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The study by Farnam and colleagues is a useful and much needed contribution to examine the effectiveness of sexual counseling models in health care [1]. It is, however, debatable whether the authors should have concluded that the Sexual Health Model (SHM) is a cost-effective option for sexual counseling. Given the mentioned need to find a more cost-effective alternative for standard models, such as the Permission, Limited Information, Specific Suggestions, Intensive Therapy (PLISSIT) model, we expected the authors to have performed a cost-effectiveness study. These data, however, were not collected, and a less firmly formulated conclusion regarding the suspected cost-effectiveness of SHM would be appropriate here. Even more so, as the SHM group still scores above the Female Sexual Distress Scale-Revised (FSDS-R) cut-off (≥11) at 28 weeks (mean [standard deviation (SD)] FSDS-R 11.7 [10.5]), while the PLISSIT group is below the cut-off (mean [SD] FSDS-R 6.8 [7.5]). It was also surprising that there are borderline significant (P = 0.051) differences reported between the groups for sexual function and sexual distress at 28 weeks, while their table 3 suggests otherwise when looking at sexual distress. Even though sexual function and sexual distress were measured with separate questionnaires on separate scales, they seem to have been analyzed as a “combined outcome” in the multivariate analysis of variance (manova). The authors, however, do not present this score, nor explain how it was constructed or is to be interpreted. Yet, they focus their discussion and conclusion on these analyses, which does not do justice to their other (univariate) analyses. Furthermore, as the manovas suggest (borderline) significant differences between groups, treatment weeks, and groups*treatment weeks, it would have been interesting to see the data for the second assessment (10 weeks) as well. It would aid the interpretation of the findings if these items were further clarified by the authors. Another issue that would benefit from clarification is that, compared with SHM, no effort seemed to have been made to make the PLISSIT model cultural specific as well. What this cultural specification might entail, also for SHM, and how this affected the outcome could be discussed. The PLISSIT model is applied based on the care provider’s competence and is tailored to the individual’s problem [2]. These features do not seem to hinder a more cultural-specific application of this model than SHM. Finally, a more in-depth discussion could also be created by speculating on the effects of certain decisions. For example, could the exclusion of patients with serious medical conditions and family issues lead to selection bias? Or how the findings may have been affected by the author (F.F.) performing sexual counseling in both study groups.

Background Age of onset is an important epidemiological indicator in characterizing disorders׳ subtypes according to demographic, clinical and psychosocial determinants. While investigated in various psychiatric conditions, age of onset and related characteristics in agoraphobia have yet to be examined. In light of the new diagnostic status in the DSM-5 edition of agoraphobia as independent from panic disorder, research on agoraphobia as a stand-alone disorder is needed. Methods Admixture analysis was used to determine the best-fitting model for the observed ages at onset of 507 agoraphobia patients participating in the Netherlands Study of Depression and Anxiety (age range 18–65). Associations between agoraphobia age of onset and different demographic, clinical and psychosocial determinants were examined using multivariate logistic regression analysis. Results Admixture analyses identified two distributions of age of onset, with 27 as the cutoff age (≤27; early onset, >27; late onset). Early onset agoraphobia was only independently associated with family history of anxiety disorders (p Limitations Age of onset was assessed retrospectively, and analyses were based on cross-sectional data. Conclusion The best distinguishing age of onset cutoff of agoraphobia was found to be 27. Early onset agoraphobia might constitute of a familial subtype. As opposed to other psychiatric disorders, early onset in agoraphobia does not indicate for increased clinical severity and/or disability.

Background Mindfulness-based cognitive therapy (MBCT) and maintenance antidepressant medication (mADM) both reduce the risk of relapse in recurrent depression, but their combination has not been studied. Aims To investigate whether MBCT with discontinuation of mADM is non-inferior to MBCT+mADM. Method A multicentre randomised controlled non-inferiority trial (ClinicalTrials.gov: NCT00928980). Adults with recurrent depression in remission, using mADM for 6 months or longer (n = 249), were randomly allocated to either discontinue (n = 128) or continue (n = 121) mADM after MBCT. The primary outcome was depressive relapse/recurrence within 15 months. A confidence interval approach with a margin of 25% was used to test non-inferiority. Key secondary outcomes were time to relapse/recurrence and depression severity. Results The difference in relapse/recurrence rates exceeded the non-inferiority margin and time to relapse/recurrence was significantly shorter after discontinuation of mADM. There were only minor differences in depression severity. Conclusions Our findings suggest an increased risk of relapse/recurrence in patients withdrawing from mADM after MBCT.

Idealiter is een mens op een flexibele manier in staat zijn gedragspatronen aan te passen en diverse interpersoonlijke stijlen te gebruiken, afhankelijk van de situatie waarin hij is. Chronisch depressieve clienten kunnen dit niet goed en hanteren vaak een rigide gedragspatroon, dat hen ernstig beperkt in interpersoonlijke interacties. De Impact Message Inventory (IMI) is een vragenlijst waarmee de therapeut per client de interpersoonlijke stijl expliciet kan maken en kan weergeven in een interpersoonlijke cirkel. Het hiermee inzichtelijk maken van het gedrag dat de client in de therapeutische relatie laat zien en de reacties die dit bij de therapeut oproept, helpen de therapeut om in de relatie met de client voorbereid te zijn op mogelijke valkuilen. Cognitive Behavioral Analysis System of Psychotherapy (CBASP) is erop gericht dit patroon te doorbreken en clienten flexibeler en empathischer gedrag naar anderen aan te leren.

