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Contains fulltext : 283391.pdf (Publisher’s version ) (Open Access) Background: Bipolar disorder is a severe, chronic mental disorder. Treatment options are limited, with pharmacological approaches continuing to dominate. However, relapse rates remain high. Several adjunctive psychosocial interventions, mostly psychoeducation (PE) and cognitive behavioural therapy (CBT), have been trialled, but treatment innovation is still needed. In the past, brief group PE has proven as beneficial as longer individual CBT in reducing levels of depression and increasing self-management strategies. We compared the relative effectiveness of group PE to an imagery focussed cognitive behavioural therapy (ImCT). Study design: This was a randomised parallel group study with both daily and weekly measures. A total of 62 adult patients were randomly allocated to either ImCT or group PE. Daily, weekly and pre-and post-intervention measures were used to assess impact on (i) mood instability, (ii) overall levels of depression, anxiety and mania, and (iii) general functioning, hopelessness and imagery characteristics. A four-week baseline and 16-week follow-up period were included. Results: Mood instability reduced in both conditions after intervention. Levels of mania, depression and anxiety also reduced in both conditions, but on the daily measures, depression and anxiety significantly more so in the ImCT condition. Compared with the PE condition, the ImCT condition additionally showed increased level of functioning, reduced hopelessness, and a decrease in intrusive, problematic imagery. Limitations These findings need to be replicated in a larger trial. Conclusions: Findings suggest that ImCT is a promising new avenue for management of bipolar disorder, an area in which treatment development is urgently needed. 10 p.

This qualitative study investigated which types of interventions are made by group therapists during group cognitive-behavioral therapy (GCBT) with individuals who have perpetrated intimate partner violence (IPV) in the "Not 'Losing It' Anymore"(NLIA) outpatient programs across the Netherlands. Audio recordings of group sessions (N = 60) facilitated by 13 co-therapist teams across 25 different groups were analyzed using the general inductive approach. Fifteen distinct therapist interventions were identified, categorized, and described using examples from the data. Two categories of interventions could be distinguished: CBT interventions and process-oriented interventions. In future research the coding manual can be tested for interrater reliability and might be used in research on the effectiveness of GCBT therapist interventions.

The current study aims to examine the causal effect of boredom on non-suicidal self-injury (NSSI), expanding prior experimental research by including an anger induction to compare to a boredom induction, and additionally measuring whether participants specifically seekpainfulstimulation. In a sample of mostly undergraduate students (N = 146), emotional state was manipulated through video induction, and NSSI behavior was simultaneously measured, operationalized through self-administration of electric shocks. Participants’ pain thresholds were measured beforehand. NSSI history and negative urgency were included as potential moderators. Results showed that boredom increased both frequency and intensity of self-administered electric shocks, especially in participants with an NSSI history. Negative urgency was not a significant moderator. No causal anger-NSSI link was found, possibly due to the anger induction not being sufficiently effective. Clinical implications are considered through suggestions of boredom coping skills training as an intervention strategy in NSSI populations.

Cognitive restructuring (CR) is an efficacious intervention for reducing transdiagnostic hostility. However, evidence suggests that the efficacy of CR can be further improved. A promising candidate for improving the efficacy of CR is mental imagery. Previous work showed that that enriching CR with mental imagery (I-CR) increased its efficacy in terms of reducing hostile beliefs and aggressive inclinations. In this article, we describe the rationale of the I-CR procedure, how to use it, and illustrate it with case examples. Our clinical experience underlines that imagery seems to capture both the hostile as well as helpful thoughts in a more effective way than verbal formulations. Future studies need to explore whether using this protocol is helpful for patients with clinical levels of hostility.

Working with extreme mood states is a regular challenge for law enforcement officers. In their encounters during police actions, they very often face manifestations of anger and aggression, as well as vulnerable states such as ones involving fear, helplessness, or humiliation. In this study, we investigated whether officers could reliably identify emotional states in the persons they encountered, using the Schema Therapy concept of “schema modes.” Although the mode concept has been extensively validated in the field of forensic mental health, this is its first application to police work. Twenty-seven police officers working for two different German police headquarters were asked to report about a recent operation involving a person showing intense emotional states. After receiving a short training in using the iModes, cards that facilitate working with modes, they retrospectively rated the presence and intensity of the schema modes of the persons whom they encountered. Two experts in Schema Therapy independently rated the same scenarios, using the Mode Observation Scale (MOS). Intraclass correlations showed moderate to excellent levels of agreement between the officers’ and experts’ mode-ratings. Modes involving anger (70%), aggression (70%), indirect hostility (44%), and arrogance/grandiosity (41%) were the most prevalent, while modes involving vulnerable emotions were less common. It can be concluded that police officers can reliably assess different modes in encountered persons, even without extensive training. This initial study suggests that the mode concept has applicability to police work and merits additional study for its potential for de-escalation and conflict management in police contexts.

Contains fulltext : 228160.pdf (Publisher’s version ) (Open Access) Binge eating disorder (BED) and bulimia nervosa (BN) are characterized by binge eating. Frequently related to negative affect, binge eating is considered unwanted eating behavior. It is often preceded by a shift away from the goal of a healthy eating pattern. Implementation intentions are 'if-then' plans that may prevent such shifts in goals. In a students' sample with subthreshold binge eating, two implementation intention conditions were compared to a control condition in which only goals were formed. In the behavior-focused condition, implementation intentions targeted binge eating; in the emotion-focused condition, implementation intentions targeted negative affect preceding binge eating. All participants received three sessions and kept food diaries for four weeks, followed by a post-test and a one-month, three-months, and six-months follow-up. Compared to the control condition, both implementation intention conditions showed significant and large reductions in binge eating lasting for six months. Effects did not differ between both implementation intention conditions. Three implementation intention sessions reduced subthreshold binge eating. This continued for six months after the final session. Contrary to expectations, behavior-focused and emotion-focused implementation intentions were equally effective, possibly due to other triggers than negative affect. Future research should address their usefulness in BED and BN. 15 p.

Contains fulltext : 249039.pdf (Publisher’s version ) (Open Access) Stress initiates a cascade of (neuro)biological, physiological, and behavioral changes, allowing us to respond to a challenging environment. The human response to acute stress can be studied in detail in controlled settings, usually in a laboratory environment. To this end, many studies employ acute stress paradigms to probe stress-related outcomes in healthy and patient populations. Though valuable, these studies in themselves often have relatively limited sample sizes. We established a data-sharing and collaborative interdisciplinary initiative, the STRESS-NL database, which combines (neuro)biological, physiological, and behavioral data across many acute stress studies in order to accelerate our understanding of the human acute stress response in health and disease (www.stressdatabase.eu). Researchers in the stress field from 12 Dutch research groups of 6 Dutch universities created a database to achieve an accurate inventory of (neuro)biological, physiological, and behavioral data from laboratory-based human studies that used acute stress tests. Currently, the STRESS-NL database consists of information on 5529 individual participants (2281 females and 3348 males, age range 6-99 years, mean age 27.7 ± 16 years) stemming from 57 experiments described in 42 independent studies. Studies often did not use the same stress paradigm; outcomes were different and measured at different time points. All studies currently included in the database assessed cortisol levels before, during and after experimental stress, but cortisol measurement will not be a strict requirement for future study inclusion. Here, we report on the creation of the STRESS-NL database and infrastructure to illustrate the potential of accumulating and combining existing data to allow meta-analytical, proof-of-principle analyses. The STRESS-NL database creates a framework that enables human stress research to take new avenues in explorative and hypothesis-driven data analyses with high statistical power. Future steps could be to incorporate new studies beyond the borders of the Netherlands; or build similar databases for experimental stress studies in rodents. In our view, there are major scientific benefits in initiating and maintaining such international efforts. 9 p.

