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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 Several scales have been developed, although many are unpublished and there is a great deal of overlap among measures.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.

Twenty-three non-maritally distressed depressed patients who were married or cohabitating were randomly assigned to either individual behavioral-cognitive therapy or spouse-aided treatment. Both treatment conditions focused on depressed mood, behavioral activity, and dysfunctional cognitions, the difference being that in the spouse-aided treatment the partner was involved in all aspects of treatment, whereas in the individual condition the partner was not involved. MANOVAs revealed that treatment led to statistically significant improvement on depressed mood, behavioral activity, and dysfunctional cognitions. Treatment did not affect relationship variables (marital satisfaction, communication, and expressed emotion) for both spouses. Spouse-aided therapy was as effective as individual cognitive-behavior therapy.

BackgroundDepressive symptoms are a common problem in patients with diabetes, laying an additional burden on both the patients and the health care system. Patients suffering from these symptoms rarely receive adequate evidence-based psychological help as part of routine clinical care. Offering brief evidence-based treatments aimed at alleviating depressive symptoms could improve patients’ medical and psychological outcomes. However, well-designed trials focusing on the effectiveness of psychological treatments for depressive symptoms in patients with diabetes are scarce. The Mood Enhancement Therapy Intervention Study (METIS) tests the effectiveness of two treatment protocols in patients with diabetes. Individually administered Cognitive Behavioral Therapy (CBT) and Mindfulness-Based Cognitive Therapy (MBCT) are compared with a waiting list control condition in terms of their effectiveness in reducing the severity of depressive symptoms. Furthermore, we explore several potential moderators and mediators of change underlying treatment effectiveness, as well as the role of common factors and treatment integrity.Methods/designThe METIS trial has a randomized controlled design with three arms, comparing CBT and MBCT with a waiting list control condition. Intervention groups receive treatment immediately; the waiting list control group receives treatment three months later. Both treatments are individually delivered in 8 sessions of 45 to 60 minutes by trained therapists. Primary outcome is severity of depressive symptoms. Anxiety, well-being, diabetes-related distress, HbA1c levels, and intersession changes in mood are assessed as secondary outcomes. Assessments are held at pre-treatment, several time points during treatment, at post-treatment, and at 3-months and 9-months follow-up. The study has been approved by a medical ethical committee.DiscussionBoth CBT and MBCT are expected to help improve depressive symptoms in patients with diabetes. If MBCT is at least equally effective as CBT, MBCT can be established as an alternative approach to CBT for treating depressive symptoms in patients with diabetes. By analyzing moderators and mediators of change, more information can be gathered for whom and why CBT and MBCT are effective.Trial registrationClinical Trials NCT01630512.

Although personality disorder not otherwise specified (PDNOS) is highly prevalent and associated with a high burden of disease, only a few treatment studies in this patient group exist. This study is the first to investigate the effectiveness of different modalities of psychotherapy in patients with PDNOS, i.e., short-term (up to 6 months) and long-term (more than 6 months) outpatient, day hospital, and inpatient psychotherapy.A total of 205 patients with PDNOS were assigned to one of six treatment modalities. Effectiveness was assessed over 60 months after baseline. The primary outcome measure was symptom severity, and the secondary outcome measures included psychosocial functioning and quality of life. The study design was quasi-experimental, and the multiple propensity score was used to control for initial differences between treatment groups.All treatment modalities showed positive outcomes, especially in terms of improvements of symptom severity and social role functioning. At 12-month follow-up, after adjustment for initial differences between the treatment groups, short-term outpatient psychotherapy and short-term inpatient psychotherapy showed most improvement and generally outperformed the other modalities concerning symptom severity. At 60 months after baseline, effectiveness remained but observed differences between modalities mostly diminished.Patients with PDNOS benefit from psychotherapy both at short-term and long-term follow-up. Short-term outpatient psychotherapy and short-term inpatient psychotherapy seem to be superior to the other treatment modalities at 12-month follow-up. At 60-month follow-up, treatments showed mostly comparable effectiveness.The effectiveness of different modalities of psychotherapy in patients with PDNOS (i.e., short-term vs long-term; outpatient versus day hospital versus inpatient psychotherapy) has not yet been compared. Different modalities of psychotherapy are effective for patients with PDNOS, and positive effects remain after 5 years. In patients with PDNOS short-term (less than 6 months) outpatient psychotherapy and short-term inpatient psychotherapy seem to be superior to the four other treatment modalities at 12-month follow-up. At 60-month follow-up, treatments showed mostly comparable effectiveness.

