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Saman Y, Pascual-Vera B, Corberán M, Arnáez S, Roncero M, García-Soriano G. A mobile app to challenge obsessional beliefs in adolescents: a protocol of a two-armed, parallel randomized controlled trial. BMC Psychiatry 2024; 24:265. [PMID: 38594680 PMCID: PMC11003130 DOI: 10.1186/s12888-024-05735-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 04/03/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Adolescence is a crucial stage for the development of OCD symptoms that, in most cases, persist into adulthood. This requires designing preventive strategies tailored to this population. Therefore, we aim to describe the study protocol that will be used to examine the effectiveness of a mobile health application to challenge obsessional beliefs in adolescents. METHODS A two-armed randomized controlled trial will be conducted on an adolescent sample from the general population. The experimental group will use the intervention module (GGOC-AD) of a mobile app on the GGtude platform for 14 days whereas the control group will use a non-active module (GGN-AD) of said app. Primary outcome measures will be obsessional beliefs and obsessive-compulsive symptoms, and secondary measures will be self-esteem and emotional symptoms. Three assessment points will be conducted at baseline, post-intervention, and one-month follow-up. A linear multiple regression model with an intention to treat approach will be used. The expected total sample size will be 55 participants. DISCUSSION We expect that the intervention group will show a reduction in obsessional beliefs and OCD-symptoms at post and follow-up in comparison with the control group. Additionally, we expect that the app will improve participants' self-esteem. This study could provide an accessible mobile health tool to prevent OCD-related symptoms in adolescents. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT06033391 . Registered September 4, 2023.
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Affiliation(s)
- Yuliya Saman
- Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Universitat de València, Avda. Blasco Ibáñez, 21, Valencia, 46010, Spain
| | - Belén Pascual-Vera
- Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Universidad Nacional de Educación a Distancia, C/ Bravo Murillo, 38, Madrid, 28015, Spain
| | - Marta Corberán
- Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Universitat de València, Avda. Blasco Ibáñez, 21, Valencia, 46010, Spain
| | - Sandra Arnáez
- Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Universitat de València, Avda. Blasco Ibáñez, 21, Valencia, 46010, Spain
| | - María Roncero
- Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Universitat de València, Avda. Blasco Ibáñez, 21, Valencia, 46010, Spain
| | - Gemma García-Soriano
- Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Universitat de València, Avda. Blasco Ibáñez, 21, Valencia, 46010, Spain.
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Cervin M, McNeel MM, Wilhelm S, McGuire JF, Murphy TK, Small BJ, Geller DA, Storch EA. Cognitive Beliefs Across the Symptom Dimensions of Pediatric Obsessive-Compulsive Disorder: Type of Symptom Matters. Behav Ther 2022; 53:240-254. [PMID: 35227401 PMCID: PMC9397538 DOI: 10.1016/j.beth.2021.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 08/06/2021] [Accepted: 08/12/2021] [Indexed: 02/03/2023]
Abstract
The cognitive model of obsessive-compulsive disorder (OCD) posits that dysfunctional cognitive beliefs are crucial to the onset and maintenance of OCD; however, the relationship between these cognitive beliefs and the heterogeneity of OCD symptoms in children and adolescents remains unknown. We examined how the major belief domains of the cognitive model (inflated responsibility/threat estimation, perfectionism/intolerance of uncertainty, importance/control of thoughts) and dysfunctional metacognitions were related to OCD symptoms across the following dimensions: doubting/checking, obsessing, hoarding, washing, ordering, and neutralization. Self-report ratings from 137 treatment-seeking youth with OCD were analyzed. When cognitive beliefs and symptom dimensions were analyzed in tandem, inflated responsibility/threat estimation and dysfunctional metacognitions were uniquely related to doubting/checking, obsessing, and hoarding and perfectionism/intolerance of uncertainty to ordering. Cognitive beliefs explained a large proportion of variation in doubting/checking (61%) and obsessing (46%), but much less so in ordering (15%), hoarding (14%), neutralization (8%), and washing (3%). Similar relations between cognitive beliefs and symptom dimensions were present in children and adolescents. Cognitive beliefs appear to be relevant for pediatric OCD related to harm, responsibility, and checking, but they do not map clearly onto contamination and symmetry-related symptoms. Implications for OCD etiology and treatment are discussed.
