or disinhibition of contralateral somatosensory areas. Cued nociceptive stimuli evoked a larger N130 than uncued stimuli, both in the transient and the sustained attention conditions. Support for increased efficiency of spatial attention in the sustained attention condition was obtained for the N180 and the P540 component. We concluded that spatial attention is more efficient in the case of sustained than in the case of transient spatial attention.

Mindfulness-based interventions (MBIs) are increasingly being delivered through the Internet. Whereas numerous meta-analyses have investigated the effectiveness of face-to-face MBIs in the context of mental health and well-being, thus far a quantitative synthesis of the effectiveness of online MBIs is lacking. The aim of this meta-analysis was to estimate the overall effects of online MBIs on mental health. Fifteen randomised controlled trials were included in this study. A random effects model was used to compute pre-post between-group effect sizes, and the study quality of each of the included trials was rated. Results showed that online MBIs have a small but significant beneficial impact on depression (g = 0.29), anxiety (g = 0.22), well-being (g = 0.23) and mindfulness (g = 0.32). The largest effect was found for stress, with a moderate effect size (g = 0.51). For stress and mindfulness, exploratory subgroup analyses demonstrated significantly higher effect sizes for guided online MBIs than for unguided online MBIs. In addition, meta-regression analysis showed that effect sizes for stress were significantly moderated by the number of intervention sessions. Effect sizes, however, were not significantly related to study quality. The findings indicate that online MBIs have potential to contribute to improving mental health outcomes, particularly stress. Limitations, directions for future research and practical implications are discussed.

Mindfulness based stress reduction (MBSR) training has been proposed to improve attentional skills by modulating thalamo-cortical loops that affect the sensitivity of relevant cortical areas like the somatosensory cortex. This modulation may be reflected in the electroencephalographic (EEG) alpha rhythm, and could affect the processing of subsequently applied intracutaneous electrical stimuli. Participants took part in an MBSR training and participated in two EEG sessions. EEG was measured in variants of an endogenous orienting paradigm in which attention had to be directed to the left or right forearm. After the orienting interval, the electrical stimulus was applied, equally likely on the attended or the unattended forearm. One group of participants took part in the EEG session before and after the training, while the other group took part after the training, and another time, eight weeks later. The influence of the MBSR training and spatial attention were examined with behavioral measures, lateralized alpha power within the orienting interval, and with event-related potentials (ERPs) evoked by the electrical stimuli. Self-reported mindfulness was clearly affected by the training, but no influence was found on other behavioral measures. Alpha power was clearly lateralized due to spatial attention and several ERP components (N130, N180, P340) were modulated by spatial attention but no support was found for an influence of the MBSR training. Finally, analyses revealed that individual differences in training time modulated some of the observed effects, but no support was found for an influence on attentional orienting.

Background: There is accumulating evidence that positive mental health and psychopathology should be seen as separate indicators of mental health. This study contributes to this evidence by investigating the bidirectional relation between positive mental health and psychopathological symptoms over time. Methods: Positive mental health (MHC-SF) and psychopathological symptoms (BSI) were longitudinally measured in a representative adult sample (N = 1932) on four measurement occasions in nine months. A cross-lagged panel design was applied and evaluated with a latent growth model combined with an item response theory measurement model. Results: Psychopathological symptoms were longitudinally related to positive mental health and vice versa, controlling for initial levels. The changes over time were even more important than the absolute levels of psychopathological symptoms and positive mental health, respectively. Conclusions: The results underline the need for a comprehensive perspective on mental health, incorporating both the treatment of symptoms and the enhancement of well-being

Mental health is more than the absence of mental illness. Rather, both well-being (positive mental health) and mental illness are actually two related continua, with higher levels of well-being defined as “flourishing.” This two-continua model and existing studies about the impact of flourishing on psychopathology underscore the need for interventions that enhance flourishing and well-being. Acceptance and Commitment Therapy (ACT) is a model of cognitive behavioral therapy that aims not only to reduce psychopathology but also to promote flourishing as well. This is the first study to evaluate the impact of ACT on flourishing. A post-analysis was conducted on an earlier randomized controlled trial of a sample of adults with depressive symptomatology who participated in a guided self-help ACT intervention. This post-analysis showed a 5%–28% increase of flourishing by the participants. In addition, the effects on flourishing were maintained at the three-month follow-up. When compared to participants in a control group, the flourishing of the ACT-trained participants increased from 5% to about 14% after nine weeks. In addition to levels of positive mental health at baseline, an increase of psychological flexibility during the intervention was a significant predictor of flourishing at the three-month follow-up.

