Over de behandeling van angst : doen we de goede dingen en doen we de goede dingen goed?

Angststoornissen behoren met een lifetimeprevalentie van bijna 20% tot de meest voorkomende en beperkende psychische stoornissen. Ze zijn vaak chronisch van aard en (daardoor) geassocieerd met ernstige beperkingen in zowel interpersoonlijk als beroepsmatig functioneren. De comorbiditeit hebben van angststoornissen met andere psychische klachten is hoog, vooral met andere angststoornissen en stemmingsstoornissen, maar ook met misbruik of afhankelijkheid van alcohol en drugs. Gelukkig bestaan er effectieve behandelingen die bij de meeste patiënten tot klachtafname leiden. Zo is duidelijk geworden uit vele effectstudies naar op exposure gebaseerde interventies voor angststoornissen, waarbij patiënten blootgesteld worden aan beangstigende situaties, gedachten of lichamelijke sensaties met als doel disfunctionele verwachtingen over het optreden van negatieve gebeurtenissen te ontkrachten. Exposuretherapie wordt dan ook beschouwd als de psychologische behandeling van eerste voorkeur, zowel in internationale als in nationale multidisciplinaire richtlijnen voor de behandeling van angststoornissen. Maar ook medicamenteuze behandeling, of combinatiebehandelingen, zijn werkzaam in de behandeling van angstklachten. Goed nieuws dus. Angststoornissen zijn goed behandelbaar. Toch worden bewezen effectieve behandelingen nog te vaak niet aan patiënten aangeboden. Maar ook als dat wel het geval is, worden ze nog te vaak niet op een goede manier aangeboden. Maar zelfs als de goede dingen goed gedaan worden, wordt niet elke patiënt met een angststoornis beter. Door patiënten vaker de behandeling van voorkeur aan te bieden en in te zetten op het adequaat uitvoeren van interventies kan winst geboekt worden bij de behandeling van angst. Maar ook door het integreren van moderne technieken als behandeling via apps, internet en beeldbellen in-, of het toevoegen van interventies gericht op het vergroten van het welbevinden en het verbeteren van het functioneren aan bestaande werkzame behandelingen voor angststoornissen.Mijn oratie gaat over de behandeling van angst- en dwangstoornissen. Het terrein waar ik me de laatste 10 jaar het meest op gericht heb. We weten al heel veel over de behandeling van angst. Maar de boodschap van mijn verhaal is dat er nog genoeg winst te boeken is. Een aantal manieren waarop dat volgens mij kan, wil ik graag met u doornemen

On the Diagnosis, Assessment, and Treatment of Generalized Anxiety Disorder

Generalized anxiety disorder (GAD) is increasingly recognized as a prevalent anxiety disorder with a chronic course and signifi cant impairment (APA, 2000; Ballenger et al., 2001; Weisberg, 2009). In the Netherlands, according to the second Netherlands Mental Health Survey and Incidence Study (NEMESIS-2; De Graaf, Ten Have, & Van Dorsselaar, 2010) GAD was found to have a 4.5% lifetime prevalence rate, and the 12-month prevalence rate was reported to be 1.7%. GAD is a long-term illness with a high likelihood of recurrence. For instance, during the 12 years of a large longitudinal study, the Harvard-Brown Anxiety Research Project (HARP; Bruce et al., 2005), the average amount of time that patients met diagnostic criteria of GAD was 74%. Further, GAD was found to have a probability of recovery of 0.58 in the 12 years the study lasted, and the probability of recurrence in patients who recovered was 0.45. GAD has been found to be associated with considerable impairment and severity. For instance, in one study GAD was the anxiety disorder with the highest rate of moderate to severe disability (Sanderson & Andrews, 2002). Further, lifetime and current GAD were found to be associated with decreased overall well-being (Stein & Heimberg, 2004) and with impairment that was equivalent in magnitude to the impairment caused by major depressive disorder (Kessler, Dupont, Berglund, & Wittchen, 1999)

Associations between Depressive Symptoms, Rumination, Overgeneral Autobiographical Memory and Interpretation Bias within a Clinically Depressed Sample

__Abstract__ There is ample research demonstrating that biases in cognitive processes, such as a negative interpretation bias, rumination, and overgeneral autobiographical memory, are potential vulnerability factors for depression. However, a key limitation is that most studies conducted so far have studied cognitive biases in depression in isolation. Therefore our goal was to explore whether or not interpretation bias, overgeneral autobiographical memory, and rumination are present and interrelated in depressive outpatients. In this explorative study we examined the relationship between negative interpretation bias, rumination, overgeneral autobiographical memory, and severity of depression in clinically depressed outpatients. According to our expectations a negative interpretation bias and rumination were associated with severity of depression. Moreover, overgeneral autobiographical memory was not associated with severity of depression, but seemed to be associated with diagnosis of depression. A negative interpretation bias, overgeneral autobiographical memory, and rumination were not significantly related with each other in this study. This finding suggests they are not strongly related and might be largely distinct vulnerability factors for depression. The study presents an important yet preliminary finding which warrants further replication with a larger sample size