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Affiliation(s)
| | | | - Sabine Wilhelm
- Massachusetts General Hospital and Harvard Medical School
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Wolters LH, Prins PJM, Garst GJA, Hogendoorn SM, Boer F, Vervoort L, de Haan E. Mediating Mechanisms in Cognitive Behavioral Therapy for Childhood OCD: The Role of Dysfunctional Beliefs. Child Psychiatry Hum Dev 2019; 50:173-185. [PMID: 30032391 PMCID: PMC6428795 DOI: 10.1007/s10578-018-0830-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Reframing cognitions is assumed to play an important role in treatment for obsessive-compulsive disorder (OCD). However, there hardly is any empirical support for this assumption, especially for children. The aim of this study was to examine if changing dysfunctional beliefs is a mediating mechanism of cognitive behavioral therapy (CBT) for childhood OCD. Fifty-eight children (8-18 years) with OCD received CBT. Dysfunctional beliefs (OBQ-CV) and OCD severity (CY-BOCS) were measured pre-treatment, mid-treatment, post-treatment, and at 16-week follow-up. Results showed that OCD severity and dysfunctional beliefs decreased during CBT. Changes in severity predicted changes in beliefs within the same time interval. Our results did not support the hypothesis that changing dysfunctional beliefs mediates treatment effect. Future studies are needed to replicate these findings and shed more light on the role of explicit and implicit cognitions in treatment for childhood OCD.
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Affiliation(s)
- L H Wolters
- Department of Child and Adolescent Psychiatry, Academic Medical Center, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands.
- Academic Center for Child and Adolescent Psychiatry, De Bascule, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands.
| | - P J M Prins
- Faculty of Social and Behavioural Sciences, University of Amsterdam, Nieuwe Achtergracht 127, 1018 WS, Amsterdam, The Netherlands
| | - G J A Garst
- Faculty of Social and Behavioural Sciences, University of Amsterdam, Nieuwe Achtergracht 127, 1018 WS, Amsterdam, The Netherlands
| | - S M Hogendoorn
- Academic Center for Child and Adolescent Psychiatry, De Bascule, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands
| | - F Boer
- Department of Child and Adolescent Psychiatry, Academic Medical Center, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands
| | - L Vervoort
- Department of developmental, personality and social psychology, Ghent University, Henri Dunantlaan 2, 9000, Ghent, Belgium
| | - E de Haan
- Academic Center for Child and Adolescent Psychiatry, De Bascule, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands
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Schultz C, Lambek R, Højgaard D, Söchting I, Thastum M, Hove Thomsen P, Anna Hybel K. Psychometric validation of a Danish version of the Obsessive Beliefs Questionnaire - Child Version (OBQ-CV). Nord J Psychiatry 2018; 72:621-629. [PMID: 30383480 DOI: 10.1080/08039488.2018.1513068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
AIM The aim of the study was to examine the psychometric properties of a Danish version of the Obsessive Beliefs Questionnaire - Child Version (OBQ-CV). The OBQ-CV assesses dysfunctional beliefs concerning responsibility/threat estimation, perfectionism/uncertainty, and importance/control of thoughts, which according to cognitive theories are important in the development and maintenance of obsessive-compulsive disorder (OCD). METHODS The study included a pediatric sample (age 7-17 years) consisting of 57 children and adolescents with OCD, 49 children and adolescents with an anxiety disorder (AD), and 58 typically developing (TD) children and adolescents without a psychiatric diagnosis. All participants completed the OBQ-CV and the Child Behavior Checklist - the School Age Scales (CBCL/6-18). The Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) was used to assess OCD symptom severity in the OCD group. RESULTS Confirmatory factor analyses supported the three-factor structure and thereby the construct validity of the OBQ-CV. Gender was not associated with subscale scores, whereas age influenced the subscale scores differently in the three groups. Reliability analyses showed acceptable to excellent internal consistency and acceptable test-retest reliability of the instrument. There were significant differences between the OCD group and the TD group, supporting the criterion validity. Results on convergent validity were mixed. CONCLUSIONS Overall, results supported the reliability and validity of the Danish OBQ-CV and thus the use of the questionnaire for future clinical and research purposes.