BackgroundAnxiety disorders increase the risk of onset of several ageing-related somatic conditions, which might be the consequence of accelerated cellular ageing.AimsTo examine the association between anxiety status and leukocyte telomere length (LTL) as an indicator of cellular ageing.MethodData are from individuals with current (n = 1283) and remitted (n = 459) anxiety disorder, and controls (n = 582) with no psychiatric disorder from the Netherlands Study of Depression and Anxiety. We determined DSM-IV anxiety diagnoses and clinical characteristics by structured psychiatric interviews and self-report questionnaires; LTL was assessed using quantitative polymerase chain reaction and converted into base pairs (bp).ResultsPatients in the current anxiety group (bp = 5431) had significantly shorter LTL compared with the control group (bp = 5506, P = 0.01) and the remitted anxiety group (bp = 5499, P = 0.03) in analyses adjusted for sociodemographics, health and lifestyle. The remitted anxiety group did not differ from the control group (P = 0.84), however, time since remission was positively related with LTL. Furthermore, anxiety severity scores were associated with LTL in the whole sample, in line with a dose–response association.ConclusionsPatients with current – but not remitted – anxiety disorder had shorter telomere length, suggesting a process of accelerated cellular ageing, which in part may be reversible after remission.

Objectives: Chronic exposure to psychosocial stressors is related to worse somatic health. This association applies both to stressors early in life, such as childhood adversities, and more recent life stress, such as stressful life events. This study examined whether accelerated telomere shortening, as an indicator of cellular aging, might be an explanatory mechanism. Methods:We examinedwhether childhood adversities and recent stressful life events were associatedwith shorter telomeres in 2936 participants (mean [standard deviation] age = 41.8 [13.1] years, 66% women, 57% current depression) of the Netherlands Study of Depression and Anxiety. Telomeres are specialized nucleic acid-protein complexes at the ends of linear DNA that shorten with age; telomere length (TL) was measured with quantitative polymerase chain reaction. Results: Childhood life events (β = .004, p = .805) and childhood trauma (β = .023, p = .205) were not related to shorter TL. However, we found negative associations between recent stressful life events and TL. Persons had shorter telomeres if they reported more stressful life events in the past year (β = .039, p = .028) and 1 to 5 years ago (β = .042, p = .018, adjusted for sociodemographics). The relationship between stressful life events and TL became borderline significant when further adjusted for smoking status. No associations with TL were found when stressful life events occurred more than 6 years ago (p < .10). Conclusions: Results show that recent stressful life events are associated with shorter TL. This association is not observed for psychosocial stressors that occur earlier in life.Whether these results are indicative of physiological resiliency remains to be explored by future longitudinal research.

Tijdens de eerste sessie wordt kort stilgestaan bij het verleden van de client, om inzicht te krijgen in het beloop van de depressie. Hiervoor wordt de beloopstabel gebruikt. In deze tabel vult de therapeut op een tijdlijn in wanneer de client last had van een depressie, te beginnen bij de eerste episode. De therapeut vraagt per episode hoe lang deze depressie duurde, of er een aanleiding voor was, of er behandeling plaatsvond, waar deze behandeling uit bestond en wat het effect ervan was. Zo wordt de hele tijdlijn tot het heden doorlopen. Door het samen invullen van de beloopstabel oefent de client in het specifieker maken van zijn klachten en daarnaast in het denken in termen van oorzaak en gevolg. Soms hebben de clienten uit zichzelf nog weinig verbanden gelegd tussen depressieve episoden en belangrijke levensgebeurtenissen. De beloopstabel helpt die verbanden alsnog te leggen.

Het aanleren van sociale vaardigheden kan moeilijk zijn als je een chronische depressie hebt, omdat bij zo’n depressie vaak hoort dat je moeite hebt om voor jezelf op te komen. Het kan ook zijn dat je juist moet leren je woede en vijandigheid in toom te houden om op een effectieve manier te kunnen communiceren. Door middel van rollenspellen kun je oefenen met het toepassen van sociale vaardigheden. Wat zijn sociale vaardigheden? Sociale vaardigheden zijn vaardigheden die nodig zijn bij contacten met andere mensen. Voorbeelden van sociale vaardigheden zijn: luisteren, een gesprek op gang houden, iemand een compliment geven, je mening geven, iets weigeren, voor je belangen opkomen en reageren op kritiek. Assertiviteit is een belangrijke voorwaarde voor het uitvoeren van sociale vaardigheden. Het gaat hierbij om vaardigheden die te maken hebben met het opkomen voor jezelf en je rechten, zonder daarbij de ander onnodig te kwetsen.

Helaas is in Hoofdstuk 5 en Bijlage 3 verzuimd te verwijzen naar het valideringsonderzoek van de Nederlandse IMI in een wat andere vertaling.

Chronisch depressieve clienten zijn vaak te angstig om echt contact aan te gaan en vermijden het daarom. Deze vermijding kan alleen doorbroken worden als de therapeut op een actieve, empathische manier het contact met de client aangaat. Gedisciplineerde persoonlijke betrokkenheid (GPB) is een techniek die de therapeut hiervoor kan gebruiken. Uitgangspunt bij de GPB is dat de therapeut de impact bespreekt die het gedrag van de client op hem heeft, dat wil zeggen dat de therapeut zich open opstelt door het contact bespreekbaar te maken. Meestal doorbreekt dit een impasse in het gesprek en in de therapie. De client leert de positieve consequenties van het zich openstellen bij anderen. Als dit lukt, kunnen pijnlijke ervaringen uit het verleden, die nog dagelijks van invloed zijn op het ontwijkende gedrag, gecorrigeerd worden. Dit leidt tot een beter algeheel functioneren van de client.

De tweede therapiesessie is bedoeld om informatie te krijgen over belangrijke personen die een grote invloed hebben gehad op je leven. In deze sessie vraagt de therapeut in detail na welke invloed deze belangrijke personen op jou gehad hebben. We weten dat er bij mensen met een chronische depressie vaak sprake is geweest van negatieve ervaringen met naaste familieleden of anderen, zoals emotionele verwaarlozing, mishandeling en vernedering. Deze ervaringen gingen gepaard met verdriet en pijn. Opgroeien met dergelijke traumatische ervaringen laat sporen na die direct van invloed zijn op de manier waarop iemand als volwassene naar zichzelf, anderen en dus ook naar de therapeut kijkt. Tijdens deze sessie probeer je samen met je therapeut na te gaan welke ervaringen bij jou een grote rol hebben gespeeld.