Background: A number of studies have demonstrated the efficacy of virtual reality exposure therapy (VRET) in specific phobias, but research in seriously impaired patients with agoraphobia is lacking. In this randomized controlled trial with patients with agoraphobia and panic disorder, VRET and exposure in vivo were compared in terms of outcome and processes involved. Methods: Patients with panic disorder with agoraphobia (n = 55) were randomly assigned to receive 4 sessions of cognitive behavioral therapy (CBT) followed by either 6 sessions of VRET or 6 sessions of exposure in vivo or to a waiting list control condition. Results: Analyses showed that both active treatment packages were significantly more effective than no treatment and that no differences between VRET and exposure in vivo were found in three out of four outcome measures. On the panic disorder severity scale, however, CBT plus exposure in vivo was more effective than CBT plus VRET. The results show clear synchrony of temporal processes involved in VRET and exposure in vivo on weekly avoidance measures and cognitive measures. Further, it was shown that initial changes in agoraphobic cognitions during the CBT phase predicted later changes in agoraphobic avoidance behavior. Conclusion: These data support the notion that therapeutic processes involved might be the same in VRET and exposure in vivo. However, given the slight superiority of exposure in vivo above VRET, the costs involved in the implementation of VRET and the lack of long-term follow-up, VRET cannot yet be recommended for patients with agoraphobia.

Hitherto, various critics have claimed that the most commonly used measure for daily hassles is confounded with psychological well-being in both content and format. In order to circumvent such contamination, the Survey of Recent Life Experiences (SRLE) was developed by Kohn and MacDonald (1992). In the present study, the SRLE was psychometrically evaluated within a general sample of the Dutch population. Confirmatory factor analysis showed that, with the exception of one item, the original six-factor structure was strongly replicated. For five of six factors, internal consistency reliabilities proved satisfactory. It is argued that the rather low internal consistency reliability of the sixth factor may be improved if additional items are subjoined. In addition, yielded relationships between the SRLE and other variables were in accordance with previous research. It is therefore argued that the results are in support of cross-cultural construct validity of the SRLE. Future use within other Western European societies is recommended.

This article reviews the comorbidity of personality disorders (PDs) and Axis I disorders and discusses implications for assessment and treatment. Pros and cons of various assessment methods are discussed. The co-occurrence of PDs with Axis I disorders is considerable; roughly half of patients with anxiety disorders, depressive disorders or eating disorders received a PD diagnosis. Comorbidity models are discussed and implications for assessment and treatment are provided. Regarding the impact of PDs on cognitive-behavioral treatment outcome for Axis I disorders, conflicting results are found due to differences in assessment methods, treatment strategies, and patient samples. It is argued that additional Axis I pathology should be taken into account when studying the impact of PDs on treatment outcome for the target Axis I disorders. Finally, it is argued that the interpersonal behavior of the PD patient and the therapeutic relationship deserve more attention in the assessment and treatment of patients with PDs. Copyright (C) 1996 Elsevier Science Ltd

This study investigated the long-term effectiveness of cognitive-behavioral treatments for patients with a specific type of social phobia: fear of showing bodily symptoms (blushing, sweating, or trembling). Patients were reassessed 18 months after they had finished one of the following treatments: (a) exposure in vivo followed by cognitive therapy, (b) cognitive therapy followed by exposure in vivo, or (c) a cognitive-behavioral treatment in which both strategies were integrated from the start. All patients were individually treated. Self-report assessments were held before and after treatment and at 3-month and 18-month follow-ups. Repeated measures MANOVAs for the patients who completed the 18-month follow-up (n = 26) demonstrated significant time effects from pretest to follow-up, indicating overall improvement. Between the posttest and the 18-month follow-up, no significant change was observed. No differences among the treatment packages were found, although the cognitive-exposure treatment showed a trend to be less effective than both other treatments.

This study investigated the long-term follow-up effectiveness-of (cognitive-)behavioural group and individual treatments for generalized social phobia. Patients were reassessed 18 months after they had finished one of the following treatment packages: (1) exposure in vivo; (2) cognitive therapy followed by exposure in vivo; or (3) a cognitive-behavioural treatment in which both strategies were integrated from the start. Half of the patients were individually treated, the other half in a group. Self-report assessments were held before and after treatment and at 3-month and 18-month follow-ups. Repeated measures MANOVAs on the patients who completed the long-term follow-up (n = 50) demonstrated significant time effects, indicating lasting improvement compared with the pretest. Between the posttest and the Ii-month follow-up no significant changes were observed. ANCOVAs either with the pretest or the posttest as covariate showed a significant interaction at 18-month follow-up between treatment package and treatment modality on three of the four compound outcome variables. The group treatment with exposure in vivo alone had been the most effective in the longer term, the integrated group treatment the least effective, while the individual treatments had given improvements in-between. Results are qualified in view of numbers of dropouts, additional treatments in the respective treatment conditions, and clinical relevance. Copyright (C) 1996 Elsevier Science Ltd.

BackgroundDepressed patients are often characterised by marital distress, but few studies investigate the effects of marital therapy on depressed mood and relationship dysfunction.MethodTwenty-seven depressed patients experiencing marital distress were randomly assigned to either individual behavioural–cognitive therapy or marital therapy. The individual treatment condition focused on depressed mood, behavioural activity and dysfunctional cognitions, whereas in the marital condition the partner was involved in the treatment and the focus was on the communication process in the marital relationship. MANOVAs revealed that treatment led to statistically significant improvements in depressed mood, behavioural activity and dysfunctional cognitions, an increase in relationship satisfaction and improvement of communication in patients and spouses. A significant interaction effect was found, showing that marital therapy had more impact on relationship variables than the individual treatment.ConclusionBoth individual cognitive–behaviour therapy and marital therapy lead to less depressive complaints, and both treatment conditions have a positive effect on the relationship, although the effect on the relationship is significantly stronger in couples who were treated by marital therapy compared with patients who were treated individually.