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Affiliation(s)
- Cecilie Schultz
- a Department of Child and Adolescent Psychiatry, Research Unit, Aarhus University Hospital , Psychiatry , Aarhus , Denmark
| | - Rikke Lambek
- b Department of Psychology and Behavioural Sciences , Aarhus University , Aarhus , Denmark
| | - David Højgaard
- a Department of Child and Adolescent Psychiatry, Research Unit, Aarhus University Hospital , Psychiatry , Aarhus , Denmark
| | - Ingrid Söchting
- c Psychology Clinic , University of British Columbia , Vancouver , Canada
| | - Mikael Thastum
- b Department of Psychology and Behavioural Sciences , Aarhus University , Aarhus , Denmark
| | - Per Hove Thomsen
- a Department of Child and Adolescent Psychiatry, Research Unit, Aarhus University Hospital , Psychiatry , Aarhus , Denmark
| | - Katja Anna Hybel
- a Department of Child and Adolescent Psychiatry, Research Unit, Aarhus University Hospital , Psychiatry , Aarhus , Denmark
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Gavino A, Nogueira R, Pérez-Costillas L, Godoy A. Psychometric Properties of the Frost Multidimensional Perfectionism Scale in Spanish Children and Adolescents. Assessment 2017; 26:445-464. [DOI: 10.1177/1073191117740204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The Frost Multidimensional Perfectionism Scale (FMPS) is one of the most used instruments to assess perfectionism. The FMPS assesses six dimensions: Concern over Mistakes (CM), Parental Expectations (EP), Parental Criticism (PC), Doubts about Actions (DA), Organization (OR), and Personal Standards (PS). CM, PE, PC, and DA are facets of a more general dimension considered Maladaptive Perfectionism. PS is frequently considered Adaptive Perfectionism. FMPS psychometric properties have been studied in adults but scarcely in children. We adapted the FMPS for Spanish children and adolescents and studied these properties in a sample of 1,648 Spanish young people (mean age = 13.36; SD = 2.28). Multigroup confirmatory factor analyses were used to test whether the FMPS dimensions found in adults are applicable to children. Results supported this hypothesis. The FMPS dimensional structure was invariant across gender and age. FMPS subscales showed good internal consistency (Cronbach’s α: .71-.92) and test–retest reliability (intraclass correlations: .70-.85). Moderate and high correlations with measures of dysfunctional beliefs, anxiety, and depression supported the validity of the FMPS scores. Results from regression equations showed that the relationship of perfectionism with anxiety and depression is mostly due to Maladaptive Perfectionism.