Chronische depressie is volgens McCullough niet curable, maar wel manageable. Hij vergelijkt chronische depressie met diabetes mellitus. Chronisch depressieve clienten zullen, net als ieder ander, de rest van hun leven interpersoonlijke problemen tegen blijven komen. Het is daarom van belang dat ze na afloop van de therapie zelf in staat zijn de technieken toe te passen. Dus dat ze zelf SA’s kunnen maken, zelf onderscheid kunnen maken tussen mensen die goed voor ze zijn en mensen die dat niet zijn en dat ze zich continu bewust blijven van het effect dat ze op anderen hebben. Chronisch depressieve clienten zullen deze technieken dagelijks moeten toepassen om het oude (disfunctionele) gedrag te overschrijven met het nieuw geleerde gedrag. Als er een stabiele situatie is ontstaan en geen veranderingen meer optreden, wordt afronden van de therapie besproken.

In de therapeutische relatie kunnen er problemen ontstaan als de client op basis van vroege negatieve ervaringen reageert op de therapeut en niet op basis van wat er daadwerkelijk op dat moment speelt. Het is de taak van de CBASP-therapeut om deze reactiepatronen, gebaseerd op ervaringen met belangrijke personen in het verleden, te vervangen door ervaringen die tot onderling vertrouwen leiden. Om dit te kunnen doen, is het van belang dat de therapeut weet welke problemen in de interactie zouden kunnen gaan spelen. De informatie uit de tweede sessie wordt hiervoor gebruikt. Op basis van deze informatie tracht de therapeut een consistent thema te identificeren dat de verhouding karakteriseert die de client met zijn belangrijke personen had. Vervolgens wordt een overdrachtshypothese geformuleerd.

Interpersoonlijk onderscheid maken (IOM) is een gestructureerde manier om clienten te laten zien dat mensen niet altijd reageren zoals zij verwachten, dat er ook andere interacties mogelijk zijn dan die zij geleerd hebben van de belangrijke personen in hun leven. De client leert differentieren tussen de negatieve reacties van belangrijke personen en de positieve reacties van de therapeut. IOM heeft als doel de interpersoonlijke angst en vermijding van de client te doorbreken, zodat de client op den duur de ‘nieuwe’ interpersoonlijke mogelijkheden (met de therapeut) kan gaan generaliseren naar contacten in het dagelijks leven. Het is de bedoeling dat de IOM-oefening gedurende de hele therapie regelmatig herhaald wordt, aangezien het vaak enige tijd duurt voordat clienten zelf in staat zijn dit onderscheid te maken.

Sexual dysfunction is prevalent in patients with type 2 diabetes mellitus, but remains one of the most frequently neglected complications in diabetes care. Both patients and care providers appear to have difficulty with discussing sexual problems in diabetes care. A sexual counselling model for care providers, such as the PLISSIT model, might be a useful tool to improve the discussion of sexual issues in patients with type 2 diabetes mellitus. PLISSIT stands for Permission, Limited Information, Specific Suggestions, and Intensive Therapy. Even though the use of the PLISSIT model has often been recommended in diabetes care, no evidence with regards to its effectiveness in patients with type 2 diabetes mellitus exists. This study describes the design of a cluster-randomised controlled trial evaluating the effectiveness of a PLISSIT-model intervention in men and women with type 2 diabetes mellitus in primary care. Patients with type 2 diabetes mellitus, aged 40–75 years, who indicate to be dissatisfied about their sexual functioning and that they would like to talk about their sexual problem(s) with their general practitioner are recruited. All participants receive an information leaflet from the practice nurse. In the intervention group, each participant will also receive sexual counselling based on the PLISSIT model from their general practitioner. In the control group, usual care will be provided to those participants requesting an appointment with their general practitioner when the information leaflet was not deemed sufficient. Primary outcomes include sexual functioning, satisfaction about sexual function, and quality of life. Secondary outcomes are depressive symptoms, sexual distress, emotional well-being, and treatment satisfaction. Outcomes will be measured by means of self-report questionnaires at baseline, and after 3 and 12 months post-baseline. Treatment satisfaction will be assessed in telephone interviews. This paper describes the design of a cluster-randomised controlled trial that will investigate the effectiveness of a PLISSIT-model intervention in patients with type 2 diabetes mellitus in primary care. Our study will add important and currently missing insight into the effectiveness of PLISSIT on important patient-reported outcomes of men and women with type 2 diabetes mellitus. Dutch Trial Registry NTR4807 .

Tijdens de eerste sessie geeft de therapeut je kort uitleg over hoe de CBASP-behandeling er uit zal zien. Vervolgens breng je samen met de therapeut het beloop van je depressieve klachten in kaart, waarbij de depressieve perioden op een tijdlijn worden ingetekend en per periode wordt nagegaan hoe lang deze periode duurde, wat de aanleiding was en of er behandeling plaatsvond.

There is considerable overlap in symptomatology between Tourette's syndrome (TS) and obsessive-compulsive disorder (OCD). Increased rates of tics are found in OCD and up to 60% obsessive-compulsive symptoms in TS. However, in OCD obsessive-compulsive symptoms are more often anxiety-related and, as a consequence, aimed at anxiety-reduction, whereas in TS these symptoms are more stimulus-bound. Therefore, it is of clinical interest to study whether these phenomenological differences are reflected in differences between dysfunctional cognitions accompanying OC symptoms in OCD with or without tics and TS. Current cognitive theory of OCD ascertains that specific dysfunctional beliefs are important in the etiology and maintenance of OCD. To assess these beliefs, the obsessive-compulsive beliefs questionnaire-87 (OBQ-87) has been developed. In the present study, OBQ-87 scores of OCD patients without tics, OCD with tics, and TS (without OCD) patients were compared to those of normal controls. Results: OCD without tic patients exhibited higher OBQ-87 scores than TS patients. No differences were found between OCD with or without tic patients on any of the OBQ-87 subscales. These results suggest that: (1) dysfunctional beliefs have no discriminative power with respect to OCD with or without tic patients; (2) the direct relationship between types of OC symptoms and specific dysfunctional beliefs is questionable. Therefore, one can doubt the specificity of cognitive theory of OCD to explain specific OC behavior. © 2005 Elsevier Ltd. All rights reserved.