Metacognitieve therapie voor de obsessieve-compulsieve stoornis

De obsessieve-compulsieve stoornis (OCS) is een veelvoorkomende en invaliderende stoornis. Cognitieve gedragstherapie (CGT) in de vorm van exposure met responspreventie (ERP) is de psychologische behandeling van eerste voorkeur. Ondanks de aangetoonde werkzaamheid van ERP is verbetering van de effectivitei

The effectiveness of metacognitive therapy in comparison to exposure and response prevention for obsessive-compulsive disorder:A randomized controlled trial

Background: The recommended psychological treatment of choice for obsessive-compulsive disorder (OCD) is exposure with response prevention (ERP). Although this treatment is quite effective, recovery rates are modest and attrition rate is relatively high. Also, ERP treatment requires amounts of therapist time. A possible way to improve OCD treatment is by taking into account key cognitive processes involved in the development and maintenance of the disorder. The metacognitive model is such an account and pilot findings suggest that the associated metacognitive therapy (MCT) might be an effective treatment for OCD. Methods: In the present study, a randomized controlled trial (RCT) is used to assess the effectiveness of MCT in comparison to ERP in an outpatient clinical sample of patients with OCD. Results: Both MCT and ERP produced significant pre-treatment to post-treatment decreases in obsessive-compulsive, comorbid psychological symptoms and metacognitive beliefs, both with moderate to large within-group effect sizes and high proportions of significant clinical change. Drop-out rates were low and treatment gains were maintained at six-month follow-up. There were no differences in efficacy observed between MCT and ERP treatments. Conclusions: MCT proves to be a promising treatment of OCD.</p

The Assessment of Thought Fusion Beliefs and Beliefs About Rituals:Psychometric Properties of the Thought Fusion Instrument and Beliefs About Rituals Inventory

Background: According to the metacognitive model, two domains of metacognitive beliefs play a role in the development and maintenance of obsessive-compulsive disorder (OCD). The Thought Fusion Instrument (TFI) has been developed to measure metacognitive beliefs about the significance of intrusive thoughts. The Beliefs About Rituals Inventory (BARI) assesses metacognitive beliefs about the necessity of performing ritual behaviors. Studies assessing the psychometric properties of the TFI and BARI are scarce. There are no studies assessing the factor structure of the TFI and the BARI. Methods: In this study, we assessed the psychometric properties of the TFI and the BARI in nonclinical (n = 141) and clinical populations (OCD [n = 60], anxiety disorder [n = 30], and autism spectrum disorder [n = 50]). In the nonclinical population, the factor structure is also explored. Results: For both the TFI and the BARI, an explorative factor analysis revealed a one-factor solution, which now needs further exploration using confirmative approaches. The internal consistency appeared good, and they had a moderate test–retest reliability. Convergent and divergent validity of the instruments appeared sufficient, but more research is required to draw firm conclusions. The criterion validity turned out to be moderate for the BARI but low for the TFI in measuring OCD-specific metacognitions. Conclusions: Based on the explorative factor analysis, we hypothesize the TFI and the BARI to measure a single-factor construct. The current study shows that the TFI and the BARI are potentially suitable questionnaires to assess metacognitions in clinical and nonclinical populations. More research is required before clear recommendations can be made for the utility and use in clinical practice.</p

The effectiveness of metacognitive therapy in comparison to exposure and response prevention for obsessive-compulsive disorder:A randomized controlled trial

Background: The recommended psychological treatment of choice for obsessive-compulsive disorder (OCD) is exposure with response prevention (ERP). Although this treatment is quite effective, recovery rates are modest and attrition rate is relatively high. Also, ERP treatment requires amounts of therapist time. A possible way to improve OCD treatment is by taking into account key cognitive processes involved in the development and maintenance of the disorder. The metacognitive model is such an account and pilot findings suggest that the associated metacognitive therapy (MCT) might be an effective treatment for OCD. Methods: In the present study, a randomized controlled trial (RCT) is used to assess the effectiveness of MCT in comparison to ERP in an outpatient clinical sample of patients with OCD. Results: Both MCT and ERP produced significant pre-treatment to post-treatment decreases in obsessive-compulsive, comorbid psychological symptoms and metacognitive beliefs, both with moderate to large within-group effect sizes and high proportions of significant clinical change. Drop-out rates were low and treatment gains were maintained at six-month follow-up. There were no differences in efficacy observed between MCT and ERP treatments. Conclusions: MCT proves to be a promising treatment of OCD.</p

Normative data for the Dutch version of the Penn State Worry Questionnaire.

Worry is a common symptom in various psychiatric problems and the key symptom of generalised anxiety disorder (GAD). The Penn State Worry Questionnaire (PSWQ) is the most widely used self-report scale for measuring worry. The present study provides normative data for the Dutch version of the PSWQ for a large community sample and a clinically referred sample of patients with GAD. Norms are not only provided for the original 16-item version, but also for an abbreviated 11-item version, which only consists of the positively worded items and has been shown to be a promising alternative to the full-length version. The percentile scores obtained for the community sample and the clinical GAD sample did not show much overlap, and this appeared true for the full-length as well as the abbreviated version of the PSWQ. These normative data seem suitable for differentiating between normal and abnormal manifestations of worrying and for evaluating the efficacy of treatments for GAD. (Netherlands Journal of Psychology, 65, 69-75.