Objective: To evaluate the effectiveness of Emotion Regulation Training (ERT), a 17-session weekly group training for adolescents with borderline personality disorder (BPD) symptoms. Method: One hundred nine adolescents with borderline traits (73% meeting the full criteria for BPD) were randomized to treatment as usual only (TAU) or ERT TAU. Outcome measurements included severity of BPD symptoms, general psychopathology, and quality of life. Multilevel analyses were conducted on an intent-to-treat basis. Clinical significant change was determined by normative comparisons on a primary outcome measurement. Results: Independent of treatment condition, the two groups improved equally on the severity of BPD symptoms, general psychopathology and quality of life. Nineteen percent of the ERT group was remitted according to the cutoff score after treatment (at 6 months) versus 12% of the control group. Follow-up assessments in the ERT group at 12 months showed some further improvement (33% remittance). With regard to predictors of outcomes, adolescents with higher levels of depression or attention-deficit/hyperactivity disorder or oppositional-defiant disorder at baseline and who reported a history of abuse had worse outcomes, regardless of treatment condition. The attrition rate for the ERT sessions was remarkably low (19%). Conclusions: Early interventions for BPD symptoms in adolescence are feasible and necessary. No additional effect of ERT over TAU could be demonstrated in the present study. There is a dear need for developing effective interventions for adolescents with persistent BPD symptomatology. Clinical trial registration information Evaluation of Group Training for Adolescents (Emotion Regulation Training) with Emotion Regulation Problems: A Randomized Controlled Clinical Trial; http://trailregister.nl/; ISRCTN97589104. J. Am. Acad. Child Adolesc. Psychiatry; 2012;51(12):1314-1323.

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.

A series of primarily laboratory-based studies found attention bias modification in socially anxious participants to lead to reduced anxiety. It is argued that the failure to replicate the positive results of attention bias modification in the study of Carlbring et al. may be due to reasons other than the application through the Internet. A number of controlled studies failed to replicate the positive effects of attention bias modification in clinically rather than subclinically socially anxious subjects. Given the lack of robust evidence for attention bias modification in clinically socially anxious individuals, the author is inclined to consider attention bias modification as 'the Emperor's new suit'. Results achieved with regular Internet-based treatments for social anxiety disorder based on cognitive therapy and exposure methods are much better than those achieved with attention bias modification procedures delivered 'face to face' in clinically distressed participants. Given the lack of robust evidence for attention bias modification in clinical samples, there is no need yet to investigate the implementation of attention bias modification through the Internet. Please see related article: http://www.biomedcentral.com/1471-244X/12/66

Background The aim of the study was to assess levels of somatic and mental health distress, well-being, AS WELL AS utilization of primary and specialist health care services among war-related widowed and non-widowed female civilian survivors of war. Methods 100 war-related widowed lone mothers and 106 non-widowed mothers who had experienced the Kosovo war ten years previously participated in the study. Measures of somatic, depressive, post-traumatic stress, anxiety, and grief complaints, subjective well-being, and utilization of health care services during the previous three months were used. Results Compared to non-widowed mothers, widowed lone mothers reported significantly higher levels of somatic, depressive, post-traumatic stress, and anxiety complaints. Further, they reported significantly lower levels of subjective well-being as composed of positive and negative affect and satisfaction with life. More than half of both widowed and non-widowed mothers reported utilization of health care services during the last three months, without significant differences between the groups. However, only three percent of widowed lone mothers and four percent of non-bereaved mothers reported utilization of mental health services during the last three months, despite high levels of mental health distress especially among widowed lone mothers. Among widowed lone mothers, severity of prolonged grief symptoms significantly predicted number of contacts of specialist health care use over and above sociodemographic variables, number of war-related events, and other psychopathology. Conclusion War-related widowed lone mothers suffer from elevated somatic and mental distress even a decade after the war. The tiny proportion of widowed lone mothers in use of mental health services can be seen as a reflection of lack of previous and current mental health services to meet mental health needs of this population.

There is great variability in the degree to which children with attention deficit/hyperactivity disorder (ADHD) improve through behavioral treatments. This study investigates the influence of the dopamine transporter gene (SCL6A3/DAT1) on outcome of behavioral parent training (BPT). Study subjects were a subsample (n = 50, for whom DAT1 genotypes were available) of a randomized controlled BPT effectiveness study (N = 94) comparing BPT plus ongoing routine clinical care (RCC) versus RCC alone in referred children (4-12 years old) with ADHD. Treatment outcome was based on parent-reported ADHD symptoms and behavioral problems. Presence of 2 versus no or 1 DAT1 10-repeat allele served as moderator variable. Time × Treatment × Genotype effect was analyzed with repeated-measures analysis of variance, controlling for baseline medication status. Results indicate that DAT1 moderated treatment response (p = .009). In children with no or 1 DAT1 10-repeat allele, superior treatment effects of BPT + RCC compared with RCC alone were present (p = .005), which was not the case in children with 2 DAT1 10-repeat alleles (p = .57). Our findings suggest that genetic differences in DAT1 in children with ADHD influence their susceptibility to a behavioral intervention directed at shaping their environment through their parents. The role of the dopamine system in motivation and learning and in the aberrant sensitivity to reinforcement in children with ADHD may explain this moderating effect, given that the management of contingencies is typically addressed in BPT. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