Treatment for Dissociative Identity Disorder (DID) often follows a practice-based psychodynamic psychotherapy approach that is conducted in three phases: symptom stabilization, trauma processing, and identity integration and rehabilitation. The percentage of patients that reach the third phase is relatively low, treatment duration is long, and the effects of this treatment on the core DID symptoms have been found to be small or absent, leaving room for improvement in the treatment of DID. Schema Therapy (ST) is an integrative psychotherapy that has been proposed as a treatment for DID. This approach is currently being investigated in several studies and has the potential to become an evidence-based treatment for DID. This case report presents an overview of the protocol adaptations for DID ST treatment. The presented case concerns a 43-year-old female patient with DID, depressive disorder (recurrent type), PTSD, cannabis use disorder, and BPD. Functioning was very low. She received 220 sessions of ST, which included direct trauma processing through Imagery Rescripting (ImRs). The patient improved in several domains: she experienced a reduction of PTSD symptoms, as well as dissociative symptoms, there were structural changes in the beliefs about the self, and loss of suicidal behaviors. After treatment she was able to stop her punitive mode, to express her feelings and needs to others, and to participate adequately in social interaction. This case report indicates that ST might be a viable treatment for DID, adding to a broader scope of treatment options for this patient group.

This experimental study examined the role of negative feedback and social rank in the experience of self-conscious emotions, shame and guilt, in typically developing children aged 8 to 13 years. Participants were tested by means of a vignette paradigm in which feedback and social rank were systematically manipulated and levels of shame and guilt were assessed after listening to each of the vignettes. In addition, children completed a set of questionnaires for measuring individual differences in shame and guilt proneness, social comparison, submissive behavior, and external shame. The results showed that children presented with negative feedback reported higher ratings of shame and guilt than when presented with positive feedback, implying that the provision of negative feedback has a significant impact on children’s experience of self-conscious emotions. Social rank had less effect on children’s report of these self-conscious emotions. Furthermore, the individual difference variables of guilt proneness, and to a lesser extent shame proneness and submissive behavior, appeared to be positively related to self-conscious emotions as reported during the vignette task.

The current experiment investigated whether counter-attitudinal information can alter a pre-existing attitude and the accompanying confirmation bias. Sixty-three non-clinical children (9–12 years) were shown pictures of a positive animal (quokka) or a dangerous-looking animal (aye aye). For both animals attitudes and information seeking patterns were obtained. Next, they received counter-attitudinal information of each animal; attitudes and seeking patterns were reassessed. We found that the aye aye was perceived as more dangerous and less kind compared to the quokka. A negative confirmation bias was observed for the aye aye, more negative than positive or neutral information was requested. For the quokka this pattern was absent, more positive and negative than neutral information was selected. The counter-attitudinal information decreased the scariness of the aye aye, but did marginally alter that of the quokka. Additionally, for the aye aye counter-attitudinal information increased search for positive and neutral information and decreased search for negative information. For the quokka the counter-attitudinal information only increased search for neutral information. The animals no longer differed from each other and no clear confirmation bias patterns were present. These results indicate that it is possible to change pre-existing values and their accompanying information search patterns.

Contains fulltext : 284955.pdf (Publisher’s version ) (Open Access) Background and objectives: Imagery rescripting (ImRs) is a promising therapeutic technique used in treatment for a variety of psychiatric disorders. During an ImRs session, an aversive disorder-related memory, is activated in imagination and rescripted to a more positive outcome. It has been shown to successfully weaken the negative cognitive meaning, so-called encapsulated beliefs of the targeted aversive memory. In many studies, ImRs is preceded by a cognitive restructuring (CR) technique focused on the encapsulated belief of the target memory. It is not clear whether adding such a CR technique is necessary or that ImRs as standalone technique can achieve comparable effects. Methods: Students with mild psychological distress (N = 53) were randomized over one session of cognitive restructuring plus imagery rescripting (CR + ImRs), a therapist attention placebo plus imagery rescripting (PLA + ImRs) and a double therapist attention placebo (PLA + PLA). Believability of the idiosyncratic encapsulated belief (primary outcome) and quality (vividness, distress and emotional connotation: secondary outcome) of the target memory were assessed at pre, post and at 1-week follow-up. Results: Results indicate that both, CR + ImRs and PLA + ImRs, reduced the believability of the encapsulated beliefs in greater extent than PLA + PLA. No differences appeared between the two ImRs conditions. For the secondary outcomes no differences between the three conditions were found. Limitations This study should be seen as a pilot study, moreover a non-clinical sample was used. Conclusion: Findings suggest that a CR technique preceding ImRs is redundant. However, this study needs replication in a larger sample. 7 p.

The purpose of this study was to study psychopathological and temperamental correlates of selective mutism (SM) (symptoms) in a mixed sample of non-clinical (n = 127) and clinically referred (n = 42, of whom 25 displayed the selective non-speaking behavior that is prototypical for SM) 6- to 12-year-old children. Parents completed questionnaires to measure their child’s symptom levels of selective mutism, social anxiety, autism spectrum disorder, and the temperament trait of behavioral inhibition. The results first and foremost showed that SM symptoms were clearly linked to social anxiety and an anxiety-prone temperament (behavioral inhibition), but findings also suggested that autism spectrum problems are involved in the selective non-speaking behavior of children. While the latter result should be interpreted with caution given the methodological shortcomings of this study, findings align well with the notion that SM is a heterogeneous psychiatric condition and that clinical assessment and treatment need to take this diversity into account.

Background The treatment of anxiety and depressive symptoms following acquired brain injury is complex and more evidence-based treatment options are needed. We are currently evaluating the BrainACT intervention; acceptance and commitment therapy for people with acquired brain injury. Rationale This paper describes the theoretical underpinning, the development and content of BrainACT. Acceptance and commitment therapy focuses on the acceptance of feelings, thoughts and bodily sensations and on living a valued life, without fighting against what is lost. Since the thoughts that people with acquired brain injury can experience are often realistic or appropriate given their situation, this may be a suitable approach. Theory into practice Existing evidence-based protocols were adapted for the needs and potential cognitive deficits after brain injury. General alterations are the use of visual materials, summaries and repetition. Acceptance and commitment therapy-specific adaptions include the Bus of Life metaphor as a recurrent exercise, shorter mindfulness exercises, simplified explanations, a focus on experiential exercises and the monitoring of committed actions. The intervention consists of eight one-hour sessions with a psychologist, experienced in acceptance and commitment therapy and in working with people with acquired brain injury. The order of the sessions, metaphors and exercises can be tailored to the needs of the patients. Discussion Currently, the effectiveness and feasibility of the intervention is evaluated in a randomised controlled trial. The BrainACT intervention is expected to be a feasible and effective intervention for people with anxiety or depressive symptoms following acquired brain injury.

