Minding the body. Mindfulness-based cognitive therapy for patients with medically unexplained symptom

Contains fulltext : 113024.pdf (publisher's version ) (Open Access)Radboud Universiteit Nijmegen, 2 oktober 2013Promotores : Speckens, A.E.M., Weel, C. van Co-promotor : Lucassen, P.L.B.J

[Mindfulness-based cognitive therapy for patients with somatoform disorders]

Item does not contain fulltextBACKGROUND The daily lives of patients with somatoform disorders are often severely impaired by the symptoms of their illness. Cognitive behavioural therapy has proved to be an effective treatment for somatoform disorders. However, patients with these disorders are often reluctant to consult a psychologist for their physical symptoms. Mindfulness-based cognitive therapy (mbct) might be a useful form of treatment because it gives explicit attention to physical experiences and because it has a strong focus on acceptance of symptoms. AIM: To measure the effectiveness and cost-effectiveness of mbct for patients with somatoform disorders and to provide insight into how the therapy can gradually bring about behavioural change. METHOD: In this randomised controlled trial (rct), half of the participants (n=61) received mbct and the other half (n=56) received usual care. Participants belonged to the 10% of patients who visited primary care practitioners the most frequently; they had unexplained medical symptoms for at least six months. The primary outcomes were health status and mental and physical functioning. Measurements were taken at baseline, after 3 months and one year after baseline. In addition, records were kept of the costs involved so that we could obtain insight into health care use. Twelve patients were interviewed extensively at three points in time. RESULTS: Although the health status and the physical functioning were almost the same in the two conditions, the mental functioning improved in the patients who had attended mbct with an effect size of 0.3. At three months past baseline vitality and social functioning were significantly higher in the mindfulness condition than in the control condition. There was no significant difference between the total healthcare costs in the two conditions. The use of hospital care was lower in the mbct condition. At the same time, however, greater use was made of mental health care in the mbct condition. The interview study enabled us to establish a process of change. As a result of this process, patients focused less on short-term symptom reduction and more on the acceptance of their symptoms and on self-care. CONCLUSION: With the improvement that occurred in patients' mental functioning, we conclude that mbct is a meaningful therapy for patients with somatoform disorders. The fact that patients increased their use of mental health care after mbct could indicate that patients with somatoform disorders become more willing to receive mental health care

Mindfulnesstraining voor SOLK.

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GPs' experiences with loneliness.

Item does not contain fulltextBACKGROUND: Loneliness has a negative influence on health. General practitioners are confronted with lonely patients in their daily practice, but there is little information about how GPs deal with loneliness. METHODS: A qualitative study using semistructured interviews with 20 GPs who practise integrative medicine in the Netherlands. RESULTS: There are GPs who never ask patients about loneliness. Others mostly raise the topic indirectly. General practitioners sometimes notice that discussing loneliness brings relief to their patients. Almost all interviewed GPs have feelings of deficiency in their ability to provide health care to lonely patients. A feeling of powerlessness and perceived lack of time are the reasons given to avoid a discussion of loneliness. DISCUSSION: Loneliness is a widespread phenomenon and a difficult problem according to the GPs interviewed in this study. Discussing loneliness with patients should not be avoided in general practice

Commentary to: medically unexplained symptoms as a threat to patients' identity? A conversation analysis of patients' reactions to psychosomatic attributions by Burbaum et al.

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Reattribution for medically unexplained symptoms.

Contains fulltext : 71264.pdf (publisher's version ) (Closed access

Geluk of ongeluk bij een hartstilstand

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The contribution of work characteristics, home characteristics and gender to burnout in medical residents

Contains fulltext : 175906.pdf (publisher's version ) (Open Access)Burnout is highly prevalent in medical residents. In order to prevent or reduce burnout in medical residents, we should gain a better understanding of contributing and protective factors of burnout. Therefore we examined the associations of job demands and resources, home demands and resources, and work-home interferences with burnout in male and female medical residents. This study was conducted on a nation-wide sample of medical residents. In 2005, all Dutch medical residents (n = 5245) received a self-report questionnaire on burnout, job and home demands and resources and work-home interference. Path analysis was used to examine the associations between job and home characteristics and work-home interference and burnout in both males and females. In total, 2115 (41.1 %) residents completed the questionnaire. In both sexes emotional demands at work and the interference between work and home were important contributors to burnout, especially when work interferes with home life. Opportunities for job development appeared to be an important protective factor. Other contributing and protective factors were different for male and female residents. In females, social support from family or partner seemed protective against burnout. In males, social support from colleagues and participation in decision-making at work seemed important. Effectively handling emotional demands at work, dealing with the interference between work and home, and having opportunities for job development are the most essential factors which should be addressed. However it is important to take gender differences into consideration when implementing preventive or therapeutic interventions for burnout in medical residents.16 p