22 research outputs found

    Welbevindentherapie:Achtergrond, doelstelling en protocol

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    Geestelijke gezondheid is meer is dan de afwezigheid van psychische klachten. Geestelijke gezondheid omvat ook emotioneel, psychologisch en sociaal welbevinden. Psychopathologie en welbevinden zijn twee gerelateerde maar verschillende dimensies van geestelijke gezondheid. Dit wordt het tweecontinuamodel genoemd. Bij cliënten met psychische stoornissen is sprake van herstel bij afwezigheid van matige of ernstige psychische klachten en aanwezigheid van voldoende welbevinden. Welbevindentherapie richt zich op het versterken van welbevinden. In dit artikel worden de achtergronden en de doelstellingen van welbevindentherapie beschreven alsook een protocol van acht sessies. Het versterken van positieve emoties, het doen toenemen van positieve ervaringen en het vergroten van zelfcompassie staan centraal in de eerste sessies. Een pilotonderzoek waarin welbevindentherapie werd aangeboden aan cliënten met een stemmingsstoornis laat positieve effecten zien. Welbevindentherapie kan ook goed na afloop van een klachtgerichte behandeling worden aangeboden

    Attachment styles and complex PTSD:An exploratory study

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    The relationship between the attachment style of patients and psychological treatment is important, because changes in attachment style are assumed to have an influence on underlying mechanisms for effective treatment. This ex-plorative study aimed to examine the attachment style in patients with complex posttraumatic stress disorder (PTSD) and changes in attachment style, PTSD-complaints and dissociative symptoms after the first phase of treatment: the stabilization course. The participants completed measures of attachment style, PTSD symptoms and dissociative symptoms before and after the stabilization course. The results show that patients with complex PTSD were not securely attached and that no change in attachment style had taken place after following the first phase of treatment. Furthermore, there was no significant and clinical relevant reduction in PTSD symptoms and dissociative symptoms after the stabilization phase. This study is relevant for the actual discussion about the importance of phase based treatment in complex PTSD

    Acceptance and commitment therapy as a web-based intervention for depressive symptoms: randomised controlled trial

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    Background: Depression is a highly prevalent disorder, causing a large burden of disease and substantial economic costs. Web-based self-help interventions seem promising in promoting mental health. Aims: To compare the efficacy of a guided web-based intervention based on acceptance and commitment therapy (ACT) with an active control (expressive writing) and a waiting-list control condition (Netherlands Trial Register NTR1296). Method: Adults with depressive symptoms from the general population were randomised to ACT (n = 82), expressive writing (n = 67) or waiting-list control (n = 87). The main outcome was reduction in depressive symptoms assessed with the Center for Epidemiological Studies - Depression scale. Results: Significant reductions in depressive symptoms were found following the ACT intervention, compared with the control group (Cohen's d = 0.56) and the expressive writing intervention (d = 0.36). The effects were sustained at 6-month and 12-month follow-up. Conclusions: Acceptance and commitment therapy as a web-based public mental health intervention for adults with depressive symptoms can be effective and applicabl

    Dropout prediction in a public mental health intervention for sub-threshold and mild panic disorder

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    Dropout is a common and serious problem in psychological research and practice. When participants terminate treatment prematurely, this may have methodological and clinical consequences. The aim of this study was to identify predictors of dropout in a sample of patients (N = 217) with sub-threshold and mild panic disorder treated with a public mental health intervention programme based on cognitive-behavioural principles. Three groups of possible baseline predictors were selected from the literature: (1) socio-demographic, (2) personal, and (3) illness-related variables. A total of 51 (23.5%) participants were classified as dropouts. Dropouts were further subdivided into pretreatment dropouts (n = 17) who attended no course sessions at all and regular dropouts (n = 34) who attended 1–5 course sessions. Multivariable logistic regression analyses were used to identify independent predictors of dropout. Few variables were significantly associated with increased odds of dropout and the total explained variance was small. Fewer years of education was the only independent predictor of total dropout and male gender was associated with more pretreatment dropout. No independent predictors were found for regular dropout. It can be concluded that it is difficult to precisely predict dropout risk in patients participating in a public mental health intervention for panic symptoms

    The Efficacy of Mindfulness-Based Cognitive Therapy as a Public Mental Health Intervention for Adults with Mild to Moderate Depressive Symptomatology: A Randomized Controlled Trial