Plain Language Summary Negative leadership-also named "destructive" leadership-has very bad effects on followers and organizations. There are not just one, but many forms of destructive leadership and it is important to understand where different sub-types come from (i.e., to understand their antecedents) and which specific effect they have (i.e., to understand their consequences). In this paper, we focus on better understanding two forms of destructive leadership, namely abusive supervision and exploitative leadership. These two forms are similar to the two main forms of aggression. Abusive supervision is similar to reactive aggression, an impulsive "hot blooded" form of aggression. Exploitative leadership is similar to proactive aggression, a premeditated "cold blooded" form of aggression. We explain the parallels between the two forms of aggression and the two forms of leadership and provide a model which allows to predict when one versus the other form of leadership occurs and to which follower behavior they lead. An important factor in this model is the physiological characteristic of the emotional reaction to an event (i.e., arousal). An emotional reaction can be high in arousal; for instance, anger is a high arousal negative emotional reaction. On the contrary, boredom, for instance, is a low arousal negative emotional reaction. Dependent on whether both a leader and a follower react to a negative event (e.g., not getting what they want, being treated badly by others) with high or low arousal, their behavior will be different. We explain how this mechanism works and how it can help us to better predict leaders' and followers' behavior. We also outline how individual characteristics of the leader and follower and characteristics of their environment and context interact with arousal and their behavior.Due to its devastating consequences, research needs to theoretically and empirically disentangle different sub-types of destructive leadership. Based on concepts derived from aggression research distinguishing re- and proactive aggression, we provide a process model differentiating abusive supervision and exploitative leadership. High versus low arousal negative affect is installed as the central mediating factor determining (1) whether perceived goal-blockage (leadership antecedents) leads to abusive supervision versus exploitative leadership and (2) whether a specific leadership behavior leads to active versus passive follower behavior (leadership consequence). Further, theoretical anchoring of individual and contextual moderators onto the model's process paths is provided and exemplary hypotheses for concrete moderation effects are deduced. Based on the provided process model, we highlight four recommendations to facilitate process-based construct differentiation in future research on destructive leadership. To precisely understand the differences and commonalities in different forms of destructive leadership will ultimately enable custom-tailored inter- and prevention. Plain Language Summary Negative leadership-also named "destructive" leadership-has very bad effects on followers and organizations. There are not just one, but many forms of destructive leadership and it is important to understand where different sub-types come from (i.e., to understand their antecedents) and which specific effect they have (i.e., to understand their consequences). In this paper, we focus on better understanding two forms of destructive leadership, namely abusive supervision and exploitative leadership. These two forms are similar to the two main forms of aggression. Abusive supervision is similar to reactive aggression, an impulsive "hot blooded" form of aggression. Exploitative leadership is similar to proactive aggression, a premeditated "cold blooded" form of aggression. We explain the parallels between the two forms of aggression and the two forms of leadership and provide a model which allows to predict when one versus the other form of leadership occurs and to which follower behavior they lead. An important factor in this model is the physiological characteristic of the emotional reaction to an event (i.e., arousal). An emotional reaction can be high in arousal; for instance, anger is a high arousal negative emotional reaction. On the contrary, boredom, for instance, is a low arousal negative emotional reaction. Dependent on whether both a leader and a follower react to a negative event (e.g., not getting what they want, being treated badly by others) with high or low arousal, their behavior will be different. We explain how this mechanism works and how it can help us to better predict leaders' and followers' behavior. We also outline how individual characteristics of the leader and follower and characteristics of their environment and context interact with arousal and their behavior.

Although it is widely accepted that human beings have an ingrained ‘need to belong,’ there seem to be a substantial subset of young people who seclude themselves for most of the time at home and no longer engage in education or work, ultimately withdrawing from participation in society. In Japan, this phenomenon has been labeled as ‘hikikomori,’ but given its global presence it may be preferable to use the term ‘extreme social withdrawal’ (ESW). In this qualitative review, we provide a description and definition of ESW, provide figures on its prevalence, and discuss a number of associated concepts, including loneliness and “aloneliness,” school absenteeism and dropout, the ‘new’ developmental stage of adultolescence, and the labor force categories of freeter (‘freelance arbeiter’) and NEET (a young person not in employment, education, or training). The core of the paper is focused on the origins of ESW in young people and provides a narrative overview of relevant etiological factors, such as aberrant brain processes, unfavorable temperament, psychiatric conditions, adverse family processes including detrimental parenting, negative peer experiences, societal pressures, and excessive internet and digital media use, which are all placed within a comprehensive developmental psychopathology framework. We will close with a discussion of possible interventions for young people with ESW and formulate a guideline that describes (the temporal order of) various components that need to be included in such a treatment.

Contains fulltext : 291492.pdf (Publisher’s version ) (Open Access) Objective Binge-eating disorder (BED) and bulimia nervosa (BN) are characterised by binge eating. Changing unwanted behaviour is difficult, as intentions do not automatically lead to action. Implementation intentions (IIs) may help bridging the gap between intentions and behaviour. IIs are ‘if-then’ plans promoting goal attainment. Effects are moderated by degree of plan formation. Using mental imagery (MI) to impress IIs may strengthen plan formation and goal attainment. Method In a students' sample with subjective binge eating, we compared IIs without MI, IIs with MI, and a control condition regarding their ability to reduce binge eating. Participants received three II-sessions and kept food diaries for 4 weeks. Results Results showed a significant and medium to large reduction of binge eating in both II-conditions compared to the control condition, that was sustained for 6 months. No additional effects of MI were found. Conclusions Applying IIs results in long-lasting reductions in subjective binge eating. The absence of additional effects of MI may be due to floor effects. Also, participants in the IIs without MI condition may have applied MI without being instructed to do so. In future research, ideally with a clinical sample, it is recommended to prevent or control for this. 29 maart 2023 8 p.

This dissertation examined the role of mental imagery, or nonverbal thinking, on mood instability in patients with bipolar vulnerability, a mental illness with limited treatment options and high suffering. At the center was Emily Holmes' cognitive model that suggests that mood instability in patients with bipolar vulnerability is associated with mental imagery and anxiety. Several studies in this dissertation examined mental imagery. One questionnaire study compared aspects of mental imagery in different groups. The association between mental imagery, anxiety and mania and depression was examined in a network study. In addition, a newly developed variant of cognitive behavioral therapy with a focus on mental imagery (ImCT) was compared with psychoeducation. Finally, a case study was described in which ImCT was used to treat manic symptoms. ImCT proved to be an effective treatment. Altogether, these findings support a new conceptualization of bipolar vulnerability in which mood instability is associated with mental imagery and anxiety. This appears to allow for more effective psychological treatment options.

Contains fulltext : 287529.pdf (Publisher’s version ) (Open Access) Different views exist regarding the nature of patients' dependency in psychotherapy (trait versus contextual dependency), and its impact on treatment outcome and duration. Therefore we examined whether patients' levels of care dependency changed over time during a 9-month treatment period, and whether care dependency was related to symptom reduction and patients' wish for treatment continuation at the end of the treatment. Participants in this longitudinal study were 113 patients (Mage = 33.6, 78% female) with personality disorders receiving inpatient or daycare group psychotherapy. Both increases and decreases on different aspects of care dependency were found over the course of treatment. Decreases in dependency were related to larger symptom reduction, and higher levels of care dependency, especially patients' lack of perceived alternative options for the current treatment, were related to patients' stronger wish to continue their treatment. Changes in care dependency during treatment mainly supports the contextual view on patients' care dependency, and decreasing levels of dependency may have beneficial treatment effects. However, dependency may also lead to prolonged treatment duration. Clinical implications for therapists are presented. 11 p.