Research has shown that depressed patients suffer from reduced autobiographical memory specificity (rAMS). This cognitive phenomenon is associated with the maintenance and recurrence of depressive symptoms.This pilot study aims to investigate the feasibility and effectiveness of a relatively new group-based intervention (Memory Specificity Training; MeST) that aims to reduce rAMS in an outpatient setting.Twenty-six depressed outpatients received MeST during the waiting period prior to psychotherapy. The Client Satisfaction Questionnaire (CSQ-8) was used to measure client satisfaction after the training. The Autobiographical Memory Test (AMT) was used to measure memory specificity before and after the training. Depressive symptoms were measured using the Beck Depression Inventory (BDI-II) and the Montgomery Asberg Depression Rating Scale (MADRS), before and after the training, and at a 3-month follow-up.Participants as well as trainers were positive about the use of MeST. Participants also showed an increase in memory specificity and a decrease in depressive symptoms.This study suggests that MeST is feasible in an outpatient setting, that it increases autobiographical memory specificity and that it may decrease depressive symptoms. A randomized controlled trial is recommended to examine MeST and its effects on autobiographical memory specificity, depressive symptoms and depressive relapse more extensively. Copyright © 2015 John WileySons, Ltd. Key Practitioner Message: Research suggests that modification of rAMS can advance recovery and reduce the chance of developing a depression relapse. However, most existing psychotherapies for depression do not include these specific interventions. This is the first study to show that MeST in an outpatient setting is feasible and can lead to an increase in autobiographical memory specificity and that it may decrease depressive symptoms. A larger scale randomized controlled trial is required to examine whether the addition of MeST to care as usual decreases depressive symptoms more effectively than care as usual without MeST, and to examine whether subgroups of patients benefit specifically from this intervention (e.g. patients with more severely decreased memory specificity).

This case report is about a 31-year-old married female with a variety of obsessions, primarily focusing on harming obsessions. Because of anxiety, numerous washing rituals have taken place as well as the avoidance of situations. This client was diagnosed with Obsessive-Compulsive Disorder (OCD) and was seen for 25 sessions of individual cognitive therapy. The aim of this study therefore was to illustrate the assessment, case conceptualization, and course of treatment in a severe obsessive-compulsive client, using cognitive therapy. Several specific cognitive interventions, which address the estimations of catastrophes and the perceptions of personal responsibility, are presented and illustrated. At posttreatment and at follow-up, a clinically significant change for improvement was demonstrated for the obsessive-compulsive symptoms.

This article reports on the validation of the Obsessive Beliefs Questionnaire (OBQ) and Interpretations of Intrusions Inventory (III) developed by the Obsessive Compulsive Cognitions Working Group (OCCWG) to assess the primary beliefs and appraisals considered critical to the pathogenesis of obsessions. A battery of questionnaires that assessed symptoms of anxiety, depression, obsessive-compulsive symptoms and worry was administered to 248 outpatients with a DSM-IV diagnosis of Obsessive-Compulsive Disorder (OCD), 105 non-obsessional anxious patients, 87 non-clinical adults from the community, and 291 undergraduate students. Tests of internal consistency and test-retest reliability indicated that the OBQ and III assessed stable aspects of OC-related thinking. Between-group differences and correlations with existing measures of OC symptoms indicated that the OBQ and III assess core cognitive features of obsessionality. However, the various subscales of the OBQ and III are highly correlated, and both measures evidenced low discriminant validity. The findings are discussed in terms of the relevance and specificity of cognitive constructs like responsibility, control and importance of thoughts, overestimated threat, tolerance of uncertainty and perfectionism for OCD.

In dit artikel beschrijven we twee behandelingen van mannen die zichzelf slaan. Naast dit zelfbeschadigend gedrag zijn geen symptomen aanwezig en derhalve is het gedrag gediagnosticeerd als een stoornis in de impulsbeheersing. Tot op heden bestaat er geen consensus over de eerste keus in de behandeling van automutulatie. De twee beschreven patienten worden behandeld met een zelfcontroleprocedure. Deze behandeling blijkt voor beide patienten effectief. Het automutileren is vrijwel geheel gestopt na de behandelingen. In beide casussen lijken de uitgebreide registratieopdrachten en de bewustwordingstraining de effectieve elementen van de behandeling te zijn.

Depression is a prevalent disorder, associated with a high disease burden and substantial societal, economic and personal costs. Cognitive behavioural treatment has been shown to provide adequate treatment for depression. By offering this treatment in a blended format, in which online and face-to-face treatment are combined, it might be possible to reduce the number of costly face-to-face sessions required to deliver the treatment protocol. This could improve the cost-effectiveness of treatment, while maintaining clinical effects. This protocol describes the design of a pilot study for the evaluation of the feasibility, acceptability and cost-effectiveness of blended cognitive behavioural therapy for patients with major depressive disorder in specialized outpatient mental health care. In a randomized controlled trial design, adult patients with major depressive disorder are allocated to either blended cognitive behavioural treatment or traditional face-to-face cognitive behavioural treatment (treatment as usual). We aim to recruit one hundred and fifty patients. Blended treatment will consist of ten face-to-face and nine online sessions provided alternately on a weekly basis. Traditional cognitive behavioural treatment will consist of twenty weekly sessions. Costs and effects are measured at baseline and after 10, 20 and 30 weeks. Evaluations are directed at cost-effectiveness (with depression severity and diagnostic status as outcomes), and cost-utility (with costs per quality adjusted life year, QALY, as outcome). Costs will encompass health care uptake costs and productivity losses due to absence from work and lower levels of efficiency while at work. Other measures of interest are mastery, working alliance, treatment preference at baseline, depressive cognitions, treatment satisfaction and system usability. The results of this pilot study will provide an initial insight into the feasibility and acceptability of blended cognitive behavioural treatment in terms of clinical and economic outcomes (proof of concept) in routine specialized mental health care settings, and an indication as to whether a well-powered clinical trial of blended cognitive behavioural treatment for depression in routine practice would be advisable. This will be determined based on the perspective of various stakeholders including patients, mental health service providers and health insurers. Strengths and limitations of the study are discussed. Netherlands Trial Register NTR4650 . Registered 18 June 2014.