ContextRandomized controlled trails have identified online cognitive behavioral therapy as an efficacious intervention in the management of common mental health disorders.ObjectiveTo assess the effectiveness of online CBT for different mental disorders in routine clinical practice.DesignAn uncontrolled before-after study, with measurements at baseline, posttest, 6-week follow-up, and 1-year follow-up.Participants & Setting1500 adult patients (female: 67%; mean age: 40 years) with a GP referral for psychotherapy were treated at a Dutch online mental health clinic for symptoms of depression (n = 413), panic disorder (n = 139), posttraumatic stress (n = 478), or burnout (n = 470).InterventionsManualized, web-based, therapist-assisted CBT, of which the efficacy was previously demonstrated in a series of controlled trials. Standardized duration of treatment varied from 5 weeks (online CBT for Posttraumatic stress) to 16 weeks (online CBT for Depression).Main Outcome MeasuresValidated self-report questionnaires of specific and general psychopathology, including the Beck Depression Inventory, the Impact of Event Scale, the Panic Disorder Severity Scale-Self Report, the Oldenburg Burnout Inventory, and the Depression Anxiety Stress Scales.ResultsTreatment adherence was 71% (n = 1071). Study attrition was 21% at posttest, 33% at 6-week FU and 65% at 1-year FU. Mixed-model repeated measures regression identified large short-term reductions in all measures of primary symptoms (d = 1.9±0.2 to d = 1.2±0.2; PConclusionsResults suggest that online therapist-assisted CBT may be as effective in routine practice as it is in clinical trials. Although pre-treatment withdrawal and long-term outcomes require further study, results warrant continued implementation of online CBT.

Repetitive negative thinking (RNT) has been shown to be involved in the maintenance of a variety of emotional problems. In addition, earlier research found that different forms of RNT such as worry and rumination show very similar characteristics. It was therefore suggested that RNT is best conceptualized as a transdiagnostic process. The Perseverative Thinking Questionnaire (PTQ) was developed as a content-independent measure of RNT to allow research into this process from a transdiagnostic perspective. In a recent study, good psychometric properties were established for the original German and English versions of the measure. The current study describes the crossvalidation of the PTQ in two Dutch-speaking samples, one from the Netherlands and one from Belgium (total N = 1,845). The factor structure of the original PTQ with one higher-order factor and three lower-order factors was replicated for the Dutch-language version of the measure (PTQ-NL) using confirmatory factor analyses. In addition, the PTQ-NL showed good internal consistency and satisfactory stability. The validity of the measure was supported by substantial correlations with existing measures of RNT as well as with symptom levels of depression and anxiety. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

The knowledge of being infected with the human immunodeficiency virus type 1 (HIV-1) brings about psychological distress and social problems including anxiety, depression, and social isolation. Participating in psychosocial intervention programs can help to reduce these problems. To date, however, very little is known about the efficacy of different intervention strategies. We implemented a study with a randomized experimental design to investigate the effectiveness of a cognitive-behavioral group psychotherapy (CBT) and an experiential group psychotherapy (ET) program for 39 asymptomatic HIV-infected homosexual men. Both therapies consisted of 17 sessions over a 15-week period. The major finding of this study was that psychosocial intervention, independent of the therapeutic orientation, decreased distress significantly, as compared with a waiting-list control group (WCG). There were no significant changes in the intervention groups as compared with the WCG in coping styles, social support, and emotional expression. Finally, CBT and ET did not differ in their effects on psychological distress or on the other psychosocial variables measured in this study.

The purpose of this study was to test the (mis)match model of Rachman and co-workers during real life exposure therapy in panic disorder patients with agoraphobic avoidance. The results showed that although the patients tended to overpredict their expected fear before the exposure sessions, their predictions did not show a tendency to become more accurate in the course of treatment.After an overprediction predicted fear tended to decrease and self-efficacy tended to increase; after a correct match both predicted fear and self-efficacy remained unchanged. Patients reports of fear tended to decrease within and across exposure sessions regardless of the occurrence of correct or incorrect matches.Patients reported significantly more positive self-statements in underprediction sessions compared to overprediction and correct match sessions. Positive self-statements increased both in underprediction and correct match sessions, but decreased in overprediction sessions. The largest reduction in negative self-statement within an exposure session was found in correct match sessions.The theoretical and clinical relevance of the results are discussed in line of the match/mismatch model of Rachman and co-workers.

Parental rearing styles are often found to be related to adult psychological disorders. In general, conclusions are based on the data of retrospective studies, in which patients' memories of their parents' behaviour are investigated. However, it has been widely recognized that memories may be sensitive to current mood states. The possible mood sensitivity of autobiographic memories is a powerful alternative explanation of the relationship commonly found between parental rearing styles and psychopathology, with implications for the hypothesis of early parenting as a vulnerability factor in the aetiology of such disorders. The present study examined whether memories of parental rearing styles are influenced by present mood. To this aim, both mood and memories of parental rearing styles were assessed on two occasions in a sample of 315 healthy subjects from the general community (Study 1) and in a group of 46 socially phobic patients (Study 2). Results showed that memories of early parenting remained quite stable, even in the face of significant and considerable changes in anxiety, depression, and hostility. The theoretical and practical implications of these findings are discussed.