Psychological flexibility receives increasing attention as the overarching process in Acceptance and Commitment Therapy (ACT). This study investigates the psychometric properties of the Psychological Inflexibility in Pain Scale (PIPS), measuring “avoidance” and “cognitive fusion” with pain, in a heterogeneous clinical sample of 428 chronic pain patients from four rehabilitation centers. Furthermore, the relationship between the PIPS and mindfulness (Five Facet Mindfulness Questionnaire, FFMQ) as a theoretically related measure within ACT is explored. Confirmatory factor analyses replicated acceptable/good model fit and internal consistencies. In a subsample from two rehabilitation centers (n = 237), the PIPS showed moderate to high relationships with aspects of mindfulness, pain interference in daily life, pain disability and mental health, and small relationships with pain intensity and physical functioning. The avoidance subscale explained additional variance in outcome variables beyond the FFMQ, ranging from 4.5 to 15.8%. Outcomes support the psychometric properties of the PIPS in a heterogeneous chronic pain sample. The PIPS and FFMQ measure slightly overlapping, but distinct constructs, and can be used complementary to assess a broad range of processes within ACT. Potential problems with the cognitive fusion subscale are acknowledged for future research.

This article describes the development and evaluation of the Engaged Living Scale (ELS) as a new self-report, process-specific measure to assess an engaged response style as conceptualized in acceptance and commitment therapy (ACT). The psychometric properties of the ELS test scores were evaluated in both a nonclinical sample (N = 439) and a clinical sample consisting of chronic pain patients who participated in a study on the effects of an online ACT intervention (N = 238). Item analysis and exploratory factor analysis in the nonclinical sample suggested a 16-item version of the ELS with 2 subscales, Valued Living (10 items) and Life Fulfillment (6 items). A bifactor model with 2 specific factors and 1 general underlying factor showed the best fit in confirmatory factor analyses in the chronic pain sample. In both samples, the scores on the ELS and its subscales showed good internal consistency and construct validity by consistent patterns of relationships with theoretically related process and outcome variables, such as psychological well-being, anxiety/depression, acceptance, mindfulness, and pain interference in daily life. Furthermore, in the chronic pain sample, the ELS showed incremental validity in explaining anxiety and depression, positive mental health, and pain interference beyond both acceptance and mindfulness. This study suggests the ELS shows promise as a useful tool for the measurement of an engaged response style, enabling more comprehensive evaluation of working mechanisms of ACT.

This study examined the role of psychological flexibility, as a risk factor and as a process of change, in a self-help Acceptance and Commitment Therapy (ACT) intervention for adults with mild to moderate depression and anxiety. Participants were randomized to the self-help programme with e-mail support (n = 250), or to a waiting list control group (n = 126). All participants completed measures before and after the intervention to assess depression, anxiety and psychological flexibility. Participants in the experimental condition also completed these measures during the intervention (after three and six weeks) and at a three-month follow-up. With multilevel modelling, it was shown that the effects of the intervention on psychological distress were stronger for participants with higher levels of psychological flexibility. Furthermore, our study showed that improved psychological flexibility mediated the effects of the ACT intervention. With a cross-lagged panel design, it was shown that especially improvements in psychological flexibility in the last three sessions of the intervention were important for further reductions in anxiety. To conclude, our study showed the importance of targeting psychological flexibility during an ACT intervention for a reduction in depressive and anxiety symptoms.