Objectives Mindfulness-Based Cognitive Therapy for Depression (MBCT-D) has been shown to be effective at repairing positive affect deficits in depressed individuals, but the mechanism of action underpinning these changes has not been empirically examined. To address this issue, secondary analyses of two randomised controlled trials in individuals with residual depression were conducted. Method Study 1 was a cross-sectional mediation analysis of a trial reporting superior effects of MBCT-D to a waitlist control in bolstering momentary positive affect in individuals with residual depression symptoms (n = 130). Study 2 replicated this analysis in the subset of individuals with residual depression symptoms (n = 117) from a second, larger trial comparing MBCT-D to maintenance antidepressants (M-ADM) to prevent depressive relapse that also included a positive affect outcome. Results In Study 1, an increase in external sensory observing uniquely mediated the superiority of MBCT-D over the control in repairing momentary positive affect. Replicating these findings, in Study 2, MBCT-D was superior to M-ADM at repairing positive affect and this was cross-sectionally mediated by changes in external sensory observing. Conclusions These findings suggest that one way in which MBCT-D enhances positive affect in individuals with residual depression may be by training the capacity to attend to external sensory experience.

Patients with acquired brain injury (ABI) often experience symptoms of anxiety and depression. Until now, evidence-based treatment is scarce. This study aimed to investigate the effectiveness of Acceptance and Commitment Therapy (ACT) for patients with ABI. To evaluate the effect of ACT for people with ABI, a non-concurrent multiple baseline design across four cases was used. Participants were randomly assigned to a baseline period, followed by treatment and then follow-up phases. Anxiety and depressive symptoms were repeatedly measured. During six measurement moments over a year, participants filled in questionnaires measuring anxiety, depression, stress, participation, quality of life, and ACT-related processes. Randomization tests and NAP scores were used to calculate the level of change across phases. Clinically significant change was defined with the Reliable Change Index. Three out of four participants showed medium to large decreases in anxiety and depressive symptoms (NAP = 0.85 till 0.99). Furthermore, participants showed improvements regarding stress, cognitive fusion, and quality of life. There were no improvements regarding psychological flexibility, value-driven behaviour, or social participation. This study shows that ACT is possibly an effective treatment option for people experiencing ABI-related anxiety and depression symptoms. Replication with single case or large scale group studies is needed to confirm these findings.

Aim: The aim of the study was to examine the psychometric properties of the Czech version of the Surgical Fear Questionnaire. Design: A cross-sectional study design. STROBE guidelines for reporting observational studies were followed for the study. Methods: The study sample consisted of 332 adult patients from the Czech Republic. The Surgical Fear Questionnaire (SFQ) was used to measure preoperative fear. Cronbach's alpha was calculated to test reliability. The construct validity of the SFQ was tested using exploratory factor analysis. Results: Reliability of the instrument as a whole was confirmed by the high value of the Cronbach alpha coefficient (0.813). Two factors were identified for the Czech version of the SFQ in factor analysis. Conclusion: The Czech version of the Surgical Fear Questionnaire showed good validity and reliability and can be used in research and clinical practice. Further analysis of psychometric properties is needed to confirm these results.

Item does not contain fulltext Background: Long-term untreated major depressive disorder (MDD) is associated with a less favorable clinical course. Waiting time, defined as the interval between diagnostic workup and treatment initiation, may be clinically relevant given the prolongation of the pre-existing duration of untreated MDD. However, it is currently unknown whether and to what extent waiting time affects treatment course in routine outpatient care. Methods: Retrospectively extracted data from 715 outpatients with MDD who received naturalistic outpatient MDD treatment were examined. Treatment outcome was defined as the difference in depression severity at the start of treatment and six months thereafter. Clinical course during waiting time was defined by the difference in severity at diagnostic workup and at treatment initiation. We analyzed the association between waiting time and treatment outcome and between waiting time and clinical course during this waiting time using multivariable regression analyses. We adjusted for severity and suicidality as potential confounders. Results: An increased duration of the waiting time was associated with a less favorable treatment outcome (B = 0.049, SE = 0.019, p = 0.01). This association persisted after adjustment for potential confounders (B = 0.053, SE = 0.02, p = 0.01). No association was found between length of waiting time and clinical course during waiting time. Limitations Strict definitions resulted in smaller sample sizes for the final analyses. The uncontrolled design may be questionable to definitively establish the impact of waiting time on treatment outcome. Conclusions: A prolonged waiting time is significantly associated with less favorable treatment outcome. Reduction of waiting time deserves priority in depression treatment planning to improve clinical outcomes. 7 p.

OBJECTIVE: The Personalized Advantage Index (PAI) is a method to guide treatment selection by investigating which of two or more treatments is optimal for a given individual. Recently, it was shown that, on average, twice-weekly sessions of psychotherapy for depression lead to better outcomes compared to once-weekly sessions. The present study applied the PAI method to assess if subgroups of patients may have a differential response to psychotherapy frequency.METHOD: Data came from a clinical trial (n = 200) randomizing depressed patients into different session frequencies: weekly sessions versus twice-weekly sessions. Machine-learning techniques were used to select pretreatment variables and develop a multivariable prediction model that calculated each patient's PAI. Differences in observed depression post-treatment scores (Beck Depression Inventory-II [BDI-II]) were tested between patients that received their PAI-indicated versus non-indicated session frequency. Between-group effect sizes (Cohen's d) were reported.RESULTS: We identified prognostic indicators generally associated with lower post-treatment BDI-II regardless of treatment assignment. In addition, we identified specific demographic and psychometric features associated with differential response to weekly- versus twice-weekly therapy sessions. Observed post-treatment BDI-II scores were significantly different between individuals receiving the PAI-indicated versus non-indicated session frequency (d = .37).CONCLUSIONS: Although a higher session frequency is more effective on average, different session frequencies seem beneficial for different patients. Future studies should externally validate these findings before they can be generalized to other settings. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

More instability (MSSD) and variability (SD) of negative affect (NA) have been related to current and future depressive symptoms. We investigated whether NA instability and variability were predictive of the rate of symptom improvement during treatment and of reaching remission status. Forty-six individuals with major depressive disorder completed six days of ecological momentary assessments (10 beeps/day) before starting a combination of pharmacotherapy and supportive therapy. During and after treatment, the Hamilton Depression Rating Scale (HDRS) diagnostic interview was performed monthly for 18 months. The rate of change in HDRS scores over five months (during treatment) and remission status (HDRS ≤ 7) over eighteen months were predicted by the SD, MSSD and Mean of NA, and relevant baseline predictors. Higher Mean NA and baseline symptom severity, but not NA variability or instability, predicted stronger depressive symptom reduction during treatment. Higher odds of remitting were only associated with lower Mean NA. Higher mean NA may indicate more room for improvement and thus for a steeper rate of symptom change, while lower mean NA levels may imply that remission status is more readily reached. To resolve the inconclusive findings for instability and variability as predictors of symptom improvement replication in larger samples is required.