The aim of this study was to investigate whether individualized tailor‐made behavioural treatment based upon a problem analysis of each case was more effective than a standardized behavioural treatment protocol. Twenty‐two obsessive‐compulsive patients were randomly assigned to two treatment conditions: (1) tailor‐made cognitive behavioural therapy and (2) standardized exposure in vivo therapy. Treatment in both conditions led to significant improvements on obsessive‐compulsive targets and on the Maudsley Obsessional‐Compulsive Inventory. Improvement generalized to general levels of psychopathology, depressed mood and social anxiety. Contrary to expectations the individualized treatment was not more effective than the standardized exposure therapy.

The present paper provides a review of the literature on the relationship between marital factors and anxiety disorders. The review is based on both a descriptive and quantitative analysis. Studies of the marital relationship and outcome of exposure therapy are reviewed, as are studies investigating the effects of exposure therapy on the partner and on the marital relationship. Results with respect to the effects of marital distress on outcome are inconclusive. Exposure does not have a negative impact on the partner or the relationship. In agoraphobia, spouse-aided therapy is no more effective than individual exposure therapy. In obsessive-compulsive patients, results are inconclusive.

This article reports on some psychometric features of the Therapist Client Rating Scale (TCRS), an instrument that claims to measure the therapeutic relationship in behaviour therapy sessions. A study is described in which the TCRS was completed after each therapy session by 28 obsessive-compulsive patients undergoing behaviour therapy, as well as by the therapists. The perception of patient behaviour correlated significantly with the treatment outcome. Further examination on the reliability and validity of the TCRS is recommended.

Objective: Inhibition deficits, including deficits in prepotent response inhibition and interference control, are core deficits in ADHD. The predictive value of prepotent response inhibition and interference control was assessed for outcome in a 10-week treatment trial with methylphenidate. Methods: Thirty-four children with ADHD (ages 8-12) received 10 weeks of methylphenidate treatment. At pretest prepotent response inhibition was assessed using the Stop-Signal Task; interference control was assessed using the Stroop Color-Word task. Methylphenidate was individually titrated to an optimal dose. Treatment outcome was assessed by parent- and teacher-rated ADHD behavior. Results: Only stop-signal reaction time of the Stop-Signal Task was a significant predictor of parent-rated levels of inattention and hyperactivity/impulsivity at outcome. Children with lower levels of inhibition showed worse outcome after 10 weeks of treatment, independent of medication dose. Conclusions: Low levels of prepotent response inhibition are associated with worse response to treatment with methylphenidate. Prepotent response inhibition may be an intermediate phenotypical predictor of treatment outcome. © 2012 Psychology Press, an imprint of the Taylor & Francis Group, an Informa business.

Although Virtual Reality (VR) treatment and Internet-based cognitive behavior therapy (CBT) have been found to be effective in a large series of studies, dissemination of these therapies in the community at large is still in its infancy. A number of reasons for the lack of dissemination are discussed, including clinicians' resistance, lack of representation of samples studied, and lack of cost-effectiveness studies. Challenges for further studies are pointed out.

In this study the effects of virtual reality exposure therapy (VRET) were investigated in patients with panic disorder and agoraphobia. The level of presence in VRET was compared between using either a head-mounted display (HMD) or a computer automatic virtual environment (CAVE). Results indicate that there was no relationship between the level of experienced presence and treatment outcome. Analyses indicate that VRET in general was more effective than no treatment. No differences in effectiveness were found between VRET using an HMD or CAVE.

Background: While psychopharmacological studies are common in patients with cluster A personality disorders, the effects of psychotherapy have received little attention. The aim of this study is to explore whether psychotherapeutic treatment yields health gains for these patients. Methods: The study was conducted between March 2003 and June 2008 in 6 mental health care centres in the Netherlands, with a sample of 57 patients with a DSM-IV-TR axis II cluster A diagnosis. Patients were assigned to 3 settings of psychotherapeutic treatment (outpatient, day hospital, inpatient), and effectiveness was assessed at 18 months after baseline. An intention-to-treat analysis was conducted for psychiatric symptoms (Brief Symptom Inventory), psychosocial functioning (Outcome Questionnaire-45) and quality of life (EQ-5D), using multilevel statistical modelling. As the study was non-randomised, the propensity score method was used to control for initial differences. Results: Patients in the day hospital and inpatient group improved substantially in terms of psychiatric symptoms, social and interpersonal functioning, and quality of life. Patients in the outpatient group showed less improvement. Direct comparison of the improvement of psychiatric symptoms showed significant results in favour of day hospital (p = 0.046) and inpatient (p = 0.01) treatment, as compared to outpatient treatment. However, due to substantial baseline differences, this direct comparison should be judged carefully. Conclusions: Cluster A psychopathology is not a contraindication to benefit from psychotherapy. This is especially true for more intensive forms like inpatient and day hospital treatment. Future research should focus more on psychotherapeutic treatment to gain further insight into effective treatment options for this patient group.