Patients with pain may be at increased risk of developing a first episode of depressive or anxiety disorder. Insight into possible associations between specific pain characteristics and such a development could help clinicians to improve prevention and treatment strategies. The objectives of this study were to examine the impact of pain symptomatology on depression and anxiety onset and to determine whether these associations are independent of subthreshold depressive and anxiety symptoms. Data from the Netherlands Study of Depression and Anxiety, collected between 2004 and 2011, were used. A total of 614 participants with no previous history and no current depression or anxiety at baseline were followed up for 4 years. Onset of depressive or anxiety disorder was assessed at 2- and 4-year follow-up by Composite International Diagnostic Interview. Baseline pain characteristics were location, duration, and severity, as assessed by chronic pain grade. Onset of depressive or anxiety disorder occurred in 15.5% of participants. Using Cox survival analyses, onset of depression and anxiety was associated with 6 pain locations (neck, back, head, orofacial area, abdomen, and joints; hazard ratio [HR] = 1.96 to 4.02; P

Background: Studies suggest that poor physical health might be associated with increased depression and anxiety recurrence. The objectives of this study were to determine whether specific chronic diseases and pain characteristics are associated with depression and anxiety recurrence and to examine whether such associations are mediated by subthreshold depressive or anxiety symptoms.Methods: 1122 individuals with remitted depressive or anxiety disorder (Netherlands Study of Depression and Anxiety) were followed up for a period of four years. The impact of specific chronic diseases and pain characteristics on recurrence was assessed using Cox regression and mediation analyses.Results: Chronic diseases were not associated with recurrence. Neck (HR 1.45, p < .01), chest (HR 1.65, p < .01), abdominal (HR 1.52, p < .01) pain, an increase in the number of pain locations (HR 1.10, p < .01) and pain severity (HR 1.18, p = .01) were associated with an increased risk of depression recurrence but not anxiety. Subthreshold depressive symptoms mediated the associations between pain and depression recurrence.Conclusions: Pain, not chronic disease, increases the likelihood of depression recurrence, largely through its association with aggravated subthreshold depressive symptoms. These findings support the idea of the existence of a mutually reinforcing mechanism between pain and depression and are indicative of the importance of shedding light on neurobiological links in order to optimize pain and depression management. © 2014 Gerrits et al.; licensee BioMed Central Ltd.

Depressieve patienten halen persoonlijke herinneringen vaker dan niet-depressieve controles op in een overalgemene vorm. Dit ‘overalgemeen geheugen’ blijkt niet zomaar een bijverschijnsel van de depressie; het gaat om een klinisch betekenisvol kwetsbaarheidsmechanisme onderliggend aan de depressie. In dit stuk geven we een korte samenvatting van het fundamenteel wetenschappelijk onderzoek naar dit fenomeen. Vervolgens belichten we een innovatieve geheugentraining bij depressie die als doel heeft dit kwetsbaarheidsmechanisme te remedieren. Zowel het opzet van deze Memory Specificity Training (MeST)1 als voorlopige resultaten inzake de effecten ervan worden besproken.

Contains fulltext : 133520.pdf (Publisher’s version ) (Closed access) BACKGROUND: Studies on the relationship between adverse childhood experiences (ACEs) and obsessive-compulsive disorder (OCD) symptom severity are scarce. Available studies leave a considerable degree of uncertainty. The present study examines the relationship between ACEs and symptom severity, chronicity, and comorbidity in a sample of patients with OCD. METHOD: Baseline data of the Netherlands Obsessive Compulsive Disorder Association (NOCDA) study, in which 382 referred patients with DSM-IV-diagnosed OCD participated, were analyzed. ACEs (physical abuse, sexual abuse, witnessing interparental violence, maternal dysfunction, paternal dysfunction, and early separation from a parent) were measured using a structured interview. Data were collected between September 2005 and November 2009. RESULTS: None of the ACEs were related to OCD symptom severity or chronicity, nor was there a dose-response relationship between ACEs and OCD severity or chronicity, but results of linear regression analysis revealed that ACEs were related to comorbidity in patients with OCD (P < .001), in particular to comorbid affective disorders (P < .01), substance use disorders (P < .01), and eating disorders (P < .01), but not to comorbid anxiety disorders. CONCLUSIONS: Results of the study suggest that unlike in other psychiatric disorders, ACEs play no significant role in symptom severity and chronicity of OCD. This study was the first to reveal evidence for a relationship between ACEs and comorbidity in patients with OCD. Conclusions about trauma-relatedness of OCD based on studies finding higher trauma rates or severity among patients with OCD than among healthy controls, should be critically reconsidered, since presence of comorbidity might account for these differences. 6 p.

Eighty-two patients with social phobia were randomly assigned to cognitive therapy or double-blind drug treatment with moclobemide (300–600 mg per day) or placebo. After 15 weeks of active treatment, a 2-month treatment-free follow-up as well as a 15-month naturalistic follow-up were scheduled. At post-test, cognitive therapy was significantly superior to moclobemide, but not to placebo, on a composite social phobia measure. At 2-month follow-up, cognitive therapy was superior to both moclobemide and placebo. Treatment gains were maintained in cognitive therapy during 2-month and 15-month follow-up, however, most patients (66%) who completed the study needed additional cognitive and/or behavioural treatment. Moclobemide proved not superior to placebo at post-test as well as at 2-month follow-up. As most patients from the medication conditions were treated with cognitive and/or behavioural treatment during the naturalistic follow-up period, at the 15-month assessment no between-group differential effects were found to remain. These results indicate that cognitive therapy is an effective treatment for social phobia in both the short and long term. As the results from previous studies on the efficacy of moclobemide in social phobia were inconclusive, our data tip the scales in the direction that there is no place for moclobemide in the treatment of social phobia. Copyright © 2001 John Wiley & Sons, Ltd.