Background A central construct in Schema Therapy (ST) is that of a schema mode, describing the current emotional-cognitive-behavioral state. Initially, 10 modes were described. Over time, with the world-wide increasing and broader application of ST to various disorders, additional schema modes were identified, mainly based on clinical impressions. Thus, the need for a new, theoretically based, cross-cultural taxonomy of modes emerged. Methods An international workgroup started from scratch to identify an extensive taxonomy of modes, based on (a) extending the theory underlying ST with new insights on needs, and (b) recent research on ST theory supporting that modes represent combinations of activated schemas and coping. Results We propose to add two emotional needs to the original five core needs that theoretically underpin the development of early maladaptive schemas (EMSs), i.e., the need for Self-Coherence, and the need for Fairness, leading to three new EMSs, i.e. Lack of a Coherent Identity, Lack of a Meaningful World, and Unfairness. When rethinking the purpose behind the different ways of coping with EMS-activation, we came up with new labels for two of those: Resignation instead of Surrender, and Inversion instead of Overcompensation. By systematically combining EMSs and ways of coping we derived a set of schema modes that can be empirically tested. Conclusions With this project, we hope to contribute to the further development of ST and its application across the world.

Children who are involved in legal cases are often interviewed about events they witnessed or that might have happened to them. Occasionally, after such interviews, children are confronted with misinformation regarding their experiences. The question that arises is whether their earlier interviews may protect them from reporting misinformation. The goal of the present experiment was to assess whether empirically based interviewing by means of the National Institute for Child Health and Development (NICHD) Protocol would affect the reporting of misinformation in children. Children were involved in an interactive event (i.e., science demonstration). Following this, three experimental groups were created: one group was interviewed using the NICHD Protocol, one group had to freely recall what they experienced, and one group was not asked to retrieve any memories about the event. Next, all children received misinformation concerning the event and were then subjected to a final memory test. We found that children’s recall during the NICHD interview protected children against the incorporation of misinformation in their accounts of the event. This effect was absent in the other two conditions. The current experiment suggests that evidence-based investigative interviewing can inoculate children’s memory against the corrupting impact of misinformation.

The down-regulation of maladaptive emotions during psychotherapy is frequently assessed via self-report, but the additional assessment of physiological arousal may provide unique insights. Maladaptive anger, as experienced by hostile individuals, can have debilitating intra- and interpersonal consequences. In a recent randomized controlled trial (RCT), it was shown that enhancing cognitive restructuring (CR) with mental imagery increases its efficacy in reducing maladaptive anger-triggering hostile beliefs, but not self-reported anger. The present secondary data analysis examines physiological data collected during the RCT to investigate whether imagery-enhanced cognitive restructuring (I-CR) facilitated the down-regulation of maladaptive anger-related arousal. A sample high in trait hostility (N = 87, 72% female, 28% male) was randomized over one session of I-CR (n = 34), traditional CR (n = 32), or an active control group (AC, n = 21). Blood pressure and heart rate were assessed pre- and postintervention, and pre- and poststressor one week after the intervention. The results showed that I-CR reduced postintervention systolic blood pressure to a larger degree than CR and AC. Diastolic blood pressure was reduced more strongly by I-CR compared to AC, but not to CR. No between-group differences in postintervention heart rate were found, nor in response to the stressor for all three measures. Limitations of this study include that the sample was rather small, non-treatment seeking, and mostly female. In conclusion, physiological down-regulation emerged immediately postintervention and was distinctive for I-CR and systolic blood pressure. Adding mental imagery to CR thus facilitates the down-regulation of maladaptive anger-related arousal.

The present study investigated the relative contributions of the Dark Triad, honesty-humility, and other HEXACO traits to externalizing problems in young people. One-hundred-and-six adolescents aged between 12 and 18 years completed an online survey containing the Dirty Dozen for Youth as an index of the Dark Triad traits of psychopathy, Machiavellianism, and narcissism, the HEXACO-Middle School Inventory to assess honesty-humility as well as five other basic personality factors, and the Youth Self-Report to measure symptoms of oppositional-defiant disorder (ODD) and conduct disorder (CD). Results first of all showed that the Dark Triad traits were positively correlated with symptoms of ODD and CD, while the HEXACO factor of honesty-humility was negatively correlated with such symptoms. Further, both types of externalizing problems were associated with a unique set of personality correlates. More precisely, ODD symptoms were predicted by higher psychopathy and lower agreeableness and extraversion, while CD symptoms were predicted by higher psychopathy (and to some extent Machiavellianism) and lower honesty-humility, extraversion, and emotionality. It is concluded that the study of the role of temperament and personality in externalizing problems should take a broad perspective that includes malevolent and benevolent traits from various theoretical models.

BACKGROUND AND PURPOSE: Self-compassion is considered as a protective psychological construct that would shield against the development of emotional problems. The aim of the present study was to compare the 'protective nature' of two measures of self-compassion: the Self-Compassion Scale for Youth (SCS-Y) and the Sussex-Oxford Compassion for the Self Scale (SOCS-S).METHODS: Eighty-seven adolescents aged 12 to 18 years completed both self-compassion measures as well as scales of anxiety and depression symptoms.RESULTS: SCS-Y and SOCS-S scores were positively correlated, and for both measures it was generally found that higher levels of self-compassion were associated with lower levels of emotional symptoms. However, the uncompassionate self-responding scales of the SCS-Y correlated positively with anxiety and depression symptoms and hence can better be seen as indices of vulnerability. Regression analyses suggested that a positive attitude toward oneself, as measured by the self-kindness scale of the SCS or its SOCS-S equivalent 'feeling for the person suffering' is particularly relevant as a buffer against emotional problems.CONCLUSION: The protective nature of self-compassion can be established by both measures. Caution is advised with the use of the uncompassionate self-responding scales included in the SCS-Y as they appear to measure vulnerability rather than protection.

OBJECTIVE: Psychotherapies for depression are similarly effective, but the processes through which these therapies work have not been identified. We focus on psychological process changes during therapy as predictors of long-term depression outcome in treatment responders.METHOD: Secondary analysis of a randomized trial comparing cognitive therapy (CT) and interpersonal psychotherapy (IPT) that focuses on 85 treatment responders. Using mixed-effects models, changes during therapy (0-7 months) on nine process variables were associated with depression severity (BDI-II) at follow-up (7-24 months).RESULTS: A decrease in dysfunctional attitudes was associated with a decrease in depression scores over time. Improved self-esteem was associated with less depression at follow-up (borderline significant). More improvement in both work and social functioning and interpersonal problems was associated with better depression outcomes in IPT relative to CT, while less improvement in work and social functioning and interpersonal problems was associated with better outcomes in CT relative to IPT.CONCLUSIONS: Less negative thinking during therapy is associated with lower depression severity in time, while changes during therapy in work and social functioning and interpersonal problems appear to predict different long-term outcomes in CT vs. IPT. If replicated, these findings can be used to guide clinical decision-making during psychotherapy.