sulting in a sample size of n = 123. FFM traits were measured at baseline with the NEO-Five Factor Inventory [22, 23]ater - d f . Sl ePTS symptoms were measured at baseline and posttest with the Impact of Event Scale [24] . PTSD diagnostic status was estab-lished at baseline and posttest with the Structured Clinical Inter-view for DSM-IV Axis I disorders [25] . Treatment consisted of a maximum of 10 1.5-hour sessions of TFCBT or structured writing therapy, and was compared to waitlist control (WLC) (for com-plete study procedures and results, see Van Emmerik et al. [21] ).Following Kraemer et al. [26] , linear multiple regression models were constructed for each FFM trait with: (1) baseline PTS symp-toms entered first (step 1), (2) main effect of each FFM trait, main effect of study condition (active treatment or not), and interaction of FFM trait and study condition entered second (step 2), and (3) posttest PTS symptoms as the dependent variable. Of note, sig-nificant interaction terms indicate differential relationships be-tween FFM traits and baseline-to-posttest changes in PTS symp-toms after active treatment compared to WLC, and thus provide a stringent test of whether FFM traits moderate treatment out-come. Similarly, logistic multiple regression models were con-structed with dropout and posttest PTSD diagnostic status as (bi-nary) dependent variables. Forty-one randomized controlled trial participants (33.3%) dropped out and did not complete the posttest. None of the inter-actions between FFM traits and study condition were significant (all p 1 0.10), indicating that the FFM traits did not moderate dropout. For the 82 completers (66.7%), baseline PTS symptoms were strongly associated with treatment outcome in each FFM multiple regression model (all p ! 0.001), as was study condition (i.e. receiving active treatment; all p ! 0. 001). In contrast, no main effects were observed for any of the FFM traits (all p 1 0.10). Ta-ble 1 displays the regression model yielding the one significant FFM moderator, i.e. openness to experience (p ! 0.05). Lower scores on openness to experience were more strongly associated with posttest PTS symptoms after active treatment than after WLC, indicating that this FFM trait moderated PTSD treatment outcome. No significant interactions were observed between ac-tive treatment and neuroticism, extraversion, or agreeableness (all p 1 0.05), and a marginally significant interaction was observed between active treatment and conscientiousness (p = 0.05). Study condition (i.e. receiving active treatment) was also associated with posttest (no-PTSD) diagnostic status across the FFM logistic mul-tiple regression models. No significant interactions emerged be-tween study condition and Five-Factor Inventory traits, suggest-ing that FFM traits do not moderate change in PTSD diagnostic status.O ur main findings can be summarized as follows. First, base-line self-reported PTS symptoms were predictive of posttest levels of PTS symptoms. This is in line with previous studies, which in Research has identified trauma-focused cognitive-behavioral therapy (TFCBT) as an effective treatment for post-traumatic stress disorder (PTSD) [1] . However, a substantial minority of PTSD patients do not sufficiently benefit from TFCBT [2–10] . Many clinicians would explain differential PTSD treatment out-come at least partly in terms of their patients’ personality charac-teristics. This contrasts with the scarcity of empirical studies on personality characteristics as predictors of PTSD treatment out-come [11–16] . Furthermore, those studies that do exist employed heterogeneous operationalizations of personality characteristics, which, perhaps accordingly, failed to demonstrate consistent re-lationships with PTSD treatment outcome. This is unfortunate because moderator analyses of personality characteristics could potentially yield information on mechanisms of change or the tailoring of treatment to individuals with extreme personality rat-ings. We therefore investigated the Five-Factor Model (FFM) per-sonality traits as moderators of dropout and treatment response in PTSD patients. The FFM (neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness) has estab-lished itself as a widely accepted and extensively researched per-sonality model [17] , and may potentially influence PTSD treat-ment outcome in various ways. For instance, a minimal degree of openness to experience is a likely prerequisite for involvement in emotionally aversive exposure procedures or in cognitive restruc-turing exercises, and some degree of conscientiousness may be essential for consistent attendance and homework compliance [18–20] . Sp ecifically, we hypothesized that neuroticism was asso-ciated with dropout, and that lower scores on openness to experi-ence, agreeableness, and conscientiousness, and higher scores on neuroticism, were associated with less favorable treatment out-come.D ata were obtained from patients meeting DSM-IV criteria for PTSD in a previous randomized controlled trial [21] . Two par-ticipants missing post-treatment PTSD data were excluded, re

Parental representations of a Dutch sample of psychiatric patients with diagnoses of dysthymia and unipolar depression were compared with those of a matched sample of non-depressed patients and a matched sample of healthy controls. No differences in recalled parental rearing styles were found between depressives with a diagnosis of dysthymia and those with a diagnosis of unipolar depression. Depressive did not differ from the mixed (but non-depressed) sample of psychiatric patients, whereas both the depressed and the mixed group of patients reported more adverse parenting than the healthy controls. Analysis of repeated measurements of parental representations showed that memories of parental behavior were highly stable across clinically significant changes in depressed mood, so that it seems unlikely that patients' relatively negative recollections of their parents' behavior were due to mood state dependent recall. Results are discussed within the framework of depression theories and with regard to the validity and utility of self-report instruments for parental rearing styles.