Past research demonstrated that age at onset might account for different clinical and etiological characteristics in panic disorder (PD). However, prior research relied on arbitrary choices of age cut-offs. Using a data-driven validated method, this study aimed to examine differences between early and late onset PD in various determinants. Admixture analysis was used to determine the best fitting model of age at onset distribution in PD. Data was collected from 511 individuals (ages 18-65) with PD diagnoses, who participated in the Netherlands Study of Depression and Anxiety (NESDA). DSM-IV comorbidities and various measures of childhood adversities, suicidal behavior, anxiety and depressive symptoms were assessed. The best fitting cut-off score between early and late age at onset groups was 27 years (early age at onset≤27 years). Univariate tests showed that participants with early onset PD were younger and more likely to be female. Early onset PD was associated with agoraphobia, higher frequency of childhood trauma and life events, and higher rates of suicide attempts as compared to late onset PD. Multivariate logistic regression analysis demonstrated that only current age, childhood trauma and agoraphobia remained significantly associated with early onset PD. Findings suggest that 27 years marks two onset groups in PD, which are slightly distinct. Early onset PD is independently associated with exposure to childhood trauma and increased avoidance. This highlights the importance of subtyping age of onset in PD. Clinical implications are further discussed. © 2013 Elsevier Ltd.

Recent theories of obsessive-compulsive disorder (OCD) emphasize the importance of cognitive contents (beliefs and appraisals) and cognitive processes in the etiology and maintenance of OCD. In order to evaluate these theories and to assess the mechanisms of treatment-related change, it is necessary to develop measures of the relevant cognitive contents and processes. Several scales have been developed, although many are unpublished and there is a great deal of overlap among measures. The purpose of the present article is to describe the progress of an international group of investigators who have commenced a coordinated effort to develop a standardized set of cognitive measures. This article describes the theoretical bases and clinical importance of such an endeavor, and the proceedings of the working group meetings are summarized. Several methods of assessment are reviewed, including idiographic methods, information processing paradigms, and self-report measures. The working group is currently developing and evaluating self-report measures of appraisals about intrusions, and self-report measures of OC-related beliefs. Consensus ratings indicated that 6 belief domains are likely to be important in OCD. These are beliefs pertaining to: (1) inflated responsibility; (2) overimportance of thoughts; (3) excessive concern about the importance of controlling one's thoughts; (4) overestimation of threat; (5) intolerance of uncertainty; and (6) perfectionism.

Background This study describes lifetime and current rates of comorbidity, its onset and its consequences in a large clinical sample of patients with obsessive compulsive disorder (OCD). A wide range of risk factors and clinical characteristics were also examined to determine whether pure OCD is different from OCD with current comorbidity. Finally, the temporal sequencing of the disorders was examined. Method Data were obtained from the Netherlands Obsessive Compulsive Disorder Association (NOCDA) study. A sample of 382 participants with current OCD (during the past month) was evaluated. Results Current comorbidity occurred in 55% of patients with OCD, while 78% suffered from lifetime comorbidity. Comorbidity is associated with more severe OCD, anxiety and depressive symptoms and more negative consequences on daily life. Multiple comorbid disorders often precede OCD and influence both its course and severity. Childhood trauma and neuroticism are vulnerability factors for the development of multiple comorbid disorders in OCD. Limitations It should be noted that causal inferences about the association between risk factors and OCD are precluded since our results were based on cross-sectional data. Conclusion (Multiple) comorbidity in OCD is clinically relevant since it is associated with a specific pattern of vulnerability, with greater chronicity, with more severe OCD and more negative consequences on daily life. This indicates that the diagnosis and treatment of all comorbid disorders is clinically relevant, and clinicians should be especially aware of multiple disorders in cases of childhood trauma and high levels of neuroticism. Primary OCD has a different developmental and comorbidity pattern compared to secondary OCD.

Background: Recognition of depression and anxiety by general practitioners (GPs) is suboptimal and there is uncertainty as to whether particular somatic health problems hinder or facilitate GP recognition. The objective of this study was to investigate the associations between somatic health problems and GP recognition of depression and anxiety.Methods: We studied primary care patients with a DSM-IV based psychiatric diagnosis of depressive or anxiety disorder during a face-to-face interview (n=778). GPs registrations of depression and anxiety diagnoses, based on medical file extractions, were compared with the DSM-IV based psychiatric diagnoses as reference standard. Somatic health problems were based on self-report of several chronic somatic diseases and pain symptoms, using the Chronic Pain Grade (CPG), during the interview.Results: Depression and anxiety was recognized in sixty percent of the patients. None of the health problems were negatively associated with recognition. Greater severity of pain symptoms (OR 118, p=.02), and chest pain (OR=1.56, p=.02), in particular, were associated with more GP recognition of depression and anxiety. Mediation analyses showed that depression and anxiety in these patients were better recognized through the presence of more severe psychiatric symptoms.Limitations: Some specific chronic diseases had low prevalence.Conclusions: This study shows that the presence of particular chronic diseases does not influence GP recognition of depression and anxiety. GPs tend to recognize depression and anxiety better in patients with pain symptoms, partly due to more severe psychiatric symptoms among those with pain. (C) 2013 Elsevier B.V. All rights reserved

In the present study, the structure of obsessive-compulsive symptoms was investigated by means of the Padua Inventory (PI). Simultaneous Components Analysis on data from obsessive-compulsives (n = 206), patients with other anxiety disorders (n = 222), and a non clinical sample (n = 430) revealed a five-factor solution. These factors are: (I) impulses; (II) washing; (III) checking; (IV) rumination; and (V) precision. Forty-one items were selected as measure of these factors. The reliability for the five subscales, assessing each of the five factors, was found to be satisfactory to excellent. Four subscales (washing, checking, rumination and precision) discriminated between panic disorder patients, social phobics and normals on the one hand and obsessive compulsives on the other. The Impulses subscale discriminated between obsessive-compulsives on the one hand and normals on the other, but not between obsessive-compulsives and social phobics or panic patients. Some evidence in support of the construct validity was found. The Padua Inventory-Revised (41-items) appears to measure the structure of obsessive compulsive symptoms: The main types of behaviours and obsessions as seen clinically are assessed by this questionnaire, apart from obsessional slowness.