Psychopathic traits come with high levels of anger and aggression. Since previous studies showed that compassion can mitigate both anger and aggression, the current research puts compassion forward as a possible target to alleviate psychopathy’s destructive patterns. Specifically, the present study explored the influence of subclinical psychopathic traits–as well as their three subcomponents egocentricity, callousness, and antisociality–on the efficacy of experimentally induced self-compassion (SC) and other-compassion (OC). This manuscript is part of a larger study in which student and community participants (N = 230, Mage = 27.41, 65.2% female) completed a psychopathic trait questionnaire to assess their dimensional level of psychopathy, filled out state SC and OC questionnaires, and were randomized to participate in an experimental self- or other-compassion induction. It was expected that psychopathic traits would positively relate to increases in SC but negatively relate to increases in OC. Baseline levels of both SC and OC negatively related to psychopathy. Overall, as expected, the results on change scores show that subclinical psychopathic traits positively related to a stronger increase in SC, irrespective of the type of compassion induction. This positive relation between a stronger increase in SC and psychopathy total and callousness was more pronounced after the SC induction, rather than after the OC induction. Psychopathic traits did not differentially influence changes in OC. One implication of this study is that high psychopathic and callousness traits predispose to profit extra from targeting SC. Furthermore, psychopathic traits do not hinder increasing compassion for others. These findings suggest that compassion is a promising intervention to improve the wellbeing of people with elevated subclinical psychopathic traits and those around them. Although further research is needed to assess the impact of compassion on anger and aggression specifically, and on clinical psychopathy, the current study suggests that both SC and OC may be useful intervention targets in case of elevated psychopathic traits.

Grandiose narcissistic traits refer to exploitative and arrogant attitudes, while vulnerable narcissistic traits entail hypersensitivity to judgment and low self-esteem. Little is known about how individuals with narcissistic traits can improve their attitudes toward themselves and others. The current research puts self- and other compassion forward as possible targets to alleviate some of destructive patterns of narcissism. Generally, self-compassion (SC) has previously been associated with beneficial effects on psychological wellbeing, while other compassion (OC) is advantageous for interpersonal relationships. This study explored the relationship between narcissistic traits and the efficacy of experimental compassion inductions. Student and community participants (N = 230, Mage = 27.41, 65.2% female) completed grandiose and vulnerable narcissistic trait, SC and OC state questionnaires, and either an SC or OC induction. It was expected that individuals with higher narcissistic traits (particularly grandiose traits) would benefit from the inductions and show higher SC after but would have greater difficulty showing meaningful increases in OC (especially OC directed at the general population). The results indicated that individual differences in grandiose and vulnerable narcissistic traits are related to the magnitude of improvements following the inductions: the theorized lack of SC in individuals with vulnerable oversensitivity to judgment traits seems possible to be counteracted through different types of compassion exercises. Moreover, higher grandiose exploitativeness–entitlement and global vulnerable narcissistic traits related to less increases than others. However, directly inducing OC in individuals with these traits was linked to greater OC improvements than improvements after inducing SC. Overall, the present findings suggest that self-compassionate behavior can be improved in individuals with high oversensitivity and that other compassionate behavior could potentially be increased if, specifically, other compassion exercises are utilized when higher levels of certain narcissistic traits are present.

Background Clinical guidelines suggest that psychological interventions specifically aimed at reducing suicidality may be beneficial. We examined the impact of two depression treatments, cognitive therapy (CT) and interpersonal psychotherapy (IPT) on suicidal ideation (SI) and explored the temporal associations between depression and SI over the course of therapy.Methods Ninety-one adult (18-65) depressed outpatients from a large randomized controlled trial who were treated with CT (n = 37) and IPT (n = 54) and scored at least >= 1 on the Beck Depression Inventory II (BDI-II) suicide item were included. Linear (two-level) mixed effects models were used to evaluate the impact of depression treatments on SI. Mixed-effects time-lagged models were applied to examine temporal relations between the change in depressive symptoms and the change in SI.Results SI decreased significantly during treatment and there were no differential effects between the two intervention groups (B = -0.007, p = .35). Depressive symptoms at the previous session did not predict higher levels of SI at the current session (B = 0.016, p = .16). However, SI measured at the previous session significantly predicted depressive symptoms at the current session (B = 2.06, p < .001).Conclusions Both depression treatments seemed to have a direct association with SI. The temporal association between SI and depression was unidirectional with SI predicting future depressive symptoms during treatment. Our findings suggest that it may be most beneficial to treat SI first.

Early adaptive schemas (EAS) are resilience-oriented counterparts to early maladaptive schemas (EMS), which are central in schema therapy. The Young Positive Schema Questionnaire (YPSQ) was developed as a measure of EAS but has been evaluated neither in relation to a clinical population nor in a German-speaking sample. Objectives of this study were therefore the psychometric validation of a German YPSQ in a community sample and the comparison of EAS to psychiatric patients. Participants were 1,418 individuals from a community sample and 182 psychiatric patients with a main diagnosis of major depressive disorder. A factor structure of 10 EAS, instead of the original 14, demonstrated satisfactory factorial validity and internal consistency in both samples. EAS exhibited divergent validity to EMS, childhood trauma, and psychopathology. Convergent validity was evident with resilience, self-efficacy, and satisfaction with life. Support for incremental validity beyond EMS was especially shown for resilience, self-efficacy, and satisfaction with life, and was also evident for several dimensions of psychopathology. Individuals in the community sample exhibited more pronounced EAS compared to psychiatric patients with the exception of empathic consideration. Especially for concepts associated with mental health, the YPSQ has the potential to be a highly valuable addition to current research and practice.

Inflammatory bowel disease (IBD) is a chronic health condition exacerbated by negative emotional stress experiences. In the current study, we examined whether the outbreak of the COVID‐19 pandemic coincided with an increase in stress experiences and accordingly an aggravation of disease activity in IBD patients. Sixty‐three IBD patients (30 Crohn's disease or CD, 33 ulcerative colitis) completed an online survey during the COVID‐19‐related lockdown, assessing clinical disease activity, disease‐related quality of life, presence of functional gastrointestinal symptoms, social isolation and stress experiences. Scores were then compared to pre‐lockdown baseline screening. The pandemic yielded a significant baseline‐to‐lockdown increase in emotional stress and social isolation. Stress increments, particularly those occasioned by interpersonal tension and excessive interpersonal proximity, were associated with a worsening of functional gastrointestinal symptoms. Exacerbations of loneliness coincided with an escalation of CD activity, functional gastrointestinal symptoms and a decline in subjective health. Lastly, COVID‐19 anxiety was significantly related to CD symptom severity and social dysfunction. The findings show that shifts in IBD expression are closely linked to changes in emotional stress experiences and interpersonal relatedness. As such, they contribute to a better understanding of inter‐individual differences in IBD progression and provide leads for therapeutic interventions.