In clinical practice, the combination of brief, cost effective, valid and reliable assessment of personality disorders (PDs) is highly important. Substantial budget cuts require optimal use of the clinician's time. PDs are related with high axis I comorbidity, poorer therapy outcome and increased health service costs. In an effort to find a screening questionnaire that meets both the demands of cost-effectiveness and methodological soundness, we investigated the use of the Personality Diagnostic Questionnaire 4+ (PDQ-4+) as a first step in a two-step diagnostic procedure. As the second step, we used the Structured Clinical Interview of DSM-IV Axis II Personality Disorders (SCID-II) as criterion measure. Our results show that the positive predictive power of the PDQ-4+ is rather low, resulting in a large number of false positives. Therefore, its added value is poor in comparison with administering the SCID-II in the first place. Also, the value of the two validity scales of the PDQ-4+ is highly questionable. We therefore conclude that the PDQ-4+ should not be used in clinical practice as a screening instrument for PD assessment.

In recent years, virtual reality exposure therapy (VRET) has become an interesting alternative for the treatment of anxiety disorders. Research has focused on the efficacy of VRET in treating anxiety disorders: phobias, panic disorder, and posttraumatic stress disorder. In this systematic review, strict methodological criteria are used to give an overview of the controlled trials regarding the efficacy of VRET in patients with anxiety disorders. Furthermore, research into process variables such as the therapeutic alliance and cognitions and enhancement of therapy effects through cognitive enhancers is discussed. The implications for implementation into clinical practice are considered.

Background: For patients with cluster B personality disorders there is no consensus regarding the optimal treatment setting. The aim of this study was to compare the effectiveness of different psychotherapeutic settings for patients with cluster B personality disorders, i.e. outpatient, day hospital, and inpatient treatment. Methods: The study was conducted between March 2003 and June 2008 in 6 mental health care centres in the Netherlands, with a sample of 207 patients with a DSM-IV-TR axis II cluster B diagnosis. Patients were assigned to 3 different settings of psychotherapeutic treatment and effectiveness was assessed at 18 months after baseline. An intention-to-treat analysis was conducted for psychiatric symptoms (Brief Symptom Inventory), psychosocial functioning (Outcome Questionnaire-45), and quality of life (EQ-5D), using multilevel statistical modelling. As the study was non-randomised, the propensity score method was used to control for initial differences. Results: Patients in all 3 settings improved significantly in terms of psychiatric symptoms, social and interpersonal functioning, and quality of life 18 months after baseline. The inpatient group showed the largest improvements. The comparison of outpatient and inpatient treatment regarding psychiatric symptoms showed a marginally significant result (p = 0.057) in favour of inpatient treatment. Conclusions: Patients with cluster B personality disorders improved in all investigated treatment settings, with a trend towards larger improvements of psychiatric symptoms in the inpatient setting compared to the outpatient setting. Specialised inpatient treatment should be considered as a valuable treatment option for cluster B personality disorders, both in research and in clinical practice.

This study was meant to investigate the psychometric properties and clinical utility of the Lehrer Woolfolk Anxiety Symptom Questionnaire (LWASQ), an instrument for assessment of somatic, behavioral and cognitive aspects of anxiety. Confirmatory factor analysis on data from social phobics (n = 108), normal adults (n = 103) and normal adolescents (n = 650) showed that the three original factors were strongly replicated in each sample. The three subscales appeared to have high internal consistency, while data on convergent and divergent validity were satisfactory. In addition, the subscales did very well in discriminating between phobic patients and normals, and were able to detect treatment effects. In the discussion the instrument is compared with other self report measures of anxiety dimensions, like the Cognitive Somatic Anxiety Questionnaire (CSAQ) and the Worry-Emotionality Scale (WES). It is suggested that similar questionnaires, adjusted to the separate anxiety disorders, should be developed.

Aansluitend op een eerder artikel over kenmerken en etiologie van sociale fobie en verwante begrippen wordt in dit artikel ingegaan op de behandeling van deze klachten. Algemene punten van belang in de behandeling van sociale fobie worden genoemd, waarna verschillende (cognitief–) gedragstherapeutische procedures, met de nadruk op exposure in vivo, sociale vaardigheidstherapie en cognitieve technieken, de revue passeren. Resultaten van onderzoeken naar de effecten van deze behandelingen worden steeds voorafgegaan door een beschrijving van de praktische uitvoering van de behandeling, met daarbij optredende problemen. Verder worden aandachtspunten genoemd bij de behandeling van angst voor lichamelijke verschijnselen en aspecten van groeps– en individuele behandeling. Besloten wordt met een bespreking van het therapeutisch gebruik van psychofarmaca in de behandeling, met resultaten van onderzoek op dit gebied.