The web-based delivery of psychosocial interventions is a promising treatment modality for people suffering from chronic pain, and other forms of physical and mental illness. Despite the promising findings of first studies, patients may vary in the benefits they draw from self-managing a full-blown web-based psychosocial treatment. We lack knowledge on moderators and predictors of change during web-based interventions that explain for whom web-based interventions are especially (in)effective. In this study, we primarily explored for which chronic pain patients web-based Acceptance & Commitment Therapy (ACT) was (in)effective during a large three-armed randomized controlled trial. Besides standard demographic, physical and psychosocial factors we focused on positive mental health. Data from 238 heterogeneously diagnosed chronic pain sufferers from the general Dutch population following either web-based ACT (n=82), or one of two control conditions (web-based Expressive Writing (EW; n=79) and waiting list (WL; n=77)) were analysed. ACT and EW both consisted of nine modules and lasted nine to twelve weeks. Exploratory linear regression analyses were performed using the PROCESS macro in SPSS. Pain interference at three-month follow-up was predicted from baseline moderator (characteristics that influence the outcome of specific treatments in comparison to other treatments) and predictor (characteristics that influence outcome regardless of treatment) variables. The results showed that none of the demographic or physical characteristics moderated ACT treatment changes compared to both control conditions. The only significant moderator of change compared to both EW and WL was baseline psychological wellbeing, and pain intensity was a moderator of change compared to EW. Furthermore, higher pain interference, depression and anxiety, and also lower levels of emotional well-being predicted higher pain interference in daily life six months later. These results suggest that web-based self-help ACT may not be allocated to chronic pain sufferers experiencing low levels of mental resilience resources such as self-acceptance, goals in life, and environmental mastery. Other subgroups are identified that potentially need specific tailoring of (web-based) ACT. Emotional and psychological wellbeing should receive much more attention in subsequent studies on chronic pain and illness.

The Acceptance and Action Questionnaire-II (AAQ-II) is a self-report measure designed to assess experiential avoidance as conceptualized in acceptance and commitment therapy (ACT). The current study is the first to evaluate the psychometric properties of the AAQ-II in a large sample of adults (N = 376) with mild to moderate levels of depression and anxiety who participated in a study on the effects of an ACT intervention. The internal construct validity and local measurement precision were investigated by fitting the data to a unidimensional item response theory (IRT) model, and the incremental validity of the AAQ-II beyond mindfulness, as measured by the Five Facet Mindfulness Questionnaire, was assessed. Results of the IRT analyses suggest that the AAQ-II is a unidimensional measure of experiential avoidance and has satisfactory reliability for group comparisons in mild to moderately depressed and anxious populations. Item functioning was found to be independent of gender and slightly dependent on age in this sample. Furthermore, the AAQ-II showed incremental validity beyond 5 mindfulness facets in explaining depression, anxiety, and positive mental health. This study suggests the AAQ-II shows promise as a useful tool for the measurement of experiential avoidance in mild to moderately depressed and anxious populations.

This study evaluated the measurement invariance of the Mental Health Continuum-Short Form (MHC-SF), a 14-item self-report questionnaire for measuring emotional, social, and psychological well-being. The study draws on data of a representative panel (Longitudinal Internet Studies for the Social Sciences of CentERdata). 1,932 Dutch adults filled out the MHC-SF at four timepoints over 9 months. We used item response theory analyses with two-parameter models to examine differential item functioning across demographics, health indicators, and timepoints. The results indicated differences in the performance of one item (social well-being) for educational level, one item (social well-being) for sex, and two items (psychological well-being) for age. The MHC-SF is highly reliable over time, as there was no differential item functioning across the four timepoints. Furthermore, the means and reliabilities of the subscales were consistent over time. The MHC-SF is a reliable and valid instrument to measure positive aspects of mental health.