The combination of pain and depression or anxiety is commonly seen in clinical practice. Little is known about the influence of pain on psychopathology over time, as previous studies have been mainly cross-sectional. The objectives of this study are to determine the impact of pain on the course of depressive and/or anxiety disorders, and investigate to what extent the association between pain and course of these mental disorders is mediated by psychiatric characteristics. Data from the Netherlands Study of Depression and Anxiety (NESDA), collected between 2004 and 2009, were used. A total of 1209 participants with a depressive and/or anxiety disorder at baseline were followed up for 2 years. Baseline pain was assessed by location, duration, use of pain medication, and severity (based on Chronic Pain Grade). Course of depressive and anxiety disorders was assessed by Composite International Diagnostic Interview (CIDI) and Life Chart Interview. A higher number of pain locations (OR = 1.10; P =.008), joint pain (OR = 1.64; P

Background Mental health problems are common and are associated with increased disability and health care costs. Problem-Solving Treatment (PST) delivered to these patients by nurses in primary care might be efficient. The aim of this study was to evaluate the cost-effectiveness of PST by mental health nurses compared with usual care (UC) by the general practitioner for primary care patients with mental health problems. Methods An economic evaluation from a societal perspective was performed alongside a randomized clinical trial. Patients with a positive General Health Questionnaire score (score ≥ 4) and who visited their general practitioner at least three times during the past 6 months were eligible. Outcome measures were improvement on the Hospital Anxiety and Depression Scale and QALYs based on the EQ-5D. Resource use was measured using a validated questionnaire. Missing cost and effect data were imputed using multiple imputation techniques. Bootstrapping was used to analyze costs and cost-effectiveness of PST compared with UC. Results There were no statistically significant differences in clinical outcomes at 9 months. Mean total costs were €4795 in the PST group and €6857 in the UC group. Costs were not statistically significantly different between the two groups (95% CI -4698;359). The cost-effectiveness analysis showed that PST was cost-effective in comparison with UC. Sensitivity analyses confirmed these findings. Conclusions PST delivered by nurses seems cost-effective in comparison with UC. However, these results should be interpreted with caution, since the difference in total costs was mainly caused by 3 outliers with extremely high indirect costs in the UC group. Trial registration Nederlands Trial Register ISRCTN51021015

The effects of non-directive supportive therapy (NDST) for adult depression have been examined in a considerable number of studies, but no meta-analysis of these studies has been conducted. We selected 31 studies on NDST from a comprehensive database of trials, examining psychotherapies for adult depression, and conducted meta-analyses in which NDST was compared with control groups, other psychotherapies and pharmacotherapy. We found that NDST is effective in the treatment of depression in adults (g = 0.58; 95% CI: 0.45-0.72). NDST was less effective than other psychological treatments (differential effect size g = - 0.20; 95% CI: - 0.32 to - 0.08, p < 0.01), but these differences were no longer present after controlling for researcher allegiance. We estimated that extra-therapeutic factors (those processes operating in waiting-list and care-as-usual controls) were responsible for 33.3% of the overall improvement, non-specific factors (the effects of NDST compared with control groups) for 49.6%, and specific factors (the effects of NDST compared with other therapies) for 17.1%. NDST has a considerable effect on symptoms of depression. Most of the effect of therapy for adult depression is realized by non-specific factors, and our results suggest that the contribution of specific effects is limited at best. © 2012 Elsevier Ltd.

Background Depression in MS patients is frequent but often not treated adequately. An important underlying factor may be physical limitations that preclude face-to-face contact. Internet-based treatment showed to be effective for depressive symptoms in general and could thus be a promising tool for treatment in MS. Methods/design Here, we present a study protocol to investigate the effectiveness of a 5 week Internet-based self-help problem solving treatment (PST) for depressive symptoms in MS patients in a randomized controlled trial. We aim to include 166 MS patients with moderate to severe depressive symptoms who will be randomly assigned to an Internet-based intervention (with or without supportive text-messages) or waiting list control group. The primary outcome is the change in depressive symptoms defined by a change in the sum score on the Beck Depression Inventory (BDI-II). Secondary outcomes will include measures of anxiety, fatigue, cognitive functioning, physical and psychological impact of MS, quality of life, problem solving skills, social support, mastery, satisfaction and compliance rate. Assessments will take place at baseline (T0), within a week after the intervention (T1), at four months (T2) and at ten months follow-up (T3: only the intervention group). The control group will be measured at the same moments in time. Analysis will be based on the intention-to-treat principle. Discussion If shown to be effective, Internet-based PST will offer new possibilities to reach and treat MS patients with depressive symptoms and to improve the quality of care. Trial Registration The Dutch Cochrane Center, NTR2772

A meta-analysis was conducted to integrate treatment results from outcome research on the efficacy of antidepressants, behavior therapy, cognitive therapy, and the combination of these methods in obsessive compulsive disorder. The effect sizes for self-rated obsessive compulsive symptoms were found to be significantly smaller than for assessor-ratings. Because of the lack of overlap in use of measurement instruments in the respective studies, no common measurement instrument could be selected. Therefore, analyses were performed on both self- and assessor-ratings. On self- and assessor-rated obsessive-compulsive symptoms, the serotonergic antidepressants clomipramine, Fluoxetine, and fluvoxamine, behavior therapy, and the combination of serotonergic antidepressants with behavior therapy were significantly more effective than placebo treatment. Although scarce, follow-up data from 3 months to 6 years indicated that the short-term treatment effects remain stable. On self-ratings, behavior therapy was significantly more effective than serotonergic antidepressants. The combination treatment tended to be more effective than serotonergic antidepressants. On assessor-ratings, however, no difference could be demonstrated between these three treatments. Future research on antidepressants and behavior therapy should adopt the same standards for self and assessor-ratings. Moreover, research should focus on long-term efficacy of treatments offered.