Objectives During all stages of oncologic diseases, pain is still a major problem. The Numeric Rating Scale (NRS) is one of the most frequently used tools for pain assessment, although interpretation is difficult. The main objective of this study is to compare two types of pain evaluation scales: NRS versus (non) acceptable pain evaluation scale. The secondary aim is to analyze a 10% sample of patients indicating non acceptable pain more in-depth. Methods To assess the pain evaluation scales, a prospective observational study, with a nested retrospective in-depth exploration, was conducted. One-year data of patients visiting the outpatient clinic of the oncology center of a university hospital were used. Besides the pain scores of all patients, a 10% sample of patients indicating non acceptable pain was analyzed more in-depth. Results During 1 year, a total of 37,580 patients registered at the outpatient clinic, of whom approximately 10% indicated non acceptable pain. The mean NRS of patients indicating non acceptable pain was 6.5 (n = 2153). For patients indicating acceptable pain, the mean NRS was 1.6 (n = 21,010). Although the presence of pain recorded in the patient record increased substantially over the year, the percentage of reported interventions only slightly increased. Conclusion The (non) acceptable pain evaluation seems a valuable addition to the NRS for assessing pain among patients with cancer. As interpretation of the NRS appears to be difficult, using the (non) acceptable pain evaluation is recommended. Moreover, creating awareness among specialists to discuss pain has a positive effect on the amount of pain discussed during consultation.

Background Surviving breast cancer does not necessarily mean complete recovery to a premorbid state of health. Among the multiple psychological and somatic symptoms that reduce the quality of life of breast cancer survivors, persistent pain after breast cancer treatment (PPBCT) with a prevalence of 15–65% is probably the most invalidating. Once chronic, PPBCT is difficult to treat and requires an individualized multidisciplinary approach. In the past decades, several somatic and psychological risk factors for PPBCT have been identified. Studies aiming to prevent PPBCT by reducing perioperative pain intensity have not yet shown a significant reduction of PPBCT prevalence. Only few studies have been performed to modify psychological distress around breast cancer surgery. The AMAZONE study aims to investigate the effect of online cognitive behavioral therapy (e-CBT) on the prevalence of PPBCT. Methods The AMAZONE study is a multicenter randomized controlled trial, with an additional control arm. Patients (n=138) scheduled for unilateral breast cancer surgery scoring high for surgical or cancer-related fears, general anxiety or pain catastrophizing are randomized to receive either five sessions of e-CBT or online education consisting of information about surgery and a healthy lifestyle (EDU). The first session is scheduled before surgery. In addition to the online sessions, patients have three online appointments with a psychotherapist. Patients with low anxiety or catastrophizing scores (n=322) receive treatment as usual (TAU, additional control arm). Primary endpoint is PPBCT prevalence 6 months after surgery. Secondary endpoints are PPBCT intensity, the intensity of acute postoperative pain during the first week after surgery, cessation of postoperative opioid use, PPBCT prevalence at 12 months, pain interference, the sensitivity of the nociceptive and non-nociceptive somatosensory system as measured by quantitative sensory testing (QST), the efficiency of endogenous pain modulation assessed by conditioned pain modulation (CPM) and quality of life, anxiety, depression, catastrophizing, and fear of recurrence until 12 months post-surgery. Discussion With perioperative e-CBT targeting preoperative anxiety and pain catastrophizing, we expect to reduce the prevalence and intensity of PPBCT. By means of QST and CPM, we aim to unravel underlying pathophysiological mechanisms. The online application facilitates accessibility and feasibility in a for breast cancer patients emotionally and physically burdened time period. Trial registration NTR NL9132, registered December 16 2020.

Although psychopathy is commonly considered exclusively maladaptive, there is growing literature on the benefits and positive outcomes observed in a subset of individuals displaying high levels of psychopathic traits. The aim of the present study was to explore the relationship between adaptive traits known to correlate with the psychopathic personality and psychopathic traits on measures of well-being. Participants were N = 2209 (84 % females) Canadian university students who completed self-report measures of adaptive traits, psychopathic traits, and well-being. A cluster analysis based on adaptive and psychopathic traits resulted in four groups: individuals above-average on both traits (HT), individuals with under-average psychopathic traits and above-average adaptive traits (AP), individuals with above-average psychopathic traits and under-average adaptive traits (NP), and those under-average on both traits (LT). Our findings suggest that individuals with high levels of adaptive traits display higher levels of well-being (i.e., durable happiness, satisfaction with life, and self-esteem). These high levels of well-being were observed in both HT and AP groups, suggesting that individuals with high levels of psychopathic traits may not display lower well-being, so long as they also possess sufficient levels of adaptive traits. Our results are discussed through the different models of successful psychopathy.

Objectives: The COVID-19 pandemic has had a profound and pervasive impact on psychosocial health and disrupted care systems world-wide. Our research aims to assess the psychosocial impact of the pandemic and related changes in chronic care provision on patients with chronic obstructive pulmonary disease (COPD) and heart failure.Design: A qualitative survey using semi-structured interviews was held among patients with COPD and heart failure.Setting and Participants: Using randomized sampling, 23 patients with COPD, heart failure, or both were recruited to participate in semi-structured interviews. Interviews were held by phone or videocall. The survey was held during the summer of 2021, when strict national containment strategies were widely implemented but gradually loosened and vaccination was ongoing.Methods: Inductive coding using Gioia's approach was used to analyze the data in Atlas.Ti 9.1 software. Using an iterative approach, the data were synthesized in a data structure and data table, which was analyzed using an interpretative approach.Results: We found 3 aggregate dimensions in which the COVID-19 pandemic has a negative impact on psychosocial health of patients with chronic disease: (1) perceived vulnerability to disease, (2) influence of health policy, and (3) a mismatch of supply and demand of health care. In these dimensions, the impact of the COVID-19 crisis was found to have a negative impact on psychosocial well-being, compounded by national strategies to contain the pandemic and a disruption of chronic care for patients.Conclusions and Implications: Health care providers should be aware of a multidimensional nature of psychosocial distress for chronic disease patients due to the COVID-19 crisis. Future practice and health policy could be improved by increasing awareness among health care providers, promote regular attention for psychosocial well-being of patients, provision of clear information related to the pandemic, and strategies to secure continuity of care. Results of this study might be further explored in larger studies.(c) 2023 The Authors. Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/).

BackgroundViolent criminal offenders with personality disorders (PD's) can cause immense harm, but are often deemed untreatable. This study aimed to conduct a randomized clinical trial to test the effectiveness of long-term psychotherapy for rehabilitating offenders with PDs.MethodsWe compared schema therapy (ST), an evidence-based psychotherapy for PDs, to treatment-as-usual (TAU) at eight high-security forensic hospitals in the Netherlands. Patients in both conditions received multiple treatment modalities and differed only in the individual, study-specific therapy they received. One-hundred-three male offenders with antisocial, narcissistic, borderline, or paranoid PDs, or Cluster B PD-not-otherwise-specified, were assigned to 3 years of ST or TAU and assessed every 6 months. Primary outcomes were rehabilitation, involving gradual reintegration into the community, and PD symptoms.ResultsPatients in both conditions showed moderate to large improvements in outcomes. ST was superior to TAU on both primary outcomes – rehabilitation (i.e. attaining supervised and unsupervised leave) and PD symptoms – and six of nine secondary outcomes, with small to moderate advantages over TAU. ST patients moved more rapidly through rehabilitation (supervised leave, treatment*time: F(5308) = 9.40, p < 0.001; unsupervised leave, treatment*time: F(5472) = 3.45, p = 0.004), and showed faster improvements on PD scales (treatment*time: t(1387) = −2.85, p = 0.005).ConclusionsThese findings contradict pessimistic views on the treatability of violent offenders with PDs, and support the effectiveness of long-term psychotherapy for rehabilitating these patients, facilitating their re-entry into the community.