To understand the adaptive value of reminiscence, a mediational model of reminiscence was tested in a sample of older adults with mild to moderate depressive symptoms. Using structural equation modeling, we investigated if psychological resources (mastery and meaning in life) mediate the relation between reminiscence (positive: identity construction and problem solving; and negative: bitterness revival and boredom reduction) and psychological distress (depressive symptoms and anxiety symptoms). A total of 202 older Dutch adults living in the community participated in this study. The present study consisted of baseline measurements of a randomized controlled trial that evaluated the effectiveness of a life-review therapy intervention on depression. Results showed that psychological resources fully mediated the relation between negative reminiscence and psychological distress. Specifically, negative reminiscing is related to decreased psychological distress through meaning in life and sense of mastery. The study contributes to current knowledge on the relation between reminiscence and mental health, both empirically and clinically. It helps to increase understanding of how reminiscence is related to psychological distress, especially in depressed older adults, and the relative importance of psychological resources, i.e., mastery and meaning in life. From a clinical perspective, these findings suggest the usefulness of focusing on strengthening psychological resources in therapeutic reminiscence-based strategies for older adults with depressive symptoms.

De meeste mensen weten wel wat ze (zouden) moeten doen om gezond te blijven: iedere dag een half uurtje bewegen, gezond eten, niet roken en niet teveel alcohol drinken. Voor onze mentale gezondheid is dit minder duidelijk. Of niet? Psyfit.nl is een online zelfhulpcursus waarmee de mentale conditie wordt getraind. Via een zestal ‘mental fitness’ principes, zoals het richting geven aan je leven, stimuleren van positieve emoties en leven in het hier en nu, werken mensen aan hun welbevinden en veerkracht wat tezamen de mentale conditie bepaalt. 1 Door de oefeningen, tests en tips krijgen deelnemers inzicht in hun krachten en mogelijkheden om met het leven van alledag om te gaan.

The objective of the paper is to explore narrative foreclosure as a sensitizing concept for studying the ways in which narrative identity development falters in later life. Two main characters in famous movies are contrasted to provide a better understanding of narrative foreclosure. The concept is further clarified by discussing similarities and differences with other theories about lifespan identity development. Last, the concept is related to theories in social gerontology to provide a better understanding of narrative foreclosure in later life. It is concluded that narrative foreclosure can be defined as the conviction that no new interpretations of one's past nor new commitments and experiences in one's future are possible that can substantially change one's life-story. In terms of the metaphor of a book, one is not only convinced about its ending and does not add new chapters anymore, but also refrains from enjoying, rewriting, and editing earlier chapters. Several interpersonal–social and structural–ideological factors are identified that promote narrative foreclosure in later life. Finally it is discussed that the narrative study of later life and of narrative foreclosure in particular, should be conducted in an interdisciplinary framework. Narrative foreclosure only exists within a certain constellation of personal, social, and societal characteristics, drawn together in a mutually dependent system

De laatste jaren is er veel onderzoek gedaan naar de functies van reminiscentie bij ouderen in relatie tot geestelijke gezondheid. In dit artikel wordt allereerst een overzicht gegeven van dit onderzoek. Er worden acht functies onderscheiden: herbeleving van bitterheid, opheffen van verveling, vorming van identiteit, oplossen van problemen, behoud van intimiteit, voorbereiding op de dood, onderwijzen/ informeren en conversatie. Sommige functies zoals het herleven van bitterheid worden vaker gebruikt door mensen met depressieve of angstklachten. Andere functies zoals identiteitsvorming worden juist minder gebruikt door mensen met psychische klachten. Op basis van deze empirische gegevens wordt een model voor reminiscentie-interventies gepresenteerd. Reminiscentie, life-review en life-reviewtherapie worden onderscheiden. Life-reviewtherapie behoort met cognitieve gedragstherapie tot de meest effectieve behandelingen van depressie bij ouderen. Tot slot worden drie effectieve interventies die in Nederland zijn ontwikkeld en onderzocht besproken. Dit zijn Op zoek naar zin, Dierbare Herinneringen en De verhalen die we leven. Het eerste deel van dit artikel is gebaseerd op Westerhof GJ, Bohlmeijer ET, Webster JD. Reminiscence and mental health: a review of recent progress in theory, research and interventions. Ag & Soc 2010; 30: 697–721.