Using data from the Netherlands Study of Depression and Anxiety, we examined among 1322 participants with a DSM–IV diagnosis of depression or anxiety: (i) whether positive and negative life events influence 1–year course of anxiety and depressive symptoms; (ii) whether personality traits (neuroticism and extraversion) predict symptom course and moderate the impact of life events on symptom course; and (iii) whether life events mediate relationships of neuroticism and extraversion with symptom course. Negative life events were predictive of both anxiety and depressive symptoms, while positive life events predicted the course of depressive symptoms only. Personality traits had significant predictive and moderating effects on symptom course, though these effects were rather small. Copyright © 2011 John Wiley & Sons, Ltd.

Background: Few studies have investigated the importance of psychological characteristics for chronicity of depression. Knowledge about psychological differences between chronically depressed persons and nonchronically depressed persons may help to improve treatment of chronic depression. This is the first study to simultaneously compare in large samples various psychological characteristics between chronically depressed and nonchronically depressed adults.Method: Baseline data were drawn from the Netherlands Study of Depression and Anxiety (NESDA), an ongoing longitudinal cohort study aimed at examining the long-term course of depressive and anxiety disorders in different health care settings and phases of illness. Participants were aged 18 to 65 years at the baseline assessment in 2004-2007 and had a current diagnosis of DSM-IV major depressive disorder (N = 1,002). Chronicity of depression was defined as being depressed for 24 months or more in the past 4 to 5 years. The chronicity criterion was fulfilled by 31% (n = 312). The NEO Five-Factor Inventory measured the 5 personality domains, the Leiden Index of Depression Sensitivity-Revised was used to measure cognitive reactivity (eg, hopelessness, rumination), and the Mastery Scale measured external locus of control.Results: Compared to the nonchronically depressed persons, the chronically depressed persons reported significantly higher levels of neuroticism (OR = 1.81; 95% CI, 1.55-2.12; P Conclusions: Our findings suggest that extraversion, rumination, and external locus of control, but not neuroticism, are differentiating psychological characteristics for chronicity of depression. These findings provide suggestions for more specific interventions, focused on extraversion, rumination, and external locus of control, in the treatment of chronic depression. J Clin Psychiatry 2011;72(3):288-294 (C) Copyright 2011 Physicians Postgraduate Press

Uit onvrede met bestaande psychotherapievormen ontstaat tussen 1955 en 1965 een nieuwe vorm van psychotherapie, de cognitieve therapie. Zowel Albert Ellis (1962) als Aaron Beck (1976) moeten worden gezien als de grondleggers van de ontwikkeling van deze nieuwe vorm van therapie. Beiden waren indertijd uitvoerig orthodox analytisch geschoold en waren werkzaam als psychoanalytici in de praktijk.

In hoofdstuk 2 behandelden we de basisprincipes van een cognitieve therapie en het opsporen, uitdagen en bijstellen van automatische gedachten. In dit hoofdstuk gaan we allereerst in op de verschillende niveaus waarop cognities kunnen worden onderscheiden, en hoe cognities op het tweede niveau (de assumpties) kunnen worden opgespoord. De nadruk van dit hoofdstuk zal liggen op het beschrijven van een reeks technieken waarmee cognities op het eerste en tweede niveau kunnen worden uitgedaagd. Tevens zullen we aandacht besteden aan technieken die zijn ontwikkeld om specifieke problemen aan te pakken binnen een cognitieve methodiek: interpersoonlijke problemen door het werken met de therapeutische relatie, traumatische (jeugd)herinneringen door rollenspel, en bij intense emoties door middel van imaginatieoefeningen en het geven van psycho-educatie. We sluiten af met hoe veranderingen beklijven (maar zie hiervoor ook hoofdstuk 9 over terugvalpreventie) en het beeindigen van de cognitieve therapie.

Een dwangstoornis, ofwel een obsessieve-compulsieve stoornis (OCS), wordt gekenmerkt door dwanggedachten (obsessies) of dwanghandelingen (compulsies) (APA, 2000). Dwanggedachten zijn vaak voorkomende zich opdringende gedachten (intrusies), beelden of opwellingen die ervaren worden als zich opdringend en ongewenst.

Background Many OCD patients present with comorbid conditions, and major depression is one of the most frequent comorbidities observed. OCD patients with comorbid depression exhibit functional disability and poor quality of life. However, it is unclear whether depressive symptoms are predictive of treatment response, and debate remains whether they should be targeted in the treatment of comorbid patients. The current study aimed at assessing the predictive value of depression and OCD symptoms in the long term outcome of OCD treatment. Methods In the current study, relations between OCD and depressive symptoms were systematically investigated in a group of 121 OCD patients who received 16 sessions of behavior or cognitive therapy either alone or with fluvoxamine. Results Depression (either as a continuous or categorical variable) was not predictive of treatment response in any of the treatment modalities for up to 5 years of follow-up. Changes in OCD symptoms largely predicted changes in depressive symptoms but not vice versa. Limitations Subsequent to participation in the RCT, almost two-thirds of the participants received some form of additional treatment (either pharmacological or psychological), and as a result, it is impossible to determine interaction effects with additional treatment received after the trial. Conclusions Treatment of OCD with comorbid depression should focus on amelioration of OCD symptoms. When OCD treatment is successful, depressive symptoms are likely to ameliorate as well.