While the Competitive Reaction Time Task (CRTT) is the most used behavioral aggression paradigm, it is characterized by methodological heterogeneity and quantification strategies for its’ outcome are unstandardized. Therefore, the standards of measuring aggression should be improved. This article contributes on such an improvement by providing: (a) a freely available CRTT online administration program, and (b) a factor-analytically derived scoring method. Based on a combined sample ( n = 423), a two-factor model was fit to the 30-trial CRTT version. The first factor included all trial scores subsequent to the first time the participant received aversive feedback (i.e., provoked factor) and the second factor included all trial scores prior to this first aversive feedback (i.e., unprovoked factor). Construct validity was evidenced based on the factors` differential relationship with self-reported aggression and narcissism. Our factor analytic findings empirically support the superiority of one of the existing CRTT scoring methods, that is, separately averaging all preprovocation versus all postprovocation trials. We discuss practical recommendations for CRTT users and outline future empirical avenues. This article aims at stimulating joint efforts to move toward standardization of CRTT implementation and outcome measure analysis.

Objective: Hostility is a transdiagnostic phenomenon that can have a profound negative impact on interpersonal functioning and psychopathological severity. Evidence suggests that cognitive bias modification for interpretation bias (CBM-I) potentially reduces hostility. However, stringent efficacy studies in people with clinical levels of hostility are currently lacking. Method: The present study investigated the effects of CBM-I in two studies: one feasibility study (Study 1) in a mixed clinical-community sample of men (N = 29), and one randomized clinical study (Study 2) in a mixed-gender sample with clinical levels of hostility (N = 135), pre-registered at https://osf.io/r46jn. We expected that CBM-I would relate to a larger increase in benign interpretation bias and larger reductions in hostile interpretation bias, hostility symptoms and traits, and general psychiatric symptoms at post-intervention compared to an active control (AC) condition. We also explored the beneficial carry-over effects of CBM-I on working alliance in subsequent psychotherapy 5 weeks after finishing CBM-I (n = 17). Results: Results showed that CBM-I increased benign interpretation bias in both studies and partially reduced hostile interpretation bias in Study 2, but not in Study 1. Findings of Study 2 also showed greater reductions in behavioral (but not self-reported) aggression in CBM-I relative to control, but no condition differences were found in self-report hostility measures and general psychiatric symptoms. Conclusions: Overall, we found modest support for CBM-I as an intervention for hostility, with some evidence of its efficacy for hostile interpretation bias and aggression. We discuss study limitations as well as directions for future research. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Background: Children within historically disadvantaged non-Western South African communities are considered as particularly vulnerable to the development of anxiety problems. Although the need for accessible mental health interventions is evident, this need has remained unmet in a country with extreme socio-economic disparities and a lack of mental health resources. Cognitive behavioural therapy-based (CBT-based) interventions that employ brief and intensive delivery methods may overcome existing barriers to access to mental health services faced by many South African children and may ameliorate the burden placed on under-resourced mental health care services. Aim: To provide preliminary evidence on the effectiveness of a brief, intensive CBT-based anxiety prevention intervention conducted in a South African context. Method: A mixed-methods approach, with quantitative and qualitative data, was used to evaluate the effects of the CBT-based programme in a sample of 21 farmworkers’ children aged 9–14 years living in disadvantaged semi-rural communities of the Western Cape. A quasi-experimental design with an immediate intervention (experimental) group and a delayed intervention (control) group was applied in the quantitative component of the study. The qualitative component was based on focus group data. Results: In general, positive effects were noted for the CBT-based anxiety prevention programme in these vulnerable children. Quantitative data revealed a trend reflecting a reduction of self-reported anxiety levels. Qualitative support for the acquisition and application of the CBT-based programme skills was also found. Conclusion: This pilot study indicates that a brief, intensive CBT-based prevention programme holds promise for the effective reduction of anxiety in vulnerable South African children.

Children and adolescents with Autism Spectrum Disorder (ASD) show difficulties in social interaction and communication. This thesis explored the desire for social interaction in youth with ASD. The results were mixed. A potential explanation for these mixed results is that the desire for social interaction in ASD might be context-related. Additionally, other variables like social skills and social anxiety might play a role. The desire for social interaction in children and adolescents with ASD deserves more attention at a scientific level, but also on the individual level. In clinical practise social skills training is often applied for children with ASD. This thesis investigated the effectiveness of this kind of intervention for children with ASD. The results showed that participation in group social skills training improved the social skills and this generalized to the home and school setting.

OBJECTIVE: Around 40% of oncology patients receive inadequate pain treatment. A previous study reported pain interventions for only 70% of patients who reported unacceptable pain at the self-service registration desk. The aim of this study is to gain insight in reasons for the absence of pain intervention among oncology patients who reported unacceptable pain.METHODS: In this mixed methods study, 20 patients visiting the oncology outpatient clinic were selected via patient record assessment and interviewed about their perceived reasons for absence of pain intervention.RESULTS: The reasons mentioned by the patients for absence of pain intervention included reluctance of the patient to discuss pain, no treatment preferred by the patient, focus of the physician on treatment of the disease, pain treatment difficult or impossible, and the perception that pain is an inevitable consequence of the cancer treatment. Almost 50% of the patients considered the physician responsible for the absence of pain intervention.CONCLUSION: In conclusion, a variety of reasons for absence of pain intervention are reported by patients, including patient-related and health professional-related reasons. Improvements can be made by promoting regular discussion of pain during hospital visits and empowerment of patients.

In a new commentary in Mindfulness, Neff once again tried to defend the use of the Self-Compassion Scale (SCS) total score by arguing that compassionate and uncompassionate self-responding (CS and UCS) are part of a bipolar continuum. In this brief reaction, we refute this notion and also clarify how the continued use of the SCS total score muddies the water of research on self-compassion as a protective variable. We also illustrate how the SCS-by separating CS and UCS-can provide more valid and valuable information on protection and vulnerability within the context of psychopathology and stress than just relying on the total score of the SCS. ispartof: MINDFULNESS vol:13 issue:6 pages:1403-1409 ispartof: location:United States status: published

Spider-fearful people tend to avoid spiders, resulting in maintaining their phobia. However, some people can overcome their fear and approach spiders. This approach might be key in the reduction of fear and avoidance behaviour. The aim of this study was to examine the effect of approach-avoidance behaviour on (changes in) spider fear and avoidance. Participants (n = 122) with varying levels of spider fear played the online “collect the coins” game. In this game, participants had to collect 100 coins by clicking on different symbols. One symbol always resulted in one coin (safe option); another symbol mostly resulted in a large reward (3 coins), but sometimes in a spider (risky option). Participants rated the digital spider on evoked fear, disgust, and distress. Spider fear was measured with the fear of spiders questionnaire (FSQ). Avoidance was measured via symbol selection, self-reported avoidance, and a digital behavioural avoidance test, dBAT. Higher FSQ scores correlated with more self-reported spider-fear, -distress and -disgust, and larger dBAT-distances. Additionally, higher FSQ scores correlated with less risky- and more safe-selections. Importantly, more risky selections resulted in a stronger decrease in self-reported spider-fear and -disgust, whereas safe selections increased these emotions. Future studies are necessary to test if this link between approach-avoidance behaviour and emotional changes holds for spider phobics and real spiders.