Objective The current study examined the efficacy of an early intervention based on acceptance and commitment therapy (ACT) for depressive symptomatology. The ACT intervention is aimed at increasing the acceptance of negative thoughts and emotions and living a mindful and value-based life. Method Adults with mild to moderate depressive symptomatology were randomly assigned to the ACT intervention (n = 49) or to a waiting list (n = 44). The mean age of the participants was 49 years. The majority of the participants was female and of Dutch origin. All the participants completed measures before and after the intervention, as well as three months later at follow-up to assess depression (CES-D), anxiety (HADS-A), fatigue (CIS), alcohol use and acceptance (AAQ-II). Results The ACT intervention led to statistically significant reduction in depressive symptomatology (Cohen’s d = .60). These reductions were maintained at the three-month follow-up. Also significant reductions in anxiety and fatigue were observed. Moreover, mediational analysis showed that the improvement of acceptance during the intervention mediated the effects of the intervention on depressive symptomatology at follow-up. Conclusion These findings suggest that an early intervention based on ACT, aimed at increasing acceptance, is effective in reducing depressive symptomatology.

Purpose:The purpose of the study was to assess the impact of a life review intervention on personal meaning in life and the mediating effect of personal meaning on depressive symptoms as the primary outcome of this form of indicated prevention.Design and Methods:A multicenter randomized controlled trial was conducted with one group of older adults obtaining life review (N = 83) and the other watching a video about the art of growing older (N = 88). Measurements took place before and after the intervention as well as 6 months later at follow-up.Results:It was found that those who followed life review improved more in personal meaning than those in the control group, although at follow-up the difference was no longer significant. Improvements in meaning during the intervention predicted decreases in depressive symptoms later in time and mediated the effects of the program on depressive symptoms.Implications:Personal meaning is an important asset in contemporary society, which some older adults find difficult to achieve. The findings from this study show that it is possible to support older persons in their search for meaning by means of life review and that this helps in alleviating depressive symptoms. © 2009 The Author. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved.

Herinneringen ophalen aan het eigen leven is voor ouderen een heel vanzelfsprekende bezigheid. Hier ligt dan ook het aanknopingspunt voor de cursus ‘De verhalen die we leven’, een laagdrempelige interventie voor mensen van 55 jaar en ouder die met een depressie en met angstklachten kampen. De eerste ervaringen zijn veelbelovend.

Objectives: The objective of this study was to examine the effectiveness of mindfulness-based stress reduction (MBSR) on depression, anxiety and psychological distress across populations with different chronic somatic diseases. Methods: A systematic review and meta-analysis were performed to examine the effects of MBSR on depression, anxiety, and psychological distress. The influence of quality of studies on the effects of MBSR was analyzed. Results: Eight published, randomized controlled outcome studies were included. An overall effect size on depression of 0.26 was found, indicating a small effect of MBSR on depression. The effect size for anxiety was 0.47. However, quality of the studies was found to moderate this effect size. When the studies of lower quality were excluded, an effect size of 0.24 on anxiety was found. A small effect size (0.32) was also found for psychological distress. Conclusions: It can be concluded that MBSR has small effects on depression, anxiety and psychological distress in people with chronic somatic diseases. Integrating MBSR in behavioral therapy may enhance the efficacy of mindfulness based interventions. © 2010 Elsevier Inc.