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Boysan M, Kadak MT, Tarakcioglu MC, Sertdurak ZS, Demirel OF. Psychometric Properties of Turkish versions of the Leyton Obsessional Inventory-Child Version (LOI-CV) and Obsessive Beliefs Questionnaire-Child Version (OBQ-CV). ACTA ACUST UNITED AC 2017. [DOI: 10.5455/bcp.20151203125902] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Murat Boysan
- Yuzuncu Yil University, Faculty of Arts, Department of Psychology, Van - Turkey
| | - Muhammed Tayyib Kadak
- Istanbul University, Cerrahpasa School of Medicine, Department of Child and Adolescent Psychiatry, Istanbul - Turkey
| | - Mahmut Cem Tarakcioglu
- Dr. Sadi Konuk Education and Research Hospital, Department of Child and Adolescent Psychiatry, Istanbul - Turkey
| | - Zeynep Seda Sertdurak
- Istanbul University, Cerrahpasa School of Medicine, Department of Child and Adolescent Psychiatry, Istanbul - Turkey
| | - Omer Faruk Demirel
- Istanbul University, Cerrahpasa School of Medicine, Department of Child and Adolescent Psychiatry, Istanbul - Turkey
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Salemink E, Wolters L, de Haan E. Augmentation of Treatment As Usual with online Cognitive Bias Modification of Interpretation training in adolescents with Obsessive Compulsive Disorder: A pilot study. J Behav Ther Exp Psychiatry 2015; 49:112-9. [PMID: 25724385 DOI: 10.1016/j.jbtep.2015.02.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 02/06/2015] [Accepted: 02/08/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES Cognitive Behavioral Therapy for children and adolescents with Obsessive Compulsive Disorder (OCD) is effective. However, since almost half of patients remain symptomatic after treatment, there remains room for improvement. Cognitive Bias Modification training of Interpretations (CBM-I) is a promising new intervention, as it targets misinterpretation of intrusions, which is seen as an important characteristic in OCD. To date, there have been no published studies of CBM-I in adolescents with OCD. The aim of the current pilot study was to examine the added value of online CBM-I training as an adjunctive treatment to the Treatment As Usual (TAU; that included CBT and pharmacotherapy) in adolescents with OCD. METHODS Patients receiving TAU were randomly assigned to either an additional CBM-I training (n = 9), or to an additional placebo variant of this procedure (n = 7). RESULTS Immediate, on-line interpretations changed in response to the CBM-I training, while no such effects were observed on slower retrospective off-line interpretations. Patients in the CBM-I training condition reported fewer obsessive compulsive symptoms after training, and clinicians rated them as having fewer obsessive symptoms (corresponding to medium-large effect sizes). No such changes were observed in the placebo group. LIMITATIONS The small sample size precludes strong conclusions and replication is necessary to test the robustness of the findings. CONCLUSIONS This small randomized controlled trial is suggestive, although not conclusive, regarding the promising additive value of OC-related CBM-I training as an adjunctive intervention to TAU in an adolescent clinical population.
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Affiliation(s)
- Elske Salemink
- Addiction, Development and Psychopathology Lab (Adapt Lab), Department of Developmental Psychology, Research Priority Areas 'Yield', and 'Amsterdam Brain and Cognition', University of Amsterdam, The Netherlands; Department of Obsessive Compulsive-, Anxiety- and Tic Disorders, Academic Center for Child and Adolescent Psychiatry, de Bascule, Amsterdam, The Netherlands.
| | - Lidewij Wolters
- Department of Obsessive Compulsive-, Anxiety- and Tic Disorders, Academic Center for Child and Adolescent Psychiatry, de Bascule, Amsterdam, The Netherlands; Academic Medical Center, Department of Child and Adolescent Psychiatry, Amsterdam, The Netherlands
| | - Else de Haan
- Department of Obsessive Compulsive-, Anxiety- and Tic Disorders, Academic Center for Child and Adolescent Psychiatry, de Bascule, Amsterdam, The Netherlands; Child Development and Education, University of Amsterdam, The Netherlands
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Halvaiepour Z, Nosratabadi M. External Criticism by Parents and Obsessive Beliefs in Adolescents: Mediating Role of Beliefs associated with Inflated Responsibility. Glob J Health Sci 2015; 8:125-33. [PMID: 26652096 PMCID: PMC4877192 DOI: 10.5539/gjhs.v8n5p125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 08/16/2015] [Accepted: 08/05/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND & OBJECTIVES Obsessive-compulsive disorder (OCD) is considered as a rare disorder in children. According to cognitive theories, criticism triggers responsibility behavior and thus causes obsessive behaviors. The purpose of the present study was to investigate the mediating role of beliefs associated with responsibility in the relationship between external criticism of parents and obsessive beliefs in adolescents. MATERIALS & METHODS In this study, 547 high school students aged from 15 to18 years were selected using multi-stage cluster random sampling from four regions of the education office in Shiraz. Obsessive Beliefs Questionnaire-child version (OBQ-CV), Pathway to Inflated Responsibility beliefs Scale (PIRBS), and perceived criticism questionnaire were used to collect data. Pearson's correlation was used to investigate the relationship between the study variables. For analysis of mediation model, multiple mediators analysis using Macro Software was used. RESULTS External criticism only indirectly and through beliefs associated with inflated responsibility accounts for 6% of the variance of responsibility, 14% of the variance of threat estimation and 10% of the variance of perfectionism of obsessive beliefs (P<0.05). However, external criticism, both directly and indirectly and through beliefs associated with inflated responsibility accounts for 7% of the variance of the importance of obsessive beliefs. CONCLUSION This study showed that the beliefs associated with inflated responsibility can mediate the relationship between external criticism and obsessive beliefs. According to the cognitive model of Salkovskis, criticism by parents, as a violation to and an influence on children, by affecting the subscales of inflated responsibility, can increase the symptoms of obsessive-compulsive disorder. In order to identify potential affecting mechanisms of criticism on obsessive-compulsive disorder, further experimental research is required.