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    Objective Although there has been growing evidence for the efficacy of mindfulness-based cognitive therapy (MBCT) for different clinical populations, its effectiveness as a public mental health intervention has not been studied. The present study evaluates a community-based MBCT intervention for adults with mild to moderate depressive symptomatology in a large multi-site, pragmatic randomized controlled trial. Method The participants with mild to moderate depressive symptomatology were recruited from the general population and randomized to the MBCT intervention (n = 76) or to a waiting list control group (n = 75). Participants completed measures before and after the intervention. Participants in the experimental condition also completed these measures at a 3-month follow-up. Results In the experimental condition significant reductions in depression, anxiety, and experiential avoidance, and improvements in mindfulness and emotional- and psychological mental health were found, compared to the waiting list (effect sizes Cohen's d = 0.31–0.56). These effects were sustained at the 3-month follow-up. The likelihood of a clinically significant change in depressive symptoms was significantly higher for the MBCT group [odds ratio (OR) 3.026, p<0.01 at post-treatment; NNT = 5.10]. Discussion MBCT as a public mental health intervention for adults with mild to moderate depressive symptoms seems effective and applicable in a natural setting

    An Internet-Based Guided Self-Help Intervention for Panic Symptoms: Randomized Controlled Trial.

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    Background: Internet-based guided self-help is efficacious for panic disorder, but it is not known whether such treatment is effective for milder panic symptoms as well. Objective: To evaluate the effectiveness of Don't Panic Online, an Internet-based self-help course for mild panic symptoms, which is based on cognitive behavioral principles and includes guidance by email. Methods: A pragmatic randomized controlled trial was conducted. Participants (N=126) were recruited from the general population and randomized to either the intervention group or to a waiting-list control group. Inclusion criteria were a Panic Disorder Severity Scale-Self Report (PDSS-SR) score between 5-15 and no suicide risk. Panic symptom severity was the primary outcome measure; secondary outcome measures were anxiety and depressive symptom severity. Measurements were conducted online and took place at baseline and 12 weeks after baseline (T1). At baseline, diagnoses were obtained by telephone interviews. Results: Analyses of covariance (intention-to-treat) showed no significant differences in panic symptom reduction between groups. Completers-only analyses revealed a moderate effect size in favor of the intervention group (Cohen's d=0.73, P=.01). Only 27% of the intervention group finished lesson 4 or more (out of 6). Nonresponse at T1 was high for the total sample (42.1%). Diagnostic interviews showed that many participants suffered from comorbid depression and anxiety disorders. Conclusions: The Internet-based guided self-help course appears to be ineffective for individuals with panic symptoms. However, intervention completers did derive clinical benefits from the intervention

    Preventing panic disorder: cost-effectiveness analysis alongside a pragmatic randomised trial

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    Abstract Background Panic disorder affects many people, is associated with a formidable disease burden, and imposes costs on society. The annual influx of new cases of panic disorder is substantial. From the public health perspective it may therefore be a sound policy to reduce the influx of new cases, to maintain the quality of life in many people, and to avoid the economic costs associated with the full-blown disorder. For this purpose, prevention is needed. Here we present the first economic evaluation of such an intervention. Methods Randomised trial of 117 people with panic disorder symptoms not meeting the diagnostic criteria of DSM-IV panic disorder. The interventions were time-limited cognitive-behavioural therapy v care-as-usual. The central clinical endpoint was DSM-IV panic disorder-free survival over 3 months. Costs were calculated from the societal perspective. Using the bootstrap method, incremental cost-effectiveness ratios were obtained, placed in 95% confidence intervals, projected on the cost-effectiveness plane, and presented as acceptability curves. Results The median incremental cost-effectiveness ratio is €6,198 (95% CI 2,435 – 60,731) per PD-free survival gained, which has a likelihood of 75.2% of being more acceptable from a cost-effectiveness point of view than care-as-usual when a willingness-to-pay ceiling is assumed of €10,000 per PD-free survival. The most significant cost driver was therapists' time. A sensitivity analysis indicated that cost-effectiveness improves when the number of therapist hours is reduced. Conclusion This is the first economic evaluation alongside a prevention trial in panic disorder. The small sample (n = 117) and the short time horizon of 3 months preclude firm conclusions, but our findings suggest that the intervention may be acceptable from a cost-effectiveness point of view, especially when therapist involvement can be kept minimal. Nevertheless, our results must await replication in a larger trial with longer follow-up times before we can confidently recommend implementation of the intervention on a broad scale. In the light of our findings and given the burden of panic disorder, such a new trial is well worth the effort
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