Background: We developed an indicated preventive life-review course, “Looking for Meaning”, based on the assumption that reminiscence styles influence coping with depressive symptoms. This study describes the impact of this course in a pragmatic randomized controlled trial.Methods: Inclusion criteria were >50 years, a score of 5 or higher on the Center for Epidemiological Studies Depression Scale (CES-D), and no depressive disorder or psychotropic or psychological treatment. Participants were randomized and stratified by gender: the experimental group (N = 83) was offered the course and the comparison group (N = 88) a movie. There were three measurements: pre-treatment, post-treatment and 6 months after post-treatment. Depressive symptoms constituted the primary outcome. Secondary outcomes were anxiety symptoms, satisfaction with life, mastery and reminiscence styles. All analyses were conducted according to the intention-to-treat principle. Missing values were replaced by regression imputation.Results: The course reduced depressive symptoms, a decrease that was retained during follow-up. A significant between-group effect size was found (d = 0.58). There was also a reduction in symptoms of anxiety; however, the comparison group showed the same reduction, resulting in a small between-group effect size. Gender and level of depressive symptoms were found to be prognostic factors for the change in depressive symptoms; age was not. Post hoc analyses showed significant between-group effect sizes for females and those with a score above the cut-off of the CES-D.Conclusion: The course “Looking for Meaning” can be recommended for people aged over 50 years, females and older adults with a clinically relevant level of depressive symptoms (above cut-off) in particular.

Contains fulltext : 73470_uitgeversversie.pdf (Publisher’s version ) (Closed access) Objectives: Finding meaning in life is often cited as an important outcome of reminiscence, but this theoretical claim has not been empirically tested until now. A new intervention combining integrative reminiscence and elements of narrative therapy was developed and the effects on meaning in life were studied. Methods: A total of 106 older adults with depressive symptomatology participated in a quasi-experimental study with two parallel conditions: integrative reminiscence vs a waiting list control group. Measurements were taken before and after the intervention. Results: A significant improvement in the overall meaning in life in the participants of the intervention was found, but these effects were not significant in comparison to a waiting-list control group. There is a specific effect of the intervention in that it results in a decline of negative evaluation of the self by the participants and an increase in positive evaluation of social relations. The program also results in more positive evaluation of the past as well as in less negative evaluation of the future. These findings are somewhat stronger for women than for men. Conclusion: Integrative reminiscence within a narrative therapeutic framework may be an effective intervention for enhancing meaning in life with depressed older adults. The intervention has to be developed further and should then be studied in a randomized controlled trial with a larger sample and with follow-up measurements.

Contains fulltext : 64132.pdf (Publisher’s version ) (Closed access) A pilot evaluation is reported of a reminiscence program aimed at increasing personal meaning. Fifty-seven older persons completed both a sentence completion questionnaire measuring personal meaning and a depression scale administered before and after the program. In comparison to a group from a representative survey that was matched on life contexts, the personal meaning profile of the intervention group was more negative and more focused on self. Hence, a group with impoverished meaning was participating in the program. After the intervention, the personal meaning profile was more positive, in particular with regard to self-evaluations and evaluations of social relations. The group that improved most on depression also improved most on personal meaning. Further research on the program is warranted.

BackgroundAlthough Web-based interventions have been shown to be effective, they are not widely implemented in regular care. Nonadherence (ie, participants not following the intervention protocol) is an issue. By studying the way Web-based interventions are used and whether there are differences between adherers (ie, participants that started all 9 lessons) and nonadherers, more insight can be gained into the process of adherence. ObjectiveThe aims of this study were to (1) describe the characteristics of participants and investigate their relationship with adherence, (2) investigate the utilization of the different features of the intervention and possible differences between adherers and nonadherers, and (3) identify what use patterns emerge and whether there are differences between adherers and nonadherers. MethodsData were used from 206 participants that used the Web-based intervention Living to the full, a Web-based intervention for the prevention of depression employing both a fully automated and human-supported format. Demographic and baseline characteristics of participants were collected by using an online survey. Log data were collected within the Web-based intervention itself. Both quantitative and qualitative analyses were performed. ResultsIn all, 118 participants fully adhered to the intervention (ie, started all 9 lessons). Participants with an ethnicity other than Dutch were more often adherers (χ21=5.5, P=.02), and nonadherers used the Internet more hours per day on average (F1,203=3.918, P=.049). A logistic regression showed that being female (OR 2.02, 95% CI 1.01-4.04; P=.046) and having a higher need for cognition (OR 1.02; 95% CI 1.00-1.05; P=.02) increased the odds of adhering to the intervention. Overall, participants logged in an average of 4 times per lesson, but adherers logged in significantly more times per lesson than nonadherers (F1,204=20.710; P