The relationship between memories of childhood experiences (e.g., adverse parenting) and adult depression often found raises questions of interpretation. On the one hand, both laboratory studies and clinicians' experiences suggest that subjects in a depressed mood frequently show a negative bias in perceptions and memories. Negative childhood memories in depressed persons might, therefore, be interpreted as epiphenomena of depressed mood instead of etiological factors. On the other hand, memories of childhood experiences seem remarkably stable across changes in depressed mood, especially when memories are elicited by means of standardized questionnaires. In the mood and memory literature several explanations for this stability are offered. For one thing, highly structured cues to elicit memories (such as in questionnaires) are hypothesized to be less susceptible to mood bias than unstructured memory cues (such as in free recall procedures). On the other hand, resource allocation theorists suggest that childhood memories, being well established and rehearsed, are relatively impervious to mood bias no matter how they are elicited. In this study we examined whether different methods of eliciting childhood memories (i.e., free recall and questionnaire-cued) are differentially susceptible to mood bias. To this aim, we used a mood induction procedure to produce depressed, neutral, and elated mood and assessed childhood memories both before and after the mood induction using both questionnaires and free recall to elicit memories. Results suggested that memories elicited by means of free recall as well as by means of questionnaire-cued recall were susceptible to depressed and elated mood bias. The implications for research addressing the link between childhood experiences and depression are discussed.

Sixty agoraphobics were treated by behavioural therapy (self-exposure in vivo) either with their partner involved in all aspects of treatment or without their partner. The two treatment formats were about equally effective. Behavioural treatment directed at the agoraphobia resulted in improvement irrespective of marital quality and partner involvement in the therapy. The effects of treatment led neither to a deterioration of the marriage nor to adjustment problems in the partner. Avoidance behaviour, intropunitivity and overprotection were found to predict treatment response. The partners of agoraphobics were not found to have psychological problems themselves.

Emotion Regulation Training (ERT) was developed for adolescents with symptoms of borderline personality disorder (BPD) and emotion dysregulation. ERT is an adaptation of the Systems Training for Emotional Predictability and Problem Solving (STEPPS) programme. This paper describes the background of the programme, and gives an outline of the treatment programme. The effectiveness of ERT was examined in a randomized controlled pilot study with 43 youth (aged 14-19 years) in five mental health centres in the Netherlands. Subjects were assessed before and after random assignment to ERT plus treatment as usual (TAU) (n = 23) or to TAU alone (n = 20). Outcome measures included assessment of BPD symptoms, locus of control, and internalizing and externalizing behaviour. Both groups showed equal reductions in BPD symptoms over time. The group receiving ERT plus TAU (and not the TAU-only group) had a significant increase in internal locus of control: ERT participants reported more sense of control over their own mood swings, and attributed changes in mood swings not only to external factors. The study was complicated by a high attrition. The implications of the findings are discussed, including the difficulties inherent in treating and researching an adolescent population, and the need for researchers to develop age-appropriate assessments.

Past research has shown a substantial prevalence of emotional disorders in professionals involved in rescue and/or relief operations following natural disasters, including earthquakes. However, no published study to date has investigated whether disaster rehabilitation and reconstruction workers involved in later phases ofthe earthquake response are also affected by emotional problems. A nearly complete sample of earthquake rehabilitation and reconstruction workers (N=267) involved in the response to the 2005 earthquake in Northern Pakistan filled in a set of self-report questionnaires assessing emotional problems and predictor variables approximately 24 months after the earthquake. Most participants had experienced the disaster themselves and suffered from a number of stressors during and shortly after the acute earthquake phase. A substantial subgroup of participants reported clinically relevant levels of emotional disorders, especially earthquake-related posttraumatic stress disorder (42.6%), as well as depression and anxiety (approx. 20%). Levels of burnout were low. Symptom levels of posttraumatic stress disorder were associated with the severity of the earthquake experience, past traumas, work-related stressors, low social support, and female gender. The results document a high prevalence of emotional problems in earthquake rehabilitation and recovery workers.

Background: Explanatory models (EMs) refer to patients’ causal attributions of illness and have been shown to affect treatment preference and outcome. Reliable and valid assessment of EMs may be hindered by interviewer and respondent disparities on certain demographic characteristics, such as ethnicity. The present study examined (a) whetherethnic minority patients reported different EMs to ethnically similar interviewers in comparison with those with a different ethnicity, and (b) whether this effect was related torespondents’ social desirability, the perceived rapport with the interviewer and level of uncertainty toward their EMs. Methods: A total of 55 patients of Turkish and Moroccan origins with mood and anxiety disorders were randomly assigned to ethnically similar or dissimilar interviewers. EMs were assessed, using a semi-structured interview, across 11 different categories of causes.Results: Participants who were interviewed by an ethnically similar interviewer perceived interpersonal, victimization and religious/mystical causes as more important, whereas interviews by ethnically dissimilar interviewers generated higher scores on medical causes. These effects were not mediated by the perceived rapport with the interviewer, and social desirability had a modest impact on the results. Higher uncertainty among participants toward medical and religious/mystical causes seemed to be associatedwith greater adjustment in the report of these EMs.Conclusion: The findings have significant implications for interviewer selection in epidemiological research and clinical practice.

Tot zo’n tien jaar geleden was men vrij pessimistisch over de behandelbaarheid van hypochondrie. De hypochondere patient werd beschouwd als onbehandelbaar, rigide en als iemand die liever bij een arts dan bij een psycholoog of psychiater zat.