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Affiliation(s)
- Zohreh Halvaiepour
- Sirjan College of Medical Sciences, Kerman University of Medical Sciences, Kerman, Iran.
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Coles ME, Ravid A, Franklin ME, Storch EA, Khanna M. Obsessive-Compulsive Symptoms and Beliefs in Adolescents: A Cross-Sectional Examination of Cognitive Models. J Cogn Psychother 2014; 28:251-263. [PMID: 32759123 DOI: 10.1891/0889-8391.28.4.251] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cognitive models of obsessive-compulsive disorder (OCD) posit that particular beliefs transform normal intrusions into disturbing obsessions. A wealth of data shows that such beliefs and obsessive-compulsive (OC) symptoms are related in adults. However, there is markedly less information regarding OCD-related beliefs in youth. The purpose of this study was to assess the relation between OCD-related beliefs and OC symptoms in unselected adolescents (ages 13-18 years; N = 159). Findings from questionnaires completed on the Internet were consistent with previous findings in adults. Increased levels of OCD-related beliefs were related to increased levels of OC symptoms. Perfectionism and certainty beliefs had a specific relation with symmetry and ordering symptoms. Contrary to expectation, levels of OCD-related beliefs in this unselected sample were similar to those found in prior studies of youth diagnosed with OCD. Implications, limitations, and future directions for the study of OCD-related beliefs in youth are discussed.
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Affiliation(s)
| | | | | | | | - Muniya Khanna
- Children's and Adult Center for OCD and Anxiety, Philadelphia, Pennsylvania
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Wolters LH, Hogendoorn SM, Oudega M, Vervoort L, de Haan E, Prins PJM, Boer F. Psychometric properties of the Dutch version of the Meta-Cognitions Questionnaire-Adolescent Version (MCQ-A) in non-clinical adolescents and adolescents with obsessive-compulsive disorder. J Anxiety Disord 2012; 26:343-51. [PMID: 22197341 DOI: 10.1016/j.janxdis.2011.11.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Revised: 11/03/2011] [Accepted: 11/28/2011] [Indexed: 12/18/2022]
Abstract
Although the meta-cognitive model (Wells, 1997, 2000) for obsessive-compulsive disorder (OCD) has clearly influenced research and treatment of OCD, little research has been performed in youth samples. In the present study the psychometric properties of the Dutch Meta-Cognitions Questionnaire-Adolescent Version (MCQ-A; Cartwright-Hatton et al., 2004) were examined in a clinical sample of adolescents with OCD (N = 40, 12-18 years) and a non-clinical sample (N = 317; 12-18 years). Results provided support for the 5-factor structure, and showed fair to good internal consistency and generally good retest reliability. Overall, adolescents with OCD reported more meta-cognitive beliefs than non-clinical adolescents. Several subscales were associated with self-reported obsessive-compulsive symptoms, anxiety and depression, but not with clinician-rated OCD severity. In conclusion, results suggest that the Dutch MCQ-A is a reliable and valid questionnaire to examine meta-cognitive beliefs in adolescents.
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Affiliation(s)
- Lidewij H Wolters
- Academic Medical Center, Department of Child and Adolescent Psychiatry, Meibergdreef 5, 1105 AZ Amsterdam, The Netherlands.
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