This paper presents the results of a meta-analysis to assess the effectiveness of reminiscence on psychological well-being across different target groups and treatment modalities. Fifteen controlled outcome studies were included. An overall effect size of 0.54 was found, indicating a moderate influence of reminiscence on life-satisfaction and emotional well-being in older adults. Life-review was found to have significantly greater effect on psychological well-being than simple reminiscence. In addition, reminiscence had significantly greater effect on community-dwelling adults than adults living in nursing homes or residential care. Other characteristics of participants or interventions were not found to moderate effects. It is concluded that reminiscence in general, but especially life review, are potentially effective methods for the enhancement of psychological well-being in older adults. However, a replication of effectiveness studies of the well-defined protocols is now warranted. © 2007 Taylor & Francis.

Contains fulltext : 55104.pdf (Publisher’s version ) (Closed access) Reminiscence may help in resolving conflicts from the past and making up the balance of one’s life. Life-review may be further enhanced by the creative expression of memories in stories, poems or drawings. In this way people are encouraged to create and discover metaphors, images and stories that symbolically represent the subjective and inner meaning of their lives. In this article, a new intervention, which combines reminiscence and creative expression aimed at early treatment of depression, is described. A pilot project showed that the intervention Searching for the meaning in life may generate small-sized effects in reducing depression. Additionally, it appears to generate effects of medium size in enhancing mastery. Several possible ways to improve the effectiveness of the intervention are described.

Acceptance-based interventions such as mindfulness-based stress reduction program and acceptance and commitment therapy are alternative therapies for cognitive behavioral therapy for treating chronic pain patients. To assess the effects of acceptance-based interventions on patients with chronic pain, we conducted a systematic review and meta-analysis of controlled and noncontrolled studies reporting effects on mental and physical health of pain patients. All studies were rated for quality. Primary outcome measures were pain intensity and depression. Secondary outcomes were anxiety, physical wellbeing, and quality of life. Twenty-two studies (9 randomized controlled studies, 5 clinical controlled studies [without randomization] and 8 noncontrolled studies) were included, totaling 1235 patients with chronic pain. An effect size on pain of 0.37 was found for the controlled studies. The effect on depression was 0.32. The quality of the studies was not found to moderate the effects of acceptance-based interventions. The results suggest that at present mindfulness-based stress reduction program and acceptance and commitment therapy are not superior to cognitive behavioral therapy but can be good alternatives. More high-quality studies are needed. It is recommended to focus on therapies that integrate mindfulness and behavioral therapy.Acceptance-based therapies have small to medium effects on physical and mental health in chronic pain patients. These effects are comparable to those of cognitive behavioral therapy.

Flourishing is the ultimate end-state in psychology and a key-concept in the field of positive psychology research. Flourishers are those individuals with both high levels of hedonic well-being and eudaimonic well-being. Although many researchers have focused on one or another of these domains, only a few have investigated the comprehensive state of flourishing. The purpose of this study was to examine the prevalence of flourishing and its association with socio-demographics, personality traits and situational factors. This study used data from the second wave of the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2), a national representative sample of adults in The Netherlands (n = 5303; 2010–2012). Findings were compared to having either high hedonic well-being or high eudaimonic well-being. Results showed that 37 % of the respondents were flourishers, mainly characterized by high levels of conscientiousness and extraversion and low levels of neuroticism. The situational factors of social support and positive life-events were significantly associated with flourishing when the analysis was controlled for socio-demographics and personality traits. Flourishing was most distinct from high hedonic well-being and showed parallelism with high eudaimonic well-being. More research is needed to establish a preferred flourishing instrument with validated cut-off points for flourishing and to understand the processes of situational factors that may underlie the promotion of flourishing. We recommend longitudinal designs and experience sampling studies to investigate the unique and modifiable predictors of flourishing. In addition, future research should include intervention studies that examine through which hedonic and eudaimonic pathways flourishing can be achieved.